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CITY AND COUNTY OF BRISTOL

THE

HEALTH OF BRISTOL

I960

R. C WOFINDEN

M.D., B.S., D.P.H., D.P.A.

Medical Officer of Health

'L^cyyO

THE HEALTH OF BRISTOL IN I960

CONTENTS

The report is published in six sections (A — F). Each section is paged separately
with the section indicated by a capital letter printed over the page number. Some of
the sections have a separate index of contents. The beginning of each section is indicated
by a coloured contents page.

SECTION

AND

PAGE

GENERAL REVIEW OF THE HEALTH OF BRISTOL IN 1960 A

Introduction . . . . . . . . . . . . . . 1

The Health Committee 1960 and The Public Health Staff 7

Summary of Vital Statistics . . . . . . . . . . . . 8

Prevalence and Control of Infectious Diseases 21

Employment in the Bristol Area . . . . 33

The Weather in 1960 . . . . . . . . 34

PERSONAL HEALTH SERVICES B

MATERNAL AND CHILD HEALTH, NURSING AND ALLIED
SERVICES

Domiciliary Midwifery Service . . . . 2

Sub-Fertility Clinic 4

Child Health and Welfare Services 5

Dental Care . . . . . . . . . . 6

Health Visiting Service . . 9

Ancillary Nursing Services . . . . 13

Health Visitor Training . . 14

Home Nursing Service .. .. .. .. .. 16

Physiotherapy in the Maternal and Child Health Service . . 17

Home Help Service . . 18

Special Families . . . . . . 19

Welfare of Unmarried Mothers . . 22

Statistics . . . . . . . . . . 23

Inoculations and Vaccination . . 25

THE MENTAL HEALTH SERVICES 27

PREVENTION OF ILLNESS, CARE AND AFTER-CARE

Tuberculosis . . . . . . . . . . 53

Venereal Diseases . . . . 57

THE AMBULANCE SERVICE 61

ENVIRONMENTAL HEALTH SERVICES C

Sanitary Circumstances . . . . . . . . 1

Administration of the Shops Act, etc. . . . . . . 47

Report of the Scientific Adviser 51

PORT HEALTH SERVICES D

1-34

SPECIAL REPORTS E

The William Budd Health Centre 1

Veterinary Officer’s Report . . . . . . . . . . . . . . 6

Care of the Aged . . . . . . . . . . . . . . . . . . 9

Civil Defence Responsibilities of the Medical Officer of Health 20

Health Education 23

SCHOOL HEALTH SERVICE F

1-62

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SECTION A

GENERAL REVIEW OF
THE HEALTH OF BRISTOL

1960

Section

Page

Medical Officer of Health’s Introduction . .

The Health Committee 1960 and The Public Health Staff

Summary of Vital Statistics . .

Prevalence and Control of Infectious Diseases

Employment in the Bristol Area

The Weather in 1960 . .

0 J

THE HEALTH OF BRISTOL IN I960

My Lord Mayor, Ladies and Gentlemen,

1 have the honour to present my fifth Annual Report on the health of the
City of Bristol for the year 1960.

Population and Marriages

The population is now 433,750, a further decline of 2,850 since 1959,
which is probably due to the housing of over-spill population in adjacent areas.
This is the sixth successive year in which the population has declined, and since
there has been no increase in the death rate during this period, and it is the
younger married age groups who are moving out of the City, the probabilities
are that the old age groups are now relatively much greater than they were. The
implications are that a greater volume of health and welfare services for the
aged will be needed as the years go by. There has been a further rise in the
marriage rate — from 15-3 persons married per 1,000 population in 1959 to
15-7 in 1960, and in keeping with the rest of the country, the average age at
marriage is getting less.

Births

There were 6,889 births registered in 1960 (226 more than in 1959) giving a
birth rate of 15-88 per 1,000 population compared with 15 -26 in 1959; this was
below the 1959 rate for England and Wales, which was 16-5 per 1,000. Of the
total births, 1,788 were delivered in their own home, i.e. 61 cases more than last
year; general medical practitioners were present at one third of these cases.
The practice continued of early discharge of selected maternity cases from
hospital with no apparent untoward effects on mother or child, but this has
thrown an increased burden on the domiciliary midwives. In 96 per cent of
domiciliary confinements, the mother received either gas and air or trilene
analgesia. It is a matter of interest to record that 1 1 per cent of all antenatal
cases in 1960 needed and received dental care.

Illegitimacy

There was disturbing increase in the number of illegitimate births to Bristol
women — from 322 in 1959 to 433 in 1960 (4-8 per cent to 6-3 per cent). Even
more disturbing to public opinion is the fact that young “teen-age" pregnancies
are becoming increasingly common. There is no ready explanation of this
phenomenon of apparent lapse in moral standards, but it should not be forgotten
that the earlier and higher standard of physical maturation of boys and girls,
for which the public health service must claim some credit, is certainly one of
the factors in the situation. It may be that, for the time being, biological progress
for the human species has not been matched by social and moral standards.

General Mortality

In 1960, there were 5,260 deaths of Bristolians, giving an adjusted death
rate of 11-89 per 1,000, compared with 11-49 per 1,000 for 1959. There has
been a slow, but steady, increase in the proportion of deaths which take place
in hospital, e.g. in 1956, about 39 per cent of all deaths were in hospital, but in
1960, 44 per cent. In the age group 1 — 15 years, the death rates are minimal
(about 0-7 per cent of all deaths); indeed, upwards of 72 per cent of all deaths
are now in the age groups 65 and over.

The principal causes of death remain in the order of — diseases of the heart
and circulation; cancers, including leukaemia; vascular lesions of the central

nervous system and respiratory diseases. Once again, there was an increase in
deaths attributed to coronary disease and angina — from 847 to 975, and most
of this increase has been in the age froup 45 — 64 years. There was only a
slight fall in deaths from cancer of the lung and bronchus — from 214 to 202;
the ratio of male to female cases was 8:1.

Infant Mortality {including Neonatal mortality) and Still Birth Rates

There were 136 deaths of infants under the age of one year in Bristol
during the year, giving an infant mortality rate of 19 -7 per 1,000 compared with
19 -5 per 1,000 for 1959. The neonatal death rate was 14-4 per 1,000, compared
with 14 per 1,000 for 1959. Considering the large increase in illegitimacy during
the year, the infant mortality rate and neonatal mortality rate may well have
been a very much higher than for 1959; that the increase has been so small,
speaks highly for the excellent health and social care of the unmarried mother
in this City. Still births during the year totalled 101, giving the phenomenally
low still birth rate for a large city of 14-5 per 1,000 total births — the previous
lowest rate of 17-8 per 1,000 being recorded in 1958.

In consequence of the reduced number of still births, the perinatal mortality
rate reached the remarkably low figure of 26-9 per 1,000 live and still births.

There was one maternal death during the year due to Septic Abortion.

Such a splendid record of maternal and child health should not pass without
comment, and it was very fitting that during the year, Bristol was the City
chosen for the Annual Conference of the Maternal and Child Welfare Associ-
ation. At that Conference, tribute was paid by the Minister of Health to the
progressive policy followed by the Health Committee and to the integration of
their service with the work of general medical practitioners, paediatricians and
obstetricians. Much of the credit for this should be given to Dr. Sarah Walker,
your Senior Medical Officer for Maternal and Child Health, whose unflagging
efforts on behalf of mothers and children in this City cannot be praised too
highly.

Notifiable Diseases

Last year, I drew attention to the poor state of protection of Bristol children
against diphtheria and of the danger of outbreaks recurring. I am pleased to
record that in spite of our low protection rate, we have not suffered the fate of
some other tov/ns which had outbreaks of infection during the year. The year
1960 was, in fact, the eleventh in succession with no confirmed case of diphtheria,
and the fourteenth consecutive year with no death from this disease. Efforts
from springtime onwards to increase the numbers of children protected, met
with a minimum of success until November (following well publicised outbreaks
in other parts of the country) when a new drive in the schools produced a better
response from parents. As a result, by the end of the year the immunity index
for children under 15 was increased from 34-2 to 40-7. Although the continuing
campaign in 1961 is likely to push the figure still higher, at the time of writing
this Report (August, 1961) it is still far too low to give any real measure of
security against this disease.

For the first time for well over a decade, there were no cases of poliomyelitis
in the City, and this satisfactory state of affairs can only be attributed to the
good public response to our poliomyelitis innoculation campaigns; indeed,
by the end of 1960, 82 per cent of children aged 0 — 15 had completed a primary
course, and 61 per cent had also received “booster” injections. Unfortunately,
the same good results cannot be recorded for young and middle aged adults
(i.e. 16 — 40 years) for whom the figures are 22 per cent who had completed a

primary course, and 14 per cent had received a booster infection by the end of
the year.

Arrangements were made during the year to collaborate with the Medical
Research Council and the Ministry of Health in live polio vaccine trials. Twenty
five co-operating families were recruited, and although it is understood that the
trials have proved to be satisfactory, no official publication has yet been issued.

Towards the end of the year 1959, the Department was aware, even in the
absence of notification, that infectious hepatitis was becoming more prevalent
in school children. In 1960, it became apparent that we had a sizeable epidemic
in our midst and that this appeared to be coupled with an increased incidence
of another non-notifiable disease — infections mononucleosis. It was not until
December 1st that both of these diseases were made notifiable in Bristol, but
by the end of the year we had recorded (from unofficial and official sources)
1,162 cases of hepatitis and 76 cases of mononucleosis, and the epidemic is
still continuing in 1961. The brunt of the infection with the hepatitis virus is
being borne by children of school age, and in the absence of any knowledge of
how to control this disease, but on the supposition of a gastro-intestinal method
of spread, efforts were made during the year to improve school hygiene and
personal hygiene practises. It is probable that by the time this epidemic subsides,
it will be the largest of this disease ever recorded in any City. By the end of the
year, two deaths from this disease and 74 cases were severe enough to need
hospital admission.

Although the number of food poisoning cases notified was only 184 (182 in
1959) an outbreak of salmonellosis in the nursery and maternity block at
Southmead Hospital caused some disruption in the Maternity Services. Eleven
people were involved and one baby died, and while the action taken cleared up
the outbreak, the original source of infection remains in doubt.

Administrative Developments

During 1960, a number of administrative re-arrangements were made
within the Department.

After prolonged discussions, the City, in February 1960, finally assumed
full responsibility for the home nursing service, the Agency arrangement with
the Bristol District Nursing Association being terminated. The administrative
staff of the nursing service was rehoused at the Central Health Clinic in a suite
adjacent to the Chief Nursing Officer and Superintendent Midwife. Field
arrangements, including the mechanism for use of the service by the public and
general medical practitioners remained undisturbed. The transfer was carried
out smoothly, which is a tribute to the goodwill and co-operation of all con-
cerned, and there can be little doubt that the new arrangement will facilitate
integration of the nursing and domiciliary services.

In January, the Public Analytical Department was transferred from the
University to the City Public Health Department and the City and University
opened joint premises in Prince Street which are now used for teaching and
research purposes. The joint Statistical Unit was transferred to Prince Street
from the Central Health Clinic, the Health Visitor Training Course from 36
Queens Square to Prince Street, and the Food and Drugs Section of the Public
Health Inspector’s Department was transferred from Canynge Hall to 36 Queen
Square. In addition, in order to provide much needed accommodation at the
Central Clinic, the Home Help Section was transferred to 36 Queen Square.

This series of moves all had to be planned with great care, and in considerable
detail and the fact that all of them were accomplished with a minimum of dis-
ruption for members of the staff or the public, speaks highly for the senior lay
administrative staff on whom most of the burdens fell.

The acquisition of the Prince Street Training Centre has been of considerable
advantage and has relieved some of the pressure on the accommodation at the
Central Clinic. Nevertheless, it remains true that until the new Headquarters
building, which will also house the Sanitary and Mental Health Sections, can be
provided in Castle Street, it will be impossible to provide a completely integrated
administration. The provision of a new Central Ambulance Station is dependent
upon this development and members of the Council will be aware of the grave
difficulties under which some of the men are working at the present time. These
developments become even more urgent in view of the unsatisfactory conditions
of the existing ambulance stations and the probable demolition for road widening
purposes in the near future of one of them, and also because of the increasing
demand made on the Service in 1960 (from 150,633 calls in 1959 to 159,151 calls
in 1960). These demands are likely to increase further as more day hospitals
and social therapy clubs are opened for the mentally disordered.

In common with other Departments of the Corporation, the administrative
working of the Health Department was investigated during the year by an
independent team of “organisation and methods” consultants. They spent
3 — 4 months in the Department and their report is awaited with interest.

During the year, a new clinic was opened at Withywood — the “Amelia
Nutt” (in honour of the long and distinguished service to public health of
Alderman Mrs. Nutt). Dr. Albertine Winner, the Minister’s Principal Medical
Officer for the South-West Region, performed the opening ceremony. No
more fitting tribute could have been paid to Alderman Mrs. Nutt and to Dr.
Winner whose great help over the years has done so much to provide the City
with adequate health services. The clinic serves the Withywood estate and by
the end of the year had become an important service to the people living there.

It is nine years since the X-ray Department was equipped at the Central
Health Clinic, and during the year it was necessary to install new equipment.

One other new administrative arrangement was made during 1960. The
retirement of the Tuberculosis Executive Officer opened up the possibility of
a partial re-organisation of Care and After Care work within the Department.
For many years, the Tuberculosis Section had been responsible for care arrange-
ments for the tuberculous person (in association with the Voluntary Tuberculosis
After Care Committee) and also for arrangements relating to notification,
liaison with chest physicians and B.C.G. vaccination.

A new section of Care and After Care was created in the charge of a Head
Almoner and care arrangements for Tuberculosis are now but a part of this new
section, which now has far wider responsibilities and closer co-operation with
the Almoning Departments of the acute general hospitals. Notification of
Tuberculosis, and B.C.G. vaccination were transferred to the re-organised
section of Epidemiology and Statistics. It is anticipated that, as the years go by,
increasing responsibilities will fall on the new section of Care and After Care.

Chiropody

During 1960, the Department, in keeping with all other Local Health
Authority Departments in the country, became responsible for the provision
of a Chiropody Service for selected classes of the population. Old people,
handicapped persons and expectant mothers form the priority classes. Hitherto,
chiropody for the elderly has been carried out on a small but very useful scale
by Bristol Old Peoples’ Welfare Association. By agreement with them, the
Local Health Authority has gradually taken over and decentralised the service
at peripheral clinics, and there will be a gradual expansion as more chiropodists
(who are at present in short supply) become available. This is valuable work.

particularly on behalf of the aged who, through the help given, are enabled to
remain ambulant instead of becoming chair, or even bed bound.

Mental Health

Reference is made in the Report to further developments in the Mental
Health Service. From the 1st November, it became possible to implement all
the provisions of the Mental Health Act. Reference has been made in previous
reports to the far reaching developments which will be needed to make the
provisions of the Act effective. There will be an increasing need to collaborate
with psychiatrists and psychiatric hospitals, and it is pleasing to record our
partnership with Glenside Hospital in the establishment of a unique factory
(Industrial Therapy Organisation (Bristol) Ltd.) for the rehabilitation of chronic
psychotic patients, which dates from March 1960. In addition, the Health
and Housing Committees are collaborating, as a further development in this
scheme, with the hospital which envisages the provision of 6 to 7 special houses
for ex-hospital cases.

Other developments in the Mental Health Service in 1960 include the opening
of the Townsend Youth Club at Marlborough House in May 1960, the provision
of a new establishment for mental welfare officers, including a trainee scheme
and the inauguration of a “pilot” social therapy club for the elderly mentally
infirm at Southmead Clinic. It is also pleasing to record that final approval
was given by the Ministry of Health and the City Council to the building of
the new Training and Industrial Centre on the Bush Estate.

Environmental Health

Attention is drawn to important developments in the section of the Report
compiled by the Chief Public Health Inspector. Considerable progress was made
during the year with the clean air programme. A new and comprehensi\e
training scheme for public health inspectors has been introduced. New problems
are arising from the sale of food from vending machines, while old problems
such as the contamination of milk and meat by tubercle bacilli have almost been
eliminated by the national eradication programme. Nevertheless, problems
of food hygiene are still considerable. Public ignorance or apathy about the
need for clean food is still rife, and once again the Chief Public Health Inspector
highlights the need for, and the potential value of, a Food Hygiene Centre for
educational purposes.

The slum clearance programme was slowed down considerably during the
year. Undoubtedly, some of the very worst slums have been cleared in Bristol,
but many obsolete or obsolescent properties remain. Present effort is being
concentrated on the conservation of obsolescent properties by improN ement and
repair.

In this brief survey of 1960, it has been impossible to refer to many other
developments in the Department, which are given in later pages of the Report,
but I would like to extend my grateful thanks to the many officers, both within
and outside the Department, who have made it possible to record once again a
very successful year. My thanks are also due to the Chairman, Vice-chairman
and members of the Health Committee and City Council for their unfailing
support and guidance throughout the year.

I am.

Your obedient servant,

R. C. WOFINDEN,

Medical Officer of Health.

THE HEALTH COMMITTEE I960

Chairman:

Alderman G. P. C. Ford

Vice-Chairman:

Mr. W. W. Clothier

Aldermen:

Mrs. A. M. Chamberlain
J. J. Milton, o.b.e., j.p.
Mrs. A. E. Nutt

Councillors:

W. E. Blackmore

S. T. Gamlin
W. Graves
Mrs. P. M. Jacob
A. E. C. Tudball

Mrs. H. Bloom
W. A. Bush

Mrs. M. E. Castle, j.p.
(resigned July I960)

(member until September 1960)
H. Trapnell

K. I. Crawford
B. J. M. Davies
W. H. England

(replaced Mrs. Castle July 1960)
A. B. Abrams

(replaced Mr. Tudball Nov. 1960)

PUBLIC HEALTH STAFF, I960

Medical Officer of Health (City, Port and Schools): R. C. Wofinden,

M.D., B.S., D.P.H., D.P.A.

Deputy Medical Officer of Health: J. F. Skone, m.d., b.s., d.c.h., d.p.h., d.i.h.

Principal Assistants

Chief Assistant Medical Officer of Health and Senior Medical Officer for Mental
Health: H. Temple Phillips, m.d., b.s., d.i.h., d.c.h., d.p.h.

Senior Medical Officer — Port: D. T. Richards, m.r.c.s., l.r.c.p., d.p.h.

Senior Medical Officer — School Health Service: A. L. Smallwood, m.d., d.c.h.,
d.p.h.

Senior Medical Officer — Maternal and Child Health : Sarah C. B. Walker,

M.D., B.S., D.P.H.

Senior Medical Officer — Epidemiology: P. W. Bothwell., m.b., ch.b., d.p.h.
Chief Dental Officer: J. McCaig, l.d.s., r.f.p.s.

Chief Public Health Inspector: F. J. Redstone, f.r.s.h., f.a.p.h.i.

Chief Administrative Officer: P. J. Room.

Chief Nursing Officer: Miss L. M. Bendall, s.r.n., s.c.m., h.v.cert.

Technical Officers

Health Education Officer: P. Mackintosh, b.a.

Medical Records Officer: Miss E. H. L. Duncan, m.a., b.Sc. (resigned 22.10.60)
Nutritionist: Miss M. Chapman.

Consultant Bacteriologist

Professor K. E. Cooper, b.Sc., ph.d., m.r.c.s., l.r.c.p., a.i.c.

Deputy Consultant Bacteriologist

H. R. Cayton, m.b., ch.b.

Scientfic Adviser

E. G. Whittle, b.sc., f.r.i.c.

SUMMARY OF VITAL STATISTICS

Population

The Registrar General has estimated the home population (including
H.M. Forces stationed in the area) at mid-year 1960 to be 433,750, a decrease
of 2,850 from that for the previous year. The rates for 1960 are based upon
this estimated figure.

The figures given in the following tables for births, stillbirths, and deaths
(but not marriages) are those allocated by the Registrar General to Bristol as
registered during the respective years and corrected for inward and outward

transfers according to residence.

Estimated home population (mid-year)

Marriages

Rate (persons married) per 1,000 population . .
Births registered during year . .

Rate per 1 ,000 population

Rate per 1,000 population adjusted (ACF. 1960

100 )

Stillbirths registered during year
Rate per 1,000 total births
Deaths registered during year

Crude rate per 1,000 population

Adjusted rate per 1,000 population (ACF. 1960

0-98)

Natural increase (per 1,000 population)

Deaths under one year registered during year

Rate per 1,000 live births registered during year
Deaths under four weeks registered during year

Rate per 1,000 live births registered during year
Deaths under one week registered during year

Rate per 1,000 Live births registered during year
Peri-natal mortality (Still births plus 1st week deaths)
Rate per 1,000 total (Live and Still) births
Deaths from puerperal causes registered during year
Rate per 1,000 total births registered during year

1959

1960

436,^00

433,750

3,334

3,407

15-3

15-7

6,663

6,889

15-26

15-88

15-26

15-88

134

101

19-71

14-45

5,174

5,260

11-85

12-13

11-49

11-89

3-41

3-76

130

136

19-5

19-7

14-0

14-4

12-31

12-63

216

188

31-8

26-9

0-29

0-14

Marriages

1960

1959

1958

1957

1956

1955

1954

1953

1952

1951

1950

1949

1948

Number

Rate persons

of marriages

married per

during year

1,000 popn.

3,407

15-7

3,334

15-3

3,213

14-67

3,446

15-68

3,581

16-26

3,535

15-98

3,377

15-18

3,460

15-58

3,585

16-15

3,506

15-88

3,512

15-87

3,783

17-20

3,786

17-41

Births

Year

1950

1951

1952

1953

1954

1955

1956

1957

1958

1959

1960

R.G.’s figures: —

Registered live births

(Bristol citizens)

7,096

6,872

6,760

6,945

6,691

6,531

6,669

6,984

6,978

6,663

6,889

Birth rate per 1,000 pop.

16-03

15-56

15-23

15-63

15-04

14-76

15-14

15-89

15-93

15-26

15-88

Live births notified in
Bristol during the year
(Births are notified in

7,897

7,511

7,557

7,781

7,641

7,469

7,785

8,324

8,580

8,265

8,815

the district where they
occur)

Non-citizens included

above (notified)

727

844

900

917

1,060

1,129

1,259

1,429

1,587

1,671

1,921

Illegitimacy (Rate: 63 per 1,000 live births registered during year).

1959 1960

Registrar General’s total —

Illegitimate live births (corrected for residence) . . . . 322 433

Illegitimate live births as percentage of total (corrected) live

births 4-8 6-3

Stillbirths Total No. (corrected by R.G. for residence) registered during
1960 — 101 (1959 — 134). Rate: 14-5 per 1,000 total births registered.

Deaths Rate: (Crude) 12T3 per 1,000 population.

(Adjusted) 11-89 per 1,000 population (Area Comparability
Factor 0-98).

During 1960 the total number of deaths actually occurring in Bristol within
the year was 5,805 of which 918 were non-citizens. The number of inward
transfers in respect of citizens who died outside the City area was 384.

The Registrar General’s corrected figure for deaths of Bristol citizens
registered during 1960 is 5,260 and the crude death rate is 12-13 per 1,000
population. Comparable figures of the Registrar General for 1959 — 5,174
deaths and the rate — 11-85.

Natural Increase Rate: 3-76 per 1,000 population.

Bristol births registered during year

1960

6,889

1959

6,663

Bristol deaths registered during year

5,260

5,174

Natural increase . .

1,629

+ 1,489

Infant Mortality (Rate: 20).

Total deaths of Bristol citizens under 1 year of age registered during 1960

136

Rate per 1 ,000 registered live births (Bristol citizens)

19-7

I960 1959 1958

1957

1956

1955

1954 1953

1952

1951 1950

Legitimate infant mortality rate per

1,000 legitimate live births reg. in

the year .. .. .. .. 19-4 18-9 20-3

181

19-6

18-9

20-7 22-3

20-9

20-2 23.0

Illegitimate I.M. rate per 1 ,000 illegiti-
mate L.B. registered in the year . . 25-4 3T1 26-8

23-9

13-7

24-6

22-0 12-9

33-1

24-8 29-0

N eO" Natal Deaths {i.e., deaths under four weeks of age).

Total deaths of Bristol citizens in this age-group, registered during 1960. . 99

Rate per 1,000 registered live births (Bristol citizens) .. .. .. 14-4

During 1960 the deaths of 99 babies during the first four weeks of life were
registered (Bristol citizens). (Comparable figure for the year 1959 is 93).

These deaths represent 73 per cent of the total infants (Bristol citizens)
dying under one year of age (72 per cent in 1959).

In 1960, 43 of these deaths occurred on the first day and 44 in the remainder
of the first week.

For 1960, of the total of 99 neo-natal deaths, shown by the Registrar
General, 8 were of illegitimate babies. This gives a legitimate neo-natal mortality
rate of 141 per 1,000 legitimate live births registered in 1960 and an illegitimate
neo-natal mortality rate of 1 8-5 per 1 ,000 illegitimate live births registered in 1 960.

Maternal Mortality There was only one death, septic abortion. This gives
a rate of 0-14 per 1,000 total births (live and still) registered during the year.

VITAL STATISTICS

TABLE I. Population, marriages, births, deaths, natural increase,
infant mortality — for Calendar Year I960 and previous six years —
(Registrations during year)

Supplied by the Registrar General

1960

1959

1958

1957

1956

1955

1954

Estimated population. Home (mid-year):

433,750

436,600

438,000

439,600

440,500

442,500

444,900

Marriages:

Number . .

3,407

3,334

3,213

3,446

3,581

3,535

3,377

Rate persons inarried per 1,000 popula-
tion

15-7

15-3

14-67

15-68

16-26

15-98

15-18

Birth registrations :

Legitimate — males

3,329

3,313

3,416

3,444

3,271

3,216

3,298

females

3,127

3,028

3,226

3,205

3,105

3,030

3,075

Illegitimate — males

231

166

175

166

150

152

158

females

202

156

161

169

143

133

160

Total

6,889

6,663

6,978

6,984

6,669

6,531

6,691

Rate per 1,000 population

15-88

15-26

15-93

15-89

15-14

14-76

15-04

Illegitimate live births per cent of total
live births

6-3

4-8

4-4

4-8

Stillbirth registrations :

Legitimate— males

females

Illegitimate — males

females

Total

101

134

122

158

170

135

160

Rate per 1,000 live and still-births

Total live and still-births . .

6,990

6,797

7,100

7,142

6,839

6,666

6,851

Death registrations:

Males

2,617

2,573

2,613

2,586

2,727

2,647

2,583

Females . .

2,643

2,601

2,614

2,598

2,668

2,561

2,582

Total

5,260

5,174

5,227

5,184

5,395

5,208

5,165

Rate per 1,000 population

12-13

11-85

11-93

11-79

12-25

11-77

11-61

Natural increase per 1 ,000 population

3-76

3-41

4-00

4-09

2-89

2-99

3-43

Deaths under one year (registered):

Legitimate

125

120

135

120

125

118

132

Illegitimate

Total

136

130

144

128

129

125

13Q

Rate per 1,000 live births

Legitimate infant mortality rate — per
1,000 live births, legitimate . .

Illegitimate I.M. rate per 1,000 live
births, illegt. . .

Deaths under four weeks: Total deaths

101

106

Neo-natal mortality rate per 1,000 live
births . .

Diarrhoea and Enteritis (under two years) :

Deaths

Rate per 1,000 live births

0-15

0-29

0-43

0-30

0-46

0-15

Maternal mortality (including abortion):
Deaths from:

Sepsis of pregnancy, childbirth and
the puerperium

Abortion with toxaemia

—

Other toxaemias of pregnancy and the
puerperium . .

Haemorrhage of pregnancy and child-
birth

Abortion without mention of sepsis or
toxaemia

Abortion with sepsis . .

—

Other complications of pregnancy,
childbirth and the puerperium

Total deaths

Rate per 1 ,000 total births (live and still)

0-14

0-29

0-28

0-14

0-29

0-30

0-58

TABLE 2. Birth-rates, death-rates, analysis of mortality, maternal
mortality and case-rates for certain infectious diseases in the

year I960

Supplied by the Registrar General

(Provisional figures based on quarterly returns)

BRISTOL ENGLAND & WALES

Rates Rates Rates Rates

per 1,000 per 1,000 per 1,000 per 1,000
Home Total Births Home Total Births
Population (Live & Still) Population (Live & Still)

Birth Registrations:

Live

15-9

17-1*

Still

14-5

19-8

Death Registrations :

ALL CAUSES (Crude)

12-13

115

(Adjusted) . .

Typhoid and paratyphoid fevers

11-89

0-00

Whooping Cough

—

0-00

Diphtheria

—

0.00

Tuberculosis . .

007

0-08

Influenza

0-02

002

Smallpox

—

Acute poliomyelitis (including polioencephalitis). .

—

000

Pneumonia

0-5

0-53

Notifications (Corrected):

Typhoid fever

0-01

0-00

Paratyphoid . .

—

O-CO

Meningococcal infection

001

0-01

Scarlet fever . .

0-42

0-70

Whooping cough

0-92

1-27

Diphtheria

—

0 00

Erysipelas

0-11

0-06

Smallpox

—

Measles

1-28

3-48

Pneumonia

0-46

0-32

Acute poliomyelitis (including polioencephalitis): —
Paralytic . .

0-00

Non-paralytic

—

0-00

Food poisoning

0-42

0-17

Puerperal pyrexia

Deaths under one year of age

11-59

Rates per 1 ,000 Live Births
England
Bristol & Wales

19-7 21-9t

Deaths from diarrhoea and enteritis (under 2 years

of age)

0-15

Maternal Mortality:

Rate per 1,000 Total Births Rate per Million

(i.e.. Live and Still)

Women

Deaths

Deaths aged 1 5 to 44

No. Rate

No.

Rate (England

BRISTOL

ENG. & WALES & Wales)

Maternal causes — excluding abortion

242

0-30 27

Due to abortion

1 0-14

0-09 7

Total maternal mortality

1 0-14

310

0-39 34

* The provisional birth rate shown above for England and Wales is the highest since 1949.
t The provisional infant death rate for England and Wales is the lowest ever recorded in the country.

TABLE 3. Total deaths of Bristol Citizens by cause and age
registered during Calendar Year I960

Compiled from figures supplied by the Registrar General

DISEASE

Sex

All

J-

15-

45-

65-

75 <4

ages

over

All Causes

2,617

126

737

725

917

2,643

429

647

1,438

T.B. Respiratory . .

—

T.B. Other

—

Syphilitic Disease

—

Diphtheria

Whooping Cough

Meningococcal Infection

Acute Poliomyelitis

Measles

Other Infective and Parasitic Diseases . .

—

10.

Malignant Neoplasm of Stomach

—

11.

,, ,, ,, Lung, Bronchus

180

—

12.

„ ,, ,, Breast . .

100

—

13.

,, ,, ,, Uterus . .

—

1 1

14.

,, Other & Lymp. Neoplasms. .

234

—

208

—

15.

Leukaemia, Aleukaemia

—

16.

Diabetes . .

—

17.

Vascular Lesions of Nervous System . .

308

—

149

534

—

153

326

18.

Coronary Disease, Angina

576

—

203

200

156

399

—

132

198

19.

Hypertension with Heart Disease

—

128

—

20.

Other Heart Disease

259

—

162

422

—

307

21.

Other Circulatory Disease

141

—

163

—

122

22.

Influenza . .

—

23.

Pneumonia (including Pneu. of Newborn)

—

116

—

24.

Bronchitis . .

181

—

25.

Other Diseases of Respiratory System . .

—

26.

Ulcer of Stomach and Duodenum

—

27.

Gastritis, Enteritis and Diarrhoea

—

28.

Nephritis and Nephrosis

—

29.

Hyperplasia of Prostate . .

—

30.

Pregnancy, Childbirth, Abortion

—

31.

Congenital Malformations

—

32.

Other Defined and Ill-Defined Diseases . .

144

166

33.

Motor Vehicle Accidents

—

34.

All other Accidents

—

35.

Suicide

—

36.

Homicide and Operations of War

—

TABLE 4. Causes of death registered during Calendar Year I960

Compiled from figures supplied by Registrar General

Death Rate

per 1,000

Disease

No. Deaths

Per cent, of

Population

1960

all Deaths

•058

T.B. Respiratory . .

•48

■007

T.B. Other

•06

•028

Syphilitic disease . .

•23

—

Diphtheria

—

Whooping Cough

—

•002

Meningococcal infection

•02

—

Acute poliomyelitis

—

Measles

•032

Other infective and parasitic disease . .

•27

•314

10.

Malignant neoplasm of stomach

136

2-59

•466

11.

,, ,, „ lung, bronchus

202

3-84

•231

12.

„ „ „ breast . .

100

1-90

•097

13.

„ ,, ,, uterus . .

•80

1019

14.

„ other and lymp. neoplasms. .

442

8-40

•055

15.

Leukaemia, aleukaemia . .

•46

•108

16.

Diabetes . .

•89

1-941

17.

Vascular lesions of nervous system

842

1601

2-248

18.

Coronary disease, angina

975

18-54

•477

19.

Hypertension with heart disease

207

3-94

1-570

20.

Other heart disease

681

12-95

•701

21.

„ circulatory disease

304

5-78

•023

22.

Influenza . .

•19

23.

Pneumonia (including pneumonia of new-

■482

born)

209

3-97

•526

24.

Bronchitis . .

228

4-33

•161

25.

Other diseases of respiratory system

1-33

•097

26.

Ulcer of stomach and duodenum

•80

•069

27.

Gastritis, enteritis and diarrhoea

•57

•067

28.

Nephritis and nephrosis . .

•SS

•076

29.

Hyperplasia of prostate . .

•63

•002

30.

Pregnancy, childbirth, abortion

■02

•115

31.

Congenital malformations

•95

•715

32.

Other defined and ill-defined diseases . .

310

5-89

•127

33.

Motor vehicle accidents . .

105

•210

34.

All other accidents

1-73

•097

35.

Suicide

•80

•007

36.

Homicide and operations of war

•06

2-127

All Causes

5,260

TABLE 5. Deaths (corrected for transfers) occurring within the
years 1959 and I960 (Local figures)

Inter- 1959 1960

national

Code No.

Total

Including

Total

Including

001 008

T.B. of respiratory system . .

010-019

T.B. other

020 029

Syphilis and its sequelae

030 039

Gonococcal infection and other V.D.

—

040 049

Infectious disease in intestinal tract

050-064

Other bacterial diseases

070 074

Spirochaetal diseases (except syphilis)

—

080-096

Diseases attributed to viruses

100-108

Typhus and other rickettsial diseases

—

110-117

Malaria

—

120-138

Other infective and parasitic diseases

—

140-148

Malignant neoplasm of buccal cavity and pharynx

150-159

Malignant neoplasm digestive organs and peritoneum

375

352

151

Malignant neoplasm stomach

151

137

153

Malignant neoplasm large intestine (except rectum)

154

Malignant neoplasm rectum

160-165

Malignant neoplasm respiratory system . .

216

212

170-181

Malignant neoplasm breast &genito-urinary system

256

258

170

Malignant neoplasm breast

100

171/4

Malignant neoplasm uterus

175

Malignant neoplasm ovary, fallopian tube and

broad ligament

177

Malignant neoplasm prostate

180/1

Malignant neoplasm kidney, bladder and other

urinary organs

190-199

Malignant neoplasm other and unspecified sites . .

200 205

Neoplasms of lymphatic & haematopoitetic tissues

210-229

Benign neoplasm

230-239

Neoplasm of unspecified nature

240-245

Allergic disorders

250-254

Diseases of thyroid gland . .

260

Diabetes mellitus

270-277

Diseases of other endocrine glands

280-289

Avitaminoses, and other metabolic diseases

290-299

Diseases of blood-forming organs . .

300 309

Psychoses

310-318

Psychoneurotic disorders

—

320-326

Disorders of character, behaviour and intelligence

330-334

Vascular lesions affecting central nervous system. .

811

853

331

Cerebral haemorrhage

281

294

332

Cerebral embolism and thrombosis

396

433

340-345

Inflammatory diseases of central nervous system. .

350-357

Other diseases of central nervous system . .

360-369

Diseases of nerves and peripheral ganglia

—

370-379

Inflammatory diseases of eye

—

380-389

Other diseases and conditions of eye

—

390-398

Diseases of ear and mastoid process

—

400-402

Rheumatic fever

—

410-416

Chronic rheumatic heart disease . .

420-422

Arteriosclerotic and degenerative heart disease . .

1410

1467

420

Arteriosclerotic heart disease, including coronary

disease

834

972

422

Other myocardial degeneration

546

462

430-434

Other diseases of the heart . .

106

440-447

Hypertensive disease

273

265

440/3

Hypertensive heart disease . .

234

231

450-456

Disease of arteries . .

169

224

460-468

Diseases of veins and other diseases of circulatory

system

TABLE 5 — continued

Inter-

1959

national

Code No.

Total

Including

Total

470-475

Acute upper respiratory infections

—

480-483

Influenza

490-493

Pneumonia (4 weeks plus) . .

197

187

500-502

Bronchitis

264

226

510-527

Other diseases of respiratory system

530-539

Diseases of buccal cavity and oesophagus

540-545

Diseases of stom.ach and duodenum

550-553

Appendicitis . .

560-561

Hernia of abdominal cavity

570-578

Other diseases of intestines and peritoneum

580-587

Diseases of liver, gallbladder and pancreas

590-594

Nephritis and nephrosis

600-609

Other diseases of urinary system . .

610-617

Diseases of male genital organs

620-626

Diseases of breast, ovary, fallopian tube and para-

metrium

—

630-637

Diseases of uterus and other female genital organs

—

640-649

Complications of pregnancy

—

650-652

Abortion

—

660

Delivery without complication

—

670-678

Delivery with specified complication

—

680-689

Complications of the puerperium . .

—

690-699

Infections of skin and subcutaneous tissue

—

700-716

Other diseases of skin and subcutaneous tissue . .

720-727

Arthritis and rheumatism, except rheumatic fever. .

730-738

Osteomyelitis and other diseases of bone and joint

740-749

Other diseases of musculoskeletal system

—

750-759

Congenital malformations . .

760-769

Birth injuries, asphyxia and infections of newborn

762

Postnatal asphyxia and atelectasis . .

763

Pneumonia of the newborn

770-776

Other diseases peculiar to early infancy . .

780-789

Symptoms referable to systems or organs

790-795

Senility and ill-defined diseases

E 800-802

Railway accidents

E8 10-825

Motor vehicle traffic accidents

E830-835

Motor vehicle non-trallic accidents

—

E840-845

Other road vehicle accidents

—

E850-858

Water transport accidents . .

E860-866

Aircraft accidents

E870-888

Accidental poisoning by solid and liquid substances

—

E890-895

Accidental poisoning by gases and vapours

E900-904

Accidental falls

E910-936

Other accidents

E940-946

Complications due to nontherapeutic medical and

surgical procedures

—

E950-959

Therapeutic misadventure and late complications

of therapeutic procedures

—

E960-965

Late effects of injury and poisoning

—

E970-979

Suicide and self-inflicted injury

E980-985

Elomicide and injury purposely inflicted by other

persons

E990-999

Injury resulting from operations of war . .

—

I960

Including

5178

5271

Totals

bjo

flu

■o

3 r)
_ 0 )

U >s

c .

' rt

O s

^ <u

2: rt

a» L.
3 3

T3 Q

-J

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x; 'u

•« ?!

^ '3
cri 3
S'3'

I'S

spjDMdn
puD S9

P9 Of gp

PP Of gi

PI Of g

p Of I

I -i^pufi

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Q-i Cl,--.

“a •—
> 2
2 '^ ’ 5 .

spjVMdti
puD g 9

P9 Of gp

PP Of gz

PZ Of gi

PI Of g

P Of I

I -i^pm

rs <u

-H (S

-H

6 6

I I
I I
I I

I -

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6 6

I I

■“ I

Q u

2 I
I I

c o

.5.§
o ^

I I

2 3

^ I

?; I I

2 I ;s

r- 1 o

1 I
I I

X >>

2 c

>> o

ri o\

— 6

rn —

«i-i O

I I I
I I I

1 - I
I I I
I I I

I I

5 1 I
2 I 1

- I
2 I
2 1

— . W-)

r- fs r-

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— <N ^

i 2 1

S Q <t

^ <

16 cases occurred at home of which 2 were subsequently removed to hospital. No deaths were directly attributed to puerperal pyrexia.
f Infective ltepatitis\ January — November (inclusive) 1960. / 1026

\Glandulor fever / voluntary notifications; — \ 71 and December 1st official notifications (as in table above) commenced.

TABLE 7. Tuberculosis Notifications In Bristol

CASES

At Un-

Sex

All

Ages

der

one

1960—

Pulmonary Tuberculosis

New notifications

141

—

Transfers from other areas

—

Deaths mentioning Tuberculosis,

not notified . .

10-

15-

20-

25-

55-

45-

55-

and

over

1960—

Non-pulmonary Tuberculosis
New notifications . . . . M

Transfers from other areas . . M
F

Deaths mentioning Tuberculosis,
not notified . . . . . . M

10 — — — 3 3 — 3 l___

17 — 1 2— 1 332 1 22

New Notifications —

Pulmonary —

1959

148

—

1958

173

—

1957

187

114

1956

191

113

—

1955

201

147

—

1954

218

2*!

168

—

1953

239

185

—

1952

266

214

—

1951

296

1 1

208

—

1950

223

205

—

■)

Non-Pulmonary —

1959

—

1958

—

1957

—

1956

•>

—

■>

1955

—

1954

—

1953

—

1952

—

1951

—

1950

—

< ^

TABLE 8. Tuberculosis in Bristol — Deaths

(Registrar GeneraTs corrected figures)

PULMONARY TUBERCULOSIS-

At All Under

Year Sex Ages One

15-

45-

65 and
over

1960

—

1959

—

1958

—

1957

—

1956

—

1955

—

1954

—

1953

—

1952

—

1951

—

1950

—

NON-PULMONARY TUBERCULOSIS—

1960 M 2 — —

—

1959

—

1958

—

1957

—

1956

—

1955

—

1954

—

1953

—

1952

—

1951

—

1950

—

TABLE 9. Infant Mortality (Corrected for transfers)

Deaths I960 (Local figures)

(Occurring within Calendar Year)

Total

From

Total

from one

Total

First

one day one week

under

month

1959

Cause of Death

1960

day

under

to four

four

to under

one week

weeks

twelve

months

T.B. respiratory . .

—

Meningococcal meningitis

—

Acute poliomyelitis

—

Whooping cough . .

—

Measles

—

Pneumonia (four weeks plus)

—

Pneumonia of the newborn

—

Influenza

—

Bronchitis . .

—

Gastro-enteritis (four weeks plus)

—

*Congenital malformations

1 1

*Birth injury

—

*Atelectasis

—

*Haemolytic disease of newborn . .

—

Haemorrhagic disease of newborn

—

*Other diseases of early infancy . .

—

^Immaturity (unqualified) . .

—

Other causes

—

131

TOTALS

138

Rate per 1,000 live births

registered in 1960

6-2

6-4

1-7

14-4

5-7

r TOTALS . .

131

Year 1959 Rate per 1,000 live

(. births registered . .

19-66

6-60

5-85

1-65

14-11

5-55

* Where there has been mention of immaturity — / 1960 — Bristol cases — 55

Infant Deaths in;—

- Hospitals

\ During 1959 — Bristol cases — 55

1 15 (including 5 in hospitals outside City area")

Nursing Homes

—

Private Residences

Total

, 138

PREVALENCE AND CONTROL OF INFECTIOUS DISEASES

Dr. P. W. Bothwell
(Senior Medical Officer — Epidemiology)

General

Last year reference was made to the higher prevalence of non-notihable
virus diseases. In 1960, as a result of an outbreak of infective hepatitis in the
City with some concurrent infectious mononucleosis (Glandular Fever), both
diseases were made statutorily notifiable in Bristol. Notification of these and
other diseases is an essential first step in research into their incidence — a simple
step no doubt but without it no further research is possible in the “population"
or epidemiologic sense.

Incidence of Infectious Diseases and other Diseases

NOTIFICATIONS
1st January to 31st December, I960

*Infective hepatitis (Officially notifiable 1 st December,

1960 (120) 1,146

*Glandular fever (Officially notifiable 1st December,

1960 (12) 83

Poliomyelitis (including polioencephalitis) .. Nil

Diphtheria . . . . . . . . Nil

Erysipelas . . . . . . . . . . 46

Scarlet Fever . . . . . . 182

Paratyphoid . . . . . . . . Nil

Typhoid . . 2

Meningococcal infection . . . . . . 4

Acute primary pneumonia . . . . 194

Acute influenzal pneumonia . . . . 9

Malaria . . . . . . . . Nil

Dysentery . . . . . . . . . . 699

Measles . . . . . . . . . . 556

Whooping cough . . . . . . 398

Acute rheumatism (under 1 6 years of age) . . 26

Food poisoning . . . . . . 184

Puerperal pyrexia (citizens only) .. 81

(102 in full)

Ophthalmia neonatorum . . . . 3

Tuberculosis Pulmonary P/7/?7my 0///3’ 198

,, Non-pulmonary „ . . 27

Total Cases . . 3,838

^Infective hepatitis and glandular fever voluntarily notified from 1st January,
1960 and officially notified from 1st December, 1960.

Virus Diseases

Infective Hepatitis and Mononucleosis

In the autumn of 1959, attention was drawn by School Welfare Officers
to the apparently raised incidence of jaundice as a cause of school absence.
Infective hepatitis was not then statutorily notifiable in Bristol. Voluntary
notification by general practitioners was requested from the 1st January, 1960,
and information from this and other sources showed that there were indeed
many cases.

The tables on page 23 show the number of cases notified month by month,
and the age groups involved, the greatest prevalence being in primary school
children.

The earliest cases about which information was obtained retrospectively
occurred in a mental deficiency hospital on the periphery of the City in July
1 959. The evidence which subsequently came in about the disease showed that the
majority of cases in the latter half of 1959 were in the central districts of the City,
but in the course of the first few months of 1960 there was a centrifugal spread,
and during 1960 cases have been scattered throughout the City, with concen-
trations in two peripheral wards.

The incubation period appeared to be usually in the region of a month.
Visits to the homes of notified patients by doctors showed that notified cases are
probably only a proportion of the total incidence, as it was found that other
patients have had some form of coincident illness, sometimes with jaundice,
which has not been notified, and it is probable that we have not recorded the
total outbreak. The reported cases reached their highest monthly level in
October and November but there were some signs that they were diminishing
in December.

Cases of mononucleosis have also been occurring in the City in the past
few months and this disease also became notifiable on 1 st January, 1960. Several
cases admitted to hospital as infective hepatitis have subsequently been diagnosed
as mononucleosis with jaundice. Consequently an effort has been made to
obtain serum from notified hepatitis cases to exclude the possibility that they
were mononucleosis with jaundice, but so far no such cases have been demon-
strated.

Gamma-globulin protection was offered to pregnant women exposed to
the infection and to the teaching staff in “infected” schools, but so far has not
been used as a means of controlling the outbreak in general, and there appears
little doubt that the infection was widespread even when we began to hear about
it.

Two deaths have occurred in children. Seventy-four cases of infective
hepatitis were admitted to hospital in 1960, and 24 cases of mononucleosis.

No relationship has been shown between this extensive outbreak of infective
hepatitis and immunising procedures in the preceding months.*

So far as we know, the outbreak in Bristol represents a real increase in
cases and we understand that similar increases in incidence have been noted in
Sheffield and to some extent in Leeds. No rise in cases has been recorded,
however, in those parts of England in which infective hepatitis is normally
statutorily notifiable.

The recording and investigation of the Bristol outbreak continues.

Infective hepatitis and mononucleosis were made officially notifiable in
Bristol from 1st December, 1960.

The Department has its own sterile syringe service for injections given anywhere
other than the smaller clinics.

Infective Hepatitis
1960

Month

Cases notified

Quarterly totals

January

February

March

128

April

May . .

111

June . .

268

July

100

August

September

121

296

October

165

November

169

December

136

470

1,162

AGE GROUPS

Pre-school . .

5 — 10 years

618

11 — 15 years

199

Over 15

262

1,162

Infective Mononucleosis

Pre-school . .

5— 10 years

1 1—15 years

Over 15

Poliomyelitis

There were no cases in Bristol in 1960. At 31st December, 1960, the
proportion of the population immunised against the disease by the Salk vaccine
by injection was as follows : —

Age Groups

Primary Course
completion

0—15

Birth years
1946—1960

0—16

Birth years
1933—1947

Birth years
Pre 1933

Totals to date
Inception {May
1956) — of Scheme
to end 1960

(82%)

22%

81,085

53,203

18,968

153,256

(61 %)

14%

60,687

39,557

7,992

108,236

Boosters

UNOFFICIAL NOTIFICATION REQUESTED FROM I. I. 60.

jAdults

Measles

The 556 measles cases were distributed throughout the population in the
following ways in 1960: —

Age Group

Male

Female

Total

Under 1

1—2

2—3

3-4

4—5

5—10

130

134

264

10—15

Over

—

Totals

212

284

556

There were no deaths attributable to measles.

Virus Meningitis

Between the 9th September and the 13th November, 1960, 25 people were
admitted to hospital because of meningeal symptoms. Seven of these patients
were adults and the rest children. Six members of one family were involved and
two and three of another two families. E.C.H.O. 9 virus was isolated from four
children. In eighteen other patients who submitted stool specimens, no isolation
of a virus was made. The symptoms were febrile and meningeal and spontaneous
recovery was the rule within twenty-four to thirty-six hours with the exception
of one fatal case in a child of sixteen months. This case was, however, located
in a different area of the City from the other cases which were grouped in one
particular area.

Bacterial Diseases

Food Poisoning {General)

The 184 cases notified (compared with 182 in 1959) consisted of 61 confirmed
single cases and 19 “outbreaks”, i.e. more than one person involved. Two
outbreaks are recorded as follows :

(7) Probable food poisoning from cheese

Food poisoning symptoms were reported in the caretaker and his wife at a
Children’s Hostel in Mangotsfield. Investigation suggested cheese as the likely
agent and samples remaining uneaten were submitted to the Public Health
Laboratory, Bristol, where a “profuse growth of staph, aureus was isolated",
with a surface viable count of 30 million staph, aureus per gram, probably
the cause of the symptoms of food poisoning associated with the consumption
of this cheese”. The cheese was New Zealand rindless Cheddar and 7 samples
of similar brand were secured from the wholesale supplier, with the following
report: “All these samples contained staph, aureus in quantity but phage typing
has shown that they are different from that strain which gave rise to illness in
the recent incident.” “These cheeses may be regarded as safe.”

2. Outbreak of Salmonella Infection in Southmead Hospital in July 1960 involving
11 people

Between 18th July and 20th July, 8 nursery babies were noted to have loose
stools and prophylactic streptomycin was given to both sick and well babies
in the nursery and prophylactic sulphonamides to the adult patients when an
unidentified Salmonella was grown from the stools. The organism was identified
on 22nd July as S. brandenburg and an ante-natal patient was found to be excret-
ing S. typhimurium.

By 23rd July, one of the originally affected babies became seriously ill and
died 24 hours later despite intensive antibiotic therapy — autopsy confirming the
diagnoses of S. brandenburg septicaemia.

At a subsequent Cross Infection Committee attended by the Medical
Officer of Health and his Deputy, it was decided to empty the affected ward,
which was closed and disinfected.

All staff and domestics submitted three stool specimens. A night nurse
on the affected ward was found to be a symptomless excretor of S. brandenburg
and it was thought that feeds in the relevant incubation period had been contam-
inated by this source. A doctor, 3 nurses and a ward orderly were found between
them to be excretors of S. arizona, S. butantan, S. heidelberg, S. saint paid and
one unidentified Salmonella, while a sick baby was found to be excreting S.
kiambu.

The affected ward was opened on the 4th August, also another ward which
had been closed as a precautionary measure when a nurse was found to be
excreting a Salmonella which was subsequently found to be Salmonella butantan.

The mother of one of the first babies affected who herself was found to
be excreting Salmonella brandenburg took her own discharge against medical
advice, infected her five other children and all the members (mother, father and
three children) of a family sharing the house.

It was reported that this mother suffered from diarrhoea about a month
before admission to hospital.

Salmonella brandenburg was isolated in the Bristol Public Health Labor-
atory on the 2nd July from specimens submitted by a student in the City whose
symptoms began on the 26th June and from an elderly lady living in the City
with symptoms starting on the 29th June. No definite source of infection or
contact with any of the Southmead Hospital patients was found.

Particulars of Outbreaks {in form of Ministry Return)

No. of outbreaks
Family Other

No of cases

Otherwise

Total
No. of

Agent

outbreaks outbreaks

Notified

ascertained

cases

Agent identified

(a) Chemical poisons

— —

—

(Type to be stated)

(b) Salmonella

(Type to be stated)

Salmonella saint paul

—

„ typhi-murium

1 —

—

„ enteritidis

—

„ thompson

1 -

—

,, brandenburg

1 1

—

2 —

—

(including toxin)

(d) Cl. botulinum

— —

—

(e) Cl. welchii

— —

—

(f) Other bacteria

— —

—

(to be named)

Totals

7 1

—

Agent not identified

11 —

—

Particulars of Single Cases

Agent

Agent identified

(a) Chemical poisons
(type to be stated)

(b) Salmonella

(type to be stated)
Salmonella hrandenburg
„ typhi-murium

,, saint paul

,, enter it idis

„ heidelberg

,, thompson

„ give

,, newport

,, anatum

,, hirodsta

,, montevideo

„ Worthington

(d) C/. botulinum

(e) CL welchii

(f) Other bacteria

Totals
Agent not identified

No. of

cases

Otherwise

Total No.

Notified

ascertained

of cases

—

Food Poisoning 1960

{a) Food Poisoning Notifications as returned to Registrar General (Corrected)

1st Quarter — 13 2nd Quarter — 44 3rd Quarter — 97 4th Quarter — 30

Total — 1 84

{b) Cases Otherwise Ascertained as returned to Registrar General

1st Quarter — Nil 2nd Quarter — 3 3rd Quarter — 3 4th Quarter — 2

Total — 8

1st Quarter — Nil 2nd Quarter — Nil 3rd Quarter — Nil 4th Quarter — Nil

Total — Nil

{d) Fatal Cases as returned to Registrar General

1st Quarter — Nil 2nd Quarter — Nil 3rd Quarter — 1 4th Quarter — Nil

Total — 1

Notified Cases of Typhoid in Bristol during 1960

Sex

TYPHOID

Age Comments

38 A seaman from M/V “Javanese Prince”. Reported

sick with malaise and fever. Admitted to Ham Green
Hospital. S. typhii isolated from faeces. M.O.H. of
next port of call informed. No information concerning
the source of the infection was received.

18 A trainee chemist at a City chemical works, handling

typhoid organisms. Admitted to Ham Green Hospital.
S. typhii confirmed. All members of his family were
cleared.

Dysentery

Of 699 notifications, 440 cases were confirmed; these being almost double
the number in 1959. In December only 3 cases were confirmed but in March
there were 117.

The number of confirmed cases might well have been higher had all those
invited to do so submitted faeces specimens.

From the St. George, Redfield and Barton Hill areas there were 117 cases
and 90 from Knowle West, Hartcliflfe and Withywood.

Over 80 confirmed cases occured in nursery schools or day nurseries.
Hotwells Day Nursery, Speedwell Nursery School and Monks Park Day Nursery
were the chief victims.

Notifications in months

Age and Sex Distribution

Total

January

Under 1

February

119

1— 1&11/12

March

168

2—4

168

April . .

105

5—9

153

May . .

10—14

June . .

15—19

July

20—29

August

30—39

September

40—49

October

50—59

November

60—69

December

70 +

All ages

348

351

699

Total Notifications

= 699

No. proved positive

= 440

Comments on the Notified Diseases, I960

Diphtheria

Outbreaks of diphtheria in other parts of the country were headline news
in 1960. No cases have occurred in Bristol since 1949 (when four cases were
notified). It is perhaps useful to recall the incidence of diphtheria in Bristol in
the past as in the following table of cases and deaths.

Deaths and Cases

Deaths

Year

No. Cases
Notified

No.

Under 1

Age Grouping {years)

1—4 5—14 15—44

45—

1949

—

1948

—

1947

— .

—

1946

—

1945

—

1944

161

—

1943

378

—

1942

370

—

1941

529

1940

784

—

1939

619

—

1938

647

—

1937

315

—

As is common elsewhere, the proportion of children immunised against
this disease had fallen below the terms required for protection in the population.

A special diphtheria immunisation effort was therefore begun in November
1960 and was concentrated in the schools. All school children were given an
explanatory leaflet and consent form and by the end of the year (2 months)
4,940 children had been given the requisite reinforcing dose while the first and
second injections of three-injection primary courses were likewise under way.
(For the whole of 1960, the number of primary diphtheria immunisation (all
combinations of injections) courses actually completed by school children was
609 out of a full total (under 15) 6,315. The inclusive booster figure of school
children was 8,358 out of a full total (all ages under 15) 9,634).

The immunity indices over the past 10 years have been as follows.

Imnmnity Index

Age on 31.12 (i.e. born in year)

Under 1

1 year

5 years

Total under

year of

15 years

Year

age

4 years

14 years

of age

1953

3-4

57-9

38-9

41-8

1954

10-3

62-5

36-1

41-6

1955

8-1

62-4

37-3

42-1

1956

11-3

61-6

31-8

38-3

1957

14-7

62-5

31-0

381

1958

22-5

63-8

27-3

36-4

1959

26-3

66-5

22-2

34-2

1960

28-9

71-3

29-5

40-7

1960

6,550

26,750

65,900

99,200— Child

population,
figures as
estimated by
R.G.

The Ministry D.I.I. Return (annually) requires . . . “Number of children
in Local Health Authority area on 31st December who have completed a course
of diphtheria immunisation at any time 1st January, 1946 and 3 1st December,
1960” . . . (that is, as was required for 1960 period).

Section “A” to show . . . “Number of children whose last course (primary or
booster) was completed in the period . . .“LAST
FIVE YEARS

Section “B” To show . . . “Number of children whose last course (primary or
booster) was completed in the period . . . “ANY-
TIME PREVIOUS TO 5 YEARS ABOVE

Section “C” To show . . . “Estimated mid-year child population"

The IMMUNITY INDEX is obtained by taking Section “A" (above),
the number of children, whose last course has been completed within the past
five years, as a percentage of the child population within the respecti\e groups
(“C”)

Thus the formula A 100 =:The Immunity Index
C

Scarlet Fever

The anomaly of notifying scarlet fever but not the equally important
streptococcal throat continued in 1960. Notification of scarlet fever and
streptococcal infection of the throat or upper respiratory tract, might stimulate
early diagnosis for the sore throats of streptococcal origin which presage an
attack of acute rheumatism. The latter is a notifiable disease in Bristol in \ iew

of its implications for rheumatic heart disease. It is the detection of the strepto-
coccal throat that is necessary in the first instance and such an arrangement
might assist in establishing areas of endemic streptococcal infection. The
current notification of scarlet fever, as has been pointed out for many years,
is practically useless.

Acute Rheumatism

Cases since notification began have been distributed yearly as follows: —

Rheumatic Fever

Cases Notified

Cases confirmed

Year

Male

Female

Total

Male

Female

Total

1947

1948

1949

1950

1951

1952

1953

1954

1955

1956

1957

1958

1959

1960

Totals

1947—60

inclusive

236

283

519

181

207

388

(14 years)

Meningococcal Meningitis

The incidence and mortality of this disease in Bristol has very much declined
in the last ten years as the following histograms show. Recent cases have been
sporadic and occurred in the great majority of cases in very young children.
Prophylactic action by the Healty Department is limited in such cases to advising,
prophylactic sulphadiazine for the contacts. Nasopharyngeal swabbing and
the finding of carriers has been shown not to be a useful exercise, since the carrier
state fluctuates rapidly and carriers seldom appear to suffer clinical disease.
Although multiple cases seldom come from the same family, this does sometimes
occur, even when the disease is sporadic, and hence the value of prophylactic
sulphediazine. Two of the fatal cases since 1950 have had the Waterhouse-
Friderickson Syndrome.

DEATHS from MENINGOCOCCAL INFECTION in BRISTOL in AGE GROUPS
in TWO PERIODS 1939 to 1948 and 1949 to I960

in ”05

^ ♦''O

tn55

-2^

W o
c>
D_

AGE GROUPS age GROUPS

EMPLOYMENT IN THE BRISTOL AREA

The figures are estimates based partly on the number of national insurance
cards exchanged in the quarter beginning June, and partly on returns rendered
by employers of five or more workpeople, showing the numbers of insurance
cards held by them.

Where information is available that cards were exchanged at one Local
Office for persons working in the area of another Local Office, the figures for
the former Office have been reduced and those for the latter correspondingly-
increased in order to make the figures in all cases relate as closely as possible
to the numbers working in each area.

Note: This statement has been prepared for the purpose of providing an
approximate indication of the industrial structure of the area. The figures
are not sufficiently precise to enable comparisons to be made in detail between
consecutive years, and no significance should be attached to relatively small
changes.

We are indebted to Mr. S. J. Murray, Manager of the Bristol Employment
Exchange of the Ministry of Labour and National Service for information
contained in this Section.

Estimated numbers of Insured Employees in the area of the Bristol, Avonmouth, Kingswood
and Westbury-on-Trym Employment Exchanges at June 1960.

Industrial Group

Distribution

Vehicles (Including Aircraft)
Professional Services
Transport etc.

Food, Drink and Tobacco
Miscellaneous Services . .
Construction

Paper, Printing & Publishing
Engineering and Electrical Goods
Public Administration
Clothing and Footwear . .

Insurance and Banking
Public Utilities
Chemicals etc.

Metal Manufacture
Timber, Furniture
Other Manufacturing Industries
Metal Goods

Shipbuilding and Marine Engineering
Bricks etc. . .

Agriculture and Fisheries

Textiles

Mining

Leather

Ex-H.M. Forces

Males

Females

aged 15

Total

and over

18,255

15,281

33,536

23,380

2,889

26,269

9,381

15,508

24,889

18,186

2,562

20,748

1 1 ,074

8,927

20,001

8,353

11,025

19,378

16,956

879

17,835

11,149

5,882

17,031

9,715

2,140

11,855

4,653

1,370

6,023

1,788

3,662

5,450

2,897

2,265

5,162

4,249

715

4,964

2,500

863

3,363

2,890

376

3,266

2,428

743

3,171

2,271

752

3,023

2,034

720

2,754

1,273

117

1,390

1,032

343

1,375

1,064

275

1,339

735

495

1,230

699

763

385

154

539

—

♦Grand Total 157,418 78,007 235,425

♦Note; Most civil servants have their contributions paid without the use of cards,
and are therefore excluded from the figures. Also excluded are seafarers
employed on foieign-going ships, whose contributions are paid in bulk.

Ot .

^ yj

t) 0 °®

to ^

rr, — .

— O

— <N

(N — .

o> —

—

SO —

6 o

os —

tO^:^ c

5 ?

Q ^

o\ —

— \0

o — —

o —

0 )

o I

s— (N

^ <N

« O —

m —

— <N a^

m — — ■

Tt —

ir> —

III

fT) « ^

§ 05

r~ —

so — '

VO —

Totals or

SECTION B

PERSONAL HEALTH SERVICES

Section

Page

MATERNAL AND CHILD HEALTH, NURSING AND ALLIED

SERVICES

Domiciliary Midwifery Service . . . . . . . . . . . . 2

Sub-Fertility Clinic . . . . . . . . . . . . . . 4

Child Health and Welfare Services . . . . . . . . . . 5

Dental Care . . . . . . . . . . . . . . 6

Health Visiting Service . . . . . . . . . . . . 9

Ancillary Nursing Services . . . . . . . . . . . . 13

Health Visitor Training . . . . . . . . 14

Home Nursing Service . . . . . . . . . . . . 16

Physiotherapy in the Maternal and Child Health Service . . . . 17
Home Help Service . . . . . . . . . . . . . . 18

Special Families . . . . . . . . . . . . . . . . 19

Welfare of Unmarried Mothers . . . . . . . . 22

Statistics . . . . . . . . . . . . . . . . . . 23

Inoculations and Vaccination . . . . . . . . . . . . 25-26

THE MENTAL HEALTH SERVICE

Introduction . . . . . . . . . . . . 27

Organisation and Staff . . . . . . . . . . . . . . 33

Courses and Conferencies . . . . . . . . . . . . 35

Subnormality and Severe Subnormality . . . . . . . . 35

Junior and Adult Training Centres . . . . . . . . . . 38

The Increasing Problem of the Sub-normal Family . . . . . . 42
Mental Illness . . . . . . . . . . . . . • • . 45

Statistical Tables 49

PREVENTION OF ILLNESS, CARE AND AFTER-CARE

Tuberculosis .. .. .. .. .. .. •• •• 53

Venereal Diseases . . . . . . . . . . . • • • 57

THE AMBULANCE SERVICE

MATERNAL & CHILD HEALTH, NURSING AND
ALLIED SERVICES

Dr. Sarah Walker

{Senior Medical Officer — Maternal and Child Health)

Looking back over the past twelve years, since the introduction of the
National Health Service, we note the gradual evolution of our own maternal
and child health services to meet modern needs, and a strengthening of the
links with the general practitioner and hospital services in the City.

In the maternity service we have seen the development of an integrated
scheme, starting in 1952 when a number of general practitioners began to under-
take the ante-natal care of their patients in the Health Clinics: there are now
eighty-six general practitioners participating in this arrangement. Reference
has been made in previous Reports to the valuable consultant service provided
by the obstetricians in certain of the main peripheral clinics. In this way, all
members of the “obstetric team” — general practitioner, obstetrician and
midwife, meet under “one roof” and the mother attends at one centre within a
reasonable distance of her home, to the mutual benefit of all concerned.

The importance of education of the expectant mother and expectant
father is now fully recognised as an integral part of a pre-natal service. Parent-
craft clubs have been provided at all ante-natal clinics, to meet this need. Again,
the approach is a team one — medical officer, midwife, health visitor, nutritionist
and physiotherapist, participating in the teaching.

With the great improvement in the physical health of babies and young
children, there has been a shift of emphasis in recent years to mental and
emotional needs. With this in mind, we are working closely with the Child
and Family Guidance Service, which now operates in some of the peripheral
Health Clinics. This association has given many of our staff, who work with
young children and their families, a greater insight and understanding of
emotional problems and human relationships.

It is important, however, not to overlook physical aspects of child care,
particularly in the so-called “special families” where standards of general
care and feeding often fall far below accepted standards. The work of the
Family Service Unit and of the Section’s team of a Medical Officer and four
health visitors, referred to later in this Report, direct much of their efforts to
improving the physical care of children in these families.

Reference is made in the section of this Report dealing with the welfare
of unmarried mothers, to the rise in illegitimacy and the increase in the numbers
of very young unmarried mothers, i.e. those under sixteen years of age. This
is a national experience and while it is certainly a matter of concern, it is impor-
tant to keep a sense of proportion since the numbers of very young girls who have
illegitimate babies is extremely small in proportion to the relevant age-groups
in the population. Nevertheless, the trend is one which focuses the attention
on the whole question of moral standards and an understanding of the adolescent.

In association with Dr. W. A. Gillespie, Bacteriologist, United Bristol
Hospitals, and Dr. Beryl Corner, Consultant Paediatrician, an enquiry into the
incidence of staphylococcal infection amongst young babies and their families
was started in November. Very encouraging results have been obtained by
prophylactic measures introduced to combat staphylococcal infection amongst

the newborn in the City’s maternity hospitals, but a follow-up enquiry is needed
to determine the degree of protection these measures confer on the infant and
his family. This enquiry, which is to cover a period of twelve months, has only
been made possible by the close co-operation of the general practitioners and
the parents of the babies concerned.

In June 1960 the National Association for Maternal and Child Welfare
held its forty-sixth Annual Conference in Bristol at the invitation of the City
Council. This conference was held in Bristol on one previous occasion, in 1938.
The delegates, who numbered over four hundred and attended from all parts
of the United Kingdom and from overseas, were welcomed at a Reception
given by the Lord Mayor, Alderman A. Hugh Jenkins and the Lady Mayoress.
The conference, which lasted three days, was opened by Miss Edith Pitt, Parlia-
mentary Secretary to the Ministry of Health.

In August of this year. Dr. Greta Hartley, a First Assistant Medical Officer
in the Maternal and Child Welfare Section, retired after thirty-one years in the
Department. Dr. Hartley was a most gifted doctor. As Medical Officer to
the Downend Babies’ and Children’s Homes, her knowledge and experience of
medical work with deprived children is probably unequalled in the country.
Dr. Hartley, by her outstanding clinical ability, integrity and humanity, earned
the respect and affection of her many patients and colleagues, and her retirement
has been a great loss to the Department.

Domiciliary Midwifery Service

Home Follow-up of Patients from

Year

Bookings

Deliveries

Investigations

Hospital

No. Visits

1959

. . 2,472

1,727

1,744

1,449

12,117

1960

. . 2,367

1,785

2,146

1,475

13,042

In 1960, 25-6 per cent of Bristol mothers were delivered at home and the
remaining 74-4 per cent in hospital. The percentage of outside City mothers
delivered in Bristol hospitals has increased over the years from 16 per cent in
1952 to 27 per cent in 1960. The high proportion of hospital deliveries in the
City has only been maintained by an increasing number of early discharges for
home nursing, as shown in the following table : —

No. of Births Mothers Discharged Early for Home Nursing —

Year

Ifl

{Bristol

Residents)

in first

3 days

4th — 6th day
inclusive

7th — 9th day
inclusive

1956 . .

5,043

178

102

240

1957 . .

5,314

284

165

406

1958 . .

5,249

396

222

662

1959 . .

4,995

423

228

692

1960 . .

5,207

476

246

753

The m.ajority of these early discharges are planned, i.e. there is a prior
home visit and report by the midwife during the ante-natal period on the suita-
bility for early discharge for home nursing, so that the mother knows in advance
that, if everything is satisfactory, she will return home early and can therefore
prepare accordingly.

The policy of early discharge is a debatable one. The Cranbrook Committee
favour retention of mother and baby in hospital for the full ten days. While
I am satisfied that with “planned” early discharge the mothers and babies have
received every care from our domiciliary midwives, I think that if the present
increasing trend continues, the matter will warrant review. I would suggest
that consideration might be given to the setting up of a unit in association with
a main maternity hospital where a mother could be delivered by her general
practitioner and domiciliary midwife, and then return home for nursing, thus
ensuring continuity of care, without the change of medical and nursing attendants
half way through the lying-in period.

Social cases, in the majority of instances, have to be retained in hospital
for the full ten days. In an appreciable proportion of social bookings, it is not
lack of suitable accommodation but the inability to ensure help to cover mother
and baby throughout the twenty-four hours. Many husbands work irregular
hours, others away from home, so that our Home Help Service cannot provide
complete cover. It is the exception today to find women relatives free to stay
with the mother at this time.

Miss D. I. Gearing, Supervisor of Midwives, reports: —

The year 1960 has been another eventful one for the Domiciliary Midwifery
Service in that it saw the commencement of the Night Rota System in which
all calls between the hours of 6 p.rn. and 7 a.m. go through to a central number.
These calls are received by a member of the Midwifery or District Nursing
Staff, who in turn notifies the appropriate midwife. The system is working very
well and is much appreciated by the staff, and has attracted some of the younger
midwives to this field of midwifery, but I regret to say that even this is not the
full answer to their settling: they complain of loneliness and isolation after
community life.

The work during the year has increased, with a slight increase in deliveries,
but a considerable increase in home investigations and in the number of visits
paid to patients discharged early from hospital for home nursing. At the 31st
December 1960, we had a staff of thirty-four full time midwives and three
part-time mid wives.

Full time and part-time midwives have combined to take an active part in
the teaching in Parentcraft clubs, run in association with all our ante-natal
clinics.

Miss Pugh, Deputy Supervisor of Midwives, has continued to give talks
to school leavers.

The Bristol City District Training of Pupil Midwives has been most suc-
cessful and to date we have had 100 per cent passes and pupils have very much
enjoyed their six months’ training. The training of pupils in conjunction with
the Bristol Maternity Hospital has also continued with good results.

Four midwives have attended post graduate courses during the year.

Foreign midwives, visiting the Department during the year, have been
very impressed with our midwifery service and much appreciated their visit.
We continue to train a number of overseas midwives each year.

The two premature baby midwives continue to do good work and maintain
a close association with the Premature Baby Units and Southmead and Bristol
Maternity Hospital.

Sub-Fertility Clinic

Mr. E. M. Edwards from Professor Lennon’s Department acts as the
consultant for this clinic: he holds regular weekly sessions at which special
investigations are carried out. Dr. Norma Boxall and Dr. Irving Bell complete
the medical team.

Dr. F. Norma Boxall, Medical Officer, reports: —

No. of new patients seen: . . . . . . . . 210

No. of attendances of old patients: . . . . 1,160

No. of pregnancies reported: .. .. .. 55

(26-5 per cent)

The Clinic continues to be used by general practitioners and others who
refer patients, not only with sub-fertility problems, but with marital problems
also.

A total of forty-one patients has been seen this year who have had marital
difficulties, with or without subfertility and to deal adequately with them is
time-consuming, but worthwhile. It is found that several interviews are necessary
to elucidate their problem and to help them achieve a normal marriage in every
sense.

Since routine haemoglobin estimations have been carried out, quite a
number of women with iron deficiency anaemia have been found and their
doctors have been asked to treat them. Also a number of women with an
unsuspected illness or pathological lesion have been found and the necessary
treatment arranged. A modification of the treatment of pelvic tuberculosis is
being tried. A new product — Ethionamide — is being used combined with
graduated rest at home, instead of hospital in-patient treatment, and should
this prove to be satisfactory, it will result in a saving of hospital beds. In all,
five new cases of pelvic tuberculosis have been detected.

One disquieting fact has emerged from this year’s figures: there has been a
large number of early miscarriages among the pregnancies. This will need to
be investigated more fully, but may not prove to be more than the average.
Our cases are almost always reported by the patient, while many miscarriages
among the general population are not mentioned to the family doctor.

This clinic would be an ideal place to detect pre-cancerous, cervical lesions
in older women by cytological measures, but unfortunately it is impossible to
find a technician with the necessary experience and time at his disposal to deal
with this.

Dr. R. J. Irving Bell, who is responsible for the male sessions of the Clinic,
reports : —

The number of new cases seen at this Clinic during 1960 was 105, and the
total attendances 244.

There has been only one full session devoted to this work each week,
namely Thursday evening, at the Central Health Clinic. A half session is
sometimes arranged on a Tuesday morning. General practitioners are re-
sponsible for the majority of referrals. An analysis of new cases shows that: —

General Practitioners referred
Female Infertility Clinic
Hospitals and self
Marriage Guidance Centre and
Family Planning Clinic

55-0 per cent.
34-4 „ „

7-6 „ „

With regard to special tests, as usual all semen analyses have been carried
out at the Pathological Department of Frenchay Hospital. Cases requiring
testicular biopsy were referred to Dr. G. L. Foss at the Bristol General Hospital.

With the increasing trend for early (even teenage) marriages in this country,
a trend to be deplored, as emotional immaturity is usual during adolescence
and often leads to marital breakdown, it would appear that some scheme
relating marriage preparation to Registry Offices might be developed.

Clinic sessions devoted to premarital examinations and marriage prepar-
ation might be set up and linked with the Marriage Guidance Centre (now at
7 Berkeley Square) and the Family Planning Clinics. Notices of these facilities
could be displayed in Marriage Registry Offices, Churches and Church Halls.

Child Health and Welfare Services

Child health sessions continue to be held throughout the City in the main
clinics and in church and community halls.

A new health clinic, the Amelia Nutt, was opened during the summer in
Withywood. This new clinic provides a much-needed centre for the many
mothers with young children who live on this estate. The local general prac-
titioners see their ante-natal mothers in the clinic, and an excellent team spirit
is apparent in the area.

Reference has already been made to the close co-operation existing between
the Maternal and Child Health and the Child and Family Guidance Services.
The three consultant psychiatrists and the team of psychiatric social workers
hold consultation sessions at the peripheral clinics at the Mary Hennessy
(Hartcliffe), Southmead, Broadfield Road, William Budd and Lawrence Weston
Clinics. The psychiatric staff hold regular conferences with the medical officer
and health visitors at each centre as part of a scheme of “in-service training'’
in the recognition and handling of problems and behaviour difficulties in young
children, considered in relation to their family background.

While the health visitors aim to keep all young children in their areas under
review, with average case loads of five hundred children under school age, it is
obvious that home visiting has to be concentrated on priority groups — the
delicate and handicapped children, and children in special families where
standards of mothercraft are poor.

Liaison arrangements

Close co-operation in the interest of maternal and child health and welfare
exists between the Department, the general practitioners and the hospitals in
the City. Dr. Hopkins, First Assistant, Maternal and Child Welfare, attends
the Bristol Children’s Hospital and Southmead Hospital for purposes of liaison,
particularly in relation to children from “special” families, who are often “in
and out” of hospital. Similarly, a health visitor attends the Children's Hospital
to act as a link with her colleague health visitors in the field.

Detailed reports on all children who have been in-patients in these hospitals
are sent to our Department.

A closely co-ordinated scheme has operated for many years for the care of
premature babies. Dr. Mary Gibson, Deputy Senior Medical Officer, Maternal
and Child Welfare, assists Dr. Beryl Corner, Paediatrician in Charge at the
Follow-Up Clinic for Premature Babies, held at Southmead Hospital. Dr.
Kathleen Faulkner, similarly, assists at the Bristol Maternity Hospital. The two
district midwives and the two health visitors who specialise in this work complete
the team.

While we have not, to date, set up any special scheme for home nursing
of sick children, as an alternative to hospital admission, it will be noted from
Miss Grazier’s report of the work of the District Nursing Service, that the
district nurses undertook visits to 84 children under five years and 121 between
five and fifteen years during 1960.

We are indebted to the Bristol Children’s Hospital for admitting young
children (2 — 8 year olds) on our recommendation, for varying periods of
convalescence at their Jan Smuts Home at Burnham-on-Sea. The children
concerned have derived great benefit from the excellent care received at this
Home.

Hearing Assessment Clinic

This Clinic, which includes facilities for the ascertainment of deafness in
very young children, is under the direction of Mr. H. D. Fairman, E.N.T.
Consultant. Dr. Helen Gibb, who acts as medical officer to the clinic, reports
in detail in Section “F” of this Report.

Day Nurseries

The seven day nurseries in the City continue to make provision for the
young child in need of care, either on a temporary basis to meet family emergen-
cies, such as illness of the mother, or long term — particularly to enable the
“unsupported” mother to earn a living and thus provide for her child.

Delicate children, including some who are retarded in development, and
children from certain special families, are also admitted, according to need.

Most of the day nurseries carry a “waiting list”. There is a very great
need for day nursery and also nursery school provision in the Hartcliffe/Withy-
wood areas. Although a special bus brings children in from these estates to
Coronation Road Day Nursery, numbers have to be limited to fifteen, so that
only the mere fringe of the problem is being met. Health and social workers
on these estates are of the opinion that a number of mothers with several young
children, who have broken down under the strain, cannot cope without some
relief in the form of nursery provision for some, at least, of their children,
particularly the 3 — 5 year olds.

Dental Care

Mr. J. McCaig, Chief Dental Officer, reports: —

There is little change in the volume of work carried out for expectant and
nursing mothers and pre-school children, since last year. The number of
expectant and nursing mothers receiving a dental inspection is 781 out of 5,000,
approximately, attending the ante-natal clinics in the City.

The need for more dental inspections is very apparent and there is con-
siderable scope for an energetic campaign to encourage dental health among
ante-natal patients. It is obvious from the above figures that many mothers
do not receive a dental inspection, and the opportunity for individual advice
and instruction is lost. Young mothers are interested and willing to learn;
they are more receptive and to make them “tooth conscious” should be our aim.
The first visit to the ante-natal clinic should include a dental inspection which
would require the full co-operation of the doctors, centre superintendents and
dental officers.

Of the 781 mothers inspected during the year, 770 required treatment and
of these 671 were treated. This is a high acceptance figure and is encouraging.
More mothers received treatment for fillings than had teeth extracted. Although
Table 3 shows 919 fillings as against 1,212 extractions, many of the extractions
were for full upper and lower dentures, therefore the latter figure is increased
proportionately.

The figures for pre-school children are not so encouraging, in fact they are
alarming, showing 1,783 extractions as against 286 fillings. This raises the
question of whether the battle against dental caries is futile, a problem which
weighs heavily on the School Dental Service. Our difficulties are increased by
the fact that the service throughout the country is understaffed with a slow rate
of recruitment. The outlook of the School Dental Service is indeed bleak unless
drastic measures are taken to correct the present trends. Treatment has taken
first place to prevention and here lies the failure of the present policy as it is
quite impossible to carry out all the treatment required for pre-school children.
There are two methods which would help to solve the problem, (a) attention to
food and (b) dental health education.

(a) Our sole hope of ensuring that future generations will have good teeth is to
carry out searching investigations into the relationship of food growth to
animal and human health and to reduce the deleterious processing and
chemical treatment of food. Today a taste of real butter, meat and eggs
and many other things is to people of mature years like a whiff from child-
hood.

The effect of tampering with food supplies is emphasised in the fact that
when the white population arrived in New Zealand nearly a century and a
quarter ago, the Maori population of that country who lived upon natural
products, had a caries rate of three per cent. At the present time the popu-
lation of New Zealand, both white and Maori, has the highest caries rate
in the world.

In November the Cook Committee reported that milk had been declining
in quality for over thirty years. Certain legal standards were recommended
to improve it, but they were rejected. Why is milk not as good as it used
to be? There are three reasons: —

(1) Underfeeding of cattle

(2) Guaranteed market abolishes incentive

(3) Swing over to herds of cattle which give high milk yields but of a
lower standard.

The same decline in standards is happening in other branches of
agriculture. The introduction of broiler hens, broiler cakes, etc. has
meant plenty to eat, but is it worth eating? In other words the accent is on
quantity before quality. When we have learned to produce both we will
have achieved something worthwhile.

There is need for more extensive tests of the effects on health of food
additives and pesticides. Their testing is a matter of urgency as some
additives already in use have not been adequately investigated. A recent
outbreak of illness ascribed to an additive used in margarine affected
100,000 people on the Continent and caused two deaths. Spraying fruit
trees may be necessary but the effects of some sprays are as yet unknown
and are a constant anxiety in medical circles. Additives can be dangerous
when they disguise faulty processing, reduce the nutritive value of food, or
exert toxic or other effects.

This is a crazy and mixed up age and 1 wonder if even Lewis Carroll would
be able to find his way around such a “looking glass” world: a world
where millions die in the East of starvation, and where in the West, the
Canine Defence League offer to spend £100,000 to save a dog, while a
comparatively small donation of £5,000 has been made in the cause of
dental health and scientists urge us to eat leaf mould.

Psychologists emphasise the aspects of food acceptance, but the high-flown
plans of nutritionists will be useless, unless the ordinary, people can be
persuaded to like the new and highly nutritious food planned for them. Leaf
protein, according to the experts, is a dry-textured food, tasting somewhere
between spinach and hay. As spinach has its opponents as well as its
adherents and hay has never been a popular foodstuff, leaf protein shows no
more promise of general acceptance than the whalemeat and the snoek
pressed on an unwilling public when m.eat was scarce.

The body assimilates and uses food. It is important for the health of the
nation that the food is of high quality and free from contamination, as the
primary requirements of sound teeth ultimately depend upon inheritance.

(b) In dental health education, publicity should not be designed to produce a
“flash in the pan” effect, but to keep continuously before the public the
importance to them of good, sound teeth. The contribution by the Dental
Hygienist in this connection is very much appreciated by the various groups
who have the benefit of lectures, talks and instruction by film strips.

In Bristol the first appeal is made to young wives, expectant and nursing
mothers, and to mothers of toddlers. Talks are arranged at ante-natal
clinics and child welfare centres and audience participation is encouraged.
Group discussion techniques are conducive to the production of attitude
changes within the individuals making up the group, as the result of a
general group reaction. Thus the aim is not only to inform, but to try to
alter attitudes to erroneous popular beliefs, e.g. that sugar is essential for
energy. It is desirable to have a knowledgeable and well-informed public
capable of making its own decision as to personal welfare.

