43399 WES 78 THE HEALTH OF WESTMINSTER 1968 Report of the Medical Officer of Health CONTENTS Introduction 3 Health Committee 6 Staff of the Health Department 7 Health Department Premises 9 Statistics and Social Conditions 10 Environmental Health Services 15 Personal Health Services 47 School Health 73 Dental Service 74 Chest Clinics 75 Appendices of Statistical Tables 77,113 Index 114 H. Briscoe-Smith, M.B., Ch.B., D.P.H., Medical Officer of Health and Principal School Medical Officer 1968 ???nner London Education Authority) 3 CITY OF WESTMINSTER Telephone: Health Department, 01 -828 8070 City Hall, Victoria Street, London, S.W.1. To The Right Worshipful The Lord Mayor, Aldermen and Councillors of the City of Westminster. My Lord Mayor, Aldermen and Councillors, I have the honour to submit my Annual Report on the Health of the City of Westminster for the year 1968. Once again the report is presented in four main parts—a general section, environmental health, personal health which includes work undertaken in connection with the school health service, and appendices of statistical tables. Each section shows a steady progression with a general increase in the volume and scope of work. Wherever possible opportunity has been taken to include comparable statistics of the previous year; they appear in the text in parentheses or elsewhere in a separate column. The staffing situation in the Department throughout the year continued to be generally satisfactory although there were certain categories (primarily nursing staff and dental surgery assistants) in which difficulties of recruitment were experienced. It is no consolation to the remaining members of the staff who continue to provide services while short-handed that these problems are common to many authorities. Two senior public health inspectors retired during the year at the conclusion of long public service. One of them (Mr. L. Pearson) proceeded to Canada with his wife in order to enjoy a wellearned retirement near to his son. Their retirement was in fact short-lived and it is with much regret that I report that both Mr. and Mrs. Pearson died as a result of a fire in a block of flats in which they were then living near Niagara Falls. The year 1968 could be called "The Year of the Reports" for it saw the publication of a multitude of documents of significance to local government—Maud, Mallaby, Seebohm and a Ministry Green Paper to name but a few—dealing with local government management, social services re-organisation, health service administration, and yet another on medical education. Many millions of words were contained in these reports, and almost an equal number of words has been written in comment. The views expressed by the City Council in relation to the Green Paper are set out later in this Report; the Maud and Mallaby reports were referred to a special sub-committee of the Council which resulted in 1969 in a complete overhaul and streamlining of the Council's committee structure. In each of the reports since 1965 opportunity has been taken to deal in detail with the work of a section of the Department. In 1965 a general resume was made of the health services in Westminster following re-organisation of London government; the 1966 report dealt in detail with the work performed by the Health Department social workers, whilst the 1967 report featured the Council's mental health service. Opportunity has been taken in this report to deal with the work of the public health inspectors in the food section. Tourism is a major industry in Westminster and each year many millions of people from all over the country and indeed from all over the world visit the City to enjoy the various attractions which exist here. This influx creates problems for the Health Department in relation to the catering industry and it is interesting to note that Westminster has more catering premises than any other local authority in the country. In addition to the work of the public health inspectors in the catering section, problems are created for members of the staff in the food control group who deal with the safety of the public food supply as well as the standards of premises in which food is sold or prepared. The standards of hygiene of itinerant food traders (the hot dog salesmen) leave much to be desired and several 4 successful prosecutions were taken during the year with good penalties and satisfactory results so far as the Council was concerned. Other matters which engaged the attention of the Department during the year were connected with the problems of noise (and a section of the report deals at length with this matter), drug dependency, and unmarried and unsupported mothers. In previous reports I have drawn attention to the number of illegitimate births which occur each year in Westminster and I make no apology for reverting to the theme again in describing the work being undertaken to help the unsupported mother. It is difficult for many to accept the unmarried mother as without blame although they may be less ready to assign blame to the man in the case. It is difficult for those on a waiting list for a house, a day nursery, or any other form of help to accept that she should have priority over, or even parity with, her married sister. For this reason most of us have moved away from the use of "unmarried mother" in favour of "unsupported mother". Perhaps our efforts would be more acceptable if we talked only of "fatherless children". After all, what we are really doing when we provide help for the unsupported mother is to use her as an agency to give that care to her child which will enable the child to become a healthy and happy citizen. If we can do this, we shall incidentally help the mother to achieve happiness too. We shall, as a bonus, save a great deal of the ratepayers' money which might otherwise have been spent. At the cost of a day nursery place or a good child minder, plus a small flat for which the working unsupported mother can pay a reasonably economic rent, many an unsupported mother can provide a more satisfactory upbringing for her child than can be bought at much greater expense if that child has to be taken into care. There are also the more intangible costs to the community if, as a result of a deprived childhood, the State has to cope with an inadequate or anti-social adult. There may be even greater savings if adequate counselling and social work support is given, so that either extra-marital conception is prevented or, where a child has been conceived, the mother can be helped to obtain support, either from the father or from her family. The value of the Social Work Advisory Service for unmarried mothers provided by the City Council cannot, I think, be over-emphasised. Not as a replacement for the many voluntary and other agencies giving direct help—but as offering a social worker, without sectarian or other partisan loyalties, who can advise the mother, impartially, of all the possible alternatives open to her, and to offer continuing support. The question of accommodation is more difficult. A place on the housing waiting list is little use to a woman choosing between adoption and bringing up her own child unless accommodation can be found quickly, and this presents many difficulties for the local authority who may be accused of allowing queue jumping. For this reason most authorities who have decided to rehouse directly have had to fall back on purpose-built hostels or blocks of flatlets even though they are aware of the stigma attaching to "labelled" accommodation of this type. It is perhaps in this field that voluntary bodies and housing associations can help most. In Westminster there has already been a gratifying response and by the end of 1968 four projects were under active discussion with voluntary organisations which will result in the provison of 24 flatlets for unsupported mothers. There is also a case for an officer appointed by the local authority to seek out private accommodation, not only for unsupported mothers but also for other clients of the Health Department. Such an officer has, in fact, been appointed by the City Council and commenced duty in March 1969. Mention must be made of the valuable work the Children's Officer is doing to arrange adoptions and for the care of children separated from their parents. It is our purpose in the Health Department to co-operate with him to ensure that these provisions are used only where the mother is unable or unwilling to care properly for her own child. Finally may I say a word about prevention. Family planning advice will, of course, help but the City Council has not missed the opportunity to establish a counselling service on a much wider 5 basis for the young and the unmarried who come to our family planning clinics or seek help directly —a service which deals not only with the immediate problems of young people, but in some measure prepares them so that they may later advise their own children. As I have said before on previous occasions, this report is an amalgam of the work of various members of the Department who each year produce their contributions on the work of their particular section. I am grateful to them all, but I would mention in particular the work undertaken by my Chief Administrative Officer who acts as Editor of the report and welds together all the various pieces to form one continuing, interesting narrative. It is with real pleasure that I again record my appreciation of the support and encouragement I have continued to receive from all Members of the Council and in particular from the Lord Mayor, as past Chairman of the Health Committee, and the Lady Mayoress. Their personal interest in the health services provided by the Department is much appreciated by all concerned. I am also indebted to the present Chairman and Members of the Health Committee for their unfailing help, understanding and ready support throughout the year. Finally, I would express my warmest thanks to colleagues in other Departments for their continued co-operation and help; and especially to the members of my own Department for the loyal, efficient and conscientious way in which they have combined to provide the local authority health services in Westminster. J. H. BRISCOE-SMITH. Medical Officer of Health. July, 1969. 6 HEALTH COMMITTEE THE LORD MAYOR (ex-officio): Councillor C. A. Prendergast THE DEPUTY LORD MAYOR (ex-officio): Councillor R. F. Shaw-Kennedy, M.B.E., F.C.A. CHAIRMAN: Councillor M. V. Kenyon, M.A. VICE-CHAIRMAN: Councillor Dr. Brian Warren MEMBERS: Councillor Winston Drapkin Councillor Mrs. E. G. Lane Councillor Princess Yuri Galitzine Councillor Max Taylor Councillor Mrs. Rachel Trixie Gardner, B.D.S. Councillor Miss Alison Tennant Councillor Dr. L. Jacobs Councillor Mrs. P. L. Veendam CO-OPTED MEMBERS: Mrs. R. T. Glenny Colonel W. Parkes, D.S.O., O.B.E., M.C., J.P., B.Com. Sir Frederick Lawrence, O.B.E., J.P. R. H. Rollins E. R. Packer Mrs. Henrietta Shire Members of the Health Committee were appointed to: City of Westminster Arts Council Councillor Dr. Brian Warren City of Westminster District Nursing Association Mr. E. R. Packer City of Westminster Old People's Welfare Association Mrs. R. T. Glenny County Primary Schools—Manager Councillor Miss Alison Tennant (Old Westminster Group—Churchill Gardens School and Millbank School) Family Welfare Association (Area 2 Committee) Councillor Mrs. E. G. Lane General Council of the South East Regional Association for the Deaf Councillor Miss Alison Tennant Greater London Conference on Old People's Welfare Councillor Miss Alison Tennant Inner London Executive Council Councillor Miss Alison Tennant Kilburn, Maida Vale and St. John's Wood Aid in Sickness Fund Councillor Mrs. E. G. Lane Linnet House Special Care Committee (Mentally Handicapped Children) Councillor Princess Yuri Galitzine London Boroughs Training Committee Councillor M. V. Kenyon London (Metropolis) Licensing Planning Committee Councillor M. V. Kenyon (also N.W. Sub-Committee) Metropolitan Water Board Councillor Winston Drapkin National Association for Maternal and Child Welfare Mrs. R. T. Glenny Paddington Charitable Estates (and Paddington Charitable Estates Educational Fund) Councillor M. V. Kenyon Councillor Mrs. E. G. Lane Sir Frederick Lawrence Paddington Chest Care Committee Councillor Mrs. E. G. Lane Primary School Manager: St. Peter's, Eaton Square, C.E. Councillor Miss Alison Tennant Royal London Homoeopathic Group (No. 22) Hospital Management Committee Councillor Mrs. R. T. Gardner St. Marylebone T.B. Care Committee Mrs. R. T. Glenny St. Mary's Churchyard (Northern Portion), Paddington, Committee of Management Councillor Mrs. E. G. Lane Councillor Mrs. P. L. Veendam South West Metropolitan Regional Hospital Board—Liaison Committee Councillor Dr. Brian Warren Southern Regional Association for the Blind Councillor Mrs. E. G. Lane West London Housing Group and London Housing Consortium Councillor M. V. Kenyon Westminster and Kensington and Chelsea Joint Computer Committee Councillor Winston Drapkin (Deputy representative) Westminster Council of Social Service Councillor Miss Alison Tennant 7 STAFF OF THE HEALTH DEPARTMENT (as at 31st December, 1968) Medical Officer of Health and Principal School Medical Officer: J. H. Briscoe-Smith, M.B., Ch.B., D.P.H. Deputy Medical Officers of Health: Hastings E. A. Carson, M.D., D.P.H., S.M.(Harv.) Mary T. Paterson, M.B., B.S., D.P.H. Principal Medical Officers: Marjory A. Dawson, M.B., Ch.B., D.P.H. Mignon B. Alexander, M.R.C.S., L.R.C.P., D.P.H. Senior Medical Officers: Hilary S. M. Hadaway, M.B., B.S., D.P.H. Patrick T. Horder, M.B., B.S., D.P.H. Senior Assistant Medical Officers: Monica M. H. Cogman, M.B., B.S., M.R.C.S., L.R.C.P. Ruth P. Mathers, M.B., B.S., M.R.C.S., L.R.C.P. Olga M. Morgan, M.R.C.S., L.R.C.P., D.P.H. Deidre R. B. Sullivan, M.R.C.S., L.R.C.P., D.P.H. Medical Officers: Full-time—2 Sessional Medical Officers: Part-time 30—40 sessions per week (full-time equivalent 4.0) Chief Administrative Officer: John H. Gillett Principal Administrative Assistant (Management Services): H. J. Parker Senior Administrative Assistants: H. G. E. Brown (Environmental Health Services) A. J. Anscomb (Personal Health Services) Administrative and Clerical Staff—112 Chief Public Health Inspector: E. W. Pike, M.A.P.H.I. Deputy Chief Public Health Inspector: V. A. Bignell, F.A.P.H.I. Principal Public Health Inspector: R. F. Stubbs, F.A.P.H.I. Senior Public Health Inspectors—18 Area or District Public Health Inspectors—38 (6 vacancies) Student Public Health Inspectors—14 Technical Assistants—24 Principal Dental Officer: R. E. Kean, L.D.S., R.C.S.(I.) Senior Dental Officer: G. F. Willcox, L.D.S., R.C.S. Dental Officers: Full-time—3; Part-time—3 (full-time equivalent 1.7) Dental Surgery Assistants—6 Chief Nursing Officer: Miss E. A. Evans, H.V., S.R.N., S.C.M. Deputy Chief Nursing Officer: Miss V. M. George, H.V., S.R.N., S.C.M., Queen's Nurse Assistant Nursing Officers—3 Student Health Visitors—7 Health Visitors—53 Clinic Auxiliaries—9 Clinic and School Nurses—21 Day Nursery Staff—126 District Nurses—46 Student District Nurses—6 District Midwives—9 Home Bathing Attendants—3 8 Principal Social Worker (Health Services): Miss i. J. McFarlane, M.A. Social Workers—19.5 Principal Mental Health Social Worker: Mrs. R. S. G. Paterson Mental Health Social Workers—15 St. Judes (Hostel for Mentally Sub-Normal Adult Males) Warden—W. T. Bailey Deputy-Warden—1; Assistant Wardens—2 Coroner's Court and Mortuary: Superintendent: W. Wilshire First Mortician—1 Mortuary Assistants—4 Ancillary Staff: Chief Chiropodist: Miss M. I. Taylor, M.CH.S. (from 10.10.68) Chiropodists—15 (full-time equivalent 7.5) Inspector of Massage Establishments—1 (full-time equivalent 0.3) Physiotherapist—1 (full-time equivalent 0.3) Home Help Service: Home Help Organisers—2 Assistant Home Help Organisers—4 Home Helps—220 (full-time equivalent 200) Rodent Control Service: Pest Control Officer—1 Assistant Rodent Officers—2 Rodent Operatives—5 Disinfection and Disinfestation Service: Supervisor, Disinfecting and Cleansing Station—1 Disinfection and Disinfestation Staff—12 Manual & Domestic Staff: 93 (full-time equivalent 75.5) staff of various categories are employed at Maternal and Child Welfare Centres, Day Nurseries, the Nurses' Headquarters and Home, and other establishments. 9 HEALTH DEPARTMENT PREMISES ADMINISTRATION City Hall, Victoria Street, S.W.1. Paddington Sub-Office, 313/319 Harrow Road, W.9. St. Marylebone Sub-Office, Council House, W.1. DAY NURSERIES 1 Bessborough Street, S.W.1. 37-39 Bloomfield Terrace, S.W.1. 86 Carlton Hill, N.W.8. Katharine Bruce, Queen's Park Court, llbert Street, W.10. Marylands Road, W.9. Portman, 12-18 Salisbury Street, N.W.8. St. Jude's, 88 Bravington Road, W.9. St. Stephen's, 38-46 Westbourne Park Road, W.2. MATERNAL AND CHILD WELFARE CENTRES 1 Bessborough Street, S.W.1. 1 Ebury Bridge Road, S.W.1. Hallfield, Pickering House, Hallfield Estate, W.2. 283A Harrow Road, W.9. Linnet House, Charlbert Street, N.W.8. 217 Lisson Grove, N.W.8. Marshall Street, W.1. Middlesex Hospital, Cleveland Street, W.1. Queen's Park, 66 Lancefield Street, W.10. Council House Extension, Upper Montagu Street, W.1. Westminster Health Society, 121 Marsham Street, S.W.1. SCHOOL TREATMENT CENTRES 283A Harrow Road, W.9. Hallfield, Pickering House, Hallfield Estate, W.2. 217 Lisson Grove, N.W.8. Council House Extension, Upper Montagu Street, W.1. 40 Alderney Street, S.W.1. CHEST CLINICS Westminster Hospital, St. John's Gardens, S.W.1. 14-18 Newton Road, W.2. Council House Extension, Upper Montagu Street, W.1. HOME NURSING Headquarters, 117 Sutherland Avenue, W.9. Southern District Office, 36 Great Smith Street, S.W.1. Nurses' Home, 90 Sutherland Avenue, W.9. ENVIRONMENTAL HEALTH Coroner's Court and Mortuary, 65 Horseferry Road, S.W.1. Rodent Control Depot, 1 Bessborough Street, S.W.1. Rodent Control, 313/319 Harrow Road, W.9. Bathing Centre, 217 Lisson Grove, N.W.8. Disinfecting Station & Medicinal Baths, Kensal Road, W.10. Disinfecting Station, Lisson Grove, N.W.8. MENTAL HEALTH 1 St. Mary's Terrace, W.2. (Terrace Day Centre) Linnet House Special Care Unit, Charlbert Street, N.W.8. St. Jude's (Hostel), Lancefield Street, W.10. 10 STASTISTICS AND SOCIAL CONDITIONS 1968 1967 (where applicable) Area (acres) 5,334 Population (Registrar General's Estimate, mid-year 1968) 24 3,960 258,930 Population, Census, 1961 271,703 Domestic rateable hereditaments 86,170 86,030 Rateable Value (at 1st April, 1968) £107,424,973 £106,190,459 BIRTHS Live Births (registered)— Total Males Females 1968 1967 1968 1967 1968 1967 Legitimate 2,649 2,882 1,337 1,426 1,312 1,456 Illegitimate 531 668 282 341 249 327 3,180 3,550 1,619 1,767 1,561 1,783 1968 1967 Birth rate per 1,000 of the estimated population 13.03 13.71 Area Comparability Factor—Births: 0.74 Birth rate (adjusted) (Rate for England and Wales, 16.9) 9.64 10.56 Stillbirths (legitimate—males 14; females 18; illegitimate—males 3; females 5) 40 33 Rate of stillbirths per 1,000 (live and still) births 12.42 9.21 Total live and stillbirths 3,220 3,583 Illegitimate live births per cent, of total live births 16.69 18.82 Premature births notified (live 250 (289); still 22 (14)) 272 303 DEATHS Net deaths (males 1,446; females 1,376) 2,822 2,794 Death rate per 1,000 of the estimated resident population 11.57 10.79 Area Comparability Factor—Deaths: 1.05 Death rate (adjusted) (Rate for England and Wales, 11.9) 12.15 11.33 Deaths arising from pregnancy, childbirth, and abortion Nil 1 Rate per 1,000 total (live and still) births — 0.28 Deaths of infants under one year (legitimate—males 25; females 16; illegitimate—males 3; females 5) 49 75 Death rate of infants under one year— All infants per 1,000 live births .. 15.41 21.13 Legitimate infants per 1,000 legitimate live births 15.48 18.04 Illegitimate infants per 1,000 illegitimate live births 15.06 34.43 Neo-natal mortality rate (deaths under four weeks per 1,000 total live births) 10.69 12.39 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 9.75 10.99 Peri-natal mortality rate (stillbirths plus deaths under one week per 1,000 total live and stillbirths) 22.05 20.09 Births The total of live births registered during the year was 3,180 (1,619 males; 1,561 females), giving a live birth rate of 13.03 per 1,000 of population, equivalent to a standardized rate of 9.64. The 11 1967 total of live births was 3,550 (1,767 males; 1,783 females), and the live birth rate 13.71 which when standardized was 10.56. The comparable figures for Greater London and England and Wales for 1968 were 16.4 and 16.9 and for 1967 17.0 and 17.2 respectively. Illegitimate live births numbered 531 (282 males; 249 females), representing 16.69 per cent, of the total live births, compared with 11.5 per cent, for Greater London, 15.5 per cent, for Inner London, and 8.4 per cent, for England and Wales. The total illegitimate live births in 1967 was 668 (341 males and 327 females) which represented 18.82 of the total live births, compared with 11.4 per cent, for Greater London, 15.3 per cent, for Inner London and 8.4 per cent, for England and Wales. Stillbirths totalled 40, representing a rate of 12.42 per 1,000 total live and stillbirths, compared with 13.5 for Greater London and 14.3 for England and Wales. In 1967 there were 33 stillbirths, which represented a rate of 9.21 per 1,000 total live and stillbirths, and the rate for Greater London and England and Wales was 13.3 and 14.8 respectively. Deaths The total number of deaths shown in Table 1, page 78, includes persons who, though normally resident in Westminster, died elsewhere in England and Wales but excludes persons who, though they died in the City, were ordinarily resident in other parts of England and Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the figures if they occurred in the City, as also are those of members of H.M. Forces who were stationed in the area. Deaths registered in 1968 numbered 2,822 equivalent to 11.57 per 1,000 which when standardized by the comparability factor, gives a figure of 12.15. In 1967 there were 2,794 deaths (10.79 per 1,000) and the standardized rate was 11.33. The comparable rates for Greater London and for England and Wales for 1968 were 11.6 and 11.9 and for 1967 10.8 and 11.2 respectively. Accidental Deaths During the year, 95 residents died from accidents of all kinds, including 38 motor vehicle accidents. In 1967 the figures were 102 and 23 respectively. Infant Mortality Deaths of infants under one year totalled 49 (41 legitimate; 8 illegitimate), giving a rate of 15.41 per 1,000 live births. The total for 1967 was 75 (52 legitimate; 23 illegitimate), and the rate was 21.13 per 1,000 live births. The rate for England and Wales for 1968 was 18.0 per 1,000 and for Greater London 18.6, compared with the 1967 rates of 18.3 and 18.4 respectively. Details showing causes of death according to age group and sex are given in Table 2, page 79. Of the 49 (75) infant deaths, 34 (44) were under four weeks old, giving a neo-natal mortality rate of 10.69 (12.39) per 1,000 live births. The neo-natal mortality rate for England and Wales was 12.3 (12.5) and for Greater London 12.8 (12.9). The early neo-natal mortality rate (deaths under one week per 1,000 total live births) was 9.75 (10.99). (England and Wales 10.5 (10.8); Greater London 11.4 (11.1)) and the peri-natal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) was 22.05 (20.09). (England and Wales 25.0 (25.4); Greater London 24.7 (24.2)). Maternal Mortality There were no maternal deaths in Westminster during 1968. The previous year there was one such death. Comparative figures Death rate 1968 1967 Westminster Nil 0.28 Greater London 0.21* 0.33 England and Wales 0.24 0.20 (*Excluding deaths due to abortion.) 12 INFECTIOUS AND OTHER NOTIFIABLE DISEASES The Public Health (Infectious Diseases) Regulations 1968, which came into operation on 1st October, 1968, caused changes and additions to be made to the list of diseases in respect of which Medical Officers of Health should be notified; acute primary and influenzal pneumonia, acute rheumatism, erysipelas, membranous croup and puerperal pyrexia are no longer notifiable, whilst leptospirosis, tetanus and yellow fever are now required to be notified. Infective jaundice had been added to the list earlier in the year. Furthermore, all existing regulations relating to notification and prevention of infectious disease were consolidated into one instrument; and by an order made under Section 50 of the Health Services and Public Health Act, 1968 the notification fee payable to all medical practitioners was increased to five shillings from 1st October, 1968. Irrespective of these changes, the incidence of infectious disease in the City continued to be at a low level. Notifications received (excluding tuberculosis) decreased from 1,400 in 1967 to 671, of which measles accounted for 253. Table 3, page 80, gives details of notifications received and the age groups concerned. Acute Poliomyelitis and Diphtheria No cases of these diseases occurred in Westminster in 1968. Dysentery Twenty-seven notifications of dysentery were received, compared with seventy-nine in the previous year. The majority were single unconnected cases. Infective Jaundice The Public Health (Infective Jaundice) Regulations 1968 came into operation on 15th June and by the end of the year 61 notifications had been received. Measles The number of measles notifications dropped from 1,098 in 1967 to 253 during 1968. Puerperal Pyrexia Puerperal pyrexia ceased to be notifiable from 1 st October, 1968 but up to that date 86 notifications of the disease had been received, thirty-eight of the patients being persons normally resident in Westminster. During the previous year 88 cases were notified, 43 being residents. Table 5, page 81, shows an analysis of the causes of pyrexia in the cases notified. Smallpox During the early part of the year under review the first full-scale smallpox alert since the amalgamation of the Boroughs in 1965, occurred in Westminster. The patient, a Pakistani boy of 15 years, travelled alone from Karachi to London Airport (Heathrow) and proceeded to an address in Kensington where he stayed with relatives. The day after his arrival he visited friends at an address in Wardour Street, Westminster. Two days later (Tuesday), because he was feeling unwell, the boy was taken by these friends to the surgery of a general practitioner in the Soho area where he received treatment. Although there was no eruption when he was first seen by the general practitioner, shortly afterwards the patient developed a rash and he was again taken by his companions to the same doctor who immediately informed the Medical Officer of Health. One of the City Council's Medical Officers and a smallpox consultant at once visited the boy at the house in Wardour Street. The diagnosis of smallpox could not be ruled out and the boy was accordingly removed to Long Reach Hospital, Dartford, Kent. Cultures were submitted to Colindale Laboratory and a positive diagnosis was made on the following Sunday morning. Although the patient had only been in the country for some four days, he had been in contact with 36 of his compatriots at the address in Kensington and with over 100 persons in Westminster. All were traced by the public health inspectors within a day or two, vaccinated by the medical officers, and then kept under daily surveillance for 17 days. Dealing with these contacts was made more difficult by the fact that few of them could speak English. Fortunately, two members of the Health Department clerical staff were able to act as interpreters for the duration of the alert. Many of the contacts worked in the catering industry in the West End and did not finish their 13 night-time duties until 2 or 3 o'clock in the morning, and this necessitated very long hours of work by the inspectors concerned. With the kind co-operation of the Director of Cleansing a special smallpox clinic was opened in a room at the Marshall Street Baths in Soho, staffed by medical officers, nursing staff, and public health inspectors, and contacts were examined there every day, including Saturdays and Sundays. The surveillance period passed uneventfully with no secondary cases occurring in Westminster, and so the disease had been contained. An alert of this kind is fortunately a rare occurrence but in these days of high speed travel it is now possible for a person to be in contact with smallpox in a far country one day and to arrive in England within a matter of hours. Constant vigilance on the part of all concerned continues to be necessary. Typhoid Fever The three cases of typhoid fever notified during the year were instances of isolated infection occurring in persons returning from abroad who were admitted to hospital shortly after arrival in this country. No secondary cases developed. There was only one case in 1967. Tuberculosis Table 3, page 80, gives information regarding primary notifications of pulmonary and nonpulmonary tuberculosis received during the year, and Table 4, page 81, shows the age and sex distribution of all new cases and deaths from all forms of the disease. It will be seen from Table 4, that there has been a slight increase in the total number of new cases which came to the knowledge of the Medical Officer of Health during 1968. The tuberculosis visitors working from the chest clinics, or in some instances from the appropriate health clinic, visit all tuberculous households to ascertain home conditions and to advise patients on such matters as isolation, steps to be taken to avoid the spread of the disease, and diet. Home contacts are urged to attend for x-ray examination or Mantoux testing and, where necessary, B.C.G. vaccination, and to attend clinic sessions for the purpose of surveillance. The tuberculosis visitor also follows up patients who do not visit the chest clinic as regularly as required and, where rehousing is sought, her detailed report on the home conditions assists with the pointing for priority of the family's application. Where insanitary conditions appear to exist the matter is referred to the public health inspector for further investigation. MASS MINIATURE RADIOGRAPHY The North West and the South West London Mass X-ray Services have continued to provide regular public sessions at numerous points within the City in addition to various closed surveys. The South West London Service also provides a six-monthly survey in conjunction with the Westminster Hospital Chest Clinic for the residents of the City Council Lodging House at Bruce House, Kemble Street, W.C.2 and in this connection they act in close liaison with the City Council Health and Welfare Departments. Twice yearly X-ray sessions incorporating a special service for the early discovery of lung cancer in men over 45 years of age are now provided for all City Hall staff and staff of adjacent office blocks, in addition to the sessions available for personnel at the Council's Gatliff Road Depot. INTERNATIONAL CERTIFICATES OF VACCINATION AND INOCULATION Arrangements continued for the authentication by the Medical Officer of Health of International Certificates of Vaccination and Inoculation completed by medical practitioners in Westminster. These certificates are required by persons proceeding abroad from this country and the purpose of the authentication is to provide proof to those health authorities abroad who desire it that the signature of the person issuing the certificate is that of a registered medical practitioner. After normal office hours, at weekends and on public holidays, certificates can be authenticated upon application to the Duty Officer at City Hall. During the year under review 18,336 (15,805) such certificates were authenticated, the demand being largely due to people going abroad for holidays. The Medical Officer of Health also issues, on request and in appropriate circumstances, certificates to the effect that no cases of smallpox have occurred in the district during the preceding month. These certificates, 13 (20) of which were issued during 1968, are sought mainly by persons proceeding to the United States of America who do not wish to submit to vaccination. It is understood that the United States immigration authorities reserve the right to place such persons under surveillance notwithstanding the production of a certificate of this kind. 14 AFTER HOURS EMERGENCY TELEPHONE SERVICE This service, which has been described fully in previous annual reports, provides a point of contact outside normal office hours for persons who in an emergency require assistance with health, welfare and other similar problems arising within the City of Westminster and the Royal Borough of Kensington and Chelsea. Senior officers for both boroughs are on standby call at these times and can be contacted through the Duty Officer based at City Hall to deal directly with urgent cases or to give specialist advice. Otherwise the Duty Officer can advise generally and when necessary refer details to the appropriate day staff for subsequent action. During 1968, a total of 11,477 (9,363) calls were received, 9,153 (6,908) relating to the City of Westminster and 2,324 (2,455) to the Royal Borough of Kensington and Chelsea. An analysis is given in Table 7, page 82. 15 ENVIRONMENTAL HEALTH SERVICES ENVIRONMENTAL HEALTH—WORK OF THE PUBLIC HEALTH INSPECTORS Chief Public Health Inspector: E. W. Pike, M.A.P.H.I. Deputy Chief Public Health Inspector: V. A. Bignell, F.A.P.H.I. At 31st December, 1968 Establishment In post Public Health Inspectors 59 (59) 53 (53) Student Public Health Inspectors 15 (15) 14 (14) Technical Assistants 24 (24) 24 (23) The staff position in respect of public health inspectors and technical assistants has been maintained during the year; despite the continued national shortage of inspectors, the vacancies resulting from resignations, seven in number, were filled reasonably quickly. Two senior inspectors retired, and their posts were filled by advancement of inspectors from the existing staff. One student completed training, and upon qualification was appointed to an established post; one abandoned his studies, and two student appointments were made. It will be appreciated by all those engaged in public service that the value of work done in the field stems from the attitude and adequacy of the officers engaged in the many and varied duties, both statutory and advisory, imposed upon and expected of them. In order to fulfil the requirements of both the City Council and the general public within the broad framework of legislation, policies and sound practice, it is necessary to establish certain codified procedures which will ensure consistent interpretations of law and technology acceptable both to the public health officers and those whom they serve. This has been achieved, and from time to time changing situations are reviewed by group consultation and by periodic voluntary meetings of all public health inspectors on the staff. To this activity behind the scenes may be attributed in no small measure the good relationships existing amongst the inspectorate. Thence also the excellent public relations outside the Department where, in the execution of his duties, the public health inspector is constantly in contact with people in all walks of life and in varying circumstances. During the year some re-deployment of the public health inspectorate was undertaken to provide adequate coverage of duties in view of the developing programme and to meet the City's peculiarly concentrated needs. The changes resulted in the provision of four areas utilising where appropriate the boundaries of the authorities merged in 1965. The number of districts has been reduced from 32-24, additional weight being given to specialist interests. This has greatly assisted the administrative section of the department, has facilitated reference to records in relation to the former constituent Authorities, and has improved public contact facilities. A further benefit which will accrue is in the management of the North Westminster Project, where a strong and well balanced team of public health inspectors and technical assistants will operate in an "Area", dealing with all general environmental matters in addition to carrying out surveys and inspections associated with this project. The Food Section has continued to function throughout the year within two inter-related spheres of activity, viz: (1) Food Control, entailing the surveillance of wholesale and retail food premises, soundness, quality and labelling of foodstuffs, and (2) Catering Hygiene related to hotels, restaurants, canteens, clubs and public houses. Inspectors in the food section also undertake enquiries and investigation in respect of food poisoning, and the specialised knowledge within this section is invaluable in the tracing and control of outbreaks. The Consumer Protection Act which came into force during the year is jointly administered within the City by the Public Control Section of the Town Clerk's Department and the Health Department, and for the purposes of this legislation all matters relating to food quality, nature and substance are dealt with by the Health Department. Close liaison exists, and has been extended between departments for consultation and in connection with matters arising under this Act. The four specialist inspectors in the Drainage and New Developments Section receive and scrutinize plans and specifications of works in connection with all building projects, and especially with regard to major contracts discuss proposals with architects, surveyors, consultants and contractors in the light of legislation and technical and practical requirements. It will be appreciated that if during preliminary or early-stage discussion all aspects of Health Department interests can be brought forward and planned into a construction scheme, this will avoid costly alterations to structure 16 and services after building works have been completed. Close liaison at this level with officers of other departments of the City Council, with London Building Act District Surveyors and other Authorities is mutually beneficial. Public Health Inspectors—Night and Weekend, etc. duties The arrangements, detailed in the Annual Report for 1966 and organised to provide as complete cover of inspectorial work as is possible outside the normal working hours, have been maintained throughout 1968. Student Public Health Inspectors—Practical Training In January 1968 there were fourteen student public health inspectors under training in the Department. During the year, one fourth-year student qualified by passing the Diploma Examination in June, and she was subsequently appointed as a public health inspector by the City Council. One second-year student abandoned his studentship and resigned from the Council's service to join his father's business. Two additional students were appointed in September and there were, therefore, still fourteen students in the Department at the end of the year. Four students will complete their four-year course and will sit for the qualifying examination during 1969. District inspection During 1968 the City was divided into four areas, and following re-arrangement of the duties of some of the public health inspectors the number of districts was reduced from thirty-two to twenty-four. Two areas, each consisting of five districts, operate from the Paddington Office in Harrow Road; the other two areas, consisting of eight and six districts, are centred at City Hall and Westminster Council House respectively. Summaries of the work carried out by District and other inspectors are included in Tables 8, 9, 10 and 11 on pages 83 and 84. Dwelling houses General inspection of dwelling houses arising from complaints and for routine purposes, as distinct from duties under the Housing Acts and other specialised functions dealt with later in this Report, are undertaken by the district inspectors. An analysis of reasons for initial inspections of dwelling houses is given in Table 8, page 83; and an analysis of 3,450 (2,763) nuisances and unsatisfactory conditions found and remedied appears in Table 9, page 83. Notices One thousand two-hundred and twenty (1,076) informal notices were served during 1968, and of these 830 (705) were followed by the service of statutory notices to secure the abatement of nuisances. In addition 36 (210) notices were served under the Clean Air Act 1956. An analysis of statutory notices served is given in Table 11, page 84. Legal proceedings A summary of legal proceedings undertaken during 1968 is set out in Table 29, page 92. Noise Definition—In July 1963 the Committee on the Problem of Noise (the Wilson Committee) submitted their Report to Parliament. Their terms of reference were "to examine the nature, sources and effects of the problem of noise and to advise what further measures can be taken to mitigate it." The Committee adopted the definition of noise as "sound which is undesired by the recipient". They stated that a noise problem must involve people and their feelings and its assessment is a matter rather of human values and environments than of precise physical measurement. They were of the opinion that neither experience nor experimental evidence supports the suggestion that some measurable figure of noise intensity might be accepted as a universal limit towards which all noise control might be directed. General Effects of Noise—As to the general effects of noise, the Wilson Committee found that "since health is defined as a 'state of complete physical, mental and social well-being and not merely an absence of disease and infirmity', there is no doubt that noise affects health" and went on to state that of all effects, repeated interference with sleep is least to be tolerated. It is therefore especially important to diminish noise during the earlier part of the night, because during the later phase of deep sleep even loud noises have less effect in wakening the sleeper. They were unable 17 to find any evidence that moderate noise produces any direct and measurable physiological effect on the average person. The general effect on health must therefore be more psychological than physical. The Committee also found very little specific evidence to support the view that noise causes mental or nervous illness and were unaware of any reliable studies of the effects of noise on the mental health of an ordinary population. In their opinion, one of the commonest and most undesirable effects of noise is its interference with communication based on sound. The Law relating to Noise—(i) Common Law: Noise can be the subject of a civil action for nuisance at Common Law. Nuisance has been defined as "the wrong done to a man by unlawfully disturbing him in the enjoyment of his property", and the disturbance may take the form of injury to property or interference with personal comfort. In England and Wales the remedy sought in an action for a nuisance at Common Law is an injunction restraining the defendant from continuing the nuisance. Sometimes damages are sought in addition, and if proceedings are brought at a County Court it is necessary for the plaintiff to claim damages as well as an injunction, since otherwise the Court has no jurisdiction. (ii) Noise Abatement Act 1960. Under Section 1 of this Act, noise which is a nuisance becomes a "statutory nuisance" and so subject to the provisions of Part III of the Public Health Act 1936. This provides a procedure for the abatement of nuisances specified in the Act as "statutory nuisances". Where a Local Authority is satisfied of the existence of a statutory nuisance it is required to serve an abatement notice on the person causing the alleged nuisance or, if he cannot be found, on the owner or occupier of the premises on which the nuisance arises. The notice requires him to abate the nuisance and if it is not complied with or if the nuisance although abated since the service of the notice is in the opinion of the Local Authority likely to recur on the same premises, the Local Authority must bring proceedings in a Magistrates Court for its enforcement. If the Magistrates are satisfied that a nuisance still exists or, although abated, is likely to recur on the same premises, they will issue an Order—called a "Nuisance Order"— requiring the nuisance to be abated on pain of a fine and a continued daily penalty for as long as the nuisance persists. A Local Authority which is of the opinion that summary proceedings would afford an inadequate remedy for a statutory nuisance may take action in the High Court for its abatement. Proceedings may also be started by a complaint to a Magistrate made by any three or more persons who, as occupiers of land or premises, are aggrieved by a nuisance. By requiring at least