AC 43399 WES 80 City of Westminster THE HEALTH OF WESTMINSTER 1970 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 15 Personal Health Services 36 School Health 59 Dental Service 60 Chest Clinics 61 Appendices of Statistical Tables 62 Index 98 J. H. Briscoe-Smith, M.B., Ch.B., D.P.H., Medical Officer of Health and Principal School Medical Officer (Inner London Education Authority) 1970 3 CITY OF WESTMINSTER Telephone: 01 -828 8070 Health Department, 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 1970. Once again opportunity has been taken to include comparable statistics of the previous year; they appear in the text in parentheses or elsewhere in a separate column. In my introduction to last year's report I foreshadowed the establishment of the Social Services Department with the consequent transfer of some social work functions. On 1 st April, 1971, the new department came into being and already in these early days excellent relations have been established. In the field of mental health strong links have been retained. The Consultant Psychiatrist employed in the Health Department has direct access to both the Medical Officer of Health and the Director of Social Services and has a good working relationship with the social workers. His help is sought in respect of individual cases, in fostering liaison with general practitioners and hospitals; the seminars he conducts are contributing materially to the training of area teams, many of whose members have not previously worked with the mentally ill. In the field of mental subnormality, a Principal Medical Officer plays a similar advisory role. The Health Department has been fortunate in being able to retain the services of a Principal Social Worker who acts as liaison officer between the two Departments and who will continue to act as secretary to an informal co-ordinating committee at which matters of mutual concern are discussed. The Health Department is thus maintaining an active partnership in the services transferred and is receiving in return willing and active co-operation from the Director of Social Services and his staff. The greatest danger facing the community health services at the present time is the "planning blight" which might be engendered by the Government's proposals to reorganise the health services in 1974. There must be no tendency to "mark time" or to "wait and see". There is much to be done to improve both the environmental and the personal community health services, and the shedding of some social work should make it possible to concentrate more intensely on developments in these areas. It has been noticeable that, far from there being any slowing-down in the Health Department following the transfer of services, there has been a marked increase in tempo since we are now concerned only with the provision of health services. In the care of mothers and young children, a recent innovation has been the extension of developmental paediatrics; in vaccination and immunisation our efforts have hitherto been directed towards the protection of the person immunised—with rubella vaccination our efforts are directed to protecting the unborn child. In health visiting and home nursing, here also roles are changing. Health visitors now take a more active part in the detection and visiting of the elderly who may need social care. Both health visitors and nurses are increasingly being attached to general practitioners so that they may work under their direction with the patients of the practices concerned. District nurses are considerably helped in their work by the use of bathing attendants and the provision of sophisticated nursing equipment, through the City Council's medical loan section, such as electric hoists, ripple mattresses and adjustable beds. The items available are constantly reviewed and added to as new or better models become available. 4 An interesting aspect of the work of the district nurses is the paediatric home care unit provided by St. Mary's Hospital, which is staffed jointly by the hospital and the City Council's Health Department, which enables many children to be treated in their own homes who would otherwise have to be admitted to hospital. With regard to home dialysis, the City Council has fully accepted its responsibility to adapt the homes of those suffering from renal disease for whom kidney machines are provided, and to help them by providing nursing assistance or advice as may be necessary. In the field of family planning, the City Council is constantly expanding its service, and as an adjunct to this has established a youth counselling service which has already proved valuable and is being further developed. So far as screening services are concerned, the City Council already provides a service for women for the detection of possible malignancy of the cervix and breast and which incidentally is instrumental in detecting many other unsuspected infections and abnormalities for which treatment is necessary. A mobile health clinic will shortly come into operation which will be used for a variety of purposes and, it is hoped, will play a part in extending the screening services to include perhaps such conditions as diabetes, hypertension, cardiac disease, glaucoma and visual acuity. A comprehensive plan has been drawn up for the future provision of health centres which will be one of the principal means of bringing together the general practitioner and other community health services under one roof and so facilitate their integration. These, then, are the ways in which it is envisaged the health services will develop over the next few years. The Health Department was formed in 1965 following a major operation. Minor surgery was undertaken in 1971 when certain services were amputated. A major transplant is now scheduled to take place in April, 1974. I am confident that the patient will again not only make a complete recovery but will continue to prosper—and, indeed, may even in the future be in better health. To turn now to the body of the Report, the vital statistics are set out on page 11. From these it will be seen that there has been a continued decline in the number of births, associated with a general fall in population and perhaps partly due to the extensive family planning service available in Westminster. An adjusted birth rate of 8.72 compared with 16.0 for England and Wales is significant and indeed is the lowest in the country. The illegitimate birth rate (17.43%) is marginally lower than in 1969 (17.63%) but is regrettable when compared with the national average of 8%. However, the illegitimate infant mortality rate in 1970 was reduced to 26.97 compared with a national average of 26. The stillbirth rate of 8.96, compared with 13.0 for England and Wales is perhaps a reflection of the excellent facilities for ante natal care and delivery provided in Westminster, and the fact that over 98% of births take place in fully equipped maternity units. It is unfortunate that as might be expected, this is counter-balanced to some extent by a relatively high neo-natal death rate, 15.91 compared with 12 for England and Wales, resulting in a perinatal death rate of 23.30 which is comparable with the national average. Out of 58 deaths of infants under one year, 42 were certainly associated with prenatally determined factors which in the present state of our knowledge are not preventable. There is, however, no justification for complacency and every death is investigated to discover whether there were avoidable factors. On page 39 the circumstances surrounding a number of these deaths are discussed and attention is drawn to the tragic death of a baby who developed eczema vaccinatum following re-vaccination of the mother. These matters are dealt with in detail in the Report, and I would direct attention particularly to the introduction to the Personal Health Services section set out on page 36, and the ensuing section on the Handicap Register (page 39). 5 So far as staff matters are concerned, there was a marked improvement in the recruitment of public health inspectors, although some difficulties in recruiting were again experienced in some other sections of the department. Theyear 1 970 saw the retirement of four members of the department's staff—Dr. H. S. M. Hadaway, senior medical officer who had formerly been Deputy Medical Officer of Health to the Paddington Borough Council; Mrs. M. Vaughan, Centre Superintendent of the City Council's largest M. & C. W. Centre in Harrow Road; Mr. W. H. Smith, senior administrative assistant; and Mrs. F. H. Rhodes, inspector of massage and other establishments. All these officers had given long and faithful service to the City Council and its predecessors and we wished them well in their retirement, which we hope will be a long, happy and healthy one. The Department also lost the services of one of the Deputy Medical Officers of Health, Dr. H. E. A. Carson having been appointed as Medical Officer of Health to the London Borough of Wandsworth. Prior to the reorganisation in 1965, Dr. Carson had been Medical Officer of Health to the St. Marylebone Borough Council and although we were sorry to see him go, all the members of the staff were pleased at his well-deserved re-appointment as a medical officer of health. 1 I record with regret the deaths of two members of the department's staff—Mr. R. E. Kean, the City Council's Chief Dental Officer who died in April, 1970, and to whom I referred in my last Annual Report; and Mr. L. G. Francis, a senior public health inspector who died in February, 1970. I have made reference earlier in this introduction to the transfer of certain functions from the Health Department to the newly formed Social Services Department in April, 1971. The services transferred were the social work aspects of mental health, day care of children and home help, and the social work services connected with unsupported mothers and family case work. All these services are referred to in the pages which follow and the premises concerned are listed on page 10, but they are now the responsibility of the Director of Social Services. Finally, it is with real pleasure that I again record my appreciation of the support and encouragement I have continued to receive from all Members of the Council, and in particular from Members of the Health and Social Services Committees. I am also grateful to the Chief Officers and members of the staff of the other Departments for their co-operation and assistance throughout the year; and especially the members of my own staff who have given loyal and efficient service without which the City Council's health services could not have been carried on. J. H. BRISCOE-SMITH Medical Officer of Health and Principal School Medical Officer July, 1971 6 HEALTH COMMITTEE (from July 1970) SOCIAL SERVICES COMMITTEE THE LORD MAYOR (ex-officio): Councillor B. Fitzgerald-Moore THE DEPUTY LORD MAYOR (ex-officio): Councillor A. W. Ramsay, M.A., J.P. CHAIRMAN: Councillor M. V. Keynon, M.A., J.P. VICE-CHAIRMAN: Councillor Dr. Brian Warren MEMBERS: Councillor The Countess Beatty Councillor Mrs. Rachel Trixie Gardner, B.D.S., G.L.C. Councillor Mrs. I. L. Bolton, J.P. Councillor Dr. L. Jacobs Councillor Mrs. Barbara Bowles Councillor Max Taylor (to September 1970) Councillor Mrs Mary Castle Councillor Miss Alison Tennant (from September 1970) Councillor Mrs. P. L. Veendam Councillor A. J. Eager Councillor Mrs. Brian Warren CO-OPTED MEMBERS: Miss Barbara Daniels, M.B.E. The Hon. Mrs. Trevor Rose, C.B.E. Mrs. R.T. Glenny Mr. J. G. Spriggs Mr. R.H.Rollins Lady Walton, M. A. Members of the Health and Social Services Committees were appointed to: Chrisitan Union Almshouses Councillor Miss Barbara Bowles City of Westminster Arts Council Councillor Dr. Brian Warren City of Westminster Old People's Welfare Association Councillor Mrs. Mary Castle Mrs. R. T. Glenny County Primary Schools - Managers Barrow, Robinsfield and George Eliot Schools Mrs. R. T. Glenny Churchill Gardens and Millbank Schools Councillor Miss Alison Tennant Hallfield and Paddington Green Schools Councillor Mrs. P. L. Veendam 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 Linnet House Special Care Committee (Mentally Handicapped Children) Councillor Miss Alison Tennant London Boroughs' Association—Social Services Committee Councillor M. V. Kenyon London Boroughs' Children's Regional Planning Committee Councillor Dr. Brian Warren (Deputy representative) London Boroughs' Training Committee (Social Services) Councillor M. V. Kenyon London (Metropolis) Licensing Planning Committee (also N.W. Sub-Committee) Councillor M. V. Kenyon (to June, 1970) National Association for Maternal and Child Welfare Mrs. R. T. Glenny Paddington Charitable Estate (and Paddington Charitable Estates Educational Fund) Councillor M. V. Kenyon 7 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-le-Strand Charity Mr. R. H. Rollins 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 Wingraves Charity Mr. R. H. Rollins 8 STAFF OF THE HEALTH DEPARTMENT (as at 31st December, 1970) Medical Officer of Health and Principal School Medical Officer: J. H. Briscoe-Smith, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health: 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. Patrick T. Horder, M.B., B.S., D.P.H. Senior 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. Departmental Medical Officers: Full-time—3.5 Sessional Medical Officers: Part-time 30=35 sessions per week (full-time equivalent 3.5) Chief Administrative Officer: John H. Gillett Principal Administrative Assistant (Management Services): H. J. Parker Senior Administrative Assistants: A. J. Anscomb (Personal Health Services) D. J. Legge (Environmental Health Services) Administrative and Clerical Staff—109 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 Inspectors: R. F. Stubbs, F.A.P.H.I., A.R.S.H. V. A. Vickers, M.A.P.H.I., M.R.S.H. (from 19.2.70) Senior Public Health Inspectors—17 (1 vacancy) Area or District Public Health Inspectors—38 (2 vacancies) Student Public Health Inspectors—12 Technical Assistants—28 (3 vacancies) Chief Dental Officer: D. K. Hardy, L.D.S., R.C.S. (from 8.7.70) Senior Dental Officer: Vacant Dental Officers: Full-time—2; Part-time—4 (full-time equivalent 2.1) 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—51 Playgroup staff—9 District Midwives—9 Home Bathing Attendants—6 Principal Social Worker (Health Services): Miss I. J. McFarlane, M.A. Social Workers—23.5 Principal Mental Health Social Worker: Mrs. R. S. G. Paterson Mental Health Social Workers—15 St. Jude's (Hostel for Mentally Sub-Normal Adult Males) Warden—Mrs. S. B. Kaye Deputy Warden—1; Assistant Wardens—2 Elder Girls Training Centre Supervisor—Mrs. S. Rideout Assistant Supervisor—1 Junior Training Centre 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—236 (full-time equvalent 210) Rodent Control Service: Pest Control Officer—1 Assistant Rodent Officers—2 Rodent Operatives—6 Disinfection and Disinfestation Service: Supervisor, Disinfecting and Cleansing Station—1 Disinfection and Disinfestation Staff—12 Manual and Domestic Staff: 95 (full-time equivalent 74.5) 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, llbert Street, W.10. Marylands Road, W.9. Portman, 12-18 Salisbury Street, N.W.8. St. Jude's, 88 Bravington Road, W.9. St. Stephen's, 38-46 Westbourne Park Road, W.2. MATERNAL AND CHILD WELFARE CENTRES 1 Bessborough Street, S.W.1. 1 Ebury Bridge Road, S.W.1. Hallfield, Pickering House, Hallfield Estate, W.2. 283A Harrow Road, W.9. Linnet House, Charlbert Street, N.W.8. 217 Lisson Grove, N.W.8. Marshall Street, W.1. Middlesex Hospital, Cleveland Street, W.1. Queen's Park, 66 Lancefield Street, W.10. Council House Extension, Upper Montagu Street, W.1. Westminster Health Society, 121 Marsham Street, S.W.1. SCHOOL TREATMENT CENTRES 283A Harrow Road, W.9. Hallfield, Pickering House, Hallfield Estate, W.2. 217 Lisson Grove, N.W.8. Council House Extension, Upper Montagu Street, W.1. 40 Alderney Street, S.W.1. CHEST CLINICS Westminster Hospital, Page Street Wing, 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) 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. *Linnet House Special Care Unit, Charlbert Street, N.W.8. Note: The above list of premises shows the position as it existed at 31st December, 1970. On 1st April, 1971, under the provisions of the Local Authority Social Services Act, 1970, the day nurseries (marked †) and the mental health premises (marked †) were transferred from the Health Department to the Social Services Department; with the exception of the Special Care Unit at Linnet House (*) and the Junior Training School (*) which were transferred to the Inner London Education Authority under provisions contained in the Education (Handicapped Children) Act 1970. 11 STATISTICS AND SOCIAL CONDITIONS 1970 1969 (Where applicable) Area (acres) 5,334 Population (Registrar General's Estimate, mid-year 1970) 234,430 240,360 Population, Census, 1961 271,703 Domestic rateable hereditaments 86,806 86,582 Rateable Value (at 1st April, 1970) £111,473,747 £109,689,288 BIRTHS Live Births (registered)— Total Males Females 1970 1969 1970 1969 1970 1969 Legitimate 2,283 2,388 1,158 1,226 1,125 1,162 Illegitimate 482 511 257 254 225 257 2,765 2,899 1,415 1,480 1,350 1,419 1970 1969 Birth rate per 1,000 of the estimated population Area Comparability Factor—Births: 0.74 11.79 12.06 Birth rate (adjusted) (Rate for England and Wales, 16.0) 8.72 8.92 Stillbirths (legitimate—males 10; females 8; illegitimate—males 4; females 3) 25 39 Rate of stillbirths per 1,000 (live and still) births 8.96 13.27 Total live and stillbirths 2,790 2,938 Illegitimate live births per cent. of total live births 17.43 17.63 Premature births notified (live 203 (219); still 18 (19)) 221 238 DEATHS Net deaths (males 1,414; females 1,392) 2,806 2,998 Death rate per 1,000 of the estimated resident population 11.97 12.47 Area Comparability Factor—Deaths: 1.04 Death rate (adjusted) (Rate for England and Wales, 11.7) 12.45 13.09 Deaths arising from pregnancy, childbirth, and abortion Nil 2 Rate per 1,000 total (live and still) births — 0.68 Deaths of infants under one year (legitimate—males 21; females 24; illegitimate—males 11; females 2) 58 65 Death rate of infants under one year— All infants per 1,000 live births 20.98 22.42 Legitimate infants per 1,000 legitimate live births 19.71 18.84 Illegitimate infants per 1,000 illegitimate live births 26.97 39.14 Neo-natal mortality rate (deaths under four weeks per 1,000 total live births) 15.91 18.28 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 14.47 16.56 Perinatal mortality rate (stillbirths plus deaths under one week per 1,000 total live and stillbirths) 23.30 29.61 12 Births The total live births registered during the year was 2,765 (1,415 males; 1,350 females), giving a live birth rate of 11.79 per 1,000 of population, equivalent to a standardized rate of 8.72. The 1969 total of live births was 2,899 (1,480 males; 1,419 females), and the live birth rate 12.06 which when standardized was 8.92. The comparable figures for Greater London and England and Wales for 1970 were 15.2 and 16.0 and for 1969 15.7 and 16.3 respectively. Illegitimate live births numbered 482 (257 males; 225 females), representing 17.43 per cent. of the total live births, compared with 11.3 per cent. for Greater London, 16.2 per cent. for Inner London, and 8.0 per cent. for England and Wales. The total illegitimate live births in 1969 was 511 (254 males and 257 females) which represented 17.63 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. Stillbirths totalled 25, representing a rate of 8.96 per 1,000 total live and stillbirths, compared with 12.0 for Greater London and 13.0 for England and Wales. In 1969 there were 39 stillbirths, which represented a rate of 13.27 per 1,000 total live and stillbirths, and the rate for Greater London and England and Wales was 12.7 and 13.0 respectively. Deaths The total number of deaths shown in Table 1, page 63, 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 1970 numbered 2,806 equivalent to 11.97 per 1,000 which when standardized by the comparability factor, gives a figure of 12.45. In 1969 there were 2,998 deaths (12.47 per 1,000) and the standardized rate was 13.09. The comparable rates for Greater London and for England and Wales for 1970 were 11.3 and 11.7 and for 1969 11.5 and 11.9 respectively. Accidental Deaths During the year, 94 residents died from accidents of all kinds, including 36 motor vehicle accidents. In 1969the figures were103 and 31 respectively. Infant Mortality Deaths of infants under one year totalled 58 (45 legitimate, 13 illegitimate) giving an infant mortality rate of 20.98. There were 44 deaths under 4 weeks giving a neo-natal mortality rate of 15.91. The early neo-natal mortality rate (deaths under one week per 1,000 live births) was 14.47. The perinatal mortality rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) was 23.30. Comparative figures are as follows:— Westminster Greater London England & Wales 1970 1969 1970 1969 1970 1969 Infant mortality 20.98 22.42 17.8 17.9 18.0 18.0 Neo-natal mortality 15.91 18.28 12.3 11.7 12.0 12.0 Early neo-natal mortality 14.47 16.56 10.7 10.2 11.0 10.0 Perinatal mortality 23.30 29.61 22.6 22.8 23.0 23.0 Details showing causes of death according to age group and sex are given in Table 2, page 64. Maternal Mortality There were no maternal deaths in Westminster during 1970. Two maternal deaths were reported in 1969 which gave a death rate of 0.68 per total live and stillbirths. Comparative figures 1970 1969 Westminster Nil 0.68 Greater London 0.17* 0.20* England & Wales 0.18 0.19 •Excluding deaths due to abortion 13 INFECTIOUS AND OTHER NOTIFIABLE DISEASES Apart from the unusual behaviour of the measles infection, the incidence of infectious disease in the City has, in general, remained low. Notifications received (excluding tuberculosis) increased only slightly from 532 in 1969 to 557 in 1970, of which measles accounted for 365. Table 3, page 65, gives details of notifications received and the age groups concerned. Acute Poliomyelitis, Diphtheria and Smallpox No cases of these diseases occurred in Westminster during 1970. Dysentery The number of cases of dysentery decreased considerably during 1970. Thirty notifications were received compared with fifty-four in the previous year. There were no outbreaks of dysentery in any Westminster Hospitals or City Council nurseries. Infective Jaundice Fifty-two notifications (59) of Infective Jaundice were received during 1970, the second full year since the disease became notifiable. Measles Measles was again prevalent in Westminster despite a striking diminution in the incidence of the disease in the previous epidemic year. This was, however, in accord with the sharp rise in the total number of cases notified in 1970 in England and Wales. Had measles followed the established pattern there would normally have been a decrease in the number of measles notifications, as 1970 would have been a non-epidemic year, but instead, the number of notifications rose slightly from 321 to 365. In addition, a large proportion of this number occurred during an abnormal summer wave. Paratyphoid and Typhoid Fever Five of the six 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. There were thirteen cases of typhoid and paratyphoid fever in Westminster in 1969. Tuberculosis Table 3, page 65, gives information regarding primary notifications of pulmonary and nonpulmonary tuberculosis received during the year, and Table 4, page 66, shows the age and sex distribution of all new cases and deaths from all forms of the disease. 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 The number of cases of whooping cough remained low, only ten notifications being received during 1970 compared with two in the previous year. 14 MASS MINIATURE RADIOGRAPHY During 1970 the North West and the South West London Mass X-ray Services continued to provide regular public sessions at numerous points in Westminster. 