The advancement of medical knowledge frequently brings to light the fact
that previously held opinions were wrong and the beliefs of one generation
of doctors and health visitors tend to persist in the next generation of
patients. Not so long ago, babies’ gums were lanced for teething troubles.
Teeth that were healthy but showed arrested decay (black, hard surfaces)
were extracted as decayed teeth. Decay in teeth is usually brown. In one
city, so many patients were sent along by doctors for extractions, that a
note was sent round to them which read “Please do not send black ones,
only brown ones.”

Learning about dental health is not limited to situations in which actual
instruction is given. It results from a wide variety of experiences in the
home and community. In one well-known firm, facilities are not provided
for dental treatment, but there is a free voluntary dental inspection scheme.
The employees are told of the wisdom of having dental treatment and are
informed of the necessity to take simple measures of oral hygiene. The
staff manageress follows up with a personal approach to each employee,
if necessary. The report from this company shows an unusually high
degree of oral health, hence the value of enlightened policy.

Parents and patients are often confused by the conflicting advice offered
on prevention. Dentists differ so much in their ideas and thoughts that
there is little chance of a generally accepted scheme being adopted. However,
every effort should be made to effect one, so that more co-operation and
respect from the public would be obtained for the professional advice given.

Grouf^ Discussion in Progress

Individuai Study in the Library

Students in the Common Room

Health Visitor Students at a Lecture

Health Visiting Service

Miss L. M. Bendall, Chief Nursing Officer, reports: —

1960 has proved itself to be a year of steady progress in the health visiting
field. This is largely due to the level of recruitment which has been maintained
through our training scheme over the past two years, resulting in an increased
permanent establishment of health visitors.

In my report last year I mentioned the re-organisation of the health visitors'
work at field level which was at that time taking place. This has now been
completed and at the end of 1960 every district was covered, and with the reduc-
tion of case loads the health visitors are able to devote more time to the families
under their care.

The health visitors’ duties continue to follow their usual pattern: (a) home
visitation, (b) work in clinics, nursery schools and classes.

(а) Home Visitation

The district health visitors continue to visit homes for the purpose of giving
advice on the care of children, persons suffering from illness, and to expectant
and nursing mothers, and on the measures necessary to prevent the spread of
infection. Each health visitor works within a prescribed area and is responsible
for all families living within that area with the exception of certain specialisations
which are dealt with later in this report.

In addition to the routine duties carried out by the health visitors I feel
special mention should be made in this report of two surveys which commenced
in i960 and are still in progress. They are in connection with the “Incidence of
Staphylococcal Infections in Babies, their Mothers and Families", and “Infective
Hepatitis”. It is not generally appreciated that a considerable amount of time
and patience goes into this particular type of visiting and the health visitors
have rallied well to this added task. 1 would like to record my appreciation of
the health visitors’ interest and co-operation.

The Area Case Committees at which the health visitors meet and discuss
cases with other interested workers continue to flourish, as also do the Case
Conferences held with psychiatrists and psychiatric social workers.

The health visitors have also carried out intensive health education in
connection with both poliomyelitis vaccination and diphtheria immunisation,
which has resulted in a most successful campaign.

(б) Work in clinics , nursery schools and classes

The health visitors continue to be responsible for the organisation of the
various clinics in the City and in addition, give advice to individuals and health
teaching to groups in both ante-natal and child health clinics. Group teaching
is carried out with the help of films and film strips. The teaching of parentcraft
is a special feature and is much enjoyed by the expectant mothers (and fathers).
The activities of the health visitors in the field of health education extend
beyond the clinics, and talks are given both during the day and in the evenings
to the various women’s organisations throughout the City and to parent teacher
associations. Some health visitors also give regular courses of lectures to Red
Cross and St. John cadets.

In the many nursery schools and classes in the City, children are kept under
supervision by the health visitors, who are also present with the doctor at the
medical examinations.

Specialisation

Specialisation has been a feature in the health visiting sphere in this city
for many years and includes: —

Prevention of Blindness

Notification and Control of Infectious Diseases

Care of Chronic Sick and Aged

Special Families

Spastics

Care of Premature Babies born in hospital

Mental Health

In the school health field, specialisation is carried out in the care of mentally
and physically handicapped children. Specialisation in prevention of blindness
and special families is reported elsewhere in the Annual Report.

Care of Premature Babies discharged from hospital

Miss E. Room reports: —

The year 1960 has proved to be a very busy one for the premature baby
health visitors. After the restricted visiting of 1959 the total number of babies
receiving this domiciliary after-care has once again risen; 353 babies were
visited within the City boundary and 166 in Gloucestershire and Somerset, a
total of 519. The average number of visits paid to each baby has also risen
despite the fact that when fit, the babies have been discharged earlier than was
practised a few years ago. The premature baby health visitors have felt that
more supervision has been needed due to sickness and the fact that the larger
babies not cared for in the Premature Baby Units have not always been established
when sent home from the hospitals.

In March a Post-Graduate Course was held in Bristol on the Premature
Baby. The matrons and premature-unit sisters attending from various parts
of the country were taken out by the two health visitors on the normal visiting
rounds.

After Care of the Mentally Sick

Miss M. Hancock reports: —

Since March 1960 I have been working part-time with the Industrial
Therapy Organisation (Bristol) Ltd. This non-profit making company has been
developed from rehabilitation work begun at Glenside Hospital, Bristol.

LT.O. is housed in a disused school in St. Philip’s Marsh. It provides
medically and industrially supervised employment training in surroundings as
near as possible to ordinary factory surroundings and conditions. The patients
then progress to work with sympathetic employers in outside industry.

Some of the I.T.O. employees are hospital in-patients, some are referred
by their general practitioners, some by the Mental Health Authorities, and some
by National Assistance Officers : so far, no-one requesting admission has been
refused.

I visit the out-patients, sometimes with the person referring them, and report
on the patient and home conditions. I also explain I.T.O. to the patient so that
he knows exactly what to expect and inform the National Assistance Officer
when new patients start, as N.A.B. supplement their earnings.

When in-patients are ready to be discharged home I work closely with the
social workers at Glenside Hospital in getting matters arranged, and when
out-patients fail to attend I visit them at home to find out the reason. When
patients have no home or relations, other accommodation must be sought and
it is very difficult to find suitable lodgings at a price the patients can afford.
There appears to be only one hostel providing full board and lodging for women
at £2 10s. Od. weekly, while the only suitable place for men seems to be the
Church Army Hostel, and this type of accommodation does not always appeal.

Since I.T.O. started, thirty patients who have been from two to thirty-three
years in hospital, have been placed in outside employment and more have been
discharged to live at home, but continue to work at I.T.O.

The reports on all patients placed in industry have been very good — only-
one has left her job for an inadequate reason, while the improvement in appear-
ance of those in-patients continuing to work at I.T.O. has been most marked.

Spastics

Miss N. Paget reports ;

As I reported last year, I commenced the supervision of spastics in Sep-
tember 1959, so that 1960 is the first complete year of follow-up. 1 continue to
attend the Cerebral Palsy Assessment Clinic at the Children's Hospital and the
rest of my time is spent at the Claremont School for Spastics, and on home
visitation, with an occasional visit to the Spastics Centre. The greatest pro-
portion of my time, however, is spent in following-up cases throughout the City
and I am glad that I am able to give advice and encouragement to the mothers
of these afflicted children.

From time to time there is evidence of the need for special appliances in
the home and these needs are referred to the Ministry of Pensions through
the Medical Officer of the Assessment Clinic.

Notification and Control of Infectious Diseases

Miss M. Hatfield reports:

During 1960 the pattern of infectious diseases continued to change. For
the first year since 1947 there were no cases of poliomyelitis. The incidence of
meningitis was increased by a mild outbreak of aseptic meningitis, mostly
confined to one area of the City. This necessitated specimens of stools being
collected from patients and household contacts.

There was also a great increase in the number of cases of infective hepatitis.
Schools involved were visited to ascertain the methods of hygiene carried out
and advice given to members of the staff concerned. Contacts of cases, mothers
of children with hepatitis, who were pregnant, were also visited to enquire into
the giving of gamma globulin serum as a preventive measure.

I would like to include in this report an interesting experiment which was
carried out on behalf of the Medical Research Council with regard to oral
poliomyelitis vaccination. Twenty-five children were selected to take part in
this experiment which necessitated a considerable amount of home visiting.
During the experimental period, specimens of stools were collected from the
children and their parents for periods varying from one to three months after
the last dose. This entailed visiting the households three times weekly over a
period of six months. The findings of this experiment are not yet complete.

Chronic Sick and Aged

Miss M. Newns reports:

I am one of the team of four who specialise in this aspect of health visiting
and find my work interesting and rewarding. It gives me wide scope to use
initiative, sympathy and understanding.

The four specialist health visitors carry out the initial visiting, ascertain
the need and make the necessary contacts to arrange services either voluntary
or statutory which will be helpful to the patient. The aim is to keep the elderly
person in her own home if possible and so relieve pressure on hospital beds.
The shortage of hospital beds is a very real difficulty, but we appreciate the
co-operation we enjoy from the Area Geriatrician and the hospital admissions
office.

For those persons who remain in their own homes the many services
provided include home nursing, home help, night-sitter, loan of nursing equip-
ment, linen and laundry loan service, and mobile meals and friendly visitation
by the W.V.S.

Other services much appreciated by these elderly folk include the chiropody
service and the provision of convalescence. Once the need has been met and we
are satisfied that the patient has been given all the help possible, the case card
is handed to the district health visitor for routine follow-up. Should a further
crisis arise, the card is returned to the specialist health visitor who will take any
further steps which may be necessary.

Each elderly person when visited for the first time is given a card with the
name of the specialist health visitor and address and telephone number of the
clinic at which she is based, so that contact can be made with her if necessary.

Chest Department

The staffing establishment in the Chest Department remained unchanged
during 1960, consisting of one sister-in-charge and eight tuberculosis visitors.
The work is interesting and varied, it includes both home visiting and work in
schools and clinics.

In the out-patients clinic, the pattern of the work is changing as more
patients with other diseases of the chest are being seen by the chest physicians.

There is close liaison between the medical staff of the Chest Department
and the Health Department. Case conferences are held once a month conducted
by the Consultant Chest Physician where clinical, housing or welfare needs are
discussed for the benefit of the patient and his family.

The follow-up by the tuberculosis visitors in the homes of the patients
constitutes much of their work. Here advice is given with regard to the general
care of the patient, hygiene, disinfection, the need for X-ray of all contacts
and the offer of B.C.G. vaccination for the under twenties. Patients are also
advised as to the help which can be given by the welfare officer.

The nursing staff are also responsible in conjunction with the school medical
officers for B.C.G. vaccination of the thirteen-year-old school children.

Home Nursing Service

A report by Miss G. M. Grazier, Senior Superintendent, is included else-
where in the Annual Report, but mention should be made of the fact that the
Home Nursing Service has completed its first year under the direct control of
the Medical Officer of Health.

At field level the work has remained the same although there have been
several minor integrations which have brought the district nurses into line with
the other nursing services.

At administration level, liaison with the Home Nursing Services has become
more firmly established, partly of course, due to the fact that the senior staff
are located in one building and under the Medical Officer of Health’s roof.

Ancillary Nursing Services

Clinic Nurses

At the end of 1960 there were five full-time and thirty-five part-time clinic
nurses on the establishment. They are all State Registered Nurses who carr>'
out routine nursing skills in the various departments of clinics. By this means
health visitors have been relieved of all duties for which their special qualifications
are not required.

I would like to mention especially the invaluable work carried out by the
clinic nurses in connection with the diphtheria immunisation campaign in
schools, and the poliomyelitis campaign in schools, factories, shops etc.

I would like also to report on the work carried out by the three full time
nurses in connection with haemoglobin tests. Specimens of blood for testing
come in from the various ante-natal clinics throughout the City. Three nurses
were trained to perform this test by Dr. Lewis, Consultant Pathologist of South-
mead Hospital, and they deal with approximately 200 specimens a week.

Physiotherapists

There has been no change in the establishment during the current year
which consists of three full-time and two part-time physiotherapists. Their
work has followed its usual pattern, namely remedial exercises, massage and
sunlight treatment, carried out in schools, clinics and Welfare Services Depart-
ment Homes. In addition one of the full-time and the two part-time staff
continue to carry out an extensive programme of relaxation classes (in con-
junction with parentcraft) in the various ante-natal clinics in the City, as well as
in the City’s Home for unmarried mothers.

Dental Attendants

There were fourteen dental attendants on the establishment at the end of
1960.

Clinic Helpers

An establishment of twenty was maintained during 1960. These clinic
helpers are women with good nursing experience and quite a number are State
Enrolled Assistant Nurses. They relieve the trained staff in clinics by performing
the lesser nursing duties under supervision, i.e. treatment of skin conditions,
minor ailments and cleansing of verminous heads. They are also concerned in
the sale of welfare foods, and escorting children to and from residential schools
and nurseries.

I would like to make special reference to the work carried out by clinic
helpers in connection with the needle and syringe service. Six of these helpers
are occupied full-time in the cleaning, sharpening, sterilising and packing of
needles, and cleaning, sterilisation and packing of syringes. They work under
the direction of the Head Pharmacist. This is a very important contribution
to the success of the poliomyelitis and diphtheria immunisation campaigns,
B.C.G. vaccination and blood testing in connection with ante-natal care.

Clinic Assistants

This continues to be a flourishing section of the nursing establishment.
Candidates are carefully selected and it is gratifying to record that a high
percentage of these girls go on to full nurse training. Indeed, quite a number of
our established nursing staff commenced their nursing careers as clinic assistants
with this Department.

Night Watcher Service

This is the newest, but by no means the least important of the nursing
services. It commenced in January 1957 and during its first year the number
of nights worked numbered 580. The growth of the service during the last
four years will be appreciated when it is recorded that during 1960 the number
of nights worked numbered 1,285.

Recruitment to this service is reasonably adequate and great care is taken
in selection of candidates who must all be mature, kindly women, with good
nursing experience. Here I would like to mention the introduction in November
of a male night watcher to the service. He is a recently retired S.E.A.N. and
has proved very useful in the night care of old men. It is hoped, if suitable
candidates are forthcoming, that one or two more men may be recruited.

The Night Watcher Service is surely one of the most compassionate of our
nursing services, assisting as it does both the sick and their relatives. Many
tributes have been paid to these women which are worthy testimonies to the
good work they are doing and a pleasing note on which to conclude this report.

Health Visitor Training

Miss J. Sangster, Principal Health Visitor Tutor, reports:

There were twenty-three students in the 1959-60 Health Visitor Training
Course which finished on July 1st, 1960. Twenty-one students were successful
in the examination of the Royal Society of Health; of these, thirteen who were
sponsored by the City are working in Bristol. The remaining two students
passed the examination of the Royal Society of Health for Health Visitors and
School Nurses for Appointments outside England and Wales. They wished
to work in their own country and one had returned to Nigeria and the other will
be going to Hong Kong.

Last year I noted the great step forward that had been made due to the
lengthening of the training in Bristol, and commented that this had enabled the
students to have a better preparation for their work as health educators and
family advisors. In 1960 the second course was completed, lasting a full acad-
emic year, and it was possible to consolidate the progress made during the
previous year; now the training has been further improved by moving to new
premises.

There has been a scheme of health visitor training in Bristol since 1930
and during most of this period it has taken place at 36 Queen Square. This is
an old house which has a certain charm but many inconveniences. Just before
the beginning of the present session, which started on October 6th, the training
centre moved to new premises at 21 Prince Street, Bristol 1. The building is
shared with doctors studying for the Diploma of Public Health and with the
Statistical Unit. In this new building each group of students has a separate
lecture room; these are quiet and spacious. There is a comfortable common
room and a kitchen. A small library provides accommodation for individual
and quiet study.

At present there is a full group of twenty-four students in training who will
complete their course on July 5th, 1961. Sixteen of them have undertaken to
remain in Bristol as health visitors until September 1962.

Clinic Assistants

Girls who are waiting to start nurse training continue to have classes for a
half day each week with Miss P. M. Tarbuck. This instruction should increase
their interest in the work they are undertaking in the Health Department and
give them a knowledge of the community health services before they enter
hospital.

Student Nurses

Lectures are given and visits to the Health Department are arranged for
nurses in training in the hospitals in Bristol. These sessions help arouse an
interest in the public health services.

Home Nursing Service

Miss G. M. Grazier, Superintendent of Home Nursing, reports:

Staff

Administrators
Queen’s Nursing Sisters
Male Queen’s Nurses
State Registered Nurses
State Enrolled Assistant Nurses
Student Queen’s Nurses
Part-time (3 Q.N.s, 1 S.E.A.N.)

Total

Students Trained during the Year
County Students . . 9

Staff Students . . 8

3
2
6
5

Total . .

Nursing Statistics

Total

Cases Sent by:-

Doctors

Hospital Authorities
Health Department
Patients’ Friends

Analysis of Cases
Tuberculosis

Other infectious diseases . .

Parasitic diseases (inc. thread worms)
Malignant and lymphatic neoplasms
Asthma

Diabetes Mellitus . .

Anaemias

Vascular lesions affecting central nervous
system

Other mental and nervous diseases
Diseases of the eye and ear
Diseases of the heart and arteries
Diseases of the veins
Upper respiratory diseases
Other respiratory diseases
Constipation and diseases of digestive
system

Diseases of urinary system and male
genital organs
Diseases of breast and female genital
organs

Complications of pregnancy and puer-
perium

Diseases of skin and subcutaneous tissues
Diseases of bones, joints and muscles
Injuries

Senility . . . .

Other defined or ill defined diseases or
disability

Diseases not specified

Total . .

Night calls — visits between 8 p.m.
8.30 a.m.

and

1960

1959

1,864

1,930

the year

4,979

5,528

6,843

7,458

5,470

5,942

1,085

1,205

206

251

Cases

Visits

Cases

Visits

3,242

3,177

922

1,076

—

430

16,205

409

13,416

429

372

60,381

406

62,840

428

12,172

480

12,058

576

22,496

550

19,685

164

8,654

159

7,667

1,503

1,803

932

32,922

1,055

36,907

192

9,314

193

8,604

129

1,073

171

1,408

479

9,462

694

12,489

646

9,156

615

8,290

117

2,214

131

2,643

200

3,330

236

2,940

101

1,002

815

242

6,168

296

6,376

296

14,175

274

12,415

233

5,647

242

5,836

447

16,708

460

16,783

263

7,308

260

8,446

397

929

492

1,066

6,843

245,050

7,458

247,169

1,871

1,412

Age Groups

Cases

Visits 1-24

Cases

Visits 25

0—4

642

289

5—14

121

837

394

15—44

619

4,884

131

9,054

45—64

1,133

9,236

572

56,112

65 +

2,482

22,744

1,681

140,858

Total

4,444

38,343

2,399

206,707

Difficulty has been experienced in the recruitment of staff, particularly
of trained staff. The group system of relief in certain areas was not possible,
and the provision of relief for off duty and holidays was largely overcome with
the willing help of the Area Superintendents.

Following the Ministry Report that a Course of District Training for Home
Nurses and a National Certificate was necessary, Bristol was approved as a
Training Centre and three Counties, through the Medical Officer, have ap-
proached us and satisfactory arrangements have been made for members of
their staff to take the Course at the Bristol Training Home.

During the year 275 Students from the Bristol Royal Infirmary, Southmead,
Homoeopathic and Childrens’ Hospitals, accompanied members of our staff
on a morning round.

The number of cases and visits paid show a decrease. This decrease could
be due to a wider use in the oral administration of anti-biotics, leading to less
requests for the administration of injection therapy.

There has been throughout the year, however, a continued increase in the
requests for the nursing of the more protracted and heavy cases and the problem
of adequate aids for “lifting” the more helpless and weighty.

The above is reflected in the fact that there were approximately 500 less
cases referred by general practitioners, but approximately 200 more referred by
hospitals, than in the previous year, and shown in the increase in the number of
cases and visits to patients suffering from malignant diseases.

Talks have been given by the Superintendents to Student Nurses, newly
appointed Staff Nurses at the Bristol Royal Infirmary, Womens' Organisations.
Old Peoples’ Associations, Toc.H., and various Church Groups.

Since the Local Authority assumed direct control of the Home Nursing
Service and the subsequent change from Berkeley Square to the Central Health
Clinic, more direct contact with other departments is possible.

Physiotherapy in the Maternal and Child Health Service

Miss B. S. Hogg, and two part-time physiotherapists. Miss Rose and Mrs.
McLaren, are, between them, responsible for the instruction in relaxation and
ante-natal exercises given in all the pre-natal clinics in the City.

Miss B. S. Hogg reports on her work as follows: —

Ante-natal relaxation and exercise sessions are held in association with the
parentcraft classes. The “cup of tea” in the interval between the two classes
provides a valuable opportunity for discussion and mothers who perhaps would
not ask questions during a class, will raise their problems at this time.

Post-natal exercises and Faradic treatment have continued to be arranged
where necessary. Relaxation treatments are also given to patients referred from
the sub-fertility clinic.

The Pre-School Child

Cases of upper respiratory infection have been attending regularly for
short wave, sunlight, breathing exercises and postural drainage, with satisfactory
results. It has been possible to continue treatment of chest cases by breathing
exercises and postural drainage at the William Budd Health Centre and other
peripheral clinics, thus saving the mothers and children the journey into Central
Clinic. Many mothers report that the common cold, which previously affected
the child’s chest, has not done so since regularly practising breathing exercises.

Home Help Service

Miss M. R. Epplestone, Home Help Superintendent, reports:

During the year 3,759 families have been supplied with a home help com-
pared with 3,539 in 1 959. The number of home helps employed on 3 1 . 1 2.60 was
569, 10 full-time and 559 part-time.

The following types of cases have been helped —

Maternity (including home confinements, early discharges, expectant and

nursing mothers) . . . . . . . . . . . . . . 230

Chronic sick, aged and infirm . . . . 3,120

Tuberculosis . . . . . . 22

Others . . 387

This year has seen the removal of the Home Help Department from Central
Health Clinic to more spacious premises at 36 Queen Square. Changes have
also taken place in the staff. The second Assistant Superintendent left in
September and an appointment was made from the case workers, which left a
vacancy in that section. This post was not easily filled. The Case Workers
were re-designated “Supervisors”.

Increasing demands are being made by all agencies, voluntary and statutory
bodies, to supply help to more and more old and chronic sick people.

Many more calls are being made on the emergency side as the service is a
dependable one, and more people are recognising this fact.

The number of maternity cases dealt with this year has also increased. As
more mothers are being admitted to hospital for delivery only, and then returning
home, the service has been made more flexible to meet the demand of putting
help into the home to care for the children during that short period and con-
tinuing for the usual lying-in period. When possible, the help visits the mother
before she is due to have her baby so that she can be introduced to the children
and the husband. This has proved very satisfactory in the cases so far covered.
Mothers have been amazed at the way the helps have handled so-called “difficult”
children.

Emergency cases included acute sickness, post-operative, mental sickness
and special families. The number of emergency cases tends to fluctuate through-
out the year — most cases are in genuine need, although a few still think that the
service is free and when the form is produced and read, miraculously remember
they have relatives who would help them out.

Aged and chronic sick offer the real challenge to the service — how can we
help the greatest number — their requirements range from half-hour daily for
lighting fires to all day and then pass on to the night sitter-up. Fortunately,
the latter does not often occur, home helps being such kindly people, they often
prefer to return to these cases themselves, making their own arrangements with
neighbours, and it is not until afterwards, that we hear of these arrangements.

The number of cases requiring help because of tuberculosis is decreasing
yearly and is now 22.

Recruitment suffered a slight setback for a short time immediately following
our departure from Central Health Clinic and dropped again at Christmas time,
otherwise it remains good and we are able to be selective.

Talks given to various Women’s Organisations often result in new appli-
cations for posts as home helps — many women not realising the variety and
scope of the work.

We would like again to express appreciation to the general practitioners,
almoners, midwives, health visitors and district nurses for their willing co-
operation and helpfulness.

Special Families

Work with special families is undertaken by the district health visitors, and
by the team of Medical Officer (Dr. C. D. Hopkins), together with four health
visitors, who are occupied full time in this field. In addition, a Family Service
Unit team, consisting of the Organiser, Mr. Strange, with two women social
workers, undertakes intensive work with families, on behalf of the Health
Department.

Dr. C. D. Hopkins, 1st Assistant Medical Officer, Maternal and Child
Health Service, reports: —

During 1960, there were 860 families considered to be in need of close
supervision. The special team of 4 health visitors paid 6,280 domiciliary visits
involving 4,444 households.

Much of the work of the team is carried out in conjunction with other
social agencies, and therefore linked to the Area Co-ordinating Committees
which were set up in 1956, and have been meeting at monthly intervals ever since.
The agencies represented regularly at the meetings are Children's, Probation,
Housing, Education and Welfare Services Departments, with representatives
from the National Assistance Board, the Family Service Unit, and the National
Society for Prevention of Cruelty to Children. Health Department representation
includes public health inspectors, mental health officers and health visitors. At
these meetings, workers exchange relevant information, and try to agree on
common policy in the management of cases. It was thought that co-ordination
of the social agencies would result in the numbers of persons visiting in the home
being reduced. This has not been possible as a number of the agencies repre-
sented on co-ordination often have a statutory duty to visit, and it is not possible
to delegate responsibility to any other body. However, as a result of frequent
meetings, the workers are now more aware of each other’s departmental policy,
and consequently, the advice they give to families is more applicable to the
various situations encountered in the home.

It is generally accepted that parental love will do much to compensate for
the low standard of certain homes and great efforts are made to maintain the
family units intact. At the same time, if children are likely to suffer as a result
of the low home standards, workers should hesitate to help perpetuate such
conditions. It is an important function of the Health Department representatives
to interpret these social-medical situations to their non-medical colleagues so
that full discussions can take place. During their five years’ existence. Area
Committees have considered 550 families and this procedure is not only achieving
results in the interest of the children of the family, it is also proving to be an
economy in welfare workers’ time.

The special health visitors report: The number of domiciliary visits paid
to families is no true measure of the work undertaken on their behalf. Extra
domiciliary assistance is very varied and includes taking parents to keep their
hospital appointments, or appointments with the National Assistance Board,
or to see their general practitioners, sometimes even a shopping expedition is
involved.

A major problem for families is that of obtaining furniture and furnishings
without getting involved in unsuitable hire purchase commitments. For example,
one family had hire purchase payments of £5 15s. Od. weekly coming from an
income of £7 10s. Od. per week ; the family consisted of father, mother and three
school-age children.

The situation of the unsupported mother is another source of concern.
In spite of material help provided by voluntary and statutory bodies, her income
remains low in comparison with that of other family groups. Socially she
remains very isolated and this is demoralising for the children as well as for
herself.

We cannot say definitely that we have “cured” a family, but we ourselves
are sure that some families who have been brought to our notice early in their
problematic stage are helped to stand on their own feet. They often not only
surprise us, but also themselves by coping with their difficult situations.

Mr. A. Strange, Organiser, Bristol Family Service Unit, reports:

The Unit provides a supportive casework service for a limited number of
families in the Southmead, Horfield and Henbury area of the City. By limiting
the field of activity and the number of families being helped at any given time
the Unit workers are able to maintain close contact and establish friendly relation-
ships with the parents. The function and purpose of the Unit service is to assist
families with some of their more serious problems, and relieve some of the
stresses which cause anxiety within the home, as well as encouraging better
organisation and performance; and thus avoid community action which might
involve the break-up of the family.

Often the Unit visits the family at the request of statutory or other services
and during the past year referrals were received from a mental hospital, health
clinic, prison welfare, industrial rehabilitation unit and approved school after-
care. In addition, long term help was given to several families who had made a
personal approach to the Unit for assistance. There were nine new referrals
during the year and ten cases were closed, leaving the Unit in touch with 41
families at the end of December. Interviews and contacts with families (at home
and at the Unit centre) totalled 3,657 and official contacts on behalf of families
numbered 1,437. Of these figures, some 450 interviews and official enquiries
were made on behalf of families or individuals who requested help with specific

problems. This use of the Unit service seems to indicate the need for an agency
to provide advice or guidance to those families having problems of a less serious,
or temporary, nature.

During the summer months, over 50 children were sent for holidays to the
homes of private hosts in the south-west, and through arrangement with the
Rotary Club and the W.V.S. Financial help received from the Lord Mayor’s
Voluntary Services Fund enabled the Unit to carry out this programme. It was
felt that the holidays provided valuable social experiences for the children as
well as being of considerable physical benefit.

In considering the areas of family life in which the Unit is able to bring
about change, the marriage partnership itself is central to the life in the home .
Of the 37 families in which both parents were present, 13 presented serious
matrimonial problems; and, during the year, in 5 cases the parents separated
for short periods, one resulting in a legal separation. Through continuity of
contact and timing of visiting, the Unit worker is usually able to maintain a
relationship with both parents, and thus facilitate consultation at times of
tension.

In 11 cases the wives were living apart from their husbands and 2 were
widows. Most of these were comparatively young wives left with large families
to care for, and for whom the future held out little hope of relief from the day
to day demands of the family. Generally their circumstances prevented them
from improving their financial position and thus they were obliged to face
several years existence on subsistence income. Many of them were glad to have
the relationship with the Unit worker and appreciated the social and personal
element in the contact.

Domestic help was given by the workers in a number of cases, but this was
provided more as spontaneous offers of help in times of illness or other crises.
Such help was of real educative value where the worker w^as able to follow-up
and continue over a period. Assisting in sorting out the families' finances,
coping with debts and encouraging regular payment of rent continue to demand
the constant attention of the Unit worker. During the year, two families were
evicted because of heavy arrears of rent, and in 17 cases the Unit was directly
involved in this problem as a major one threatening the home.

A brief study of families helped during the past few years seems to indicate
that the family tends to be referred to the Unit when the pressures on the organis-
ation inside the home are at their greatest i.e. when there are three or more
children under five at home. Nursery placement often eases the strain for the
mother, who may be in poor physical condition, and quite unable to cope with
two or three children at the stage when they need training and guidance in social
behaviour in the home. Consequently standards and conditions deteriorate,
and may even cause community concern, although later developments point to
underlying strengths and abilities which had been taxed to breaking point at a
certain stage. Although it is difficult to assess or predict future development,
the Unit’s experience seems to indicate that some of the larger families are
able to cope quite well if assistance of a practical and tangible nature is available
in an acceptable form at the right time.

A number of children have been helped directly by the Unit, either through
individual contact or in small groups. Normally the children are selected for
special reasons, e.g. behaviour problems, absentee father . . . and wherever
possible the contact is continued over a period, sometimes as long as two years.
This work, which is ancillary to the main contact with the child's home, is

always arranged with the consent and interest of the parents. Frequently the
relationship with the Unit is linked up with the psychiatric help being given
through the local Family and Child Guidance Service.

One problem which affects the lives of many of the families is that of their
limited articulation and their doubts regarding their ability in expressing them-
selves when seeking help with problems especially those of the more personal
and intimate nature concerning relationships within the home. This inhibition
has been referred to by a number of parents, and from their own comments
it would appear that the informality and permissiveness of the Unit service, as
well as the accessibility and identification with the local community, has helped
to convey an impression of sympathetic understanding of their point of view.

The Unit has continued to benefit from the services of Mrs. F. Bodman
(psychiatric social worker) who has been available for consultation on some of
the more difficult problems in the casework, and, as in previous years, the Unit
has received valuable support from officers and fieldworkers in both the statutory
and voluntary services.

Welfare of Unmarried Mothers

Reference has already been made to the rise in illegitimacy this year and the
increasing incidence among very young girls, i.e. those under sixteen years of age.

During 1960, Miss M. Reed, Welfare Officer to the Maternal and Child
Health Section, gave help and advice to 657 unmarried mothers. Of these,
458 were in respect of a first illegitimate baby. 111 of a second illegitimate baby,
and in one case the girl was found not to be pregnant. The remaining 87 were
in respect of a third or more illegitimate baby, although in the majority of these
cases, the parties were cohabiting.

Miss Reed comments “There has been a general increase in applications
coming from every section of the community. The most noticeable trend in
the work during the year has been the increase in the number of girls in the
younger age group. Restlessness causing constant change of accommodation
and change of work still persists. Much help has been forthcoming from
employing bodies in the City and the help of the day nurseries is as invaluable
as ever”.

Dr. Marjorie Mair holds an evening ante-natal clinic for unmarried mothers.
Dr. Mair also acts as Medical Officer to Snowdon Road Mother and Baby
Home, and advises on the care of the babies in St. Raphael’s Home and Hostel,
thus providing continuity of medical care.

During 1960 47 mothers were admitted into our Mother and Baby Home,
Snowdon Road, and 14 mothers were admitted into voluntary Homes.

STATISTICS

Table I — Maternal and Child Health

Live births (Bristol mothers — from Birth Registrations) . . . . . . 6,889

Live birth rate 15.88

Stillbirths (Bristol mothers — from Birth Registrations) . . . . . . 101

Stillbirth rate per 1,000 total (live and still) births . . . . . . . . 14-45

Total births (live and still) 6,990

Infant deaths 136

Infant mortality rate per 1,000 total live births . . . . . . 19-74

Legitimate infant mortality rate per 1,000 legitimate live births . . . . 19-40

Illegitimate infant mortality rate per 1,000 illegitimate live births . . 25-40

Illegitimate percentage of live births .. .. .. .. .. .. 6-3%

Neo-natal mortality rate (deaths under 4 weeks per 1,000 total live births) 14-37

Early neo-natal mortality rate (deaths under 1 week per 1,000 total live births) 12-63

Perinatal mortality rate (stillbirths -I- deaths under 1 week combined per

1,000 total live and stillbirths . . . . . . . . . . 26-90

Maternal deaths (including abortion) . . . . . . . . . . . . 1

Maternal mortality rate per 1,000 total live and stillbirths . . . . . . 0-143

Number of live premature births .. .. .. .. .. .. 471

Number of live and still births at home (from birth notifications) .. .. 1,788

Number of live and still births in institutions (from birth notifications) . . 5,364

(The above figures relate to Bristol residents)

Clinic attendances

(a) Ante-Natal New Patients

Total Attendances

(i) Medical officers’ sessions

779

5,604

(ii) General practitioners’ sessions

3,593

25,589

(iii) Cinsultant sessions

3,486

6,923

(iv) Midwives’ sessions

346

5,542

(b) Post-Natal

Medical officers and general practitioners

3,601

4,651

(i) Total number of infants under 1 year

5,502

Total attendances of infants . .

57,949

(ii) Total number of children 1 — 5 years

11,141

Total attendances of children 1 — 5 years .

26,990

{d) Parentcraft Classes

(i) Mothercraft

7,867

(ii) Relaxation and exercises

8,208

(e) Special Diagnostic Clinic

(i) New patients . .

327

(ii) Attendances

732

Health Visiting

Home Visits — Ante-Natal

1,861

Primary (new babies)

7,827

Infants under 1 year (excluding

primary

visits)

37,160

Children, 1 — 5 years

63,210

Sessions Attended — Clinics

5,358

Nursery Schools and Classes

1,468 hours

Recuperative Convalescence

Mothers accompanied by children

26 mothers
51 children

Unaccompanied children admitted to Jan Smuts Home

Adults (including 143 over 65 years)

205

Welfare of Unmarried Mothers

Number admitted to Snowdon Road Home

Number admitted to other Mother and Baby Homes . .

Table 2 — X-Ray Section

The following are the numbers of X-rays carried out
Health Clinic during 1960:

at the Central

School Health Service

Referred from Minor Ailment Clinics,
etc.

327

Referred by consultants;

E.N.T.

553

Orthopaedic

133

686

Teachers’ periodic X-Rays of chest . .

613

Tuberculosis Service:

Adult contacts

310

Child contacts . .

485

Children inoculated with B.C.G.

2,768

3,563

Maternal and Child Hecdth Service:

Children

Mothers — X-Rays of chest

3,684

Mothers — X-Rays of abdomen

141

3,841

Staff Medical Examinations and Periodic
X-Rays {excluding Teachers)

2,924

Miscellaneous

153

Total No, of Films taken

12,107

Total No. of Persons X-Rayed

11,212

Table

3 — Dental

Treatment

Examined

Requiring Treated

Treatment

Made

Dentally

Fit

Expectant and nursing mothers

781

770

671

535

Children under 5

1,065

1,020

1 032

981

Scalings and
Gum treatment

Fillings

Silver

Nitrate

Crowns
or Inlays

Expectant and nursing mothers

273

919

Children under 5

—

286

111

—

Extractions General
Anaesthetics

Dentures

Full upper Partial
or lower

X-rays

Expectant and nursing mothers

1,212

214

101 70

Children under 5

1,783

809

— —

—

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Table 5 — Smallpox Vaccination

Number of persons vaccinated (or re-vaccinated)
1959 1960

No.

Age at time of Vaccination

vaccinated

re-vaccinated

vaccinated

re-vaccinated

Under 1 year

2,130

224

1,700

110

1—

270

490

2—

134

314

5—

147

262

15 years and over

156

259

229

287

Totals

2,837

613

2,995

502

Table 6— Vaccination against Poliomyelitis

During 1960 : —

Year of Birth

Primary Courses

Booster

1955-1960

5,293

7,142

1944-1954

677

5,268

1933-1943

3,435

16,699

Before 1933

13,871

6,325

Totals

23,276

35,434

Since Inception of Poliomyelitis

Vaccination : —

1955-1960

25,013

15,971

1944-1954

67,888

54,568

1933-1943

41,387

29,705

Before 1933

18,968

7,992

Totals

153,256

108,236

THE MENTAL HEALTH SERVICES

Dr. H. Temple Phillips

{Chief Assistant Medical Officer of Health and Senior Medical Officer for

Mental Health)

and

F. Morton

{Mental Health Officer)

Introduction

On the 1st November, 1960, the provisions of the Mental Health Act, 1959,
were implemented in full.

The introduction of the Act reads as follows: — “An Act to repeal the
Lunacy and Mental Treatment Acts, 1890 to 1930, and the Mental Deficiency
Acts, 1913 to 1938, and to make fresh provision with respect to the treatment
and care of mentally disordered persons and with respect to their property and
affairs; and for purposes connected with the matters aforesaid."

Those Acts which have thus been repealed formed the basis of mental
health legislation for very many years — they were good Acts, planned with
considerable thought and foresight, but they had seen their day. They included
many provisions for the protection of patients, but they were principally designed,
as were our original mental hospitals, to provide custody and restraint and to
protect the community. They were drafted at a time when means of treatment
were few and ineffective, and when no one could possibly foresee the develop-
ments which were to take place in the study, prevention and treatment of mental
disorder, or the rapid growth in the public understanding and acceptance of this
problem.

The 1st November, 1960, marks the commencement of a new era, and
mental disorder has now been brought into line with physical disorder. W’e can
anticipate that our psychiatric hospitals will be considerably reduced in size
but will be much more actively therapeutic. The way is now open for the
creation of more Day Hospitals and Treatment Centres, and we can look forward
to the time when the majority of mentally disordered patients will be treated
successfully in the community without being exposed to the risk of “institutional-
isation”, and without having to suffer from a disruption of their employment
and social security.

The Mental Health Service of the future will undoubtedly be a live and
all-embracing one. The principal authorities active in the field will probably
remain the Regional Hospital Boards and the Local Health Authorities, between
whom the closest co-operation must exist, but there will also be an important
place in the scheme for many other statutory, social, and voluntary agencies,
each with a contributory part to play.

The Changing Aspects of the Community Mental Health Service

The sweeping changes brought about by the repeal of the Lunacy, Mental
Treatment, and Mental Deficiency Acts, and the introduction of the Mental
Health Act, 1959, will result in greater flexibility and considerable expansion
of the Local Health Authority’s Mental Health Service.

During 1960, amended proposals of the Bristol City Council for the pro-
vision of this service were submitted to the Minister, as directed by him in Circular
28/59.

The following is an outline of some of the principal changes in legislation,
together with an indication of the way in which the Mental Health section of
the Local Health Authority proposes to deal with problems associated with
mental disorder in the community.

A number of the terms used in the repealed Acts were unsuitable for
everyday use, and were generally regarded as objectionable. With the full
operation of the Mental Health Act, the terms “Mental Deficiency”, “Mental
Defective”, “Idiot”, “Imbecile”, and “Feebleminded” have become obsolete,
and the rigid distinctions previously drawn between mental illness on the one
hand and mental deficiency on the other, have been removed. “Mental Disorder”
is introduced as a term covering all forms of mental ill health, and four main
categories of mentally disordered patients will be recognised, i.e., those suffering
from mental illness, severe subnormality, subnormality and psychopathic
disorder.

The two groups subnormality and severe subnormality together cover the
range of disorders previously included in the term Mental Deficiency.

The term “psychopathic disorder” is defined as “a persistent disorder or
disability of mind (whether or not including subnormality of intelligence)
which results in abnormally aggressive or seriously irresponsible conduct on
the part of the patient, and requires or is susceptible to medical treatment."

These classifications are contained within Part I of the Act which, in addition,
decrees the dissolution of the Board of Control, whose functions are transferred
partly to the Ministry of Health, partly to Local Health Authorities, and partly
to Mental Health Review Tribunals. Other important provisions of Part I of
the Act include the setting up of these Tribunals and permit any hospital or
mental nursing home to receive, on an informal basis, patients who are not
unwilling to be so admitted.

Part II of the Act deals with Local Health Authority services. It extends
the provisions of the National Health Service Act 1946, the National Assistance
Act, 1948, and the Children Act, 1948, so that relevant sections of these Acts
will have effect in relation to persons who are, or who have been, suffering from
mental disorder, and allows for the provision of residential accommodation
by both the Welfare Authority and the Children’s Authority. It amends the
Education Act, 1944, by revising the procedures for classifying children as being
unsuitable for education, and by repealing Section 57 (5) of the Education Act
which formerly made provision for the referral of children to the Local Health
Authority on leaving school. It also gives the Local Authority the power to
compel the attendance at Training Centres of children of compulsory school
age who have been excluded from school, and who are not receiving adequate
training elsewhere.

In Bristol, consultations have taken place between the Local Health
Authority, the Welfare Authority, the Children’s Authority and the Education
Authority with a view to establishing a policy, and apportioning responsibility
for the carrying out of duties imposed by the Mental Health Act.

Although Statutory Supervision by the Local Health Authority has now
been superseded by Informal Supervision, steps will be taken to ensure that all
possible help and advice are provided for children excluded from school and
to their parents or guardians. In the case of those children leaving special
schools or special classes in ordinary schools, where a need exists for help after
leaving school, careful consideration will continue to be given to the limitations
and requirements of the child at School Leavers’ Conferences, and the Mental
Health Section will arrange for friendly guidance to be given.

The Local Health Authority will ensure that an adequate number of places
are made available in Junior and Adult Training Centres. The new Training
Centre at Hengrove is about to be commenced and should be ready for occu-
pation in two years’ time. When these premises are completed, provision will
become available for very young and severely physically handicapped children
who cannot be accepted for training at Marlborough House, and residential
accommodation will be provided for short and long term care. In addition,
hostels and other accommodation for the mentally disordered will be established
as and when required.

Part III provides for the registration and inspection of “mental nursing
homes”, i.e., premises used or intended to be used for the reception of, and
provision of nursing or other medical treatment for, one or more mentally
disordered patients, whether exclusively or in common with other persons, and
“residential homes for mentally disordered persons”, i.e., establishments the
sole or main object of which is, or is held out to be, the provision of accom-
modation, whether for reward or not, for persons suffering from mental disorder.

A review has been undertaken of all premises believed to fall within the
above categories, and consideration is being given to registration where ap-
plicable.

Part IV of the Act deals with methods of compulsory admission to hospital,
and provides for three main procedures: —

(a) Admission for observation for a maximum period of 28 days (Section
25)

(b) Admission for treatment (Section 26)

A summary of procedure for admission to hospital was drawn up by
officers of the Mental Health Section and printed copies were distributed to all
doctors and hospitals in the City. A copy of this summary is set out on pages
30, 31 and 32.

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It will be noticed that the Magistrates will not in future have any part to
play in the compulsory admission of mentally disordered patients to hospital.
The view was expressed by the Royal Commission on the Law Relating to
Mental Illness and Mental Deficiency that this function should be the responsi-
bility of suitably qualified medical practitioners and this policy has been incorpor-
ated in the Mental Health Act. Many will regret that the Justice of the Peace
will no longer enter into this aspect of mental health work. In Bristol, a panel
of Magistrates have devoted a great deal of time to dealing with mental health
problems, and their experience and sound judgment contributed considerably
to the successful operation of the former legislation.

Mental Welfare Officers in Bristol are now working as a team with consultant
psychiatrists. They are attending psychiatric out-patient clinics and hospital
case conferences, and are responsible for arranging the majority of admissions
to psychiatric hospitals. They are providing social care and after-care for many
patients in the City, and it is hoped that ultimately there will be still further
integration of hospital and Local Health Authority social workers so that
patients may receive the continuous attention of one social worker through all
phases of their illness.

This part of the Act also provides for guardianship. It is anticipated that
many patients will be placed under the guardianship of the Local Authority, or
that the Local Authority will be responsible for approving the appointment of
private individuals as guardians. The guardianship system in the future is
expected to differ from that of the past, in that it may well be used as an altern-
ative to hospital care, and its provisions are now extended to mentally ill persons
as well as to subnormal and severely subnormal patients. The operation of the
sections of the Act relating to guardianship will undoubtedly add considerably
to the responsibilities and volume of work of the Mental Health Section.

Part V of the Act deals with the admission to hospital and guardianship of
patients concerned in criminal proceedings, and the transfer of patients under
sentence.

Other parts of the Act are concerned with removal to and from Scotland
and Northern Ireland, and with the provision of institutions for treatment under
conditions of special security.

Part VIII of the Act lays down procedures for the management of property
and affairs of patients, and will ensure the continuation of arrangements which
have hitherto been in operation.

The miscellaneous and general provisions in Part IX of the Act provide
details of powers and proceedings of Mental Health Review Tribunals, and the
First Schedule of the Act is devoted to the constitution of these Tribunals.

Organisation and Staff

The Health Committee of the Council is responsible for the control of the
Mental Health Services, and has established a Mental Health Sub-Committee.

The Medical Officer of Health is responsible to the Health committee for
the organisation and control of the Mental Health Service. To assist him in
this work he has the services of a Medical Director (the Chief Assistant Medical
Officer of Health) and of the following medical and non-medical staff.

Present

H'hole or

Medical

Establishment

Staff

part time

*Senior Consultant Psychiatrist

part time

*Consultant Psychiatrists

„ „

Non Medical

Mental Health Officer

whole time

Deputy Mental Health Officer

Mental Welfare Officers

Assistant Mental Welfare Officers . .

*Senior Psychiatric Social Worker . .

^Psychiatric Social Workers . .

51 11

*Psychiatric Social Worker . .

part time

*Senior Educational Psychologist

* Educational Psychologists

Senior Clerk . .

whole time

Clerical Assistants

Secretary

*Clerical Assistant

Shorthand Typist

*Shorthand Typist

11 11

*Employed in Child and Family Guidance Service (joint

service with Local Education

Authority).

Junior and Adult Training Centres

Training Centre Supervisor . .

whole time

Training Centre Assistant Supervisors

11 1 *

Psychologist . .

part time

Speech Therapists

91 11

Teacher of the Deaf . .

—

11 11

Nursing Sister

11 51

Industrial Centre Supervisor . .

whole time

Male Adult Training Centre Instructors

11 11

Occupational Therapists

15 11

Caretaker

51 51

Domestic Helpers

part time

Guides

11 11

Cleaners

„ „

Staff Changes

With the repeal of the Lunacy and Mental Treatment Acts 1890 to 1930,
and the Mental Deficiency Acts 1913 to 1938, and the introduction of the Mental
Health Act 1959, it was necessary to terminate the appointment of the two
certifying medical practitioners, but both doctors have been approved for the
purpose of carrying out duties under the Mental Health Act, and an adequate
number of additional medical practitioners with special experience in the
diagnosis or treatment of mental disorder have also been approved for this
purpose.

On the 11th April, 1960, Miss M. J. McNaught who had previously acted
as Health Visitor for Mental Health After-Care at the Day Centre at Barrow
Hospital, was appointed to the vacant post of Mental Welfare Officer.

Other minor changes took place in the Clerical and Training Centre staffs
during the year, and all vacant posts have been filled.

Courses and Conferences

The annual conference of the National Association for Mental Health
was held in London on the 24th and 25th March. This was attended by the
Chairman of the Mental Health Sub-Committee, the Chief Assistant Medical
Officer of Health, and the Mental Health Officer. The theme of the conference
was “Mental Health at Home and Abroad.”

The Deputy Mental Health Officer and the Supervisor of the Training
Centre attended the Annual Conference of the Federation of Associations of
Mental Health Workers at Torquay from the 1st to 4th April.

On the 26th May, a One-Day Conference on Psychiatric Social Work was
held at Barrow Hospital, and was attended by all available officers of the mental
health section.

The Mental Health Officer, at the invitation of the National Association
for Mentally Handicapped Children, toured Holland to study the Dutch mental
health service from the 6th to 12th June.

From the 13th to 17th June, two Assistant Mental Welfare Officers attended
the Refresher Course for Mental Health Workers at Dillington House, Ilminster,
organised by the Somerset Local Health Authority.

“The Community Care of the Mentally Handicapped” was the subject of
the National Society for Mentally Handicapped Children’s National Conference
in London held on the 14th, 15th and 16th July. The Deputy Mental Health
Officer attended, being sponsored by the Bristol and District Society for Mentally
Handicapped Children.

On the 18th, 19th and 20th November, the Mental Health Officer attended
the Association of Psychiatric Social Workers’ Conference at High Leigh,
Hoddesden, Hertfordshire. This conference dealt with the relationship between
social working staffs of mental hospitals and local authorities.

On the 1st December the Chief Assistant Medical Officer of Health attended
a One-Day Conference arranged by the National Association for Mental
Health in London, the subject of which was “Hostels for Mentally Disordered
Patients”.

Two members of the Training Centre staff enrolled for the Diploma Course
for Teachers of the Mentally Handicapped (September 1960 to July 1961). One
member was forced to retire from the course owing to illness on the 31st Decem-
ber, 1960.

In-service training of Assistant Mental Welfare Officers has continued to
be carried out within the Department.

During the year the Supervisor of the Training Centre obtained the diploma
of the St. Nicholas Training Centre in Montessori training, and has been
granted an associate membership.

As in previous years, many students, including post-graduate students,
medical students, social science students and those from training colleges, as
well as many visitors from home and overseas, have visited the Training Centres.

The Mental Health Officer and his Deputy have continued to provide
numerous talks and lectures to organisations throughout the City.

Subnormaiity and Severe Subnormality

At the end of 1960, the number of subnormal and severely subnormal
persons known to the Local Authority was 1,800. This represents a total of
4T per 1,000 of the estimated population — a similar figure to that in 1959.
The following table shows details of the numbers of such persons under care
since 1949.

Year

In Hospital
and on

Extended Leave

Informal

Supervision

Under

Guardianship

Receiving

Voluntary

Aftercare

Pending

Action

1949

676

736

1950

678

804

116

1951

685

857

147

1952

670

876

210

1953

665

932

105

1954

657

972

113

1955

669

1013

116

1956

678

962

1957

683

911

107

1958

704

923

125

1959

703

908

125

1960

716

926

137

During the period up to 31st October, 1960, 81
following sources:

cases were referred from

Total

General Practitioners 2

Courts . . . . . . . . 1

—

Local Education Authority . . 35

Other sources . . . . . . 12

Totals . . . . 50

They were dealt with in the following manner:

Admitted to hospital . . 6

Placed under Supervision 31

Action not yet taken . . . . 8

Action found to be unnecessary 4

Died before action could be taken 1

Totals

50 31 81

Waiting List

At the commencement of 1960 there were 30 names on the list of persons
awaiting admission to mental subnormality hospitals and during the course of
the year 24 names were added. Of this total of 54, 20 were admitted to hospital,
2 died and in 8 cases admission became unnecessary. This left a total of 24
awaiting admission at December 31st, 1960.

In addition to the 20 patients admitted to hospital from the waiting list,
it was necessary to admit a further 29 as a matter of urgency, making a total of
49 admissions during the period ending 31st October, 1960. The following
table shows the method of admission.

M. F. Total

Informal 22 14 36

Section 3 of M.D.A. 1913 . . 1 4 5

Sectionbof M.D.A. 1913 ..2 3 5

Section 8 of M.D.A. 1913 ..3 — 3

28 21 49

Totals

Temporary care under the provisions of Ministry

of Health Circular 5/52

was arranged in 63 cases, as follows : —

Total

At Stoke Park Hospital . .

At Hortham-Brentry Hospital . .

Others

Totals

Difficulty in admission has once again been experienced, particularly
with regard to young children and adult males, but it has been possible in many
instances to arrange attendance at Assessment Clinics, and subsequent treatment
recommended by the consultant psychiatrist to the general practitioner has often
resulted in alleviation of many of the problems and avoidance of admission to
hospital.

Assessment Clinics

{Dr. Heaton Ward's Clinic)

During the period under review, 32 new patients have been referred for
assessment and 42 patients have been followed up. Close liaison by letter has
been maintained with general practitioners in every case.

In all cases, appointments have been made at the request of Bristol or
some other Local Health Authority, and a disappointing feature has been that
no cases have been referred direct to the clinics by general practitioners. It
would appear that they have not yet come to regard the clinic as comparable
with out-patient clinics in other branches of medicine, to which they no doubt
refer cases.

Cases have been accepted with a view to treatment, for example, behaviour
disorders, epilepsy, and nocturnal enuresis, and encouraging results have been
obtained, although it has been necessary in some cases to admit patients to a
mental subnormality hospital for further treatment on a short term basis.
However, the fact that each Consultant holds a clinic only once a month has
inevitably reduced the effectiveness of the treatment. It is readily recognised
by all those working in the clinics that their frequency should be increased to
once a fortnight at least, possibly ultimately to once a week, but this is impossible
at present with the existing Consultant establishments in the psychiatric hospitals
which staff them.

{Dr. W. Litmsden Walker's Clinic)

Part of the Assessment Clinic for Mental Subnormality is run by kind
invitation of, and with the co-operation of, the Local Authority on their premises,
and again a part of these services is staffed by the Hortham-Brentry Hospital
Group (South Western Regional Hospital Board) and by the Social Welfare
and Mental Welfare Officers from both Hospitals and Local Authority. The
Hospital provides the medical staff for the clinic, which is held monthly, and
during the period under review, 38 new cases have been seen and 27 patients
seen for follow-up.

The Assessment Clinic has proved of great value, not only to Local Authority
medical staff, but to general practitioners and other Consultants. In many
cases it has been necessary to arrange the admission of these patients to hospital
but in many other cases it has been possible by means of out-patient care, to
keep the patients within their own homes because of this medical cover. More

patients have been helped by discussion of their problems and in almost all
cases parents have been helped by discussion of problems. Advice can be given
readily to Mental Welfare Officers and medical investigations both for clinical
and research purposes can be carried out. Medication given to patients for
whom the general practitioners wish advice, has helped to control anomalies
of behaviour and relieve the strain on the home.

Junior and Adult Training Centres

At the end of the year the total number of patients on the register (277)
was as follows : —

Male Female

Under 16 Over 16 Under 16 Over 16

Junior Training Centre .... 71 — 54 —

Adult 1 'raining Centre .... — 89 - 63

There was an average daily attendance of 227.

Medical Care

The regular routine medical and dental inspections and vaccinations
against poliomyelitis have been carried out on both adults and children by
medical officers of the Department. The services of the dietitian have also been
made available to the patients attending the Centre.

Special Care Unit

Thirteen children are accommodated in the Special Care Unit, under the
supervision of a qualified Supervisor and a Nursery Assistant. These are children
who could not successfully be trained in association with other children. Their
ages range from 3 to 13 years. They are mostly doubly incontinent and have
to be spoon-fed. Some of these children cannot walk when they are accepted
for training, but with care, patience and encouragement, they learn to walk
unaided. One boy suffers from the triple defects of subnormality, blindness and
epilepsy.

The premises at present used for the Special Care Unit are unsuitable and
space is limited. When the new Training Centre buildings are ready for occu-
pation, it will be possible to extend the scheme considerably.

The Montessori Method of Education

A Montessori Group has been established in the Junior Training Centre
for 14 children whose chronological ages range from 8 to 1 1 years, but whose
mental ages are between 3 and 5 years. These are problem children who have
not responded satisfactorily to the usual methods and have therefore been
unable to take their proper place in the planned timetable of an ordinary syllabus.

They include those who have shown personality problems of various types,
for example, the hyperactive, the inhibited and the aggressive. Their behaviour
has tended to disrupt the limited activities of the classes of backward children
who are amenable to, and can profit by, regular training.

In adopting Montessori methods, in which there is so much freedom and
activity, it is hoped to stimulate the interest, and set free the latent ability which
under routine methods is obstructed by emotional. barriers set up by a “difficult”
child. In a state of fear, resentment and anger, the learning process is slowed
down, or completely halted. It is essential to attempt some solution to., these
emotional tangles which result in “naughty” behaviour, and this attempt is
based on the principles of freedom.

Under a regime where children are made to feel that they are free to choose
the activity they like, free to continue or discontinue it, free to move around
the room without constantly being ordered back to their chairs, the need to be
“naughty” and restless is diminished. The necessity for threats and commands
from the teacher is no longer present, her position being that of a grown-up
friend and helper, not a “policewoman”.

We hope that this new approach to children in the Training Centre will
prove successful; our experimental group is at present limited to children who
are probably mentally above average for a Training Centre, but whose individual
difficulties in forming satisfactory human relationships may prevent their true
development.

In a “free” environment, we confidently hope to find that the inhibited
child will gain courage to step out for himself, that the restless child will find
his own best pattern of work periods, and learn to increase his concentration
through greater interest, and that the aggressive child will be more satisfyingly
absorbed in his chosen activity, and will no longer need the constant assurance
of superiority, which causes him to abuse his own powers. Results may not be
obvious at once, but we feel that as a long term policy, the Montessori Method
will bring its own reward.

Psychologist's Report

{Mrs. A. E. Sedgley)

This year’s work has been carried on mainly in the following ways: —

(i) Routine testing of children and adults in attendance at the Junior and
Adult Training Centres.

(ii) Testing of patients in their homes or in hospital.

(hi) Group therapy with a selected number of children.

(iv) Individual therapy.

Routine Tests

When children first arrive at the Centre, they have already had an intelligence
test at some time during the preceding weeks, and therefore they are given
several months in which to settle down before further testing is needed. There
are, however, regular consultations with the Training Centre Supervisor when
the suitability of various environments for the new child is discussed and when
it is decided which group each child shall join.

When children reach the age of 16 years and are about to leave the Junior
Training Centre, they are retested, and again after consultation, they are placed
in the most suitable group in the Adult Centre.

In individual cases, tests are also given at the request of the Supervisor,
members of staff, or the parents, when progress or deterioration is noticed,
when behaviour difficulties occur, or before patients are sent to the Assessment
Clinic.

Domiciliary and Hospital Tests

There are a relatively small number of older patients who have to undergo
an intelligence test, when requests have been received for hospitalisation. These
people have been interviewed in hospitals, clinics, or at home.

A number of cases of young people referred by general practitioners or
psychiatrists on account of their poor adjustment to the community, have been
visited in order to help assess their mental capacity and personality problems.

Group Therapy

This is carried out with the idea of developing some degree of poise and
self confidence in the children. Many of these children are unable to speak
clearly or efficiently and such defects come within the province of speech therapy.
But where the enunciation is reasonably clear, and where there is reason to
hope that social efficiency might be improved, these children receive a special
type of help in weekly sessions. In preparing for these sessions, various members
of the staff are invited to become dramatis personae of short and simple playlets
which are put on to the tape recorder. The themes are chosen with the idea of
describing incidents within the scope and experience of children and adolescents.
Typical of these are the titles “Christmas Shopping”, “Guy Fawkes Day”, and
“A Day’s Outing to the Sea”. The characters in these short episodes find
themselves in various predicaments and these provide talking points for discus-
sion within the group. The aim is to encourage the children to listen together,
to pick up indirectly some items of general knowledge, to attempt to formulate
their own opinions and to find appropriate words in which to express themselves.
Their efforts in this direction are played back to them and this gives rise to a
mixture of embarassment and delight among the listeners as each recognises
his own voice or applauds the effort of another. Weekly notes are kept on each
child in the hope of estimiating the efficiency of this method.

Individual Therapy

Quite frequently in the Centre, minor behaviour problems arise due to the
innate character of mental handicap. The emotional and instinctive forces of
adolescence are strongly present, without the mental powers of self-criticism
and capacity for self-restraint. Emotional frustration appears often as anti-
social behaviour. In the case of one little girl aged nine years, it is of practical
importance that her aggressiveness should be reduced to avoid the necessity of
exclusion from the Centre. At present she is liable to attack other children
with serious scratching which occurs intermittently and without warning. When
she arrives for a session of therapy she is allowed freedom to express her anti-
social feelings in a way which is not possible in the classroom. At the same time
she accepts coaching in reading which, if successful, may give her a permissible
feeling of self-importance and achievement. This type of treatment is long-term
and cannot bring quick results.

With the acquisition in recent months of a pleasant, newly decorated room
for psychological work in the Centre, it is hoped that the therapeutic side may
prove a real help to the staff in dealing with some of their difficult and interesting
charges.

Speech Therapy Report

(Miss H. M. Streat)

During the year there has been one change of Speech Therapist. Miss
A. Johnson left in June and her place was taken by Miss M. J. Henshaw who
began work in December. This meant that for some months a smaller number
than usual was under treatment.

All the new entrants are assessed by the Speech Therapist during their
first few weeks and those in need of treatment are either seen regularly or reviewed
periodically.

Though one would like to report marked improvement in the speech of the
children who have received treatment during the year, it must be remembered
that progress is infinitely slower with these children than with normal children.

Their concentration span is limited, often to a few seconds, they are distracted
by any and every external stimulus, and their ability to retain sounds and to
associate them with words and objects is often negligible. However, they are
always eager to come for treatment and enjoy thoroughly all that they do in the
session.

Several low-grade children whom we had felt previously would not benefit
at all from speech therapy have been taken again with encouraging results, and
their teachers report that these children are now making much more effort
towards verbalisation.

We are grateful for the good liaison with the psychologist and this has
proved to be most helpful. The staff are always interested and anxious to
cooperate and this has been an encouraging factor in any progress towards
achieving satisfactory and adequate speech.

Teacher of the Deaf

The Teacher of the Deaf, Mrs. J. Stephens, continued to attend on a
sessional basis until her resignation in July. Since that time it has been impossible
to replace her owing to the national shortage of teachers of the deaf.

Margaret Morris Movement

Miss J. Turner reports a most satisfactory year's work. All groups have
completed their schedule covering remedial and aesthetic training. It has been
possible to give more time to percussive movement and the conscious use of
direction and effort.

Scouting and Guiding

The 72nd Bristol (Marlborough House) Scouts and Cubs again completed
a most successful year, the highlight of which was their first Scout Camp under
canvas, held in the grounds of the Bristol Children’s Help Society Camp at
Winscombe. Three Scouters and 23 Scouts attended.

The 68th Bristol (Marlborough House) Girl Guide and Ranger Companies
consist of 22 Rangers and 12 Girl Guides. During Guide Week the girls collected
the sum of £4 14s. 3d. The Annual Church parade was held at St. James’
Church in the Horsefair with the Rev. E. Hopkins inspecting the companies
at the conclusion of the service.

The sum of £7 was gratefully received from 177th Bristol Girl Guides
(Southville Methodist), this being the collection taken at their Christmas Carol
Service. It is very encouraging to know that the normal Guides are in sympathy
with their less fortunate sisters, and wish to help them.

The Rangers contributed four dozen eggs for distribution to elderly people
living at Hengrove, and the sum of £4 4s. Od. was given to Blackboy's Coal
Fund — this being the profit made on the sale of Christmas Cards.

Visits of observation have been made during the year to the Red Lodge.
Cabot Tower and the Museum.

Sheltered Workshops

In the Annual Report for 1959, concern was expressed over the difficulty
which was being experienced in obtaining suitable contractual work from local
manufacturers. As a result of intensive negotiations with manufacturers in the
City there has, in 1960, been a reversal of previous circumstances. At the close
of the year all men and women attending Marlborough House who were capable
of carrying out the simple repetitive operations involved, and who were not
engaged in other tasks, were fully occupied in the sheltered workshop section,
and there is every indication that this state of affairs will continue.

A number of jobs have been carried out during the year. Those now in
hand include the welding of polythene discs as part of a process for manu-
facturing car licence holders; finishing and stringing of carrier bags, and sorting
of polythene, P.V.C. and paper offcuts for salvage purposes.

With the considerable increase in work available, a new and pressing
problem has presented itself. Each contract undertaken entails considerable
storage space and this is not available at Marlborough House, neither is there
enough room in the workshops to carry out some processes, so that expansion
of the project is not possible at present. The difficulties are aggravated by the
unsuitable approaches to the Training Centre and the various levels on which
the premises are situated. Properly planned workdays, loading bays and store
rooms will be available at the new Training Centre, but this will not be ready for
two years. In the meanwhile it may be necessary to ask for temporary accom-
modation to be made available for storage purposes.

Experience over the past four years has proved conclusively that sheltered
workshops provide valuable training for both boys and girls, and there can be
no doubt that an extension of the scheme is essential.

Marlborough House Parent-Teacher Association

The members of this Association have held numerous meetings and functions
during the year. Of these some have been designed to provide entertainment
or social activities, and others to raise funds from which to provide amenities
for the patients attending Marlborough House. In addition, several talks on
matters related to the problems of mental disorder have been arranged, and have
proved instructive and interesting to both staff and parents.

The organisation does a great deal to encourage the cooperation of parents
with staff, and to assist in the task of providing care and training at Marlborough
House.

Bristol and District Society for Mentally Handicapped Children

1960 being World Mental Health Year, the Bristol and District Society for
Mentally Handicapped Children have done all in their power to increase public
awareness and understanding of the problems of the mentally handicapped,
and thus try to remove some of the stigma and prejudice which still unfortunately
exists. A number of events have been organised, the general theme throughout
the year being “The Care and Acceptance of the Mentally Handicapped within
the Community”.

During the year the National Society for Mentally Handicapped Children
organised a week’s visit to Holland to study Dutch facilities and methods, and
also held a three-day International Conference in London. The Bristol and
District Society were pleased to sponsor Local Authority officers to attend
both these events — Mr. F. Morton, Bristol Mental Health Officer going to
Holland, and Mr. Pennington, Deputy Mental Health Officer attending the
London Conference.

The Increasing Problem of the Subnormal Family

As pointed out in the Annual Report for 1959, the Mental Health Act does
not specifically make provision for the supervision of subnormal and severely
subnormal persons living in the community as did the Mental Deficiency Act,
1913. The advantages and disadvantages of Statutory Supervision were con-
sidered in last year’s report.

Social and Diversional Therapy Club at Southmead Health Clinic

Club for the Elderly at Southmead Health Clinic

Townsend Youth Club (Marlborough House)

Sheltered Workshop at the Bristol Training Centre
(Marlborough House)

Now that the new legislation has been fully implemented, it is appropriate
to consider some of the problems which are arising now that Mental Welfare
Officers can no longer impose help and advice upon mentally retarded persons
unwilling to accept it — even when it is apparent that such guidance is necessary'.
Many higher grade subnormal persons are totally without insight into their
limitations, and are so sure of their ability to cope with their own affairs, and
resentful of any sort of control, that they refuse to accept any proffered help.

Difficulties encountered by subnormal families which are coming increasingly
to the notice of the Mental Health section, fall mainly under two headings: —

/, Finance

Instability in employment frequently results in an uncertain and low
average income. An inability to understand hire purchase agreements often
leads to financial difficulties, and it is not unusual to find a family who have
accepted so many commitments that their total expenditure exceeds their
income. While it is appreciated that hire purchase can be of great help to certain
sections of the community, and that the majority of firms doing business through
the medium of extended payments are reputable in every way, unfortunately
there are in existence some traders who take advantage of the limited intelligence
and understanding of a subnormal family. The subject of hire purchase is
being looked at critically by the staff of the Mental Health Section and will
probably be the subject of a report in a subsequent year.

2. Family Responsibilities

There are an increasing number of subnormal persons married to each
other in Bristol. This is in part due to early discharge from hospital, and also
to the discontinuation of statutory supervision by the Mental Welfare Officer.
There is no legal barrier to the marriage of mentally subnormal persons and
although such a union is usually undesirable and steps are taken to discourage it,
it is not easy to persuade a man or woman in this category to accept advice.
They are usually unable to realise that they are unfit to cope with inevitable
difficulties and are often incapable of foreseeing them.

Such young married couples tend to find themselves accommodation in
furnished rooms which are squalid and depressing, and for which they pay a
high rent. In a high percentage of cases the girl is pregnant at the time of
marriage, in others a baby is born within the first year. The problem is then
intensified by the responsibility of caring for a child in an unsuitable home
environment. It quickly becomes apparent that they are incapable, under
existing circumstances, of providing adequate care for their off-spring, and the
Local Authority is faced with a decision as to whether to take steps to have the
child placed in the care of the Children’s Department, action which may well
have to be repeated within a further period of twelve months. The alternative
to removing the child from the parents would be to seek to improve the home
environment, but it is often very difficult to support an application for the
tenancy of a council house if the man and wife are of dull intelligence, lack
housekeeping ability and are of known irresponsible attitude.

On occasions when an application is before the Court to secure the removal
of a child from its parents, or when steps are being taken to keep the child in
the long term care of the Children’s Department, the Magistrate may express
the view that because the parents have been without suitable accommodation,
they have not had a reasonable opportunity of proving their ability to establish
an independent family unit, For this reason the Medical Officer who is asked
to express an opinion as to the mental ability of parents to care for their child,
would have some difficulty in reaching a conclusion.

There may well be an advantage to be gained from making available to the
Local Health Authority’s Mental Health Section, some sub-standard accom-
modation in which mentally subnormal families can be housed and kept under
the close supervision of the Mental Welfare Officer.

The following cases illustrate this problem :

Case A

This mentally subnormal man now aged 29 years has been under the
supervision of the Mental Health Section since leaving a special day school for
educationally subnormal children in 1948. He lived with his parents in a com-
paratively good home, and, as a result of his parents’ influence and the support
and advice given by the Mental Welfare Officer, he had a good employment
and behaviour record until he married when 27 years of age.

His wife, now aged 31 years, is of very low intelligence but was never
formally ascertained as subnormal. She attended an ordinary school until
14 years of age and then found employment in a local factory where she worked
satisfactorily for fourteen years. She had an unstable home environment due
to her mother’s chronic mental illness, which resulted in frequent periods in
hospital and eventual death by suicide when the girl was 1 1 years old. Her
father, a man of aggressive personality, later remarried, but the stepmother
found the girl difficult to control. She has a younger brother who is severely
subnormal and who attends the Marlborough House Training Centre.

Against the advice given to them, the couple married in March 1959, and
thereafter it became difficult to obtain any cooperation. Their first child was
born in hospital two months after the marriage. The infant was in poor health
and underweight and was admitted to a residential nursery where it has remained
in the care of the Children’s Officer.

The couple have moved on innumerable occasions from one set of furnished
rooms to another; usually the accommodation has been in the basement of a
squalid tenement house. Frequently they have returned to their respective
families for shelter when they have been homeless. Their name is on the waiting
list for a Corporation house but it is generally recognised that they would be
unsatisfactory tenants.

Since marriage the man has developed such a poor work record that the
Ministry of Labour are considering suspending his benefit on the evidence of
his having left five jobs since October 1960 without reasonable cause. The
couple have lived most of their married life on state insurance benefits supple-
mented by National Assistance Allowance.

They have shown themselves to be completely irresponsible and socially
unacceptable. They have persistently failed to pay their debts, have fallen
into substantial arrears of rent, have been quite unable to use the considerable
help offered by various social agencies, and have exhausted the patience of their
own families. They seem incapable of appreciating the seriousness of their
situation, resorting to lying and childish behaviour to save them from the
consequences of their social incompetence.

They have made repeated efforts to secure the return of their child to their
care, and have increased their hire purchase commitments by acquiring bedding
and nursery equipment. Their fear of being judged incapable of providing the
minimum material standard needed to allow them to have their child with them,
and their fear of permanent separation from each other, seems to drive them on
to even more irresponsible behaviour.

They are now under notice to quit their present undesirable accommodation,
and a second child is expected in May 1961.

Case B

This man was excluded from Special School at the age of 13 years. He
had been found to have an I.Q. of 47 and to be incapable of benefiting from
education. He was referred to the Mental Health Section, and was placed under
statutory supervision in June 1942. He attended the Local Health Authority
Training Centre until August 1947, when he obtained work as a labourer.
Regular visits were made to his home by the Mental Welfare Officer between
1942 and 1956, and all reports indicated that despite the fact that he often
changed his job, he was making satisfactory progress.

In June 1956 it was reported that he had formed an association with a
girl from a well known local problem family. The Mental Welfare Officer
repeatedly tried to persuade the man not to marry the girl, but his advice was
rewarded with abuse. The marriage took place in January 1958, and on the 8th
May, 1958 a child was born, though the man’s parents entertained doubts about
the paternity. The couple went to live at the girl’s home and it became difficult
to maintain contact with him. Two years later the entire family were evicted
for non-payment of rent. The man then returned to his parents while the girl
entered Part III accommodation provided by Welfare Services Department,
and the child was placed temporarily in the care of the Children’s Officer.

From the date of marriage the man had an increasingly erratic work record
and several periods of unemployment. He appeared before the Magistrates
on two occasions and was found guilty of stealing from workmates. After
the eviction it was found that the couple had incurred several hire purchase
commitments — the man did not know the whereabouts of the articles in question,
and the woman said they had been returned to the shop, but the firm concerned
denied this — consequently the man appeared before the County Court and was
ordered to pay an amount of £3 per week to clear the debt. It appeared to the
officers concerned in the case that the furniture had been sold by the wife
and some member of her family.

A second child was born subsequently and consideration was given to
providing accommodation in which to set up the family as a unit, but it was
appreciated that a considerable amount of marital discord existed. At this
stage the woman applied for a Separation Order and this was granted.

It has since been reported that the woman is again pregnant and the man
denies responsibility for this. Since the separation the man's mother has died
and he has remained in the care of his father. He has accepted the help of the
Mental Welfare Officer and is cooperating well. He is in settled employment,
is paying off his hire purchase debts, and is contributing regularly to the main-
tenance of his wife and the children who are now subject to a “Fit Person
Order”. There is every hope that he is now well settled.

Mental Illness

During 1960 the number of cases dealt with by Mental Welfare Officers
was 490.

Full statistical details of mental illness are given at the end of this report.

An accompanying map shows the geographical distribution of Bristol
cases dealt with during the five years ending 31st December, 1960. It is inter-
esting to compare this with the map showing the distribution of subnormality
and severe subnormality also published in this report.

Social Therapy and Rehabilitation

Industrial Therapy Organisation

(Dr. D. F. Early, Physician Superintendent, Glenside Hospital)

Industrial Therapy Organisation (Bristol), Ltd., is a non-profit making
company, limited by guarantee, which was formed early in 1960, by a group of
doctors, industrialists, trade unionists, church and civic leaders who now
constitute the Board of Directors.

It sprang from the industrial therapy unit in Glenside Hospital (formerly
Bristol Mental Hospital, Fishponds) where since early 1958 long term patients
have been doing contracts for outside firms. By the end of 1959 nearly 400
were working in the unit. The effect of this on their health and outlook was
so favourable that it was decided to carry the venture a stage further by providing
work outside the hospital in factory conditions, through which patients could
return to the community completely fit for work in industry and commerce.

Many firms and organisations gave money or services to equip the old
church school building in York Street, St. Philip’s Marsh, and on March 7th,
1960, the factory opened with 24 worker patients. Now there are about 100
helped by qualified nursing staff, I.T.O’s own staff assisted by industrial super-
visors from local firms, and social workers from the Local Health Authority.

A considerable number of worker patients have already been successfully
rehabilitated and are doing well in industry and commerce.

Mental Health Social Centres

The Social and Diversional Therapy Club established in 1953 at the South-
mead Clinic has continued to provide benefit to inhibited and introvert patients,
most of whom have been successfully treated for mental disorder but have been
left with a residual anti-social or a-social problem. During the year a number
of patients have been rehabilitated and have found it possible to return to a
normal mode of life. A consultant psychiatrist from Barrow Hospital has
maintained the discussion groups and play-reading sessions in the club each
week. Outings to local factories and to theatres and seaside resorts have been
arranged as part of the social activities of the club.

Close liaison has been established with the Industrial Therapy Organisation
and four patients have been accepted for training and employment in that unit.
There is now developing a flow of patients from the hospital to the Social
Therapy Club and on to the Industrial Therapy Organisation.

At the end of the year 33 patients were in regular attendance.

Club for Elderly Mentally Disordered Persons

In association with the Diversional and Social Therapy Club at Southmead,
a club has been opened for elderly mentally disordered patients as an experimental
unit. This club occupies one small room in the clinic premises and is held each
week-day afternoon. Space does not permit the expansion of the group which
now provides facilities for six elderly patients at each session. There are 7
persons on the register.

Voluntary helpers provided by the British Red Cross Society have made it
possible to operate this club without employing additional staff. All patients
have to be transported to and from the club and this service is rendered by the
Ambulance Service and Hospital Car Service.

In the short time that this club has been in operation, it has been found to
be a highly successful venture. It provides elderly confused patients with some
occupation and they no longer have to sit about at home each day with nothing

to do. It also provides a necessary period of rest and relaxation for their
relatives. It has been found that after attending the club patients have been
more settled and less inclined to wander the house at night. In many instances
the need for admission to hospital has been delayed or obviated. There is,
however, a pressing need for new accommodation for this unit in order that the
facilities can be extended.

Townsend Youth Club

In May of this year a club for mentally handicapped persons over the age
of 16 years was established at Marlborough House. The club opens on three
nights each week from 7 to 9 p.m. A grant from the Youth Services Committee
enabled the appointment of two part-time youth leaders. The bulk of the club
membership is drawn from those attending the Training Centre at Marlborough
House, although quite a number come in to the club from the hostels administered
by the local hospital management committees, and to a lesser degree from boys
and girls under informal supervision living and working in the community.

The club is run on almost identical lines to other Youth Clubs in the City
which cater for normal young people and activities include knitting and sewing,
leatherwork, beauty therapy and movement classes, physical training, and
painting classes; it is hoped in the near future to start a reading class. Table
tennis and television are also available to club members.

There is, at present, a membership of over 90.

Suicide, 1960

Age Incidence

Suicide

Total

Attempted

Total

Under 20

—

20-29

—

30-39

40-49

50-59

60-69

70-79

—

80+

—

Totals

Method

Poisoning

Suicide

Total

;V/.

Attempted

Total

Coal Gas

Aspirin

Narcotic

—

Tablets

Chloroform . .

—

Drowning

■)

Cutting throat

—

■)

Cutting wrist . .

—

Stabbing

—

Hanging

—

Choking

—

Jumping from ship

—

„ „ window

—

„ „ gorge

—

,, ,, roof of store

—

Crashing car

—

Strangulation

—

Starvation

—

Total number of Persons known to Mental Health Services at 3 1st December, I960

In the Community

Total

Under Supervision on 31st October 1960

514

412

926

Added to Supervision list during November/ Decern-

ber 1960

Discharged or Died during November/December

1960

Remaining under Supervision (Informal) at 3 1st

December 1960

515

413

928

Receiving After-Care on 31st October 1960 . .

103

121

224

Added to After-Care list during November/December

1960

—

Discharged or Died during November/December

1960

Receiving After-Care on 31st December 1960

205

Under Guardianship on 31st October 1960 . .

Placed under Guardianship during November/Dec-

ember 1960

—

Discharged or Died during November/December

1960

—

Remaining under Guardianship at 31st December 1960

Total in Community at 3 1st December, 1960

Under Supervision

515

413

928

Under Guardianship

Receiving After-Care . .

205

Totals

616

526

1,142

In Hospital

Total

In Hospital on 31st October 1960

Detained . .

271

192

463

Informal

684

937

1,621

Admitted during November/December 1960

Detained . .

Informal

151

229

Discharged or Died during November/December

1960

Detained

Informal

169

259

Remaining in hospital on 31st December 1960

Detained . .

279

205

484

Informal

672

919

1,591

Regraded from Informal to Detained . .

—

Regraded from Detained to Informal . .

Remaining (after Regrading) on 31st December 1960

Detained . .

248

175

423

Informal

703

949

1,652

MENTAL ILLNESS

Distribution of Cases dealt with during the five years ending 31st October, i960

AypN MOUTH

LAWRENCE

WESTpN

SOUTHMP/giD

SH I RE HAM p. J on

HtNLEASE

STOKE .
BISHOP

FISHPON

.^v:6gOB.6e,

BATH

LONG ASHTON

BED\m1I^:

RIVER

e5^1^?-ington

ROAD

7*V.:i<NovvL*

RAILWAY

BOUNDARY

BATH

^jrHOPSWORTH

STOCK WOOD

BRIDGWATER

WHITCHURCH

MENTAL DEFICIENCY

Def.c...es known .o .ho Local Hoalth AuChorlc, a. 3..C Oc.obar,

I960

LAWRENCE

WE3TON

AVpNMOUTH

SOUTHMEAD

shireh.ampton

lockleaze

FISHPON^

STOKE

BISHOP

HILL

BRiSLINGTOH'

STOCK wogb

b.ishopsworth

•-/“•'•'r J

HEtj(6 -URY- . _ • ^quoUCESTEB

• \ CHIPPING
- '-^>ODBURY

mCLlFTOM.J^^ • . v.*

S v l ^PPE N HAN

I* .•♦*• • •/ •• .y/ •• K *»:**!^ —

BATH

LONG ASHTON

RIVER
ROAD
RAILWAY
BOUNDARY

BRIDGWATER

BATH

WHITCHURCH

Statistical Tables

(i) Total Mental Defectives known to Local Health Authority at

31st October, I960

{a) Under Mental Deficiency Acts:

Total

In Mental Deficiency Hospitals (including
licence)

Detained

207

164

371

Informal

178

167

345

Under Guardianship

Under Supervision . .

514

412

926

Totals

905

746

1,651

(6) Not under Mental Deficiency Acts:

Pending

Discharged from Order (After-care)

137

Totals

149

All known cases

970

830

1,800

Cases Referred as Mentally Defective up to 31st October

i960

ia)

Referred by

Total

Local Education Authority

General Medical Practitioners

Courts or Police

—

Others

Totals

Disposal:

Admitted to Mental Deficiency Hospitals
Admitted to Mental Deficiency Hospitals

—

(informally)

Placed under Supervision . .

Action not yet taken :

School Leavers

—

Others

Action unnecessary:

Left District

—

Died

—

“Friendly” Supervision

—

(lii) Analysis of Mental Defectives in Hospital (including those

on Licence)

Total

At 31st December, 1959 . .

375

328

703

Admitted during 1960 {up to 31st October 1960)

From Supervision

Others

Methods of admission:

Section 3 M.D. Act

Section 6 „ „

Section 8 „ „

—

Informal admissions

Totals

Discharges during 1960 {up to 31st October
1960

By order of Board of Control

165

By operation of law . .

Discharged from Informal care

Died

Totals

104

192

Discharged from Order but remaining in

hospital informally

156

Remaining in hospital at 31st October

1960

385

331

716

(iv) Analysis of Mental Defectives under Guardianship

M. F. Total

At 31st December, 1959 .. .. .. .. 7 3 10

Admitted during 1960 (up to 31st October

1960) — — —

Discharged up to 31st October 1960 .... 1 — 1

Remaining under Guardianship at 31st October
1960

(v) Analysis of Mental Defectives under Supervision

Total

At 31st December 1959 . .

504

404

908

Added during I960 (up to 31st October 1960)

Removed during 1960 (up to 31st October 1960):
Discharged from Supervision

Admitted to M.D. Hospital

Left District . .

Died . .

Totals

Remaining under Supervision at 31st October

1960

514

412

926

(vi) Bristol Patients in Mental Hospitals at 31st October

I960

Total

Detained . .

Under Informal care

506

770

1,276

Totals

570

798

1,368

(vii) Persons Receiving Psychiatric After-Care from

Local

Health

Authority at 31st October

, I960

A/.