three separate occupiers to complain the provision minimises the risk of vexatious proceedings as, for example, among neighbours, which is possibly greater in the case of noise than with other nuisances since noise is so much a matter of personal reaction and temperament. It should be noted that noise and vibration caused by statutory undertakers are exempt from the provisions of the Noise Abatement Act, as also are noise or vibration created by aircraft. (iii) The Civil Aviation Act 1949, however, contains provisions for dealing with:— (a) noise and vibration caused by an aircraft on an aerodrome and (b) liability for nuisance caused by aircraft in flight. In the latter case, no action lies in respect of nuisance by reason only of the flight of an aircraft over any property at a height above the ground which having regard to wind, weather and all the circumstances of the case is reasonable or by reason only of the ordinary incidents of such flight, so long as the provisions of the Act are duly complied with. Thus, the protection given is lost if the aircraft flies below a reasonable height or if, in any respect, the provisions of the Act have not been complied with in relation to the aircraft. A system of monitoring is in operation in and around London which applies to noise or vibration created by aircraft provisional standards which differ during the night from those applicable during the day. (iv) Local Government Act 1933 (Sec. 249). Bye-laws made under this Act give Local Authorities a measure of control over music near houses, near churches and near hospitals, and noise from organs, wireless loud speakers, noisy street trading, touting, shooting galleries, noisy animals and bird-scaring devices as well as the use of indecent language, which may also involve a noise element. (v) Road Traffic Act 1930 and Motor Vehicles (Construction and Use), Regulations made under the Act. Authority under this legislation is vested in the Police and relates to noise from cars and other motor vehicles. (vi) Metropolitan Police Act 1839 (Sec. 54), and the Public Control Act 1936 (Sec. 5). These Acts refer to disorderly conduct and are also enforced by the Police Classification of Noise Nuisances—Nuisances from noise may be broadly classified as follows:— (1) Those arising from the personal behaviour of individuals or groups of persons to the detriment of their neighbours or others, e.g. loud speakers, bands, parties, uncontrolled animals, avoidable noise from motor vehicles, etc., and 18 (2) Those arising from industrial, commercial and other operations, manufacturies and businesses by way of machinery, plant handling, demolition, building operations, transport vehicles, aircraft, etc. Action with regard to Noise Nuisances—The Wilson Committee considered that the main aim of legislation against noise should be prevention. In this connection appropriate action under the Town & Country Planning Act may preclude the establishment of potential sources of noise nuisance by the refusal of planning permission whenever application is made for them to be set up. Problems of noise and air currents can be created by the erection of new buildings, especially tall buildings which may give rise to the funnelling of sound and wind. In planning the Council's own building projects due attention is given to these factors, but with regard to private developments the Council's powers of control are limited. All complaints of noise made to the Health Department are investigated. Not all prove to be well-founded but where nuisances are found the vast majority are abated or the offending noise reduced to a reasonable level by informal action. Two hundred and fifty-two (285) complaints of noise were received during the year under review and these necessitated 1,141 (1,193) visits by the public health inspectors. Many of the complaints related to noise occurring late at night or at weekends and necessitated investigations outside normal office hours. As is usual, noise coming from building sites or demolition and engineering works, and particularly those involving pneumatic drills, compressors and pumps, accounted for a high proportion of the complaints but it was again pleasing to find that almost all of the contractors concerned co-operated readily in seeking and applying noise-reducing methods, even when some loss of efficiency resulted or hours of working had to be restricted. Other complaints alleged noise from sources such as machinery in workships and factories, garages, motor repairs, fuel-oil and other delivery vehicles, banging of car doors, clubs, parties and social functions, noisy neighbours, radio or record players, artificial ventilation plant, and animals. Where persuasion fails and more formal action is necessary nuisances in Category (1) can in many cases be effectively and rapidly dealt with (a) by the Police or Local Authority using the Bye-laws, or (b) by the persons aggrieved bringing proceedings through the Civil Courts. Certain types of nuisances, however, such as the banging of car doors, present special difficulties because of their transient nature and the fact that the offenders are quickly away from the vicinity. The cumulative effect of many such incidents in one place spread over a period of time may nevertheless constitute a very serious disturbance. This is particularly in evidence where large numbers of people leave clubs and other places where they congregate at night, when it frequently happens that noise from cars is also accompanied by shouting and loud conversation. The Police are often called upon to deal with this kind of behaviour, and as the law stands they are able to do little more than bring pressure to bear on the owners of the clubs or other premises to use their influence with their clients, and to keep continued observation. The Wilson Committee recommended that not only should new vehicles be so designed and constructed that their noise levels do not exceed certain measurable intensities, and that it should be an offence for any vehicle on the road to emit more noise than this, but also that drivers making unnecessary noise should be liable to prosecution. This would enable legal action to be taken against drivers who do such things as racing their engines whilst the vehicle is stationary. Nuisances in Category (2) should be capable of being dealt with equally rapidly and effectively by the Local Authority as those mentioned in Category (1), but they are not. By the nature and effect of the Noise Abatement Act 1960 (Sec. 1) whereby any noise or vibration which is a nuisance shall be a statutory nuisance, a Local Authority must have similar regard to noise as to any other statutory nuisance in its assessment and in the decision to institute legal proceedings. The notice and enforcement provisions contained in the Public Health Act 1936 apply and the process is slow, cumbersome and inadequate to deal with transient circumstances or other conditions calling for prompt and effective remedy. Aircraft noise—This was considered by the Wilson Committee mainly in relation to the area around London Airport and the conclusion was reached that there are only two practical ways of improving the present situation, or possibly even maintaining it:— (a) to reduce the noise of individual aircraft as new types come into service; and (b) to provide houses near the boundary of the Airport with better insulation against noise. 19 In other respects aircraft noise at points further away from the Airport, they felt, could only be minimised by controls over the operation of the aircraft, a matter which is beyond the jurisdiction of the City Council. Subsequently, in November, 1966, an international conference on the reduction of noise and disturbance caused by civil aircraft was held at Lancaster House, London, when specific suggestions were made for future action which might be taken by those responsible for, or concerned with, the control of disturbances from aircraft noise. It was recognised, however, that it would be for Governments and other authorities concerned to decide what action they should take thereon, either domestically or internationally. The principal suggestions made included:— (1) Immediate action to introduce a system of noise certification of aircraft. (2) Research on aircraft noise to be urgently pursued. (3) In the field of the control of land use near airports there should be a full and continuing exchange of information about action being taken nationally to apply land use controls. (4) Further research and study in regard to noise reduction by the use of operating techniques. (5) Perceived Noise Level in decibels is the best available predictor of the subjective attributes of "noisiness", but the International Organisation for Standardisation should proceed to specify modifications which should be used for the purposes of noise certification of aircraft. (6) The need for comparable procedures to be used in social surveys carried out by different countries. (7) Further research in the matter of the insulation of buildings against aircraft noise by countries whose airports cause serious disturbances to local residents. (8) Airport authorities and airport operators should be encouraged to pursue all possible measures to reduce the noise made by aircraft "running-up" engines on the ground. Training The serious view of the noise problem taken by the Ministry of Housing and Local Government is evidenced by Circular 22/67 issued on 18th May, 1967, referring to noise related to industrial processes. This Circular mentions many aspects of the problem and stresses the need for the establishment of short part-time courses at approved technical institutes for the specialised training of Local Authority officers who have to deal with noise problems, notably public health inspectors. This suggestion has been acted upon and by the end of 1968 eleven of the Department's public health inspectors had attended such a course and it is proposed that eventually all the inspectorial staff will do so. Conclusion—As the law stands at present in respect of excessive noise other than that controllable by the Bye-laws, no offence is committed until the person responsible for the noise has received notice from the Local Authority that this noise is a nuisance and he has failed to take all practicable steps to abate it. If the noise problem is to be adequately tackled there is need for the powers of Local Authorities to be strengthened and it is suggested that any person causing excessive noise should be guilty of an offence. Where the appointed officer is satisfied that by reason of the intensity, duration or nature of a noise that nuisance exists, he should be empowered to lay information before a Court of Summary Jurisdiction, calling upon such witnesses and/or evidence of fact as he can produce to support his information. Notice of intent so to do could forthwith be given verbally to the person causing the nuisance by act or default, and this could be confirmed in writing within 48 hours. Such procedure would involve no departure from precedent and practice as, for example, under the Clean Air Act 1956 which, subject to the provisions of the Act, makes the emission of dark smoke from the chimney of any building an offence. Section 30 of this Act lays a duty upon an authorised officer of the Local Authority, when he is of the opinion that an offence under the Act has been committed, to notify the alleged offender "as soon as may be" and provides that "if his notification is not in writing (he) shall within 48 hours after he became aware of the offence confirm the notification in writing". It is important that in any new legislation, penalties in respect of noise nuisance should be greatly increased so as to provide an adequate deterrent in all cases, and particularly where financial considerations may have a powerful effect as, for example, on large building sites where the use of equipment to suppress noise may not only be costly but also reduce efficiency to some extent. 20 In March 1968 the City Council after considering a report upon the subject of noise expressed the view that the following aspects of the problem should be examined as a matter of urgency and requested the Association of Municipal Corporations to make representations to H.M. Government accordingly:— (i) The enforcement procedure under the Noise Abatement Act should be replaced or supplemented by a speedier procedure. (ii) Statutory undertakers and their contractors have exemption from the effects of the Act. While appreciating the reasons for this, the City Council is not convinced that due thought is always given to local residents in the siting and use of mechanical equipment. The City Council feels that consideration should be given to the limitation of this exemption. (iii) The recommendations of the Wilson Committee should be implemented as soon as possible. During the year the City Council extended its publicity by exhibiting and distributing posters and pamphlets on the subject of noise abatement via the various departments of the Council and with the kind co-operation of the Citizens' Advice Bureaux, old people's welfare organisations and commercial firms through the Westminster Chamber of Commerce. Drainage and New Developments There has been no change in the organisation of this section of the Department during the year under review, i.e. all new buildings, larger alterations, conversions and adaptations being dealt with by the same team of specialist public health inspectors and the smaller works being supervised by the district public health inspector. Of the 1,082 (1,036) drainage applications approved during the year 61 (93) related to new buildings and a total of 12,024 (13,075) visits were made to inspect and test works in progress. As the object of this service is to prevent drainage problems arising at the time of installation rather than eradicating them after completion, no prosecutions have been found to be necessary. The building of new and the conversion of existing hotels continues at an increasing pace and it is anticipated that the Government incentives announced in April 1968 will add a further impetus to this form of development. None of the new hotels previously reported as being under construction has been completed, but an additional four have been started. The number of bedrooms in course of construction at the end of the year in new buildings was in the region of 1,750. Conversion of existing hotels both large and small would bring the total of additional bedrooms in course of creation to approximately 2,500. A feature of the year's work has been the modernisation of several West End cinemas. They do not appear to have had anything more than small maintenance work carried out since pre-war days, but have now been completely rehabilitated; one has been converted into two cinemas by horizontal sub-division. In the field of housing, 423 houses and flats have been built by private enterprise during the course of the year and at its close, a further 744 were in course of construction. Another notable contribution towards the housing problem has been made by the conversion of many of the large older houses in the Bayswater area into flats. In addition, close liaison with other Departments of the City Council and with the Greater London Council has been maintained in connection with local authority developments which, of course, demand an equal degree of supervision. Work to new educational establishments continues. Such long-term projects as the College of Science and Technology, New Cavendish Street; Imperial College, Prince Consort Road area; King's College, Strand; and London School of Economics, Houghton Street have all made considerable progress during the course of the year. The Luxborough Lodge site consisting of a College of Architecture, a School of Management, and two 22-storied blocks to be used for hostel and housing accommodation, is now well advanced and completion is expected in 1969. A new fire station in Harrow Road, claimed to be the most up-to-date and expected to receive more calls than any other in the country, is nearing completion. Sewerage Once again, no reports of flooding from surcharged sewers were received and the officers continue to work in close collaboration with those of the City Engineer's Department in trying to ensure that, in new buildings, no sewer connections are made which would make the buildings liable to flooding by surcharge. 21 Town Planning Observations were made by the Department on 70 (90) plans submitted to the Council under the Town and Country Planning Act 1962. Clean Air Until the end of March, daily volumetric measurements of smoke and sulphur dioxide were taken at stations situated at the following premises: *Anson House, Churchill Gardens, S.W.1. *Monck Street Depot, S.W.1. *London College of Fashion, Holies Street, W.1. Westminster Council House Extension, N.W.1. *Rutherford School, Penfold Street, N.W.8. "Newstead", Greville Place, N.W.6, and *Paddington District Office, 313 Harrow Road. W.9. Larger particles of grit and dust were collected and measured in standard deposit gauges placed at: Bessborough Street Day Nursery, S.W.1. Farm Street Depot, W.1. Winchelsea House, St. John's Wood Road, N.W.8. Maternal and Child Welfare Centre, 283A Harrow Road, W.9. Arrangements for these measurements are made in conjunction with the Warren Spring Laboratory of the Ministry of Technology, who supervise the National Survey of Air Pollution. With a view to possible economy they were consulted as to the practicability of closing some of these stations without adverse effect on the National Survey; as a result six of the 11 stations mentioned above were discontinued and only those marked with an asterisk were operated from 1st April, 1968. Two sequential fog samplers at Anson House and Westminster Council House are still being used. They were installed by arrangement with the Air Pollution Division of the Medical Research Council and the results obtained are always available to them and to Warren Spring Laboratory. These instruments measure the smoke content of smog more completely than the apparatus used for the daily measurement of smoke and sulphur dioxide, and are switched on at the discretion of the City Council's Smoke Control Officer when smog is imminent or at the request of the Medical Research Council. The City Council's programme for smoke control areas continues to be implemented and it is gratifying to record that the amount of smoke in the City's atmosphere is now about one-third of what it was when the programme was embarked upon. Smoke Control Orders for Westminster (Maida Vale North) and for Westminster (Maida Vale South) came into operation on 1st July and 1st December respectively. Three Orders still to be made to complete the programme were scheduled for 1968 but deferred for twelve months in view of the national economic situation. All undue emissions of smoke observed or reported to the Health Department, are investigated and appropriate action taken. There are many oil-fired boilers of varying sizes used in the City to provide heating to offices, flats and shops and in addition to the usual smoke problems, they also give rise to complaints of smuts and odours. Unlike visible smoke, the sources of smuts and odours are more difficult to trace; nevertheless, although these investigations are somewhat time-consuming, considerable success is achieved in remedying this kind of nuisance. During the year, the Smoke Control Officer made 258 (288) visits in connection with complaints, 384 (331) smoke observations and 907 (912) routine visits. New boiler installations notified to the Council under Section 3 of the Clean Air Act 1956 are investigated to ensure that (a) they are capable of operating smokelessly and (b) the flue gases are discharged so as not to inconvenience persons working and living nearby. During 1968 a total of 82 (71) such notifications were received, of which 17 (27) included application for the Council's approval of the new boilers. Housing Acts 1957-1964—Inspectorate A specialist group of public health inspectors deal with work under the provisions of the Housing Acts relating to slum clearance, houses in multiple occupation, and the improvement of dwellings, 22 and report on behalf of the Health Department upon applications for loans for the purchase of houses and grants for improvement works. In addition two of these inspectors commenced, toward the end of the year, a survey of the hotels in the City. During 1968 progress was made towards the implementation of the North Westminster Project in conjunction with the other departments concerned. Public Inquiries by the Minister of Housing and Local Government were held in 1968 in respect of three areas in the Project (Herries Street (North), Herries Street (South), and Tavistock Crescent area). The Herries Street (North) Compulsory Purchase Order was confirmed (with modifications) and decisions are awaited in respect of the other two areas. By arrangement with the Greater London Council the City Council is also dealing with the Mozart Street area for which a compulsory purchase order was confirmed in 1967. Toward the end of the year regrouping of the public health inspectors was effected so that a specialist team could initiate a full inspection of all privately owned premises within the Project area and undertake subsequent action required of the Health Department. A summary of all visits made is given in Table 12, page 84. Houses in Multiple Occupation-—Management Orders, Directions and Notices In addition to the normal work in other parts of the City in connection with houses in multiple occupation a house-to-house survey in the Pimlico area was commenced in March by two public health inspectors. The survey will continue in this area throughout 1969. At the end of the year, 207 properties had been inspected of which 116 required action either informally or by service of notice. Details of the management orders made, directions given and notices served under the Housing Acts 1961 -1964 are shown in Table 13, page 84. Houses in Multiple Occupation—Control Orders At the end of the year three control orders under the Housing Act 1964 were in operation. Two of these were made in 1964 and one in 1965. Unfit Premises Details of closing orders on parts of buildings made under the Housing Act 1957 are given in Table 14, page 85. Housing Priority on Medical Grounds At the request of the Inner London Local Medical Committee, and with the co-operation of all general practitioners and hospitals in Westminster and on its borders, a revised procedure in relation to medical priorities associated with applications for rehousing has been operating since March, 1968. Basically, the new system provides for applicants wishing to obtain medical priority to indicate their reasons for making the claim and give authority for the Medical Officer of Health to communicate directly with the medical adviser concerned if further information is required. This supersedes the earlier procedure whereby applicants submitted a medical certificate. Thanks to the ready participation of general practioners and hospital medical staff and the co-operation of the Housing Manager and his staff the new scheme is operating smoothly and successfully. While credit must be given to another London Borough for initiating such a scheme, it is of interest to note that the revised "Westminster procedure" has now been adopted by some other Inner London Boroughs. During the year, 1,254 (969) cases of rehousing applications supported by either medical certificates or claims for medical priority were dealt with. Unlawful Eviction, Harassment and Provision of Rent Books An officer on the inspectorial staff of the Health Department is now engaged full time on the investigation of these matters and during the year made enquiries into 178 new cases of alleged harassment and 26 instances of non-provision of rent books. The figures for 1967 were 112 and 43 respectively. Overcrowding Table 15, page 85, gives statistical information on the known cases at the end of the year. 23 Certificates of Disrepair For the second consecutive year no applications were received for certificates under the provisions of the Rent Act 1957. These provisions have been re-enacted in the Rent Act 1968. A copy of the return required by the Ministry of Housing and Local Government is shown in Table 16, page 86. Slum Clearance During the year the compulsory purchase orders made by the Council in connection with the following areas were confirmed by the Minister of Housing and Local Government:— Ashmill Street/Broadley Street (confirmed 20.8.1968). Herries Street (North) (confirmed with modification 11.12.1968). St. Anne's Court/Richmond Buildings (confirmed 13.6.1968). The clearance order made on St. Anne's Buildings, St. Anne's Court was also confirmed on 13th June, 1968. The compulsory purchase order relating to the Herries Street (South) area was the subject of a Public Inquiry on 19th November, 1968 and the decision of the Minister is awaited. Loans, Grants and Subsidies During the year, 80 (105) applications for loans and 46 (92) applications for grants were referred to the Health Department for inspection and comment. Comments were also requested and given on 55 applications under the Housing Subsidies Act 1967. Common Lodging Houses There are two common lodging houses in the City. One, accommodating 550 men is kept by the Salvation Army at 18 Great Peter Street, S.W.1, whilst another for 706 men is run by Westminster City Council Welfare Department at Bruce House, Kemble Street, W.C.2. Regular inspections of these premises are made by the public health inspectors, particular attention being given to fire precautions, number of lodgers accommodated, sanitary and washing facilities, and to general compliance with the Bye-law requirements. Both common lodging houses were well managed and maintained throughout 1968. Facilities are provided at Bruce House for the disinfestation of any residents who require this service, together with a doctor's room in which local general practitioners can see their patients. Arrangements also exist for regular visits to this lodging house by the Council's social workers. Local Land Charges The number of formal enquiries dealt with during 1968 was 8,622 (7,783). Radioactive Substances Act 1960 Persons who keep or use radioactive materials are, unless exempted, required to register with the Ministry of Housing and Local Government and obtain authorisation for the accumulation and disposal of radioactive waste. Copies of certificates of registration, authorisation and supplementary provisions, the cancellation or variation of certificates issued by the Minister in respect of users in the City, are received and recorded. Appropriate action is taken in respect of any special precautions so far as they relate to the Department in connection with the conditions specified in the certificates. Rodent Control A staff of eight rodent operatives under the supervision of the Pest Control Officer is based on two centres, namely, 313/319 Harrow Road for the northern half of the City, and at Brydges Place, Covent Garden, for the southern half of the City. Primary and follow-up visits are made without charge in respect of complaints of rat and mouse infestation in domestic and business premises and a free disinfestation service is provided for domestic premises. Short-term treatment only is undertaken at business premises and for this a charge is made. Where treatment necessitates regular attention on a long-term basis, business firms are advised to employ a commercial pest control organisation. 24 Continued attention is given to advances in methods of treatment and with particular regard to formulations of poison baits as recommended by the Ministry of Agriculture, Fisheries and Food. Statistics in regard to Rodent Control are given in Table 17, page 86. Insect Pest Control—Disinfestation The work of insect disinfestation is carried out from two centres, namely Lissonia, 217 Lisson Grove, N.W.8 and Wedlake Street Medicinal Baths, Kensal Road, W.10 by a staff of five disinfectors who also undertake disinfection. Continued attention is given to methods of insecticidal treatment and the formulations of spray and powder in use are specified with particular regard to the Ministry of Agriculture, Fisheries and Food recommendations. As in the case of rodent control, a free service is provided in domestic premises but in business premises where insect control is a matter of routine maintenance it is advised that a commercial pest control organisation be employed. During the year 3,917 (2,760) rooms were disinfested. Disinfection During the year, 45 (99) rooms, 6,653 (6,073) articles of bedding and clothing and 209 (482) books were disinfected. The Department continued to be asked by residents to certify that clothing intended for despatch to foreign countries, mainly in central eastern Europe, was free from infection. In such cases disinfection is carried out only when the articles concerned have actually been in contact with infectious disease. Fifty-eight (83) certificates were issued indicating that no infectious disease had been reported for at least one month at the premises from which the clothing was purported to have come. Pigeon Control Section 74 of the Public Health Act 1961, empowers the City Council to take any steps necessary for the purpose of mitigating any nuisance, annoyance or damage caused by the congregation of pigeons in a built-up area. Where pigeons congregate at the feeding or roosting sites much fouling of the adjacent buildings, or other surfaces, is caused by their droppings. At their nesting sites the fouling is more concentrated which, apart from being unsightly, encourages insect infestation. The control of pigeons is not helped by the indiscriminate and regular feeding of pigeons by members of the public which is almost always the cause of the concentrations of pigeons which give rise to complaint. The investigation of complaints is carried out by the public health inspectors and the pest control staff who, depending upon the circumstances of the complaint, arrange wherever possible the remedial measures to be taken and give advice, where necessary, on the use of repellents. Water The chief source of a constant water supply throughout the City is from the mains of the Metropolitan Water Board whose Director of Water Examination has kindly provided the following information which, it should be noted, relates to the Board's direct supply to the area and not to supplies from any other source:— "1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1968. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after results are found to be satisfactory. The quality control of the Board's laboratories at Rosebery Avenue, E.C.1, is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in Westminster but the population supplied direct according to the Registrar General's estimates at 30th June, 1968, was 240,272. 25 (ii) No artificial fluoride was added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:— Thames Valley Works and Stoke Newington Works. No new sources of supply were instituted and there were no changes to the general scheme of supply in the area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown in Tables 18 and 19, page 87. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are not considered to be plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead. Special tests for lead have been carried out during 1968 on 100 premises where a lead supply pipe is installed. The premises were chosen to give an even distribution of samples throughout the whole of the Board's area. Two samples were collected from each premises; one was the first running of water standing in the lead pipe overnight and the other was a sample of water after running the tap for a few minutes. The results are set out in Table 20, page 88. These are very satisfactory and the figures are within the limits of the World Health Organisation European Standards for Drinking Water Quality. This states that the upper limit for lead in running water in the supply should not be more than 0.1 mg/l (Pb); but where water undertakings continue to use lead piping the concentration of lead (as Pb) should not exceed 0.3 mg/l after 16 hours contact with the pipes." In the event of any suspicion of contaminated public mains water, the Metropolitan Water Board is informed and investigations are made: if necessary, samples are taken for examination. Complaints (which are extremely few) have usually referred to some alleged unusual taste. In common with many of the London Borough Councils, the City Council is in favour of the Metropolitan Water Board being asked to adjust the fluoride content of the public water supplies to the optimum amount necessary to prevent dental caries. Private Water Supplies—Deep Wells The water from 68 boreholes is used for drinking and domestic purposes in 54 premises. Of this number, 19 bores supply water to 18 premises occupied by Government departments or Crown Agents and, where this obtains, arrangements for maintenance and examination are in the hands of the Ministry of Public Building and Works and the Government Chemist. During the year, in relation to the 49 boreholes in private ownership and control, 77 (83) samples of water were submitted for bacteriological examination and 26 (26) for chemical analysis. One of the bacteriological examinations indicated bacterial impurity including coliform bacteria in considerable numbers. The borehole in question, one of two supplying one building, was not in use at the time, having been the subject of recent overhaul and the contamination reflected the disturbance occasioned by these works. Further tests established the resumption of a satisfactory supply before this bore was brought into commission again. All other examinations indicated satisfactory supplies. Swimming Bath Water Examination Monthly examinations of the water were carried out at each of the 11 municipal swimming baths in the City. During the year, 210 (196) samples were submitted to the Public Health Laboratory Service for bacteriological examination, and the same number of samples were examined at the baths for residual chlorine and pH value. In one instance the bacteriological examination indicated the probable presence of faecal bacteria in minimal numbers, namely two per 100 millilitres. As the bath had not been used, and there were no users at the time of sampling, this otherwise inexplicable contamination may have been introduced by one of the long-handled squeegees with which the floor of the bath was being cleansed. Attention was drawn to this possibility and subsequent examinations, in similar circumstances, proved entirely satisfactory. Offices, Shops and Railway Premises Act 1963 The Council is responsible for administering the general provisions of the Act in such premises as are required to be registered with the local authority. 26 There were 1,319 new registrations during 1968 and, after allowing for removals and the transfer of registrations to other authorities, there remained on the register 17,455 premises, employing a total of 351,943 persons. During the year, 2,960 general inspections were carried out and 6,821 visits were made. Contraventions were found in 1,379 premises and, of these, 552 were referred to public health inspectors for further investigation and any necessary action. There were no prosecutions, compliance with the Act being secured by informal action. Notification was received of 495 accidents and investigations revealed four cases where contraventions of the Act may have been a contributory cause. There were two fatal accidents; one of these was caused by the after-effects of a fall whilst working at a height of eight feet; the other, due to carbon monoxide poisoning, appeared to be linked with four deaths from similar cause occurring in a neighbouring authority's area. A sudden short heat-wave on 30th June and 1st July, 1968 created conditions in which shared flues might prove dangerous and the Coroner, who conducted all five inquests, drew attention to this hazard which was subsequently given publicity in the press. The Offices, Shops and Railway Premises (Hoists and Lifts) Regulations 1968 are intended to secure the safe operation of lifts and hoists in premises to which the Act applies, and in anticipation of the operative date (28th May, 1969) advice was given to a number of occupiers as to the ultimate compliance or otherwise of their equipment with the requirements of the Regulations. Statistics, including some contained in the Annual Report to the Department of Employment and Productivity, will be found in Table 21 on page 88. Factories There were 4,639 (4,722) factories on the register at the end of the year. Statistics of matters dealt with by the Health Department under Parts I and VIII of the Factories Act 1961, are given in Tables 22 and 23, page 89. Outworkers Returns made by 174 (224) employers, together with 168 (170) notifications from other authorities, accounted for a total of 1,814 (2,247) outworkers. Of these, 794 (956) were residing in the City of Westminster. It is of interest to note that the number of persons engaged on out-work is steadily declining. (Table 24, page 90.) Basement Bakehouses The Factories Act 1961, which re-enacted with amendments the Act of 1937, requires that a "basement bakehouse" shall not be used unless a Certificate of Suitability has been issued by the Council and that the premises were so used in 1937. There are three basement bakehouses in Westminster for which Certificates of Suitability are in force. The next quinquennial review is scheduled for 1969. Food and Catering Premises—Inspection The estimated number of food and catering premises in Westminster on the 31 st December, 1968 was 6,824 categorised as shewn in Table 25, page 90. During the year 10,230 (11,894) visits were made by the Public Health Inspectors and 352 (550) informal notices were served in respect of matters requiring attention. During the year some 576 complaints were received concerning general food matters, conditions of premises, noise, smells, dirty crockery, matters relating to staff, etc. Appropriate action was taken in each instance. Catering Premises—General Matters The wide variety of catering carried on from premises in Westminster and the large number of establishments involved has resulted in the Inspectors engaged on this work being under considerable pressure throughout the year. There can be few local authority areas where such a concentration of premises dealing in foodstuffs occurs as it does in some parts of Westminster. The influx of foreign nationals, who now operate many of these premises, has resulted in foods being available in varieties which cater for almost every cosmopolitan taste. 27 Whilst in the past the British have not been regarded as venturesome in the matter of nontraditional foods, a change in eating habits appears to have taken place. Perhaps this is associated with the journeys abroad now being made by so many people. These travels may well lead to new culinary interests which with little effort can now be satisfied at home. It can be said with some satisfaction that the structural standards of food premises continue to improve, as does the equipment designed for easy cleaning, but unfortunately such advancements are not always matched by improvements in maintenance, cleansing and, in some cases, management. The key to the situation is labour—particularly for the routine menial tasks. Too often managements employ whatever labour they can get and accept a poor standard because of fear that a word of reprimand will leave them without staff at short notice and possibly at a critical time. So much has this weakened the status of some managers that they are content to leave the responsibility of guidance and criticism to the inspector on the occasions when he makes his routine visits. The inspectors are prepared to accept this but it is a further inroad on the resources of the Department. Other managers choose to remain remote from the problems of the kitchen, only deigning to discuss such matters with impersonal detachment after the inspector has completed his inspection. It is noteworthy that conditions are generally better where those in control from time to time work alongside their staff at some of the less congenial tasks. A large percentage of kitchen employees are from overseas, and whereas some make a conscious effort to adapt themselves to the standards of this country, others make no progress in understanding or communicating in English and remain unmoved and apparently untouched by their experience until their work permit expires. They are then replaced by persons of similar type also from abroad. There are some matters which occupy the time of the inspectors in the catering group with unfailing regularity. These involve not only specific premises, but also affect neighbours and other members of the general public. One is the question of refuse disposal. With the co-operation and good will of the City Council's Cleansing Department most establishments seem to cope with this admirably. There remain, however, those cases which give rise to complaints that the refuse is indiscriminately scattered and not properly contained in the refuse bins or is giving off an offensive odour. A visit usually results in an immediate improvement in the situation but sometimes there is a drift back to former ways and frequent revisits are required. Fault does not always lie with the management. Irresponsible members of the public on seeing waste material neatly piled ready for collection sometimes appear to delight in scattering it about in a disgusting manner. One solution is for the refuse to be kept within the premises until collection, but as most of the larger establishments operate their businesses from late evening until early morning this is often not practicable and there is no alternative but to leave the containers outside the premises for collection. For many years kitchen ventilation has been a special problem—together with that of the disposal of cooking fumes, both as regards working conditions and also to prevent nuisance to occupiers of adjoining premises. Many people who enter the catering industry have to be convinced of the need for expensive plant to ensure that cooking fumes are adequately dealt with, and even multiple caterers although they usually accept the requirement regard it as an unwelcome liability. Well designed, flexibly balanced plant to meet varying seasons and fluctuations in business is in reality a good investment. Complaints of alleged nuisance from cooking smells are all investigated and the best means of overcoming them discussed with the parties concerned. Sometimes the answer is the simple one of keeping the kitchen door closed to prevent fumes escaping at low level which would otherwise be discharged at roof level through the ventilating equipment. The Health Department has a requirement that the discharge of cooking fumes shall be at a "safe height where no nuisance will be caused to the surrounding occupiers". This in effect usually means above roof height but in some cases it is beyond the bounds of practicability or reasonableness—as in the case of a multi-storey building where there is a ground floor restaurant. The cost of requiring ventilation to roof level in such circumstances would be immense and unreasonable to expect—apart from other considerations as to the mechanical possibilities of such a scheme. In other cases difficulty is experienced with landlords of premises who, whilst having regard to the interest of their tenants, are sometimes reluctant to sanction the erection up the back of a building of unsightly trunking which would become a permanent feature of the structure. Efforts to secure necessary consents to instal essential ducting can sometimes take months or even years. Firms of ventilating engineers are naturally anxious to provide what is necessary to ensure a satisfactory installation but nuisance from cooking fumes generally, and particularly where buildings are close together and space is at a premium, as in central London, is a subject which deserves further special attention. It would therefore seem that the time is coming when local authorities, government departments and others interested should undertake a study of this problem to try and find some 28 scientific means of making the installation of complicated equipment and machinery unnecessary, and also to provide an authoritative evaluation of existing schemes which purport to do this. During the year an investigation at a restaurant disclosed serious infestation by black rats. Sacks of rice, bay leaves and flour were found to be heavily contaminated and the situation was such that legal proceedings were instituted, resulting in fines of £100 with £10. 