3399 WES 79 City of Westminster THE HEALTH OF WESTMINSTER 1969 City of Westminster Report of the Medical Officer of Health CONTENTS Introduction 3 Health Committee and Social Services Committee 6 Staff of the Health Department 8 Health Department Premises 10 Statistics and Social Conditions 11 Environmental Health Services 18 Personal Health Services 38 School Health 62 Dental Service 62 Chest Clinics 63 Appendices of Statistical Tables 65-99 Index 100 H. Briscoe-Smith, M.B., Ch.B., D.P.H., Medical Officer of Health and Priincipal School Medical Officer nner London Education Authority) 1969 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 present for your information my Annual Report on matters affecting the health of the City of Westminster in the year 1969. As in previous years, comparative statistics have been included either as a separate column in the various tables or in parentheses in the text. Since the new City of Westminster was formed in 1965 there has been a steady decline in the population - from 266,770 in 1965 to 240,360 in 1969. The number of births has also decreased, from 3,952 in 1965 to 2,899 in 1969. During 1969 there was a fall in the number of illegitimate births although this, in fact, resulted in a rise in the illegitimacy rate. Although the number of infant deaths rose sharply, from 49 in 1968 to 65 in 1969, it will be seen from the figures given below that this is still less than the average for the five year period even allowing for the abnormally low figure in 1968. Elsewhere in this report an analysis is made of the causes of these infant deaths. It should be noted that 28 deaths were due to conditions related to prematurity and 18 to congenital malformations. Only 5 deaths occurred as a result of the process of birth and 12 as the result of conditions arising after birth. The death rate of illegitimate infants was more than double that for the previous year, but when the figures for the five year period are examined no definite trend is apparent. There were two maternal deaths, reference to which is also made in the text of the report. The actual numbers and rates for the years 1965-1969 are summarised below. It must be borne in mind that the numbers from which these rates are computed are small and that fluctuations are bound to occur from year to year. 1965 1966 1967 1968 1969 Illegitimate births per cent of total live births 18.59 18.57 18.82 16.69 17.63 Deaths of infants under 1 year 74 83 75 49 65 Infant death rate 18.72 22.73 21.13 15.41 22.42 Illegitimate infants death rate 21.77 41.29 34.43 15.06 39.14 Maternal deaths 3 1 1 — 2 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 local authority health services in Westminster following reorganisation 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. My report for the year 1968 covered the work of the public health inspectors in the food section. Opportunity has been taken in this report to deal with the City Council's medical and nursing services, with particular reference to the work of the medical officers and developmental paediatrics. Turning next to staff matters, it is with regret that I record the death of the City Council's Chief Dental Officer, Mr. R. E. Kean, who fell ill in July 1969 and died in April, 1970. Mr. Kean had joined the City Council's service in July 1965 and had built up the local authority dental service of which the City Council can justifiably be proud. During his long illness his duties were undertaken by the Senior Dental Officer, Mr. D. K. Hardy, who had joined the Department's staff only a short time prior to Mr. Kean's illness. It is therefore all the more commendable that he took over the duties and responsibilities with commendable skill and efficiency. It is my pleasure to be able to record that in July 1970 Mr. Hardy was appointed to the position of Chief Dental Officer. 4 There was as usual shortage of staff in various sections of the Department, notably the nursing grades and dental surgery assistants. The recruitment of public health inspectors improved marginally during the year. The year 1969 saw the retirement from the Department of three senior officers, Mr. H. G. E. Brown (who had served 46 years in local government); Mr. C. F. Brockett (40 years) and Mr. C. Chesterman (33 years). All these officers had joined the staff of the new City of Westminster Health Department in April 1965 and brought with them a wealth of knowledge and experience. Prior to the amalgamation of the boroughs, Mr. Brown had been Chief Clerk in the St. Marylebone Health Department; Mr. Brockett was formerly Deputy Chief Public Health Inspector with the old Westminster City Council, and Mr. Chesterman had been a senior public health inspector with the Paddington Borough Council. Each of these officers had devoted a life-time's service to local government and we wished them well in their retirement which we hope will be long, happy and healthy. In my Annual Report for 1968 I made reference to the various reports which had been issued (Maud, Mallaby and Seebohm) which related to the future structure of local government and the social services. I also recorded that the then Minister of Health had issued a Green Paper on the administrative structure of the medical and related services in England and Wales. All these reports were referred by the City Council to a special Review of Management Committee which was set up for the purpose. This Committee reported to the Council in July 1969 when it was decided that the fourteen standing committees which had been set up in 1965 should be reduced to a total of nine. Included in this re-arrangement of functions was the creation of a Social Services Committee which became responsible for matters formerly referred to the Health, Welfare and Children's Committees. The first step was therefore taken towards the recommendation of the Seebohm Committee that a unified Social Services Department should be established within each major local authority. Concurrent with this reorganisation of the Council's Committee structure, the Local Authority Social Services Bill was introduced into Parliament which was intended to put into effect the recommendations of the Seebohm Committee. This Bill received the Royal Assent in May 1970 and inter alia required each local health authority to appoint a Director of Social Services and set up a Social Services Department. To this new department will be transferred all the social work content of the community services at present provided by the City Council's Health Department including day nurseries, child minding, social worker services, mental health, and home help. The City Council's newly appointed Director of Social Services will therefore become responsible for a number of the Health Department staff who, since 1965, have built up excellent health services. I know that all members of the Health Department staff who are transferred to the Social Services Department will continue to provide the same loyal support and efficient service which they gave to me and to the citizens of Westminster since the Department was formed in 1965. By the time my next Annual Report is published in July 1971 this transfer will have been accomplished and I would therefore take this opportunity of expressing my warmest thanks to all the members of my staff concerned for their loyal assistance and the good work they have undertaken particularly in the somewhat difficult times immediately following reorganisation. It is impossible not to feel some regret that staff and services must be lost, but it is inevitable in any family that from time to time growing children must reach maturity and should set up house for themselves. Local authority social services had their birth and grew up in forward looking health departments and it would be strange if in the future there were not more offspring even if these are conceived as the result of a new marriage. Towards the end of 1969 the Government issued the Green Paper (Mark II) on the future structure of the national health service. This paper proposes that some of the services at present provided by local authorities shall, at a time be to decided, be transferred to Area Health Authorities which are to be established. Briefly, the local authority health services will be divided, all the functions relating to the medical and nursing services being transferred to an area health authority, leaving the City responsible for environmental health as were the Metropolitan Boroughs before 1965. The City Council's Health Department and all its present functions will, therefore, be subjected at varying stages to a tripartite division—part being transferred to a Social Services Department in the relatively near future; part being transferred to an area health authority to be set up at some time in the future and possibly 4-5 years distant; and part remaining with the local authority. An added complication arises from the proposed transfer of responsibility for junior training schools for mentally handicapped children from the local health authority to the Education Authority. The 5 Government has introduced legislation to put this proposal into effect from a date to be decided— probably 1 st April, 1971. Against this background of uncertainty the preparation of comprehensive plans for the future development of the health services at present provided by the local authority presents many problems. Your officers have felt, however, that forward plans should be prepared on the basis of the needs of the community irrespective of which authority or which department will ultimately be responsible for the actual services to be provided. All these changes or proposed changes naturally have an unsettling effect on the members of the staff, coming as they do so shortly after the wholesale reorganisation of local government in London in 1965. With the passage of time there will undoubtedly be some recruitment difficulty because staff will not be anxious to enter a service which is about to be radically altered; there is indeed already a noticeable reluctance on the part of some staff to enter the local government service and this is to be expected in the face of the coming changes in the organisation of the national health service. Changes in some aspects are undoubtedly needed particularly since it is now some 22 years since the national health service in its present form was set up. It is to be hoped however that the Government will bear in mind the fact that the services are provided for the people and that every endeavour should be made to ensure that they continue to be administered locally and on a sufficiently flexible basis so that local needs may be given due weight where these conflict with centrally determined policy. Finally, my Lord Mayor, may I express to you and to all the members of the Council, and particularly to the members of the former Health Committee and the new Social Services Committee, my warmest thanks for the support and encouragement I have received during the past year. My thanks are also due to the other Chief Officers and their staffs with whom the closest co-operation exists at all levels; and especially to the members of my own staff for their loyal and conscientious help so readily given at all times during the year. J. H. BRISCOE-SMITH Medical Officer of Health and Principal School Medical Officer. July, 1970 6 HEALTH COMMITTEE (January—23rd July, 1969) 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., J.P. 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. Mr. R. H. Rollins Mr. E. R. Packer Mrs. Henrietta Shire SOCIAL SERVICES COMMITTEE (24th July—December, 1969) THE LORD MAYOR (ex-officio): Councillor Leonard Pearl THE DEPUTY LORD MAYOR (ex-officio): Councillor John E. Guest CHAIRMAN : Councillor M. V. Kenyon, M.A., J.P. VICE-CHAIRMAN: Councillor Dr. Brian Warren MEMBERS: Councillor The Countess Beatty Councillor Mrs. I. L. Bolton, J.P. Councillor Mrs. Barbara Bowles Councillor A. J. Eager Councillor Mrs. Rachel Trixie Gardner, B.D.S. Councillor Dr. L. Jacobs Councillor Max Taylor Councillor Miss Alison Tennant Councillor Mrs. P. L. Veendam Councillor Mrs. Brian Warren CO-OPTED MEMBERS: Miss Barbara Daniels, M.B.E. Mrs. R. T. Glenny Mr. R. H. Rollins The Hon. Mrs. Trevor Rose, C.B.E. Mr. J. G. Spriggs Lady Walton, M.A. Members of the Social Services Committee were appointed to: Christian Union Almshouses Councillor Mrs. Barbara Bowles City of Westminster Arts Council Councillor Dr. Brian Warren City of Westminster Old People's Welfare Association Mrs. R. T. Glenny County Primary Schoois—Manager Councillor Miss Alison Tennant (Old Westminster Group Churchill Gardens School and Millbank School) 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 Mrs. R. T. Glenny Inner London Executive Council Councillor Miss Alison Tennant 7 Linnet House Special Care Committee (Mentally Handicapped Children) Councillor Miss Alison Tennant London Boroughs Association—Social Services Committee Councillor M. V. Kenyon London Boroughs Training Committee Councillor M. V. Kenyon London (Metropolis) Licensing Planning Committee Councillor M. V. Kenyon (also N.W. Sub-Committee) National Association for Maternal and Child Welfare Mrs. R. T. Glenny Paddington Charitable Estates (and Paddington Charitable Estates Educational Fund) Councillor M. V. Kenyon Primary School Managers: St. Peters, Eaton Square, C.E Councillor Miss Alison Tennant St. James's and St. Michael's Schools Mr. J. G. Spriggs Royal London Homoeopathic Group (No. 22) Hospital Management Committee Councillor Mrs. R. T. Gardner St. James's United Charities Councillor Mrs. Brian Warren Sarah, Duchess of Somerset's Charity Miss Barbara Daniels St. Marylebone T.B. Care Committee Mrs. R. T. Glenny St. Mary's Churchyard (Northern Portion) Paddington, Committee of Management Councillor Mrs. P. L. Veendam Councillor Mrs. I. L. Bolton South West Metropolitan Regional Hospital Board—Liaison Committee Councillor Dr. Brian Warren West London Housing Group and London Housing Consortium Councillor M. V. Kenyon Westminster Amalgamated Charity Councillor The Countess Beatty Westminster City Council—Joint Council and Manual Employees Committee (Council's side) Councillor Mrs. I. L. Bolton (Deputy Representative) Westminster Community Relations Council Councillor Mrs. R. T. Gardner Westminster Council of Social Service Councillor Miss Alison Tennant Westminster Council of Social Service—Harrow Road Project Councillor Mrs. P. L. Veendam 8 STAFF OF THE HEALTH DEPARTMENT (as at 31st December, 1969) 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) (to 31.12.69) D. J. Legge (Environmental Health Services) (from 15.12.69) A. J. Anscomb (Personal Health Services) Administrative and Clerical Staff—108 (4 vacancies) 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., M.R.S.H. Principal Public Health Inspector: R. F. Stubbs, F.A.P.H.I., A.R.S.H. Senior Public Health Inspectors—18 (2 vacancies) Area or District Public Health Inspectors—38 (5 vacancies) Student Public Health Inspectors—15 Technical Assistants—22 (2 vacancies) Chief Dental Officer: R. E. Kean, L.D.S., R.C.S. (I) Senior Dental Officer: D. K. Hardy, L.D.S., R.C.S. (from 2.6.69) Dental Officers: Full-time—3; Part-time—3 (full-time equivalent 1.7) Dental Surgery Assistants—5 (1 vacancy) 9 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—4 Student Health Visitors—7 Health Visitors—57 Clinic Auxiliaries—9 Clinic and School Nurses—21 Day Nursery Staff—131 District Nurses—45 Playgroup staff—9 District Midwives—9 Home Bathing Attendants—3 Student District Nurses—6 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—16 St. Jude's (Hostel for Mentally Sub-Normal Adult Males) Warden—W. T. Bailey (until 31.5.69) A. Santolaya (from 8.9.69) Deputy Warden—1; Assistant Wardens—2 Elder Girls Training Centre (from 8.9.69) Supervisor—Mrs. M. S. Rideout Assistant Supervisor—1 Junior Training Centre (from 8.9.69) Supervisor—Mrs. P. Matthews Assistant Supervisor—1 Coroner's Court and Mortuary: Superintendent—W. H. Wilshire First Mortician—1 Mortuary Assistants—4 Ancillary Staff: Chief Chiropodist: Miss M. I. Taylor, M.Ch.S. Chiropodists—15 (full-time equivalent 7.5) Physiotherapist—1 (full-time equivalent 0.3) Home Help Service: Home Help Organisers—2 Assistant Home Help Organisers—4 Home Helps—219 (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: 97 (full-time equivalent 76.5) staff of various categories are employed at Maternal and Child Welfare Centres, Day Nurseries, the Nurses' Headquarters and Home, and other establishments. 10 HEALTH DEPARTMENT PREMISES ADMINISTRATION City Hall, Victoria Street, S.W.1. Paddington Office, 313/319 Harrow Road, W.9. St. Marylebone Office, Council House, N.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, Ilbert 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. Elder Girls Training Centre, Lancefield Street, W.10. Junior Training School, 1 Ebury Bridge Road, S.W.1. 11 STATISTICS AND SOCIAL CONDITIONS 1969 7968 (where applicable) Area (acres) 5,334 Population (Registrar General's Estimate, mid-year 1969) 240,360 243,960 Population, Census, 1961 271,703 Domestic rateable hereditaments 86,582 86,170 Rateable Value (at 1st April, 1969) £109,689,288 £107,424,973 BIRTHS Live Births (registered)— Total Males Females 1969 1968 1969 1968 1969 1968 Legitimate 2,388 2,649 1,226 1,337 1,162 1,312 Illegitimate 511 531 254 282 257 249 2,899 3,180 1,480 1,619 1,419 1,561 1969 1968 Birth rate per 1,000 of the estimated population 12.06 13.03 Area Comparability Factor—Births: 0.74 Birth rate (adjusted) 8.92 9.64 (Rate for England and Wales, 16.3) Stillbirths (legitimate—males 15; females 12; illegitimate—males 8; females 4) 39 40 Rate of stillbirths per 1,000 (live and still) births 13.27 12.42 Total live and stillbirths 2,938 3,220 Illegitimate live births per cent. of total live births 17.63 16.69 Premature births notified (live 219 (250); still 19 (22)) 238 272 DEATHS Net deaths (males 1,542; females 1,456) 2,998 2,822 Death rate per 1,000 of the estimated resident population 12.47 11.57 Area Comparability Factor—Deaths: 1.05 Death rate (adjusted) 13.09 12.15 (Rate for England and Wales, 11.9) Deaths arising from pregnancy, childbirth, and abortion 2 Nil Rate per 1,000 total (live and still) births 0.68 — Deaths of infants under one year (legitimate—males 29; females 16; illegitimate—males 9; females 11) 65 49 Death rate of infants under one year— All infants per 1,000 live births 22.42 15.41 Legitimate infants per 1,000 legitimate live births 18.84 15.48 Illegitimate infants per 1,000 illegitimate live births 39.14 15.06 Neo-natal mortality rate (deaths under four weeks per 1,000 total live births) 18.28 10.69 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 16.56 9.75 Peri-natal mortality rate (stillbirths plus deaths under one week per 1,000 total live and stillbirths) 29.61 22.05 12 Births The total of live births registered during the year was 2,899 (1,480 males; 1,419 females), giving a live birth rate of 12.06 per 1,000 of population, equivalent to a standardized rate of 8.92. The 1968 total of live births was 3,180 (1,619 males; 1,561 females), and the live birth rate 13.03 which when standardized was 9.64. The comparable figures for Greater London and England and Wales for 1969 were 15.7 and 16.3 and for 1968 16.4 and 16.9 respectively. Illegitimate live births numbered 511 (254 males; 257 females), representing 17.63 per cent. of the total live births, compared with 11.0 per cent. for Greater London, 15.4 per cent. for Inner London, and 8.0 per cent. for England and Wales. The total illegitimate live births in 1968 was 531 (282 males and 249 females) which represented 16.69 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. Stillbirths totalled 39, representing a rate of 13.27 per 1,000 total live and stillbirths, compared with 12.7 for Greater London and 13.0 for England and Wales. In 1968 there were 40 stillbirths, which represented a rate of 12.42 per 1,000 total live and stillbirths, and the rate for Greater London and England and Wales was 13.5 and 14.3 respectively. Deaths The total number of deaths shown in Table 1, page 66, 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 1969 numbered 2,998 equivalent to 12.47 per 1,000 which when standardized by the comparability factor, gives a figure of 13.09. In 1968 there were 2,822 deaths (11.57 per 1,000) and the standardized rate was 12.15. The comparable rates for Greater London and for England and Wales for 1969 were 11.5 and 11.9 and for 1968 11.6 and 11.9 respectively. Accidental Deaths During the year, 103 residents died from accidents of all kinds, including 31 motor vehicle accidents. In 1968 the figures were 95 and 38 respectively. Infant Mortality Deaths of infants under one year totalled 65 (45 legitimate, 20 illegitimate) giving an infant mortality rate of 22.42. There were 53 deaths under 4 weeks giving a neo-natal mortality rate of 18.28. The early neo-natal mortality rate (deaths under one week per 1,000 live births) was 16.56. The perinatal mortality rate (still births and deaths under 1 week combined per 1,000 total live and still births) was 29.61. Comparative figures are as follows:— Westminster Greater London England & Wales 1969 1968 1969 1968 1969 1968 Infant mortality 22.42 15.41 17.9 18.6 18.0 18.0 Neo-natal mortality 18.28 10.6 11.7 12.8 12.0 12.3 Early neo-natal mortality 16.56 9.75 10.2 11.4 10.0 10.5 Perinatal mortality 29.61 22.05 22.8 24.7 23.0 25.0 Details showing causes of death according to age group and sex are given in Table 2, page 67. Maternal Mortality Two maternal deaths were reported during the year giving a death rate of 0.68 per 1,000 total live and stillbirths. There were no maternal deaths in Westminster during 1968. Comparative figures Death rate 1969 1968 Westminster 0.68 Nil Greater London 0.20* 0.21* England and Wales 0.19 0.24 (•Excluding deaths due to abortion) (See also Page 40 and Table 3, Page 67) 13 INFECTIOUS AND OTHER NOTIFIABLE DISEASES Although this is the first complete year since the list of diseases in respect of which Medical Officers of Health should be notified was revised by the Public Health (Infectious Diseases) Regulations, 1968, the incidence of infectious disease in the City has, in general, remained low. Notifications received (excluding tuberculosis) decreased from 671 in 1968 to 532 in 1969 of which measles accounted for 321. Table 4, page 68, gives details of notifications received and the age groups concerned. Acute Poliomyelitis Two notifications were received during the year. One notification related to a 38 year old man who was admitted to hospital on arrival in this country from Nigeria, where he had been taken ill. The other was in respect of a Westminster resident, a young woman of 19 years, who was admitted to hospital a week after being unwell with muscular pains. The source of infection was not traced. All close contacts remained well and fortunately both patients made a good recovery. No cases occurred in Westminster during 1968. Diphtheria and Smallpox No cases of these diseases occurred in Westminster during 1 969. Dysentery Fifty-four notifications of dysentery were received compared with twenty-seven in the previous year. The majority of the notifications were in respect of single unconnected cases, but during the year under review there were minor outbreaks of Sonne Dysentery at two children's hospitals and a junior school within the City, and also at one of the Children's Department's residential nurseries. Infective Jaundice Fifty-nine notifications of Infective Jaundice were received during 1969, the first full year since the disease became notifiable. Measles It is interesting to note that measles did not follow the well established pattern, as although 1969 would normally have been an epidemic year, when the number of cases more than doubles, the number of measles notifications only rose slightly from 253 in 1968 to 321. This striking diminution in the incidence of the disease in an epidemic year would appear to be attributable at least in part to the recent introduction of measles immunisation. Paratyphoid and Typhoid Fever The majority of the thirteen cases of these diseases notified during the year were instances of infection occurring in persons returning from abroad who were admitted to hospital shortly after arrival in this country. During the latter part of the year an outbreak of typhoid fever occurred amongst passengers who disembarked from the S.S. Angelina Lauro at Southampton, the ship having travelled from Australia via Capetown and Teneriffe. As a result it was necessary for the Public Health Inspectors to keep under surveillance some twenty persons who were visiting or staying in Westminster. Three of these persons were admitted to hospital and found to be suffering from the disease. Fortunately, no secondary cases developed. There were only three cases of typhoid fever in Westminster in 1968. Tuberculosis Table 4, page 68, gives information regarding primary notifications of pulmonary and nonpulmonary tuberculosis received during the year, and Table 5, page 69, shows the age and sex distribution of all new cases and deaths from all forms of the disease. It will be seen from Table 5, page 69 that the total number of new cases which came to the knowledge of the Medical Officer of Health during 1969 was almost unchanged. 14 The tuberculosis visitors working from the chest clinics 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 visitors also follow up patients who do not visit the chest clinic as regularly as required and, where rehousing is sought, their detailed reports on home conditions assist with the award of "points" 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. Whooping Cough There was a significant decrease in the number of cases of whooping cough, only two notifications being received during 1969 compared with fourteen in the previous year. The figure for this year, which is the lowest recorded, is in accord with the sharp decline in the total number of cases notified in England and Wales. MASS MINIATURE RADIOGRAPHY The future of the mass miniature radiography service has been considered by the Standing Medical Advisory Committee to the Secretary of State for Social Services and, acting on the recommendations of this Committee, the Department of Health and Social Security has now asked all regional hospital boards to consider, in consultation with local health authorities, how the need for chest x-ray services in their regions can best be met, with a view to integrating mass miniature radiography units with hospital radiological departments. It is the Department's view that in many areas the proportion of new cases of active respiratory tuberculosis currently being found by general factory and office surveys and volunteers from the general public does not justify the continuation of this work, and that this part of the service should be terminated as soon as the resources at present devoted to providing it can be redeployed. However, the Department has stated that provision should continue to be made for the examination of volunteers from the general public by hospital static units, perhaps at stated times on certain days, until an assessment is possible of the demand for their use. There is a higher than average yield of new cases of active respiratory turberculosis from special surveys, from examination of persons in prisons and borstals, from examination of contacts, and from examinations of school children with positive Mantoux tests. It is clearly desirable that this work should continue. In some of these groups, however, the numbers examined are relatively small, and Boards are asked to consider, in consultation with local health authorities, to what extent it may be practicable and economically advantageous for some of this work to be performed in hospital departments. During 1969 however the North West and the South West London Mass X-ray Services continued to provide regular public sessions at numerous points in Westminster in addition to various closed surveys. The South West London Service also undertook six-monthly surveys in conjunction with the Westminster Hospital Chest Clinic for the residents of the City Council's Lodging House at Bruce House, Kemble Street, W.C.2. and in this connection they acted in close liaison with the City Council's 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 were provided for all City Hall staff and staff of adjacent office blocks, in addition to the sessions 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 20,996 (18,336) 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. 15 These certificates, of which 19 (13) were issued during 1969, 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. AFTER HOURS EMERGENCY TELEPHONE SERVICE This service has continued to prove its value as a simple and effective means of providing comprehensive coverage of health, welfare, medical and similar emergencies arising outside normal office hours. It is administered by the City of Westminster Health Department and financed jointly with the Royal Borough of Kensington and Chelsea to cope with any such problems arising within the areas of the two Authorities. The control centre is at City Hall, Westminster, and it is manned by four Duty Officers working on a rota system. Each Duty Officer has at hand files of general and specialised data relating to all available services, and the telephone numbers of senior officers and other staff on standby duty for the respective Health, Welfare and Children's Departments together with details of parallel emergency telephone services in the other London Boroughs and elsewhere. He is thus able to refer any given emergency directly to the appropriate officer or service, and to supply information, advise generally, or pass the less pressing matters to the appropriate day staff for attention. The officers always available on call for Westminster and for Kensington and Chelsea include the Medical Officers of Health or their Deputies, senior medical officers, mental welfare officers, children's officers, welfare officers, midwives and public health inspectors. Senior officers in other departments of the Council and other officials such as Coroner's Officers, District Surveyors, can also be contacted through the control centre if necessary. The Duty Officers have a working knowledge of the services with which each of the various departments deals and this, together with information from the files, and their experience of the types of problems likely to arise, enables them to advise on many matters which require no immediate specific action. Further advantages of the system are that officers called to a particular case are enabled to report back periodically to the centre to receive additional messages, seek the advice or assistance of colleagues, pass reports for subsequent action by day staff, or instruct the Duty Officer to make telephone calls on their behalf with a consequent saving of time. The Duty Officers are also available to authenticate international certificates of vaccination where early departure prevents this being done during normal office hours, to receive bacteriological specimens and transmit them to the laboratories for examination, to issue vaccines to medical practitioners, to summon police or ambulance services, and finally to take cremation bookings. Information concerning such things as the times and location of the various health and welfare clinics, including venereal diseases clinics (which are dealt with on a separate line), can be supplied at any time to callers. The service benefits increasingly from the special knowledge and experience which the Duty Officers continue to gain in the course of their work, and by the other officers concerned taking fuller advantage of the system and placing greater reliance on it as they become accustomed to its possibilities. Hospitals, police, ambulance service, G.P.O. telephone operators, emergency medical relief services, medical practitioners, social workers, and a widening range of official and unofficial organisations are making reciprocal use of the facilities to mutual advantage. During 1969, a total of 11,835 (11,477) calls were received, 9,630 (9,153) relating to the City of Westminster and 2,205 (2,324) to the Royal Borough of Kensington and Chelsea. An analysis is given in Table 7, page 70. VISITORS TO THE DEPARTMENT In addition to the practical training provided for various members of the Health Department staff (to which reference is made in the next section) no fewer than 630 persons were welcomed during 1969 for visits of observation. Being located close to the central Government departments and near to many Embassies or Legations of other countries, the City Council receives numerous requests to receive visitors comprising officials from central or local government of this country or from abroad members of foreign municipalities or Commonwealth countries; doctors, students from teaching hospitals, nurses, social workers, etc. Indeed, the point has now been reached when it has become necessary to "ration" the number of visitors who can be received without seriously interfering with the day-today work of the Department. 