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 aimed at 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 25,326 (20,996) such certificates were authenticated, the demand being largely due to people going abroad for holidays and to the fact that during the summer there was a westward extension of El Tor cholera from those areas of the world where the disease has long been endemic. Subsequently an isolated case reached Britain with the result that travellers to known or possibly infected areas were advised to be vaccinated against the disease, and travellers to Britain were required to produce an international certificate of vaccination against cholera on arrival. Arrangements were also made for travellers not in possession of a certificate to be kept under surveillance for five days. The Medical Officer of Health also issues, on request and in appropriate circumstances, certificates to the effect that no cases of smallpox have occurred in the district during the preceding month. These certificates, of which 28 (19) were issued during 1970, were sought by persons proceeding to the United States of America who did not wish to submit to vaccination. Evidence of vaccination is not now required for persons entering the United States unless they have been in a country reporting smallpox within the previousl 4 days. AFTER HOURS EMERGENCY TELEPHONE SERVICE The telephone service maintains a focal point of contact for persons requesting urgent help or advice with health, welfare and related problems within the City of Westminster and the Royal Borough of Kensington and Chelsea, which arise outside normal office hours. As has been stated in previous Reports the control centre is at City Hall, Westminster, and is manned by four Duty Officers working on a rota system. Officers always available on call for Westminster and for Kensington and Chelsea include the Medical Officers of Health or their Deputies, Senior Medical Officers and Senior Specialist Officers, who can be contacted through the control centre to deal with emergency matters. With regard to the less urgent problems, the Duty Officer will, if necessary, give advice and subsequently will convey messages for the attention of the appropriate daytime staff. During 1970, a total of 12,058 (11,835) calls were received by the Duty Officers, 9,784 (9,630) relating to the City of Westminster and 2,274 (2,205) to the Royal Borough of Kensington and Chelsea. An analysis is given in Table 6, page 67. Three meetings were arranged during the year, two at City Hall and one at the Health Department, Royal Borough of Kensington and Chelsea. The meetings were called by the respective Medical Officers of Health and were attended by the Duty Officers and Senior Officers from each Borough. The primary purpose was to afford an opportunity for the Duty Officers and Senior Officers to meet each other and to exchange views relating to the operation of the emergency telephone service. It is the intention to arrange further meetings in 1971 to consider what changes or improvements may be necessary consequent upon the reorganisation of the Health Departments and the formation of the new Social Services Departments. 15 ENVIRONMENTAL HEALTH SERVICES 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, 1970 Establishment In Post Public Health Inspectors 59 (59) 56 (52) Student Public Health Inspectors 15(15) 12(15) Technical Assistants 28 (24) 28 (25) WORK OF THE PUBLIC HEALTH INSPECTORS During 1970 it has been possible to maintain and slightly improve the numbers of public health inspectors and technical assistants employed; moreover, there was only a small turnover of posts. This is a matter of some satisfaction when it is realised that a large majority of the staff live outside the City and many have long and expensive journeys to and from work. Furthermore, the strong element of specialist work combined with the high standard of application demanded to provide the sort of service the centre of the Capital has a right to expect, is not an inducement to recruitment when vacancies exist in places where work stress is not so intense nor so constant, and where residential and other fringe benefits are available. It has also been a year when the value to the public health inspectorate of a strong nucleus of experienced personnel has been clearly demonstrated. Without it the concentration of effort required to impart the momentum to the phased housing programme in Paddington could not have been achieved. Even so, the transfer of staff to this project has had repercussions on other aspects of the inspectors' work. District inspection and the control of catering premises were particularly affected, and although complaints were investigated with the minimum of delay, regular and consistent routine inspections, which are the basic requirements for the effective control of shops, offices, factories, restaurants and canteens were not maintained to the extent that is desirable in the City with its large transient working and tourist population. The North Westminster Project is possibly the most ambitious exercise of its kind yet undertaken in London. Its success depends to a large extent on the efforts of the team of public health inspectors who were seconded from other duties to this important specialist work. As the operation is principally one to encourage improvements of a high standard by "friendly persuasion", it is necessary that officers must not only be extremely knowledgeable in every detail of housing legislation but also completely dedicated to the ultimate success of the Project. The team of Inspectors and Technical Assistants headed by a Principal Public Health Inspector also carry out the normal district duties, such as the routine investigation of complaints and rodent control, at the same time as the main objective, namely the promotion of satisfactory improvement schemes, is being pursued. Thus the members of the team are seen by residents to be the Council officers involved with all the problems relative to their living accommodation, and to whom they can look as authoritative and impartial advisers and arbiters on their housing problems, matters vital to their comfort, and the future happiness of their children. Confidence between parties is an essential ingredient to the success of the whole scheme. Public Health Inspectors—Duties outside normal office hours The need for regular inspection of itinerant food vendors and premises where visits are only possible during the late evening, particularly at weekends, referred to in previous reports, remains a necessary feature of effective food and food premises control. The number of contraventions of the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations found by the inspectors employed on a "duty rota" basis illustrates the need to continue the arrangement. As far as the itinerant food vendors are concerned, however, the inspectors' time and cost involved in dealing with food hygiene contraventions, when the trading activity is unauthorised, must inevitably pose the question as to whether more positive action to prevent the continued appearance of such traders on the streets would not be a more economic and realistic solution. 16 Student Public Health Inspectors Since amalgamation, Westminster has proved the value of the fully comprehensive and systematic training scheme provided within the Department for its complement of students. The overall supervision of the four-year studentship of accepted pupils to ensure that experience gained is balanced in all aspects of the work, and that it is, as far as possible, co-ordinated with the programme of lectures and practical visits of instruction arranged by the Technical Colleges, remains the responsibility of a senior inspector. Three who completed their studies during the year passed the qualifying examination. Two were referred back for further training in specific subjects and were successful in the December examination. A further three students were appointed during the year, bringing the total still in training to twelve. Technical Assistants Prior to the amalgamation of the London Boroughs in 1965, Westminster, St. Marylebone and Paddington had employed technical assistants as a supplement to their establishment of public health inspectors to assist them with their work in various ways. In general terms they were essentially enquiry officers, as in principle they still are, although naturally their usefulness and capacity is relative to the experience they acquire. It has been found that the value of the technical assistant to the particular inspector or to the section within which he works is greater if he remains more or less permanently attached to that section. Changes are therefore kept to a minimum although it has been accepted that each technical assistant may progress in salary subject to his proven ability indicating that he can undertake work of more responsibility. The establishment of technical assistants to the public health inspectors in Westminster has been increased to the present figure of 28. It was realised and accepted that the ever increasing scope of the public health inspectors' work, its highly technical nature, and its potential legal involvement, make it more necessary than ever to ensure that the services of public health inspectors are utilised to the best advantage. As far as possible they concentrate on duties which require their full professional skills. The appointment of assistants, without previous training, experience or qualifications, must not be regarded as alternatives to inspectors, but none the less the assistants have a valuable part to play in the environmental health scene, subject to discretion being used in their deployment. It is recognised that there is no substitute for the skill and judgement of the fully qualified officer. District Inspection The district public health inspectors work in three groups under the day to day control of three Area Inspectors of senior grading. As has been said earlier, their work has suffered as a result of the depletion in strength occasioned by the priority needs of the North Westminster Project team and the essential duties of the Food Section. A comprehensive study of the full range of the public health inspectors' duties in district and specialist sections was undertaken by the Chief Public Health Inspector during the year, to assess future departmental needs bearing in mind the implications of recent legislation and measures which it is anticipated will shortly be effected. 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 public health inspectors. An analysis of reasons for initial inspections of dwelling houses is given in Table 7, page 67, and an analysis of 2,613 (2,327) nuisances and unsatisfactory conditions found and remedied appears in Table 8, page 67. Notices Seven hundred and twenty eight (646) informal notices and 528 (629) statutory notices were served in 1970, to secure the abatement of nuisances. In addition, 15 (35) notices were served under the Clean Air Act, 1956. An analysis of statutory notices served is given in Table 10, page 68. 17 Legal proceedings The summary of legal proceedings undertaken during 1970 is set out in Table 25, page 75. 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 twenty (257) complaints of noise were received during the year under review, and this necessitated 828 (1,117) visits 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, 1,944 (1,326) Notices of Execution of Drainage Works were registered, and a total of 12,051 (13,017) visits to sites and to premises were made in connection with these notices. Of the proposals to do work, which required the specialist knowledge and attention of the Development Team of four public health inspectors, 275 (262) related to large scale development and 130 (68) concerned new buildings. The number of houses and flats constructed by private enterprise was 467 (195), and at the end of the year 998 (928) housing units exclusive of municipal development were in various stages of construction. There was a marked increase in the work of this section relating to hotels; 19 new premises were completed and 32 were under construction at the end of the year. In addition, 20 premises were being modernised to provide "en suite" bathrooms, and in some cases the premises were modernised to provide enlarged kitchens and restaurants. Phase I of the new School for American Nationals has been completed and is in occupation. Phase II, which will complete this development, was well in hand at the end of 1970. Interdepartmental collaboration between officers of Government Departments, Greater London Council and the City Council, having related responsibilities, continues to ensure that the fullest information is available to all applicants in respect of new projects. Sewerage Incidents of flooding occurred, due to storm water resurgence, on 7th August, 1970, in the Westbourne Grove area. The Paddington Chamber of Commerce has since made an approach to both the Greater London Council and the City Council with a view to remedial works being carried out, and this matter is under consideration. Town Planning Observations were made by the Department on 93 (103) 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. (up to and including 28th September). Westminster Council House Extension, Upper Montagu Street, W.1. (from 29th September). Paddington Office, 313 Harrow Road, W.9. 18 Arrangements for these measurements are made in conjunction with the Warren Spring Laboratory of the Department of Trade and Industry as part of the National Survey of Air Pollution. The apparatus at Rutherford School suffered recurring interference rendering some measurements invalid. It was therefore decided, with the concurrence of the Warren Spring Laboratory, to transfer this station to the Westminster Council House Extension, and this was effected on 29th September. 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 effects 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. Three Smoke Control Orders, Westminster (Paddington Church Ward), Westminster (Hyde Park No. 2) and Westminster (Paddington Town Ward) came into operation on 1st July and, with the exception of a few exempted areas, the whole of the City is now smoke controlled. The rapid closure of conventional gas-works, causing a decrease in production of open-fire coke which increased production of other similar fuels was not quite meeting, caused some concern in the summer as to the sufficiency of supplies of these fuels during the following winter. Various discussions took place with representatives of the solid fuel manufacturers and distributors and with the London Boroughs' Association, as a result of which the Department of the Environment, at the request of the Council, made an order, operative from the 7th November, temporarily suspending 13 of the Council's 38 Smoke Control Orders. 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 215 (263) visits in connection with complaints received, 371 (325) smoke observations and 957 (914) 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 1970 a total of 64 (54) such notifications were received, of which 12 (15) included application for the Council's approval of the new boilers. Section 6 of the Clean Air Act 1968 gives the Council control over the height of chimneys of the larger boiler installations. All new chimneys, or existing chimneys serving boilers the combustion space of which has been enlarged, must be approved by the Council, this approval being additional to all existing planning and constructional requirements. Thirteen (4) such applications were received, and all were approved. North Westminster Project It was reported last year that a small team had been set up to commence the inspection of premises within the areas determined for rehabilitation as a preliminary to the implementation of this Project. During February the team was enlarged and the programme of inspection rapidly extended. As a result, by the end of the year approximately two-thirds (843) of the houses in private ownership had been inspected and the process of follow up to inform their owners of the conversion or improvement desired was proceeding. Every effort was made to discuss the matter personally with each owner so that he could be fully advised as to all relevant matters and, in particular, as to assistance which might be available to him, both financially and otherwise, and guidance given as to procedures to be followed. 19 This course of action has enabled the public health inspector to ascertain the owner's point of view, his long and short term intentions for his property and any difficulties which stood in the way of his co-operation in the Project objectives. The tenants' interests were, of course, also taken into consideration at this stage and as appropriate thereafter further discussions took place between landlord and tenant, between tenant and public health inspector, or among all three parties. As anticipated, even where owners are willing to co-operate it is often impracticable to carry out immediate or even early improvements or conversions in this type of intensely multi-occupied property. The changes brought about by the 1969 Housing Act have proved very helpful in regard to this type of property and have opened up the way to improvements and conversions which hitherto had seldom been possible of achievement. The Council's declaration of two General Improvement Areas (Lanhill and Marylands) in July should also give more encouragement to private owners since it should have the effect of extending the area improvements from the redevelopment areas into the adjacent rehabilitation areas. Thus the collective Project area should have even greater advantage to both owner and tenant in the immediate future. The response from the owners contacted so far has been encouraging and whilst there are as yet schemes actually proceeding in only 41 houses, involving 95 self-contained units of accommodation, there are many more schemes known to be in course of preparation and more still contemplated. It is reasonable at this stage therefore to look forward to steady progress during 1971 when the surveys have been completed and all the private owners made personally aware of the Project objectives and potential. Slum Clearance Circular No. 92/69 issued by the Ministry of Housing and Local Government in November 1969 required a return to be made of slum clearance proposals for the next four years, i.e. 1970-1973. Based upon surveys conducted during 1969, a new slum clearance programme was formulated and, after approval by the City Council, was submitted to the Minister in February 1970. The programme indicated that there were 523 premises, including 192 dwellings in tenement blocks, which were in areas proposed to be declared clearance areas within the period 1970-1973. During 1970 the properties in the Mozart Street area were demolished and works commenced on the Council's housing development scheme in the area. Further progress was made in the rehousing of qualifying tenants from the Herries Street (North) and (South) areas. The decanting of tenants from premises in the St. Anne's Court/Richmond Buildings area has been completed, and a hoarding erected around the site preparatory to demolition works. A survey of the proposed Amberley Road area was nearing completion at the end of the year. Comprehensive reports on conditions in the Archer Street, Peter Street/Green's Court/Brewer Street and St. Michael's Street areas have been under consideration. It is anticipated that decisions on the action to be taken in respect of these areas will be made by the City Council early in 1971. A summary of visits in connection with slum clearance is included in Table 11, page 68. Unfit Premises Details of action taken during the year in relation to closing order procedure are given in Table 13, page 69. Houses in Multiple Occupation (a) Management Orders, Directions and Notices The survey of houses in multiple occupation in the Pimlico area has continued throughout the year, although one of the two public health inspectors formerly engaged in this work was transferred to the North Westminster Project area early in 1970 as a matter of urgency. The remaining inspector, with technical assistance, has continued the survey in addition to carrying out inspections of those premises within the City which were the subject of applications for loans under the Housing Acts. 20 A summary of the work of the inspectorate in connection with multi-occupied houses is given in Table 12, page 69. (b) Means of escape in case of fire The Director of Architecture and Planning served 14 (54) notices under Section 16 of the Housing Act 1961 and 14 (26) were complied with during the year. In respect of a further 53 (97) premises proper and adequate means of escape were provided as a result of informal action taken by the Director. (c) Control Orders The remaining control order in operation terminated in January 1970 on expiry of the statutory period. No further orders were made. Grants, Subsidies and Loans The following summary indicates the number of applications referred to the Health Department for inspection and comment during the year:— No. of Dwellings Discretionary Grants (a) Works of improvement 246 (92) (b) Conversions 369 (197) Standard Grants 43 (24) Subsidies to Housing Associations for the improvement and conversion of properties 208 (178) Loans for the acquisition and/or improvement of premises in Westminster 16 (40) A summary of visits made is given in Table 11, page 68. Qualification Certificates At the end of the year 695 (183) applications for qualification certificates had been received. Details appear in Table 14, page 69. A qualification certificate certifies that a dwelling satisfies the qualifying conditions laid down in the Housing Act 1969. The "qualifying conditions" are that the dwelling is provided with all the standard amenities (bath, wash-hand basin, sink, hot water supply to these, and water closet) for the exclusive use of the occupants, is in good repair and is fit for human habitation. If a dwelling is improved to reach these standards (or if it already satisfies such conditions) the controlled tenancy can be converted to a regulated tenancy. Unlawful Eviction, Harassment and Provision of Rent Books During the year, the Health Department's Enquiry Officer received 311 complaints from landlords and tenants, and other various sources including Rent Tribunal, Citizens' Advice Bureaux, etc. Full investigation of each of these complaints confirmed that the majority of them related to matters having no connection with Rent Act legislation. Whilst there has been an upward trend in the number of complaints received, experience has shown that there is no general deterioration in landlord/tenant relationship. In most of the cases it was found that discussion with an unbiased third party was all that was required to resolve problems of a minor character. In 109 cases (35%) of the complaints received, the facts were recorded and forwarded to the City Solicitor for his consideration as to whether or not further action was possible or necessary. In all these cases there had been a technical breach of legal requirements as between landlord and tenant, but in 103 instances the investigations revealed no evidence suggesting intent to harass, and the complaints were resolved by discussion and reasoning, and where applicable the provision of satisfactory rent books. In the remaining 6 cases, the evidence was considered to justify legal proceedings and in 2 cases convictions were obtained. 21 Certificates of Disrepair Two certificates of disrepair were issued during the year, one of which referred to an application made in 1969. Overcrowding (1) Number of new cases of overcrowding reported during the year 120 (35) (2) Number of cases of overcrowding relieved during the year 22 (15) Housing Priority on Medical Grounds During the year under review 1,675 (1,678) medical certificates or claims for priority in respect of applications for rehousing or transfers were considered and assessed by a Principal Medical Officer. Local Land Charges The number of formal enquiries dealt with and reported upon during 1970 was 10,884 (8,336), exclusive of personal searches and supplementary enquiries. An enquiry may, of course, refer to more than one property, and it is noteworthy that two of the enquiries received during the year concerned 900 properties in the southern part of Westminster. Tourism It is common knowledge that during recent years the numbers of overseas visitors arriving in this country have increased by over 20% each year. During 1970 almost 7 million overseas visitors came to Britain, most of whom spent some of their holiday time in Westminster. The majority of these visitors arrive between April and October, and the problems arising from such an influx inevitably increases the work of most of the Departments of the City Council. The Health Department must necessarily bear a large proportion of the burden of the additional pressures. The enormous increase in the work arising from the construction of new hotels, and the conversion of many other buildings to provide accommodation for tourists, was further stimulated by the Government's decision not to extend the financial aid to hotels under the Hotels Development Incentive Scheme. Many new restaurants have been opened to provide a service for our visitors, and the high level of activity arising from these and similar developments has added to the demands made upon all sections of the Public Health Inspectorate. The separate hotel section within the Department has concentrated primarily on the many conversion schemes which have been submitted. Also, the section has been responsible for liaison with other sections concerned to ensure that the necessary supervision in relation to building and conversion schemes has been applied in a co-ordinated manner from the Department as a whole. 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 the Westminster City Council. 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 satisfactorily maintained throughout 1970. 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. Radioactive Substances Act 1960 Persons who keep or use radioactive materials are, unless exempted, required to register with the Secretary of State for the Environment. 