Total

Ex-Service

—

Ex-Mental Hospitals

Others

(viii) Mental Illness-Cases dealt with by Mental Welfare Officers during period up to 31st October, I960

[Jh

—

271

148

219

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PREVENTION OF ILLNESS, CARE & AFTER CARE

TUBERCULOSIS

Dr. P. W. Bothwell
{Senior Medical Officer, Epidemiology)

There were further reductions in the fatal and notified new cases of tubercu-
losis in 1960, as the following table shows: —

T.B. Notifications
Primary Pulmonary
Primary Non-pulmonary

Transfers in and other sources of information:
Pulmonary
Non-pulmonary

T.B. Deaths

Pulmonary

Non-pulmonary

1958

1959

1960

271

219

198

408

334

299

The number of persons on the T.B. Register at 31st December was 4.116,
compared with 4,164 at the end of 1959.

Of the new notifications in 1960, 22 were sputum positive. Of all the cases
on the register, 83 were sputum positive. The trend for new cases to come
from the older age group males continued in 1960. Two new cases came from
the hostels in Bristol. The routine examination of contacts of cases at places
of work was made in 28 cases but no new cases of T.B. were found in this way.
There were no new cases of tuberculosis in teaching staff necessitating special
investigation during the year.

The Care and After-Care of Patients and their Families

The scope of arrangements for the care and after care of patients and their
families has widened to include those discharged from general hospitals. .A.
Head Almoner was appointed in May to develop and co-ordinate case work
services, in association with other officers in the Department administering
services already well established to meet responsibilities in the same, and the
wider field of social and preventive medicine, and in co-operation w ith Almoners
in the hospitals. After a preliminary survey, which included discussion with
these officers and with the Head Almoners responsible for the medical social
care of people in hospital and attending as outpatients, a scheme was evohed
to meet the needs of patients in the age group sixteen to sixty and this was put
into operation at the beginning of July. Because of the importance of pro\ iding
a comprehensive and integrated service for this group the work is undertaken
in close co-operation with general practitioners and the Nursing Ser\ ices and
health visitors are undertaking the long term follow up of these patients when
casework has concluded, as a safeguard against further breakdow n.

Since the introduction of the extended ser\'ice the majority of referrals
have been from Almoners in the local hospitals and the individuals concerned
have been experiencing quite complex difficulties often arising out of long term
illness or disability or terminal illness. A picture is gradually emerging of the
hazards which these patients and their relatives may encounter in endca\ouring
to come to terms with serious and protracted illness and disability. In some
cases the inability to adjust or adapt successfully has led to marital or famih

disharmony while in others financial strain has become acute because of the
gradual loss of ability to manage a small income effectively, and this is particu-
larly true of those families where one member is suffering from an incurable
disease which has such an emotional and physical impact on the rest. Another
large group is the one where recovery from disability is immensely slow and for
which the normal rehabilitation services are rarely used because of this fact and,
finally, the smaller number who find adjustment almost impossible to achieve
because of temperamental difficulties. It has been possible to give constructive
help to a large proportion of these patients by casework, in partnership with
nursing and social services offered by this Department. A close liaison is being
established with officers of other Corporation Departments dealing with diff-
erent aspects of social care and also with voluntary associations and statutory
bodies with similar aims.

The general pattern of the work for patients suffering from tuberculosis
and their families remains the same and the co-operation and assistance of other
Corporation departments together with the National Assistance Board and
voluntary societies has resulted in the maximum help for these people.

It should be noted that the notifications for 1960 were 225 and this only
shows a decrease of 41 on the previous year. It is perhaps significant that only
sixteen patients required the Disablement Resettlement Service of the Ministry
of Labour. With the introduction of new drugs the period of illness is much
shorter and where previously it was only possible to deal with the most pressing
problems with which our patients were confronted, during the past year it has
been possible to do much needed casework.

The special Remploy Factory at Southmead continues to provide sheltered
employment for our patients. During the past year, however, after consultation
with the Medical Officer of Health the Disablement Resettlement Officers and
the Care Committee, it was decided to allocate 25 per cent of the vacancies to
disabled people other than those suffering from tuberculosis providing a vacancy
was not required for such a person.

Patients have continued to benefit from the Council's scheme for the
provision of free milk and this was granted to an average of 284 per day on
medical recommendation and subject to an income limit.

Housing conditions in 62 families were such that support was given to
applications for re-housing and 47 families were re-housed.

The Tuberculosis Voluntary Care Committee continues to operate Kiosks at
Southmead Hospital, Frenchay Hospital, Ham Green Hospital and Winsley
Chest Hospital and nine ex-patients are now employed at these Kiosks. Towards
the end of last year, owing to the return of Snowdon Road Hospital to the
control of the Local Authority and the consequent change in its character, the
Kiosk was no longer required and the Care Committee have now closed it.
Fortunately, it is now comparatively easy to find employment for ex-patients
and already a number of the staff, who had worked in the Kiosk for some six
years, have found better employment.

Increasingly the essential needs of the family are being met by the National
Assistance Board and, therefore, the Care Committee funds have been released
to help with such things as the payment of insurance premiums, entrance fees
for examinations and also giving holidays to the patient and his family.

The Care Committee continued to provide occupational therapy for patients
in the form of classes and the occupational therapist visits the homes of those
patients unfit to attend.

The following table shows the numbers of BCG vaccinations and positive
skin tests in various groups, together with results of follow-up of positive
reactors.

B.C.G. Vaccination Skin Test and X-ray Results

-i; oo oo

Tf Tf

b (N

^ c«-)

m vc*

— r^~.

rs ^
H ^ T

^ ,

'>0

B ^

IJ- T-
'?■ H'

2 ?::

o y

< z

Z ^

< X Z
Z ^

< S

z ^

wo _

t/3

>^ 7i

S O

X z

•

^ 0

S C

0 -0

(L)

^ .2

"c^

ej)

ct 3

.> 0

'[75

Cl,

03 wo

X-ray results of 191 N. A. I). 147 N. A. I). K7 N.A.I). 77 N.A.I). S N.A.P. 37 N.A.I).

under 15 m.m. 1 1 ? x-rays 15 ? x-rays 3 ? x-rays () ? x-rays 3 ? \-rays

No act. No act. No act. No act. No act.

The mass radiography service examined 35,188 Bristol residents in 1960
and revealed 66 cases (one-third of new cases) of active tuberculosis 25 requiring
observation, 156 inactive cases, and 680 non-tuberculous conditions; 41 still
have to be classified.

Analysis of Cases of Patients treated in General Hospitals

No. of

Cases

Source

Disease or Disability

Bath United Hospital

Chronic bronchitis

Bath Rheumatic Diseases Hospital

Carcinoma

Bristol United Hospitals

Cerebral lesion

Cossham Hospital

Crohn’s disease

Frenchay Hospital

Diabetes

Ham Green Hospital

Disseminated sclerosis

Southmead Hospital

Emotional disturbance

District Nurses

Heart disease

General Practitioners

Hemiplegia

Health Visitors

Malignant hypertension

Ministry of Labour

Mastoid

Patients

Muscular dystrophy

T.B. Welfare Officer

Parkinson’s disease

Pulmonary infarct

Rheumatoid arthritis

Tuberculous kidney

No. of

Cases

Reason for referral

Result

Care of family

Need met

Difficulties of adjustment

Need partially met

emotional or environmental

Family disharmony

Need not met

Financial difficulties

Marital difficulties

Rehousing

Rehabilitation

B.C.G. Vaccination for T.B. Contacts

No. Skin Tested

987

No. Positive

113

No. Negative

877

No. Vaccinated

1,066

VENEREAL DISEASES

A. E. Tinkler, M.A., M.D., D.P.H.

{Consultant V.D. Officer)

The number of new cases attending the Bristol V.D. Clinics continues to

rise.

Table I New Cases — All Conditions — Seen at the
Bristol V.D. Clinics 1956-1960

All Cases

Bristol Residents

1956

1,802

1,269

1957

1,880

1,325

1958

2,027

1,502

1959

2,280

1,664

1960

2,766

2,070

Syphilis

Although the incidence

of syphilis remains

very low there was a slight

increase in early syphilis in

England and Wales in 1959 and 1960. Of the 33

cases of early syphilis seen

in the Bristol clinics,

19 occurred among seamen

(17 foreign and 2 British), who attended the Avonmouth clinic.

The number of cases of early syphilis occurring in Bristol residents is so small
that no conclusion can be drawn from the increase in 1960.

Table 2 Number of New Cases of Syphilis seen at the
Bristol V.D. Clinics 1956-1960

All Cases

Bristol Residents Onlv

Early

Late

Early

Late

Syphilis

Total

Syphilis

Total

1956

1957

1958

1959

1960

For the second year in succession no new Bristol cases of congenital syphilis
were seen at the clinics. This is the most encouraging aspect of the venereal
disease situation in the City and is a tribute to the excellent co-operation which
exists between the ante natal and venereal disease services.

Gonorrhoea

The number of new cases of gonorrhoea continues to rise, but fortunately
not so steeply as in 1959 when the incidence more than doubled over the previous
year.

Table 3 Incidence of Gonorrhoea 1956-1960

Bristol Clinics

England and Wales

All Cases

Bristol Residents Only

1956

20,310

249

151

1957

24,352

257

152

1958

27,915

249

1959

31,320

604

433

1960

33,640

675

482

The proportion of immigrants among the male patients with gonorrhoea
attending the Maudlin Street Clinic remains very high.

Table 4 Gonorrhoea — Male only — Maudlin Street Clinic

Percentage of West Indians —

All Cases

Bristol Residents Only

Total

West

Total

West

Cases

Indians

West

Indians

Cases

Indians

West

Indians

1958

190

17%

143

23%

1959

336

131

39%

280

131

47%

1960

353

153

40%

321

153

47%

The following report has been submitted by Miss Gwyneth Stinchcombe, the
Medico-Social Worker: —

During the past few months wide publicity has been given to the problem
of promiscuity amongst young people, with particular emphasis to the teenagers.
In order that the problem as it affects the V.D. Clinics might be viewed in
perspective the following tables may be of some assistance in assessing the extent
of “known” promiscuity of female patients between the ages of 12 and 25.

Table 5 gives the number of female patients seen at Maudlin Street and
Southmead Clinics in 1960 according to age group and diagnosis.

Table 5

Diagnosis

Age

No. of
Patients

Conor rhoea

Syphilis

Non-

venereal

Total

12-15

—

16-19

188

140

188

20-25

189

121

189

433

113

314

433

Table 6 shows the agency through which these patients were referred to the
Clinics.

Table 6

Age

Self

Remand

Home

A.N.C.j&

Hospitals

Social

Worker

Own

Dr.

Other

Agencies

Total

12-15

—

16-19

188

20-25

—

189

—

190

433

The number of unmarried mothers included in these figures is 180 representing
30 per cent of the total, 17 in the 12-15 age group, 83 in the 16-19 group and 80
in the 20-25 age group, but two factors should also be borne in mind — (a) that
all the 433 patients seen had run the risk of infection, and (b) that these figures
represent only the patients who actually attended either Maudlin Street or
Southmead Clinics and are therefore only symptomatic of a trend which it is
impossible to assess statistically.

Contact Tracing

It is gratifying to note that the number of male contacts successfully traced
and examined shows 100 per cent increase over 1959, indicating a marked
improvement in the patient’s response to routine interrogation. The number
of female contacts remain steady and demonstrates the vital importance of being
quick off the mark in an effort to keep the incidence of V.D. as low as possible.
The tracing of females named as contacts of male patients with gonorrhoea has
been most successful, 80 per cent of the female patients treated for gonorrhoea
at Maudlin Street Clinic were brought in by the Social Worker.

Default Control

Some improvement is noticeable this year and is a valuable means of keeping
in touch with the patients until, both medically and socially, they are ready to
be discharged from the clinic, although there seems to be an increasing number
of refusals to attend for routine surveillance due, possibly, to the efficacy of
modern treatment.

Owing to reorganisation and structural alterations at Ham Green Hospital
the number of in-patients visited has been negligible, but now the alterations
are completed, the usual rehabilitation efforts will be resumed.

THE AMBULANCE SERVICE

The following report has been submitted by Mr. R. F. Wood, Chief
Ambulance Officer: —

Statistics
Table I

Ambulance Service Vehicles only

1952 1953 1954 1955

Patients 114,554 143,590 147,990 148,720

Mileage 731,969 813,353 804,662 792,847

M. Per Pat; 6-39 5-66 5-44 5-33

1956

1957

1958

1959

1960

152,386

150,341

148.884

149,168

156,599

792,405

771,670

755,048

741,794

762,466

5-20

513

5-07

4-97

4-87

This table indicates the number of patients carried in Ambulance Ser\’ice
vehicles since 1952 together with the mileage run and average miles per patient
figure for the same period.

It will be noticed that despite the large variation between the number of
patients carried in 1952 as opposed to those carried in 1960 the miles per patient
figure has progressively decreased from 6-39 in 1952 to 4-87 in 1960.

Table 2

Total number of Patients carried 1958-1960

Number of Patients

Increase or
decrease

Number of

Increase or
decrease

Month

1958

1959

over 1958

1959

patients

I960

over 1959

1960

January

12,991

13,115

- 1-124

13,308

+ 193

February

12,188

12,003

—185

13,013

- 4 - 1,010

March

12,530

12,379

-151

13,801

- 1,422

April

12,041

12,670

+ 629

11,770

—900

May

13,617

1 2,440

— 1,177

13,606

+ 1,166

June

12,491

13,002

+ 511

13,102

-100

July

12,861

12,848

— 13

13,135

+ 287

August

10,783

11,118

+ 335

12,107

- 4-989

September

12,159

12,356

+ 197 •

13,557

- 1,201

October

13,525

13,420

— 105

14,109

- t -689

November

12,846

12,967

+ 121

14,834

- 4 - 1,867

December

12,544

12,305

—239

12,809

+ 504

Totals

150,576

150,623

+ 47

159,151

- 8,528

This table indicates the comparative figures over the past three years of
the total number of patients carried in Ambulance Service vehicles plus those con-
veyed by the supplementary services, i.e. the Hospital Car Service and the Ta.xi
Association.

It indicates quite clearly the increase in 1960, culminating in a total increase
for the year compared with 1959, of 8,528 patients.

Personnel

Sickness and the untimely death of Station Officer Ashley created a difficult
situation as far as control of the Service was concerned for a considerable
period during the year. The proposed introduction of a 42 hour working week
for all driver/attendants as from January 1st, 1961 plus the extra 3 day annual

leave period to which personnel who have completed 10 years service are
entitled, made it necessary to seek the approval of the Health Committee for an
increase in the Establishment of six Driver/Attendants.

Stations

A general sense of frustration was felt by everyone in the Service that no
positive date could be given in the foreseeable future for the building of a Central
Ambulance Station. This was agravated to a considerable extent by the
knowledge that the Home Office considered one of the existing stations which
is shared with the Fire Service to be the worst in the Country.

The work carried out at each of the existing stations was sufficient only to
make the station habitable and to fulfil the minimum requirements of men on
operational duties.

Vehicles

One ambulance and one dual purpose vehicle were purchased and delivered
during the year.

Supplementary Services

The existing arrangements with the Hospital Car Service, the Taxi Associ-
ation and Avonmouth Docks Ambulance Committee continued to work well
and thanks are due to the organisers of these services for the ready help provided
and sustained throughout the period under review.

Adjoining Authorities

Close liaison was maintained between the Bristol Service and those of the
adjoining services of Gloucestershire and Somerset County Councils. As a
direct result of such liaison 6,215 cases were passed to other Authorities for
conveyance in their own vehicles.

Warning Device — Sirens

Despite active representation through all available channels it was not
possible to revert to the use of sirens as a warning device for ambulances on
emergency journeys through the City. This was a great disappointment to
service personnel because they realized to the full how much easier was the
task of reaching accidents victims made by the use of the siren as a warning
device and how much time could be saved by such means.

Safe Driving Award

In recognition of the efforts made by drivers in maintaining an accident
free record throughout the year Committee approval was obtained for an
evening function to be organised and awards to be presented by the Chairman
of the Health Committee to the 65 men who were qualified to receive them.
Such action gave an undoubted stimulus to all personnel to drive Service vehicles
at all times with due care and attention and should do much to raise the standard
of driving throughout the Service.

Vehicle Maintenance

The care and maintenance of vehicles was again in the safe hands of Mr.
H. M. Ellis the Corporation Transport and Cleansing Officer. As a result of
discussions with him and other interested people it was agreed that with the
additional demands now being made upon the Service and the numbers of
vehicles required on the road each day, it was necessary to increase the numbers
of vehicles available to the Service. The prescribed steps were taken to bring
this about including an amendment to the existing proposals agreed w'ith the
Ministry of Health.

Generally speaking the year was a difficult one from the point of view of
day to day working and the inability to plan adequately for the future. It is
hoped however that as a result of what has transpired throughout the year
much good-will will be forthcoming as a direct result of increased appreciation
of the work of the Service and the difficulties under which it has to operate
at the present time.

Everyone in the Service is very much concerned with the care and comfort
of the patients carried and the efficient and economical running of the Service.
Given the necessary encouragement and help when and uhere necessary, there
is no doubt that Bristol can and will have a Service of which it can be justly
proud.

SECTION C

ENVIRONMENTAL HEALTH
SERVICES

F. J. Redstone, F.R.S.H., F.A.P.H.L
{Chief Public Health Inspector)

ENVIRONMENTAL HEALTH SERVICES

Section

Page

SANITARY CIRCUMSTANCES, ETC 1-46

Environmental Health Services . . 1

Public Health Inspections . . . . 4

Factories Acts, 1937 and 1948 . . . . 6

Housing . . 8

Food Inspection . . 12

Milk and Food Inspection 21

Atmospheric Pollution . . . . 30

General Environmental Health Work . . . . 36

Rat Destruction, Disinfection and Disinfestation . . 42

ADMINISTRATION OF THE SHOPS ACT, 1950, AND KINDRED

LEGISLATION DURING 1960 47

REPORT OF THE SCIENTIFIC ADVISER AND OFFICIAL

AGRICULTURAL ANALYST 51-85

Introduction 52

Food and Drugs Act 54

Fertilizers and Feedings Stuffs Act . . 61

Water and Sewage Analyses . . . . 62

Rag Flock Act 65

Pharmacy and Poisons Act . . . . 65

Miscellaneous Analyses . . . . . . . . 67

Report on Work for the County of Gloucester 75

Report on Work for the City and County of Gloucester 78

Atmospheric Pollution . . . . . . . . 78

Spectroscopy . . . . . . . . . . 84

Other Activities . . . . . . . . . . . . . . 84

ENVIRONMENTAL HEALTH SERVICES

F. J. Redstone, F.R.S.H., F.A.P.H.I.

{Chief Public Health Inspector)

The past year has seen the arrival of many new and amending health and
food laws. It is not generally recognised how extensive are the Acts, Orders and
Regulations which have been passed to safeguard the health of the people.
The Environmental Health Services are administered by officers who endeavour
at all times to bring a friendly but firm approach to the many problems assoc-
iated with this work and, although twelve months is a comparatively short
time to assess progress an all-seeing eye on the year’s work can again report
trends towards improvement in many directions.

The air we breathe, conditions under which people live and work, the food
we eat, the water we drink, adequate drainage, freedom from pests, are all
matters which have again received concentrated attention by the Department.
Progress in some of these important subjects is inevitably slow and one feels
the need for early training in the schools and in the home which will bring about
a greater appreciation of the rules and value of healthy living. This is partic-
ularly so in connection with the handling of food as it is evident that in spite
of new and improved premises and equipment, methods of food handling in
some quarters leave much to be desired.

This is reflected in the number of food poisoning cases and other illnesses
which occur, many of which are due to the bad habits of some food handlers.

Members of the Health Committee raised questions on this important
matter during the year and once again the Chief Public Health Inspector ex-
pressed the view that there was a need for the establishment of a food hygiene
centre in the City. The object of such a scheme would be to train all employees
in food establishments in the techniques and methods essential for the clean
handling of food. Whilst this work would have to be continuous it is felt that
the food trades and their employees would co-operate readily in a uell organised
scheme.

A comparatively new development is the number of food vending machines
now being installed at bus stations, canteens, shops and various other sites
within the City area. These machines, some of which dispense hot drinks
and snacks, present special problems from a hygiene point of view and these
developments are being closely watched.

The campaign for cleaner air has moved forward slowly during the year
but already it is pleasing to receive comment that atmospheric conditions in
the central smoke control area appear to be much improved and those of us
who consider the air we breathe important to health are much heartened thereby.

Further steps towards the complete elimination of tuberculosis in dairy
cattle have been made and it is pleasing to report that of all milk samples
submitted for test in 1960, none was found infected with tubercle bacilli. This
is a striking improvement from the days when many young people and others
suffered from tuberculosis as a result of drinking infected cow's milk and much
unhappiness and suffering is being avoided by the good work carried out by
the veterinary profession in dealing with the health of live animals, together
with the now widespread heat treatment of milk supplies.

The Slaughterhouses Act, 1958 required local authorities to report on the
present and future slaughtering requirements of their district. The Health
Committee were faced with a need to integrate the slaughtering facilities within
the City area and with a view to adopting the best possible layout and slaught-
ering system members of the Sanitary Sub-Committee made many Nisits to

newly constructed slaughterhouses in the South-Western region. The preparation
of the Slaughterhouse Report submitted to the Minister and these associated
visits absorbed much time and thought, which should, however, be amply
repaid in the eventual result. A further step forward in the control of meat
found to be unfit for human consumption was made by the passing of the Meat
(Staining and Sterilisation) Regulations which came into operation on the 1st
November, 1960. These Regulations are not in all ways a complete answer
to this problem or to that of raw meat supplied through knacker’s yards, but
those concerned appear to be co-operative in this matter.

The need for new wholesale fruit, vegetable and fish markets in this City
has been recognised for some time and active steps are now being taken to
resolve problems associated with the siting and construction of new markets.
During the early part of the year members of the Estates Committee made a
tour of food markets in Nottingham, Sheffield, Leeds and Coventry. The
Chief Public Health Inspector was invited, along with other officers, to accom-
pany the members concerned on this tour and subsequently reported to the
Estates Committee on the various public health aspects and facilities required
in new markets.

The condition of housing accommodation forms a large part of the work
performed by public health inspectors and in recent years, in accordance with
the requirements of the Government, a great deal of attention has been paid
to the clearance of unfit houses.

The duties to be carried out under the Housing Acts include many assoc-
iated problems such as the closure of unfit basement dwellings and the re-
conditioning of properties which it can be seen have further useful life. One of
these problems now facing many large local authorities throughout the country
is the condition of what has been termed “twilight” areas. These, according
to Sir Keith Joseph, Parliamentary Secretary to the Ministry of Housing and
Local Government, are “areas of old and out-dated houses, usually badly
run-down and generally having a shabby and squalid air. Often, because
of their condition, arrangement or setting, they are incapable of or not worth
improving. In many cases, they include larger houses which are being used as
was never intended, being occupied by several families without, however,
providing adequate facilities for decent family living. Often they are badly
overcrowded and lacking almost entirely in convenience, comfort and privacy.
Though there is now much less overcrowding than there was, bad pockets
remain here and there. These are the “black” spots of the “twilight areas”.
They are the first priority after the worst slums have been dealt with.”

Areas of this kind are to be found in many towns and cities and cause
many problems. Not the least of these is how best to establish satisfactory
living conditions in the larger houses which, although originally built to accom-
modate one family, and perhaps servants, are now occupied by several. This
change was bound to occur because this type of house is far too large for a
single family today. The process has usually been hastened by a general deterior-
ation of the standard of the district and, in some cases, by the arrival of im-
migrants. The trouble has been that little has been done to ensure that the houses
are properly adapted for this change in their use.

The sharp and heavy rainfalls experienced from time to time during the
year again caused serious flooding in certain parts of the City and much suffering
and inconvenience was occasioned as a result. Many questions were raised
about the need for a flood emergency scheme which would be brought into
operation quickly in an endeavour to alleviate the aftermath of flooding. A
central control for reporting these occurrences with a co-ordinated action
from all the various departments concerned was evolved and the Public Health

Department assists with the drying of carpets and other household effects,
the inspection of damaged foodstuffs and similar public health matters.

In addition, powers were included in a Bristol Corporation Act under
which compensation may be made to the victims of flooding. The new and
extensive sewerage scheme now being carried through by the City Engineer's
Department will, in time, prevent these flooding incidents and this cannot
be too soon for the people living in affected areas.

During the year the Rodent Control Officer retired and in future pest
control work will be supervised by a senior public health inspector with resulting
closer integration and efficiency of this work.

Since the Health Committee has been responsible for the control of the
Diseases of Animals (Waste Foods) Order, 1951, a more frequent inspection
of piggeries in the City has been undertaken. The value of this was emphasized
during the widespread foot and mouth disease outbreaks and ever>^ effort was
made by increased inspection to secure the adequate treatment of waste foods
used for pig and poultry feeding.

The Managements of offensive trades situated within the City area have
for some years been uncertain as to the future tenure of this class of business.
This has been mainly due to planning proposals which envisaged the re-siting
of these premises but this is no easy problem and during the year one firm who
wished to carry out extensive works appealed against a 15-year planning per-
mission for this' work and the Ministry of Housing and Local Government
allowed the appeal. The Chief Public Health Inspector then recommended that
new bye-laws for the control of offensive trades should be applied for and this
matter was receiving attention towards the end of the year.

The coming into operation of the Caravan Sites and Control of Development
Act, 1960 stressed the need for close collaboration with the Planning Otficer
and there is now an agreed scheme to deal with applications for the siting of
caravans to be used for human habitation.

Although the Offices Act, I960, has now been placed on the Statute Book
it will not come into operation until 1st January, 1962. However, it is probable
that a more comprehensive measure will be brought in e\en before that date
and the new Bill will deal with health, welfare and safety in shops, offices and
railway premises. The administration of such a measure will create an immense
amount of work as many thousands of offices will have to be assessed against
the new requirements and visited frequently to ascertain maintenance of
satisfactory conditions.

The new Public Health Inspectors’ Education Board issued the conditions
of training to all local authorities and technical colleges and during October
an approved training course commenced in Bristol. The foresight of the Bristol
Health Committee in establishing a public health inspectors' trainee scheme
some six years ago has been amply justified and, as a result, no difficulty was
experienced in attaining the Board’s requirements.

The following trainees qualified as Public Health Inspectors during 1960 —
Mr. M. J. Dimambro and Mr. N. Jacobs. Other examination successes by
officers of the Division were: — Certificate of the Public Health Inspectors'
Education Board — Mr. E. N. Stinchcombe. Certificate for Inspectors of Meat
and Other Foods, Royal Society of Health — Mr. M. J. Abrams and Mr. H.
M. Ellis. Certificate for Smoke Inspectors, Royal Society of Health— Mr. D.
A. J. Herbert. Part II Final, Diploma of Municipal Administration — Mr. F.
C. Henley.

In completing this opening statement 1 would like to record my thanks
to all the staff for their excellent work during the year and to those who ha\e
contributed to this report.

PUBLIC HEALTH INSPECTIONS

Sanitation, Housing, Shops Acts, etc.

1959

Re-

1960

Re-

Visits

visits

Total

Visits

visits

Total

—

4,062

Complaints

Visits:

—

4,256

4,091

11,666

15,757

Dwelling houses

4,404

12,101

16,505

Houses let in lodgings

Common lodging houses

188

206

394

Food shops — Registerable . .

174

247

1,126

1,541

2,667

Non registerable

929

1,986

2,915

148

205

353

Other shops . .

148

347

495

119

168

Bakehouses . .

109

210

722

932

Workplaces and offices

228

476

704

154

Factories — Non-mechanical

482

785

1,267

Mechanical

328

524

852

Outworkers . .

Removal of aged persons

Offensive trades

108

137

183

Entertainment places

135

181

203

Tents, vans and sheds

280

310

156

239

Keeping of animals . .

121

574

246

820

Food inspection

556

238

794

144

398

542

Sites . .

146

432

578

127

182

Institutions, hospitals, etc. . .

116

185

758

1,023

1,781

All other matters

628

996

1,624

—

Infectious disease visits

—

334

1,138

1,472

Clean Air Act — Smoke observations

225

891

1,116

2,088

—

2,088

— Smoke Control Areas

5,540

5,549

New Chimneys

New Furnaces

1959

In-

tima- Statu-

Compliance

1960

In-

tima- Statu- Compliance

tion

tory

Notices: —

tion

tory

324

442

213

326

Dwelling houses (P.H.)

507

518

205

263

—

Houses let in lodgings

—

Common lodging houses . .

—

Food shops — Registerable

—

Non-registerable

—

Other shops

—

Bakehouses . .

—

Workplaces and offices

—

Factories — Non-mechanical

—

Mechanical

—

Outworkers

—

Removal of aged persons . .

—

Smoke observations

—

Offensive trades

—

Entertainment places

—

Tents, vans and sheds

—

Keeping of animals

—

All other matters

Smoke abatement

—

Sanitation, Housing, Shops Acts, etc. — Remedial Action

1959 1960

Drainage Works : —

53 New drains laid . . . . . . . . . . . . 44

226 Drains repaired . . . . . . . . . . 270

679 Choked drains cleared 937

182 Tests made . . 166

Sanitary Conveniences: —

5 Flushing appliances introduced . . . . 2

32 Additional closets fitted 13

1 Separate closets for sexes provided . . 4

1 5 New pans fitted . . . . . . 20

— Action re bathroom and geyser vent . . . . . . —

2 Urinals fitted . . . . . . . . . . 3

90 Other works 101

13 Intervening vent space provided .. 13

2 Cesspools abolished . . . . —

Water Supplies: —

5 New and additional installations 4

43 Hot water installed . . . . 54

— Wells closed . . . . —

Other Sanitary Fittings:—

1 1 New sinks fitted 15

1 Additional sinks fitted 3

51 Wash basins provided . . . . 37

Other Works: —

176 Roofs repaired . . . . 258

91 Dampness remedied .. 135

337 Other new and repair works . . 486

5 Yards paved and drained 14

30 Houses cleansed — dirty .. 17

137 — verminous . . 66

1 Food store installed . . . . —

— Cooking facilities provided . . . . . . —

15 Lighting improved . . 12

10 Ventilation improved .. 11

1 Meal rooms provided . . . . —

10 Heating provided 4

3 Exhumations . . 2

Keeping of Animals: —

2 Removal of manure . . 1

— Provision of manure receptacles . . . . —

— Drainage provided . . . . . . —

Aged and Infirm Persons: —

3 Removals — voluntary 5

1 — Court Order . . 2

Smoke Observations: —

1 1 Infringements — dealt with 6

Noise Nuisances: —

9 Dealt with , . . . . . . . 4

Other Nuisances: —

271 Dealt with . . . . 284

Food Hygiene Regulations, 1955: —

150 Miscellaneous requirements .. 152

Repairs to Property in Owner's Default

At the beginning of the year one case was outstanding from 1959; this
was not proceeded with.

During the year 10 cases were referred to the Defaults Officer for consider-
ation. Of these, 6 were repaired by the Corporation's contractor, 1 case was
not proceeded with and 3 cases were pending at the end of the year.

Six orders were issued to various Corporation contractors and accounts
totalling £55 9s. lid. were passed for payment.

Works by Agreement under Section 277 of the Public Health Act, 1936

One such case was referred during the year. An order was issued and an
account totalling £85 Os. Od. was passed.

FACTORIES ACTS, 1937 TO 1959

Inspection of Factories

Premises

Number

Number of
Written

Occupiers

Inspections

Notices

Prosecuted

(2)

(3)

(4)

(5)

(i) Factories in which Sections 1,
2, 3, 4 and 6 are to be enforced
by Local Authorities . .

131

(ii) Factories not included in (i) in
which Section 7 is enforced by
the Local Authority . .

1,074

328

(iii) Other premises in which Section

7 is enforced by the Local
Authority (excluding out-
workers’ premises)

366

Total

1,303

724

—

Cases in which Defects were Found

Particulars

Want of cleanliness (S.l)
Overcrowding (8.2)

Unreasonable temperature (S.3)
Inadequate ventilation (S.4)
Ineffective drainage of floors (S.6)

Sanitary Conveniences (S.7); —

(a) Insufficient

(b) Unsuitable or defective . .

Other offences against the Acts
(not including offences relating
to Outwork)

Other works

No. of

No. of cases in which defects cases in

were : — which

Found Remedied Referred prosecu-

to H.M. by H.M. tions were
Inspector Inspector instituted

(2) U) (4) (5) (6)

12 17 — 9 —

4 4 — 1

1 7 20 — 2 —

9 13 — 2 1

1 1 — 2 —

7 2

Total

Part VIII of the Act
Outwork

(Sections 110 and 111)

Section 110

Section 111

No. of

out-workers

cases of

prosecu-

instances

in August

default

tions for

of work in

Notices

Nature of Work

list required in sending

failure

unwhole-

served

by Section

lists to

to supply

some

7/0 (7) (f) the Council

lists

premises

(2)

(S)

(4)

(5)

(6)

Wearing apparel —

Making etc., Cleaning and

Washing . . . . . . 14

Shoes . . . . . . . . 1

Household linen

Wire embroidery . . . . . . 1

Lace, lace curtains and nets
Gloves . . . . . . . . 8

Curtains and furniture hangings . . 1

Embroidery . . . . . . . . 1

Furniture and upholstery . . . . —

Electro-plate . . . . . . . . —

File making . . . . . . . . —

Brass and brass articles . . . . —

Fur pulling

Iron and steel cables and chains

Iron and steel anchors and grapnels —

Cart gear . . . . . . . . —

Locks, latches and keys . . . . —

Umbrellas, etc. . . . . . . —

Artificial flowers

Nets, other than wire nets . .

Tents . .

Sacks . .

Raquet and tennis balls
Paper bags

The making of boxes or other recept-
acles or parts thereof made
wholly or partially of paper . . —

Brush making . . . . . . —

Pea picking . . . . . . . . —

Feather sorting

Carding, etc. of buttons, etc. . . —

Stuffed toys . . . . . . . . —

Basket making . . . . . . —

Chocolates and sweetmeats . . . . —

Cosaques, Christmas stockings, etc. —
Textile . . . . . . . . . . —

Lampshades . . . . . . . . —

Prose-

cutions

Total

HOUSING

Since 1954, when full scale clearance procedure was recommended, repre-
sentations by the Medical Officer of Health had been followed by the appropriate
Clearance Orders or Compulsory Purchase Orders, confirmation by the Minister
following public inquiries; or in the case of individual houses Closing Orders
or Demolition Orders were made. In the case of Clearance Areas the Council
had satisfied themselves as to “unfitness and best method” by seeing a sample
of the houses. Approximately 5,000 out of an estimated total of 10,000 had
been dealt with in this way.

A change in policy, however, now envisages a sub-division of the remaining
5,000 houses still to be dealt with under the 1954/55 programme into two broad
categories : —

(a) Those individual or small groups that had a future housing potential
if properly repaired and improved, estimated at 3,000 and —

(b) those groups which in all the circumstances, were best dealt with by
demolition (2,000).

Of the former class the Corporation are prepared to purchase selected
houses by agreement and repair or if necessary rebuild where an owner is
unable to do so.

With regard to the groups of houses to be demolished the Council views
each house after representation, and proceeds normally to the declaration of
the Clearance Area. Thereafter, to secure the demolition of the houses, the
properties are acquired by agreement.

Since May 1960 no Clearance Orders or Compulsory Purchase Orders have,
therefore, been made.

A Problem of Values

In dealing with individual unfit houses the relationship between cost
of works and the value of the house is of paramount importance in establishing
“reasonable cost”.

In the case of houses controlled by the Rent Act, the investment value is
a sum obtained by capitalising the net annual income derived from rents.

Upon what basis must the net annual income be calculated — on the actual
rent paid by the tenant or a rent that could be charged if the limits of the Rent
Act, 1957 were applied? Experience has shown that a “potential” value cal-
culated on the latter basis can be as much as four times as great as a value
calculated on the former. A house which could be repaired at reasonable cost
on the one basis is not repairable at reasonable cost on the other.

Is it a good thing, in law, for a local authority to take action under the
Housing Act, 1957 on the assumption that a landlord would always charge as
much as the law permitted; knowing as we do that a plot of land could be of
greater value with the unfit house demolished than if it were repaired?

Some guidance on this point can be obtained from the case of Leslie Maurice
Sl Co. Ltd., V. Willesdon Corporation {1953) where it was ruled that the material
facts to be taken into consideration were those obtaining at the time action was
taken. It would be wrong to presume, therefore, that an owner would always
exercise his permissive right to increase rents.

If this basic principle is applied to decontrolled property where the rents
are high either of itself or by reason of multi-occupation, then a very unrealistic
value results; sometimes many times what a normal market value would be.

Conscious as we are of the permutation of housing circumstances which
occur in practice, it is high time that the legislature gave local authorities some
guidance on the general principles to be applied in the valuation of properties.

Rent Act, 1957

The function of the local authority as between landlord and tenant in
matters of the Rent Act is that of referee and in the main little difficulty is

experienced where the landlord and tenant act reasonably. The odd case does
arise however, where the parties refuse to co-operate and the local authority's
position is a difficult one, as a decision in favour of the one could lead to litigation
by the other.

The tenant of a house made an application for a Certificate of Disrepair
and in the absence of an undertaking the Certificate was issued. The items
listed included broken and missing tiles to four fireplaces. The owner applied
to the County Court and succeeded in his plea that the defective fireplaces were
due to the tenant’s neglect and misuse of the fixtures. The items were deleted
from the Certificate.

The remaining works were attempted but to every application for cancel-
lation the tenant objected successfully, using the time thus won to apply for a
further Certificate of Disrepair on other defects. Eventually an application
for the cancellation of both Certificates was received and notwithstanding a
further objection the Council decided to cancel, whereupon the tenant applied
for a third Certificate of Disrepair detailing the defective fireplaces which the
Court had deleted from the first.

On the strict point of law it was appreciated that the local authority had
to consider the application on its merit bearing in mind that it was not the
Council’s concern to inquire into obligation as between landlord and tenant
or into the origin of any defect.

It was, however, realised that the effect of the issue of a Certificate of
Disrepair would be to force the owner into the County Court again on an issue
previously decided. To refuse to issue the Certificate would lease the local
authority open to be proceeded against by the tenant.

It was decided to issue the Certificate and the owner was advised of the
Council’s proposal so to do, whereupon he gave an undertaking to remedy the
defects.

The Council could under the permissive power vested in them by Paragraph
5 (a) of the First Schedule to the Act refuse to accept the undertaking and issue
a Certificate instead. Having regard to all the facts, hossever, the undertaking
was accepted.

Whilst the undertaking has still some months to run, the owner's effort
to effect repairs to the fireplaces has so far proved abortive in that the tenant
has refused the builder entry for the purpose of repair demanding new grates
instead.

The end of the story has yet to be written but it is interesting to conjecture
whether the owner will now apply to the Courts for possession.

Cost of Demolition

It was found necessary to make application to the County Court for the
recovery of £130 as expenses incurred in the demolition of a house in default
under Section 23, Housing Act, 1957.

The defaulting owner, who had been supplied with a detailed account of
the expenses claimed that the charges were excessive, included items which
could not be properly charged, and did not have regard to the proper \alue
of salvable material. In fact, he contended that the demolition work could
have been done for £30.

The house in question is situated at the end of a cul-de-sac and separated
from the road by a forecourt, the rear wall of the building being, at one point,
only 4 ft. away from a metal railing fence which separated the site from a railway
cutting some 40 ft. below. Many of the metal railings were missing, broken
and patched with odd materials. The house was physically connected to one
other property so that the question of support was involved and its demolition
such a complicated affair that special equipment had to be used.

In proving the case, the Corporation demonstrated by expert evidence
that the situation of the house to the road, other buildings and railway demanded
great care in demolition and that the time taken on the work was not excessive,
and that the use of special equipment was justified by the circumstances. It
was submitted by the Council that the value of salvable material was controlled
by the market for it at the time the demolition was in progress, — the material
had no value if it could not be sold.

The cost of coke for a fire and soap for washing were other points in dispute,
but by far the most interesting issue was with regard to the erection of a timbered
fence to protect the site against trespass by children. The Council submitted
that trespass of children upon the site was such a likely thing to happen that
danger from the defective railings could be anticipated, and that the Council
had only done that which a prudent owner would do. The case of Davis v. St.
Mary's Demolition and Excavation Co. Ltd., was cited.

The Judge in summing up stated that he had to be satisfied that the apparent
high cost of demolition were expenses actually incurred by the Corporation
in the exercise of their default powers. Section 23, Housing Act, 1957 stated,
expenses “incurred” and not “reasonably incurred”. The Judge also said that
he was satisfied that the cost of erecting a fence could be properly included in the
cost of demolition if it could be shown, as it was in this case, that the absence of
fencing could lead to danger to children.

The Judge found for the Corporation with costs.

Houses demolished

The following table shows progress during the period 1955-1960 towards
the total of 10,000 houses. Some 5,044 houses have so far been dealt with:

1955

from
5th May

1956

1957

1958

1959

1960

Houses in Clearance Pre-war US']

1 1

Areas and already Post-war up > 211
covered by operative to 5.5.55. 73 J
Clearance Orders

—

or Compulsory Pur-
chase Orders.

Houses already in

Clearance Areas and

for which Clearance

Orders or Compul- Post-war up

sory Purchase Orders to 5.5.55. 56

have been submitted

to the Minister, but

have not yet become

operative.

—

Number of houses Pre-war and"!
subject to operative post-war up >238
Demolition Orders, to 5.5.55. J

—

115

Total demolished

152

Houses represented — Clearance Areas

537

1215

1191

371

143

135

Demolition Orders made

Certificates of Unfitness — Houses

owned by Corporation

Undertakings given by owners to

—

189

118

demolish

—

Unfit houses voluntarily demolished

by Corporation and others

—

Grand Totals 607 1503 1603 619 344 368

Bridging the Gap

The period between the declaration of a Clearance Area and the rehousing
of the occupants can prove very difficult. The gap has to be bridged.

Whilst occupants normally, with the hope of better things to come wall
bear with fortitude and understanding a great deal of inconvenience and mental
disturbance, circumstances do arise where in the interest of public health, action
has to be taken, either by rehousing the family or requesting the owner to spend
money on temporary repairs.

When danger is involved of course the occupants’ safety must be the prime
consideration and rehousing is effected with or without the owner's undertaking
not to relet. The position is much more difficult, however, where normal
urgent nuisances are involved. It is wrong that a tenant should be asked to
suffer unsatisfactory conditions for an undefined period; equally it is undesirable
that an owner should be requested to spend money on property where active
steps have been taken for demolition. The service of Public Health Notices,
though legally justifiable, may result in Court action and ultimately the carry ing
out of default works by the Corporation — all this against the background of
ultimate demolition.

The problem is not a new one of course, but it has been rendered the more
acute by the Corporation’s policy of acquisition by negotiation. Some houses
indeed are purchased much more quickly that they would be if orders were made,
but there always remains a hard core of houses where the end of the road cannot
be estimated.

Housing and Sanitation

1959

Houses Inspected; —

Section 9

I960

140

Section 16 . .

171

126

Clearance Area

10,310

Visits for improvement grants, estimated life and other

8.739

matters

Represented to Committee; —

Section 9

140

Section 16

171

209

Clearance Area

135

Orders made; —

Demolition Order — (Section 17, Housing Act, 1957)

Closing Orders — Whole house (Section 17, Housing Act,

1957) ^ . .

Closing Orders — Whole house (Section 17, SS. 3, Housing

Act, 1957)

Closing Order — Underground rooms and parts of build-

ings (Section 18, Housing Act, 1957)

Closing Orders substituted for Demolition Orders —

(Section 35, Housing Act, 1957)

Undertakings to repair accepted— (Section 16, Housing

Act, 1957)

Undertakings not to use— (Section 16, Housing Act, 1957)

Undertakings to demolish — (Section 3 SS.4 Financial
Provisions Act, 19 5S)

Houses Repaired ; —

Section 9 — informal . .

—

Section 9 — formal

—

Section 9 — formal by Corporation in default

—

Undertakings to repair

Undertakings not to use, cancelled after repair . .

Other repairs

Closing Orders determined after repair

—

Demolition Orders cancelled

—

Certificates of Disrepair

Revocation of Certilicates of Disrepair

Refusal of Certificates of Disrepair

—

FOOD INSPECTION

Slaughtering Facilities

The reports to be made under the Slaughterhouses Act, 1958, have made
their mark in Bristol this past year. The Public Abattoir and Hotwells Lairs
continue to supply the needs of the butchers in and around Bristol. Of the four
private slaughterhouses attached to the bacon factories, one has ceased to operate.
Considerable works were necessary to bring it up to standard, and factors such
as the age of the occupier, the shortage of pigs and the cost of a new lease
persuaded the occupier to close down. The other three slaughterhouses, are
all in need of alteration to comply with the Regulations, but in the absence of
an appointed day for compliance with the Regulation, work is progressing very
slowly. All have provided locked accommodation for condemned meat. Pigs
for the bacon trade are still in very short supply and it is difficult to determine
whether it will be an economical proposition for the bacon curers to carry on.

The total number of animals slaughtered in the City shows a decrease of
approximately 19T per cent (132,878 to 107,372). This decrease is due to the
continued drop in the number of pigs slaughtered, 26-9 per cent (43,087 to
31,463). The drop in the number of sheep slaughtered, 34 05 per cent (69,110
to 45,573) was expected because the dry season of 1959 compelled farmers to
send in large numbers of sheep for slaughter and this was bound to be reflected
in this year’s kill.

Cattle slaughtered showed a welcome increase of 38 -98 per cent (18,030 to
25,059), with the principal increase occurring at Hotwells Lairs of approximately
76 per cent (5,717 to 10,063), and a satisfactory increase of 21 -7 per cent (12,313
to 14,996) at the Abattoir. Most of the increased kill at Hotwells Lairs was due
to the large influx of Irish cattle, amounting in all to 2,726 animals or 27-08
per cent of the total kill. Of the 14,996 cattle killed at the Abattoir, 1,300 or
8 -6 per cent were Irish.

The effect of the Tuberculosis Eradication Orders of 1958/59 is now
becoming apparent. In 1959, the percentage of cows and other bovines found
to be affected with tuberculosis on post mortem examination was 7-89 per cent
and 2-29 per cent respectively. This shows a considerable decrease but when
the figures are split up into English, Irish and Reactors, the picture is even more
favourable. Of the total kill of 25,059 cattle, 20,856 were English with 16
affected with tuberculosis or 0.07 per cent; Irish kill totalled 4,026 with 311
affected with tuberculosis or 7.72 per cent, and Reactors 177 killed with 115
affected with tuberculosis or 64-6 per cent. If this decrease is maintained
throughout the country it would appear that tuberculosis in cattle will soon
be eliminated. It also appears that with the eradication scheme fully operative,
the general condition of all bovine animals has improved. This is shown by
the decreasing number of animals found to be unfit for human consumption.
One result of this is that it makes the collection of material for veterinary
student examination purposes exceedingly difficult and specimens have to be
cold stored for varying periods before the examinations are held. Calves
slaughtered showed an increase of approximately 20 per cent (2,647 to 3,273.)

Animals affected with Cysticercus Bovis, show an increase (0-54 per cent to
0-98 per cent), (99 to 247). Broken down, the increased number of cows affected
is 0-43 per cent to 0-63 per cent, and steers and heifers from 0-64 per cent to
1 -25 per cent. It would appear that the increase is due to the high incidence
found in the Irish cattle. Of the 4,026 Irish cattle killed, 104 were affected
(including one case of generalised affection) or 2-58 per cent. Of the 21,033
English cattle killed, 143 were affected, or 0-67 per cent which compares very
favourably with last year’s figure of 0-54 per cent when very few Irish cattle

were killed. With the exception of the generalised case, all carcases were
submitted to cold storage treatment and subsequently released for sale for
human consumption.

Public Abattoir, Gordon Road, Whitehall

The Health Committee decided upon the introduction of charges for Chill
Room storage from April 1st. The original intention regarding the Chill Room
was that storage facilities, up to a limited period, should be given free as part
of the Abattoir service. It was found, however, that in some cases excessive
use was being made of this facility, resulting in severe congestion of accom-
modation and difficulties in connection with hanging equipment.

It was, therefore, decided that a reasonable period of three days for free
Chill Room storage should be given, after which charges would be made. A
simple system of indicating on each caracse the date of slaughter was adopted
and a daily check made of all meat hanging in the Chill Room to ascertain what
charges, if any, are due, on removal. Since the inception of this scheme the
difficulties previously experienced have been substantially reduced.

Slaughterhouses, including Bacon Factories

The year 1960 will go down in history as an important year for the owners
and occupiers of slaughterhouses. Under the Slaughterhouses Act. 1958, all
local authorities were charged with the duty of inspecting all slaughterhouses
within their areas and submitting their reports to the Minister not later than the
2nd November, 1960. Particulars of the reports were standard for the whole
country but the detailed reports submitted to the owners of the slaughterhouses
did not have to be reproduced in the report to the Minister. All local author-
ities, when submitting their reports, were required to recommend a day for full
compliance with the Regulations. Many meetings and discussions were held
during the year and, because of special difficulties, the Committee finally agreed
to recommend July 1965, as the date for full compliance with the Regulations.

Hotwells Lairs

The above mentioned date was determined through the expiration of the
lease at Hotwells Lairs. To integrate the Company using Hotwells Lairs with
slaughtering procedure at the Public Abattoir means considerable re-building
and re-organization, and meetings have been held to determine how this could
best be accomplished. The cost of making Hotwells Lairs comply with the
regulations is economically impracticable, having regard to its limited life as a
slaughtering centre. However, under the Prevention of Cruelty Regulation.
1958, stunning pens must be provided in all cases where adult bovine animals
are slaughtered, and as the last day for compliance with this Regulation is the
1st day of January 1963, consideration is being given to the provision of three
light-weight stunning pens. Locked condemned meat room accommodation
is being provided and some floors re-concreted. The existing mess rooms are
being removed and accommodation for the slaughtering staff is being provided
in the disused canteen.

Improvements to the three bacon factories are progressing slowly and it is
hoped that the increase in the sow population will reflect an increased kill at
the bacon factories with earlier completion of the Hygiene Regulations in con-
sequence. The improvements to the lighting system at the Public Abattoir has,
as yet, not been attempted, the reason being that an overall reconstruction is
proposed, and the lighting arrangements would be attended to when these
proposals are carried out.

The Abattoir was again extensively used for lectures and demonstrations
to students taking one of the many courses held in Bristol, viz: — Diploma in
Public Health, 4th and 5th Year Veterinary Students, Second Year Public
Health Inspectors Trainees and the Meat & Other Foods Inspectors’ Course.
Many students, doctors and foreign visitors have been taken over the Abattoir
and have commented favourably on the standard of hygiene prevailing there.
It is hoped that in the reconstruction programme a suitable lecture and dem-
onstration theatre will be provided. Such a room would also be useful for the
occasional Health Committee meetings held at the Public Abattoir.

Meat Inspection

It is pleasing to record that a 100 per cent meat inspection service was
provided during 1960 at the various slaughtering points. Fully qualified meat
inspectors are always on duty at the Public Abattoir and Hotwells Lairs, assisted
by full-time trainees who keep records and generally assist in the slaughterhouses.
Peak slaughtering periods demand extra assistance and this is made available
when required. Following the death last year of Mr. R. Brooks, Meat Inspector
at Hotwells Lairs, Mr. A. D. Soloman undertook the duties of full-time meat
inspection and is doing an excellent job. Sunday slaughter has been fairly
consistent at Hotwells but only on very isolated occasions at the Public Abattoir.
The sudden increase in slaughtering during October— December called for two
inspectors to be on Sunday duty at the Lairs and a rota was worked successfully,
with Mr. Howick from the Abattoir co-operating as required.

Farious specimens have been submitted for confirmation and diagnosis to
Dr. H. R. Cayton, Director of Public Health Laboratory Service, Canynge Hall,
and our thanks are due to him and his staff. The value of this type of service
can be gauged from the results of samples sent in from a cow slaughtered at
the Abattoir. The animal was a casualty cow and the lesion on the peritonium
and lymphatic nodes in general appeared to be a typical tubercular infection,
and as the animal was from an area which had already been attested, it was
decided to submit specimens to Canynge Hall. Their diagnosis of general
multiple adeno carcinomatosis did not alter the decision as to fitness for food
for human consumption but it did mean that veterinary inspectors of the Animal
Health Division were not involved in re-testing the herd for tuberculosis.

Another very interesting case occurred at Hotwells Lairs. Acute lesions
were found all over the entire surface of the back of a heifer, penetrating fairly
deeply into the tissue, and appeared to resemble one of the Actinomyces. This
was confirmed by Canynge Hall as Actinomyces Bacillus Lignieresi and the
condition was so unusual that a short paper with photographs may be prepared
on the case.

A total of 962 specimens of meat from bacon pigs were submitted to Dr.
H. D. Crofton, Zoology Department, University of Bristol, for the detection
of the parasite Trichinella Spirallis. Fortunately, no positive results were
obtained from the digestion test and microscopical examination of the specimens.
The total number of specimens submitted during the past few years now amounts
to over 3,000 with only five positive results during this period. The results,
prove that at present no routine test for Trichinella Spirallis is called for. This
work is a voluntary effort on the part of Dr. Crofton and thanks are expressed
to him for carrying out these and other tests and for his offer to examine any
specimen submitted to him.

The system of meat marking introduced last year has been continued
throughout the year. To obtain sufficient relief at the Abattoir and Hotwells
during holidays and peak periods, it has been necessary to arrange for district
inspectors, approved by the Minister, to hold and use a numbered stamp. It

lYI'lfAl (jKANUI AR I.ISIONS OI A( IIN() HA( II I us I KiNIIKISI Sll()\VIN(i 1)11*111 ()l
Pi NIFKA I ION IN If) M US( Ul A I UKI . ( I MMI I )l A 1 1 I V AHOVI KuIIK)

Lesions of Actino Bach eus Lignifrlsi on the Back of a Bovine Carcase Showinc;
THE Depth of Penetration into the Musci e (see Point of Knife)

must be remembered that affixing the stamp to any carcase indicates that on
ante- and post-mortem examination no evidence of disease has been found. This
fact makes it necessary for the inspector to be always on duty while killing is in
progress, and means that the meat inspector has to be prepared to start work
at varying times to suit the slaughtering unit.

Meat Depots

All meat depots in the Old Market Street area now have deep freezing
units capable of holding imported frozen meat and offal. Most of them also
recently installed band saws for cutting up this class of meat to give a better
service to butchers. Imported chilled and frozen meat, as well as fresh meat
from all over the country, is regularly received in these depots. With the excep-
tion of some Yugoslavian pork loins, and shoulder pieces, and one stack of
frozen lamb carcases, very little trouble was experienced during the year. Trim-
ming is at times resorted to and the occasional broken bone with diffused bleeding
is found, but specific cases of diseased meat have been entirely absent this year.
One new depot is in course of construction and from the plans the premises
should attain good hygienic standards.

Meat Transport

The pattern of this supervision has been much the same as in previous years.
Early morning visits are regularly made and a census of vehicles using the
Abattoir during one average week was prepared for future reference. No
prosecutions for contravention of the Hygiene Regulations in connection with
meat transport, were instituted during the year, but warnings were sent in some
cases.

Canteens

A number of spot visits were paid to the kitchens of the School Meals
Service but very little trouble has been experienced this past year, although
suppliers vary each time a fresh contract is awarded. In the event of any doubt
about supplies received at any particular canteen a phone message enables the
matter to be dealt with promptly.

Knackers Yards

Two premises are licensed as Knackers Yards in the City, but very little,
if any, slaughtering has taken place at these premises. It is much easier to
transport a dead animal and in the majority of cases animals received have been
slaughtered elsewhere and not at licensed premises within the City.

Piggeries

Local authorities have, since 1957, been charged with the responsibility
of enforcing the provisions of the Diseases of Animals (Waste Foods) Order.
Staff difficulties have prevented a systematic and routine inspection of the class
of premises mentioned in the Order, but reorganisation carried out during
April enabled the number of visits made to be stepped up from approximately
160 in 1959 to nearly 300 during 1960. This was achieved by arranging for one
of the inspectors assisting in meat inspection at the Abattoir, to spend the equiv-
alent of two days a week for these visits.

The number of recorded small holdings in the City has fallen from 85 to 55.
Of the 30 that closed, due to demolition of premises or for other reasons, 7 were
previously licensed to boil swill.

The 55 small holdings in the City are sub-divided as: —

Licensed to

No. Use Boil Swill

11 Keeping poultry only 2

15 „ pigs only 7

29 ,, ,, and poultry 15

Of the 31 unlicensed small holdings, eight may be licensed in the near future
but the recommendation for licensing has not been approved to date because of —

(a) Construction defects.

(b) Change of feeding materials.

Most of the piggeries are only of part-time occupation and it is, at times,
difficult to find the occupier on the site to register specific complaints. Piggeries
on land owned by the local authority are now of reasonable standard, and where
trouble is experienced, reference to the appropriate department has the desired
result.

Pet Shops

In July 1960 new regulations entitled The Meat (Staining and Sterilisation)
Regulations, 1960, were introduced and came into operation on the 1st Novem-
ber, 1960. These regulations control the disposal of unfit meat from slaughter-
houses or knackers yards and require that all unfit meat from a slaughterhouse
must be sterilized on the premises. By arrangement with the local authority
this class of meat can be moved to a recognised processor for treatment, and as
no slaughterhouse in the City has the equipment to treat this class of meat, the
local authority agreed to allow the two processors in the City to remove this
unfit meat for treatment provided it was adequately stained. Meetings were
held with the processors concerned and it was agreed that stain, in sprays,
would be kept on the lorry to stain unfit meat collected from the slaughterhouse.
The managements of knackers yards have an obligation to stain or sterilise all
meat sold from the premises.

The owners of pet shops have been visited and the regulations explained
to them. Very few are selling this class of meat, but where it is so sold all
shopkeepers are supplied with a stain by the pet meat wholesalers so that the
meat can be re-stained just prior to sale over the counter. Many pet shops
are now selling imported boneless horse flesh, of which there appears to be a
continuous supply. Correspondence is going on with the Ministry concerned
to try and determine whether this horse flesh is, in fact, fit for human consump-
tion. The Public Health (Imported Meat) Regulation does not define horse
flesh, and consequently official certificates are not required for fitness. If this
horse flesh receives suitable examination in the country concerned to be able
to determine its fitness for food for human consumption, then no further action
will be required in this country. Failure to determine this fact could mean that
all this imported horse flesh would have to be treated as unfit for human con-
sumption and would then have to be either stained or sterilized, depending
upon whether the animal was slaughtered in a slaughterhouse or a knacker's
yard.

Cold Stores

Regular routine visits are made to the Cold Stores in the City and the
general standard of hygiene of the premises is good. New regulations came
into force this year giving control over this class of premises, which had always
been excluded from the earlier regulations.

Legislation

New legislation affecting Meat Inspection which came into operation this
year includes : —

The Meat (Staining & Sterilization) Regulation, 1960.

The Movement of Animals (Records) Order, 1960.

The Authorised Officers (Meat Inspection) Regulation. 1960.

The Food Hygiene (General) Regulation, 1960 — which replaces The Food
Hygiene Regulation, 1955 — 1957.

The Food Hygiene (Docks, Carriers etc.) Regulations, 1960 — which
controls premises exempted from the General Regulations.

Inspection of Meat and Other Foods

1959 Visits:

1960

1,465 Slaughterhouses and bacon factories

1,251

50 Butchers’ shops

2,767 Fish shops

2,781

43 Food preparing premises

121

1,201 Meat markets

1,211

— Street traders

—

213 Schools/Institutions

197

224 Cold stores

226

557 Other premises

527

160 Piggeries

298

Fish and Canned Foods Condemned

Fish

Other Foods

Tons cwt. qrs. lb.

Tons

cwt.

qrs. lb.

1959 .. 10 18 3 26

1 13

1960 ..6 1 3 15

1 21

Meat Inspection — Animals Examined

1959

I960

Hotwells Bacon

Hotwells

Bacon

Lairs Abattoir Factories Total

Lairs

Abattoir Factories Total

and City

5,717 12,313 — 18,030 Beasts

10,063

14,996

— 25,059

662 1,985 — 2,647 Calves

609

2,664

— 3,273

43,003 26,107 — 69,110 Sheep

22,456

25,117

— 47,573

16,887 14,070 12,130 43,087 Pigs

11,787

12,022

7,654 31,463

— 4 — 4 Goats

— 4

66,269 54,479 12,130 132,878

44,917

54,801

7,654 107,372

Total Weight of Meat Condemned

1959

1960

Tons

cwt. qrs.

lb.

Tons

cwt. qrs.

lb.

11 1

27 Hotwells Lairs

6 0

131

5 2

7 Abattoir

2 1

3 0

18 Bacon Factories

8 0

2 2

22 Butchers shops and City

6 0

213

2 3

134

2 3

1959

Meat destroyed from : —

1960

Tons

92-69

Slaughterhouses and Shops

75-87

131-73

Abattoir

68-14

—

Cold Stores

—

43-49

Fish, poultry, vegetables, etc.

41-81

Carcases and Offal Inspected and Condemned in Whole or in Part

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Weight Carcases 29193 9548 19895 11930 91862 18501 45391 15118 1578 291 2841 2356 122633 28340 68127 29404

in lb. Part carcases 1630 2184 1976 757 1488 337 2635 1610 82 45 211 141 3200 2566 4822 2508

Schedule of Whole Carcases and Part Carcases Condemned
indicating Disease or Condition

Steers and

Cows Heifers Calves Sheep Pigs

Part

Car-

case

Abscess

Actinomyces . .

Arthritis

Bruising

Corynebacterium

Emaciation . .

Fevered

Immature

1 1

Jaundice

Johne’s Disease

Lymphadenoma

Malignant \

Neoplasms /

Mastitis

Metritis

Moribund

Cysticercus "1

Bovis /

Oedema

Pericarditis . .

Peritonitis — Septic . .

Pleurisy

Pleurisy — Septic

Pleurisy — Peritonitis

Pyaemia

Pneumonia Septic . .

Septicaemia . .

Swine Fever . .

Toxaemia

! ! 1

Urticaria

Uraemia

! 1

Total

1 1

Tuberculosis . .

Grand Total

Cattle affected with Cysticercosis: —

Cows 67; Steers and Heifers 180 = Total 247

MILK AND FOOD INSPECTION

Legislation

The Milk {Special Designation) Regulations, 1960

These replace two earlier sets of Regulations governing Tuberculin Tested,
Pasteurised and Sterilised Milk. Principal amendments are that licences to
use the designations are now valid for five years instead of one. Supplementary'
licences to enable a dairyman to trade in an area other than that of the licensing
authority are abolished and the statutory tests of designated milks are changed.

The Food Hygiene {General) Regulations, I960 and The Food Hygiene
{Docks,Carriers, etc.) Regulations, 1960.

The former are amendments of the 1955 Regulations and the latter embraces
food handling at places previously excluded from the earlier Regulations.

The Public Health {Infectious Diseases) Amendment Regulations 1960

These Regulations amend the 1953 Regulations by the inclusion of anthrax
as a notifiable disease.

The Fertilisers and Feeding Stuff's Regulations, I960

The Regulations amend the methods of analysis of these commodities.

The Tuberculosis {England and Wales Attested Area) Order, I960

This Order is a landmark in the campaign against bovine tuberculosis.
Under the Order, the Ministry of Agriculture, Fisheries and Food, . . . “ is
satisfied that tuberculosis of cattle is for practical purposes non-existent*' . . .
in the whole of England and Wales, with certain minor exceptions. In con-
sequence all dairy herds in the country became subject to the requirements
imposed in Attested Areas.

Matters of Special Interest

Coconut

Following reports of the discovery of food poisoning organisms in imported
desiccated coconut in other parts of the Country, a considerable number of
samples were secured from local bakeries and bakers' sundriesmen.

In a few cases positive results were reported and steps were taken to ensure
satisfactory treatment of the consignments before distribution. The same
action was taken in respect of imports to Avonmouth, destined for City ware-
houses, upon which the Senior Port Health Inspector had received adverse
reports.

Fish Products

Fish cakes and similar fish products came under suspicion as being, in
some cases, infected with staphylococcus aureus and in consequence samples
were secured from retailers and from a local cold storage warehouse.

A conference between the Medical Officer of Health and representatives
of one of the manufacturers was held and their methods of production were
explained. Sampling of these commodities continues in order to be certain
that improvement will ensue.

Alcoholic Sweets

Imported toffee containing whisky or rum was submitted to the Public
Analyst who found, in one sample, 12 per cent proof spirit. As this was con-
sidered rather considerable if consumed by a child, the Public Analyst

communicated with Customs and Excise Department and it was revealed that
steps had been taken to confine future sales of this article to licensed premises.
Subsequently, this became headline news in one of the national daily papers.

Odorous meat pies

A baker approached the Public Analist for advice in regard to a very
objectionable odour in a large number of meat pies he had made the previous
day. Investigation by the District Inspector revealed that the ingredients
included imported dehydrated onion, leading to a suspicion of the use of ex-
cessive sulphur dioxide preservative. Samples of onion heated in the laboratory,
resulted in the odour complained of and it was concluded that there was a
breakdown of the amyl sulphide naturally present in the onion.

The baker was satisfied to have found the cause of the trouble and ceased
using this onion.

Complaints

The number of complaints made by the public about articles found in food
does not diminish. A common one is in respect of rodent excreta in bread
which usually turns out to be burned dough.

"‘‘Rat's Paw" in pancake

The most striking complaint received for a long time was made by a woman
who found what appeared to be a “rat’s paw” in her mouth whilst eating a home
made pancake. The usual ingredients had been used, together with raisins.
The Public Analyst’s report was of a “foreign body almost black in colour f"
long by J" wide, having a striking resemblance to a minute hand. Demonstrated
microscopically it proved to be of vegetable origin, possibly part of a seed
capsule”. The Professor of Botany at the University was consulted and he
reported it to be the pericarp of a fruit but positive identification was not possible.

The lady was justified in her supposition. A more realistic substitute
for a rat’s paw could hardly be made. It was concluded to have originated
in the raisins and the retailing Company's representative who saw the specimen
agreed to institute a more detailed examination of dried fruit when packing it
in their shop.

""Chewing gum" in tinned fruit

A lady purchased a tin of imported apricots and found, adhering to the
inside of the tin, what appeared to be a piece of chewed chewing gum. The
Public Analyst reported it to be an adhesive rubber with zinc oxide plaster.
The importers were informed. They undertook to take the matter up with the
packers and to re-imburse the complainant.

Oil in carrots

An unpleasant flavour in cooked carrots was reported from a school
kitchen. The Public Analyst confirmed an oily taint but could not isolate oil.
Enquiries revealed a probability that vaporised oil from a tractor, used on the
growing fields, may have penetrated the soil with some absorption by the carrots.
They were unpalatable but not unfit for consumption and the School Meals
Department were so informed.

Legal Proceedings

Ojfence

Selling meat unfit for human consumption
Smoking in a food room
Smoking in a food room
Foreign body in a bottle of milk

Result

Fine £25 and costs
Fine £2
Fine £2 2s.

Fine £75

In certain other cases warning letters were sent by the Town Clerk.

A shopkeeper who has been a listed seller of Part 2 Poisons for a number
of years, ignored repeated reminders to renew his registration. He was also
selling a Part 2 Poison incorrectly labelled. A summons for offences under the
Pharmacy & Poisons Act was withdrawn upon his compliance before the date
of hearing.

Milk

Chemical Analysis

Some 902 samples of milk were submitted to the Public Analyst. Sixty-
nine were deficient in fat but 46 of these were satisfactory on bulking and repeat
samples of the remainder were satisfactory. Later samples of the 9 found to
contain added water were also satisfactory; 7-64 per cent of all samples were
deficient in fat. Over one-third of the samples were “Channel Islands'* milk,
i.e., by contract with the Milk Marketing Board required to contain at least
4 per cent fat; 15-4 per cent of these were below that standard compared with
1 '92 per cent of milks not designated as “Channel Islands".

The decline in the non-fat solids content of milk has been of concern to
the dairy trade for some years and schemes are in operation to improve the
position. The percentages of samples taken in Bristol showing deficiencies in
non-fat solids have fluctuated: —

1956 6-21 per cent

1957 2-2 per cent

1958 2-1 per cent

1959 4-35 per cent

1960 1-55 per cent

It would not be safe however to assume from the apparent improsements
in 1960, that it is entirely due to the schemes mentioned above. Other factors
such as climatic and economic conditions have some bearing on the matter and
an assessment can only be made over a long period. Dairy companies exper-
ienced an increase in 1959 when there was a hot, dry summer.

It was not necessary to take legal action in respect of any milk samples
last year.

Biological Examination

Nine of the 451 samples submitted were infected with brucellosis; these
came from 6 producers. None was found to contain tubercle bacilli. In each
case the milk was consigned to a processing dairy.

Designated Milk

Four hundred and fifty-two samples of pasteurised milk and 22 of sterilized
milk were secured. None of the latter failed the statutory test but 1 1 pasteurised
milks failed to pass the phosphatase test. These were from 5 difl'erent processors.
Appropriate action was taken and repeat samples were satisfactory. Six
samples of pasteurised milk failed the methylene blue test. There were 14
failures of the methylene blue test of 206 samples of tuberculin tested milk.

With reference to vending machines, a total of 300 samples was secured
for the phosphatase or methylene blue tests or for chemical analysis. Five
pasteurised milks from machines and 8 tuberculin tested milks failed the meth-
ylene blue test. These are included in those referred to above. Six were below
the presumptive fat standard. From one machine an Inspector secured nothing
for his sixpence, and on another day he received a carton only half full. From
the same machine on another occasion, a carton of milk turned sour in the
laboratory the next day. The operators were advised in all these cases and
repeat samples were satisfactory.

Ice Cream

A development in Bristol in the manufacture and sale of ice cream has
been the appearance of sales vans equipped with freezers, operated by an
engine sited at the rear of the van. Ice cream mix is made in the factory, stored
in closed containers in a cold cupboard on the van and fed into the freezer as
required. It is served direct from the freezer and gives a softer ice cream than
the factory-made type which undergoes a period in a hardening room. Many
people prefer this ice cream to that to which they are accustomed.

Freezing is a necessary part of manufacture and when done on “premises"
the latter are registrable. Vans, not being “premises", are not registrable.
The vans from which soft ice cream is being sold in Bristol at present are com-
pletely satisfactory but it is open to an operator to purchase ice cream mix
and to freeze it in a van under conditions which are less desirable.

All the 160 samples taken complied with the compositional standard and
they were graded as follows: —

1960

1959

Grade 1

119

115

Unclassified

160

204

Over 74 per cent attained Grade 1, compared with 56 per cent in 1959.

Medicines and Drugs

Seven hundred and twelve samples of medicines and drugs were submitted
to the Public Analyst. Although repetition of sampling of the common varieties
is unavoidable, it serves the purpose of keeping retailers and manufacturers
aware that products available without a medical prescription are under scrutiny
as will be seen from some of the typical faults found in samples secured during
the year. A constant watch is kept for samples of new products available to
the public.

Phenolated iodine
Tincture of quinine
Rennet

Charcoal tablets
Seidlitz powders
Tincture of iodine
Halibut liver oil
Sal. volatile
Powdered ginger
Gripe mixture . .
Tartaric acid . .

Ingredients deficient. Manufacture discontinued 4 years ago.
Deficient in ammonia.

Contained prohibited preservative.

Incorrectly labelled.

Incorrectly labelled
Deficient in potassium iodide.

Deficient in vitamin A.

Deficient in ammonia.

Contained exhausted ginger.

Badly dispensed.

Was citric acid.

A letter of appreciation was received from a well known company for
having drawn their attention to a defective method of corking their bottles of
halibut oil, resulting in loss of vitamins.

Pharmacy and Poisons

Fifty-one amples of articles likely to come within the control of thQ Pharmacy
and Poisons Act, 1933, were obtained.

There are 471 persons on the local authority’s list of those selling Part 2
poisons and 716 visits were paid to their premises during the year.

In 1959, formic acid was added to the list of Part 2 poisons. During 1960,
it was found that certain types of adhesives to which the formic acid in the outfit

had to be added, were on sale at Model shops, garages, cabinet makers, iron-
mongers and tool shops. Twenty-three retailers who were not “listed” sellers
of this Part 2 poison were found.

Several samples of caustic soda were found to be improperly labelled.
The wholesalers were advised and the matter was rectified.

During the year a number of articles have been purchased to ascertain
whether they are or contained scheduled poisons. In some cases they are
outside the scope of the Act but useful work is performed by such sampling
as is evidenced by the purchase of a stain remover. The Public Analyst's
report included “. . . a general observation on this type of collapsible tube
pack is the danger of mistaking it for toothpaste or some foodstuffs which
are now similarly packed”. Attention was also drawn to the inconspicuous
nature of the word “inflammable”.

The manufacturers were advised of these comments and as a result they
stated their intention of improving the pack and the warning.

Sampling at Corporation Establishments

One hundred and twenty-four samples of milk were submitted from schools
and 498 samples of foods were secured from school kitchens. Plant defects
were the cause of test failures in respect of 5 samples of milk. Steps were taken
to rectify matters at the dairy.

Fertilisers and Feeding Stuffs

Forty-nine formal and 107 informal samples of fertilisers and of animal
feeding stuffs were submitted.

The 24 minor infringements of the Fertilisers and Feeding Stuff's Act and
Regulations, were dealt with by letter and repeat samples and no legal action
was required.

Notices

Eighty notices and letters were issued in respect of infringements of the
Food Hygiene Regulations, the Shops Act, Weeds, etc. Forty-seven notices
were complied with and these included 11 outstanding from 1959.

Dairies and Milkshops, etc.

1959

Registrations

1960

Milk and Dairies Regulations, 1949

Dairies

631

Distributors

659

Food and Drugs Act, 1955

Manufacture, storage and sale of ice cream

1,394

Storage and sale of ice cream

1,455

240

Preparation of sausages or potted, pressed, pickled or
preserved food

245

137

Fish frying premises

120

—

Butter factories

—

Wholesale dealers in margarine . .

—

1959

Licences

1960

Quinquennial

Licences issued under the:

Milk {Special Designation) Regulations, I960

To process Pasteurised Milk . .

429

To sell ,, .

452

„ ,, ,, ,, (Supplementary licences)

—

To process Sterilised Milk

529

To sell

546

,, ,, ,, ,, (Supplementary licences)

—

To sell Tuberculin Tested Milk

,, ,, ,, ,. ,, (Supplementary licences) *

—

1,051

Grand Total . .

1,030

* Under the above-named Regulations, supplementary milk licences are no
longer required to be held by milk vendors who live outside the City but sell
designated milk within the boundaries.

Dairies

Samples

and Milkshops, etc.

Samples

not Samples

Samples

not

Taken satisfactory Chemical Analysis Taken

satisfactory

1959

1960

1,079

173

Milk

902

182

—

Ice Cream

158

—

2,171

Other foods

2,344

595

Medicines and drugs . .

712

—

Poisons . .

—

Rag flock

136

Fertilisers and feeding stuff's

156

114

Water (Baths) . .

105

—

Water (Other) . .

125

Miseellaneous . .

173

464

3 ,

Bacteriological examination : —

Milk T.B. exam: City . . . . 1

Somerset . . i

^ 451

218

Gloucestershire I
Other Counties J

Milk, pasteurised

328

—

Milk, sterilised . .

—

140

—

Milk, schools

124

180

Milk, T.T

206

204

Ice Cream

160

—

Plant tests

103

—

447

Churn and bottle tests

346

Shellfish

Water

124

173

Miscellaneous samples

322

684

Visits (Not Sampling)

Pharmacy and poisons

716

220

Dairies

177

297

Ice Cream shops

355

399

Other food premises

424

760

Butchers shops

926

Infectious diseases (except food poisoning)

317

Dysentery

765

223

Food poisoning

154

Noxious weeds

Rag flock

674

Other Visits

600

Notices

Informal notiees served

Informal notices complied with

—

Statutory notices served

—

Statutory notices complied with

—

Remedial Action

Premises altered and repaired

Premises cleansed and decorated . .

Other defects remedied (premises)

Hot water handwashing facilities provided

Heating provided

— •

Drainage — Drains tested

—

Drains repaired

—

Choked drains repaired

—

Water closets — Flushing appliances provided

—

New pans provided

Other repairs

Lighting provided

Other nuisances abated

Other Registrations, Licences, etc.

1959 1960

The Rag Flock and Other Filling Materials Act, 1951

3 Licences to store rag flock . . . . 3

30 Premises registered to use filling material . . 30

Pet Animals Act, 1951

33 Licences to keep a pet shop . . 27

Pharmacy and Poisons Act, 1933

466 Listed sellers of Part II poisons 471

Slaughter of Animals Act, 1933-1954

72 Licensed slaughtermen . . 72

Food and Drugs Act, 1955 — Section 62

4 Licensed slaughterhouses (Bacon Factories) . . 3

1 Licensed slaughterhouse . . 1

2 Licensed knackers’ yards . . 2

Public Health Act, 1936
Offensive trade — annual consent —

6 Premises . . 6

12 Trades . . . . . . . . 10

Statistics

Samples submitted to the Public Analyst 1st January to 31st December
1960:

1959 Sampled under the Food and Drugs Act : — 1960

2,948

Dry goods, spirits and drugs

3,241

1,079

Milk

902

4,027

Total

4,116

114

Water, swimming baths

105

Water, other

Filling materials

136

Fertilisers and feeding stuff’s

156

Poisons — Part II

125

Miscellaneous

173

498

Total

583

4,525

Grand Total

4,699

Samples submitted to the Bacteriological Laboratory
1st January to 31st December, I960

1959

Milk:—

1960

464

Tubercle examination

451

180

Tuberculin tested

206

218

Pasteurised

328

140

Pasteurised (schools) . .

124

Sterilised

204

Ice Cream

160

Water

124

Plant tests

103

447

Churn and bottle rinses

346

Shellfish

173

Miscellaneous

322

2,073

Total

2,247

Adverse reports were received from the Bacteriological
ect of the following samples:

Laboral

1959

Milk:—

1960

Tuberculous*

T.T

Processed

Ice Cream — Grades 3 and 4

—

Plant tests

—

Churn and bottle rinses

Shellfish

Water: —

—

Baths

—

Other . .

* Includes B. Abortus

Appropriate action was taken in all of the above cases.

Food Hygiene Regulations

The Food Hygiene Regulations, 1955-1957 were revoked and replaced
by the Food Hygiene (General) Regulations, 1960, and the Food Hygiene
(Docks, Carriers, etc.) Regulations, 1960. The Food Hygiene (General) Regu-
lations deal with all food premises in the same manner as the previous Regulations
but they have been extended to bring within their scope the handling and
service of food on particular home going ships and certain other vessels. The
ships and vessels to which the Regulations apply are in the main passenger
ferries and river and coastal excursion vessels.

The new Regulations contain a number of amendments made in the light
of experience gained during the operation of the original Regulations during
the past five years.

The Food Hygiene (Docks, Carriers etc.) Regulations are designed to
meet a long felt need for legislation to cover these undertakings as they were
exempted from the operation of the Food Hygiene Regulations, 1955. By and
large it can be said that these Regulations enact the same requirements for the
clean handling of food upon the docks and other undertakings to which they
apply as are contained in the Food Hygiene (General) Regulations relating
to other premises.

Public Swimming Baths

There are 12 public swimming baths in the City. Of these 11 are owned
by the Corporation and are under the control of the Baths Committee. Ten

of the baths are of the closed type and the remaining bath is an open-air swim-
ming pool. The open-air bath and two of the indoor baths are closed for
bathing purposes from October to March of each year.

The water source for all Corporation baths is mains supply and by reason
of constant topping-up to compensate for normal water loss, adequate water
changes are ensured. All baths water is treated on a continuous basis, varying
from a to a 4 hour cycle for closed baths and every five hours in the open-air
bath. Treatment in all cases consists of rapid pressure filtration, aeration, and
break-point chlorination. Thermal storage or steam injection is employed
in all closed baths for water heating and soda ash treatment ensures suitable
alkalinity of the water in all cases. Field tests are taken at intervals throughout
each day by Bath Superintendents to check on the residual chlorine figure.

The non-Corporation bath consists of a lake whose depth varies from 20' to
40' and has an estimated water capacity of 31,000,000 gallons. Water change
is continuous, the lake being fed by a number of below-water-level springs.
The water in the lake is clean and clear in appearance and since treatment is
impracticable for such a large body of water, natural purification is relied upon.

Public health inspectors take monthly chemical samples of the waters of
all public swimming baths. During the year under review all samples were
satisfactory. No bacteriological sampling is carried out.

ATMOSPHERIC POLLUTION

It is now two-and-a-half years since the Clean Air Act became fully operative.
In that time the public and industry cannot have failed to have been touched
in some respect by the many exhortations and references to the necessity of
cleaning the air we breathe. That beneficial action has resulted is evidenced by
the fall in the air pollution deposit gauge readings over the past four years.
It is hoped, with the increased acreage of Smoke Control Areas operative, that
the figures will fall even more, especially the level of floating pollution. In
connection with the measurement of this suspended pollution — which of course
is what we breathe — it is interesting to record that Bristol is one of a number
of selected local authorities, who will be co-operating with D.S.I.R. in a national
survey of the measurement of “floating” or aerosol pollution.

There is no doubt that domestic smoke is now the main overall cause of
the atmospheric pollution in Bristol. The daily measurement of air pollution
mentioned in the previous paragraph will be carried out in 1961 on a larger
scale than hitherto, and will, surely give real evidence of the beneficial effects
of existing Smoke Control Areas and also the need for smoke control in other
areas. Apart from the reduction in the quantity of house coal in use as a result
of smoke control there appears to be a voluntary change-over by householders
from the use of house coal to smokeless fuels. In 1957 approximately 250,000
tons of house coal was used in Bristol, the figure for 1960 was approximately
225,000 tons.* Another change in fuel trends that may have repercussions,
and which is causing concern to many sanitarians, is the increased use of fuel-oil
industrially and commercially. The lighter distillate oils are not involved,
but the heavier residual fuel oils, even with blending, can have a relatively high
sulphur content and sulphur dioxide measurement readings are likely to rise.

The increasing volume of vehicle exhaust fumes discharged at low level in
our streets, is a problem that still has to be tackled; whether as a public health
problem or traffic problem, it should not matter, so long as the achieved end

*This figure is a weighted assessment.

is the same. The presence of this type of urban pollution is repeatedly used as
a red herring pulled across the path to smoke control. Nevertheless the nuisance
and probable dangers to health caused by these vehicular fumes certainly warrant
a full investigation into their prevention.

So much pollution in the past has been caused by new processes and
industries being introduced without proper regard to the possible production
of waste products — gaseous, liquid and solid — and their proper disposal. In
many cases, it was not always known what nuisance might be caused, but in
others it was obvious that certain emissions would occur but nothing was
really done to control their dispersal until the Public Health Department
investigated as a result of complaint. Because of their co-ordination with the
Planning Department a great deal is done in Bristol by the Public Health
Department to avoid subsequent nuisances when new factories are to be erected.
At the planning approval stage the plans of the new factory are checked by the
public health inspectors and any doubts about certain processes are allayed or
subject to constructive criticism. More detailed remarks about this aspect of
the Department’s work are included in subsequent chapters. Within the scope
of the existing methods of power and heat production, it is obvious that some
degree of air pollution will be always with us. It is the important duty of Health
Departments to see that it is a minimum degree.

Smoke and Grit Emissions

During the year fifty-two complaints regarding smoke, fume and grit
emission were dealt with. These complaints were in connection with the follow-
ing sources —

Industrial chimneys 20, Ships 1, Oil-fumes 3, Burning of rubbish 15,
Burning of old cars 7, Burning of wood waste 3, Burning of grass 2, Chimney
in Smoke Control Area 1.

Some of these were not direct complaints by the public but resulted from
the observations of District Inspectors on routine inspection of their districts.
Most of the industrial emissions were odd occurrences and did not necessitate
more than a visit and caution given to the firm concerned. One oil-fired boiler
plant gave rise to smut emission, usually on lighting up after the week-end
shut down. This condition was cured by reducing the heating efficiency of the
plant. This seemingly surprising measure was used because of the design
lay-out of the boiler plant, which consisted of an oil-fired Economic Boiler
with automatic modulating flame burner, plus a free-standing economiser.
The chimney was a brick one, connected to the boilerplant by a relatively short
metal flue. The heat transfer was exceedingly good, evidenced by the flue-gas
temperature at the economiser outlet being as low as 302°F. Normally oil-
smuts are due to the cooling of the flue-gases in the chimney, but in this case
the flue-gases were already approaching dew-point. The answer was to by-pass
the economiser, thus giving a higher flue-gas temperature at the chimney base.