16 These visits embrace all the activities of the Health Department and although they may be time-consuming they prove interesting and stimulating to the staff concerned. STAFF TRAINING The City Council is well aware of the importance of the training of its staff. It aims to have a fully qualified staff and to this end it has adopted the following policy: 1. To employ and train staff especially recruited for the purpose, namely student public health inspectors, nursery students, district nurses, both state registered nurses and state enrolled nurses. 2. To provide facilities under its Post-Entry Training Scheme whereby staff wishing to obtain either a basic qualification or an additional qualification are released, usually on one day each week, to attend college. The City Council normally makes a 100% grant of tuition and examination fees and the cost of travelling for the purposes of training when an initial qualification is being sought and 75%for an additional qualification. 3. In addition to 1 and 2 above, staff are sent on a number of courses organised by specialist bodies for particular designations of officer, e.g. refresher courses for nursing and nursery staff, management courses for administrative and clerical staff. The City Council is also aware of its responsibility to train staff for the general advantage of the local government service and to this end the Health Department accepts a number of social worker students on placement from universities and colleges of further education. In addition instruction in the role of the local authority is given to student nurses from the Royal College of Nursing and from the teaching hospitals in the City. It has become the practice during January of each year for three trainees in hospital administration, who are university graduates employed by the North West Metropolitan Regional Hospital Board, to spend a week in the department talking to senior members of the staff about the services for which they are responsible. All this training of persons from outside the department is accepted by the membersof staff involved as a responsibility they have to the local government service and they find also that it is a most stimulating challenge leading to a reappraisal of their own duties and methods. Medical Officers During 1969 the Medical Officer of Health attended a medical computer course; one Deputy Medical Officer of Health attended a three months management course for Chief and Senior officers organised by Birmingham University; a senior medical officer attended a course in developmental paediatrics, organised by the Society of Medical Officers of Health; one departmental medical officer received instruction in the ascertainment of mentally subnormal children, and one attended a course in the assessment of severely subnormal young children. Public Health Inspectors Three inspectors attended a course on air pollution, four a course on noise and five a variety of courses on food control. Student Public Health Inspectors Fifteen student public health inspectors were employed during the year, two of whom qualified in the mid-summer examinations and were appointed as public health inspectors on the staff of the department. Social Workers Three social workers were seconded to one-year courses leading to a professional qualification; others attended a number of shorter courses. District Nurses Ten State Registered Nurses successfully completed the training for the National Certificate in District Nursing; this included four from the Hammersmith Hospital Integrated Course. Five State Enrolled Nurses attended district nursing courses and received the Queen's Institute of District Nursing certificate. Two district nurses attended a practical work instructors course at Chiswick Polytechnic. 17 Nursery Staff Thirty-two nursery nurse students were employed by the City Council and were undergoing training during 1969. Four nursery nurses were successful in the Course for Qualified Experienced Nursery Staff which qualifies for appointment as Nursery Warden. One Deputy Matron attended a residential refresher course. Nursing Staff One assistant nursing officer attended a residential middle management course and was complimented on her contribution to its success; six health visitors attended a field work instructor course, and four took part in refresher courses. Administrative and Clerical Staff Four members of the administrative and clerical staff attended courses on clerical and office management arranged by the Chiswick Polytechnic; the Chief Administrative Officer attended a three-week management course for Chief and Senior Officers organised by the Portsmouth College of Technology, and accompanied the Medical Officer of Health at a computer course organised by LAMSAC. The London Boroughs' Training Committee arranged a variety of courses for members of the Health, Welfare and Children's Departments of the London Boroughs. The majority of the courses were for social workers, but courses were also arranged for health education officers, nursing and nursery staff, home help organisers, health visitors, and hostel and training centre staffs. The Health Department took advantage, as far as staffing commitments allowed, of all the courses and seminars appropriate to Health Department staffs, and some 30 courses were attended by one or more members of the department's staff. In addition to the above courses, various members of the staff were given the opportunity of attending courses of short duration (half day or single day) and conferences which were available in London, dealing with a variety of subjects. 18 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., M.R.S.H. At 31st December, 1969 Establishment In post Public Health Inspectors 59 (59) 52 (53) Student Public Health Inspectors 15 (15) 15 (14) Technical Assistants 24 (24) 22 (24) The staff position in respect of public health inspectors and technical assistants has been well maintained during the year in the face of shortage of inspectors throughout the country and increasing difficulties in recruitment of technical assistants of a high calibre. Three inspectors resigned, and two senior inspectors retired from the service. Two students completed training, and upon qualification were appointed to established posts; one abandoned his studies, and four appointments were made. Constant and close liaison between the inspectorate and other departments of the City Council's services, also with officers of other bodies having allied interests and duties, continues to be maintained, as does the regular meeting and exchange of views between inspectors upon matters of technology and administration, and the furtherance of professional knowledge. As a result, public relations continue to be very satisfactory, the service provided being reliable and widely appreciated. Within the following pages will be found references to particularised items and statistics of the work of the inspectorate in the various specialized sections of the department and on general public health (district) duties. There has been no fundamental change in the disposition of the inspectorate, the members of which continue to carry out their duties both satisfactorily and with enthusiasm. The policy of allowing, where possible and practicable, individuals to gain experience in the different sections continues, and contributes greatly towards maintenance of the establishment. The anticipation of continued service with the City Council in a congenial atmosphere, and where newly qualified inspectors can see rewarding prospects for their efforts, are incentives valued by professional officers. Public Health Inspectors—Night and Week-end duties Arrangements continue to operate whereby coverage of "out of hours" duties is maintained as far as is practicable. More emphasis has been placed on the supervision of street traders in the field of sale of foodstuffs, particularly by itinerant vendors from unlicensed stalls outside recognized market places, and valuable liaison with the Police has been established in this regard. This activity provides all inspectors, in addition to those in the Food Section, with an opportunity to gain wider experience in matters of food control and hygiene, and incidentally, with court procedure. Student Public Health Inspectors During the year the training of students continued to be supervised by a senior public health inspector, and the established principle of providing all-round practical experience by two-monthly periods in different sections of the department was adhered to. Especial attention to individual needs is arranged during the final year of study. Of the four students completing their course of study during 1969 two were successful in the Diploma examination and the other two were referred to undergo further training in order to re-sit one section of the examination. A further four students were appointed. District Inspection The division of the City into four areas, comprising a total of twenty-four districts, in 1968, has proved to be both practicable and, as anticipated, beneficial to the attendant administration. It is expected that early in 1970 when the North Westminster Project is fully launched, the minor adjustments to Areas 3 and 4 occasioned thereby will be assimilated smoothly. Summaries of the work carried out by the district and other inspectors are contained in Tables 8, 9, 10 and 11, on pages 70 and 71. 19 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 70, and an analysis of 2,327 (3,450) nuisances and unsatisfactory conditions found and remedied appears in Table 9, page 70. Notices Six hundred and forty six (1,220) informal notices, and 629 (830) statutory notices were served in 1969 to secure the abatement of nuisances. In addition 35 (36) notices were served under the Clean Air Act, 1956. An analysis of statutory notices served is given in Table 11, page 71. Legal proceedings A summary of legal proceedings undertaken during 1969 is set out in Table 27, page 79. Noise All complaints of noise made to the Health Department are investigated. Not all can be substantiated, but where nuisances are established, a large majority of them are abated or the offending noise reduced to a reasonable level by persuasive action. Two hundred and fifty seven (252) complaints of noise were received during the year under review and these necessitated 1,117 visits (1,141) by public health inspectors. Many of the complaints continued to relate to noise occurring late at night or at weekends and investigations outside normal office hours were necessary. Drainage and New Developments During the year under review 1,326 (1,082) Notices of Execution of Drainage Works were registered, and a total of 13,017 (12,024) visits to sites and to premises were made in connection with these notices. Of the proposals to do work, 262 Notices related to large scale developments and works requiring specialist knowledge and attention (which comes within the purview of the Developments' Team of 4 inspectors) and 68 (61) concerned new buildings. The number of houses and flats constructed by private enterprise was 195 (423), but in addition to this figure 434 (nil) flats built under the auspices of the Central London Housing Trust for the Aged also reached completion during the year. At the end of the year 928 (744) housing units, exclusive of municipal developments, were in various stages of construction. New educational establishments referred to in previous reports were nearing completion, and it is expected that these will be occupied during the course of the coming year. A new school for the children of American Nationals is in course of construction in St. John's Wood, and will replace the presently used premises at York Terrace East. Sewerage 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 endeavouring to ensure that, in new buildings, no sewer connections are made which would make the buildings liable to flooding by surcharge. Town Planning Observations were made by the Department on 103 (70) plans submitted to the Council under the Town and Country Planning Acts, 1962/1968. Clean Air 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. Rutherford School, Penfold Street, N.W.8. Paddington Office, 313 Harrow Road, W.9. 20 Arrangements for these measurements are made in conjunction with the Warren Spring Laboratory of the Ministry of Technology as part of the National Survey of Air Pollution. At the request of the Consultant Physician of the Westminster Hospital Chest Clinic results from Anson House and Monck Street are supplied to him at weekly intervals, to assist his research into the effect of various factors on bronchitics and asthmatics living in Westminster. Two sequential fog samplers operate at Anson House and Westminster Council House. 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 measurements 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 smoke control programme is nearing completion and has played a large part in reducing the amount of smoke in the City's atmosphere to about a quarter of what it was when the programme was embarked upon. Three final Smoke Control Orders, Westminster (Paddington Church), Westminster (Hyde Park No. 2), and Westminster (Paddington Town) were made during the year, and were confirmed by the Minister of Housing and Local Government. A further order, Westminster (Wild Street), was also made to regularise the position created when the Westminster (Covent Garden) Smoke Control Order was made. This relates to a small area of about 2 acres in the Covent Garden Ward which was excluded pending works of improvement by the owners to all the dwellings therein. This work has since been completed and the area was already smokeless when the Wild Street order was made. 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 263 (258) visits in connection with complaints received, 325 (384) smoke observations and 914 (907) 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 1969 a total of 54 (82) such notifications were received, of which 15 (17) included application for the Council's approval of the new boilers. The Clean Air Act 1968 came into force during the year. Section 6 gives the Council control over the height of chimneys serving new or adapted boilers which burn (a) pulverised coal, (b) solid fuel at a rate of 100 pounds or more per hour, or (c) liquid fuel or town gas at a rate of 1¼ million British Thermal Units or more per hour. The control relates to new chimneys, or to existing chimneys serving boilers in which the combustion space has been enlarged, and is additional to all existing planning and constructional requirements. Four applications for approval under this section were received and all were approved. Housing Acts 1957-1969—Inspectorate This specialist group of public health inspectors continued to deal with slum clearance, houses in multiple occupation, the improvement of dwellings, and applications for loans and grants for the purposes of purchase and improvement of houses. During the year progress was made upon the declared slum clearance programme, as reported in a subsequent paragraph, and preliminary surveys were conducted for the purpose of formulating a slum clearance programme for 1970-1974. Investigations continued into conditions prevalent in hotels, guest houses, boarding houses and hostels, particularly with regard to premises which were being converted for these purposes. The Development of Tourism Act 1969, which came into operation on the 1st August, brought many enquiries concerning the financial incentives to encourage the provision of accommodation for visitors, and for advice as to standards of amenity required. It would appear in this latter respect that standards could be applied by a Tourist Board as a condition attaching to a grant or loan, and perhaps the British Standard Code of Practice C P Chapter VII (1950) will be adopted in this respect. An enforceable minimum standard of accommodation and amenity applicable to all hotels and hostels could well prove to be necessary in the full implementation of the intention of the legislators. 21 A summary of visits for various purposes will be found in Table 12 on page 71. Houses in Multiple Occupation (a) Management Orders, Directions and Notices Throughout 1969 two public health inspectors continued a survey in the Pimlico area on the basis of a house-to-house inspection. At the end of the year a further 220 properties in that area had been inspected, of which 106 required action either informally or by the service of notice. The Director of Architecture and Planning served 54 (50) notices under Section 16 of the Housing Act, 1961 (means of escape in case of fire) and 26 (19) were complied with during the year. A summary of the work of the Inspectors in connection with multi-occupied houses is given in Table 13 on page 72. (b) Housing Act 1964—Control Orders Of the 5 premises which had been made the subject of control orders by the City Council and the former Paddington Borough Council, a further two orders ceased to have effect in 1969 after the expiration of five years from the date on which the orders came into force. (This left one order in operation which terminated in January 1970 on expiry of the statutory period.) Unfit Premises Details of closing orders made during the year are given in Table 14, page 72. Housing Priority on Medical Grounds During the year 1,678 (1,254) rehousing applications supported by medical certificates or claims for priority on medical grounds were considered and assessed by a Principal Medical Officer. Unlawful Eviction, Harassment & Provision of Rent Books The number of cases of alleged harassment and illegal eviction investigated during the year was 203 (178), and in addition 36 (26) specific complaints of non-provision of rent books were dealt with. Rent books are automatically inspected in all cases of harassment investigated. The number of visits paid by the officer concerned was 560. No legal proceedings were instituted in relation to these matters. Overcrowding The majority of cases of overcrowding came to the notice of the City Council through applications for rehousing, and the statistical information on the known cases is given in Table 15, page 73. Certificates of Disrepair Towards the end of the year, one application was received for a Certificate of Disrepair, which was subsequently issued. Slum Clearance During the year the Herries Street (South) Compulsory Purchase Order was confirmed without modification by the Minister of Housing and Local Government. The rehousing of the qualifying families from this area, together with those from the Herries Street (North) and Mozart Street areas has commenced, preparatory to the demolition of the properties. The Ashmill Street/Broadley Street area has now been cleared. A comprehensive report on the conditions in the Archer Street/Brewer Street/Green's Court/ Peter Street areas has been prepared for consideration in 1970. A survey of the proposed St. Michael's Street Clearance Areas was completed towards the end of the year and a detailed report is in course of preparation. Housing Act 1969 The Housing Act 1969 came into effect on 25th August 1 969 and deals with house improvement 22 and repair, area improvement, rents of dwellings, houses in multiple occupation and slum clearance. With regard to the first two of these matters, although compulsory powers are still available, emphasis continues to be laid on encouraging owners to carry out works. Revised higher grants for improvement and repair are dealt with more fully in this Report under "Grants, Subsidies and Loans". Legislation regarding area improvement under the 1969 Act replaces the powers given in Part II of the Housing Act 1964. In broad terms the objective is the "improvement of predominantly residential areas", with emphasis on the improvement of the area as a whole and not only the dwellings. Great importance is also attached to consultation and public participation. No improvement areas were declared by the Council under the 1964 Act and experience of the working of such schemes is limited. Improvement areas are not intended as an alternative to slum clearance. Under Part III of the Act (rents of dwellings in good repair and provided with standard amenities) controlled tenancies will be converted to regulated tenancies where the qualifying standard is reached. (It is interesting to note that prior to this Act, the issues of "fitness" and "rent" were dealt with under separate legislative codes.) This standard is certified by the Council by way of "Qualification Certificates". There was no immediate response to the coming into operation of the legislation, but 178 applications for Qualification Certificates were received by the end of the year. Details appear in Table 16, page 73. Powers in relation to houses in multiple occupation under previous Housing Acts have been strengthened and extended by, inter alia, a new definition of houses in multiple occupation and an extension of the power under section 22 of the Housing Act 1961 to control multiple occupation by way of registration. Consideration is being given to the value of a scheme to register houses in multiple occupation. The amendments to slum clearance legislation are confined mainly to the financial aspects of compensation. However, section 4 of the Housing Act 1957 which prescribes matters to be considered in determining whether a house is unfit, has been amended to include "internal arrangement"; the reference to facilities for the storage of food has been omitted. Improvement Grants In an effort to encourage voluntary improvement of dwellings, the Housing Act 1969 introduced more generous assistance by increasing the value and scope of grants to improve and modernise sound older homes. The main changes, summarised below, became effective from 25th August 1969. Standard Grants These are grants made to help meet the cost of improving houses by providing for the first time any missing standard amenities. Under the new scheme this type of grant is payable in respect of half the cost of the improvement work, subject to a maximum of £200 for providing all five improvements for the first time, and a lower maximum in other cases. In certain specified circumstances the grant is subject to an overall maximum of £450 instead of the normal £200. Discretionary Grants These are made at the discretion of the Council to help owners improve houses to a good standard, or to provide dwellings either by converting houses of an unsatisfactory size, or by converting non-residential buildings to a housing use. The new discretionary grants are worth up to half the estimated cost of work subject to an upper limit of £1,000 per house, or for converting a house into flats half the cost of conversion up to a maximum of £1,000 per flat. For a house of three storeys or more the upper limit is now £1,200 per flat. Special Grants At the discretion of local councils, special grants may be payable towards the cost of providing standard amenities which will be shared in houses in multiple occupation where there is no immediate prospect of conversion into permanent separate dwellings. The grant which may be made in these cases is for half the cost of the improvement works, subject to a maximum determined by the number of amenities installed. 23 Grants, Subsidies and Loans The applications received by the Council during 1969, and referred to the Health Department for comment, were as follows:— No. of Dwellings Discretionary Grants (a) Works of improvement 92 (b) Conversions 197 Standard Grants 24 Subsidies to Housing Associations for the improvement and conversion of properties 178 Loans for the acquisition and/or improvement of premises in Westminster 40 A summary of visits made is given in Table 12, page 71. North Westminster Project Members of the Council will be aware that in 1967 the following classifications were approved :— 'A'—Principally areas of worst housing and environmental conditions in which the Council should immediately start to acquire premises with the object of redeveloping the areas over a period. 'B'—Areas in which redevelopment should be carried out after the completion of the redevelopment of the 'A' areas, but in which, in the meantime, the Council would endeavour to eliminate overcrowding and ameliorate living conditions. 'C'—Areas where full rehabilitation of the houses by the owners was to be encouraged for long term use. In April 1969 the plans for the 'B' areas were revised, the original 'B' areas being reclassified as 'A' or 'C' or a new category designated 'A/C'. The 'A/C' areas were to be treated as 'C' areas except that the Council would not basically oppose redevelopment by owners as an alternative to improvement or conversion. A senior public health inspector was made responsible for a small team of inspectors and technical assistants to commence the inspection of premises within the area, as a preliminary to implementing the overall long-term objectives of the project. Until the Government's intentions were finally made known by the passing of the Housing Act 1969 progress was concentrated on the original 'A' areas (compulsory purchase order action being taken in respect of Tavistock Crescent and St. Stephen's Gardens areas) and on general guidance and preliminary surveys in the 'C' areas. This Act came into operation on 25th August, 1969 and is more fully examined elsewhere in this Report. The improved grants and loans available and the revised legislation regarding the declaration of general improvement areas should facilitate more rapid progress and an even more comprehensive approach to the rehabilitation of the 'C' areas. There are three classifications of ownership involved; Council owned property (mainly the Queen's Park Estate) and the 'A' areas being acquired, privately owned property and property owned by Housing Associations. The approach regarding privately owned property in 'C' areas is informal inasmuch as there is minimal reference to legal requirements although really urgent matters are followed up in the normal way including, if necessary, statutory action. It is too early to assess the possible response from private owners but in my next Report it is hoped to provide a more comprehensive account as a result of a full year's work on this project. Common Lodging Houses There are two common lodging houses in Westminster. One, accommodating 550 men is kept by the Salvation Army at 18, Great Peter Street, S.W.1., whilst the other for 706 men at Bruce House, Kemble Street, W.C.2. is directly controlled by Westminster City Council Welfare Department. Regular inspections of the premises are made by the public health inspectors, particular attention being given to fire precautions, the number of lodgers accommodated, sanitary and washing facilities, and to general compliance with bye-law requirements. Both common lodging houses were well managed and maintained throughout 1969. 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. 24 Local Land Charges The number of formal enquiries dealt with during 1969 was 8,336 (8,622). This figure does not include supplemental enquiries or personal searches. 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 Bessborough Street M. & C. W. Centre 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. Commencing in June, 1969, the baiting of sewers against rat infestation, in accordance with the requirements of the Ministry of Agriculture, Fisheries and Food, was undertaken by a contractor on behalf of the City Council. Every manhole and side entry to the sewers is baited with an approved rodenticide, and this method of treatment, which at the end of the year was proving to be very successful, is expected to be completed within twelve months. By then every manhole and side entry will have been baited on four occasions. The operation requires advance information to be given to the Metropolitan Police, the Greater London Council, the adjoining London Boroughs and the City of London Corporation, the Ministry of Agriculture, Fisheries and Food and the City Engineer with regard to safety precautions which apply. Continued attention is given to advances in methods of treatment, 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 74. 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 2,920 (3,917) rooms were disinfested. Disinfection During the year 87 (45) rooms, 5,247 (6,653) articles of bedding and clothing and 270 (209) 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. Seventy-three (58) 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. 25 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. Although perhaps well-intentioned, indiscriminate and regular feeding of pigeons by members of the public results in concentrations which give rise to nuisance and is one of the most important factors which militate against effective control. The investigation of complaints is carried out by public health inspectors and the pest control staff who, depending upon the circumstances of the complaint, arrange wherever possible for remedial measures to be taken and give advice, where necessary, on the use of repellents. During the year 108 complaints were investigated. 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 1969. (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 from these laboratories 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 your area. (ii) No houses were permanently supplied by standpipe. (d) 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:— River Thames-derived water (all stations). New River-derived water from Stoke Newington Works. No new sources of supply were instituted and there were no changes to the general scheme of supply in your 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, pages 74 and 75. (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. Surveys carried out between 1966 and 1968 on analyses of water from consumers' premises confirmed this statement." 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. 