10s. Od. costs being imposed. Arising from this investigation, seventeen other premises in the immediate vicinity were found to be infested, though not to the same serious degree. The inspector concerned obtained the cooperation of all the pest control contractors engaged in disinfestation work by the firms in question and made known to them the extent of the baiting and work required to rat-proof the individual premises. Some months elapsed before the situation was brought under control but further inspections since intensive treatment has been undertaken showed the position to be satisfactory. This illustrates that constant vigilance is necessary where there are old premises dealing in comestibles, and especially where there are other similar establishments close nearby. When signs of infestation occur immediate and effective steps must be taken otherwise it requires only a short time for the situation to get out of hand. Utensils used in catering premises, particularly those intended for the service of food, give rise to complaint, usually of crockery being chipped or cracked, or crockery and cutlery not being in all respects clean or having been improperly dried. Most instances are due to the carelessness of the employees, and reflect unfavourably on the supervising staff. Sometimes the fault is due to the water in a washing-up machine not being kept sufficiently hot with a result that food residues on the crockery or cutlery are not dislodged in the washing process and are retained even after rinsing. In one investigation one quarter of all cups, one third of the saucers and all the glasses at the servery were wet and dirty. Fortunately this is not representative but further surveys are to be undertaken to obtain information on a wider basis. In connection with the deficiencies referred to above, it is sometimes found that the lighting available in the place where washing-up operations are performed is of a low standard, and this undoubtedly has some bearing on the poor performance of the staff who are engaged in this duty. The Offices, Shops & Railway Premises Act 1963, requires that "effective provision shall be made for securing and maintaining in every part of the premises to which the Act applies, in which persons are working and passing, sufficient and suitable lighting, whether natural or artificial". No Regulations have been issued as to what constitutes sufficient and suitable lighting although the Department of Employment and Productivity has issued a circular recommending certain standards. When making light readings these should be taken at 2 ft. 9 ins. above floor level or at the normal working level. The standards are given in terms of "Minimum values (lumens per sq. ft.)" and the "Recommended values of the Illuminating Engineering Society (lumens per sq. ft.)". A survey was made during the year of the lighting provided in the food preparation area, cooking area and wash-up area at 82 catering premises, and the results were as follows:— Area Number of the 82 premises surveyed with:— Below minimum recommended values of 20 lumens per sq. ft. Minimum recommended values of 20 lumens per sq. ft. I.E.S. recommended values of 55.7 lumens per sq. ft. Food preparation area Cooking area Wash-up area 55 (67%) 56 (68%) 59 (72%) 27 (33%) 26 (32%) 23 (28%) nil nil nil In 29 per cent. of the total inspections the standard was below 10 lumens per sq. ft. and it appears that a marked improvement is necessary if this study is representative of the conditions generally prevailing. The Food Hygiene (General) Regulations 1960 require "Now Wash your Hands" notices to be exhibited in a prominent position, requesting persons to wash their hands after using the sanitary convenience. It is to be hoped this essential part of personal hygiene is strictly observed. Certainly 29 every opportunity is taken of impressing staff with the importance of this requirement—although the necessary notice is often missing. The Regulations also require that at or near every wash hand basin available for the use of persons engaged in the handling of food there shall be provided supplies of soap or other detergent, nail brushes and clean towels. It is a frequent occurrence that one or all of these essential items for maintenance of personal hygiene are missing at the time of inspection. Their absence tends to imply that the hand basin is not used as much as it should be. Licensing Act 1964 The provisions of this Act enable a local authority to lodge an objection in respect of an application to the Magistrates' Court for a Club Registration Certificate, where it is desired to provide intoxicating liquor for members and their guests, on the grounds that the premises are not suitable and convenient for the purpose in view of their character and condition, and of the size and nature of the club. Similar powers are available to a local authority to lodge an objection in respect of an application to the Licensing Justices for a licence to sell intoxicating liquor in restaurants, private hotels, guest houses etc. The Justices may refuse an application if the premises are not structurally adapted and bona fide used for the purpose of habitually providing customary main meals or, if after reasonable steps have been taken, it was not possible to inspect the premises. All premises in respect of which such applications to the Licensing Justices were received during the year were inspected before the hearing. In one case action was taken to raise a formal objection to a variation in a Club Registration Certificate on the grounds that the new premises were not suitable for the purpose for which they were intended by reason of their general condition. The solicitors acting for the applicant were informed of the Council's intention, and the application was withdrawn. In another instance concerning an application for a residential licence at hotel premises the inspector gave evidence to the Bench of the inadequate catering facilities available and the application was refused. The possible formation of the necessary kitchen on lines recommended by the inspector was later raised with the applicant but no further approach was made to the Department. Other cases were held over or refused until the Department had satisfied the Justices' Clerk that action had been taken to remedy inadequacies or that works outstanding were sufficiently advanced to permit the application to be granted. Street Traders—Markets and Stalls Co-operation between officers of the City Council and the Market Traders Association, who represent the street traders on sites in Westminster, has been further strengthened. During the year meetings took place between the Association and Health Department officers who were able to offer advice on a number of matters. At the close of the year, the twelve street traders' premises forming part of the Church Street Development were completed but not yet occupied. At the outset it was agreed that in planning the scheme provision would be made for adequate off-street storage accommodation for traders dealing in foodstuffs, and additionally that there should be space for storing the stall and stock of foods, sufficient working area for the preparation and sorting of foods, and facilities for washing food and equipment. Sanitary accommodation, personal washing facilities, clothes lockers and bulk refuse compartments were also to be provided. The result is a most satisfactory arrangement which is acceptable to the street traders and complies with the Regulations. It is probably the first of its kind in this country. Of all the problems confronting the street trader that of obtaining satisfactory storage facilities within easy reach of his stall is probably the greatest and one which without the help of the local authority he may find it impossible to solve. The outcome is that quantities of produce are taken to the stall, or delivered to the stall site, and stacked in a manner which not only looks unsightly but can lead to indiscriminate dumping of refuse once the boxes and cartons are opened and the food removed. The practice also subjects the goods to risk of contamination. Discussions have been taking place with street traders' representatives as to the type of stall for use in street markets which will comply in all respects with the Food Hygiene (Markets, Stalls & Delivery Vehicles) Regulations 1966, at a cost within reach of the trader. Following investigation into several possibilities, a firm manufacturing fibre-glass components has offered to provide a "mock up" of any suggestion for a suitable stall which would be likely to be acceptable to the traders concerned and be a commercial proposition. It has been suggested that the base of the 30 present four wheeled type of stall should be retained to carry a separate purpose-made unit incorporating the requirements of the Regulations. Where washing facilities are required these would form one section of the stall; provision also would be made for refuse sacks to be hung at one end of the vehicle. One difficulty is the desire of traders to serve from the rear of the stall, whereas the proposals under consideration might only permit service from the front. This matter is at present only in the preliminary stages of discussion but seems to be the most realistic of the many proposals which have been examined. If it proves to be a viable proposition, it might be the forerunner of a "model" stall universally acceptable by all concerned and one which will meet all current requirements. Unauthorised Street Traders In the 1967 Annual Report on the health of Westminster reference was made to the unsatisfactory situation then prevailing in regard to unauthorised street traders. The standard of hygiene found on most "hot dog" and itinerant ice cream vendors' stalls and vans continues to give no grounds to believe that the situation has improved. In the Report it was mentioned that the public ought not to be exposed to the health risks which can arise from this form of street trading, and so that the Council could exercise a more positive and effective control over these traders it would be helpful if the Minister concerned would consider implementing the powers contained in Section 21 of the Food and Drugs Act 1955 for the licensing by the City Council of all food stalls. This would in effect place the onus on the trader to inform the City Council of his proposals before commencing trading, and furthermore ensure that vehicles and equipment meet statutory requirements before coming into use. It would appear however, that the Government Department responsible do not favour a system of licensing of mobile food traders, as they take the view that the Regulations already in force are sufficient to ensure a satisfactory standard of hygiene. Of 24 cases for which summonses were authorised during the year, 12 were not served (one was for a joint offence, one summons was not served, and the other adjourned sine die), six have yet to be heard, and six were successfully concluded. Experience points to the Courts being more ready to deal severely with these itinerants if, in addition to the usual charges of absence of proper facilities, it is possible to prove unhygienic practices, but for this purpose it is frequently necessary to keep the trader under observation for a long period to obtain the necessary evidence, even for as much as a continuous period of 24 hours. The majority of the traders operate from bases outside Westminster and when the inspectors follow them in an effort to establish the address of the premises from which they operate, they sometimes find that no such premises in fact exist, the stalls being left in vans over-night and brought back to the West End the following night without the utensils or equipment having been properly cleaned. The many other duties devolving on the small number of inspectors in the Food Control Group, and the difficulties encountered in obtaining the required evidence, mean that the number of cases of the kind described which can be taken is limited, and the officers concerned can do no more than deal with as many of these traders as the pressure of other duties permits. Unfortunately, where one stallholder discontinues trading, either for personal reasons or following a successful prosecution by this Department, invariably another steps into his place, and so the cycle starts again. If the general public were more discriminating in their patronage of stalls, perhaps the more undesirable elements would cease to trade through lack of custom, though the fact would still remain that these itinerant traders are unlicensed to trade in foodstuffs, or any commodity for that matter. Perhaps if even only in a few cases the full penalties permitted by the Regulations were imposed the whole scene might dramatically change. Apart from other considerations in relation to the failure of the stalls and vehicles to meet the requirements of the Regulations, the greatest difficulty with street traders is to get them to equip their stalls with suitable sinks and wash hand basins conveniently accessible. It has been found that on the closed-in four wheel trolley type "hot dog" stall the hot water is obtained from a half size biscuit tin placed over a calor gas burner at the base of one of the end compartments, with a plastic bowl as a wash hand basin. The trader has virtually to get down on his knees to obtain water and after prolonged observations it is found that in practice the facilities, even if they exist, are not used. The wash-hand basin should be sited at or near the counter or working surface level, and connected to a waste tank to ensure the proper discharge of waste water. 31 Food Hygiene, etc.. Lectures The inspectors of the Food Section have continued to meet requests for lectures on subjects associated with food hygiene and food control. Some of these have been arranged on a sessional basis to ensure that new staff joining certain catering organisations are made aware of the requirements of the current Regulations in relation to the preparation and handling of food, and the importance of personal hygiene. One of the lectures given was to a group of Polish caterers who under the auspices of the British Council came to the Health Department as part of a programme to study matters associated with large catering undertakings and in this connection visited suitable establishments within the City. Although this type of work occupies the inspectors' time it provides a useful link between the Health Department and the firms concerned. This leads to improved co-operation at manager level in addition to the better standards of hygiene which result from the use of properly trained staff. Lectures have continued to be given periodically to student public health inspectors on all aspects of the work they will meet when undertaking duties in relation to food and drugs administration. Demonstrations have been given showing foods in various stages of deterioration and illustrated by colour slides. Tinned and packeted foods have been examined to study deficiencies in labelling and description, and case notes prepared by the Senior Public Health Inspector (Food Control) have been made available to assist the Students in their studies. The lectures have included visits to Covent Garden Market and food factory premises. Advice on Labelling Requests have continued to be received in the Department for advice on the labelling of various products intended for marketing in the United Kingdom. Some have concerned imported products and the range of commodities in question included such things as beer, processed peas, health foods, canned fruits, fruit and vegetables, evaporated milk, artificial sweeteners, low alcoholic beverages, etc. This work mostly devolves on the Senior Public Health Inspector of the Food Control Group, and each inquiry must receive careful attention for a great deal of capital outlay could be involved in the marketing of a new product. The Regulations and Orders operating in other countries usually differ from those which apply here, and tentative proposals for labelling various products are sometimes at variance with current legislation in this country. Requirements for the labelling of pre-packed foods are contained in the Labelling of Food Order, 1953, as amended. Following a review of food labelling and advertisements, the Labelling of Food Regulations, 1967, were introduced to secure clearer and more informative labelling and at that same time draft Regulations on Claims and Misleading Descriptions were issued. It is now the Government's intention to make Regulations in 1969 consolidating the 1967 Regulations and the draft Regulations, and when they come into force three years after the date of making they will replace the 1953 Order. When manufacturers and others submit labels to the Health Department for comment opportunity is taken to draw attention to any new provisions, even if they are not yet operative, so that if desired they may be embodied in the design and thus save the need to prepare and print fresh labels at a later date. In the course of examining labels, pictorial illustrations on certain foods have given cause for adverse comment during the year. In some instances items depicted in the illustration were not present in the food, or ingredients incorrectly stated. For example in the case of one soup mix, none of the vegetables illustrated on the packet was present in the pack. Some countries appear to permit a certain degree of licence in illustrations which manufacturers use to make the pack more attractive to the purchaser. In this country however illustrations are not permitted which could lead a purchaser to believe erroneously that a food product contains ingredients which are not in fact present. Section 6 of the Food and Drugs Act, 1955 makes it an offence to give with any food a label which falsely describes the food or is calculated to mislead as to its nature, substance or quality. During the year legal proceedings were instituted in respect of the label appearing on a jar of honey which indicated that it was a pure product derived from a certain area of the country from which it was exported. In fact it was a blend of honeys from all over the world. The case was further aggravated by the publication in a magazine of an advertisement which also falsely described the food. Legal proceedings were taken following approval by the Ministry of Agriculture, Fisheries 32 and Food, and although the Magistrate gave an Absolute'Discharge 25 guineas costs were awarded to the Council. The exploratory work to bring about this prosecution involved considerable investigation and enquiry; at the conclusion of the case discussions were in progress with the firm concerned regarding the introduction of a suitable label which would comply with current statutory enactments. One difficulty experienced in the labelling of pre-packed food is what the Order describes as the "appropriate designation". It requires that, except as respects intoxicating liquor pre-packed for sale as such, the statement on the label shall specify:- (a) in the case of a food consisting of one ingredient the appropriate designation of the ingredient, (b) in the case of a food made of two or more ingredients the common or usual name of the food and the appropriate designation of such ingredients (except when a standard is already prescribed). In the 1967 Regulations "appropriate designation" means, as respects any food, a name or description or a name and description, sufficiently specific in each case to indicate to a prospective purchaser the true nature of food to which it is applied. In these days when the manufacture and distribution of food is such a highly specialised industry involving tremendous capital investment, a central organisation to advise traders and manufacturers, both here and abroad, on labelling and allied subjects would provide a valuable service. Some years ago the then Food Standards and Labelling Division of the Ministry of Agriculture, Fisheries and Food provided such a service, and by securing the co-operation of many traders and trade organisations did much to encourage honest labelling and advertising. From 1953 this has devolved on food and drugs authorities, and every year sees the introduction of additional Acts, Regulations, Orders, Reports, etc. concerning foodstuffs on a scale and of such complexity that the work can only be satisfactorily carried out by specialist officers within the Department. Food Storage Improper storage can cause goods to go out of condition for various reasons. Moisture and too high a temperature increase the rate of oxidation which develops "off" flavours in fats. Heat can bring about discolouration, as when fat in chocolate comes to the surface and on cooling leaves a "bloom". A high humidity causes sugar in goods with a large sugar content to dissolve in moisture which forms on the surface; when this dries the surface becomes covered with glassy hard particles of sugar which are unsightly. If the store is damp, however, the sugar solution will form a suitable medium for mould growth, whilst yeast may cause fermentation with resultant "off" flavours. Odours and tastes from strong smelling goods are readily absorbed by some foods. The humidity of the air makes little difference with regard to insect pests but temperature control has a definite bearing on the problem as they develop slowly below 60°F. Inadequate ventilation and air movement will hasten spoilage in fruit and vegetables as the continuing respiratory processes evolve heat and carbon dioxide which must be removed. Storage injury can also occur in many foods if refrigerated at too low a temperature. It is essential to ensure that staff, particularly those in wholesale stores and supermarkets where responsibility is often delegated, are fully instructed in the correct storage of food so as to avoid spoilage by circumstances which could be avoided. Food Sampling and Analysis During the year a total of 1,985 (1,761) samples of foodstuffs were submitted to the City Council's Public Analysts by routine or on complaint. Of this number adverse reports were received in respect of 222 (262) samples and appropriate action was taken. The following notes on a selection of these are given as points of interest:- Sausage rolls purchased from a local baker were noted by the purchaser to have a peculiar taste. Inspection disclosed a dark coloured material in the meat filling which analysis showed was due to heavy contamination with iron. At the bakery a similar material was found adhering to the casting round the mixer spindle, and some of this had presumably become detached and mixed with the filling of the rolls. The complainant did not wish to participate in any further action, and the matter was dealt with by way of a caution. 33 After boiling a tinned steak and kidney pudding, an unpleasant odour and taste were alleged. A small piece of the contents was retained and submitted to the Public Analyst who reported as follows:- "The sample was made up of portions of coarse muscle fibre, cartilage and pastry. On boiling it up with water, the odour was not unpleasant, but was meaty and could have been slightly spicy. Chemical tests failed to reveal any toxic ingredient and there were no foreign substances. Feeding tests on experimental animals were quite satisfactory. If there was anything present with a strong smell, it might have disappeared between opening the can and receiving the sample, but tests failed to find any grounds for the complaint, and no harm would ensue from eating this steak and kidney pudding." This analysis is quoted in full to illustrate the extent of the tests which are made following a complaint of this nature. Not only is this a substantial public service, but also it serves to allay fears often expressed by members of the public concerning matters relating to food which is in fact quite sound and fit for human consumption, thus restoring confidence which might otherwise have been destroyed. A pint of Channel Island milk contained a cap from another bottle through some inadvertence at the filling plant. The bottling Company concerned have country-wide interests and in London alone fill some three million bottles of milk and cream daily. Milk distributors take elaborate precautions in an endeavour to eliminate the imperfectly washed bottle, or bottles containing "foreign matter", and employ "spotters" whose sole job is to examine bottles which have passed through the washing and sterilising plant and before they pass on the conveyor belt to the bottle filling room. Inevitably, due to the human element complaints do arise, but the percentage received by the Company is said to be less than four per million bottles. The bottles of course, on their passage through the plant prior to filling are washed and sterilised in several processes, and whilst this does not mitigate the seriousness of a bottle arriving in the hands of the customer in an unsatisfactory condition, it does ensure that the bottle is in a sterile condition and free from harmful bacteria before being filled with milk. The matter in question was dealt with by cautionary action. Margarine when opened by the purchaser was found to be affected with a dark stain which analysis showed to consist of growths of mould belonging to the genus penicillium. Enquiries at the retail premises—a firm with branches throughout the United Kingdom—and also of the packers, revealed that the margarine had been packed some six months previously. The defect appeared to have arisen through insufficient care being exercised in the storage of the particular pack. Others of the same batch number in stock were satisfactory. A cautionary letter was sent to the retailers. Bars of chocolate purchased from a confectioners turned out to be dummy bars used in window displays. The complainant had returned with them to the shop and alleged that on pointing out the error he received abuse. This Department hears from time to time of complainants who in good faith take back foodstuffs of doubtful fitness to the place of purchase only to be met with a storm of denial and recrimination which infuriates them and does nothing to remedy the situation. Complaints are received occasionally that rabbit instead of chicken has been served as part of a meal. It must escape the attention of persons who make these complaints that in recent years rabbit has been twice the price of chicken, and it is unlikely from a standpoint of economics alone that it would be used in substitution for chicken. Complaints are seldom now received alleging the use of horseflesh for meat dishes, but this relic of the wartime era still occasionally occurs. Complaints of foodstuffs affected with mould growth again occupied the usual amount of inspectors' time. This occurs particularly during humid weather, and with a little forethought and care, usually on the part of the retailer, many of the cases need not have occurred. One complaint related to a chocolate roll which was found to be five weeks old. There was obviously a gross dereliction in the stock control rotation, and the Company was cautioned that any further incident could lead to legal proceedings. A tin of sardines labelled as containing olive oil actually contained tomato sauce. Due to an inadvertence at the factory a batch of tins had been wrongly labelled. This is an unusual occurrence, and the Company took steps to avoid a repetition. A bee found baked in a loaf purchased at premises in Westminster resulted in an investigation at the bakery (not in Westminster) by the local authority of the area in which it was situated. Major reconstruction works had been in progress at the bakery for some months, and these had necessitated a large opening being made in the external walls to permit entry of building materials, 34 etc. This exposed the plant to an unusual degree and permitted the ingress of insects. Fly screens were in position to all windows and doors, and in addition apparatus for killing flying insects was in use. The Company were aware of their responsibility in the matter of the hygienic production of food and gave an assurance that every effort would be made to avoid any similar incident. A piece of wood found in a portion of french bread presented the Department with the difficulty of endeavouring to decide where the blame lay. The retail shop received the same type of bread from two sources and it was not possible to identify the sample with the particular supplier involved. Both bakehouses were inspected by the respective local health departments, and the proprietor of each was reminded of the care necessary in the preparation of food intended for human consumption. The fact that the bread might have been supplied by either of the two companies involved precluded the possibility of legal proceedings being taken against either one of them, and the alternative would have been to proceed against the retailer. As, however, no blame could be attached to him, this course of action was not considered appropriate and the matter was dealt with informally. Communications are often received alleging that articles purchased or served at premises are unfit, or contain "foreign material". In some cases these have been returned by the complainant or left at the premises, or even destroyed. Unless the offending article is examined by the public health inspector, or submitted for analysis, there is little the local authority can do other than inspect the premises concerned, and give a warning. This may give little satisfaction to the complainant, but formal action on the hearsay evidence of the complainant alone is virtually impossible. Complaints are sometimes received relating to alleged bad conditions or practices at premises where the complainant is an employee, and "is just about to leave". These are all investigated, but as might be expected they are not always justified. Apples were requested from a display in the front shop of greengrocer's premises. The assistant proceeded to serve the apples from a box at the back of the shop and the purchaser insisted that he asked for apples "from the display" in the front shop. On failing to get satisfaction he requested to see the manager, who also refused to serve from the display. The matter was reported to this Department. It is perhaps generally known that there is no provision in law which requires a trader to sell goods from a prepared display. If the customer is supplied from another source in the shop, and the goods are in no way inferior to those on display, and which were requested, this satisfies the requirements of Section 2 of the Food and Drugs Act, 1955, in that the goods sold were of the substance, nature or quality demanded. In this instance, a test purchase of apples on display was subsequently made and these were also served from the rear of the shop. Examination of the fruit showed it to be in all respects satisfactory, and to be of similar quality to that on display. Sandwiches purchased were alleged to contain glass but this was found to consist of magnesium ammonium phosphate commonly known as struvite. Struvite crystals frequently develop in products such as canned salmon, canned crab and other fish or marine products on keeping, and although not harmful may at first sight be mistaken for pieces of glass. Legal proceedings—Food and Food Premises The following matters resulted in legal proceedings being taken by the City Council against those responsible:— A rye loaf purchased at a large departmental store was found to contain a cigarette end. The bakers were prosecuted and a fine of £20 with £8 8s. Od. costs resulted. During the consumption of ice cream and chocolate sauce as part of a meal, the diner crunched on what she thought was a piece of ice. On closer inspection it proved to be a piece of glass. At the hearing the Magistrate granted an Absolute Discharge but awarded £5 5s. Od. costs to the Council. A further case of glass in food occurred at a restaurant. It was not possible to determine the source of the contamination but it was obvious that sufficient care had not been exercised in the preparation of the sandwich concerned. A fine of £10 with £2 costs resulted. Following a complaint alleging milk chocolate purchased was infested with insect larvae, a visit made to the retail premises confirmed that some 13 lbs. of stock was affected. This was seized and taken before a Magistrate under the provisions of Section 9 of the Food and Drugs Act 1955, and he ordered its destruction. At the subsequent legal proceedings a fine of £20 with £15 15s. Od. costs was imposed. A chocolate cake was thought by the purchaser to be "off". Analysis confirmed it had an odour 35 of moulds and that moulds were evident throughout the sponge layers. Legal proceedings against the manufacturers resulted in an Absolute Discharge and £5 5s. Od. costs awarded to the Council. A diner at a restaurant thought she noted a rat dropping in a dish of prawn curry and rice served to her. She retained a portion of the meal, and subsequent examination proved her suspicion to be correct. Investigation at the premises concerned disclosed infestation by rats, and no apparent attempt had been made to protect the food. Summonses were issued for: (a) failing to take reasonable steps necessary to protect food, and (b) selling food intended for but unfit for human consumption. Total fines of £50 with £5 5s. Od. costs resulted. A cockroach emerged with the sauce from a bottle used at the table in a restaurant. The bottle had been filled on the premises from a container. Some evidence of cockroach infestation was noted during a subsequent investigation which the proprietor had apparently ignored. A fine of £10 with £20 costs was imposed. The high costs in this case were related to the necessary attendance of a public health inspector formerly in the employ of the City Council, who at the time of the hearing had moved to another local authority in Scotland. A Cornish pasty purchased at a multiple catering concern was found by the purchaser to contain a screw. The manufacturers suggested this may have come from wooden packing cases at the factory. At the hearing the Magistrate imposed a fine of £20 with £5 5s. Od. costs. Pharaoh's ants were found in a ham and tomato roll. A minor infestation about which the proprietor declared he was unaware was found at the retail premises. However, had he displayed reasonable caution the infestation would have been noticed. The case resulted in a fine of £25 with £5 5s. Od. costs. During the year, proceedings were also taken in respect of certain catering premises where conditions of hygiene or other circumstances warranted legal action. Nine such cases were involved, and fines totalling £701 with £131 5s. Od. costs were imposed in respect of 71 summonses. Other cases for which legal proceedings had been authorised were pending at the close of the year. Sale of Drugs—Fraudulent Substitution—Legal Proceedings A complaint was made to the Health Department alleging that a firm of manufacturing chemists with headquarters in Westminster were supplying in capsule form a drug wrongly claimed to be "ampicillin", an antibiotic protected by patents and sold under the registered trade name of "Penbritin". The substance being supplied was alleged to be penicillin V, a different and cheaper antibiotic which would be unsuitable for conditions for which ampicillin would be prescribed. It was established that the defendants did not sell their products from their head office in Westminster but enquiries disclosed that the controlling director held a similar position with two retail pharmacies in Westminster. Formal samples of the capsules were taken on prescriptions from both these pharmacies. The canisters from which the capsules were dispensed were those of the pharmaceutical research laboratories where ampicillin is manufactured and bore their registered trade name. The samples were submitted to the Public Analyst. One was found to be genuine, but the other was penicillin V instead of ampicillin which was the drug demanded. Investigations following the receipt of this adverse report were extremely involved and covered several months of intense enquiry in an effort to trace the source of the capsules. Enquiries ranged from Durham to Dorset and involved co-operation with H.M. Customs in the search for possible suppliers abroad. They also included visits to capsule manufacturers and fillers. Summons were issued against the defendants for the following contraventions:— (1) Selling to the prejudice of the purchaser a drug not of the substance demanded by the purchaser. (2) Having in their possession for sale certain goods to which a certain trade mark was falsely applied. (3) That at their premises they did falsely apply a certain description to goods. The defendants introduced a firm of wholesale suppliers into the action under the provisions of 36 Section 113 of the Food and Drugs Act 1955 (in order to prove that the act or default was due to these suppliers). This wholesale firm, who supplied the patented drug in the normal way to retail chemists, also took advantage of the same provisions and brought the pharmaceutical research laboratories into the action as suppliers. After hearing the case for the prosecution, the Magistrate was satisfied that there had been a contravention in respect of the first summons (taken under the Food and Drugs Act 1955) but not in respect of the alleged application of a false description and trade mark (taken under the Merchandise Marks Acts). Following an adjournment a sample of the capsules, each of which comprised two halves, one black and the other red, was released in order that they could be examined by a firm of capsule manufacturers who were able to tell the Court that they had been made by them as two consignments, one of wholly red capsules and the other of wholly black capsules and that they had supplied these capsules to a firm associated with the defendants. The wholesale suppliers and the pharmaceutical research laboratories were thereupon dismissed from the proceedings. In giving judgment the Magistrate mentioned that the fraud perpetrated by the defendants, which included charging seven times the proper price, was a deliberate substitution of a drug not prescribed with a real possibility of serious harm to the patient. He imposed the maximum fine of £100. £300 costs were awarded to the City Council, and £1,500 and £1,000 respectively to the wholesale suppliers and the pharmaceutical research laboratories. During the third party proceedings, the Magistrate remarked that the defendants' action in joining the wholesale suppliers and later the pharmaceutical research laboratories in the action was bound to be costly if it failed. It had served to make apparent the wickedness of the defendants and those in control in making defamatory allegations which they knew to be untrue against a responsible firm of wholesalers, and challenging the competence and integrity of the pharmaceutical research laboratories. Following the completion of this case the Senior Public Health Inspector (Food Control) attended a Disciplinary Court meeting of the Pharmaceutical Society in order to give evidence in the Society's examination of the case. Ice Cream (Heat Treatment) Regulations 1959—Sampling During the year, 32 (101) samples of ice cream were submitted to the Public Health Laboratory for the methylene blue test. The reports classified the samples in provisional grades, based upon the method of examination recommended by the Ministry of Health, as follows:— No. of samples Grade 1 5 (40) Grade 2 9 (21) Grade 3 7 (7) Grade 4 11 (33) The methylene blue reduction test has been used for ice cream since March 1947, but it has not been made "statutory" and can only be taken as indicating whether further investigation is called for. The provisional grading is 1 if time taken to reduce dye is 4 hours or more, 2 for to 4 hours, 3 from ½ to 2 hours, and 4 for under ½ hour. Although sterile mixes are used by the majority of caterers the unsatisfactory samples, which were of soft ice cream, indicate improper hygiene. There still is much to be learned by those engaged in the cleaning procedure essential to the dispensing of ice cream in a hygienic condition. Every opportunity is taken of making these requirements known to the staff engaged in this activity, and the methods recommended by manufacturers of the equipment are demonstrated. Lack of general supervision by those responsible seems to be the basis of failure to produce satisfactory results. Milk and Dairies (General) Regulations 1959 Under these Regulations a local authority is required to keep a register of persons carrying on the trade of distributor of milk at or from premises within their district whether or not such premises are occupied by the distributor. At the 31st December 1968, 363 (367) distributors of milk were so registered. 37 Milk (Special Designation) Regulations, 1963 (as amended) The City Council is responsible for the granting on application of Dealer's Licences in relation to pre-packed milks sold under the special designations "Untreated", "Ultra Heat Treated", "Pasteurised" and/or "Sterilised". A Dealer's Licence permits the sale of milk both outside as well as inside the area of the licensing authority. The numbers of such licences current in the City at the end of 1968 were Untreated 74 (74) Ultra Heat Treated 108 (96) Pasteurised 348 (353) Sterilised 246 (246) Milk supplies—Brucella abortus Brucella abortus is the organism associated with contagious abortion in cattle and its transmission to man occurs through drinking raw milk. As almost the entire supply of milk sold and consumed in Westminster is heat-treated, no tests to determine the presence of this organism were carried out during the year Food and Drugs Act, 1955—Section 16 Under this Act no premises shall be used for:- (a) the sale, or the manufacture for the purpose of sale, of ice cream, or storage of ice cream, intended for sale, or (b) the preparation or manufacture of sausages, or potted, pressed, pickled or preserved food intended for sale, unless they are registered for that purpose by the local authority. Premises used wholly or mainly as catering premises, or as a school or club are exempt from these requirements and those used as a theatre, cinematographic theatre, music hall or concert hall, are exempt from registration in respect of the sale and storage of ice cream. The number of premises registered with the City Council at the 31 st December, 1968 is shewn in Table 26, page 91. The Liquid Egg (Pasteurisation) Regulations, 1963 There are no egg pasteurisation plants in Westminster, and any liquid egg used at premises in the City would be subject to supervision by the local authority at the place of manufacture or examined on import. Food Poisoning During the year, information was received of some 300 persons stated to be suffering from food poisoning. Not all were notified as such; in fact most of the incidents which come to the notice of the Health Department are never officially notified. Sometimes the investigation following the report of a single case discloses that others have also been involved. The difficulty of obtaining information regarding an outbreak is that by the time symptoms are experienced the sufferers have usually gone their own way, and much time can be expended in seeking details from them individually. Nevertheless this effort must be made for it may result in the prevention of a further outbreak from the same source, particularly where heat resistant Clostridium welchii is responsible. As will be noted in the following reports, this organism accounted for several cases during the year. Had the persons concerned with the preparation of the food been aware of the nature of the organism, and of the requirements of the Food Hygiene (General) Regulations, 1960 in relation to temperature control, it is conceivable that much of the illness might have been prevented. It may be of interest to recall that Clostridium welchii is a spore-bearing organism which lives in the intestinal tract of animals and man, and frequently gains access to raw meat and poultry before these products reach the kitchen. The danger from this organism is that in its spore-form it can survive cooking, and this is particularly so with large masses of meat and poultry as the heat does not then penetrate fully. If after cooking meat is allowed to cool slowly or is kept in a warm kitchen for any length of time, or is warmed-up later, or is subjected to a combination of these conditions, the surviving spores will germinate and lead to a rapid growth of the organisms. Illness results from dosage of the organisms beyond the resistance of the individual. 