One very big factory using a large quantity of coal each week, was the
source of a widespread grit nuisance. The factory boilers are equipped with
chain grate stokers, and multi-cell centrifugal grit arrestors and normally gave
no trouble. Early one morning a flap-valve on the arrestors became stuck
and grit was dispersed over a large area of domestic property. Following
discussions and correspondence with the Chief Engineer, the firm not only
tightened up their arrangements for checking the grit arrestors, but also, the
National Coal Board were brought into the discussion because of the high degree
of fines in the coal delivered.

The disposal of grass cuttings on a large scale, can be a problem even in
dry weather, but during the wet summer of the past year, the disposal of the

cuttings in the City not only was a problem but caused nuisance. There is no
outlet for the grass and the space needed for composting is so great as to make
the measure an impracticability. Burning on the site is, therefore, resorted to,
and if the grass is properly dry and burnt under proper supervision, makes a
minimum of smoke. During the wet weather of last summer the grass was very
rarely dry and on being burnt, only smouldered often through the night, causing
justifiable complaint.

In this affluent age more and more cars are being bought and more and
more old cars are being scrapped. To recover any useable metal can be a
tedious and time consuming job if dismantling is resorted to, and scrap dealers
realise it is easier to burn away unwanted materials from broken car bodies.
The seven complaints about smoke from the burning of old cars were mainly
in connection with cleared sites, where dealers had appropriated space for
parking the old cars. The problem is one that will have to be kept in mind,
not only because of air pollution, but of the condition in which some cleared
sites get. In America it has got to the position where old car bodies are being
taken in large numbers out to sea and dumped!

Smoke Control

The work of establishing smoke control areas continued in 1960 and Nos.
2, 3, 4 and 5, Smoke Control Orders were confirmed by the Minister of Housing
and Local Government to become operative on September 1st, 1961. No. 6
Order was also submitted to the Minister for confirmation but at the end of
the year this had not been given. The delay on the Minister’s part is probably
due to four householders making objection to the Order. Three of the objectors
based their opposition on the cost of adapting fireplaces ; the cost of smokeless
fuels; fumes from the burning of coke; the proximity of railways and the
principle of liberty for the individual. The fourth objector, although agreeing
in principle with smoke control had an even more personal and material interest
in the project. His job is that of chimney sweep and alleged that with the oper-
ation of the Order, his livelihood would suffer. He felt that he should be paid
compensation for loss of business. Such is the price of progress !

The survey of further potential Smoke Control Areas in the City continued
and in connection with this work, the Housing Department have co-operated
in providing the necessary information on fireplaces in Council houses included
in proposed Smoke Control Areas.

As smoke control develops so the administrative problems become more
apparent. The time involved in the procedure laid down for the establishment
of smoke control areas has been the subject of much complaint by local author-
ities and the prior approval procedure is one that should be dispensed with
in the opinion of many authorities. Since the Minister appears to wish that
Smoke Control Areas should become operative at the beginning of the heating
season, it means that the timing of the various stages in procedure is very im-
portant. If there should be a delay at any point, then it can mean, in order to
get the six months minimum period between confirmation and operation and
also avoid the operative date falling within the winter months, that the proposed
operative date is postponed. The most likely cause of delay is the receipt by
the Minister of objections, necessitating a local public inquiry. To avoid these
objections is important, but they are almost certain to occur at some time or
another, even though there may be ready answers to the reasons for objection.

There is no doubt also, that until there is developed a solid smokeless fuel,
incorporating the characteristics of being cheap, easy to light, long burning
and being reasonably available, there will be complaints from some householders
who have to use the existing solid smokeless fuels. Notwithstanding that

smokeless fuels used properly are good fuels, householders have been so used
to the ease of lighting bituminous coal and maintaining a fire in old-fashioned
stool and fret grates, that to have to use some thought and m.ethod in relation to
modern firegrates and fuel is too much inconvenience to some. Plenty has been
said and written in one way or another about the effects of air pollution and the
benefits to be derived by removal of domestic smoke from our air; most people
accept that it is a bad thing to throw so much dirt into the air, and that the
principle of smoke control is sound and proper. But the stage has now come
when the education should go further. Householders living in a proposed
Smoke Control Area are apprehensive about the cost, use and heating ability
of the smokeless fuels. The Coal Utilisation Council, the Gas Board and the
Solid Smokeless Fuels Federation do a great deal to educate people in the proper
use of fuels but their impact is to a great degree limited. The householder
to-day does not wish to journey to learn something and this means that the
facilities have to be taken to them. For that reason it is hoped, with the co-
operation of the Housing Department for at least one house to be available
in each Housing Estate, to demonstrate smokeless fuels in use.

The National Coal Board are hoping in the near future to introduce a
new carbonised fuel, the result of research at Stoke Orchard Laboratories. In
addition, the South-Western Gas Board are investigating the possibilities of
producing “Cleanglow” at the local gas works. The availability of suitable
coal seems to be the factor which will decide its advent. The new National
Coal Board fuel and “Cleanglow” are both reactive smokeless fuels.

Two enquiries from interested firms were put to the Public Health Depart-
ment regarding the acceptability of two fuels in Smoke Control Areas. One
fuel was a briquette made from anthracite duff and partly carbonised ; the other
was a briquette made from Irish peat by great pressure; both made some smoke
on burning. In any event it is not local authorities who decide on the “accepta-
bility” of any fuel in a Smoke Control Area and since neither fuel could be said
to fall within a category listed in the Authorised Fuel Regulations, both firms
were advised to write to the Ministry of Housing and Local Government.

It may be remembered in the previous year’s report, the case of the lady,
who was annoyed that whilst her house was included in the No. 1 Smoke
Control Area, the opposite side of the street was not. The reason for making
the boundary where it was, was explained and she seemed satisfied. In the
early part of 1960, this same lady complained that she could not burn coke and
other smokeless fuels satisfactorily, and asked if she could burn bituminous
coal; amongst other things she pleaded health reasons. A visit by the Deputy
Medical Officer of Health and a Senior District Inspector resulted in the Inspector
spending an evening with the lady and her sister to show conclusively how easy
it was to ignite gas coke with gas ignition and to maintain a good fire with a
minimum of effort. These personal approaches by the officers often achieve
far more than pages of written publicity and advice.

Smoke Control Publicity

Many hours, both inside and out of the normal working day, have been
spent in talking to the public, usually in groups such as women’s guilds, about
atmospheric pollution and smoke control areas ; in most cases a film has been
shown. Printed publicity has been also much used and apart from that eman-
ating directly from the Public Health Department, an issue of the “Civic News”
was devoted to atmospheric pollution. In Hartcliffe, an area included in the
proposed No. 6 Smoke Control Area, the united churches publish a magazine
called “Hartcliffe Herald”. An article and photographs dealing with smoke
control were included in the autumn issue of this magazine.

As the Smoke Control campaign spreads to affect more and more of the
City, it becomes increasingly apparent that the question is not just the simple
one of — “Do Bristolians want clean air or are they content with a smoky
grimy City?”. The problem is not only scientific and administrative; it is an
economic one. The industrialist and householder want to know not only when
and how we are going to reduce pollution, but how much is it going to cost.
That cost must seem to give good value. It is, therefore, necessary to show
clearly the benefits that are going to accrue to a city from the clearance of smoke
from its atmosphere.

New Chimneys

During the year 40 plans submitted in accordance with building bye-law
requirements showed that new chimneys were to be erected. Of these chimneys
33 were considered of sufficient height, but 7 were subject of discussions with
the proposers and were increased in height before the plans were approved.

The erection of high chimneys can be a costly business, and as a means
for attaining draught, can be replaced by fans. They can also be an architectural
“eyesore”. However, to prevent nuisance and get proper dispersal of potent
flue gases, a high chimney is the only economic and practicable method.

By the time this report is published a well-known landmark in central
Bristol will have disappeared, namely the Fry’s old factory chimney. Its
demolition was necessary in order to make way for new development. Since
this brick chimney served the boilers used for heating the factory — now used
by H. M. Stationery Office — a new metal stack 116 ft. high has been installed
and because it is sited close to the building is not so obtrusive as the old stack.

In some of the cases where new chimneys are to be erected, the proposers
have approached the Public Health Department prior to submitting plans.
Discussions on the chimney heights have saved time and subsequent delay in
approval.

New Furnaces

Of the 39 new furnaces installed during 1960 all but one were oil-fired
and this trend indicates the grip that oil-fuel has upon the architects’ and
industry’s outlook. The “odd man out” is a small sectional boiler fired with
bituminous coal by underfeed stoker.

Special Industries

The Eastville gas works were a subject of complaint by one person and
although many visits by the Deputy Medical Officer of Health, the Chief Public
Health Inspector, the Senior District Inspector and the Alkali Inspector were
made to the complainant’s house and to the works, no relevant evidence could
be found to substantiate the complaint.

One of the duties of the Public Health Department is to prevent nuisance
as far as possible and where new industrial projects are brought to the notice
of the Corporation it is usual for the Health Department to be informed and
asked for their observations. In this category came two new plants — one for
the preparation of beryllium-copper and the other a tar distillery with all its
ancillary processes. It was considered advisable that both projects should be
investigated fully before approval was given and in each case a meeting of all
officers concerned was called under the Chairmanship of the Medical Officer
of Health. Representatives of the two firms were invited to attend the appro-
priate meeting and all aspects of the processes were discussed.

In the case of the beryllium alloy works, the main public health concern
was the possibility of emissions of toxic beryllium compounds. Firm assurances

being given that these emissions would not occur, together with the knowledge
that monitoring both inside and outside the works would be maintained, made
it possible to agree to the development.

Tar distilleries are associated with smells — phenolic, tarry, and others — and
concern was felt that the siting of the new works should not be such as to cause
nuisance to food warehouses in the vicinity. At the close of the year this
project was still being considered by the local authority.

Railways

During the year the Bath Road Motive Power Depot was closed down and
all cleaning and maintenance work transferred to St. Philip’s Marsh. This
action is a preliminary to the building of a depot for diesel engined locomotives
being built to replace the steam locomotives.

Meetings in Connection with Atmospheric Pollution

In October a very well attended sessional meeting of the Royal Society
of Health in the Council House, was partly devoted to the reading by Mr.
A. H. Clarke, F.R.I.B.A., A.M.T.P.I., City Architect, Bristol of a paper entitled
“Clean Air and Buildings”.

Earlier in the year the Bristol and West Clean Air Committee held a meeting
at Bath. The meeting was given an address by Mr. A. Marsh, Director, National
Society for Clean Air, on the progress of the Clean Air Act and another by
Mr. T. Silvey, Chairman of the Bristol Coal Merchant’s Association on the
Clean Air Act from the Coal Merchants’ point of view.

At the request of The Bristol Coal Merchants’ Association, the Chief
Public Health Inspector attended one of the Association’s meetings and spoke
to the Members on Smoke Control in Bristol.

Concrete Mixing Plant

In January, planning approval was given to the establishment of a ready-
mix concrete plant at Clay Hill. The site seems to have caused adverse public
reaction for some time and for various reasons. Originally it was a quarry
in which eventually accumulated a deep pool of water. The condition of the
fences and the danger of the deep water provoked complaint from the nearby
householders. Consequently, filling-in was carried out by the dumping of
builders’ rubble, but as so often happens at tips, other material, in this case,
waste paper was tipped. Considerable hydrogen sulphide smells were generated
which again provoked complaints. After that matter was settled, complaint
was made about clouds of dust in dry weather and mud in wet weather, caused
by trucks travelling to and from the quarry-tip. Then a consolidated part
of the tip was approved for the site of the ready-mix concrete plant. Immediately
an outcry arose about the development and the industrialisation of the area.
A meeting was held on the site attended by elected Council members and officers
to discuss the matter with the house-holders. Assurances were given that the
plant would cause no nuisance.

GENERAL ENVIRONMENTAL HEALTH WORK

River Pollution

Particularly since the Industrial Revolution, rivers have been the natural
outlet for waste discharges of many kinds. The two rivers that flow through
Bristol, the Avon and the Frome, are no exception to this. Since the Avon,
joined by the River Frome, has its estuary within the boundary of Bristol County
Borough, they receive a considerable quantity of pollution before they enter
the City. However, the work of the River Board and the desire by the local
authorities and industrial concerns to appreciably reduce the degree of pollution
will result in much cleaner rivers in the not too distant future.

The year opened with a request from the Bristol River Avon Board for
the Medical Officer of Health to provide evidence for a public inquiry in support
of a new sewage disposal system for the South-West Area of Gloucester County.
In order to do this the sewage works of neighbouring local authorities whose
sewage works discharged treated, partially treated and crude sewage into the
Frome, were inspected. The river was also examined within the City boundary
and water and swab sampling was carried out. A Senior Public Health Inspector
prepared evidence for the Local Inquiry which was subsequently attended by
the Deputy Medical Officer of Health and the Senior Public Health Inspector.
The Minister of Housing and Local Government has now approved a scheme
to dispense with the offending sewage disposal plants and the connection of
South-West Gloucestershire sewers to Bristol’s main drainage scheme. When
this scheme is in operation the daily flow of some 1,600,000 gallons of sewage
effluents will cease to be discharged into the Frome.

New and additional works to local authority sewage treatment plants in
the Somerset area will improve the state of the River Avon before it reaches
the eastern boundary of the City and when the new sewage disposal works have
been constructed at Avonmouth a daily flow of approximately 50 — 60 million
gallons of sewage and trade wastes from Bristol itself, will cease to flow into the
river. This, as can be imagined, is a major engineering project, but every step
is a welcome move towards the reduction of pollution of the rivers of our City.

At the request of the Medical Officer of Health another investigation which
was carried out during the year by the Chief Public Health Inspector was an
examination of the extent of swimming in the Rivers Avon and Frome and an
assessment of the potential danger to health from such a practice. The investi-
gation proved that swimming in rivers had reached a very low level. Neverthe-
less, it was considered that whilst the rivers were receiving heavy pollution
everything should be done to discourage swimming. Water sampling of the
rivers provided positive evidence of the dangers which could result from this
use of rivers. It is apparent that two main factors have in themselves brought
about the voluntary dis-use of rivers for swimming purposes : —

(1) The appreciation by the general public, through local and national
publicity, of the state of rivers and,

(2) The adequate provision and dispersal of swimming baths throughout
the City.

Following the investigation, a meeting was called by the Medical Officer
of Health and representatives of the River Board, City Engineer’s Department,
Public Health Laboratory, City Analyst, Police, Port of Bristol Authority and
Chief Public Health Inspector and others attended and discussed ways of dis-
couraging bathing in the rivers. In particular, it was suggested that the Edu-
cation Department should take the opportunity of warning school-children
of the health hazards attending swimming in rivers. The Medical Officer of
Health reporting on this matter to the Health Committee said — “It is not

numerically a big problem but potentially it might be a serious one”. The
Health Committee decided that other Corporation Departments should be
asked to assist in this campaign and as a result, the matter was referred to the
joint Health and Education Committee and the Planning & Public Works
Committee.

The introduction during 1960 of the Clean Rivers {Estuaries and Tidal
Waters) Act, now brings new and altered outlets and discharges into tidal
waters, under the control of River Boards. River Boards are advised by the
Minister of Housing and Local Government to liase with “interested bodies”
in laying down satisfactory conditions for new and altered outlets and discharges,
and the Public Health Department is always prepared to assist in any way
towards this end.

Civil Defence

As a nation we are known to adopt an attitude of “Don’t worry it may
never happen”. This in itself can be regarded as a good health measure since
it does not encourage ulcers. The maxim however, cannot be unduly adopted
since preparedness is a valuable asset when an emergency arises. “Civil Defence
is commonsense” says the caption and with this one cannot disagree.

War is our last desire, but if it does occur the public health inspectors of
this country will need to be ready with advice and assistance in many directions.
Any future war of a nuclear character will undoubtedly result in a considerable
death-roll, heavy casualties, mass evacuation of large numbers of people to a
safe area, untold destruction of properties, disruption of sewer systems and
water mains, radio-active contamination of foodstuffs and water supplies and
many other factors. It is at such times and under such circumstances that
environmental hygiene and sanitation are of paramount importance. Under
peace-time conditions safe water, safe food supplies and proper sewage disposal
measures, are matters to which the general public give little thought. They
will have little idea of the field measures which can and must be adopted following
the dislocation of these services. Historically infestations and disease have
played a major role in times of war and in any future war our lives may yet
again be endangered by “Biological Warfare” of our own making.

It is important, therefore, that the extent of the problem should be reason-
ably assessed and that public health inspectors should be trained in Civil Defence
in order that they may be able to assist and advise on environmental control
measures necessary under the war-time circumstances.

During the year two Senior District Inspectors were invited to attend
refresher training courses in Civil Defence and Emergency Feeding and these
commenced during October. Active roles are also played in Civil Defence
exercises held in the City. During September, the Chief Public Health Inspector
was invited to participate in a large scale sub-regional exercise named “More
Reliance” and for this a model ground was prepared which illustrated what
can be done in the way of hygiene and sanitation in the field. Three of the
Inspectorial staff acted as umpires and demonstrators during the exercise
and subsequently a full scale report was submitted to the South-Western Regional
Hospital Board. In the final exercise report high tribute was paid to the public
health inspectors for their work and the constructive criticism contained in their
report which referred, amongst other things, to a generally apathetic approach
to matters of hygiene and suggested that instruction in field sanitation should
be included in the training programmes of all Civil Defence Units.

The Caravan Sites and Control of Development Act, I960

The Caravan Sites and Control of Development Act, 1960, came into oper-
ation on 29th August, 1960. Part 1 of the Act deals with the licensing and
control of caravan sites whilst Part II is concerned with the general control of
development from the planning point of view. The Health Department’s
officers are, therefore, concerned with matters within Part 1 of the Act. This
legislation makes a fundamental change in the basis of the control of caravans,
so that Section 269 of the Public Health Act, 1936, ceases to have effect in relation
to caravans. Whereas under the provisions of the Public Health Act, 1936 the
local authority could either issue a licence for the use of land as a caravan site
or issue a licence authorising the use of a particular caravan, under the provisions
of the Caravan Sites and Control of Development Act, 1960, the licence can only
apply to a site and individual caravans can no longer be licensed.

Whereas the Public Health Act allowed a caravan to be stationed in any
place for a period not exceeding 42 days before an offence against Section
269 had been committed, the new Act allows a period of only 2 nights before a
licence is required.

The Minister has issued model standards for the guidance of local author-
ities in drawing up their licence conditions.

Sewerage

The arrangements regarding sewage and sewage disposal in Bristol County
Borough are under the control of the Planning & Public Works Committee.

The system at present in use dates back to the middle of the last century
and is inadequate having regard to the present size of the City. Crude discharge
to the tidal reaches of the River Avon is the present final disposal method. To
ameliorate the odour nuisance during the summer months chlorine treatment
of the sewage outfalls and river itself have been in operation for the last 20 years.

A major scheme designed to collect and treat the sewage of the City and
discharge the effluent to the Severn, just north of the mouth of the River Avon,
is at present under construction, and as successive stages of these works come
into operation a progressive improvement in the condition of the River Avon,
as it runs through the City, should result.

Aged Persons

The enforcement of the provisions of Section 47 of the National Assistance
Act, 1948, and of the National Assistance {Amendment) Act, 1951, involving the
compulsory removal of an aged person from his or her home to an appropriate
institution is unpleasant and often distressing for all concerned.

Every effort is made by the officers of the Health Department to persuade
people who are in urgent need of care to enter an institution voluntarily and the
success of this policy is proved by the fact that in the last 9 years compulsory
removal has had to be resorted to on only 13 occasions, an average of only
3 people every 2 years. There are probably some 6,000 — 8,000 aged persons in
the City who, but for the welfare work which is being constantly pursued,
would quickly become cases for removal.

The result of this welfare work is that the basis for compulsory removal
is changing in emphasis from the insanitary conditions in which people live to
the physical illness from which they are suffering and cases are, therefore, far
more likely to become matters for medical action than for action by the public
health inspector.

During 1960, 4 cases were taken of which 2 were husband and wife.

Goram Fair

The Goram Fair which has not had a settled site for some years, was held
this year at the Ashton Court Estate, which is now owned by Bristol Corporation.
In other years the Public Health Department has been actively concerned with
the hygiene and sanitation of the fair-ground. The Ashton Court site, however,
is not within the administrative area of the Bristol County Borough Council,
but in the Long Ashton Rural District. In view of past experience, it was
arranged that the Senior District Inspector concerned with the Fair in previous
years, should visit the site with an Officer from Long Ashton Rural District
Council’s Public Health Department in order to discuss the sanitary and hygienic
arrangements to be made at the Fair. Further combined visits were made
during the holding of the Fair.

Health Education

The desire to be better informed on environmental health aspects of life
has again been evident from the number of invitations extended to the Chief
Public Health Inspector and his staff during the year to give talks, demonstrations
and film shows to all sections of the community. Encouragement and education
towards better health through preventive measures, is promoted in many ways —
the press, magazines, pamphlets, radio and television and these all make a
valuable contribution to the improvement of health in general. Many feel,
however, that the greatest impact can be made by the education work of the
local health department. An active health department backed by good speakers
and a variety of visual aids has many ready audiences and through this medium
people of all ages can make a greater contribution to the health of the com-
munity. There are few amongst us who are not willing to listen and learn. The
incessant “why” of our childhood remains with us through life as we seek
knowledge and when the “why” has been answered there is a greater understand-
ing of our responsibilities to the maintenance of health in ourselves and others.
There are many impediments to health and to the control of illness and disease
because there is very often lack of appreciation of what is harmful or v/hy it is
harmful. This is where health education is valuable. It is not a question of
lecturing to people but of talking to them. It is the informal approach which
develops the personal understanding and more co-operative attitude. For some,
any new campaign towards improvement of our environment creates the im-
pression that “Here once again is another bee in the bonnet of the health
department.” The hygiene of food handling, the reduction of atmospheric
pollution, the control of insect pests and other matters may appear to be un-
necessary intrusions on their freedom. This is where the Health Department
has the opportunity of winning over the unbeliever. A good deal of thought
has been given during the year to the subject of Clean Air since this facet of
health is much to the fore at the present time as the result of the smoke control
work of the Department. Gas and Electricity Board films “Window to the Sky”
and “The Future is Electric” respectively are on long-term loan to the Health
Department and are used in connection with talks designed to demonstrate the
purpose and effects of the work, towards cleaner air. A talk and an appro-
priate film are a useful and convincing means of illustrating this and other
aspects of health education.

On 19 occasions during the year talks and demonstrations were given to a
total number of 600 children. Talks on environmental health matters were
given to 530 members of the general public, who represented a variety of organiz-
ations. Special food hygiene talks and demonstrations were given to 320
people in various sections of the food trade including Licensed Victuallers,
Industrial Caterers, a Store training school, Institute of Packaging and the

University catering staff. A hospital group once again requested talks and this
included demonstrations and films for 90 of their hospital catering staff. Al-
together films were shown on 30 occasions and film strips on 17.

The interest shown by the various audiences and their invitations to “Come
again” is proof in themselves of the public response to health education.

Technical Training

The Chief Public Health Inspector and his staff have again taken an active
part in numerous technical courses where environmental health forms the whole
or part of the curricula. Apart from those courses which are designed speci-
fically for the training and further education of public health inspectors, lectures
were given, and where requested visits arranged, for health visitors, pre-nursing
classes, food handling courses, house matrons, nurses’ training classes of a
hospital and an Institute of Housing course.

The growing demand for public health inspectors with special training in
atmospheric pollution again resulted in a Smoke Inspectors’ Course being
arranged through the Engineering Department of the Bristol Technical College.
The consistent attendance of inspectors, some from local authorities distant
from Bristol, is proof of the value placed upon such courses. An opportunity
for further education of public health inspectors in micro-biology of food
inspection was made possible during the year following the arrangement by the
College of Advanced Technology of a specially designed course on this subject.
The implementation of a course of this character which has been a long felt
need is very much appreciated by inspectors in the Western Region and the help
and advice of the Medical Officer of Health and the Advanced College of
Technology is greatly appreciated.

By far the most important event of the year was the introduction by the
Public Health Inspectors’ Education Board of a new scheme of training. The
basic theoretical and practical training programme was laid down by the Board,
but the way in which training courses were to be implemented was left, subject
to the approval of the Education Board, to individual training centres. The
Medical Officer of Health, Head of Department (Building), Bristol Technical
College, and the Chief Public Health Inspector gave considerable thought to
the new scheme and following joint discussions decided that a part-time two
day release course, over a period of 4 years, was best suited to the needs of local
authorities and students in the Western Region. The few large centres of
population in the West are widely dispersed and students are, therefore, drawn
from a number of counties, including some in South Wales, and from local
authorities of varying sizes. Distance of travel and the need in some cases to
remain in Bristol overnight, were factors which had to be considered.

Whereas the basic recommendation of the Board was for a part-time one
day release scheme, it was considered that this left insufficient time for com-
prehensive instruction or adequate opportunity for tutorial work. Furthermore
it would not enable students to take full advantage of the excellent practical
facilities aflforded by the Advanced College of Science and Technology and the
Bristol Technical College. Apart from college training it was felt that since
Bristol County Borough is able to provide practical visits on almost every
aspect of the training programme, time should be set aside so that advantage
could be taken of the facilities available.

The two day release scheme allows continuity of instruction with adequate
time for further study and practical instruction at approved training centres
and this is much appreciated by the students. There are 13 students on the
course which commenced in early October.

Consideration was given initially to the introduction of a sandwich course,
that is six months in College and six months with a local authority over a training
period of three years and the possibility of this type of course is to be reviewed
at a future date.

Trainee Public Health Inspectors

The establishment of 6 trainees has again been maintained throughout the
year and no difficulty has been experienced in filling posts as they have become
vacant. As in other parts of the country, there has been no spate of applications,
but sufficient have been forthcoming to enable the right type of young man to be
appointed. It is important that trainees should have a good educational back-
ground and a genuine vocational approach to environmental health work. Every
applicant is made fully aware of the nature of the work and is thereby given an
opportunity to assess, in his own mind, whether this is a profession for which
he is physically and mentally suited. Young men coming straight from school
need to be fully informed of the nature of the work on which they are attempting
to embark and great stress is laid on the ability of any applicant to face up to
the educational and enforcement aspects of the work. So far this initial care
has resulted in the appointment of trainees whose enthusiasm for the work has
developed with each stage of their training.

It is important too, that trainees should be regarded as such and whilst
they take an active part in clerical, administrative and practical work they are
not assigned to permanent duties. A regular change over from one section to
another, every 6 months, that is, Port Health, Food and Drugs, Housing,
Meat Inspection and general district work, gives them an opportunity of good
experience in environmental health work as a whole and prevents the boredom
which could result from lack of variety in training.

During the year 2 trainees were successful in the qualifying examination
of the Public Health Inspectors’ Education Board and were subsequently
appointed to the Bristol stalf. One vacancy was outstanding from 1959, so
that during the year under review three trainee vacancies were filled. At the
present time five trainees are attending the new training course at the Bristol
Technical College and one is re-sitting the qualifying examination in early 1961.

The new examination scheme which is discussed elsewhere in the report
under “Technical Training”, came into being during 1960 and the revised training
at the Technical College which is on the basis of a part-time two day release
scheme, commenced in October. The combination of adequate opportunities
for theoretical and practical work each week is greatly appreciated by trainees
and must result in well-informed and adequately trained public health inspectors
of the future.

Foreign Visitors

Once again visitors from overseas have studied the work of the Environ-
mental Health Services in Bristol. The visitors were from Malta, Chile, West
Africa, India, Malaya and the Sudan.

Our friends from overseas are very appreciative of the discussions which
take place and the tours which are arranged for them. It is a pleasure to meet
them and to demonstrate the preventive health work which is carried out in
this City.

RAT DESTRUCTION
DISINFECTION AND DISINFESTATION

Rodent Control

The work of rodent control followed the usual pattern until the retirement
of the Rat (Repression) Officer in May 1960. The Deputy Chief Public Health
Inspector was responsible for the control of rat repression work until August,
when Mr. G. E. Bennett, a Senior District Public Health Inspector was appointed
to take charge of the rat repression service. Other duties assigned to this
Officer were, to act as a consultant to the Disinfecting Station Superintendent
for problems in connection with insect infestation, consultant to a group of six
district public health inspectors on all district matters, and to be the Flooding
Emergency Officer of the Health Department.

Since August, the emphasis of the work has changed, from considering the
rat as an ever present problem to the rat as a pest that can and should be elimin-
ated. More consideration is now being given to the source of rat infestations
and the number of routine inspections of places likely to create rat harbourage
and infestations has been greatly increased.

A major item in the work of pest control for the latter portion of the year
has been the start of a widespread programme for the extermination of the
common rat in the City sewers.

The only method to prevent re-infestation by rat migration is to deal with
the sewers in drainage catchment areas and for this purpose the City was divided
into three specific areas, each area to be a complete programme. The area of the
City south of the River Avon and New Cut was selected to be programme No. 1 .
1960.

There are four drainage catchment areas in this programme and the work
was phased accordingly into the following groups of districts: —

Phase 1 St. Anne’s, Brislington, West Town, Stockwood.

Phase 11 Knowle, Whitchurch, Hengrove, Gilda Estate.

Phase III Knov/le West, Bedminster Down, Highridge, Hartcliffe,
Bishopsworth, Withywood.

Phase IV Ashton Gate, Bedminster, Lr. Knowle, Southville, Knowle
Park, Totterdown.

Considerable thought was given to the materials to be used and it was
decided that the most satisfactory and economical poison to obtain the required
results was: —

3 ( 1 -Pheny l-2-acetyl-ethyl-4-hydroxycoumarin-4-hydroxy-3- 1 -phenylbotan-
3-on-l-yl-coumarin — commonly known as Warfarin, this poison being of the
chronic type as distinct from the zinc-phosphide and arsenious oxide formu-
lations, it is unnecessary to use prebaiting methods and therefore the first bai-
laid contains the actual poison.

Full consultation was held with officers of the Ministry of Agriculture,
Fisheries and Food over the extent and nature of the programme, together
with the materials to be employed and agreement was reached on the use of
Warfarin in the City sewers on an experimental basis.

The interest of the Ministry in this work is considerable as Bristol is one
of the first local authorities to use Warfarin for the control of the common rat
in sewers. The actual work of baiting was commenced on the 31st October
and was still in progress at the end of the year.

Sewer Baiting Operation in Progress by the City Engineer's Staff at One
OF THE 5,127 Manholes in Programme No. 1 which Covered the South

OF THE City

Even the Buried Manhole Cover must be Located by the City Engineer’s
Staff if the Sewer Baiting Programme is to be Effective

An Example of Conditions Conducive to Rat Harbourage Found During
One of the Many Routine Inspections Carried out in the City

Photograph of a Rat, on Waste Ground, Moving Towards Food which
HAS HFFN Deliberately Thrown there for Birds

The table of results gives an indication of the success of the programme,
of the fluctuation of the rat population in the sewers and the amount of work
achieved by seven men in the field.

Phase No.

Total

Manholes visited

1,012

678

1,552

1,650*

4,892*

Visits required

2,353

1,454

2,964*

2,164*

8,935*

Complete bait takes

Nil*

43*

Part bait takes . .

Nil*

127*

212*

Estimated rat kill

838

276

Nil*

943*

2,057*

Figures not completed by 31st December 1960: — *

The first half yearly sewer treatment was made on the usual lines previous
to the re-organisation and the figures below give the result of that treatment. : —

No. of manholes baited . . . . . . 875

No. of manholes showing prebait take . . . . 466

No. of manholes showing poison take . . . . 396

No. of manholes showing complete poison take . . Nil

As part of the drive against rats special treatment was carried out on
vacant sites and brooks, and over 2,500 baits have been laid and results show
nearly 60 per cent take of baits.

Perhaps the most satisfactory part of this work has been an increase in the
number of notifications from the general public about dead and dying rats
observed.

Rat Repression — Summary of work done during I960

1959 1960

Business Business

Premises Houses Other Total Premises Houses Other Total

112

Complaints incompletely
dealt with brought
forward

113

771

1,627

485

2,883

Complaints received

789

1,485

421

2,695

805

1,678

512

2,995

826

1,533

449

2,808

746

1,437

474

2,657

Remedial action:—
Infestation cleared : —

By Corporation

744

1,297

425

2,466

By occupiers

121

144

No action required . .

115

156

113

Incompletion at end of
year carried forward

106

805

1,678

512

2,995

826

1,533

449

2,808

Under Paragraph 1 of Section 2 of the Prevention of Damage by Pests Act
{1949), 2,622 occupiers notified the Department that their premises were infested
with rats or mice.

Verbal notices were served on owners or occupiers of 73 premises drawing
attention to the conditions which were giving rise to the infestation and which
required certain works to be carried out. In all cases these notices were complied
with.

Defective drainage systems continue to cause rat infestations and 116 cases
have been referred to the district public health inspectors for appropriate action
to be taken.

The Offensive Trades areas in the City have been subject to a more rigorous
routine treatment. Also more attention has been paid to the 45 miles of river
banks within the City, and the large number of vacant and derelict plots of land.

A few of the more unusual cases of mice infestation were found in the
ventilating ducts of a large multiple store in Broadmead, under the seats of two
of the City’s main theatres, and in the organ in one of Bristol’s churches, where
they were eating leather washers on the pipes.

Special attention has been paid to building construction sites where drainage
systems are opened for reconstruction, and this has resulted in only three
complaints during the year from cases of this nature.

All the Corporation refuse tips are regularly inspected and at present are
reasonably clear of infestation.

The following table shows the number of rats recovered from all sources:—

1959

Avon- Portis-

mouth Bristol head

Total

Avon-

mouth

1960
Portis-
Bristol head

Total

2 — —

Rats recovered: —

Docks, quays, wharves,etc.

Brown

28 45 —

Black . .

106

— —

106

— — —

—

Mice . .

—

— —

—

— 77

City:—

Brown

64 —

— 176 —

176

Black

—

34 —

— 23 —

Examined for plague

—

63 —

— 28 —

Mice . .

—

41 —

Grand total —

328 rats recovered

Grand total —

208 rats recovered

The difference in the figures for 1960 compared with 1959 is due to the fact
that in 1959 a considerable number of premises within the dock areas were
classified as City premises for the purpose of this return.

There were the usual complaints regarding wasps nests and it is interesting
to note the lengthening of the “wasp season”, the last complaint for the year
being November 30th.

IVasp Complaints

1960 1959

Destroyed . . . . . . 570 508

Advised . . . . . . 32 105

During the year there was an increase in the number of complaints of damage
by foxes, badgers, and squirrels. Where it has been possible to locate the actual
“earth” or “sett” appropriate measures have been taken.

As the year closed there was a slight increase in complaints of mice infest-
ations over the whole City and it would appear that 1961 may show an increase
in the number of mice dealt with.

Generally, the year can be reviewed with satisfaction but, there are two
aspects of pest control which should be given more consideration by the public
generally.

The first is the alarming rapidity with which occupiers of new buildings
in the centre of the City and new flats report mice infestations. The importation

of mice in packing cases and materials is considered to be the prime cause, and
investigations are to be started to find ways of preventing this transfer of vermin.

The second point to which attention should be paid is the frequent practice
of the public of throwing food for birds on to roads and pavements, docks,
wharves and vacant ground. To put food anywhere but on a bird table is to
feed both rats and mice. It is known that feeding pigeons at the Centre by
throwing food on to the adjacent quays has been directly responsible for the
creation of a troublesome rat infestation at the outfall of the River Frome near
the statue of Neptune.

Disinfection and Disinfestation

Once again the Disinfecting Station has played an active role in the pre-
ventive work of the Department and the co-operation of the Superintendent
and Station staff in coping with the many emergencies which arose outside
normal working hours is to be commended.

The disinfection or disinfestation of some 60,000 articles at the Station
indicates the measure of work performed by the Station staff. In addition,
12,234 premises were disinfected or spray-disinfested during the year, this
incurring 3,000 more visits than in 1959. An increase in work was also brought
about in the collection and disposal of condemned foodstuffs from food premises
throughout the City and from dock areas. Altogether over 45,000 cans and
some 19,000 lb. weight of other foodstuffs were collected and disposed of in a
satisfactory manner.

The soiled linen collection, laundering and return service has also shown
a marked increase, so much so that owing to limited facilities, laundering at the
Disinfecting Station had to be abandoned. The clothing is now being washed,
by arrangement, at a laundry attached to a large Welfare Services Home for the
Aged. In 1957, the service involved 40 calls each week for collection and return
of linen. This has now increased to 294. The number of articles collected in
1 957 was 201 , whilst at the present time this has grown to almost 900. By careful
routing and arrangement of transport, the distance travelled for this service
has only increased by 98 miles.

The heavy periods of rainfall during the latter part of the year which
resulted in flooding of parts of the City again called for the services of the
Station staff. During the months of August and December the Station was
open night and day for some time, and disinfection of affected properties and
drying of bedding, clothing, carpets and furniture was carried out. Assistance
was also given to outside authorities where properties were similarly affected
by flooding.

A number of large-scale disinfecting and disinfestation jobs were performed
including an area of houses affected with beetles, an Education Department
site infested with caterpillars, a large licensed restaurant in the City which had
been infested with pharoahs ants, cockroaches and crickets, treatment of a
Civil Defence store, theatre wardrobe rooms and the costume store rooms of a
drama club. Regular disinfection of the animal houses and dissecting rooms
of the Medical Department and the Anatomy Department fo the Veterinary
School of Bristol University also was carried out. Special schools of the Bristol
Education Department sited in Somerset, were treated for cockroach infestation.
Putting the carcase of a chicken into the dustbin of a dwelling resulted, ulti-
mately, in a large scale maggot infestation of houses in the surrounding area.

An additional duty was taken on by the Disinfecting Station staff during
the year, that of disinfecting all equipment returned to the Medical Equipment
Loan Service store which adjoins the Station.

Disinfections, Drain Tests, etc.

1959

1960

9,175

Premises disinfected . . . .

12,234

53,968

Articles disinfected

56,694

3,125

Articles disinfested . .

3,259

3,672

Articles destroyed

3,137

539

Vermin repression — by spraying

390

100

Vermin baths — men

122

— women

Disinfections for hospitals and nursing homes . .

402

Public library books collected and disinfected

292

Private library books collected and disinfected

44,935

Foodstuffs, etc., destroyed — canned food

45,691

11,345

other foodstuffs

19,322 ]

675

Food premises visited

760

Drain tests

3,027

Other work . .

3,737

ADMINISTRATSON OF THE SHOPS ACT, 1950
AND KINDRED LEGISLATION DURING I960

SHOPS ACT, 1950

General Administration

The Shops Act, 1950, which was introduced to consolidate the Shops Acts,
1912 to 1938 and certain other enactments relating to shops, has again survived
without amendments. New hope for more up to date legislation was revived by
a statement in Parliament that the Government proposes to introduce legislation
dealing with health, welfare and safety in shops, offices and railway premises,
but it is not anticipated that this will mean any alteration to some of the more
controversial issues, such as Sunday trading restrictions and the closing hours
for shops.

A new interpretation on the phrase “open for the serving of customers”
resulted from an Appeal to the High Court in the case of Betta Cars Ltd., v.
Ilford Corporation. The Company were convicted and fined for keeping a
showroom open for display purposes only. The Lord Chief Justice said — “It
seems to me here that where a shop is open to allow people to come in and view
goods which are for sale which have the prices upon them and the terms upon
which business will be done and an employee there presumably to answer
questions and see that the public do not damage the vehicles, to say that in those
circumstances the shop is closed for the serving of customers seems to run
counter to all common sense”. At the time of the offence, no customer was
seen to approach the shop nor was there any evidence that any sale to a customer
had taken place.

The Western Counties Divisional Secretary of the Motor Agents Association,
after consultations with the Inspectorate, circulated this decision to all his
members and this was followed up by an inspector visiting ail motor traders in
Bristol who advertised that they were open for viewing on Sundays.

One prosecution in respect of Sunday trading and four in respect of the
hours worked by shop assistants and failure to maintain records resulted in
five traders paying a total of £42 4s. Od. in fines and costs.

The Health Committee considered five applications for exemption from the
general closing hours in respect of exhibitions; four were granted and one.
The Bristol Ideal Homes Exhibition, 1960, refused. Those granted were: —

(1) The Bristol Aquarists’ Society

(2) The Bristol Budgerigar and Foreign Bird Society

(3) The Bristol Flower Show

(4) The Bristol Ideal Homes Exhibition, 1961

A member of the Health Committee was to have been accompanied by one
of the shops inspectors at the Annual Conference of the Institute of Shops
Acts Administration at Morecambe but owing to his resignation from the Coun-
cil shortly before the Conference was dlue to be held, the Inspector went alone.

At the request of the Union of Shop Distributive and Allied Workers’
Organiser an inspector gave a talk on the Shops at a general meeting of the
managers of Boot and Shoe Shops.

Other Enactments

(a) Young Persons {Employment) Act, 1938

This Act, which controls the working hours of a number of young persons
outside the scope of previous legislation, involves visits to various transport
undertakings and this year rather more infringements were noted than in recent
years. In all cases the employers adjusted the hours to comply at the request
of the inspectors without further action being necessary.

(b) Sunday Entertainment Act, 1932

There are now 18 cinemas open for Sunday performances, one more having
closed down during the year. At one cinema it was found that staff had been
employed contrary to the requirements of the Act. The facts were reported to
the Clerk to the Licensing Justices, who in view of ail the circumstances, dealt
with the matter by the issue of a written warning.

No infringements were reported under this Act.

Shops Act, 1950

1959

1960

5,678

Visits — Retail

5,644

314

Wholesale

114

1,181

Revisits — Retail

1,313

Wholesale

876

Infringements — ■ Failure to exhibit notices . .

998

Closing hours

Sunday employment

Half holiday

Hours of young persons . .

Meal intervals

Seats for female assistants . .

1,046

Verbal Warnings

1,207

Warning Letters

Legal Proceedings

Assistants' Facilities — Section 38

(a) Improved

(b) Referred to Public Health Inspectors

Employment of Women, Young Persons

and Children Act, 1920

Visits

—

Revisits

—

Infringements — Records

—

Night employment

—

Verbal Warnings

—

Written Warnings

—

Legal Proceedings

—

Sunday Entertainment Act—Cinemas

1959 1960

57 Visits 53

1 Revisits . . . . . . . . . . 6

— Infringements — Holidays . . . . . . 1

1 Records . . . . 3

1 Verbal Warnings . . . . . . . . 2

— Reported to Licensing Justices . . . . 1

— Legal Proceedings . . . . . . . . —

Young Persons (Employment) Act, 1938

41 Visits 71

3 Revisits . . . . . . . . . . 9

1 Infringements — Notices . . . . . . 2

— Sunday employment . . —

— Half holidays . . . . 3

— Hours 1

1 Meal intervals . . . . 3

— Night employment . . 1

1 Verbal Warnings . . . . . . . . 10

— Warning Letters . . . . . . . . —

Legal Proceedings

Time Worked Outside of Office Hours and Observation Patrols
(a) Shops Inspectors —

1959

22 hrs. 20 mins.

61 hrs. 45 mins.
180 hrs. 50 mins.

4 hrs.

(b) Assistants —
17 hrs. 15 mins.

65 hrs.

Evenings

Sundays

Wednesdays (p.m.)
Saturdays (p.m.)

Evenings

Sundays

Wednesdays (p.m.)
Saturdays (p.m.)

1960

29 hrs. 30 mins.
52 hrs. 25 mins.
199 hrs. 25 mins.
3 hrs. 10 mins.

Shops Act Environmental Health Aspects

The control of sanitary and other arrangements in shops has again received
a good measure of attention. The working environment of shop employees
is reflected in their health and efficiency and the standards of lighting, ventilation,
comfort, sanitary accommodation and the provision of suitable and sufficient
hand-washing facilities are all important environmental factors to which par-
ticular attention is paid on inspections. Both the Shops Act and Food Hygiene
Regulations have factors in common so that on many occasions visits are dual
purpose in character. Since the Chief Public Health Inspector is also the Chief
Shops Inspector, close liaison exists between the officers concerned with “con
ditions of employment” and the public health inspectors, and an arrangement
exists whereby the Shops Inspectors, following routine work at premises, notify
the district public health inspectors of any apparent contravention of the Shops
Act.

The progressive development of the Broadmead shopping area, in partic-
ular, has again called for careful examination of plans for new premises and
every care is taken at this stage, by discussion and correspondence with proposers
and architects to ensure compliance with the requirements of the Shops Act, 1950.

During the year a total of 3,657 visits and revisits were made by Public
health inspectors to registrable and non-registrable food shops and to other
shops.

THE REPORT OF THE SCIENTIFIC ADVISER AND
OFFICIAL AGRICULTURAL ANALYST FOR THE
CITY AND COUNTY OF BRISTOL FOR THE

YEAR 1960

{Incorporating the Work on behalf of the County of Gloucester and the City of

Gloucester)

E. G. Whittle, B.Sc. (London), F.R.I.C.

STAFF FOR THE YEAR

Scientific Adviser
Deputy Scientific Adviser
Principal Assistant
Principal Assistant
Assistant Analyst
Assistant Analyst
Assistant Spectroscopists

Field Officer . .

Chief Technician
Technicians . .

Junior Technicians . .

Student Technicians

Secretary

Assistant Secretary
Laboratory Attendants

Research Assistant . .

E. G. Whittle, B.Sc. (Lond.), F.R.I.C.

I. Dembrey, B.Sc. (Bristol), F.R.I.C.

G. G. Fisher, B.Sc. (Birm.), F.R.I.C.

D. J. Taylor, B.Sc. (Lond.), F.R.I.C.
Miss M. V. Westcott, M.Sc. (Bristol).
Mrs. A. Jones, B.Sc. (Dublin), A.R.I.C.

Miss J. Ayerst, B.Sc. (Bristol).

Mrs. P. M. Isaac, B.Sc. (Birmingham).

R. C. M. Putnam, M.I.P.H.E.

C. R. Turner

Mrs. J. Withers
G. P. Hall

Miss V. Bromwich
B. L. Bullock
Miss H. Ninnes

D. Morgan
Miss A. Chippett
P. C. Cox

Mrs. I. Hall
Miss S. J. Kirby
Mrs. N. Budd

Mrs. K. Comber (part-time)

To be appointed.

INTRODUCTION

January 1st 1960 was the date on which the Department returned to full
Corporation control after 25 years of close association with the University
of Bristol as the Chemical Section of the Preventive Medicine Department.
This Report is therefore the first to be made on the year’s working in much
closer association with the Health Department. The year has been a successful
one in many ways. In volume of work the 10,000 mark has been exceeded for
the second year running and it now appears that we can expect a steady 2,500
samples each quarter with slight rises in the winter and autumn quarters and
falls in spring and summer.

Considering the City examinations, the total was over 8,000 which is now
5 to 1 in relation to Gloucester County which can be compared with a 3 to 1
ratio pertaining in 1951 when work for the County began. In other words in
nine years the work for the City has increased from some 4,000 to over 8,000 —
a remarkable increase indicative of the ever growing value of the work and the
increasing legislation.

On the purely domestic front I have to record that certain staff changes
have occurred. Mrs. J. K. Noyes left early in the year and was succeeded by Mrs.
P. M. Isaac whilst among the Student Technicians Mrs. M. Humphreys, B. L.
Bullock and M. A. Wagner all left. Bullock and Wagner secured other ap-
pointments, the former at Berkeley Power Station Laboratories and the
latter with the Ministry of Agriculture, Fisheries and Food. Both Mrs. Noyes
and Mrs. Humphreys left a few months before the arrival of babies, and we
congratulate them both on the birth of their sons. Miss A. Chippett and P. C.
Cox joined the staff and we have yet to appoint one Student Technician.

It is a matter of regret that it has not been possible to secure the services
of a Research Assistant and it seems probable now that the type of individual
we have in mind is not likely to be persuaded at the salary that can be offered.

Mrs. A. Jones, one of our Assistant Analysts, was successful in obtaining
the Associateship of the Royal Institute of Chemistry in November and Miss
H. Ninnes was able to satisfy the conditions for promotion and was upgraded
to the Technician status.

It will be recalled that this laboratory has dealt with the analytical work
for Gloucester County since 1951 and since that time we have come to value
the great interest and experience shown by the Chief Inspector of Weights and
Measures in whom was vested the Food & Drug control. It was, therefore, a
great shock to learn of the sudden death of Mr. T. A. Bramley in November.
Mr. Bramley was not only an experienced officer but it can be truly said that he
was a gentleman.

Professor Garner, a very good friend of the Department, particularly
during the University regime, died earlier in the year. In recent years we had
close contact with him on Civil Defence affairs. Professor Garner was the
Regional Scientific Adviser on Civil Defence and we met on many occasions
with reference to the Scientific Intelligence Officer’s activities.

It is also with regret that I record the death of another senior officer of this
City. Our direct contact with Mr. Kirkup, the Chief Fire Officer, was primarily
through the section of the Fire Brigade now responsible for enforcement of the
Petroleum Regulations. Mr. Kirkup died in April.

Finally I wish to take this opportunity of expressing my appreciation of
the co-operation and valuable help given by all members of the staff, and I
thank the sampling officers of the City, and the County and City of Gloucester
for their willing help and their kindness and consideration throughout yet
another busy year.

The Report is divided in the usual fashion into the Introduction and eleven
parts as under : —

Part I Food and Drugs Act

Part II Fertilisers and Feeding Stuffs Act

Part III Waters, Swimming Bath Samples, Effluents, Sewage and
Chlorination

Part IV Rag Flock Act

Part V Pharmacy and Poisons Act

Part VI Miscellaneous Analyses

Part VII The County of Gloucester Report

Part VIII The City of Gloucester Report

Part IX Atmospheric Pollution

Part X Spectroscopy

Part XI Other Activities

Table I— Summary of Samples examined during the year ended
31st December 5960, for the City and County of Bristol,
the County of Gloucester, and the City of Gloucester

Bristol

Gloucester County

Gloucester City

Milk

902

735

Food and drugs

3,214

531

Waters and swimming baths

235

Fertilisers and feeding stuffs

305

Miscellaneous

504

—

Port Health Office samples

714

—

5,874

1,476

Rag Flock Act

District Health Inspectors’ samples

—

Pharmacy and Poisons Act

—

Atmospheric Pollution —

Lead peroxide . .

Deposit gauges

Zinc and Fluorine

—

Smoke recordings. City

221

—

„ „ Port Authority

642

—

Spectrophotometric analyses

953

Chlorination . .

215

—

Vitamin B 12 assays . .

—

2,360

211

Total

8,234

1,687

116

Grand Total 10,037

PART i. FOOD AND DRUGS ACT

New Legislation, Reports and Recommendations

Statutory Instruments 1960 No. 398 — The Agriculture {Poisonous Substances)

{Extension Order.)

This order which applies to great Britain now includes in the Agriculture
{Poisonous Substances) Act 1952, with subsequent Regulations, substances the
molecular structure of which consists of a bridged six membered ring with
substituents in the ring together with organo-mercury compounds, arsenical
compounds and fluoracetic acid and its derivatives. The Minister of Agriculture,
Fisheries and Food and the Secretary of State for Scotland are satisfied that the
use of these compounds in agriculture involves substantial risk of poisoning to
agricultural workers.

The Ministry of Agriculture, Fisheries & Food also issued a scheme agreed
between the Government and Industry on the Notification of Pesticides. The
scheme of notification was evolved in a voluntary basis by negotiation between
Government Departments and the Industrial Associations concerned and is
intended to provide only for the safe use of chemicals and is not concerned
with approval of claims for biological uses.

Statutory Instruments 1960 No. 698 — The Poisons Lists Order

The order makes some additions to the Poisons List. In particular the
order brings under control certain tranquillising compounds which previously
were far too freely available. Typical of these are acetylcarbromal, azacyclonol,
benactyzine, bromvaletone, carbromal, (Relaxa tablets etc.) mephenesin,
meprobamate and methocarbamol.

Statutory Instruments 1960 No. 699 — The Poisons Rules

These Rules consolidate with amendments the Rules specified in Rule
35 (1). The principal amendments are as follows. By reason of amendments
to Rules 5 and 12 the requirements of Rule 12 (3) as to the form of prescription
and of Rule 5 as to labelling are relaxed as respects certain poisons previously
included in the Fourth Schedule (which sets out the poisons which may be
sold by retail only upon prescription) and these poisons are now set out in a
separate part of the Schedule, Part B, which includes also other poisons among
which are certain poisons added to the Poisons List by the Poisons List Order,
1960. The requirements of Section 19 (3) of the Pharmacy and Poisons Act, 1932
(which requires particulars of medicines supplied or dispensed under that
Section to be entered in a book) are relaxed by Rule 8 in the case of certain
prescriptions given by a registered dentist. The provision of Rule 7 (3) (c) of
the Poisons Rules, 1952, requiring that an article to which Rule 7 (3) applies
which is sent by post should be sent by registered post, is omitted. Rule 16
is amended so that a certificate authorising the purchase of monofluoroacetic
acid or its salts is required to state the quantity authorised to be purchased and
so that the seller is required to retain the certificate. Rule 22 (3) (which provides
that where a poison other than a poison included in the First Schedule is sold in
the container and outer covering in which it was obtained by the seller the name
and address of the seller need appear only on the outer covering) is now extended
to all poisons. There is added to the Seventh Schedule a new paragraph,
paragraph 9, requiring the labelling of certain medicines for the prevention of
motion sickness. Certain insertions have been made in the First and Fourth
Schedules in order to impose appropriate restrictions in respect of the poisons
added to the Poisons List by the Poisons List Order, 1960. Certain other
changes have been made in the lists of substances in respect of which restrictions

or requirements are imposed by virtue of the various Schedules, and account
has been taken of changes of nomenclature and classification.

Radioactive Substances Act 1960

Described as an Act to regulate the keeping and use of radioactive material
and to make provision as to the disposal and accumulation of radioactive waste
and for purposes connected with matters aforesaid. The Act deals with such
details as —

(a) General provisions for registration of users of radioactive material

(b) Exemptions

(d) Disposal of radioactive waste

(e) Provisions as to functions of public and local authorities

(f) Rights of entry and inspection, and many other matters.

In addition dealing with the meaning of radioactive material, certain
elements are specified and include actinium, lead, polonium, protoactinium,
radium, radon, thorium and uranium, together with any substance possessing
radioactivity which is wholly or partly attributable to a process of nuclear
fission or other process involving bombardment by neutrons or ionising radia-
tions.

Statutory Instrument 1960 No. 1542 — The Milk {Special Designations) Regulations
These Regulations replace and consolidate with amendments, the Milk
(Special Designation) (Raw Milk) Regulations 1949 to 1954 and the Milk
Special Designation (Pasteurised and Sterilised Milk) Regulations 1949 to 1953.

Statutory Instrument 1960 No. 1165 — The Fertilisers & Feeding Stuffs Regulations
These Regulations consolidate, with amendments, the Regulations made
in 1955 and 1956 under the Fertilisers and Feeding Stuffs Act, 1926.

The Regulations prescribe the manner of marking parcels of fertilisers
and feeding stuffs intended for sale, and the forms of registers to be kept by
certain persons dealing with fertilisers and feeding stuffs. The five schedules
to the Act are varied by the substitution of five schedules, similarly numbered,
which appear in the First to the Fifth Schedules to the Regulations. The
manner in which samples are to be taken for analysis is described in the Sixth
Schedule. The Seventh and Eighth Schedules prescribe the methods in which
analyses are to be undertaken. The Ninth Schedule sets out the limits of variation,
or permitted tolerances, in the particulars given by a seller of the amounts of
the ingredients of a fertiliser or feeding stuff. The Tenth and Eleventh Schedules
respectively prescribe forms of certificates of analysis and of returns by local
authorities.

The principal changes comprise the revision of the methods of analysis
of fertilisers and feeding stuffs and alterations in the forms of certificate of
analysis.

Of particular interest to the Analyst are the 7th and 8th Schedules which
deal with Methods of Analysis. Changes introduced include the following:

For Fertilisers

1. For granular fertilisers a No. 60 sieve is now specified.

2. Kjeldahl process digestion is to be continued 2 hours after clearing and not
1 hour. A mercury catalyst is now compulsory and sodium thiosulphate
(not sulphide) is to be added to the distillation flask.

The Devarda alloy reduction method is now prescribed whether chlorides
are present or not.

3. For phosphoric acid the vanado-molybdate method is now official. The
Unicam SP.600 is a most suitable instrument for the technique involved.

4. The perchloric acid and chloroplatinate methods are retained but the flame
photometer may be used for fertilisers with not more than 20 per cent of
potash.

5. Screened methyl red replaces methyl orange for free acid in ammonium
sulphate.

For Feeding Stuffs

1. The oil figure now means the extract obtained by applying the official
method. There is an interesting modification for samples containing
full cream dried milk involving a moisture adjustment and a note on
re-extraction where the oil exceeds 10 per cent.

2. Protein and phosphoric acid determinations follow the lines for fertilisers.

3. The fibre determination remains as before with only minor modifications.
The acid and alkali strengths are the same but look different being now
expressed in terms of normality.

4. Sugar determinations are now to be carried out by the Lane and Eynon
methylene blue method.

5. For salt the sample is now ignited with lime and not sodium carbonate.

Statutory Instrument 1960 No. 2261 — Arsenic in Food {Amendment) Regulations
These regulations increase from 2 0 to 5 0 parts per million, the maximum
amount of arsenic permitted in brewer’s yeast intended for use by manufacturers
in the manufacture of yeast products. The final yeast product sold to the public
must still contain not more than 2 0 p.p.m. calculated on the dry matter. The
reason for the relaxation in brewer’s yeast is that during fermentation yeast
removes arsenic and other trace metals from beer.

Statutory Instrument 1960 No. 2331 — The Skimmed Milk with Non-Milk Fat
Regulations

This is a somewhat belated piece of legislation and even now does not
become operative until 19th September, 1961.

These regulations, which apply to England and Wales only —

(a) impose requirements as to the labelling and advertising of certain “specified
foods” which have the appearance of milk, condensed milk or dried milk
and which contain skimmed milk and non-milk fat (Regulations 3 and 5
(1) and the First Schedule), but exempt the foods named in Part I of the
Second Schedule from the requirement to bear on the label the declaration
“Unfit for babies” (or the permitted alternatives) provided that the compos-
tion of the food is as prescribed in Part II of that Schedule;

(b) prohibit (subject to certain savings) the labelling or advertising of the
specified foods and beverages containing skimmed milk, in a manner suggestive
of milk or anything connected with the dairy interest (Regulations 4 and
5 (2); and

(c) provide that the Condensed Milk Regulations, 1959, and the Public Health
(Dried Milk) Regulations, 1923 to 1948, shall not apply to any specified
food (Regulation 8).

Food Standards Committee Report — Bread and Flour Report, published 17th
November 1960

This Report makes recommendations for the control over composition,
description, labelling and advertising of bread and flour. The report takes

into account evidence received from the food industry and other interests
including those concerned with the enforcement of food and drugs legislation.
The main recommendations concerning bread are —

1 . There should be a statutory permitted list of the ingredients which may be
used in bread.

2. That descriptions of “protein” breads should be controlled.

3. That slimming claims in connection with bread should be controlled.

4. That exaggerated claims for enrichment of bread or for energy-producing
qualities should be prohibited.

Concerning flour the Committee recommends that —

1 . The present Regulations which require all flour to contain specified amounts
of Vitamin Bi., nicotinic acid and iron and the addition of chalk (creta
preparata) to all flour except whole meal flour, should be continued for the
present.

2. That the sampling of flour to ensure that it complies with these regulations
should be confined to docks and mills.

3. That only certain bleaching and improving agents should be allowed for
the treatment of flour.

The Report does not commit Ministers and before deciding v/hether and to
what extent the recommendations should be implemented, full consideration
will be given to any representations by interested parties. Such representations
must be made by 17th February 1961.

Interdepartmental Committee Report — Milk Composition in the United Kingdom
This Report known as the Cook Report was presented to Parliament by
the Secretary of State for the Home Department, the Secretary of State for
Scotland, the Minister of Agriculture, Fisheries and Food, and the Minister of
Health in September 1960.

This most important document running to ninety odd pages is most difficult
to summarise in a concise manner, but it is helpful perhaps to outline the
Committee’s approach to the problem.

Part I of the Report in four sections deals with —

Section 1 Historical background

Section 2 Milk and nutrition

Section 3 National trends in milk composition

Section 4 Milk composition and the individual herd

Part II Proposals for the future.

Section 5 The broad objective
Section 6 Legal standards
Section 7 Marketing standards
Section 8 Other changes

Followed by Conclusions and a Summary of Recommendations. There are
three Panel Reports —

(1) Report of the Medical Panel

(2) Report of the Animal Husbandry Panel

(3) Report of the Hortvet Panel

and three appendices relating to the list of witness, the Sale of Milk Regulations
1939 and existing schemes to improve milk composition.

The general tenor of the Report is excellent and the underlying principle
that every effort must be made to stop the decline in the compositional standard
of milk is welcomed.

Equally acceptable is the shift of emphasis from fat to solids-not-fat as
the criterion of quality. One recommendation suggests a penalty scheme for
for poor milks but in some quarters there is the feeling that some bonus scheme
for good quality milk would be more acceptable although more difficult to
operate.

The main points on page 36 to 38 embody no less than 23 recommendations
and it is felt that of these items (ii) and (viii) must stand or fall together. If legal
difficulties are to be avoided it would also appear vital that the abolition of
presumptive standards should coincide with the composition of absolute
standards. Similarly the abolition of presumptive standards should also
coincide with the adoption of the Hortvet test as legal proof of the presence of
added water. In this connection it will be essential to find a suitable preservative
for milk samples.

One final point should be stressed. In view of the unsatisfactory nature
of the present definition of Milk in the Food and Drugs Act there is urgent
need of a new legal definition of milk. The suggested definition by the Cook
Committee has the merit of simplicity and conciseness and might be difficult
to better. It is : —

“Cow’s milk means the secretion, excluding colostrum, which can be

gained by normal milking methods from the lactating mammary gland

of the healthy, normally fed cow.”

The Weights and Measures Bill

Finally mention should be made of the Weights & Measures Bill to replace
existing legislation. The yard, metre, pound and kilogram continue to be the
basic units in the United Kingdom but the yard and pound are defined by
reference to the metre and kilogram instead of by reference to Imperial standards.

The Third Schedule of the Bill lists the weights and measures lawful for
use for trade. It is interesting to note that the rod, pole and perch will disappear
and this must surely be a matter of rejoicing among school children if it also
implies the disappearance of the many problems of conversion to and from
these awkward units.

The Bill proposes also to tidy up one of the housewife’s real bones of con-
tention in that many miscellaneous prepacked foods and cleaning materials etc.
will have to be sold by or marked with net weight and will be prepacked only
in fixed quantities. Among other things this will prevent the pernicious growth
of an advertising technique in Giant packs etc. where the giant refers to the size
of the package and not the contents.

There is much also of great value and interest in the Bill but which is outside
the scope of the report.

Table 2 — Percentage Adulteration over 7 years (Bristol Only)

1954

1955

1956

1957

1958

1959

1960

Total number of samples

2,750

3,179

3,012

4,868

3,917

4,028

4,116

Milks per cent adulterated

8-58

5-52

8-48

5-64

13-61

Milk — ordinary

—

• —

—

1-94

Milk — Channel Isalands

—

17-9

Foods

0-36

0-35

0-36

0-33

0-34

0-76

Drugs

2-42

0-77

2-99

1-2

1-8

1-36

2-85

Total

2-65

1-26

2-81

2-0

1-87

4-29

3-06

The milk adulteration

data reveals a

most

disquieting feature.

Whilst

the adulteration rate of ordinary milk is of low order it comes as a disagreeable
surprise to note the high adulteration rate of Channel Island milk. Over 350
samples were examined and nearly 18 per cent were found to be deficient in fat

i.e. they contained less than the absolute standard of 4 per cent required for this
class of milk. This is a sad reflection on allegedly quality milk. It can be added
of 318 genuine milks that the average quality at 4-7 per cent of fat and 9 0 per
cent solids-not-fat is a much more presentable picture.

Table 3— Average Composition of Genuine Milks for I960

Bristol— Ordinary Milks

No. of Fat Non-Fatty solids

Month

samples

% average

January

3-52

8-57

February . .

3-43

8-65

March

3-37

8-71

April

3-41

8-76

May

3-37

8-88

June

3-48

8-72

July

3-17

8-73

August

3-46

8-71

September . .

3*51

8-79

October

3-56

8-72

November . .

3-92

9-08

December . .

3-81

8-69

Total 504

3-50

8-75

Bristol — Channel

Island Milks

January

4-66

9 09

February . .

4-86

8-83

March

4-40

8-79

April

4-69

9-13

May

4-41

906

June

4-35

8-82

July

4-63

8-86

August

4-88

903

September . .

4-95

911

October

4*73

9-27

November . .

4-92

8-76

December . .

4-90

910

Total

318

4-70

8-99

Gloucester County — Ordinary

Milks

January

3-74

8-61

February . .

3-69

8-65

March

3-50

8-62

April

3-40

8-46

May

3-24

8-78

June

3-62

8-73

July

3-64

8-77

August

3-67

8-72

September . .

3-53

8-68

October

3-81

8-73

November . .

3-87

8-72

December . .

3-80

8-68

Total

555

3-63

8-68

Gloucester County — Channel Island Milks

No. of

Fat

Non-fatty solids

Month

samples

% average

January

4-43

8-74

February . .

4-36

9 08

March

4-33

901

April

4-18

8-86

May

4-18

8-92

June

4-41

9 04

July

4-55

8-88

August

4-77

8-76

September . .

4-71

9-14

October

4-97

9-16

November . .

4-60

9-00

December . .

4-55

8-94

Total

132

4-50

8-96

Gloucester City— Ordinary

Milks

March

3-13

8-84

April

2-81

8-40

August

3-40

8-52

Total

311

8-59

Gloucester City— Channel Island Milks

March

3-48

9 00

August

4-40

9-10

Total

3-94

9-05

The action taken on milk samples found adulterated varied with the
circumstances. Thus in several instances of informal milks, follow-up samples
were found satisfactory. Again several fat deficient milks when bulked within
a consignment were found to produce a satisfactory bulk fat. In other cases
warning letters were sent to producers. In no case did the Town Clerk’s Depart-
ment suggest recourse to prosecution.

Of other food and drugs found to be irregular in some aspect the following
may be briefly noted: —

Several samples of corned beef contained excess of lead ranging from 7 to
15 p.p.m. Some of the meat was returned to suppliers whilst in another case
the brand was out of stock.

A condensed Tomato Rice Soup also contained excess lead but repeat
samples were satisfactory.

Ten samples of Ammoniated Tincture of Quinine were all deficient in
ammonia. The worst deficiencies being 64, 81 and 72 per cent. Two of the
samples besides ammonia deficiencies were respectively 95 per cent deficient
in quinine and 8 per cent in excess of quinine. For the most part these samples
represented old stocks which were destroyed. New stocks were found satis-
factory. An Indian Chicken Curry was quite devoid of chicken but a repeat
sample was satisfactory. Italian apples contained excess of both lead and
arsenic.

Formal samples of butter contained excess moisture and the wholesalers
received warning letters.

Soda water samples were found to be practically devoid of sodium bicarb-
onate and subsequent investigations at the local bottling plant indicated the
likelihood that bicarbonate was indeed never added. The bottlers were v/arned.

Essence of Rennet was found to contain 2,500 p.p.m. of boric acid and
350 p.p.m. of benzoic acid. Both additions are a contravention of the Preserv-
ative Regulations. An undiluted Cheese Rennet was found to contain 13,700
p.p.m. of boric acid and 4,200 p.p.m. of benzoic acid. It appeared that the
Rennet was intended for cheese manufacture and should not have been sold
retail. Follow up investigations indicated that cheese prepared from this
Rennet did not, in fact, contain either preservative.

Five samples of bread sold as milk bread were found to contain no lactose.
The several vendors were warned that assistants must be informed that ordinary
bread must not be “palmed off” as milk bread.

Four samples of Luncheon Meat were found to contain excess of tin
ranging from 350 to 800 p.p.m. The remaining stocks were surrendered for
destruction.

Two samples of marzipan and two of almond paste were found to be from
24 to 40 per cent deficient in ground almonds. The local manufacturers working
for the Christmas trade were warned that 25 per cent of ground almonds in such
products would be expected in future.

Various drug preparations were deficient in active constituents and proved
to be largely old stocks which were readily destroyed or surrendered by retailers.
Follow up samples of new stocks were satisfactory.

PART 81. FERTILISERS AND FEEDING STUFFS ACT

Table 4—Summary of Samples Examined

Formal

Informal

Comment or
Irregularity

Bristol —

Feeding Stuffs . .

Fertilisers

Avonmouth

Feeding Stuffs . .

149

—

198

107

Of the 16 feeding stuffs from Avonmouth, 5 samples had an excess of
fibre, 5 contained excess of oil, 2 contained excess of protein, one sample was
deficient in oil and protein, one deficient in oil only, one deficient in protein
only, and one with slight excesses of oil and protein.

The City samples of which 41 required comment on irregularities, some
admittedly for minor infringements, were largely dealt with by letters and copies
of the certificate to retailers or manufacturers.

There was a slight increase in sampling rate of fertilisers and animal feeding
stuffs over the year.

The principle item of interest, however, during the year was the introduction
of new regulations made under the Act, namely the Fertiliser & Feeding Stuffs
Regulations 1960, which came into operation on the 1st October 1960. The
main change was the revision of methods of analysis, which up to then had been
somewhat tedious and long in view of modern analytical techniques. The

introduction of such methods as spectrophotometry and flame photometry
has brought the analysis of fertilisers and feeding stuffs into line with modern
food analysis, and as a result the whole organisation has been standardised,
enabling the analyst to perform far more determinations with increasing accur-
acy.

PART UL WATER AND SEWAGE ANALYSES
Table 5— -Bristol

City water from tap at Canynge Hall . . . . . . . . 26

City water from pumping station, Knowle . . . . . . 12

Downend Home and Frenchay Hospital . . . . . . . . 22

Seepage, sewage effluents and streams . . . . . . . . 25

Ships in port . . . . . . . . . . . . . . 2

Council House (heating system) . . . . . . . . . . 30

Swimming Baths . . . . . . . . . . . . . . Ill

Miscellaneous . . . . . . . . . . . . 7

235

All the samples of potable water were satisfactory as the result of chemical
examination. There was only a trace of dissolved oxygen in samples of water
from the Council House heating system, and the sulphite content ranged from
nil to 30-5 parts per million.

Table 6

Bristol Waterworks Supply West Gloucester Division

Tap at

Tap at
Frenchay

Canynge Hall

Jubilee Road

Downend Homes

Hospital

No. of samples

Total solids . .

Range of variation {parts per
154-315 131-149

million)

133-404

158-401

Chlorine as Chloride

11-16

10-16

14-44

15-44

Nitrate Nitrogen

0-53-2-15

0-32-2-11

0-50-1 -52

0-30-1-58

Total hardness

164-246

74-100

78-236

130-236

Permanent hardness

32-60

38-58

31-60

35-49

These samples from the mains were taken throughout the year at the points
indicated above. The wide variation in the figures of analysis is due to admixture
of water from different sources of supply.

Table 7-- Gloucester (County)

Mains supplies (Public and Private) . . . . . . . . 18

Wells, Boreholes, Springs, etc. . . . . . . . . . . 29

Streams . . . . . . . . . . . . . . 10

Seepage . . . . . . . . . . . . . . . . 1

Sewage and Trade effluents .. .. .. .. .. 16

Swimming Pools and Baths . . . . . . . . . . 23

Forty-seven samples of drinking water were examined. Thirty-eight were
satisfactory, the remainder possessed undesirable features from a chemical
point of view.

Table 8 — Gloucester (City)

Mains supply . . . . . . . . , . . . . . 3

Seepage . . . . . . . . . . . . . . . . 2

The three samples of drinking water were satisfactory chemically.

Report of the Field Officer

General

There has been a considerable increase in field activities during recent years.
To the single major responsibility of sewage chlorination has been added a
variety of duties. These are mainly requests for help with problems of a
chemical or technical nature, and come from several departments of the
Corporation and also from Gloucester County.

The officer attended a two week’s intensive course on river pollution,
sewage and trade waste treatment at Birmingham University, and also the
Public Works Congress in London. Great appreciation is expressed for the
permission readily granted to attend these gatherings. It is only by such visits
and by the reading of much technical literature that one can bring early exper-
ience up to date and still “see the wood for the trees.”

Sewage Chlorination

Last year’s successful river treatment at Bedminster Bridge suggested the
need for active dosing by the new Cattle Market Road plant early in the season.
However, before the equipment there became operational the v/eather had
broken, and so the builders were transferred to more urgent work elsewhere.
In spite of the weather in July and August, there were several days on which a
good dose of chlorine would have improved conditions in the Temple Meads
and St. Philips area.

At this river treatment station a new type of chlorine vaporiser has been
installed which incorporates much improved safety and alarm equipment. It
is hoped in the near future to purchase the single high capacity chlorinator
designed to work in conjunction with this vaporiser. The complete installation
will then be efficient and flexible, affording the best possible protection against
leakage and other hazards. The telephones at this station and Ashton, also
those in the homes of the Officer and Chief Chlorination Plant Operator, have
been placed on the Emergency List by the Telephone Manager. This service,
which is taken very seriously by the telephone service and for which there is
no charge, has already proved of great value. On one occasion, when the wires
were brought down by a crane, repairs were completed in two hours.

Four men attached to the Works Department under the City Engineer are
employed throughout the year as a chlorination team, working under the direct
supervision of the Officer. To cover the spread of hours and extra duties when
plant is operational, roughly May to October, extra men are assigned to the
team, but there is a desperate shortage of suitable candidates. Even in a summer
as poor as 1960, the hours are long although there is not much strenuous work.
The Works Department Manager and the Officer have an informal agreement
to try out any man irrespective of age or strength who seems to have reliability
and plain horse sense in fair measure. A man in his 50’s who can use a telephone
and can be made to realise that “The price of survival is eternal vigilance” is
usually satisfactory provided he does not get too enthusiastic and become a
danger to himself and the public at large. A slight physical weakness may be
an advantage as the building foreman is then more willing to release him!

Much of the transport difficulty has been overcome by the v/illingness of
the Transport and Cleansing Department to supply a “Van, with driver, 24
hours per day, 7 days per week”, throughout the busy season but the problem
of finding enough men who are competent to control any chlorine hazard seems
unlikely to be solved in the foreseeable future.

Other Chlorination Duties

The chlorination team also deal regularly with the handling, separation,
and disposal of some thousands of gallons per week of cutting oil and degreasing
fluid from engineers. Occasional loads of cyanide, chromic acid etc. are also
handled by the team under the direct supervision of the Officer.

A small capacity chlorination station, treating the effluent from Stockwood
Refuse Tip has been operating throughout the year. A satisfactory method of
lime treatment has been devised, producing a final effluent acceptable to the
Avon River Board. The liming and pumping is now carried out by the Cleansing
Department, but the chlorination process is under the direct control of the
Officer.

Emergency treatment of sewage for de-gassing, sewer flushing, ventilation,
lighting and gas testing is frequently undertaken, and the service is available
at any hour of the day or night.

Other Field work, Bristol

The officer, under the Scientific Adviser, is directly responsible for the
regular sterilising of water in the childrens’ paddling pools at Blaise Castle,
St. Andrews Park and Arnos Court, and also for the unofficial paddling pool
in Victoria Rooms Fountains.

The heating services in the Council House are checked for corrosion or
other trouble.

It is hoped soon to make an organised start on the long term survey of
the River Severn, requested by the Haven Master. This has been held up by the
non availability of new type apparatus, and of the difficulty in obtaining suitable
parts from which to make it.

A number of calls has arisen, mostly from the Engineer’s or Health
Departments, for detection of difficult toxic gases. Three of these were in
private houses, and in total, many hours were spent when we “called about the
smell on the landing.” Where appropriate action could be taken, members
of the chlorination team did the work with a minimum of upheaval in the homes
concerned.

Early in the year some work was done with the Fire Prevention Officer
in an endeavour to calibrate the hazards of drip feed oil stoves. There was so
much difficulty in producing a uniform draught of constant speed without
building a very expensive wind tunnel, that the project had to be abandoned.

Field Work — Gloucester County

Continuing from 1959 the temporary chlorination of Old Dean Hall School
water supply was maintained until the public supply was connected.

After a few weeks the school water showed an unsatisfactory bacterial
count, so chlorination was restarted and maintained for a further term.

The chlorinator has now been disconnected, and subject to a final satis-
factory water sample will shortly be returned to the laboratory.

Assistance has been given to several schools where swimming pools have
been built.

Stratford Park Pool, Stroud U.D.C. has also been visited to confirm the
satisfactory working of the latest design chlorination plant installed there.

In the last two months of the year two sewage purification problems have
received much attention. At the County Farm Institute where the existing
settlement tank and sludge drying bed were unsatisfactory, it was recommended
that a good septic tank be built, feeding the effluent on to the existing filter
through the distributor which needs some adaption.

In the North Cotswold area, the effluent from a poultry packing station
appeared to be causing trouble at the sewage purification works. After a series
of visits, with appropriate sampling, preliminary treatment at the factory,
coupled with a Trade Waste Discharge Agreement under the appropriate Acts
was recommended. At the close of the year assistance was being given in the
chemical and biological control of the activated sludge process of this sewage
purification works.

Conclusion

The assistance which it has been possible to give to a few of the people
with problems of the nature outlined above has produced some very kind
comments and emphasises the need for on-the-spot investigations.

The officer is encouraged to say that, under the Adviser, and subject to his
existing commitments, he is ready to assist in any technical problem to which
he is called. If matters of an unfamiliar nature arise there always seems to be
some friendly expert available who can give the benefit of his experience and so
help to produce the right answer.

PART IV. RAG FLOCK ACT

Thirty-five samples were taken informally and examined with reference
to the 1913 Regulations. A preliminary microscopic examination for the nature
of the fibre involved is of considerable value in determining whether or not the
chloride limit test is applicable. With one exception ail samples satisfied the
30 parts per 100,000 maximum chloride (Cl) requirement. The exception
RF.26, Rag Flock, contained 42 parts per 100,000.

There is little change to report concerning the enforcement of the Rag Flock
and Other Filling Materials Regulations 1951, SR. 1846. These Regulations
had several objectionable features and could in particular only be satisfactorily
and economically carried out by a relatively small number of Public Analysts
prepared to set up the necessary apparatus and with a guaranteed minimum
of at least 100 samples per annum. It also appears desirable to revise the
ridiculously low fees for specialised analyses which were proposed ten years
ago and there are signs that the Ministry of Housing and Local Government
may be giving some thought to these difficulties for there is little doubt that as
originally conceived the 1951 Regulations sought to place the work in the hands
of the Public Analyst at least finally rather than leaving the analytical work
in the control of “prescribed Analysts” who seem in the main associated with
the Trade interest.

PART V. PHARMACY AND POISONS ACT

Fifty-one samples were examined for active principles and close attention
was also paid to labelling. A selection of the more interesting of these products
is given.

P. and P.4 Vaporising Fumigator — contained 45-4 per cent v/v of nicotine
against a declared 37-5 per cent v/v. Whilst this excess of nicotine is not perhaps
to the prejudice of the purchaser in respect of the quantity of nicotine received,
one would perhaps expect better accord with the declared nicotine content.

P. and P.8 Liquor Cresolis Saponatus B.P. — this product was of satisfactory
composition, and since it was described as Liquor Cresolis Saponatus B.P. it must
comply with the monograph laid down for that article. This being so the fol-
lowing labelling faults were apparent :

(a) The words “nearly twice the germicidal strength of ordinary Lysol”
cannot be justified since the product is the same cresolic strength
as Lysol.

(b) The words “super Lysol” are similarly not justifiable.

P. and P.12 Glasshouse Fumigating Tubes — contained 20 per cent w/w of
nicotine. Its actual nicotine content was only 2-3 per cent w/w, which suggests
that the article is of some age or has been subjected to adverse storage conditions.
Further sampling is desirable.

P. and P.14 Sanitary Fluid — contained 29 T per cent w/w of formaldehyde
against a declared 30 per cent w/w and is satisfactory in this respect. The
product is a Part II poison under the Pharmacy and Poisons Act, and as such
should bear the name and address of the seller. No such information had been
provided.

P. and P.19 Resin Glue with Formic Acid Hardener — the sample consisted
of two separate articles, one being a polythene packet of a solid (the glue)
and the other, a bottle labelled Hardener GBP.X

FORMIC ACID w/v 344% \ Wt. per ml.

„ „ w/w 31-9% / 1-078 g.

The contents had the above composition and in this respect was quite satis-
factory. There is no doubt whatsoever that the bottle itself contains a Part 11
Poison and cannot be exempted under the Rules. Had the two articles been
sold in a mixed state, they might have been exempted under the heading of
“adhesives”. Therefore the vendors must be registered with the Local Authority.
In all other respects i.e. labelling, the sample is astisfactory.

P. and P.20 Synthetic Resin Glue — the sample was in two portions, glue and
hardener. The hardener was labelled as “Hardener Gux” and it was stated to
contain acid which should not be allowed to come into contact with the skin.
There was the further instruction — use with care. This hardener contained
24 per cent w/w of formic acid and must therefore be regarded as a Part II
poison.

P. and P.28 Rust Destroyer — no reference to the active ingredient on the
label, save that it was mildly corrosive. On an accompanying leaflet, phosphoric
acid was declared to be present. The label contained sufficient warnings, in
view of the nature and amount of the acid. The phosphoric acid content was
39 -6 per cent w/w and it is to be hoped that there will soon be some restriction
on the sale of strong solutions of phosphoric acid similar to those controlling
formic acid.

P. and P.42 Spot lifter — the carton and the tube was marked “inffammable”
but in rather small print and both were rather inconspicuous. This, in fact, was
the only criticism, and in my opinion both tube and carton could be marked more
prominently with the words “Inflammable — keep away from naked flames.”
This might prevent small accidents in the home. A general observation on this
type of collapsible tube pack is the danger of mistaking it for toothpastes or
some foodstuff's which are now similarly packed.

PART VS MISCELLANEOUS ANALYSES
Table 9

General

1. City of Bristol .. .. 185

2. Biochemical and toxicological . . . . . . . . . . 62

3. Foreign bodies, insects and infestation . . . . . . . . 122

4. Gloucester County . . . . . . . . . . . . . . 41

5. Gloucester City .... . . . . . . . . . . —

6. Zinc and fluorine determinations . . . . . . . . . . 23

Bristol Corporation Departments

7. Central Purchasing and Town Clerk . . 2

8. City Engineer .. .. .. .. 112

9. Port Health Office .. 714

10. City Architect . . . . . . . . 3

11. Baths .. .. .. .. .. 1

12. Housing . . . . . . . . . . . . . . . . . . 3

13. Public Health Inspectors’ samples .. .. .. .. .. 23

14. Cemeteries . . . . . . . . . . . . . . . . 1

15. City Valuer . . . . . . . . . . . . . . . . 1

16. Education .. .. .. .. .. .. .. 4

17. Fire Brigade . . . . . . . . . . . . . . . . 3

18. Port of Bristol . . . . . . . . . . . . . . . . 4

Other Authorities

19. Bristol Mental Hospital . . . . . . . . . . . . 1

1,305

7. City and County of Bristol — General examinations

The 185 specimens from various sources include also certain essential
examinations made for purely laboratory information. A few of the more
interesting items are selected for brief comment.

The first specimen gives an opportunity to make yet another plea for the
correct use of food containers. The examination of a bottle of lemonade
indicated the presence of a small amount of petrol and it was apparent that the
bottle had earlier been used to store petrol — an illegal practice. Over the years
many instances of the use of food containers for the storage of strong smelling
fluids have been noted and the public does not help its case for clean food by
returning such containers to the manufacturers.

Two toy watches were submitted from Taunton because of suspected
radioactivity. The dials of these watches were undoubtedly luminous but not
radioactive. The luminosity was due to zinc sulphide.