26 Private Water Supplies—Deep Wells The water from 66 boreholes is used for drinking and domestic purposes in 49 premises. Of these, 18 bores supply water to 16 premises occupied by Government departments or Crown Agents, and examination and maintenance of these are in the hands of the Government Chemist and the Ministry of Public Building and Works. In relation to the 48 boreholes in private ownership, 48 (77) samples of water were submitted for bacteriological examination and 22 (26) for chemical analysis. With one exception, the results of all these tests were satisfactory. One sample showed an abnormally high bacterial plate count, which on investigation appeared, to be due to recent servicing of a pump. This deduction seemed to be confirmed when further samples were taken from the same point in the supply after 2 days and 10 days, both being found satisfactory. Swimming Bath Water Examination Monthly examinations were carried out at each of the 11 municipal swimming baths in the City. Two hundred and two (210) samples were submitted to the Public Health Laboratory Service for bacteriological examination, and the same number of samples were also examined at the baths for residual chlorine and pH value. The results of these examinations were generally satisfactory. One case of slightly lower bacterial purity was probably due to a pump breakdown, and another to a fully clothed man having fallen into the bath shortly before the sample was taken. River Thames Flood Precautions The Health Department, in co-operation with other departments of the City Council concerned in precautions in the event of flooding, has prepared plans to be brought into operation immediately on receipt of warning by the Police, in accordance with the London Tidal Flood Warning System. Offices, Shops and Railway Premises Act, 1963 The number of new registrations received during 1969 was 1.042 and, after taking into account removals, the total number of registered premises at the end of the year was 17,728, the number of persons employed therein being 352,727. The number of registered premises receiving one or more general inspections during the year was 1,924. The decrease on the previous year's figure (2,960) was due to a shortage of staff which included technical assistants who could be made available for this work, arising from the Department's commitments in relation to the North Westminster Project. For the same reason, the number of visits of all kinds to registered premises fell from 6,821 to 5,789. Employers are required under the Act to submit details to the appropriate authority of all notifiable accidents occurring on their premises and 471 notifications were received during the year. Of these 171 required investigation revealing 9 contraventions. There was 1 fatal accident concerning an electrician who fell from a height of 8 feet. The Offices, Shops and Railway Premises (Hoists and Lifts) Regulations, 1968 came into operation on 28th May, 1969 and require the submission, to the appropriate authority, of copies of reports from competent lift engineers concerning lifts and hoists where examination has shown that the appliance cannot continue to be used with safety. Since the operative date there has been a progressive increase in the number of reports received and by the end of the year 287 had been submitted. The necessary work to meet the requirements of the Regulations had been carried out in 34 cases by the end of 1969. This aspect of the Act has greatly increased the duties of all the staff concerned with its administration. Statistics, including some contained in the Annual Report to the Department of Employment and Productivity, are set out in Table 20, page 75. Factories There were 4,314 (4,639) 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 21 and 22, page 76. 27 Outworkers Returns made by 158 (174) employers, together with 124 (168) notifications from other local authorities, accounted for a total of 1,841 (1,814) outworkers. Of these 760 (794) were residing in the City of Westminster. Nearly all were engaged in the tailoring and gown trades. (Table 23, page 77.) 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 and the quinquennial review was held during the year. The inspection of the individual bakehouses showed they were suitable for continued use, and the certificates of suitability were renewed. Food and Catering Premises—Inspection The estimated number of food and catering premises in Westminster on the 31 st December, 1969 was 6,816 categorised as shewn in Table 24, page 77. During the year 8,427 (10,230) visits were made by the public health inspectors and 472 (352) informal notices were served in respect of matters requiring attention. During the year some 702 complaints were received concerning general matters affecting food premises, staff etc. Appropriate action was taken in each instance. Catering Establishments All who are connected with Westminster, and in particular the Soho area, cannot fail to be impressed by the concentration of catering premises actively in operation day and night, and where the problems of seeing that proper standards of food preparation are maintained are self-evident. To be able to report an entirely satisfactory state of affairs in the catering industry as far as this department is concerned would require a far greater concentration of inspections than can be achieved with the existing number of staff available and, furthermore, would need the essential co-operation and in many cases a change of outlook both by members of the catering trade and their patrons, the general public. However, certain positive factors have improved the hygienic potential of food premises. There has been an enormous contribution to improvements in the catering industry in such things as: a. Planning of kitchens b. Production of easily cleansed equipment c. Efficient detergents d. Refrigeration in which field, fortunately, economic factors of preserving food, run parallel to hygienic considerations. These improvements have not, however, in all respects produced the desired results. Much has been nullified by a deficiency in staff management, weak, indifferent and remote control of the daily routine in the kitchen and the difficulty in obtaining suitable kitchen staff. The year has again been one of considerable activity by the public health inspectors in the catering section, and a great deal of the inspectors' time has been taken up not only with necessary routine inspections, but with the study and discussion of proposals for new establishments or alterations in existing ones. In an endeavour to assist all those who desire to open catering establishments, a list of 'General Requirements' is available, setting out matters about which, in general, the department requires to be satisfied, bearing in mind eventual nuisances which might arise from noise, vibration, smell, refuse disposal etc. Much of the inspectors' time is taken up with ventilation problems, and with associated complaints of cooking smells and noise from the operation of the plant. These are matters which continue as a principal source of complaint. Infestation by black rats in restaurants is rare, but during the year in a restaurant situated in a property awaiting block development, and of which the upper three floors had for some time been derelict, infestation by black rats occurred, with a co-incidental infestation by cockroaches. Legal 28 proceedings were authorised. Although treatment for the infestations was immediately undertaken, an inspection of the premises on the morning of the Court Hearing disclosed living and dead cockroaches in open cans of food. After hearing the evidence the Magistrate suggested in view of the conditions disclosed, that the premises should be closed until the inspector was satisfied they were fit to be re-opened. The defendant's Solicitor, on his client's instructions, gave an informal undertaking to this effect. At the adjourned Hearing fines totalling £100 were imposed, plus £65 costs awarded to the Council. The premises eventually re-opened with satisfactory conditions, and have since changed ownership. Whilst in the case mentioned above it was possible to deal with the closure of the premises informally, under existing legislation, in a particularly bad case, it is possible only to obtain the disqualification of the person responsible for running the business; and there is nothing to stop the same premises being immediately re-opened under different management. Admittedly the processes of the law could once again be invoked, but this could be obviated if legislation were provided to disqualify the premises until they had been brought up to the standard required. During the year a withdrawal of labour by the refuse collectors posed a problem within the industry in relation to kitchen waste. In some cases private contractors were engaged to remove the waste; in large concerns the firm's own transport was used. However, the main difficulty was experienced with the smaller type of restaurant which hitherto had relied on a daily collection. A daily watch was kept on the situation throughout the period of the emergency, and in all over 500 visits were made to all types of food businesses for this purpose; fortunately work was resumed without any serious health hazard arising. Licensing Act, 1964 The provisions of Part II 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 under Part IV of the Act in respect of an application to the Licensing Justices for a licence to sell intoxicating liquor in restaurants, private houses, guest houses etc. The Justices may refuse to grant a licence if the premises are not structurally adapted and bona fide used for the purpose of habitually providing customary main meals, or, after reasonable steps have been taken, it was not possible to inspect the premises. Public health inspectors are 'authorised officers' for the purpose of the above-mentioned parts of the Act. Facilities are provided at the Justices' meetings for views to be expressed on applications for new licences and of alterations or extensions proposed to existing licensing areas. Whilst it is rare for a licence, or approval to carry out work, to be refused absolutely, the application can be deferred for weeks and sometimes months if the Court wishes to be satisfied that the requirements of this Department are first met. Caterers are often more concerned about their licences than that formal action will be taken by this Department. Whilst not intended to be punitive, a deferred licence may prove more costly than a fine imposed for contraventions of the Food Hygiene Regulations, as the fine may only amount to the equivalent of a few days' rent and rates. Licensed Street Trading The purpose of the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966 is to bring stalls more in line with the hygiene standards applicable to food shops and catering establishments as laid down in the Food Hygiene (General) Regulations, 1960, and to prohibit the placing of open food or refuse on the ground in the vicinity of the stall. The action taken during the year has again been on an informal basis and considerable time has been given in explaining the Regulations to existing and new traders. Meetings have been held with the various street marketing associations on related matters. Two problems which continue to face traders are the adaptation of an outmoded stall to meet the new requirements, and the securing and/or maintaining of suitable premises as a store. A newly designed stall has now been constructed which, if acceptable to traders, appears to meet all the hygiene requirements at a reasonable cost. In this design the moulding is of durable fibre glass and is supplied complete and requires only simple hand tools to attach to the traditional barrow. In the case of traders dealing in poultry, fish, hot dogs, ice cream and coffee stalls, access to the wash unit can be from within the stall. The Company concerned are also able to provide a completely new stall, if the trader so desires, on solid rubber tyres and rubber suspension. 29 Legal proceedings were taken during the year in respect of a bakery delivery van, which was apprehended by the Police and subsequently inspected by a public health inspector, who found unhygienic conditions to be present with accumulated dirt and filth half an inch deep on the vehicle floor on which loaves of bread had been placed without protection. The Company operating the van were fined a total of £50 with £7 7s. 0d. costs. Unauthorised Street Traders Reference has been made in past Annual Reports to the unsatisfactory situation prevailing regarding unauthorised street trading where the standards of hygiene found on hot dog and ice cream vendors' stalls and vans continued to give cause for anxiety due to the very real danger of contamination of food. The year commenced with cases being heard in Court for which offences had occurred in the previous August. Some were successfully concluded, but in others, summonses could not be served and warrants were issued. The difficulties associated with the enforcement of the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966, have mainly arisen from the inability to exercise a more positive and effective control of the traders due to the difficulties of obtaining the required evidence. An approach was accordingly made to the Police who agreed to co-operate, and a procedure was introduced whereby a public health inspector on request would attend at the Police Station to inspect the stall or vehicle of a trader, arrested by the Police for an obstruction offence. Where on such stall or vehicle, hygiene contraventions were found to exist, the trader was charged with the hygiene offences at the same time as the obstruction charge, and the public health inspector gave the necessary evidence. In addition, public health inspectors accompanied Police Officers on evening and late night tours of inspection in the West End, and street traders found by personal observation to be contravening the Regulations were similarly dealt with. This procedure resulted in a more speedy and efficient enforcement of the Regulations than had hitherto been possible, as all arrested offenders were brought before the Court the day following the offences. In association with this improved procedure, a system of printed adhesive attachments have been introduced by the Health Department and are used by public health inspectors. Police, and the Court Officers on charge sheets and summons applications enumerating the offences observed. A new style of report book for each individual case has also been formulated. Both these measures have considerably assisted in streamlining the procedural work prior to the case being heard. Towards the end of the year the City Council delegated individual authority to public health inspectors to institute and conduct such proceedings on its behalf in respect of offences under the Regulations. The Medical Officer of Health would place on record the thanks of the department to the Police for their willing and efficient co-operation. Thanks are also due to the City Council's Director of Cleansing who kindly loaned to the Department portable radio sets with which the public health inspectors engaged on food control were able to be alerted quickly, wherever they were in Westminster, to a case requiring their attention. So successful were these "walkie-talkie" sets that it is proposed to purchase some hand-sets for use by the Department's staff; arrangements have also been made to equip more of the department's vehicles with two-way radio as this has made a notable contribution to efficiency. Legal proceedings were also instituted during the year in respect of unhygienic conditions at premises used for the storage and preparation of food associated with 'hot dogs' stalls. Seventeen mobile stalls were found within the premises, and eight outside; none complied with the Regulations. Although no action could be taken in respect of the stalls, as they were not at the time engaged in trading food, contraventions of the Food Hygiene (General) Regulations, 1960 in respect of the premises resulted in fines of £84 plus £15 15s. Od. costs. Judgement was later obtained by the owner for possession of the premises. Food Hygiene etc., Lectures Again the year has seen an increased demand for lectures on subjects associated with food hygiene and food control. The Industrial Training Act, 1964 imposes an obligation on caterers to train their staffs, and the public health inspector plays his part as a Health Educationalist by ensuring that he contributes to these training courses. 30 Lectures have been given to staff and management engaged in all spheres of catering, and a departure from previous years has been the use of a series of coloured slides depicting good and unsatisfactory hygiene practices. This has been followed by a discussion with the members in the restaurant kitchen with the public health inspector demonstrating typical unhygienic practices. Not the least of this instruction is that associated with temperature control of certain foods as required by the Food Hygiene (General) Regulations, 1960. It is the failure to carry out this important task which contributes to the major portion of food poisoning outbreaks. This type of co-operation with the trade is welcomed but it is unfortunate that the turn-over of kitchen staff sometimes makes it an unrewarding task unless the management are also prepared to do their part in educating both present and future staff. Food Sampling and Analysis Recent years have shewn new developments and changing customs in our daily food supply, and this has been particularly marked in the introduction of pre-packed food, for the greater part of our food supply is now sold pre-packed. It has recently been stated that food and drink make up about a third of all the country's imports, and that on average over £1 of every £4 spent by every family in Britain goes on food and drink and catering. For all these reasons, food, its manufacture and marketing, are bound to be of national importance. During the year a total of 1,730 (1,985) samples of foodstuffs were submitted to the Council's Public Analysts by routine or on complaint. Of this number 193 (222) adverse reports were received and appropriate action taken. The following notes on a selection of these will be of interest. A tin of salmon was found to contain what the purchaser thought was a piece of glass. Examination of the material proved it to consist of 'Struvite' which is a compound of magnesium, ammonium and phosphate and occurs naturally in tinned salmon. An assistant in a shop confirmed that eggs offered for sale were "free range". The purchaser, however, had some doubts as to the authenticity of this description following previous enquiries she had made which confirmed that the farm supplying the eggs did not guarantee them to be 'free range'. The expression 'free range' originally referred to eggs from hens completely at freedom in orchard or meadow, but under modern conditions it has come to include hens in enclosed grass runs or other open air conditions, but not those in battery cages or deep litter houses. The subsequent investigation by the inspector at the retail premises confirmed that the manager genuinely believed that the eggs supplied to his shop from the same supplier over a long period were 'free range'. The Head Office of the company concerned agreed that a false description had been mistakenly applied to the eggs, and took steps to ensure that this did not occur at their other branches. They apologised for the incident. A glass of milk served at a restaurant was found to contain a length of rubber tubing. The investigation disclosed that milk, intended for use in a dispenser machine, was contained in a polythene bag which had a sealed rubber tube leading therefrom. When required, the end portion of the tube was cut off to allow the milk to run. This end had been allowed to fall into a glass and had not been removed when the glass was subsequently used for service. A cautionary letter was sent to the management of the restaurant concerned. A bottle of milk delivered to premises was found by the complainant to have a greenish stain on the inside of the bottle, with particles of loosely attached material. It was found that the milk has been bottled at a North London plant. The local authority for the district was informed of the matter and instituted legal proceedings against the dairy company concerned. A fine of £50 with £10.10.0 costs was imposed. A loaf was found to contain a piece of rubber. An immediate investigation was conducted by the Bakers who found that rubber piping contained within a 10-ton silo had slightly fractured and a small slither of rubber had become dislodged. Rashers of bacon purchased at a large multiple store were being prepared by the purchaser when she noted 'something black' on the surface of one of the rashers. Examination revealed this to be the legs and part of the body of a cockroach. The management admitted they had knowledge of a cockroach infestation in another area of the premises, but not in the preparation room. However, regular treatment was extended immediately by their disinfestors to all parts of the premises, and in the light of this prompt response, no further action was taken. 31 Legal proceedings—Food and Food Premises The following matters arising from complaints received in 1968 resulted in legal proceedings being taken by the City Council against those responsible and were heard during 1969:— A loaf purchased from the retail section of a large catering concern was found to have been contaminated by mice. A heavy infestation of mice was found at the premises, although contractors were employed to carry out disinfestation work. A fine of £5 and £5 5s. Od. costs were imposed. Half a cooked chicken was found by the purchaser to be mouldy shortly after purchase. A fine of £20 with £5 5s. Od. costs were imposed. (See Table 27, page 79 —Analysis of Legal Proceedings). 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 31 st December, 1969, 368 (363) distributors of milk were so registered. Milk (Special Designation) Regulations, 1963 (As Amended) The City Council is responsible for the granting on application of Dealers' 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 1969 were: Untreated 74 (74) Ultra Heat Treated 108 (108) Pasteurised 350 (348) Sterilised 248 (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 for registration in respect of the sale and storage of ice cream. The number of premises registered with the City Council at 31st December, 1969 is shewn in Table 25, page 78. Food Poisoning The declared object of the Food Hygiene (General) Regulations, 1960, was to prevent food poisoning. Almost all food poisoning can be traced to a breakdown in food hygiene, which need never have occurred. During the year information was received of 36 persons stated to be suffering from food poisoning, and a summary of individual outbreaks affecting more than one person is as follows 32 Four persons had a restaurant meal and all later suffered diarrhoea. Meat sauce had been consumed by all four, although in different dishes, and at the time of inspection a quantity of this sauce was being kept in the bain marie below the statutory temperature of 145°F. The sauce had been made in bulk three days previously, cooled, placed in the refrigerator, and small quantities taken out as required and placed in the bain marie pending service. The causative organism appeared to be Clostridium Welchii. After a meal of Nan (Indian bread), vegetable curry and lamb curry, four persons were taken ill. No information concerning the incident was received in the department until three days had elapsed by which time all suspected food had been disposed of. No conclusion could be reached in this case. Salmonella enteritidis (Phage type 8) was isolated from a faecal specimen submitted by one of four persons, who each consumed kidneys cooked in wine over which mushroom sauce had been poured. One was admitted to hospital for an overnight stay. Specimens obtained from the two chefs engaged in food preparation proved to be negative upon examination. The facilities available in the kitchen and temperature control of sauces and other foods were all satisfactory. The matter did not come to the notice of the department until two days after the onset, and an immediate investigation did not disclose the cause. Specimens submitted by three members of a family were all found to be positive for Salmonella typhimurium. The investigation did not disclose any likely common dish consumed by all three, but it is possible that one contracted the disease and cross infected the others, although this could not be substantiated. A further incident occurred of meat sauce being the vehicle of infection in which two persons were ill following a restaurant meal. Heat resistant Clostridium Welchii organisms were isolated from meat sauce, and also from a faecal specimen of one patient. The attention of the management was directed to the importance of temperature control, particularly when associated with meat dishes. Subsequent visits to the premises disclosed that the advice given was being acted upon. (SeeTable 26, page78) Unsound or Unsaleable Food—Disposal 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. 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 237 (183) tons of unsold or unsaleable foodstuffs were voluntarily surrendered for disposal. 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. Imported Food Regulations, 1968 It is an offence to import into the United Kingdom food intended for human consumption which is unfit. Enforcement of the Regulations is undertaken 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 the examination had been deferred until the food reaches the place of destination, of which prior notice will have been given. Nearly all imported food coming into Westminster is examined at the port of entry, although there is a wharf in the City and also a freight depot at a main line station where large consignments of imported goods arrive which have not been previously examined. On notification of their despatch appropriate action is taken by the Health Department before the goods are released for distribution by the importer. 33 One case during the year concerned imported garnishing paste, which is used mainly for improving the appearance of cold dishes. After arrival at the importer's premises in Westminster a sample of the paste was found to contain a prohibited preservative. Arrangements were made for the whole consignment to be returned to the country of origin. During the year 79 notifications were received concerning large quantities of foodstuffs which had not been examined at port of entry, and detailed examination was undertaken by the City Council's public health inspectors prior to distribution. Export Certificates Applications for Certificates of Export received in the Health Department during the year in respect of foodstuffs to be despatched abroad numbered 35 (22). A food inspector examines 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. Consumer Protection With the technological advancement in modern large scale food production there has been a corresponding increase in the amount of legislation necessary to protect the consumer. Varieties of food are now available, which ten years ago, were unknown. The work of the public health inspector in the fields of food sampling, enforcement of food hygiene and education of food handlers, and in connection with the Trade Descriptions Act, are all examples of Consumer Protection, and there are many others. The Department has continued to maintain close liaison with other Departments of the City Council who are also concerned with providing consumer protection and an advisory service. Trade Descriptions Act, 1968 This Act has been in operation since 30th November, 1968. Although certain matters are expressly removed from its ambit, and its application is somewhat modified in relation to others, its provisions overlap in many respects those of other and more specialised legislation such as the food and drugs laws. The Board of Trade stated that it hoped and expected that where prosecutions were undertaken in such cases of overlapping offences, it would be taken under the appropriate specified legislation rather than the Trade Descriptions Act. The City Council has a mandatory duty to enforce the Act, and the enforcement work in relation to its application to foodstuffs is undertaken by the public health inspectors. During the year, 27 matters were reported to the Department alleging contraventions of the Act in respect of the description associated with food supplied. In nearly all cases the necessary action required was taken under the appropriate food legislation. One case reported concerned a description appearing on a wrapper of a foodstuff which indicated that it had been specially prepared for a particular store, and furthermore, that individual treatment had been afforded the commodity to the exclusion of other retail outlets. The complainant alleged that the commodity concerned was available at many other stores, and therefore the statement in this context was untrue, as the food was produced by the same process as that of the same product supplied to other premises throughout London. Following an examination of the circumstances in relation to the Act, it was decided, on legal opinion, that in the absence of information as to the internal production arrangements of either the retail premises or the suppliers, it would be possible to base a defence that the article had been ordered before manufacture, and could be described in terms as having been specially prepared. The complainant was informed accordingly. A further enquiry concerned imported wine from a country abroad which comprised a blending of two or three wines from different countries. The advice of the Department was sought as to whether the blended wine could be labelled as being the produce of the country from which it was first exported. Section 36 of the Trade Descriptions Act defines 'country of origin' and provides that 'for the purposes of the Act' goods are to be taken as manufactured or produced in the country where they last underwent a treatment or process resulting in a substantial change. The view was taken by the officers concerned that the mere blending of wines could not in itself be regarded as a treatment or process which would result in the wine undergoing a substantial change within the meaning of the Act, even if such wines were subjected to any form of fining, filtering or sweetening. The solicitors who made the enquiry on behalf of their clients, accepted the advice given. 34 During the year, 56 informal notices were served on traders within the City for failure to mark imported fruit with the country of origin, and in all cases the requirements of the notices were met. Vending Machines Vending machines automatically dispensing items of food for immediate consumption, and offering a 24 hours service, were first installed around 1955, and this changed aspect of trading brought problems in the preparation and packing of the foods offered for sale, in the maintenance of correct temperatures for food storage within the machines, and in their cleaning and servicing. It has been stated that between the years 1961 and 1966 the number of vending machines dispensing food and drink in this country almost doubled in number to some 400,000. The number of machines operating inside and outside premises in Westminster is unknown, but from a preliminary survey, it is quite considerable. During the year, inspections have been made of some 500 machines, dispensing wrapped and unwrapped food, drinks, milk etc. It was found that in many of the machines inspected, the standard of hygiene maintained was unsatisfactory, and informal action was taken to bring about immediate remedial measures. In some instances it was found that the cleansing of the machines was the responsibility of a part-time employee. The trade has been slow to adopt the Codes of Practice issued by the Ministry of Agriculture, Fisheries and Food, particularly the recommendation that records of servicing and cleaning should be kept with the machine. These provisions are aimed at stimulating regular cleaning by enabling closer supervision. On new vending machines which are now being produced an 'inspection eye' is being provided which will enable the internal condition of the machine to be viewed without the need to open it. 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. 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. Thirty one (31) such licences were issued during the year; 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 Under an arrangement entered into in 1965 the Corporation of the City of London acts on an agency basis on behalf of the Westminster City Council 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. Veterinary officers of the Corporation of London undertake routine inspection of animals in transit and inspections for licensing purposes under the Riding Establishments Act, together with inspections specially 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. Pharmacy and Poisons Acts 1933 and 1941 At the end of the year the names of 119 (144) 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 162(195). Rag Flock and Other Filling Materials Act, 1951 Under the provisions of this Act various types of premises concerned with the upholstery trade 35 or with the provision of materials for the trade must be registered or licensed with the local authority. At the end of the year 14 premises were on the register and one was licensed for storage purposes. Verminous Persons The cleansing of persons baths at Lissonia and Wedlake Street dealt with 975 (826) verminous persons: adults 718 (629)—men 564 (507), women 154 (122); children 257 (197)—boys 64 (61), girls 193 (136). Scabies The two establishments mentioned in the foregoing paragraph treated 574 (422) scabies patients : adults 320 (243)—men 137 (129), women 183 (114); children 254 (179)—boys 63 (40), girls 191 (139). 