38 A summary of the food poisoning investigations made during the year is given in Table 27, page 91, and the following is a resume of incidents involving two or more persons: Three persons suffered diarrhoea and abdominal pain, one fairly severely, following a lunch which comprised hors d'oeuvres, roast turkey with gravy and vegetables. Two days later when information was first received in the Department, no food remained from the suspected meal. The turkey used had been purchased already cooked and was reheated prior to service. Clinical symptoms suggested Clostridium welchii food poisoning due to faulty technique in its preparation and service; the requirements of the Regulations in relation to temperature control associated with meat dishes were emphasised to the management. Another case involved nine persons who had chicken curry and suffered upset some 11 to 14 hours afterwards. Two days elapsed before a note of this case was received in the Department. A stool specimen received from one patient was positive for Clostridium welchii. Specimens of curry were negative, but it was probable that the chicken served on the day concerned did contain the organism and had been left in the warm kitchen long enough to produce the necessary toxin. The management was instructed regarding the need for rapid cooling following cooking, and thereafter refrigeration. Two persons had shepherd's pie for lunch and afterwards felt ill. Specimens from both patients, and a sample of shepherd's pie from a subsequent menu were positive for Clostridium welchii. The proprietress of the restaurant confirmed that the meat used was delivered and cooked on the day of service. Two further visits to the premises revealed no evidence to suggest that the technique employed in the preparation of the food was at fault. Two further cases of Clostridium welchii food poisoning were found to be due to inadequate temperature control. The food concerned had been kept in a warm kitchen overnight, thus providing ideal conditions in which the organism could grow. Although the patients had different types of meal, it is thought probable that a spoon used in serving the foods caused a cross infection. Appropriate advice was given to the management. After eating veal and ham pie in a restaurant at an exhibition two persons were taken ill. Faecal specimens from both were positive for Clostridium welchii. The pie consumed was part of a large one which produced 30 portions in all, but no information was received of others who attended the function being affected. The management of the restaurant were well aware of the Regulations regarding temperature control. None of the food remained at the time of the investigation. Clostridium welchii was again the organism which caused illness in two persons after they had eaten beef curry. No other food common to both had been taken during the previous 24 hours. The restaurant concerned was visited, and it was found that the cooling of the meat used took place in the vessel in which it had been cooked and that the time taken could be as much as 12 hours during which, under suitable atmospheric conditions, surviving spores could germinate and cause proliferation of the organism. Appropriate advice was given as to temperature controls to be closely followed. Two persons were taken ill with abdominal pain and diarrhoea after eating braised chicken at a restaurant which only did a lunch time service. Brown sauce served with the dish was prepared from a base kept in a stockpot which the chef agreed was kept unchanged for about a week, the heat being turned off at 3 p.m. each day. This was undoubtedly the cause of this typical Clostridium welchii incident and the chef was instructed in the proper procedure for preparing stock. Five persons forming a party were ill with symptoms consistent with Clostridium welchii food poisoning following a restaurant meal. The only food served in common with the various dishes ordered was a meat-based sauce. The chef claimed that this was made freshly every day but a subsequent visit to the premises disclosed that stock was kept overnight. It appeared that the sauce used in the meal had been previously prepared and improperly stored thus enabling the Clostridium welchii organisms to grow. The chef was instructed accordingly. Two other patients suffered symptoms of Clostridium welchii infection after consuming beef goulash which investigation revealed was made freshly each day. The kitchen staff appeared to be well informed on matters of hygiene and temperature requirements, and conditions in the kitchen were satisfactory. It was not possible to determine the circumstances which gave rise to this occurrence. Following a banquet some 147 members of the party were ill. The clinical symptoms were consistent with Clostridium welchii infection and this organism was found to be present in four of the five faecal specimens submitted. Notification was not received until four days after the occurrence. 39 and no food remained. During his enquiry the inspector was informed that 43 saddles of lamb were served of which 20 were cooked at 4.30 p.m. and the remainder at 7 p.m. Both lots were stated to have been kept on the hot plates until 8 p.m. and then removed to the service kitchen on the banquet floor for plating and serving. Whilst the temperature of the hot plates was around 220°F there is some doubt whether the temperature of the meat in the dishes stored upon them would have reached the required minimum. The other possible cause was the stock pot which provided the base for the sauce served with the meat. If either had been stored at a temperature below the statutory level, large numbers of organisms could have been developed. Of 570 persons who attended a banquet thirteen were reported later to have been ill, their symptoms being vomiting and abdominal pain. One patient was admitted to Hospital for a short while. The meal taken by those affected comprised fish with egg-based sauce, chicken supreme and vegetables. The sauce gave rise to suspicion as being the vehicle of infection, and during his enquiries the public health inspector was assured that it was only prepared approximately one hour before serving and any remaining following the banquet was discarded. The clinical symptoms were suggestive of Staphylococcus exterotoxin but there was no evidence of staphylococcus infection amongst the kitchen staff. The large quantity of alcohol consumed during the function may have accentuated the severity of the symptoms. Staphylococcus aureus was isolated in an outbreak affecting six persons. None of the food from the suspected meal was available but specimens of hollandaise sauce from a subsequent menu were positive for this organism which was also isolated from swabs taken from food handlers. Advice was given to the management on the difficulties associated with temperature control in the keeping qualities of this particular sauce, and to the necessity, if prepared in bulk, of any sauce remaining at the close of the meal being discarded. It should never be retained for longer than three hours. Another incident related to three persons who became ill—two had eaten chicken pie, and one shepherd's pie. Staphylococcus aureus organisms of a food poisoning type were found in a sample of frozen chicken pie and were also isolated from swabs taken from the chef's hands. Of two stool specimens examined, one was positive, but it was of a different phage type to that found in the food. At the time of the investigation minor burns were noted on the chef's hands, together with a small uncovered cut, but he alleged these had occurred after the investigation had commenced. Nursing staff who used the staff restaurant at a London hospital suffered symptoms of temperature, abdominal pain and diarrhoea. Investigation disclosed 48 cases of Salmonella enteritidis of which 27 were clinical cases and 21 were symptomless. These were discovered following the screening of all the nursing staff. There was a considerable variation in the incubation period. A questionnaire completed by staff members showed that whilst some cases followed a specific lunch, others also occurred after meals consumed at the restaurant on different days and involving more than one kind of dish. Many samples of food were examined but no positive results were obtained. The indications were that poultry was the most likely source of the initial infection and as the chicken served had been drawn on the premises it would seem that this could have given rise to a generalised infection. Information concerning the outbreak was not received in the Department until 10 days after the initial infection, and this delay prevented full evaluation of the circumstances of the case. Seven persons after eating oysters suffered abdominal discomfort with vomiting and diarrhoea which in most cases developed after an initial period of malaise, and in some continued for six days. Samples of oysters taken from a subsequent delivery to the premises were bacteriologically satisfactory. It was not possible positively to identify oysters with the upset suffered but they were the only food consumed in common and could conceivably have been the cause. Unsound or Unsaleable Food—Disposal The past two decades have seen an increase in the amount of food, both imported and home produced, which is marketed nationally with the result that there has been a corresponding increase in the number of requests for surrender certificates for goods which are no longer marketable. Under Section 73 (1) of the Public Health Act, 1936, a local authority may undertake the removal of trade refuse from premises within their district, and having so undertaken shall, at the request of the occupier remove such trade refuse. Westminster has entered into such an undertaking. Schedule 11 (Part II (7)) of the London Government Act, 1963, states that any person who has in his possession or under his control any article of food which is unsound, unwholesome or unfit for human consumption, may, by notice to the local authority, specifying and identifying the article, request its removal as if it were trade refuse. 40 In Westminster, a saving of the inspector's time is made possible by the introduction of a form of request for removal. On this the trader enters beforehand all relevant particulars relating to the article of food concerned and, because of the large quantity which is sometimes involved, a clause safeguarding the Council against any subsequent liability is incorporated. Food condemned or voluntarily surrendered is taken to the Council's Central Depot at Gatliff Road and removed by barge for disposal by controlled tipping at Pitsea. During the year some 183 (285) tons of unsold or unsaleable foodstuffs were voluntarily surrendered for disposal. Additives and Contaminants in Food Large scale food processing, with preservation as its prime purpose, has brought about considerable increases in the use of chemical additives with the consequent need of deciding what limits are acceptable before rendering the food unfit. Before any Regulations are issued the Ministry of Agriculture, Fisheries & Food have a Committee, known as the Food Additives and Contaminants Committee, to advise them and since 1950 some 30 reports have been submitted. In consequence Regulations are now in force controlling antioxidants, arsenic, artificial sweeteners, colouring matter, emulsifiers, stabilisers, fluorine, lead, meat treatment, mineral hydrocarbons, preservatives and solvents. These Regulations almost without exception empower the Public Health Inspector to deal with any food found on analysis to contain a non-permitted additive as unfit food under Section 9 of the Food and Drugs Act, 1955. In practice there is very little trouble with home produced foods as most manufacturers in this country now employ a chemist who, being aware of statutory requirements, undertakes tests to ensure that the suppliers of the raw materials maintain a specified standard of quality and that plant and process in the factory produce a standardised product showing the minimum variation from one batch to the next. In the case of imported foods however, overseas manufacturers are not always made aware of the standards applicable and as certain additives permitted abroad as colouring, preservatives, raising and similar agents are different from those allowed in this country contraventions sometimes occur. An importer is required to take reasonable steps to check that the produce he imports complies with the Act. Some are aware of their responsibility but others fail to take the necessary positive action to ensure that the regulations are complied with. Pesticides and other toxic chemicals The Council has continued to participate in the scheme for systematic enquiry through the medium of selective food sampling into the extent of contamination of foodstuffs by toxic chemicals and particularly organochlorine pesticide residues. The original exercise commenced in 1966 was completed during the year and sampling was discontinued pending a study of the accumulated data. During the year, twelve samples were obtained and submitted for examination. The results are shewn in Table 28, page 91. Imported Food Regulations 1968 These Regulations came into force on 1st August 1968 and contain measures for the protection of public health in relation to imported food. They replace the Regulations of 1937 and 1948. It is an offence to import food intended for human consumption which is unfit. Enforcement of of the Regulations is by the port health authority through an 'authorised officer' (i.e. public health inspector) at the port of entry or, in certain circumstances, by an inland local authority (such as Westminster) in cases where examination has been deferred until the food reaches the place of destination of which prior notice will have been given. If an authorised officer finds on examination any food which contravenes the Regulations he may by notice in writing to the persons concerned prohibit its removal from the place of examination until the food has been dealt with by a Justice of the Peace. The Regulations make provision for the submission of samples to the Public Analyst for analysis. With certain exceptions, the importation of meat products cannot be undertaken without an official certificate from the country of origin. This is recognised by the Ministry of Agriculture, 41 Fisheries and Food as guaranteeing that the meat or meat product has been prepared in accordance with satisfactory standards of hygiene. Meat products which do not satisfy these requirements can be re-exported but, if this is not done, destruction of the food may be required in such a manner that it will not be used for human consumption. Provision is made for a right of appeal by the importer. Nearly all imported food coming into Westminster is examined at the port of entry. However, there is a wharf in the City where large stocks, mostly of canned goods, arrive which have not been previously examined. On notification of such consignments being received from the port of entry, immediate inspection is made to ascertain suitability for human consumption. Export Certificates Applications for Certificates of Export received in the Health Department during the year in respect of foodstuffs to be despatched abroad numbered 22 (52). A food inspector inspects the consignment intended for export and where necessary submits a representative sample to the Public Analyst or Public Health Laboratory to ascertain the fitness of the product concerned before issuing the certificate. Trade Descriptions Act, 1968 This new Act to protect the consumer came into operation on 30th November 1968. It replaces and expands the former Merchandise Marks legislation dealing with misdescription of goods in general. Its purpose is to ensure, as far as possible, that people tell the truth about goods, prices and services, and it is important that the public should know what it does to help the individual—and where it leaves the individual to help himself. The Act inter alia does the following three things:— 1. Certain kinds of untrue statements about goods, prices and services become offences punishable by fines and imprisonment. 2. It makes local weights and measures authorities responsible for seeing that the law is observed. 3. It gives the Board of Trade power to define the meaning of words traders use to describe their goods and services. Enforcement of the Act is a mandatory duty of the City Council as a weights and measures authority and it has been decided that the weights and measures inspectors shall undertake the necessary work, with the exception of its application to foodstuffs. This will fall to the public health inspectors of the Food Control Group, since the Act has much in common with existing powers and duties under food labelling legislation. Some of the new provisions in the Act will be a useful extension to the powers already available under the Food and Drugs Act, 1955, particularly the power to seize and detain goods (including food) suspected of contravening the Act pending an investigation, and the maximum penalty of £400 on conviction for an offence under the Act. It is as yet too early to say just how much additional work will be involved but at the close of the year enquiries directly arising from the Act were already being received. Although the Trade Descriptions Act replaces the former Merchandise Marks Acts, the Section relating to Orders in Council contained in the 1926 Act concerning the marking of certain foodstuffs (e.g. apples, tomatoes, cucumbers, etc.) with the country of origin will remain in force until 30th November, 1971. Consumer Protection It may be of interest to note the principal legislation at present available for the protection of consumers in relation to foodstuffs, and also the officers of the City Council who have a responsibility for ensuring compliance with its requirements, viz:— 42 Principal Statutes Officers responsible Weights and Measures Act, 1963. (Method of Weights and Measures Inspectors (Public marking weights and measures of pre-packed Control). articles). Trade Descriptions Act, 1969. (Applying Weights and Measures Inspectors or other false indications or trade descriptions to designated officer of the Town Clerk's goods). Public Control Section; matters relating to food by Public Health Inspectors (Food Section of the Health Department). Public Health Act, 1936 (Abatement of Public Health Inspectors (Food Section of Statutory nuisance in food premises). the Health Department). Food and Drugs Act, 1955. (Hygiene, Public Health Inspectors (Food Section of adulteration, description, standards and the Health Department). labelling). It has been important to define clearly the division of responsibility for matters associated with consumer protection and this has involved close liaison between the weights and measures inspectors and the public health inspectors concerned. In the past the local Citizens' Advice Bureaux have provided a consumer protection and advisory service for the general public. The Council decided, however, that this should be extended by setting up a liaison Committee on which Public Control, the Food Section of the Health Department, and the Citizens' Advice Bureaux would be represented for the purpose of:— (a) providing publicity as to the assistance the Council and the C.A.B. can give to consumers; (b) collating and distributing information of consumer interest, and (c) ensuring that any enquiry or reasonable complaint falling within the definition of consumer protection is speedily directed to the source of information or action most likely to be effective. In this connection meetings have been taking place between the officers of the Departments concerned and representatives of the four Citizens' Advice Bureaux in the City. From the division of responsibilities in the Food Section between the Food Premises Group and the Food Control Group, which embraces consumer protection, it will be noted that the former specialises in matters to do with the hygienic construction, equipping, and general operation of food premises, including catering establishments, whilst the latter control the description, composition and conditon of food, including all facets of food trading in other than fixed premises. In order to give full coverage to these duties, the inspectors of the Section and inspectors and technical assistants from other Sections of the Department have throughout the year been undertaking late night duties. In the work of the Food Control Group this has included a special investigation in relation to specific foods and itinerant street vendors. In the Premises Group the arrangement has enabled frequent inspections to be made of club kitchens which operate only at night, and to examine them under working conditions. The visits however were not confined only to clubs—other catering establishments were visited and conditions of food handling and preparation examined where staff were working under the pressures of evening trade. The past year has seen a greater public awareness of the work of the Department in the field of consumer protection and in consequence the number of enquiries received will undoubtedly increase. This upward trend is likely to continue now that the City Council has implemented measures for giving greater publicity to its consumer protection service. Poultry Processing Premises There are no poultry processing premises in Westminster. Slaughter of Animals There are no slaughter houses in Westminster, but in the grounds of the Zoological Society of London for many years there has been a knacker's yard, licensed by the Council, where slaughtering takes place for animal feeding purposes. The necessary licence for this and for the slaughterman who works there were renewed during the year. 43 Applications are also received from time to time from the Royal Society for the Prevention of Cruelty to Animals for Slaughterman's licences to be issued to probationary inspectors. Twenty eight (15) such licences were issued during the year, and they are necessary in order that the inspectors concerned can commence training as slaughtermen and receive from the Society practical training and instruction in modern methods of humane slaughter. Diseases of Animals Act 1950 and Other Acts Relating to Animals By arrangement with the City Council the Corporation of the City of London acts for them on an agency basis in connection with duties under the Diseases of Animals, Riding Establishments, Performing Animals, Pet Animals and Animal Boarding Establishments Acts where veterinary services are involved. Officers of the Corporation undertake routine inspection of animals in transit and inspections for licensing purposes under the Riding Establishments Act, together with inspections specifically requested by the Medical Officer of Health of Westminster. All other necessary inspections are made by the public health inspectors. The Corporation issues any notices and advertisements which may be required under these Acts but licensing and registration of residents of premises in Westminster is undertaken by the City Council. Fertilisers and Feeding Stuffs Act, 1926 Four (6) samples were taken during the year, two being fertilisers, one a plant food and one a garden compound manure. Three were satisfactory but the report on the garden compound manure indicated that the insoluble phosphoric acid content was 1.1 per cent, more than the stated amount, although in the opinion of the Public Analyst this difference was not to the prejudice of the purchaser. The matter was taken up with the manufacturers who mentioned that this problem was one which was extremely difficult to solve. They dealt with large quantities of fish offal from fishmongers and various small fishing ports and this raw material varied in composition. It was composted with other organic matter and the resulting compound usually gave a reasonable average analysis. However.difficulty occurred when a batch being processed happened to contain an excess of material such as that received from a filleter which consisted largely of bones, this being a material which provided the excess of insoluble phosphoric acid referred to. Pharmacy and Poisons Acts 1933 and 1941 At the end of the year the names of 144 (143) traders were on the Council's lists of persons entitled to sell poisons included in Part II of the poisons list, the number of premises concerned being 195 (194). Rag Flock and Other Filling Materials Act 1951 Under the provisions of this Act various types of premises concerned with the upholstery trade and using or providing certain filling materials must be registered or licensed with the local authority. At the end of the year 24 premises were on the register and one was licensed for storage purposes. Use of short wave radio communication During the year, by the kind co-operation of the City Council's Director of Cleansing, the Food Section had the temporary use of a two-way radio hand transmitting and receiving set. Urgent calls received in the Health Department at City Hall during the day when the inspector in possession of the set was out covering other duties were passed to him through the Council's Radio Control Centre operated by the Cleansing Department. These related particularly to such things as food poisoning investigations, and complaints of unfit food or unsatisfactory premises. Having only a single set limited the calls to one inspector at a time but it added greatly to his mobility and saved much time. In addition the vehicle used by the Food Section for general duties, including the collection of unsound food, was fitted experimentally with a two-way radio which also operated through the Council's Radio Control Centre. It proved a very useful link between the officers on the van and their base and, like the hand set, enabled immediate and effective action to be taken on important matters which would otherwise have had to wait until the return of the inspector to the office at the end of the day. The prompt service thus facilitated has undoubtedly been welcomed by the public, and arrangements have been made to continue the scheme on a permanent basis. 44 The radio hand set was also used by the night duty inspectors and provided immediate communication between the Health Department duty officer in the City Hall and the duty inspector. It proved of particular value in connection with observation of the movements of itinerant "hot dog" vendors from the place of setting up the stall to the eventual point of trading, and assisted the inspector in passing instructions to his assistant at base in relation to the continuous chain of evidence required for an eventual successful prosecution. This experimental use of two-way radio in connection with Health Department activities has been so successful that arrangements have been made to instal the apparatus in a further four Health vehicles during 1969. Verminous Persons The cleansing of persons baths at Lissonia and Wedlake Street dealt with 826 (810) verminous persons: adults 629 (569)—men 507 (428), women 122 (141); children 197 (241)—boys 61 (43), girls 136 (198). Scabies The two establishments mentioned in the foregoing paragraph treated 422 (452) scabies patients: adults 243 (312)—men 129 (138), women 114 (174); children 179 (140)—boys 40 (32), girls 139 (108). Bathing Under the provisions of Section 43 of the London County Council (General Powers) Act 1953. sanitary authorities are empowered to make arrangements for bathing old people at their own request or with their consent. During the year a total of 525 (599) baths were given, 448 (486) to women and 77 (113) to men, under a scheme for bathing old persons at the Lisson Grove Centre. The old people are conveyed between their homes and the Centre by a Health Department vehicle. Special Laundry Service The Department continues to operate a service for laundering bed linen and clothing of the acutely ill, incontinent or very dirty and verminous old people. In certain cases a certificate is given by the Medical Officer of Health under the provisions of Section 84 of the Public Health Act 1936. The work is carried out by the staff of the Department's Laundries at 217 Lisson Grove and, to a limited extent, at Wedlake Street Baths. During the year, 10,875 (8,027) bags each containing about 10 lbs. of soiled linen were collected, laundered and returned to the owners. This considerable increase in the volume of work undertaken results from the installation of additional washing and ironing equipment at the Lissonia Centre during 1967, with benefit to the persons concerned. Disposable Incontinence Pads In response to Ministry of Health Circular 14/66, a service was inaugurated in May, 1967, for patients resident in the City, on written application by a general practitioner or district nurse, to be supplied free of charge with disposable incontinence pads and, where required, protective rubber pants. These are either collected by the patient or his representative from a stipulated convenient Centre, or, where necessary, delivered to the patient's home by a Health Department van. If difficulty is experienced at the home in disposing of the soiled pads, these are placed in disposable waterproof bags, collected by the van delivering new supplies and, through the kind co-operation of St. Mary's Hospital, Harrow Road, taken to the hospital for incineration. During the year under review 138 (104) new cases arose, making a total of 182 (104) persons who received deliveries of supplies in their homes, whilst 15 (37) arranged for them to be collected from the Centres. Establishments for Massage or Special Treatment The City Council is responsible for the licensing and regulation of establishments for massage or special treatment in the City. This matter is dealt with by the Public Control Section of the Town Clerk's Department but by arrangement enquiries and inspections with regard to apparatus, matters of technique, and the qualifications and suitability of persons employed upon the premises are undertaken by the Health Department. For these purposes a qualified physiotherapist is employed on a sessional basis and during the year she made the following visits: 45 Enquiries and inspections for reports on new applications for licences 48 (28) Special inspections and enquiries 123 (95) Routine inspections 63 (105) Establishments coming within this category range from premises giving facial beauty treatment, general massage, and certain forms of electrical treatment to those which provide Turkish and sauna baths and chiropody. The basic objects of the legislation are to prevent immorality and to ensure that the only persons employed to give other than non-remedial treatments are those who can show that by examination or experience they are suited to give such treatments. At the end of the year 317 (311) licences were in operation. Betting Shops These establishments are required to be licensed by the Betting Licensing Justices and applicants for such licences must by law submit copies of their application to the police and to the City Council in order that, if necessary, these authorities may raise objection to the licence being granted. During the year under review 49 (75) applications for betting shops were referred to the Health Department for reports as to sanitation and in connection with these the City Council lodged objection to 10 (31); 12 (16) applications were refused by the Justices. Employment Agencies Applications for licences to run employment agencies are dealt with by the Town Clerk who refers them to the Health Department for reports as to the suitability of the premises. A total of 981 (959) employment agencies are licensed by the City Council and during the year 302 (273) applications were referred to the Health Department and reported upon. 46 CORONER'S COURT AND MORTUARY The Coroner's Court and Mortuary is situated in Horseferry Road, S.W.1. The arrangements made by H.M. Coroner (Western District) for the reception at the mortuary of bodies under his jurisdiction in the City of Westminster and from the Royal Borough of Kensington and Chelsea continue to operate satisfactorily. The Greater London Council (which is responsible for the provision of Coroner's Courts) contributes to the City Council's costs in regard to the Coroner's accommodation and the City Council has a financial arrangement with the Royal Borough of Kensington and Chelsea in respect of bodies from that borough accommodated in the mortuary. The staff comprises the Superintendent, a First Assistant, four Mortuary Assistants and a cleaner. Details of the work of the Mortuary during the year are set out in Table 30, page 93. It will be noted that included in the Table are 12 cases awaiting proceedings at the Central Criminal Court, and in consequence no cause of death can be shown in respect of these. BURIALS AND CREMATIONS ARRANGED BY THE CITY COUNCIL Under the provisions of Section 50 of the National Assistance Act 1948, it is the duty of the City Council to cause to be buried or cremated the body of any person who has died or is found dead in its area if no other arrangements have been made for the disposal of the body. Where persons without known relatives die in the City, it is necessary to arrange their funeral and in certain cases to dispose of the contents of their homes. This is done in consultation with the Treasury Solicitor. Such action is necessary to avoid rent accruing, to release the accommodation for housing purposes as early as possible, and occasionally to enable the proceeds to be applied towards the cost of the funeral. During 1968 a total of 126 (107) burials or cremations were arranged by the Health Department as follows:— Burials at City of Westminster Cemetery, Hanwell 29 Paddington Cemetery, Mill Hill, N.W.7 12 St. Marylebone Cemetery, Finchley, N.2 7 Kensal Green Cemetery, W.10 1 Cremations at the City Council's Crematorium, East Finchley, N.2 77 At the request of a relative a burial was carried out at the Kensal Green Cemetery so that the body could be interred in an existing family grave. Requests for burial or cremation were received from the following sources: H.M. Coroner 63 Relatives or friends of the deceased 42 Hospitals in the City 21 Age Groups 0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 5 9 — — 2 — 3 1 10 2 15 3 18 7 18 12 9 10 — 2 CREMATION—WORK OF THE MEDICAL REFEREE The Medical Officer of Health is Medical Referee for the Council's Crematorium, which is situated at the St. Marylebone Cemetery, East Finchley. During the year, 1,832 (1,651) certificates authorising cremation were issued, and since December, 1937 when the crematorium was opened 35,699 cremations have taken place. 47 PERSONAL HEALTH SERVICES The quality of the personal health services depends on the number and calibre of the staff. Westminster is in many ways fortunate. Because of its central position and the great variety of field work available and the excellent opportunity for experience, many newly trained health visitors' district nurses and social workers are anxious to apply for posts in the City; and although the turnover is regrettably high it is possible to fill junior posts. It is much more difficult to obtain experienced professional field workers, especially psychiatric social workers. It is therefore essential to use the existing senior staff so as to put their special skills to full advantage and to delegate the less exacting duties to junior and less highly qualified workers. The need for in-service training is obvious and this takes much of the time of the senior supervisory staff. Regular courses and seminars are arranged and when possible promising members are sent on full time courses. During the year, a new post of Senior Medical Officer was created. The holder is responsible for reorganising the observation and handicapped registers, for supervising the clinical work in the child welfare centres, for the training of medical staff in developmental paediatrics and for developing co-operation with the hospital paediatric departments particularly in a new district assessment centre. An appointment system has been introduced in the child welfare clinics, and although it cannot be rigidly enforced, it does mean that every child can have a full developmental examination at the appropriate times. It is on this aspect of the work that the medical officers are mainly engaged, while advice on feeding, management and family problems is undertaken by the health visitors. With a large number of working mothers and many over-occupied and unsuitable homes, the day care of pre-school children presents great problems. The Council's day nurseries are fully used and have long waiting lists, there are not enough private registered day nurseries and child minders to meet the heavy demand. There are a number of unsatisfactory child minders: as a result many socially deprived children require stimulation and training before they are fit to attend school. It is hoped that the new powers under the Health Services and Public Health Act 1968 will enable the Council to improve the situation. Facilities for part-time care have improved as a result of an increased number of play groups and creches. The decline in the number of births continues and the birth rate for 1968 was 13.03, compared with 13.71 in 1967 and 13.89 in 1966. One effect is that there is no pressure on hospital beds and that every woman who wishes to or needs to have a hospital delivery can do so. It also means that there is very little demand for the Domicilliary Midwifery Service; only 57 cases were undertaken during the year. Fewer births also result in smaller case loads for the health visitors. They are, therefore, able to devote more time to families in need and to undertake a variety of other duties for families, for old people, for adolescents, and in health education. An increasing demand is made on the services of the social workers, and further specialised work is being developed to deal with drug abuse, unsupported mothers and young people who need advice and counselling. Although the number of mentally disordered patients in community care has not increased much the complexity of their problems has, chiefly owing to difficulties in obtaining hospital beds and in finding suitable accommodation and employment. The number of compulsory hospital admissions was 20 per cent, higher than in 1967. There is a need to expand this overburdened section of the Department which it is hoped to meet in 1969. Infant Deaths There were 49 deaths of infants under one year, giving an infant mortality rate of 15.41 per 1,000 live births. The details are summarised as follows: Total Male Female Legitimate Illegitimate 49 28 21 41 8 Age at death Total 0-7 days 7-28 days 1 -3 months 3-6 months 6-12 months 49 32 2 9 5 1 The causes of infant deaths in 1968 as set out by the Registrar General are shown in detail in Table 2, page 79. Seventeen deaths were due to prematurity or causes associated with prematurity whilst a further 18 were due to congenital malformations. 48 All except one of the first week deaths occurred in properly equipped hospitals with specialist paediatric care available. Seventeen of these babies were premature according to weight or period of gestation; five were under 2 lbs. and five between 2 and 3 lbs. Two of the mothers were unmarried and had had no ante-natal care. This might have been an associated cause of the prematurity. Ten babies had severe congenital abnormalities incompatible with life. These included one anencephaly, one hydrocephalus and four multiple malformations. In none of these was it possible to discover a causal factor either in the family history or in the mother's pregnancy. Two babies died of asphyxia; one of these was found dead at Victoria Station and presumably there was lack of proper care. Of the five other neo-natal deaths (7-28 days) three were due to congenital cardiac lesions, one had haemolytic disease for which it received exchange transfusion, and one died from gastroenteritis shortly after discharge from hospital. Eleven deaths occurred between one and six months. One was in a baby who had received an exchange transfusion for rhesus incompatibility, and one was attributed to haemolytic anaemia possibly associated with a defect in carbohydrate metabolism. Four died from severe congenital cardiac defects and one from brain damage associated with ante partum haemorrhage and prematurity. A further four died from acute broncho pneumonia or pneumonitis; two of these became ill suddenly and were admitted to hospital and died within 12 hours; the other two were found dead in their cots having been apparently quite well a few hours before. In all four cases the care of the babies had been good and the rapid development of fatal respiratory infection could not have been foreseen or prevented. Of the babies dying of gastro-enteritis, one, the infant of an elderly multipara, failed to thrive and was admitted to hospital as a possible case of malabsorption. The other was discharged early from hospital to the care of the family doctor and midwife; it developed persistent vomiting and died shortly after re-admission to hospital. The only death over the age of six months occurred in a baby with severe cystic fibrosis. Out of these 49 infant deaths therefore 36 were due to extreme prematurity or congenital abnormalities incompatible with life. All except one (the baby found at Victoria Station) received specialist medical and nursing care and it is difficult to see how any of their deaths could have been prevented. Health Centres The City Council has approved proposals for providing two Health Centres in Westminster in accordance with the provisions of section 21 of the National Health Service Act 1946. These two centres will be located in Lisson Green, N.W.1, and in Hall Place, Edgware Road, W.2. Designs for the Lisson Green Health Centre are being prepared and preliminary discussions have been held with all the interested parties. In regard to the Centre at Hall Place the Health Committee decided that, owing to the current economic situation, the proposal should be deferred for a period of one year. It was, however, agreed that works to strengthen the car park roof (on which the Health Centre would be built) should be carried out in order to facilitate the eventual construction of the Centre. The City Council's Ten Year Plan for the development of the local authority health services, approved by the Council in 1965 and submitted to the Ministry of Health, is continually under review and the various proposals will depend on the exigencies of the City Council's budgetary priorities and the current economic situation. Opportunity is being taken to review the provision which is made in various parts of Westminster for the local authority health services with a view to a comprehensive plan being prepared for the future location of health centres. Urban Programme The Ministry of Health in Circular 35/68 dated 4th October, 1968 and issued jointly with the Home Office and the Department of Education and Science, detailed the Government's proposals to initiate an urban programme of expenditure mainly on education, housing, health and welfare in areas of special social need. Westminster was included as one of 17 London Boroughs and 17 County Boroughs which qualified to seek immediate approval for proposals for additional expenditure in regard to nursery schools and classes, day nurseries and children's homes. 