22 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 ecorded. Appropriate action is taken in respect of any special precautions so far as they relate to the epartment 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 where circumstances permit 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. The baiting of sewers against rat infestation, in accordance with the requirements of the Ministry of Agriculture, Fisheries and Food is now undertaken by a contractor on behalf of the City Council. Every manhole and side entry to the sewers is baited with an approved rodenticide, on four occasions annually. The operation requires advance information to be given to the Metropolitan Police, the Greater London Council, the adjoining 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 15, page 70: it is of interest to note the considerable increase in complaints relating to infestation by mice. Insect Pest Control—Disinfestation The work of insect disinfestation is carried out from two centres, namely Lissonia, 217 Lisson Grove, N.W.8 and Wedlake Street Medicinal Baths, Kensal Road, W.10, by a staff of five disinfectors who also undertake disinfection. Continued attention is given to methods of insecticidal treatment and the formulations of spray and powder in use are specified with particular regard to the Ministry of Agriculture, Fisheries and Food recommendations. As in the case of rodent control, a free service is provided in domestic premises, but in business premises where insect control is a matter of routine maintenance, it is advised that a commercial pest control organisation be employed. During the year 3,015 (2,920) rooms were disinfested, and 62 wasp nests destroyed. Disinfection During the year 85 (87) rooms, 5,806 (5,247) articles of bedding and clothing and 149 (270) books were disinfected; 35 articles of furnishing were dried and disinfected after damage by storm water flooding of premises. In addition 112 refuse dumps were treated as a result of the unofficial withdrawal of labour in the Director of Cleansing's Department. The Department continued to be asked by residents to certify that clothing intended for despatch to foreign countries, mainly those 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. Eighty-six (73) 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. 23 Pigeon Control Section 74 of the Public Health Act, 1961 empowers the City Council to take any steps necessary to reduce the number of pigeons, 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 complaint, and is one of the most important factors which militate against effective control. There is no legislation applicable which prevents persons feeding birds. 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, and other measures. During the year 85 (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 1970. (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 the analytical 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, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1970, was 230,886. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being 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 and 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 16 and 17, pages 70 and 71. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not 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." 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. 24 Private Water Supplies—Deep Wells The water from 65 boreholes is used for drinking and domestic purposes in 48 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 Department of the Environment. In relation to the 47 boreholes in private ownership, 102 (48) samples of water were submitted for bacteriological examination and 31 (22) for chemical analysis. Of these, the results of 125 tests were satisfactory. The remaining 8 all related to one premises, where the bore linings and the basement storage tank were found to be defective. The former were repaired and the latter by-passed (other storage tanks being available) and all subsequent samples were satisfactory. Swimming Bath Water Examination Monthly examinations were carried out at each of the 11 municipal swimming baths in the City. One hundred and twelve (202) 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 104 of these examinations were satisfactory. Of the remaining 8, one may have been due to some children undergoing a survival test which entails jumping into the bath fully clothed, and two to the rather low level of free residual chlorine in the samples; there was no apparent reason in respect of the remaining five samples. 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 1970 was 729, bringing the total number of registered premises at the end of the year to 18,052 and the number of persons employed therein to 371,036. The implementation of the Hoists and Lifts Regulations marked a further step towards safety in premises covered by the Act. The number of Lift Engineers' reports submitted was 292. The high costs involved in properly enclosing lifts in accordance with the requirements has presented some difficulties but, generally speaking, property owners have been co-operative and have shown a willingness to comply. Accidents involving lifts are fortunately rare, but during 1970 a serious accident occurred in the lift motor room of a modern office block where repairs were being carried out by a maintenance engineer to one of six lifts. The other five lifts were in operation. The engineer was badly injured because of lack of space and the impracticability of safety fencing off the lift machinery. But for the prompt action of a colleague the accident would almost certainly have resulted in a fatality. The circumstances were fully investigated and many visits to the site took place involving meetings with the owners, management and the manufacturers' own maintenance engineers; agreement was reached on measures to be taken in order to prevent any recurrence. Notifications concerning 527 accidents were received during the year, none of which was fatal. In 177 cases investigations were carried out and in 16 instances contraventions of the Act were noted; any necessary action was taken. Ensuring compliance with the Hoists and Lifts Regulations has imposed much extra work on the section of the department dealing with the Act and has necessitated transferring a technical assistant formerly engaged on general inspection duties to those solely connected with hoists and lifts. This factor, together with changes caused by retirement, affected the number of routine inspections, which decreased from 5,789 in 1969 to 4,788 in 1970. 25 Statistics which are set out in Table 18, page 71, include some of those contained in the Annual Report to the Department of Employment and Productivity. Factories There were 4,893 (4,314) factories on the register at the end of the year. Statistics relating to matters which are the concern of the Health Department under Parts I and VIII of the Factories Act, 1961, are given in Tables 19 and 20, page 72. Outworkers Returns made by 130 (158) employers, together with 101 (124) notifications from other local authorities, accounted for a total of 1,387 (1,841) outworkers. Of these 598 (760) were residing in the City of Westminster. Nearly all were engaged in the tailoring and gown trades. (Table 21, page 73.) Basement Bakehouses The Factories Act 1961, which re-enacted with amendments the Act of 1937, requires that a basement bakehouse shall not be used unless a Certificate of Suitability has been issued by the Council and that the premises were so used in 1937. There are three basement bakehouses in Westminster for which Certificates of Suitability are in force, but this figure does not include those catering establishments large enough to maintain separate basement baking rooms from which a variable proportion of their products may be sold. Food and Catering Premises The estimated number of food and catering premises in Westminster on 31st December 1970, was 6,800 categorised as shewn in Table 22, page 73. During the year 11,723 (8,427) visits were made by public health inspectors and 1,007 (472) informal notices were served in respect of matters requiring attention. During the year 753 (702) complaints were received concerning general matters affecting food premises, staff etc. Appropriate action was taken in each instance. Catering Establishments Much publicity was received during the year in the national press and in other publications in relation to catering premises in Westminster. As in all matters of this nature, the satisfactory premises tend to be merged with those that are not, and this results in a picture of many unhygienic and unsatisfactory premises being used for the preparation and sale of food. Food is prepared at some premises in conditions which leave much to be desired in spite of the continuous efforts made by the Inspectorate responsible to ensure that acceptable conditions are maintained. Much of the problem revolves around those who are actually engaged in the day to day operation of the business, and the labour situation in respect of the lower paid and frequently casual catering worker is such that there are far more situations vacant than the labour force can fill. It follows that a dissatisfied worker will move elsewhere taking his attitude to his daily task with him, with the outcome that at the new premises his lower standard will continue to prevail. This situation is accentuated by the fact that many catering premises form part of vast impersonal complexes. During the year the withdrawal of labour by refuse collectors once again posed a problem of disposal of waste refuse from catering premises. This dispute was of longer duration than the previous year's, and in some dumps waste matter assumed immense proportions. Where danger to health was established appropriate action was taken, but in other cases the waste remained until the refuse workers returned to work. A close watch was kept on the situation and, although some residents were justifiably concerned at the close proximity of the rubbish to their residences, there was no serious outcome apart from obvious unpleasantness. This situation brought again to the fore consideration being given to water borne removal of food refuse, in which a waste disposal unit discharges putrescible refuse to the drainage system. In the Food Hygiene (General) Regulations 1970, which come into effect on 1 st March 1971, it is a requirement that any layout of food premises shall be such as to provide adequate space, suitably sited, for the purpose of the removal of waste from food, and the separation of unfit food and the storage of any such waste and unfit food prior to disposal. In view of the limited obligation on any Council for the collection of refuse under the Public Health Act 1936, the space should be of sufficient size to safely contain 7 days accumulation of refuse. In new premises this requirement will have to be fulfilled, but it will pose problems in old premises where there is little enough room to carry on present activities. 26 There have been proposals in the past for registration with the local authority of all premises where food is prepared and sold, to ensure that new premises are suitable at the outset, and in existing premises that all requirements of the local authority are satisfied under the Food and Drugs Act, 1955. At present if there are infringements of statutory provisions a magistrate may disqualify a caterer from carrying on his business for a period not exceeding two years. Such disqualification however relates only to the person conducting the business, not the business itself, and the caterer's wife, or anybody else, may carry on the business under the same conditions which existed before disqualification. There are many considerations a propos registration, but if legislation is ever introduced, it must contain effective measures which will give the local authority some substantial control and the penalities associated with the legislation should be realistic with an absolute minimum of exemption clauses. Certainly the closure of a highly profitable restaurant would be more salutary than the present maximum fine of £100 for respective offences under the Food Hygiene (General) Regulations, 1960, which could in some instances mean little more than a slight drop in profits commensurate with a fall off in trade due to a wet weekend. Complaints which have been investigated by the inspectors during the year include the usual quota of those concerning cooking smells and noise from extract systems. Whilst practical advice is given by the department to overcome deficiencies in extract systems by the overhauling of motors, fans, machinery and deodourising equipment, and fitting silencers, complaints relating to cooking smells are not always so readily resolved. Where it appears feasible to obtain improvements affecting the general amenity of a neighbourhood, the department is prepared to render assistance. Equally the complainant must decide whether there is such interference to the quiet enjoyment of his premises as to justify seeking legal protection of his own rights under common law. The practice of open food display persists, perhaps intermittently, but particularly where the demand for speedy service makes the use of protective facilities an impediment to the staff. There is sometimes difficulty in persuading proprietors that customers can be a source of contamination. The Food Hygiene (General) Regulations 1960 require that a person who engages in the handling of food shall not so place the food as to involve the risk of contamination, and in appropriate cases prompting by this department has resulted in the provision of suitable protection. The 1970 Regulations have to some measure specifically underlined the danger as they require that open food, while exposed for sale or during sale or delivery, shall be kept covered or effectively screened from possible sources of contamination. Licensing Act 1964 This department has continued to exercise the powers under Part II of this Act in respect of applications for Club Registration Certificates made to the Magistrates Court where it is desired to provide intoxicating liquor for members and their guests. No objections were raised to the applications received. Public health inspectors have attended all meetings of the Licensing Justices of both North and South divisions during the year in connection with applications to sell intoxicating liquor in restaurants, guest houses etc., under Part IV of the Act, which requires the premises to be structurally adapted for catering purposes. A number of representations were made to the Magistrates in respect of premises where the occupier had been particularly dilatory in meeting his obligations. The courtesy of the Bench in giving their time to the consideration of this department's observations in respect of certain applications before them at their sessions has been much appreciated. Licensed Street Trading The anticipated progress in the adaptation of the present outmoded street trading stall by the attachment of a fibre glass unit to meet the requirements of the Food Hygiene (Markets, Stalls & Delivery Vehicles) Regulations 1966, has unfortunately not so far been achieved. Until such time as the unit is available, and suitable financial arrangements have been made by traders for its purchase, this department will continue to ensure that as far as practicable, with the limited facilities and storage provisions which are at present available to some traders, the requirements of the Regulations are met. 27 Unauthorised Street Traders The year has again seen considerable activity by public health inspectors in enforcing the Food Hygiene (Markets, Stalls & Delivery Vehicles) Regulations 1966 in relation to unauthorised street traders. The total fines set out in Table 25, page 75 are an indication of the high number of cases in which legal proceedings were instituted. It has been gratifying to note that the Courts have seen fit to impose suspended prison sentences and, where further contraventions by the trader have occurred, such sentences have in some cases been implemented. This must indeed be a deterrent. There is mild optimism that the standard of hygiene on many stalls has improved, even though the supply of constant hot water and provision of a suitable wash hand basin are still problems applicable to most of the stalls. There still remains, of course, the anomalous situation that even though standards of hygiene may improve, these traders are trading without authority. The Medical Officer of Health would again place on record the warmest thanks of the department to the Police for their willing and efficient co-operation. Food Hygiene etc., Lectures Despite the resignation during the year of a Senior Public Health Inspector who undertook considerable lecture commitments, lectures to management and staff of various catering organisations, as well as to student nurses and public health inspectors preparing for examinations, have continued. Instruction of staff by inspectors during the course of routine inspections of premises is, of course, an invaluable means of communicating essential knowledge to those engaged in the handling of food. Much of this is nullified by those engaged in the catering trade who do not speak or understand English and, in consequence, cannot appreciate the significance of the inspector's remarks. It is a factor of life that the best method of learning is by example and if management and senior staff are prepared as they should be to educate their staff and see that their instructions are followed, this would render invaluable service in the promotion of satisfactory hygienic conditions. Food Sampling and Analysis During the year a total of 1,626 (1,730) samples of foodstuff were submitted to the Council's Public Analyst by routine or on complaint. Of this number 148 (9.1%) (193—11.1 ) were reported upon adversely. The following includes a selection of these reports together with other matters concerning samples of foodstuff brought to the department on complaint. Chocolates eaten in the dark of thetheatre, the remainder which wereretainedforconsumption later, were found to have marks on the confectionery which resembled rodent teeth marks. On examination it was found that the marks were made by the packing material. This complaint is not uncommon, particularly if chocolates are stored in unsuitable temperatures. A bag of pre-fluffed rice was found to contain a cigarette end. The packers were very concerned, and took severe disciplinary action against several members of their staff, and introduced effective measures to avoid a recurrence. Consumption of the major part of a bottle marked "Ginger Ale" caused lethargy, vomiting and diarrhoea to the consumer. Examination of the portion remaining disclosed it to be whisky. It appeared likely that the complainant was the victim of a practical joke. Mould growth on a chocolate eclair was caused by the retention of the confection beyond the normal "shelf life". A caution was given. A loaf containing a metal bolt was the result of a mishap at a bakery (not in Westminster). Apparently a thorough search had been made of the manufacturing processes at the time, and several doughs had been discarded. The complainant did not wish to participate further in the case. A joint of meat purchased from a local butcher was found to contain part of a knife. It appeared the blade had broken when in use by a junior employee, and he failed to report the incident to his superior. 28 A 31b. bag of flour contained what the purchaser thought was a mouse. It was rather an unusual case for the shape of the object produced to the inspector strongly resembled the outline of a dehydrated mouse. On closer examination, however, it was found that the material was dried dough. Oxygen bulbs used for inhalation purposes were noted by the complainant to have an unusual odour. Analysis disclosed this to be a minute amount of trichlorethylene. The manufacturers confirmed that this substance was used at the factory as a solvent for degreasing the bulbs prior to filling with oxygen. The serious implications of the offence were drawn to the attention of the Company. Legal Proceedings—Food and Food Premises During the year legal proceedings were taken against the proprietors of two catering premises in respect of unhygienic conditions. Fines of £190 with £51.5.0d. costs were imposed. Other similar cases were pending at the close of the year. The following matters arising from complaints also resulted in legal proceedings. An investigation made concerning a decomposed sandwich disclosed further sandwiches at the retail premises affected by rodent droppings. The Company concerned were fined a total of £30 with £5 costs. Fresh cream pineapple dessert affected by mould resulted in a fine of £15 with £10 costs. A bread roll, baked in premises outside Westminster, contained a razor blade. The bakers were fined £10 with £5.5.0d. costs. Two complaints regarding confectionery resulted in a visit to the retail premises. Conditions were found to be very unsatisfactory; indeed, some stock held was 13 years old. Proceedings were taken in respect of the premises and the infested stock. Fines totalling £205 with 20 gns. costs were imposed A mouse dropping in a tart, baked at premises outside Westminster, resulted in a fine of £15 with 20 gns. costs. A steak and kidney pudding was found to be affected by mould, and the offence of offering for sale other meat products unfit for human consumption resulted in a fine of £100 with £25 costs. A bread roll, baked at premises outside Westminster, was found to contain a cigarette end; legal proceedings were instituted and the bakers were fined £25 with 2 gns. costs. The sale of a decomposing packet of ham, together with the exposure for sale of unfit packets of meat, resulted in a £75 fine with 25 gns. costs. A nail found in a buttered bun resulted in a fine of £10 and £5 costs. Other cases for which legal proceedings had been authorised were awaiting hearing at dates in the new year. See Table 25, page 75—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 a distributor of milk at or from premises within their district whether or not such premises are occupied by the distributor. At the 31st December 1970, 370 (368) distributors of milk were registered. Milk (Special Designation) Regulations, 1963 (as amended) The City Council is responsible for the granting on application of Dealer's Licences in relation to pre-packed milks sold under the special designations "Untreated", "Ultra Heat Treated", "Pasteurised" and/or "Sterilised". 29 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 1970 were:— Untreated 74 (74) Ultra Heat Treated 110 (108) Pasteurised 352 (350) Sterilised 249 (248) 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, notests 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 1970, is shewn in Table 23, page 74. Food Poisoning During the year information was received of 258 persons stated to be suffering from food poisoning, and a summary of some of the individual outbreaks affecting more than one person is as follows:— Following the consumption of smoked trout, four persons were ill; one was admitted to hospital for an overnight stay. Bacteriological examination of the trout disclosed the presence of staph, aureus. The source of the infection was not determined. A game pie delivered to retail premises in Westminster from the country, was later consumed with cold salad at a house party, by a party of five. All were ill. CI. welchii was isolated from a portion of the pie. Enquiries were made by the local Medical Officer of Health for the area where the pie was made and cooked, and advice given regarding temperature control. Twenty-two persons were ill following a party at which the only common food consumed was prawn cocktail. Twelve received hospital treatment. None of the prawns remained but the caterer's bacteriologist carried out an examination of a specimen the Company had retained and this showed a heavy count of a staphylococcal organism. It appeared that there had been failure to carry out explicit Company instructions in relation to the storage of the prawns, and steps were taken to ensure there was no repetition. Human failure on the part of staff at licensed premises resulted in seven persons being ill following consumption of beef and chicken sandwiches. CI. welchii was found to be the causative organism. The meat and poultry used in the sandwich preparation had been left to cool in a kitchen temperature for 16 hours before being placed in the refrigerator. Appropriate advice was given. Following a birthday celebration, 10 persons were ill. One was subsequently found to be excreting the Sal. Typhimurium organism—phage type 1 a. No food remained from the meal and no conclusion could be reached. Two outbreaks of CI. welchii occurred amongst patrons of the Meals on Wheels service operated in Westminster. Following an investigation certain practices in relation to the pre-cooking of foods were revised, and provision of additional facilities and accommodation reviewed. 