A dye stuff used in the manufacture of sausages was shown to be Ponceau
MX, a permitted dyestuff.

A sample of carrots was found to have an unpleasant oily taint which was
shown to be due to vaporising oil used by tractors in preparing the soil. The
oil can apparently be taken up by the root system. Certainly the carrots proved
quite uneatable.

Some large sized tablets proved to be essentially sodium bicarbonate. The
tablets were obviously intended for use in preparing a solution in which to soak
and tenderise dried peas.

The Deputy Medical Officer of Health submitted several samples of dusts
from domestic pets and household furniture such as upholstered chairs and
settees. The request was for the possible detection of flea infestation in relation
to its possible cause of Papular Urticaria. This was the subject of a paper in

the British Medical Journal in May 1956, p. 1131. The species can apparently
be recognised only in the adult form and it thus becomes desirable to rear eggs
and larvae to the adult stage. A technique is given in the paper for this purpose
and is stated to rear 90 per cent of adult fleas from the eggs collected. From
the various dust specimens submitted to us several insects have been noted
including a red mite and live psocids. In one dust from a tortoise box, two
minute flies belonging to the genus Psychoda were found. According to Dr.
Paul Freeman of the British Museum, this and similar species are found in
damp situations and around household drains, but have never been accused of
biting man. These flies can therefore by ruled out as a cause of urticaria, at
any rate as a result of bites. Attempts have been made to rear fleas from the
dusts submitted but to date without success.

Several samples of tea infusion, water, tea and sugar were examined with
reference to a complaint from a railway employees canteen concerning the taste
of the infusion. The complaint could not be substantiated and there was a
strong suspicion that the trouble arose from the lack of hygienic control of the
cups and spoons used by the men in a small railway hut used for their tea breaks.

A complaint made by a Corporation employee involved two samples, one
of soldering fluid and the second of the liquid taken from the carburettor of
the individual’s car. The vehicle had apparently been left in a yard and was
unattended for long periods. On two occasions the vehicle stalled when the
owner attempted to start for home after work. To our own amazement and
the disgust of the complainant we found that the fluid from the carburettor
contained petrol and urine. The man, a foreman in a depot, subsequently
delivered a warning to the men in his charge and as far as we know there has
been no recurrence of his troubles.

A sample of dried onion alleged to have been used in the preparation of
some meat pies caused the wholesale rejection of a large number of pies because
of the development of a most offensive smell. It was demonstrated that the
trouble was without doubt due to enzymic action on the natural sulphur com-
pounds in the onion resulting in the development of mercaptan like compounds
of most offensive odour. An odd fact arising from the complaint was that the
smell of the offending pies was more or less normal once the pies had cooled
down several hours later.

Banana stems were found to have deposits of Bordeaux mixture.

Ham rolls in polythene bags had a strong smell due to the freshness of the
rolls, the predominant yeasty smell being retained by the bag.

A complaint regarding canned sardines were found to be due to the curd-
like material in the fish which was produced during processing.

A sterilised milk from a private complainant was found to contain 86 per
cent of added water, and one was almost tempted to report as a sample of water
adulterated with 14 per cent of milk. It appeared that plant washings had been
accidentally bottled and sent out as milk.

2 . — Biochemical and Toxicological

The bulk of the work under this heading relates to blood and urine samples
examined for lead content. Sixteen bloods and 18 urines were submitted.

Other examinations were made upon a breast milk and a proprietary baby
food for their respective Vitamin Bi contents, hair and nails tested for arsenic,
and one urine examined for mercury and found to contain 0 026 mgm. per 24
hours. The latter case was of interest inasmuch as a mercury based teething
powder was alleged to have been given to a two year old child. The powder
was obtained from a general store in a rural area outside the City.

The presence of lead was confirmed in the stomach contents of an individual
who had committed suicide by swallowing paint.

Three further urines examined for mercury had in one instance a somewhat
excessive amount, 0 04 mgm. per 24 hours specimen (normal range 0 0005 to
0 001 mgm. per 24 hours), a second contained 0 08 mgm, whilst the third sam^ple
was free from mercury.

One sample of raw plums contained no lead, arsenic or copper.

Two specimens of urine were examined for selenium which was demonstrated
to be absent.

One vomit was free from lead and arsenic but contained traces of sodium,
magnesium, copper, silicon, iron and tin as might be expected from the normal
diet.

Two samples of water submitted by a Hospital Dispensary were shown to
comply with the B.P. standards for purified water.

3 — Foreign Bodies in Foods etc. including infestation and Identification of Insects

Table 1©

Lab. No.

Article

Comment

M. 26

Sliced loaf

Foreign matter shown to be portions of
soiled dough with mineral oil.

Bread

Contained portions of soiled dough and
fragments of husk.

Custard tart . . . . 7

Cooking fat . . . . . . 1

L Only the cooking fat showed slight

Custard powder . . . . I

'' abnormality being slightly rancid

Dried milk . . . . J

85-94

Butters

No evidence of contamination with
aluminium dross

130

Joint of meat

Foreign matter was a portion of faeces
of the cow or sheep

139

Bread

Insect shown to be the red rust flour beetle

146

Menthol and eucalyptus

“Grittiness” due to small sugar crystals

pastilles . .

and not to sand as alleged

147

Processed English Peas

Insect shown to be the common ground
beetle

149

Meat pie

“Insect” larva shown to be Ephestia larvae

184

Canned salmon

Alleged glass fragments were the natur-
ally occurring struvite

188

Bread

Foreign matter shovm to be portions of a
rubber washer

191

Part of a loaf

Contained fragments of a moth

197

Bread

Foreign matter was soiled dough

202

Weetabix biscuit

Black deposit was a portion of charred
biscuit

204

Milk powder

Brown particles were portions of milk
powder overheated during processing

242

Milk bottle

Foreign matter most probably residues of
cement

252

Oat food

No infestation by moth larvae or mites

241

Milk powder

Foreign matter consisted of 6 long hairs
of horse hair probably from a brush or
broom and 3 short flat hairs of sisal from
a stiff brush

268

Vinegar

Vegetable debris present with twenty
small fruit flies of species of Drosophila

274

Ground rice

Live larvae and webbing of Ephestia
kuehniella

290

Insect

Classified as belonging to the cockroach
family

303

Bread

Foreign matter was a portion of soiled
dough

321

Loaf of bread

Contained a soft sticky patch with an
objectionable acetous odour. Condition
characteristic of infection by “rope” due
to the organism mesentericus vulgatus

No.

326

330

331

332

334

335

340

341

344

346

350

359

372

376

378

379

380

389

392

396

409

411

413

414

428

443

444

445

446

447

449

451

452

455

456

457

465

Article

Comment

Piece of bread
Bread

Milk bottle . .

Orange drink

Skimmed milk powder

Continental Slice
(Fancy cake)

Butter

Corned beef
Canned salmon

Picnic bar

Larvae

Insects

Piece of cake

Bread

Brown bread

Part of loaf

Fancy cakes

Bread crumbs
Slice of bread
Bread crumbs
Bread bap . .

Sultanas

Dried milk powder

Meat pasty . .

Part of a pork pie . .
Dust from mat
Material from cat
Material from bird cage
Grapenuts . .

Maggot in bread
Chocolate biscuit . .

Porridge oats

Stuffing
Sliced loaf . .

Part of a bar of Kit Kat . .
Corned beef

Tin of apricots

Portions of an insect probably Tribolium
or Ptinus

Contained portions of soiled dough but
no rodent excreta

Dark particles were small particles of
dust

Contained portions of a stoutish buff
envelope

Contained a number of soft bodied lice —
probably the Book lice
Contained one pellet of rodent excreta
on the top of the slice

Contained fragments of metallic tin

Contained pieces of skin and cow hairs
Contained small “glass like” fragments of
struvite

Some attack by insects — the Mediter-
ranean flour moth
Identified as Tenebrionidae
Identified as Flower Bugs; Anthocoris
Confusus

Contained mould growth of the peni-

cillium species

Contained soiled dough

Lighter patch in brown bread due to

lighter rough

Contained five moths with mesh of
webbing and excreta

One cake had a small dead larval form
of the flour moth.

Contained fragments of charred dough
Contained a brown beetle — Ptinus tectus
Contained fragments of the meal worm
Contained a whole insect of the yellow
meal worm species

Grubs were of the species of Ephestia
moth

Brown particles were masses of minute
unicellular organisms. These were yeast-
like cells compacted into masses
Foreign body was a portion of a tooth
whose source could not be ascertained
Contained pellicles of mould growth

Some mites present
No fleas or other infestation

Contained one specimen of Ptinus tectus
Larvae of the Ephestia moth
Excreta and webbing probably of the
cocoa moth

Webbing and one live moth of the
Ephestia type

Some webbing and one small moth
Several lengths of jute fibres. Not cooked
with the loaf but probably introduced
during the slicing process
Webbing and excreta probably of the
Ephestia moth

Small tuft of hairs of bovine origin
incorporated probably during the canning
of the meat

The portion of foreign material resembled
chewing gum but this was disproved and
the material seemed to consist mainly of
rubber and a zinc compound probably
zinc oxide

Lab. No.

466

Article

Ice lolly

480

Raspberry split

482

486

Battenburg fancy cake
Custard slice

489

Sterilised milk bottle

493

Cheese sandwich

494

Bread

495

Bread

496

Foreign body from fruit

513

520

Cornish pasty

Bread

522

525

Dark substances in bread
Sliced Bread

Comment

Foreign matter consisted of a small
bundle of jute fibres probably derived
from sacking

Foreign matter was a small piece of brass,
Y long and Vio" wide

Small foreign body was a caraway seed
Insect identified as the front portion of
the German cockroach or Steam fly,
Blatella germanica. Caterers fined £5
Bottle about \ full of milk with a large
portion of fungal growth. Dairy subse-
quently fined £75.

Green foreign matter was mould growth.
The small insect also present was a moth
larva

Foreign matter was a portion of charred
flour

Foreign matter was a husk and soiled
dough

An almost black body long and Y wide
bearing a strong resemblance to a small
mummified hand, but shown to be a seed
capsule of a herb which had dried out in
a most unusual shape
A mass of fluff in the filling of the pasty
Carbonised and burnt oil and not charred
flour or dough

Found to consist of a soiled dough
Contained a thin piece of cardboard

Most of the foregoing specimens were the result of complaints received by
the Food Inspectorate from members of the public. Where action was necessary
a warning letter or a visit by the Inspector usually sufficed. Only in a few cases
was it necessary to institute proceedings.

4 — Gloucester County

Forty-one specimens were examined and these are tabulated in the report
to the County authority.

5 — Gloucester City

No miscellaneous samples were submitted in the year under review.

6 — Zinc and Fluorine

The survey on the tv/o sites in the Avonmouth area for zinc and fluorine
continued throughout the year. The information is summarised in Table 29
under Part IX Atmospheric Pollution.

7 — Central Purchasing Department

Two samples of Lysol prepared by different manufacturers were compared
and showed little chemical difference. These are the last two samples to be
examined for the Central Purchasing Department, as following a recommen-
dation of the O and M specialists it is to be disbanded.

8 — City Engineer's Department

The majority of the 112 specimens submitted were soils and subsoil waters
for examination for sulphates in connection with various building projects.
Other items included rock, fragment of metal, packing and drainage from a
culvert and a bitumiinous material from a trench filling.

9 — Port Health

Some 714 samples were submitted by the Port Inspectorate. The bulk of
the specimens consisted of canned goods from all parts of the world, whilst
dried fruit and fresh fruit accounted for most of the remaining samples.

For the most part the canned goods Vv/ere in excellent condition and free
from undue metallic contamination, that is, excess of tin, lead and copper. A
few samples of corned beef contained undue amounts of lead ranging from 5 to
27 parts per million and one sample actually contained a sizeable piece of solder.
Corned beef being a solid pack is very difficult to sample satisfactorily and
generally lead contamination is erratically distributed throughout the mass.
Heaviest contamination as might be expected occurs at the can ends and seams,
and one suspects that the brogue holing sealing method may increase the
possibilities of lead contamination of the pack.

Canned fish products particularly from Japanese waters have been regularly
monitored with a small Panax instrument and so far without any evidence of
radioactivity.

Fresh citrus fruits have all satisfied the statutory requirements in respect
of the addition of diphenyl or ortho-phenyl-phenol.

One sample of spray dried skim milk powder had a rather high free acidity
which would warrant prompt release and use if the commodity was to be saved.

A bread improver ex Holland was shown to be a glycerinated fat of the
type permitted to be used in food manufacture. The product was pure and free
from liquid paraffin and mineral oil.

Several samples of grapes were found to be dusted with sulphur. This
is a technical but harmless infringement of the Preservative Regulations.

Sliced gherkins in glass jars were in satisfactory condition and in particular
free from benzoic acid.

A sample described as “Farinoca” was principally potato starch partially
gelatinised and pressed into platelets.

A number of bottled jams, raspberry, strawberry and apricot of Hungarian
origin were found to be low in total soluble solids. Several samples of some
fifty examined ranged from 60 to 65 per cent soluble solids. The requirement
for hermetically sealed jams is a minimum of 65 per cent. This fault was
unfortunate in otherwise excellent jams.

Samples of peach and cherry pie fillings were re-examined some months
after the preliminary finding of added benzoic acid. Such addition is not
permissible by our Preservative Regulations and representations were made to
the Canadian authorities. These follow-up samples were free from benzoic acid.

An “Irish Coffee” chocolate preparation was stated to contain “Irish
Whisky” and had in fact just sufficient alcohol to justify the name and at the
same time to satisfy the Excise requirements. “Irish Coffee” itself is a somewhat
better commodity being prepared in certain Irish hotels and consisting of a
mixture of Irish Whisky and Coffee topped off with a thick cream.

Fresh strawberries of French origin entered this country by air as the first
of the season’s crop. They were inspected at Lulsgate airport and submitted
for analysis.

A canned fruit salad from Spain showed signs of incipient fermentation
with break down of the fruit which looked soft and “fluffy” and certainly
unappetising.

Some seedless raisins from Iran contained straw and fibres and were not
quite of the quality to be expected.

Samples of Hamburger Relish and Hot Dog Relish from U.S.A. contained
small but declared amounts of alum.

10 — City Architect

11 — Baths Superintendent

12 — Housing

14 — Cemeteries

15 — City Valuer

16 — Education

17 — Fire Brigade

18 — Port of Bristol

19 — Bristol Mental Hospital

The various specimens received from the above Departments are considered
serially as they reached the laboratory during the year. The number in brackets
refers to the source of the sample.

65 Plastic material (10)

66 Beef sausages (19) . .

76 Mortar mix (10)

107 Fluid from Fire Engine (17)

108 Petrol and foam

111 Mortar mix (10)

143 Dust from skating hall (11)

161

Rendering (12)

162

Rendering (12)

177

Disinfectant solution (16)-

178

Disinfectant solution (16)

180

Fire protective (10)

311

Disinfectant fluid (16)

312

Disinfectant fluid . .

347

Insects (12) . .

363

Witch Hazel (18) ..

430

Bird repellant preparation (1 5)

450

Killgerm Fluid (16)

487

Weedkiller (14)

490

Emulsion (18)

510

Petroleum spirit (17)

511

Water-less cleansing cream (18)

516

Deposit from boiler (18)

Solvent action on this material was

negligible. The material was mildly

combustible leaving glass fibres

67 per cent meat content

Not more than 2 per cent of mortar

instead of the 12-5 per cent as specified

Two liquids very similar

Not more than 6 per cent of mortar
instead of the 12-5 per cent specified
(see M.76 above)

Dust contained 7 per cent of siliceous
matter. Material contained wood dust
arising from abrasion of floor by roller
skates

Inner and outer renderings of M. 161 very
similar. Outer renderings of M.162 very
different with more sand and less lime

Disinfectant actions compared

Insignificant solvent action and less fire
risk than M.65 above

Actions compared

Demonstrated to be blow flies
Examined for flash point
This preparation appeared to consist of
zinc oleate in a petroleum jelly
Composition required
Contained 36 per cent of phenols
Comment made on the removal of oil
from Dock waters

Flash point and nature of liquid deter-
mined

Cream had an unpleasant and persistent
smell and could not be regarded as
satisfactory for use by food handlers
Material mainly calcium carbonate with
some iron oxide

13 — District Public Health Inspectors Samples

8
9

The 23 specimens submitted included insects and —

Water from a kitchen tap
Insects

Rust-like material
Lunch tongues

Itching powder

Insects

Grubs and fleas

Beetle

Insects

Shark skin coat
Choice dairy butter . .

Deposit from a roof
Canned blackcurrants in syrup

Rat bait

Insects

Dusts (from dog’s bedding)

,, (from tortoise box) . .
„ (from budgerigar)

„ (from armchair)

„ (from cot)

Disinfectant

No evidence of lead, copper, iron or zinc

Identified as Plaster beetles and a species of
Cryptophagus

Identified as a brown algae

Small dark patches due to interaction of
traces of metals with sulphur compounds in
the meat

Powder consisted of the hairs from the pods
of cowhage. This is a legume indigenous to
India, Africa and South America. The hairs
are extremely irritating to the skin and when
used medicinally have a rubefacient and
anthelmintic action. Owing to these proper-
ties it is very unwise to use the powder
indiscriminately, especially near the eyes

Confirmed as bed bugs

Identified as cat or dog fleas

Identified as the meal worm Tenehrio molitor

Identified as Dermestidae

Observations made on staining on the coat

Mould growth on wrappings and on the
butter

Problem resolved by visit to the site concerned

Severely blown. Fruit decomposing and
fermenting

Found to be barium carbonate and not
arsenious oxide as suspected

Several insects identified including house
mites and two beetles

No insect life or larvae
Two minute moth flies
No insect life or larvae
Possibly one flea
No insect life or larvae

Comparative tests of efficiency required

PART VSL REPORT ON WORK FOR THE COUNTY OF

GLOUCESTER

This is the ninth annual report on the analytical services provided for the
County in accordance with the agreement of 1951. The bulk of the work
relates to analyses in accordance with the Food and Drugs Act and the Fertilisers
and Feeding Stuffs Act, but the report also includes work on Atmospheric
Pollution, Chlorination and Miscellaneous Analyses for the County and for
Urban and Rural Districts.

Table M— Summary of Examinations

Total

Milk

735

Food and drugs . .

531

Waters and swimming baths

Fertilisers and feeding stuffs

Miscellaneous

1,476

Atmospheric Pollution —

Lead peroxide

Deposit gauges

Spectrophotometric analyses

Chlorination visits and inspections

Total

211

Grand Total

1,687

Table 12—Summary of Milk Analyses

Total

Fat deficient . . . . . . . . . . 34

Added water . . . . . . . . . . 4

Abnormal solids-not-fat . . . . . . . . 38

Poor quality fat. Just less than 3.0 per cent. . . 14

Suspicious. Low S.N.F. and freezing point
depression less than 0-530°C. . . . . . . —

Channel Island satisfactory . . . . . . 125

Channel Island unsatisfactory . . . . . . 10

Channel Island, poor quality . . . . . . 2

Total Milks 735

Formal samples . . . . . . . . . . 265

M.M.B. Contract . . .. .. .. .. 11

M.M.B. Contract. Poor quality . . . . —

M.M.B. Contract S.N.F. abnormal . . . . —

Appeal to cow . . . . . . . . . . 3

Thus of 735 samples examined, 38 were abnormal in respect of solids-no-fat,
that is they gave figures below 8 -5 per cent but the freezing point depression did
not indicate added water.

Of the 125 Channel Island Milks examined, 10 were deficient in fat and 2
were of poor quality.

Of the 610 Ordinary Milks examined, 34 were deficient in fat, 4 contained
added water, and 14 were of poor quality.

The adulterated or otherwise irregular samples may be summarised thus : —

Three samples of sausages contained undeclared preservative.

Two Halibut Liver Oil capsules were deficient in Vitamin A.

Seventeen pies were returned as unsatisfactory inasmuch as they contained
less than 20 per cent of meat.

Two meat pastes contained less than the statutory requirement of 55 per
cent of meat.

Two samples of cheese contained in one case excess moisture and in the
second was deficient in fat on the dry basis when assessed on the respective
requirements in the country of origin.

One whisky contained 64-6 per cent of proof spirit indicating the presence
of at least 0-6 per cent of added water.

One mincemeat was slightly deficient in fat and had a small excess of acetic

acid.

One pork sausage contained only 60 per cent of meat together with 32
p.p.m. of undeclared preservative.

A loaf of bread contained portions of a black beetle.

A bottle of Coca Cola contained two safety razor blades.

Table 13—Waters Effluents, etc.

Mains supplies (Public and Private) . . . . . . 18

Wells, boreholes, springs, etc. . . . . . . 29

Streams . . . . . . . . . . . . . . 10

Seepage . . . . . . . . . . . . . . 1

Sewage and Trade effluents . . . . . . . . 16

Swimming Pools and Baths . . . . . . . . 23

Forty-seven samples of drinking water were examined. Thirty-eight were
satisfactory, the remainder possessed undesirable features from a chemical point
of view.

Table 14—Miscellaneous Samples — Including Atmospheric
Pollution Examinations

Atmospheric pollution —

Lead peroxide . . . . . . . . 75

Deposit gauges . . . . . . . . 74

Milk 11

Soils and sub-soil waters . . . . . . 2

Flies . . . . . . . . . . . . 1

Deposit from sewer . . . . . . . . 1

Canned Pears . . . . . . . . . . 1

Loaf . . . . . . . . . . . . 1

Liquorice Allsorts . . . . . . . . 1

Insects . . . . . . . . . . . . 2

Sand 2

Blue Clay . . . . . . . . . . 1

Clay . . . . . . . . . . . . 2

Canned Pineapple Pieces . . . . . . 1

Gravel . . . . . . . . . . . . 1

Water 2

Ice Lolly . . . . . . . . . . . . 3

Canned Peaches . . . . . . . . . . 1

Small Apple Pie . . . . . . . . . . 1

Fish meal . . . . . . . . . . 1

Aggregate 1

Seepage . . . . . . . . . . . . 1

Soil or Packing Material . . . . . . 1

Maggot in Milk Bottle . . . . . . . . 1

Sausage Roll . . . . . . . . . . 1

Sliced loaf 1

190

Survey of Samples of Cheese
Cheddar Types

The country of origin requires a minimum of 50 per cent of fat calculated
on the dry basis. There is no standard prescribed for moisture.

Number of samples examined
Range of moisture per cent
Range of fat on dry basis per cent
Number failing to comply
Price range per lb.

Includes 3 Australian Cheddar and 6 Canadian

27-0 to 35-7
45-5 to 58-2
3

2/5|d. to 6/Od.

Danish Blue

The country of origin requires a minimum of 45 per cent of fat on the dry
basis with a maximum of 46 per cent of water.

Number of samples examined . .
Range of moisture per cent
Range of fat on dry basis per cent
Number failing to comply
Price range per lb.

29-0 to 48-3
44-7 to 69-2
2

3/2id. to 5/4d.

Includes one Mini Fynbo (not a Danish Blue Cheese) and one Norwegian Blue.

Dutch Edam

The country of origin requires a minimum of 40 per cent of fat on the dry
basis with a maximum moisture (according to the season) of 47 to 48 per cent.

Number of samples examined . . . . . . 20

Range of moisture per cent . . . . . . 37-9 to 54-2

Range of fat on dry basis per cent . . . . 3 TO to 49-0

Number failing to comply . . . . . . 8

Price range per lb. . . . . . . . . 2/5d. to 4/Od.

Of the three varieties of cheese analysed during the year there were 3
failures of the 39 Cheddar types, 2 failures in 31 Danish Blue Cheeses, and 8
failures in the Dutch Edam types of 20 examined. The high proportion of
failures in the Dutch Edam types could be attributed in some instances to some
drying out of the cheese at the cut surface whilst in the hands of the retailer.
There is a remarkable price variation per pound of cheese which bears no relation
to the moisture or the fat content of the article.

Fertilisers and Feeding Stuffs Act

Formal

Fertilisers . . . . 5

Feeding Stuffs . . 37

Requiring
Informal Comment

10 6

18 7

Of the six fertiliser samples requiring comment, one fish m,eal contained
excess of insoluble phosphoric acid, two granular fertiliser likewise, two fertilisers
contained an excess of potash, one sulphate of potash was undeclared in K 2 O
content.

Of seven feeding stuffs, a Sow and Weaner Meal contained too little oil
and a Chick Mash was likewise deficient. Pig pellets contained an excess of oil,
a Pig Fattening Meal and Turkey Starter Crumbs were both slightly deficient
in protein, whilst a Millers Offal and Hill Sheep Pencils contained an excess
of fibre.

PART VUU REPORT ON THE WORK FOR THE CITY OF

GLOUCESTER

Table 15— -Summary of Examinations

Milk

Foods

Water

Atmospheric Pollution-

Lead Peroxide

Deposit Gauges

Fertilisers

Spectrograph ic Analysis

116

Five samples required comment although only one was adulterated. This
was a milk found to be 61 per cent deficient in fat. Eleven milks were “appeal
to cow” samples with a bulk fat of 2-8 per cent.

A sample of Chicken Patties contained only 14-6 per cent of meat calculated
on chicken. I have suggested 25 per cent of chicken as a reasonable standard
but expressed doubt on the chances of establishing this in a court of law.

Three of the six fertiliser and feeding stuff samples required comment.
An organic fertiliser contained excess of nitrogen, phosphate and potash; a
fertiliser based on peat was deficient in insoluble phosphate with a slight excess
of soluble phosphate, whilst a bone meal was under declared on phosphate.

PART IX. ATMOSPHERIC POLLUTION
Table 16

Bristol

Gloucester

County

Gloucester

City

Lead peroxide . .

Deposit gauges

Zinc and fluorine

—

Smoke recordings, City

221

—

Smoke recordings. Port of Bristol Authority

642

—

1,040 149 48

The total number of examinations for the year was 1,237 or just over 12
per cent of the Department work.

The City Survey

The five stations concerned in this survey were Marsh Street (City Centre),
Shaftesbury Crusade (St. Philip’s), the Zoological Gardens (roof of the elephant
house), Blaise Castle (roof of the stables), and Wootton Road, St. Anne’s
(garden of a private house). After the first quarter the Site at St. Anne’s was
abandoned so full years observation concerns four stations only.

It is worthwhile to indicate how the degree of pollution is measured
and in respect of the rain gauges, we have the D.S.I.R. approved apparatus which
consists essentially of a glass collecting bowl of known area, which feeds the
rainfall into a bottle of some 10 litres capacity. Very approximately a full
bottle of 10 litre would represent some 5 inches of rainfall. Each apparatus
is left for one month, and on or about the first of each month the rainfall is
collected and a fresh 10-litre bottle placed in position. In all cases the bottle

is contained in a lagged box to protect it during frost conditions. At periods
of heavy rain it may be necessary to inspect each site at mid-month, or as
dictated by weather conditions. Upon receipt at the laboratory, the collected
rainfall is measured and examined for soluble, insoluble and tarry matters with
estimations of calcium, chloride, sulphate and pH value. The Local Authority
is a co-operating body of the D.S.I.R. in pollution surveys, and all results are
submitted for correlation and assessment to the Director of the Warren Spring
Laboratory, at Stevenage, Herts.

The trends of the last seven years can be seen from the following tables.

Table 17

Total deposit in tons per sq. mile per year

Deposit gauge

1954

1955

1956

1957

1958 1959

1960

Waterworks

263

187

201

156

172

146

(11

138

mths.)

Shaftesbury Crusade

273

226

206

(11 mths.)

180

193

216

(11

184

mths.)

Zoological Gardens . .

143

126

101

(11 mths.)

105

101

1 mths.)

114

115

Blaise Castle

124

103

110

(11 mths.)

108

115

100

St. Annes

—

156

188

(11

152

mths.)

(3 mths.)

The improvement in general conditions noted in 1959 is well maintained
and the depositions at the Waterworks offices, Shaftesbury Crusade and the
Zoological Gardens are at practically the same level. At Blaise Castle there
is a distinct improvement over the 1959 and 1958 depositions and a return to
something approaching the best year 1957. No conclusions are drawn from the
short period of survey at the St. Annes Site.

Table 18

Total rainfall in inches

Rainfall

1954

1955

1956

1957

1958

1959

1960

Waterworks

41-4

23-7

25-7

27-2

34-5

27-6

(11

36-7

mths.) (40-0)*

Shaftesbury Crusade

38-7

22-5

24-1

28-1

34-4

29-4

(11

34-1

mths.) (37-0)*

Zoological Gardens . .

40-2

25-5

26-9

32-9

36-0

31-0

41-0

Blaise Castle

40-2

24-4

25-2

32-6

33-7

301

39-7

St. Annes

27-6

36-5

30-7

7-6

(3 mths.)

*Corrected to 12 months for comparison.

There is perhaps little need to comment on the rainfall in 1960 but it is of
interest to note that the year parallels the rainfall for 1954 and that the rainfall
has increased year by year since 1955 and in 1960 practically doubled the 1955
figures. The Meteorological Office in the Kingsway has recorded some 48
inches of rain for 1960, the highest figure, they state, in living memory. It is
understood that 49 inches were recorded in 1872 and just over 50 inches in 1852.
We can only hope for better things in 1961 !

Table 19

Average SO 3 ingms. per 100 sq. cm. per day

Sulphur Pollution

1954

1955

1956

1957

1958

1959

1960

Waterworks

1-94

3-0

2-03

2-24

206

1-34

1-36

Shaftesbury Crusade

2-29

2-75

2-07

2-40

2-04

1-37

Zoological Gardens

0-61

0-89

105

1-20

0-81

0-64

Blaise Castle

0-96

1-24

1-03

0-93

0-96

0-62

St. Annes

—

117

100

0-77

The gratifying results of falling sulphur pollution noted in 1959 continued
in 1960. The levels at the Waterworks and Shaftesbury Crusade are identical
with the 1959 results, whilst pollution levels at the Zoological Gardens and
Blaise Castle are at the best and lowest level for the seven years reported in the
Table. These excellent results may be due at least, in part to the heavy rainfall
in 1960 which would have the effect of dissolving sulphur gases and hence
decreasing the amount of these gases collected upon the absorbing peroxide
surface. Heavy rainfall is, therefore, not without some beneficial effects!

The data for the Kingswood area are similarly summarised.

Table 20

1954

1955

1956

1957

1958

79.59

1960

Tons per sq. mile

183

116

109

100

Average SO 3 mgms. per
100 sq. cm. per day . .

0-94

1-82

1-24

1-02

0-89

0-8

0-5

Rainfall in inches

40-9

19-9

22-7

27-6

300

28-0

36-3

The total deposition shows some improvement on the 1959 figures and the
sulphur pollution is at the lowest level for the seven years under review. As
indicated in the Bristol Survey it is highly probable that the heavy rainfall
accounts at least, in part for the vast improvement so far as sulphur dioxide
pollution is concerned.

The Avonmouth Survey

Table 21

SO 3 mgms. per 100 sq. cm. per day

1955

1956

1957

1958

1959

1960

Avonmouth Docks

3-60

3-22

2-12

1-95

2-20

1-81

Green Splot

1-21

1-81

* Barracks Lane

0-71

0-97

0-91

0-65

0-35

*Prior to April 1957

this site

was at

T. Farm.

The level of sulphur pollution in the area is at its lowest for the six years
under review with the best improvement noted at the Barracks Lane site where
pollution is about half the 1959 figure and only one-third of the 1958 level.

The rain gauges at Avonmouth Dock and Barracks Lane are not examined
in the conventional manner but are used to assess the zinc and fluorine pollution
in the area. No attempt is made to determine the actual form of these depos-
itions and the table below gives the total zinc and its compounds, and the total
fluorine and its compounds respectively.

Table 22

1957

1958

1959

1960 1960

Avonmouth Dock

Total zinc

2-13

1-82

3-14

1-69 2-03

(10 mths.)

Total fluorine . .

0-95

1-09

1-50

1-08 1-30

(10 mths.)

Rainfall in inches

28-9

33-1

32-0

27-7 33-2

(10 mths.)

Barracks Lane

Total zinc

0-34

0-31

0-28

0-31

Total fluorine . .

0-31

0-19

0-22

0-27

Rainfall in inches

29-4

29-8

40-0

The Barracks Lane figures indicate a more or less stabilised picture at 0-3
tons of zinc and 0-25 tons of fluorine per sq. mile, whatever the rainfall. At
the Dock site conditions are more variable. In 1 960 the data indicate a reversion
to the 1957 and 1958 levels and there is a considerable improvement over the
rather high figures recorded in 1959.

The Dursley Survey

The Council Office site was operative throughout the year but the Street
Farm site was abandoned at the end of the 1st quarter.

Table 23

Average SO 3 mgms. per 100 sq. cm. per day

1960 1959

1958

1957

1956

Street Farm . .

0-74 0-55

(3 mths.)

0-49

0-81

0-85

Council Offices

0-45 0-53

0-75

0-93

1-07

Rainfall in

inches fo.

r each

year

1960 1959

1958

1957

1956

Street Farm . .

7-34 32-0

(3 mths.)

33-9

28-6

24-6

(11 mths.)

Council Offices

37-7 32-8

34-9

26-9

24-6

Deposit in tons per sq. mile

1960 1959

1958

1957

1956

Street Farm . .

23-2 86-6

(3 mths.)

71-7

59-8

73-2

Council Offices

104-5 78-0

81-7

59-0

94-0

(11 mths.)

It is obviously unreasonable to include the three months survey at Street
Farm in any comparison with previous years.

The level of sulphur pollution at the Council Offices continues to improve
and the figure of 0-45 is the lowest yearly average since 1956. The rainfall is
the highest recorded for the five years of the survey and the total deposit of
104-5 tons for the year is the highest for the same period with three months
January, October and November accounting for just over 36 tons. The rainfall
figures ranged from 1-16 inches in April to 5-18 inches in October. The rainfall
in July, August, October and November was 4-50, 4-66, 5-18 and 4-96 inches
respectively.

The Stroud Survey

The Gaumont Cinema and Girls’ High School sites gave the following data
for the year and this is compared with earlier years.

Table 24

Average SO 3 mgms. per 100 sq. cm. per day

1960

1959

1958

1957

1956

Gaumont Cinema

0-77

0-88

1-32

1-41

0-81

Girls’ High School

0-54

0-67

0-76

0-95

1-21

Rainfall in .

inches fo

r each year

1960

1959

1958

1957

1956

Gaumont Cinema

40-4

28-6

34-6

27-9

24-1

Girls’ High School . .

38-4

28-9

31-7

26-7

23-0

Deposit in tons per sq. mile

1960

1959

1958

1957

1956

Gaumont Cinema

145-5

126-1

154-9

115-9

171-7

Girls’ High School . .

94-3

68-9*

74-5

60-5

82-2

* for the period of 1 1 months.

The average degree of sulphur pollution shows the lowest values for the
five years under review, whilst the rainfall was at its highest. There is undoubt-
edly some correlation of these factors. In other words the sulphur pollution
will tend to fall as deposition of rain increases a state of affairs which is predic-
table in view of the solubility of sulphur gases in water.

The deposit at both sides has increased as compared with 1959.

The deposition at the Cinema site has increased by about 19 tons, whilst
at the Girls’ School conditions have worsened from 75 tons to 94 tons, taking
due notice of the 1 1 months observations in that year. The conditions at the
two sites ranged from 2-79 tons (rainfall 2-96 inches) in September to 13-71
tons (rainfall 4-15 inches) in November at the Girls’ High School, whilst at the
Cinema site it was 6-83 tons (rainfall 3-47 inches) in September to 19-29 tons
(rainfall 4-76 inches) in November.

The Thornbury Survey

The Walning and Brynleaze Farm sites gave the following results: —

Walning Farm
Brynleaze Farm

Table 25

Average SO 3 mgms. per 100 sq. cm. per day

1958

1959

1960

0-61

0-41

0-47

(10 mths.)

0-71

0-57

0-49

(10 mths.)

Deposit in tons per sq.

mile

1958

1959

1960

62-2

80-6

99-8

(9 mths.)

(11 mths.)

51-8

68-5

76-5

(9 mths.)

(11 mths.)

1958

Rainfall in inches
1959

1960

28-8

31-9

37-1

(9 mths.)

(12 mths.)

17-6

22-9

29-3

(9 mths.)

(11 mths.)

Walning Farm
Brynleaze Farm

As far as sulphur pollution is concerned the level at Brynleaze continues
to fall and conditions appear to be improving. At Walning there is a slight
retrogression over 1959 conditions.

There is a slight worsening of the deposition figures at both sites as com-
pared with 1959 conditions. Rainfall at both sites was much heavier and it is
intriguing to note that there is a surprising difference of the order of 4 to 5
inches in the deposition. In 1958, 1959 and 1960 there was much more rain at
the Walning site.

The Gloucester Survey

Table 26

Deposit in tons per sq. mile

1958

1959

1960

The Lannet . .

138

107-0

Technical College

(11 mths.)

107

115-6

Average SO 3 mgms. per 100 sq. cm. per day

1958

1959

1960

The Lannet . .

109

(11 mths.)

0-96

0-72

Technical College

1-31

1-04

Rainfall in inches

1958

1959

1960

The Lannet . .

29-2

21 0

(11 mths.)

28-0

Technical College

26-7

26-4

31-1

(11 mths.)

There is a continuing improvement in the sulphur pollution level at the
Lannet site, whilst at the Technical College the level is the same as in 1959 and
markedly better than 1958. In both cases the improvement is mainly due to
the higher rainfall. Even so the rainfall in Gloucester City remains the lowest
of all the sites under our jurisdiction. In the generally poor weather year of
1960 the rainfall in the City was not noticeably above average although mainly
concentrated in the last four months of the year.

The deposit figures at the Lannet site rose significantly in the year as com-
pared with 1959, but were noticeably better than 1958. At the Technical
College there was a worsening by some 8 tons per sq. mile over the levels for
the two previous years.

Particularly heavy deposits were noted in the Technical College site in
June (19 tons), October (12-4 tons), and November (12-0 tons). That is 43
tons of the years total of 115 tons inside 3 months. At the Lannet site there
were 16 tons in January and 13 -3 tons in May and 10 tons in November. That
is 29 tons of the year’s 107 tons.

Finally mention must be made of the “rural” site at Church Road, Heywood,
Wilts. Here as might be anticipated the deposition of 75 tons in the year was
the lowest deposit gauge figure of all the sites. Even so this is a worsening
from the 54-5 tons in 1959. In 1960 the rainfall was 36 inches compared with
25*9 inches for the eleven months in 1959.

PART X. SPECTROSCOPY

The section has handled 912 samples during the year, 710 of which were
routine examinations of canned food for lead and tin content, 89 were ice lollies
examined for metallic contamination and pH, 42 were toxicological and the
remaining 71 of a miscellaneous nature. Contamination by lead is still found
in those makes of corned beef where the square can with a round soldered seal
in the lid is used, but otherwise the food examined is almost all free from undue
metallic contamination. The 42 toxicological examinations consisted of two
for selenium, eight for mercury and thirty-three for lead, one sample being
examined for both lead and mercury. A number of the 71 miscellaneous were
examinations for copper and the rest were identifications of an unknown. The
spectrographic method for copper is now in working order but it is hoped to do
a little more work on interference by other elements before it is completed.
Canned fish from Pacific waters is still monitored for radioactivity and the
results are all negative. Work on the determination of colouring matter in
foods has been extended this year; it is interesting to note that no prohibited
colours have been found although some red colourings have been misnamed
cochineal.

PART XL OTHER ACTIVITIES

A search through the year’s diary brings to light many interesting events
and with it a realisation that an Analyst’s life is certainly not all analysis.

Thus no less than 22 lectures were given to a number of organisations and
students. These included the Royal College of Midwives, two lectures, one
in Bath and one in Clifton, three lectures to Meat and Other Food Inspectors,
8 lectures to D.P.H. students, three lectures to students qualifying for the Smoke
Inspector’s Certificate, and single lectures to Veterinary students; Old Age
Pensioners at Ashton Gate; Women’s Institutes in the Dursley area; the
Bristol International Club; the Bristol Mothercraft Club and the prisoners at
Falfield.

Various members of the staff were on the “receiving end” for lectures on
a variety of subjects including Sewage Disposal and Trade Effluent Treatment;
The Royal Society of Health Conference on the Cleanliness of Bathing Beaches ;
the Clean Air Council Annual Conference at Bath; Two R.S.H. sessional
conferences in Bristol and also in Torquay; the Standing Conference on Atmos-
pheric Pollution with meetings in London and Stevenage and several other
visits to give technical advice mainly on water and sewage problems. Mr.
Taylor and I also attended series of seven Friday lectures on Radiochemistry
which included both theory and practical work. For this opportunity and for
my chance to attend the Pure Food Centenary Lectures in London in September,
I would express my thanks to the Health Committee.

Interest in Civil Defence was maintained throughout the year and included
exercises in February and March; a four day study at Sunningdale also in March
on Radiation Monitoring of Foods and the Annual Conference of Scientific
Intelligence Officers at Exeter in April.

There was also the usual quota of Committee work which included the
four quarterly visits to Gloucester, seven meetings of the Scientific and Ancilliary
Services Sub-Committee and several conferences and committees with the
Medical Officer of Health and Food Inspectors on matters of sampling, pesti-
cides in food and discussions on a beryllium copper process and the setting
up of some ten stations located in schools in the City area for a survey of smoke
and sulphur dioxide pollution.

We were pleased to welcome to the laboratory several visitors including
Dr. and Mrs. A. Serigo from Madrid; Dr. D. Riston from Chile, Messrs M. P.
Camilleri and Scerri, Public Health Inspectors from Malta and Dr. Hassan
Kushkush from Khartoum; Miss Toler (D.S.I.R.), and Dr. Cookson, M.O.H.
Gloucester City. Several parties also toured the laboratories including pupils
from Redland Hill House, Veterinary, D.P.H. and Public Health Students.

Several Court actions were taken during the year and included the following
with brief details of the outcome.

May Three milk samples with added water ranging from 5 to 9 per cent. This
case was held at Coleford and a plea of guilty was entered. A fine of
£15 and £3 3s. 9d. costs was imposed.

July Razor blades in a bottle of Coca Cola. This was indeed a most interesting
case and involved a whole day at Tewkesbury. A plea of not guilty was
entered but the manufacturers were eventually fined £10 and £113 costs.
Sept. A milk found to be 31 -7 per cent deficient in fat. This case was heard at
Dursley. A plea of guilty was entered and a fine of £5 and £5 costs was
imposed.

Dec. Sample M.150 Petrol submitted by the Fire Brigade. The sample was
demonstrated to be petrol with the meaning of the Petroleum Regulations.
The vendor was summoned for keeping petroleum spirit without a
licence A plea of guilty was entered and the two persons concerned
were each fined £4.

In several other instances cautions were issued and in some cases involving
foods and drugs the articles were withdrawn from sale.

On the purely consultative aspects of the work many enquiries were made
notably from the Docks Office on a variety of goods entering or due to enter
the Port. These included Plasticised Nitro-cellulose Flakes with not less than
18 per cent of dibutyl phthalate, Nitrocellulose Chips with plasticers. Aromatic
solvents of various types, and “Methanol Hydro-peroxide”.

Other enquiries concerned gas leaks, the seizure of a diesel engine, illicit
sheep dipping in arsenical dips, the spraying of mushrooms with Lindex and/or
Murphane. It is understood that Lindex is applied as a 5 per cent spray or
dust and is B.H.C. The Ministry of Agricultural regulations require a 14-day
interval between use and marketing crops. Murphane is zinc-ethylene-bis-
dithio-carbonate and is used against bacterial spot and other diseases.

Finally I must refer to the work of the Standards Committee of the Assoc-
iation of Public Analysts. I had the honour to be re-appointed as Chairman
and this Committee continues to do much valuable work in the formulation
of Standards, Codes of Practice and allied matters. The year also saw the form-
ation of the Local Authorities Joint Advisory Committee on Food Standards.
At the first meeting in June discussions were conducted on a number of com-
modities and A.P.A. members were empowered to conduct negotiations with
appropriate Trade interests on several of these selected for priority consideration.

The formation of this Joint Advisory Committee is an important step in the
food legislation of this Country and such a committee can do most valuable
work in the formulation and revision of Codes of Practice, a task somewhat
regrettably rejected by the Ministry of Agriculture, Fisheries and Food.

As Chairman of the major Committee of the A.P.A. on Foods I am most
appreciative of all the effort that goes into the safeguarding of the nations
food supplies and I do sincerely thank the Health Committee for their under-
standing of the value of this work and for the permission granted to me to
attend meetings outside Bristol.

SECTION D

PORT HEALTH SERVICES

ANNUAL AND QUINQUENNIAL REPORT

MEDICAL INSPECTION AND SANITARY CIRCUMSTANCES

Dr. D. T. Richards
Senior Medical Officer {Port)

This Report is prepared on the lines indicated in
Form Port 20, issued by the Ministry of Health to
Port Health Authorities

PORT HEALTH SERVICES

ANNUAL AND QUINQUENNIAL REPORT

Medscai and Sanitary Carey mstances

Dr. D. T. Richards
Senior Medical Officer {Port)

SECTION !

Introdyctioo

The expansion of trade at the Port of Bristol continued with undiminished
activity in 1960. A total of 1,748 “foreign-going” ships, together with 6,404
coastwise vessels entered the port during the year. The net tonnage of foreign
arrivals totalled 4,895,022 a figure well above the average for the post-war years.
Traffic returns provided by the Port of Bristol Authority show that imports
amounted to 4,007,292 tons, exceeding the previous year’s peace-time record by
150,000 tons. Exports, amounting to 164,319 tons, were 9,000 tons greater
than in 1959.

Throughout the year the staff of the Port Health Department maintained
a careful watch over all shipping entering the port. Routine health control
measures were in continuous operation throughout the twenty-four hours,
often concurrently, at Avonmouth, Bristol and Portishead Docks. The pro-
visions of the Public Health (Ships) and the Public Health (Aircraft) Regulations,
1952, were properly enforced at ail times. Incoming ships were immediately
boarded, inspected and kept under careful supervision whilst in port; 356 of
these vessels, from ports and seaboards reporting the occurrence of one of the
“quarantinable” diseases, were singled out for detailed attention. The health
of more than 65,000 crew members and passengers was checked on arrival;
566 of these were discovered to be in need of medical attention. In 36 instances
visits were made to vessels for the purpose of investigating sickness reported to
be of an infectious nature; 14 of the cases, so ascertained, v/ere sent to the
infectious diseases hospital.

Prevention of the importation and spread of communicable diseases is
unquestionably the primary function of a port service. The inspection and
clearance of vessels arriving at the port must claim the unfailing attention of the
port health officer. Second in importance is the systematic inspection of
imported food for the purpose of assessing its purity and quality, or to discover
the presence of adulterants. During 1960, 618,000 tons of imported food came
under the supervision of the inspectorate ; 1 ,690 samples of this food were taken,
and submitted to the laboratory for chemical and bacteriological analysis. An
outstanding feature of this work was the detection of organisms of the salmonella
group in consignments of desiccated coconut from Ceylon. From March
onward, intensive sam.pling of successive shipments of this commodity became
necessary. As a result many salmonella strains were isolated and large quantities
of the coconut, declared to be infected, were detained at the port. A fuller
account of these investigations is given in Section XVII of this report.

Medical inspection and detailed medical examinations of incoming aliens,
in accordance with the requirements of the Aliens Order, 1953, were carried
out at the Seaports and at the Airport. No rejection certificates were issued
during the period.

■ 33 :

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On November 1st, the Food Hygiene (Docks, Carriers, etc.) Regulations,
1960, came into force. These regulations place certain obligations and responsi-
bilities upon food handlers, port employers and persons allocating accom-
modation in parts of the dock to which the regulations apply. They bring the
handling of imported foodstuffs into line with the provisions of the principal
Regulations. A survey of the local requirements was made during November;
this survey is summarized in Section XVIL

This Report is prepared, as in previous years, in the manner prescribed in
Form Port 20, issued to Port Health Authorities by the Ministry of Health;
but on this occasion it is in the form of a quinquennial report, giving a more
detailed account of port health procedure than in the intervening years.

SECTBON 11

Amount of Shipping Entering the District During the Year

The following table provides a yearly comparison of the trading figures
during the last quinquennial period.

Vessels normally trading Tonnage of foreign

Year

Foreign

Coastwise

Imports and Exports

1960 .

1,748

6,404

4,007,292

164,319

1959 .

1,703

6,743

3,856,903

155,290

1958

1,814

6,611

3,840,997

132,999

1957

1,563

4,334

3,421,199

94,856

1956 .

1,442

4,855

3,607,490

126,577

SECTION ill

Character of Shipping and Trade During the Year

This remains fairly constant in character from year to year and is adequately
dealt with in tables (B) and (C) which follow.

TABLE B

Amount of Shipping Entering the District During the Year

No. of ships

Number inspected reported as

having had

Ships by the during the

from*

Number*

Tonnage*

Medical
Officer of
Health

by the
Health
Inspector

voyage infec-
tious disease
on boards

Foreign ports

1,748

4,895,022

356

1,819

Coastwise

6,404

1,871,150

—

942

—

Total

8,152

6,766,172

356

2,761

* Figures supplied by courtesy of the Port of Bristol Authority. (Discrepancy between
number of vessels shown as arriving and number inspected in foreign section arises
from differing classification of “ Foreign ” and “ Coastwise ” vessels as applied
by the Port of Bristol Authority and the Bristol Port Health Authority).

t Excluding vessels having venereal disease on board.

TABLE C (a)

Passenger Traffic

Seaport Airport

inwards British 1,876 1,323

Alien 287 729

Outwards British
Alien

793

312

1,411

658

TABLE C (b)
Cargo Traffic

Principal Imports

Commodities

Tons

Cereal Products . . . . . . . . . . 24,368

Cocoa 27,143

Coffee 14,509

Feeding Stuffs for Livestock 478,811

Fertilisers 311,421

Fruit: Bananas 41,189

Canned . . . . 21,840

Dried . . . . 5,149

Other kinds . . . . . . . . 20,951

Grain: Barley .. .. 109,606

Maize .. .. .. .. .. 431,795

Wheat 386,197

Other kinds 164,822

Metals : Aluminium .. .. .. .. 72,473

Copper . . . . 18,555

Iron and Steel . . . . . . . . 92,563

Zinc and Spelter 37,951

Other kinds . . 9,834

Molasses . . 103,969

Oilseeds and Oilnuts 59,144

Ores 172,517

Paper 49,300

Petroleum: Spirit . . . . . . . . 271,632

Other kinds .. .. .. 508,711

Provisions: Frozen Meat .. .. .. 23,933

Other kinds . . . . . . 39,039

Sugar . . . . . . 3,945

Tea 9,607

Timber 166,239

Tobacco 34,496

Wines and Spirits 9,479

Woodpulp . . . . . . . . . . 165,867

Other Goods . . . . . . . . . . 120,237

Total foreign imports .. 4,007,292

Principal Exports

Carbon Black . . . . . . . . . . 1 8,083

Chemicals . . . . . . . . . . 4,726

Clay 4,852

Cocoa and Cocoa Waste .. .. .. 1,715

Coke 37,216

Government Stores . . . . . . . . 584

Metals: Iron and Steel . . .. .. .. 30,451

Non-ferrous .. .. .. .. 11,614

Motor Vehicles and Parts . . . . . . 27,610

Ores 2,968

Petroleum . . . . . . . . . . 4

Strontia . . . . . . . . . . . . 6,054

Timber manufactures . . . . . . . . 198

Other Goods . . . . 18,244

Total foreign exports . . 164,319

Note : — Figures supplied by the courtesy of the Port of Bristol Authority,

TABLE C (c)

Principal Ports from which Ships Arrive

Country

Algeria

Argentine

Australia . .

Belgium

Brazil

British Guiana
British West Indies

Bulgaria

Burma

Canada

Canary Islands

Ceylon

Chile

Cyprus

Cyrenaica . .

Denmark . .

Estonia

Eire

Fiji . .

Finland

Formosa

France

French Cameroons
French West Africa
Gambia
Germany . .

Ghana

Greece

Guatamala

Hawaii

Iceland

India

Indonesia . .

Iran

Israel

Italy

Japan

Jordan

Kenya

Libya

Madras

Malaya

Mexico

Morocco . .

Mozambique

Ports

Algiers, Oran, Philippville, Mostagagam.

Buenos Aires, Bahia Blanca, Rosario, San Lorenzo,
San Nicolas, San Antonio.

Adelaide, Albany, Bunbury, Brisbane, Cairns, Freemantle,
Geelong, Geraldton, Melbourne, Gladstone, Port
Pirie, Sydney, Townsville, Urangan, Wallaroo.

Antwerp, Bruges, Ghent, Zeebrugge.

Bahia, Forteleza, Natal, Port Elegre, Rio de Janeiro,
Recife.

Pointe-a-Pierre, Georgetown.

Antigua, Barbados, Dominica, Kingston, Montega Bay,
Port Antonia, St. Kitts, Trinidad.

Buges.

Rangoon.

Botwood, Halifax, Kittimat, Chemainus, Montreal,
New Westminster, Port Alfred, Port Fortune,
Port Churchill, Prince Rupert, Quebec, St. John,
Sorel, Three Rivers, Toronto, Vancouver, Bai
Comeau.

Las Palmas, Teneriffe.

Colombo

Puntarenas, Talcahncano, Valparaiso.

Famagusta, Limassol, Nicosea.

Tripoli

Copenhagen, Esburg, Frederikssund, Skagen, Thyboron.

Tallin.

Cork, Dingle, Dublin, Foynes, Limerick, Waterford.

Souva

Hamina, Helsingford, Kotka.

Formosa

Abbeville Bordeaux, Boulogne, Deauville, Calais, Caen,
Dieppe, Dunkirk, Donger, Dahouet, Le Havre,
Cherbourg, Honfleur, La Rochelle, Libourne,
Marseilles, Fecamps, Nantes, Rouen, Tonnay-
Charente, La Pallice.

Tiko.

Dakar, Port Gentil.

Bathurst.

Bremen, Bremerhaven, Emden, Friedickshaven, Hamburg,
Keil, Stettin, Stralsund, Wismar.

Accra, Takoradi.

Patras, Piraeus, Zante.

Le Paz.

Hilo

Nodfjordur.

Bedi, Bombay, Bhavengar, Calcutta, Chalna, Cochin,
Madras, Mangalore, Vizagapatam.

Djakarti, Surabaya, Tegal.

Abadan, Basra, Bahrein, Bushire, Hormuz, Mena el
Ahmadi.

Haifa, Jaffa.

Bari, Genoa, Livorno, Naples, Palermo, Salerno, Spezia,
Cagliari, Civitavecchia, Ravenna, Taranto, Venice.

Kobe, Yokohama, Tokio.

Aqaba.

Mombassa.

Benghazi.

Pondicherry.

Penang, Singapore.

Coatzacoalcos, Mazatlan, Tampico.

Agadar, Ceuto, Casablanca, Saffi, Sousse.

Beira, Mozambique.

TABLE C (c) continued

Country

Ports

Netherlands

Netherlands West Indies . .
Nigeria
Nauru Islands
New Zealand

Norway

Pakistan
Persian Gulf
Peru
Portugal

Portugese East Africa
Puerto Rico
Rumania . .

Poland
Saudi Arabia
Sierra Leone
Siam

South West Africa
Spain

Sudan

Sweden

Syria

Tanganyika

Tunisia

Turkey

Uruguay

Union of South Africa

U.S.S.R

United Arab Republic
Tasmania . .

United States of America

Venezuela . .

West Indies (U.S.A.)
Yugoslavia

Amsterdam, Deldyzl, Dordrecht, Flarrinden, Rotterdam,
Spisk, Zandevoort, Zaandan, Vlaardinger.

Aruba, Curacao.

Lagos, Sapele, Port Harcourt, Warri.

Nauru,

Auckland, Port Chalmers, Lyttleton, Napier, Dunedin,
Timaru, Wellington, New Plymouth.

Aalesund, Ardalstangen, Bergen, Floro, Kopervik,
Kristiansund, Oslo, Havanger, Stavenger, Svolvaer,
Saandalsova, Tredestrand, Trondheim, Tronsa,
Halso,

Chittagong, Karachi.

Ras Tanura.

Callao, Mollendo, Materina,

Faro, Lagos, Lisbon, Oporto, Leixors, Vila Real

Nacula, Lourenco Marques.

San Juan.

Constanza, Galatz.

Gdynia.

Aden.

Freetown.

Bangkok.

Walvis Bay.

Almeria, Barcelona, Bilboa, Cartagena, Huelva, La Vera,
Tarragona, Seville, Valencia.

Port Sudan.

Gelfe, Gothenburg, Iggesund, Kramfors, Malmo,
Nyhammar, Stockholm, Sundsvall.

Latakia.

Dar-es-Salam, Lindi, Mitwara, Tanga, Zanzibar.

Sfax, Tunis.

Iskenderon, Istanbul, Izmir, Mersia.

Las Piedras, Puerto La Cruz, Montevideo.

Cape Town, Durban, East London, Port Elizabeth.

Archangel, Leningrad, Kalingrad, Novorossik, Nikolajas.

Alexandria, Port Said, Liboa.

Hobart.

Baltimore, Baytown, Baton Rouge, Beaumont, Boston,
Boco Grande, Charleston, Corpus Christi, Freeport,
Galveston, Houston, Los Angeles, Mobile, New
Orleans, Newport, New York, Port Arthur, Bridge-
port, Philadelphia, Port Jacksonville, San Francisco,
Tacoma, Tampa, Texas City, Wilmington, Chicago.

Carpito, Punta Cardon, Caracas.

Porto Rica.

Rijeka, Split, Sibenik.

SECTION IV
Inland Barge Traffic

The number of craft and tonnage for
INLAND BARGE TRAFFIC is included
in the Coastwise Traffic by the Port of
Bristol Authority

Places served by the traffic :

Banbury

Barry

Bridgewater

Cardiff

Frampton

Gloucester

Lydney

Newport

Sharpness

Stourport

Swansea

Upton

Worcester

SECTION V
Water Supply

(1) Source of supply for : —

(a) District

Water, supplied by the Bristol Watervv'orks Company, is available to
all premises in the dock area.

(b) Shipping

Fresh water mains, carrying the Bristol Waterworks supply, are laid
on to the quayside berths.

(2) Reports of tests for Contamination : —

(a) Quayside supply

During the year 34 drinking water samples were drawn from the
water mains at Avonmouth, Bristol and Portishead Docks. Thirty-one of these
samples were satisfactory, but three from Avonmouth Docks had a high bacterial
count. Repeat samples, taken immediately afterwards from these three sources,
were found to have a normal bacterial count.

(b) Ships" water tanks

No complaints concerning ships’ drinking water supplies were received
during the year.

The m.v. “Parima” reported that eight days before arrival a member of
the crew, suspected to be suffering from an enteric infection, had been removed
to hospital at Porto Grande, Cape Verde Islands. Although no further case of
sickness had occurred, it was considered advisable to sample the drinking water
on this ship, which was a mixture of supplies obtained at various Brazilian
ports and at Las Palmas. The bacteriological report stated that the water,
from which the Ps. Pyocaneus was recovered, was probably from an unchlorin-
ated source. The information v/as forwarded to the Port Medical Officer, Hull,
to v/hich port the vessel had proceeded. It was later learned that all drinking
water tanks had been emptied and cleansed.

Routine samples of drinking water were taken from the regular traders
'' Sandholm"" and '' Ravens field"" . These were reported to be quite satisfactory.
Samples were also taken from the small drinking water storage tanks on the
floating grain elevators ''Beta"" and "Calais"" at Avonmouth Docks. These were
also satisfactory.

Drinking Water Samples from Ships

Name of Ship Result

s.s. “Parima” . . . . . . Unsatisfactory

m.v. “Sandholme” , . . . . . Satisfactory

m.v. “Ravensfield” . . . . . Satisfactory

G.E. “Beta” . . . . . . Satisfactory

G.E. “Calais” . . . . . . Satisfactory

(i) Precautions taken against Contamination of Hydrants and Hosepipes

Close attention is regularly given to the hydrant chambers, specially those
on quaysides which are prone to contamination and where blockage of the
outlet pipes is likely to occur. Whenever defects, or the accumulation of
stagnant water, were discovered in these chambers the facts were reported to
the Port Authority and were promptly dealt with. In order to prevent any
possible contamination of the water supplied to ships, the watermen were
frequently reminded of the need to flush the hydrants, standpipes and hoses
with a considerable quantity of v^ater before commencing to All ship’s tanks.

(4) Number and Sanitary condition of Water Boats

These have been discontinued at the Port of Bristol.

SECTION VI

Public Health (Ships) Regulations, 1952

(1) List of Infected Areas {Regulations) (6)

This list is prepared and brought up to date monthly. It summarises the
information contained in the World Health Organisation’s Weekly Epidemio-
logical Record of Quarantinable Diseases prepared for the guidance of Port
Health Authorities, and is regularly circulated as follows, any im.portant
addition or amendment being subsequently forwarded during the month as a
separate memorandum : —

H.M. Customs and Excise (Seaport and Airport)

H.M. Immigration Officer (Seaport and Airport)

The Haven Master (for distribution to pilots)

The Manager, Lulsgate (Bristol Airport)

Medical Officers, Shipping Federation
Medical Officers, Special Treatment Centres
The Docks Superintendent
Waterguard Superintendent
Pilotage Collector, Pill

(2) Radio Messages

(a) Arrangements for sending permission by radio for ships to enter the
District {P^egulation 13)

(b) Arrangements for receiving messages by radio from ships and for acting
thereon {Regulation 14 (i) {a) and (2)

If there are any circumstances on board requiring the attention of the
Medical Officer, a wireless message is relayed to “Portelth” Bristol, via Burnham-
on-Sea Radio or Lands End Radio, giving the necessary details. These messages
are forwarded from the Central Health Clinic to the Port Medical Officer and
Senior Port Health Inspector for appropriate action.

(i) Notifications otherwise than by Radio {Regulation 14) (7) {b)

Arrangements for receiving notification otherwise than by radio and for
acting thereon

Visual signals for transmission to the Port Medical Officer are in certain
cases directed to the Port Authority’s signal station at Walton Bay and then
telephoned to Port Health Officials.

{4) Mooring Stations {Regulations 22 to 30)

Situation of stations, and any standing directions issued under these
Regulations

(a) Inner mooring stations

(i) Royal Edward Dock — North Wall

(ii) Old Dock — Dolphin Buoy

(iii) Bristol — Railway Wharf

(b) Outer mooring station

Avonmouth, Bristol and Portishead Docks— Walton Bay.

All vessels, coastwise or from foreign ports, are boarded at the docks on
arrival by the Health Inspector on tidal watch. All vessels from infected
foreign ports, all vessels reporting sickness, and all vessels requiring measures
to be taken under the Aliens’ Order, are boarded by the Medical Officer. Vessels
reporting sickness suspected to be infectious in nature are boarded by the Medical
Officer and Health Inspector at Walton Bay from a tug chartered for this
purpose. For these reasons no standing directions have been issued under the
Regulations.

(5) Arrangements for : —

(a) Hospital accommodation for infectious disease {other than smallpox)

Patients suffering from infectious disease, and all cases requiring observation
are removed to the isolation hospital at Ham Green.

(b) Surveillance and follow-up of contacts

Inspectors make daily visits to all vessels in port which have arrived from
or called at infected areas and secure a signed report concerning the health
of the crews from the officer-in-charge. Any sickness developing after arrival
is thus brought immediately to the notice of the Medical Officer. On arrival
the destinations of passengers and crew are also obtained as a routine in respect
of these ships. When surveillance is required, forward notices, giving the
appropriate information, are posted to the Medical Officers of Health of the
districts to which contacts proceed after leaving the ship.

The cleansing and disinfection of infected ships’ quarters is carried out
whenever necessary, under the supervision of the inspectorial staff. Clothing,
bedding and other articles are removed by van and treated by steam under
pressure at the City Disinfecting Station. The cleansing of persons is provided
for by the City Cleansing Station.

SECTION VII
Smallpox

1. Cases and suspected cases of smallpox occurring within the district
are sent to the smallpox wing of the Ham Green Hospital, Pill near Bristol.

2. Ambulance facilities are provided by the Ambulance Service of the
Bristol Corporation, which is administered by the Medical Officer of Health.
The vaccinal state of the ambulance crews is satisfactory and subject to contin-
uous review.

3. One consultant is available in the event of smallpox; he is Dr. J. Macrea,
of the Ham Green Hospital, Pill near Bristol.

4. Facilities for the laboratory diagnosis of smallpox are available in
conjunction with the Public Health Laboratory Service.

SECTION VIII
Venereal Disease

A new clinic for the treatment of venereal disease amongst seamen is in
the course of construction at Avonmouth Dock. It is expected to be opened
early in 1961.

Full information concerning the situation, and giving the hours during
which the Medical Officer is in attendance at the venereal disease centres at
Avonmouth and Bristol Docks, is given to the crew of every vessel entering the
port. Diagnostic facilities and treatment are available throughout the day and
during the forenoon of Sundays and public holidays. This information is
contained in handbills (including a sketch map) which are freely distributed
to each ship. When indicated, in-patient treatment under the direction of the
venereal diseases consultant is available at Ham Green Hospital.

The arrangement whereby the Port Medical Officer, who is usually the
first to ascertain venereal conditions, acts in an additional capacity as Medical
Officer to the venereal disease centre has continued. This arrangement has
worked satisfactorily.

The following table related to seamen treated at the Avonmouth and Bristol
Centres during the past five years : —

Year

Syphilis

Lympho-

Chancroid granuloma Gonorrhoea

Non

V.D.

Total

1955 . .

150

339

547

1956 . .

124

299

472

1957 . .

133

295

469

1958 . .

140

111

458

1959 ..

139

302

495

1960

163

292

537

SECTION iX

Table “D” which follows is self-explanatory, no other incidents of outstand-
ing interest have occurred during the year.

TABLE D

Cases of Notifiable and Other Infectious Diseases on Ships

Category and number of cases during the year

Cases landed
from ships
from foreign
ports

Cases which have
occurred on ships
from foreign ports Cases landed
but have been from other

disposed of ships

Total

Number

ships

con-

cerned

Chicken Pox . .

Pass.

Crew

before arrival
Pass. Crew

Pass. Crew

Dysentery

. . 1

—

— —

Enteritis

—

— —

Influenza

—

— — •

— —

Measles

—

— —

Mumps

. . —

—

— 1

— —

Pneumonia . .

—

— —

— — ■

Tuberculosis (pul.)

. . —

— . - —

— . —

Typhoid fever

—

— 1

— —

Vaccinia

. . —

— —

Scabies

. . —

— —

Totals

. . 3

— 2

— —

SECTION X

No case of malaria was ascertained during the year on any vessel arriving
at the port.

SECTION XI

Measures taken against Ships Infected with or Suspected

for Plague

1. All vessels from infected or suspected ports are required to attach efficient
rat guards to the mooring ropes.

2. Suitable lengths of tarred hessian are wrapped around mooring outside the
leads, when the standard types of rat guards are not available.

SECTION XI!

Measures taken against Rodents in Ships from Foreign Ports

/ Procedure for Inspection of Ships for Rats
{a) Foreign-going Ships

As soon as possible after the arrival of a vessel a thorough inspection of
the undisturbed surface of the cargo, the cargo holds and all available storage
space is made. These are the initial stages of rodent control at the port. A.
daily search then follows, together with trapping when considered necessary.

Further action is dependent upon the estimated degree of infestation, this
being based upon the evidence of activity discovered and the numiber of rats
trapped during the first few days. If a vessel is found to have m.oderate or
pronounced infestation and is completing discharge of cargo at this port, the
owner or the master in the case of a foreign-owned ship is advised of the need
to have the vessel de-ratted upon completion of discharge. When the vessel
is proceeding to another port for completion of discharge of cargo the relevant
information is forwarded to the Port Health Authority concerned.

The above measures of inspection and repression were effectively maintained
throughout the year, and our experiences confirm the impression, implied in
previous annual reports, that the vast majority of cargo ships are now more or
less free from rodent infestation. The figures given in the accompanying table
illustrate this very well.

This is an encouraging trend, but it does not justify an attitude of com-
placency. Standards in the various ports of the world vary considerably, and
it is advisable to be prepared for the unexpected and to assume that the next
ship to arrive miay well be infested with rats. This happened at the port during
1960.

Within a comparatively short period of time, three vessels arrived from
River Plate ports with cargoes of bulk grain and bagged provender. They were
the "^Achaean'', the ""Korf and the '"'‘Kapitan Kostis'\

The ''Achaean"', which was the first to arrive, is a modern, well maintained
ship with very slight rat harbourage in the cargo holds, and at the time of arrival
possessed a Deratting Exemption Certificate which was valid for a further two
months.

Signs of moderate to pronounced rat activity were discovered in the hold
and eighteen rats were caught after traps had been set for one night. The owners
were advised, and fumigation with HCN gas was recommended after completion
of the discharge of the cargo at Cork.

The Port Medical Officer of Cork was informed of the facts but he was
unable to pursuade the owners to fumigate, and the vessel sailed from Cork to
the Argentine for the same type of cargo without any treatment. When the
vessel arrived at Avonmouth on the second occasion, having in the meantime
been provided with a new Deratting Exemption Certificate in Rosario, the rat
infestation was much more pronounced and had spread to the saloon accom-
modation.

Altogether, 25 adults and 36 young rats were destroyed whilst part of the
cargo was being unloaded at Avonmouth. The young rats were recovered
from seven nests in the bagged meal. Soon afterwards, upon completion of
discharge at Cork, the vessel was treated throughout with HCN gas and the
formidable total of 214 dead rats were recovered.

From the foregoing it will be noted that in a period of about three months
nearly 300 rats were killed in this ship.

The next to arrive was the '"Kapitan Kostis'". This vessel also had a valid
Derailing Exemption Certificate issued three months previously. It was soon
established that rat activity was pronounced in all cargo holds and 85 adult
together with 138 young rats, found in eighteen nests, were killed whilst the
cargo was being unloaded.

Despite considerable discussion and persuasion the owners would not
agree to a fumigation of the vessel with HCN gas. In a final effort on our part
they consented to the treatment of the holds and stores with sodium fluor- acetate
baits. A total of 223 baits were laid and 63 poisoned rats were recovered. In
all, 286 rats were killed, but it is considered that far better results would have
been achieved if fumigation with HCN gas had been carried out.

The last of the three vessels, the "'‘KorC, also had a Deratting Exemption
Certificate which was valid for a further three months. There was ample
evidence of rat activity from the outset and a total of 95 rats were destroyed,
32 adults and 63 young rats, found in 10 nests. The vessel proceeded to Glasgow.
It was learned that fumigation was carried out at that port, but we were not
informed of the results obtained.

From what has been described it is apparent that : —

(1) Measures of rodent control are far from satisfactory in some foreign ports.

(2) Deratting Exemption Certificates are being issued without adequate
inspection in certain of these ports.

(3) Port Health Authorities cannot legally enforce appropriate treatment in
the case of infested ships which possess valid certificates, despite well
founded evidence that these certificates may have been wrongfully issued.

Information concerning these three ships v/as sent to the Ministry of Health,
From enquiries made at other ports the Ministry v/as able to ascertain that
instances of heavy rat infestation in ships from ports in the Argentine were
infrequent, and it was concluded that no special action was required at this stage.

During the year a number of ships trading regularly with the port have
installed permanent Warfarin bait boxes at suitable points in stores and cargo
holds. This method or repression is proving to be highly successful; ships
officers are showing added interest by ensuring that the boxes are regularly
replenished with bait.

{b) Coastwise Vessels

These vessels present no problem. Only very slight traces of mice were
found in three of the numerous coastv/ise vessels inspected during the year.
Rodent control certificates were issued on two occasions during 1960.

The barges, tugs and dredgers have been quite free from rats, and attention
was concentrated on the grain elevators, all of which are now fitted with perma-
nent bait boxes containing Warfarin which is replenished as required. In this
way the rats were kept at a satisfactory minimum despite the fact that from time
to time there was a temporary increase in activity immediately after the elevators
had been used to discharge bulk grain from rat infested ships.

II Progress of Rat Proofing on Ships

This has received its due share of attention in the design of all newly con-
structed ships. Throughout the year proofing has been found to be adequate
in vessels inspected at the port, most of which have been of recent construction.

III Arrangements for the Bacteriological or Pathological Examination of Rodents,
with Special Reference to Rodent Plague, including the number of Rodents
sent for Examination during the Year

A routine proportion of all rats recovered is sent for examination for
evidence of B. pestis to the Public Health Laboratory Service, Canynge Hall,
Clifton. During the year, 126 ship rats were sent for post examination. All
were reported to be free from plague.

IV Arrangements in the District for De-ratting Ships, the methods used, and, if
done by a Commercial Contractor, the Name of the Contractor

The derailing of ships is done by commercial contractors who use hydrogen
cyanide gas for the purpose. The undermentioned firm carried out this work
at the Port during 1960: —

The London Fumigation Co. Ltd., London

TABLE E

Rodents Destroyed during the Year in Ships from
Foreign Ports

Category Number

Black rats . . 556

Brown rats . . —

Species not known . . —

Sent for examination . . 126

Infected with plague , . —

Mice . . . . —

TABLE F

Deratting Certificates and Deratting Exemption Certificates Issued
during the year for Ships from Foreign Ports

No. of Deratting Certificates issued

After

fumigation After After

with Other fumigant trapping poisoning Total
H.C.N.

2 — — 3 5

Number of
De-ratting
Exemption
Certificates
issued

173

Total

Certificates

issued

178

TABLE G

Nature of
defects and
inspections

Inspection of Ships for Nuisances

No. of
inspections
carried
out

Notices served

No. of

Forward defects
Statu- In- (PHAsI found
tory formal M.O.T.)

Result of
serving notices

No. of defects

Not

Rem- rem-
edied edied

Original construction
Structural wear
and tear

Dirt, vermin, etc.

2 148

77
1^304

246

3,780 2 148 16 382 292 90

Summary of Rodent Activity found in Foreign-going Ships
for the Five Year Period 1956 — S960 (inclusive)

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SECTION XIH

SnspectSon of Ships for Nuisances

The majority of the ships visited during the year were either new or of
recent construction. In consequence the number of dirt and verm.in nuisances,
structural or “wear and tear” defects discovered v/as small.

(7) Structural Defects

These were found in only one ship, a 38 years old coastwise vessel, and were
so widespread that the Ministry of Transport Surveyor detained the vessel
for certain essential repairs to be carried out before permitting it to depart for
another port for a general survey and overhaul.

(2) Wear and Tear Defects

These were found in 40 British ships and in the ships of 5 other nationalities.
They were either remedied at this port or included in the voyage repair list for
attention at a terminal repair port.

(3) Dirt, Vermin and Other Nuisances

Of the 304 nuisances ascertained, 51 were smoke nuisances, referred to
elsewhere in this report.

{a) Insect vermin

Bed bug infestation was discovered in two British and two foreign
owned ships. The former were treated with insecticidal lacquer, which appeared
to be quite effective. The latter were treated with BHC liquid insecticide under
the supervision of a port health inspector.

Pronounced cockroach infestation was found in only five ships. Three
of these were treated at this port, the other two being later disinfested at Antwerp.
There is some evidence to suggest that an immunity is being acquired by these
insects to the insecticidal lacquer which has in the past proved to be so effective.

Storeroom infestations, commonly due to the “flour”, “grain” or “saw-
tooth” variety of beetle, were concentrated mainly in supplies of flour, rice and
farinaceous foods.

Rejected infested foods, landed at the request of the Ministry of Transport
Ships’ Stores Inspector were either surrendered for destruction, or utilized
under guarantee as animal food.

{b) Ships Refuse

Accummulations of ships’ refuse on deck, usually in disused oil drums, was
most prevalent in foreign owned ships. In many cases the excuse put forward
was that the crew were entitled to demand extra pay for work not carried out
upon the ship, nevertheless removal of this refuse to the quayside refuse bays
was compelled in all cases.

Smoke Nuisance

Formal notices, concerning offences caused through excessive black smoke
emission were served on two ships during the year. In each case it was claimed
by the Chief Engineer that the emissions were solely due to an unforseen break-
down of the machinery controlling the oil supply to the furnaces. Investigations
confirmed this. It was therefore decided to take no further legal action.

It was necessary to give 51 oral warnings concerning excessive dark smoke
emission. This is a considerable improvement upon the figure for 1959. In
most of the ships an oral warning was effective and there were no recurrences.

The principal reasons were : —

Want of attention . . . . . . . . . . 43

Loss of forced draught due to breakdown of fans . . 3

Excessive load on boilers . . . . . . . . 2

Bad coal . . . . . . . . . . . . 1

Oil fuel contaminated with ammonium sulphate . . 1

Natural draught oil-fired auxilliary boilers in a

deisel engined vessel . . . . . . . . 1

In the last mentioned case, lack of maintenance of the oil pumps and the
absence of thermometers to record the oil temperature were important con-
tributory factors. This vessel had been the cause of considerable concern to
the Hull Port Authority some months earlier, and its impending arrival was
therefore viewed with somx disquietude. Fortunately, it was not necessary
to use winches for the discharge of cargo at Avonmouth, as it had been in Hull.
Consequently, the boiler load would be very much reduced, steam being
required for auxilliaries, such as pumps and dynamo only. In view of this the
Chief Engineer was asked to try and maintain steam with only one furnace
firing. He was at first doubtful but later became satisfied that sufficient steam
pressure could be maintained by this method. The smoke, although continuous,
now rarely exceeded in density shade 2, on the Ringelmann Chart. At our
request, the oil feed pump was overhauled and new oil temperature recording
thermometers were installed.

Three new diesel driven tugs were brought into operation at the docks
during the year. They replace older, coalfired tugs, and make an important
contribution to the abatement of smoke at the port.

Hygiene of Cre¥/s* Spaces
Vessels Trading Coastwise and Foreign

British Foreign

No. of revisits

to vessels

in dock by

s.s. m.v.

s.s.

m.v.

Totals

Inspectors

503 1,539

369

1,369

3,780

No. of vessels reported defective

12 83

229

No. of vessels—

-defects remedied

58 65

185

DEFECTS

Original

Wear and Tear

Dirt and vermin

No. of

Construction

Ships

No. of No. of

No. of

Nationality

Inspected

Ships defects

Ships

defects

Ships

defects

British s.s.

111

— —

m.v.

1,235

1 1

120

Foreign s.s.

221

— —

m.v.

1,022

— —

Totals

2,761

1 1

207

304

No. of Defects

No. of Defects
reported by Forward

No. of Ships

DEFECTS

NATURE

Found Pxem'd

Not

Rem'd

Notices, etc., to : —

Other M.O.T. Owner Bri-
PHAs. Surv'r Master tish

For-

eign

Original construction

1 —

1 — 1

—

Wear and tear

77 46

2—73

Dirt, vermin and other
causes

304 246

13 — 180

139

Totals

382 292

16 — 254

180

Summary of Defects and other Nuisances on Ships
Wear and Tear Defects

Nature of Defect

No.

No. Not

found

Remedied

Defective waste pipes . .

,, soil pipes

,, W.C. pans . .

,, side scuttles . .

„ heaters

,, shower fittings

—

,, floor drainage

,, floors

,, Calorifiers . .

„ washbasins . .

,, messroom fittings . .

—

„ galley

—

Leaking deck heads

Blocked scuppers

—

Defective cabin doors . .

Other nuisances

No.

No. Not

Nature of defect

found

Remedied

Cockroach infestation

Bug Infestations

Weevil Infestation, stores

Dirty accommodation

Accumulation of refuse

—

Quayside fouling

—

Dirty galleys

—

,, galley fittings

—

,, pantries

—

,, pantry fittings . .

—

,, storerooms

—

,, refrigerated rooms

—

„ Handling rooms

—

Smoke nuisances

—

304

246

Overall Totals

381

292

SECTION XIV

Public Health (Shell Fish) Regulations 1934 and 1948

There are no shell-fish beds or layings within the jurisdiction of the Bristol
Port Health Authority. The supply of shell-fish marketed in Bristol is obtained
from other sources.

SECTION XV

1. List of Medical Inspectors of Aliens Holding Warrants of Appointment

Dr. R. C. Wofinden, Medical Officer of Health

Dr. J. F. Skone, Deputy Medical Officer of Health

Dr. D. T. Richards, Senior Assistant Medical Officer (Port)

Dr. G. N. Febry, Assistant Medical Officer (Port) (Until 10.10.60)

Dr. P. Tomlinson, Assistant Medical Officer (Port) (From 10.10.60)

Dr. A. Fraser, Assistant Medical Officer
Dr. J. E. Kaye, Assistant Medical Officer

2. Other Staff— Nil

3. Organisation of Work

The Medical Examination of aliens is normally carried out at the time
when a ship or an aircraft is visited for health control purposes. In all
other cases the Medical Inspector is summoned to the airport or seaport
at the request of the Immigration Officer who meets the arriving alien,
and for this purpose a rota of Medical Inspectors is available.

4. Accommodation for Medical Inspector and Examination

When convenient, inspection and examination is carried out on board
ship, by arrangement v/ith the master. If this is not possible, or if a detailed
examination is required, adequate accommodation is available in the medical
inspection room of the Port Health Office, or at the Bristol (Lulsgate)
Airport.

Medical Inspection of Allens

S»

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<it

S .2

• \s'2 "§ -S

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I-

Number of vessels/aircraft dealt with by the Medical Inspector

SECTION XVI

Arrangements for Burial on Shore of Persons who have Died
on Board Ship from Infectious Disease

The Council of the City and County of Bristol is also the Port Health
Authority for the district. The ambulance and mortuary facilities of the City
are therefore available for the conveyance and detention prior to shore burial
of persons who have died on board ship from infectious disease.

SECTION XVif
Other Hatters

1 . Imported Foods

The quantity of food imported during the year was 618,000 tons — 17,000
tons more than in 1959. Compared with the previous year, imports of coffee
rose by 7,500 tons and cocoa by 7,000 tons. The increase in shipments of tea
and frozen meat advanced by 4,000 tons and 2,500 tons respectively. All
food shipments discharged at the port during the year were inspected and
sampled.

Sampling

A total of 1,690 samples were taken during the period; 701 of these were
samples of desiccated coconut, referred to in some detail below. The remaining
989 samples were from diverse food products, only a few of which were found
to be chemically or bacteriologically unsatisfactory :

(a) The tin content in American asparagus and beans, and in Australian
canned stewed steak, was found to approach the permitted limit of 250 parts
per million. In each case the merchants were advised to arrange for early
disposal.

(b) Samples of Australian skimmed milk powder, although suitable for
consumption, had rather high free acidity figures. The importers were
informed of the need for prompt release to the trade and early use.

(c) Sampled cans of Spanish fruit salad yielded a scanty growth of yeasts.
This consignment included a high percentage of “springer” or “blown”
tins. A full examination was carried out, the sound tins being released for
early distribution.

(d) A scanty growth of aerobic rod forming bacilli was obtained from
Sam. pies of Argentine canned meat. Repeat samples were all found to be
sterile.

(e) A fairly high lead content was discovered in tins of Argentine corned
beef, due to careless soldering. The canner’s representative was informed
and subsequent samples have shown an improvement. These soldered
cans are rapidly being replaced by cans sealed with sanitary caps.

Desiccated Coconut

The transmission of salmonellae from one country to another in food
products is claiming more and more attention at the ports. Early in the year
the discovery of strains of this organism in imported Ceylonese desiccated
coconut led to an intensification of measures for the examination and control
of this commodity, which is so extensively imported for use by confectioners.
With the co-operation of the importers it was decided that port health authorities
should arrange for all consignments to be held for sampling at the docks and
to promote a degree of uniformity at each of the ports it was recommended
that sampling should be carried out as follows : —

(i) Initially, 5 % from differently marked parcels.

(ii) If positive, repeat taking 10% samples.

(iii) If repeat samples prove to be negative, release the consignment
except for the original infected bags or cases.

(iv) If repeat samples prove to be positive, detain the affected consignment
for suitable treatment.