49 The Health Committee were concerned insofar as day nurseries were in the programme and the following projects in respect of the day care of children under five years of age were put forward for approval: (i) Day Nursery (50 places) Mileage Yard Site, Paddington. (ii) Day Nursery (50 places) in Paddington area, site to be found. (iii) Replacement (and enlargement to 60 places) day nursery for present St. Jude's Day Nursery, 88 Bravington Road, W.9. (iv) Playgroups The Government Circular prescribed provision for children whose health and welfare may be affected by lack of opportunity to play with others as one of the functions of a day nursery. This need is largely catered for in Westminster by pre-school playgroups and proposals for three further groups were submitted. None of these proposals was approved in the first phase of the urban programme. However, following a further joint Circular dated 7th February, 1969, the City Council agreed that these projects should be re-submitted and approval in principle was given by the Government for expenditure on the three further playgroups in the second phase of the urban programme. Organisation of the Social Services Green Paper In August the Minister of Health issued a Green Paper on the Administrative Structure of the Medical and Related Services in England and Wales. The Minister referred to widespread recognition that the structure as a whole should be radically reconsidered and submitted in the Green Paper "entirely tentative" proposals for a long-term re-organisation. It was stated that no decision would be taken by the Government until representatives of the authorities concerned and of those providing services had been consulted and proper account had been taken of their views. The scheme put forward was that some 40 to 50 Area Boards, responsible directly to the Minister, should be set up to replace and undertake the functions of the National Health Service Executive Councils, Regional Hospital Boards, Boards of Governors and Hospital Management Committees and also to undertake the community health service provided by the major local authorities. The City Council submitted to the London Boroughs' Association the following observations on the proposals contained in the Green Paper: (a) The establishment of Area Boards appointed by and responsible to the Minister would not be a democratic arrangement and should be resisted. (b) It is noted that the Medical Officer of Health would serve the Area Board while the social services would be under the care of another authority. This would be regrettable and would create difficulties. (c) The administration of personal services from Area Boards will be liable to result in the loss of local contacts and the interest of local organisations which play such a useful part in this field. This would not be to the advantage of the local population. Subsequently the Minister indicated his intention of issuing a further document taking account of the observations he had received from all the bodies concerned. Report of the Seebohm Committee In 1965 the Government appointed a committee on Local Authority and Allied Personal Social Services ("the Seebohm Committee") "to review the organisation and responsibilities of the local authority personal social services in England and Wales, and to consider what changes are desirable to secure an effective family service". This Committee's report was published in July, 1968, and the City Council has taken note of its recommendations, whilst at the same time bearing in mind the Government's expressed wish that no action should be taken by local authorities to anticipate any conclusions it may reach when it has completed its study of the Report. The City Council will review the position of the Health, Welfare, and Children's Departments when the Government makes known its conclusions on the recommendations of the Seebohm Committee. 50 THE WORK OF THE HEALTH VISITORS (Miss E. A. Evans, H.V., S.R.N., S.C.M., Chief Nursing Officer) This advisory service is available to all members of the community, provided by trained health visitors, assisted by trained nurses and clinic auxiliaries. Each health visitor is responsible for a geographical area and we are fortunate they are based at Welfare Centres throughout the City, making the service more easily available to members of the public, to colleagues from all other departments and to social workers from statutory and voluntary organisations. As always, one of the most important functions of this service is the home visiting carried out by the health visitors, which brings advice and support to members of the community in their own homes. It results in the health visitor becoming a well-known figure, whose skills and knowledge are provided on the spot, and when these services are needed most. She herself also benefits by this as she is able to build up her experience and knowledge of community needs within this area, making the service more useful and practical. A continued difficulty is the amount of movement of families from one address to the other; this can be within the same house, or street or anywhere in the City, to other authorities or to any other part of the country. To ensure an adequate follow-up in these cases is well nigh impossible and families who are at risk socially and medically and who are in need of special care are very easily lost sight of. Many families need intensive help, and co-operation with social workers who are able to provide it and this is sought by the health visitor. In such cases it is almost always necessary to continue contact to support the family and indeed the social worker. Small amounts of material help can be given, often successfully preventing a crisis in the family, but it needs a good deal of understanding and sympathy on all sides and co-operation from the family concerned for success. Of course, there are many successes, but equally many failures, and it is these who require the continued patience and understanding and much prolonged hard work to reach anything like a solution. It is very obvious to those working closely with the health visitors that social problems continue to be one of their main concerns. In view of this, the preventive role should not be overlooked, and advising the normal happy family is equally important. First visits to the mother and young baby of 10 to 14 days old is a unique opportunity for advice on good child care, diet, hygiene and general management. Helping to promote happy, satisfying mother and child relationships, which is the most important period in the infant's life, emotionally and mentally, is one of the health visitor's most vital functions. It is this experience, which provides the unique knowledge of normal development of the child that helps her to recognise deviations from normal, and give special support to mothers who need it. Health visitors undertake urine tests on all babies between the ages of six and eight weeks either at the infant welfare clinics or at the children's homes. Where a phenistix test gives a doubtful reaction the ferric chloride solution test is carried out. During 1968, 2,803 (2,814) tests were made; no positive reaction was seen. It is noted that 530 babies moved out of the City before tests could be made. Infant welfare clinics, ante-natal clinics, family planning clinics, cytology clinics are held at M. & C.W. Centres and health visitors join in their organisation, and co-operate with the medical officers. These centres are a local land mark and mothers know information and help is available to them whenever they care to attend. The clinics are friendly and informal. Health Education This also is an important part of the programme of work, and a lively and active interest is shown. Education Sessions are held at many of our clinics, and films, discussion groups, mothers' clubs, sewing classes, mothercraft classes for expectant mothers with occasional creches for minding the children of mothers who attend, are regularly organised. Regular commitments are undertaken at schools, e.g. The London School of Fashion where a series of discussions and talks were given to the students, the regular session at College Park School for E.S.N. girls, and many other schools in the City who co-operate and ask for health education sessions with the nursing staff, given regularly and as a continuing programme to the benefit of the students. Visual aids are provided on many topics and frequent changes of display arranged to provide variety. One health visitor participated in a Careers Conference at Paddington and Maida Vale High School, and talked about nursing and health visiting as an interesting future career. We have helped with a Child Care Course at the Sarah Siddons School, arranging suitable visits for the pupils to the day nurseries. Another health visitor is now helping with the nursery nurse training at 51 Southwark College of Further Education, and is responsible for the health content of the syllabus of training. Talks have been given by senior nursing staff to professional and other groups during the year. Programmes and individual lectures for in-service training have been carried out by them, and they have frequently taken part in the London Boroughs Training Committee Courses. Refresher Courses An up-to-date programme is maintained and all nursing staff are given opportunities to attend courses and lectures planned to keep them fully aware of changes and progress on all aspects of their work. Recruitment and Training Six health visitor students sponsored by the City Council were trained in 1968. In addition nursing staff have taken part in field work training for students from other authorities, and six field work instructors have been appointed for this work. Group Practice Attachment This interesting development has been extended to include two more health visitors, who are now working with two groups of doctors. We now have four group practice attachments, which appear to be working very well, to the benefit of the patients. The general practitioners are very appreciative and the health visitors are happy with the arrangements. Staff One Day Nursery Matron retired after almost 20 years service; she was very much missed, but her successor has been appointed and has settled into the service very well. Nursery nurses continue to be in very short supply; it is the one field where there is a constant shortage of trained staff in spite of our efforts to maintain the establishment. School Health Service Health visitors as well as other nursing staff take part in this activity, where regular medical examinations and surveys are undertaken. Close co-operation with head teachers and medical officers is encouraged, and in Infant and Junior Schools there is the advantage that many of the children are already well known to the health visitor from her contact with the child in its own home, thus providing continuity. Encouragement and stimulation for a health education programme is the aim of senior nursing staff, with success in some measure at many of our schools. Visitors to the Department Student nurses from all the hospitals have visited Centres and been given talks and information on the work of the Department. Social workers, house parents, child care officers and overseas students have also attended and a total of 580 passed through the Department this year. DAY CARE OF CHILDREN UNDER 5 YEARS The Day Nursery Service The eight day nurseries in the City continue to provide day care for 450 children, who are in special need. Apart from children who need care so that a single parent may work and maintain them at home, children whose environment does not provide the opportunity for healthy normal development, or who have social, physical or mental handicaps are selected, and careful consideration is given to each individual child. This service enables many children to be brought up at home who would otherwise need full residential care. Close co-operation is maintained between matrons, health visitors and senior nursing officers, to ensure those who need this care are brought forward. Five of the nurseries are registered for training for the Nursery Nurses Certificate and last year nine nursery students qualified. Much effort and interest is shown by all staff in ensuring a high standard of care and to provide interesting and stimulating equipment. Continued contact is maintained with the Colleges for Further Education who assist us in this training; this provides much interest and enables nursery staff to keep abreast of the latest developments, to the benefit of the children who attend. 52 There are special units for handicapped children in three of the nurseries providing a total of 24 places and extra staff are specially trained for this work. The staffing of the day nurseries continues to present serious difficulties. Although as mentioned earlier five of the nurseries are approved by the Ministry of Health for the training of nursery nurses, owing to the many less arduous and better paid opportunities, often outside the expensive central area of London, which are available to these trainees few remain in the Council's service after the end of their training period. Nurseries and Child Minders There are 23 private day nurseries in the City providing 630 places and these are regularly visited and supervised by the City Council's medical officers. Most of these private nurseries, however, provide only part-time care at morning or afternoon sessions and do not fulfil the need of the mother who wishes to find full-time day care for her child. Supervision of child minders is carried out by health visitors, who offer advice on diet, care, and play equipment to the child minder. They visit child minders who care for two or more children, and give as much support and help as they do in the child's own home. Because of the pattern of the work carried out, the health visitors become aware of illegal childminding and report the facts to the Medical Officer of Health. This continues to be a serious problem in the City, and is a constant source of worry to them, because of the inadequacies in the quality of care offered by such child minders. Proceedings were taken during 1968 against two women in respect of illegal child minding (see Table 29, page 92). Twenty women are registered under the Nurseries and Child Minders Regulation Act 1948 to mind a total of 90 children. These women are visited regularly by a senior nursing officer and health visitor to advise in regard to the general care of the children, meals and play activity. Thirty-two women each minding no more than two children are voluntarily registered with the City Council and supervised by health visitors. Playgroups Medical Officers and health visitors supervise private play groups, of which there are nine in Westminster, with provision for 200 children between the ages of two and five years. There are also 29 playgroup or occasional creche sessions held each week in the City Council's child welfare clinics. New Government legislation under the Health Services and Public Health Act 1968, has amended the Nurseries and Child Minders Regulation Act 1948, to enable local authorities to improve and maintain a higher standard in the existing private nursery and child minder service. In addition to the child minders minding more than two children already registered with the City Council, under the amending Act anyone minding one child or more in her own home for reward will need to apply for registration and will be supervised by the City Council's officers. In December, 1968, a comprehensive report on the new legislation and its effect on the Department's work was presented to the Health Committee, and new administrative procedures to meet the anticipated considerable increase in work in the future have been formulated, including the provision of additional staff. VACCINATION AND IMMUNISATION Vaccination and immunisation is provided for all children under school leaving age either at the child welfare clinics, in schools or by family doctors. Parents are continually reminded of the importance of having their children immunised, but in spite of increasing efforts on the part of health visitors there was no increase in the number of children who completed immunisation at the welfare centres in 1968. Smallpox vaccination In accordance with instructions issued by the Ministry of Health in June 1967, that the issue of smallpox lymph was to be the responsibility of the Boroughs, this service has been carried out and approximately 16,000 doses have been issued to doctors, hospitals and welfare centres. Emergency supplies of lymph are kept at Middlesex, St. Mary's (Harrow Road) and Westminster Hospitals, where they can be obtained by local medical practitioners at weekends or Bank Holidays. The Health Department Duty Officer at City Hall can also issue lymph if the need arises outside normal office hours. 53 Smallpox vaccination is also available in certain instances in the Medical Suite at City Hall for adults residing or working in Westminster and 150 persons were vaccinated during 1968. Measles vaccination In April 1968, measles vaccine was made available by the Ministry of Health for all susceptible children up to and including the age of 15 years—priority being given to children in the age group 4-7 years. A campaign was launched in Westminster and parents of all children attending Infant and Primary schools, who were not known to have already had natural measles or measles vaccination received an invitation to have their children vaccinated at special sessions arranged at their school. The result was very disappointing. Out of 5,764 letters sent out only 2,986 replies were received. Of these, 2,116 children had already had measles or measles vaccination, 78 were to be vaccinated by their general practitioner and 82 had contra-indications. The number of children eventually vaccinated at school was 710. In August the age range was extended to include children aged 1-4 years and a further 658 were vaccinated. It was proposed to start measles vaccination for the 8-15 years age group at a later date when vaccine was more plentiful. Influenza vaccine In view of the expected epidemic of Hong Kong influenza the Council obtained sufficient vaccine to protect the staff in key positions such as midwives, district nurses and staff of residential nurseries. Vaccination against Anthrax In 1966 the Secretary of State urged authorities within whose areas there are establishments which may be handling potentially infected raw materials to make arrangements under Section 26 of the National Health Service Act 1946, for vaccination against anthrax, and issued his approval under the Act to the making of such arrangements. Although there are no establishments within the City of Westminster in which workers are particularly at risk from anthrax, it was felt that there may be residents working elsewhere who may need protection and seek this from their family doctors. The City Council at its meeting on 17th March, 1966 decided to make provison for vaccination against anthrax under this scheme; vaccine is supplied free, on request, to general practitioners and factory doctors and the customary payment is made to any general practitioner providing a record of anthrax vaccination. No application for vaccine was received during 1968. HANDICAPPED CHILDREN It is axiomatic that early detection of handicap is necessary to successful treatment, and it is for this reason that "At Risk" (Observation) registers are maintained. Nevertheless the Medical Officer of Health is concerned with the enormous bulk of work, much of it abortive, created by the maintenance of such a register. A survey recently undertaken in the Department has led him to question the advantages of the existing system. During the years 1963 to 1967 some 500 names were added to the observation register each year; that is, 14 per cent, to 15 per cent, of live births. Near the end of 1968 over 1,700 entries were examined and the following facts emerged: (1) The number of handicapped children born in each of those years was fairly constant, being about 60 a year. This figure includes those with delayed development, many of whom later progress to everage or low average attainment; the number with a substantial degree of handicap is therefore lower. No definite figure can be given since prognosis is not yet certain in all cases. (2) Of the 60 or so handicapped children notified each year, about 70 per cent. were first reported by hospital paediatricians or clinic medical officers; of the remainder, a few moved into the area after birth, some were reported by the Children's Officer and some were known from birth records to have a congenital abnormality. It seems clear therefore that if developmental examinations are carried out on all children attending welfare clinics and if good lines of communication exist between local consultant paediatricians and 54 the Medical Officer of Health, there is no need for an observation register. Its maintenance is an expensive and cumbrous procedure with, as has been said, a great deal of abortive work. A valuable lesson has however been gained from the observation register system—all children, and not merely a selected group, need regular developmental examinations. This is becoming an established procedure in the Council's clinics. To complement this service, the Medical Officer of Health has arranged for members of his medical team to attend the course in developmental examination run by Dr. Ruth Griffiths or the course in developmental paediatrics arranged by the Society of Medical Officers of Health, as opportunity arises. Medical Officers are encouraged also to attend shorter courses dealing with a specific handicap, e.g. deafness, blindness, etc. Most of the City Council's full-time medical staff have attended the standard course for ascertainment of educationally subnormal children and have been approved for this work. The special units established in three of the Council day nurseries (Katharine Bruce, Bloomfield and Bessborough Street) together form a most valuable adjunct to the service for pre-school handicapped children. Children are admitted to a special unit for a period of systematic observation, assessment, and to give the mother some relief from 24-hour care. Special clinics for assessment and parent counselling Assessment clinics for pre-school children with suspected or known handicaps have continued to be held at welfare centres in the City. Parent counselling is an integral part of their function. During the year an assessment centre was established at Paddington Green Children's Hospital, staffed by Dr. P. J. N. Cox, Consultant Paediatrician to the hospital, and by one of the City Council's senior medical officers. This has the obvious advantage of providing supporting diagnostic facilities on the spot. Since the hospital catchment area extends beyond the City boundary, not all of the children seen are Westminster residents. The majority, however, are, and this clinic is providing a valuable service. The Medical Officer of Health would like to express his gratitude to the hospital paediatricians, not only for making this clinic possible but also for their generosity in so readily sharing their clinical knowledge with the City medical staff concerned. Transport Children attending the special unit at Katharine Bruce day nursery are transported to and from the nursery; those attending the other two special units (which have a more local catchment area) are transported if necessary. The I.L.E.A. provides transport for all children attending special schools, and, where needed, for handicapped children attending ordinary schools. HOME NURSING Comprehensive nursing care is given in the homes of the sick, elderly and disabled, by skilled district nurses and State enrolled nurses, assisted by bathing attendants. Patients are referred mainly from hospitals and general practitioners. Although there is good co-operation between the nursing staff and the many general practitioners in the area, closer contact is to be encouraged. With the use of modern disposable equipment and the loan of necessary nursing articles, there are very few nursing treatments which cannot be carried out at home, and many unnecessary journeys to hospital can be avoided. Also, extremely ill patients are successfully cared for in their own homes by the district nurse helping the family, and calling on the aid of other supportive services. Particular help for day and night nursing in special cases is obtained through the Marie Curie Memorial Fund, which has been greatly appreciated during the year. Organisation The whole area is covered by nursing staff working from two centres, in the North from 117 Sutherland Avenue, W.9, and in the South from 36 Great Smith Street, S.W.1. 55 All requests for the service can be received throughout the 24 hours at City Hall, by the Nursing Officer during the day and by the Duty Officer at night and weekends. Visits are normally made to patients between 8.30 a.m. and 9.30 p.m. A clinic is held at 117 Sutherland Avenue from 4.30 p.m. to 7 p.m. Monday to Friday for ambulant or working patients requiring injections or other forms of nursing treatment. Accommodation This is available in the Nurses Home at 117 and 90 Sutherland Avenue. A resident housekeeper was appointed in July 1968 and is responsible for all the domestic arrangements. Training Nine State Registered Nurses completed their district nurse training during the year, five of whom were in the last group to gain the Queen's Certificate of District Nursing. Since May 1968 the students receive their theoretical instruction at Chiswick Technical College and their practical training as before, qualifying after examination for the National Certificate in District Nursing. Three student nurses from the Hammersmith Hospital Integrated Course undertook five weeks' district nursing as the first part of their training, to be completed in 1970. Five State Enrolled Nurses received the Queen's Certificate for the Inservice Course of Instruction which they completed during the year, and nine pupil nurses from Westminster Hospital spent two weeks working with district nurses as part of their S.E.N. training. The bathing attendants employed in the Home Nursing Service enjoyed six study days arranged for them at Sutherland Avenue. Observation Visits Eighty-eight student nurses from six hospitals and nine medical students spent a day observing the work of district nurses. Refresher Courses Appropriate refresher courses attended this year by district nurses included Practical Work Instructors Courses and a Management Course for the first time. Paediatric Home Care Unit A district nurse works full-time with the St. Mary's Hospital Home Care Unit, visiting sick children in their homes. Royal Household The district nurse resident in Buckingham Palace Mews to provide nursing care for members of the Royal Household, received her long-service badge from the Queen Mother in November, for 21 years continuous district nursing service. City of Westminster District Nursing Association This Association continues to administer various charities in the area, which are of particular benefit to the sick and the elderly. Certain amenities for patients and staff are available from Association funds. DOMICILIARY MIDWIFERY The City Council provides a domiciliary midwifery service to meet the needs of mothers who wish to be confined at home, and for those who are confined in hospital for medical reasons but whose social conditions permit planned early discharge. The Westminster Hospital provides the service on an agency basis for the S.W.1 area and the remainder of the City is covered by four full-time domiciliary midwives employed by the City Council. Training Two pupil midwives from St. Mary's Hospital, Harrow Road, completed their Part II midwifery training in the Westminster area. One midwife is an approved teacher and a revised training has now been approved by the Central Midwives Board requiring only six home confinements and more public health observation visits during the three month's district experience. 56 Nurses from the Middlesex Hospital spend a day working with a domiciliary midwife as part of their obstetric training. LOAN OF HOME NURSING EQUIPMENT The City Council's scheme for the free loan of nursing equipment for use in the home continues to operate satisfactorily and requests from Westminster residents for varied items of equipment are met as far as possible. There is no doubt that this service provides considerable assistance to relatives who have the difficult task of nursing patients who would otherwise be occupying a bed in hospital. During the year the pattern of items needed followed the same trend as in previous years. The City Council is grateful to the British Red Cross Society (Paddington, St. Marylebone and Westminster Divisions) for acting as agents in issuing smaller items of equipment. Relationships with the professional and lay bodies in the field continue to be very satisfactory. HOME DIALYSIS The City Council was glad to assist with the installation of an artificial kidney machine at the home of a 17 year old girl living in the Pimlico area. At the request of the Home Dialysis Administrator, Royal Free Hospital, North Western Branch, certain plumbing, electrical and other works were carried out in the girl's bedroom to enable the hospital equipment to be installed and to function satisfactorily. The then Ministry of Health has given general approval for expenditure on works of this nature to be incurred by a local health authority and this case is an example of the rapid and successful co-operation which can be achieved between two branches of the Health Service. It is understood from the hospital that home treatment is proceeding satisfactorily and that the girl is able to follow her normal employment. FAMILY PLANNING The National Health Service (Family Planning) Act 1967, conferred on local health authorities a general power to provide either directly or through other organisations a service to advise on contraception and to supply appropriate contraceptive substances and appliances. In compliance with recommendations of the former Minister of Health, the City Council approved as from 1st April, 1968, a service to be available to any person, irrespective of marital status, who required family planning advice on medical or social grounds. A service was already provided for Westminster residents recommended for family planning on medical grounds and this has accordingly been extended to the unmarried. In such cases both advice and supplies and appliances are now free. A full service has also been provided for Westminster residents who seek advice on social grounds, but while advice is free for these patients a charge is made for supplies and appliances. The City Council has increased the number of its own clinics while still using the Family Planning Association as its agents; facilities are also granted to the Catholic Marriage Advisory Service. A special service is also provided for women who find it difficult to attend one of the regular clinics. This has replaced the former domiciliary family planning service run by the Marie Stopes Memorial Foundation on behalf of the City Council. The health visitor in whose area the mother lives visits the mother in her own home and then arranges for transport for her to one of the clinics, often collecting her and arranging for the children to be cared for. The new arrangements are working satisfactorily. To provide help for the young unmarried person a special advisory clinic has been set up where a doctor and social worker deal with the problems of young people. Any person male or female under the age of 23 can visit the clinic for advice. More detailed reference is made by the Principal Social Worker later in this Report to this service which it is felt is doing valuable work in this field, both in helping young persons and as a preventive measure in combatting delinquency and promiscuity. Demand for the family planning service has increased considerably during the 9 months from 1st April and it is expected that this upward trend will continue steadily during 1969. 57 CERVICAL CYTOLOGY The number of new patients seen in 1968 at the four weekly cervical screening sessions totalled 2,295, an increase of 287 on the previous year; of these 600 were seen at Ebury Bridge, 595 at Harrow Road, 594 at St. Marylebone and 506 at Hallfield. In addition, 135 women had a further cervical smear examined, increasing the number of screening examinations carried out during the course of the year to a grand total of 2,430. Eight of the women seen for the first time proved to have a pre-cancerous condition, and it is interesting to note that three of these were under the age of 35. Arrangements for the necessary treatment were effected promptly through the general practitioners concerned. Particularly heartening was the case of the 29 year old mother with one child, who had been unable to conceive again for some years. She visited one of our clinics in January, when a cervical smear was found to be positive necessitating admission to hospital the following month for a small operation which was successful in removing the abnormal tissue. Before the end of the year this mother had had another child and all cervical smears taken since the operation had proved negative. Attendance at a cytological clinic frequently acts as the spur to do something about gynaecological ailments producing symptoms of which the individual has often been aware for some weeks or even months. Thus, in 1968, no fewer than 723 of the 2,295 new patients were advised to consult their doctors about minor infections or local abnormalities detected incidentally. This included 17 women who were found to have abnormalities of the breast on routine examination. In summary, during the year approximately one woman in every 300 attending a City Council screening clinic for the first time was found to have a positive cervical smear, one in every three women had to be referred to her family doctor, and one in nine had to be requested to return for a repeat examination. From the wider "well woman" standpoint screening proved productive irrespective of age, marital status, or size of family. The commonest incidental findings comprised Trichomonas or Monilia infections, cervical erosions, cervical polyps, uterine fibroids, and various forms of uterine prolapse. Screening facilities for the general public are made available in Westminster to all women under the age of 65 who live or work within the City boundaries. The policy of encouraging office workers to be screened is strikingly endorsed by the results achieved in the case of one national concern. An analysis of 641 employees of this body who attended for screening showed that three had positive cervical smears, and a further 167 needed to be referred to their family doctors in relation to other findings. Notwithstanding the results achieved in 1968 there can be no grounds for complacency. Indeed, although the screening sessions arranged at the Westminster Council House Extension (St. Marlyebone) and the Ebury Bridge Maternal and Child Welfare Centres continued to be in great demand throughout the year, being particularly conveniently situated for office workers, an appreciable fall in attendance occurred in the autumn at the clinics held at the Hallfield and Harrow Road Centres. This decline took place in spite of the liberal use of posters and leaflets in public libraries, maternal and child welfare centres, and the staff rooms of private and public organisations. Whilst recognising that an increasing number of women were being screened by their own general practitioners, or during attendance at hospital outpatient departments or family planning clinics, as well as in hospital wards, there could be no doubt that many had not yet taken advantage of this new preventive weapon. To this end further encouragement of the public in general, and of the local resident in particular, seemed desirable, and by the end of the year plans were already afoot for an intensive publicity campaign to be launched in the north west part of the City early in 1969. Finally, it is again a special pleasure to record the gratitude of the Health Department to the consultant cytologists and their laboratory staffs at the Samaritan Hospital, the Chelsea Hospital for Women, and St. Stephen's Hospital for the help willingly given during the year. Unfortunately, staffing difficulties compelled the Chelsea Hospital for Women to cease examining the slides obtained at Ebury Bridge towards the end of the summer; St. Stephen's Hospital in the Fulham Road very kindly undertook this role until arrangements had been completed for these slides to be examined at the Samaritan Hospital. Thanks to this generous assistance, the total number of women screened since the inception of the service in September 1966 numbered 4,753 by the end of the year, of whom 17 had been found to have positive cervical smears. An account of this service, entitled "Cervical Screening and the Community" appeared in the March newsletter of the Women's National Cancer Control Campaign—a voluntary organisation to the forefront of the national endeavour to persuade women to be screened. 58 RECUPERATIVE HOLIDAYS Recuperative holidays, normally of two weeks duration, are arranged for adults who have been suffering from a recent illness and who, although not requiring special medical and nursing care provided at a convalescent home, would benefit by rest, fresh air and good food at a recuperative holiday home. Expectant mothers, mothers with babies, or children under five years who cannot be left at home are also catered for under this scheme. A basic charge is made, but if they are unable to afford this, an assessment is made and patients are charged according to means. Recommendations for recuperative holidays for school children are referred to the Inner London Education Authority who bear the cost. During 1968, the following admissions to recuperative holiday homes were arranged:— 1968 1967 Expectant and Nursing Mothers Nil 2 Tuberculosis 3 1 Other Adults 92 86 Accompanied children 15 11 Unaccompanied children under 5 years 6 1 School children 57 58 173 159 Of the 92 adults 17 were psychiatric cases. The City Council is indebted to the proprietors of the various establishments used for these holidays for their assistance. CHIROPODY SERVICE A chiropody service is made available under Section 28 of the National Health Service Act, 1946 for the elderly, physically handicapped, expectant mothers and children. At the commencement of 1968 this service was provided both directly by the City Council and by the City of Westminster Old People's Welfare Association on behalf of the City Council, but on 1st April, 1968, at the request of the Association, the service was integrated under Health Department control. It continues to be provided at fully equipped clinics situated in Health Department establishments and in the Association's accommodation. Arrangements are made for domiciliary treatment or for patients to receive their treatment at the surgeries of three private chiropodists. Further, by arrangement with the Director of Welfare a clinic at the Welfare Centre for the Handicapped at 10 Warwick Row, S.W.1., provides a service for persons who normally attend the centre and other handicapped people who are conveyed there in the Welfare Department's special coaches. In addition to the amalgamation of the service under Health Department administration, the City Council approved the appointment of a full-time Chief Chiropodist who took up her duties in October, 1968. A surgery and office were equipped at the Bessborough Street Maternal and Child Welfare Centre for her use; she divides her time between treatment of patients and general administration of the service. The Health Committee also gave consideration to the small income received from charges made to patients in relation to the cost of administrative and clerical work involved in assessing their cost and decided to provide free service to all comers within the agreed categories. During the year, the City Council relinquished accommodation used for chiropody at the Inner London Education Authority's premises, 40, Alderney Street, S.W.1., and patients attending there were offered other facilities within the City Council's scheme. One of the former City of Westminster Old People's Welfare Association clinics was situated in rented accommodation in Golden Square, W.1., where the patients were required to negotiate steep and difficult steps for their treatment in the basement. The service provided there was transferred on 1 st July to the Marshall Street Maternal and Child Welfare Centre nearby. A room on the ground floor was made available and this rearrangement has proved to be highly satisfactory. It has long been considered that a number of patients receiving domiciliary service might well be able to attend a clinic provided suitable transport were made available to convey them between their homes and the centres. The duties associated with one of the Health Department's mini-buses, used extensively for carrying the elderly to old people's clubs, have been extended to include 59 conveying suitable patients to some of the chiropody clinics and it is confidently expected that this arrangement will expand rapidly. Apart from receiving their treatment the patients have the opportunity of an outing and the company of others. During December, 1968, the Chief Chiropodist and part time chiropodists were working 29 sessions weekly and 7 part-time chiropodists were engaged on domiciliary work of approximately 80 treatments a week. Details of the number of treatments undertaken in 1968 are set out in Table 40, page 100. HOME HELP SERVICE The home help service is provided under Section 29 of the National Health Service Act, 1946 when such assistance is required by reason of infirmity, ill health or age of a member of a household, for which a charge, abatable in necessitous cases, is made. In order to provide local facilities the service is administered from three offices, situated at the City Hall and the two sub-offices in the Marylebone and Paddington areas. A Home Help Organiser is in charge at the City Hall and a second Organiser stationed at the Paddington office controls both the Paddington and St. Marylebone offices. There is a supporting staff of Assistant Home Help Organisers and clerical officers. The demand for service continues to arise very largely from the elderly, but help is given as required to families with young children when the mother is ill. In these circumstances the home help will visit the home early in the morning to prepare the children for school, give them breakfast and take them to school. Later in the day she will collect them from school, return them to their home, prepare a meal and leave after handing them over to the father upon his return from work. This is a very valuable side of the service since it often prevents children having to be taken into care. The Council also employs specially trained home helps who work with inadequate parents giving guidance on housekeeping, child care and other domestic matters. To supply the amount of home help demanded by every applicant would be far beyond the resources of the Department, especially bearing in mind the present Government's policy of financial stringency. Much care and thought must therefore be given to deciding how the limited resources can best be used. The Department's Chief Administrative Officer and the Organisers therefore undertook a review of all aspects of the home help service. As a result of this, rigid zoning of the districts in which home helps are employed was introduced and more stringent assessment of the amount of work necessary was undertaken. Travelling time was thus reduced to a minimum and there was a slight reduction in the time allocated to a number of recipients without detriment to them. This has resulted in a more efficient service within the Council's budget. Number of home helps: 1968 1967 (a) Joining service 41 97 (b) Leaving service 83 68 (c) Employed as at 31st December 220 262 = full-time equivalent 184 200 Details of the number of cases in which this service was provided during 1968 are set out in Table 41, page 100. MENTAL HEALTH (Mrs. R. S. G. Paterson, Principal Mental Health Social Worker) The existing services provided by the City Council in the field of Mental Health have been maintained throughout 1968. No new major projects have been undertaken but the general impetus given to the appraisal of social services engendered by the publication of the Seebohm Report has been regarded as an opportunity to consider whether our services are meeting needs and being used to the best advantage. The section continues to be concerned with various activities such as clubs, out-patient departments and liaison with psychiatric hospitals. The mental health social workers carry heavy case loads of mentally ill, subnormal and severely subnormal patients. This is the most important but the least apparent aspect of the section's work. A mental health social worker may well be the only person to whom a patient, isolated from 60 his fellow men through his disability, can turn in times of need; often the social worker is the only person to whom a family, bravely bearing the burden of caring for a severely subnormal person, can express their feelings of distress, the difficulties in which they find themselves, and their