30 An outbreak of food poisoning due to Salmonella enteritidis occurred amongst delegates to an educational course, which had to be abandoned. The case came to light a week after the onset by which time the 33 members who attended the course had dispersed. In all, 24 firms were contacted in order to reach the 33 persons at risk, and 19 Health Departments throughout the country were involved in the follow-up procedures. At the premises concerned two food handlers and two resident members of the staff were found to be excreting the organism. No food samples were available but the investigation pointed to cold chicken as being the likely vehicle of infection. It was thought to have been infected prior to roasting and the subsequent short cooking period had been insufficient to kill the bacteria present. Appropriate advice was given to the management. Following notification of a child suffering from Sal. typhimurium, enquiries disclosed that the patient attended a private day nursery where other children were also absent on account of illness. Extensive enquiries at local hospitals revealed that some children from the nursery had recently been admitted. Faecal specimens were obtained from 91 children and 11 members of the staff; of these 17 children and one staff member (a staff nurse) were found to be excreting the organism. The staff member was not unwell but she had been engaged in food handling and immediate action was taken to exclude her from work. In all, some 200 specimens were bacteriologically examined before the conclusion of the investigation. It appeared likely that the combination of a staff member who handled food being a carrier of the organism, and the community atmosphere in which the children spent their day, helped in the spread of infection. Protective measures were introduced to prevent any further spread of infection. Two outbreaks occurred at licensed premises on the same day, but at different functions. The common food was turkey and this was the suspected vehicle of the Sal. typhimurium organism isolated. None of the food remained at the time of investigation but examination of a prepared bird of a similar size to that consumed at the functions, showed it to have been insufficiently cooked. Typhoid Fever Several investigations were conducted during the year in connection with persons who had been confirmed cases, or contacts of cases, typhoid fever. A mother and two of her children, one a new born baby, were all suffering from typhoid fever, but each was in a different hospital. Against medical advice the mother discharged herself and returned home. The husband owned two restaurants where his wife sometimes assisted in the kitchen. She was warned that in no circumstances might she work in her husband's restaurants. She proved to be a co-operative patient, but at the close of the year was still a carrier of the disease. A second investigation related to one of a party of 24 persons from overseas who disembarked in the United Kingdom in October. There then followed a short tour of the continent during which time one of the party became unwell. On return to London he was admitted to hospital and typhoid fever was diagnosed. The patient was in hospital for some four months where he eventually died. Whilst the cause of death was not directly the outcome of the typhoid infection, it was understood to be a contributory factor. A waiter at a Westminster restaurant was admitted to hospital with typhoid shortly after returning from abroad. Some 50 staff members were kept under surveillance, and all submitted specimens. The respective local authorities and medical practitioners were kept informed of the progress of the case. The patient made an uneventful recovery. Unsound or Unsaleable Food—Examination and Disposal Under Section 72(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 II (Part II (7)) of the Local Government Act, 1963, states that any person who had 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. 31 During the year some 294 (237) tons of unsold or unsaleable foodstuffs were voluntarily surrendered for disposal. Under Section 9 of the Food & Drugs Act, 1955, a public health inspector may at all reasonable times examine any food intended for human consumption which has been sold, or is offered or exposed for sale, or is in the possession of, or has been deposited with or consigned to, any person for the purpose of sale or of preparation for sale, and if it appears to him to be unfit, he may seize it and remove it in order to have it dealt with by a Justice of the Peace. During the year four applications were made to the Court for orders to seize food, which had been found to be infested or otherwise contaminated. In each case the order was granted. It became necessary in one case to make an application to the Court for an Order under Section 100 of the Act for a warrant to enter premises in the face of refusal of access by the proprietor. Legal proceedings ensued in all four cases. 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 Nearly all imported food coming into Westminster is examined at the port of entry. However, in some cases the examination of goods is deferred until the food reaches the place of destination. Immediately notification of this is received concerning goods destined for premises in Westminster action is taken to contact the importer before distribution takes place. During the year 78 notifications were received of imported foodstuffs coming into Westminster which had not been examined at the port of entry. One notification received in the department concerned Golden Mustard which was found on analysis, after arrival at the importers' premises, to contain benzoic acid contrary to the Preservatives in Food Regulations 1962. Arrangements were made for the whole of the consignment to be returned to the country of origin. Imported Soya Paste examined at the port of entry was found to contain sorbic acid, a nonpermitted preservative. The goods had already been forwarded to the recipient in Westminster. He was immediately contacted and voluntarily surrendered the consignment, comprising two five gallon containers, which were destroyed. Export Certificates Applications for Certificates of Export received in the Health Department during the year in respect of foodstuffs to be despatched abroad numbered 15 (35). Eight of these were in respect of relief supplies despatched by a charitable organisation. 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. Trades Descriptions Act, 1968 Some 26 complaints alleging contraventions of the Act, were received in the department during the year. These included matters relating to eggs, reconstituted potatoes, meat, wine and tea. As recommended by the Department of Trade and Industry, where overlapping offences occur in respect of other and more specialised legislation, such as food and drugs laws, appropriate action should be taken under that legislation, and the matters were dealt with accordingly. Advice on Labelling During the year the Labelling of Food Regulations 1970 were published. These revoked the Regulations of 1967 before they came into operation. The new Regulations will supersede the present labelling legislation (Labelling of Food Order, 1953) and will come into force on the 1st January 1973. 32 The Ministry of Agriculture, Fisheries & Food in a report on labelling published in 1964 referred to guiding principles which should be the basis of deliberations on the subject of labelling of foodstuffs. One of these was that all labelling ('which includes any pictorial design') should be as clear and informative as possible. Advice given to enquirers on labelling requirements of products intended for distribution in the United Kingdom has incorporated this principle within the scope of current legislation, and has also taken into account the requirements of the new Regulations in order that manufacturers will not be required to make any further amendment when the new Regulations come into operation. The most frequent cause for adverse comment by this department on specimen labels is the name used to describe the product. Whilst "coined" names are not in themselves prohibited, it is a requirement of labelling legislation that the appropriate designation or common or usual name of the food, shall be clearly indicated on the label. Pictorial designs used must also be accurate e.g. fruit must not be depicted on a food which contains only fruit flavouring. The new Regulations will require the letters of the appropriate designation to be of a specified height in direct relation to the largest dimension of the container. Apart from matters associated with the special requirements in respect of labelling and the advertisement of certain foods, the new Regulations extend the requirement for the declaration of ingredients to additional articles of food. The regulations also deal with claims for general energy, calories and protein, and those relating to vitamins, minerals, slimming, diabetics, tonic restorative and medicinal matters. Under present legislation a "registered trade mark" where in use is sufficient identification of the manufacture of that particular food. Under the new Regulations the name and business address of either the packer or labeller of the food or a person in the United Kingdom on whose instructions this was done must be displayed on the label. A trade mark will no longer be an acceptable alternative. Consumer Protection—Date Stamping of Pre-packed Foodstuffs During the year the public health inspectors investigated a number of complaints concerning mould growth or out of condition pre-packed foodstuffs sold to members of the public. Checks at a number of retail premises revealed failure to rotate stock. This has sometimes been the result of a misunderstanding between retailers and salesmen as to their individual sphere of responsibility. Manufacturers give advice on the storage and handling of their products and code them in a way which gives information as to the date of manufacture. Suggestions have been made that the date of expiration of the "shelf life" of a product should be plainly exhibited on the wrapper or container and if this was accepted the incidence of the sale of out of condition goods would be greatly reduced. Every opportunity has been taken by the inspectors to impress on retailers the need for their own simple coding system which can be understood by all the staff concerned. If applied universally, this should reveal cases where stale foodstuffs are removed from one premises and delivered to another in association with improper "sale or return" practices. The Government has recently intimated its intention to study the question of legislation to enforce the marking of food with the date it was packed and it is anticipated that the review will take a year to complete. The Food Standards Committee of the Ministry of Agriculture, Fisheries and Food reported in 1964 that the marking of food with the date when packed was attractive to traders and consumers. This, however, was considered impracticable at the time. The recent growth in high pressure sales techniques has emphasised aspects which were not apparent when the Committee prepared their Report in 1964, and the Government's decision to review the matter is welcomed. 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. 33 Applications are also received from time to time, from the Royal Society for the Prevention of Cruelty to Animals for Slaughtermen's Licences to be issued to probationary inspectors. Twenty eight (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. The person giving this training and instruction also renewed his licence during the year. Fertilisers and Feeding Stuffs During the year six samples of fertilisers and feeding stuffs were submitted to the Agricultural Analyst for analyses. Four were found to be of a satisfactory compositional standard. In the remaining two the composition differed by more than the prescribed limits of variation from the statement of particulars given with the article. One contained an excess of nitrogen and the other an excess of phosphoric acid insoluble in water. However, neither difference was to the prejudice of the purchaser, and no further action was required. 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 especially requested by the Medical Officer of Health for 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 114 (119) traders were on the Council's lists of persons entitled to sell poisons included in Part 11 of the poisons list, the number of premises concerned being 153(162). Rag Flock and Other Filling Materials Act, 1951 Under the provisions of this Act various types of premises concerned with the upholstery trade 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 728 (975) verminous persons: adults 571 (718)—men 418 (564), women 153 (154); children 157 (257)—boys 51 (64), girls 106 (193). Scabies The two establishments mentioned in the foregoing paragraph treated 251 (574) scabies patients : adults 178 (320)—men 123 (137), women 55 (183); children 73 (254)—boys 35 (63), girls 38(191). The number of persons cleansed, and the number treated for scabies at the Health Department centres had shown a steady increase during the years 1966-1969. However, in 1970 there was a sudden decrease in the numbers attending as will be seen in Tables 26 and 27 on pages 75 and 76. 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 396 (466) baths were given, 336 (415) to women and 60 (51) 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. 34 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 has been 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 11,182 (11,261) bags each containing about 10 lbs. of soiled linen were collected, laundered and returned to the owners. This essential service is much appreciated by the recipients; and a special word of praise is again due to the staff at the centre for the noteworthy productivity of work which is not only hard but also unpleasant. Disposable Incontinence Pads In response to Ministry of Health Circular 14/66, a service is maintained for patients resident in the City, on written application by a general practitioner or district nurse, the patient being 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 136 (181) new cases arose, making a total of 258 (256) persons who received deliveries of supplies in their homes, whilst 18 (11) 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 with regard to apparatus, matters of technique, and the qualifications and suitability of the persons employed at the premises are referred to the Medical Officer of Health for his observations. Prior to 31st March, 1970, inspections of these premises were carried out by a qualified Physiotherapist attached to the Health Department, but upon her retirement the inspectors of the Public Control Section undertook the routine visits. The number of enquiries referred to the Health Department during the year was 50. The establishments about which enquiries were made ranged from those premises giving facial beauty treatment, general massage, and certain forms of electrical treatment, to those which provided 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 273 (283) establishments 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, eight applications for betting shops were referred to the Health Department for reports as to suitability. The City Council lodged two objections; five 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 (Inner West London) 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. 35 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 Mortician, four Mortuary Assistants and a cleaner. Details of the work of the Mortuary during the year are set out in Table 28, page 76. 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 1970 a total of 122 (108) burials or cremations were arranged by the Health Department as follows:— Burials at City of Westminster Cemetery, Hanwell 26 Paddington Cemetery, Mill Hill, N.W.7 10 St. Marylebone Cemetery, East Finchley, N.2 8 Cremations at the City Council's Crematorium, East Finchley, N.2 78 In addition to the cases actually dealt with by the City Council, a further twelve 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 49 Relatives or friends of the deceased 47 Hospitals in the City 26 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. 34 _1 5 — 1— 71 22 732 6121245 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 2,058 (1,983) certificates authorising cremation were issued, and since December, 1937 when the crematorium was opened 39,740 cremations have taken place. 36 PERSONAL HEALTH SERVICES Deputy Medical Officer of Health MARY T. PATERSON, M.B., B.S., D.P.H. As this is the last year in which the Health Department was entirely responsible for the personal health services, it is an appropriate time to review these services, analysing both the achievements and the shortcomings. Since 1918 Health Departments have been empowered to provide a service for mothers and young children, and over the years this has been expanded to meet all needs, ante and post natal care, health education, child health, day care, and support for families with special problems. Many of the problems which confront the Health Department stem from families living in unsatisfactory or inadequate housing conditions. Much progress has been made over the years in improving housing and many new or converted dwellings have been provided by the local authority, housing associations and private landlords. Indeed, during 1970 a total of 765 families were provided with housing accommodation by the City Council (331), the Greater London Council (246) and by nomination to housing associations (188), irrespective of the number who obtained accommodation through private landlords. None the less, much still remains to be done until every family is adequately and satisfactorily housed and the imaginative scheme now being actively undertaken in connection with the North Westminster Project (referred to earlier in this Report) will help to alleviate some of the problems which families face at the present time. During the past 5 years, there has been a steady decline in the number of births and consequently in the child population (1966, total births 3,651; 1970, total births 2,790). Notification of births ensures that the health visitor service is available and offered to all regardless of social need; but those who are in need are identified early and given special attention. Because the numbers are small, personal contact can be achieved with every mother. The mobility of the population, however, means that case loads are constantly changing, and personal communication with field workers both within the City and in other boroughs is vital. Ante-natal care is still provided on a tripartite basis—by hospitals, general medical practitioners and the local health authority. The important thing is to ensure that every mother receives adequate medical and social care and that health education is available to all. The illegitimacy rate in Westminster is still regrettably high (17 per cent, compared with 8 per cent, for England and Wales); in addition there are mothers unsupported for a variety of reasons who require special help. The City Council has fully implemented the National Health Service (Family Planning) Act, 1967, and provides free advice to residents with free supplies to all in medical and social need. Residents may attend sessions run by the Council itself, of which there are 7 weekly (including 3 evening sessions) or those run by the Family Planning Association in Council premises. Increasingly the hospitals are providing this service for both in and out patients who desire it. For the young, two weekly special youth advisory clinics are available, where counselling on personal problems is given as well as family planning advice. One important advance in preventive medicine has been the introduction of the Guthrie test for phenylketonuria. Blood samples are taken by hospital and domiciliary midwivesfrom every baby shortly after birth and examined in two hospital centres. It is the duty of the Health Department to check the results, both positive and negative, and to ensure that the necessary follow up is achieved. This has thrown an extra burden on the staff which they have accepted willingly, and for this I must pay tribute to their diligence and efficiency. With the decrease in the child population, it is inevitable that the number of attendances at Child Health clinics should also fall. In many ways this is an advantage. The quality of service provided has been improved. Fewer attendances mean that more attention can be given to each individual mother and child. Developmental screening and parent counselling is readily available, and the facilities for child minding during sessions, with play under expert supervision and observation, have been improved. The health visitors have provided stimulating social and educational sessions for mothers, and in many cases the mothers themselves undertake the management of their "clubs". One important aspect of the Child Health service is the early identification and care of handicapped children. This subject is considered in detail elsewhere in this Report, but here it may be stressed that because the numbers are small, a full and expert service can be provided of which the City may well be proud. 37 One of the major problems in Westminster is the number of children under 5 who require day care. Some of these are the children of unsupported mothers who require full day care in a day nursery or with a child minder because the mother must work. Some are the children of professional mothers, teachers or nurses who wish to return to work. Some have mothers who are students who should continue their courses, or the fathers are students depending on the wife for support. But the majority of children for whom day care is needed are those from a "deprived" environment—children whose parents cannot look after them adequately, cannot provide a healthy and stimulating home in which the child can thrive and develop normally. Priority is given in the City Council's day nurseries to handicapped children—those handicapped by mental or physical disability or by social environment. This is an important sphere of developmental paediatrics. Given special education and training in a good day nursery or playgroup, these handicapped young children can and do achieve a performance commensurate with their chronological age and are able to adapt to the infant school when the time comes to enter it. The appointment of an assistant nursing officer with responsibility for the day care of children has resulted in considerable improvement in facilities. Her main task has been to improve the quality of care given by child minders and playgroups, and to encourage suitable new applicants to register. Playgroup leaders and assistants, as well as child minders have been advised about courses of training, and have also been offered opportunities to observe existing groups. At one new playgroup opened by the City Council, special arrangements are made for child minders to attend with their children and learn about general child care as well as suitable play activities. The attachment of health visitors to general practices proceeds slowly. In Westminster, the number of family doctors greatly exceeds those of health visitors, and the majority of general practitioners work singly or in partnership of two. However, two health visitors were allocated to practices during the year and 3 district nurses on a part-time basis. There are now six health visitors and three district nurses attached to practices. As in other areas, it has been found that attachment means more rather than less work for both general practitioner and nurse, but the increased duties are welcomed. They provide a better service to the public and real preventive medicine for all ages can be practised. In the City of Westminster a significant proportion of its population lives alone in bed sitting rooms, hotels and hostels. Some of these are students, often from overseas; some are mentally ill, or they may be handicapped or elderly, but the majority are normal working people whose needs are varied and largely unmet. London can be one of the loneliest places in which to live. True neighbourliness is uncommon. Some people value the privacy and independence that this ensures, but for the shy, the inadequate, the proud and poverty stricken, conditions may become well nigh intolerable. For the mentally ill and mentally subnormal the City provides a social worker service with day care facilities and some hostel accommodation (see page 49). For the elderly, the service is provided partly by the Health and Social Services Departments and partly by the City of Westminster Old People's Welfare Association. There are, however, many elderly residents who need help but are unwilling to avail themselves of old people's clubs, day centres, meals on wheels, home helps, and who will not even apply for Social Security benefits. This is where the attachment of health visitors to general practice can be most beneficial, in the identification of need and in persuading the people concerned to accept what is their right. In 1966, 3,570 patients were nursed in their homes by domiciliary nurses. This number has remained fairly constant in spite of the increasing proportion of the population over the age of 65. For these patients, the incontinent laundry service, meals on wheels, home help and chiropody services are available where necessary. There are