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 466 (525) baths were given, 415 (448) to women and 51 (77) 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. (See also Home Bathing Service, pages 46 and 47) 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 11,261 (10,875) bags each containing about 10 lbs. of soiled linen were collected, laundered and returned to the owners. It is of interest to note that in 1967 the number of bags of laundry dealt with at this centre totalled 8,027. The considerable increase in the number of bags now being dealt with arises from the installation of additional washing and ironing equipment at the Lissonia Centre in 1967. This essential service is much appreciated by the recipients; and a special word of praise is due to the staff at the centre for their noteworthy increase in productivity in work which is not only hard but also unpleasant. 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 181 (138) new cases arose, making a total of 256 (182) persons who received deliveries of supplies in their homes, whilst 11 (15) 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 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 36 these purposes a qualified physiotherapist has been employed on a sessional basis, and during the year she made the following visits: Enquiries and inspections for reports on new applications for licences 33 (48) Special inspections and enquiries 106 (123) Routine inspections 51 (63) 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 treatment are those who can produce evidence that by examination or experience they are suited to give such treatments. At the end of the year 283 (317) 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 32 (49) 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 4 (10); 6 (12) applications were refused by the Justices. 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 28, page 79. It will be noted that included in the Table are 9 cases which at the end of the year were awaiting proceedings at the Central Criminal Court, and, in consequence, no cause of death is 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 1969 a total of 108 (126) burials or cremations were arranged by the Health Department as follows:— Burials at City of Westminster Cemetery, Hanwell 10 Paddington Cemetery, Mill Hill, N.W.7 9 St. Marylebone Cemetery, East Finchley, N.2 9 Carpenders Park Cemetery, Carpenders Park, Herts 1 All Souls Cemetery, Kensal Green, W.10. 1 Cremations at the City Council's Crematorium, East Finchley, N.2. 78 In two cases burials were carried out at cemeteries other than those of the City Council so that the body could be interred in an existing family grave. 37 In addition to the cases actually dealt with by the City Council, a further thirteen were referred for action, but enquiries resulted in relatives being traced and private funerals arranged. Requests for burial or cremation were received from the following sources:— H.M. Coroner 56 Relatives or friends of the deceased 35 Hospitals in the City 17 Age Groups 0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 84— — — — 5— 93 15 3 14 6 14 16 47 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 1,983 (1,832) certficates authorising cremation were issued, and since December, 1937 when the crematorium was opened, 37,682 cremations have taken place. 38 PERSONAL HEALTH SERVICES Since 1965 when the new City of Westminster was formed, there have been many changes affecting the demands made on the personal health services. There has been an estimated decline in the total residential population from 266,770 in 1965 to 240,360 in 1969 while the number of births has fallen from 3,952 in 1965 to 2,899 in 1969. The illegitimacy rate remains high (17.63%) compared with the rest of London (11 %), details of which are given on page 12. The entrance of new immigrants from the Commonwealth has slowed down and there is evidence that those already in the City have settled well and are becoming accepted by their neighbours. More immigrants are coming from Europe, chiefly because of the availability of work, especially in hospitals, hotels, restaurants and private domestic service. In the field of housing, both the Greater London Council and Westminster City Council have made strides in slum clearance and have rehoused many families in new flats or reconditioned older properties. Rehousing, however, nearly always results in higher rents; added to this, the increasing cost of gas, electricity and transport leads to financial difficulty for many families. Because of the shortage of sites within the City, many families with children are housed in tower blocks of flats. This gives rise to many social problems. Many mothers of young children have to, or wish to, go out to work - perhaps to meet the high cost of rents in new property or because they live in old, depressing and unsuitable housing or perhaps because mothers are the sole supporters of the family whatever the cause, the problem of day care of their children is acute. Mental health presents a special problem in the City. The number of temporary residents without roots, often lonely and living in bed-sitting rooms and the attraction of the West End for unstable misfits, produce an undue concentration of the vulnerable or mentally ill within the City's bounds. The medical services within the City are excellent. There are five teaching hospitals, two of which are now accepting full district responsibility. So far as maternity is concerned, it is now possible for every woman who wishes to do so to have a hospital confinement and in 1969, 97 per cent, of births took place in a hospital. Two hospitals have accepted responsibility for geriatric cases and only from the southern part of the City is it necessary for elderly patients to be sent to Regional Hospital Board hospitals outside the City boundaries. A small in-patient unit for psychiatric cases has been opened, but most of the mentally ill have to travel to Regional Hospital Board hospitals in Surrey. There are nearly 350 general practitioners providing services under the National Health Service Act in the area, besides many engaged solely in private practice. Co-operation between general practitioners and the City of Westminster Health Department is excellent. Westminster has an undue proportion of elderly residents, 13.8 per cent, compared with 12 per cent, for the rest of England and Wales. It is almost impossible to identify all those in social need but increasing numbers are coming to the attention of the statutory or voluntary workers. In this field increasing demands are made on the home help service; referrals rose from 1,188 in 1966 to 1,266 in 1969 (see report on page 48 and Table 39, page 86). Tribute must be paid to the work of the various voluntary organisations providing services in the City. The City Council has always encouraged voluntary effort and makes substantial financial contributions to enable these bodies to undertake their work. There is close co-operation between the Council's staff and the voluntary bodies and their work in all spheres is appreciated ; particularly is this true of their efforts for the elderly. Maternal and Child Health Antenatal care Antenatal clinics are held at seven of the Council's maternal and child welfare centres. Most of the patients book for hospital delivery and for these patients antenatal care may be provided by the hospital and the local authority clinic or by the hospital and the general practitioner. Cases booked for home confinement receive their antenatal care from the general practitioner and domiciliary midwife. A co-operation card is used in the Council's clinics for record purposes. Courses in mothercraft are undertaken by the health visitors and antenatal and postnatal exercises are taught and supervised by a physiotherapist with special training in this field. In order to cater for the needs of working mothers one antenatal clinic each week is held in the evenings. 39 Family Planning The City Council has fully implemented the National Health Service (Family Planning) Act, 1967. Free advice is provided for all residents of the City, either directly in its own clinics or through a voluntary agency such as the Family Planning Association or the Catholic Marriage Advisory Service. Where family planning is needed on medical grounds, supplies of appliances or drugs are provided free of charge. A new service has been set up at one of the Council's welfare centres in collaboration with the Board of Governors of St. Mary's Hospital and the Eugenics Society. All patients in the maternity unit are visited by a health visitor trained in family planning methods. She invites those mothers who are interested to attend the special session at which the postnatal examination is combined with family planning advice. After this visit most patients are referred to their family doctor or to a clinic in their own area. This arrangement has proved very successful; over 70 per cent, of the mothers kept their appointments. Young people, especially the unmarried, frequently require counselling and support as well as advice on family planning. To meet their needs two Youth Advisory Clinics are held each week. A doctor and a social worker, both experienced in the needs and problems of the young, attend. More detailed reference to this service is made later in this report (see page 50). Child Health The initial examination of the neonate is undertaken by the midwife, who notifies obvious congenital malformations and screens the baby for congenital dislocation of the hips and for phenylketonuria. Arrangements have been introduced for performing the Guthrie test on all babies on their sixth day. Babies discharged early from hospital and those requiring further examinations are tested by the domiciliary midwives. All neonates in hospital are examined by a doctor before discharge, and the paediatrician is called in for advice when necessary. Premature babies and others needing specialised nursing and paediatric care are nursed in special care units of the hospital and are usually followed up by the paediatrician in his outpatient clinic. Reports on all these babies are sent to the Medical Officer of Health so that after-care arrangements can be co-ordinated. From the fourteenth day onwards, the health visitor has a key role to play in the care of the infant and young child. Reference is made later to the work of the health visitor but the supervision of all babies and children in her area remains one of her main responsibilities. On her first visit to a new baby, she will assess the mother's needs and, where necessary, give continued advice and support. She will impress upon the mother the need for regular medical examinations and for immunisation. She will later have opportunities for observing the child in his home and for assessing his progress. She is often the first person to suspect that a child is not developing normally and she is of inestimable value in identifying abnormalities. INFANT DEATHS As already indicated, the services available in Westminster for the care of mothers and young children are excellent. It is therefore disappointing to find that in 1969 the number of deaths of infants under the age of one year has risen to 65, and that the infant mortality rate is 22.42 compared with 18 for the rest of England and Wales. More dramatic, perhaps, is the illegitimate infant mortality rate of 39.14. Although the numbers are small and not of much statistical significance, it is necessary to examine them in detail to try to find out how many were avoidable and what steps might be taken in future to prevent this wastage. Forty-eight of the deaths occurred during the first week of life; 28 were due to prematurity and allied causes, and a further 12 were due to severe congenital abnormalities. Five deaths were attributable to birth injuries, two to inhalation pneumonia and one to asphyxia. All but one of these babies were born in hospital and received expert paediatric care. Among the 48 were 15 illegitimate infants; of these, 2 of the mothers received no antenatal care. Seventeen infants died between the ages of one week and one year; six from congenital malformations, three from gastro-enteritis, two from broncho-pneumonia, and two as a result of inhalation pneumonia. These two latter cases were unexpected "cot deaths" and in both there was inhalation of vomit. Other causes of death in this age group were asphyxia (1), intestinal obstruction (1), meningitis (1) and peritonitis (1). In all these cases there had been good care in the home, and appropriate medical care had been provided. In none of them was there an apparent avoidable factor. 40 In two of the above deaths, however, an avoidable factor must be presumed. One new-born infant which was found at Victoria Station had been asphyxiated by its umbilical cord, whilst a five-month old infant perished from asphyxia in a fire. From the causes of death it is apparent that the greatest remaining problems are the incidence of prematurity, especially in unmarried mothers, and severe congential abnormalities. (See Analysis of causes of infant deaths, Table 2, page 67.) MATERNAL MORTALITY It is regrettable to have to record that there were two maternal deaths in Westminster during 1969; there were no such deaths in the City in 1968. Comparative statistical rates are set out in the General section of this report, page 67. Both these maternal deaths were associated with abortion. In one case, a married woman of 37 years, therapeutic termination of pregnancy (associated with sterilisation) was carried out in a teaching hospital. Unfortunately, an infection developed leading to death from suppurative bronchopneumonia. The second death related to a young single woman of 20 years who had undergone a criminal abortion which lead to the development of septicaemia. This patient was admitted to hospital but unfortunately died notwithstanding intensive treatment. THE ROLE OF THE DEPARTMENTAL MEDICAL OFFICER Nine full-time medical officers undertake child health work in clinics, day nurseries and schools and they are assisted by twelve part-time medical officers. As far as possible, the medical officers work in defined areas, thereby becoming acquainted with the local mothers, the health visitors, the voluntary workers and the general practitioners. In the child health clinics, the medical officers' main duties are to undertake developmental screening of all children at regular intervals and to immunise the children. Subject to parental consent and provided there is no contra-indication in the child's health, the course of immunisation recommended by the Department of Health and Social Security is completed. The health visitor is responsible for the social and educational work of the clinic and for advice on infant feeding and general management. But many problems of management, behaviour and other maternal anxieties are brought to the doctor's attention for more detailed investigation and advice. Early psychiatric problems may be detected and sympathetic listening and support can be of immense benefit. Both developmental examinations and counselling interviews are time-consuming and require experience, skill and enormous patience. Medical officers, as far as possible, see their patients by appointment and by limiting the numbers seen at each session, ensure that adequate time is available for each. The purpose of developmental screening is to identify deviations from the normal at an early stage. Identification must be followed by action. Children with suspected defects of hearing or vision are referred to the appropriate specialist department of hospitals for diagnosis and treatment. Those with orthopaedic defects, herniae, cardiac murmurs and enlarged tonsils are referred to the family doctor for any action he considers appropriate. However, the commonest condition either suspected or found is developmental retardation. Delay in locomotor development with or without clumsiness may make one suspect cerebral damage. Mental retardation or delay in speech may be due to emotional factors or to an unstimulating deprived environment (which is not uncommon in cases where the child is cared for by a succession of people other than his mother) or it may be an indication of mental subnormality. The Council's medical staff, both full-time and part-time, bring very great clinical skill and judgment to this aspect of their work. It is a field in which they excel and one in which many hospitalorientated doctors are not yet fully conversant. 41 Assessment Special sessions are held for handicapped children in five of the child health clinics. A senior member of the medical staff with special experience in handicapped children examines each child referred and decides what further action to take. Such action could be referral to a hospital consultant or to a speech therapist, formal recommendation for education in a special school or return visits to the clinic to establish diagnosis. Often, however, where it is thought that observation, stimulation and training are required, arrangements will be made for the child's admission to one of the special day nursery units. The service thus provided for children with environmental handicaps has proved to be of the greatest benefit and some children who were functioning as severely subnormal at three years of age have, after a time in a special unit, been able to take their place in ordinary school at the age of five. For the children who are severely subnormal, mongols, microcephalics and the cerebral palsied, these special clinics also provide an excellent opportunity for assessment of progress and for parent counselling. District assessment clinics are held at two of the teaching hospitals in the City. A senior medical officer from the Council attends and works with the paediatrician. If special placement is recommended for the child, the senior medical officer arranges this. Total attendances at the special sessions for handicapped children in the Council's welfare centres were 160, of whom 37 were new referrals. Unfortunately, figures for the district assessment clinics are not available since they relate only in part to children from Westminster. HANDICAPPED CHILDREN The Handicap Register Since it has been possible to implement a system of developmental screening tests on all infants, the "At risk" or "Observation" Register has been discontinued. This allows opportunity for greater concentration on the handicapped. A single register of all handicapped children is maintained at City Hall by the senior medical officer for child health and a senior administrative assistant. Children are placed on the Register at birth if they are notified as having some congenital abnormality. Others who have had a stormy neonatal existence will be placed on the register as a result of a hospital discharge report. Most of the children, however, are notified to the Department later in life as a result of hospital admission, diagnosis by a clinic medical officer or even later notification can come from a school medical officer. Most of this last category arise when they move into the area as school children. The purpose of the register is to ensure that handicapped children are followed up at the appropriate times and that there is co-ordination and implementation of recommended action. The Handicap Register is used flexibly; many children are on it for a time only. Some conditions, such as under-stimulation with consequent slow speech development, are rectified by time and other conditions may be cured by surgery. Thus, to be included in the Handicap Register is by no means a permanent label, nor does it always indicate that special education will be necessary. THE DAY CARE OF CHILDREN As stated earlier, the City Council has a special responsibility for the day care of pre-school children. A high proportion of working mothers, children being brought up under adverse environmental conditions, a large immigrant population and a high incidence of mental illness among parents - all combine to produce an ever-increasing demand for substitute mother care during the day. The City Council has eight day nurseries with 450 places. These are open from 8 a.m. to 6 p.m. Although these hours are long from the point of view of the staff and the children, they do not entirely meet the needs of mothers who have to work. To an increasing extent, day nursery admission is recommended in the interests of the child rather than of the parent. Priority is given to children who are suffering as a result of a deprived home background rather than on purely financial grounds. Day Nurseries are also being used more and more to avoid the reception of children into care in the absence of their mothers; many lone fathers are thereby helped to keep their children at home. But the main contribution of the day nurseries is in the care of "disadvantaged children". Some of them come from deprived homes where a parent is missing, some from homes where the mother is mentally ill or mentally subnormal and some from families with multiple problems where the child may be in danger of neglect or ill treatment. In addition to these social problems, day nursery places are increasingly being sought for retarded children who need a period of observation and stimulation in an ordered environment. Twenty-four places in special units are available for these children, many of whom are not severely handicapped but would benefit from day nursery placement. 42 Six of the Council's day nurseries are approved by the Department of Health and Social Security for the training of 36 students. Eleven students qualified this year but with the number of openings for qualified nursery nurses, it is difficult to keep them after training and so it sometimes happens that because of staff shortage, a nursery may not be able to take its full quota of children. Child Minding Amendments contained in Section 60 of the Health Services and Public Health Act, 1968 to the Nurseries and Child Minders Regulation Act, 1948 enabled the City Council to make improvements in relation to child minding by imposing more stringent requirements before registration under the amended Act is approved. These requirements which are imposed by Order of the Council cover such aspects as the number and age of the children who may be minded, staffing numbers and health of the staff, general safety of the children, precautions regarding sickness, records, etc., all of which are contained in a Schedule set out below, to which the prospective child minder must agree as a prerequisite to registration and subsequently must observe at all times. SCHEDULE (i) the number of children to be received into the home shall not at any time exceed under the age of five years of which may be under the age of years; (ii) in addition to the registered minder full-time assistant shall be employed OR arrangements shall be made for a second person nearby to be on call in case of emergency and to be present in the absence of the registered minder; (iii) the registered minder and any staff employed by her shall produce a certificate of chest x-ray examination prior to employment and thereafter at three yearly intervals or such lesser period as may be required by the Medical Officer of Health; (iv) adequate fireguards to be provided and fixed to all gas, electric, solid fuel or oil heaters with which the child/children may have contact; the following equipment shall be provided at the said premises: (specified as necessary) (v) the home and all equipment shall be adequently maintained, and kept in a safe condition; (vi) if any person residing temporarily or permanently in the premises of which the home forms part is suffering from any infectious or contagious disease, no child is to be admitted to the home other than the registered person's own children or relations, unless the Medical Officer of Health certifies that there is no likely danger of infection to the child ; (vii) no child who appears to be suffering from any infectious or contagious disease is to be admitted to the home; (viii) in the event of the registered person being informed, or should she herself observe, that any child attending the home is suffering from any infectious or contagious disease, this fact must be reported immediately by the registered person to the Medical Officer of Health; (ix) adequate arrangements shall be made for feeding the children with a diet adequate in quantity and content; (x) the children received in the home shall be under medical supervision; (xi) records shall be kept in relation to the children received in the home specifying the following (a) details of each child attending the minder's home, including name, date of birth, record of infectious diseases and immunisations, mother's name and address, place of work and telephone number; (b) name, address and telephone number of each child's own general practitioner; (c) attendance and absence register; (d) record of medical inspections, if any; (e) record of any accidents or serious illness occurring whilst in the home; (f) diet. An assistant nursing officer was appointed early in 1969 to be responsible for the registration and supervision of child minders and private day nurseries. She is helped by a male administrative assistant who deals with infringements and enforcement. The assistant nursing officer can therefore retain her role as helper and adviser to the people concerned. 43 Women already minding children together with those wishing to mind them were invited to apply for registration on an official application form supplied by the Health Department. This form, to be signed by the applicant, contains a statement that neither she nor any person over 16 years of age living at the premises or any person employed or proposed to be employed in the house is disqualified from taking a foster child under the Children's Act, or has had a child removed from their care. In addition, each applicant submits a statement as to the health of these persons. All applicants are visited by the assistant nursing officer and the new standards laid down by the Department of Health and Social Security are applied. A general recommendation that no woman without assistance should mind more than three children under the age of five years is a sensible one, and the requirement to have another adult on call is also valuable. Difficulties arise in the provision of outdoor play space and in the guarding of fires. In no instance will a prospective child minder be registered until all fires with which a child may be in contact have been sufficiently and safely guarded. If a minder is unable to afford or to obtain a suitable fireguard, the City Council will provide one and recover the cost from the minder wherever possible. In order to supplement the City Council's day nursery places (450) a scheme is in operation whereby a retaining fee of £1 per week is payable to suitable child minders who mind not more than 3 children including their own under 5 years of age. These minders must agree to accept children nominated by the Medical Officer of Health who are eligible for inclusion in the priority waiting list for the day nurseries. It must be emphasised that a good child minder can provide an excellent alternative to day nursery care by taking children from the ages of 0-5 and by suiting her hours to the hours of the mother's work. A short pilot course for child minders was run in July, 1969, in conjunction with the Inner London Pre-School Playgroups Association at one of their affiliated groups. This course proved useful in giving minders ideas on the use of play materials; it is proposed to hold similar courses in the future, including reference to children's diet as well as play facilities. Pre-school playgroups As in other parts of the country, interest is growing in the provision of playgroup facilities for children aged 2-5 years, and there have been several enquiries from persons with plans to start new groups in the near future. The City Council is pleased to assist in this matter and provides financial support where necessary as well as advice in setting up and subsequently running the playgroup. The Council provides financial support to playgroups run by the following bodies:— Organisation No. of groups City of Westminster Health Society 5 Save the Children Fund 2* Westminster Council of Social Service 2 Inner London Pre-school Playgroups Association 2 (*Plus 2 playgroups in Welfare Department accommodation) In addition, three playgroups are run directly by the City Council's Health Department in child welfare centres. Registration of persons and premises under the Nurseries and Child Minders Regulation Act 1948 as amended by section 60 of the Health Services and Public Health Act, 1968 Following the former Health Committee's decision to increase the establishment to deal with the extra work involved to comply with the amended Act, an assistant nursing officer and an administrative assistant were appointed and commenced their duties in April, 1969. The following details therefore cover the period April to December, 1969, and show the position at the end of the year:— Child Minders Under the original Act, 20 women were registered to mind 90 children. In addition, 32 women each minding one or two children who were not required to be registered under the Act were voluntarily registered with the City Council. No. of applications received 161 No. of applications withdrawn 21 44 No. of applications under consideration 53 No. of applications registered (included in above 161) 87 No. of children accommodated in premises now registered 194 No. of children who will be accommodated when all registrations have been effected for 1969 applications 314 (approx.) No. of child minders who are being paid a retaining fee 18 Private Day Nurseries No. of applications received 9 No. of applications withdrawn 0 No. of applications under consideration 1 No. of applications registered (included in above 9) 8 No. of children accommodated in premises now registered 182 No. of children who will be accommodated in premises when all registrations have been effected for 1969 applications 252 Under the original Act, 8 private day nurseries were registered to provide 210 places. Playgroups, etc. No. of applications received 27 No. of applications withdrawn 3 No. of applications under consideration 7 No. of applications registered (included in above 27) 17 No. of children accommodated in premises now registered 428 No. of children who will be accommodated in premises when all registrations have been effected for 1969 application 600 Under the original Act, 24 playgroups were registered providing 620 places. (Note : Included under the above heading are the City of Westminster Health Society Toddlers'Clubs). Services provided by the City Council's Health Department City Council Day Nurseries No. of premises 8 No. of children accommodated 450 City Council Playgroups No. of playgroups 3 No. of children accommodated 52 City Council Occasional Creches No. being held 7 No. of children being catered for 100 Services provided at City Council's Welfare Department homeless families accommodation Playgroups run at Norfolk Square and Leinster Square on behalf of the Welfare Department by the Save the Children Fund for the resident children. No. of playgroups 2 No. of children accommodated 38 45 URBAN PROGRAMME I indicated in my report for 1968 that no health services projects were approved under the provisions of Phase 1 of the Government's Urban Programme, but that in February 1969, upon re-submission of the original projects, approval in principle was given under Phase II of the Programme for the setting up of three further pre-school playgroups. Two of these projected playgroups, for which planning has progressed duuring 1969 are at— (i) Clipstone Street, W.1. - purpose built as part of a residential development. (ii) *Stowe Boys Club, Harrow Road, W.2. - renting of suitable accommodation. (*This group commenced operation in April 1970) It is hoped to site the third playgroup in South Westminster and the availability of suitable premises is under investigation. Approved projects attract a Home Office grant at the rate of 75% of approved expenditure under the Local Government Grants (Social Need) Act 1969. Initial capital expenditure by the local health authority is thus offset in this way and running costs will be similarly reduced for the next three years in the first instance. HEALTH VISITOR SERVICE During the year 1969 the health visitors expanded their functions to provide a service defined by the World Health Organisation as "A special field of nursing which combines the skills of nursing, public health, and some phases of social assistance. It functions as part of the total health programme for the promotion of health, the improvement of conditions in the social and physical environment, rehabilitation and prevention of illness and disability". To fulfil this role the health visitors work from the 10 welfare centres in the City where the various preventive clinics are organised—child welfare, immunisation, antenatal and family planning, cytology; also the special investigation clinics for schoolchildren and the special clinics for handicapped children, and chiropody. Thus they are involved in the total health programme. The health visitors accept a great deal of responsibility for the smooth running of the clinics and a valuable function is their persuasion of the public to keep appointments there. Besides the training which enables them to identify at an early stage deviations from normal in the young, they also are skilled in developing good relations with the older members of the public and encouraging them to attend for such things as cytology screening. Home visiting remains one of their most vital functions, and it is in the home that so much is done in a friendly and informal way to reassure and to offer help and support to those in need. From the experience thus gained the need for intensive help is recognised, and the health visitors are always ready to seek the co-operation of social workers and other colleagues within and outside the Council. This year saw the introduction of home visiting to elderly people. There is much concern for the older population and there is every reason to hope that successful and useful results can come from the health visitors' visits and from their co-operation with the agencies involved with the elderly. During the year liaison schemes have started with two of the teaching hospitals in the City; two members of the nursing staff attend weekly sessions with the consultant geriatricians and their teams to discuss admissions and discharges of their patients. This gives the opportunity to ensure that all the necessary services are pre-arranged, making transition from hospital to home as smooth as possible. This will, in time, ensure a much more comprehensive care for the aged. A more detailed report on the Department's nursing services for old people is contained in the next section. Education sessions are held at the welfare centres; this year saw the introduction of classes in English language for mothers with little or no knowledge of the language and who had often been dependent on their children as interpreters. Nine health visitors carry out weekly teaching sessions in schools and three teach regularly in Technical Colleges. Other health educational activities have continued as in previous years and displays and exhibitions are used frequently. 