sufferings which they take such pains to hide from the world. It is in this field particularly that further developments can be expected when additional staff can be made available. It was hoped that St. Judes Hostel for subnormal boys and men opened by the Lord Mayor in June, 1967, would meet the requirements of an extensive group of such people who had no proper home when the City extended considerably the age range of 16-18 years for which this hostel was originally planned. It has been found that the hostel provides excellent service for young men who have had a period of rehabilitation in hospitals, boys straight from residential E.S.N. schools and men in their forties who have had a stable home life until their natural guardians are unable to continue caring for them. It has become apparent, however, that subnormal men who have lived independent, often vagrant, lives, probably extremely unsuccessfully and at a very poor level, find it impossible to adjust to a hostel life where they are expected to maintain an acceptable standard in matters of personal hygiene and social behaviour. They have failed to integrate with the group and cannot accept the necessary supervision exercised by the Warden and his staff. Their presence in the hostel has been found to be detrimental to other residents who themselves have considerable difficulties of adjustment. It was not necessary actually to discharge any of these men as they left of their own accord. It is now thought this group of men may be better helped by placement in supervised lodgings and plans are in hand to develop this work with the help of an Accommodation Officer, whom it is the City Council's intention to appoint in the forthcoming year. The hostel is being used for a small afternoon Club, meeting once a week. This "Monday Club" provides for a group of severely subnormal adults who are unsuitable for training centres. The relatives of these patients are grateful for the modest relief that this Club gives them. It would be impossible to provide this service without transport; this is, therefore, provided by the City Council and the kindly help given by our drivers should be recognised. They are indeed making a valuable contribution to the success of the Club. During 1968 the Mental Health Section has given a good deal of attention to the deployment of staff and to extending support from senior staff. The exacting nature of the work imposes great stress and it is very important that help and advice can be readily obtained. In addition, joint programmes were organised with the Children's and Welfare Departments to introduce new social workers to the City to gain a background of knowledge of the work of their particular local authority and busy senior officers from many Council Departments helped by giving friendly and informative talks. Following the appointment of two Assistant Principal Mental Health Social Workers both of whom hold the Mental Health Certificate, and the recruitment of other professionally qualified social workers, it has been possible to accept for training students on varying social work courses for both observation and case work placements. It is, of course, proper that the City Council should help in the training of social workers. By this means, too, the extensive social work of the section becomes known and should have a beneficial effect on recruitment by attracting trained staff to the service. As a general development the City is extending opportunities to medical students to learn of the services of a local health authority. The Mental Health Section may be said to have pioneered in this field as for many years medical students on a psychiatric course from a teaching hospital have spent a day with the section, going out with mental health social workers and taking part in any activity in progress. Latterly, arrangements have been made for senior staff to give regular talks to Middlesex Hospital students receiving psychiatric training. From the time the City Council became responsible for the Mental Health Services it was apparent that there was a very great need to survey the City's need in the field of mental health and with the knowledge so obtained plan development. The pressure of day to day work made it impossible for existing staff to undertake this very extensive piece of work. The first task undertaken by Dr. J. D. Hailstone, Senior Psychiatric Registrar at St. Mary's Hospital, appointed in 1967 by the City Council on a part-time basis, was to conduct a survey and to make proposals for the City's future services. His task proved to be formidable and it was not until November that the Medical Officer of Health was able to present his report to the Health Committee. The report is of the highest calibre. The Survey covers the present work of the City Council in the mental health field; interviews have been held with many organisations concerned with mental 61 health, including representatives of the Department of Health, Regional Hospital Boards, catchment and teaching hospitals and general practitioners. Information has been obtained from many other local authorities for the purpose of comparison and studies have been made of existing "model" services here and in other countries. Dr. Hailstone expressed strongly his opinion that in order to provide a model comprehensive community care service related to his findings specialist guidance would be required, and recommended that as a first step a psychiatrist be appointed as a consultant to the City of Westminster Health Department and as a Co-ordinator of Psychiatric Services. Although it is evident that the magnitude of the task and present economic restrictions will prevent immediate large scale expansion, the appointment of a part-time psychiatrist has been agreed in principle and the slight increase in the Mental Health Section's staff establishment is stimulating and encouraging. It is now confidently anticipated that any future development will be along admittedly long but correctly signposted roads. Training Centres—Future Proposals Following the re-organisation of London Local Government in 1965, Westminster was unfortunately one of the areas in the metropolis without a training centre within its own boundaries. Neighbouring authorities have co-operated most generously in continuing to provide training centre places for Westminster patients. It is, however, understandable that the various authorities concerned need the places in the training centres occupied by Westminster residents for their own patients; and during 1968 the City Council was requested to make arrangements at a date to be mutually agreed to remove some of the Westminster patients. Co-incident with these requests the Westminster Chest Clinic vacated the ground floor accommodation formerly occupied at the Maternal and Child Welfare Centre at No. 1, Ebury Bridge Road, S.W.1. The City Council's Health Committee felt that the vacated accommodation would be suitable after certain works of adaptation had been carried out, for use as a small Junior Training Centre. Provision has accordingly been made in the Committee's Estimates for 1969/1970 for the necessary adaptations and subsequent running costs, with a view to the Centre opening in September, 1969. The Medical Officer of Health also received a request to remove from a Training Centre in a neighbouring Borough some 12 adolescent girls whose places were urgently needed by patients in that borough. Arrangements have accordingly been made as a temporary expedient to use accommodation which is available during the day at St. Judes Hostel in Lancefield Street, W.10, as a training centre for these girls. No works of adaptation will be required and it is hoped that the centre will also come into operation in September, 1969. The City Council's long-term proposals for training centres in Westminster were set out in detail in the Annual Report of the Medical Officer of Health for 1967. The projects include an 80 place (40 adults, 40 children) centre in Lisson Grove, and a 100 place Junior Training Centre for which a site has yet to be found. The proposals set out above, therefore, provide for only a minor proportion of the need which exists, but will at least form a beginning to alleviate the demand for this type of service. Mentally Disordered Patients The number of patients referred in 1968 totalled 1,681 (1967—1,328); 583 patients were admitted to psychiatric hospitals—informally or compulsorily (1967—485); 677 patients were received into community care (1967—499). All other cases were investigated and appropriate advice or assistance given. Patients in Community Care 1968 1967 Mentally ill 565 542 Subnormal and severely subnormal 313 300 Residential Care 1968 1967 Mentally ill 35 40 Subnormal and severely subnormal 41 43 In addition, there are 20 subnormal and severely subnormal children in care of the Children's Department in residential homes. 62 OTHER SERVICES FOR SUBNORMAL AND SEVERELY SUBNORMAL PATIENTS Day Training Centres for junior and senior trainees There are 68 children and adults from Westminster attending training centres: 1968 1967  Hanworth Junior, Middlesex (two in residential care) 2 2 Attleborough Diss, Norfolk (in residential care) 1 — Kensington Junior 32 32 North Kensington Senior 11 15 Balham 3 3 Clapham 1 3 College Park 10 10 Bennett Court 4 4 Terrace Day Centre 4 4 Transport An efficient and satisfactory service is provided by the City Council for the Trainees to the Kensington Junior and College Park (Senior Girls) Training Centres and there is good liaison between the transport contractor and the Mental Health Section. Socialisation Course for Educationally Subnormal School-Leavers Pengwern Hall, Rhuddlan, Flintshire Three Westminster patients attended the two 12 week courses at Pengwern Hall this year (1967—3). These are arranged by the National Society for Mentally Handicapped Children for young adults who are in need of guidance in coping with employment and other aspects of social life. Organised Annual Holiday for Trainees Twenty-two (17 in 1967) Westminster trainees participated in the two week holiday at St. Mary's Bay Holiday Camp, Dymchurch, Kent. The City Council is most grateful to the Medical Officer of Health for Hammersmith who organises this holiday. As usual this very successful occasion was much enjoyed by all concerned. Home Tuition Three patients, in community care, received training in their homes by qualified home tutors (1967—2). Special Day Nurseries There are two special day nurseries in Westminster which are grant-aided by the City Council and run by the City of Westminster Society for Mentally Handicapped Children: Frances House, 86 Bravington Road, W.9 Thirty children are in attendance at this nursery where specialised training is given (1967—24). The adjoining premises were purchased in 1967 with the aid of a grant from the City Council and after adaptation were opened by the Lord Mayor in 1968. Edgson House, Ebury Bridge Estate, S.W.1 This nursery is registered for 12 children; nine children are now attending and are receiving very valuable training (1967—4). City of Westminster Day Nurseries In December there were 24 handicapped children attending the Special Units provided in the City Council's day nurseries (1967—20). All children at these nurseries are seen regularly by one of the City Council's medical officers. Linnet House Special Care Unit, Charlbert Street, N.W.8 A full complement of 12 severely mentally handicapped children are attending this specialised 63 unit for children up to the age of approximately 12 years (1967—12). A specially adapted coach conveys the children to and from the unit each day. This unit is also run by the City of Westminster Society for Mentally Handicapped Children on the City Council's behalf and there exists a close liaison between the Council and the Society. University House Special Care Unit, Bethnal Green Arrangements have been made for a severely mentally handicapped girl of 13 years of age to attend this special unit which is maintained by the Borough of Tower Hamlets. The City Council is grateful for this help as Westminster's own special care unit is unable to accommodate a child of this age. Centre for Spastic Children, Cheyne Walk This is a voluntary centre for severely handicapped children conducted by the Chelsea and Kensington Hospital Management Committee and four Westminster children are in attendance there (1967—2). Special Counselling Clinics for Retarded Children There are three special counselling clinics in the City where children are seen by a Principal Medical Officer. Atendances at these clinics were as follows: 1968 1967 Attended New Referrals Attended New Referrals Harrow Road 120 27 89 25 Bessborough Street 29 9 32 11 Queens Park 25 7 3 — Short-Term Care During 1968 holidays from 2-8 weeks were arranged for 49 patients, either in hospital or suitable residential homes. 1968 1967 In hospital 7 7 In residential homes 42 28 St. Judes Hostel, Lancefield Street, W.10 At the end of December there were 18 subnormal residents accommodated at this hostel (1967—8). Further applications were in hand. There is now an afternoon club at the hostel for severely sub-normal persons where handicrafts and other social activities are enjoyed by all; there are seven in constant attendance. There is also an evening club for the residents only— at which woodwork instruction is given. Gateway Club (Terrace Day Centre, 1 St. Mary's Terrace, W.2) In March this year a social club for subnormal adolescents was initiated by the City of Westminister Society for Mentally Handicapped Children and a room at the Terrace Day Centre is used for this purpose. The Society reports that the club is well attended and that there is an extremely happy atmosphere there. OTHER SERVICES FOR THE MENTALLY ILL Terrace Day Rehabilitation Centre, 1 St. Mary's Terrace, W.2 Attendances at this centre continue to be excellent and 39 patients were on the roll at December, five of whom were patients from other London Boroughs (1967—45). Day Rehabilitation Centres Five patients attended the following centres: 1968 1967 Castle Day 2 2 Ladbroke Grove 1 2 64 Raydon (Camden) 1 — Marlborough Hill (Harrow) 1 — Blackfriars — 1 Crossways — 1 Beauchamp Lodge Social Club, 2 Warwick Crescent. W.2 This establishment is run by a voluntary organisation and financial assistance is given by the City Council. Mental health social workers arrange for patients to attend the two clubs and assist with functions. Meetings are held on two afternoons each week and an average of 30 patients continue to attend and derive great benefit (1967—30). The objects of the club are to provide facilities for social communication, to encourage its expression and to provide a focal point for people living in isolation. In addition, an evening club has been opened for subnormal patients which is much appreciated by all who attend. GENERAL Application and re-approval of medical practitioners for the purposes of section 28 of the Mental Health Act: Approved Re-approved 1968 5 1 1967 2 7 Mental Health Week—10th-14th June, 1968 During Mental Health Week, Linnet House, Edgson House, Frances House and St. Judes Hostel were open to the public each day during normal working hours. Films on mental disorders were shown by members of the Health Department staff at the Salvation Army Regents Hall, Oxford Street, W.1, and the City Council is grateful for the assistance readily given by this organisation. On one evening a public meeting was held at the Ebury Bridge maternal and child welfare centre in connection with the proposed hostel for the mentally ill in Cambridge Street, S.W.1. Additional activities during this Week included a wine and cheese party held at the Terrace Day Centre, which proved to be a most enjoyable occasion. On one afternoon a meeting was held at the City Hall at which films were displayed dealing with various mental health topics, and which was well attended by consultant psychiatrists, medical social workers and officers from voluntary organisations. The whole programme proved to be a successful contribution to the national efforts in Mental Health Week. THE TERRACE DAY CENTRE Report for 1968 (by Dr. R. A. Stewart, Medical Officer in Charge of the Centre) The year 1968 was one of expansion in our endeavours to help the mentally ill to take a place in the community. My definition of Mental Health is to feel wanted, to have a sense of belonging, to feel part of society, to have a sense of usefulness and to feel comfortable and confident in the business of living. It is towards this ideal that the staff at the Terrace set themselves. The mentally ill individual usually has a sense of feeling different from other people and in many types of mental disorder the individual is actually rejected by his or her relatives and contacts. There is an innate fear of mental disorder in the community and this fear leads to many social problems in the treatment and prevention of mental breakdown. The Institute of Social Psychiatry has been concerned with these problems for many years and the Institute was appointed by the City of Westminster to act as agent in the management of the Terrace Day Centre. 65 At the Terrace the staff work as a team in close association with the patients, working with them, listening and giving advice and support, having meals together, interviewing relatives, friends and social workers and also communicating with doctors and the many agents who are concerned with the welfare of the patients. We accept patients of all groups from adolescence onwards, both male and female who work together in a social group. It happens that we have about equal numbers of men and women with a total roll of 50 at one time. The statistical table (Table 46, page 102) gives a picture of the composition and results achieved. The daily routine is always directed towards the individual in a social setting. The mornings are given over to simple industrial work or work in the well equipped carpentry shop in the basement. All domestic duties are shared on rota and include shopping for the midday meal, and for the many items needed during the day. The midday dinner is prepared by the patients under supervision of one of the staff. There is great therapeutic value to be derived from working together in the kitchen. There is also a rota for washing up and tea making. The regular task of cleaning and polishing floors is also undertaken. We also do our own laundry work and members of the group may use the laundry for their own personal washing. There are errands to be undertaken in connection with our industrial work, supplies for the workshop and also trips to the bank. These activities help to build up confidence and trust. Our industrial work in the mornings varies and depends on our success in negotiations with various firms and organisations, and we are constantly in need of new contacts. During the year we have had work involving collating, stapling, addressing, packing and counting circulars for a number of organisations. We have assembled ball-point pens, and packed articles for the post such as stockings, cameras etc. Money obtained for this outwork is distributed to members of the group on a points system. The payments are small but do act as an incentive for punctuality and interest. We do not penalise the slow workers if they are obviously giving of their best. These activities approximate to the routine when employment is eventually undertaken. The kitchen from time to time is engaged in jam and marmalade making to the tune of several hundred pounds and before Christmas many puddings were produced. These items always find a ready sale. The workshop has undertaken repairs to the fabric at the Terrace and provided extra cupboards etc. There has been continued production of racks for holiday postcards which are dispatched to many holiday centres. Furniture has been repaired for individual orders and large display cabinets made for the Centre. The workshop is also employed in making equipment and toys for the City Council's Health Department. Various articles can be made to order such as bath seats for the disabled. The garden although small is tended by those of our members who show themselves interested and involves the usual care and lawn mowing. Unless there is a rush order in connection with the industrial work, the afternoons are devoted to social activities and outings. The social activities are many and include discussions, musical appreciation, films, tape recording and play back, dancing and folk dancing, play-reading, drawing and painting, charades, card games, bingo, quiz games, mock trials, table tennis and darts. We have also had cosmetic demonstrations, fashion design sessions and visiting speakers. Regular outings have been made to factories, art galleries, museums and exhibitions. Use is made of Paddington Green for outside games and the Paddington Recreation Ground for tennis. Visits have also been made to the swimming baths. The Terrace Magazine has appeared every month and we have been rewarded by the number of patients who have contributed. Many members were anxious to help on Mental Health Flag Day and some also did house to house collecting. 66 Our staff consists of Dr. Stewart who attends on a sessional basis, Miss Blair, Miss Munster, Miss Hanbury and Mr. Clark. Mrs. Penton was appointed by the City Council to the post of domiciliary Occupational Therapist and works from the Terrace Day Centre. The staff is concerned in some cases with the task of ensuring that a patient is taking medication as prescribed. This is particularly important in cases of epilepsy and in some cases of schizophrenia as neglect to do so may lead to relapse. There is a difficult problem involving some patients referred who either do not attend for interview or do not accept the help offered and revert into complete isolation. Our domiciliary Occupational Therapist has been able to do valuable work in these situations. The City Council's Mental Health Social Workers are also concerned in this problem but there still remain many people who could be helped out of their isolation if means could be devised to do so. Our patients are referred to us usually by Westminster Mental Health Social Workers but also direct from psychiatrists at Mental Hospitals, Psychiatric Clinics and General Hospitals. We also accept patients referred from general practitioners and various social services. Occasionally a patient may be resident in Hospital and attend the Centre until fit enough to return home, take up lodgings or enter a hostel. We are indeed fortunate in the support and ready help given to us by the Westminster Mental Health Social Workers under Mrs. Paterson. Liaison with these officers is so important and they continually pay welcome visits to the Centre and are well known to the staff and patients. We have had many visitors to the Centre interested in the rehabilitation of the mentally ill including groups of nurses from Middlesex Hospital and St. Mary's Hospital who have observed and joined in our activities as part of their training. There always remains a hard core of patients who would never be able to tolerate the demands of outside employment and for whom we provide custodial care. This is a valuable service in that relatives are relieved of the patient during the day and able to pursue their own activities. Where there are no relatives these patients are at least saved from reverting to social isolation. Many of those unable to cope with ordinary work in industry might well graduate to a Sheltered Industrial Unit perhaps as part of the Terrace Day Centre but conducted on purely commercial lines and staffed by industrial supervisors. At the Terrace we also conduct the Goodfellows Club which meets on a Wednesday evening. This is a therapeutic social club for people in full-time employment who have difficulties in mixing, as well as patients who are attending the Centre daily. For these the day staff provide a light supper and some ex-patients now employed also attend, keeping a link with the Centre, enabling us to follow up their progress. The Terrace premises are made available on Monday evening for a Club for the Westminster Mentally Handicapped young people and on a Tuesday evening a club is conducted by Westminster Council for Social Service for unsupported mothers. Throughout the year we have been encouraged in our work by the interest taken in the Centre by Members of the Westminster City Council and the Health Committee. We have been honoured by a visit from the Lord Mayor of Westminster, Councillor C. A. Prendergast and Mrs. Prendergast, the Lady Mayoress. Mr. Prendergast took a great interest in the Terrace Day Centre which was set up during his period of office as Chairman of the Health Committee. We have also been glad to welcome the present Chairman of the Health Committee, Councillor M. V. Kenyon, M.A. SOCIAL WORKERS (HEALTH SERVICES) (Miss I. J. McFarlane, M.A., Principal Social Worker (Health Services) ) The social workers in this section of the Health Department report that 1968 has been a particularly busy year and various new developments have taken place which are proving interesting and stimulating. The public is using the department increasingly for general advice and information and it is essential, therefore, that the staff is kept up-to-date with social legislation. In some cases the role of the social worker is to assist people to use the services to which they are entitled by right and there are straight-forward cases where this can be carried out quite easily. Often, however, 67 the people who ask for help are those who are experiencing serious personal problems and some need long-term support. In reviewing the work for 1968 there is agreement concerning the many advantages of working together as members of a team. There is close co-operation between all the social workers in whatever field they are working and this integration is vitally important. The staff attached to the school health service find that their duties often extend far beyond school health and they very often become involved in family case work. In many instances there are problems in the family connected with old people or immigrants and because she works as a member of a comprehensive social worker team she can either call upon one of her colleagues for advice or give direct help herself. Six members of the staff specialise in work connected with the school health service and they ensure that the school children who are referred to them have access to the many facilities which exist for their medical supervision and treatment, and they provide social work help as and when required. They attend special investigation clinics where children receive help in connection with behaviour disorders, and failure to make satisfactory physical and educational progress. The number of children attending these clinics at the end of the year was 154 and 124 had been discharged throughout the year. The number of home visits made during the year was 285. These clinics are becoming increasingly popular with parents and children and in May a new clinic was opened in the Paddington area where there was a long waiting list of children referred for treatment. It is anticipated that yet another centre will be required in the near future. In connection with the work undertaken for children who are deaf or partially hearing, a social worker made 43 visits to the children's homes or schools and attended 414 interviews at the local audiology clinic. One social worker is employed full-time in connection with families who have special difficulties and during the year he made 720 visits and there were 21 office interviews. This work is usually long-term and involves frequent home visits and liaison with other social workers. Many of the families need intensive and prolonged support but they can often be constructively helped if referred at an early stage. Six members of the staff carry a limited case load of such families in addition to their other duties. At the end of the year the number of families being visited was 29. Five hundred and fifty-five home visits were made and there were 86 office interviews. There are three social workers in the Health Department concerned with the care of old people and they made 5,960 visits during the year. A wide range of services is available to old people and every encouragement is given to them to make full use of these facilities. At present discussions are taking place concerning methods by which social workers may come to hear of people requiring help. It is thought that many may be unaware of the help to which they are entitled. There is close co-operation with hospital staff, general practitioners, the Westminster Old People's Welfare Association and other voluntary organisations. Venereal Diseases Contact tracing Five social workers are employed at three hospitals which have special clinics for the treatment of venereal diseases. The need for an increasing amount of case work has been reported and much time is also spent in tracing contacts and following up defaulters and arranging for their treatment. We continued our policy of appointing case workers with considerable experience at these clinics and during the year a professionally trained social worker joined the team. During the year, 1,906 home visits were made and 2,417 interviews took place in the clinics. The City Council has also been responsible since 1st April, 1965, for certain functions previously carried out by the former London County Council for tracing contacts in the London area notified by Service bases from abroad to the Department of Health and from local authorities outside the London area. One hundred and forty-two such notifications were received during the year and of these 82 per cent. were from American service bases in and around London; 53 per cent. of the contacts notified were traced and brought to treatment. Credit for these continuing satisfactory results must be given to the social workers engaged on Venereal Diseases; their enquiries are often hampered by scanty information of the place of contact and the minimum of a person's description. On many occasions merely a christian name, colour of hair and height, is given. London Public Enquiry Telephone for venereal diseases (928-3401) This telephone is located in the Westminster Health Department and is manned day and night; approximately 600 calls were received during the year. The majority of the calls received were 68 for information on the locality of clinics and times of treatment. Other calls were requests for literature on the dangers of venereal diseases. No other matter is dealt with on this telephone, the number of which is widely advertised throughout the London area. Notices Meetings were held with representatives from the City Engineer's Department for a new design of notices in the City Council's public conveniences. The new notices are expected to be produced in 1969 in plastic, others in ceramic tiles, which will be fixed permanently in each water closet of the City Council's public conveniences. Notices of a less durable material have succumbed to vandalism. Chest Clinics The three social workers at the chest clinics report that they deal with an increasing number of problems connected with housing, finance, and employment. They undertake fairly prolonged case work where necessary. During the year they made 115 home visits and interviewed 2,166 patients in the clinics. The number of cases being dealt with at the end of the year was 428. Drug Dependency Two projects which had been started by two members of the staff in 1967, continued in 1968. The first was in connection with drug dependency among young people in the City. The aims of the survey were as follows: (1) To find out by discussions with those in touch with young people in Westminster whether they had problems in this field. (2) To discuss with individuals and organisations already working in the field the contribution they were making. (3) To reach some conclusions from these interviews regarding (a) the extent of the problem in Westminster and (b) to consider what gaps exist in the provision at present made, and to explore the possible ways in which the local authority might help. A report was submitted to the Health Committee in January, 1968, when it was suggested that the Health Department might help in the following ways: 1. The Department could keep abreast of all developments in this field and maintain an up-todate information service, which could be available to other workers. 2. The Department could offer a social worker service to people with problems of drug dependency of whatever kind. Whilst other social workers will have a statutory obligation with regard to certain categories of young people (e.g. Children's Department, Probation Service) there are other cases not covered in this way. 3. The Department could have speakers available on this topic for youth clubs, technical colleges, etc. The possible co-operation with the Inner London Education Authority Health Education Officers at parent-teacher meetings and with lectures to school children could be explored. This could be useful in informing parents who are anxious that they can discuss the matter with the head teacher or arrange for the child to be seen by the school medical officer. 4. The Department could investigate with the Inner London Education Authority the possibilities of a statistical survey being carried out in schools in Westminster amongst young people of 14 to 16 years of age which would provide factual evidence of the pattern of drug taking. This would be valuable in enabling health education for young people to start from a basis of knowledge. 5. It is likely that there will be a need for many facilities for the rehabilitation of patients who have been withdrawn from drug dependence, but it is difficult at this stage to make positive recommendations. It is planned to maintain close contact with the psychiatrists in charge of the treatment centres at Westminster, St. Mary's and Charing Cross Hospitals in order to obtain details of the numbers of patients who will need accommodation and help during the period of rehabilitation. At present it is planned that the work of this survey should continue with visits to general practitioners, hospital psychiatrists, Colleges for Further Education, Technical Colleges, Youth Leaders, etc. The Health Committee decided to adopt as its policy the various suggestions set out above. 69 Services for unmarried and unsupported mothers and their children The second project was in connection with services for unmarried and unsupported mothers and their children. An account of this follows in some detail because the project has resulted in the provision of a new service in this section of the Health Department. It had previously been agreed by the Health, Welfare and Children's Committees that a research study should be undertaken by a senior social worker in the Health Department. Her report which followed was considered by these Committees and it was felt that there was a need for a further study to be undertaken in collaboration with the statutory and voluntary bodies concerned. A seminar was, therefore, held in September 1967, attended by representatives of some 31 statutory and voluntary organisations, together with members of the City Council's Committees and officers of the Departments concerned. The general feeling was expressed that there was a need for more continuity of social worker support for unmarried and unsupported mothers. There was also a great need for the provision of more accommodation, either by voluntary or official sources. The record of the proceedings at the seminar was then considered by the Children's, Welfare, Housing, and Health Committees. The Health Committee asked the Medical Officer of Health to confer with the other Chief Officers concerned and to report on possible further action, particularly on the likelihood of the voluntary organisations providing accommodation. Accordingly a Joint Report is to be submitted to the Health, Welfare and Children's Committees. One social worker is at present employed full-time and one part-time in helping to provide a service for unsupported mothers. It is hoped that in the near future a full-time additional appointment will be authorised as all the other social workers are over-committed. The volume of work is steadily increasing as the service becomes better known. The number of referrals during the year was 98. Many of the clients require practical help and casework support over a long period. Usually the girls are seen weekly for the first month of contact in order to establish a relationship and to crystalise the more immediate plans. They are then given fortnightly appointments, unless there are indications for more frequent visits, until a few weeks before the birth of the baby. Contact is then usually increased as the imminence of the birth reinforces many of the anxieties about the birth itself and about the decision regarding the baby's future. Contact with the girls is retained as long as she indicates that this is necessary to her. This service for the unmarried mother has not been running for sufficient time to ascertain how long this need for contact with the social worker is likely to continue. There do, however, seem to be crisis periods—e.g. when the baby is about six months old and another when the baby is around 12 to 15 months old. Another difficult time comes when the child reaches school age and the mother has then to cope with the shorter school hours instead of day nursery hours. Consideration is being given to the possibility of running a series of group discussions with unmarried mothers whose children are between 12 and 18 months. It would be of great benefit if something more was known of the emotional crises common to lone mothers at various stages of their children's development. In addition to this work with pregnant girls there have been developments concerning our work with lone mothers who already have a child or children, varying in age from one week to six years. The overwhelming difficulty here has invariably been accommodation and this is a vast problem. In the past year 61 applications for urgent help with accommodation were referred to the social workers. It is considered that suitable accommodation plays a vital part in whether or not the lone woman can successfully cope with her child and therefore every effort is made to help in this direction. Much help is received from Housing Associations and from the National Council for the Unmarried Mother and her child. It is, however, a time-consuming job and it is hoped that it will be possible to appoint an Accommodation Officer in the near future who will be able to search for accommodation not only for unmarried and unsupported mothers, but also for mental health patients. Some of the mothers with children referred to the social workers have complained of loneliness and isolation and a Club has been started for them, which is making some contribution towards meeting this need. The Club meets once a week at No. 1, St. Mary's Terrace, W.2 and is run by the Westminster Council of Social Service in conjunction with the Health Department social workers. Family Planning—Counselling Service Another interesting new development came into being in May 1968. When the Health Committee were considering the family planning services to be provided under the National Health Service (Family Planning) Act 1967, it was felt that a counselling service should also be provided for 70 young persons seeking family planning advice who would benefit from counselling, or who requested it. Consequently in May an evening session was begun at the Hallfield Clinic. This session is held weekly on Tuesday evenings and is run by Dr. Faith Spicer who has had extensive experience in counselling, adolescent problems, and family relationships. A psychiatric social worker staffs the clinic with Dr. Spicer and deals with an increasing amount of follow-up work. A clerical officer acts as clerk/receptionist. This service has proved so much in demand that it will be essential to open a second clinic as soon as possible in 1969. So far 23 sessions have been held. One hundred and fourteen appointments have been offered to clients and 43 of these have been new referrals. In-service Training In a Department carrying out a wide range of social services it is essential that the staff are suitably qualified and that they should be encouraged to undertake further professional training. Two members of the staff are at present seconded on a year's professional course and there is no doubt that when they return to the department their additional training will prove of real value. During the year our staff meetings often took the form of discussion groups and expert speakers led discussions on such subjects as psychiatric depression, the one-parent family and the personality of deviants. It had been felt for some time that case work discussion on a more academic level would be a useful learning experience for the newer members of the department and would provide valuable revision for our more experienced staff. From these meetings came the suggestion that a series of seminars should be held and we are fortunate that Miss Parsloe, a Lecturer at the London School of Economics, has agreed to lead such a series beginning in January 1969. We plan to hold 12 seminars attended by 10 of our case work staff joined by two from the Welfare Department. Fortunately it has now been possible to arrange regular supervision for new members of the staff and also to hold case work discussions. These are proving to be of great support and benefit and are under the direction of an Assistant Principal Social Worker. New members of the staff also benefitted from a course of inter-departmental in-service training, which was held during the year. A considerable number of requests are received from Universities and Colleges for Further Education to take students for practical training, and they come for periods ranging from two weeks to five months. CO-ORDINATION The Co-ordinating Committee consists of representatives from the City Council's Health, Children's, Welfare and Housing Departments; the Inner London Education Authority and the Greater London Council Housing Department. The Chairman is the Medical Officer of Health, the Vice-Chairman is the Children's Officer and the Secretary is the Principal Social Worker (Health Services). The Committee considers matters of policy and principle and reviews arrangements for ensuring co-operation and co-ordination between the City Council's departments and statutory and voluntary agencies. Case conferences concerning individual families are held as and when required and during the year 32 conferences took place. Most of the cases discussed were first brought to the notice of the Committee by the health visitors but the Housing, Children's and Welfare Departments and the Divisional School Care Organiser (Inner London Education Authority) frequently refer families at risk. Field workers in all departments keep each other informed of developments as they know only too well that unilateral action by someone not in possession of all the relevant information may undo much useful work. Everyday co-operation is the essential basis on which successful co-ordination is built. The directory of social services which was compiled as a result of a recommendation made previously by the Co-ordinating Committee was revised during the year. It has proved to be a most useful document and is in great demand. 