special problems connected with the home help service. Because of difficulties in the recruitment of home helps and financial stringency service can only be provided where help cannot be obtained from the family, friends or voluntary organisations. The number of applications is fairly constant—1,529 in 1966 and 1,556 in 1970. The number of patients receiving help in 1966 was 2,695 and in 1970, 2,674. However, some patients receiving help would undoubtedly benefit from more hours per week if this were possible. Normally home help service is provided during five days a week only but I must pay tribute to those home helps who work on Saturdays, Sundays and on Bank Holidays, often in a voluntary capacity, to ensure that their patients' needs are met. The City Council's policy is to give every encouragement both financial and otherwise to voluntary organisations, to continue existing work and to start new projects. For children, the City of Westminster Health Society, the Save the Children Fund, the Westminster Council of Social Service and the City of Westminster Society for Mentally Handicapped Children are fully supported. For the mentally ill, services are provided by the National Association for Mental Health and the Institute for Social Psychiatry; for family problems the Family Service Units, Family Welfare Association and the 38 National Society for the Prevention of Cruelty to Children are utilised, whilst for the elderly the City of Westminster Old People's Welfare Association and Task Force are the main agencies. There are many others to whom the City Council owes it gratitude—Paddington Charitable Estates, Marylebone Health Society and Westminster Amalgamated Charities make financial grants to suitable cases recommended by field staff. One of the duties of the Health Department's Principal Social Worker (Miss J. McFarlane) is to arrange case conferences to coordinate the field work of statutory and voluntary agencies, to prevent overlapping and to ensure that the most appropriate help is provided for every family in need. The City Council has a duty to provide facilities for students of all kinds to obtain some insight into community services. Owing to the number of teaching hospitals and educational establishments in the area there is a great demand for training and for visits of observation. Post graduate doctors, medical students, student nurses, social work students and student teachers either in groups or as individuals apply for instruction and field experience. It is extremely difficult to meet all their requirements with the limited staff available. With the increasing attention being paid to community medicine and social care a stage of saturation has been reached and the Department is having to refuse or limit the attendances of some groups. There are also local or national surveys in which the Council is asked to participate—the pilot scheme, survey and follow up of the British Births survey 1970, the rubella survey, the Inner London Education Authority's spina bifida research project, are examples. Although the organisation and statistical analysis is the responsibility of the bodies concerned, most of the collection of data is undertaken by Health Department field staff. Participation in research is considered to be of the utmost importance and is willingly undertaken; but the demands upon individual members of the staff are very heavy. It can be claimed that the services for mothers and young children (with the possible exception of nursery school services) are second to none and that they are well used by the majority of the population. There is, however, a proportion of residents in need, for medical or social reasons, who do not know of or do not wish to avail themselves of the existing services and in future every endeavour will be made to redress this. INFANT AND CHILDHOOD DEATHS With a decline in the number of births a decrease in the number of infant deaths was to be expected, and this is confirmed by the figures (Table 2, page 64). Fifty eight children under one year of age died during 1970, compared with 65 in 1969. This still produces an infant mortality rate of 21, which is higher than the national average (18) but compares favourably with the 22.42 infant mortality rate in Westminster in 1969. It is also satisfactory to note that the infant mortality rate for illegitimate infants is 27 for 1970, as against 39 in 1969. 98.5 per cent, of births took place in hospitals or nursing homes and only 1.5 per cent (43) were born at home. The total number of stillbirths was 25, giving the very low stillbirth rate of 9, compared with the figure of 13 for England and Wales. However, the neonatal mortality rate of 16, which is higher than the national average, must be associated with the low stillbirth rate. Forty four children died during the first month of life and 40 of these occurred during the first week. Thirty-two of these infants were premature and died despite expert care in special units. Four of the early deaths were due to congenital abnormalities incompatible with life. Twin infants who had died of inhalation asphyxia were found at Marylebone Station. Most of these neonatal deaths can be regarded as inevitable and can only be prevented when the causes of prematurity and congenital abnormalities are fully understood. Our attention should therefore be focussed on the post neonatal deaths, those occurring between the second and twelfth month of life. Fourteen children died in this period of life, six of them from severe congenital abnormalities, although all received expert care and treatment. One baby of eight months died from overwhelming infection associated with hypogammaglobulinaemia. Another of four months died from septicaemia and meningitis. Both parents of this child were drug addicts, but the care of the infant, undertaken by the grandmother, was excellent. A tragic death from gastroenteritis occurred in a baby of eight months, living under adverse social conditions. The father was in prison and the mother and baby were living part of the time with the grandmother. They were not in touch with the family practitioner and help for the baby was obtained too late to save life. 39 An unfortunate death to which I must draw attention is one which occurred in a baby of five months whose mother was revaccinated. The baby developed eczema vaccinatum and died from massive gastro-intestinal haemorrhage. There were two "cot deaths". One was an illegitimate infant of three months who, in spite of excellent care by a registered daily minder, died from acute bronchopneumonia. The other infant, also aged three months, was found suffocated in its perambulator. This infant was extremely well cared for, and there was no question of any negligence on the part of the mother. Turning to the older age range, nine children between the ages of one and five years died, and 10 between the ages of five and fifteen years. Four deaths were due to leukaemia or malignant neoplasms, three to severe congenital abnormalities and five children died as a result of road or other accidents. It is perhaps worth noting that two children in the older age group died from asthma. It used to be thought that asthma was a troublesome condition rather than a cause of death in childhood. But in spite of sophisticated therapy these tragedies do occur. MATERNAL MORTALITY No maternal deaths were reported in Westminster in 1970; there were two such deaths during the previous year. HANDICAPPED CHILDREN Of recent years considerable attention has been focussed on the needs of the handicapped child and his family. A child may be handicapped by reason of some congenital abnormality or deformity, as a result of disease or injury in early life or of adverse emotional and environmental conditions. There is a tendency for handicaps to be multiple. The same pathological process that causes a physical handicap may also lead to an intellectual one. A child with impaired physical or mental development may also suffer from emotional deprivation, over protection and lack of opportunity in his home environment to achieve his potential. The emotional needs of handicapped children—the longing for love which a physically unattractive child so badly needs, the self-awareness which he must learn at a very early age, or the frustration at lack of ability which is expressed in temper tantrums—these are problems for the family. The whole family must be involved, but when the daily regime of a young child is considered, it is the mother who bears the greatest burden. The mother will need help in understanding that when the other siblings have outstripped the handicapped child in agility, performance and control of bodily functions, this one will continue to need the care usually bestowed on a baby. She will also need to learn, and this is a difficult lesson, that a handicapped child must also be subject to the ordinary rules of social behaviour. He must be allowed and encouraged to do things for himself such as feeding and dressing. He must learn to accept "no" without resorting to temper tantrums or even fits in an attempt to get his own way. The local authority, the hospital and general practitioner service and voluntary organisations all have a part to play in meeting the needs of handicapped children and their families. The early diagnosis of and treatment for the condition is a medical responsibility. Support of the family in the home by provision of material help and advice on day to day management is a role undertaken by health visitors or social workers, while early training and education may be undertaken by nursery nurses or nursery teachers. For any satisfactory service a team approach is essential. No matter who provides the help it must be co-ordinated. There must be full assessment of the family's immediate needs and of the child's potential. The parents must be given a realistic prognosis and helped to accept it by counselling on a long term basis. As a first step in the co-ordination of the services for handicapped children, the Health Department maintains a register to encourage the early identification of handicaps, to ensure follow up by regular review, to arrange for appropriate management and treatment, and where necessary to ascertain for special education. Children may be placed on the register because of congenital abnormalities notified at birth, or because of failure to make normal progress in any sphere of development whether this is due to physical or mental handicap or adverse emotional or environmental conditions. 40 In 1970, 46 children were notified at birth as having congenital abnormalities compared with 48 in 1969. Of these 46, nine were abnormalities of the central nervous system or severe multiple deformities, and six of them were still born or died shortly after birth; seven were cases of talipes, and six suspected congenital dislocation of the hip. The remaining 24 children had abnormalities of a minor nature and their names have subsequently been removed from the register. For the identification of handicaps and the compilation of the register the Department depends upon two main sources. The health visitor may suspect disorders and bring children forward to the clinic doctor for developmental screening. As far as possible all children are screened at key ages and those failing to make normal developmental progress in any sphere are referred for further observation and investigation. The second source of information concerning handicapped children is the hospital paediatrician or family doctor. The regular follow up of handicapped children is undertaken by the clinic medical officers at child health centres or day nurseries, by principal medical officers at special clinics for handicapped children, or at hospital assessment centres. During 1970,111 children were examined at special sessions by principal medical officers trained in the diagnosis, care and management of handicapped children. Sufficient time is allowed for full examination and assessment of the child's immediate needs and as far as possible of his future requirements and potential. Placement may be recommended in a special unit or day nursery in order to provide training by skilled staff and an opportunity for the child to play and learn with others. Health visitors and social workers are encouraged to attend at the same time as their families, and parent counselling on a long term basis is provided. In the City of Westminster there are two district assessment centres in teaching hospitals. In both, the consultant paediatrician is assisted by a principal medical officer from the local authority whose duties are to undertake psychometric testing, and to arrange for the implementation of recommendations for treatment, care, management and education in the home area. He acts as a co-ordinator, and secures the co-operation of all concerned in bringing the necessary services together to meet the needs of the whole family. At both these assessment centres ophthalmic, audiological, orthopaedic and neurological investigation and treatment are available. As will be seen from the statistics included in Table 34, page 81, the total number of children of five and under on the handicap register is 363. Of this number 41 children under five received training in special day units and a further 34 were placed in ordinary day nurseries; 12 were in residential homes or long stay hospitals. Every child on the register on reaching the age of 4J had a special medical examination to decide on the most suitable type of education. Of the 113 born in 1965 and 1966, eight were recommended for schools for the educationally subnormal, five for training schools for the severely subnormal, 12 for other special schools (physically handicapped etc). But a satisfactory finding was that 51 were recommended for admission to ordinary infant schools. In many cases their handicaps, often retardation associated with emotional or environmental deprivation, had been treated and overcome so that they could take their place satisfactorily and compete with normal children. The service for handicapped children has two main objectives. One is to provide the necessary help to the child and his family from an early age so that he shall learn to live with the handicap, to adjust to it and ultimately to become an independent member of the community. The other is to prevent handicaps developing: to identify and treat deviations from the normal before all the secondary disadvantages, emotional disturbance, educational failure and social maladjustment have overwhelmed him and turned him into an unacceptable, unsuccessful, unhappy misfit. (Statistics—Table 34, page 81). DAY CARE OF CHILDREN UNDER 5 YEARS Day Nurseries The eight day nurseries again had a busy year. The need for places for children aged 1-5 years continued, although the pressure for places for the under 1 -year olds was slightly less. Even mothers in difficult circumstances seem to wish to keep their young babies with them, but the stresses increase as the child gets older if they are living in overcrowded or shared homes, or need to work to support themselves. Single parent families and socially deprived children constitute the majority of those applying for admission. In some cases the mother needs to attend a day centre for psychiatric treatment, or may be admitted to hospital for a short period. 41 Priority is also given to handicapped children, those suffering from physical or mental defects and those who fail to make satisfactory developmental progress owing to environmental deprivation. Where necessary these children are placed in three special units in the day nurseries, but the less severe cases are cared for in the ordinary nurseries. The nurseries are bright and gay inside with pictures and handicrafts made by nurses, students and children. These are often made out of "waste" materials such as brown paper, cartons, egg boxes, paper tissues, string, cotton or woollen materials, etc. An exhibition of toys, musical instruments and decorations made in the City Council's day nurseries was on show at the Conference on Maternal and Child Welfare held at Church House, Westminster in June 1970, attended by medical officers and health visitors from all overthe country. Although more playgroups and toddler clubs are opening the need for day nursery places is still indicated by the number of referrals for placements from doctors, health visitors, social workers and child guidance clinics. Over the years some of the day nurseries, especially in the Paddington area, have suffered from break-ins and vandalism. Damage and financial loss were fortunately reasonably small, but on each occasion considerable inconvenience was caused to the nursery staff, who are also always most upset at finding their nursery in turmoil, and many of their hand made toys and art work destroyed. In 1969 an increase in these incidents at one of the nurseries led to the installation of a burglar alarm in October of that year, since when there have been only two attempted break-ins, both forestalled by the sounding of the alarm. However, intruders then switched their attention to another day nursery in the area, and in 1970, after three minor entries followed by two serious break-ins, which resulted in the need to replace stolen articles and petty cash and repairs to the building, amounting to approximately £560, approval was given to the installation of a burglar alarm at that nursery. To date, this has proved to be a valuable deterrent. 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 Under delegated authority the Medical Officer of Health is responsible to the City Council for the registration under the amended Act of all child minders, private day nurseries and pre-school playgroups in the City of Westminster. Initial inspection of the premises concerned with full discussion with the applicants is undertaken by an assistant nursing officer. All improvements and additions considered necessary to comply with the City Council's requirements must be completed before registration. These requirements, imposed by Order of the Council, cover such aspects as the number and age of the children who are received, 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 to which the applicant must agree as a pre-requisite to registration and subsequently must observe at all times. After registration, the assistant nursing officer is responsible for the continuing supervision of the playgroups and the private day nurseries. She is helped by a male administrative assistant who deals with infringements and enforcement. Child Minders A steady flow of applicants wishing to register as child minders continues to be received. On the Health Department's register there are many excellent minders, a number of whom are in receipt of a retaining fee of £1 per week for which they agree to receive certain priority children nominated by the Medical Officer of Health. The Council's health visitors supervise all registered child minders closely and where the standard is not so high, are endeavouring to improve it often with a good measure of success. Pre-School Playgroups The ever increasing public interest in playgroups for children aged 2-5 years continues. More and more applications are received for registration from persons wishing to start new groups and as a result, a wide variety of care is available catering for children with differing needs. Indeed, due to the increasing numbers of groups in some areas, it is necessary to encourage prospective applicants to 42 consider alternative sites. The staff assists with advice and guidance, and the City Council, in the undermentioned cases, gives financial help towards the running expenses of the groups:— Organisation No. of groups City of Westminster Health Society 5 Save the Children Fund 4* Westminster Council of Social Service 2 Inner London Pre-School Playgroups Association 5 (* Includes one playgroup in Welfare Department accommodation) There are now four playgroups run directly by the Health Department, three in Maternal and Child Welfare Centres and one in outside premises. The following details show the position as at 31st December, 1970, in respect of the number of child minders and premises registered, the number of children concerned and other relevant information. Child Minders 1970 1969 No. of registered child minders 144 87 No. of children accommodated in homes of registered child minders 347 194 No. of applications under consideration 22 No. of child minders who are being paid a retaining fee 16 18 Private Day Nurseries No. of applications registered 10 8 No. of children accommodated in premises now registered 330 182 Playgroups etc. No. of applications registered 33 17 No. of children accommodated in premises now registered 1120 428 Eleven applications for the opening of day nurseries and playgroups are under consideration for registration, which will provide between 250-300 places if final registration is effected in each case. One playgroup closed during the year due to the lack of local support. Services provided by the City Council's Health Department City Council Day Nurseries 1970 1969 No. of premises 8 8 No. of children accommodated 450 450 City Council Playgroups No. of playgroups *4 3 No. of children accommodated 112 52 City Council Occasional Creches No. being held 7 7 No. of children being catered for 100 100 *During the year, the City Council opened a fourth playgroup at the Stowe Boys Club, Harrow Road, W.2, providing facilities for 20 children in the mornings, and a further 20 in the afternoons. All the places were filled almost at once and the group has proved to be highly successful and popular. 