46 All nursing staff take part in the school health service; regular medical examinations and surveys proceed as in previous years. There is excellent co-operation between nursing staff, head teachers and school medical officers. There has been no increase during the year in group practice attachments, of which there are four, but some enquiries are being explored. Health visitor students come forward for sponsorship in adequate numbers but it is more difficult to recruit trained staff; the national shortage is inevitably reflected in Westminster. As usual, every effort has been made to keep the staff up-to-date by sending them on appropriate refresher courses; seven attended such courses during the year. A more detailed report on training undertaken in the Department is set out in the General section of this Report, page 16. HEALTH DEPARTMENT SERVICES FOR OLD PEOPLE In April 1966 the Health and Establishment Committees agreed in principle that the establishment of health visitors should be increased by four posts per annum until the level recommended by the former Ministry of Health was reached (62 posts). This decision, which was subject to review annually in the light of circumstances then obtaining, was based on the 1966 Westminster population of 270,140; since then the decline in population to 240,360 would make the target number 55.2 posts. In 1969 the authorised establishment was 54 posts and the final increase of two posts to the recommended level would take place in September 1971. During the past few years there has been a steady decline in the number of births in Westminster with the result that the health visitors' duties relating to mothers and young children have correspondingly decreased. Conversely, the number of persons in Westminster above pensionable age is higher than the average and statistics produced by the Greater London Council Research and Intelligence Unit show that Westminster has the sixth highest number of persons above pensionable age out of the 32 London Boroughs. In this connection the following statistics based on the 1966 census are of interest:— Distribution of population by age and sex in London Boroughs—1966 Census. Distribution per 1,000 population Children Older Persons Persons Males Females 0-4 5-14 65+ 60+ Westminster, City of 55 77 48 120 Greater London 77 124 44 110 Rest of England and Wales 87 149 47 107 England and Wales 85 145 47 108 The Medical Officer of Health had discussions during 1969 with the City of Westminster Old People's Welfare Association to determine the best method of ensuring the ascertainment of old people in need and their referral to the appropriate agency. As a result it was agreed that health visitors should accept responsibility for discovering and keeping under observation all old people on their districts and for ensuring that those in need are under the close supervision of a named case worker who is in turn responsible for bringing in such supportive services as may be necessary. It was agreed that the case worker be supplied by the Old People's Welfare Association where support required is mainly of a social nature, that the Health Department would supply a social worker where more intensive care is needed including home nursing, and that the Welfare Department social workers would supervise those registered as handicapped or awaiting admission to Part III accommodation. This revised system has worked well, but it has resulted in the discovery of an increasing number of old people in need of the services of home nurses and who require home bathing. Having regard to this changing situation the City Council agreed early in 1970 that in lieu of the four health visitor posts which were due to be filled with effect from September 1970 four State Enrolled Nurses should be recruited in order to undertake the additional nursing duties involved. Furthermore, it was agreed that the need for home bathing should be met by increasing the number of home bathing attendants from the present establishment of 5J posts to 6 posts. 47 PILOT SURVEY OF ELDERLY PERSONS RESIDENT IN THE CITY OF WESTMINSTER In February and March 1968 a survey was undertaken by Dr. G. Kazantzis, Senior Lecturer in Social and Preventive Medicine at the Middlesex Hospital, and members of the Health Department staff, of a number of elderly persons resident in Westminster. The original purpose of the survey was to estimate the incidence and significance of low body temperatures on old people living at home-a subject of increasing public interest in recent years. Subsequently, the survey was expanded to include information on the utilisation of services being provided for this section of the community by the City Council and by voluntary organisations in Westminster, and the extent to which the old persons' needs were being met. A group of persons aged 65 and over were selected for the study, but for a variety of reasons this random sample dwindled considerably. It was, therefore, necessary to bolster this number with a selected sample of old people known to the Health Department. Dr. Kazantzis later submitted to the Medical Officer of Health a highly comprehensive report comprising some 22 pages of narrative, 15 pages of statistics, and 13 pages of case notes on individual patients. It cannot be pretended that the findings of the survey are entirely valid for the elderly population as a whole, but it served as a useful pilot investigation from which some interesting impressions have been gained. For instance, it was found that there was a relationship between low oral temperature and low bedroom temperature, with significantly more low temperature readings obtained when the bedroom temperature was below 60°F than when it was above this figure. Further, there was an apparent need for an increase in the chiropody service. In regard to the meals supplied by the "Meals on Wheels" service, it was felt that any future investigation should include a detailed study of the nutritional value of the meals in relation to the needs of those supplied. It is possible that a further survey of this kind will be undertaken in due course by the Middlesex Hospital involving some 88,000 persons in their catchment area, all but 8,000 of whom would be residents of Westminster. This latter survey is intended to serve as a guide to the Middlesex Hospital of the services that should be provided in their new role as a district hospital. Arising out of the survey, the Social Services Committee and the Establishment Committee subsequently approved an increase in the establishment of home helps by 10 full-time employees (400 hours per week) and the addition of 18 chiropody sessions a week, both to be operative from April 1970. Opportunity was also taken in the interests of uniformity to transfer to the Health Department the chiropody service then being provided by the Welfare Department at the various residential homes for old people situated in Westminster and elsewhere. VACCINATION AND IMMUNISATION Vaccination and immunisation are available to all children under school-leaving age, either at child welfare centres, in schools, or at the surgeries of their family doctors. In May 1969, the new schedule of immunisation recommended by the Department of Health and Social Security was introduced ; this new schedule reduces the number of injections to be given for completion of the primary course of protection against diphtheria, tetanus and whooping cough. Oral poliomyelitis vaccine is given at the same time. In July an occurrence of poliomyelitis in Spain caused an increased demand for protection. The vaccine was made available to adults as well as children and attendances at welfare centres for this purpose showed a marked increase for several months. Sixteen thousand doses of calph lymph for smallpox vaccination were obtained from the Central Public Health Laboratory and issued to hospitals, general practitioners and welfare centres. Smallpox vaccination is also available in the medical suite at City Hall for adults residing or working in Westminster, and 95 adults were vaccinated in 1969 in addition to 27 vaccinated at welfare centres. Vaccination against measles for children from the age of one year onwards is provided in the Council's welfare centres and by family doctors; 987 doses were given in 1969. LISSON GREEN DEVELOPMENT—INTERIM ARRANGEMENTS FOR GENERAL PRACTITIONER SERVICES My earlier reports have referred to the City Council's approval of the inclusion of a Health Centre within the housing scheme to be developed at Lisson Green, N.W.1. 48 It will riot be possible to commence building the Health Centre until towards the final phase of the whole redevelopment scheme (1972/73) and plans are therefore being put in hand to make earlier temporary surgery accommodation available to those general practitioners who have expressed their firm intention to practise from the Health Centre when built. The temporary accommodation will comprise newly built flats suitably adapted, and this interim arrangement will afford the new residents within the development a conveniently available general practitioner service from the outset, pending the permanent service that will be provided from the Health Centre. QUEENS PARK MATERNAL AND CHILD WELFARE CENTRE LANCEFIELD STREET, W.10. Temporary replacement by prefabricated building On 23rd September 1968 the former Health Committee approved in principle the replacement of the Maternal and Child Welfare Centre at 66 Lancefield Street, W.10 which is included in an 'A' area of the North Westminster project, and forms part of Herries Street North area which is scheduled for redevelopment in 1971. The proposed site for the new health centre (in the Harrow Road Centre area) will not be available for some time; the present building is required for demolition in 1970, and therefore to preserve continuity of service the Social Services Committee in December 1969 approved the provision of a temporary maternal and child welfare centre on a site at Lancefield Street, W10., which is adjacent to and to the north of St. Judes Hostel. It is anticipated that the new clinic will be in operation by the Autumn of 1970. MOBILE HEALTH CLINIC The ten maternal and child welfare centres in Westminster provide adequate coverage for most of the City. There are, however, two areas which are not adequately served—a small area immediately behind the Albert Hall and the Covent Garden/Drury Lane area. So far as the Albert Hall area and parts south of Kensington Road and Knightsbridge are concerned, residents from this portion of Westminster who wish to make use of the local authority health services are required to travel to the centre at No. 1 Ebury Bridge Road, S.W.1., which is nearly two miles distant and is a difficult journey involving two buses. Alternatively, some mothers from the area make use of services provided by the Royal Borough of Kensington and Chelsea, but the nearest clinic near Kensington High Street is also over one mile away. In regard to the Covent Garden/Drury Lane area, persons wishing to use the City Council's health services are required to go to the maternal and child welfare centre in Marshall Street or to the Middlesex Hospital where a weekly session is held; in both cases busy traffic routes have to be traversed. Some mothers cross the boundary and make use of the services in the London Borough of Camden. In order therefore, to improve the amenities of the City Council's maternal and child welfare services, the Social Services Committee in December 1969 approved the purchase of a mobile health clinic. Apart from covering the aforementioned inadequacies the use of such a clinic will permit the closure of two part time clinics in not completely satisfactory premises in the north-western part of the City and will also enable chiropody, cervical cytology and other screening services to expand. Mobile clinics have been brought into use with considerable success in three London Boroughs, viz., Southwark, Ealing and Hillingdon. The City Council has approved expenditure for such a project in the financial year commencing 1st April 1970, and I hope in my next report to be able to describe the early days of operation of this venture in Westminster. HOME HELP SERVICE The City Council, under Section 29 of the National Health Service Act 1946, provides a comprehensive home help service for those who require assistance by reason of infirmity, ill health or age. An hourly charge is made which is abatable in necessitous cases; the service is free to those receiving supplementary benefit. A home help's duties are many and varied and although they include some cleaning work, much of their time, especially when serving the aged and infirm, is spent on more personal attention for their clients. The tasks they undertake include collecting pensions, shopping and preparing simple meals, laundry work and so on. For some clients who because of a crippling condition are confined 49 to their rooms, the home help is the main contact with the outside world. It is known (and here gratefully acknowledged) that the home helps' kindness and attention to their clients extends in many cases far beyond the normal expected duties. The home help is often the means of preventing children being taken into care while a mother is ill, in hospital or unable to cope. She will ensure that during the daytime the children are fed and cared for, and if necessary, will take them to day nursery or school, collecting them later in the day. Some home helps are specially trained to work with and to advise inadequate parents on general aspects of child care and household management. By being in touch with so many of the City's residents in need of aid, the home help is able to report the need for other necessary services—meals-on-wheels, district nursing, incontinence service, etc. To ensure that maximum use is made of the existing staff, the position is kept under continual review. It has become clear that although no one in urgent need of help is ever refused, additional home helps are required to provide and maintain an adequate service. It is hoped that the establishment will be increased by 10 posts in April 1970 which will help to satisfy the ever-increasing demands for service. Number of home helps 1969 1968 (a) Joining service 53 41 (b) Leaving service 54 83 (c) Employed on 31st December 219 220 full-time equivalent 200 184 Statistics relating to the home help service are set out in Table 39, page 86. NURSING HOMES There are 10 registered nursing homes in the City of Westminster. All take medical patients; six also take surgical patients. Three take maternity patients and one is registered under Part 3 of the Mental Health Act 1959 to take patients suffering from mental illness. Under Section 1 of the Abortion Act 1967, six of the 10 registered nursing homes applied to the Department of Health and Social Security and obtained approval to take patients for termination of pregnancy. No new nursing homes were registered during 1969. The nursing homes are regularly inspected by a senior medical officer and a public health inspector and advice is given about alterations and improvements. RECUPERATIVE HOLIDAYS Recuperative holidays, usually of two weeks' duration, are arranged for adults who have been suffering from a recent illness, and while not needing special medical or nursing care, would benefit from rest, fresh air and good food. Expectant mothers and mothers with babies or children under five years who cannot be left at home are also catered for under this scheme. Most patients are assessed for payment according to their means; those who object to assessment are asked to pay the actual cost of the holiday. Recommendations for recuperative holidays for schoolchildren are referred to the Inner London Education Authority, who bear the cost. The following recuperative holidays were arranged in 1969: 1969 1968 Expectant and nursing mothers 1 Nil Tuberculosis 1 3 Other adults 82 92 Accompanied children 7 15 Unaccompanied children under 5 years 7 6 Schoolchildren 74 57 Total 172 173 50 SOCIAL WORK (PERSONAL HEALTH) Apart from the social workers employed in the Mental Health Section, 24 are employed in personal and school health work. Social work help is now accepted much more readily by people from every stratum of society and to meet the need highly skilled case work help is often required. Members of the public are increasingly seeking help with deep-seated marital problems or difficulties in relationships. Many prefer to come to City Hall instead of being visited at home; students and housewives come during working hours and business people at lunch-time or in the evening. The staff vary their hours to suit the needs of their clients. The number of such referrals has increased significantly during the year. As an adjunct to the social work services provided by the Health Department, a most successful development took place during 1969 of the Youth Advisory Service, which grew from the family planning counselling service set up in 1968. An evening session is held weekly at Hallfield Clinic, and an afternoon session which was formerly held at the Westminster Council House clinic was transferred in September, 1969, to nearby premises in Nottingham Place. Both these sessions are attended by a medical practitioner who is specially skilled in youth counselling, and a psychiatric social worker from the Health Department's staff. Seventy-eight clinic sessions were held during the year involving some 471 personal interviews. An ever-increasing amount of follow-up work is essential because of the nature of the problems presented and the high degree of unhappiness and disturbance found in many of the young people. Clients are also seen almost every day by the department's social workers at the City Hall. An essential part of this work is to maintain contact with Colleges for Further Education, unattached youth workers, club leaders, social workers at drug addiction centres and with other agencies involved in helping adolescents. Many of the referrals come from such agencies and from health visitors also, but the number of self-referrals has increased too. Five social workers attend the special investigation clinics which are an extension of the school health service. During the year there were 156 new referrals and 516 attendances were made at 172 clinic sessions. The majority of new referrals were for nocturnal enuresis, but many attended for obesity or for minor behaviour problems. The parents of all children are interviewed by a social worker before the child is seen; through such contacts the social workers are able to help with disturbed family relationships, housing difficulties, etc. Towards the end of the year consideration was given to provision of a case work service for the families of children attending special schools. A psychiatric social worker is in charge of this development. One member of the staff is responsible for the social work connected with children who are deaf or partially hearing. Besides her regular attendance at the audiology clinic, she made 49 visits during the year. Another member of the staff is employed full-time with families who have special difficulties; the work is usually very long-term and involves frequent home visits and close liaison with many statutory and voluntary bodies. Seven other social workers also have limited case-loads of similar families, in addition to their other work. At the end of the year the total number of families being assisted was 59 and during the year 1,100 home visits had been made in addition to 150 interviews at City Hall. Two members of staff work full-time with unsupported parents. The volume of work has increased steadily as the service has become better known. The overwhelming problem is still that of accommodation for pregnant girls and mothers with a young child. There were 162 new referrals during the year, giving a total current case-load of 109. The social workers attached to the Chest Clinics, besides dealing with the problems customary to their work, have become concerned about the problem of alcoholism. They are working as a group to study this question. There were during the year 374 new referrals to the social workers. The work of the social workers attached to clinics for venereal disease is separately dealt with on page 55. Three social workers concentrate their efforts on the frail elderly. As has been mentioned elsewhere in this Report, Westminster has a high proportion of elderly residents. The social workers give a great deal of personal support to their clients and maintain close co-operation with colleagues within and outside the Health Department, and with general practitioners. During the year there were 482 new referrals; the case load at the end of the year was 1,102 and 5,627 home visits were made. 51 Two social workers deal specifically with the problems of immigrants. Many of these have reached the stage where they can no longer truly be called immigrants, but because of skin colour many of their problems remain. However, many of the tensions which existed in the past have eased, undoubtedly due to the amount of effort which has been made nationally and locally. CO-ORDINATION The Co-ordinating Committee consists of representatives from the City Council's Health, Children's, Welfare & Housing Departments; the Inner London Education Authority and the Greater London Council Housing Department. The Chairman is the Medical Officer of Health, the ViceChairman 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 at the request of any social worker or agency interested in the family. At such meetings, field workers in the various departments, and any organisations involved, have the opportunity of discussing ways in which the difficulties in the family situation may be met. During the year 33 case conferences were held at which 107 families were discussed. MENTAL HEALTH When in 1965 the City of Westminster assumed responsibility for the community mental health services, it was recognised that this was an expanding service, but it is doubtful whether anyone envisaged the demands which would be made by 1969. At first the demands were mainly related to persons showing obvious symptoms of mental disorder which caused serious disruption to their families and neighbours. The social support provided for the mentally ill in their own homes has, however, resulted in an increasing number of referrals to the mental health section from or on behalf of sick but inadequate and inoffensive patients. In the March quarter of 1965 51 patients were taken into community care, whereas in the corresponding quarter of 1969 the number was 118. These numbers impose a considerable burden on the social worker staff and the City Council increased its establishment of mental health social workers from 14 in 1965 to 17 in 1969; a further increase in establishment is planned in 1970-71. The year 1969 saw the City's mental health service taking its first step towards independence in respect of training services. The junior training school at Ebury Bridge Road was opened in September. The premises have been adapted most successfully at a comparatively modest cost. The head teacher and her staff are enthusiastic and have in a very short time created an integrated and happy group of children who are already showing the benefit of the skilled training they are receiving. The school will accommodate 30 children ; by December 1969 14 were attending and it is expected that all the places will be filled in 1970. Also in September 1969, a new day centre for older girls and women was established at St. Jude's Hostel, which also provides residential accommodation for young men and male adults. Before establishing the day training centre a successful meeting was held with the girls' parents who accepted with enthusiasm the suggestion to use local premises instead of sending the girls to centres in surrounding boroughs, as had been done.Thanks to the good sense and adaptability of the centre supervisor, none of the difficulties so often attendant on shared accommodation have arisen and a most successful day centre has been established. Provision was made for 20 girls, and by December 1969 19 were attending and the last place had been allocated. There are inevitably some trainees for whom no provision yet exists in the City; some, although the responsibility of the City, live elsewhere and attend centres nearer their homes, while others, by reason of age or sex are not yet catered for within the City's environs. 52 In December, trainees attending centres run by other authorities totalled 44 (as against 68 in the previous year) and details of their placings were as follows:— 1969 1968 Hanworth Junior, Middlesex (in residential care) 1 2 Attleborough, Diss, Norfolk (in residential care) 1 1 John Farmer Junior, Hants (in residential care) 1 — Farnham Junior, Surrey (in residential care) 1 Kensington Junior 19 32 North Kensington Senior 12 11 Balham — 3 Clapham 1 1 College Park — 10 Bennet Court, Islington 2 4 Isledon, Islington 2 — St. Judes's Hostel, Lancefield Street, W.10 The year 1969 proved very difficult for St. Jude's residential hostel. There were serious staffing shortages and the number of admissions had to be limited. In December 1969 there were 15 boys in residence as against 18 in December 1968. The demolition of many streets in the neighbourhood resulted in local hooliganism which was extremely troublesome to the staff and the residents. Terrace Day Centre A report on the activities at the Terrace Day Centre during 1969 is given on page 88. Special day nurseries and special care unit for mentally handicapped children Frances House Day Nursery, 86 Bravington Road, W.9. This nursery accommodates 30 children; there were 20 in attendance in December 1969. Edgson House, Ebury Bridge Estate This nursery is registered for 12 children; in December 1969 11 were attending daily and the remaining vacancy had been allocated for early in 1970. Linnet House Special Care Unit, Charlbert Street, N. W.8 This unit is full, with 12 severely handicapped children between the ages of 5 and 12. Children attending these two nurseries and the special care unit are transported daily in specially adapted coaches. The children are all seen regularly by the City Council's medical officers. The two nurseries and the special care unit mentioned above are all run by the City of Westminster Society of Mentally Handicapped Children, grant-aided by the Council. Liaison between the Society and the Council is excellent. Besides the nurseries mentioned above, mentally handicapped or dually handicapped children may be admitted to the special units in the City Council's day nurseries, where a total of 24 children can be accommodated (see report on page 41). Short term care - holidays Holidays lasting from 2 to 8 weeks were arranged for 48 persons, either in hospital or in suitable residential accommodation. Patients in community care The number of persons referred to the Mental Health Section in 1969 totalled 1,865. Six hundred and seventy patients were admitted to psychiatric hospitals, informally or compulsorily (583 in 1968) and 652 were received into community care (677 in 1968). Socialisation Course for Educationally Subnormal School-Leavers Pengwern Hall, Rhuddlan, Flintshire One Westminster patient attended the 12 week course at Pengwern Hall this year (1968-3). The course, arranged by the National Society for Mentally Handicapped Children, is for young adults in need of guidance in coping with employment and other aspects of social life. 53 Organised annual holiday for trainees Sixteen (22-1968) Westminster trainees went on the two weeks holiday at St. Mary's Bay Holiday Camp, Dymchurch, Kent. The City Council is most grateful to the Medical Officer of Health for Hammersmith for organising this service which the Westminster trainees greatly enjoy. Home Tuition Three patients in community care received training in their homes by qualified home tutors (1968-3). University House Special Care Unit, Bethnal Green (Tower Hamlets) A severely mentally handicapped 14 year old girl attends this unit two days each week and is conveyed from and to her home by car (1968-1). Centre for Spastic Children, Cheyne Walk This is a centre for severely handicapped children run by the Chelsea and Kensington Hospital Management Committee. Two Westminster children are in attendance there (1968-4). Spastics Centre, Harrow Road, W.9 A spastic severely subnormal 17 year old girl attends this centre daily and is progressing well. This centre is run by the Spastics Society. "Noah's Ark", 31 Shaftesbury Road, N.19 The "Noah's Ark" is a private centre catering for the severely handicapped. One girl, severely subnormal and handicapped, attends from Westminster 2 days a week. Regent Hall Nursery, W.1. This nursery which accommodates handicapped children is open one day each week and one girl from Westminster is in attendance there. The City Council is most grateful for all the help which these agencies extend to the Mental Health Section. Afternoon club at St. Jude's Hostel, Lancefield Street, W.10 The afternoon club at the hostel for severely subnormal persons continues to flourish and the activities are enjoyed by all who take part. Transport is provided for the convenience of these patients. Also well attended is the evening club at which woodwork instruction is given for residents of the hostel. Gateway Club, (Terrace Day Centre, 1 St. Mary's Terrace, W.2.) The social club for subnormal adolescents run by the City of Westminster Society for Mentally Handicapped Children is very successful and well attended. It is held in a room at the Terrace Day Centre. Day Rehabilitation Centres Three patients attended the following centres:— 1969 1968 Castle Day — 2 Lad broke Grove 1 1 Raydon (Camden) 1 1 Marlborough Hill (Harrow) 1 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. Two club meetings are held each week and an average of 30 patients participate in functions arranged by the mental health social workers who are present on these occasions (1968-30). Beauchamp Lodge Club for Subnormal Patients This is open one evening each week and attendance is most encouraging. 