From March 1st when sampling began, to the end of the year, 701 samples
were sent to the laboratory for bacteriological analysis. The following is a
summary of the results of this investigation. (In all cases disposal of the infected
packages was carried out under the supervision of a Medical Officer of Health.) :

No. of consignments . . . . . . . . . . 31

No. of separate parcels (different Marks) . . . . 175

No. of samples taken . . . . . . . . . . 701

No. of samples positive . . . . . . . . 40

No. of parcels where initial 5% samples were all

negative . . . . . . . . . . . . 148

No. of parcels where initial 5 % samples only were

positive . . . . . . . . . . . . 21

Disposal of individual infected packages

Destroyed . . . . . . . . . . . . 2

Heat treatment (oil extraction) . . . . . . 3

Controlled heat treatment .. .. .. .. 16

No. of parcels where 5% and 10% samples were

positive . . . . . . . . . . . . 6

Disposal:

Controlled heat treatment . . . . . . . . 5

Still under detention at end of year . . . . . . 1

Salmonella types isolated from the 40 infected samples

9 S. Bareilly

8 S. Thompson

4 S. Rubislav

2 S. Perth

2 S. Way Cross

2 S. Paratyphi B

2 S. Newport

1 S. Typhimurium

1 S. Tshongwe

1 S. Munster

1 S. Litchfield

1 S. Welterden

1 S. Mchanga

1 S. Charity

3 Unidentified Group B Salm.

1 „ „ C Salm.

Total 40

The following table gives the monthly percentage of desiccated coconut
samples found to be infected with Salmonellae. The trend suggests an improve-
ment during the course of the year.

I960 March April May June July August Sept. Oct. Nov. Dec.

No. of samples

taken (5%) 90 63 126 37 111 64 95 49 35 31

% Positive IMO 7-94 7-12 — 5-41 3-12 6-31 4-1 — —

Imported Jams

Samples of imported strawberry, raspberry and apricot jam were found
to be free from preservatives and colouring matter. The Public Analyst,
however, reported that the total soluble solids, in each of the samples, was
below the legal minimum prescribed in the Food Standards (Preserves) Order,
1953. Repeat samples were taken and these were also found to be deficient
in total soluble solids. The importers were informed that the sale of this jam
would be a breach of the above regulations. The two consignments concerned
were not permitted to be distributed to the trade and arrangements are being
made for alternate disposal. Samples from a third consignment, which arrived
in mid-December, showed that the total soluble solids were in excess of the
minimum legal requirements.

Frozen Meat Imports

Thirty-five shipments of frozen meat, amounting to 23,933 tons, were
imported during the year. These imports were all from Australia or New
Zealand and consisted mainly of frozen lambs or sheep, together with small
parcels of frozen beef quarters, sundry beef cuts, lamb cuts and offal.

Inspection of the meat within the holds at the timic of discharge gave evidence
of the care which had been taken to ensure that it would arrive in a satisfactory
condition, but unfortunately gross dirt contamination sometimes takes place
after arrival, either at a previous discharging port in this country or on the
continent. Because of the London Docks strike, some of the ships with meat
cargoes were diverted to the continent to unload London cargoes. When
these ships finally arrived at Avonmouth to complete discharge, the working
tiers of mutton and lamb carcases were found to be in a disgustingly dirty
condition.

More than 5,200 lamb and sheep carcases from 13 different ships, were
detained because of dirt contamination. These were reconditioned and re-
covered at the local cold store under supervision.

Contamination of this nature is mainly the result of neglect or indifference
on the part of the stevedores and their employees, but blame must also be attached
to ships officers who, through lack of supervision, fail to insist that meat in the
cargo holds is adequately protected from contamination during the course of
discharge.

It is anticipated, so far as ports in England and Wales are concerned, that
the implementation of the provisions contained in the Food Hygiene (Docks,
Carriers, etc.) Regulations, 1960, which came into force in November, will
bring about an improvement in the protection of cargoes of this nature. Poly-
thene bags, have recently been brought into use for the transport of mutton
and lamb carcases. It is hoped that this form of protection will be extended to
ail shipments. One result of this additional, impervious covering is a minimum
of carcase desiccation with less reduction in weight.

Preservatives in Food

A small parcel of canned Canadian fruit pie fillers, intended for a Food
Trade Exhibition in London, was inspected on arrival at Avonmouth. The
labels stated that the contents included sodium benzoate. Chemical analysis
confirmed the presence of this preservative, which is prohibited in the Preserva-
tives in Food Regulations.

The food was not intended for sale for human consumption, and formal
action was unnecessary, but in order to prevent any future infringements, the
Canadian Trade Ministry was asked to inform the Canadian canners of the
relevant provisions of our regulations. Samples drawn from subsequent
shipments have contained no sodium benzoate, permissible amounts of sulphur
dioxide having been substituted as a preservative.

Samples of Imported Foodstuffs taken during I960 and sent to the
Analyst or Bacteriologist for examination

No. of Description

Country

Exam.

Samples of commodity

of origin

for*

Result

Apples, fresh

Holland

Satisfactory

Asparagus tips (canned) . .

U.S.A.

9 ? 99 99

Apricots (canned)

Canada

South Africa

99 99 • •

Australia

9 9 99

Spain

„ (dried) . .

South Africa

„ nectar (canned)

Australia

Beef steak (Canned)

Australia

2 Unsatisfactory

Beets (canned)

Holland

Satisfactory

99 99

Beans cut (canned)

Canada

U.S.A.

„

South Africa

Bloater Spread (canned)

Belgium

Canada

Beef stock (jar)

Tanganyika

Biscuits (pkts.)

Belgium

Bread improver

Holland

Carrots (canned) . .

Belgium

Holland

Celery (canned)

Belgium

7 Unsatisfactory

Corned beef (canned)

Argentine

99 99 99

Brazil

Satisfactory

South Africa

East Africa

Ireland

France

Chocolate . .

Ireland

Cockles (jars)

Holland

Coffee, grounds

Germany

Cheese pieces

Swiss

Chicken (canned)

Holland

U.S.A.

Crab meat (canned)

99 99 99

Corn Kernel (canned)

Canada

Japan

Canada

Chili sauce (bottled)

Canada

]

Currants

Australia

Cherry pie filling (c)

Canada

1 Unsatisfactory

Condiments (canned)

Italy

Satisfactory

Consomme soup (canned)

Canada

Corn relish (jars) . .

Canada

Cherries (canned) . .

* See

Canada

: key at end of Table

No. of Description

Samples of commodity

Country
of origin

Exam.

for^

Result

720

Desiccated coconut (jars)

Ceylon

43 Unsatisfactory

Egg rusks (packets)

Holland

Satisfactory

Egg albumen, Frozen

Holland

Dates

U.S.A.

Farinoca

Holland

Fruit salad (canned)

South Africa

?? ??

Italy

?> ?? 5?

Spain

Grapefruit juice (canned)

U.S.A.

Holland

55 55 55

Israel

55 55 55

U.S.A.

55 55 55

Trinidad

Grapefruit fresh . .

Israel

„ section (canned)

U.S.A.

55 55 55

South Africa

55 55 55

Brazil

Grapes fresh

Spain

„ in syrup (canned)

South Africa

Groundnut flaked

Holland

Gherkins (canned)

Holland

Guavas (canned)

South Africa

Ham (canned)

Denmark

55 55

Holland

55 55

„ and Pork (canned)

Germany

Brazil

55 55 55

Argentine

Hearts, frozen

New Zealand

Hot Dog Relish (canned)

U.S.A.

Hamburger Relish (canned)

U.S.A.

Haddock in sauce (canned)

Warehouse

Irish Stew (canned)

Australia

Jelly Almond

Eire

Jam apricot (jars) . .

Hungary

„ raspberry (jars)

„ strawberry (jars)

Lemons fresh

Cyprus

55 55

Italy

„ juice (canned)

U.S.A.

Loganberries (canned)

South Africa

Luncheon meat

Australia

Lobster (canned) . .

Canada

Marmalade (canned)

South Africa

Minced beef loaf (canned)

Australia

•5

Mushrooms (canned)

South Africa

55 55

Australia

55 55

Denmark

Meat curing powder

Canada

Mangoes sliced (canned) . .

South Africa

Milk condensed (canned)

N. Ireland

55 55 55

Holland

„ evaporated (canned)
Milk powder

Holland

Ireland

Mussels in brine (jars)

Denmark

Melons, fresh

Spain

Oranges fresh

Israel

55 55

Spain

„ „ mandarin . .

Oranges mandarin (canned)

Spain

Japan

Orange juice (canned)

Trinidad

55 55 55

U.S.A.

5 5 55

Israel

„ „ . . . . Spain

* See key at end of Table

No. of Description

Samples of commodity

Country
of origin

Exam.

for*

Result

Oyster soup (canned)

Canada

Satisfactory

„ spread (canned) . .
Pimentoes (canned)

Canada

Italy

Peas, garden (canned)

South Africa

9 9

Paw paws (canned)

Italy

South Africa

Prunes (packets) . .

U.S.A.

5 , ,5

Canada

Australia

Peaches (canned) . .

Canada

,, 59

South Africa

9 5 99

U.S.A.

9 9

Australia

9 9 9 9

Peaches (dried)

Spain

Australia

Pears (canned)

Italy

9 9 9 9

South Africa

Australia

99 9 9

„ fresh

Holland

Pineapple (canned)

Malaya

>9 99

China

9 9

9 9 99

South Africa

,, juice (canned)

South Africa

Potato powder

Holland

Pork luncheon meat (canned)

Denmark

Pork brawn (canned)

Denmark

Pineapple juice

Hawaii

Pilchards in tomato (canned)

South Africa

Pilchards natural (canned)

South Africa

Peach pie filling (canned)

Canada

1 Unsatisfactory

Peel, cut (dried) . .

South Africa

Satisfactory

59 99 99

Peach, nectar (canned)

Australia

Pickles, wafer (jar)

Canada

Pork luncheln meat (canned)

Germany

Raisins (packet) . .

Canada

U.S.A.

99 99

Australia

99 99

South African

9 9 99

Iran

Ravioli (canned) . .

Italy

Red cherries (canned)

Italy

Raisins, seedless (packets)

U.S.A.

Red cherries (canned)

Canada

Sauce (bottles)

Italy

Steak and veg. (canned) . .

Australia

Stewed steak (canned)

South Africa

1 Unsatisfactory

99 99 99

Australia

Satisfactory

99 99 99

East Africa

Steak casserole (canned)

Eire

Australia

Steak and kidney pudding (canned)

Australia

Salmon (canned) . .

U.S.A.

99 99 ....

Canada

99 99 ....

Salmon and Shrimp spread (jars)

Japan

Canada

Salmon spread (jars)

Canada

Sultanas (packets)

Australia

„ (jars)

Turkey

Spaghetti (canned)

Canada

Spaghetti and sausage (canned) . .

Denmark

Sweet corn (canned)

Canada

See key at end of Table

No. of Description

Samples of commodity

County
of origin

Exam,
for *

Result

Sardines (canned)

Portugal

Satisfactory

Spray dried skim milk (pkt.)

Australia

9 9

Shrimps (canned)

Canada

Shrimps in brine (canned)

Norway

Sausages (jars)

Denmark

„ (canned)

Germany

,, .

Ireland

Strawberries (fresh) (bskts)

France

1 Unsatisfactory

Spinach (canned) . .

Belgium

Sweets (loose)

Eire

Satisfactory

Tomatoes (canned)

Italy

„ (Jars)

Bulgaria

„ juice (canned) . .

Italy

5 ? ?5

Canada

Australia

„ puree (canned)

Hungary

Italy

„ ketchup (canned)

Italy

Tea (packets)

Ceylon

Tongue (canned) . .

Australia

,5 59

Holland

9 5 99

Tuna fish spread (canned)

Denmark

Canada

Truffle

Denmark

9 9

Veg, dehydrated . .

Holland

Figs in Syrup (canned) . .

Italy

Figs (packets)

Turkey

Key Examined for

B Bacterial contamination.

C Chemical contamination.

P Preservatives.

Miscellaneous Foods (Condemned)

Description

Reason for condemnation

Butter . .

. . Crushed and contaminated

Cereals . .

. . Insect infested

Citrus peel

. . Dirt contaminated

Cocobeans

Mould contaminated

Coffee beans . .

Mould contaminated

Desiccated coconut

Dirt and bacterial contaminated

Flour . .

. . Dirt contaminated

Grapefruit fresh

. . Decomposed and mouldy

Lard

. . Dirt contaminated

Milk powder . .

. . Contaminated

^ ’ 18

Onions

. . Decomposed

Peas

. . Wet and mouldy . .

Peanuts

Mould contaminated

Raisins . .

. . Dirt contaminated

Rusks . .

Crushed and burst pkts.

Sultanas

. . Dirt contaminated

Strawberry pulp

. . Crushed & dirt contaminated

Tea

. . Contaminated and mouldy

Tomatoes (fresh)

. . Decomposed

Wheat . .

. . Wet damaged and mouldy

117

Total Weight .. 154 13 2 3i

000^O^-^^K)000^-P>■0^'OO

Meats (Condemned)

Bacon . .

Beef

Lamb and mutton
Pork

Abcess in neck
Mould contaminated
Mould contaminated and rancid
Mould contaminated

T. C. Q. lb.

9 3 10

1 9 2 13

6 0 12

Total Weight . . 2 5 2 9

Canned Goods (Condemned)

Qty. Tins

Ib.

Condiments

Crushed and broken

Cream Milk

336

Stale and solidified

Fish

265

Crushed and burst . .

8-1

Fruit

9,665

Crushed, blown, burst

Fruit juice

287

Crushed, blown, burst

Jam

111

Crushed and burst . .

22^

KetchuiD

121

Broken and burst

Meat

589

Broken, blown and burst

Sauce . .

Broken

Tomatoes

1,688

Blown, burst, rust holed

Tomato paste . .

575

Burst and holed

„ puree . .

?? 99

„ juice . .

99 ....

Vegetable

104

Burst, crushed and holed

Total

. . 13,949

Total Weight

Total weight of all foodstuffs
condemned . . . . 169 18 2 15

Particulars of Foods Detained for Re-exportation or
Re-conditioning at Local or Other Food Depots

Tons

Description of food Reason for detention {approx.)

Butter

. . Brine stain, wet damage and dirt contamination

Canned fruit

Crushed and burst and blown tins

134

Canned meat

Crushed and burst and blown tins

Canned tomatoes . .

. . Crushed and burst and blown tins

Canned tomato paste

. . Crushed and burst and blown tins

Cocoa beans

. . Wet damaged and mouldy

Coffee beans

Wet damaged and mouldy

108

Dried fruit . .

. . Wet damaged fermenting and mouldy

Dried milk powder

Wet damaged and mouldy

Desiccated coconut

. . Bacterial contamination and mouldy . .

Flour

Wet damaged and mouldy

126

Ground nut kernels

. . Wet damaged and mouldy

Lambs tfrozen)

. . Dirt contamination

Lard

. . Dirt contamination and rancidity

Tea . .

Wet damaged and mould contamination

Total weight . .

699

2. Dock Sanitation

Factories and Canteens

These premises were regularly inspected. A list of the defects found, and
afterwards remedied by the management is given hereunder:

Factories

Defective fittings in sanitary accommodation . . . . . . . . 3

Blocked drainage in washplaces . . . . . . . . . . . . 3

Blocked soil pipes and inspection chambers . . . . . . . . . . 14

Dirty condition of sanitary accommodation . . . . . . . . . . 15

Rearrangement of sanitary accommodation and installation of urinal . . 1

Unsatisfactory refuse disposal . . . . . . . . . . . . . . 3

Messrooms and cloakrooms requiring redecoration . . . . . . . . 4

Defective table tops . . . . . . . . . . . . . . 2

Canteens

Defective (worn out) washup sinks . . . . . . . . . . . . 2

Lack of constant hot water supply . . . . . . . . . . . . 1

Insanitary garbage containers . . . . . . . . . . . . . . 9

Defective garbage containers . . . . . . . . . . . . . . 4

Use of unclean crockery . . . . . . . . . . . . . . 3

Defective mechanical washing machine . . . . . . . . . . 1

Defective drainage . . . . . . . . . . . . . . . . 5

Absence of hand washing notices . . . . . . . . . . 4

Defective paintwork (walls and ceilings) . . . . . . . . . . 2

Defective ventilation in food store . . . . . . . . . . 1

Public Conveniences

Num.erous complaints were received concerning the dirty condition of
public conveniences at the Dry Dock in Avonmouth. “Special ratings” have
been using this place because the existing “native type” closets provided for
them are not readily accessible, and difficult to approach after dark. For this
reason the Port Authority was asked to provide toilets for them in a more
convenient place.

Pigeons

Nuisances caused by pigeons in transit sheds have again been a matter
for concern. As an experiment the Port Authority arranged for one shed at
the City Docks to be treated with a deterrent. Further action depends upon
the result of this trial, but the range of pigeon activity makes it impracticable for
such a method of control, however successful, to be used at Avonmouth Docks.

3. Measures against Rodents on Docks, Quays, etc.

Systematic trapping, alternating with “Warfarin” bait treatment, and
occasional baiting with zinc phosphide was in continuous operation throughout
the year. By these means, rodent control in mills, factories, warehouses and
waste land was satisfactorily maintained. Occasionally it became necessary to
give special attention to some of the granaries and mills. These were the
occasions when rat activity was observed immediately after an intake of bulk
grain or bagged provender from infested ships. In these circumstances very
close co-operation was maintained with the managers of mills and granaries,
who were forewarned of the need to watch the cargo — especially bagged animal
food — to prevent rats gaining access to their premises.

Of the 110 rats killed on the dockside during the year only 4 were of the
brown species {Rattus Norvegicus). Brown rat activity is very slight in the dock
area, and is confined to a few locations where burrowing is possible, and where
feeding conditions are most suitable for this species.

Complaints of slight infestation with mice were received from various
premises during the year. These were given prompt and effective attention.

A complete survey of all warehouses, transit sheds and business premises
was carried out at all docks during the year. This survey showed that the
repressive measures in operation were keeping the rodent population down to a
satisfactory minimum. Shortly after the survey was completed, a heavy rat
infestation occurred quite suddenly in one of the City Docks transit sheds.
This was believed to arise from bales of infested sacks which had been brought
into the building. Prompt action brought about a clearance of the trouble
and there v/as no recurrence.

In warehouses, mills and transit sheds, day to day changes in the kind of
commodity handles and stored, som.e of this possibly from infested sources,
make it necessary to carry out frequent inspection. As in ships, successful
rodent control can only be achieved by continuity of action.

4. New Legislation

The Food Hygiene (Docks, Carriers, etc.) Regulations, 1960, came into
operation on November 1st. The enforcement of those parts of the regulations
which necessitate structural work has been deferred until May 1st, 1961. A
survey of requirements at Bristol and Avonmouth Docks, was made during
November. This is included below. Discussions have been held with Port
Authority and Stevedoring Company’s representatives, and no difficulty or
delay in bringing the regulations into effect is anticipated. Indeed, many of the
requirements have been accepted as routine procedure at this port for a con-
siderable time.

SURVEY OF REQUIREMENTS AT BRISTOL AND
AVONMOUTH DOCKS

Food Hygiene (Docks, Carriers, Etc.) Regulations, I960

Regulation No., Heading and General
Purport

5. Condition of accommodation allo-
cated for handling food

A person allocating accommodation
for the handling of food shall not permit
the use of accommodation which is in
such a state as to expose the food to the
risk of contamination.

Recommendations, Action taken and
Comments

Bristol Docks

(1) Periodic cleansing of the floors of
transit sheds where bacon sides are
handled and stored. (Transit Sheds
U, V, A, and T.)

(2) Measures for the suppression of
pigeon infestation in premises used for
the temporary storage of food. (It is
understood that these measures are now
under consideration by the Docks
Engineer.)

Avonmouth Docks

Conditions are satisfactory throughout
the docks area and are under continuous
survey.

Regulation No., Heading and General
Purport

6. Cleanliness of vessels, vehicles,
equipment, etc.

A person providing these for the
movement of food must ensure that
“any surface with which food is liable
to come into contact — is kept in such a
condition — as to prevent — any risk of
contamination.”

7. Food to be protected from the risk
of contamination

A port employer must secure that any
person employed by him shall so place
the food as to avoid the risk of contam-
ination.

(Note: (a) “Contamination” includes
contamination by odour. (b) This
regulation applies particularly to quay
surfaces and transit shed floors.)

9. Personal Cleanliness

Incompletely covered food must be
handled in such a way as to prevent
any contamination, and a series of rules
must be observed by persons engaged
in the handling of food.

Recommendations, Action Taken and
Comments

Bristol Docks

Regular cleansing of the wooden
pallets used for stacking bacon in the
transit sheds. These should be periodic-
ally moved to the outside quay and
washed down with water and a detergent.
This is the responsibility of the stevedores
who provide this equipment, ihe Port
Authority is responsible for the pro-
vision of an adequate supply of clean
water.

Avonrnouth Docks

Vessels, vehicles, containers and equip-
ment such as discharging gear, nets,
trays, pallets, skips, dillies, wagons and
trucks are regularly inspected. Defects
are remedied by the stevedores who
employ this equipment at the request of
the port health inspector. This action
has always been along informal lines,
and I anticipate that this will continue.

Bristol Docks

Pallets used for the temporary
stacking of sides of bacon should be
raised to at least A" from the floor by
means of cross bearers to prevent
carcase overhang and contamination
from the shed floor, and suitable means
should be devised to prevent the
deposition of bales of bacon upon the
floors of transit sheds whilst awaiting
loading. The existing method is an
objectionable one.

Avonmouth Docks

Steps are being taken to provide and
instal movable platforms and adequate
netting to prevent contamination. The
commodities mainly concerned are meat
and cheese.

Avonmouth and Bristol Docks

Notices summarizing the requirements
which apply to dock workers should be
prominently displayed at call stands,
quays and transit sheds at these docks.
The obligations of dock workers as to
the cleanliness of person, clothing, etc.,
should be clearly set out on this notice,
together with the penalty for contra-
vention of these regulations.

Regulation No., Heading and General
Purport

10. Handling of meat

Precautions must be taken to prevent
meat (which includes bacon and ham)
from coming into contact with exposed
parts of the person, other than the hands
and forearms, or with any clothing other
than protective clothing or a washable
head covering.

(Note: There is no meat “humping”
at this port; head coverings are there-
fore not required.)

1 1 . Persons suffering from certain infect-
tions, etc.

When any handler of open food
becomes aware that he is suffering from,
or is a carrier of one of the enteric
infections or any staphylococcal infection
likely to cause food poisoning, he must
at once give notice of this fact to his
employer, who shall at once inform the
M.O.H.

12. Responsibility of occupiers and
owners

The owner, or person allocating the
premises, shall be responsible for such
of these regulations as are of a structural
character. The occupier of the premises
or place to which these regulations apply
shall comply with the remaining provis-
ions, e.g., cleanliness and hygiene.

13 and 14. Soil drainage systems and
Cisterns

As in the Principal Regulations.

Recommendations, Action Taken and
Comments

Avonmouth Docks

The Port Authority is giving the lead
to other employers by providing aprons
for meat handlers in their employ.
Canvas overshoes would be an ideal
protection, but they would be expensive
and operationally impracticable because
of the size and diversification of the dock
labour force. Clumsily fitting overshoes
would also increase the accident hazard.
With frozen meat, foot wrappings of
clean hessian meet the requirements of
the regulations.

Imports of bacon from Holland, Eire
and Northern Ireland present a problem
at Bristol Docks. Approximately 600
bales, each consisting of four sides of
bacon, are delivered each week. These
are wrapped in hessian, which seldom
provides an adequate covering. By
contrast with frozen meat, bacon sides
are soft and flaccid, and their hessian
coverings become soaked with a greasy
saline exudate which leads to excessive
dirt contamination within a ship’s hold.
Moreover, walking over these bales is
sometimes inevitable during the off-
loading stages. The process is regularly
supervised by the port health inspector,
who advises accordingly, but consider-
ation may eventually have to be given
to the provision of washable canvas
overshoes for this work.

See my recommendation under regu-
lation No. 9. The proposed notices
should set out in full the provisions of
Part 3 of these Regulations, and should
be prepared and issued by the Health
Department.

A distinction between the responsi-
bilities of owner and occupier is made
under the various headings of this
survey.

No action is required.

Regulation No., Heading and General
Purport

15. Sanitary Conveniences

Cleanliness, Lighting and Ventilation,
etc.

16. Water Supply

To be provided in reasonable
proximity to all food buildings.

17. Washing Facilities

“Suitable and sufficient washing fac-
ilities — conveniently accessible to persons
engaged” in the handling of open food.

Essentially, it is considered that the aim
of these Regulations is the prevention of
the spread of the enteric infections. It is
therefore felt that the ultimate ideal
should be the provision of washing facilities
at each of the existing modern type
conveniences at Avonmouth and Bristol
Docks. This cannot be insisted upon
under present circumstances, but is a
long term recommendation.

18. First Aid Materials

The Regulations prescribe, inter alia,
waterproof dressings for the use of
persons engaged in the handling of
food.

19. Lighting of Food Buildings
“Suitable and sufficient”.

20. Ventilation

“Suitable and sufficient”.

21. Sleeping Places

Not to be used as food buildings.

Recommendations, Action Taken and
Comments

Bristol Docks

Conveniences at T, U, L and M sheds
have poor natural lighting. This should
be improved by the provision of light
coloured interior decoration to reflect
the natural light, or by the provision of
artificial lighting during working hours.

(The adaptation of some of the
sanitary conveniences is also dealt with
under Regulation 17, below.)

No action recommended. At all food
loading quays and transit sheds, there
is an adequate supply of clean and
wholesome water.

Avonmouth Docks

(1) The inclusion of three wash-
basins with soap dispenser and paper
towels at the modern convenience
situated between O and P sheds. Nearly
all of the open food at Avonmouth is
discharged at this berth.

(2) The provision of a mobile hand
washing machine which dispenses a
waterless washing compound, for use on
the occasions when open food is dis-
charged elsewhere.

Bristol Docks

Installation of a wash-basin at the
sanitary convenience situated at the end
of T shed.

These have been installed in all first
aid boxes at quays and transit sheds.
First aid boxes are regularly inspected
and replenished when necessary.

No structural alterations required.

This Regulation does not apply.

Regulation No., Heading and General
Purport

'22. Cleanliness and repair etc., of food
buildings

Cleanliness of internal surfaces, the
promption of hygiene and the prevention
of infestation by vermin.

23. Accumulations of refuse etc.
Prohibited,

Recommendations, Action Taken and
Comments

This is a matter of departmental
routine, and is under constant super-
vision. In this Regulation, provision is
made for the effective proofing of food
buildings in order to prevent any risks
of infestation by rats, mice and insects.

This is dealt with during the course
of daily inspections.

5. Miscellaneous

Bananas

As in previous years, through the kindness of Messrs. Elder & Fyffes,
your officers have been able to arrange for the distribution of gifts of bananas
which were too ripe for storage. The amount available has been higher this
year, and distribution was as follows: —

Dr. Barnardo’s Homes 604 lb.

Hortham & Brentry Hospital 392 lb.

Day Nurseries 528 lb.

Children’s Committee 280 lb.

Children’s Hospital 504 lb.

Frenchay Hospital 616 lb.

Ham Green Hospital 560 lb.

Muller’s Homes 624 lb.

Southmead Hospital 504 lb.

Total 4,612 1b.

SECTION E

SPECIAL REPORTS

Section

THE WILLIAM BUDD HEALTH CENTRE

VETERINARY OFFICER’S REPORT

CARE OF THE AGED

CARE OF HANDICAPPED PEOPLE (ADULTS)

CIVIL DEFENCE RESPONSIBILITIES OF THE MEDICAL
OFFICER OF HEALTH

Page

HEALTH EDUCATION

THE WILLIAM BUDD HEALTH CENTRE

Introduction

The year under review has unfortunately seen no material expansion in
the services provided at the Centre, but the need for a diagnostic unit and a
consulting physician becomes more and more apparent. Nevertheless, a start
has been made on what should be some interesting experiments in making the
best use of existing facilities and staff. The doctors have already expressed
enthusiasm about the idea of attaching to each practice either a health visitor or
a combined health visitor/home nurse.

Fresh interest has been aroused in the concept of health centre practice
by the completion of Dr. Sluglett’s survey which was sponsored by the Medical
Practitioners’ Union who have now published “Report on Health Centres”
and which has already received favourable press notices. Dr. Sluglett, who has
been Chairman of the House Committee since its inception and previously
Chairman of the Working Party set up to prepare a scheme for the health centre,
was awarded an M.D. for his thesis on Health Centres.

Staffing

The staffing position has stabilised. For the first time there has been no
permanent staff change during the year and the general practitioners have
recorded their indebtedness for the willing assistance invariably given. In-
creasing work, however, has made it necessary to augment the staff allocated
from the Department’s central nursing pool.

The doctors have agreed to leave to individual firms whether or not white
coats should be uniformly worn. It is a sign of the times that steps have had to
be taken to restrict the use of the car park since, during surgery times, patients’
cars were filling the park.

Equipment

At the request of the physiotherapist, an infra red lamp has been provided
and the doctors are making the greatest use of it.

The number of referrals to hospital diagnostic units has remained consis-
tently high and the purchase of a haemoglobin photometer has enabled routine
and special blood estimations to be done on the spot by the nursing staff.
An occasional check is made on the results by the examination of parallel
specimens by the pathological laboratory.

The provision of additional E.N.T. equipment has been deferred pending
the appointment of a sessional E.N.T. consultant by the Regional Hospital
Board.

Committees

The House Committee met formally on two occasions, the 30th May and
the 17th October but informal meetings dealing with individual services and
interested bodies were held throughout the year. Mr. S. A. Forster, who had
succeeded Mr. Pillinger as Clerk to the Bristol Executive Council, joined the
Committee. It was not found necessary during the year to convene a meeting
of the Joint Advisory Committee.

Research Surveys

After carefully reviewing possible projects, it was felt that the basic need
was for operational research in general practice. The basic data will be provided
by carrying out a census of age and sex composition of the various practices and
the register should be completed soon. It is already providing a useful check on
records and the Executive Council is co-operating to the full in completing dates
of birth. Although the initial production is necessarily a slow process, the staff
working on it are showing interest as the usefulness of the register emerges.
Some interesting data should become available for future reports.

Appointment System

Careful thought has been given to the possibility of introducing an appoint-
ment system for patients but the idea was rejected for this area.

Co-operation with Teachers

The doctors’ relationships with the teachers and the school health service
in the district have been improved by a series of lunch time meetings and
discussions and the School Welfare Officer has been asked to attend regularly
at the Health Centre for consultation with the doctors.

Care and After Care

Special attention has been given by the doctors to the early diagnosis of
diabetes and the Diabetic Association has been allowed to hold meetings at the
clinic.

A weekly chiropody session has now been established and about ten elderly
people are treated per session. The clientele number 70 — 80.

Discussion has taken place on the possibility of inaugurating a geriatric
clinic run by either one of the doctors interested in this work who would take
patients referred by other doctors, or perhaps by a local authority medical
officer. The main purpose would be health education and “secondary preven-
tion”; nutritional advice would be given and haemoglobin tests performed as a
routine. It was agreed that such a clinic might relieve the doctors of regular
calls on some old people and benefit some mentally confused old folk. The
age-sex census will be of use in this venture.

Nutrition Clinic

Increased use of the services of the nutritionist was made during 1960, 180
new patients being referred compared with 139 in the previous year. Total
attendances were 891. Participation in classes and demonstrations arranged
for school children, housewives and expectant mothers in the locality have also
continued.

Psychiatric Social Work

From the beginning of 1960 psychiatric work at the Health Centre has
formed part of the overall Child and Family Guidance Service in the City.

One weekly session has been regularly given by the whole team working
together, both for diagnostic and treatment cases, and one by the psychiatric
social worker only — when mothers are seen by themselves, or with their pre-
school children.

The educational psychologist regularly visits schools in the area and is
thus in a position to help teachers with nervous, difficult, or backward children
and give valuable reports to the Health Centre staff, and to general practitioners.

Once a month the consultant psychiatrist holds a conference attended by
the medical officer, the sisters, the health visitors working at the Centre, and the
rest of the psychiatric team. Discussion and inter-change of views on every
kind of emotional problem arising in their respective fields has been found to be
both stimulating and helpful.

The psychiatric social worker has continued to give talks on emotional
problems of pregnancy and lactation to ante-natal mothers attending parentcraft
courses, and these have been linked as closely as possible with the work of the
health visitors on infant feeding and care.

Seventy-six new cases have been referred, of whom 71 had been seen by
the end of the year, — 38 by the whole team, 21 by the psychologist only, and 12
by the psychiatric social worker only. Of the total number of children referred,
11 were under 5 years. Six pre-school children seen in 1959 have continued to
attend in 1960.

There have been 258 interviews with old patients (of whom 15 have attended
for regular weekly treatment for periods varying from three to twelve months) ;
124 home visits have been paid.

There has been one staff change during the year. Mr. King left Bristol in
February, and Mr. Alan Hickish replaced him as educational psychologist.

Relaxation and Parentcraft Classes

Relaxation classes are now an accepted part of ante-natal work and are
conducted by Miss Hogg, Senior Physiotherapist. There have been 42 classes
and 300 attendances.

Parentcraft classes are held on the same afternoon at the Centre as the
relaxation classes. There have been 41 sessions and 294 attendances.

Also there were four evening sessions for expectant mothers and fathers
when films were shown. 116 people have been present.

These sessions continue very successfully.

General Practitioner Work

At the end of 1960 there were 11,766 patients registered at the Centre, an
increase of 132 since the last report.

Patients'’ Attendances at the Centre

Table I shows the attendance by each quarter for each general practitioner

firm.

Table I

Doctors

1st Quarter
1959 1960

2nd Quarter
1959 1960

3rd Quarter
1959 1960

4th Quarter
1959 1960

Totals

1959 1960

3,916

3,731

3,296

3,331

3,205

3,273

3,295

3,159

13,712

13,494

631

591

534

500

644

546

617

2,268

2,426

2,836

2,502

2,264

2,318

2,076

2,134

2,226

2,332

9,402

9,286

1,421

1,639

1,129

1,556

1,351

1,271

1,469

1,417

5,370

5,883

1,816

1,704

1,509

1,588

1,403

1,460

1,576

1,552

6,304

Totals

10,620

10,207

8,789

9,327

8,535

8,782

9,112

9,077

37,056

37,393

Table 2 shows the volume of work undertaken by the nursing and medical
staff in the minor surgery theatre (electro-cardiograms included).

Table 2

1st Quarter

2nd Quarter

3rd Quarter

4th Quarter

Totals

Doctors

1959

1960

1959

1960

1959

1960

1959

1960

1959

1960

1,945

2,062

2,131

1,993

2,094

2,415

2,024

2,054

8,194

8,524

152

194

129

164

160

112

141

557

624

858

514

610

718

834

645

626

499

2,928

2,376

137

343

182

403

371

292

408

369

1,098

1,407

601

415

711

434

712

495

596

455

2,620

1,799

Totals

3,693

3,528

3,763

3,677

4,175

4,007

3,766

3,518

15,397

14,730

Schools

247

162

587

209

Casuals

363

203

354

322

508

264

296

237

1,521

1,026

Full Total

4,303

3,770

4,279

4,059

4,764

4,319

4,159

3,817

17,505

15,965

Table 3 — General Practitioner — Maternal and Child Health

Work

1959

1960

Sessions

243

225

Mothers attended

1,374

1,579

Average

5-6

Table 4 — Number of patients referred to Hospital Specialists

(all doctors)

Year

Orthop.

Paed.

Phys.

Surg.

E.N.T.

Gyn.

Total

1958

107

307

Ill

252

116

1,059

1959

134

319

296

258

151

1,211

1960

170

319

342

245

153

1,298

Table 5 — Patients referred to Hospital Diagnostic Units
(all doctors and Local Authority)

Year

Chest

X-ray

Haemoglobin

Blood

Count

E.S.R.

Urine

Total

1958

160

356

—

600

1959

104

414

—

581

1960

/598

—

1,435

\606 (A. Natal)

Number of patients referred by all doctors for X-ray other than chest X-rays =
60 during 1960.

Table 6 — Emergency Calls

Number of

Year

night calls —

Total

Doctors

Sisters

1958

617

305

922

1959

645

378

1,023

1960

820

400

1,220

Table 7 — Local Authority Work— Maternal and Child Welfare

Medical Officers’ session

1959

1960

Mothers attended

297

—

Average

—

Midwives’ sessions . .

Attendances . .

166

289

Average

3-8

7-4

Table 8 — Local Authority Work-

—School

Health

1959

1960

School doctors’ sessions . . . .

New children

204

124

Attendances . .

409

244

Average

VETERSNARY OFFICER'S REPORT

J. Allcock, B.V.Sc., M.R.C.V.S.
{Inspector under the Diseases of Animals Act)

Notifiable Diseases

Nineteen-sixty was a disastrous year for the number and extent of the
outbreaks in the whole country of foot and mouth disease, swine fever and
fowl pest — almost three times the average number of outbreaks of foot and
mouth, twice the number of outbreaks of fowl pest and swine fever at the same
peak level as the past two years. The City has remained free from fowl pest
and foot and mouth disease during the year and only three outbreaks of swine
fever have occurred. The national outbreaks have affected the City indirectly: —

Foot amd Mouth Disease

Because of the serious spread of foot and mouth disease during November
and the presence of infected and contact animals in public markets a Controlled
Area Order was made on 26th November, 1960 declaring, amongst other places,
Bristol as a Controlled Area. This prohibited the holding of markets except for
animals for immediate slaughter; and prohibited all cattle, sheep or pig move-
ments except under licence. This Order remained in force until 10th December,
and during this period 329 licences were issued comprising 321 for ordinary
animal movements, 3 occupation licences, one licence for breeding purposes and
4 for the movement of inedible offal. The numbers of animals involved were
2,924 cattle, 3,946 sheep and 2,594 pigs. A further complication was provided
by the floods in Bath affecting a bacon factory and some hundred pigs consigned
there had to be diverted to Bristol and thus licenced, at very short notice.
During this dislocation of the normal life of the farming and meat-trading
community the greatest co-operation has always been obtained from the vast
majority but I would suggest to one or two individuals that 10.30 p.m. on a
Sunday evening is hardly a reasonable time to ask for a licence — in fact a recent
Magistrates Court decided that 6.15 p.m. on a weekday was not a reasonable
time for a Constable to ask to inspect a farmer’s Movement of Animals’ Register.

Fowl Pest

This disease began to assume epidemic proportions during the Autumn
of 1959 and there were fears that a similar or worse position would develop
during the Autumn of i960. The National Farmers’ Union sponsored meetings
in each County of England and Wales as a result of which, County Fowl Pest
Committees were formed in almost every County to organise a publicity cam-
paign designed to prevent the spread of fowl pest by bringing home to the
poultry keeper, and all who in their normal work visit poultry farms, the
importance of proper hygiene and other management aids. I attended the
inaugural meeting in Gloucester and subsequently was appointed to the Com-
mittee. The original idea was to have a campaign for six weeks starting on
1st October, 1960 but this has since been modified so that the committee is still
in being and functioning. The early results were disappointing at a national
level resulting in a drop of only about 25 per cent in the number of cases com-
pared with the corresponding period in 1959. There were no outbreaks in
Gloucester however, and none in Bristol.

Swine fever

Swine fever was confirmed on three occasions during the year. One of the
cases was in Hotwell Lairs in pigs consigned from Cornwall from an infected
herd. The other two cases were on holdings owned by the Corporation and
in each case there was a strong suspicion the swill boiling regulations were not
being properly observed. Furthermore, in these two cases the general standard
of hygiene was appalling. A letter has since been sent to all tenants of Corpor-
ation allotments and agricultural holdings emphasising the importance of the
Diseases of Animals Acts and all other Orders calculated to prevent the spread
of infectious disease.

Cattle Market

Nine pig sales were held during the year at which 219 licences were issued
for 308 pigs. In my last report I expressed concern at the lack of “policing” of
various regulations and the disinfection of cattle lorries was one of the points
I had in mind. The Transit of Animals Order 1927 and the various amending
Orders require that public transport vehicles shall be disinfected between loads
of animals and in any case shall be disinfected before leaving the market. At the
Bristol market a charge of 2/- is made to cover the use of water, apparatus and
disinfectant. At two consecutive pig sales not a single person paid to disinfect
his vehicle. The Chief Constable arranged for an Officer to be on duty at the
next few sales to check each vehicle before it left the miarket and the position
now seems to be that every public vehicle is being properly disinfected in Bristol
Market at least.

Importation of Dogs and Cats Order

This Order which prohibits the importation of dogs and cats except under
licence and after six months quarantine is designed to prevent the introduction
of rabies — a most unpleasant, highly fatal disease transmissable to humans
by the bite of an infected dog or cat. This disease has not occurred in this
country except in quarantine kennels since 1926, but it is endemic in many
parts of the world. Only the very strictest observance of quarantine regulations
have made this fortunate position in this country possible.

Two incidents at Avonmouth have therefore been very disquieting. On
the first occasion a dog owned by the ship’s carpenter was found by the Docks
police wandering on the quay-side— as a result of this (the Order requires the
detention of animals living on a vessel whilst that vessel is in port) the owner
was prosecuted and fined £1.

The second incident was much more serious. A seaman took a cat ashore
and the cat was finally detained in Brixton, London. The tracing of this cat
was due very largely to the efforts of the Avonmouth Docks Police under Supt.
Gillespie, and inevitably was an expensive business. I would estimate that the
total costs including the final destruction of the cat after it had been transferred
to quarantine kennels, exceeded £50. The seaman was prosecuted and fined
£1 and £1 10s. Od. costs.

Considering the potential danger to human life caused by this irresponsible
escapade and the costs incurred by public funds, I must confess that I feel that
the penalty was somewhat light and is hardly likely to help either the Docks
Police or myself in our efforts to prevent similar occurrences.

Brucellosis

One possible human case of Brucellosis was reported during the year and
a dairy herd within the City was possibly incriminated. The farm was visited
and milk samples examined by the Public Health Laboratory.

Sheep dipping

These regulations are still proving very difficult to enforce satisfactorily,
and I am finding that in one or two cases the stockowner seems to imagine that
any dip — a Cresol type disinfectant in one case — will suffice.

Pet Animals Act

Routine visits have been paid to pet shops and in the case of new licences
I have specified the types and numbers of animals that shall be kept in each
shop with the existing cage pen or tank accommodation.

Importation Orders

Importation Orders have been issued during the year authorising the
landing at Avonmouth of three Giraffes, two Oryx, two Duikers, one Dik-Dik
and one Bushbuck.

Finally I would like to thank all those who have helped in so many ways —
the City Police, the Docks Police, the staffs of all the Corporation Departments,
and my own staff.

CARE OF THE AGED
Statutory Services

Housing Committee

Most bed-sitting room and one-bedroomed flat accommodation is occupied
by old people and details are given below ;

{a) Pre-war Estates

There are 166 one-bedroomed flats on Bedminster, Knowle, and
Southmead Estates ; 96 flats, some part furnished, in the Central Area and
62 Council Houses have been converted to provide 124 one-bedroomed
and bed-sitting room flats. The rents range from 15/- to 22/6d. a week
plus rates and water charges.

{b) Post-war Programme

By December 31st i960, 2,149 one-bedroomed and bed-sitting room
dwellings, mainly on the Hartcliffe, Stockwood, Withywood, Lawrence
Weston and Henbury Estates, had been completed, and another 178
dv/ellings were being built.

The rents range from 20/- to 22/6d. a week plus rates and water charges.

Of the 36,867 units of permanent housing erected by the Corporation
up to 31st December, 1960, 2,567 (6-9 per cent) were bed-sitting room or one-
bedroomed dwellings. In post-war building the proportion of these units has
risen to 9-7 per cent and of the 1,505 dwellings due to be included in the 1961
building programme 539 (35-8 per cent) are of this type.

Welfare Services Committee

The Welfare Services Committee is responsible either directly or through
the agency of voluntary bodies for providing residential accommodation for
persons in need of care and attention; services to handicapped people including
the blind and deaf, many of whom are old; safe-guarding the property of
people admitted to hospitals or other institutional accommodation; burials
or cremations where no relative can assist; and meals to old and infirm people
living in their own homes and the provision of club facilities for elderly people.

The details and capacity of accommodation provided under Part III of the
National Assistance Act can be summarised as follows: —

100, Fishponds Road* 550

5, All Saints Road 18

119, Pembroke Road 20

159/161, Redland Road 27

14, Blenheim Road 21

9, Priory Road . . . . . . . . 25

Bourton Grange . . . . . . . . 42

“Gleeson House”, Oldbury Court . . 46

“St. Peter’s”, Bishopthorpe Road . . 46

Total . . 795

It is hoped that Snowdon Road, Fishponds, with accommodation for about
200 residents will become available for occupation in 1961.

* Excludes Temporary Accommodation.

The Department supervises 22 Homes for old people accommodating 554
residents registered under Section 37 of the National Assistance Act, 1948, while
66 blind people live in three Homes administered by Bristol Royal Workshops
for the Blind.

Advice on health matters is given and administrative health arrangements
are made by the Medical Officer of Health on behalf of the Welfare Services
Committee and nine general practitioners provide general medical services
for the residents of the Council’s Homes. The present standard charge for
residents is £8 7s. lOd. per week.

Mobile Meals Service

The mobile meals service is provided on behalf of the Welfare Services
Committee by the Bristol Old People’s Welfare (Voluntary) Ltd., and the
Women’s Voluntary Service. During 1960 they provided approximately 500
meals per week.

Health Committee

The Health Committee is responsible for domiciliary services for many
old people including:

Chiropody Service —

The Development of a Chiropody Service in Bristol

In 1946, a friendly visitor of Bristol Old People’s Welfare reported that
an old lady whom she was visiting was unable to cut her very thickened toe
nails and had persuaded a gardener to cut them with his secateurs. The old
lady later disclosed that her father had died “of blood poisoning in his feet.”
The local health authority was asked whether old people could attend clinics
for schoolchildren which were operating at that time, but, because of the pending
implementation of the National Health Service Act, the Health Committee of
the City Council were unable to undertake a new scheme. Under the National
Health Service Act, no provision was made for a local health chiropody service,
except in those areas where clinics already existed, and Bristol Old People’s
Welfare therefore attempted to raise funds to start a service. The Soroptimist
Club of Bristol made a grant of £150 for an experimental scheme for one year,
and a chiropodist who was a Registered Medical Auxiliary started the service
in December, 1949. At first a nursing supervisor of the Bristol District Nursing
Association investigated patients who were reported to be in need of treatment,
but, because nearly all patients were in urgent need of chiropody, this preliminary
investigation was discontinued after about six months. At first, patients were
seen in chiropodists’ own surgeries, but this arrangement proved unsatisfactory
both for the chiropodist and for Bristol Old People’s Welfare, since few old
people kept appointments at the correct time and sometimes failed to attend at
all.

Clinic sessions were wstablished in 1950 and the Soroptimist Club renewed
its grant each year until 1960 and, in some years, the amount was increased to
£200. In addition, financial help was received from the Clifton and Bristol
Dispensary Funds for home chiropody treatment, and from the National
Corporation for the Care of Old People, who made grants of £200 in 1956,
£500 in 1957 and £800 in 1958. It was possible, in this way, to increase the
range of the service and, in addition to sessions held in the headquarters of

Bristol Old People’s Welfare, four sessions a week were established in the Char-
lotte Keel and Bedminster Local Health Authority Clinics. In September, 1959,
the funds of Bristol Old People’s Welfare were exhausted, and the City Council
made a grant of £350 to enable the Clinic and Domiciliary Service to continue
until April, 1960.

A Local Authority Chiropody Service

In March, 1959, the Minister of Health announced that he was prepared
to approve proposals by local health authorities who wished to establish, or
where one already existed extend, a chiropody service as part of their arrange-
ments for the Prevention of Illness under Section 28 (1) of the National Health
Service Act, 1946. While it was not suggested that the new proposals should
contain any formal limitation of the scope of the service, the Minister suggested
that at least in the early stages, priority should be given to the elderly, the
physically handicapped and expectant mothers.

He hoped that where it was proposed to provide a service in the authorities’
own premises, it would generally be possible to make use of suitable existing
buildings, such as Clinics, at times when the necessary accommodation was not
in use for other purposes. It would also be open to authorities to arrange for
treatment to be provided at chiropodists’ own premises. Domiciliary visits by
chiropodists to patients who were unfit on medical grounds to attend for treat-
ment might be necessary, though, no doubt, authorities would consider whether,
in particular cases, it would be more economical to provide transport for the
patient concerned. He gave approval to local health authorities providing a
service to exercise their power to the making of such charges, if any, as were
considered reasonable, having regard to the means of the persons availing
themselves of the service provided. The authority was reminded that to qualify
for employment, chiropodists must satisfy one or other of the qualifications
laid down in Section 3 of the National Health Service (Medical Auxiliaries)
Regulations, 1954, i.e. chiropodists must have been employed on the 31st March,
1954, by a Regional Hospital Board, the Board of Governors of a Teaching
Hospital, a Local Health Authority, or must have passed the qualifying exam-
ination of the Joint Council of Chiropodists or the Society of Chiropodists,
after attending a full-time day course of training in chiropody for not less than
two years. In Bristol, the Minister approved proposals of the City Council
for the establishment of a service which could be provided by any or all of the
following methods: —

(a) by establishing sessions at clinics;

(b) by agency arrangements;

(d) by arrangement at the chiropodists’ own surgeries or any such other
manner as may be necessary.

Developments in 1960

It was decided to attempt to preserve the chiropody service established by
Bristol Old People’s Welfare Limited by giving a grant to the voluntary organis-
ation while clinic sessions in their headquarters (10a Whiteladies Road, Clifton),
were run down and patients transferred to local health authority clinics more
conveniently situated to their own homes. The clinic sessions already held in
Corporation Clinics would be extended and the limited domiciliary service to

150 patients preserved. The details of the Clinic and domiciliary sessions
commencing from October, 1960, are given below: —

Monday

T uesday

Wednesday

Thursday

Friday

Saturday

9.00 a.m.

1.30 p.m.
9.00 a.m.

1.30 p.m.

9.00 a.m.
afternoon
9.00 a.m.

1.30 p.m.
Afternoon
9.00 a.m.

Morning
1.30 p.m.
Afternoon
9.00 a.m.

Southmead Clinic
William Budd Health Centre
Southmead Clinic
Charlotte Keel Clinic
Bedminster Clinic
Brooklea Clinic
Bedminster Clinic
Charlotte Keel Clinic
Domiciliary Visits
Charlotte Keel Clinic
Clifton Clinic

Lawrence Weston, Portway,

Henbury and Verrier Road Clinics
(on a 4-weekly rota)

Clifton Clinic

Domiciliary Visits

Charlotte Keel Clinic

Bedminster Clinic (alternate weeks only)

Domiciliary Visits

Bedminster Clinic (alternate weeks only)
Domiciliary Visits
Charlotte Keel Clinic (as required)
Domiciliary Visits as required

A charge of 3/- is made for each treatment in a Clinic Session and 3/6d.
for each home visit. People who cannot afford to pay these charges are specially
considered by the Health Committee, but it is usually found that these fees are
reasonable.

Between the 1st April, 1960 and 31st December, 1960, 312 Chiropody
Sessions were held in Local Authority Clinics, and 3,022 treatments were given.
At the end of the year 1,354 patients were receiving treatment at clinics, as
follows: —

Bedminster Clinic . . . . 272

Brooklea Clinic . . . . . . . . 80

Charlotte Keel Clinic . . . . . . 478

Clifton Clinic, Mortimer Road . . . . 295

John Milton Clinic, Henbury . . . . 22

Southmead Clinic . . . . . . . . 130

Verrier Road Clinic . . . . . . . . 16

William Budd Health Centre . . . . 61

During the same period 814 visits for domiciliary treatment were made and
237 patients were being treated as at 31st December 1960.

At the end of the year four sessional chiropodists were employed by the
Health Committee. Between them, they carried out 13 weekly, 2 fortnightly
and 2 monthly Sessions at clinics; two of them carried out domiciliary visits
during three days of the week.

Gerontology Clinic

Dr. R. J. Irving-Bell reports: —

“During 1960 forty sessions for the aged were held on Wednesday mornings
at Charlotte Keel Clinic, and 35 people, of whom 4 were new cases, attended.
No clinical examination or treatment was undertaken but information and
advice were given and home help and other assistance in the home supplied. If
required, a visit to the patient’s home was arranged.

Domiciliary Cases

Of greater importance in the field of Geriatrics were the home visits made
at the request of one of the four special health visitors, general practitioners,
public health inspectors. Welfare Department Officers and others.

Two morning sessions per week were allocated for this work. In four out
of the thirty-seven new cases visited, implementation of Section 47 of the
National Assistance Acts 1948 and 1951 was necessary. Attendances at Court
were required for these, and on several other occasions also when Renewal
Orders were made every 3 months for those still needing care in the Residential
Homes of the City Council.

Self-neglect

A constant feature found in many of the aged people visited was that of
near starvation, the last stage of self-neglect. As a result of chronic undernu-
trition and malnutrition (a probable intake of under 800 calories daily) the mental
powers decline steadily and extreme weakness and apathy result. They refuse
all offers of help; and a fatal termination is likely before treatment can be
given. This was so in three of the thirty-seven cases which I attended.

Preventing Fatalities

When these recluses are discovered in time, feeding (under supervision)
with an easily assimilated high protein food will bring about recovery both
mental and physical in a few days. Eight aged women with varying degrees of
malnutrition and emaciation were given Complan powder (J lb. daily for 10 days)
and the results noted. The powder is easily mixed with cold or warm, water to a
cream, and is pleasant to take; J lb. = 500 calories. Unfortunately, it was
impossible to supervise the feeding in the majority of the cases. But those who
took the powder daily showed a mental and physical improvement.

This gain in strength and well-being enabled them to look after themselves
at home, and with some outside assistance like meals-on-wheels twice a week,
made unnecessary their admission to Hospital or Home. The only difficulty
with Complan or other food product is, of course, the regular daily adminis-
tration necessary. If Complan could be supplied ready mixed in bottles or
plastic flasks and delivered by the milkman or meals-on-wheels staff to specified
houses, I consider that admissions to Hospital and Home would decline fairly
rapidly, and the grovv'ing percentage of over 65 ’s prevented from becoming
“emergencies”.

Health Visiting Service

Four health visitors dealt particularly with the care of old people and had a
total case load of 5,311 persons, 590 of whom were visited regularly. At the
end of 1960, thirty-four people were considered to need admission, as soon as
possible, to hospital and forty to old persons’ Homes. During the year, 196
convalescent holidays were arranged.

Home Help Service

There were 10 full-time and 566 part-time home helps who assisted 1,992
old and chronically sick people and worked 560,000 hours in 1960 (i.e. 92 per
cent of all hours worked by home helps).

Home Nursing Service

There were 78 full-time, 4 part-time and 5 student nurses. During the year,
4,163 people aged over 65 years of age were nursed in 163,602 visits; 60-8
per cent of all patients treated by the district nursing service were aged 65 years

or more. The main types of cases dealt with were cancer; diabetes mellitus;
diseases of heart and circulation; gastro intestinal; respiratory and senile.
The average cost per patient treated was approximately 5/1 Id. per visit and
£11 7s. 6d. per year.

Laundry Service

The laundry service provided by the Health Committee continued success-
fully and it became apparent during the year that additional facilities would
have to be provided for dealing with soiled linen at the Disinfecting Station.
Upon investigation it was found that it would be more economical for the
laundering to be carried out by the Welfare Services Department at their laundry
at 100 Fishponds Road. This new arrangement started on 14th November 1960.
The Disinfecting Station staff continued the daily service of transport, and soiled
linen collected in the mornings is delivered to 100 Fishponds Road by 2.30 p.m.
The articles are laundered and ready for collection the following afternoon, thus
ensuring a daily service of changing soiled with clean linen.

The extent of the service can be seen in the following statistics : —

1959 8,353 visits 21,637 articles laundered

1960 12,616 „ 30,770 „

During 1960, 411 elderly persons were making use of this service.

As in previous years the Health Committee contributed £250 to the Bristol
Old People’s Welfare (Voluntary) Ltd., towards the laundry service maintained
by that organisation.

Local Health Authority — W.V.S. Friendly Visiting

Members of the Women’s Voluntary Services carry out friendly visits to
housebound elderly, lonely people, who appreciate this service.

Mobile Physiotherapy Service

During 1960, 396 patients were treated in a total of 5,752 visits by three
physiotherapists. Treatment is recommended by general practitioners and by
orthopaedic and other hospital consultants when patients are unfit to travel to
hospital for treatment.

Each physiotherapist makes about six visits a day and the cost is estimated at
about 13/- per visit. The average am.ount actually received from each patient is
4/- and the balance is made up by payments by the Ministry of Health for patients
referred by hospital consultants. Since January 1st 1960, any patient contri-
buting to the Bristol Hospitals Fund may, on obtaining a voucher, claim 5/-
per visit for Physiotherapy Treatment to a maximum of £5 in any one year, this
to be paid direct to the Mobile Physiotherapy Service.

Night Watcher Service

This service completed its fourth year in December, 1960. During the first
year, 1957, the number of nights worked numbered 580. In 1960 the number of
nights worked numbered 1 ,285. The payment to the attendant increased in 1960
from 2/3d. an hour to 2/9d.

Samaritan Fund

At the start of the year the Health Committee allocated a portion (£140) of
a legacy received from the late Mrs. S. Wright to the Samaritan Fund. With
the appointment of a Flead Almoner and an increase in the handling of grants
etc., from various sources for the benefit of patients, the Samaritan Fund has
been used as a holding account from which grants are dispersed over a period.
Consequently income appears for the first time and approximately £6 of the
balance was due to patients on behalf of the National Society for Cancer Relief.

Balance at 1st January 1959: . . . . 96

Income :

Legacy . . . . . . . . 140

Bristol United Hospitals Fund . . 5

Bristol Royal Hospital Fund . . 8

Bristol Dispensary Fund . . . . 30

Bristol Comforts Fund . . . . 5

Bristol Misericordia Society . . 2

National Cancer Relief Fund . . 75

Interest . . . . . . . . 4

£365

Expenditure:

On behalf of various Funds .. 114

Night Watching Services . . . . 6

Chiropody . . . . . . . . 7

Replacement of stolen remittances 10

Sheets and Blankets . . . . . . 6

Boarding Old People’s pets . . 4

Fares . . . . . . . . 2

Electric razor for loan to heart cases 3

Miscellaneous . . . . . . 2

— £154

Balance as at 31.12.60 . . .. £211

Voluntary Services

Bristol Old People's Welfare {Voluntary) Ltd.

This voluntary body which receives a grant of £400 from the City Council
provides the following services : —

A ccommodation :

Stratheden containing 27 furnished “lettings” and guest room for
able-bodied elderly people — men, women and married couples. A mid-day
meal is provided.

Dulverton House containing accommodation for 18 frail ambulant
women. There are 4 single rooms and the other residents share cubicled
rooms.

Cote is similar to Stratheden, but is most suitable for the middle
income group. There are 20 unfurnished “lettings” and guest room, for
able-bodied elderly people.

Beverley Cottage is a Holiday Rest Home for 8 frail elderly people, on
the Esplanade, Burnham-on-Sea, where there is a resident warden.

Friendly Visiting

Approximately 80 volunteers in the City help with shopping, mending,
etc.

Holidays

Convalescent holidays subsidised from voluntary funds are arranged
for about seventy infirm old people and about 1,250 able bodied elderly
are sent for holidays in seaside hotels and guest houses.

Mobile Library

Fifteen volunteers take books by van to about 150 old people in their
own homes. There is a stock of more than a thousand books and a loan
charge of Id. per week is made.

Miscellaneous Services

These services include assistance with clothing; the loan of blankets;
wireless for the housebound; the loan of sick room equipment; comforts;
advisory service and the distribution of fruit, flowers, firewood, etc.

CARE OF HANDICAPPED PEOPLE (ADULTS)

Local Health Authority Services

The Local Health Authority has a general responsibility for making arrange-
ments for the prevention of illness and the care and after care of persons suffering
from illness. These arrangements may include the provision of nursing aids in
the home such as special beds, various items of nursing equipment and certain
aids to rehabilitation e.g., hoists. They also provide health visitors to give
education and help, subject to the general practitioner’s wishes, to a patient and
his family on the implications of his disease, and home nurses to give any nec-
essary nursing help. In the case of those suffering from mental deficiency or
mental illness, there is also a specialised after-care service with mental welfare
officers.

Miss M. Moncaster, A.M.I.A. who took up her duties as Head Almoner
on the 16th May, 1960, has contributed the following notes;

“Handicapped patients referred for casework services presented a variety
of problems but for the majority it has been one of learning to accept a restricted
life or the emotional difficulties which have been set up within the family as a
direct outcome of the patient’s illness.

I have worked in co-operation with colleagues in the District Nursing and
Health Visiting fields in helping patients to realize their potential even though
limited by disease and to find the solution to practical difficulties.

More intensive case work has been undertaken with those patients whose
emotional difficulties have been paramount. As a long term policy all cases
are followed up by the health visitors and, where appropriate, those which are
not already known to Welfare Services Department have been referred so that
they can enjoy the facilities available to handicapped persons”.

The Council’s Eye Consultant conducts weekly clinics for the examination
and registration of blind persons. A close “follow up and liaison service”
between the Bristol Eye Hospital Eye Clinic, the Bristol Royal Workshops for

the Blind and the Medical Officer of Health’s Department is provided through
the appointment of a special health visitor from the Health Department, Miss M.
Hatfield, who has contributed the following report: —

“No persons were deregistered during 1960, and the number of blind persons
on the list maintained by me now stands at 869 and the partially sighted 275.
During 1960, the work followed similar lines to that in previous years. The
Clinics for Blind and Partially Sighted people v/ere held weekly and 101 blind
and 29 partially sighted persons, including 17 sufferers from diabetes were
registered. Twenty-two patients were seen who did not qualify for registration
but were in need of optical attention. These were referred to the Bristol Eye
Hospital and I arranged their attendance there, on occasions taking them. With
adequate treatment and in some instances, a change of spectacles, registration
was not necessary. Notifications were received from the following sources:

National Assistance Board . . . . . . 64

Bristol Eye Hospital 32

Other persons (i.e. health visitors, general

practitioners. Clergy, lay persons etc.) 34

One baby who was registered v/as admitted to a Sunshine Home for Blind
Babies, and another has returned home.

Day to day liaison continued between the Health Department, Bristol Eye
Hospital and the Home Teaching Service for the Blind.

The follow-up of patients on the Glaucoma and Cataract Register at the
Bristol Eye Hospital has continued and many patients have been seen and
advised to continue treatmxnt. Constant vigilance and encouragement needs
to be given to these patients. There were no cases of retrolental fibroplasia
during 1960.

There is a considerable amount of visiting involved in following-up children
suffering from squints. In many cases, of course, the parents take the children
regularly for orthoptic exercises but some fail to keep their appointments.

All the services to the blind are provided under statutory requirements,
and in their different spheres are subject to inspection and report by the Ministry
of Education for educational services to blind persons, the Ministry of Labour
for the training and employment of adult blind persons in sheltered workshops,
home-workers schemes or in open industry, and the Ministry of Health for all
welfare services to the blind.”

Services provided by Voluritary Organisations on behaSf of
Welfare Services Committee

{a) The Blind and Partially Sighted

The General Superintendent, Mr. E. H. Getliffe, O.B.E., has sent me
the following notes :

The Bristol Royal School and Workshops for the Blind were appointed
agents for the Bristol City Council under the 1948 National Assistance Act.

Their services include the care of children under five years of age through
the Home Teaching Service ; the education of blind children in Kindergarten,
Primary and Secondary Modern classes in the School for the Blind, West-
bury-on-Trym, Bristol, where further education and technical training are
also provided for pupils from sixteen to twenty years of age ; the provision
of training for newly blind adults and the employment of trained blind men
and women in the Workshops for the Blind, St. George’s Road, Bristol.

The Bristol Royal School and Workshops for the Blind administers
and supervises the working of the Home Teaching Service and the Home
Workers Scheme in Bristol. The service of residential accommodation
for blind women training or in employm.ent at the Workshops for the Blind
is provided at the Hostel for Blind Women, where a few retired women
workers are also resident under the arrangements for accommodation under
Part III of the National Assistance Act. Three Homes for the Blind have
also been provided by the Bristol Royal Workshops for the Blind, affording
Part III accommodation to some 65 elderly blind men and women. These
services to adult blind persons are provided under arrangement with the
Welfare Services Committee of the City Council in fulfilment of the statutory
requirements of the 1948 National Assistance Act.

The Workshops for the Blind continue to provide employment for
suitable blind persons in basket-making, mat-making, circular machine-
knitting, hand loom weaving, chair-seating, wire-drawn brush-making and
some soft toy making. The light engineering department, which has been
developed, is now providing work for 14 persons, including services to
severely disabled sighted workers. This development is an arrangement with
the Welfare Services and Ministry of Labour. The growth of the light
engineering department has warranted a new building and equipment
project at a cost of £20,000. The Committee of the Bristol Royal Workshops
for the Blind have already spent £12,000 of their capital holdings in estab-
lishing and developing the experimental workshop. The new expenditure
requirement of £20,000 is being provided from three sources, viz. the
Ministry of Labour, Local Authorities, and the voluntary fund of the
Bristol Royal Workshops for the Blind.

The Home Teaching Service pays regular visits to all blind persons
in their homes, and has established seven very successful social clubs for the
blind, which meet weekly in different parts of Bristol. This Service also
provides handicraft classes, summer outings, and communal holidays for
groups of elderly blind persons. The Service also works closely with the
Mental Health Authorities of Bristol, and provides socials and outings for
high grade mentally defective selected blind persons from the mental
hospitals.

A special development under the Welfare Services Committee has
been the provision of a Deaf-Blind Guide Help Service. This is a pilot
scheme, initiated in Bristol, and now being developed at the request of
the Ministry of Health as an extra and special service to deaf-blind persons.

Statistics for the year 1959-60 show that 9,011 visits were paid to
blind persons; 205 lessons in Braille, 264 lessons in Moon type, and 275
lessons in pastime occupations were given by the Home Teachers; 668
visits to the deaf-blind were paid by the special Deaf-Blind Visitor, and
304 handicraft classes were taken by the Home Teachers. Additional to
these individual services to blind people the Home Teaching Service
organised 20 outings in which over 1,100 persons took part, and 8 weeks
of communal holidays in which 244 persons shared the pleasures of such
activities. Two socials and two outings for the deaf-blind were arranged,
and the main handicraft class had an outing to which 93 persons went. The
Home Teaching Service also visits blind persons who are temporarily or
permanently resident in hospitals in the Bristol area.

Welfare work connected with partially-sighted persons is carried on
through the Home Teaching Service to the blind and partially sighted.

At the 31st December, 1960, there were 78 pupils and 25 technical
trainees in the School for the Blind, and 79 employees and 3 trainees in the
Workshops for the Blind.

(b) The Deaf and Hard of Hearing

The Rev. S. W. Hartnoll, B.A., B.D., Chaplain and Superintendent
of the Bristol Institute for the Deaf has sent me the following notes : —

For persons in Bristol who are handicapped by deafness, specialised
welfare services are provided under the National Assistance Act, 1948.
Bristol Institute for the Deaf is the agent of the Corporation of Bristol for
this purpose.

Persons who lose their hearing, wholly or partly, after leaving school,
are different in mental outlook and in other ways, from those who have
been deaf from birth or early infancy. The phrase “hard of hearing”,
often used in relation to the former class, is a very inadequate description
of their handicap. Some of them are totally deaf and some have lost the
ability they once had to speak normally.

Social activities are provided for both classes on the Institute’s premises,
but separately. This is in accordance with the advice of the Ministry of
Health (Circular 32/51).

A third main class has recently been identified — the “partially-deaf”.
This phrase refers to those who have been deaf since birth or early childhood,
but who have sufficient hearing to enable them to be educated at a normal
school: some of them, at a special unit within a normal school. Their
needs are different from those of the other two classes, but should not for
that reason be overlooked.

In promoting the welfare of persons who are handicapped by various
degrees of deafness, and many of whom are deaf and dumb, the Institute
pursues a two-fold aim. First, to help them find a secure place within
the normal community of hearing people. Second, to provide for them a
comprehensive welfare service, including special facilities for leisure
activities, recreation and worship. The two aims do not conflict with each
other. Deaf or deafened persons who find recreation, worship and op-
portunities for services at an “institute for the deaf”, are thereby better
enabled to find a satisfying place in the normal world.

In addition to the provision of a wide range of social and recreational
activities (indoors and outdoors), for persons of all ages, the Institute helps
its members in a great variety of ways to overcome a serious handicap.
Deafness, defective speech and, in many cases, a very limited knowledge
of the English language, raise a grave problem of “communication” between
deaf and hearing people.

On 4th February, 1961, the foundation stone of the Institute’s new
building in King Square is to be laid by Alderman Harry Crook, J.P. The
estimated cost of the building is £65,650, towards which the Corporation
of Bristol have agreed to contribute £25,000. This new building will be
ready for use early in 1962. Bristol will then have one of the finest institutes
of its kind in the country.

Numbers on the register, of persons living in Bristol on 31st December
1960, were: —

Deaf over 16 years of age . . . . . . 291

Deafened over 1 6 years of age .. .. 287

Deaf and Partially-deaf children . . . . 92

Total

670

CIVIL DEFENCE RESPONSIBILITIES OF THE
MEDICAL OFFICER OF HEALTH

Dr. H. Temple Phillips
{Chief Assistant Medical Officer of Health)

and W. J. C. Winterson

As foreshadowed in the previous Annual Report, the results of the various
Working Parties that had been considering the re-organisation of the casualty
services, became evident with the publication of a circular from the Ministry of
Health on their new proposals.

It was decided to change the name of the Ambulance & Casualty Collecting
Section of the Civil Defence Corps to Ambulance & First Aid Section, and to
form within the Section First Aid Parties in place of the present Casualty
Collecting Parties. The Council was asked to put in hand the re-organisation
of the Section and to plan for its combination in war with the Ambulance
Service, making the appointments called for by the new organisation as suitable
candidates become available.

The basic units of the Ambulance & First Aid Section will be the Ambulance
Detachment and the First Aid Party. These will be formed into Platoons and
Companies, which will make up an Ambulance Column under the command of
a Column Ambulance Officer and Deputy, who will have at their disposal
72 ambulances, 18 personnel/equipment vehicles and some 334 personnel. The
Column is designed to meet the requirements of a Forward Medical Aid Unit
to maintain a regular flow of casualties from the forward area to the F.M.A.U.
and thence to hospitals.

Acting in consultation with the Regional Director, the Authority should
now draw up plans for the re-disposition of ambulance services in war, taking
into account the need to co-ordinate with the plans of the hospital authorities
for the provision of emergency hospital accommodation.

In due course the Regional Director will be notifying the Council as to the
war duty establishment of the Ambulance & First Aid Section. Meanwhile, it
appears that the existing arrangement whereby units meet in various parts of
the City, whether for training or social purposes, must continue. The compos-
ition of the units and the type of training being undertaken, must enable them
to take their place in an Ambulance Column.

Prior to the introduction of the new organisation, a number of studies were
organised at the Civil Defence Staff College, to enable Chief Ambulance Officers
to consider the practical problems arising therefrom, and these were attended by
Mr. R. F. Wood.

Dr. J. F. Skone, the Deputy Medical Officer of Health, also attended the
Staff College in May, when a study was held to consider plans for the Hospital
and First Aid Service and the tactical role of Medical Officers of Health in
wartime.

Two voluntary members of the Ambulance Section, Mrs. I. Terry and Mr.
A. Davis, attended special Officers’ Courses at the Home Office Training School,
designed to acquaint personnel with their duties and responsibilities in an emerg-
ency.

Various exercises, designed to introduce the Officers and members of the
Section to the new organisation, took place during the year. Many of these
concentrated on convoy work and brought out the salient points of road move-
ment control. This training culminated in a full-scale exercise entitled “More
Reliance”, organised in conjunction with the Home Office, Ministry of Health
and Regional Hospital Board, which took place on Sunday, 25th September.
The exercise was concerned primarily with testing arrangements for casualty
clearance in the event of an emergency. The assumption was that a nuclear
weapon had been exploded in North East Somerset, causing extensive damage
throughout Bristol and Bath. Ambulance Units were called in from Devon,
Cornwall, Somerset, Gloucestershire and Wiltshire, The military were also
called upon to help cope with the flood of casualties.

A column of 70 ambulances assembled at Patchway and was despatched
to a number of casualty loading points in Bristol. A thousand volunteers had
made themselves available as casualties and, after loading, the ambulances
were directed to a Forward Medical Aid Unit staffed by members of the National
Hospital Service Reserve, which had been set up at the T. A. Drill Hall at Horfield
Common. A mobile radio and telephone control unit directed ambulances to
the required points and provided a vital link in the system of control.

A well deserved tribute must be paid to the public health inspectors, who
not only assessed the hygiene and sanitation requirements for the exercise,
but also laid on a first-class practical demonstration of field sanitary appliances.

The exercise was described by the Regional Director as “highly satisfactory.”

The Ministry of Health intimated that it was their intention in future to
provide training ambulances by the central purchase of new vehicles. In
October the Ministry confirmed that one such vehicle had been allocated to
Bristol and it has since been delivered and is now in service. It is a box-type
van body mounted on a Ford “Thames” 10/12 cwt. chassis, fitted with two sets
of stretcher gear. The Minister proposes to call for a report in due course on the
use of the vehicle for the training of volunteers and its suitability for such
training.

During the latter part of the year structural work took place to the existing
garage accommodation at St. John’s Lane, Bedminster, as a result of which the
fleet of nine Civil Defence ambulance vehicles are accommodated there under
cover. Office and store facilities are also available for the full-time Instructor
and Driver/Storekeeper.

The Ministry of Health offered Local Health Authorities the opportunity
of acquiring on loan a stock of stretchers. These are not available for training
purposes, but can be used in the event of a major peacetime disaster. Two
hundred stretchers have since been received and have been placed in store.

The Annual Competition for the Ambulance & First Aid Section took
place on Sunday, 29th May, at the Civil Defence Training Ground at Netham.
Teams were entered by each of the six Units and each team comprised an am-
bulance crew and a first aid party. In the team test a survey had to be made of
an incident, first aid rendered, and the removal of casualties by ambulance to a
Forward Medical Aid Unit organised and carried out. In addition there was an
oral test for each member of the team.

The winning team came from Bedminster, with St. George as close runners-

up.

Dr. H. Temple Phillips presided at the presentation of awards that took
place at the close of the competition. The Ambulance Cup and prizes to the
winning teams were presented by Major-General C. F. Watson, Principal
Regional Officer, Ministry of Health, who congratulated all the members of the
team taking part on their splendid performance.

Driving instruction continued for members of the Ambulance Section,
but was principally confined to those who had previous driving experience.
Driving Warrants were issued to 18 successful candidates, authorising them to
drive Civil Defence ambulance vehicles.

Ten classes in First Aid and four classes in Home Nursing were organised
for all sections of the Corps and were attended by some 250 members. At the
subsequent examinations arranged with the St. John Ambulance Association
and the British Red Cross Society, certificates were awarded to 180 successful
candidates.

HEALTH EDUCATION

P. Mackintosh
{Health Education Officer)

^inoculation Year**

Late in 1959 it was decided that during 1960, every effort should be made to
improve the level of all protective inoculations among the City’s residents.
Although the City’s figures for most inoculations were above the national
average, it was felt that there was an increasing apathy towards diphtheria,
whooping cough and tetanus immunization, with national propaganda putting
most of the emphasis on vaccination against poliomyelitis.

As a good deal of preparatory work would be necessary to organise an
intensive campaign, “Inoculation Year”, did not start until Monday, 1st Febru-
ary, 1960.

The Campaign

In the weeks preceding the opening date as many responsible persons as
possible were informed of the “inoculation state” and what steps we proposed
to take to improve the position. All general medical practitioners were informed
through the medium of the Monthly Bulletin of the Medical Officer of Health.
After discussions with all Medical Officers of the Department, a memorandum
was sent to all Sections of the Health Department explaining the aims and
intentions of the campaign and how individuals could help.

The support of the general public was enlisted by a variety of means.
Letters to the heads of Churches of all denominations asked members of the
clergy to bring their influence to bear on their parishioners. The help of more
than 120 women’s organisations and many men’s organisations was sought
also.

The campaign was opened by articles in all three local newspapers, coupled
with a broadcast by the Medical Officer of Health, a recording of which was
repeated on the following day by the B.B.C. During the opening weeks articles
on infectious diseases and preventive measures, appeared in the “Civic News”
and the “Unicorn” — a N.A.L.G.O. publication. Copies of a special poster
designed by a Clinic Superintendent were produced and distributed to all
Clinics and Infant Welfare Centres, general practitioners waiting rooms, all
hospital out-patients’ departments, over 140 public notice boards, housing
estate offices and notice boards, cinemas, the City Information Bureau, Police
Stations, several of the larger stores, youth clubs, the office of the Registrars’
of Births and Deaths, Gas and Electricity Show Rooms, public libraries, football
and other sports clubs’ pavilions, swimming baths and the Territorial Army
Drill Halls.

Fifteen cinemas projected either a slide or filmlet concerning diphtheria
immunisation and appropriate leaflets were distributed with welfare foods.
An announcement was given out over the public address system during the local
“Football Derby” between Bristol City and Bristol Rovers.

Later in the year further press publicity was used and additional propaganda
material distributed. In September, at the Annual Flower Show, an exhibition
on the subject of “Infectious Diseases” was held, the stand being staffed by
health visitors.

Mobile ^^CliniC^

Several other methods were used in an attempt to induce members of the
public to protect themselves and their children. Health visitors were asked to
delineate areas in the City where it was known that the proportion of children

adequately protected, was low. Two areas were defined, in Kingsdown and
Southmead. In each of these areas, health visitors conducted an intensive
door-to-door campaign, telling parents that a mobile clinic would soon be
visiting the area and their children could be inoculated without having to visit
a Clinic. Later a van equipped with a public address system toured each area,
and public “reminders” were announced just prior to the arrival of the mobile
“Clinic”; this was a converted motor coach, kindly provided by the Transport
and Cleansing Department. Mothers in the area brought their children along
to the coach where the children were given the necessary inoculation. In those
instances where mothers were reluctant to come health visitors went to the houses
and with a little encouragement, the mothers and their children were brought
along to the “Clinic”.

Evening Clinics

Evening sessions for vaccination against poliomyelitis have been held at
Central and Granby House Clinics for some time. Many people who either
work or pass through the areas served by these Clinics have been vaccinated at
these evening sessions. However, many people living on the peripheral estates
find it inconvenient to attend these Clinics. It v/as decided that as an experiment,
we should try to cater for these by holding evening sessions on one of the estates.
Henbury Clinic was selected and for several weeks, intensive propaganda was
conducted on the estate by everyone working at the Clinic. All shopkeepers
displayed posters announcing the time and date of the sessions and all buses
serving the estate carried appropriate streamers. Despite all these efforts only
44 people attended, many of these being husband and wife. In view of this
poor response and of the many other commitments of the staff, the evening
session at Henbury was discontinued.

Visits to Factories and Shops

Just after the “Year” started the Ministry of Health increased the age
range up to forty for persons eligible for vaccination against poliomyelitis.
Arrangements were rapidly made to cope with the hoped for “rush”; special
evening sessions were arranged at Granby House and Central Clinic and large
quantities of publicity material, supplied free by one of the drug houses were
distributed to all these sources previously listed. In addition, with the co-
operation of the Chamber of Commerce many hundreds of business concerns
were offered and accepted propaganda material. Some examples of how this
material was used were, chemists who put wage packet slips in wrapped pres-
criptions, petroleum distributing companies handing out car streamers to their
customers, the large brevv^ery companies displaying posters in their public
houses and off-licences.

With the new age group eligible, it became necessary once more to offer
managements vaccination for members of their staff on their own premises.
In this way several thousand employees have received their injections ; altogether
the personnel of 24 factories have received 3 injections, two have had two
injections and in 6 cases, the firms’ own medical staff have given the injections.

Considering the amount of time and material that was put into this cam-
paign, one would have hoped to have been able to announce a great improve-
ment in the protective state of the population. In the main the figures at the
end of the year were disappointing. So far as the children under five were
were concerned, there were increases of between three or four hundred only,
over the previous year, in respect of diphtheria, tetanus and whooping cough.
Booster doses for children under 15 years showed a more promising increase:
for diphtheria immunisation, the figure was 9,634 compared with 1,756 in 1959.

In this same age group the increased number for whooping cough immunisation
was 3,857 as against 1,507 in 1959 and for tetanus the figures were 2,774 in 1960
and 629 in 1959.

It would appear that people just cannot be bothered to visit the clinics
to have themselves and their children protected. On the other hand if the
parent is asked to sign a consent form and the child is immunised at a session
held at school, then nobody is inconvenienced except the members of the medical
team and the exasperated schoolteachers. It is a sad reflection in this “do it
yourself” age, that so many people are not prepared to carry out simple tasks
of maintenance of their most priceless possession — health.

The story is the same with vaccination against poliomyelitis of the older
age groups — a trickle of people to the clinics, but take the vaccine to the place of
work and get vaccinated “in the firm’s time” and you get a much better response.
One gets the impression at times that we are asking some members of the public
to “do us a favour” by being protected against disease. Propaganda and pub-
licity, such as a Health Department can provide seems unable to surmount the
barrier of indifference, the attitude of “it won’t happen to me”. From past
experience it seems that fear is the most powerful propaganda weapon: no
amount of publicity or personal advice by doctors and health visitors will
otherwise penetrate the hard core of resistance.

Films and Film Shows

The two films “Marlborough House” and “Claremont”, made for the
Department by Bristol Cine Society have continued to be in great demand.
Copies are hired out not only in Britain, but on occasions to Continental
countries as well. Copies have been sold to the B.M.A. Film Library, the
British Film Institute, a medical film library in Sweden, the British Film Library
in the Netherlands, and the Department of Preventive Medicine, University of
Brisbane, Australia. During the year “Claremont” was entered for the B.M.A.
Annual Film Competition and won a Silver Medal Award — the top prize in
its class; this film also won the Daily Mail Challenge Cup in the London
Amateur Film Festival, and was shown on A.B.C. and T.W.W. Television.

The third film in this series was completed during the year. Entitled
“The Helping Hand” this film shows the provisions made for other handicapped
children — the blind, the deaf, the physically handicapped and the educationally
sub-normal. Once again, Bristol Cine Society were responsible for the produc-
tion and we were very fortunate to have the services again of Mr. Philip Grosset,
as cameraman.

The number of film shows given was again a record; 382 screenings were
arranged, and this we were better fitted to do than in early years, because in the
late Autumn the Health Committee agreed to the purchase of a second Bell &
Howell Film Unit.

Talks

The Health Education Officer once again gave a series of lectures to D.P.H.,
Health Visitor Students and District Nurse Students. Special lectures were
given to R.A.F. personnel and to a group of officers of the R.A.M.C. Talks
were also given to several women’s organisations, the Association of Nursery
Nurses, students of Redland Training College, and the Sixth Formers of Clifton
High School.

At the request of the P.T.A. of Brislington School, a series of talks was
organised on sex education and child health. The talks were “The Need for
Sex Education” by the Rev. A. H. Birtles, B.A. — a Marriage Guidance Coun-

seller; “Plain words & Sex” by Dr. Elizabeth Townsend, — a general practitioner;
“Health Education in School” by J.S. Hellier, B.Sc., — Headmaster; “Children’s
Ailments,” by Dr. M. B. Lennard — a general practitioner. The final session was
entitled “Any Questions” and the panel included all the above speakers. Dr.
Smallwood and myself. The series was quite successful and served a useful
purpose; it is probable that similar talks will be given to other Parent-Teacher
Associations.

In addition to the above, many hundreds of talks were given by medical
officers, health visitors, midwives and public health inspectors, and the Environ-
mental Hygiene Section carried out an extensive programme of education.

Courses for school leavers were again arranged at Connaught Road,
Marksbury Road and Speedwell Girls Schools; a special study day on “Home
Safety” was conducted by two members of the Home Safety Council’s panel
of speakers at Redfield Girls’ School and a special course of talks and visits
were arranged at Brislington County Secondary School for pupils studying
for their U.E.I. Certificate. Advice and assistance were given to many teachers
from other schools, as well as students and individual pupils.

The Bulletin of the M.O.H.