43 Services provided at City Council's Welfare Department homeless families accommodation One of the two playgroups run on behalf of the Welfare Department by the Save the Children Fund at Norfolk Square closed down during the year. The other playgroup at Leinster Square remains open and caters for approximately ten children. NURSERIES FOR MENTALLY HANDICAPPED CHILDREN There are three special day nurseries registered by the City Council, two of which are operated by the City of Westminster Society for Mentally Handicapped Children catering for 42 children, and one operated by the Salvation Army for 20 children on one day per week. URBAN PROGRAMME The Government's Urban Programme was initiated in 1968 and at the present time projects that are approved under the programme attract a Home Office grant of 75 per cent, of capital and revenue expenditure (provisionally the first five years revenue expenditure). Phase III of the programme was promulgated in August 1970 and a number of projects relating to day care of children, family and housing welfare were submitted by the City Council on behalf of the several departments concerned. Also re-submitted from 1969, was the Brunei Estate Day Nursery project (50 places) and it can be mentioned at this juncture that the Home Office in January 1971 indicated its approval in principle for grant aid in respect of this nursery. A cleared grassed area has been reserved for this nursery and it is anticipated that it will be completed by early 1973. THE HEALTH VISITING SERVICE This service has continued throughout 1970, following the pattern of previous years, with the work organised from the ten Maternal and Child Health Centres within the City. Home visiting and follow up and after care visits and the organisation of the various clinics e.g. child health, ante-natal, family planning etc., is the permanent responsibility of the nursing and health visiting staff. It is in these activities that they fulfil the role for which they were trained, practitioners in their own right, detecting cases of need on their own initiative and also acting on referrals from other field workers. The year 1970 saw the extension of visiting of elderly people, and improved co-operation with other agencies dealing with them. Several meetings and group discussions were organised in co-operation with the City of Westminster Old People's Welfare Association, in an endeavour to clarify the role of the health visitor, as well as that of other workers, and to bring about more understanding and co-operation between them. This in the main has been successful, and small local groups have continued to meet, resulting in more benefit to elderly people in the way of a visiting service. Much remains to be done and the difficulty of knowing which of the elderly most need the service also remains; tracing those who need help is not an easy task in a City of this size and complexity, and having regard to the high numbers living within the area. Two further attachments of health visitors to group practices have been organised, bringing the total to six; here the health visitor does not work on a geographical basis, as is the usual arrangement, but provides service for all patients in the group practice. This brings the health visitor into contact with all age groups, therefore providing a comprehensive service for all registered patients. As a result of the co-operation and discussion undertaken by the senior nursing officers with the general practitioners, it is pleasing to record that all attachments have proved most successful, and appreciation of the health visitor's work has frequently been expressed by the doctors concerned. It is hoped that more attachments will be arranged in future, as health visitors have come to hold the view that there is more job satisfaction for them, and the patients also much appreciate the improved service provided for them. Understanding between the doctors and health visitors has resulted in happier relations all round. It has been a marked feature that the health visitors involved in this scheme have volunteered to work in this way, and have shown great interest and enthusiasm, thus ensuring success. This is a development which it is hoped to continue, and encouragement is given by senior nursing officers, who guide the staff to use the special skills of nursing, social training, and health education they have in this sphere of work. 44 In-service Training—Refresher Courses One nursing officer completed a Middle Management Course during the year, and two senior health visitors attended a First Line Management Course. All assistant nursing officers have now attended Middle Management Courses, but as there have been such frequent changes in this grade in the City Council's service, this cannot be regarded as a permanent situation, e.g. two assistant nursing officers left the Council's service during the year, and two joined so that further training will undoubtedly be required in the future. Six health visitors were given Field Work Instruction Training during the year, and one assistant nursing officer completed her District Nurse Training course. One health visitor attended a Refresher Course. All nursing staff are heavily involved in training students in the different disciplines, resulting in regular and frequent commitments, as well as the day to day work of the Department. This, of course, is inevitable if the standard of work and service to the community is to be maintained. Liaison with Hospitals The liaison scheme, commenced in 1969, whereby members of the nursing staff attend weekly sessions with the consultant geriatricians and their staffs at two teaching hospitals to ensure that all necessary services are available to patients upon return home from hospital, has continued. This arrangement has proved of great value in the field of care to the aged and discussions are taking place with other hospitals to enlarge the scheme. Health Education Weekly teaching sessions continue in schools and Technical Colleges, and displays and exhibitions were organised. Regular Health Education sessions for mothers on ante-natal preparation, child care and house management are held in all the Maternal and Child Health Centres. The English language classes for mothers continue with health visitors encouraging and persuading them to attend. School Health Service Most nursing staff take part in this service. Health surveys are undertaken and also preparation for and assistance at medical examinations. Here continuity is more difficult to organise, as the frequent turn-over of staff is a problem. Health Visitor Training Sponsorship Students come forward for sponsorship, but this is not such a satisfactory field of recruitment as it has been in previous years. It appears that numbers are falling nationally and a similar pattern is apparent in Westminster. Recruitment of trained staff is also more difficult reflecting the national situation, and conditions of work and housing in Central London does not help the situation. Family Planning The City Council has fully implemented the provisions of the National Health Service (Family Planning) Act, 1967. The service is provided both directly by the City Council and by use of the Family Planning Association and the Catholic Marriage Advisory Service, both of these organisations having the free use of accommodation in Health Department establishments. All forms of contraception are available and free advice is provided for all residents of the City irrespective of marital status and sex, and where family planning is needed on medical grounds, supplies of appliances or drugs are provided free of charge. The City Council makes a financial contribution to the Family Planning Association in respect of service given to Westminster residents. Persons living outside the City of Westminster may attend the Family Planning Association's clinics run in the Council's establishments in which case the Association applies to the appropriate local authority for reimbursement of their expenses. 45 During the year, the Family Planning Association opened a further clinic on Thursday evenings at the Maternal and Child Welfare Centre, Westminster Council House Extension, to satisfy a demand for this service by women working and residing in the Baker Street area. The new service set up at one of the Council's maternal and child welfare centres in collaboration with the Board of Governors at St. Mary's Hospital and the Eugenics Society is continuing to prove most successful. A health visitor trained in family planning methods visits the patients in the hospitals maternity unit and invites interested mothers to attend a 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 home area. In 1968, a weekly counselling clinic for young persons seeking family planning advice was opened; need necessitated a second clinic opening in 1969 and further expansion has resulted in the appointment of a full-time social worker in this field. Detailed reference to this service is given on page 48. VACCINATION AND IMMUNISATION Vaccination and immunisation against diphtheria, tetanus, whooping cough, poliomyelitis, measles and smallpox are available to all children under school-leaving age, either at the child welfare centres, in schools or at the surgeries of their family doctors. Smallpox vaccination is also available in the medical suite at City Hall for adults residing or working in Westminster, and 76 adults were so vaccinated in 1970 in addition to 29 at maternal and child welfare centres. In addition, immunisation against poliomyelitis and tetanus is provided for adults on request. It is well known that an attack of rubella (German measles) in early pregnancy may harm the unborn child and much research has been undertaken over a long period to find a way to protect girls against this disease. Ultimately a safe vaccine was produced and in 1969 extensive national trials of this vaccine were carried out; indeed, some volunteer girls at Sarah Siddons School in Paddington took part. The successful outcome prompted the Department of Health and Social Security to recommend that vaccination against rubella should be offered to all girls between their eleventh and fourteenth birthdays. In view, however, of the limited supply of vaccine this could only be made available initially to girls in their fourteenth year. Accordingly, in September, 1970, parents of all girls within that age group were given information about the disease, the possible consequences if contracted during pregnancy and the protection which their children could be given either by arrangement with their general practitioner or by the City Council's school medical officers. Further details are given under the report of the School Health Service on page 60. QUEENS PARK MATERNAL AND CHILD WELFARE CENTRE LANCEFIELD STREET, W.10 Due to redevelopment of the Herries Street North area of the North Westminster project, the Maternal and Child Welfare Centre situated at 66 Lancefield Street, W.10 will be demolished in 1971. Pending replacement of this building by a new health centre on a site which will not become available for some time, the City Council approved the construction of a temporary prefabricated building on Council ground, adjacent to St. Jude's Hostel in Lancefield Street. Work commenced during 1970 and the temporary centre opened in March 1971. MOBILE HEALTH CLINIC In my last Annual Report I expressed the hope that in 1971 I would be able to describe the early days of operation of a mobile health clinic in Westminster. Unfortunately, after interminable delays, the two specialist firms from whom quotations were invited eventually withdrew from all negotiations; one firm went into Receivership, whilst the other, which was experiencing production difficulties, finally referred the City Council's specification to a company specialising in building mobile clinics and other similar units for foreign governments, the Foreign Office, etc. The clinic is now being built and present indications are that it will be in operation towards the end of 1971, a year later than originally envisaged. 46 HOME HELP SERVICE A comprehensive home help service for those who require assistance by reason of infirmity, ill health, or age, is provided by the City Council, under Section 29 of the National Health Service Act, 1946. So as to provide local facilities, the service operates from three offices, situated at the City Hall and the two district offices in Paddington and St. Marylebone. Prior to 1965, courses of in-service training were arranged for new entrant home helps from time to time by the former London County Council, who were then responsible for the service. On amalgamation, the home help organisers assumed this responsibility and imparted guidance to the home helps about their work by individual discussion, and gave practical advice as to the performance of their duties in the patients' homes. It was decided in 1969 that in the interests of uniformity in-service training should be reintroduced and courses consisting of five sessions of 1 to 1½ hours duration were devised; each course held during five consecutive weeks on one afternoon a week. In order to provide a local venue, convenient to the home helps, two courses were run concurrently, one in the north and one in the south of the City. The syllabus consisted of sessions devoted to (a) introduction to the health and social services; (b) conditions of service—time sheets; travelling times; expenses; special jobs; (c) domestic duties of the home help; (d) health requirements of all groups (children; maternity cases; home safety, etc.); (e) posture and lifting, for which a film was provided; (f) households with special difficulties (tuberculosis; mentally and physically handicapped; incontinence, etc.). Talks on these subjects were given by the Chief Nursing Officer, home help organisers, and an administrative officer from the Health Department's Management Section. Each course was followed by a week's practical training at a College for Further Education in the cleaning of rooms, preparation of meals, shopping for foodstuffs, simple calculations, etc. These practical courses were not entirely satisfactory and plans for future in-service training will probably include practical work undertaken in some of the City Council's residential establishments, under the supervision of the home help organisers and their assistants, in place of attendance at a Technical College. To meet the increasing demand upon the service, the City Council approved the employment of a further ten full-time home helps during the financial year 1970/71, and this has proved to be of considerable assistance in helping to maintain an adequate service, although recruitment difficulties abound in some parts of the City. The practice of rigid zoning of the home helps' districts and a stringent assessment of the assistance required by the patients introduced some two years ago continues to be imposed. By these means, the available work force is used to its maximum. Number of home helps 1970 1969 (a) Joining service 61 53 (b) Leaving service 55 54 (c) Employed on 31st December 225 219 =full-time equivalent 210 200 Statistics relating to the home help service are set out in Table 41, page 84. NURSING HOMES Ten nursing homes are registered with the City of Westminster, all of which take medical patients; 6 also take surgical patients; 3 take maternity patients and one is registered under Part 3 of the Mental Health Act, 1959 to take patients suffering from mental illnesses. Three of the homes are non-profit making. Under Section 1 of the Abortion Act, 1967, 5 of the ten registered nursing homes applied to and were approved by the Department of Health and Social Security to take patients for treatment for the termination of pregnancy. No new nursing homes were registered during 1970. 47 All the nursing homes are regularly inspected by a Principal Medical Officer and a Public Health Inspector, and advice given about alterations and improvements. At one of these routine inspections of a long established nursing home it was apparent that the standard of the operating theatre had fallen below that which is required of any accommodation used to carry out surgical procedures. It was necessary, therefore, to amend the registration to exclude surgery for a period whilst improvements were effected to the operating suite. Later in the year when the work was satisfactorily completed, re-registration to include cases involving surgical treatment was approved. RECUPERATIVE HOLIDAYS Under the City Council's scheme arrangements are made for adults who have been suffering from a recent illness, expectant mothers, mothers with babies or children under five years old who cannot be left at home, to receive recuperative holidays, usually for a fortnight, whereby they benefit by rest, fresh air and good food. Persons who are unable to meet the full charge for the holiday are assessed to pay in accordance with the City Council's assessment scales; those in receipt of supplementary benefit receive free holidays. The Inner London Education Authority bears the cost of and arranges placement for recuperative holidays for school children. The total number of applications received during 1970 was 276 (256 in 1969) of which 176 received holidays. The remaining 100 were abortive due largely to the patients not taking up offers made to them, to appropriate accommodation not being available or to the persons recommended not being considered suitable or not coming within the schemes. The 176 holidays were arranged for:— 1970 1969 Expectant and nursing mothers 5 1 Tuberculous adults 5 1 Other adults 65 82 Accompanied children 11 7 Unaccompanied children under 5 years 12 7 School children 78 74 176 172 Of the "other adults" 12 were psychiatric cases. Recipients of the holidays are accommodated in voluntary or private homes and in ordinary boarding houses. The total number of homes is limited and those for special types of patients, for example, psychiatrics and mothers and babies, extremely so. During the year, four homes regularly used for the reception of Westminster residents closed. One re-opened later under new management. Recommendations for recuperative holidays increase yearly and because of competition with other local authorities to obtain places, more and more difficulty is being experienced in finding suitable vacancies. The City Council is most appreciative of the co-operation, assistance and care given by the proprietors of the various homes who provide the recuperative holidays for Westminster residents. There is no doubt that these holidays are of great benefit to the recipients. SOCIAL WORK (PERSONAL HEALTH) During 1970 with a view to the implementation of the Local Authority Social Services Act, 1970, the social workers in this section of the Health Department continued their previous policy of learning more of their colleagues' duties as well as specialising in their own particular spheres. The 24 social workers come from many disciplines and are able to offer a wide variety of help and it is therefore possible to offer our clients a family service. There are many areas of common concern to all social workers - problems of poverty, of mental and physical illness, of the care of children, of homelessness - to mention only a few. As far as possible one social worker carries out all the tasks in assisting a family and consults a colleague or senior member of the staff for expert advice. 48 In the earlier part of the year, a Lecturer from the London School of Economics led a series of twelve seminars on casework methods attended by colleagues from the Children's and Welfare Departments, as well as by Health Department staff. In the autumn, a discussion group, again consisting of social workers from the various Departments, and led by the Council's Consultant Psychiatrist, examined different methods of working with groups. During the year the Youth Advisory Service expanded and a full-time social worker was appointed. In addition to being available at the two clinics attended by a medical practitioner who is specially skilled in youth counselling, the social worker has been exploring the needs of the community as far as adolescents are concerned. She found that there is a large group of adolescents who are very much at risk but unable to make use of the existing social services. She has, therefore, been attending various youth clubs, technical colleges, coffee bars/discotheques, in order to make accessible either on the spot or in the clinics - the services and advice which those young people need. The results are encouraging and many adolescents are now directly approaching her for help. Eighty clinic sessions were held during the year, involving some 465 personal interviews. There has been an expansion in the number of Special Investigation Clinics and parents value the opportunity of being able to discuss their difficulties with the medical officer and social worker. The latter keeps in close touch with the child's home and where necessary works with the whole family towards the solution of practical and emotional problems. The importance of the preventive aspect of this work cannot be over-emphasised as the treatment of minor behaviourproblemsoften prevents more serious difficulties from developing. Consideration is being given to the possibility of group work particularly for adolescents who are overweight. Several meetings have been held where doctors and social workers can discuss the treatment of cases and ways in which they can work together. It is anticipated that these seminars will be further developed next year and that the Council's Psychiatrist will lead the group. In 1970 there were 128 new referrals and 660 attendances were made at 183 clinic sessions. There were 837 home visits. One member of the staff is responsible for the social work connected with children who are deaf or partially hearing. She attends the local audiology clinic and visits parents to give advice and support as well as acting as the liaison between the child's home and school. During the year she made 69 visits. The number of attendances at the clinic was 290. The casework service for the families of children attending special schools has been developing and at the end of the year the social worker concerned was in touch with twelve families. One social worker is employed full-time with families who have special difficulties and five other members of the staff have a case load of similar families in addition to their other work. Comment is made by the social workers on the increasing complexity of the problems with which they deal and also on the fact that many families require help and support over a long period. At the end of the year the number of families being assisted was 53; 1,240 home visits were made in addition to 153 interviews at City Hall. Two members of the staff work full time with unsupported parents. Although in some cases the client needs limited help for a short time only, in many cases practical help and casework support is required over a long period. There were 159 new referrals during the year; 273 home visits were made and 335 interviews took place at City Hall. The three social workers attached to the Chest Clinics have been dealing with a considerable number of problems connected with housing, finance and employment. Many of the patients with whom they are in touch are very seriously ill and a considerable amount of support is often given to them and their families. During the year there were 272 new referrals to the social workers; the number of current cases at the end of the year was 325 and there were 227 home visits. Three social workers concentrate on visiting the frail elderly and help in situations where intensive supervision is necessary. They work very closely with other statutory and voluntary organisations as well as with hospital staff and general practitioners in identifying and meeting the needs of the elderly. In 1970 there were 208 new referrals; the case load at the end of the year was 953 and 5,474 home visits were made. One member of the staff deals specifically with the problems brought to him by immigrants. These include difficulties connected with accommodation, matrimonial and family matters as well as problems resulting from immigration. The work of the social workers attached to clinics for venereal diseases is separately dealt with on page 55. 49 CO-ORDINATION Case Conferences are held at the request of any social worker or agency interested in the family. During the year 32 conferences were held at which 127 families were discussed. MENTAL HEALTH During 1970-71 the general services of the Mental Health Section have been well maintained. The social clubs for the mentally ill are meeting regularly and there has been a noteworthy improvement in many chronically sick patients. For the first time arrangements were made for club members at Christmas to go to the pantomime on ice at Wembley Stadium; this was a very successful outing and was the first public entertainment visited by several of the patients for many years. Both Ebury Bridge Junior Training School and St. Judes Elder Girls Centre for subnormal and severely subnormal patients which opened in 1969 are now well established. The elder girls centre is full and the Ebury Bridge Training School has now 33 children, almost the maximum number it is possible to accommodate. At both the centres the average daily attendance is extremely high, which is the best indication of the high standard of training and care given by the staff, as it demonstrates clearly that the trainees are happy and their parents are well satisfied with the services provided. The Inner London Education Authority is taking over the training school on 1 st April, 1971, in accordance with the requirements of recent legislation which is transferring the training of mentally handicapped children to the local education authority and it is pleasing to record that the Inner London Education Authority is impressed by the high standard of this centre in respect of the calibre of staff, the training of the children and the premises and equipment provided by the City Council. Although St. Judes Hostel for boys and men has still had some problems, these are largely related to its geographical situation, located as it is in an area which at present is being cleared for redevelopment ; but the present wardens have worked hard to provide the residents with a home life and have, in addition to their excellent general support to the residents, organised outings and excursions which have been thoroughly enjoyed. There is little doubt that the general atmosphere of the hostel has markedly improved and that the morale of the residents and of the staff is higher than ever before. During the year Dr. B. Snowdon, Consultant Psychiatrist, was appointed for five sessions weekly to the Health Department. Dr. Snowdon's primary duties are in the field of mental health and the contribution he has made to the Mental Health Section has been of a high order. He has concerned himself with improving liaison with teaching hospitals, has developed in-service training through seminars and individual support, and has given advice on policy. Through this members of the staff have been enabled to give a higher standard of service to their clients and the City's prestige in respect of its mental health services is being enhanced. During the recent months, much time and thought has been given by the City Council to the setting up of a Social Services Department. Dr. Snowdon has been able to act as a most valuable link between departments and has held joint seminars with field workers for other disciplines and mental health social workers who will soon be joining the Social Services Department which is aiming ultimately at a fully integrated service. Since the passing of the Social Services Act the Mental Health section has been very concerned with ensuring that in the new department the services to the mentally disordered will be maintained. There is general recognition that the full integration of the City's social work service will be in the long run a great step forward and will particularly benefit the mentally disordered in that they will no longer be seen as a class apart but will be regarded in terms of their social problems and their sometime isolation through categorisation will gradually disappear. When the City of Westminster came into being on 1 st April, 1965, the Mental Health section was regarded as a developing service. At the end of 1970 it can be seen that very real progress has been made although expansion is far from complete. Nevertheless, the Mental Health section entering the new Social Services Department is mature and well established and able to take its proper place in the new Department's services. 