54 Methodist Church Hall, Ebury Bridge Road, S.W.1 The Church authorities have very kindly placed a room at the disposal of the City Council and a club has been formed there; 12 patients attend regularly. The aim of these clubs is to provide facilities for social communications, to encourage its expression and to provide a focal point for people living in isolation. Residential care The number of persons in residential care during 1969 was as follows:— Mentally ill 49 (35 in 1968) Subnormal or severely subnormal 54 (41 in 1968) In addition, there are 21 subnormal or severely subnormal children in care of the Children's Department in residential homes. Applications for approval or re-approval of medical practitioners During 1969, three medical practitioners were approved or re-approved for the purposes of section 28 of the Mental Health Act, 1959. THE TERRACE DAY CENTRE Report for 1969 (by Dr. R. A. Stewart, Medical Officer in Charge of the Centre) Throughout the year 1969 we have continued to expand our endeavours in order to help the mentally ill to gain confidence, overcome isolation and become useful members of the community. The signs and symptoms of mental illness are many and among these is the factor of social isolation. The patient usually has a sense of feeling different from other people and this leads to problems of social acceptance within the family and within the community at large. Tolerance on the part of the patient's contacts very often breaks down and this combined with an innate fear of mental disorder in the community present many problems in treatment. At the Terrace Day Centre we accept patients of all categories of mental disorder, other than mentally handicapped, from adolescence onwards and of both sexes who work with the staff together in a social group. We usually have about equal numbers of men and women with a total roll of 50 to 60 at one time. The statistical table (Table 44, page 88) gives an analysis of the composition and the results achieved. Out-patients are referred to us from various social services but usually through Westminster mental health social workers. We also accept referrals from general practitioners, psychiatric clinics, mental and general hospitals and also many other sources including the Department of Employment and Productivity. The morning routine follows a social pattern in that the members work together on simple productive industrial work. The type and quantity of work depends on the success we have in obtaining contracts from firms and organisations. We have facilities for assembling and packing small articles and also collating, stapling, addressing and counting circulars for posting. Advertising material can be sorted and arranged prior to posting. The Centre is always grateful for contract work of this nature and it is surprising and rewarding how quite ill people can be encouraged and helped to regain health if persuaded to pursue this useful work. The midday dinner is prepared daily by the patients in the well-equipped kitchen under the supervision of one of the staff and again the accent is on the social value of a working group. The patients are allotted to this activity on a rota. We also have a rota for washing up and tea-making and the regular task of cleaning and polishing floors throughout the premises. From time to time we have sessions of jam making and produce many hundreds of pounds during the year which find a ready sale. Our small laundry copes with the Centre's linen and all members of the group may use its facilities for their own washing as many of our patients have little or no facilities in their own lodgings. The carpentry workshop undertakes simple repairs to the fabric of the building at the Centre. Furniture has been repaired for individual orders and various articles can be made on request. We continue to produce racks for postcard display which are sent to holiday resorts on contract. Some quite elaborate toys and equipment have been made for the City Council's Ebury Bridge Junior Training Centre. 55 There are many errands to be undertaken for catering supplies, workshop materials and banking in connection with the management of the Centre. Reliability and trust can be built up by these activities. Distribution of money received from our work is made on a points system and may be used as an incentive. We do not penalise slow workers who are considered to be doing their best. The afternoons as a rule are given over to social activities unless occasionally there is a rush order in connection with the industrial work. Social activities are many and include discussions, play reading, painting and drawing, musical appreciation, dancing and folk dancing, films, tape recording and playback, visiting speakers, card and quiz games, table tennis and darts, etc. Outings are made to factories, art galleries, museums, exhibitions, swimming baths and other places of instruction and recreation. The Terrace magazine has appeared every month and has proved to be a rewarding activity in that so many patients have contributed and exercised their talents. The staff at the Terrace consists of Dr. Stewart who attends on a sessional basis, Miss Blair, Miss Munster and Miss Fabian who are qualified occupational therapists, and Mr. Clark, our experienced technician. Mrs. Lowe holds the post of domiciliary occupational therapist, having been appointed by the City Council and attached to the Terrace Day Centre part-time. The staff is concerned in some cases with the tasks of ensuring that the patient is taking medication as prescribed, which is particularly important in cases of epilepsy and some cases of schizophrenia, as neglect to do so may lead to relapse. The situation may arise when a patient is referred and does not attend for interview or does not accept the help offered and thereby reverts into isolation. The City Council's mental health social workers and the domiciliary occupational therapist have been able to do valuable work in these situations. Occasionally we have a patient attending who is still resident in a hospital until fit enough to return home, take up lodgings or enter a hostel. The mental health social workers under Mrs. Paterson are well known to the patients and staff and we are continually grateful for their visits to the Centre and for their ready help. There will always remain a proportion of patients who because of their disabilities could never cope with the demands of earning a living in the ordinary market of life. For these there is a need for an Industrial Unit as part of the Terrace Day Centre but conducted on commercial lines and staffed with industrial supervisors skilled in the problems presented by mentally disordered people. The Goodfellows Therapeutic Social Club meets at the Terrace on Wednesday evenings and is attended by some of the day patients and by people who are in employment but who have difficulties in mixing and who look for help in a social group. The Club also provides a method by which we can follow-up the welfare of our former day patients who have taken up employment. A light and inexpensive supper is provided by the day staff on the club evening. The Terrace premises are made available on Monday evenings for a club for mentally handicapped young people in Westminster. We have had many visitors interested in the rehabilitation of mentally ill both from this country and from abroad. Groups of nurses from Middlesex Hospital and St. Mary's Hospital have also joined in our activities as part of their training. Throughout the year we have been encouraged in our work by the interest shown by the Medical Officer of Health for Westminster, Dr. Briscoe-Smith, and for the ready help from various administrative officers of Westminster City Council. We have been honoured by visits from the Lord Mayor of Westminster and members of the Social Services Committee. VENEREAL DISEASE There are four special departments in teaching hospitals in Westminster for the treatment of venereal disease. All of them show an increase in attendance, but it is significant that the increase is mostly in those with non-specific conditions. Perhaps this indicates a greater willingness on the part of patients to avail themselves of the excellent diagnostic facilities provided. 56 The City Council employs five social workers in this service. They trace the contacts of confirmed cases and persuade them to attend for diagnosis and treatment. In this sphere they are remarkably successful. They also undertake social work in this very difficult field and are being employed much more frequently by consultants to undertake the necessary case work. Owing to it's central position, the City of Westminster maintains a general information service on venereal disease. A special telephone is manned day and night to provide information to any enquirer. During 1969 543 calls were received, mostly to enquire about the locality and times of clinics. There were also requests for literature on venereal disease and for "check-ups" for prospective bridegrooms before marriage. The City Council also provides a contact tracing service for the American Service bases in and around London; 58% of the contacts notified by them were traced. Education and publicity on venereal disease is also an important duty of the local authority. New notices with up-to-date details of all London clinics have been produced with a board backing, and covered with clear perspex. These notices are displayed in all public conveniences in Westminster. Separate notices on ceramic tiles are also being produced for the inside wall of each water closet. (See Table 45, page 89). HEALTH EDUCATION The special health education project for 1969 was the Cervical Cytology Campaign which was launched in April in collaboration with the Women's National Cancer Control Campaign. The campaign was basically to encourage women working and living in the north-western part of Westminster to be screened. The importance of screening was publicised by means of a specially designed poster and post-card type of leaflet which was given a wide distribution, and which contained details of the facilities for screening at the Harrow Road, Hallfield and Queen's Park maternal and child welfare centres. A detailed report of the campaign is also included in another part of this report (page 59). One hundred and fifty-two educational films were screened during the year at maternal and child welfare centres, and day centres. New visual aids were screened for appropriate staff both in the City Hall for staff working in the southern area, and at Lisson Grove maternal and child welfare centre for those employed in the northern part of Westminster. Appropriate staff from local hospitals, the Children's and Welfare Departments of the City Council were also invited to all suitable new films which were previewed at these two venues during the year; these included : Type Title Distributor Slides and tape recording "Medical Examination of the Medical Recording Service pre-school child" Slides and tape recording "Screening tests for Phenylketonuria" Medical Recording Service Slides and tape recording "Definitions relating to developmental Medical Recording Service paediatrics" Films "Take one Baby" British Sugar Bureau (subsequently purchased for use in the Department) Film "A Cruel Kindness" British Medical Association Film "Steps towards Maturity" Walt Disney Production Film "Understanding Stresses and Strains" Walt Disney Production Film "Cast Us Not Out" Jewish Welfare Board The Department's visual aids were used in conjunction with talks given by medical officers, health visitors, social workers, public health inspectors and the health education assistant at the City Hall, maternal and child welfare centres, Colleges for Further Education, schools and to local organisations including catering establishments. The topics covered home safety, ante-natal care, mothercraft, nutrition, food hygiene, venereal diseases and general health and hygiene. The health education assistant who is a member of the Greater London Home Safety Committee represented the City Council at the National Home Safety Conference which was held in November at Folkestone, Kent. 57 BLIND AND PARTIALLY SIGHTED PERSONS During 1969,130 (145) 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, 61 were new cases and 69 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. Sixty-five (45) certificates were also accepted from hospitals and other local authorities. HOME NURSING Comprehensive nursing care is provided for the sick patient at home by home nursing teams consisting of experienced state registered and state enrolled district nurses assisted by bathing attendants. With the large number of visits requested for frail, elderly people not in need of skilled nursing attention, more use was made of bathing attendants and this establishment was increased slightly during the year. The trained nursing staff carry out injections, dressings and other treatments requested by hospitals or general practitioners. Closer liaison developed between the nursing staff and family doctors during the year and in the hospital field co-operation was encouraged by the participation of district nurses invited to study days arranged for hospital nurses. With the aid of other supportive services and the use of special nursing equipment, many people were cared for at home who might otherwise have required hospital admission. Special appreciation is due for the help given by the Marie Curie Memorial Foundation when more intensive care, such as night nursing, was extended to certain patients. Organisation Requests for home nursing are received throughout the twenty-four hours at City Hall and relayed to the appropriate District Nursing Centre, 117 Sutherland Avenue, W.9 for areas north of Oxford Street and Bayswater Road, and 36 Great Smith Street, S.W.1 for areas south of Oxford Street. The nursing staff are based at these centres and visits are made to patients between 8.30 a.m. and 5.30 p.m. with an emergency service until 10 p.m. A clinic is held at 117 Sutherland Avenue from Monday to Friday, 4.30 p.m. to 7 p.m. for ambulant or working patients requiring treatment. Comfortable accommodation for staff is available in the Nurses' Hostel at Sutherland Avenue, which has recently been renovated, redecorated and refurnished. Training A full report detailing courses provided for members of the nursing staff is set out in the General section of this Report, page 16. Mention should also be made of the fact that five pupil nurses from Middlesex Hospital spent two weeks district nursing as the first part of their integrated State Nurse/ District Nurse course. Observation visits Sixty-two student nurses from various hospitals in the area spent a day observing the work of district nurses and four pupil nurses from Westminster Hospital enjoyed two weeks observation. Courses Several district nurses attended study days on subjects of specific interest. Two nurses attended the Practical Work Instructors Course at Chiswick College; with the increasing demands for the provision of instruction and experience in community nursing for hospital staff it is essential for district nurses to have special preparation for this task. Paediatric Home Care Unit A district nurse works full-time with the St. Mary's Hospital Home Care Unit, visiting sick children at home and advising and helping the mothers with their care. Buckingham Palace Mews A district nurse continues to be resident in the Royal Mews and provides nursing care for members of the staff. The cost is reimbursed to the City Council. 58 District Nursing Association This voluntary Association is active in providing amenities for patients and staff and administers various charities which benefit the sick and elderly in the area. 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. As the number of domiciliary confinements has drastically declined it was considered expedient to employ district nurse/midwives rather than full-time domiciliary midwives, with the exception of the S.W.1 area, where the Westminster Hospital continued to provide the service on an agency basis. Training Two pupil midwives from St. Mary's Hospital, Harrow Road completed their Part II midwifery training in the area in the first half of the year. Nurses from Middlesex Hospital spend a day with a domiciliary midwife as part of their obstetric training. LOAN OF HOME NURSING EQUIPMENT Articles of nursing and sick room equipment are loaned free of charge for an indefinite period to Westminster residents who are being nursed in their own homes. Requests for this service are received from general practitioners, medical staff and medical social workers of hospitals, district nurses and social workers of the Health Department. Considerable assistance is also given to the physically handicapped on the recommendation of the Council's Welfare Department. A very close liaison is maintained with all these bodies. The provision of thick plastic sheeting, treated as a disposable item, has provided an invaluable service to the incontinent being nursed at home; this eases the pressure on the Incontinent Laundry Service. The British Red Cross Society continues to issue small items of equipment on our behalf and I should like once again to express my gratitude for the service they render. In all, there are over 1,200 items on loan. During the year, 508 requests were met and 557 items of equipment issued; many patients often require more than one item. The number and variety of items on loan is as follows:— Air and Sorbo rings 15 Back Rests 96 Bed Blocks 22 Bed Cradles 57 Bed Pans 19 Bed Tables 2 Bottles 20 Egerton Bed 1 Hospital Beds 29 Commodes 422 Fracture Boards 103 Hoists:'Easi-Carri' 8 Hoists: Penryn 16 'Humidaire' Tent and Motor 1 Inflatable Toilet Seats 3 Mattresses 32 Quadrupeds 37 Ripple Mattresses 5 Tripods 20 Special Bath Seats 2 Walking Frames 167 Walking Sticks 4 Wheelchairs145 In addition to the above, a number of items of a specialised nature are issued mainly for use by handicapped children. 59 HOME DIALYSIS The City Council was glad to assist with the installation of an artificial kidney machine at the home of a young man living in South Westminster. At the request of the Consultant Physician, Renal Dialysis Unit, Lambeth Hospital, certain plumbing, electrical and other works were carried out in the patient's bedroom to enable the hospital equipment to be installed and to function satisfactorily. General Ministerial approval has been given for expenditure on works of this nature to be incurred by a local health authority. It is understood from the hospital that home treatment is proceeding satisfactorily and that in this case and in the similar case reported last year, both persons have been able to follow their normal employment. 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. Treatment is available for residents at eleven centres in the City Council area, including, by arrangement with the Director of Welfare, a clinic at the Welfare Centre for the Handicapped at 10 Warwick Row, S.W.1 for persons who normally attend the centre and for other handicapped people who are conveyed there in the Welfare Department's special coaches. Arrangements are made for some patients to receive their treatment at the surgeries of three private chiropodists, and for those who are housebound to receive treatment at home. As mentioned earlier in this report, the chiropody service formerly provided in the Welfare Department's residential homes will become the responsibility of the Health Department as from 1st January, 1970. As mentioned in my Annual Report for 1968, opportunity was taken in April 1968 to integrate under Health Department Control the chiropody service formerly provided by the City of Westminster Old People's Welfare Association. This further transfer of services from the Welfare Department therefore completes the process of centralisation of the chiropody service in the Health Department. New applicants for the service are visited by the Chief Chiropodist who establishes need and refers them to an appropriate source for treatment. The provision of transport for patients unable to make their own way to centres for treatment has proved highly successful. This transport service has enabled some patients who had been receiving treatment at home, and others who would otherwise have been provided with the domiciliary service, to have the advantage of attending a centre. In addition, it is anticipated that the use of the proposed Mobile Health Clinic, which will include chiropody facilities, will reduce difficulties experienced by some patients in travelling to their nearest centre, and thus enable these centres to accept other patients. During the latter part of the year a sessional chiropodist was appointed to provide treatments at Marsham Street Centre where a reduced service had been operating following the resignation of the chiropodist for health reasons. This appointment also facilitated an increase in chiropody sessions at the Welfare Department's Centre for the Handicapped and at two other centres. The chiropody clinic at All Soul's Club, Greenwell Street, W.1, was closed at the end of the year as the premises and facilities were considered to be inadequate to provide this service, the patients being transferred to an adjacent City Council clinic. The Social Services Committee in October 1969 approved an increase in the staffing establishment for chiropodists in the next financial year and further improvements and expansion of this much needed service are envisaged during 1970. Arrangements have also been made to purchase a hydraulic chiropody chair for use at the Welfare Centre for the Handicapped which will greatly assist both patients and chiropodists. During December 1969 the Chief Chiropodist and 11 sessional chiropodists were working 36 sessions in a week, and 7 chiropodists were providing approximately 90 domiciliary treatments a week. Details of the number of treatments undertaken in 1969 are set out in Table 38 Page 86. 60 CERVICAL CYTOLOGY Last year, mention was made of the need to boost attendances at the screening clinics in the north-west of the City and, to this end, early in 1969 preparations began for the launching in the Spring, in collaboration with the Women's National Cancer Control Campaign, of an intensive publicity drive in the Paddington area. In anticipation of the interest which it was hoped to arouse locally by actively seeking the support of local women's organisations, voluntary associations, business concerns and public bodies— circulating for this purpose a specially designed poster and matching postcard giving full details of the screening clinics—and by arranging a house-to-house delivery of the special postcard, in close liaison with the local health visitors, a fifth cervical cytological screening clinic was opened at the Queen's Park Maternal and Child Welfare Centre, 66 Lancefield Street, W.10, on 28th March 1969. This clinic was designed to cater for up to 20 women at each of the two sessions to be held every month, and both general practitioners in the Westminster area and the local press were informed well in advance of the opening. The publicity campaign was inaugurated by a Press Conference, held at City Hall on 21st April, at which the Lord Mayor, Councillor C. A. Prendergast, presided. The opening speakers at this Conference were the Lord Mayor, who had taken a personal interest in this Service since its commencement in 1966 when he was Chairman of the Health Committee, Lady Donaldson, the Chairman of the Women's National Cancer Control Campaign, and Dr. I. M. Pinkerton, the Chief Medical Officer of Marks and Spencer Ltd., and they were joined by Dr. J. G. Bate, the Consultant Cytologist of the Samaritan Hospital, Dr. D. R. Cook, the Secretary of the Inner London Local Medical Committee, and the Medical Officer of Health, to form a panel, which then answered questions posed by representatives of the Press. Officers of the Women's National Cancer Control Campaign, representatives of local industry and commerce, members of the Health Committee and of the medical and nursing staff of the City Council's Health Department were also present at this well-attended inaugural event. Points highlighted during the Conference included the role of the voluntary organisation in stimulating the provision of adequate screening facilities and the full use of them by the general public; the value of screening in terms of the effect on the mortality rate from cancer of the cervix; the priority groups for screening ; the frequency of screening considered desirable and the significance of the incidental gynaecological findings which are a by-product of the screening process; the part which the family doctor has to play; the importance of encouraging him in this role, and the need to keep him fully informed when his patients are screened by the hospital or local health authority services; the contribution of industry to population screening by providing a service directly or otherwise making suitable arrangements for their employees to be screened on the premises or at a local clinic; the importance of the local health authority screening clinics in catering for women who would not otherwise be screened, and the vital part which the health visitor has to play in persuading those most at risk to take advantage of the available screening facilities. The immediate response to the resultant publicity in the national and local press was good attendances being appreciably higher than in the first quarter of the year, although the degree of public interest shown in the new mobile trailer, made available by the Women's National Cancer Control Campaign for the purpose of distributing literature and interesting the public in the work of the Campaign generally and in the local screening facilities in particular, was disappointing. This trailer was stationed at various strategic points in the Paddington area during the period from 9th-27th June but it did not attract the attention hoped for. Far more disheartening was the paucity of volunteers to undertake the house-to-house delivery of the specially designed postcard and, in the event, this key task was undertaken by a few sturdy volunteers, supported by local health visitors. In the circumstances, it is perhaps not surprising that the response to this publicity campaign was shortlived, the very satisfactory attendance figures during the second quarter of 1969 sagging appreciably in the Autumn. Consequently, by the end of the year, early closure of the Queen's Park clinic seemed inevitable owing to lack of support, and the more effective utilisation of the screening resources available in the Paddington area was under close scrutiny. However, notwithstanding the disappointing results of the publicity campaign, 1969 was by no means a year lacking in achievement in this important field of cervical cytological screening. In the first place, the St. Marylebone and Ebury Bridge clinics continued to flourish unabatedly and the attendances there were most gratifying. Secondly, a large department store arranged for more than 100 members of their female staff to be examined at the St. Marylebone cervical screening clinic and this small project was successfully completed by the end of the year, much to the appreciation of the firm concerned. Thirdly, the City Council's Health Department joined forces with the Women's 61 National Cancer Control Campaign in an experimental venture, using the new trailer already mentioned, to ascertain whether members of the general public would take immediate advantage of mobile clinic facilities. To this end, the trailer was stationed near St. Martin-in-the-Fields, just off Trafalgar Square, and it was used on 17th June to publicise the importance of cervical cytological screening and to invite those women who showed an interest to be screened on the following day in the vehicle, which was fully equipped to serve as a mobile clinic. Sessions in the morning and afternoon were arranged for 18th June and the project proved a great success, no fewer than 32 women being examined. The interest which this venture aroused amongst women working in offices in the area was reflected in the large numbers of staff employed in Whitehall who attended the Ebury Bridge Road clinic during the ensuing weeks. In the year as a whole, 1,984 new patients were seen, showing a decline of 311 on the previous year; of these, 552 were seen at Marylebone, 550 at Ebury Bridge, 416 at Harrow Road, 339 at Hallfield, 95 at Queen's Park, and 32 in the mobile clinic near Trafalgar Square. In addition, 228 women had a further cervical smear examined (compared with 135 the previous year), making a grand total of 2,212 screening examinations carried out during 1969. Four of the women seen for the first time proved to have a positive smear, their ages ranging from 57 to 37 years, and all were referred promptly to their family doctors for the necessary treatment to be arranged. Approximately one in every three women seen had to be referred to her general practitioner in relation to some abnormality discovered incidentally—principally Trichomonas or Monilia infections, senile vaginitis, cervical erosions, cervical polyps, uterine fibroids and various forms of uterine prolapse—and one in eight of those attending was requested to return for a repeat examination. Thus, the screening process continued to be productive in the wider sense, irrespective of age, marital status, or size of family. 58 per cent, of all the women attending were over the age of 35. Finally, it is again a very real pleasure to record the gratitude of the Health Department to Dr. Bate and his cytology staff at the Samaritan Hospital, for help given unstintedly throughout the year. To end on an optimistic note, arrangements were in hand at the end of the year for a screening team from the Health Department to undertake a weekly visit to a large store in the West End, employing several thousand women. Such a venture may well prove a more effective means of screening those married women whose families have grown up, and who belong to the group most in need of this service, than seeking to persuade them to attend clinics near their homes. For this reason 1970 will be a year of particular interest. 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 1303 medical questionnaires scrutinised by the Principal Medical Officerduring 1969,inonly89cases 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 large 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 1969 are set out in Table 46, page 90. 