The Bulletin of the Medical “Officer” of Health continued its success as a
medium of health education. Some indication of it’s popularity may be shown
by those general practitioners who, when they change their accommodation,
take time to write or ’phone and ask us to send “The Bulletin” to the new address.
The monthly mailing list now exceeds 800 copies and this number includes many
schoolteachers. In fact, there appears to be a real need for a special bulletin
to be prepared for schools. Such a bulletin could be issued once each term and
might contain two or three leading articles dealing with child health, a review
section of health education material e.g. films, film strips, charts, books, leaflets
etc., and perhaps a section dealing with teachers’ questions, or even contri-
butions from teachers themselves.

Health Education Committee

In December, the first meeting was held of a new Health Education Com-
mittee. Members of this Committee are five health visitors elected from different
parts of the City. Dr. M. Gibson, First Assistant Medical Officer, Miss A.
Rowbottom, Deputy Chief Nursing Officer and myself.

The aims of this Committee are to encourage the development of health
education among all members of the Department, review and “vet” new material
and discuss and promote any new ideas or schemes put forward by district
health visitors. Already, a series of study days have been prepared for 1961.

Visitors

During the year, a record number of visitors were welcomed to the Depart-
ment. Fifty-four doctors, nurses, health education lecturers and social workers
from many countries spent some time in the Department. In addition, 32
doctors, from many countries, who were studying for their D.P.H. at the London
School of Hygiene and Tropical Medicine, visited Bristol and were shown
something of the work of a local health authority and the hospital services, in
an intensive study day organised by this Department and Professor Neale, the
Professor of Child Health in the University of Bristol.

From the 22nd to 24th June, the Annual Conference of the National
Association of Maternal and Child Welfare was held in Bristol. Some 500
delegates from all parts of the country attended.

Home Safety

The activities of the Bristol Home Safety Council are outlined in the tv/o
six monthly reports which are presented each year to the Health Committee.

1st January — 30th June, 1960

New Chairman

At the Annual General Meeting in January, Mrs. G. M. Pearson, M.B.E.
representing the Association of Hospital Matrons, was elected unanimously
as Chairman of the Council and Committee. Mrs. Pearson has been a member
of the Home Safety Council since its foundation in January, 1957.

Alderman Mrs. A. E. Nutt was unanimously re-elected Vice-Chairman.
Members of the Home Safety Council would like to record their appreciation
of Mrs. Nutt’s work as Acting Chairman during the last 6 months of 1959.

Annual Home Safety Competition

In memory of the late Chairman, Mrs. E. M. Boyce, individual members
of the Council, as well as representative groups, subscribed towards a fund
raised to provide some form of annual award for home safety activities. A
beautiful silver rosebowl was purchased and inscribed with the words “The
Ethel Boyce Memorial Rose Bowl, awarded by Bristol Home Safety Council”.
This form of award, it was felt, could be offered for competition by persons
of all age groups and of varied interests.

The 1960 Competition was organised by the Nursery Schools Association
in the form of a project competition for the infant schools, and a poster com-
petition for nursery nurses and students. The response was most gratifying,
15 infant schools submitting an exhibit as well as 92 posters entered by the
nursery nurses and students. All entries were displayed in the schools’ exhi-
bition room at the Museum and remained on show to the public for 10 days.
The Lord Mayor, Alderman Cozens, opened the exhibition and presented the
rose bowl to children from the winning school, Novers Lane Infants’ School.
In the poster competition three entries were regarded as outstanding, three were
judged first-class and three were highly commended. The Nursery Schools
Association provided winning certificates and contributed three guineas towards
the prizes and the Chairman donated a further two guineas.

The competition and exhibition were highly successful and received very
good press reports in our local newspapers. The Home Safety Council would
like to record its appreciation of all the work put into this venture by the Nursery
Schools Association and by the competitors themselves.

In 1961, it is proposed to offer the memorial rose bowl for a competition
to be organised by the Young Wives’ Group of the Mothers’ Union.

Oil Heaters

The Home Safety Council records with a certain degree of satisfaction
that the Government has, during the past six months, taken steps to ensure
that certain oil heating appliances will in future have to conform with statutory
safety standards. The Council notes with approval that the Children’s Com-
mittee recently circulated 600 foster parents in the City, warning them of the
dangers of such appliances and drawing their attention to safety precautions
to be taken. However, unmodified heating appliances are likely to continue
in use for some time and the Council intends to continue its safety campaign in
this matter.

The Council is particularly concerned with the use of certain oil heating
appliances by the West Indian community in the City. Talks have been held

with Mr. Gregory, the West Indian Welfare Officer, and it has been agreed that
one measure to be adopted will be to supply those Health Visitors, who have
West Indian families in their districts, with photographs showing oil heaters
actually “flaring”. These photographs were taken and supplied by officers of
the Fire Brigade. In addition, the Chief Fire Officer provided a list of safety
precautions to be observed with oil heaters and copies of this have been given
to all Health Visitors, District Midwives and District Nurses, who, armed with
these photographs and information will be better fitted to advise on safety
measures to be taken.

Safety Devices — Gas Appliances

Following discussions with the South-Western Gas Board, a meeting of
Health Department and Welfare Services Officers was held at Radiant House,
on the 29th February. The South-Western Gas Board arranged a demon-
stration of the latest safety devices incorporated in gas equipment as well as
equipment designed for handicapped people. The meeting was held primarily
to discuss safety in the use of gas appliances used by old people and all the
representatives present agreed to co-operate with the Gas Board in providing
information of elderly people living alone who would receive regular visits
from gas maintenance fitters to ensure that their gas appliances were safe.

A report of the meeting was prepared, containing details of the appliances
and services demonstrated and this was circulated with the Medical Officer
of Health’s Monthly Bulletin to all doctors in the City. Copies were also
issued to Health Visitors for whom two demonstrations were later arranged
by the Gas Board.

Pram Safety

Early in the year, the Council’s attention was drawn to a request for infor-
mation on the safety of perambulators. The information was asked for by the
Women’s Advisory Committee of the British Standards Institution. The
Health Visitors were asked if they were concerned about the number of “pram
accidents” and also for their observations on the possible factors involved.

From their replies it was revealed that the number of accidents in which
prams were involved were relatively few and were usually caused by carelessness
or overloading, e.g. a toddler sitting on the rear of the pram, or a heavy shopping
basket placed near the infant’s feet. It was generally agreed that the design of
the modern pram was not very satisfactory from a safety standpoint and the
following suggestions were made: —

(a) Harness straps should be sold as part of the pram and not left to be
purchased at a later date when the infant was becoming very active.

(b) Most modern prams were considered to be too shallow so that an
energetic baby, if not strapped in, could easily topple over the side.

These views will be made known to the British Standards Institute. It may
be remembered that about 2 years’ ago following a complaint to the manufact-
urers, about the design of a tricycle, later models showed a marked improvement.

''‘Haphazard House"

This electrically operated exhibit continues to be put to good use. Apart
from its use in Clinics it has recently been displayed at North Somerset Agri-
cultural Show on Whit- Monday and, in June, it was on display at the British

Medical Association’s Pharmaceutical and Scientific Exhibition at Torquay.
It was one of the exhibits seen by the Duke of Edinburgh when he officially
opened the Exhibition.

Film — '‘'’Fabrics and Fireguards’’'

The home safety film “Fabrics and Fireguards” has been used on a number
of occasions during the past 6 months. It has been shown at some Infant
Welfare Clinics, to Health Visitor students and some women’s organizations
in the City. For two weeks during April, it was borrowed by a large store in
Bristol, and shown daily at a Consumer Research Fortnight. On each occasion
the film was followed by a demonstration of flame-resistant fabrics. The
Home Safety Council feels that this film will help considerably in making the
public more aware of these fabrics and help to create a demand for the materials.

Area Meeting

The second Area Meeting was held on 16th May when representatives from
Bristol, Cheltenham, Swindon, Salisbury, Wilton and Street met for discussions
on present and future activities.

Among other business, it was agreed that meetings should be held quarterly,
just before the National Home Safety Committee meetings, so that the Area
Representatives could be thoroughly briefed before attending the National
Committee.

It was agreed, too, that Area Meetings should take place in different
towns where facilities were available for such meetings.

Home Safety Talks

During the 6 month period, members of the panel of speakers gave 29
talks and demonstrations on the prevention of accidents in the home.

Water Safety

The summer campaign has been devoted to the prevention of accidents by
drowning. Suitable posters have been distributed to all schools in the City
as well as to the City’s Sv/imming Baths. The Baths Department have also
co-operated by offering for sale the new Water Safety Code. The three local
newspapers have again been generous in their support, and their publicity has,
as always, been excellent.

Membership

Two new organizations have recently joined the Home Safety Council.
They are the Bristol and District Ironmongers’ Association — members of which
have earlier helped us in our campaigns, and the Joint Women’s Section of the
Labour Party.

The total number of organizations — statutory and voluntary — now repre-
sented on the Home Safety Council, is forty-five.

A cknowledgements

Members of the Home Safety Council would like to record their appreci-
ation of the continued support and interest of the Health Committee and to
thank, once again, those many individuals and organizations who are so ready
and willing to help in the continuous campaign to prevent so much unnecessary
suffering and death caused by home accidents.

1st July — 31st December 1960

Broken Glass

During the last week of July, a window display was arranged in the Infor-
mation Bureau. The display dealt with the dangers associated with broken
glass, particularly by the indiscriminate disposal of bottles on the beaches and
in the parks and countryside.

National Home Safety Committee

In July, the Assistant Secretary of the Home Safety Council attended the
quarterly meeting of the National Home Safety Council. It was announced
that the Royal Society for the Prevention of Accidents was hoping to draw up a
syllabus of home safety for the Scout and Guide movements, as a basis for a
proficiency badge test. It is worth recording that for some time now, the Home
Safety Council in Bristol has given considerable assistance to local Cub groups.
More recently too, assistance has been given to groups of St. John Ambulance
Nursing Cadets, in training the cadets in home safety.

Two resolutions were put forward by the South-Western Area to the
National Home Safety Committee. It has now been decided that the time
devoted to home safety during the National Safety Congress will be increased
from half a day to one whole day; the timing of National Home Safety Week
will be reconsidered in view of its nearness to the Guy Fawkes celebration and
the beginning of Christmas publicity in the large stores and shops.

Flower Show

Once again, free space was allocated to the Home Safety Council at the
Annual Flower Show on the Downs. The model “Haphazard House” used the
year previously was again displayed, this time with a garden attached. In the
garden the “Haphazard Family” were shown involved in a whole chapter of
accidents. The unit aroused a good deal of interest and the members of the
Townswomen’s Guilds and the Mothers’ Union, who staffed the stand, took
the opportunity of distributing literature and answering many questions.

Area Meetings

Two Area Meetings were held during this latter half of the year. On 29th
September, 1960, Alderman Mrs. Nutt, Vice-Chairman of the Home Safety
Council, and Miss Finch, Assistant Secretary, attended an Area Meeting at
Swindon. Delegates from five other Home Safety Committees were present
and they were welcomed by the Mayor of Swindon who remained afterwards
for the business meeting.

On the 8th December, 1960, an Area Meeting was held at Wilton. Here
again, delegates from four Committees were greeted by the Mayor of Wilton
who remained for the rest of the meeting. Members of the Press attended the
meeting and it is understood that good publicity was given to the Committees’
activities.

Delegates were unanimous in agreeing that a great feature of these Area
Meetings lay in stimulating the activities of the local committees and in rousing
the interests of those authorities where no home safety organizations existed;
in this respect it was felt that such authorities might well be invited to send
representatives to future Area Meetings, to encourage the establishment of more
Home Safety Committees.

Annual Home Safety Competition

The Ethel Boyce Memorial Rose Bowl has been offered for competition in
1961 to the Young Wives’ Groups of the Mothers’ Union. The competition is
to take the form of a drama festival, the “playlets” to be performed being con-
cerned with home safety ; these will be written, produced and performed by the
members of the Groups.

General

It is difficult to assess the results of the work of the Home Safety Council at
this stage; the Council has been in existence only four years, but one gets the
impression that people are becoming more safety conscious. However, it was
most encouraging to read in the Medical Officer of Health’s Statistical Review
for 1960 that “there has been a welcome fall in deaths due to all forms of acci-
dents — from 115 to 89, of which only 36 were home accidents. It would be
gratifying to claim some credit for this, but the Home Safety Council has not
been in existence for a long enough period to assess the results of its activities.
Like all health education, results can only be seen over a fairly long period of
time; health education in all its aspects is largely an exercise in persuasion,
and this takes time.

In concluding this Report, we should once again like to record our appreci-
ation of the continued support of the Health Committee and all the many organ-
izations and individuals who are always ready to help in this work. The Press
continues to give us a good deal of publicity and articles on the prevention of
home accidents appear frequently and are always well presented.

SECTION F

SCHOOL HEALTH SERVICE

ANNUAL REPORT

OF THE

PRINCIPAL SCHOOL MEDICAL OFFICER
R. C. Wofinden, M.D., B.S., D.P.H., D.P.A.

A. L. Smallwood, M.D., D.C.H., D.P.H.
(Senior Medical Officer^ School Health Service)

NDEX

Page

Blind children 15

Cardio-rheumatic clinic . . . . . . . . . . . . . . 31

Child guidance clinic . . . . . . . . . . . . 3

Children’s chest clinic . . . . . . . . . . . . 6

Chiropody clinic . . . . . . . . . . 6

Clinics . . . . . . . . . . . . . . 51

Deaf children . . . . . . . . . . . . . . 16

Deaths of school children . . . . . . 7

Delicate children . . . . . . . . 25

Dental clinics . . . . . . . . 7

Ear, nose and throat service . . . . . . . . . . . . . . 11

Educationally sub-normal children . . . . . . . . . . . . 19

E.S.N. School leavers 24

Employment of children . . . . . . . . . . 13

Enuresis clinic . . . . . . . . . . . . . . 13

Epilepsy in school children . . . . . . . . . . . . 28

Eye clinics . . . . . . . . . . . . . , 15

Home teaching . . 26

Hospital teaching . . . . . . . . . . . . . . 27

Immunisation . . .... . . . . . . . . . . . . 34

Ineducable children . . . . . . . . 24

Infectious diseases . . . . . . . . . . . . . . 32

Infestation . . . . . . . . . . . . . . 35

Maladjusted children . . . . . . . . . . . . . . . . 24

Medical examination of entrants to teaching profession . . . . . . 36

Medical inspection 34

Milk and meals in schools . . . . . . . . . . . . . . 36

Milk, food and hygiene Inspections . . . . . . . . . . . . 36

Nutrition clinic . . . . . . . . . . . . . . 37

Open-air schools . . . . . . . . . . 25

Orthopaedic and postural defects . . . . . . . . 38

Partially sighted children 15

Partially deaf children 16

Physical education . . . . . . . . . . . . . . . . 39

Physically handicapped children 25

Psychological service . . . . . . . . . . . . . . 41

Spastic children 29

Speech clinics . . . . . . . . . . . . . . . . . . 42

Staff 48

Statistical tables 58

Sunlight clinic . . . . . . . . . . . . . . . , 44

Tuberculosis . . . . . . . . . . . . . . . . . . 44

X-ray of teaching and other staffs . . . . . . . . . . . . 45

Youth Employment Service . . . . . . . . . . . . . . 45

An experiment in health education (Appendix A) 52

Films on handicapped children (Appendix B) 56

School Accidents (Appendix C) 57

INTRODUCTSON

To the Chairman and Members of the Education Committee

I have much pleasure in presenting the Annual Report of the Bristol School
Health Service for 1960, the 53rd Report of the series.

The general health of the children of the City continues to be good. The
provision of clinic facilities in the outlying areas of the City has continued, and
the Amelia Nutt Clinic was opened during the year to serve the growing housing
estate at Withy wood on the southern outskirts of the City. This is a joint
clinic similar to others that have been erected in various parts of the City and
provides medical and dental services for children of the district, together with
an ear, nose and throat service, as well as providing services for mothers and
young children, including the usual maternity and child welfare services.

A re-arrangement of the Child Guidance Clinic services was made during
the year. Hitherto the service has operated from central premises at Brunswick
Square near the centre of the City. The Health Committee have for some time
been conducting a Family Guidance Service at some of the outlying clinics,
and it was felt that since the two services were doing much the same work for
different ages of patients, there was much to be said for an integration of these
two services. It was agreed therefore that the two services should be integrated
at a functional level, and this integration was brought into operation in October.
It seems to have worked extremely well, and has enabled Child Guidance Clinic
facilities to be taken to several of the clinics on the outskirts of the City, much
to the advantage of the parents concerned (page 3).

In his report on the Dental Service, Mr. J. McCaig, the Chief Dental
Officer, again comments on the staffing difficulties. At the time of going to
press, however, there has been some slight improvement in the dental staff
position, and it is hoped that the salary award which was made to take effect
from December, 1960, will encourage recruitment to the service. Mr. McCaig
also mentions an interesting experiment which took place in one of our schools
to try to encourage the sale at school tuck shops of such things as apples and
dried fruits rather than sweets and biscuits so as to try and reduce the amount
of dental decay in school children (page 8). A fuller account is given of this
exercise by Miss Chapman (page 37).

Both Mr. Fairman and Dr. Gibb refer to the development of the hearing
assessment work, which is still unfortunately hampered by lack of teachers of
the deaf, willing to work in the City. Dr. Kaye (page 1 3) refers to his experiences
with the enuresis alarm and considers this to be a useful method of treatment
with children who suffer with enuresis, particularly for children between about
seven and tv/elve.

Reference is made (page 32) to the epidemic of infectious hepatitis, which
took place throughout 1960 and towards the end of the year showed no sign
of diminishing. It was possible to offer a certain amount of protection to adults
of special risk groups, but it is not possible to say how much effect this mieasure
had. Control is particularly difficult in a disease which has so long an incubation
period, but opportunity was taken to revise the methods of hygiene treatment of
lavatories, etc., in schools by caretaking staff, and the advice given is recounted
on page 33.

A brief reference is made to the medical inspections which have been started
at the College of Science and Technology on a voluntary basis, at the request
of the College, on page 35. Mr. Saunders offers advice on the interpretation

of the “I.Q.” test and the principles involved in recommending the placement
of a child in a special school or class on page 41. A very interesting account is
given by Dr. Macara (page 52) of his experiences at a new bilateral school where
he has been doing all the traditional medical work, and in addition taking part
in health education activities of various sorts. Miss Cooke continues her account
of the investigation into school accidents (page 57) and reference is made
(page 56) to the three films that have been made by the Bristol Cine Society about
handicapped children in Bristol. The first “Marlborough House” refers to the
mentally handicapped persons, the second “Claremont”, refers to cerebral
palsied children and the third “The Helping Hand”, which was made during
1960 deals with the difficulties of some of the other sorts of handicapped children.

We are fortunate in the City in having good relationships with the hospitals
and General Practitioners, and the efficient running of the service depends to a
large degree on this excellent collaboration. We are grateful also to Mr. G. H.
Sylvester, the Chief Education Officer, and his staff, the teachers and school
welfare officers for their continued help in very many ways, which affect the
health of the school children in the City. A happy relationship is enjoyed with
the Heads and Staffs of the schools who assist in many ways the work of the
School Health Service.

I should also like to record my thanks to Dr. A. L. Smallwood, the Senior
Medical Officer of the School Health Service, for his help in preparing the Report,
and once again I should like to express my appreciation of the work of Mr.
Middleton in assembling and editing the contributions to this Report.

R. C. WOFINDEN,

Principal School Medical Officer.

CHILD & FAMILY GUIDANCE SERVICE R. F. Barbour

Changes of Staff

Mr. Dunham and Mr. Hickish, Educational Psychologists, joined the Clinic
Staff in January 1960, to fill the increased establishment of 6 psychologists. The
Senior Assistant Psychologist, Mr. King left on 29th February, 1960 to take up
a post in Berkshire, and Miss E. J. Horn was appointed in his place. To fill
this vacancy, Mr. K. Wedell was appointed on the 2nd August, 1960.

Dr. Helen Mathewson replaced Dr. W. Johnson as part-time Registrar,
in May 1960.

Mrs. J. Serine, part-time Psychiatric Social Worker, resigned in August
1960 as her family was moving to the Channel Islands.

The clerical establishment was increased by one clerk in September 1960.

Annual Statistics

Psychiatric

1959

1960

Diagnostic interviews . .

352

511

Physical examinations

339

485

Treatment interviews . .

1,354

2,135

Parent interviews

203

Others interviewed

Psychologists

Examinations, including Juvenile Court cases

603

594

Treatment interviews . .

934

1,468

Parent interviews

117

260

Others interviewed

Other visits

119

128

Social

Interviews with parents

2,141

3,654

Interviews with others . .

244

Home visits

294

662

Other visits

The following is a report by Dr. H. S. Coulsting, Consultant, on the peri-
pheral clinics :

Peripheral Aspect

As had been anticipated the volume of work at the peripheral clinics has
shown an enormous increase and in some areas there is a waiting period of up to
three months before cases can be seen and a considerable delay before treatment
can be undertaken; however, some improvement in this situation is hoped for
when extensions of the premises will make it feasible for the staff to devote
more time to these areas. The realisation of this will, of course, be dependent
on the availability of skilled staff who are in short supply throughout the country.
It is likely, however, that this City with its progressive attitude towards mental
health will have much to recommend it to suitable persons in this field of work.

Another interesting and most important feature of the referrals is the
slowly growing tendency to refer children of under 5 years of age and in some
clinics the proportion of under 5’s referred now constitutes some 25 % of new
referrals. This reflects great credit on the psychiatric social workers and health
visitors in these areas and shows that the root causes of mental ill health are
being more adequately appreciated. Much of the work done with this group,
of necessity falls to the psychiatric social workers, as treatment in this age group
is largely performed with and through the parent. This tendency to refer
problems in this age group is most encouraging and the fruits of this work
should be shown in better adjustments in later years.

Other functions of the personnel in the peripheral clinics are regarded as of
paramount importance for the future. Although they are not readily demon-

strable in the form of statistical returns, these are seen best in the close working
relationship with clinic staff both from day to day contact and more formally
in case conferences which are held at all the peripheral clinics and which are
attended by the various teams. These contacts provide an excellent opportunity
for interchange of knowledge between all parties and create a learning situation
for all concerned; they also enable us as a group to consider such fascinating
and important problems as the early roots of maladjustment in the pre-school
years. In this situation the health visitors’ understanding of the problems of
early emotional development is all-important, if we are to learn to deal with
maladjustments at a time nearer to their causation or to give such advice or
help as will avoid unnecessary emotional traumata in early life.

Other advantages of the peripheral clinics have become apparent in the
course of the year; many of these were fundamental considerations in the
development of the service. Very many patients are now able to attend the
clinics, who for financial reasons or because of commitments to the younger
children in the family, would not have been able to come regularly to a distant
central clinic.

A closer link has been forged between the team members and the schools,
members of whose staff visit the clinic from time to time, and with those general
practitioners who have close contact with the health clinic, in addition to which
psychiatric social vv^orkers are on the spot to take part in the antenatal services.

On the other hand, this interim phase has imposed a considerable strain on
the professional staff, in the shape of travelling, lack of on-the-spot filing or
clerical services and makeshift accommodation, but it is hoped that in two more
of the peripheral clinics there will be an improvement with the completion of
alterations at Broadfield Road Clinic and the purpose-built extension at Hart-
cliffe; this latter will be of especial interest as it is the first purpose-built unit
available to the service. I think that the steady progress maintained throughout
the year is a great tribute to the excellence of the personnel.

Having worked for over a year at one of the peripheral clinics I would
like to indicate some of the “new” situations to which one is trying to adapt.
Broadly, they fall into four categories :

(i) Inter-Clinic-Staff relationships

(ii) Altered arrangements with the Administration

(iii) Inter-disciplinary relationships

(iv) Changed pattern of client-doctor relationships.

Previously the Child Guidance staff numbered some 1 1 professional persons,
plus 3 clerks. They were based on one building which was not shared with
any other Health or Education personnel. In this building each had his own
room and they met formally or informally most days. Documents, if borrowed
from the office, were usually returned the same day and it was easy for clerks
to keep check on letters, attendances, records and statistics. The professional
staff, now numbering 18, work as much in their peripheral areas as centrally.
Inevitably, conflicting loyalties develop. Some are more attached to the service,
others to the peripheral teams. Each team as it “works in depth” gradually
becomes closer knit and the requests of the centrally based staff are felt as
demands. Each team tends to evolve its own standards of note-taking and
record-keeping which may or may not agree with previous practice.

Clarity of communication between teams and departments is essential.
In any multi-disciplinary organisation it is of special importance when it bridges
administrative gaps such as are found, say, between Health and Education.
Teams may not agree as to whether all teachers and all doctors should have
reports, no matter whether it was the doctor or the teacher who referred. Other
departments, for instance the Children’s Department or the Juvenile Court,
used to having reports set out in one fashion, are disconcerted if the facts are

presented in different ways by different teams. Doctors, and also psychologists,
tend to be individualists and do not like to have their professional views queried
by “higher authority”. When, however, their judgments are as much in the
social as in the Health or Education fields, and when sending a child to a boarding
school may cost the community £450 a year, it is barely surprising if they are
asked to state a case in terms which the layman, who usually holds the purse-
strings, can understand.

Form-filling is seen as a waste of precious time which should be more
properly devoted to people. Possibly one of the big problems both in medicine
and in the larger community services, is the need for “co-ordinators” who can
bring together and arrange priorities between different specialists or teams.
In our case, where previously, owing to the close-knit staff based on one building
and with a shared office staff, this could be done informally, now it tends to
require official administrative procedures.

The peripheral clinics can be a rejuvenating experience for the specialist
too long used to the hospital psychiatric set-up and possibly spoiled by the
material comforts of a clinic solely devoted to one specialty. One is back again
in a multi-disciplinary set-up and one is at once aware of how different and
intangible the modern psychiatric approach seems to doctors and nurses trained
on the older and more “organic” lines. Although there is an increasing number
of health visitors and doctors who are receiving more adequate teaching in
psychological medicine, one still realises how much medicine is diagnosis-
centred rather than patient-centred. One diagnoses a condition and only
incidentally helps the client while the modern mental health approach is more
concerned with helping the patient to resist and overcome his diseases and
stresses. One still feels that to many medical personnel the emotions are unreal
and that the only thing they think they can do with a “functional” condition is
to assure the patient that he will grow out of it. In the peripheral clinic there are
opportunities to meet general practitioners, opportunities which tend to be
lacking in hospitals and the bigger central clinics, and one becomes aware of
the price that is usually paid for specialisation with its greater technical effi-
ciency. The gaps between teachers and doctors, between health doctors and
family practitioners, are seen as real handicaps and causes of stress and strain,
when in fact the aim of each discipline is the welfare of the individual.

The pattern of working in a mental health set-up which is client-orientated
is difficult to superimpose on many health set-ups which are possibly service-
orientated. Too tight a time-table or moving personnel from clinic to clinic,
though possibly important for administrative reasons, loads the dice against
personal relationships. While official case conferences are of use, it is the
individual contact over cups of tea that probably is really the more educative,
but one soon appreciates the difficulties of arranging a “fluid schedule” —
something that is almost essential if one is going to work with dependent people.
Possibly the health problem of this quarter-century is how to enable dependent
immature people to grow into stable reliable parents. Medicine has learned
how to deal with vitamin deficiency; can a Health Service remedy equally
successfully parental deficiency ?

Treatment interviews in the peripheral clinics enable one to see more
clearly the family in their local surroundings. Visiting a central clinic or a
hospital is an event. They dress accordingly, ask neighbours to look after the
other children. Going “round to the clinic” is different; mother may bring
several other children with her, and one can see how she looks after them. One
can watch the referred child and his younger brother or sister play together or
possibly struggle together. Although by no means the same thing as seeing the
family in their own home, the gap is narrowed, and it is correspondingly easier
to assess the inter-personal strains and stresses.

CHILDREN’S CHEST CLINIC W. H. Sutcliffe

Dr. Sheerboom was responsible for the work of the clinic until September,
1960.

The work of the clinic is summarized below : —

New Patients Old Patients Total Patients

17 28 45

Total attendances 144
Sex ratio M : F (3:2)

N.P. Age Under 5 — 3 patients
Over 5 — 14 patients

Discharges . . . . 26

E.N.T. Consultant . . 9

Child Guidance Clinic . . 2

Periton Mead . . . . 5

Cases in general have fallen into one of three groups:

First, asthma and its related syndromes of eczema, hay fever etc. In these
cases it has been unusual for psychological factors to be absent.

Second, recurrent upper respiratory tract infection followed by lower
respiratory tract involvement accompanied or unaccompanied by spasm. This
is a distinct problem in infant school children and is probably the main cause of
school absence at this time. Such cases have not always shown abnormality
in the upper respiratory tract, but certainly several have had chronically infected
tonsils etc., from which infected material has been aspirated into the lower
respiratory tract. The role of influenza and other respiratory viruses is difficult
to assess.

It is hoped that the preventive aspect of the work of the clinic might be
expanded in the near future since influenza and anticatarrhal vaccines are
increasingly available.

Lastly, there are a group of children in whom the history would be in
keeping with bronchiectasis and a decision has to be made concerning the value
of bronchography. Consultation with the chest physicians has been most
valuable on this point.

CHIROPODY CLINIC L. I. W. Tasker

The number of children attending the clinic for foot treatment during 1960
was a little higher than in 1959, there being 774 school patients as compared
with 629 in the previous year. The number of treatments given to children of
school age was 3,384 compared with 2,827 in 1959.

There were 578 new cases of Verrucae Plantaris (2,210 treatments) as
compared with 436 (1,856) in 1959.

Other categories of defect remained very much the same as in other years
and some 30 children were referred to the Orthopaedic Department for further
advice or physiotherapy.

Attendances

Primary and Secondary

M. & C. W.

1st

Other

1st

Other

Metatarsalgia

—

Hammer toes

—

Verrucae plantaris .

578

2,210

—

Hallux valgus

—

Foot strain

—

Miscellaneous

142

283

774

2,610

DEATHS OF SCHOOL CHILDREN A.L S

The number of deaths among Bristol children of school age during 1960
was 21(11 boys and 10 girls). This is the lowest number recorded in Bristol and
compares with 24 in 1959, and 23 in 1958. There were 3 cases of death
from leukaemia during the year, compared with 5 in 1959. There was 1 other
death because of a malignant growth. There were only 2 deaths from road
accidents this year, and only one of these actually occurred in the City. This
reflects great credit on teachers and others who are concerned with road safety
and precautions against accidents. There was one other death due to accidental
causes, that of a boy who was drowned whilst on holiday.

DENTAL CLINICS J. McCaig

The year 1960 was one of struggle for the School Dental Service in Bristol.
The dental department at Brooklea Clinic remained closed because of staff
shortage and Portway dental clinic had to close in October because of the
untimely death of Mr. Chaplin on the 5th October 1960. At the end of the
year the staffing position was equivalent to 9-3 full-time officers made up in
the following way : —

Full-time Dental Officers = 6-3

(including the P.S.D.O.)

Part-time Dental Surgeons = 3 00

Sessions equal to full-time officers

Late in the year, the dental department of the Amelia Nutt Clinic was
opened, on a part-time basis, when a sessional Dental Officer was appointed.

The staffing difficulties encountered in the year produced a decrease in
school inspections and attendances made by children for treatment. The
number of pupils inspected by the Dental Officers of the Authority were: —

(a) At periodic inspections : 42,081

(b) As specials : 4,370

giving a total of 46,451 compared with 51,431 last year.

The number of children found to require treatment was 29,053, the number
treated 14,955, giving a percentage of 50%. This is a very good treatment rate,
compared with an overall picture of the rest of the country. The number of
attendances for treatment was 37,499, while last year 46,083 attendances were
made. The school inspections reveal that many children obtain treatment in
the dental practitioner service.

There is little room for complacency and as the caries rate is increasing,
the combined efforts of both services are required to maintain a balance, but
no child in Bristol need go for long without treatment. This does not solve the
School Dental Service problems, two of which are : —

(1) Continued staff shortages. (2) Increase in caries.

(1) The continual loss of full-time officers is a serious matter. In Bristol
two full-time officers will retire in about five years. At the moment there is no
sign of permanent replacements by young dentists. We are grateful the local
Dental Committee give us every assistance in employing sessional officers.
These offset to a certain extent the lack of full-time officers, but, in five years
time the loss of full-time officers might not be regained by the employment of
sessionals. The great need is to try and get young dentists to take up the School
Dental Service as a career. This calls for new thinking in how to attract them.
Our progressive policy in Bristol of renewing old equipment and making our
surgeries more colourful is one of the methods.

The Chief Medical Officer to the Ministry of Education in his 1958-59
report, “The Health of the School Child”, stated that salaries offered in the
School Service are out of character with the remuneration in the National
Health Service. This is one of the reasons why recruitment to the School Service
is about at a standstill. The recent increase in salary of 12i per cent granted to
School Dental Officers may have some effect, and the termination of National
Service this year may encourage some young Dental Surgeons to enter the Local
Authority dental services. The report also puts forward other suggestions,
such as recognition of the status of the Principal School Dental Officer and the
need for more responsible posts in the School Dental Service.

But is money the only yardstick? Take-over bids, more profits, higher
salaries are universally accepted as our outspoken standards of success. If
any service is understaffed it seems to be accepted that the automatic cure is
more money in the pocket. Real stature is personal and is attained by those
whose achievements are not measured solely by income. However much we
are impressed by outward material possessions, we still respect the nurse, the
teacher, the school dentist, and so on, who chooses his role as a vocation and
because he can tolerate no other.

(2) A new era of rapid deterioration has set in, and with the rising preval-
ence of dental disease and a profession small in numbers, it is true to say that
“never in the field of human ‘misery’ has so much been required from so few”.

Numerous suggestions are offered and methods advised. While awaiting
the enlightenment of public authorities to sanction the supplementary fluori-
dation of deficient water supplies, possible approaches to improving the teeth
of children should be considered.

(a) It is necessary to expand the treatment services and educate the public
in the use of them.

(b) Improve oral hygiene and feeding habits.

(a) Much has been said on how to expand the treatment services, and we must
wait and see if the new salary increases have any effect.

(b) In improving oral hygiene and feeding habits in children, the battle of the
tuck shops has been waging all year. In my last annual report, I advised retaining
the tuck shops in the hope that they might be persuaded to sell products less
harmful to the teeth, such as nuts and raisins, potato crisps, etc. Some author-
ities have tried to ban the school tuck shop altogether, but this seems unreason-
able, as life would be dull without a bun or a sweet. The aim of introducing
other foodstuffs into the tuck shops is a twin action technique because it is
found that the increased consumption of sweets and cakes is turning children
into Billy and Bessie Bunters, as well as increasing dental decay. School clinics
originally set up to deal with cases of malnutrition are now handling cases of
the over-fed child, some as many as five stones overweight. In Bristol, the
Principal School Medical Officer, Dr. Wofinden, sent a circular to the Heads
of all school departments on the subject of “The sale of biscuits and sweets in
schools”. Head teachers were advised to sell less harmful products such as
apples, etc.

Miss Adams, Head Mistress of Speedwell Girls’ School, at a meeting with
Dr. Wofinden, Dr. Smallwood, Miss Duncan and myself, agreed to the experi-
ment of introducing apples into the school tuck shop. I am happy to report
that the experiment is proving successful and Miss Adams assures me that the
girls are co-operating. The problem of handling apples is not an easy one because
of their bulk and difficulty in disposing of the cores, but Miss Adams considers
it is not insurmountable and tackles it with her usual zeal and energy.

Miss Ram, Head Mistress of the Claremont School for Spastics, and other
Head Teachers are also taking part in this campaign to save the children’s
teeth. Here then we have teachers who do not ignore the teaching of others.

We are up against tremendous opposition from the confectionery trade
because the sweet tooth has its profits. The amount spent per annum on choco-
late and other sweets is £260 million while £140 million is spent on sugar, jam
and jelly. To confirm our reputation as the world’s most avid eaters of sugar,
each man, woman and child, will consume this year 26 lb. of sweets (about
£4 worth) and 60 lb. of sugar (excluding jam or jelly) (about £2 worth). It is
no wonder that £5 million can be spent by the sweet industry in advertising in
the Press, or on television. To combat this, £5,000 is donated for dental health,
a very small crumb indeed.

(c) In promoting dental health, it is very difficult to persuade children to
comply with the simple measures advocated. It is now considered that dental
caries is very largely preventible for some people, and amenable to control in
others. The nature of the disease is such, that its onset is early in childhood, and
preventive measures should be applied to young children. Failure to do this
will result in costly and time-consuming treatment. Thus, dental health edu-
cation is important, but to be successful with children, one must aim at sincerity.
In finding out why children do this or that, the purpose should be to find out the
true reason.

Slogans and gimmicks are all very well, but when the slogan, “Clean teeth
do not Decay” failed, and pamphlets stating that “animals’ teeth do not decay”
had little effect, it was not difficult to reason why ; of course clean teeth decay,
and children will soon tell you that their pet dog has bad teeth. In advocating
tooth-brushing, pastes, rinsing, etc., one must be sure to emphasize that these
measures are beneficial but not a certain preventive. The education of the whole
community in the value of children’s dentistry is essential, if the children are to
benefit from up-to-date knowledge, new techniques and advances in control
and prevention of dental disease. Only in this way can parents, and those in
authority over children, be persuaded to take part in the programmes for the
betterment of dental health.

Dental Hygienist

The work of the dental hygienist continued during the year and 1,039
children were seen and treated. Scalings and gum treatment were carried out
and instruction given in oral hygiene.

When the children are receiving treatment by the hygienist, the opportunity
is taken to teach them adequately the elementary procedures of tooth brushing
and rinsing. They are encouraged to reduce their intake of sweets and chocolates
and told that eating a few immediately after meals is less harmful than eating
them between meals. Thus they are brought round to the idea that measures
exist to reduce decay in their teeth and that this is within the scope of their own
behaviour and effort and if pursued with some diligence can have beneficial
results.

One dental hygienist to 65,000 children is only a drop in the ocean and it may
be of interest to compare this with New York where there are 150 hygienists,
one to every 6,000 children approximately. In New York the hygienists carry
out prophylactic treatment and, not content with seeing the children, they
interview some of the parents as well. One interesting point may be worthy
of attention; during their working year they concentrate their treatment on
children who do not have dental care that year.

In Bristol the dental hygienist also visits the schools giving instructive talks
showing dental health education films and these are much appreciated by all.

The figures relating to the work of the dental hygienist are: —

Number of children seen .. .. .. .. 1,039

Number of attendances for treatment .. .. .. 1,344

Number of mothers seen .. .. .. .. 116

Number of attendances for treatment . . . . . . 183

Maternity and Chiid Health Service

The school dental officers and the dental hygienist carry out work for
expectant and nursing mothers and pre-school children.

During the year there were 318 sessions devoted to mothers and young
children. Most of the work done for mothers is conservative treatment, but
for the pre-school children, extractions still outnumber by a long way the amount
of fillings done.

Hospital Facilities

The Dental Hospital in Bristol is responsible for some of the Local Author-
ity’s schools and the children attending these schools are given a dental inspec-
tion by a dental surgeon from the Department of Children’s Dentistry at the
Hospital and treatment is subsequently carried out at the Hospital.

The work carried out during 1960 is shown below: —

Number of children inspected . . . . . . . . 926

Number of children found to require treatment . . 662

Number of children treated . . . . . . . . 233

Attendances . . . . . . . . . . . . 1,475

Mr. Hazell, who is Senior Hospital Dental Officer to the Regional Hospital
Board, continues to give us three sessions a week at Southmead Clinic. In
addition he admits patients to hospital who are sent by our dental officers where
it is considered that their dental treatment should be carried out under hospital
conditions, e.g. patients suffering from extreme nervous conditions, or where
it is known that patients have excessive haemorrhage following tooth extraction.

Dental Technician

Output of the laboratory is shown below: —

No. of dentures for mothers . . 171

No. of dentures for children . . 89

No. of repairs for mothers . . 18

No. of repairs for children . . 8

No. of inlays . . . . . . 5

No. of crowns . . . . . . 2

Orthodontic Clinic

The Committee approved for implementation during the year 1961/62 a
scheme of expansion of the orthodontic service, including alterations to the
laboratory, and an outlay of equipment to cost £1,000.

This will enable our dental officers to carry out simple orthodontic pro-
cedures at their own clinics and save some children travelling to the Dental
Hospital from outlying districts. This scheme will come into effect in April,
1961, and with this in view a change of policy on the part of the Consultant
Orthodontist is being tried out on an experimental basis. Previously Mr. Nicol,

who is the Consultant Orthodontist at the Dental Hospital, visited Central
Clinic one session per week; now he visits each clinic in turn. Bringing a
consultant service to the outlying clinics enhances the prestige of the dental
officer and the clinic. It is more convenient for the patients and it is hoped that
this change of policy will be successful. During this experimental phase, im-
pression sessions were stopped as it was found that many patients lost interest,
having attended twice at Central Clinic, one visit for impressions, and one visit
for consultation, before being referred to the Dental Hospital. Hence the drop
in the num.ber of attendances. Cases will still be referred to the Dental Hospital
for teaching purposes, but more cases will be referred back to the clinics for
treatment by simple appliances, instead of just extractions.

Details of the work during the year are as follows : —

No. of new patients . . . . . . . . 382

No. of attendances for consultation . . . . 613

No. of attendances for impressions . . . . 129

No. referred to the Dental Hospital . . . . 292

No. of treatments completed . . . . . . 33

Extension Dental Services

Children from residential schools, nursery schools, handicapped children
and those in Homes run by the Authority are given dental inspection by the
Authority’s dental officers.

Mr. Swallow, Lecturer in Children’s Dentistry, King’s College Hospital,
London, visited Claremont School for Spastic Children and carried out a survey.
At the moment of writing the result of this survey is not known. I attended a
meeting of Public Health Dental Officers at Central Clinic following his visit to
this school, and asked his advice about dental treatment for the children attending
Claremont School. He agreed with me, that ideally, treatment should be carried
out in Hospital. The three sessions Mr. Hazell gives the Authority at Southmead
Clinic could be utilised in this way as severe cases could be dealt with in South-
mead Hospital which is in close proximity to the Clinic.

This is put forward as a possible solution to this most difficult problem.

EAR, NOSE AND THROAT SERVICE H. D. Fairman

The Ear, Nose and Throat Service in Bristol has two main functions;
firstly, to examine and treat those children referred to the clinic by School Medical
Officers, and secondly, to seek out deaf children, assess them and tender advice
in regard to their education.

The examination of children referred to the Ear, Nose and Throat Clinics
has proceeded as in former years. The service has been expanded by the ad-
dition of one clinic session a week under the care of Mr. K. Roddie, F.R.C.S.
whom we are pleased to welcome to the staff. One of the E.N.T. Clinics is now
held at the Amelia Nutt Clinic, Withywood, and this is a great amenity to the
parents and children of the populous post-war estates of Withywood and
Hartcliffe. Children are referred chiefly because of recurrent or chronic infec-
tions of the upper respiratory tract or middle ear.

The number of patients seen at the Ear, Nose and Throat Clinics during
the year was 1,041. These were mostly cases of tonsils and adenoids, and where
appropriate these children were passed on to the hospitals for operative treatment.
There were 75 cases of otorrhoea which had been referred to the consultant
clinic by the School Medical Officers because of failure to respond adequately
to treatment in the local clinics. There were only 5 of these cases still under
treatment at the end of the year.

The search for deaf children, their assessment and placement, is a function
of the Hearing Assessment Service which has been developed over the past
5-6 years and is assuming an increasing importance and is engaging an ever
growing proportion of our effort. Since the addition of the services of Mr.
Roddie, who has relieved the pressure of work in the E.N.T. Clinics, more
time has been made available for the service to deaf children. This work falls
into three parts. Firstly, the screening of babies at risk, i.e. children of deaf
parents, premature infants, “rhesus” infants, etc., and ideally of all babies in
the 3-6 months age group. Infants who fail the screening tests for deafness
are then referred to one of the E.N.T. Clinics or directly to the Hearing Assess-
ment Clinic. The screening of infants under risk is well organised, but the
screening of all babies is still not done and owing to the lack of this service in
the past, some deaf children are not recognised until they attain school age and
are then picked out by the school medical officers and sometimes by the school
teacher. The screening of ail infants requires that all health visitors be trained
to administer the screening test. Happily a beginning is to be made in June,
1961, to train health visitors to apply the screening tests. Secondly, those
infants who fail the screening tests are referred for diagnosis to the Hearing
Assessment Clinic. Here they are examined by a team consisting basically of a
Consultant Otologist, a Medical Officer, a Teacher of the Deaf, and an Edu-
cational Psychologist ; other interested persons or those with special knowledge
also attend. The diagnosis at the Hearing Assessment Clinic may be made at
one visit. Usually two visits are necessary and in not a few instances many
visits are required. Even after the child has been conditioned for testing by the
teacher of the deaf over many visits, the team may still be in doubt over the
diagnosis and may even be in doubt in some cases as to whether deafness is
present at all. If the child is found to be deaf then the third or educational
aspect of the service to deaf children is considered. The pre-school child usually
attends the Teacher of the Deaf of the Assessment Clinic for auditory training.
For the school age child, the Assessment Clinic team comes to a decision and
makes a recommendation to the Education Authority for placement. This
recommendation may be for attendance at a normal school, the child to wear a
hearing aid and have help from visits by a peripatetic teacher of the deaf —
attendance at a unit for partially deaf children, attached to a school of the
appropriate standard — attendance at the Authority’s Elmfield School for the
Deaf, or attendance at a school for children with multiple disabilities.

The medical and the educational functions of this service overlap and one
may be frustrated by the actions of the other to the detriment of the child.
To mis-diagnose a case of deafness would lead to a wrong placement for a child
but equally non-availability of the type of educational facility recommended
by the Assessment Team could result in wrong placement. For instance a
partially deaf child could be placed either at Elmfield or at a normal school; at
Elmfield it would lack the stimulus of a hearing environment; at the normal
school it might be unable to cope with the situation. Throughout the year we
have been hampered by lack of staff, i.e. lack of Teachers of the Deaf. Whether
there be a national shortage of Teachers of the Deaf or not,there is no doubt
that as far as Bristol is concerned there is a shortage and until it is overcome
we will be unable to offer what we consider to be adequate educational facilities
to all types of deaf children. At the present time we have no Teacher of the Deaf
for the Assessment Clinic and no teacher for the proposed Infants’ Partially
Deaf Unit.

Hope for the future lies in the fact that one of Bristol’s teachers is now
undergoing training as a Teacher for the Deaf and next year another teacher
goes for training. It is to be hoped that further candidates will consider taking

up this absorbing, satisfying, and, in the best sense of the word, charitable
branch of the teaching profession and that the Education Authority will support
any candidates who may come forward. Without teachers the service fails, in
fact it scarcely begins.

EMPLOYMENT OF CHBLDREN L. A. Tavener

During the year ended 31st December, 1960, appointments for medical
examinations were made for 723 children. Of this number three children
were found to be unfit to take part-time employment and therefore, registration
was refused. The remaining 720 children were registered for part-time employ-
ment as shown below.

There was an increase of 49 children registered for employment over the
1959 figure of 671. The average number of children employed at any time was
about 500.

Three children were examined and found fit to take part in public entertain-
ments for which licences were granted. No adverse reports were received
respecting the conditions under which such children were employed.

Children Registered

Trades

Boys

Girls

Total

Newsagents

607

658

Butchers

Grocers

Multiple Stores

Others

Total

635

720

No child was found to be unfit for further employment when re-examined
on change of employer or occupation.

ENURESIS CLINIC J. E. Kaye

During last year 160 children were treated at my sessions at the Enuresis
Clinic, held at the Central Clinic, Of these, 25 children were discharged as
cured after not less than six months’ observation; 43 failed to keep appoint-
ments and were discharged (16 of them attended only not more than three
times and 8 were probably dry but failed to attend for a final check-up) and 92
children remain under treatment.

The treatment of nocturnal enuresis followed the usual pattern of previous
years, but it was possible to use the nocturnal enuresis electric alarm on a larger
scale. This is a device which wakes the child at the beginning of micturition
and this eventually should establish a conditioned reflex and the child should
wake up before wetting himself.

Altogether, 28 patients were treated with the alarm. Of these 17 were
cured, 4 were discharged and 13 remain under observation; 3 showed marked
improvement but still were occasionally wet.

The remaining eight cases can be divided into the following groups; 3
refused to co-operate, one of them a boy of 15 years of age and two younger
boys. These children had other emotional problems and were “not ready” for
treatment of enuresis.

Five patients showed no improvement at all, one of them was a boy of 16i
and another of 15 years of age. A boy of 11 years of age slept so soundly
that he did not hear the alarm bell. All these children had full urological

examination and showed no pathological changes. From our limited experience
it appears that the best response to this mechanical treatment was with children
7 to 12 years of age and who had no serious emotional problems. Children
under seven years seemed to be too young to co-operate and some of them were
disturbed or even frightened by the loud bell. The older children over 12 years
of age responded more slowly that the younger group and some of them did not
respond at all. This is, however, only the impression from the results we had
with our limited number of cases.

The treatment with the enuresis alarm lasts on average three months.
Children who respond to the alarm become dry within two or three weeks or
even sooner, but they sleep on it for another eight to ten weeks to make sure
that the reflex is established and to give time for the patient to develop self-
confidence and convince himself that he has full control of the bladder. In
two cases when the treatment was discontinued too soon by anxious mothers,
children reverted to enuresis and it was necessary to start treatment from the
beginning.

It was also shown that some children wet themselves several times a night.
In some cases the alarm went off four times a night, but as the patient improved
the bell rang less frequently — once a night, once in two or three nights, and
eventually the child became dry.

The results so far are very encouraging and we hope that next year it will
be possible to produce a more comprehensive report on this method.

W. M. Sutcliffe

The accompanying table shows the number of patients attending my sessions
at the Enuretic Clinic during 1960.

Cases first seen in 1959

(1) Discharged during 1960

(2) Still under treatment at 31st
December, 1960 and carried

forward to 1961

Cases first seen in 1960

(1) Discharged during 1960

(2) Still under treatment at 31st

December 1960

Of the 51 cases discharged during the year 19 were dry at night, 23 failed
to attend for various reasons (mainly due to non-co-operation on the part of
the mother) 8 were referred to the child guidance clinic whilst one was discharged
still wet. (This is an E.S.N. child who failed to respond to any form of treat-
ment.)

It is interesting to note that 7 cases were still under supervision after first
attending in 1959. These were all cases with a tendency to relapse if supervision
was relaxed.

The usual simple psychological methods were used (reward for dry nights
etc.). A few patients were treated with the bell blanket device but experience
with this method was so limited that it is not possible to comment on its efficacy
at present.

A small number of children have definitely been helped by the exhibition
of a tranquiliser during the day.

EYE CLINICS P. Jardine

The work of the Refraction Clinics was continued during 1960 in much the
same way as in previous years. The total number of children who were exam-
ined for errors of refraction was 4,371 including 1,142 new patients, and the
total attendances made by children at the Ophthalmic Clinics during the year
was 6,349. Surgical treatment of squint is arranged at the Bristol Eye Hospital
and 88 operations were carried out for this condition during the year on Bristol
school children. The preliminary investigations in these cases are made at the
Bristol Eye Hospital or at the Central Health Clinic and a period of orthoptic
treatment may precede or follow the operation.

The Orthoptist, Miss M. J. Smith, has continued in charge of the Orthoptic
Department at the Central Health Clinic. She divides her time between the
Clinic and the Bristol Eye Hospital where an orthoptic service is also provided
for children including numbers of Bristol school children.

The figures relating to the orthoptic work at the Central Health Clinic
during the year are as follows : —

Number of sessions . . . .

366

Number of new cases seen

453

Other attendances

1,969

Total attendances

2,422

HANDICAPPED CHILDREN AND SPECIAL SCHOOLS

Blind Children A.L.S.

There was again a slight fall in the numbers of blind children maintained
by the Authority at the Bristol Royal School and Workshops for the Blind,
Westbury-on-Trym. There were 12 children (9 boys and 3 girls) there at the
end of the year, as compared with 16 (10 boys and 6 girls) at the end of 1959.
Two of the girls were attending as day pupils, the remaining girl and the boys
being boarders. In addition to these children there were 4 children (1 boy and
3 girls) being maintained at the Royal Normal College for the Blind, and 1
boy at the Worcester College for the Blind. There was 1 girl only at Condover
Hall School for Blind E.S.N. Pupils. This makes a total of 18 blind children
of school age for whom provision was being made by the Authority at the end
of the year.

In addition there were 4 young persons receiving training at the Royal
School and Workshops for the Blind under further education arrangements.
1 young man was attending as a boarder, and the other 3 as day pupils; 3
others were also receiving training under further education arrangements, 1 at
the Hethersett Pilot Training Centre, Reigate, 1 at Wallingford Farm Training
School, Oxfordshire, and 1 young woman at the Royal Normal College for the
Blind, Shrewsbury.

Partially Sighted Children

There were 21 children on the registers of the partially sighted unit at South
Bristol Open Air School at the end of the year (16 boys and 5 girls) as compared
with 19 (14 boys and 5 girls) at the end of 1959. The preponderance of boys
continues to be a feature of these classes, and indeed it is even more marked
than in the previous year. The children are of course kept under constant
ophthalmic review, either through the Authority’s own opthalmic service or at
the Bristol Eye Hospital.

In addition to the children attending the partially sighted unit at South
Bristol Open Air School there were 5 children attending residential schools at

the end of the year as follows : —

Boys Girls Total

West of England School for Partially Sighted Children, Exeter 12 3

Exhall Grange School, Coventry , . . . . . . . 2 - 2

3 2 5

Deaf Chifdren R. E. Olding

Elmfield School for Deaf Children

During the past year children and staff gained increasing experience of the
use of the auditory equipment. A voice-level meter was incorporated in the
auditory system in each class room. The meter is a valuable aid to both teacher
and child, particularly during voice production exercises. Generally, all the
equipment works extremely well, but the loop system is limited by the per-
formance of the present N.H.S. transistor aids, which we can only hope will
eventually be replaced by models approaching the best now offered commercially.

Subject teaching was introduced into the Upper School and will be extended.
Valuable use of the B.B.C. Television Educational Broadcasts was made. A
Company of Girl Guides and a senior section of Boy Scouts were formed.
Useful visits and journeys were made during the year to other Bristol schools,
to Towyn, to London Airport, and to camp, near Minehead. Two girls were
awarded Bronze Medallions and two others Intermediate Certificates by the
Royal Life Saving Association.

The usual close liaison with the Assessment of Hearing Clinic at the Central
Health Clinic, the Hearing Aid Clinic at the Bristol General Hospital, the
Partially Deaf Unit at Eastville Junior School, and the Peripatetic Teacher of
the Deaf, was maintained.

At the end of the year 57 children were in attendance at “Elmfield”: —

Boys

Girls

Bristol L.E.A.

Gloucestershire L.E.A.

Bath L.E.A.

—

In addition to the children at Elmfield the following deaf children were
being maintained at various residential schools at the end of the year: —

Mary Hare Grammar School, Newbury

Boys

Girls
' 1

Total

Royal West of England School for the Deaf, Exeter

—

Yorkshire School for the Deaf, Doncaster

—

St. John’s School for the Deaf, Boston Spa, Yorks. . .

—

Unit for Partially Deaf Children Eastville, J. M. School

K.
R. G.

Smith

Lewis

During the past year the range in ability, age and deafness of the children
in the Partially Deaf Unit has increased. Owing to staffing difficulties the five
children who have reached secondary school age have remained at Eastville
because they are not ready for full integration within secondary schools. In
spite of this, it was agreed that two new children should be admitted; these are
six years of age, and one has considerable hearing but is emotionally disturbed.

During the year one girl has taken the entrance examination for the Mary
Hare Grammar School for the Deaf.

The integration of the children into normal hearing society remains the
main aim of the unit and all the children spend a proportion of time with hearing
classes. Two boys and a girl join the top class for English, six go to other
classes for arithmetic, all for P.E., games, handwork and needlework, and six
for music while the other six have music with a music teacher. The teacher of
the deaf works closely with the other teachers to give extra help to the children
with these subjects.

The Westrex Auditory Training Unit and loop have proved most beneficial
while an extra amplification stage has improved the Phillip’s Group Aid con-
siderably. Eleven children have Medresco hearing aids of the transistor type,
while one boy, who is very deaf but still benefits educationally in the unit, has
a Multitone aid.

Close contact is maintained with the parents and with all other workers
for the deaf in the City.

In addition to the children at Eastville School, the following partially deaf
children were being maintained by the Authority at residential schools at the

end of the year : —

Tewin Water Residential School for partially deaf children.

Boys

Girls

Total

Herts.

—

Ovingdean Hall Residential School, Brighton

—

Burwood Park School, Walton-on-Thames

—

Partially Deaf Children Visited by the

Peripatetic Teacher of the Deaf

R. H.

Sturman

The hope to establish a Partially Deaf Unit in an Infants’ School mentioned
in last year’s report has not been realised because there was no response to
advertisements for a Teacher of the Deaf to do this work. Children who would
have been placed in this Unit have remained under the care of the Peripatetic
Teacher or been placed in the Junior Unit.

A new Westrex portable individual auditory training amplifier which was
added to the equipment has proved most helpful.

The year commenced with twenty-six children on the register, twenty-four
carried forward from 1959 and two new ones. Two boys and one girl left
school at Easter and started work in April and are happy in their jobs. During
the Summer term two girls and three boys were added to the list. At the end of
the school year in July two children left to commence work and four needed no
further help.

In September one boy from a nursery school was transferred to the School
for the Deaf, two boys from Primary schools to the Partially Deaf Unit at East-
ville School, and one new girl was added to the list. Two boys moved up from
Infant to Junior classes and one new boy was added in December.

Most of the children have made good or satisfactory progress. One junior
girl who maintained her position at the top of her class hopes to obtain a grammar
school place next year. One boy wrote the most interesting of forty essays from
his class. Another boy in a comprehensive school moved up to sixth place in
his class of thirty-five.

The infants and lower juniors through lack of staff to start an Infant P.D.
Unit have not been able to have as much individual attention as they really need.
This should be remedied in the coming year.

Altogether 795 visits were made during the year and at the end of December
the children receiving help were placed as indicated below : —

School

Boys

Girls

Total

Comprehensive & Secondary

Primary

Open Air School

Special Schools

Totals:

Provision for Partially Deaf Children of Nursery School Age A.L.S.

In the Report for 1959 a proposal was mentioned to establish a class for
partially deaf children of nursery school age at Ashton Vale Primary School.
Unfortunately it was not found possible to open this class in 1960 as had been
hoped because it was impossible to appoint a suitable teacher of the deaf. The
classroom has now been fully equipped, however, and it is hoped to make an
appointment and to commence this class early in 1961.

Hearing Assessment Clinic H. M. Gibb

During 1960 the work of the Hearing Assessment Clinic was curtailed by the
difficulty of obtaining adequate clinical time for auditory training of the young
deaf child. Mrs. Joan Stephens, the Teacher of the Deaf, resigned in July
and her post has not been filled. Auditory training therefore came to a standstill.

It had been hoped that the Infant Unit for Partially Deaf Children at Ashton
Vale would be opened in September 1960 and would meet the needs of partially
deaf children of the 2 — 7 age group. This was not possible because no Teacher
of the Deaf could be obtained for the work. Consequently, the children who
required placement there have of necessity either remained at home or been
placed in nursery classes or schools or day nurseries, or, in the case of the children
of school age, in primary schools.

It is recognised that these placements are on the ground of expediency and
not really suitable for these severely handicapped, partially deaf children who
have too much hearing to be placed at Elmfield School for the Deaf, and require
a different educational approach from the severely deaf child. This has retarded
the progress of these children and caused a good deal of anxiety to the parents
and also to the teachers of the primary schools, who have had to accept children
with severe partial deafness in large classes in Infant Schools. They have felt
unable to give them teaching suitable to their need.

The work of the Hearing Assessment Team has therefore been mainly
concerned with the diagnosis and recommendations for educational placement.
Besides the severely deaf and partially deaf children seen, many cases are referred
to exclude deafness in children who have delayed development of speech or
speech defect. These are referred for appropriate treatment. A number of
children of the 4-5 year age group are seen with acquired conductive deafness
due to upper respiratory infection. These cases are referred to routine E.N.T.
Clinics and are followed up there.

Mr. Walter King, the Psychologist, resigned in February 1960. His
work was done by Mr. R. V. Saunders, Senior Educational Psychologist until
Dr. Klaus Wedell was appointed to join the team. Dr. Wedell now holds
regular sessions at the Central Health Clinic for psychological assessment.

This is an essential part of the diagnosis of partially deaf children who become
backward and emotionally disturbed, often presenting serious behaviour
disorders. Dr. J. E. Kaye, Assistant Medical Officer, has joined the team.

Two sessions are held weekly by Dr. Helen Gibb and Dr. Kaye for screening
observation and preparing of children for audiometry. The whole team meets
for consultant sessions with Mr. H. D. Fairman once a month. The following
is the number of children attending the Clinic.

Total attendances, 1960 . . . . . . . . 371

No. of cases requiring auditory training . . . . 33

No. of cases referred to Elmfield School for Deaf . . 5

No. of cases referred to Eastville Partially Deaf Unit 3

Total No. of current cases . . . . . . . . 120

Educationally Sub-normal Children

Russell Town Day Special School for Senior Boys J. N. Tolley

We began 1960 with 115 boys on roll, twelve fewer than the previous term,
and by mid-summer our numbers had fallen to 108 — the lowest figure in twelve
years. By the end of the year the roll had increased again to 115, including 2
extra-district children.

The year has seen two changes of staff and, in addition, one teacher seconded
to a third-year training course.

The year 1960 will be particularly remembered because of the visit of the
Chief Education Officer to present prizes at the end of the mid-summer term,
and the visit of the Chairman of the Education Committee to do the same at
Christmas. We have also had a welcome visit from Her Majesty’s Inspector
of Special Schools. During the Open Week in July, held under the Mental
Health Year arrangements, a number of people came to see the school and
expressed interest in our work.

During the year more positive steps have been taken to aid the transition
of our boys from school to work, with the further development of “Probationary
Employment” and an increasing tendency for boys to remain at school until
work is found for them. These arrangements have been widely welcomed by
boys, parents and employers.

House-in-the-Garden Day Special School for E.S.N. Senior Girls I. M. Bond

The year 1960 at House in the Garden was one of steady growth and
expansion of work. For most of the year the school was full, but by Christmas
the number of pupils on registers had dropped to 97.

Our aim is to equip the girls to be good women in homes, making them
happy places. Also we prepare the girls to earn their living, helping them to
come to terms with themselves and form natural, happy relationships with
others. We try to inculcate good habits, and to broaden their interests and
experiences.

The school is run on a family basis caring for the needs of individuals, but
bearing in mind that we all need to be able to fit into society.

We have entertained many groups of visitors from many places. Our
entrance hall is a source of great interest. It comes alive as a post office at
Christmas time; a house; a section of a store showing materials and garments
made from them; a cake shop at Easter with the meaning of Easter cookery
suitably explained. Using these displays of different kinds, we are encouraging
the girls to read and to gain a sound background of general knowledge which
serves to increase their self-respect and confidence, so necessary for girls at this
school.

Additional activities, furthering our main aims, are the continuance of our
link with Lawrence Weston Old Age Pensioners Unit, establishment of a link
with Gloucestershire Special School, Stokesbrook, an interchange of visits with
other schools, a visit to Portishead, and visits to factories and showrooms and
to a performance of the “Coppelia” ballet at the Hippodrome.

In July, as part of Mental Health Week in Bristol, our school was open to
visitors every afternoon. All branches of the work were shown; a large group
of parents attended and were especially delighted with the dress show, when
girls modelled clothes they had made themselves.

Henbury Manor Day Special School Jean Davis-Morgan

for Junior E.S.N. Children

This year has brought further improvements to Henbury Manor School
and in addition to the new Hall we now have a highly efficient heating system so
that as well as providing spacious accommodation for their work and play the
comfort of our children is ensured too.

Now that special classes in the primary schools have been organised the
number of multiple handicapped pupils admitted has increased and many
present social as well as educational problems.

The courses arranged for teachers of E.S.N. children have attracted some
of the Staff and in consequence we have had more changes than are desirable.
The number of teachers interested in our work is increasing and we have many
visitors, both local and from overseas, as well as numerous parties of students.

A recent investigation has revealed the following figures which may be of
interest.

1946—1961

650 children admitted { gg Z “

per cent

340 transferred to Sen. Day Sp. Schools . . . . . . 52-3

52 „ „ Residential Spec. Schools . . . . 8

18 „ ,, Special Classes . . . . . . . . 2-7

120 excluded as ineducable .. .. .. .. .. 18-4

3 to Epileptic Colonies . . . . . . . . . . -46

1 to Remand Home . . . . . . . . . . -15

6 to St. Christopher’s (Rudolf Steiner) , . . . . . -92

2 returned to Primary Schools . . . . . . . . -3

6 trans. to South Bristol Open Air . . . . . . -92

4 withdrawn by parents in favour of Private Schools . . -6

14 left Bristol 2-15

1 transferred Deaf School .. .. .. .. -15

3 deceased . . . . . . . . . . . . -46

80 still on registers . . . . . . . . . . . . 12-3

650 Total.

Diagnotic Unit B. J. Boulton

During the year there was a steady demand for places in this section of the
school. I now see most of these young children of doubtful educability before
admission, and all of them immediately after admission. They often present
many problems.

The child of 5i years with an I.Q. in the upper fifties and a corresponding
mental age of about 3J years will behave and talk much as the normal child of
3 J years behaves and talks. By the time he is seven years old it can fairly safely
be assumed that his mental age will be little more than four years (I.Q. 58).
It is not surprising that he lacks attainments in reading and number because he

cannot be expected to have made a start in these subjects. After giving close
attention to the views of those who are attempting to teach them, perhaps all
we can say is that past experience has shown that children of the borderline
developmental level at the age of seven years may, or may not make the grade
in a Special School. No doctor whose knowledge of such a child is limited to a
single Clinic examination can be expected to reach a firm conclusion in the
matter.

On the other hand, a number of children admitted to the Diagnostic Unit
have I.Q’s in the lower fifties or upper forties, and from observation of their
conduct and conversation it is often obvious well before they reach the age of
seven years that they will be more suitable for Training Centre care.

During the year, after consultation between the headmistress. Miss Davis-
Morgan, the educational psychologist, Mr. I. Hickish, and myself, a number of
children from the Diagnostic Unit and two or three from the Junior School
have been transferred to the Training Centre. It is clear from our records over
the last ten years that the proportion of children admitted to the Diagnostic
Unit who fail to make the grade in the Special School proper is so large that
some may consider that the Diagnostic Unit of the future might be more con-
veniently placed as a special section of the Training Centre.

When the time comes for the transfer of children from the Special School
to the Training Centre, we are already finding that parents are more ready to
accept the situation when they know that within the terms of the new Mental
Health Act, they have the right to request a review of their child’s case in twelve
months’ time. The dropping of the term “ineducable” with its suggestion of
finality has also helped.

Junior Special School

Very occasionally, near the end of his or her time in this section of the
school, a child may show such a low level of ability as still to give rise to doubt
about his or her future in the Special School. Under these circumstances we
now recommend a twelve months trial in the Senior Special School to be followed
by a review of the case at the end of the year.

Both in the Diagnostic Unit and in the Junior Special School, a number
of children (about 30 per cent) are under Hospital treatment or observation
for additional disabilities. Various degrees of epilepsy, mostly minor in type,
form the largest group. Second on the list comes defects of hearing.

In such cases, the medical notes are kept up to date as far as possible both
by the co-operation of the Bristol Royal Hospital for Sick Children and by the
valuable information obtained for me by Sister Head following her visits to the
homes of our children.

Special classes for E.S.N. children in ordinary schools A.L.S.

The policy of providing for the less severely educationally sub-normal
children in special classes in ordinary schools was extended during 1960, when
several new classes were opened in both primary and secondary schools. There
are now 17 special classes for educationally sub-normal children in primary
schools and 9 in secondary schools. In addition a special class for children
with problemiS of maladjustment was opened at Bankleaze Junior School.
These special classes enable provision to be made for the special educational
treatment of the less severely retarded children, and this policy is much more
acceptable to parents than provision in special schools. The unit at Hillfields
Park School which was commenced about two years ago to give practical
training to teachers undertaking work with backward children has continued to
function throughout the year, and the experiment has proved a great success.

Residential Special Schools

Croydon Hall Special School for Educationally Sub-normal Senior Girls' Felon's

Oak^ Minehead M. H. Davies

There are at present 39 girls on the books of Croydon Hall School; 15
of these are from Bristol, eight from Wiltshire, five from Somerset, three from
Dorset, two from Bath and one each from Coventry, Kent, Plymouth, Poole,
Bucks, and Newport.

Of these girls nine are 15 years old, six are 14, 14 are 13, five are twelve and
five are 11. The I.Q’s of these girls range from 46 to 93.

Four girls are taking various drugs for epilepsy, two are sub-thyroid, and
one is a spastic.

Twelve are under Care or Protection and of the remaining 27, 17 have
shocking homes. One girl has lost an eye through rough treatment in her own
home, one girl was assaulted by her father, a second by her stepfather, one girl
saw her mother mmrdered by her father, one child is the result of incest ; four girls
have fathers serving prison sentences, three are unaware of ever having had
parents, and in four cases there is parental insanity.

This shows the desperate need of a school like ours, and the imperative
necessity of making such a school, as far as is humanly possible, a place where
some of these scars can be smoothed away.

In a school such as ours which caters for girls who are educationally
retarded, the use of visual and other educational aids is of the greatest importance.
With the help of such aids educational difficulties can be much more easily-
overcome. Film slides, records and instrumental music all assist the girls to
reach standards of achievement which it would be otherwise difficult to attain.
Besides their educational value these aids have a beneficial effect on the emotional
stability and general well being of the girls. The title of a recent thriller called
“The Listening Eye” set us thinking about how much we owe in our work to
these helps. We all came to the conclusion that without the Visual Aids at our
disposal and an extensive library of good recordings our rate of progress would
be greatly slowed down.

Units from the Foundation Film Library, a weekly film from the Education
Committee’s store, Unilever, Petroleum and other films supply us with a wealth
of delightful entertainment.

The appreciation with which these films are received, the requests for
encores, the amazing memory for detail in a second showing constantly surprises
us. The lovely woodpeckers, the charming principals in the “Earth and its
Peoples” series are all old friends and ever welcome. We know all about looking
for oil and how to deal with forestry in any part of the world; and we can join
in and sing with Toscanini’s great choir. Curiously the real thing is more
popular than the cartoon, “Laxton” much more acceptable than “Speed the
Plough”. By these means Saturday nights are a constant joy and the store of
our knowledge is greatly increased with the minimum of effort.

On Sunday afternoons we follow a serial (Spiritus Gladius) of St. Paul,
and share his exciting adventures, or at other times watch the very lovely colour
series of the “Life of Christ” by Cathedral Films.

The sum of £40 Os. Od. is allowed for recreational films and these showings
are events of note. We prefer to spend our allowance on a few good ones in
colour and we share these with our neighbours. “Robin Hood”, “A Yankee
at the Court of King Arthur”, “Little Women”, “Stanley and Livingstone”,
“Geordie” have been among our favourites, and “The Black Shield of Falworth”
produced an orgy of jousting in the corridors!

Most of us think our own shows are much better than the public ones and
Saturday night best of all.

Our growing collection of colour transparencies have added to this and an
evening with the School plays renews pleasant memories of old friends and gives
us new confidence in our own powers. Holidays too can be shared.

To the retarded child the printed word could never open so many doors.
But once these doors are open and interest roused, the standard of reading
benefits automatically.

Our ears are still in good use as well. We have a splendid collection of
L.P. records and several good record players. We listen as we embroider or
sew or mend or paint, or make baskets. We are never tired — it may be Pat
Boone, or Berlioz, or Robeson, or Kathleen Ferrier; well as we know them,
we listen again and again.

Recently we have had a Pianola given to us and 197 rolls for use with it.
It is our fourth piano and we have an organ as well. We are never dull.

It is our task to find the right key for the rusted locks of many minds.
For us the film, the colour slide, and our music provide the oil to make the
opening easier.

Kingsdon Manor School for Senior Boys, Somerton G. A. Morris

During the past twelve months there has been an average of sixty boys
on the registers of the school, with an average attendance of 98 per cent. The
intelligence quotients of the boys range from 52 to 85, with the majority between
60 and 70.

There have been no epidemics of any kind and the health of the boys has
been very good with no serious accidents. There has been no infectious disease
even though there have been several outbreaks of mumps and measles in the
village.

The greatest difficulty has been in getting parents to co-operate in keeping
appointments with their children at the various eye and dental clinics in Bristol
during the holidays.

All the boys are registered with the local General Practitioner, Dr. M. J.
Foley of Somerton. He has been most helpful and very prompt in answering
any call upon him. I should also like to acknowledge the co-operation which
we have received from the local dentist and the hospitals who have been most
helpful in giving emergency appointments.

One of the School Medical Officers, Dr. A. M. Fraser, visits the school
each term to ensure that each boy has an annual medical inspection.

Most of the boys will have been immunised against diphtheria by the time
this report appears in print. It has also been decided that all new pupils will be
immunised before they are admitted.

In addition to the children at the Authority’s residential special schools,
the following children were being maintained in independent schools for E.S.N.
children.

Boys Girls Total

Besford Court R.C. School, Worcestershire
Clyffe House School, Dorset
Stokesbrook School, Filton
Amberley Ridge School, Stroud
High Close School, Wokingham
Meadows House School, Kent . .

All Souls School, Middlesex

6—6
1 — 1

1 1

1 — 1

1 1

Ineducable children and E.S.N. school leavers A.L.S.

On 1st November, 1960, Section 11 of the Mental Health Act. 1959, was
brought into operation. This Section amends Section 57 of the Education Act,
1944, substituting new Sections 57, 57A and 57B for the present Section. This
new legislation provides that in the case of a child found to be suffering from a
disability of mind of such a nature or to such an extent as to make him unsuitable
for education at school the decision shall be recorded, and the Local Health
Authority shall be furnished with a report of the decision. The period during
which a parent has a right to refer the case to the Minister of Education before
the decision is recorded is extended from 14 to 21 days, and when a decision
has been recorded the parent may now, not earlier than twelve months after
the recording or more than once in any subsequent twelve months, request
the Local Authority to review the decision. The use of the term “ineducable”
has now been discontinued and “unsuitable for education” substituted.

The Mental Health Act also contains provisions empowering Local Health
Authorities to compel the attendance at training centres of children who have
been found to be unsuitable for education at school. The general effect of this
new legislation is to provide parents with greater safeguards and to give them a
right to call for a periodic reviev/ of the case. The Minister emphasises the
desirability for an informal and friendly approach to parents in dealing with
children who are handicapped in this way, and the need for full information
being given as to the Authority’s intentions and purposes and of the parents’
own rights in connection with the placement of their child. The arrangement
for the issue of a report to the Local Health Authority that a child may require
supervision on leaving school has now been discontinued.

Up to the end of October, 1960, 65 children were reported to the Local
Health Authority for the purposes of the Mental Deficiency Acts, 32 under
Section 57 (3) and 33 under Section 57 (5) of the Education Act, 1944. Since
1st November the Committee have registered their intention to record a decision
in the cases of 6 children found to be unsuitable for attendance at school, and
the parents have been notified of this decision. Information has also been
passed to the Local Health Authority concerning 4 children leaving special
schools at the end of the year who it is thought will require some care or guidance
after leaving school.

E.S. N. School Leavers to 31st October 1960

Reported to the Local Health Authority under Section 57 (5)

From

Special

Schools

From

Ordinary

Schools

of the Education Act . .

Referred to After-Care Officer

Referred for supervision by Children’s Officer . .

—

No supervision necessary . .

Total

Maladjusted Children

At the end of the year there were 40 children (28 boys and 12 girls) placed
by the Authority at various residential schools or hostels for maladjusted
children. This compares with 33 children (21 boys and 12 girls) in 1959. The
number of girls placed in schools or hostels is the same as in the previous year,
but the number of boys has increased from 21 to 28. Efforts are always made
to place children in this part of the country but for special reasons it is some-
times necessary to place a child at a school at some distance from the City.

Details of the schools and hostels attended by maladjusted children at the
end of the year are as follows: —

Boys Girls

Sutcliffe School, Winsley, Wilts. 5 —

Muntham House School, Sussex . . . . . . 2 —

Edward Rudolf Memorial School, Dulwich . . . . — 1

Redhill School, Kent . . . . . . . . . . 1 —

Chaigeley School, Thelwall, Lancs. . . . . . . 1 —

Swalcliffe Park School, Oxon. . . . . . . . . 1 —

St. Peter’s School, Horbury, Yorks — 2

Breckenborough School, Yorks. . . . . . . 2 —

Bourne House Hostel, Lines. . . . . . . . . — 2

Pittsburgh House Hostel, Stoke-on-Trent . . . . — 1

Whatcombe House School, Somerset . . . . . . 2 —

St. Ann’s Special School, London . . . . . . — 3

St. Andrew’s School, Bridgwater . . . . . . 4 —

Cotswold Chine School, Glos. . . . . . . . . 1 —

Pitt House School, Torquay . . . . . . . . 1 —

St. Rose’s Convent School, Stroud . . . . . . — 1

Halcon House Hostel, Taunton . . . . . . — 1

Cam House Hostel, Dursley . . . . . . . . 2 —

Heathercombe Brake, Manaton, Devon .... 1 —

St. Michael’s Hostel, Uckfield . . . . . . — 1

St. Margaret’s School, Stockland, Nr. Bridgwater . . 3 —

Drayton Manor School, Sherfield on Loddon, Hants. 1 —

Peredur Home, East Grinstead, Surrey . . . . 1 —

Total

4
1
1
1
1
2
1
1
3
1
1

Delicate and Physically Handicapped Children

Periton Mead Residential Open Air School C. Organ

During the year 36 Bristol children were admitted to Periton Mead School
and 7 children from other authorities. The number of children on the registers
at the end of the year was 52. Most of the children are admitted to the school
because of asthma or general debility. Some of the asthma cases suffer from
eczema also. Most of these children do well in Minehead and the debility cases
thrive on good food and country air. Although the improvement in the health
of the children is the primary concern at Periton Mead, the academic side is also
well maintained and two of our asthma pupils gained grammar school places
during 1960. Some of the admissions this year have been children whose health
has been affected by emotional disturbances in their homes. In most cases
the transfer to a happy, healthy atmosphere has done a great deal for these
children.

Report of the Medical Officer P. Tomlinson

This residential school at Minehead has continued to provide facilities for
delicate children during the year. At the end of 1960 there were 52 pupils on
the roll. Seven of these children were from other authorities. There were a
small number of vacancies for girls at the end of the year chiefly due to the
reluctance of some parents to allow their children to leave home for a short
period. It is felt that the advantages of a period at Periton Mead should compen-
sate for this factor.

South Bristol Open Air School C. Williams

The school roll at the end of the year was a follows: —

Boys

Girls

Total

Delicate . .

Physically handicapped

Partially-sighted

135

The above totals, however, tell only part of the story. Many pupils suffer
from two or more disabilities but are listed under one. Included in the figures
are many E.S.N. pupils, a dozen epileptics, several maladjusted children and a
partially deaf child. All these of course, are recognised as separate disability
categories by the Ministry of Education and this shows that our problem is
complex.

During the year 45 names were taken off the register, and 43 added. Move-
ment on this scale is unavoidable but is bound to have a braking effect on the
educational progress of the individuals concerned and on the school. Many
visitors have come to see something of our work; doctors, nurses, students and
teachers, some from as far afield as Sweden, France, Uganda, Somaliland and
Formosa. To give particular guidance and assistance we have had visits
from an orthopaedic surgeon (for his usual very welcome termly clinic), psy-
chologists, a psychiatric social worker, an H.M.I. and our own inspector of
schools.

Several educational visits were made during the year, the main one being
in May when nearly all the school and several parents spent an enjoyable day
in London. Smaller parties visited a local factory, a secondary school, a
warship, and the Severn Wild Fowl Trust. A local firm also invited 36 pupils
to be its guests at a City pantomime. Christmas found our good friends, indi-
viduals, other schools, and business groups as generous as ever. But it is
sometimes difficult to accept gifts and kind invitations without establishing or
reinforcing the false belief that a handicapped person is entitled to special
help of this kind. To counter that we give when we can. An example was
provided at our Harvest Festival when the gifts were sent on to the Corner
Cottage Settlement. A wrong attitude of mind is sometimes of greater con-
sequence that the degree of physical disability in producing a “cripple” to use
the ugly word still in use. This sensitivity is not just South Bristol’s; think how
many times we prudently choose the euphemisms plump, or well-built, or slim.

Home Teaching

The work of this smallest but not least important section of South Bristol
Open Air School’s work continued and was extended during the year. The
two full-time teachers were assisted in June by a temporary teacher who was
able to give nine hours weekly until the end of term. Mrs. Bonner commenced
in September to provide an extra five sessions a week. This enables home-
bound pupils either to be visited more frequently or for longer periods.

Another improvement might have been secured before the end of the year.
The pupils’ sense of isolation could have been eased by establishing a link by
portable two-way radio between school and home. A major radio manufacturer’s
very generous offer of the necessary equipment is still open, but it has not yet
been possible to obtain the G. P.O.’s permission.

The roll stood at 21 at the end of the year, 13 boys and eight girls. Thirty-
nine names were taken off the roll during the year for the following reasons: —

Boys Girls

Returned to ordinary school . . . . . . 10 8

Admitted to Open Air School . . . . . . 5 2

Admitted to other special school . . . . . . 1 —

Admitted to training home . . . . . . . . — 1

Admitted to hospital . . . . . . . . 3 4

Admitted to convalescent home . . . . . . — 1

Ol age 1 2

Died — 1

20 19

The teachers’ joint total of visits during the year was 1,868.

Hospital Teaching

The two schoolmasters, aided by a woman student teacher at the Children’s
Hospital for two terms, continued this useful service. The greater part of their
time is spent at this hospital where 377 children v/ere visited during the year.

Southmead Hospital is visited by one of the teachers on three afternoons
a week and the total number of children seen during the year was 195. However,
the stay of children here is usually brief. It is appreciated that the Sister of
Ward M has made available a small room for study purposes, and that there is a
television set which is used to receive school broadcasts.

Only eighteen children were visited at the Bristol Royal Infirmary in 1960,
but the teaching service there is restricted to children who are likely to be in
hospital for a minimum of three weeks.

It will be seen that the total number of pupils visited again moved down.
The year’s total was 590 (as against 634 for 1959) but the range taught was as
great and the teachers had no easy task to deal with the constantly-changing
children in the hospitals.

Report of the School Medical Officer P. Tomlinson

The number of pupils attending the school at the end of 1960 was 114.
Of these 74 children were classified as physically handicapped and 40 as delicate.
The principal conditions from which these children were suffering were: —

Post poliomyelitis paralysis . . 20

General debility . . . . . . 17

Muscular dystrophy . . . . 12

Epilepsy . . . . . . . . 11

Cerebral palsy . . . . . . 9

Asthma . . . . . . . . 8

Congenital cardiac disease . . 5

Amyotonia congenita . . . . 3

Two items of interest in the above list are firstly, the increase in the number of
children with epilepsy attending the school. Some of these children have
frequent fits with possible detriment to the other children, and it is felt that it
would be undesirable to increase the number of children with epilepsy above
the present figure. Secondly, there is an increase in the number of muscular
dystrophy cases from 8 to 12, compared with last year.

There were 31 new admissions to the school in 1960 consisting of 16 physically
handicapped children and 15 delicate children. Five of these new cases were
suffering from epilepsy. It is of interest to record that there was only one case
of post poliomyelitis paralysis of recent origin admitted.

During the year 35 children ceased to attend the school for the following
reasons : —

Returned to ordinary school . . . . . . 20

Transferred to other special schools . . . . 5

Reached school leaving age . . . . . . 4

Put on home tuition . . . . . . . . 3

Died 2

Moved from Bristol . . . . . . . . 1

Thirteen children were admitted to hospital schools during the year, and then
re-admitted on discharge. Nearly all the admissions were to Winford Ortho-
paedic Hospital. The visits every term by the Orthopaedic Surgeon were
continued during the year.

There has been a continual demand for places in the school during 1960,
particularly for children in the younger age groups. Although the school has
always had its full complement of pupils the Headmaster has nearly always
been able to make a place for the deserving case without delay.

Epii epsy in School Children A.L.S.