50 MENTALLY DISORDERED PATIENTS The number of patients referred to the Mental Health section during 1970 totalled 1,769; (19691,685). Six hundred and thirty two patients were admitted to psychiatric hospitals - informally or compulsorily (1969 - 670); 736 patients were received into community care (1969 - 652). All other cases were investigated and appropriate assistance was given. In addition, 300 patients came to City Hall for help and guidance. 1970 1969 Patients in Community Care Mentally ill 709 652 Subnormal and severely subnormal 272 341 Residential Care Mentally ill 50 49 Subnormal and severely subnormal 67 54 In addition there are 16 subnormal and severely subnormal children in care of the Children's Department in residential homes. (1969 - 21). OTHER SERVICES FOR SUBNORMAL AND SEVERELY SUBNORMAL PATIENTS Day Training Centres for Junior and Senior Trainees Ebury Bridge Training School, S. W. 1. Twenty eight children are in attendance at this school and there are a number of children to be admitted early next year. St. Judes Elder Girls Training Centre, Lancefield Street, W. 10. This centre accommodates 20 senior trainees and a full complement has been maintained throughout the year. In addition to trainees placed at the City Council's Training School/Centre there are 45 Westminster children and adults (1969 - 45) attending training centres maintained by other Authorities:— 1970 1969 Hanworth Junior, Middlesex (in residential care) 1 1 Attleborough, Diss, Norfork (in residential care) 2 1 John Farmer Junior, Hants (in residential care) 1 1 Farnham Junior, Surrey (in residential care) 1 1 Kensington Junior 20 19 North Kensington Senior 11 12 Rosemary Junior (Islington) 1 1 Crispin House (Southwark) 1 — Clapham 2 1 Bennett Court, Islington — 2 Isledon, Islington 2 2 Roberts Hall Work Centre 1 — Terrace Day Centre 2 4 Socialisation Course for Educationally Subnormal School Leavers Pengwern Hall, Rhuddlan, Flintshire One Westminster patient attended the 12 week course at Pengwern Hall this year (1969 - 1). The National Society for Mentally Handicapped Children arrange these courses for young adults in need of guidance in coping with employment and other aspects of social life. Organised Annual Holiday for Trainees St. Mary's Bay Holiday Camp, Dymchurch Thirteen Westminster trainees enjoyed two weeks holiday at Dymchurch in May, which was arranged as usual by the Medical Officer of Health for Hammersmith. The City Council much appreciates the work undertaken by members of the staff of the Hammersmith Council in this respect. 51 Home Tuition Two patients in community care are receiving training in their homes by qualified home tutors (1969-3). Special Day Nurseries Specialised training is provided at two day nurseries in Westminster which are grant-aided by the City Council and run by the City of Westminster Society for Mentally Handicapped Children: Frances House, 86 Bravington Road, W.9. There are 25 children in attendance at this nursery (1969 - 20) and it is anticipated that the numbers will reach 30 early next year. Edgson House, Ebury Bridge Estate, S.W.1. The nursery caters for twelve children and all vacancies are filled. Linnet House Special Care Unit, Charlbert Street, N.W.8. This specialised unit is full with 12 severely handicapped children aged 5-12 years in attendance (1969-12). A specially adapted coach conveys the children to and from the unit each day. This unit is also run by the City of Westminster Society for Mentally Handicapped Children on the City Council's behalf and the close liaison continues between the Council and the Society. Tower Hamlets Training School, Special Care Unit A severely mentally handicapped 15 year old girl attends this special unit two days each week and is conveyed from and to her home by car (1969 - 1). Centre for Spastic Children, Cheyne Walk This is a voluntary centre for severely handicapped children administered by the Kensington and Chelsea Hospital Management Committee and two Westminster children are in attendance (1969-2). Spastics Centre, Harrow Road, W.9. A spastic severely subnormal 18 year old girl attends this centre daily and is progressing well; the centre is run by the Spastics Society. "Noah's Ark", 31 Shaftesbury Road, N.19. One severely subnormal girl attends this voluntary centre two days each week - she is very handicapped and transport is arranged for her. The "Noah's Ark" is a private centre and caters for the severely handicapped. The City Council is most grateful for all the help which these agencies provide for these handicapped children. Short term care Holidays from 2-8 weeks were arranged for 36 patients, either in hospital or suitable residential homes. 1970 1969 In hospital 13 9 In residential homes 23 39 St. Judes Hostel, Lancefield Street, W.10 At the end of December there were 17 subnormal residents accommodated at St. Judes (1969-15). 52 The evening club is well attended by the residents who receive woodwork instruction. The afternoon club at this hostel for severely subnormal clients is well established and two mental health social workers ensure that all take an active part in the activities. Transport is provided for the clients. 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. The City Council has allocated a room at Terrace Day Centre for the Society's club. Beauchamp Lodge Club for Subnormal Patients This is open one evening each week and attendance is most encouraging. OTHER SERVICES FOR THE MENTALLY ILL Terrace Day Rehabilitation Centre, 1 St. Mary's Terrace, W.2 Attendance at this Centre remains high, 59 patients were on the roll at December (1969 - 51), five of whom were patients from other London Boroughs. 1970 1969 Day Rehabilitation Centres Seven patients attended the following centres: Ladbroke Grove 1 1 Raydon (Camden) 1 1 Lynden (Camden) 1 — Marlborough Hill (Harrow) 1 1 Charles Jordan Centre (J.W.B.) 3 — 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. (1969-30). Methodist Church Hall, Ebury Bridge Road, S.W.1 This club was newly formed in 1969 and mental health social workers have organised a weekly meeting for patients from South Westminster. Twelve persons attend regularly (1969 - 12) and transport is arranged for them to and from this club. The aim of these clubs is to provide facilities for social communication, to encourage its expression and to provide a focal point for people living in isolation. Application and re-approval of medical practitioners for the purposes of section 28 of the Mental Health Act: Approved Re-approved 1970 10 20 1969 3 1 THE TERRACE DAY CENTRE Report for 1970 (by Dr. R. A. Stewart, Medical Officer in Charge of the Centre) Our resources have been fully occupied throughout 1970 in our endeavours to help the varied group of people suffering from mental disorder who have been referred to us for rehabilitation. 53 In all forms of mental disorder, the individual has developed a sense of social isolation and eventually is unable to cope effectively with the responsibilities and demands of the business of living. Many lead intensely lonely lives and have shut themselves away from others. As a consequence they may have to face rejection by their families and may become confused in the complex social environment in which we live. The staff at the Terrace Day Centre work towards the ideal of providing an atmosphere of security and ultimate acceptance of the duties of everyday life and, where possible, a return to employment. The staff work closely together as a team. They have meals with the group, give advice and support to the patients, interview relatives, friends and social workers, and communicate with doctors and the many agencies concerned with the patients' welfare. The group is composed of about 50 male and female patients above the age of adolescence. They are of mixed social status and intelligence presenting all forms of mental disorder other than cases of frank sub-normality; they work together as individuals in a social setting. It is necessary to inculcate a sense of punctuality. As attendance is voluntary this may be difficult especially in the case of schizophrenics, but treatment is largely dependent upon it and is of paramount importance if transfer to future employment is to be successful. With some patients it is necessary to build up confidence in travelling to and from the Centre. Some cases of agoraphobia may have to be accompanied by a relative or social worker at first, until confidence is established. Mornings are given over to useful work and quite ill people will often respond in a most gratifying way, working in a social setting. The Centre is always grateful for contracts for simple industrial tasks, such as assembling and packing of small articles and collating, stapling, addressing and counting circulars for mailing. Excellent facilities exist for duplicating typewritten material to order. The well-equipped carpentry workshop has undertaken various simple repairs to the fabric of the Centre. The contract to produce racks for postcard display continued in 1970. Various articles have been made to order such as simple furniture, play centre equipment, etc. One large item this year was the construction and installation of a counter for the coffee bar set up by the Westminster Council of Social Services Project in Harrow Road. Orders for woodwork articles continue to be accepted. Morning is the time for preparing the mid-day meal, an activity which has great therapeutic value. The patients are allotted to its preparation by rota and are supervised by one of the staff. There is also a rota for washing-up and tea-making. The regular task of cleaning and floor polishing throughout the premises is undertaken by members of the group. The small laundry is at the disposal of the group where they may do their own washing since many of our patients have no facilities in their lodgings. The Centre's linen is also laundered here. A shower bath has now been installed making an appreciated addition to our facilities. Further activities, which build up reliability and trust, consist of errands for catering supplies, workshop materials and banking in connection with the management of the Centre. Money obtained from outwork is distributed to members of the group on a points system. The payments are small but do act as an incentive for punctuality and interest. Slow workers are not penalised if they are giving of their best. These activities approximate to routine when employment is eventually undertaken. Unless occasionally there is a rush order in connection with industrial work, afternoons are given over to social activities. These variously include films, discussions, play reading, painting and drawing, musical appreciation, dancing and folk dancing, tape recording and playback, card and quiz games, table tennis, darts, bingo and mock trials; there have also been talks and discussions from visiting speakers. Outings are arranged to places of instruction and recreation, including museums, art galleries, exhibitions and factories. There are also visits to swimming baths and occasional coach outings to the coast. Paddington Recreation Ground provides facilities for tennis and putting. The Terrace Magazine appears regularly every month and it is most encouraging to find how many patients contribute, exercise their talents and see their names in print. 54 Many members were anxious to help on Mental Health Flag Day and some undertook house-tohouse collections. They again have helped in collections for the various projects of the Institute of Social Psychiatry who act as agents to the City of Westminster in the management of the Centre. The Terrace Day Centre is staffed by Dr. Stewart who attends on a sessional basis. Miss Blair, Supervisor, Miss Hunter and Miss Fabian, qualified occupational therapists and Mr. Clark, an experienced technician. Attached to the Centre as domiciliary occupational therapist is Mrs. Lowe, appointed by the City of Westminster. Close liaison has existed with the Mental Health Social Workers of the Westminster City Council with the ready co-operation of Mrs. R. S. G. Paterson, Principal Mental Health Social Worker. These officers continually pay welcome visits to the Centre and are well known to the staff and patients. We derive a large proportion of our referrals from these officers and direct from psychiatrists at mental hospitals, psychiatric clinics and general hospitals. We also accept referrals from general practitioners and various social agencies. Occasionally we have a patient who attends daily but who is still resident in hospital until adjusted sufficiently to return home, take up lodgings or enter a hostel. There will always remain a hard core of patients who will never be able to tolerate the demands of outside employment and for whom we provide custodial care. This is a valuable service in that relations are relieved of the patient during the day and able to pursue their own activities. Where there are no relatives these patients are at least saved from reverting to social isolation : they do however block places in the Centre for others. The Centre does not of course issue prescriptions as patients attend psychiatric clinics and their own general practitioners. However, the staff is concerned with the task of ensuring that a patient is taking medication as prescribed since, in some cases, failure to do so may lead to relapse. The statistics set out in Table 46, page 86, give an analysis of the composition of the group and the results achieved over the year at the Centre. We have had many visitors from home and abroad who are interested in the rehabilitation of the mentally ill. Medical students from University College Hospital have attended, as well as groups from the Royal College of Nursing, the Middlesex Hospital Tutors Courses and student nurses from Horton and Friern Hospitals; some nurses have joined in our activities as part of their training. Dorset House School of Occupational Therapy has started to send third year students for six weeks of their psychiactric clinical experience. This has been particularly valuable because it has helped the students to acquire some knowledge of the facilities available in the community service provided by the Local Authority. They have brought new ideas and youthful enthusiasms into the group, and their presence has proved stimulating, especially to the group's younger members. The Goodfellows Therapeutic Social Club meets at the Centre on Wednesday evenings and is attended by some of the day patients and by people who are in employment but have difficulties in mixing and look for help in a social group. The club is also a valuable method by which we can follow up the welfare of our former day patients who have entered employment. A light and inexpensive supper is provided by the day staff on the club evening. The Centre premises are also made available on Monday evenings for a club for mentally handicapped young people in Westminster. We are continually grateful for help and interest shown in our endeavours by the Medical Officer of Health, Dr. J. H. Briscoe-Smith; we have received assistance and understanding from various administrative officers of Westminster City Council. VENEREAL DISEASES There are four special clinics in teaching hospitals in Westminster for the treatment of sexually transmitted diseases. Three of these special clinics show an increase in attendance from the previous year, particularly in those patients with non-specific conditions. 55 Five social workers, provided by the City Council, work in these clinics where they trace the contacts of confirmed cases and persuade them to attend for examination and possible treatment. They are often able to give help of a practical nature as well as casework support. Close liaison is maintained with other agencies. During 1970, social workers interviewed 3,631 patients in the clinics and made 1,437 home visits. Owing to the increased attendances at these special clinics, it has been found necessary to increase the establishment by the appointment of another full time social worker, who will commence duty in April, 1971. Apart from their work in Westminster clinics, two of the social workers are responsible for tracing contacts notified by the American bases in and around London; contacts notified from abroad, forwarded by the Department of Health and Social Security, and contacts notified from local authorities outside the London area. They are remarkably successful in this very difficult work, particularly as some notifications have few relevant details of the contacts; 60.7% of all cases notified through these sources were traced and brought to treatment. (See Table 47, page 87). The City Council also maintains a Public Enquiry Telephone Service (928 3401) which is manned by day and night to provide information to any enquirer. During 1970, 924 calls were received, 719 (76%) were requests for clinic times, locations and directions; 173 (20%) were requests for literature on venereal diseases; and 32 (4%) were requests from prospective bridegrooms for a "check-up" before marriage. Education and publicity on venereal diseases is an important duty of a local authority. Notices faced with perspex to prevent defiling, with up to date details of all London clinics and including the City Council's public enquiry telephone number, have been fixed in all its public conveniences. Smaller notices produced on ceramic tiles have also been fixed to the inside wall of each water closet in the new and reconditioned public conveniences in the City Council area. As a result of this, some 300 letters have been received asking for literature on venereal diseases and for clinic details. The symptoms of venereal disease in the earlier stages are not obvious in women and a leaflet entitled "Venereal Diseases in Women" was produced during the year. Talks on venereal diseases were given during the year by a Principal Medical Officer, a social worker and an administrative assistant to students in Colleges for Further Education; to nurses undertaking a Degree course in Sociology, and to cadets of the British Red Cross Society. HEALTH EDUCATION The special health education project for 1970 was an exhibition of Improvised Toys at Church House, Westminster, from 24th to 26th June 1970. The exhibition was held in conjunction with the Annual Conference of the National Association for Maternal and Child Welfare and was opened by the Lord Mayor and Lady Mayoress of Westminster, Councillor and Mrs. Fitzgerald-Moore. Over 300 delegates to the Annual Conference visited the exhibition and commended the toys which were produced in the City Council's day nurseries and at the Ebury Bridge Training School. One hundred and forty-five educational films were screened during the year at the City Council's maternal and child welfare centres, day centre and training school. New educational films and slides were screened in the City Hall for staff working in the southern part of Westminster and at Lisson Grove maternal and child welfare centre for staff working in the northern part of the area. These included: Type Title Distributor Film John—9 days in a Residential Nursery Concord Films Council Film The Five (Care of the Feet) British Medical Association Film B.C.G. for the World Glaxo Co. Ltd. Tape recording (a) Slimming (Weight Watchers Ltd.) Medical Recording and slides (b) Venereal Diseases (Questions and Service Answers for school children) Film Margin of Safety (Ante Natal service Bencard and Co. provided by General Practitioners) Film Barnet (Swedish film on Childbirth) National Audio Visual Aids Centre Film Out of the Mouths (Dental Health Oral Hygiene Service Education) 56 The Department's visual aids were used to illustrate talks given by medical officers, health visitors, social workers, public health inspectors and the Assistant for Health Education in the City Hall, maternal and child welfare centres, schools, Colleges for Further Education, catering organisations and local organisations. The topics of these talks were Home Safety, Ante Natal Care, Parentcraft, Food Hygiene, Nutrition, Venereal Diseases, General Health and Hygiene. The Assistant for Health Education, who is a member of the Greater London Home Safety Council, represented the City Council at the National Home Safety Conference which was held at Friends House, Euston, on 21 st and 22nd October 1970. The theme of the conference was "Home Safety— Education in the Seventies". As a preliminary to the 1971 Dental Health Campaign in Primary Schools in Westminster, Head Teachers from these schools were invited to the City Hall to discuss plans for the campaign. These plans were fully endorsed by them and a detailed report on the campaign will be given in my 1971 report. BLIND AND PARTIALLY SIGHTED PERSONS The City Council's Welfare Department provides services under the provisions of the National Assistance Act 1948 for registered blind and partially sighted persons. On behalf of that department the Health Department during 1970 carried out 127 examinations (130 in 1969) of such persons in respect of certification under the Act. Of these 63 were new cases and 64 were re-examinations. In addition 56 (65) certificates were also accepted from hospitals and other local authorities. HOME NURSING The sick and the disabled of all ages are nursed in their own homes by teams of state registered and state enrolled district nurses assisted by bathing attendants. The district nurses have a close working relationship with the general practitioners in the area, and during the year two more group practice attachments were formed. Closer liaison with the hospitals is developing. Skilled treatments are carried out and special equipment is available; nevertheless, more acute work could still be undertaken in the community. The increasing needs of the elderly chronic sick could be largely met by the judicial use of ancillary staff with the support of the social services. During the year, district nurses have attended Old People's Liaison meetings in their areas, when all staff involved in the care of the elderly pool their knowledge and resources. Organisation In the Group Practice attachments the district nurses have daily personal contact with their doctors, but otherwise messages are taken from general practitioners and hospital staff throughout the 24 hours at City Hall. The majority of the nursing staff work from two centres—117 Sutherland Avenue for areas north of Oxford Street and Bayswater Road, and 36 Great Smith Street for the southern areas. Visits to patients are made between 8.30 a.m. and 5.30 p.m. with an emergency service until 10 p.m. An evening clinic for ambulant or working patients requiring treatment is held at 117 Sutherland Avenue. Training During the year seven state registered nurses, plus two Hammersmith Hospital Integrated Course students, qualified for the National Certificate in District Nursing. Two remained on the staff at the end of the year. Seven state enrolled nurses, plus six Middlesex Hospital Integrated pupil nurses qualified in district nursing during the year, five of this total remaining on the staff. Six Hammersmith Hospital student nurses and thirteen Middlesex pupil nurses spent varying periods in district nursing as part of their Integrated Courses to be completed in 1971 and 1972. It is therefore obvious that although much time is spent by the permanent staff in training nurses for work in the community, the majority do not continue to work in Westminster. 57 Observation Visits In addition to the above programme, twelve pupil nurses from Westminster Hospital each spent two weeks observing the work of district nurses and ninety-one student nurses from various hospitals in the area, plus nine nursing degree students and twelve diploma of nursing students from the Middlesex Hospital, all attended for short periods of observation. Responsibility for arranging and implementing so many visits adds to the work of the Council's registered nurses and any future programme for hospital students to have longer periods of community experience as envisaged in the G.N.C. Syllabus 1969 will require careful planning and supervision if the present high standard of service is to be maintained. Other visitors during the year included a research assistant from the Queen's Institute of District Nursing, two Physiotherapists, an Occupational Therapist, two Ward Sisters, a hospital administration student and a public health nursing administration student. Courses Several members of the nursing staff were able to attend study days of specific interest; one nurse attended a refresher course and another completed a practical work instructor's course. Paediatric Home Care Unit The Home Care Unit nurse left in the Autumn to train as a health visitor and a new appointment was made for the new year. The nurse works with a Paediatrician from St. Mary's Hospital, visiting sick children at home to advise and help with their medical and nursing care. Buckingham Palace Mews A district nurse is resident in the Mews and provides nursing care for members of the staff. The cost is reimbursed to the Council. District Nursing Association This Association is active in providing amenities for patients and staff and administers various charities which benefit the sick and elderly in the area. This help is much appreciated. 