62 SCHOOL HEALTH SERVICE The responsibility for providing a school health service falls on the Inner London Education Authority (Section 30 of the London Government Act, 1963). The arrangements made prior to 1965 for the joint use of professional, administrative and clerical staff by the City Council and the Education Authority are still operating satisfactorily. Of the 62 I.L.E.A. schools in Westminster, full-time medical officers carry out medical inspections at 42, with sessional medical officers attending the remainder. So far as possible, the full-time medical officers undertake child welfare clinics and primary school medical examinations in the same area. This, combined with the fact that most of the health visitors act as school nurses within their own areas, provides a large measure of continuity in care. Educationally subnormal children—Seven medical officers are approved to undertake statutory E.S.N, examinations. During 1969, 98 children were examined under sections 34 or 57 of the Education Act. Of the 98, 38 were recommended for admission to E.S.N, schools and 28 for admission either to training centres or the special care unit. Immunisation—special project—A trial of rubella vaccine was carried out at Sarah Siddons School. Girls aged 12-13 were invited to have the vaccine; all who accepted were to have a blood sample taken at the time of vaccination. Those whose blood showed a negative antibody response were to be bled again after 6 weeks, together with a 10% sample of those with a positive antibody response. About 180 girls accepted ; of these, 47 were sero-negative. These, together with 13 (a 10% sample) of sero-positives were re-bled. This trial, taken in conjunction with similar trials elsewhere, was of undoubted value. Fuller reports have appeared in the medical journals. B.C.G. Vaccination—Five colleges, 20 secondary schools, two day nurseries for handicapped children and the special care unit were visited during the year. The figures for those skin-tested and vaccinated are shown on page 91. The big discrepancy between the 1968 and 1969 figures arises from the fact that during 1968 an active case of tuberculosis was found at one of the largest colleges, with the consequent increase in skin-testing and vaccination of contacts which it entailed. Vision clinics—Owing to a seemingly insoluble staffing problem at the hospital concerned it was necessary to close the vision clinic which had been held for many years at Lissonia Treatment Centre. Children needing urgent appointments were seen at Western Opthalmic Hospital; discussions are proceeding for the transfer of the of whole body of work from Lissonia Treatment Centre vision clinic to the hospital. Special investigation clinics—The work of this valuable adjunct to the school health service is dealt with in the section on the work of the social workers (see page 50). Scheme for selective medical examinations in schools—The Principal School Medical Officer is considering a much more extensive use of this scheme, which appears to have been very valuable, where it has been tried, in channelling medical and nursing resources to the area of greatest need. (See Tables 47, 48, 49, 50,51, 52, 53 and 54, pages 90, 91, 92, 93, 94, 95 and 96). DENTAL SERVICE (Mr. D. K. Hardy, L.D.S., R.C.S., Eng.) Senior Dental Officer The year 1969 has seen the continuation of the City Council's dental service without the leadership of its Chief Dental Officer, Mr. R. E. Kean, who fell ill on 22nd July, 1969 and died on 22nd April, 1970. Mr. Kean served the Inner London Education Authority and the City Council well and did much to promote a high standard of dental care. The service has been well staffed by dental officers, but unfortunately the difficulty of obtaining dental surgery assistants continued. 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. The Social Services and Establishment Committees considered making representations to the appropriate National Joint Council for an improved salary scale which would be applicable to the 63 Inner London Boroughs, but a new salary scale was promulgated at that time and it was decided to leave the matter in abeyance. It will remain to be seen whether the revised salary scale is sufficient to attract dental surgery assistants to work for local authorities in the central area; but it cannot be stressed too strongly that dental clinics cannot function to capacity without a complete dental team. It is disappointing that dental decay should remain at a high level when dental services are so easily available both from the local authority and the general dental services. It is refreshing to note though that over the past four years there has been a decrease in the percentage found to require treatment; in 1966 this was 76.2 whereas for 1969 it was 63.5. This 12% change might be showing the success of our activities. It is at first heartening to see (from the statistical tables at the end of this Report) that fewer treatment sessions were devoted to the under 5's and expectant and nursing mothers, but when we see that more older children were examined and that some 80% required treatment we see how big is the problem which still confronts the dental officers. It is hoped to start a dental health education programme for the under 12's in the spring of 1971 and that this will be an annual event within the schools; such a campaign would involve the parents since the children would undoubtedly talk of it at home. In May 1969 an additional dental surgery was brought into operation at the Westminster Treatment Centre in Alderney Street, S.W.1. This surgery is fully equipped to the highest modern standards and has proved to be a valuable addition to the local authority dental service. The other dental clinics continue to be modernised and during the past twelve months two clinics have had new bowl installations provided in the recovery rooms, in place of the former troughs. The local authority dental service depends to a large extent on personnel other than in the dental clinics and to these, and especially those members of the staff in the school health office, the Senior Dental Officer extends his warmest thanks. 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 55 and 56, pages 97 and 98. 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, N.W.1. (935 7766) Westminster Hospital Chest Clinic ,St. John's Gardens, S.W.1. (828 8965) I am indebted to the Consultant Physician at each of these Clinics for the following reports of their activities during 1969:— Paddington Chest Clinic—Dr. P. A. Zorab, Consultant Physician We had a very busy year at this Chest Clinic and referrals from general practitioners increased considerably. Our regular contact clinics, B.C.G. clinics, X-ray only service, and following up tuberculin positive school children, proved most helpful in our aim to eradicate tuberculosis. Several new surveys are in the process of being carried out and postgraduate and nursing teaching remains a regular feature of clinic work. The Paddington Chest Clinic Care Committee have been most successful in their fund raising efforts and this has enabled our social worker to help many patients where cases of hardship have arisen through illness. St. Marylebone Chest Clinic—Dr. G. Shneerson, Consultant Physician The number of newly notified cases of tuberculosis, and deaths from cancer of the lung is essentially the same as those in 1968. The out-patient facilities for diagnosis and treatment of tuberculosis and allied chest diseases remain unchanged. 64 Westminster Hospital Chest Clinic—Dr. P. A. Emerson, Consultant Physician The number of patients attending the clinic has increased since last year, but again the number of newly diagnosed cases of tuberculosis has fallen slightly compared with the previous year. Twentyeight new cases of tuberculosis were notified during 1969; twenty-one were males, seven were females and there was one case of tuberculosis in a child. Only three of the tuberculous patients were referred to the clinic by their general practitioners. Nine were discovered by the South West London Mass X-ray Unit and another fourteen were notified by various other hospitals and mass X-ray units. The regular visits to Bruce House and the lodging houses in Great Peter Street to offer chest X-rays to the men who live there have continued. A research project studying the effects of atmospheric conditions and air pollution on the conditions of patients with bronchitis and asthma living in Westminster is continuing. Statistics relating to notifications of tuberculosis in Westminster, and deaths, during 1969, are set out in Table 5, page 69, 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 57, page 99. 65 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 Maternal mortality. 4 Notifications of infectious and other notifiable diseases. 5 Tuberculosis—new cases and deaths. 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 Qualification Certificates. 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 Offices, Shops and Railway Premises Act, 1963. 21 Factories—inspections for purposes of provisions as to health. 22 Factories—defects. 23 Outwork. 24 Estimated percentage of compliance of premises in Westminster with Food Hygiene (General) Regulations 1960, in relation to washing facilities and provision of sinks. 25 Premises registered for preserving food, or manufacture, storage or sale of ice-cream. 26 Food poisoning investigations. 27 Analysis of Legal Proceedings. 28 Coroner's Court and Mortuary. 29 Sessions at Maternal and Child Welfare Centres. 30 Clinic services—ante-natal and post-natal clinics. 31 Mothercraft and ante-natal exercises. 32 Child Welfare Centres. 33 Health Visiting. 34 Vaccination of persons under age 16 completed during 1969 at Welfare Centres and by general practitioners. 35 Smallpox vaccination of persons aged under 16. 36 Home Nursing. 37 Domiciliary Midwifery. 38 Chiropody service. 39 Home Help Service. 40 Mental Health Service—number of patients referred to City Council during year ended 31st December, 1969. 41 Number of patients for whom hospital admissions were arranged. 42 Mental Health Service—number of cases in community care at end of year. 43 Number of patients admitted for temporary residential care during the year (e.g. to relieve the family). 44 The Terrace Day Centre (Day centre for the mentally ill, 1 St. Mary's Terrace, W.2). 45 Venereal diseases—cases treated in Westminster during 1969. 46 Medical suite at City Hall—work undertaken, 1969. 47 School Health service—full-time equivalent employees. 48 Tuberculin Test and B.C.G. vaccination of school-children and students. 49 School medical inspections 1969. 50 Routine medical inspections in schools, 1969—defects found. 51 School health service—findings at health surveys, 1969. 52 School health service—non-routine medical inspections, 1969. 53 School health service—routine medical inspections, 1969—vision. 54 School health service—comparison of defects noted at 7-plus routine and 7-plus special medical inspections, 1969. 55 Dental services for expectant and nursing mothers and children under 5. 56 School dental service statistics, 1969. 57 Tuberculosis—care and after-care—work at Chest Clinics in Westminster. 66 Table 1.—Deaths—According to Age-Group and Sex CAUSE OF DEATH 1968 1969 Net Deaths at the sub-joined ages of residents (Male and Female) whether occuring 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 . 2 1 2 1 1 - - - - - - - - - - - 1 Tuberculosis of respiratory system 13 9 3 1 6 1 3 1 Other tuberculosis, including late effects 4 7 1 — — — — — — 1 — 1 — 3 — 2 1 Meningococcal infection 1 - - - - - - - - - - - - - - - - Syphilis and its sequelae 5 4 2 2 — 2 2 Other infective and parasitic diseases 3 5 — — — — — — — 1 — — — 1 — 3 Malignant neoplasm—buccal cavity etc. — 9 2 - - - - - - - - - - 3 1 6 1 Malignant neoplasm—oesophagus — 10 14 - - - - - - - - - 1 5 6 5 7 Malignant neoplasm—stomach 53 30 28 - - - - - - - - 3 — 10 4 17 24 Malignant neoplasm—intestine — 26 48 - - - - - - - - - 2 6 14 20 32 Malignant neoplasm—larynx — 4 1 - - - - - - - - - - 2 1 2 — Malignant neoplasm—lung, bronchus 199 151 50 - - - - - - - - 3 1 70 19 78 30 Malignant neoplasm—breast 62 1 56 - - - - - - - - - 4 1 26 — 26 Malignant neoplasm—uterus 23 — 31 — — — — — — — — — 2 — 17 — 12 Malignant neoplasm—prostrate — 14 — — — — — — — — — — — 1 — 13 — Leukaemia 22 8 10 — — — — 1 — — 1 1 — 2 2 4 7 Other malignant neoplasms 318 113 107 — — 1 1 1 1 3 3 11 4 50 32 47 66 Benign and unspecified neoplasms 8 3 2 — — — — — — — — — — 3 — — 2 Diabetes mellitus 33 10 18 - - - - - - - - - 1 3 5 7 12 Avitaminoses, etc. 1 — 2 — — — — — — — — — — — — — 2 Other endocrine etc. diseases 9 2 8 - - - - - 1 - - - - 1 2 1 5 Anaemias 3 2 4 - - - - - - - - - - - - 2 4 Mental disorders 11 8 6 - - - - - - 2 — 5 2 1 1 — 3 Meningitis 3 — 1 — 1 — — — — — — — — — — — Other diseases of nervous system, etc. 29 16 14 - - - - - - - - 2 1 4 3 10 10 Chronic rheumatic heart disease 48 27 32 - - - - - - 2 3 5 5 10 10 10 14 Hypertensive disease 61 25 34 - - - - - - - 1 1 11 7 13 26 Ischaemic heart disease 595 421 262 - - - - - - - - 11 1 181 25 229 236 Other forms of heart disease 104 39 75 1 - - - - - - - 1 1 9 10 28 64 Cerebrovascular disease 284 115 173 - - - - - - - - 4 1 34 20 77 152 Other diseases of circulatory system 146 54 77 - - - - - - - - 2 — 14 8 38 69 Influenza 15 10 11 - - - - - - - - - - 7 2 3 9 Pneumonia 194 93 125 3 3 1 — — — 1 — — 2 15 6 73 114 Bronchitis and emphysema 127 80 33 - - - - - - - - - - 24 9 56 24 Asthma 14 4 4 - - - - - - - - 2 — 1 2 1 2 Other diseases of respiratory system 31 17 9 - - - - - - - - - - 5 1 11 8 Peptic ulcer 25 12 14 — — — — — 1 — — 1 — 5 2 6 11 Intestinal obstruction and hernia 16 7 6 1 - - - - - - - - - 1 — 5 6 Cirrhosis of liver 15 8 7 - - - - - - - - 2 — 5 5 1 2 Other diseases of digestive system 46 17 22 — 1 - - - - - - - 1 5 2 12 18 Nephritis and nephrosis 11 13 9 - - - - - - - 1 3 3 5 2 5 3 Hyperplasia of prostrate 4 7 — — — — — — — — — — — 2 — 5 — Other diseases, genito-urinary system 22 10 12 - - - - - - - - 3 1 2 3 5 8 Abortion — — 2 — — — 1 — 1 — — — — Diseases of skin, subcutaneous tissue 3 — 2 - - - - - - - - - - - - - 1 Diseases of musculoskeletal system 11 2 9 - - - - - - - - — 2 1 1 1 6 Congenital anomalies 34 21 15 12 9 — 1 6 — 2 1 — 1 1 — — 3 Birth, injury, difficult labour, etc. 10 13 8 13 8 - - - - - - - - - - - Other causes of perinatal mortality 7 7 3 7 3 - - - - - - - - - - - - Symptoms and ill-defined conditions .. 8 2 3 - - - - - - - - - - - - 2 3 Motor vehicle accidents 38 18 13 — — — — 1 — 5 1 3 2 4 3 5 7 All other accidents 57 35 37 — 1 __ 1 1 — 1 2 6 2 13 11 14 20 Suicide and self-inflicted injuries 60 36 36 - - - - - - 6 1 13 9 9 17 8 9 All other external causes 28 16 13 — — - 1 1 1 8 4 6 6 1 1 Other diseases of blood, etc 3 - - - - - - - - - - - - - - - - Active rheumatic fever 1 - - - - - - - - - - - - - - - - Appendicitis 2 - - - - - - - - - - - - - - - - 1,542 1,456 38 27 3 4 10 3 25 15 91 57 544 286 831 1064 Totals 2,998 65 7 13 40 148 830 1.895 1968 2,822 — 49 11 15 26 141 727 1,853 67 Table 2.—Infant Mortality—According to Cause, Age-Group and Sex CAUSE OF DEATH Under 1 week 1-4 weeks 1-3 months 3-6 months 6-9 months 9-12 months Total M. F. M. F. M. F. M. F. M. F. M. F. M. F. Asphyxia 1 - - - - - - 1 - - - - 1 1 Birth Injury 5 - - - - - - - - - - - 5 — Bronchopneumonia - - - - - - 1 - - - 1 — 2 — Gastro Enteritis — — — 1 1 — — — — 1 — — 1 2 Inhalation Pneumonia — 2 - - - 2 - - - - - - - 4 Intestinal Obstruction - - - - 1 - - - - - - - 1 — Malformations— Heart and Great Vessels 3 3 2 — — — 3 — — — — — 8 3 Hydrocephalus and Spina Bifida — 1 - - - - - - - - - - - 1 Microcephaly — — - — — — 1 — — — — — 1 — Multiple Congenital Abnormalities 1 3 - - - - - - - - - - 1 3 Oes. Trach. Fist. — 1 — — — — — — — — — — — 1 Meningitis - - - 1 - - - - - - - - - 1 Peritonitis - - - 1 - - - - - - - - 1 Prematurity and Allied Causes 18 10 - - - - - - - - - - 18 10 Totals—1969 28 20 2 3 2 2 5 1 - 1 1 - 38 27 48 5 4 6 1 1 65 Totals—1968 (in brackets) (32) (2) (9) (5) (1) (-) (49) Number of deaths of illegitimate infants 15 2 2 1 - - 20 included in above (5) (-) (1) (2) — — (8) Table 3.—Maternal Mortality Age Cause of death 37 Suppurative bronchopneumonia following infection of the abdominal operative incision for hysterotomy and therapeutic abortion. 20 Septicaemia due to septic abortion. 68 Table 4.—Notification of Infectious and Other Notifiable Diseases Numbers originally notified Measles (excluding rubella) Dysentery Scarlet Fever Diphtheria Acute meningitis Acute poliomyelitis Other notifiable diseases Specify disease and sex but not age Paralytic Nonparalytic Original Final M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Total (All Ages) 149 172 25 29 8 14 — — 4 — 1 1 — Smallpox Final numbers after correction Under 1 year 8 8 2 2 - - - - 1 - - - - - - - - 1 year 24 25 3 4 1 — — — 2 — — — — — Ophthalmia neonatorum 2 years 25 30 3 1 3 - - - - - - - - - - - - - 3 „ 26 28 5 2 1 1 - - - - - - - - - - - - 4 „ 23 24 2 1 - 2 - - - - - - - Anthrax 5-9 „ 37 51 4 8 3 5 - - - - - - - - 10-14 „ 1 2 - - - 4 - - - - - - - - - - - - 15-24 „ 1 2 2 4 — 2 — — — — — 1 — — Yellow fever 25 and over 3 1 3 6 - - - - 1 - 1 - - - - - - - Age unknown 1 1 1 1 - - - - - - - - - - Malaria (from abroad) Total (All Ages) 149 172 25 29 8 14 — - 4 — 1 1 — - 3 - 3 — Numbers originally notified Acute encephalitis Leptospirosis Paratyphoid fever Typhoid fever Food poisoning Whooping cough Infective Post infectious M. F. M. F. M. F. M. F. M. F. M. F. Numbers originally notified Total (All Ages) M. F. Total (All Ages) - - - - - - 2 2 2 7 28 24 1 1 Final numbers after correction Final numbers after correction - - - - - - - 1 - - 4 4 Under 3 months - - 5—14 years - - - - - - 1 - - - 2 2 3 months 1 - 15—44 „ - - - - - - 1 1 2 6 6 7 6 „ - - 45—64 „ - - - - - - - - - - 2 2 9 „ - - 65 and over - - - - - - - - - - - - 1 year — — Age unknown - — — - - - — — — — - - 2—4 years — 1 Total (All Ages) - - - - - - 2 2 2 6 14 15 10—14 „ — — 15—19 „ — — 20—24 „ - - Tuberculosis 25—34 „ - - Infective 35—44 „ - - Number originally notified Tetanus Jaundice 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 jver — — Total (All Ages) — — 39 20 83 43 — — 9 12 Age un knowr — — Final numbers Males Females Total ( All Age s) 1 1 Under 1 year 13 2 1 year 1 2—4 years - - 1 - - 2 - — — — 5—9 „ - - 3 1 1 3 - - - - 10—14 „ - - 4 4 - - - — Total Notifications of infectious and other Notifiable Diseases received during the year. 15—19 „ - - 2 3 1 2 - - - 1 20—24 „ - — 12 8 9 7 — — 1 — 25 34 „ - - 11 4 16 8 - - 5 5 35—44 „ - - 3 - 9 3 - - 3 1 1969 679 45—54 „ - - 2 3 14 7 - - — 1 1968 732 55 64 „ - - - - 16 7 - - - 1 65—74 „ — — 1 1 11 3 — — — 1 75 and over - - - - 1 - - - - 1 Age unknown - - - - 1 - - - - - Total (All Ages) - - 39 20 83 42 - - 9 12 69 Table 5.—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 - - - - - - - - 1-5 - 2 - 1 - - - - 5-15 5 3 - - - - - - 15—25 11 9 1 1 — — 1 — 25—35 16 8 5 5 — — — — 35—45 9 5 5 1 — 1 1 — 45—55 16 7 — 1 1 — 1 — 55—65 21 7 — 1 5 1 2 — 65 and upwards 15 4 — 2 3 1 2 1 Age unknown 1 - - - - - - - Totals 1969 94 45 11 12 9 3 7 1 1968 100 43 11 14 9 4 3 1 * 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 6.—Specimens Submitted to the Public Health Laboratory Nature of Specimen Number Examined Positive Findings Nasal, throat and mouth swabs 116 Haemolytic Streptococci 17 Staphylococcus Aureus 7 Monilia 3 Faeces 1,193 Shigella Sonnei 64 Shigella Flexneri 1 B. Coli 026 3 B. Coli 0128 1 Salmonella typhimurium 16 Salmonella Indiana 2 Salmonella Virchow 2 Salmonella Enteritidis 4 Salmonella Reading 1 Salmonella Thompson 2 Salmonella Dublin 1 Salmonella Muenchen 1 Salmonella Stanley 1 Salmonella Kiambu 4 Salmonella Infantis 4 Salmonella Heidelberg 2 Salmonella (un-named) 1 S. Para typhi 6 S. typhi 1 Clostridium Welchii 8 Trichuris trichiura 1 Vincent's organisms 2 Blood 2 Urine 25 (The total number of specimens examined during 1968 was 732) 70 Table 7.—Night and out of office hours emergency service— Analysis of calls made to Duty Officers Month 1969 Mental Health 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 175 98 40 35 19 2 70 24 31 — 442 4 777 163 February 125 100 30 10 13 3 48 6 25 1 376 2 617 122 March 192 145 28 3 36 3 78 16 26 1 454 3 814 171 April 171 170 52 25 21 4 71 26 27 1 417 2 759 228 May 211 128 45 18 26 8 112 51 41 — 445 7 880 212 June 286 159 7 18 23 2 94 20 56 — 391 10 857 209 July 158 155 20 11 17 7 83 25 45 1 396 4 719 203 August 198 142 18 32 35 3 82 36 52 4 489 8 874 225 September 196 95 19 22 22 3 88 17 42 5 430 8 797 150 October 234 117 28 9 21 5 97 13 39 4 432 10 851 158 November 194 137 47 13 21 5 112 18 44 2 393 12 811 187 December 187 121 34 11 18 8 114 29 40 1 481 7 874 177 TOTAL— 1969 2,327 1,567 368 207 272 53 1,049 281 468 20 5,146 77 9,630 2,205 1968 2,254 1,641 425 279 292 44 927 235 496 20 4,759 105 9,153 2,324 * "W" refers to calls relating to the City of Westminster. "K" refers to calls relating to the Royal Borough of Kensington and Chelsea. Table 8.—Dwelling Houses—Reason for Initial Inspection 1969 1968 Complaints 3,426 3,774 Routine 898 1,158 Smoke Control 914 907 Infectious Disease 430 380 Underground Rooms 418 397 Applications for Grants and Loans 239 245 Housing circumstances 775 1,103 Drainage 1,449 1,405 Rodent Control 501 658 Miscellaneous 551 600 Table 9.—Dwelling Houses—Nuisances and Unsatisfactory Conditions Found and Remedied 1969 1968 Houses, damp, dirty or dilapidated 235 248 Doors, windows, floors, ceilings, firegrates defective 618 1,158 Insufficient or unsuitable W.C. accommodation 26 100 Drains, W.Cs and waste pipe stoppages 199 196 Drains, W.Cs and waste pipe defective 298 461 Yard, area and wash house defects 35 37 Roofs, gutters and rainwater pipes defective 247 477 Water supplies absent or insufficient 24 22 Water cisterns dirty or defective 33 37 Ashpits, dustbins, etc., insufficient or defective 71 102 Rubbish accumulations 222 253 Animal nuisances 8 8 Miscellaneous 311 351 71 Table 10.—Summary of Visits by Public Health Inspectors 1969 1968 Clean Air Act 1,511 1,549 Drainage and New Developments 13,017 12,024 Dwelling Houses (general matters) 17,943 17,728 Factories (other than building sites) 502 551 Food and Catering Premises 8,427 10,230 Hairdressers' Establishments 85 51 Infectious Disease 1,184 979 Noise 1,117 1,141 Offices 1,591 2,063 Pigeons 90 79 Rodent Control 1,516 1,685 Shops 658 803 Smoke Observations 607 480 Town Planning 43 49 Vermin investigations 526 703 Other purposes 2,403 2,151 Table 11.—Statutory Notices Served 1969 1968 Public Health Acts, 1936 and 1961 610 795 Clean Air Act, 1956 35 36 Greater London Council Drainage ByLaws 3 1 Greater London Council Water Closet Bylaws 2 1 Factories Act, 1961 — 1 Noise Abatement Act, 1960 2 2 Prevention of Damage by Pests Act, 1949 4 5 Greater London Council (G.P.) Act, 1967 Local Bylaws: 1 2 Artificial Lighting of Common Staircases 7 20 Cleansing of Cisterns — 3 Removal of Refuse - - Table 12.—Summary of Visits by Housing Act Inspectors 1969 1968 Work in connection with the Housing Acts 1961 — 1964 1,666 1,659 Clearance and development area surveys 546 1,005 Grant, subsidy and loan applications 480 1,301 Other visits 415 209 Hotel inspections 417 818 72 Table 13.—Summary of Work Carried Out by Public Health Inspectors under the Housing Acts 1961-1964 in connection with Houses in Multiple Occupation 1969 1968 Premises in course of inspection at end of year 227 42 Premises inspected 295 403 Management Orders made (section 12) 8 9 Directions given (Section 19) 51 31 Notices served for contraventions of Management Regulations (Section 14) 2 5 Notices served for the provision of amenities (Section 15) 13 7 Work in progress at end of year 42 63 Notices under Section 14 complied with 2 2 Notices under Section 15 complied with 11 7 Table 14.—Unfit Premises 1969 1968 Closing orders made on underground rooms 49 (132 rooms) 27 (63 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 12 (37 rooms) 5 (12 rooms) Undertakings accepted on upper parts of buildings and mews premises 2 (10 rooms) 1 (4 rooms) Closing orders made on houses in lieu of demolition orders 2 (21 rooms) - Undertakings accepted in lieu of closing orders on houses - - Closing orders on underground rooms determined when work carried out 36 (155 rooms) 33 (100 rooms) Closing orders on upper parts and mews premises determined when work carried out 10 (26 rooms) 2 (5 rooms) Undertakings cancelled as a result of work carried out - - Closing orders or undertakings cancelled when premises demolished 179 (459 rooms) 15 (42 rooms) 73 Table 15.—Known cases of Overcrowding 1969 1968 Dwellings overcrowded at end of year 237 217 Persons dwelling therein 942 units 825 1/2 units (1,237 persons) (1,087 persons) New cases of overcrowding noted during the year 35 21 Persons involved in new cases 156 units 91 units (203 persons) (120 persons) Cases of overcrowding relieved during the year 15 17 Persons involved in relieved cases 64 1/2 units 70 1/2 units (86 persons) (97 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. Table 16.—Housing Act 1969: Qualification Certificates (This Table relates to the period 25th August, 1969, when the Act came into operation, to 31st December, 1969) Improvement cases: Applications for qualification certificates under Section 44(2) under consideration at end of period 3 Certificates of provisional approval issued 4 Qualification certificates issued under Section 46(3) Nil Standard amenities already provided: Applications for qualification certificates under Section 44(1) under consideration at end of period 175 Qualification certificates issued under Section 45(2) 1 Exemption for low-income tenants from Section 54 Certificates issued under Section 55 Nil 74 Table 17.—Rodent Control 1969 1968 Complaints: Complaints of rats received 757 777 Complaints of mice received 1,652 1,206 Total premises involved 2,409 1,983 Infestations treated by Council's staff: (Including properties inspected for reasons other than notification) Premises rid of rats 795 824 Premises rid of mice 1,664 1,226 Total premises disinfested 2,459 2,050 Inspections by Public Health Inspectors and visits by Rodent Officers to such places 3,898 3,670 Intimation notices served Statutory notices served 4 5 Table 18.—Chemical Examination of Water Supplied to City of Westminster—Average Results Milligrammes per Litre (unless otherwise stated) Analysis Date Source of Supply Stoke Newington R. Thames Derived Ammoniacal Nitrogen 0.015 0.024 Albuminoid Nitrogen 0.059 0.083 Nitrate Nitrogen 4.7 4.4 Oxygen abs. from Permanganate 4 hrs. at 27°C. 0.62 1.05 Hardness (total) 314 282 Hardness (non-carbonate) 84 79 Magnesium as Mg 5 5 Sodium as Na 30.8 24.0 Potassium as K 5.3 5.4 Chloride as CI 41 32 Phosphate as PO4 1.7 2.1 Silicate as Si02 10 9 Sulphate as SO4 68 58 Natural Fluoride as F 0.25 0.25 Surface active material as Manoxol 0.02 0.02 Turbidity Units 0.0 0.1 Colour (Burgess units) 7 11 pH value 7.9 7.9 Electrical Conductivity (Microhms) 630 550 75 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 18.0 — 100.0 100.0 R. Thames-derived 3,698 12.9 - 99.89 100.0 Table 20.—Offices, Shops and Railway Premises Act, 1963 Total Number Number of Registered Number Registered Registered at Premises receiving Category of Premises in 1969 31st December, 1969 a general inspection during the year Offices 859 11,747 1,336 Retail Shops 132 3,735 473 Wholesale Shops, Warehouses 29 818 28 Catering Establishments open to the public (Canteens) 22 1,428 87 Fuel Storage Depots — — — Totals 1,042 17,728 1,924 Analysis of persons employed in Registered Premises by workplace Offices 268,438 Retail Shops 38,584 Wholesale departments, Warehouses 18,942 Catering Establishments open to the Public 21,084 Canteens 5,679 Fuel Storage Depots — Total 352,727 Total Males 191,185 Total Females 161,542 Inspections and Contraventions Inspections of all kinds 5,789 Premises at which contraventions were found 1,333 Accidents Notifiable accidents 471 Accidents investigated 171 Accidents investigated which revealed contraventions 9 Accidents where a contravention may have been a contributory cause 5 Fatalities 1 76 Table 21.—Factories: Inspection for purposes of provisions as to health Number Number of Occupiers prosecuted on Register Inspections Written notices 1969 1968 1969 1968 1969 1968 1969 1968 (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 745 758 105 119 1 5 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2,754 2,968 397 432 16 50 — — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 815 913 1,381 1,445 Total 4,314 4,639 1,883 1,996 17 55 — — Table 22.—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 1969 1968 1969 1968 1969 1968 1969 1968 1969 1968 Want of cleanliness (S.1) 6 20 6 15 1 2 1 4 - - Overcrowding (S.2) - - - - - - - - - - Unreasonable temperature (S.3) - - - - - - - - - - Inadequate ventilation (S.4) 14 7 8 6 1 1 — 2 - — Ineffective drainage of floors (S.6) - - - - - - - - - - Sanitary Conveniences (S.7) (a) Insufficient 5 2 3 1 - - - - - - (b) Unsuitable or defective . . 29 45 28 33 — 2 6 6 - — (c) Not separate for sexes 5 10 4 8 — — — 1 - — Other offences against the Act (not including offences relating to Out-work) 17 21 10 13 1 - - - - - Total 76 105 59 76 3 5 7 13 — — 77 Table 23.—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 1969 1968 1969 1968 1969 1968 1969 1968 1969 1968 1969 1968 Wearing apparel—making, etc. 1,816 1,799 - - - - - - - - - - Household linen 10 2 - - - - - - - - - - Lace making, mending, etc. — 3 - - - - - - - - - - Curtains and furniture hangings 6 2 - - - - - - - - - - Furniture and upholstery 2 1 - - - - - - - - - - Paper bags — 2 - - - - - - - - - - Feather sorting — 3 - - - - - - - - - - Lampshades 7 2 - - - - - - - - - - 1,841 1,814 - - - - - - - - - - Table 24.—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 1,755 95 100 Grocers and provision merchants 507 95 95 Canteens and clubs 1,464 97 97 Public houses 543 96 96 Confectioners 541 85 50 Greengrocers and fruiterers 188 90 75 Schools, nurseries and hostels 84 100 100 Butchers 131 97 97 Off licences 256 80 -* Bakers, cake and pastry premises 130 100 82 Chemists 180 80 20† Fishmongers and poulterers 47 97 100 Food factories 20 100 100 Wholesale premises, stores and depots 270 86 77 * Provision not required by Regulation 19 t Maximum percentage required by Regulation 19 78 Table 25.—Premises Registered for Preserving Food, or Manufacture, Storage or Sale of Ice Cream 1969  Preserved food, etc. 180 175 Ice cream: Manufacture, and/or storage and/or sale 686 685 Table 26.—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 ns (2+4+5) (1) (2) (3) (4) (5) (6) (7) S. typhimurium — — 1 3 1 2 4 Other Salmonellae 1 4 — - 1 2 5 CI. welchii 1 4 1 2 — 2 6 Staph, aureus — — — — — — — Other causes — — — — — — — Cause unknown - 4 — — 17 18 21 Total 1969 3 12 2 5 19 24 36 Total 1968 14 262 2 4 34 50 300 79 Table 27.—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— 11 cases 21 0 0 36 7 0 Byelaws as to artificial lighting in tenement houses— 1 case 3 0 0 - Housing Act. 1957 Contravention of Closing Orders— 6 cases 50 0 0 10 10 0 Food & Drugs Act, 1955 (Sec. 2) Selling food not of the substance demanded— 1 case 20 0 0 5 5 0 Food & Drugs Act. 1955 (Sec. 8 (1)) Selling food unfit for human consumption— 1 case 5 0 0 5 5 0 Food Hygiene (General) Regulations 1960— 25 cases 216 0 0 84 10 0 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations. 1966— 348 cases 1031 5 0 72 19 0 1969 £1346 5 0 £214 16 0 1968 £1219 0 0 £698 19 6 Table 28.—Coroner's Court and Mortuary 1969 1968 Bodies received in the Mortuary on Coroner's Warrants, etc. 1,244 1,197 Bodies deposited to await burial 12 7 Inquest cases 365 320 Non-inquest cases 891 884 Post-mortem examinations held 1,227 1,179 Causes of death in the foregoing:— Accidental drowning 7 1 Found drowned 5 6 Suicide by drowning 3 1 Suicide by other means 116 106 Accidents: Street 35 37 Domestic 38 38 Others 68 44 Natural causes 903 885 Misadventure 6 5 Murder 5 9 Miscellaneous causes 61 60 Awaiting proceedings at Central Criminal Court 9 12 Table 29.—Maternal & Child Welfare Centres—Activities held as at December 1969 Note: The following Table sets out the sessions held at the various Centres in December, 1969. Changes occur from time to time to meet the need. CENTRE MONDAY TUESDAY WEDN ESDAY 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. Dental (School) Discussion Group (Psychiatric) Infant Wei. Occ. creche Dental (School) Chiropody Family Planning Clinic (I.U.D.) Evening:— Child Wel. Ante-natal Infant Wel. Dental (School) Ante-natal (exercises) Chiropody Infant Wel. Immunisation Home Advice Dental (School) Infant Wel. Dental (School) Anta-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) Dental (M.C.W.) Evening:— Family Planning Chiropody Dental (School) Cytology Special Investigation Infant Wel. Chiropody Dental (School) Special investigation clinic (2nd and 4th Friday in month) Family Planning 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) Playgroup Infant Wel. Dental (School) Dental (M.C.W.) Playgroup Dental (School) Infant Wel. Immunisation and Vacc. 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 (1st and 3rd week) Infant Wel. 80 00 Table 29.