71 WORK WITH IMMIGRANT FAMILIES (Miss I. O. D. Harrison, M.B.E., J.P., S.S.D., Assistant Principal Social Worker) The year 1968 was an eventful one which brought to the fore many aspects of the problems of immigration and race relations. Events such as the Asian Kenyan situation, and publicly declared concern of well known people over what they considered to be problems caused by the presence of coloured people, led not only to nation wide and controversial discussion, but unfortunately, also emotional reaction from certain groups of people. These events, coupled with frustrations arising from unresolved social problems, and from the insecurities of economic crises manifested themselves by certain groups of people voicing resentment and fears against the presence of coloured workers, many of whom have been here for so long that they cannot be described as immigrants, but only as citizens. Tragic assassinations in the United States, protest movements there, and to a lesser extent over here, I believe also increased feelings of insecurity because such events inevitably introduced a reality of violence, suggesting particularly to the emotionally susceptible, that violence should be considered to be an ingredient of race relations in this country. It is understandable that people may feel threatened by "unlike" people whom they believe to be "flooding the country"; threats which are sometimes reinforced by individual unhappy experiences with unsatisfactory neighbours, landlords and tenants. It is not easy to explain the difference between uninvited immigrants and Commonwealth immigrants, invited by virtue of work vouchers because it is felt that they have skills and work contributions which are still necessary for our employment forces, because people consumed with their individual problems are obviously not receptive to this kind of reasoning. A disconcerting aspect of this unhappy situation is the understandable reaction of minority groups, who though welcomed for the work potential, had it brought increasingly to their attention through the various organs of public opinion, and publicised statements by certain people that they were considered to be responsible for the social problems in the communities, and not therefore welcomed for themselves as citizens in the communities. They can only turn inwards for mutual self protection, or look towards the more vociferous members of their ethnic communities to protect their interests as an alien group. Unfortunately of course not all such representatives are fully capable of leadership and balanced comment. A further consequence was that among white people concerned with community relations were some who, becoming disturbed by the situation, emotionally over-identified with the victims of the unhappy predicament and, as a coloured man remarked, "became white people trying to be blacker than the black man", which is not a progressive step. This behaviour then resulted in criticism against other workers in the field of race relations. Resentful white people sometimes claimed that these workers are all extremists and politically rather then socially oriented, while some embittered leaders of vociferous groups accused officers not engaged in active protest of being uncaring. (I received letters accusing me of all these offences.) I think it would be true to say that, despite the fact that many coloured citizens wish only to be left in peace, even though they experience the hurt of being the subject of controversy for reasons over which they have no control, and that the numbers of people working towards the solutions of the problems increased, the situation as a whole became more tense during the year. It would, therefore, be belabouring a point to explain the many ways in which the overall situation increased and complicated my work. Suffice it to say that while still being available to assist and advise individuals with personal problems, the aspect of the work which I consider to be of tremendous importance—that of disseminating facts and dispelling false beliefs, and addressing groups of people and organisations (both official and unofficial) to consider and attempt to work out difficulties increased enormously. Problems brought to my attention arising from the Race Relations Bill increased, not because of the objects of the Act and what it says, but because of what some people believe the objects to be, and believe it to say. Unsatisfactory and unsuitable coloured staff are not expected to be tolerated in the belief that they must be treated differently from others. Behaviour resulting from such a belief can only hamper the aims of the Bill and create an unfair disadvantage for other workers. The Bill is not designed to give privileges to coloured people, but to prevent underprivilege on ethnic grounds. Nevertheless, this is still a commonly held belief. I spent a great deal of time discussing problems of this kind with staff managers and personnel and welfare officers in places of employment. 72 Mr. James Mangar (Social Worker assisting me) again attended Harrow Road for regular sessions where he also was available for consultation. Many problems were brought to Mr. Mangar directly, others were referred by social agencies. Problems included those of accommodation and housing, matrimonial and family matters as well as those resulting from immigration regulations. Mr. Mangar visited a number of people in their homes, particularly as in cases of friction and misunderstanding prolonged conciliatory work is necessary entailing a great deal of after care. Many visits are necessary outside normal office hours. HEALTH EDUCATION In addition to the health education activities mentioned earlier in this Report the Department arranged two special projects during the year. The first was connected with Mental Health Week when films on mental health were screened by kind permission of the Salvation Army at their Regent Hall, Oxford Street, W.1 during the lunch hours for members of the public. Other film shows on mental health were arranged at Maternal and Child Welfare Centres in the Victoria and Paddington areas of Westminster. The second project concerned child development and three separate programmes dealing with hearing, vision and examination of the pre-school child were organised at the City Hall and Lisson Grove Maternal and Child Welfare Centre for the Department's professional staff. General practitioners and staff from local hospitals were also invited to attend. In order to further health education in the City, the Department possesses sound film projectors, screens, films and film strips, flannelgraphs and other visual aids as well as a very comprehensive library of booklets, pamphlets, posters and leaflets, many in various languages covering all aspects of the Health Department's work. Talks using these aids were given by medical officers, health visitors, social workers and the health education assistant at the City Hall, Maternal and Child Welfare Centres, Colleges for Further Education, schools, and to local groups. Topics included home safety, general health, nutrition, anatomy, B.C.G. vaccination, venereal diseases, smoking and health and general hygiene. A film on the residential care of mentally subnormal children entitled "Warrendale" was screened in the City Hall for professional staff of the Health, Children's and Welfare Departments; 83 persons attended. A total of 197 films were screened during the year. The administrative assistant for health education represented the City Council at the National Home Safety Conference which took place at Southport in October and other members of the Department attended the quarterly meetings of the Greater London Home Safety Council. NURSING HOMES It is the responsibility of the Health Department under Part VI of the Public Health Act 1936 to register and supervise at regular intervals all nursing homes in the area. Two new nursing homes were registered during 1968 making a total of ten registed nursing homes in the City of Westminster. All the homes take medical patients, in addition to which six take surgical patients, three take maternity patients and one is registered under Part III of the Mental Health Act 1959 to take patients suffering from mental illness. Three of the homes are non-profit making. Under Section I of the Abortion Act 1967, which came into operation on 27th April, 1968, six of the 10 registered nursing homes applied to and were approved by the Department of Health and Social Security (formerly the Ministry of Health) to take patients for treatment for the termination of pregnancy. BLIND AND PARTIALLY SIGHTED PERSONS During 1968, 145 (118) examinations were carried out by the Health Department for the certification of Blind and Partially Sighted persons under the provisions of the National Assistance Act, 1948. Of these 87 were new cases and 58 were re-examinations. This service is carried out in liaison with the City Council's Welfare Department which provides welfare services for registered Blind and Partially Sighted persons. Forty five certificates were also accepted from hospitals and other local authorities. 73 STAFF MEDICAL SERVICE A medical suite is provided in the Health Department at the City Hall and is staffed by a Principal Medical Officer and a trained nurse. First aid is available for any member of the staff in City Hall and arrangements are made as necessary for patients to be referred to their own general practitioners or to hospitals. The system of physical medical examination prior to entry to the Council's service has been replaced by a medical questionnaire, a medical examination only being necessary in cases in which there is any doubt or matters which need to be further considered. It is of interest to note that out of 1,280 medical questionnaires scrutinised by the Principal Medical Officer during 1968, in only 120 cases was it necessary to call the patient for interview and examination. Medical examinations are also undertaken in regard to extended sick leave of members of the City Council's staff, some who unfortunately have to be retired on grounds of permanent ill-health, and in respect of parking meter exemptions. The extension of parking meter areas to other parts of Westminster has inevitably resulted in a larger number of applications for exemption from the charges made. Medical examinations of certain categories of staff, such as drivers and sewermen, are carried out as a routine measure at entry to the Council's service and are repeated at regular intervals thereafter. As a matter of mutual convenience, arrangements also exist to medically examine persons who are joining local authorities in various parts of the country and thus obviate their having to travel long distances again after the initial interview and appointment; the City Council obtains a reciprocal service from other authorities. Statistics relating to work undertaken in the medical suite during 1968 are set out in Table 48, page 103. SCHOOL HEALTH Section 30 of the London Government Act 1963, places the responsibility for providing a school health service upon the Inner London Education Authority; the day to day operation of the service in Westminster is my concern as Principal School Medical Officer. For its efficient and economical working, arrangements were made under the provisions of the Act for the joint use by the City Council and the Authority of professional, administrative and clerical staff and premises. The following report to the Inner London Education Authority was submitted in respect of the school health service for the year 1968. In addition to the usual arrangements made for sessions in schools to cover health surveys, medical inspections, special medical examinations, re-inspections and school journeys, attention is drawn to the following special features:— Educationally subnormal children—Six medical officers are approved to undertake the statutory examination of children who are reported to be educationally subnormal. During the year 92 children were examined and 48 of these were ascertained to be educationally subnormal and recommended for placement in E.S.N. schools. Twenty-eight were admitted to such schools. A further 20 of the children examined were deemed unsuitable for education at school and recommended for places in training centres. Special Investigation Clinics—Children who require a longer time and more privacy than is available at school medical inspections are referred to Special Investigation Clinics where a social worker attends with a doctor. Any necessary social work in the home is carried out by the social worker. Seven special investigation clinics are held each week in Westminster and in 1968 there were 128 new referrals and a total of 561 attendances. Vision Clinics—The commonest defect found at school medical examinations are errors of refraction. Children with visual defects are referred to special ophthalmological sessions. Three such sessions are held weekly in Westminster, two at school treatment centres and one at the Western Ophthalmic Hospital, Marylebone Road, N.W.1. I record with regret the untimely death of the Ophthalmologist at Lisson Grove Vision clinic. Temporary replacements have been provided by the Regional Hospital Board but no permanent appointment has so far been made. This has meant that the number of children treated has decreased. 74 Immunisation—Measles—When vaccine was released by the Ministry, immunisation was offered to children in Infant schools. Special sessions were held and vaccination was also undertaken during school medical inspections. Six hundred and eighty-nine children between the ages of four and seven years were vaccinated during the Summer term of 1968. B.C.G. Vaccination—The vaccination scheme for schools continues to work smoothly and a total of 25 secondary schools were visited during the year. In addition special programmes were arranged in eight Colleges for Further Education with X-ray facilities provided by the Mobile Units of the London Mass X-ray service. The attendance at some of these sessions was poor. A high positive rate on skin tests was found in 4 schools in the Paddington and St. Marylebone areas and special measures were taken for all pupils and staff to be screened. School Medical Officers—Out of a total of 63 schools in Westminster, four are attended by general practitioners, 16 by sessional medical officers other than general practitioners and forty three by whole time medical officers. As far as possible full-time medical officers undertake examinations at both child welfare and local junior schools in the area, thus providing continuity of medical care. Diathermy—The clinic for diathermy treatment of verrucas continues to be well attended and expands from one to two sessions weekly as the need arises. Six hundred and sixty-seven patients were seen during this year. Opportunity has been taken this year to include in greater detail statistics relating to various aspects of school health work in the City of Westminster, together with totals for the whole of the Inner London Education Authority area. (Tables 50-56, pages 104-110). DENTAL SERVICE (Mr. Robert E. Kean, L.D.S., R.C.S.(I), Chief Dental Officer and Principal School Dental Officer. Inner London Education Authority) The pattern of events in the Council's dental services during the year 1968 continued in much the same vein as the previous year, and notwithstanding intermittent staff shortages of both dental officers and dental surgery assistants, the total number of sessions in the School and Maternal and Child Welfare services increased from 2,117 in 1967 to 2,261 in the year under review. The total number of first inspections in the schools and clinics increased to 12,490 as compared with 11,484 during the previous year, but despite all the efforts of treatment and propaganda, the percentage of children found to require treatment is disturbingly high at 64.6 per cent.; this pattern appears to be more or less constant throughout all the schools in the Inner London Education Authority. The three main functions of local authority dental services are (a) prevention, (b) dental health education and (c) treatment, the extent of the latter function being in direct ratio to the effectiveness of the first two. The Chief Dental Officer has expressed the opinion on numerous previous occasions, that until such time as the authority concerned will introduce the fluoridation of our water supplies, the incidence of dental caries in children will continue at its present undesirably high level. Since the children are the citizens of the future it must be obvious that apart from their physical well-being, the saving to the Exchequer for dental treatment in the General Dental Services would amply repay the introduction of this most vital preventive measure. The staffing position remained reasonably satisfactory during the year but there were the usual difficulties in recruiting and retaining Dental Surgery Assistants. The salary scale for this class of officer is a nationally negotiated one and whilst it may be sufficient to attract trained staff in some parts of the country it is quite inadequate for an area like Westminster where there is direct competition with the many specialists in the Harley Street and Wimpole Street areas. With a total staff of only six assistants to cover six surgeries the loss of one creates immediate difficulties. In times of acute shortage members of the clerical staff from the School Health Section at City Hall have assisted in the surgeries; whilst this help is much appreciated, it is only a "temporary filling" and a fully-trained assistant is of course of far greater help to the dentist. A special "weighting" allowance to recognise local difficulties would be helpful but this might create difficulties during the present period of financial stringency. 75 It had been hoped to install an additional surgery at the Westminster Treatment Centre some time during the year, but owing to a combination of unfortunate delays in adapting the premises, difficulty in obtaining the necessary equipment, and shortage of professional staff, this very desirable project was unable to be completed by the end of the year; but it is gratifying to record at the time of writing this Report (May 1969) that the surgery is now equipped up to the highest modern standards and is fully functional. No report on the dental service would be complete without mention of all the staff concerned in maintaining its efficient running, both in the surgeries and the school health office, and the Chief Dental Officer would wish to record his thanks and congratulations on the continued high standard of work in this important branch of the Council's services. Statistics relating to the dental service for expectant and nursing mothers and children under 5, and the School Dental Service are set out in Tables 57 and 58, pages 111 and 112. CHEST CLINICS There are three Chest Clinics in Westminster situated at the following addresses:— Paddington Chest Clinic, 14-18 Newton Road, W.2. (229-8821) St. Marylebone Chest Clinic, Council House, Marylebone Road, W.1. (935-7766) Westminster Hospital Chest Clinic, St. John's Gardens, S.W.1. (828-9811) I am indebted to the Consultant Physician at each of these Clinics for the following reports of their activities during 1968;— Paddington Chest Clinic—Dr. P. A. Zorab, Consultant Physician The problem of tuberculosis in this area continues to have special features in that so many of the immigrant population live in grossly over-occupied conditions and, in consequence, any new case may spread infection rapidly unless discovered in good time. Holding regular contact clinics, B.C.G. clinics, providing an X-ray service for general practitioners, and following up tuberculin positive schoolchildren, has proved most helpful in our aim to eradicate tuberculosis. Referrals from general practitioners of patients suffering from asthma, bronchitis and lung cancer as well as many less common chest diseases, have increased over the past year. A new Research Project passed by the Regional Board on "The Diaphragm in Obstructive Airway Disease" was started in August 1968. Postgraduate and Nursing Teaching remains a regular feature of clinic work. St. Marylebone Chest Clinic—Dr. G. Shneerson, Consultant Physician Both the incidence of new cases of tuberculosis and the deaths from cancer of the lung are remarkably similar to those of the preceding year. The out-patient facilities for diagnosis and assessment of tuberculosis and other non-tuberculous conditions remains unchanged; the transfer of Paddington General Hospital, which contained the in-patient component of the Unit, to the control of the St. Mary's Group has made the resources of the latter even more readily available than in the past. Westminster Hospital Chest Clinic—Dr. P. A. Emerson, Consultant Physician The year 1968 has seen great changes in the Westminster Chest Clinic. In the summer of this year the clinic moved from its old premises at 1 Ebury Bridge Road into the new Page Street Wing in Westminster Hospital and the facilities are now excellent. There is now a pulmonary function testing laboratory which is being linked with a computer and all the facilities of the main hospital are now always immediately available to patients attending the clinic. Although the number of patients attending the clinic has increased, the number of newly diagnosed cases of tuberculosis has fallen slightly compared with the previous year. Thirty-two new cases of tuberculosis were notified during 1968; twenty-four were males and eight were females. There were no new cases of tuberculosis in children. 76 Only three of the tuberculous patients were referred to the clinic by their general practitioners. Seven were discovered by the South West London Mass X-ray Unit and another 22 were notified by various other hospitals and mass X-ray units. The regular visits to Bruce House to offer chest X-rays to the men who live there have continued and this year we have started regular visits to the lodging houses in Great Peter Street. These visits have been made monthly and although in the last year about 80 men had abnormalities on their chest-X-rays and were asked to attend the clinic only about 48 per cent. of them actually did so. The clinic is planning a research project to study the effects of atmospheric conditions and air pollution on the condition of patients with bronchitis and asthma living in Westminster; this work will be undertaken with the co-operation of the Westminster City Council's atmospheric pollution monitoring stations. Statistics relating to notifications of tuberculosis in Westminister, and deaths, during 1968, are set out in Table 4, page 81, whilst further statistics dealing with care and after-care of tuberculous patients, and work undertaken at the three Chest Clinics, are set out in Table 59, page 113. 77 LIST OF STATISTICAL TABLES Table Title 1 Deaths—according to age-group and sex. 2 Infant Mortality—according to cause, age group and sex. 3 Notifications of Infectious and Other Notifiable Diseases. 4 Tuberculosis—New cases and deaths. 5 Puerperal pyrexia—analysis of causes. 6 Specimens submitted to the Public Health Laboratory. 7 Night and out of office hours Emergency Service. 8 Dwelling houses—reason for initial inspection. 9 Dwelling houses—nuisances and unsatisfactory conditions found and remedied. 10 Summary of visits by Public Health Inspectors. 11 Statutory notices served. 12 Summary of visits by Housing Act Inspectors. 13 Summary of work carried out by Public Health Inspectors under the Housing Acts. 14 Unfit premises. 15 Overcrowding. 16 Certificates of Disrepair. 17 Rodent control. 18 Chemical examination of water supplied to City of Westminster—average results. 19 Bacteriological examination of water supplied to City of Westminster—average results after treatment. 20 Lead content of water from main taps in consumers' premises. 21 Offices, Shops and Railway Premises Act, 1963. 22 Factories—inspections for purposes of provisions as to health. 23 Factories—defects. 24 Outwork. 25 Estimated percentage of compliance of premises in Westminster with Food Hygiene (General) Regulations 1960, in relation to washing facilities and provision of sinks. 26 Premises registered for preserving food, or manufacture, storage or sale of ice-cream. 27 Food poisoning investigations. 28 Analyses for Pesticides in Food. 29 Analysis of Legal Proceedings. 30 Coroner's Court and Mortuary. 31 Sessions at Maternal and Child Welfare Centres. 32 Clinic services—ante-natal and post-natal clinics. 33 Mothercraft and ante-natal exercises. 34 Child Welfare Centres. 35 Health Visiting. 36 Vaccination of persons under age 16 completed during 1968 at Welfare Centres and by general practitioners. 37 Smallpox vaccination of persons aged under 16. 38 Home Nursing. 39 Domiciliary Midwifery. 40 Chiropody service. 41 Home Help Service. 42 Mental Health Service—number of patients referred to City Council during year ended 31st December, 1968. 43 Number of patients for whom hospital admissions were arranged. 44 Mental Health Service—number of cases in community care at end of year. 45 Number of patients admitted for temporary residential care during the year (e.g. to relieve the family). 46 The Terrace Day Centre (Day Centre for the mentally ill, 1 St. Mary's Terrace, W.2). 47 Venereal diseases—cases treated in Westminster during 1968. 48 Medical suite at City Hall—work undertaken, 1968. 49 School Health service—full-time equivalent employees. 50 Tuberculin Test and B.C.G. vaccination of school-children and students. 51 School medical inspections 1968. 52 Routine medical inspections in schools, 1968—defects found. 53 School health service—findings at health surveys, 1968. 54 School health service—non-routine medical inspections, 1968. 55 School health service—routine medical inspections, 1968—vision. 56 School health service—comparison of defects noted at 7-plus routine and 7-plus special medical inspections, 1968. 57 Dental services for expectant and nursing mothers and children under 5. 58 School dental service statistics, 1968. 59 Tuberculosis—care and after-care—work at Chest Clinics in Westminster. 78 Table 1.—Deaths—According to Age-Group and Sex CAUSE OF DEATH *1967 1968 Net Deaths at the sub-joined ages of residents (Male and Female) whether occurring within or without the City Totals All Ages All Ages Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Enteritis and other diarrhoeal diseases + 1 1 — — — — — — — — — — 1 — — 1 Tuberculosis of respiratory system 14 9 4 — — — — — — — — — — 6 3 3 1 Other tuberculosis, including late effects — 3 1 — — — — — — — — — 1 2 — 1 — Meningococcal infection 1 — 1 — — — — — — — — — — — 1 — — Measles 1 — — — — — — — — — — — — — — — — Syphilis and its sequelae 10 3 2 — — — — — — — — — — 1 1 2 1 Other infective and parasitic diseases 3 1 2 — — — — — — — — — — 1 — — 2 Malignant neoplasm—stomach 58 26 27 — — — — — — — — — 2 6 6 20 19 Malignant neoplasm—lung, bronchus 175 151 48 — — — — — — — — 2 1 73 17 76 30 Malignant neoplasm—breast 55 — 62 — — — — — — — — — 3 — 29 — 30 Malignant neoplasm—uterus 28 — 23 — — — — — — — — — — — 13 — 10 Leukaemia 22 14 8 — — — 1 1 — 2 1 1 1 4 1 6 4 Other malignant neoplasms, etc. 367 172 146 — — — 1 1 1 2 1 15 7 59 46 95 90 Benign and unspecified neoplasms + 3 5 — — — — — — — — — 1 1 1 2 3 Diabetes mellitus 13 13 20 — — — — — — — 1 2 — 2 3 9 16 Avitaminoses, etc. + 1 — 1 — — — — — — — — — — — — Other endocrine, etc., diseases + 5 4 1 1 — — — — — — 1 — 1 1 2 2 Anaemias + 1 2 — 1 — — — — — — — — — — 1 1 Other diseases of blood, etc. + 3 — 1 — — — — — — — 2 — — — — — Mental disorders + 4 7 — — — — — — — — 3 1 1 5 — 1 Meningitis + 3 — — — — — 1 — — — — — 2 — — — Other diseases of nervous system, etc. + 14 15 — 1 — — — — 1 — 1 2 2 5 10 7 Active rheumatic fever + — 1 — — — — — — — — — — — — — — Chronic rheumatic heart disease + 28 20 — — — — — — 1 — 7 1 16 / 4 12 Hypertensive disease + 24 37 — — — — — — — — 2 — 8 1 14 36 Ischaemic heart disease + 339 256 — — — — — — — — 6 2 117 31 216 223 Other forms of heart disease + 33 71 — — — — — — — 1 3 — 4 5 26 65 Cerebrovascular disease + 99 185 — — — — — — — — 4 3 25 24 70 158 Other diseases of circulatory system 128 74 72 — — — — — — — — 3 1 15 6 56 65 Influenza 1 6 9 — — — — — — 1 — — — 2 1 3 8 Pneumonia 208 94 100 5 2 1 — 1 — — — 1 1 8 10 78 87 Bronchitis and emphysema 135 95 32 — — — — — — — — — — 24 10 71 22 Asthma + 3 11 — — — — — — — — 1 4 2 5 — 2 Other diseases of respiratory system + 21 10 — — — — — — — — 2 1 5 1 14 8 Peptic Ulcer 25 16 9 — — — — — — — — — — 5 2 11 7 Appendicitis + 2 — — — — — — — 1 — — — 1 — — — Intestinal obstruction and hernia + 8 8 1 — — — — 1 — — — — 2 — 5 7 Cirrhosis of liver + 11 4 — — — — — — — — 1 — 6 4 4 — Other diseases of digestive system + 19 27 1 — — 1 — 1 1 1 1 1 4 4 12 19 Nephritis and nephrosis 16 8 3 — — — — — — — — 2 1 2 — 4 2 Hyperplasia of prostate 7 4 — — — — — — — — — — — — — 4 — Other diseases, genito-urinary system + 9 13 — — — — — — — — — 1 4 1 5 11 Diseases of skin, subcutaneous tissue + 1 2 — — — — — — — — — — — — 1 2 Diseases of musculo-skeletal system + 4 7 — — — — — — — 1 — — 2 1 2 5 Congenital anomalies + 16 18 9 6 1 2 3 4 1 2 1 — 1 2 — 2 Birth injury, difficult labour, etc. + 3 7 3 7 — — — — — — — — — — — — Other causes of perinatal mortality + 5 2 5 2 — — — — — — — — — — — — Symptoms and ill-defined conditions + 1 7 — — — — — — — — — — — 2 1 5 Motor vehicle accidents 23 22 16 — — — — — — 2 — 7 2 6 4 7 10 All other accidents 79 28 29 2 — 2 1 1 — — — 8 3 12 5 3 20 Suicide and self-inflicted injuries 68 31 29 — — — — — — 3 2 11 6 13 11 4 10 All other external causes + 16 12 — — 1 — — — 1 — 4 3 9 3 1 6 Homicide and operations of war 3 — — — — — — — — — — — — — — — — Totals 1,446 1,376 28 21 5 6 8 7 16 10 91 50 455 272 843 1010 2,822 49 11 15 26 141 727 1,853 1967 2,794 — 75 9 11 33 117 729 1,820 *Note: The Registrar General's Table of Causes of Death has been substantially changed in respect of the year 1968. The Causes of Death marked thus + did not appear in the Tables for previous years or in certain instances have been modified in content because of the changes in the list of specifically defined causes. Accordingly statistics for the year 1967 cannot be given against them for purposes of comparison. 79 Table 2.—Infant Mortality—According to Cause, Age-Group and Sex CAUSE OF DEATH Under 1 week 1 and under 2 weeks 2 and under 4 weeks 1 and under 3 months 3 and under 6 months 6 and under 9 months 9 and under 12 months Total M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Acute Pneumonitis — — — — — — — — 1 — — — — — 1 — Anencephaly — 1 — — — — — — — — — — — — — 1 Anoxia — 1 — — — — — — — — — — — — — 1 Asphyxia 1 3 — — — — — — — — — — — — 1 3 Bronchopneumonia — — — — — — — 1 1 1 — — — — 1 2 Cardiac Arrest 1 — — — 1 — 1 — — — — — — — 3 — Choanatresia — 1 — — — — — — — — — — — — — 1 Congenital Heart Disease — — — — — — 2 — — — — — — — 2 1 Congestive Cardiac Failure — — — — — — 1 — — — — — — — 1 — Cystic Fibrosis of Pancreas — — — — — — — — — — 1 — — — 1 — Exomphalos 1 — — — — — — — — — — — — — 1 — Gastro Enteritis — — — — 1 — — 1 — — — — — — 1 1 Haemolytic Anaemia — — — — — — — 1 — — — — — — — 1 Hyaline Membrane Disease 1 — — — — — — — — — — — — — 1 — Inhalation of Vomit — — — — — — — — 1 — — — — — 1 — Intestinal Obstruction 1 — — — — — — — — — — — — — 1 Left Ventricular Failure 1 — — — — — — — — — — — — — 1 — Multiple Congenital Abnormalities — 1 — — — — — — — — — — — — — 1 Oesophagal Atresia — 1 — — — — — — — — — — — — — 1 Pneumonia 1 1 — — — — 1 — — — — — — — 2 1 Prematurity 5 3 — — — — — — — — — — — — 5 3 Renal Agenesis 1 — — — — — — — — — — — — — 1 — Respiratory Distress 4 2 — — — — — 1 — — — — — — 4 3 Spina Bifida 1 — — — — — — — — — — — — — 1 — Totals—1968 17 15 — — 2 — 5 4 3 2 1 — — — 28 21 Totals—1967 (in brackets) 32 (39) — (—) 2 (5) 9 (15) 5 (11) 1 (5) — (—) 49 (75) Number of deaths of illegitimate infants included in above 5 (12) — (—) — (1) 1 (6) 2 (4) — (—) — (—) 8 (23) 80 Table 3.—Notification of Infectious and Other Notifiable Diseases Numbers originally notified Total (All Ages) Measles (excluding rubella) Dysentery Scarlet Fever Diphtheria Acute meningitis Acute poliomyelitis Other notifiable diseases Paralytic Nonparalytic Original Final M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 132 121 9 18 6 11 — 2 — — Smallpox Final numbers after correction Under 1 year 3 6 2 1 1 1 year 20 19 — 2 Ophthalmia neonatorum 2 years 3 19 30 14 29 1 1 1 1 1 2 1 2 4 5—9 12 36 13 32 1 1 1 7 1 4 2 7 Anthrax 10—14 „ 1 2 1 1 15—24 „ 8 Malaria (from abroad) 25 and over 1 2 4 5 3 — 3 — Age unknown 2 4 Puerperal pyrexia Total (All Ages) 132 121 9 18 6 11 2 86 86 Numbers originally notified Total (All Ages) Acute encephalitis Acute pneumonia Paratyphoid fever Typhoid fever Food poisoning Erysipelas Whooping cough Infective Post infectious M. F. M. F. M. F. M. F. M. F. M. F. M. F. Numbers originally notified Total (All Ages) M. F. 1 — 6 2 1 2 23 66 1 3 6 8 Final numbers after correction Under 5 years 1 3 4 3 Final numbers after correction Under 3 months 1 5—14 years — — — — 1 — — — 1 — 3 2 — 1 3 months 15—44 „ 2 7 45 6 45—64 „ 1 4 6 — 2 9 65 and over — — — — 2 1 — — — — — 1 1 1 year 1 1 Age unknown 2—4 years 2 3 5—9 „ 2 3 Total (All Ages) — 1 — — 6 2 — — 1 2 18 62 1 3 10—14 „ 1 — 15—19 „ — — Number originally notified Tetanus Infective Jaundice Tuberculosis 20—24 „ — — 25—34 „ — — 35—44 „ — Respiratory Meninges & C.N.S. Other Cases of fatal tuberculosis not notified before death — 45—54 „ — — 55—64 „ — — M. F. M. F. M. F. M. F. M. F. 65—74 „ — — 75 and over — — Total (All Ages) Final numbers 46 15 94 41 2 9 14 Age unknown — — Males Females Total (All Ages) 6 8 Under 1 year — — — — 1 — 1 — — — 6 2 1 year 1 ? ? ? 1 5—9 „ — — 4 2 1 3 — — 1 Total Notifications of infectious and other Notifiable Diseases received during the year. 10—14 „ — — 5 2 5 4 — — — 1 15—19 „ — — b b 1 1 — — — — 20—24 „ — — 17 2 7 3 — 3 25—34 „ — — 6 2 13 8 — — 5 3 35—44 „ — — 5 1 14 6 — — 3 2 1968 .. 732 45—54 „ — — 1 — 1/ b — — 1 2 1967 .. 1,518 55—64 „ — — — 1 18 4 — — — — 65—74 „ — — — — 12 4 — — — 2 75 and over — — 1 — 1 1 — — — — Age unknown 1 Total (All Ages) 46 15 94 41 2 9 14 81 Table 4.—Tuberculosis: New Cases and Deaths At ages— years *NEW CASES DEATHS Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 0—1 1 — 1 — — — — — 1—5 3 2 1 — — — — — 5—15 6 7 — 2 — — — — 15—25 8 4 — 3 — — — 25—35 14 8 5 3 — — — — 35—45 14 6 3 2 — — — 1 45—55 18 5 1 2 — — — — 55—65 22 5 — — 6 3 2 — 65 and upwards 13 5 — 2 3 1 1 — Age unknown 1 1 — — — — — — Totals 1968 100 43 11 14 9 4 3 1 1967 77 30 6 5 9 5 — — * Including all primary notifications and also any other new cases of tuberculosis which came to the knowledge of the Medical Officer of Health during the year. Table 5.—Puerperal Pyrexia: Analysis of Causes Cause Number of cases Pharyngitis 1 Caesarean section 3 Haemolytic streptococcal infection 1 Urticarial rash 1 Breast engorgement 3 Pneumonia 2 Urinary tract infection 1 Pyelonephritis 1 Unspecified or unknown 73 Total 86 (Puerperal Pyrexia ceased to be notifiable from 1st October 1968. There were 88 cases in 1967.) 82 Table 6.—Specimens Submitted to the Public Health Laboratory Nature of Specimen Number Examined Positive Findings Nasal, throat and mouth swabs 177 Haemolytic Streptococci 21 Staphylococcus Aureus 20 Monilia 3 Faeces 525 Shigella Sonnei 32 Shigella Flexneri 2 B. Coli 0111 2 B. Coli 026 2 B. Coli 0126 1 Salmonella typhimurium 10 Salmonella St. Paul 11 Salmonella Muenster 2 Salmonella Enteritidis 5 Salmonella Stanleyville 1 Salmonella Seftenberg 1 S. Para typhi B. 1 Clostridium Welchii 2 Trichuris trichiura 1 Urine 28 Sputum 2 (The total number of specimens examined during 1967 was 1,294) Table 7.—Night and out of office hours emergency service— Analysis of calls made to Duty Officers Month 1968 Mental Welfare Midwives Welfare Department Children's Department P.H.I. Miscellaneous Total *W. K. W. K. W. K. W. K. W. K. W. K. W. K. January 166 132 44 31 31 2 87 14 27 — 395 12 750 191 February 206 119 22 21 24 4 47 6 30 2 346 12 675 164 March 169 126 50 23 16 3 86 14 66 11 405 13 792 190 April 185 102 51 15 30 — 85 21 20 1 355 3 726 142 May 163 152 29 31 19 10 81 20 26 — 377 5 695 218 June 242 165 57 29 23 — 70 29 42 1 447 6 881 230 July 203 159 36 17 21 1 88 35 46 1 375 4 769 217 August 185 146 26 18 33 6 96 24 52 2 438 13 830 209 September 196 128 37 18 20 5 71 25 56 2 399 6 779 184 October 214 92 28 31 40 4 96 8 53 — 369 6 800 141 November 169 163 14 19 15 2 63 20 42 — 392 10 695 214 December 156 157 31 26 20 7 57 19 36 — 461 15 761 224 TOTAL— 1968 2,254 1,641 425 279 292 44 927 235 496 20 4,759 105 9,153 2,324 1967 2,107 1,836 507 326 276 41 842 181 394 20 2,882 51 6,908 2,455 * "W" refers to calls relating to the City of Westminster. "K" refers to calls relating to the Royal Borough of Kensington and Chelsea. 83 Table 8.—Dwelling Houses—Reason for Initial Inspection 1968 1967 Complaints 3,774 3,585 Routine 1,158 1,183 Smoke Control 907 912 Infectious Disease 380 359 Underground Rooms 397 399 Application for Grants and Loans 245 341 Housing circumstances 1,103 1,368 Drainage 1,405 1,676 Rodent Control 658 493 Miscellaneous 600 520 Table 9.—Dwelling Houses—Nuisances and Unsatisfactory Conditions Found and Remedied 1968 1967 Houses, damp, dirty or dilapidated 248 217 Doors, windows, floors, ceilings, firegrates defective 1,158 1,019 Insufficient or unsuitable W.C. accommodation 100 101 Drains, W.Cs and waste pipe stoppages 196 167 Drains, W.Cs and waste pipe defective 461 397 Yard, area and washhouse defects 37 51 Roofs, gutters and rainwater pipes defective 477 355 Water supplies absent or insufficient 22 28 Water cisterns dirty or defective 37 23 Ashpits, dustbins, etc, insufficient or defective 102 52 Rubbish accumulations 253 217 Animal nuisances 8 2 Miscellaneous 351 134 Table 10.—Summary of Visits by Public Health Inspectors 1968 1967 Clean Air Act 1,549 1,531 Drainage and New Developments 12,024 13,075 Dwelling Houses (general matters) 17,728 18,707 Factories (other than building sites) 551 538 Food and Catering Premises 10,386 11,894 Hairdressers' Establishments 51 76 Infectious Disease 979 948 Noise 1,141 1,193 Offices 2,063 2,304 Pigeons 79 154 Rodent Control 1,685 1,463 Shops 803 864 Smoke Observations 480 331 Town Planning 49 42 Vermin investigations 703 721 Other purposes 2,151 1,730 84 Table 11.—Statutory Notices Served 1968 1967 Public Health Acts, 1936 and 1961 795 652 Clean Air Act, 1956 36 210 Greater London Council Drainage Bylaws 1 12 Greater London Council Water-Closet Bylaws 1 11 Factories Act, 1961 1 2 Noise Abatement Act, 1960 2 2 Prevention of Damage by Pests Act, 1949 5 1 Greater London Council (G.P.) Act, 1947 Local Bylaws: 2 1 Artificial Lighting of Common Staircases 20 19 Cleansing of Cisterns 3 4 Removal of Refuse - 1 Table 12.—Summary of Visits by Housing Act Inspectors 1968 1967 Work under Housing Acts, 1961-1964 1,659 2,183 Clearance and development area surveys 1,005 618 Loan and grant applications 1,301 588 Improvement area inspections — 120 Hotel etc., inspections 818 — Other visits 209 74 Table 13.—Summary of Work Carried Out by Public Health Inspectors under the Housing Acts 1961 -64 in connection with Houses in Multiple Occupation 1968 1967 Premises in course of inspection at end of year 42 6 Premises inspected 403 78 Premises where action was required 247 62 Informal action taken—premises 113 11 Management orders made (Section 12) 9 15 Directions given (Section 19) 31 31 Notices served for contraventions of Management Regulations (Section 14) 5 7 Notices served for the provision of amenities (Section 15) 7 8 Notices served for means of escape in case of fire (Section 16) 50 12 Work in progress at end of year 63 7 Notices under Section 14 complied with 2 15 Notices under Section 15 complied with 7 12 Notices under Section 16 complied with 19 17 85 Table 14.—Unfit Premises 1968 1967 Closing orders made on underground rooms 27 (63 rooms) 22 (58 rooms) Undertakings accepted in lieu of closing orders on underground rooms 2 (4 rooms) - Closing orders made on upper parts of buildings and mews premises 5 (12 rooms) 3 (6 rooms) Undertakings accepted on upper parts of buildings and mews premises 1 (4 rooms) - Closing orders made on houses in lieu of demolition orders 4 (32 rooms) Undertakings accepted in lieu of closing orders on houses - Closing orders on underground rooms determined when work carried out 33 (100 rooms) 53 (120 rooms) Closing orders on upper parts and mews premises determined when work carried out 2 (5 rooms) 2 (4 rooms) Undertakings cancelled as a result of work carried out 3 (16 rooms) Closing orders or undertakings cancelled when premises demolished 15 (42 rooms) 36 (94 rooms) Table 15.—Known cases of Overcrowding 1968 1967 Dwellings overcrowded at end of year 217 213 Persons dwelling therein 825½ units (1,087 persons) 807 units (1,070 persons) New cases of overcrowding noted during the year 21 36 Persons involved in new cases. . 91 units (120 persons) 149 units (205 persons) Cases of overcrowding relieved during the year 17 41 Persons involved in relieved cases 70½ units (97 persons) 155 units (221 persons) Note: The Housing Act, 1957 provides that in calculating the number of "units":— (i) no account shall be taken of a child under one year old, and (ii) a child who has attained one year and is under ten years old shall be reckoned as a half-unit. 86 Table 16.—Certificates of Disrepair 1968 1967 Applications for certificates: Applications for certificates Nil Nil Decisions not to issue certificates Nil Nil Decisions to issue certificates: (a) in respect of some defects listed Nil Nil (b) in respect of all defects listed Nil Nil Undertakings given by landlords Nil Nil Undertakings refused by Council Nil Nil Certificates issued Nil Nil Applications for cancellation of certificates: Applications by landlords for cancellation of certificates Nil 1 Objections by tenant to cancellation of certificates Nil Nil Decisions by Council to cancel certificates despite objections Nil Nil Certificates cancelled by Council Nil 1 Table 17.—Rodent Control 1968 1967 Complaints: Complaints of rats received 777 965 Complaints of mice received 1,206 1,140 Total premises involved 1,983 2,105 Infestations treated by Council's staff: (Including properties inspected for reasons other than notification) Premises rid of rats 824 1,003 Premises rid of mice 1,226 1,159 Total premises disinfested 2,050 2,162 Inspections by Public Health Inspectors and visits by Rodent Officers to such places 3,670 3,804 Notices: Intimation notices served — — Statutory notices served — — 87 Table 18.—Chemical Examination of Water Supplied to City of Westminster—Average Results Milligrammes per Litre (unless otherwise stated) Analysis data Source of Supply Stoke Newington All Thames derived Ammoniacal Nitrogen 0.014 0.020 Albuminoid Nitrogen 0.060 0.083 Nitrate 4.8 3.9 Chlorides as Cl. 40 32 Oxygen abs. from Permanganate 4 hrs. at 27°C 0.69 1.20 Turbidity units 0.1 0.1 Colour (Burgess units) 7 8.0 Hardness (total) 308 280 Hardness (non-carbonate) 78 76 p.H. Value 8.0 7.9 Phosphate as Po4 1.7 2.0 Silicate as Sio2 10 10 Sulphate as So4 66 62 Natural Fluoride as F 0.30 0.30 Magnesium as Mg. 5 4 Sodium as Na 29.9 23.2 Potassium as K 5.2 5.3 Surface active material as manoxol 0.01 0.02 Electrical Conductivity (microhms) 630 570 Table 19.—Bacteriological Examination of Water Supplied to City of Westminster—Average Results after Treatment Source of supply Number of Samples Agar plate count per ml. Coliform count E.coli count 20-24 hours 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. Stoke Newington 257 18.9 — 100.0 100.0 All Thames-derived 3,651 11.4 — 99.4 99.97 88 Table 20.—Lead Content of Water from Main Taps in Consumers' Premises Lead content (mg/l Pb) Samples of water standing in lead pipe overnight Samples of water after running the tap Less than 0.01 10 37 0.01 31 57 0.02 21 4 0.03 8 1 0.04 9 0 0.05 5 0 0.06 5 0 0.07 4 1 0.08 1 0 0.09 3 0 0.10 1 0 0.12 1 0 0.16 1 0 100 premises 100 premises Table 21.—Offices, Shops and Railway Premises Act, 1963 Category of Premises Number Registered in 1968 Total Number Registered at 31st December, 1968 Number of Registered Premises receiving a general inspection during the year Offices 984 (1,147) 11,513 (11,164) 2,043 (2,332) Retail Shops 190 (390) 3,710 ( 3,507) 730 (338) Wholesale Shops, Warehouses 75 (63) 810 (827) 118 (5) Catering establishments open to the Public (Canteens) 70 (84) 1,422 (1,282) 69 (119) Fuel Storage Depots — (-) — (— ) — (— ) Totals 1,319 (1,912) 17,455 (16,281) 2,960 (5,751) Analysis of persons employed in Registered Premises by workplace 1968 1967 Offices 267,510 259,766 Retail Shops 38,552 37,435 Wholesale departments, Warehouses 19,134 19,229 Catering Establishments open to the Public 21,092 20,094 Canteens 5,655 5,587 Fuel Storage Depots — — Total 351,943 342,111 Total Males 191,079 185,820 Total Females 160,864 156,291 Inspections and Contraventions Inspections of all kinds 6,821 9,763 Premises at which contraventions were found 1,379 1,506 Accidents Notifiable accidents 495 573 Accidents reported and found not to be notifiable 21 19 Accidents investigated . . 241 290 Accidents investigated which revealed contraventions 7 67 Accidents where a contravention may have been a contributory cause 4 17 Accidents resulting in one or more fatalities 2 — Fatalities 2 — 89 Table 22.—Factories: Inspection for purposes of provisions as to health Number on Register Number of Inspections Written notices Occupiers prosecuted 1968 1967 1968 1967 1968 1967 1968 1967 (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 758 777 119 48 5 2 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2,968 3,080 432 354 50 11 — — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 913 865 1,445 1,373 — — — Total 4,639 4,722 1,996 1,775 55 13 — — Table 23.