Of recent years there has been a marked improvement in the condition of
school children who suffer from epilepsy. Modern medication has resulted in
many more children being able to take their place in the ordinary school. With
the diminution in the number and severity of the fits many children are able to
work up to their true potential of ability in contrast to former times when so
many depressant drugs were used with consequent unfortunate effect on the
progress of children in school. In Bristol it is estimated that at least T7 per cent
of school children have some sort of epileptic episodes. This is probably an
under-estimate since many mothers still will not freely confess the occurrence
of occasional fits which might take place in the evening, during sleep, or in the
early morning. It is also possible that a mother may anticipate a fit or a group
of fits by noting a true aura or abnormal behaviour of her child and take the
precautionary step of withdrawing the child from school at the time of the
expected occurrence of the fit.

The national incidence, as found by Dr. Peter Henderson, some years ago
was -2 per cent of the school population but there is some evidence that even
this may be a low estimate. Children who have fits can cause a severe disruption
in school life more marked perhaps in the secondary school than in the primary
school. It is also true that the larger the child the more concern is usually
expressed at the physical risk to himself or those about him during a fit. On
the other hand, it is remarkable how well epileptic children are managed in the
schools by sympathetic and understanding teachers. In fact, only two children
at present are placed by the Education Authority at Lingfield Hospital School
for Epileptics in Surrey. It is the policy at this school wherever possible to
adjust the way of life and medication of the child so that he can return to the
ordinary school and in quite a high proportion of the cases this result is attained
inside two years.

Eleven other epileptic children are placed at the Local Education Author-
ity’s South Bristol Open Air School at Novers Hill as delicate children. This
is a fairly recent development and is only possible by the good offices of the
Head of the school and the presence of the nurse who is available full-time to
deal with any casualties. There is obviously a limit to the number of epileptic
children who can be dealt with in this way, but the arrangement has proved a
very useful half-way house in providing special educational treatment, especially
for the younger epileptic child.

When children who are known to have had epileptic attacks reach school
leaving age, the School Health Service is responsible for advising the Youth
Employment Officer about the employment risks involved. The parents are
usually asked to allow the child to go on the Disabled Persons register so that he
can receive special consideration in placement in employment. One is bound
to comment that although much progress has been made in recent times in the
attitude of employers to the epileptic employee, there is still much misunder-
standing and fear of the consequences of this disability. It is believed that it is
best for an epileptic person to be quite frank with a prospective employer, who
is then able to make suitable allowances for the employee. On the whole,
one feels that there have been such advances made recently in caring for the
epileptic child and with such good results that one can look forward to more
progress in the future — such is the pace of advancement in the production of
new remedies for this disorder.

Spastic Children Grace E. Woods

Cerebral Palsy Assessment Clinic

The Cerebral Palsy Assessment Clinic has continued to be held each
Monday afternoon at the Children’s Hospital. Many of the new cases seen
during the year have been very young. At one time there were eleven cases of
hemiplegia under the age of two years receiving physiotherapy. We have
become increasingly impressed with the value of early treatment, and it is hoped
that suspected cases will be referred to the Clinic even before one year of age.
The improvement brought about by early treatment is reflected in the children
in the nursery unit at Claremont School. Many of our visitors have remarked
on the liveliness, mobility and normal play of these children. Interest in the
early diagnosis of cerebral palsy has been stimulated by an invitation I received
to read a paper on the subject at the Eighth World Congress for the Welfare of
Cripples in New York in August.

There is now a widespread interest in the problem of the brain damaged
child with minimal motor handicap, and cases in this category have been
referred to the Clinic for full neurological examination and appraisal of the
educational difficulties. Dr. Peter Henderson of the Ministry of Education
has asked for reports on these children and one was sent from the Clinic. There
may be a fair number of these cases in ordinary schools who need assessment
and understanding. The following child, known to me from birth, illustrates
the type: —

S.Mc. Her mother attended an antenatal clinic which I held and twins
were diagnosed. The second twin S. was born fifteen minutes after the first,
following a difficult delivery due to partial placenta praevia. He had white
asphyxia and did not breathe for 15 minutes. During the neonatal period he
had convulsions and was severely ill. However, on leaving the hospital he made
steady progress and only appeared to be slightly behind his girl twin. He walked
at 16 months and talked before two years. After the age of two years he was
not followed up at the Clinic as he appeared to be normal and we did not wish
to worry the miother. After five years, at the age of seven, he was referred quite
independently to the Clinic. He had been noted in school to have a speech
defect, a general inco-ordination of movement, was easily knocked over and was
backward in class. On neurological examination there were minimal but definite
abnormal signs and the E.E.G. showed localised abnormality in left fronto-
parietal region, presumably accounting for the speech defect. There were no
behaviour problems. His mother was placid and accepting of the child’s

disability. He illustrates a type of brain damaged child who will need to be
watched.

Another aspect of cerebral palsy which is now causing national concern is
the ineducable spastic. There are 157 such cases on our files which are drawn
from Bristol and district. Many of these are of very low intelligence, epileptic
and unable to walk. They occur in every social group and each one is a family
tragedy. Many could make some progress with training and be less of a burden
to their family. At present some attend the Special Care Unit at Marlborough
House Training Centre, and some are catered for at the Bristol Spastic Centre.
There are a number in mental deficiency hospitals and a large number on the
waiting lists for admission. It is hoped that when the new Bristol Training
Centre is built, all children of this type living in Bristol will be able to attend
and so relieve the mother of the burden of day-time care.

In addition to provision for the severely mentally handicapped home-
bound cases, there is a need for places to accomm.odate severely physically
handicapped cerebral palsy cases who cannot obtain outside employment on
leaving school. Many, perhaps all, of these could do very simple factory work,
which involves a few arm movements only. There are jobs of this sort and it is
hoped that a Work Centre will be built under voluntary auspices in Bristol to
give this type of employment. Dr. Wedell, Educational Psychologist, has made
a survey and has found thirty-five adults under the age of 30 years who would
come into this category, and every year there will be one or two similar children
leaving Claremont School. There is a further group of adolescent spastics who
need special training when they leave school, if they are to obtain independent
employment. A few have been sent to resident training centres and one hemi-
plegic girl has gone to Colwall Court, a new centre opened by the National
Spastics Society.

Habilitation of these children has been assisted by the staff of the Ministry
of Pensions, who have provided equipment and readily made all the necessary
adaptations. Push-chairs, wheel-chairs, home-chairs, specially made cot
transport and tricycles have all been sent where the need is.

The work with cerebral palsy children is thus widely varied from the care of
the infant to that of the school leaver, from the intellectually bright to the
extremely mentally handicapped, and from mild brain damage to severe motor
disability.

Claremont School for Spastic Children M. Ram

During 1960 we have had 40 — 41 children on the register, ending the year
with 24 girls and 17 boys.

Since the school opened, we have had a majority of girls am.ong the pupils,
and in this we have been, apparently, unique among schools for the cerebrally-
palsied. Now the disproportion may be growing smaller; in the Senior Unit
we have seven girls and three boys, but among the younger children the propor-
tion is 17 to 14.

Another change is appearing in the proportion in which the two main
forms of the handicap are represented. Of the children who were seven years
old and younger at the end of 1960, eleven were spastics and three athetoids.
At the same period in 1955 there were 13 spastics and 8 athetoids in this age
group, and in 1957 five spastics and 10 athetoids. There are still some partially
deaf children in this youngest group, but the bulk of those with severe high-
frequency loss are now in the Junior Section.

Thanks to the very helpful attitude of the Head Teachers and staffs con-
cerned, we have been able to place two more children in the neighbouring
Henleaze Primary Schools and another is to follow in January. They will
continue to come to Claremont for physiotherapy and speech therapy.

Preparations have been going ahead to provide the older boys with training
in handicrafts, and it is hoped to make a start early in 1961. Mr. Goddard,
one of our Schools’ Inspectors and I visited the Thomas De-la-rue School for
Spastics at Tonbridge, to see how a woodwork syllabus had been worked out
there and how the handicraft masters had devised aids and adaptations to enable
severely handicapped boys to handle the ordinary woodworking tools. With
their generously given permission, we hope to put these methods into practice
at Claremont.

As part of the training in self-help which has been planned for our Senior
Unit, the children from it were taken in June to stay for a week at the National
Spastics’ Society Hostel at Bexhill-on-Sea. Most of them had never been away
from their parents before, and all are heavily handicapped. The object of the
expedition was to show them how, with suitable gadgets and aids, they could
attain a considerable degree of physical independence. It was an enjoyable,
if strenuous week, and the children are eager to go again next year. Other
less ambitious journeys and visits were arranged as well, to theatres and concerts,
and (for the youngest children) to the Zoo. We did not go to Weston-super-Mare
this year, but one of the Weston donkeys, “Silver”, was given to us by the
proprietor, and is now a much-loved member of the school outdoor staff.

HEART DISEASE AND RHEUMATISM C. Bruce Perry

As the figures published in the table show, the work of the clinic has con-
tinued on the same lines as before. There has been a slight increase in the number
of new cases but fortunately the majority of these showed no incidence of cardiac
involvement and were mild. This increase was mainly due to a small “epidemic”
that occurred early in the year in and around Shirehampton where there must
have been an epidemic of streptococcal sore throats, although this apparently
did not come to light and was only revealed by the subsequent acute rheumatism
which, being notifiable, was recognised. Once again, as far as can be ascertained,
few, if any, of the children who developed acute rheumatism received what is
now considered adequate treatment for the antecedent sore throat, neither was
the causal organism identified. This is particularly disappointing especially in
view of the full bacteriological service available. It is probably only by more
careful attention to sore throats by both parents and practitioners that we shall
be able to reduce still further the incidence of acute rheumatism.

Summary of School Cases attending Cardio-Rheumatic Clinic, I960,
including Primary, Secondary, Nursery and Special Schools

New cases:

Rheumatic heart disease
Chorea

No organic disease
Congenital heart disease
Acute rheumatism

Re-examinations:
Rheumatic heart disease
Chorea

No organic disease
Congenital heart disease
Acute rheumatism

Treatment Treatment Institurional

reatment treatment

and

treatment

Total

but

school

exclude

^striction

restriction

from

school

games.

etc.

—

■—

—

236

237

. —

205

—

206

589

—

611

No. of individual children examined

. . 387

No. of new cases for 1960

No. of re-examinations

. . 611

Total number of attendances

681

INFECTIOUS DISEASES A.L.S.

In contrast to the previous year, 1960 was a light year for measles cases,
there being only 279 cases of this disease amongst children of school age com-
pared with 2,058 cases in 1959. Scarlet fever cases were also fewer, 120 cases as
compared with 173 in 1959. Whooping cough was more prominent, there being
1 67 school cases as against 74 in the previous year. The problem which caused
a good deal of concern during the year was the sharp increase in the number of
cases of infective hepatitis which totalled 890 during the year, though towards
the end of the year the number of cases was tending to diminish. Families
where cases of this disease had occurred were visited and advice given and
Heads of schools where there were a number of cases were also advised on the
hygienic measures to be taken.

The members of the teaching staffs of schools most severely affected were
offered protection against the disease by injections of Gamm.a Globulin, and
this was given to all those who wished to have it. Incidentally this protection
was also offered to expectant mothers who were contacts of their affected children.
It is not possible to say how much effect this has had in influencing the control
of the epidemic. The disease was made notifiable in November, 1960, but
before this time the general practitioners had co-operated well in giving notifi-
cations voluntarily.

As a result of some disquiet about the continuance of infections of a food
poisoning type, mostly Salmonellae, and of the recent occurrence of infective
hepatitis which is believed to be intestinally transmitted, a review was undertaken
of the cleansing and hygiene arrangements carried out by caretakers in schools.

The following instructions were issued to the caretakers of the Authority’s
schools on the use of cleansing agents and germicides.

“A good deal of research has been undertaken in an effort to combat the
various types of infection which have recently been notified in schools. As a
result it is strongly recommended that the following treatment should be apphed
to certain areas in schools, viz. changing rooms, showers or footbaths, sports
pavilions, cloakrooms, gymnasia and rooms where any form of activity is
carried out in bare feet.

The floors of these places should be treated at the end of every morning
and afternoon session with a solution in the proportion of two tablespoons full
of the approved germicide in a 2-gallon bucket of warm water. Seats should
also be wiped over with a cloth soaked in this solution. An extensive treatment
on similar lines should be carried out immediately before the opening of schools
after holiday periods. Bathrooms in housecraft flats should also be regularly
cleaned with the same solution. The germicidal qualities of the solution will not
be impaired by the further addition of about one-third of a pint of detergent
to each bucket of water and this will materially assist in the removal of dirt and
stains. In showers and footbaths the floors can be thoroughly washed down
and the final rinse made with this solution, floors then being left to dry of their
own accord; this will give a maximum period of germicidal effect. It will
obviously be undesirable to use the solution in similar quantities on floors of
gymnasia, changing rooms and assembly halls where physical activities may be
carried on in bare feet. In these cases, it is suggested that a light mopping
with the same solution be carried out, care being taken to keep the actual amount
of liquid introduced on wood floors to a minimum. If the latter type of floor has
been sealed as outlined in a previous memorandum to caretakers, no harm will
be caused provided no surplus liquid is allowed to remain on the floor. In ad-
dition, these floors should be swept daily with the compounds mentioned in the
earlier memorandum, as ail the sweeping powders have some germicidal content.

A solution in the proportion of two tablespoons full of germicide and one-
third of a pint of one of the approved detergents to a two-gallon bucket of
warm water should be used for sluicing floors of outside toilets. Floors of
indoor toilets should be mopped with the same solution, which should also be
used for daily cleaning of taps and washbasins, doors, door knobs, chain handles,
partitions and walls, these being wiped over with a cloth dipped in the solution.
W.C. seats should be similarly treated, both sides of “lift-up” seats and the
exposed part of fixed seats being wiped over carefully. Mops, brushes and
floor cloths should be thoroughly washed out after each operation and rinsed
in a solution of germicide.

Water closets should be checked at intervals during the day to see that they
have been flushed after use. This particularly applies in Infants’ schools.

Measuring pumps will be provided in all schools. These pumps may be
fixed to the top of the drum to measure the appropriate amounts of germicide
to use for the various operations detailed in these instructions. Two strokes of
the pum.p dispense two tablespoons full of the germicide and this, in a two-
gallon bucket of water, gives a suitable dilution.

The solution described above is suitable for most school purposes, but
special treatment may be necessary to remove stains from urinal stalls. In the
past some caretakers have used spirits of salts. This should not be used because
of its corrosive effect; chloride of lim.e (in liquid or powder form) or soda ash
should be adequate if cleaning is carried out frequently and regularly.”

The details of the cases of measles, whooping cough, and scarlet fever
occurring amongst school children and pre-school age children during the year
are as follows: —

Measles

Whooping cough
Scarlet fever

School age

Pre-School (

children

279

276

167

228

120

Admissions of patients of school age to Ham Green Hospital during the
year totalled 184, the average stay of patients being 19-7 days.

Poliomyelitis Vaccination

Following the intense campaign conducted in 1959 to secure the immuni-
sation against poliomyelitis of school children, the number of children immunised
during 1960 was considerably below that for the previous year. Among children
of school age 796 received a full course of two injections and 5,510 received a
booster injection during the year. The total number of school children who
have been given this protection is now approximately 61,000 out of the total
school population of 66,490, which shows a percentage of 91-7, a very satis-
factory position concerning the protection of school children against this disease.
There were no cases of poliomyelitis among children of school age during the
year.

Immunisation against Diphtheria

Towards the end of the year a campaign for increased immunisation
against diphtheria of school children was commenced in the schools following
one or two cases of this disease which had occurred elsev/here in the country.
Up to the end of the year 553 children of school age were given a full course of
three injections and 7,761 were given a booster injection. When this campaign
is completed in 1961 it is hoped that the level of protection against this disease
will have reached a more satisfactory point. There has again been no case of
diphtheria amongst children in the City, the eleventh successive year in which
this has been the case.

Concern still continues that the need for diphtheria immunisation tends
to be treated lightly by the general public. Experience in other towns has
shown that diphtheria is still a risk that has to be faced, and the possibility of an
epidemic arising cannot be ruled out. A far greater proportion of children
should be protected against this disease, and it is believed that until at least
seventy-five per cent of the child population has been protected there will always
be a risk of the disease gaining a foothold in the City.

MEDICAL INSPECTION A.L.S.

A complete periodic medical inspection was made during the year of 19,329
children attending the Authority’s Primary, Secondary and Special schools.
The statistical tables relating to these inspections can be found at the end of the
report.

Co-operation of Parents

The number of parents present at periodic medical inspections during the
year was as follows : —

Age groups inspected

No.

Parents

{by year of birth)

examined

present

Per cent

1956 (and later)

904

831

91-92

1955

833

593

71-19

1954

3,585

3,186

88-83

1953

1,242

1,041

83-82

1952

401

287

71-57

1951

749

513

68-49

1950

2,042

1,550

76-39

1949

1,624

1,218

73-76

1948

722

378

52-62

1947

650

250

38-46

1946

1,471

478

32-49

1945 (and earlier)

5,106

1,509

29-55

19,329

11,834

61-17

Infestation

The number of individual children found to be infested and the percentage
of those children of the school population again shows a downward trend, and
the figures are the lowest so far recorded, the percentage figure being only 1 -3
per cent of the school population for 1960. The figures relating to this year and
the five preceding years are as follows : —

School

No. population per cent

1955

1956

1957

1958

1959

1960

2,347

65,177

3-6

2,133

65,979

3-2

1,841

66,439

2-8

1,584

66,555

2-4

1,278

66,700

1-9

869

66,490

1-3

The intensive campaigns which have been undertaken and the constant
supervision of the families of known offenders, coupled with the rising social
standards, have been reflected in the continued reduction in the numbers and
the percentage of the school population who are found to be infested. In those
schools where infestation still causes concern, arrangements are made for the
health visitor to carry out a routine inspection of all the children immediately
after holiday periods and at other times where necessary. There is of course
still the hard core of special families who require constant supervision to prevent
the condition recurring. It is hoped, however, that in time these cases will be-
come fewer in number and that infestation will cease to be a problem in the
schools.

Medical Inspections at the College of Technology

Mention was made in the report for 1959 of the proposed arrangements
for the routine medical inspection of the pupils at the College of Technology
and the proposed College of Science and Technology which opened in 1960.
It was agreed by the Governors of the College and by the Education Committee
that arrangements should be made for the routine medical examination on a
voluntary basis of students entering the College in September, 1959. Dr.
Tomlinson, one of the Medical Officers, was allocated to this work, and 60 of
the students who had given their consent were medically examined during 1960.

It was agreed that for students entering in i960 or in subsequent years that they
should be recommended to accept routine medical inspection, and arrangements
are being made to carry out a full medical inspection of the entrants to the College
in 1961 and subsequent years.

Medical examination of entrants to the teaching profession

The arrangements for the medical examination by the Medical Officers
of the Local Authority of candidates applying for entry to training colleges and
entrants to the teaching profession were continued during the year. Altogether
227 candidates were examined in connection with admission to or on leaving
training colleges, and 146 teachers were examined on appointment in Bristol
or for some other reason. In a further 107 cases the examination was carried
out by other Authorities, and this Authority dealt with medical examinations
for other Authorities in 28 cases.

MILK AND MEALS IN SCHOOLS T. B. J. Hetherington

The number of children taking the meal increased in September to 26,952
per day — the highest figure yet reached — 2,338 free and 24,614 paid — i.e.
45 03 per cent of children in attendance throughout the City. The total number
of meals produced daily reached 32,000 including those supplied to teaching and
other staff. Institutions of Further Education, Independent Schools and the
Marlborough House Training Centre. Altogether 1,161 staff were employed
in school kitchens and canteens. New kitchens were opened at Brislington
School (second kitchen) and Lockleaze School, now making a total of 102
kitchens supplying meals to 217 school departments. Some of these kitchens
are also dealing with beverages, snacks, catering for courses, sports, etc. The
main task, however, remains the provision of a well cooked appetising, balanced
meal at less than lOd. per head for food. It is still a great challenge to ensure
that the required nutritional content of the meal is attained. In order to
achieve the 20 grammes of animal protein out of the required 30 grammes
of total protein, approximately half the cost of the meal is spent on this
one item and a large proportion of the meat bought must necessarily,
because of cost, be frozen rather than chilled or English. It is interesting
to note that over recent years we have widened the variety of the sources
of protein and the “non-meat” meals tend to become more popular. The
analysis of the content of individual meals shows that the majority are well
up to standard and there is a greater understanding among the staff of the
nutritional requirements, a wider variety in menus and a break down in the
“bulk” in which the meals are cooked.

Courses have been held at the Training Kitchen throughout the year, staff
have continued to attend courses of training at the Bristol Technical College
and two supervisors passed the Royal Society of Health (Nutrition) Examination
held at the University in September, 1960.

The percentage of children taking milk under the milk-in-schools scheme
increased to 83-77. The figure for 1959 was 82-82.

MILK, FOOD AND HYGIENE INSPECTIONS F. J. Redstone

The work of the public health inspectors associated with schools and school
kitchens — sampling foodstuffs, investigating complaints and cases of disease
associated with food has continued during 1960 without untoward incident.

Cases of dysentery occurring in the south side of the City were numerous
but not confined to pupils of any particular school and there has been no known

outbreak of food poisoning. Two nurseries where a number of dysentery
cases occurred in the latter part of the year, gave rise to many visits and re-visits
by public health inspectors.

A few complaints were investigated relating to unsatisfactory bottles of
milk delivered to schools. A serious one was a child’s discovery of small
particles of glass in a bottle. It could not be established at which point the glass
entered the bottle, but the matter was taken up with the dairy company and
the whole staff was addressed by an inspector. School milk bottles continue
to give dairy companies more trouble than other types, and many hundreds
have to be set aside for destruction or for special cleansing because of the
condition in which they have been returned from schools.

During the year 124 samples of milk were secured on delivery to schools
and submitted to the statutory tests. Very exceptionally, five samples secured
on two different days failed the phosphatase test of heat treatment. Investigation
revealed plant failures which were immediately reported to the plant engineer.
Subsequent samples were satisfactory. The methylene blue reduction test is not
applied to milk when the storage temperature after sampling has exceeded 60°
F. and this was the case in regard to eight samples; all taken on the 1st June,
a significant reflection on the weather of last summer.

During the year 498 samples of various foods were secured for analysis
from eleven school kitchens. In a few cases slight grub infestation or deterior-
ation was discovered and the foods were destroyed or withdrawn from stock.

At the request of Dr. Bothwell, who was investigating infective hepatitis,
samples of the water supply were secured from several schools. Although
in some instances water taps to which children had access were supplied from
storage tanks in roofs, no adverse reports on the samples were made.

A close working relationship continues with the Education Department’s
School Meals Organiser and her staff. On a number of occasions during the
year problems in connection with kitchens and canteens, including infestations,
were investigated and satisfactory conditions attained.

NUTRITION CLINIC Margaret Chapman

In the 1959 “Health of the School Child” it was reported that some concern
was felt about the incidence of overweight and dental decay among children
and that a factor influencing both of these, namely, the increased consumption
of carbohydrates, was being condoned in many schools by the sale of biscuits
and similar confectionery.

In looking for an acceptable substitute to sell instead of such commodities,
it was thought worth while investigating the habits influencing mid-morning
eating in schools, and the following information emerged from a small survey
carried out in a secondary school attended by girls chiefly from the immediate
neighbourhood, a good industrial employment area of the City.

Of 562 girls aged 11 — 18 years, who completed a questionnaire relating
to their eating habits on a day in June, 48 (1 in 12) had eaten no breakfast at all,
and a further 212 had eaten only bread and/or biscuits before coming to school,
so that in ail, practically half of the pupils (260) had received a nutritionally
poor breakfast in that it provided no significant amount of animal protein,
i.e. obtainable from milk, meat, cheese, fish or eggs.

Although one-third of a pint of milk is available free of charge to every
child at school, 169 (30 per cent) did not have it on the day in question, and
correlating this with the type of breakfast eaten it was found that 78 children
(1 in 7) had neither milk nor a satisfactory breakfast, while 8 had no breakfast,
no milk and nothing to eat at mid-morning.

Pupils were unable to leave the premises during the mid-morning break to
buy food. They could bring it from home and buy biscuits or apples from the
school shop.

It was found in this enquiry that 419 (74-6 per cent) ate something at mid-
morning, but 50 children ate nothing and had no milk at mid-morning and 271
children spent a total of £4 Is. lid. at the school shop, 255 spending 3d. or
more. Of the total, £1 4s. 8d. was spent on biscuits, and £2 17s. 3d. was spent
on apples at 3d. each.

This was the first day that apples had been for sale; previously between
£2 3s. Od. and £3 Os. Od. daily had been spent on biscuits only.

The results of this investigation have been discussed at a number of Parent/
Teacher and other Group meetings throughout the City and it has been pointed
out that in addition to the immediate dental and overweight problems, other
general health factors also might be involved.

Many people comment on the apparent fatigue, lack of concentration and
mental confusion found among school children today. Nutritional research
shows that all of these can be brought about by the prolonged fasting incurred
through the omission of an adequate breakfast. Additionally, the formation
of a habit of not eating breakfast could lead to an inadequate intake of protein
in children because the normal quantities of milk, meat, cheese, fish and eggs
provided at the other two main meals are unlikely to cover the requirement of
first-class protein.

Discussion of the possible reasons for the decline in breakfast eating by
children indicated that it was attributed by the audiences to (1) insufficient time
being allowed for the preparation and/or eating of the traditional type of
breakfast, through the family getting up late and/or mothers going out to work;
(2) lack of knowledge of food values, aggravated by misleading advertisements,
particularly when there was constant presentation of these as with television
advertising. Economy was not thought to play a significant part in the decline,
rather the reverse, for higher incomes seem to account for more being spent on
biscuits which replaced other foods of greater nutritional value, viz. 155 children
had eaten two or more biscuits before coming to school.

Mr. McCaig, the Principal School Dental Officer, has mentioned in his
report, a letter which was sent to the Heads of all schools suggesting the sale of
such things as apples, dried fruits etc. in school tuck shops rather than sweets
and biscuits. Though the primary object of this letter was to try and reduce
the amount of dental decay among children, this proposal, if carried out, would
also have a beneficial effect on children from the dietary aspect. It is hoped
that many Heads of schools will be able to carry these suggestions into effect.

ORTHOPAEDIC AND POSTURAL DEFECTS A.L.S.

The two Orthopaedic Surgeons of the Regional Hospital Board, Mr.
Pridie and Mr. Jones, have continued to attend at the Central Health Clinic
on one session per week during the year to see children suffering from postural
disabilities. The figures for 1 960 show little change in the case of school children,
but the number of patients under school age is considerably fewer than during
1959, 79 as against 96. The figure for 1960 is however, about the average for
children under five years of age seen during recent years. The only point of note
in the figures for this year is an increase in the number of cases of tuberculosis
of bones and joints which number five as compared with one in 1959.

In addition to the orthopaedic arrangements at the Central Health Clinic,
Mr. Lucas has continued his visits once a term to South Bristol Open Air

School to advise on the problems of the physically handicapped children at the
school. These visits have proved most useful and his advice is always welcomed
by the staff.

The figures relating to the children seen at the Orthopaedic Clinic during
the year are as follows : —

Paralysis {a) Flaccid

Age 5 years
and over

Age un
5 yea,

(b) Spastic

Tuberculosis of bones and joints

Congenital abnormalities of bones and joints

Amputations

—

Genu valgum . .

Various (Flat foot, spinal curvature, etc.) . .

351

462

PHYSICAL EDUCATSON J. McA. Milne

In the latter part of 1960 the Wolfenden Report on Sport was published.
This spot-lighted the need for better facilities, both indoor and outdoor, for
more trained coaches and for a wider application of physical activities. In the
case of facilities, improvements are taking place all the time, new playing fields
and gymnasia are becoming available in the new schools and conditions in the
older schools and existing playing fields are gradually receiving attention as far
as the financial position allows. An outdoor swimming pool will soon be
constructed at Withywood Secondary School and plans are prepared for the
inclusion of a swimming bath at the new Secondary School at Hartcliffe. The
new swimming bath at Filwood Park, construction of which has now been
commenced, will provide the much-needed additional accommodation for the
schools of Knowle West and Hartcliffe.

The physical education staff are well able to cope with demands of pupils
in school but these demands leave very little time for a teacher to help youth or
adult organisations and the increased number of coaches in various activities
recommended in the Wolfenden Report will have to be recruited from sources
other than the teaching profession. The report makes a plea for the greater
recognition of some of the less popular pursuits such as camping, cycling, judo,
canoeing, rock-climbing and the scope of physical education has been extended
to include many of these activities.

The courses arranged for teachers during the year included Infant and
Junior Physical Education, Educational Dance, Folk Dancing, Cricket, Tennis,
Basket-ball as well as Lightweight and Heavyweight Camping, Trampolining,
Swimming and Judo.

Netball and Rounders Tournaments have again been held including two
Primary School Tournaments. The school County Netball teams have played
against Somerset, Devon and Gloucestershire. The Bristol Association of
Mixed Clubs and Girls Clubs have also held Netball and Hockey Tournaments.
This year one school took part in the Lacrosse Tournament at Cheltenham and
met many schools from the South-West of England and Wales. Other schools
are now playing Lacrosse and show much enthusiasm for this very fast and
skilful game.

Two children’s Country Dance parties have been held in conjunction with
the Bristol and District Branch of the English Folk Dance and Song Society.

A sword dance team from the choir of St. Mary Redchife Boys’ School gave
displays in several tov/ns in Germany during their tour of that country.

Coaching evenings for rounders, both at Primary and Secondary levels
have also been arranged. “Keep Fit” is becoming more popular and several
leaders’ courses and open evenings have been held in addition to a festival at
which various groups took part.

Three girls and six boys were selected to attend the Outward Bound Schools
this year. The courses were strenuous and very much enjoyed.

The Duke of Edinburgh’s award scheme continues to flourish and the number
of boys who have visited Buckingham Palace to receive Gold Awards from the
Duke of Edinburgh is now 25. Roger Bullock, formerly of Greenway Secondary
School and one of the first winners of this award was chosen as a member of
Sir John Hunt’s survey party to Greenland in August.

A number of teachers co-operated during the year in a Tests and Measure-
ments Survey which was conducted on a national scale and when the results
were published it was interesting to note that British boys were found to be
generally superior to their American counterparts in all but one of the tests taken.

The demand for swimming is still increasing and it becomes more difficult
every year to find accommodation for schools wishing to participate in this
most useful activity. All secondary schools have periods allocated for swimming
either in school time or after school hours, and the majority of junior schools
also attend the swimming baths.

At a meeting of all organisations interested in swimming for the physically
handicapped an “ad hoc” Committee was formed to explore possibilities of
providing swimming facilities and giving assistance to handicapped persons
of all ages. Arrangements have been made for the children from the Open Air
School to have the use of Bedminster Down Secondary School Bath one after-
noon per week and for the Bristol Spastic Association to have the use of the bath
one evening per week. Helpers are provided by the Red Cross Association and
the School.

During the year 3,386 four length certificates and many Royal Life Saving
Awards have been gained. The Amateur Swimming Association medallist
award for proficiency in swimming was gained by 200 boys and girls and 45
obtained the A.S.A. Advanced Award.

The Mimic Dance Theatre visited Bristol for one week and gave perform-
ances in various schools. The work which is based on modern educational
dance principles was much appreciated.

School visits to discuss modern physical education were arranged for
doctors taking the D.P.H. course.

Parent/Teachers meetings have been held in various schools and have proved
very helpful, not only as regards clothing for physical education, but more
especially for the help given by the doctor to individual parents on such things
as thumb sucking and bed-wetting in children, and other behaviour disorders.

Miss Halonen, a midwife and nurse from Helsinki interested in accident
research, gave great encouragement by her conviction that freedom to experiment
on climbing apparatus was the greatest factor in preventing accidents.

Sports and games are efficiently run by the different school organisations
controlling them and the standards compare favourably with those in other
parts of the country. Successes nationally have been gained by boys in rugby,
football, boxing and swimming with county honours in many other sports.

PSYCHOLOGICAL SERVICE R. V. Saunders

Educationally Sub-normal Children

In this section of the Annual Report for 1957, one of the tvv^o chief points
mentioned as requiring discussion was the need for re-thinking the role of the
special schools in view of changes in the nature of their population, as a result
of the setting up of a system of special classes.

In this connection, it is interesting to note in the 1960 International Confer-
ence Edition of “Forward Trends” (Guild of Teachers of Backward Children)
that Mr. S. S. Segal, the Conference Adviser, says “One does not need to be a
prophet to foresee that with a greater supply of skilled teachers of the backward
in our ordinary schools, part of the population of our special schools will be
able to shift upwards and be catered for within our ordinary schools. Similarly
one can foresee the I.Q. floors and ceilings in Special Schools being lowered to
include the most able of those now excluded from schools as ineducable.”

If we do accept that such a change is taking place, it becom.es necessary to
consider such matters as the supply and training of teachers for this work, the
nature and purpose of the ascertainment process, and the difference between
special school and special class in ordinary school, in their educational aims,
in the types of children they take, and in their methods and techniques for dealing
with these children.

Ascertainment

Lip-service is generally accorded to the idea that ascertainment should not
be on the basis of an I.Q. score so much as on the basis of the child’s adjustment
and his social and educational needs. It is still unfortunately true, however,
that the first item considered by doctor, psychologist, and teacher, is normally
the child’s ability test score, or I.Q., and that they tend to work on the figure
obtained as the child’s “true I.Q.” How much are they impressed by the fact
that the operation of purely chance factors in the obtaining of this score, obliges
even the most skilled tester to say that the child’s “true” score may be some three
points more, or less, than the one he actually obtained ? We should also add to
this that with the Terman Merrill Test, which is the one most commonly in use,
the spread of scores differs from one age level to the next, so that it is quite
misleading to compare scores obtained at different ages unless they are “correc-
ted” by using one of the standard correction tables now available.

In ascertainment, we should consider the nature and degree of the child’s
failure in the ordinary school setting in determining his need for special edu-
cational treatment in special school or special class. The I.Q. test should serve
to indicate simply the ability level or grade of the child, with, frequently, inciden-
tal information about his reasoning, learning, and perceptual processes.

Special School and Special Class

The special class should aim to keep the child adjusted to the environment
of the ordinary school, at first by affording him substantial support and shelter,
which should ideally become less necessary as time passes, until he should finally
be able to join fully in the normal life of the school.

The children selected for treatment in special classes should therefore be
those who at the time of ascertainment are judged to be capable of making this
kind of progressive adjustment.

Children selected for special school treatment are likely in consequence
to be those considered to be in need of a sheltered environment throughout
their school days. This group is likely to include not only children who are
severely impoverished intellectually but also those children who by reason of

their unadaptability or “rigidity” in learning situations, are not able to make
use of their possibly fair intellectual ability, e.g. “brain damaged” children and
certain emotionally disturbed children v/hose problems arise out of their poor
ability and educational failure.

Staffing

These differences in function should be reflected in the staffing of special
schools and special classes, both in the training and outlook of their teachers,
and in the size of their classes. Where a child requires more assistance than
a special class can give, and his learning difficulties are greater and more intrac-
table, it seems necessary that he should be in a smaller unit. Classes in special
schools require to be smaller than special classes in ordinary schools. (In this
connection it is interesting to note the National Union of Teachers’ recent
recommendation to the Minister of Education that the maximum class number
should be 1 5 pupils rather than the present 20.)

Educational Aims

The educational aims of the special class in the ordinary school require
to be kept related to the aims of the ordinary school community in which it is
situated. This means that more formal educational demands are likely to be
made of it than need be made of the special school.

The latter has too long been expected to justify its existence in terms of intel-
lectual attainments, at the expense of all-round personal development and a
realistic approach to the life-needs of its pupils.

A franker recognition by all concerned of the type of service which the
special school can give, and the type of pupil whom it has to help can result
in a much freer and more experimental approach to its problems which should
prove very rewarding in the long run.

SPEECH CLINICS Kathleen Coleman

Southern Area

This has been an interesting year, with many changes.

Whereas previously, the greater amount of time has been given to children
who stammer, this year only a few stammerers have been under treatment and
only a few cases of stammering have been reported. Schools that usually have
several cases under treatment have remarked on the absence of this type of
difficulty.

An interesting and new development is the increase of gross speech
disability; children with an unrecognisable speech pattern who, although not
deaf, appear unable to follow any sustained speech pattern. They can learn to
make a sound, and combine a consonant with a single vowel sound, but are
unable to follov/ more than two or three variations of sounds and give an
impression of confusion. Cases of this nature appear from time to time, but
this increase in numbers is interesting and suggests the possibility of some
research.

Speech sessions have been started at the Amelia Nutt and Brooklea Clinics
and are much appreciated. The Clinic at Granby House has continued as before.
Sessions have been held at Connaught Road Junior School, and South Bristol
Open Air School. The possibility of visits to Nover’s Lane Junior School was
considered, but although several of the children there have incorrect speech,
it is a matter for speech training than speech therapy.

There is no doubt that much poor speech is the result of poor speech pattern
and habits that children are allowed to develop, rather than to any defect of
speech.

Statistics 1960

No. of cases in attendance January 1960 . . 53

No. of new cases .. .. .. .. .. 116

No. of discharges . . . . . . . . . . 98

No. of children in attendance December i960 . . 71

No. of children attending in 1960 . . . . 169

No. of attendances during year . . . . . . 1,459

SPEECH THERAPY Helen M. Streat

Northern Area

Until the end of June, work was being carried on at the Portway, John
Milton and Southmead Clinics, at Argyle Road Speech Clinic and at Henbury
Manor and House in the Garden Special Schools.

In June Miss Johnson resigned and her sessions at John Milton Clinic and
at Henbury Manor had to be discontinued.

Since October two weekly sessions at Argyle Road have been undertaken
by Mrs. Gordon Thomson so that all Miss Johnson’s patients from the District
5 area of Bristol have been reviewed and several have continued treatment.

At the beginning of December Miss M. J. Henshaw joined the staff and she
is concentrating her work in the Southmead area, having carried out a thorough
survey of the schools in that neighbourhood.

The Stammerer’s Club has been meeting with considerable success. It is
held at three-weekly intervals with an average attendance of six, and there has
been a marked improvement in the speech of a number of the boys. The acqui-
sition of the new tape recorder during the year has been of particular benefit
to this group.

A good link has been established with Russell Town and House in the
Garden Special Schools and it is satisfying that it has been found possible to
give some necessary assistance to these two schools.

About a dozen pre-school children with delayed speech have been seen
during the year. In some cases the advice and re-assurance given to parents
have been sufficient for speech to show improvement but in several instances
the children have come to the Clinic for a weekly play session. It is important
that these children should be helped as much as possible before starting school
and it has been found that they have settled more easily into school life when
this help has been given. Each child is kept under close observation until
speech is well established.

In the earlier part of the year a survey was begun to try to discover the
approxim.ate number of speech defective children attending Bristol schools.
The speech of random groups of children in infant and junior schools has been
assessed and some interesting results produced, one of which was the discovery
of a large number of interdental sigmatisms. It is hoped that the assessment of
the 14 year age group will be completed during the early part of 1961.

Statistics for 1960

No. in attendance January 1st 1960 . . 53

No. of new cases . . . . . . . . . . 64

No. transferred to other authorities . . . . 4

No. of cases discharged . . . . . . . . 52

No. of cases receiving treatment on Dec. 31st 1960 57

No. of attendances 1,603

Analysis of cases receiving treatment on December 31st, 1960

Stammerers . . . . . . . . . . . . . . 11

Cleft palate . . . . . . . . . . . . . . 5

Dysarthria . . . . . . . . . . . . . . 1

Delayed speech . . . . . . . . , . . . 2

Dyslalia . . . . . . . . . . . . . . 38

Speech Therapy at Claremont School for Spastic Children Beryl Saunders

There has again been a slight increase in the number of children at Clare-
mont requiring speech therapy — just over half the total of 40 on the register.
Seven have treatment three times a week, 13 tvv^ice weekly, and three once
weekly.

We have been much concerned this year with the diagnosis and treatment
of language difficulties, or dysphasia. There are children with limited language
development, where intellectual, environmental, and physical factors are not
sufficient to account solely for such poor acquisition of language. The problem
is largely on the executive side, but one or two children have a receptive dysphasia
also. Treatment is complicated by motor handicap, severe in some cases, as
the approach must be visual and kinaesthetic, and sometimes the presence of a
partial hearing loss adds further to the difficulty of “getting through” to these
patients. The co-operation of the teaching staff is a most necessary aid to therapy.

Last year we were much concerned with the provision of dental treatment
for our children. With the co-operation of the Bristol Dental Hospital some
severely handicapped children are now receiving treatment there, but it is
disappointing that few parents have availed themselves of the services of the
panel of dentists willing to treat less severely affected children which was compiled
with the assistance and co-operation of local dental surgeons and Dr. Grace
Woods. Despite a circular letter sent to all parents, and lessons on dental care
and hygiene at school, regular dental inspection is the exception. This is to be
deplored all the more as many cerebral-palsied children would be unable to
tolerate the wearing of dentures, and optimum conservation of their teeth is
therefore of the greatest importance.

The figures for the year are listed below : —

Under treatment 1st January 1960 . . . . 21

Admitted . . . . . . . . . . . . 4

Discharged . . . . . . . . . . . . 2

Under treatment 31st December 1960 . . . . 23

Total no. of children treated 1960 . . . . 27

Total no. of treatments 1960 . . . . . . 1,218

SUNLIGHT CLINIC A.L.S.

During the year 42 children of school age attended the artificial sunlight
clinic. The conditions treated were mostly those of general debility, bronchitis
and other chest troubles. The number of children completing the course during
the year was 32, and there were 10 children under treatment at the end of the
year.

TUBEPXULOSIS

Children’s Contact Clinic Mary D. Gibson

There is again no change to report in the method of referral of cases to this
clinic.

We have continued to give prophylactic chemotherapy with Isoniazid and
P. A.S. to all children with active primary tuberculosis. In this group are included

all children under the age of three who are found to have a positive tuberculin
skin test (not due to previous B.C.G. vaccination), whether or not such children
show clinical or radiological evidence of the site of the primary lesion.

The majority of these children receive their treatment at home, the necessary
drugs being prescribed by their family doctors through the National Health
Service.

During 1960, 29 such children received prophylactic chemotherapy at
home ; those of school age, as in previous years, continued to attend school and
take part in all school activities except swimming. In addition, four children
were admitted to hospital for treatment. In three cases the child was ill with
its primary T.B. infection and, in one case, the child developed an acute pneu-
monia soon after showing signs of the primary T.B. infection and it was felt that
it would be safer to have her under close observation. Both conditions cleared
up uneventfully.

During 1960, 767 attendances were made at this clinic, the miajority of these
by children having check up examinations for old infections ; 95 were discharged
as being no longer in need of further follow up.

X“Ray of Teaching and Other Staffs

The arrangements for the periodic chest X-ray of teachers were continued
throughout the year. Altogether 589 teachers were X-rayed out of 867 who were
given appointments. Of this number, 13 teachers were given further appoint-
ments to have large films taken. The reports of these large films in one case
showed a collapse which was later found to be due to old pleural thickening
due to old effusion, the remainder were satisfactory as regards tuberculosis.
One teacher was found to have pleural thickening in the right cardio-phrenic
angle. The proportion of absentees is about the same as last year, though
every effort is made to meet the convenience of the teachers and the schools
in making appointments. Occasionally also we still encounter teachers who
refuse to have X-rays and there were three such refusals during the year.

The arrangements for the periodic routine medical examination of school
meals staff, including chest X-ray, were continued during the year, and 650
members of school meals staffs were examined during 1960 under these arrange-
ments.

YOUTH EMPLOYMENT SERVICE B. M. Dyer

The EmpSoyment of Handicapped Children

During the year 43 educationally sub-normal boys and 18 girls were inter-
viewed by the Youth Employment Officer prior to leaving the special schools.

The good employmient situation has helped boys in starting work. Only
one boy, who had very low attainments, has stayed at the Training Centre.
Two others attended for a short time prior to entering employment, and another
boy with good attainments, but having a severe speech defect and poor appear-
ance, was placed in employment following assessment at the Industrial Re-
habilitation Unit. A notable achievement was the acceptance by British
Railways of two boys from Russell Town Special School for E.S.N. boys to
become junior messengers.

The fullest co-operation has been given by the schools, the Mental Health
Service and the Special Schools Welfare Department.

As far as the girls are concerned, difficulties have been encountered in
finding employment in factories, as much of the work requires the worker to
keep up to a certain speed. During the year girls have entered employment

such as domestic and laundry work, work in a bakery and simple factory work.
On the whole the employment situation is quite good, but in two cases it has
been necessary for girls to go to the Training Centre as no suitable employment
could be found for them when they left their jobs. Several of this year’s leavers
have settled well into employment and in two instances, employers have remarked
to the Youth Employment Officer on their good work.

The Youth Employment Officers have visited all the Authority’s special
schools and in addition have seen a number of physically and mentally han-
dicapped pupils in other schools. By means of interviews with parents and
school staffs as well as help from medical and social workers, the Youth Em-
ployment Officer tries to find out as much as possible about each boy and girl
in order to suggest suitable occupations and make contact with the right type
of firm. In some cases special assessment at the Ministry of Labour’s Industrial
Rehabilitation Unit is of great assistance, and one severely handicapped girl
(spastic paraplegia and hydrocephalus) after a course at the Industrial Rehabili-
tation Unit is now learning bookbinding in a printing firm. Deaf and partially
deaf children found work without great difficulty; two girls in sewing factories
and one in an office; one boy in a factory and another on a farm. A partially
sighted girl obtained work as a shorthand-typist, having been trained for this.

BRISTOL EDUCATION COMMITTEE

Chairman: Councillor P. C. Berrill
Vice-Chairman: Councillor N. G. Reece »

Special Services Committee

Chairman: Alderman F. G. W. Chamberlain

Chief Education Officer

G. H. Sylvester, M.A.

Principal School Medical Officer and Medical Officer

of Health

R. C WOFINDEN, M.D., B.S., D.P.H., D.P.A.

Deputy Principal School Medical Officer and
Deputy Medical Officer of Health

J. F. Skone, M.D., D.C.H., D.P.H., D.I.H.

Senior Medical Officer, School Health Service

A. L. Smallwood, M.D., D.C.H., D.P.H.

City and County of Bristol

Population (estimated mid- i960) . . 433,750

Schools ; —

Number of School Departments . . . . . . . . . . . . 221

Average Number on Registers . . . . . . . . . . . . 66,490

Average Attendance . . . . . . . . . . . . . . 60,065

STAFF

Principal School Medical Officer and Medical Officer of Health
R. C. WOFINDEN, M.D., D.P.H., D.P.A.

Deputy Principal School Medical Officer and
Deputy Medical Officer of Health

J. F. SKONE, M.D., D.C.H., D.P.H., D.I.H.

Senior Medical Officer, School Health Service

A. L. SMALLWOOD, M.D., D.C.H., D.P.H.

School Medical Officers

(Joint Appointments with the Local Health Authority)

Mrs. Monica A. Pauli, M.B., Ch.B., B.A.O.

R. J. Irving Bell, M.R.C.S., L.R.C.P., D.P.H.

Mary Gibson, M.B., Ch.B., D.P.H.

A. M. Fraser, L.R.C.P., L.R.C.S., D.P.H.

B. J. Boulton, M.B., Ch.B.

Clara Jahoda, M.D. (Vienna)

Helen M. Gibb, M.B., Ch.B., D.P.H.

J. E. Kaye, Med. Dip. (Warsaw), D.P.H.

J. L. S. James, M.R.C.S., L.R.C.P. (Anaesthetist)

Kathleen E. Faulkner, M.B., Ch.B., D.C.H., D.P.H.

D. J. Sheerboom, M.B., B.S., D.P.H. (to 30.9.60)

Mrs. Marjorie Mair, B.Sc., M.B., Ch.B.

P. Tomlinson, M.D., D.P.H.

G. N. Febry, M.B., Ch.B., D.P.H.

M. R. Alderson, M.B., B.S., M.R.C.S., L.R.C.P., D.R.C.O.G.
Irene L. Chesham, M.B., Ch.B., D.P.H.

W. M. Sutcliffe, M.B., Ch.B., D.P.H., D.I.H.

R. P. Ryan, M.B., B.S., D.P.H. (to 21.5.60)

D. B. Hill, M.A., M.B., B.Ch., D.P.H. (from 15.8.60)

A. W. Macara, M.B., Ch.B., D.P.H. (from 7.9.60)

Part-time School Medical Officers

H. F. M. Finzel, M.D.

C. Jean Fraser, M.B., Ch.B., D.P.H.

Consultants-Part-time

Ear, Nose and Throat

H. D. Fairman, F.R.C.S.E., D.L.O.

J. Freeman, F.R.C.S., D.L.O.

R. K. Roddie, F.R.C.S.* (from 4.6.60)

Orthopaedic

. . K. H. Pridie, M.B., B.S., F.R.C.S.*

D. M. Jones, M.B., B.S., M.Ch.(Orth.), F.R.C.S.*

H. Keith Lucas, M.Ch. (Orth.), F.R.C.S.E.

Ophthalmic

. . R. R. Garden, M.A., M.B., D.O.M.S., D.P.H.

P. Jardine, F.R.C.S.

H. Bannerman, M.B., D.O.M.S.*

Cardio-rheumatic

. . C, Bruce Perry, M.D., F.R.C.P.

(by arrangement with United Bristol Hospitals)

Dermatology

. . R. P. Warin, M.D., M.R.C.P.*

C. D. Evans, B.A., M.B., B.Ch. (Camb.)*

Chiropody

. . L. 1. W. Tasker, M.Ch.S.

Orthoptist

. . Miss M. J. Smith, SRN, D.B.O.=^

Dental Surgeons

(Joint Appointments with the Local Health Authority)

Principal School Dental Officer . . J. McCaig, L.D.S.

School Dental Officers

. . A. H. V. Williams, L.D.S.

H. W. Williams, L.D.S.

Alice M. Trump, L.D.S.

Helena Blinkworth, L.D.S.

J. F. Sellin, L.D.S.

R. D. Hepburn, L.D.S.

W. E. C. Chaplin, L.D.S. (to 5.10.60)

H. Hazell, L.D.S. (part-time)*

Dental Hygienist

. . Jean E. Bailey

Child and Family Guidance Clinic

Senior Consultant . .

. . R. F. Barbour, M.A., F.R.C.P., D.P.M.

Consultant Psychiatrists

. . W. L. Walker, M.B., Ch.B., D.P.H., D.P.M. *

H. S. CoLilsting, M.B., Ch.B., D.P.M.*

Psychiatric Registrars

. . W. Johnson, M.R.C.S., L.R.C.P. (to 30.4.60)*
Helen S. Mathewson, M.B., Ch.B., D.P.M.
(from 1.5.60)

Senior Educational Psychologist

. . R. V. Saunders, M.A., B.Ed.

Senior Assistant Educational

Psychologist . . W. C. King, B.Sc. (to 29.2.60)

Educational Psychologists . . . . E. Jean Horn, M.A., Dip. Ed. (from 1.3.60)

Psychiatric Social Workers

Kathleen Craib, M.A., B.Ed.

J. Dunham, M.Ed., B.Sc. (from 1.1.60)

H. I. Hickish, B.A. (from 1.1.60)

K. W. Wedell, M.A., Ph.d. (from 2.8.60)

. . Miss B. Stubbs (Senior P.S.W.)

Mrs. L. Gatliff

Miss B. Harrison (to 31.12.59)

Miss J. Laver

Miss P. Birkett

Mrs. J. D. Serine (part-time) (to 1.8.60)

Speech Therapists . .

Speech Therapy

. . Kathleen Coleman, L.C.S.T., S.R.N.

Helen M. Streat, L.C.S.T.

Anne Johnson, L.C.S.T. (to 30.6.60)

Margaret J. Henshaw, L.C.S.T. (from 1.12.60)
Mrs. Beryl Saunders, L.C.S.T. (Claremont

School)

Chief Nursing Officer

Deputy Chief Nursing Officer

Nursing Service

. . Miss L. M. Bendall, S.R.N., S.C.M., H.V. Cert.

. . Miss A. I. Rowbottom, S.R.N., S.C.M.,
Q.I.D.N., H.V.Cert.

By arrangement with the Regional Hospital Board.

The following staff changes took place during the year in the joint staff
of the Local Health and Education Authorities: —

Medical

Appointments . . D. B. Hill, M.A., M.B,, B.Ch., D.P.H. (5.8.60)

A. W. Macara, M.B., Ch.B., D.P.H. (7.9.60)

Resignations . . D. J. Sheerboom, M.B., B.S., D.P.H., (30.9.60)

R. P. Ryan, M.B., B.S., D.P.H. (21.5.60)

Dental

W. E. C. Chaplin, L.D.S. (died 5.10.60)

Child and Family Guidance

Resignation . . Joan D. Serine, Psychiatric Social Worker (part time) 1.8.60

Persons other than those whose names appear in the list of staff who have
contributed to this report are the following: —

L. A. Tavener, Superintendent Welfare Officer.

Miss T. B. Hetherington, Chief Organiser of School Meals

F. J. Redstone, F.R.S.H., F.S.P.H.I., Chief Public Health Inspector

J. MacA. Milne, Chief Organiser of Physical Education

Miss C. Cooke, M.B.E., Senr. Woman Organiser of Physical Education

R. E. Olding, Head of Elmfield School for Deaf Children

R. G. Lewis, Head ofEastville Junior Mixed School

Miss R. Smith, Teacher of the Deaf, Eastville Junior School

Miss R. H. Sturman, Visiting Teacher for Partially Deaf Children

J. N. Tolley, Head of Russell Town School for E.S.N. Senior Boys

Miss I. M. Bond, B.A., Head of the House-in-the-Garden School for E.S.N. Senior
Girls

Miss J. Davis-Morgan, Head of Henbury Manor School for E.S.N. Junior Children
Miss M. H. Davies, Head of Croydon Hall Residential School for E.S.N. Senior Girls
Mr. G. A. Morris, Head ofKingsdon Manor Residential School forE.S.N. Senior Boys
Mr. C. Williams, Head of South Bristol Open Air School
Miss M. J. Ram, B.A., Head of Claremont School for Spastic Children

Mrs. Grace E. Woods, M.D., D.C.H., D.P.H., Medical Officer, Cerebral Palsy
Assessment Clinic and Claremont School for Spastic Children

B. M. Dyer, M.B.E., B.A., Youth Employment Officer.

Name of Clinic
Central Health
Clinic

Charlotte Keel
Clinic

Bedminster Health
Clinic

Granby House
Clinic

Speedwell Health
Clinic

Portway Health
Clinic

Southmead Health
Clinic

Brooklea Clinic

Knowle Health
Clinic

Lawrence Weston
Clinic

William Budd
Health Centre

Mary Hennessy
Clinic

John Milton
Clinic

Amelia Nutt
Clinic

Connaught Road
School Clinic

Verrier Road
Clinic

Child and Family
Guidance Clinic

Speech Clinics

SCHOOL CLINICS

Address

Clinics Held

Tower Hill,
Bristol 2.
Tel. 2-6602
and 29-2070.

Claremont Street,
Stapleton Road.

Tel. 5-1545.
Wedmore Vale,
Bristol 3.

Tel. 66-3798
St. John’s Road,
Bedminster.

Tel. 66-4443.
Whitefield Road,
Speedwell,

Bristol 5.

Tel. 67-3194.

Shirehampton,

Bristol.

Tel. Avonm’th 2900.
Monks Park Ave.,
Southmead.

Bristol.

Tel. 62-6414.

Wick Road,
Brislington.

Tel. 7-8861.
Broadfield Road,
Bristol 4.

Tel. 7-6643.
Ridingleaze,
Lawrence Weston.
Tel. Avonm’th 3205.
Leinster Ave.,

Bristol 4.

Tel. 66-1112.
Hareclive Road,
Hartcliffe,

Bristol 3.

Tel. 66-4282.

Crow Lane,

Brentry, Bristol.

Tel. 62-2160.
Withywood
Tel. 66-4901

Connaught Road
School, Bristol 4.

Minor Ailment Inspection and Treatment.
Dental Inspection and Treatment.
Ophthalmic, Orthopaedic, Aural and Der-
matological Consultant Clinics, Chiropody
Clinic, Enuretic Clinic, Artificial Sunlight
Clinic, T.B. Contact Clinic, Children’s Chest
Clinic.

Minor Ailment Inspection and Treatment.
Dental Inspection and Treatment.

Minor Ailment Inspection and Treatment.
Dental Inspection and Treatment.
Ophthalmic and Aural Consultant Clinics.
Minor Ailment Inspection and Treatment.

Minor Ailment Inspection and Treatment.
Dental Inspection and Treatment.
Ophthalmic and Aural Consultant Clinics.

Minor Ailment Inspection and Treatment.
Dental Inspection and Treatment.
Ophthalmic and Aural Consultant Clinics.
Minor Ailment Inspection and Treatment.
Dental Inspection and Treatment.
Ophthalmic and Aural Consultant Clinics.

Minor Ailment Inspection and Treatment.
Dental Inspection and Treatment.

Minor Ailment Inspection and Treatment.

Minor Ailment Inspection and Treatment.
Dental Inspection and Treatment.

Minor Ailment Inspection and Treatment,
Dental Inspection and Treatment.

Aural Consultant Clinic
Minor Ailment Treatment.

Verrier Road, Minor Ailment Treatment.

Redfield.

Tel. 5-6387
7 Brunswick Square,

Bristol 2. (Headquarters).

Tel. 2-6181
1 Argyle Road,

St. Paul’s, Bristol 2. (Headquarters).

Tel. 2-6760 and Knowle Health Clinic.

APPENDIX A

An Experiment in HeaSth Education A. W. Macara

Many workers in the School Health Service are urgently discussing its
development and adaptation to meet changing circumstances and new needs.

A modest contribution to this study is being made at one of the Authority’s
Secondary Schools which opened its doors in 1959, and comprised a first and
second year by October 1960, when a School Medical Officer was seconded to
attend for one half-day every week. The idea was to integrate him as a member
of the staff, and give him an opportunity to acquire an intimate knowledge of
the work of a school catering for children of a wide range of ability. This should
provide a firm basis for an appraisal of the provisions and functions of the Service
and a study of the possibilities for its development and the extension of co-
operation between the interested parties.

The S.M.O.’s first few months have been spent in getting to know both the
staff and the children informally and in the classroom. He has observed teachers
taking classes in a wide range of subjects, and has personally taken lessons with
most classes, in various aspects of Science and Health Education, dealing with
matters which have some topical relevance which are related to the current
curriculum, or which are raised by the children in free question and answer
sessions. Practical instruction has been given to several classes in the rationale
and techniques of artificial respiration. This work has been of two-way value;
to the S.M.O. in acquiring teaching techniques and assessing needs, and to
teachers in stimulating their interest and co-operation in Health Education.

During this period the S.M.O. has carried out periodic medical inspections,
receiving beforehand a short briefing on each child from notes provided by the
teachers, which gave him a much clearer picture of the whole child and made the
inspections more valuable than is usually possible to all concerned. He has
also examined children referred by teachers who have had reason to suspect
either that some defect exists requiring medical advice or that there is some other
problem affecting the child’s attention, conduct or progress at school which the
S.M.O. is well placed to investigate and follow up. The S.M.O. has been im-
pressed by the number of speech defects and early behavioural disorders detected
by an alert teacher, which might well have remained unsuspected at a periodic
medical inspection and yet required immediate attention.

One case, perhaps typical of many, stands out as an example of the value
of close co-operation. An 11 -year-old girl, an only child, was not making the
expected progress in her first few months in a lower set, chiefly due to repeated
absences for a variety of apparently genuine yet trivial reasons. Observation
and examination of the girl revealed no physical abnormality although she was
not very robust. She appeared to be shy and introspective, but there were no
manifestations of nervousness; she liked school, had good friends and was a
conscientious scholar. The family doctor, who had not been consulted during
this period, indicated that the parents were decent but inadequate people.
Mother was very highly-strung with a long psychoneurotic history. The
Headmaster and the S.M.O. interviewed the parents together, confirmed this
background and were satisfied that the trouble lay in parental over-anxiety;
every innocent little sniffle was a sinister threat to their delicate child’s health,
and demanded confinement at home. The parents also showed a complete
lack of imagination in their attempts to support the girl’s school work. This
was the ideal opportunity for the Headmaster and S.M.O. jointly to give re-
assurance and advice. The girl’s progress in three months to the time of writing
has been much improved, and there has been only one short absence from school.

A pilot survey on smoking by schoolchildren has been conducted, the whole
second year being covered in one day to reduce the prejudicial effects of dis-
cussion to a minimum. It is believed that the personal presentation of the
questionnaire by a doctor whom the children knew, reinforced by the Head-
master’s splendid reassurance of anonymity, provoked answers of a high degree
of reliability. The aim was to assess the smoking habits and views of the
children as pointers to the best lines of approach in anti-smoking propaganda.
An initial analysis reveals some interesting facts. By the age of 13 about 30
per cent of the boys, and half this proportion of girls, are smoking cigarettes
regularly. The maternal influence is very striking. There is a cheerful disrespect
for the law, the large majority of smokers confidently asserting its illegality.
A remarkable awareness is shown of the grave dangers to health: most of the
children in every ability stream believed that smoking caused cancer. On the
other hand, when they were asked to give arguments against smoking only a
minority cited health reasons, compared with many who considered it unecon-
omic. These results suggest two things ; that those who advocate re-
inforcing the law (which covers only the sale of cigarettes to children under the
age of 17) are wasting their time ; the only type of propaganda likely to succeed
is that which tries to counteract the tendency of these children to think that the
consequencies are so remote that they need not be concerned at the present.

Sex Education

Sex Education is truly education for life, and ideally it should begin v/ith
simple, truthful answers from the parents to the young child’s first tentative
queries. Evasiveness or deception at this stage can prejudice the development
of a balanced attitude in the mind of the growing child, and where the parents
neglect their duty, it might be felt that the Primary School teacher is best placed
to make a timely rescue bid. They might also consolidate the embryonic
understanding of the child who does receive help at home.

Rightly or wrongly, little specific effort is devoted to the subject at the
primary stage and most Primary Heads regard it as lying outside their province.
Thus the Secondary Schools find themselves faced with a problem, the gravity
and urgency of which far outweighs any other single factor in the health and
welfare of the school child. It is a harsh fact that there is a startling increase in
promiscuity amongst our young people, with ever more tragic consequences.
Whatever the reasons, and it may be largely that children mimic the worst
excesses of adult society, the need for action is clear. Our chief aim must be to
inculcate a healthy attitude before the ever-lower age when emotional involve-
ment in the changes of puberty begins to complicate the situation. So it is
felt that sex education should be given as early as possible in the Secondary
school and we are indebted to the Deputy Headmistress, whose subject is
Biology, for this account of the approach employed at her school: —

“A reasonable understanding of human reproduction cannot be
absorbed unless the more obvious anatomy and physiology of the respir-
atory, vascular, digestive and excretory systems are understood. Con-
sequently, hum.an reproduction was not reached until the middle of the
first term of the second year, but next year, by reorganising the General
Science course in the first year and spending more time on Biology, re-
production will be brought into first year work.

Before an explanation of human reproduction was attempted the
reproduction and life history of the herring, frog and bird were studied.
Herring and frogs were dissected by children and respiratory, digestive
and reproductive systems examined. The hen’s egg was examined. The

mating and fertilisation methods of these three animals were discussed, the
advantages of internal fertilisation being agreed.

The text book used for the whole of the course on the human body is
Cyril Bibby’s “An active Human Biology”. When left to read alone from
another chapter in the book children frequently turned to the chapter on
reproduction, thus the lessons on human reproduction came as a matter
of course. In taking the lessons with five sets of children from “A” to
“Lower B” only two children were noticeably embarrassed and both of
these were physically well-developed boys. All “A” and “B” sets were
given books to read on their own, in school or at home. They had either
the two books “A Story about You” and “What’s Happening to Me” by
Lerrigo and Southard, or “How Life is Handed On” by Bibby. Before
children started reading these books the teacher turned through the pages
with them, explaining the aim of each chapter and studying each diagram.
The importance of reading the book from the beginning was emphasised,
particularly in the case of the Lerrigo and Southard books. At this stage
they are better than Bibby for private reading as they have less scientific
fact and a considerable amount on social behaviour which is very well
expressed. It seems undesirable to talk at any length in a mixed class of
boys and girls on such topics as feeling unwell during menstruation, or
“wet dreams”. Each sex should understand the emotional as well as the
anatomical and physiological make-up of the opposite sex and these books
should help that understanding.

The “Lower B”, “C” and “D” sets were not given any books to read
as it was considered they may not understand the text and might glean
misinformation from their lack of understanding and possible lack of
persistency in reading the book right through. More lessons were spent
on reproduction and more questions were asked by the children.

It is not considered that these lessons complete the sex education of
these children. House Tutors are being encouraged to be ready to answer
any questions and the girls’ P.E. teacher is prepared to cope with any
menstruation problem a girl might have.

Note — The children are divided into seven sets: two “A” sets, two “B”
sets, a “Lower B” and “C” and a very small “D” set.”

The S.M.O. and members of the Staff all benefited from a full discussion of
the problem at a staff meeting and all were agreed that teachers should welcome
and exploit rather than shun opportunities arising in the course of lessons in
any subject, to impart sound enlightenment. The S.M.O. addressed an enthusi-
astic meeting of parents, stressing their primary privilege and responsibility
and advising upon the handling of general and specific aspects of the subject.
At this meeting parents stated that children had shown them the books they had
been given to read and that they had been interested in reading the books with
the children and much appreciated that they had access to such books in school.
It is intended to discuss the subject further with parents and it is felt that a meeting
early in the school session to co-ordinate the educational approaches of home
and school and to secure the co-operation of the parents of new entrants is
desirable.

Physical Education

Never before, in the field of physical education, has the standard of per-
formance of the average child in this country been so high, and it has recently
been shown that boys and girls in Britain are fitter and perform set tests better

than their United States counterparts. Indeed, British girls aged 10-13 showed
superiority over American boys of the same ages in a majority of the tests.

This general upgrading in performances has thrown the plight of the
inadequate performer into ever-sharper relief. It is planned to test both the
physical capacity and the specific athletic skills of the boys at the school to
ascertain which individuals fall significantly below the standards which might
reasonably be expected in relation to their fellows. They will then be subjected
to further study by both the P.E. teacher and the S.M.O., to determine how best
to assist those boys with recognised physical handicaps, and also to guide and
encourage those whose disadvantage appears to be psychogenic. It is felt that
when this part of the child’s development is backward it can have a dispropor-
tionately adverse effect on his progress as a whole.

Recommendations

Bristol schoolchildren are taught to swim in their first year of secondary
school life if they have not already learned to do so at the primary stage and
every effort is made at this school, as elsewhere, to attain the highest standards
leading to proficiency in life-saving. In view of this fact, and in the light of the
recent tragic fatality at Speedwell Baths which revealed that attendants are not
necessarily trained in first aid, it seems strange that provision is not made to
teach a simple technique of artificial respiration simultaneously with the early
swimming instruction. The children are themselves first on the scene of any
mishap and are the real potential “first aiders”. At this school the P.E. teacher
and the S.M.O. will join forces to teach each new swimming class the currently-
approved method of artificial respiration before they enter the water.

It is suggested for general application throughout the Service that teachers
might be encouraged even more than they are, to provide the S.M.O. at medical
inspections, with any information or observations on individual children which
they think might be relevant.

It is too early to make detailed proposals upon the integration of instruction
in health matters with the curriculum as a whole, but two recommendations
might be offered. First, every opportunity to offer enlightenment should be
fully exploited; before immunisation sessions or BCG vaccination, for example,
the children concerned might be assempled and addressed by the S.M.O. who
would briefly explain the nature of the disease, the rationale of immunisation
and the advantages of prophylaxis. Second, S.M.O.s might conduct “Forums”
in health matters, to correct the many fallacious ideas children commonly put
forv/ard which are beyond the scope of the lay teacher, and to discover those
topics which lend themselves profitably to well-timed advice.

APPENDIX B

Films on Handicapped Children

Three films have been produced in recent years showing the work carried
out in Bristol for the care and education of children suffering from various
forms of disability. These films have all been made for the Authority by Mr.
P. Grosset of the Bristol Cine Society and are in 16 m.m. colour film with a
sound commentary.

The first film was produced in 1958 with the help of funds provided by the
parents of children at the industrial and training centre. It is entitled “Marl-
borough House” and deals with all aspects of the care and training of mentally
handicapped children including country and folk dancing by the girls, and shots
of the Guides and Scouts activities. The film shows that mental subnormality
can be treated just as can physical disorders. It shows a positive approach to
the problem where children who have been thought to be unsuitable for edu-
cation in school can be trained and equipped to take their places in society as
useful citizens. This film was widely acclaimed as one of the best amateur
films of its kind and gained the award of the trophy for one of the ten best
amateur films of the year, a prize as the best documentary film at the Scottish
Amateur Film Festival, and a special award in the B.M.A. film competition.

The second film produced in 1959 is entitled “Claremont” and describes the
education and treatment of children suffering from cerebral palsy who attend
the Bristol Education Committee’s special school for spastic children at Clare-
mont, Bristol. It shows the various forms of treatment and scenes of classroom
acitivities. There are shots showing children receiving instruction in educational
subjects from the teacher v/ith the help of many ingenious aids to enable them to
write and manipulate figures. Scenes are also included of the children receiving
physiotherapy, movement training and speech therapy, and the film indicates
the special difficulties of the children at play and at meal times and in domestic
science lessons. There are also scenes taken of the children on an excursion to
Weston-super-Mare. This film gives a graphic insight into the work which
is being done for these severely handicapped children, and the way in which
they are being helped to overcome their disabilities. This film also aroused
great interest, and it was regarded as one of the best amateur films of its year.
It received several awards, including an award as one of the ten best amateur
films of the year, the Oliver Bell Trophy at the Scottish Amateur Film Festival,
the Daily Mail Challenge Cup at the Annual Competition of the Institute of
Amateur Photographers, an award of a cup for the best documentary film,
and a silver medal from the British Medical Association.

The final film made in 1960 is entitled “The Helping Hand” and financial
assistance of the cost of producing the film was given by the Bristol and District
Society for Mentally Handicapped Children. It shows the facilities provided
for the education and training of children suffering from various handicaps.
It starts with scenes at Winford Orthopaedic Hospital School, and follows with
shots at South Bristol Open Air School for delicate and physically handicapped
children, the School for the Deaf, and of children attending the special classes
for educationally sub-normal pupils in an ordinary school, and finally scenes
taken at the Education Committee’s Croydon Hall Residential School for
senior educationally sub-normal girls. This film also was very well received and
gained an award in the reserve category of the ten best amateur films of the
year.

All these films have been in constant demand for showing not only in the
Bristol area but in all parts of the country. In fact they have become so well
recognised as being among the best films of their type that enquiries have been
received for the purchase of copies of the films from a number of countries
outside Britain.

It is hoped that they will do much to help the public appreciate the services
available for handicapped children.

APPENDIX C

School Accidents

C. E. Cooke

On comparing the accident rate per cent over the years 1958-60, it would

appear that some schools are indeed accident prone.

The following schools have a consistently high

accident

rate per 100 of

total accidents reported.

1958

1959

1960

School A. Bilateral mixed . .

4-8

4-6

,, B. ,, „

2-3

5-5

3-6

„ c.

4-2

3 0

3-6

,, D. Secondary Modern Boys

2-3

4-5

4-1

„ E. Infant School

2-5

2-3

2-8

It must be remembered that som.e Heads are more meticulous in reporting
minor accidents than others, but even so it is difficult to understand why these
schools should have a consistently high accident rate. It will be necessary to
record the accident statistics over a longer period of years, however, before
drawing any definite conclusions. School E is well above the average for infant
schools, four of which had no accidents recorded over the same period of years.

Medical and architectural reasons for accidents should also be considered.
In school A, for example, several accidents have occurred on the staircase. Chil-
dren are still having fingers squeezed in doors.

The environment of the school may also be an important factor, and large
new schools appear to take some years to settle down to the calmer atmosphere,
experienced in the more established older schools, where cramped space does
not seem to account for more accidents.

Most of the accidents in the Bilateral schools were sustained on the games
field or in the gymnasium, and in the case of schools A and C, in the passages
and on the stairs.

School A had many cuts, one received by a boy on the games field who
had his mouth cut by a knitting needle — needless to say this occurred in play-
time. Five accidents were caused by forks piercing feet while gardening.

Schools with the highest number of accidents in i960 were as follows: —

1. A junior boys’ school with a rate of 7-2

2. A secondary boys’ school v/ith a rate of 4-6

3. A junior mixed school with a rate of 4-3

4. Another junior mixed school with a rate of 4-1

1. Is a small school of 180 boys. Most accidents took place in playtime.

2. Five of these accidents took place during woodwork, and the others in
playtime were various.

Fifty-eight accidents occurred in the classroom, chiefly falls, cuts, bumps
and foreign bodies. These last included acid, pencil and glass in the eyes, and
one infant swallowed a halfpenny, a junior boy swallowed a pin, and a secondary
girl swallowed a safety pin. None suffered ill effects.

There are, however, 15 schools where no accidents have been reported
during the last three years.

1 Secondary Modern Boys’ School
10 Junior Mixed Schools
4 Infants’ Schools

In 1960 alone 53 schools reported no accidents. This absence of accidents
may be accounted for by a more relaxed atmosphere which often exists in well
established schools, and where the relationship between Heads, staff and children
is one of ease and respect.

STATISTICAL TABLES

YEAR ENDED 31st DECEMBER, I960

PART I— MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED
PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY AND

SPECIAL SCHOOLS)

TABLE A.— PERIODIC MEDICAL INSPECTIONS

Age Groups Physical Conditions of Pupils Inspected

Inspected

No. of Pupils

Satisfactory

Unsatisfactory

{By year of birth)

Inspected

No.

% of Col. 2

No.

% of Col. 2

(2)

(3)

(4)

(5)

{6)

1956 and later

904

890

98-5

1-5

1955

833

802

96-3

3-7

1954

3,585

3,454

96-3

131

3-7

1953

1,242

1,201

96-7

3-3

1952

401

388

96-8

3-2

1951

749

717

95-7

4-3

1950

2,042

1,980

97-00

3-0

1949

1,624

1,593

98-1

1-9

1948

111

702

97-2

2-8

1947

650

634

97-5

2-5

1946

1,471

1,443

98-1

1-9

1945 and earlier

5,106

5,046

98-8

1-2

Total

19,329

18,850

97-5

479

2-5

TABLE B.—PUPILS FOUND TO REQUIRE TREATMENT AT PERIODIC
MEDICAL INSPECTIONS (excluding Dental Diseases and Infestation with

Vermin)

For defective

For any of the

Age Groups Inspected

vision

other conditions

Total indivi-

{By year of birth)

{excluding

recorded in

dual

squint)

Part II

pupils

{!)

(2)

{3)

{4)

1956 and later

1955

104

111

1954

543

588

1953

177

204

1952

1951

105

142

1950

232

304

1949

135

183

307

1948

155

1947

106

181

1946

172

131

289

1945 and earlier

615

418

971

Total

1,370

2,230

3,439

TABLE C.— OTHER INSPECTIONS

Number of Special Inspections

18,114

Number of Re-inspections

27,575

Total

45,689

TABLE D.~INFESTATION WITH VERMIN

{a) Total number of individual examinations of pupils in schools by school

nurses or other authorised persons

123,485

{b) Total number of individual pupils found to be infested

869

issued (Section 54 (2), Education Act, 1944)

138

{d) Number of individual pupils in respect of whom cleansing orders were

issued (Section 54 (3), Education Act, 1944)

PART II— DEFECTS FOUND BY MEDICAL INSPECTION DURING THE

YEAR

TABLE A.— PERIODIC INSPECTIONS

Defect or Disease

Entrants

Leavers

Others

Total

(T)

iO)

(T)

iO)

{T)

(0)

(T)

(O)

Skin

101

153

148

402

Eyes — {a) Vision

100

690

580

1,370

133

{b) Squint

173

Ears — (fl) Hearing

111

(b) Otitis Media. .

111

—

Nose and Throat

317

218

141

511

306

Speech . .

Lymphatic Glands

—

111

Heart

Lungs

Developmental —

157

170

(a) Hernia

—

(i) Other

Orthopaedic —

165

(a) Posture

(b) Feet

Nervous System —

119

117

(a) Epilepsy . .

(b) Other

Psychological —

(a) Development

(b) Stability . .

121

Abdomen

—

Other

120

163

(7’)=Treatment,

{oy

= Observation.

TABLE B.-

-SPECIAL INSPECTIONS

Defect

or Disease

Pupils req.

Treatment

Observation

Skin

3,159

Eyes — {a) Vision . .

1,061

152

fb) Squint . .

419

Ears — (a) Hearing

114

(b) Otitis Media

168

Nose and Throat . .

451

141

Speech

Lymphatic Glands

Heart

Lungs

Developm.ental —

(a) Hernia . .

(b) Other . .

Orthopaedic —

(a) Posture

(b) Feet . .

Nervous System —

(a) Epilepsy

(Z)) Other ..

Psychological —

(a) Development

(b) Stability

Abdomen . .

Other

4,167

PART III— TREATMENT OF PUPILS ATTENDING MAINTAINED
PRIMARY AND SECONDARY SCHOOLS (INCLUDING NURSERY
AND SPECIAL SCHOOLS)

TABLE A.— EYE DISEASES, DEFECTIVE VISION AND SQUINT

Number of cases
known to have
been dealt with

External and other, excluding errors of refraction and squint . . 1,315

Errors of refraction (including squint) . . . . . . . . . . 4,371

Total . . 5,686

Number of pupils for whom spectacles were prescribed . . . . 2,298

TABLE B.— DISEASES AND DEFECTS OF EAR, NOSE AND THROAT

Number of cases
known to have

' been dealt with

Received operative treatment —

{a) for diseases of the ear . . . . . . . . 86

lb) for adenoids and chronic tonsillitis .. .. 1,771

Received other forms of treatment . . . . . . . . 678

Total . . 2,749

Total number of pupils in schools who are known to have been
provided with hearing aids —

{a) in 1960 . . 22

(b) in previous years . . . . 106

TABLE C.— ORTHOPAEDIC AND POSTURAL DEFECTS

Number of cases
known to have
been treated

(a) Pupils treated at clinics or out-patients departments . . . . 389

(b) Pupils treated at school for postural defects . . . . . . —

Total . . 389

TABLE D.— DISEASES OF THE SKIN

(excluding uncleanliness, for which see Table D of Part I)

Number of cases
known to have
been treated

Ringworm — (a) Scalp . . . . . . . . —

ib) Body 122

Scabies . . . . . . . . . . . . . . . . . . 9

Impetigo . . . . . . . . . . . . . . . . 107

Other skin diseases . . . . . . . . . . . . 3,086

Total . . 3,324

TABLE E.— CHILD GUIDANCE TREATMENT

Number of cases
known to have
been treated

Pupils treated at Child Guidance Clinics . . . . . . . . 425

TABLE F.— SPEECH THERAPY

Number of cases
known to have
been treated

Pupils treated by speech therapists .. .. .. .. .. 311

TABLE G.— OTHER TREATMENT GIVEN

Number of cases
known to have
been dealt with

(a) Pupils with minor ailments .. .. .. .. .. 16,713

lb) Pupils who received convalescent treatment under School Health

Service arrangements . . , . . . . . . . . . 21

(d) Other than (a), (b) and (c) above

Chiropody . . . . . . . . . . . . 774

U.V.L 41

Enuresis . . . . . . . . 214

Asthma . . . . . . . . . . . . 35

Tb. Contacts . . . . 464

Total (a)—(d) . . 23,317

PART IV— DENTAL INSPECTION AND TREATMENT CARRIED OUT
BY THE AUTHORITY

( 1 )

( 2 )

( 3 )

( 4 )

( 5 )

( 6 )

( 7 )

( 8 )

( 9 )

Total (1)

Number of pupils inspected by the Authority’s Dental Officers : —

(a) At Periodic Inspections .. 42,081 \

(b) As Specials 4,370 /

Number found to require treatment
Number offered treatment

Number actually treated . .

Number of attendances made by pupils for treatment, including those
recorded at 11 (h)

Half days devoted to :

(a) Periodic (School) Inspection

(b) Treatment
Fillings:

(a) Permanent Teeth

(b) Temporary Teeth
Number of Teeth filled :

(a) Permanent Teeth

(b) Temporary Teeth
Extractions :

(a) Permanent Teeth

(b) Temporary Teeth

310\
*4,701 /

18,106\

3,404/

16,616/

3,266/

4,774/

13,302/

Total (6)

Total (7)

Total (8)

Total (9)

(10) Administration of general anaesthetics for extraction

(11) Orthodontics:

(a) Cases commenced during the year . .

(b) Cases brought forward from previous year

(d) Cases discontinued during the year

(e) Pupils treated with appliances
(/) Removable appliances fitted

(g) Fixed appliances fitted

(h) Total attendances

(12) Number of pupils supplied with artificial teeth

(13) Other operations :

(a) Permanent Teeth . . . . 9,504/

(b) Temporary Teeth . . . . 5,608 /

Total (13)

46,451

29,053

26,794

14,955

37,499

5,011

21,510

19,882

18,076

7,422

382

231

654

102

15,112

* In addition 318 sessions to mothers and young children were given.

The figures given under (11) Orthodontics refer to work done at the diagnostic
clinic held at the Authority’s Central Clinic. Children requiring treatment with
appliances are referred to the Bristol Dental Hospital for further treatment and
provision of the necessary appliances. The cases completed (c) are those that were
dealt with at the clinic by extractions.

SCHOOL CLINICS

1959

No. of
attend-
ances

Work

1960
No. of
attend-
ances

31,589

Central Health Clinic

Inspection clinic; treatment of minor
ailments; ear, nose and throat clinic;
dental treatment; orthodontic treatment;
oral hygienist; refraction clinic; asthma
clinic; enuretic clinic; T.B. contact clinic;
treatment of scabies cases; orthopaedic
clinic; remedial exercises; electrical treat-
ment; physiotherapy, massage and foot
treatment; artificial sunlight treatment . .

30,064

4,998

Brooklea Clinic

Inspection clinic; treatment of minor
ailments

3,705

14,736

Bedminster Health
Clinic

Inspection clinic; treatment of minor
ailments; ear, nose and throat clinic,
dental treatment ; and refraction clinic . .

13,495

411

William Budd Health
Centre

Inspection clinic; treatment of minor
ailments

315

3,687

Granby House Clinic

Inspection clinic; treatment of minor
ailments

3,633

1,466

Lawrence Weston Clinic Inspection clinic; treatment of minor
ailments; dental treatment

1,735

9,248

Knowle Health Clinic

Inspection clinic; treatment of minor
ailments ; dental treatment

7,927

14,185

Speedwell Health Clinic

Inspection clinic; treatment of minor
ailments; ear, nose and throat clinic;
dental treatment and refraction clinic . .

10,148

1,979

Verrier Road Clinic

Treatment of minor ailments

1,874

10,169

Portway Clinic

Inspection clinic; treatment of minor
ailments; ear, nose and throat clinic;
dental treatment and refraction clinic . .

9,268

18,680

Southmead Clinic

Inspection clinic; treatment of minor
ailments; ear, nose and throat clinic;
dental treatment and refraction clinic . .

13,548

8,454

Charlotte Keel Clinic

Inspection clinic; treatment of minor
ailments; dental treatment

7,308

8,592

Mary Hennessy Clinic

Inspection clinic; treatment of minor
ailments; dental treatment

6,979

3,901

John Milton Clinic

Inspection clinic; treatment of manor
ailments; dental treatment

4,449

Amelia Nutt Clinic

Inspection clinic; treatment of rninor
ailments; ear, nose and throat clinic;
dental clinic

1,831

13,372

Connaught Road

Treatment of minor ailments

12,505

305

School Clinic

Day E.S.N. Special

Treatment of minor ailments

655

11,269

Schools

No vers Open Air
School

Remedial exercises and massage; treat-
ment of minor ailments

11,265

667

Cardio-Rheumatic

Clinic

Cases of heart disease and rheumatic
disease

681

2,630

Child Guidance Clinic

4,276

5,160

Speech Clinics . .

4,713

1,361

Dental Hospital

1,475

167,039

Total Attendances

151,849

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