—Maternal & Child Welfare Centres—Activities held as at December 1969—(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. Dibdin House, Maida Vale, W.9. Infant Wel. St. David's St. Mary's Terrace, W.2. Infant Wel. Infant 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 Special Investigation as required 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 Chiropody Westminster, Council House Extension, W.1. Dental (School) Playgroup Dental (School) Diathermy Infant Wel. Dental (School) Cervical Cytology Playgroup Toddlers (1st and 3rd weeks) Dental (School) Mothers' Club & Creche Immunisation and Vacc. Dental (School) Special Investigation Playgroup Infant Wel. Dental (School) Toddlers by appt. Ante-natal Dental (M.C.W.) Playgroup Sewing Dental (School) Diathermy Creche Evening:— Family Planning Dental (School) (Gas Sess. 2nd Fri. in month) Playgroup Infant Wel. Dental (School) 00 N> Table 29.—Maternal 8- Child Welfare Centres—Activities held as at December 1969—(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. Middlesex Hospital Infant Wel. Mothercraft Infant Wel. Bessborough Street, S.W.1. Chiropody Ante-natal Chiropody Vaccination and Immunisation (alt. weeks) Chiropody Infant Wel. Chiropody Occ. creche Sewing class Evening:— Family Planning Family Planning Chiropody Family Planning Chiropody 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 Cytology Mothers' Club Occ. creche Ante-natal Mothercraft Infant Wel. Marshall Street, W.1. Toddlers' Club Chiropody Infant Wel. Vaccination and Immunisation Toddlers' Club Family Planning Toddlers' Club Chiropody (alt. weeks) Toddlers' Club Chiropody Infant Wel. Vaccination and Immunisation 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. 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. 83 Table 30.—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 Mid wives Medical Officer Sessions Midwives Sessions 1969 922 1,067 402 45 4,574 92 1968 941 130 500 121 4,058 345 Table 31 .—Mothercraft and Ante-Natal Exercises 1969 1968 Total number of women who attended during the year 740 583 Total number of attendances during the year 2,897 2,733 Total number of sessions during the year 311 268 Table 32.—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 handicapped register at end of year Born in 1969 Born in 1968 Born in 1964-7 Total 2,220 2,557 3,432 8,209 2,195 43,486 16,301 385 1968 I 8,218 2,122 42,669 19,406 *830 *Oberservation ("at risk") register discontinued Table 33.—Health Visiting Cases visited by Health Visitors Number of cases 1 Children born in 1969 2,534 2 Children born in 1968 2,308 3 Children born in 1964-67 5,129 4 Total number of children in lines 1-3 9,971 5 Persons aged 65 or over 721 6 Number included in line 5 who were visited at the special request of a G.P. or hospital 462 7 Mentally disordered persons 65 8 Number included in line 7 who were visited at the special request of aG.P.or hospital 41 9 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 127 10 Number included in line 9 who were visited at the special request of a G. P. or hospital 103 11 Number of tuberculous households visited 56 12 Number of households visited on account of other infectious diseases 41 13 All other cases 2,350 14 Number of tuberculous households visited by tuberculosis visitors 1,264 84 Table 34.—Vaccination of Persons under age 16 completed during 1969 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 1969 1968 1967 1966 1962-65 At Clinics By G.P.s 1. Quadruple D.T.P.Po — - - - - - - - - 2. Triple D.T.P 417 1,158 78 22 41 1 1,717 1,609 108 3. Diphtheria/Pertussis — — — — - - - - - 4. Diphtheria/Tetanus 3 39 7 14 163 92 318 294 24 5. Diphtheria — — — — - - - - - 6. Pertussis — — — - - - - - - 7. Tetanus — 1 — - 5 42 48 32 16 8. Salk — — — - - - - - - 9. Sabin 399 1,160 115 50 217 120 2,061 1,905 156 10. Measles — 356 333 122 160 8 979 864 115 Lines 1+2 + 3+4 + 5 (Diphtheria) 420 1,197 85 36 204 93 2,035 1,903 132 Lines 1+2+3 + 6 (Whooping cough) 417 1,158 78 22 41 1 1,717 1,609 108 Lines 1+2+4- 7 (Tetanus) 420 1,198 85 36 209 135 2,083 1,935 148 Lines 1+8+9 (Polio) 399 1,160 115 50 217 120 2,061 1,905 156 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 1969 1968 1967 1966 1962-65 At Clinics By G.P.s 1. Quadruple D.T.P.Po. - - - - - - - - - 2. Triple D.T.P — 785 554 38 85 - 1,462 1,371 91 3. Diphtheria/Pertussis — — — — - - - - - 4. Diphtheria/Tetanus — 45 68 52 1,171 510 1,846 1,714 132 5. Diphtheria — — 1 - 16 18 35 34 1 6. Pertussis — — — — - - - - - 7. Tetanus — — — 1 4 21 26 2 24 8. Salk - - - - - - - - - 9. Sabin — 681 126 37 1,198 379 2,421 2,200 221 Lines 1+2+3+4+5 (Diphtheria) - 830 623 90 1,272 528 3,343 3,119 224 Lines 1 2 3 6 (Whooping Cough). — 785 554 38 85 — 1,462 1,371 91 Lines 1+2+4+7 (Tetanus) — 830 622 91 1,260 531 3,334 3,087 247 Lines 1+8 + 9 (Polio) - 681 126 37 1,198 379 2,421 2,200 221 D = Diphtheria Po= Poliomyelitis T =Tetanus Salk = Poliomyelitis vaccine P = Pertussis (Whooping cough) Sabin = Poliomyelitis vaccine (oral) Table 35.—Smallpox Vaccination of Persons aged under 16 Age at date of Vaccination Number vaccinated Number Revaccinated 1969 1968 1969 1968 0-2 months - 3 - - 3-5 months 4 8 — — 6-8 months 16 10 — — 9-11 months 25 27 1 — 1 year 794 806 3 — 2-4 years 334 392 17 21 5-15 years 38 39 93 98 TOTAL 1,211 1,285 114 119 85 Table 36.—Home Nursing 1969 1968 Total number of persons nursed during the year 3,319 3,217 Number of persons who were aged under 5 at first visit in year 196 207 Number of persons who were aged 65 or over at first visit in year 2,264 2,097 Table 37.—Domiciliary Midwifery Domiciliary Midwives employed by Administrative and Supervisory Staff District Nurses/Midwives Whole-time (1) Part-time (2) Whole-time equivalent of (2) (3) Whole-time (4) Part-time (5) Whole-time equivalent of (5) (6) City Council — 3 0.35 — 3 2.5 Hospital Management Committee or Board of Governors — — — 3 — — Number of Midwives approved as teachers included in above OTHER MIDWIVES (not included in Table above) Number practising in the City Council's area (excluding those in N.H.S. Hospitals) 34 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 Wholly on the district Number in training at end of year Partly on the district 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 1969 4 54 58 216 1968 2 102 104 226 86 Table 38.—Chiropody Service A. Number of persons treated By City Council By City of Westminster Old People's Welfare Association Total 1969 1968 1969 1968 1969 1968 *Persons aged 65 and over 2,042 1,358 2,004 2,438 4,406 3,796 Expectant mothers 6 3 8 — 14 3 Others 135 129 — — 135 129 Total 2,183 1,490 2,012 2,438 4,195 3,928 * Includes women over 60. B. Number of treatments given By City Council By City of Westminster Old People's Welfare Association Total 1969 1968 1969 1968 1969 1968 In clinics 8,035 7,019 3,625 4,013 11,660 11,032 In patients' homes 1,035 590 3,708 3,697 4,743 4,287 In old peoples' homes 1,128 — 199 19 1,327 19 In chiropodists' surgeries 7 — 3,429 2,870 3,436 2,870 Total 10,205 7 609 10,961 10,599 21,166 18,208 Table 39.—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 1969 1968 Paddington 475 - 66 8 9 85 643 594 St. Marylebone 360 - 34 4 7 28 433 406 Westminster 431 1 27 — 16 73 548 577 Total 1,266 1 127 12 32 186 1,624 1,577 B. Number of cases in which help was given during the year Paddington 1,083 2 115 10 2 53 1,265 1,234 St. Marylebone 517 — 50 1 — 15 583 578 Westminster 841 7 49 — 7 58 962 986 Total 2,441 9 214 11 9 126 2,810 2,798 C. Cases receiving service as at 31 st December, 1969 Paddington 671 1 59 6 - 12 749 803 St. Marylebone 311 — 22 1 — 1 335 322 Westminster 534 7 34 — — 15 590 607 Total 1,516 8 115 7 — 28 1,674 1,732 87 Table 40.—Mental Health Service—Number of Patients referred to City Council during year ended 31st December, 1969 Referred by Mentally III Subnormal Severely subnormal *Total Under age 16 16 and over U nder age 1 6 16 and over Under age 16 16 and over M. F. M. F. M. F. M. F. M. F. M. F. 1969 1968 (a) General practitioners - 1 29 65 - - 2 - - 1 - - 98 100 (b) Hospitals, on discharge from in-patient treatment - - 103 174 - - 4 1 - 1 - - 283 329 (c) Hospitals, after or during - - 39 58 - - - 1 - - - - 98 113 out-patient or day treatment (d) Local education authorities — — 3 3 3 4 11 7 5 5 1 1 43 46 (e) Police and courts — — 9 9 — — 4 2 — — — — 24 32 (f) Other sources — — 180 233 4 3 21 8 7 8 3 2 469 478 Total — 1 363 542 7 7 42 19 12 15 4 3 1,015 1,098 * Excludes referrals for the purpose of obtaining admission to hospital. Numbers so admitted are shown in the following table. Table 41.—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 1969 157 180 9 263 11 50 670 1968 157 168 3 219 1 35 583 Table 42.—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. 1969 1968 (a) (i) Attending workshop/day centre or training centre - - 23 23 3 6 5 4 28 12 13 21 138 104 (ii) Awaiting entry thereto — — — — — — — — 6 3 — 2 11 13 (b) (i) Receiving home training - - - - 1 - 1 1 - - - - 3 3 (ii) Awaiting home training - - - - - - - - - - - - - 2 (c) (i) Resident in L.A. home/ hostel - - 1 2 - - 5 2 - - 2 1 13 11 (ii) Awaiting residence in L.A. home/hostel - - 3 - - - 1 - - - - - 4 - (iii) Resident at L.A. expense in other residential homes/hostels - - 19 20 5 3 6 7 14 11 7 12 104 84 (iv) Resident at L.A. expense by boarding out in private household - - - - - 1 - - - - - - 1 - (d) Receiving home visits and not included under (a) to (c) — — 186 375 12 3 41 44 5 12 24 17 719 661 Total number — — 232 420 21 13 59 58 53 38 46 53 993 878 88 Table 43.—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. 1969 1968 To N.H.S. Hospitals - - - - - - - 1 2 2 1 — 6 5 Elsewhere — — — 2 1 2 — 1 23 8 6 3 46 22 Total — — — 2 1 2 — 2 25 10 7 3 52 27 Table 44.—Terrace Day Centre—1969 (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 attendance Half-day session 1969 1453 1968 (1272) 1317 (1097) 1343 (1213) 1396 (1388) 1353 (1497) 1348 (1128) 1456 (1347) 1393 (1343) 1370 (1314) 1726 (1416) 1627 (1227) 1692 (1218) Average attendance 31 1/2 (27 3/4) 33 (26) 32 (28) 34 (35) 32 (33) 32 (29 1/2) 32 (29) 34 (30 1/2) 33 (33) 37 1/2 (31) 41 (29) 42 (30 1/2) Percentage attendance 71% 67% 65% 73% 72% 65% 63% 65% 63% 70% 71 1/2% 69 1/2% Roll at beginning of month 47 (46) 46 (43) 47 (45) 51 (48) 50 (49) 45 (49) 51 (46) 54 (45) 57 (44) 57 (49) 57 (45) 60 (47) Admissions 5 (3) 8 (8) 6 (7) 7 (6) 4 (5) 9 (4) 11 (7) 6 (5) 6 (12) 13 O) 6 (7) 5 (6) Discharges 6 (6) 7 (6) 2 (4) 8 (5) 9 (5) 3 (7) 8 (8) 3 (6) 6 (7) 13 (13) 3 (5) 4 (6) To: Work 1 3 - 4 3 2 2 - 4 3 1 2 Further training 1 - - - - - - - - - 1 - Hospital 2 3 - 1 2 - 1 2 1 3 - 1 Non-co-operation 1 - - 3 3 - 4 - - 4 - - Moved away - 1 1 - 1 1 1 - - - - 1 Home 1 - - - - - - - - - - - Not suitable - - 1 - - - - 1 1 2 - - Relieved - - - - - - - - - 1 1 - Patients referred and interviewed but did not attend for admission 1 3 5 1 2 - 2 - - - 1 - Patients offered interview 2 3 3 - 1 2 2 - - - - 2 89 Table 45.—Venereal Diseases Cases treated in Westminster — 1st January-31st December, 1969. Hospital M. F. Total 1969 Total 1968 Middlesex Hospital, W.I. Syphilis 105 28 133 218 Gonorrhoea 1,450 559 2,009 2,031 Other conditions 5,337 3,476 8,813 7,509 6,892 4,063 10,955 10,368 St. George's Hospital, S.W.1 Syphilis 32 8 40 56 Gonorrhoea 392 81 473 463 Other conditions 1,569 897 2,466 2,373 1,993 986 2,979 2,892 St. Mary's Hospital, W.2. Syphilis 268 34 302 361 Gonorrhoea 3,603 586 4,189 3,513 Other conditions 9,243 4,131 13,374 11,593 13,114 4,751 17,865 15,467 Westminster Hospital, S.W.1. Syphilis 16 13 29 50 Gonorrhoea 383 94 477 349 Other conditions 1,246 779 2,025 1,495 1,645 886 2,531 1,894 Vernereal Diseases - Contact Notifications Number of notifications received from American Forces, from abroad (through Department of Health & Social Security) and from other Local Authorities 142 (142) Number traced and treated 82 58% (70 (49.3%)) 90 Table 46.—Medical Suite at City Hall: Work Undertaken 1969 1968 Medical Questionnaires returned for scrutiny 1,303 1,280 Persons leaving the City Council's service 1,023 1,203 Medical Examinations of Staff (special categories) 96 154 Interviews and examinations re medical questionnaires 89 120 Examinations—extended sick leave 77 58 „ —parking meter exemptions 121 208 „ —retirement on grounds of ill health 31 24 Advice or First Aid 766 823 Referrals to general practitioner or hospital 62 68 F.F.I, examinations 26 22 B.C.G. vaccinations Nil 98 Tetanus immunisations 26 37 Vaccinations—Smallpox 95 148 Vaccinations—Influenza 15 — Table 47.—School Health Service The table below shows the grades and numbers (full.time equivalents as at 31 December, 1969) 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, 1969 IN: City of Westminster Inner London Education Authority 1969 Inner London Education Authority 1968 Medical—M.O's. & G.P's. (excluding for the boroughs centrally.directed Consultants and Specialists) 5.30 9300 90.21 Nursing (all categories of staff) 14.70 268.70 259.02 Speech Therapists (centrally.directed) 100 29.50 26.20 Social Workers 5.30 62.10 54.59 Physiotherapists — 17.60 16.30 Remedial Gymnasts — 100 1.00 Occupational Therapist — 1.00 1.00 Dental Officers 5.50 81.10 78.75 Dental Auxiliaries — 10.47 8.51 Dental Surgery Assistants 500 90.59 85.57 Dental Technicians — 8.40 4.70 Dental Health Education Officers - 1.00 1.00 91 Table 48.—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 1969 1968 (i) Number of skin tested 472 476 (ii) Number found positive 276 238 (iii) Number found negative 196 238 (iv) Number vaccinated 149 163 B. School Children and Students (i) Number of skin tested 1,574 4,174 (ii) Number found positive 181 1,955 (iii) Number found negative 1,146 2,219 (iv) Number vaccinated 1,146 1,809 Table 49.—School Medical Inspections (excluding Dental and Health Surveys)—1969 City of Westminster Inner London Education Authority 1969 1968 SCHOOL ROLL - MAY 1969 21,766 421,925 418,280 ROUTINE INSPECTIONS Number inspected 8,120 159,217 157,376 Number found not to warrant examination (7 plus special scheme) 41 604 1,060 PERCENTAGE OF No. INSPECTED OF:- Parent present 46.7 53.1 51.8 Care Committee present 78.9 70.7 74.6 No. vaccinated against smallpox 73.8 71.7 720 No. immunised against diphtheria 89.2 88.1 87.3 No. immunised against whooping cough 870 81.2 79.7 No. vaccinated against poliomyelitis 89.2 87.6 86.1 Physical condition unsatisfactory 0.4 0.4 0.4 Referred for treatment of defects 11.3 14.7 13.8 Referred for treatment of defects other than vision 5.8 7.3 7.1 NON.ROUTINE INSPECTIONS (i) Specials 2,182 48,050 49,696 (ii) Re.inspections 4,050 69,448 71,920 Total (i) and (ii) 6,232 117,498 121,616 No. of routine inspections as percentage of school roll 37.5 37.8 37.6 No. of non.routine inspections as percentage of school roll 28.6 27.8 29.1 92 Table 50.—Routine Medical Inspections 1969—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 1969 1968 8,120 159,217 157,376 DEFECTS ‡ SKIN T 7.27 9.65 8.81 0 18.84 12.61 11.25 EYES (a) Vision T 54.43 73.56 72.77 0 71.55 55.09 52.16 (b) Squint T 7.27 8.62 8.21 0 8.62 5.61 4.71 (c) Other T 1.35 1.43 1.68 0 3.08 2.54 2.75 EARS (a) Hearing T 4.43 6.35 5.76 0 9.85 7.90 7.18 (b) Otitis Media T 1.60 1 .71 1.66 0 4.93 3.98 3.91 (c) Other T 0.49 0.80 0.57 0 0.86 0.96 0.93 NOSE AND THROAT T 3.94 5.41 5.55 0 25.99 27.03 26.92 SPEECH T 4.19 4.55 4.07 0 7.64 7.81 6.99 LYMPHATIC GLANDS T 0.25 0.61 0.58 0 10.34 8.22 7.69 HEART 'Congenital T *0.49 †0.62 *1.58 †0.52 2.48 t Acquired 0 *4.06 †3.82 *5.98 †2.70 8.39 LUNGS T 4.19 5.28 5.41 0 12.57 12.86 11.74 DEVELOPMENT (a) Hernia T 1.23 1.09 1.12 0 3.45 3.25 2.86 (b) Other T 2.71 1.43 1.34 0 9.36 6.56 5.58 ORTHOPAEDIC (a) Posture T 0.74 0.79 0.97 0 6.16 4.72 4.77 (b) Feet T 2.96 3.68 3.37 0 10.34 13.98 14.96 (c) Other T 2.22 2.09 2.06 0 9.36 4.83 5.08 NERVOUS SYSTEM (a) Epilepsy T 1.11 1.63 1.46 0 2.71 1.53 1.41 (b) Other T 0.25 0.52 0.72 0 3.20 1.71 1.66 PSYCHOLOGICAL (a) Development T 1.23 1.64 1.49 0 11.70 6.17 5.36 (b) Stability T 2.96 2 52 2.40 0 16.50 11.81 10.83 ABDOMEN T 0.86 0.52 0.37 0 5.42 1.64 1.24 OTHER T 12.19 17.72 17.34 0 33.61 38.13 35.65 ‡T = Treatment 0 = Observation 93 Table 51.—School Health Service—Findings at Health Surveys 1969 SCHOOL ROLL—May 1969 City of Westminster Inner London Education Authority 21,766 1969 421,925 1968 418,280 1. Comprehensive Surveys (a) Number examined 17,790 290,878 285,917 (b) Number (occasions) found verminous 133 2,945 3,105 (c) Percentage found verminous 0.75 1.01 1.09 2. Selective Surveys (a) Number examined 6,826 130,756 116,716 (b) Number (occasions) found verminous 465 3,763 2,712 (c) Percentage found verminous 6,81 2,88 2.32 3. (a) Total times vermin found (1 (b) + 2 (b)) 598 6,708 5,817 (b) Total percentage found verminous (3 (a) as percentage of 1 (a) + 2 (a)) 2.43 1.59 1.44 (c) Number of individual pupils found verminous 243 5,062 4,372 (d) Percentage of individual pupils found verminous (of school roll) 1.12 1.20 1.05 4. Action taken with verminous cases (a) Advice and/or Lorexane 534 5,675 5,001 (b) Further action 64 1,033 816 (c) 4 (b) expressed as a percentage of 4 (a) 12.00 18.20 16.32 Analysis of 4 (b) cases—referrals of hardcore cases to bathing centres — — — Voluntary attendance at bathing centres Number of pupils 18 863 750 Number of Statutory notices issued — 15 3 Number cleansed at centres following statutory notices Voluntarily - 15 3 Compulsorily - — — 5. Communicable disease surveys Number examined for: Athlete's foot 392 23,531 31,342 Plantar Warts 393 Dysentery — 1,811 3,000 Other communicable diseases 989 20,056 34,067 Total of (5) 1,774 45,398 68,409 94 Table 52.—School Health Service—Non-Routine Medical Inspections 1969 Type of Inspection City of Westminster Inner London Education Authority 1969 1968 Re-inspections 4,050 69,448 71,920 Bathing Centre Inspections—Scabies - 55 38 Bathing Centre Inspections—Other 7 130 71 Employment certificates 256 3,901 4,971 Theatre children — 442 293 School Journeys 874 22,869 22,286 Recuperative holidays—pre-departure 89 982 908 Recuperative holidays—on return — — 8 Secondary school annual surveys 395 681 1,554 Candidates for higher awards — 114 84 Nautical school entrants — 15 62 Outward bound courses 9 138 125 Infectious disease investigation 1 158 44 T.B. contacts — 12 5 Boarding Schools for the delicate pre-departure 1 196 192 Boarding Schools for the delicate on return 1 98 37 Handicapped Pupils—Statutory examination 123 2,048 2,394 Handicapped Pupils—Periodic special defect examination 23 5,603 5,782 Research investigations and enquiries 4 168 46 Sub-Total 1,783 37,610 38,900 SPECIALS—At request of: Head Teacher—Child's name entered in special book 29 1,541 1,517 Head Teacher—Others 60 3,297 3,438 School Nurse following health survey 51 579 742 School Nurse—Others 65 855 1,063 Divisional Education Officer 34 772 759 District Care Organiser or Care Committee 14 295 305 Parent 48 1,077 1,160 School Medical Officer 54 1,647 1,381 Sub-Total 355 10,063 10,365 Other—Accident on School premises - 38 44 Boxing—Reference from schools A.B.A. — 25 — or similar association for free travel — 1 64 Reference: (i) connected with remedial exercises foot classes 35 126 59 (ii) by gymnast or physiotherapist Referred by hospital — 5 5 Referred by speech therapist — 3 3 Referred by general practitioner 1 2 5 Miscellaneous 8 177 251 Sub-Total 44 377 431 Total of all Non-Routine Medical Inspections 6,232 117,498 121,616 95 Table 53.—School Health Service—Routine Medical Inspections 1969—Vision Number Tested PERCENTAGE OF NUMBER TESTED Percentage of total number tested and noted for treatment A—Not Wearing Glasses B—Wearing Glasses 6/6 6/9 6/12 or worse Noted for Treatment 6/6 6/9 6/12 or worse Noted for Treatment Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys and Girls City of Westminster 3,955 3,408 76.6 76.2 8.3 10.0 6.0 5.5 3.9 4.8 4.3 4.1 2.6 2.3 2.2 1.8 1.0 2.5 6.0 I.L.E.A. 1969 71,571 69.361 82.5 80.6 6.0 6.7 4.9 5.0 4.4 5.0 3.4 3.9 1.6 2.0 1.6 1.8 3.0 4.3 8.3 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 96 Table 54.—School Health Service Comparison of Defects noted at 7.Plus Routine and 7.Plus "Special" Medical Inspections in 1969 Number of Children Noted for Treatment and Observation expressed as a rate per 1,000 inspected City of Westminster Inner London Education Authority 1969 1968 Number inspected at 7.plus routine inspections 1,492 37,692 36,657 Number inspected at 7.plus experimental scheme inspections 51 1,421 2,160 Defects * A † B * A † B * A † B Skin 27.4 39.2 23.2 20.4 20.3 19.0 Eyes— Vision 152.8 196.1 137.3 147.0 135.5 138.9 Squint 12.7 19.6 15.5 11.3 14.7 11.1 Other 4.7 — 2.8 5.6 4.0 3.7 Ears— Hearing 28.1 19.6 19.0 23.2 16.9 17.6 Otitis media 11.4 — 5.9 7.7 5.7 11.6 Other 1.3 — 2.0 2.1 1.3 3.2 Nose and throat 32.2 — 37.6 37.2 36.3 32.4 Speech 13.4 — 12.3 12.7 11.3 9.7 Lymphatic Glands 16.0 — 9 8 17.6 9.3 21.8 Heart 9.3 — 11.0 12.7 11.0 11.1 Lungs 24.5 — 18.4 28.8 18.8 22.3 Developmental—Hernia 4.0 19.6 4.9 2.8 4.5 3.2 Other 10.7 19.6 10.5 4.2 8.3 6.0 Orthopaedic— Posture 7.3 - 5.7 4.2 4.7 7.4 Feet 12.0 — 17.8 14.8 17.3 15.3 Other 11.3 — 6.2 5.6 6.2 8.3 Nervous System— Epilepsy 6.0 - 3.2 2.8 3.1 3.2 Other 4.0 — 2 4 1.4 2.5 1.9 Psychological— Development 16.7 39.2 10.1 21 .1 9.1 16.2 Stability 27.5 39.2 17.3 27.4 16.2 17.6 Abdomen 6.0 — 2.1 .7 1.6 — Other 67.0 78.4 63.4 92.9 59.3 82.9 * Column 'A' refers to 7-plus routine medical inspections, † Column 'B' refers to 7-plus experimental scheme inspections. 97 Table 55.—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 1969 1968 1969 1968 First Visit 317 347 59 61 Subsequent Visits 351 378 101 97 Total Visits 668 725 160 158 Number of Additional Courses of Treatment other than the First Course commenced during year 43 24 8 3 Treatment provided during the year— Number of Fillings 867 779 190 227 Teeth Filled 546 597 115 145 Teeth Extracted 39 62 12 12 General Anaesthetics Given 15 35 3 2 Emergency Visits by Patients 43 16 21 11 Patients X-rayed 2 2 5 14 Patients Treated by Scaling and/or Removal of Stains from the Teeth (Prophylaxis) 193 150 84 57 Teeth Otherwise Conserved 126 132 — — Teeth Root Filled - - 5 6 Inlays - - - Crowns - - 1 1 Number of Courses of Treatment completed during the year 200 184 40 31 Part B.—Prosthetics 1969 1968 Patients supplied with F.U. or F.L. (first time) 2 1 Patients supplied with other Dentures — — Number of Dentures supplied 4 3 Part C.—Anaesthetics 1969 1968 General Anaesthetics administered by Dental Officers — — Part D.—Inspections Children 0-4 (incl.) Expectant and Nursing Mothers 1969 1968 1969 1968 Number of Patients given First Inspections during year (a) 274 (a) 221 (d) 54 (d) 24 Number of Patients in (a) and (d) above who required Treatment (b) 217 (b) 196 (e) 49 (e) 23 Number of Patients in (b) and (e) above who were offered Treatment (c) 214 (c) 196 (f) 49 (f) 22 Part E.—Sessions Number of Dental Officer Sessions (i.e. Equivalent complete half-days) devoted to Maternity and Child Welfare Patients— 1969 1968 For Treatment 94 167 For Health Education 11 — 98 Table 56.—School Dental Service Statistics 1969 (Statistics, 1968 shown in brackets) NUMBER OF SESSIONS Inspection Ordinary treatment Anaesthetic 91 (113) 2034 (1,934) 41 (47) Total no. of sessions: 2,166 (2,094) INSPECTIONS First inspection at school First inspection at clinic Percentage found to require treatment 8,098 (8,913) 3,514 (3,577) 63-5 (64-6) Re-inspection at school or clinic 960 (1,144) 80-7 (74-7) NUMBER OF VISITS FOR TREATMENT Number of 1st visits 4,208 (3,558) Number of subsequent visits 6,993 (7,468) Emergencies 404 (282) Total (including emergencies) 11,605 (11,026) FILLINGS AND EXTRACTIONS Permanent teeth Temporary teeth Fillings 5,658 (7,052) 6,709 (4,536) Extractions 322 (377) 1,382 (1,726) Other operations (prophylaxis. X-ray, inlays, crowns, etc.) 4,638 (4,117) Number of dentists employed (effective whole time equivalent) 5-9 (4) 99 Table 57.—Tuberculosis—Care and After Care Paddington Chest Clinic Marylebone Chest Clinic Westminster Hospital Chest Clinic 1969 1968 1969 1968 1969 1968 T.B. patients on Register of Chest Clinics at 31st December 623 694 441 465 950 909 T.B. Visitors—Visits to homes 2,582 1,833 1,008 918 — — After-Care Work (Social Worker): Number of patients in receipt of extra nourishment at end of year 7 9 8 9 14 11 Patients assisted for the first time with bed or bedding 8 5 1 — - - Patients assisted for the first time with clothing or footwear 25 34 2 - - - B.C.G. Vaccinations during the year in accordance with City Council scheme 105 108 21 24 23 31 Rehabilitation Hostels: Patients in residence at end of year — — — - 2 3 Hostels for Homeless tuberculous men: Patients in residence at end of year — — — — 20 16 Child contacts boarded out during the year — — — — — — 100 INDEX Page Accidental Deaths 12 Acute Poliomyelitis 13 After Hours Emergency Telephone Service 15,70 Analysis of Calls made to Duty Officer 70 Animals, Slaughter of 34 Area of the City 11 Artificial Kidney Machine 59 Assessment of Children 41 At Risk Register 41 Attachment of Health Visitors to Medical Practitioners 45 Attendances at M . and C.W. Clinics 83 Basement Bakehouses 27 Bathing Service for Old People 35,45 BCG Vaccination 91 Betting Shops 36 Births 11,12 Blind and Partially Sighted Persons 57 Brucella Abortus, Milk Supplies 31 Burial or Cremation of the Dead 36 Catering Premises and Food Shops, Inspection 27 Certificates of Disrepair 21 Cervical Cytology 60 Chest Clinics 63,99 Child Minders 42,43 Children under five years, Day Care of 41 Child Welfare Centres 80 Chiropody Service 59,86 City of Westminster District Nursing Association 57,58 Clean Air 19 Committees, Appointment of Members of Social Services Committee to 6 Common Lodging Houses 23 Consumer Protection 33 Control Orders, Houses let in Multiple Occupation 21 Co-ordination 51 Coroner's Court and Mortuary 36,79 Cremation, Work of Medical Referee 37 Day Care of Children under five years 41 Day Nursery Service 43 Deaths 11,12 Deaths, Accidental 12 Deaths, Causes of, According to Age Group and Sex 66 Deaths, Infant Mortality 39,67 Deep Wells 26 Dental Services 62 Diphtheria 13 Diseases of Animals Act 1950, and other Acts relating to Animals 34 Disinfection 24 Disinfestation, Insect Pest Control 24 Disposable Incontinence Pads 35 Disposal of Unsound or Unsaleable Food 32 Disrepair, Certificates of 21 District Inspection, Public Health Inspectors 18 District Nursing Association 58 Domestic Rateable Hereditaments 11 Domiciliary Midwifery 58,85 Drainage and New Developments 19 Duty Officer, Calls made to 70 Dwelling Houses 19,70 Dwelling Houses, Inspections 70 Page Dwelling Houses, Nuisances and Unsatisfactory Conditions 70 Dysentery 13 Elderley Persons, Survey of 47 Emergency Telephone Service 15 Environmental Health Services 18 Establishments for Massage or Special Treatment 35 Eviction, Unlawful, Harassment and Provision of Rent Books 21 Export Certificates 33 Factories 26 Factories, Inspections 76 Factories, Defects 76 Family Planning 39 Food and Drugs Act 1955—Section 16 31 Food Hygiene, etc., Lectures 29 Food, Legal Proceedings 79 Food Poisoning 31,78 Food Premises, Legal Proceedings 31,79 Food Premises, Number of 77 Food Premises, Registration of 78 Food Sampling and Analysis 30 Food Shops and Catering Premises, Inspection 27,77 Food, Unsound or Unsaleable, Disposal of 32 Grants and Loans 23 Handicap Register 41 Handicapped Children, Pre-School Assessment, Clinics for 41 Harassment, Unlawful Eviction and Provision of Rent Books 21 Health Centre, Lisson Green 47 Health Committee 6 Health Department, Premises 10 Health Education 56 Health Visitors, Attachment to Medical Practitioners 45 Health Visitors, Students 45 Health Visitors, Work of 45,83 Home Dialysis 59 Home Help Service 48,86 Home Nursing 57,85 Home Nursing Equipment, Loan of 58 Houses in Multiple Occupation, Management Orders and directions 21 Houses in Multiple Occupation, Control Orders 21 Houses, Unfit 21 Housing Act, 1969 21 Housing Acts 1957-1969, Inspectorate 20 Housing Acts, Visits by Public Health Inspectors 71 Housing Acts 1957-1964, Work Carried out by Inspectors 71,72 Housing Priority on Medical Grounds 21 Imported Food Regulations, 1968 32 Immunisation and Vaccination 47 Improvement grants 22 Incontinence Pads 35 Infant Deaths 12 Infant Mortality 12,67 Infectious and Other Notifiable Diseases 13,68 Infective Jaundice 13,68 Insect Pest Control, Disinfestation 24 101 Page Inspection of Dwelling Houses 70 International Certificates of Vaccination and Inoculation 14 Introduction 3 Laundry Service, Special 35 Legal Proceedings 19,79 Legal Proceedings, Food and Food Premises 79 Licensing Act 1964 28 Liquid Egg (Pasteurisation) Regulations 1963 32 Lisson Green Development 47 Loan of Home Nursing Equipment 58 Loans and Grants 23 Local Land Charges 24 Lodging Houses, Common 23 Management Orders, and Directions—Houses in Multiple Occupation 21 Mass X-ray 14 Massage and Special Treatment Centres 35 Maternal and Child Welfare Centres 80 Maternal Mortality 12,40 Measles 13,68 Medical Referee, Work of 37 Mental Health 51 Mental Health, Approval of Medical Practitioners 54 Mental Health, Community Care 52,87 Mental Health, Patients referred in 1969 52,87 Mental Health, Services 51 Mental Health, St. Jude's Hostel 52 Mental Health, Terrace Day Centre 52,54,88 Mental Health, Training Centres 51 Midwifery 85 Milk and Dairies (General) Regulations, 1959 31 Milk, Dealers' Licences 31 Milk (Special Designation) Regulations, 1963 31 Milk Supplies, Brucella Abortus 31 Mobile Health Clinic 48 National Assistance Act 1948, Section 50 36 New Developments, Drainage 19 Noise 19 North Westminster Project 23 Notices 19 Notifications of Infectious Diseases 68 Nursing Homes 49 Observation Register 41 Offices, Shops and Railway Premises Act 1963 26,75 Old People, services for 46 Old Persons' Bathing Service 46 Outworkers 27,77 Overcrowding 21,73 Paediatric Home Care Unit 57 Partially Sighted and Blind Persons 57 Personal Health Services 38 Pharmacy and Poisons Acts 1933 and 1941 34 Pigeon Control 25 Play Groups and Occasional Creches 44 Poliomyelitis, Acute 13 Population 11 Poultry Processing Premises 34 Pre-school Playgroups 43 Priority on Medical Grounds, Housing 21 Private Water Supplies, Deep Wells 26 Public Health Inspectors, District Inspection 18 Public Health Inspectors, Night and Weekend Duties 18 Public Health Inspectors, Work of 18 Page Qualification Certificates 22,73 Queen's Park M & CW Clinic Replacement 48 Radioactive Substances Act 1960 24 Rag Flock and Other Filling Materials Act 1951 34 Rateable Value 11 Recuperative Holidays 49 Refresher Courses 16 Rent Books, Provision of 21 River Thames Flood Precautions 26 Rodent Control 24,74 Role of the Departmental Medical Officer 40 Sampling and Analysis, Food 30 Scabies 35 School Dental Service 62 School Health Service 62,90 School Health Service, Number employed in 90 School Medical Inspections, Defects found 92 School Medical Inspections, Health Surveys 93 School Medical Inspections, Non-routine Inspections 94 School Medical Inspections, Routine Medical Inspections 91,92 School Medical Inspections, Comparison of Defects found 96 School Medical Inspections, Dental Service 98 Sewerage 19 Slaughter of Animals 34 Slaughterman's Licences 34 Slum Clearance 21 Smallpox 13 Smallpox Vaccination 84 Social Services Committee 6 Social Workers (Health Service) 50 Special Laundry Service 35 Special Counselling Service, Family Planning 50 Specimens Submitted to Public Health Laboratory 69 Staff of Health Department 8 Staff Medical Service 61,90 Staff Training 16 Statistical Tables, List of 65 Statistics and Social Conditions 11 Statutory Notices served 71 Street Traders, Licensed 28 Street Traders, Unauthorised 29 Student Health Visitors 45 Student Public Health Inspectors 18 Swimming Bath Water Examination 26 Terrace Day Centre 52,54,88 Town Planning 19 Trade Descriptions Act 1968 33 Training Centres 52 Training of Staff 16 Tuberculin Test and B.C.G. Vaccination 91 Tuberculosis, Care and After Care 14,99 Tuberculosis, New Cases and Deaths 13,69 Typhoid Fever 13 Unauthorised Street Traders 29 Unfit Premises 72 Unlawful Eviction, Harassment and Provision of Rent Books 21 Unsound or Unsaleable Food, Disposal of 32 Urban Programme 45 Vaccination against Smallpox 84 Vaccination and Immunisation 47 Vaccination and Inoculation, International Certificates of 14 102 Page Vaccinations performed 84 Vending Machines 34 Venereal Diseases 55,89 Verminous Persons 35 Visitors to the Department 15 Voluntary child minders 42 Page Water 25 Water, Bacteriological Examination 75 Water, Chemical Examination 74 Water Supplies, Private Deep Wells 26 Whooping Cough 14 Youth Advisory Service 50 VAIL & CO. LTD . LEEKE STREET. LONDON. W.C. † (V