—Factories: Defects Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector 1968 1967 1968 1967 1968 1967 1968 1967 1968 1967 Want of cleanliness (S.1) 20 17 15 19 2 3 4 3 — — Overcrowding (S.2) — 1 — 1 — 1 — — — — Unreasonable temperature (S.3) — — — — — — — — — — Inadequate ventilation (S.4) 7 6 6 6 1 — 2 — — — Ineffective drainage of floors (S.6) — — — — — — — — — — Sanitary Conveniences (S.7) (a) Insufficient 2 6 1 3 — 2 — 1 — — (b) Unsuitable or defective 45 21 33 21 2 10 6 10 — — (c) Not separate for sexes 10 4 8 4 — — 1 — — — Other offences against the Act (not including offences relating to Out-work) 21 18 13 11 — 9 — — — — Total 105 73 76 65 5 25 13 14 — — 90 Table 24.—Outwork Nature of work Number of out-workers in August list required by Section 133(1) (c) Number of cases of default in sending lists to the Council Number of prosecutions for failure to supply lists Number of instances of work in unwholesome premises Notices served Prosecutions 1968 1967 1968 1967 1968 1967 1968 1967 1968 1967 1968 1967 Wearing apparel—making etc. 1,799 2,186 - - - - - - - - - - Household linen 2 23 - - - - - - - - - - Lace making, mending, etc. 3 - - - - - - - - - - - Curtains and furniture hangings 2 25 - - - - - - - - - - Furniture and upholstery 1 1 - - - - - - - - - - Paper bags 2 - - - - - - - - - - - Boxes and other receptacles (paper, etc.) 10 - - - - - - - - - - Feather sorting 3 - - - - - - - - - - - Lampshades 2 2 - - - - - - - - - - 1,814 2,247 - - - - - - - - - - Table 25.—Estimated Percentage of Compliance of Premises in Westminster with Food Hygiene (General) Regulations, 1960 in relation to (a) Regulation 16— Washing Facilities for the use of Staff, and (b) Regulation 19—Provision of Sinks for Cleansing of Equipment and Food Preparation Type of Premises to which Sections 16 and 19 apply Number Estimated percentage of compliance with Regulation 16 Estimated percentage of compliance with Regulation 19 Hotels and boarding houses (estimated) 700 85 85 Restaurants, cafes and snack bars 1,721 93 95 Grocers and provision merchants 510 95 95 Canteens and clubs 1.494 97 97 Public houses 544 96 96 Confectioners 555 84 50 Greengrocers and fruiterers 186 90 75 Schools, nurseries and hostels 83 100 100 Butchers 132 95 95 Off licences 254 80 — Bakers, cake and pastry premises 133 100 82 Chemists 180 80 20† Fishmongers and poulterers 48 97 100 Food factories 15 100 100 Wholesale premises, stores and depots 269 86 77 * Not applicable. † Maximum percentage requiring this facility. 91 Table 26.—Premises Registered for Preserving Food, or Manufacture, Storage or Sale of Ice Cream 1968 ###] Preserved food, etc. 175 164 Ice cream: Manufacture, and/or sale and/or storage 685 642 Table 27.—Food Poisoning—Investigation of Incidents and Cases Causative agent General Outbreaks Family Outbreaks Sporadic Cases Total Total Number of separate outbreaks Number of cases notified or ascertained Number of separate outbreaks Number of cases notified or ascertained Notified or ascertained Number of outbreaks and sporadic cases Columns (1+3+5) Number of cases Columns (2+4+5) (1) (2) (3) (4) (5) (6) (7) S. typhimurium — — — — 4 4 4 Other Salmonellae 1 59 1 2 13 15 74 Cl. welchii 9 174 1 2 — 10 176 Staph, aureus 1 6 — — — 1 6 Other causes 1 13 — — — 1 13 Cause unknown 2 10 — — 17 19 27 Total 1968 14 262 2 4 34 50 300 Total 1967 12 386 1 5 28 41 419 Table 28.—Analyses for Pesticides in Food Description Country of Origin Vapouriser with Open Foods D.D.T. p.p.m. Other Organochlorine Compounds p.p.m. Organophosphorus Compounds p.p.m. Metals p.p.m. Fly Test Channel Island Milk- U.K. — Less than 0.02 Less than 0.02 Less than 0.05 — Negative Pasteurised Cheese U.K. No Less than 0.05 Less than 0.02 Less than 0.05 — Negative Lard U.S.A. — Less than 0.05 Less than 0.02 Less than 0.05 — Negative White Bread U.K. — Less than 0.05 Less than 0.02 Less than 0.05 — Negative Beef Sausage U.K. No Less than 0.05 Less than 0.02 Less than 0.05 — Negative Bacon Denmark Yes Less than 0.05 Less than 0.02 Less than 0.05 — Negative New Potatoes U.K. No Less than 0.05 Less than 0.02 Less than 0.05 — Negative Raspberries* U.K. No Less than 0.05 B.H.C. 0.02 Less than 0.05 — Positive Wholemeal Bread U.K. Yes Less than 0.05 Less than 0.02 Less than 0.05 — Negative Pork Chops U.K. Yes Less than 0.05 Less than 0.02 Less than 0.05 — Negative Eggs U.K. — Less than 0.05 Less than 0.02 Less than 0.05 Mercury, Less than 0.1 Negative Lettuce U.K. No Less than 0.05 Less than 0-02 Less than 0.05 — Negative •From street stall 92 Table 29.—Analysis of Legal Proceedings Fines Costs £ s. d. £ s. d. Public Health Act, 1936 (Sec. 92) Premises in such a state as to be prejudicial to health or a nuisance— 24 cases 39 0 0 78 15 0 Paddington Borough Council Byelaws— 1 case 3 0 0 — Housing Act, 1961 (Sec. 19)— Permitting new persons to reside in premises when overcrowded— 2 cases 13 0 0 10 10 0 Food & Drugs Act. 1955 (Sec. 2) Selling food not of the substance demanded— 7 cases 175 0 0 331 3 0 Food & Drugs Act, 1955 (Sec. 8 (1)) Selling food unfit for human consumption— 6 cases 115 0 0 57 10 0 Food & Drugs Act, 1955 (Sec. 6 (1) and (2)) Selling food bearing a label calculated to mislead— 1 case Absolute discharge 26 5 0 Being a party to the publication of an advertisement calculated to mislead— 1 case Food Hygiene (General) Regulations, 1960 83 cases 752 0 0 156 10 0 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 44 cases 117 0 0 30 19 6 Nurseries & Child Minders Regulation Act, 1948 2 cases 5 0 0 7 7 0 1968 £1219 0 0 £698 19 6 1967 £531 10 0 £260 14 0 93 Table 30.—Coroner's Court and Mortuary 1968 1967 Bodies received in the Mortuary on Coroner's Warrants, etc. 1,197 1,164 Bodies deposited to await burial 7 94 Inquest cases 320 335 Non-inquest cases 884 838 Post-mortem examinations held 1,179 1,164 Causes of death in the foregoing:— Accidental drowning 1 1 Found drowned 6 2 Suicide by drowning 1 1 Suicide by other means 106 141 Accidents: Street 37 36 Domestic 38 40 Others 44 48 Natural causes 885 843 Misadventure 5 4 Murder 9 2 Miscellaneous causes 60 46 Awaiting proceedings at Central Criminal Court 12 9 94 Table 31.—Maternal & Child Welfare Centres—Activities held as at December 1968 Note: The following Table sets out the sessions held at the various Centres in December, 1968. Changes occur from time to time to meet the need. CENTRE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. 283A Harrow Road, W.9. Toddlers Dental (School) Discussion Group (Psychiatric) Infant Wel. Occ. creche Dental (School) Family Planning Evening:— Child Wel. Ante-natal Infant Wel. Dental (School) Ante-natal (exercises) Infant Wel. Immunisation Home Advice Occ. creche Dental (School) Infant Wel. Dental (School) Ante-natal Infant Wel. Chiropody Dental (M.C.W) Occ. creche Evening:— Catholic Marriage Advice (3rd and 4th in month) Chiropody Dental (M.C.W. and School) (Gas sess. 1st Thurs. in month) Mentally handicapped children Post-natal Family Planning Infant Wel. Chiropody (also evening) Mothercraft Dental (M.C.W.) Evening:— Family Planning Toddlers Chiropody Dental (School) Cytology Infant Wel. Immunisation Chiropody Dental (School) Special investigation clinic (2nd and 4th Friday in month) Hallfield, Pickering House, W.2. Cytology Dental (School) Infant Wel. Dental (School) Playgroup Infant Wel. Dental (School) Evening:— Youth Advisory Clinic Ante-natal Dental (School) (Gas Sess. 4th Wed. in month) Infant Wel. Dental (School) Dental (M.C.W.) Dental (School) Infant Wel. Toddlers (2nd and 4th) Immunisation and Vacc. (1st and 3rd) Dental (School) Occ. creche Mothers' Club Dental (School) Queens Park, 66 Lancefield Street, W.10. Home Advice Group Evening:— Infant Wel. Infant Wel. Ante-natal Immunisation and Vacc. Infant Wel. Evening:— Family Planning Infant Wel. Infant Wel. Special Assessment (once a month) Infant Wel. Dibdin House, Maida Vale, W.9. Infant Wel. 95 Table 31.—Maternal & Child Welfare Centres—Activities held as at December 1968—(continued) CENTRE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. St. David's St. Mary's Terrace, W.2. Infant Wel. Child Wel. (1st and 3rd) Linnet House, Charlbert Street, N.W.8. Toddlers (2nd and 4th weeks in month) Infant Wel. Infant Wel. 217 Lisson Grove, N.W.8 Dental (M.C.W. and School) Playgroup Toddlers (1st, 2nd 3rd weeks only) Sewing Occ. creche Physio. Cleansing (School children) Special investigation (as required) Dental (M.C.W.) Evening:— Family Planning Speech Therapy Chiropody Dental (School) Special investigation (as required) Playgroup Speech Therapy Infant Wel. Chiropody (also Evening) Dental (School) Relaxation and Mothercraft Chiropody Dental (School) Playgroup Discussion Group Chiropody Dental (School) Chiropody Speech Therapy Dental (M.C.W. and School) Playgroup Infant Wel. Dental (School) Cleansing (School children) Chiropody Speech Therapy Chiropody Dental (School) Playgroup Ante-natal Dental (School) (Gas Sess. 3rd Friday in month) Westminster, Council House Extension, W.1. Dental (School) Playgroup Dental (School) Diathermy Mothers' Club Creche Dental (School) Cervical Cytology Playgroup Toddlers (1st and 3rd weeks) Infant Wel. and Toddlers (2nd and 4th weeks) Dental (School) Immunisation and Vacc. Dental (School) Special Investigation Playgroup Infant Wel. Dental (School) Ante-natal Dental (M.C.W.) Playgroup Sewing Dental (School) Diathermy Creche Dental (School) (Gas Sess. 2nd Fri. in month) Playgroup Infant Wel. Dental (School) Middlesex Hospital Infant Wel. Mothercraft Infant Wel. 96 Table 31.—Maternal & Child Welfare Centres—Activities held as at December 1968—(continued) CENTRE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. Bessborough Street, S.W.1. Chiropody Ante-natal Vaccination and Immunisation (alt. weeks) Chiropody Infant Wel. Chiropody Occ. creche Sewing class Evening:— Family Planning Family Planning Chiropody Family Planning Evening:— Family Planning Mentally handicapped children (1st Fri. in month) Chiropody Infant Wel. Ebury Bridge Road, S.W.1. Infant Wel. Infant Wel. Sewing Occ. creche Ante-natal Mothercraft Cytology Mothers' Club Occ. creche Infant Wel. Marshall Street, W.1. Toddlers' Club Chiropody Infant Wel. Toddlers' Club Family Planning Toddlers' Club Ante-natal (1 session monthly) Chiropody (alt. weeks) Toddlers' Club Chiropody Infant Wel. Toddlers' Club Sewing Occ. creche 121 Marsham Street, S.W.1. Sewing Occ. creche Infant Wel. Immunisation and Vaccination Chiropody Relaxation and Mothercraft Ante-natal Chiropody Sewing Occ. creche Infant Wel. Chiropody 40 Alderney Street, S.W.1 (I.L.E.A. School Health premises) Dental (School) Speech Therapy Dental (School) Speech Therapy Dental (School) Dental (School) Dental (School) Vision Dental (School) 2nd Wed. monthly Gas Sess. Special Investigation (alt. weeks) Dental (School) Dental (M.C.W.) Vision Dental (School) Dental (School) Immunisation and Poliomyelitis vaccination is available at all infant welfare sessions. Minor ailments sessions are held Monday to Friday from 8.45 a.m. to 10 a.m. at: Alderney Street. Harrow Road. Lisson Grove. Westminster Council House Extension. 97 Table 32.—Clinic Services Ante-Natal and Post-Natal Clinics Number of women Attended Number of sessions held by Total Attendances For Ante-natal Examination For Post-natal Examination Medical Officers Midwives Medical Officer Sessions Midwives Sessions 1968 941 130 500 121 4,058 345 1967 1,165 136 644 149 4,698 436 Table 33.—Mothercraft and Ante-Natal Exercises 1968 ###] Total number of women who attended during the year 583 599 Total number of attendances during the year 2,733 2,496 Total number of sessions during the year 268 284 Table 34.—Child Welfare Centres Number of children who attended during the year Total number of sessions Total number of attendances Total medical examinations Number of children on "at risk" register at end of year Born in 1968 Born in 1967 Born in 1963-6 Total 2,494 2,499 3,225 8,218 2,122 42,669 19,406 830 1967 | 8,448 2,174 46,516 19,905 1,298 Table 35.—Health Visiting Cases visited by Health Visitors Number of cases 1 Children born in 1968 2,736 2 Children born in 1967 2,684 3 Children born in 1963-66 5,382 4 Total number of children in lines 1-3 10,802 5 Persons aged 65 or over 694 6 Number included in line 5 who were visited at the special request of a G.P. or hospital 254 7 Mentally disordered persons 31 8 Number included in line 7 who were visited at the special request of a G.P. or hospital 17 9 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 53 10 Number included in line 9 who were visited at the special request of a G.P. or hospital 18 11 Number of tuberculous households visited 31 12 Number of households visited on account of other infectious diseases 50 13 All other cases 1,643 14 Number of tuberculous households visited by tuberculosis visitors 895 98 Table 36.—Vaccination of Persons under age 16 completed during 1968 at Welfare Centres and by General Practitioners TABLE A.—Completed Primary Courses—Number of persons under age 16 Type of Vaccine or Dose Year of Birth Others under age 16 Total Total Completed 1968 1967 1966 1965 1961-64 At Clinics By  1. Quadruple D.T.P.Po. - - - - - - - - - 2. Triple D.T.P. 373 1,024 108 33 57 39 1,634 1,431 203 3. Diphtheria/Pertussis - - - - - - - - - 4. Diphtheria/Tetanus 12 28 7 10 243 175 475 413 62 5. Diphtheria 1 — — - - 4 5 5 - 6. Pertussis - - - - - - - - - 7. Tetanus — — 1 1 5 13 20 3 17 8. Salk - - - - - - - - - 9. Sabin 248 1,484 197 54 301 200 2,484 2,238 246 10. Measles 5 279 210 144 195 33 866 658 208 Lines 1 +2 + 3+4 + 5 (Diphtheria) 386 1,052 115 43 300 218 2,114 1,849 265 Lines 1 +2+3 + 6 (Whooping cough) 373 1,024 108 33 57 39 1,634 1.431 203 Lines 1 +2+4+7 (Tetanus) 385 1,052 116 44 305 227 2,129 1,847 282 Lines 1 +8 + 9 (Polio) 248 1,484 197 54 301 200 2,484 2,238 246 TABLE B.—Reinforcing Doses—Number of Persons under age 16 Type of Vaccine or Dose Year of Birth Others under age 16 Total Total Completed 1968 1967 1966 1965 1961-64 At Clinics By G.P.s. 1. Quadruple D.T.P.Po. — — — — — — — — — 2. Triple D.T.P. — 777 571 47 54 17 1,466 1,370 96 3. Diphtheria/Pertussis — — — — — — — — — 4. Diphtheria/Tetanus — 14 48 40 1,258 476 1,836 1,766 70 5. Diphtheria — 2 — — 11 31 44 41 3 6. Pertussis — — — — — — — — — 7. Tetanus — — — — 7 16 23 — 23 8. Salk — — — — — — — — — 9. Sabin — — — 3 1,397 350 1,750 1,632 118 Lines 1 +2+3+4 + 5 (Diphtheria) — 793 619 87 1,323 524 3,346 3,177 169 Lines 1 +2+3+6 (Whooping Cough) — 777 571 47 54 17 1,466 1,370 96 Lines 1 +2+4+7 (Tetanus) — 791 619 87 1,319 509 3,325 3,136 189 Lines 1+8+9 (Polio) — — — 3 1,397 350 1,750 1,632 118 D = Diphtheria T =Tetanus P =Pertussis (Whooping cough) Po = Poliomyelitis Salk = Poliomyelitis vaccine Sabin = Poliomyelitis vaccine (oral) Table 37.—Smallpox Vaccination of Persons aged under 16 Age at date of Vaccination Number Vaccinated Number Revaccinated 1968 1967 1968 1967 0-2 months 3 2 - - 3-5 months 8 8 - - 6-8 months 10 22 - - 9-11 months 27 30 - - 1 year 806 1,024 - - 2-4 years 392 344 21 11 5-15 years 39 39 98 97 TOTAL 1,285 1,469 119 108 Table 38.—Home Nursing 1968 1967 Total number of persons nursed during the year 3,217 3,344 Number of persons who were aged under 5 at first visit in year 207 200 Number of persons who were aged 65 or over at first visit in year 2,097 1,929 99 Table 39.—Domiciliary Midwifery Domiciliary Midwives employed by Administrative and Supervisory Staff Domiciliary Midwives Whole-time Part-time Whole-time equivalent of (2) Whole-time Part-time Whole-time equivalent of (5) (1) (2) (3) (4) (5) (6) City Council — 2 •4 4 — — Hospital Management Committee or Board of Governors — — — 3 — — Number of Midwives approved as teachers included in above 1 OTHER MIDWIVES (not included in Table above) Number practising in the City Council's area (excluding those in N.H.S. Hospitals) 46 PUPIL MIDWIVES Number of pupils who have completed district training in the area during Wholly on the district the year as part of a Part II Midwifery course Partly on the district 2 Number in training at end of year Wholly on the district Partly on the district 1 DELIVERIES ATTENDED BY DOMICILIARY MIDWIVES Number of Domiciliary Confinements attended by Midwives under N.H.S. arrangements Number of cases delivered in hospitals and other institutions but discharged and attended by Domiciliary Midwives before tenth day Doctor not booked Doctor booked Total 1968 2 55 57 226 1967 8 139 147 515 100 Table 40.—Chiropody Service A. Number of persons treated By City Council By City of Westminster Old People's Welfare Association Total 1968 1967 1968 1967 1968 1967 Persons aged 65 and over 1,358 1,219 2,438 4,603* 3,796 5,822 Expectant mothers 3 3 — — 3 3 Others 129 206 — — 129 206 Total 1,490 1,428 2,438 4,603 3,928 6,031 * Includes women over 60. B. Number of treatments given By City Council By City of Westminster Old People's Welfare Association Total 1968 1967 1968 1967 1968 1967 In clinics 7,019 7,219 4,013 4,882 11,032 12,101 In patients' homes 590 427 3,697 3,841 4,287 4,278 In old peoples' homes — — 19 — 19 — In chiropodists' surgeries — — 2,870 3,064 2,870 3.064 Total 7,609 7,646 10,599 11,797 18,208 19,443 Table 41.—Home Help Service A. Applications received during year Area Aged 65 and Over Aged under 65 Total T.B. Chronic Sick Mentally Disordered Maternity Others 1968 1967 Paddington 445 4 50 8 5 82 594 679 St. Marylebone 353 — 18 — 5 30 406 405 Westminster 481 3 35 — 9 49 577 540 Total 1,279 7 103 8 19 161 1,577 1,624 B. Number of cases in which help was given during the year Paddington 1,056 4 106 9 2 57 1,234 1,268 St. Marylebone 514 — 48 — 2 14 578 657 Westminster 878 8 58 — 8 34 986 937 Total 2,448 12 212 9 12 105 2,798 2,862 C. Cases receiving service as at 31st December, 1968 Paddington 719 2 67 4 — 11 803 823 St. Marylebone 300 — 22 — — — 322 372 Westminster 560 6 33 — — 8 607 583 Total 1,579 8 122 4 — 19 1,732 1,778 101 Table 42.—Mental Health Service—Number of Patients referred to City Council during year ended 31st December, 1968 Referred by Mentally III Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M. F. M. F. M. F. M. F. M. F. M. F. 1968 1967 (a) General practitioners 22 76 1 1 100 196 (b) Hospitals, on discharge from in-patient treatment — — 133 185 — — 6 4 — — 1 — 329 254 (c) Hospitals, after or during out-patient or day treatment — — 47 63 — — 1 1 1 — — — 113 242 (d) Local education authorities 1 — 3 1 4 4 9 16 7 1 — — 46 45 (e.) Police and courts — — 8 14 — — 6 4 — — — — 32 125 (f.) Other sources — — 162 269 3 1 12 9 13 6 2 1 478 466 Total 1 — 375 608 7 5 34 35 21 7 4 1 1,098* 1,328 • Excludes referrals for the purpose of obtaining admission to hospital. Numbers so admitted are shown in the following table. Table 43.—Number of Patients for whom Hospital Admissions were arranged SECTION OF MENTAL HEALTH ACT Total Informal Sec. 25 Sec. 26 Sec. 29 Sec. 136 Sec 60 1968 157 168 3 219 1 35 583 1967 95 131 2 228 — 29 485 Table 44.—Mental Health Service—Number of cases in community care at end of year Mentally III Subnormal Severely subnormal Grand Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M. F. M. F. M. F. M. F. M. F. M. F. 1968 1967 (a) (i) Attending workshop/day centre or training centre — — 21 15 3 — 2 1 23 9 14 16 104 101 (ii) Awaiting entry thereto — — — — — — — — 7 4 — 2 13 5 (b) (i) Receiving home training — — — — — — — — — — 1 2 3 2 (ii) Awaiting home training — — — — — — — — 1 1 — — 2 — (c) (i) Resident in L.A. home/ hostel — — 3 2 — — 3 — 2 — 1 — 11 13 (ii) Awaiting residence in L.A. home/hostel — — — — — — — — — — — — — — (iii) Resident at L.A. expense in other residential homes/hostels 12 17 4 3 5 7 12 7 7 10 84 86 (iv) Resident at L.A. expense by boarding out in private household — — — — — — — — — — — — — — (d) Receiving home visits and not included under (a) to (c) — — 179 316 7 5 49 43 10 12 21 19 661 635 Total number — — 215 350 14 8 59 51 55 33 44 49 878 842 102 Table 45.—Number of patients admitted for temporary residential care during the year (e.g. to relieve the family) Number of admissions Mentally III Subnormal Severely subnormal Grand Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M. F. M. F. M. F. M. F. M. F. M. F. 1968 1967 To N.H.S. Hospitals — — — — — — — — 3 — — 2 5 7 Elsewhere — — — — 3 — 2 — 5 4 3 5 22 28 Total — — — — 3 — 2 — 8 4 3 7 27 35 Table 46.—Terrace Day Centre—1968 (Day Centre for the Mentally III, 1 St. Mary's Terrace, W.2.) Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. Total attendances Half-day session 1968 1272 1097 1213 1388 1497 1128 1347 1343 1314 1416 1227 1218 1967 (759) (876) (1066) (954) (1076) (1152) (978) (1059) (1184) (1419) (1369) (1049) Average daily attendance 27½ 26 28 35 33 29½ 29 30i 33 31 29 30½ (17) (22) (25) (23½) (24½) (26) (23) (24) (28) (32) (31) (27½) Roll at beginning of month 46 43 45 48 49 49 46 45 44 49 45 47 (20) (26) (32) (36) (34) (37) (36) (37) (43) (44) (44) (45) Admissions 3 8 7 6 5 4 7 5 12 9 7 6 (9) (8) (5) (5) (9) (9) (4) (9) (6) (7) (6) (6) Discharges:— 6 6 4 5 5 7 8 6 7 12 5 6 (3) (2) (1) (7) (6) (8) (3) (3) (5) (7) (5) (5) Work 3 1 3 3 1 4 4 2 3 7 2 2 Further training 1 — — — — 1 — — — — — — Transferred to other centres — 1 — — — — — — 1 1 — — Fit for work — — — — — — — — — 1 1 — Hospital — 2 — — 2 — — 2 1 — — 1 Non co-operative 2 2 1 2 1 2 1 2 1 2 2 3 Moved away — — — — — — 2 — 1 — — — Not well enough to attend — — — — 1 — 1 — — — — — Not suitable — — — — — — — — — 1 — — Patients referred and interviewed, but did not attend for admission 1 2 2 3 — 1 2 — — 4 1 Patients not attended for interview — 1 3 2 2 2 2 — 2 — 2 2 103 Table 47.—Venereal Diseases Cases treated in Westminster — 1st January-31st December, 1968. Hospital M. F. Total 1968 Total 1967 Middlesex Hospital Syphilis 161 49 218 165 Gonorrhoea 1,668 363 2,031 2,029 Other conditions 5,420 2,707 8,127 7,509 7,249 3,119 10,368 9,703 St. George's Hospital Syphilis 46 10 56 61 Gonorrhoea 382 81 463 377 Other conditions 1,620 753 2,373 1,675 2,048 844 2,892 2,113 St. Mary's Hospital Syphilis 298 63 361 273 Gonorrhoea 2,992 521 3,513 3,363 Other conditions 8,087 3,506 11,593 9,645 11,377 4,090 15,467 13,281 Westminster Hospital Syphilis 41 9 50 26 Gonorrhoea 279 70 349 274 Other conditions 1,037 458 1,495 1,207 1,357 537 1,894 1,507 Number of referrals to Social Workers from Ministry of Health, Service establishments and other local authorities 142 (184) Number of contacts traced 70; 53% (124; 67%) Table 48.—Medical Suite at City Hall: Work undertaken, 1968 Medical Questionnaires returned for scrutiny 1,280 Persons leaving the City Council's service 1,203 Medical examinations of staff (special categories) 154 Interviews and examinations re medical questionnaires 120 Examinations—extended sick leave 58 „ —parking meter exemptions 208 „ —staff retired on grounds of ill health 24 Advice and First Aid 823 Referrals to general practitioner or hospital 68 F.F.I, examinations 22 B.C.G. vaccinations 98 Tetanus immunisations 37 Vaccinations (Smallpox) 148 104 Table 49.—School Health Service The table below shows the grades and numbers (full-time equivalents as at 31 December, 1968) of staff employed on school health work in the City of Westminster together with the totals for the Inner London Education Authority as a whole. Grade FULL-TIME EQUIVALENT EMPLOYEES AS AT 31 DECEMBER, 1968 IN: City of Westminster Inner London Education Authority 1968 Inner London Education Authority 1967 Medical—M.O's. & G.P's. (excluding for the boroughs centrally-directed Consultants and Specialists) 5.50 90.21 92.06 Nursing (all categories of staff) 14.68 259.02 263.69 Speech Therapists (centrally-directed) 1.10 26.20 31.80 Social Workers 5.20 54.59 52.79 Physiotherapists — 16.30 16.40 Remedial Gymnasts — 1.00 1.00 Dental Officers 4.60 78.75 69.61 Dental Auxiliaries — 8.51 5.60 Dental Surgery Assistants 4.40 85.57 77.47 Dental Technicians — 4.70 5.00 Dental Health Education Officers — 1.00 1.00 Table 50.—Tuberculin Test and B.C.G. Vaccination Number of persons vaccinated through the Authority's approved arrangements under Section 28 of the National Health Service Act. A. Contacts 1968 1967 (i) Number of skin tested 476 479 (ii) Number found positive 238 255 (iii) Number found negative 238 224 (iv) Number vaccinated 163 172 B. School Children and Students (i) Number of skin tested 4,174 1,664 (ii) Number found positive 1,955 312 (iii) Number found negative 2,219 1,352 (iv) Number vaccinated 1,809 1,352 105 Table 51.—School Medical Inspections (excluding Dental and Health Surveys)—1968 City of Westminster Inner London Education Authority 1968 1967 SCHOOL ROLL - MAY 1968 22,080 418,280 412,555 ROUTINE INSPECTIONS Number inspected 8,138 157,376 158,668 Number found not to warrant examination (7 plus specials scheme) 63 1,060 1,648 PERCENTAGE OF No. INSPECTED 0F:- Parent present 48.6 51.8 53.5 Care Committee present 81.0 74.6 79.1 No. vaccinated against smallpox 74.5 72.0 73.0 No. immunised against diphtheria 89.1 87.3 86.6 No. immunised against whooping cough 82.2 79.7 77.4 No. vaccinated against poliomyelitis 88.3 86.1 84.8 Physical condition unsatisfactory 0.3 0.4 0.5 Referred for treatment of defects 11.1 13.8 13.9 Referred for treatment of defects other than vision 5.4 7.1 7.1 NON-ROUTINE INSPECTIONS (i) Specials 3,327 49,696 52,935 (ii) Re-inspections 3,957 71,920 72,423 Total (i) and (ii) 7,284 121,616 125,358 No. of routine inspections as percentage of school roll 36.9 37.6 38.5 No. of non-routine inspections as percentage of school roll 33.0 29.1 30.4 106 Table 52.—Routine Medical Inspections 1968—Defects NUMBER OF CHILDREN NOTED FOR TREATMENT OR OBSERVATION EXPRESSED AS A RATE PER 1,000 INSPECTED Number Inspected City of Westminster Inner London Education Authority 8,138 1968 1967 157,376 158,668 DEFECTS SKIN T 5.04 8.81 8.19 O 19.54 11.25 10.45 EYES (a) Vision T 61 07 72.77 74.02 O 63.65 52.16 52.49 (b) Squint T 5.16 8.21 7.46 O 6.39 4.71 5.70 (c) Other T 1.11 1.68 1.83 O 3.81 2.75 2.82 EARS (a) Hearing T 2.70 5.76 5.72 O 8.72 7.18 7.35 (b) Otitis Media T 1.35 1.66 1.92 O 5.78 3.91 3.76 (c) Other T 0.25 0.57 0.68 O 0.74 0.93 1.06 NOSE AND THROAT T 4.18 5.55 6.93 O 31.46 26.92 28.68 SPEECH T 4.55 4.07 3.85 O 7.74 6.99 7.38 LYMPHATIC GLANDS T 0.74 0.58 0.45 O 14.38 7.69 8.33 HEART T 1.35 2.48 2.31 O 11.30 8.39 8.40 LUNGS T 3.07 5.41 4.63 O 12.90 11.74 11.45 DEVELOPMENT (a) Hernia T 1.23 1.12 1.03 O 4.06 2.86 2.78 (b) Other T 1.72 1.34 1.53 O 8.60 5.58 6.06 ORTHOPAEDIC (a) Posture T 0.98 0.97 1.15 O 6.39 4.77 5.64 (b) Feet T 1.84 3.37 4.36 O 10.81 14.96 14.22 (c) Other T 0.61 2.06 1.97 O 6.51 5.08 5.58 NERVOUS SYSTEM (a) Epilepsy T 0.74 1.46 1.39 O 2.58 1 .41 1 .51 (b) Other T 0.37 0.72 0.73 O 2.83 1.66 1.68 PSYCHOLOGICAL (a) Development T 1.60 1.49 1 .41 O 12.53 5.36 5.36 (b) Stability T 4.18 2.40 2.10 O 18.31 10.83 9.57 ABDOMEN T 0.37 0.37 0.28 O 4.67 1 24 1.34 OTHER T 14.87 17.34 17.25 O 29.37 35.65 35.87 * T = Treatment O = Observation 107 Table 53.—School Health Service—Findings at Health Surveys 1968 SCHOOL ROLL—May 1968 City of Westminster Inner London Education Authority 22,080 1968 418,280 1967 412,555 1. Comprehensive Surveys (a) Number examined 16,599 285,917 277,606 (b) Number (occasions) found verminous 133 3,105 3,093 (c) Percentage found verminous 0-80 109 1-11 2. Selective Surveys (a) Number examined 10,112 116,716 121,086 (b) Number (occasions) found verminous 1.62 2,712 3,225 (c) Percentage found verminous 1.60 2.32 2.66 3. (a) Total times vermin found (1 (b) + 2 (b)) 295 5,817 6,313 (b) Total percentage found verminous (3 (a) as percentage of 1 (a) + 2 (a)) 1.10 1.44 1.58 (c) Number of individual pupils found verminous 133 4,372 4,467 (d) Percentage of individual pupils found verminous (of school roll) 0.60 1.05 1.08 4. Action taken with verminous cases (a) Advice and/or Lorexane 275 5,001 5,356 (b) Further action 20 816 957 (c) 4 (b) expressed as a percentage of 4 (a) 7.27 16.32 17.87 Analysis of 4 (b) cases—referrals of hardcore cases to bathing centres — — — Voluntary attendances at bathing centres Number of pupils 20 750 771 Number of Statutory notices issued — 3 7 Number cleansed at centres following statutory notices Voluntarily — 3 5 Compulsorily — — 2 5. Communicable disease surveys Number examined for: Athlete's foot 795 31,342 46,231 Plantar Warts 735 Dysentery 3,000 1,867 Other communicable diseases 187 34,067 20,856 Total of (5) 1,717 68,409 68,954 108 Table 54.—School Health Service—Non-Routine Medical Inspections 1968 Type of Inspection City of Westminster Inner London Education Authority 1968 1967 Re-inspections 3,957 71,920 72,423 Bathing Centre Inspections—Scabies — 38 140 Bathing Centre Inspections—Other 1 71 76 Employment certificates 307 4,971 5,490 Theatre children 14 293 389 School Journeys 1,173 22,286 23,434 Recuperative holidays—pre-departure 32 908 1,163 Recuperative holidays—on return 3 8 2 Secondary school annual surveys 1,172 1,554 1,730 Candidates for higher awards — 84 46 Nautical school entrants — 62 112 Outward bound courses — 125 241 Infectious disease investigation — 44 301 T.B. contacts — 5 5 Boarding Schools for the delicate pre-departure 2 192 161 Boarding Schools for the delicate on return 1 37 35 Handicapped Pupils—Statutory examination 70 2,394 2,293 Handicapped Pupils—Periodic special defect examination 14 5,782 5,725 Research investigations and enquiries — 46 64 Sub-Total 2,789 38,900 41,407 SPECIALS—At request of: Head Teacher—Child's name entered in special book 61 1,517 1,627 Head Teacher—Others 154 3,438 3,488 School Nurse following health survey 74 742 758 School Nurse—Others 73 1,063 1,174 Divisional (Education Officer) 35 759 824 District Care Organiser or Care Committee 18 305 413 Parent 57 1,160 1,275 School Medical Officer 40 1,381 1,378 Sub-Total 512 10,365 10,937 Other—Accident on School premises — 44 37 Boxing—Reference from schools A.B.A. — — 93 or similar association for free travel — 64 14 Reference: (i) connected with remedial exercises foot classes 18 59 124 (ii) by gymnast or physiotherapist Referred by Hospital 5 7 Referred by Speech Therapist — 3 7 Referred by general practitioner — 5 5 Miscellaneous 8 251 304 Sub-Total 26 431 591 Total of all Non-Routine Medical Inspections 7,284 121,616 125,358 109 Table 55.—School Health Service—Routine Medical Inspections 1968—Vision Number Tested PERCENTAGE OF NUMBER TESTED C—BOYS AND GIRLS A—Not Wearing Glasses B—Wearing Glasses Percentage of Number Tested with and without Glasses 6/6 6/9 6/12 or worse Noted for Treatment 6/6 6/9 6/12 or worse Noted for Treatment Noted for Treatment Noted for Observation Total noted for Treatment or Observation Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls City of Westminster 3,299 3,201 79.0 75.0 7.8 8.4 6 6 8.4 5.1 6.8 2.8 4.2 1.9 1.8 1.9 2.2 0.9 2.5 7.7 8.0 15.7 I.L.E.A. 1968 69,314 66,340 82.6 80.6 6.1 6.7 4.9 5.2 4.8 5.4 3.3 3.8 1.5 1.9 1.5 1.8 2.8 3.9 8.4 6.1 14.5 I.L.E.A. 1967 67,700 64,057 81.3 79.7 6.5 6.7 5.1 5.3 5.1 5.4 3.6 4.2 1.8 2.0 1.7 20 3.3 4.2 8.9 6.3 15.2 110 Table 56.—School Health Service Comparison of Defects noted at 7-Plus Routine and 7-Plus "Special" Medical Inspections in 1968 Number of Children Noted for Treatment and Observation expressed as a rate per 1,000 inspected City of Westminster Inner London Education Authority 1968 1967 Number inspected at 7-plus routine inspections 1,789 36,657 35,767 Number inspected at 7-plus experimental scheme inspections 76 2,160 2,256 Defects * A † B * A † B * A † B Skin 21.8 39.5 20.3 19.0 18.1 12.0 Eyes— Vision 12.80 78.9 135.5 138.9 136.1 142.3 Squint 12.9 — 14.7 11.1 15.1 14.6 Other 5.6 13.2 4.0 3.7 4.5 2.2 Ears— Hearing 11.7 — 16.9 17.6 16.7 13.3 Otitis media 4.5 26.3 5.7 11.6 5.8 6.2 Other 1.1 — 1.3 3.2 2.4 1.3 Nose and throat 39.1 25.3 36.3 32.4 39.0 33.7 Speech 15.1 26.3 11.3 9.7 12.2 9.8 Lymphatic Glands 14.5 13.2 9.3 21.8 8.6 8.0 Heart 12.3 13.2 11.0 11.1 10.0 8.4 Lungs 21.8 — 18.8 22.3 17.5 16.4 Developmental Hernia 5.0 — 4.5 3.2 4.2 5.3 Other 8.4 — 8.3 6.0 9.1 4.4 Orthopaedic— Posture 3.4 — 4.7 7.4 6.5 11.5 Feet 12.9 — 17.3 15.3 19.7 13.7 Other 6.7 — 6.2 8.3 6.6 6.7 Nervous System Epilepsy 1.1 3.1 3.2 3.0 3.6 Other 50 — 2.5 1.9 3.0 3.1 Psychological— Development 11.2 13.2 9.1 16.2 9.0 16.0 Stability 24.6 52.6 16.2 17.6 14.5 19.9 Abdomen 2.2 — 1.6 — 1.7 0.4 Other 61.5 26.3 59.3 82.9 58.0 93.1 * Column 'A' refers to 7-plus routine medical inspections. † Column 'B' refers to 7-plus experimental scheme inspections. 111 Table 57.—Dental Services for Expectant and Nursing Mothers and Children under 5 Part A.—Attendances and Treatment Number of Visits for Treatment during year Children 0-4 (incl.) Expectant and Nursing Mothers 1968 1967 1968 1967 First Visit 347 358 61 109 Subsequent Visits 378 484 97 198 Total Visits 725 842 158 307 Number of Additional Courses of Treatment other than the First Course commenced during year 24 26 3 8 Treatment provided during the year— Number of Fillings 779 774 227 266 Teeth Filled 597 671 145 236 Teeth Extracted 62 14 12 38 General Anaesthetics Given 35 6 2 — Emergency Visits by Patients 16 3 11 3 Patients X-rayed 2 5 14 22 Patients Treated by Scaling and/or Removal of Stains from the Teeth (Prophylaxis) 150 188 57 77 Teeth Otherwise Conserved 132 93 — — Teeth Root Filled — — 6 10 Inlays — — — — Crowns — — 1 — Number of Courses of Treatment completed during the year 184 218 31 77 Part B.—Prosthetics Patients supplied with F.U. or F.L. (First time) 1968 1967 1 1 Patients supplied with other Dentures — 13 Number of Dentures supplied 3 19 Part C.—Anaesthetics General Anaesthetics administered by Dental Officers 1968 1967 — — Part D.—Inspections Children 0-4 (incl.) Expectant and Nursing Mothers 1968 1967 1968 1967 Number of Patients given First Inspections during year (a) 221 (a) 427 (d) 24 (d) 74 Number of Patients in (a) and (d) above who required Treatment (b) 196 (b) 294 (e) 23 (e) 69 Number of Patients in (b) and (e) above who were offered Treatment (c) 196 (c) 286 (f) 22 (f) 68 Part E.—Sessions 1968 1967 Number of Dental Officer Sessions (i.e. Equivalent complete half-days) devoted to Maternity and Child Welfare Patients— 212.25 For Treatment 167 For Health Education — 112 Table 58.—School Dental Service Statistics 1968 (Statistics, 1967 shown in brackets) NUMBER OF SESSIONS Inspection Ordinary treatment Anaesthetic 113-0 (125) 1,934.1 (1729) 47.0 (51) Total no. of sessions: 2,094.1 (1905.0) INSPECTIONS First inspection at school First inspection at clinic Percentage found to require treatment 8,913 (8,003) 3,577 (3,481) 64.6 (65.6) Re-inspection at school or clinic 1,144 (2,046) 74.7 (56.5) TREATMENT SESSIONS* Number of 1st visits 3,558 Number of subsequent visits 7,468 Emergencies 282 Total (including emergencies) 11,026 The comparative figures for the previous year are not available owing to differences in statistical presentation. FILLINGS AND EXTRACTIONS Permanent teeth Temporary teeth Fillings 7,052 (6,084) 4,536 (4,967) Extractions 377 (304) 1,726 (1,695) Other operations (prophylaxis, X-ray, inlays, crowns, etc.) 4,117 (2,697) Number of dentists employed (effective whole time equivalent) 4.0 (3.3) 113 Table 59.—Tuberculosis—Care and After Care Paddington Chest Clinic Marylebone Chest Clinic Westminster Hospital Chest Clinic 1968 1967 1968 1967 1968 1967 T.B. patients on Register of Chest Clinics at 31st December 694 779 465 465 909 882 T.B. Visitors—Visits to homes 1,833 1,695 918 845 — 99 After-Care Work (Social Worker): Number of patients in receipt of extra nourishment at end of year 9 12 9 9 11 11 Patients assisted for the first time with bed or bedding 5 — — — — — Patients assisted for the first time with clothing or footwear 34 — — 19 — — B.C.G. Vaccinations during the year in accordance with City Council scheme 108 92 24 16 31 64 Rehabilitation Hostels: Patients in residence at end of year — — — — — 3 Hostels for Homeless tuberculous men: Patients in residence at end of year — — — — — 16 Child contacts boarded out during the year — — — — — — 114 INDEX Page Accidental Deaths 11,78 Acute Poliomyelitis 12 Additives and Contaminants in Foods 40 Advice on Labelling 31 After Hours Emergency Telephone Service 14,82 Analysis of Calls made to Duty Officer 82 Animals, Slaughter of 42 Anthrax, Vaccination against 53 Area of the City 10 Artificial Kidney Machine 56 Ascertainment of ESN 73 At Risk Register 53 Attachment of Health Visitors to Medical Practitioners 51 Attendances at M. and C.W. Clinics 97 Basement Bakehouses 26 Bathing Service for Old People 44 BCG Vaccination 74,104 Betting Shops 45 Births 10 Blind and Partially Sighted Persons 72 Brucella Abortus, Milk Supplies 37 Burial or Cremation of the Dead 46 Catering Premises and Food Shops, Inspection 26 Certificates of Disrepair 23,86 Cervical Cytology 57 Chest Clinics 68,75 Child Minders, Voluntary 52 Children under five years. Day Care of 51 Child Welfare Centres 94,97 Chiropody Service 58,100 City of Westminster District Nursing Association 55 Clean Air 21 Committees, Appointment of Members of Health Committee to 6 Common Lodging Houses 23 Consumer Protection 41 Contaminants and Additives in Food 40 Control Orders, Houses let in Multiple Occupation 22 Co-ordination 70 Coroner's Court and Mortuary 46,93 Cremation, Work of Medical Referee 46 Day Care of Children under five years 51 Day Nursery Service 51 Deaths 10,78 Deaths, Accidental 11,78 Deaths, Causes of, According to Age Group and Sex 78 Deaths, Infant Mortality 10,79 Deep Wells 25 Dental Services 74,111 Diathermy 74 Diphtheria 12 Diseases of Animals Act 1950, and other Acts relating to Animals 43 Disinfection 24 Disinfestation, Insect Pest Control 24 Disposable Incontinence Pads 44 Disposal of Unsound or Unsaleable Food 39 Disrepair, Certificates of 23,86 District Inspection, Public Health Inspectors 16,83,84 District Nursing Association 55 Page Domestic Rateable Hereditaments 10 Domiciliary Midwifery 55,99 Drainage and New Developments 20 Drug Dependency 68 Duty Officer, Calls made to 14,82 Dwelling Houses 16 Dwelling Houses, Inspections 83 Dwelling Houses, Nuisances and Unsatisfactory Conditions 83 Dysentery 12 Emergency Telephone Service 14,82 Employment Agencies 45 Environmental Health Services 15 Establishments for Massage or Special Treatment 44 Eviction, Unlawful, Harassment and Provision of Rent Books 22 Export Certificates 41 Factories 26 Factories, Inspections 89 Factories, Defects 89 Family Planning 56 Fertilisers and Feeding Stuffs Act 1926 43 Food, Additives and Contaminants 40 Food and Drugs Act 1955—Section 16 37 Food Hygiene, etc.. Lectures 31 Food, Legal Proceedings 34 Food Poisoning 37,91 Food Premises, Legal Premises 34 Food Premises, Number of 90 Food Premises, Registration of 91 Food Sampling and Analysis 32 Food Shops and Catering Premises, Inspection 26 Food Storage 32 Food, Unsound or Unsaleable, Disposal of 39 Grants and Loans 23 Handicapped Children, Pre-School Assessment, Clinics for 54 Harassment, Unlawful Eviction and Provision of Rent Books 22 Health Centres 48 Health Committee 6 Health Department, Premises 9 Health Education 50,72 Health Services and Public Health Act 1968 52 Health Visitors, Attachment to Medical Practitioners 51 Health Visitors, Students 51 Health Visitors, Work of 50,97 Home Dialysis 56 Home Help Service 59,100 Home Nursing 54,98 Home Nursing Equipment, Loan of 56 Houses in Multiple Occupation, Management Orders, Additional Amenities and directions 22 Houses in Multiple Occupation, Control Orders 22 Houses, Unfit 22,85 Housing Acts 1957-1964, Inspectorate 21 Housing Acts, Visits by Public Health Inspectors 84 Housing Acts 1957-1964, Work Carried out by Inspectors 84 Housing Priority on Medical Grounds 22 115 Page Ice Cream (Heat Treatment) Regulations, 1959, Sampling 36 Illegal Child-minding 52 Immigrant Families, Work with 71 Imported Food Regulations, 1969 40 Immunisation and Vaccination 52 Incontinence Pads 44 Infant Deaths 10,47,79 Infant Mortality 10,79 Infectious and Other Notifiable Diseases 12,80 Infective Jaundice 12 Influenza Vaccination 53 Insect Pest Control, Disinfestation 24 Inspection of Food Shops and Catering Premises 26 Inspection of Dwelling Houses 83 International Certificates of Vaccination and Inoculation 13 Introduction 3 Labelling of Foodstuffs 31 Laundry Service, Special 44 Legal Proceedings 16,92 Legal Proceedings, Food and Food Premises 34 Legal Proceedings, Sale of Drugs 35 Licensing Act 1964 29 Liquid Egg (Pasteurisation) Regulations, 1963 37 Loan of Home Nursing Equipment 56 Loans and Grants 23 Local Land Charges 23 Lodging Houses, Common 23 Management Orders, Additional Amenities and Directions—Houses in Multiple Occupation 22 Markets and Stalls, Street Traders 29 Mass X-ray 13 Massage and Special Treatment Centres 44 Maternal and Child Welfare Centres 94 Maternal Mortality 11 Measles 12 Measles Vaccination 52,74 Medical Referee, Work of 46 Mental Health 59 Mental Health, Approval of Medical Practitioners 64 Mental Health, Community Care 61,101 Mental Health, Patients referred in 1968 61,101 Mental Health, Services 61 Mental Health, St. Jude's Hostel 63 Mental Health, Terrace Day Centre 63,64,102 Mental Health, Training Centres 61 Mental Health Week, 1969 64 Midwifery 55,99 Milk and Dairies (General) Regulations, 1959 36 Milk, Dealers' Licences 37 Milk (Special Designation) Regulations, 1963 37 Milk Supplies, Brucella Abortus 37 National Assistance Act 1948, Section 50 46 New Developments, Drainage 20 Noise 16 Notices 16,84 Notifications of Infectious Diseases 80 Nurseries and Child Minders Regulation Act 1948 52 Nursing Homes 72 Observation Register 53 Offices, Shops and Railway Premises Act 1963 25,88 Old Persons' Bathing Service 44 Organisation of the Social Services 49 Outworkers 26,90 Page Overcrowding 22,85 Paediatric Home Care Unit 55 Parent Counselling, Special Clinics 56,69 Partially Sighted and Blind Persons 72 Personal Health Services 47 Pesticides and other Toxic Chemicals 40,91 Pharmacy and Poisons Acts 1933 and 1941 43 Phenylketonuria 50 Pigeon Control 24 Play Groups and Occasional Creches 52 Poliomyelitis, Acute 12 Population 10 Poultry Processing Premises 42 Priority on Medical Grounds, Housing 22 Private Water Supplies, Deep Wells 25 Public Health Inspectors, District Inspection 83 Public Health Inspectors, Night and Weekend Duties 16 Public Health Inspectors, Work of 83 Puerperal Pyrexia 12 Puerperal Pyrexia, Analysis of Causes 81 Radio, Use of Short-wave sets 43 Radioactive Substances Act 1960 23 Rag Flock and Other Filling Materials Act 1951 43 Rateable Value 10 Recuperative Holidays 58 Refresher Courses 50,55 Rent Books, Provision of 22 Rodent Control 23,86 Sale of Drugs, Fraudulent Substitution, Legal Proceedings 35 Sampling and Analysis, Food 32 Sampling, Ice Cream (Heat Treatment) Regulations, 1959 36 Scabies 44 School Dental Service 74,112 School Health Service 51,73 School Health Service, Number employed in 104 School Medical Inspections, Defects found 106 School Medical Inspections, Health Surveys 107 School Medical Inspections, Non-routine Inspections 108 School Medical Inspections, Routine Medical Inspections 109 School Medical Inspections, Comparison of Defects found 110 School Medical Inspections, Dental Service 112 Seebohm Committee 49 Sewerage 20 Slaughter of Animals 42 Slaughterman's Licences 42 Slum Clearance 23 Smallpox 12 Smallpox Vaccination 52,98 Social Workers (Health Service) 66 Special Laundry Service 44 Special Counselling Service, Family Planning 56,69 Specimens Submitted to Public Health Laboratory 82 Staff of Health Department 7 Staff Medical Service 73,103 Statistical Tables, List of 77 Statistics and Social Conditions 10 Statutory Notices served 84 Storage of Foodstuffs 32 116 Page Street Traders, Markets and Stalls 29 Street Traders, Unauthorised 30 Student Health Visitors 51 Student Public Health Inspectors 16 Swimming Bath Water Examination 25 Terrace Day Centre 63,64,102 Town Planning 21 Trade Descriptions Act 1968 41 Training Centres, Future Proposals 61 Tuberculin Test and B.C.G. Vaccination 74,104 Tuberculosis, Care and After Care 13,113 Tuberculosis, New Cases and Deaths 13,81 Typhoid fever 13 Unauthorised Street Traders 30 Unfit Houses 22,85 Unlawful Eviction, Harassment and Provision of Rent Books 22 Unmarried and Unsupported Mothers 69 Unsound or Unsaleable Food, Disposal of 39 Page Urban Programme 48 Use of Short-wave Radio Communication 43 Vaccination against Anthrax 53 Vaccination against Influenza 53 Vaccination against Measles 53,74 Vaccination against Smallpox 52,98 Vaccination and Immunisation 52 Vaccination and Inoculation, International Certificates of 13 Vaccinations performed 98 Venereal Diseases 67,103 Verminous Persons 44 Visitors to the Department 51 Voluntary Childminders 52 Water 24 Water, Bacteriological Examination 87 Water, Chemical Examination 87 Water, Lead Content 88 Water Supplies, Private Deep Wells 25 VAIL a CO. LTD.. LEEKE STREET, LONDON. W.C.I