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. District nurse-midwives cover the needs of this service in the majority of Westminster with the exception of the S.W.1 area where Westminster Hospital continues to provide a domiciliary service on an agency basis. There are no longer sufficient home confinements to provide experience for the training of pupil midwives. Nurses from the Middlesex Hospital spend a day with a domiciliary midwife as part of their obstetric training. LOAN OF HOME NURSING EQUIPMENT The scheme for the free loan of items of nursing and sick room equipment continues to be a vital service to residents in the City who are being nursed at home. 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. In addition, many calls are made on the service by the City Council's Welfare Department for help to the physically handicapped. Not only does the provision of this equipment help to make life more bearable for the sick and handicapped but often proves invaluable in easing the burdens placed on relatives who look after the patients. Further, the issue of these articles enables some patients to be discharged from hospital who would otherwise have to remain there for much longer periods. Thick plastic sheeting has proved a great boon in the nursing of incontinent patients. The demand is ever-increasing and continues to help reduce the calls on the Incontinent Laundry Service. 58 The British Red Cross Society (Westminster Division) acts as the City Council's agents for the issue of the smaller items of equipment and I should once again like to express my gratitude for their services. In addition to equipment already on loan, the following items were issued during the year:— Air rings 12 Easi carri hoists 3 Back rests 46 Fracture boards 37 Bed blocks 2 Hospital beds 14 Bed cradles 27 Penryn hoists 11 Bed pans 15 Quadrupeds 4 Bed tables 5 Ripple mattresses 13 Carri chairs 2 Toilet seat 1 Commodes 226 Tripods 15 Cot sided beds 5 Urine bottles 15 Dunlopillo mattresses 16 Walking frames 108 Wheelchairs 66 CHIROPODY SERVICE The chiropody service is provided under Section 28 of the National Health Service Act 1946, and treatment is made available to the elderly, handicapped persons, expectant mothers and children. The service is provided by a Chief Chiropodist, one Senior Chiropodist, and nine sessional chiropodists; they work at 10 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 Welfare Department's special coaches. Arrangements are also made for some patients to receive their treatment in the surgeries of three private contractual chiropodists. Domiciliary treatment is provided by seven private chiropodists on a fee per treatment basis for patients who are housebound. Transport facilities are now available for patients attending six centres, and further expansion is envisaged. A hydraulic chair has been purchased for the clinic at the Welfare Centre for the Handicapped, and has been much appreciated by the patients and the staff at the Centre. A regular service has been maintained in all but two of the residential old people's homes, and it is hoped that these vacancies will be filled fairly soon. Consequent upon the indisposition of the sessional chiropodist who attended Marshall Street Centre, and the impossibility of recruiting a replacement, the City Council came to a temporary arrangement with the Chelsea School of Chiropody for the provision of treatment for a number of City Council patients during the period of one year from the end of April, 1970. These patients were conveyed to the Chelsea School of Chiropody by City Council transport. Liaison with hospital staff and allied services has been maintained concerning the welfare and treatment of City Council patients. As an example of the amount of chiropody treatment being provided, during December 1970 a total of 43 sessions per week were worked at Centres; 67 treatments were provided in chiropodists' own surgeries each week, and 104 treatments were provided in the homes of patients each week. CERVICAL CYTOLOGY This service continues to be offered at four screening clinics to all women under the age of 65 who live or work within the City of Westminster. During the year 1,826 new patients were seen and a further 364 repeat examinations were carried out, making a total of 2190 in 1970; 48 per cent of all women attending were over the age of 35. An interesting new aspect of the service was the setting up of a weekly clinic at two of the large department stores in the West End where the attendances numbered 401. 59 Positive smears were found in nine women whose ages ranged between 24 and 50 years, and all were referred promptly for further investigation and treatment. A total of 622 women were referred to their family doctors regarding abnormalities discovered at clinical examination—mainly common gynaecological complaints. This early referral of cases detected when the abnormality is relatively slight often obviates longer and more complicated treatment at a later stage. The generous assistance given to the department by Dr. Bate and his staff at the Samaritan Hospital is once again gratefully acknowledged. STAFF MEDICAL SERVICE This service continues to be provided in the medical suite in the Health Department at City Hall. The number of applicants joining the staff during 1970 was slightly lower than in the previous year, as was the number called for interview following scrutiny of medical questionnaires. Two hundred physical examinations were carried out (more than double those done in 1969); this was due to the fact that medical examinations of drivers for suitability for heavy goods vehicles driving licences are carried out by the Council's medical officers as part of the staff medical service. During the year there were 877 attendances at the medical suite for first aid or advice. Of these, 85 members of the staff were referred to their own general practitioner or to a hospital for further attention. The number of disabled persons examined on applying for exemption from parking meter charges (141) remained about the same as in the previous year. Statistics relating to work undertaken in the medical suite during 1970 are set out in Table 48, page 88. SCHOOL HEALTH SERVICE Section 30 of the London Government Act 1963 places the responsibility of providing a school health service upon the Inner London Education Authority, and the day to day operation of the service in Westminster is my concern as Principal School Medical Officer. Arrangements were made under provisions in the Act for the joint use by the City Council and the Authority of professional and clerical staff and of premises. The following report to the Inner London Education Authority was submitted in respect of the school health service for the year 1970: In addition to the usual arrangements made for sessions in schools to cover health surveys, medical inspections, re-inspections, special medical examinations, school journeys, audiology and teacher training college medicals, attention is drawn to the following special features: Educationally subnormal children There are 7 medical officers approved to undertake the statutory examination of children reported to be educationally subnormal. During the year, 84 children were examined and 60 of these were found to be in need of special education as educationally subnormal. School medical officers Out of a total of 56 schools in Westminster, 5 are attended by local general practitioners, 16 by sessional medical officers other than general practitioners, and 35 by whole time medical officers. As far as possible full-time medical officers undertake examinations at both child welfare clinics and local primary schools in the area thus providing continuity of medical care. Handicapped children's register A register is maintained of handicapped children attending both ordinary and special schools. A careful follow up programme is undertaken for all such children. 60 Visual defects Two ophthalmic sessions are held weekly, one in Inner London Education Authority premises in the south of the City and the other at the Western Ophthalmic Hospital, Marylebone Road, N.W.1, where clerical assistance is provided by staff from the Health Department. Diathermy The diathermy clinics for the treatment of plantar warts held twice a week continue to be well attended. Special investigation clinics Children who require a longer time and more privacy than is available at school medical examinations are referred to special investigation clinics where a social worker attends with a doctor. Immunisation Parents are encouraged to take their children to welfare centres for immunisation before school entry. During school life every effort is made to persuade parents to allow their children to complete the immunisation programme as laid down by the Department of Health. A measles campaign was launched in September 1970 to encourage vaccination against measles of children in the infant schools who had not already been protected. Rubella In September 1970 Rubella vaccination was offered to all thirteen year old girls in the eleven secondary schools in Westminster. By December sessions had been held in 5 secondary schools and a total of 325 girls had rubella vaccination. In addition some pupils requested that the vaccination should be given by their own general practitioners. It is anticipated that the sessions at the remainder of the schools will be completed during the following term. It is also hoped to extend the scheme to include girls of 11 years upwards. BCG Vaccination BCG vaccination in schools continues. In addition special programmes are arranged in Colleges for Further Education with X-ray facilities provided by the Mobile Units of the London Mass X-ray service. Statistics relating to the School Health Service are set out in Tables 50-57 inclusive, on pages 89-95 inclusive. DENTAL SERVICE D. K. Hardy, L.D.S., R.C.S., Eng. (Chief Dental Officer and Principal School Dental Officer) It is very encouraging to report that for 1970 the City Council's Dental Service has provided an increasing number of first inspections of children in both the School and Maternal and Child Welfare Services. The increase is most marked in the latter service where more than twice the number were examined, namely 556, than in 1969; the sessions allotted increased by 30%. The service offered to the under five year old is a very important and worthwhile one since, if the mother comes with her first child, it might be possible to guide her thoughts towards better dental health for her subsequent children as she has probably only brought her child in with toothache—a first meeting under duress with a dentist. The number of under fives attending who require treatment is approximately 70%. The City's School Dental Service was able to inspect 60% of the school population, an increase of approximately 7%, but the percentage requiring treatment remains about the same as in 1969 at 63%. These inspection figures are influenced by staff shortages particularly among the dental surgery assistant posts. Although there have been some increases the salary scales for these posts are unrealistic for the responsibilities and qualities required of a dental surgery assistant. There were two posts vacant for most of the year and, as dental officers are advised by the Defence Societies not to work unaided, it was necessary to employ agency staff at greater expense to the Authority. This is a serious problem, as to meet the requirements of an annual inspection of every school child, the service must be expanded to some extent. This will happen in 1971 since plans are going ahead to open a dental surgery within the Quintin Kynaston School. With this opening another dental surgery assistant will have to be recruited if the capital spent on the equipment is to be utilised to the fullest amount. 61 During 1970 plans were made to hold a Dental Care Campaign within the Primary and Junior schools. The Head Teachers of these schools were invited to a meeting in November at City Hall when plans were explained to them. This was to send out teams to the schools to give dental health talks in the classrooms aided by models and posters and then the school to congregate together to see a film. The theme of the campaign was "Why not an apple ?" and to this end we were fortunate in having Mr. Eric Woodruff, a director of Apples for Schools Ltd., to explain how children could be provided with apples all the year round at very low cost. The meeting also watched a film titled "Out of the Mouths". This is a project teaching film produced by the Oral Hygiene Service. The holding of this campaign from 1st March, 1971 for five weeks was approved at the meeting. There was an inspection of the service in September by a dental officer from the Department of Education and Science. Statistics relating to the school dental service and the dental service for expectant and nursing mothers and children under 5 years of age, are set out in Tables 57 and 58, on pages 95 and 96. 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, Page Street Wing, S.W.1 (828 9811). I am indebted to the Consultant Physician at each of these Clinics for the following reports of their activities during 1970. Paddington Chest Clinic—Dr. P. A. Zorab, Consultant Physician We again had a very busy year—our new-patient attendances having risen to 2003—184 more than in 1969. An increased amount of student teaching was, and still is, being undertaken. Several clinical surveys are being carried out and a new research project "The effects of Drugs on Sputum Viscosity" started recently and promises to be of great interest. Very successful fund-raising efforts were made by the Paddington Clinic Care Committee enabling our Social Worker to help many patients. An additional "X-RAY ONLY" session is now held making three in all—these are held on Monday morning, Tuesday evening and Friday afternoon, by appointment. St. Marylebone Chest Clinic—Dr. G. Shneerson, Consultant Physician The incidence of newly notified cases of tuberculosis during the past year has been very similar to that of 1969 and 1968: there has however been an increase of more than twenty per cent in the number of deaths from lung cancer. As hitherto, the clinic, together with its in-patient component at St. Mary's Hospital, Harrow Road, has provided full facilities for the continued prompt diagnosis and assessment of both tuberculous and non-tuberculous conditions. Westminster Hospital Chest Clinic—Dr. P. A. Emerson, Consultant Physician The total number of patients attending the Clinic continued to increase in 1970, but the number of newly diagnosed cases of tuberculosis again decreased slightly compared with the previous year. Twenty-six new cases of tuberculosis were notified; twenty-one were males and five females. Of the tuberculous patients referred to the Clinic, five were sent by their General Practitioners, eight were discovered by the South London Mass X-ray Unit and the remainder were notified by various other hospitals and mass X-ray units. The South West London Mass X-ray unit has continued its monthly visits to Bruce House and Great Peter Street throughout the year. The 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 1970 are set out in Table 4, page 66, whilst further statistics dealing with care and after-care of tuberculous patients, and work undertaken at the three Chest Clinics, are set out in Table 59, page 97. 62 LIST OF STATISTICAL TABLES Table Title 1 Deaths—according to age-group and sex. 2 Infant Mortality—according to cause, age group and sex. 3 Notifications of infectious and other notifiable diseases. 4 Tuberculosis—new cases and deaths. 5 Specimens submitted to the Public Health Laboratory. 6 Night and out of office hours Emergency Service. 7 Dwelling houses—reason for initial inspection. 8 Dwelling houses—nuisances and unsatisfactory conditions found and remedied. 9 Summary of visits by Public Health Inspectors. 10 Statutory notices served. 11 Summary of visits by Housing Act Inspectors. 12 Summary of work carried out by Public Health Inspectors under the Housing Acts. 13 Unfit premises. 14 Qualification Certificates. 15 Rodent Control. 16 Chemical examination of water supplied to City of Westminster—average results. 17 Bacteriological examination of water supplied to City of Westminster—average results after treatment. 18 Offices, Shops and Railway Premises Act, 1963. 19 Factories—inspections for purposes of provisions as to health. 20 Factories—defects. 21 Outwork. 22 Estimated percentage of compliance of premises in Westminster with Food Hygiene (General) Regulations 1960, in relation to washing facilities and provision of sinks. 23 Premises registered for preserving food, or manufacture, storage or sale of ice-cream. 24 Food poisoning investigations. 25 Analysis of Legal Proceedings. 26 Verminous persons cleansed. 27 Scabies—persons treated. 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 Family Planning. 33 Child Welfare Centres. 34 Handicap Register. 35 Health Visiting. 36 Vaccination of persons under age 16 completed during 1970 at Welfare Centres and by general practitioners. 37 Smallpox vaccination of persons aged under 16. 38 Home Nursing. 39 Domiciliary Midwifery. 40 Chiropody service. 41 Home Help Service. 42 Mental Health Service—number of patients referred to City Council during year ended 31st December, 1970. 43 Number of patients for whom hospital admissions were arranged. 44 Mental Health Service—number of cases in community care at end of year. 45 Number of patients admitted for temporary residential care during the year (e.g. to relieve the family). 46 The Terrace Day Centre (Day centre for the mentally ill, 1 St. Mary's Terrace, W.2) 47 Venereal diseases—cases treated in Westminster during 1970. 48 Medical suite at City Hall—work undertaken, 1970. 49 Tuberculin test and B.C.G. vaccination of school-children and students. 50 School Health service—full-time equivalent employees. 51 School medical inspections, 1970. 52 Routine medical inspections in schools, 1970—defects found. 53 School health service—findings at health surveys, 1970. 54 School health service—non-routine medical inspections, 1970. 55 School health service—routine medical inspections, vision—1970. 56 School health service—comparison of defects noted at 7-plus routine and 7-plus special medical inspections, 1970. 57 School dental service statistics, 1970. 58 Dental services for expectant and nursing mothers and children under 5. 59 Tuberculosis—care and after-care—work at Chest Clinics in Westminster. 63 Table 1.—Deaths—According to Age-Group and Sex CAUSE OF DEATH 1969 1970 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 3 1 1 1 — — — — — — — — — — 1 — — Tuberculosis of respiratory system 12 9 1 — — — — — — — — 2 — 2 1 5 — Other tuberculosis, including late effects 8 5 2 — — — — — — — — 1 1 2 1 2 — Syphilis and its sequelae 6 2 — — — — — — — — — — — — — 1 — Other infective and parasitic diseases 5 1 3 1 — — — — — — — — — — — — 3 Malignant neoplasm—buccal cavity etc. 11 6 3 — — — — — — — — — — 3 — 3 3 Malignant neoplasm—oesophagus 24 11 8 — — — — — — — — — — 5 2 6 6 Malignant neoplasm—stomach 58 29 25 — — — — — — — — 1 — 8 3 20 22 Malignant neoplasm—intestine 74 39 40 — — — — — — — — 1 — 12 3 2b 37 Malignant neoplasm—larynx 5 6 1 — — — — — — — — 1 — 1 — 4 1 Malignant neoplasm—lung, bronchus 201 148 55 — — — — — — — — 4 2 53 18 91 35 Malignant neoplasm—breast 57 — 68 — — — — — — — — — 5 — 29 — 34 Malignant neoplasm—uterus 31 — 23 — — — — — — — — — 1 — 9 — 13 Malignant neoplasm—prostate 14 21 — — — — — — — — — — — 3 — 18 — Leukaemia 18 14 9 — — — 1 — 1 1 — 1 — 5 3 7 4 Other malignant neoplasms 220 115 91 — — 2 — — — 5 — 7 2 43 31 58 58 Benign and unspecified neoplasms 5 4 3 — — — — — — — — 1 1 — — 3 2 Diabetes mellitus 28 11 12 — — — — — — — — — — 6 1 5 10 Avitaminoses, etc 2 — 1 — — — — — — — — — — — — — 1 Other endocrine etc. diseases 10 5 7 — 2 — — — — 1 — — — 3 2 1 3 Anaemias 6 3 8 — — — — — — — — — — — 1 2 7 Other diseases of blood, etc. — 1 1 — — — — — — — — — — — — 1 — Mental disorders 14 4 3 — — — — — — 2 1 — — 1 1 1 1 Meningitis 1 — 1 — — — — — — — — — — — — — 1 Multiple Sclerosis — 1 4 — — — — — — — — — 1 1 1 — 2 Other diseases of nervous system 30 14 8 — — — — — — — — — — 6 2 8 6 Chronic rheumatic heart disease 59 29 31 — — — — — — 1 — 5 5 17 13 6 13 Hypertensive disease 59 30 27 — — — — — — — — — — 12 9 18 18 Ischaemic heart disease 683 368 270 — — — — — — — — 14 1 137 42 211 227 Other forms of heart disease 114 46 64 — 1 — — — — 2 — 1 2 11 3 32 58 Cerebrovascular disease 288 87 180 — — — — — — — — 1 2 17 25 69 1 53 Other diseases of circulatory system 131 41 74 — — — — — — — — — 1 14 8 27 65 Influenza 21 4 4 — — — — — — — — — — 3 1 1 3 Pneumonia 218 89 117 2 1 — 1 — — — — 1 — 14 7 72 108 Bronchitis and emphysema 113 72 31 — — — — — — 1 — — — 17 6 4 2b Asthma 8 3 5 — — — — 1 1 — — 1 — 1 2 — 2 Other diseases of respiratory system 26 17 10 1 — 1 — — — — — — — 3 — 12 10 Peptic ulcer 26 13 7 — — — — — — — — — — 7 1 6 6 Intestinal obstruction and hernia 13 4 10 — 3 — — — — — — — — — — 4 7 Cirrhosis of liver 15 6 6 — — — — — — — — — — 4 2 2 4 Other diseases of digestive system 39 12 18 — — 1 — 1 — — — 1 4 1 4 8 10 Nephritis and nephrosis 22 8 10 — — — — — — — — — — 5 3 3 7 Hyperplasia of prostate 7 1 — — — — — — — — — — — — — 1 — Other diseases, genito-urinary system 22 8 14 — — — — — — — — — — 3 4 5 10 Diseases of musculoskeletal system 11 1 12 — — — — — — — — — — — 3 — 9 Congenital anomalies 36 6 7 2 4 1 — — 2 — 1 — — 1 — 2 — Birth, injury, difficult labour, etc. 21 13 10 13 10 — — — — — — — — — — — — Other causes of perinatal mortality 10 11 5 11 5 — — — — — — — — — — — — Symptoms and ill-defined conditions 5 1 9 — — — 1 — — — — — — — — 1 8 Motor vehicle accidents 31 25 11 — — — 1 1 — 4 — 4 2 6 4 10 4 All other accidents 72 33 25 1 — — — 3 — 8 2 12 3 5 4 4 16 Suicide and self-inflicted injuries 72 25 44 — — — — — — 3 6 9 11 11 17 2 10 All other external causes 29 11 13 — — — — — — — 1 5 5 2 5 4 2 Abortion 2 — — — — — — — — — — — — — — — — Diseases of skin, subcutaneous tissue 2 — — — — — — — — — — — — — — — — Totals 1,414 1,392 32 26 5 4 6 4 28 12 75 50 446 272 822 1,024 2,806 58 9 10 40 125 718 1,846 1969 2,998 — 65 7 13 40 148 830 1,895 64 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 2 2 — — 1 — — — — — — — 3 2 Birth Injury 1 — — — — — — — — — — — 1 — Gastro Enteritis — — — — — — — — 1 — — — 1 — Intestinal Obstruction — — — — — — — 1 — — — — — 1 Bronchopneumonia 1 — — 1 — — 1 — — — — — 2 1 Malformations— — — — — — — — — — — — — — — Heart & Great Vessels 1 — — — 1 3 — — — — — — 2 3 Hydrocephalus and Spina Bifida — — — — — — 1 — — — — — 1 — Multiple Congenital Abnormalities — — — 1 — — — — — — — — — 1 Hyaline Membrane Disease 1 1 — — — — — — — — — — 1 1 Enterocolitis. Hirschsprungs Disease 1 1 Overwhelming Infection. Immunity Deficiency (Swiss type) — — — — — — — — — — — 1 1 Peritonitis — — — — — 1 — — — — — — — 1 Neonatal Haemorrhagic Disease 1 — — — — — — — — — — — 1 — Septicaemia — — — — — — — 1 — — — — — 1 Acute Bronchiolitis — — — — 1 — — — — — — — 1 — Prematurity and Allied Causes 17 13 2 — — — — — — — — — 19 13 Totals—1970 24 16 2 2 3 4 2 3 1 — — 1 32 26 Totals—1969 (in brackets) 40 4 7 5 1 1 58 (48) (5) (4) (6) (1) (1) (65) Number of deaths of illegitimate infants included in above 9 1 1 1 1 — 13 (15) (2) (2) (1) — — (20) Table 3.—Notification of Infectious and Other Notifiable Diseases Numbers originally notified Total (All Ages) Measles (excluding rubella) Dysentery Scarlet Fever Diphtheria Acute meningitis due to infection with Acute poliomyelitis Meningococcus Other specified organisms Unspecified organisms Paralytic Non-paralytic M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 196 169 14 16 9 19 — — — 1 1 — 1 2 — — — — Final numbers after correction Under 1 year 14 11 2 — — — — — — — — — — — — — — 1 year 17 15 1 1 — — — — — — — — — — — — — — 2 years 19 21 2 — 1 — — — — — — — — — — — — — 3 „ 34 23 — 1 — 1 — — — — 1 — — — — — — — 4 „ 37 26 — 1 — 4 — — — — — — — — — — — — 5-9 „ 64 61 4 2 7 12 — — — — — — — — — — — — 10-14 „ 5 3 — — 1 2 — — — — — — — — — — — — 15-24 „ 4 5 3 3 — — — — — 1 — — — 1 — — — — 25 and over 2 — 2 6 — — — — — — — — 1 1 — — — — Age unknown — 4 1 — — — — — — — — — — — — — — — Total (All Ages) 196 169 13 16 9 19 — — — 1 1 — 1 2 — — — — Numbers originally notified Total (All Ages) Acute encephalitis Leptospirosis Paratyphoid fever Typhoid fever Food poisoning Malaria The total number of notifications of infectious and other notifiable diseases received during the year was:— 1970 703 1969 679 Infective Post infectious M. F. M. F. M. F. M. F. M. F. M. F. M. F. — — — — — — 1 1 4 — 30 25 3 1 Final numbers after correction Under 5 years — — — — — — — — 1 — 3 1 — — 5-14 years — — — — — — — — — — — 1 — — 15-44 „ — — — — — — 1 1 2 — 12 16 2 1 45-64 „ — — — — — — — — 1 — 9 4 1 — 55 and over — — — — — — — — — — 1 2 — — Age unknown — — — — — — — — — — — — — — Total (All Ages) — — — — — — 1 1 4 — 26 24 3 1 Cases of Smallpox, Anthrax, Ophthalmia neonatorum and Yellow fever. Original Final Original Final Original Final Original Final M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Smallpox Anthrax Ophthalmia neonatorum Yellow fever — — — — — — — — 1 1 1 1 — — — — Number originally notified Tetanus Infective Jaundice Tuberculosis Whooping cough Respiratory Meninges & C.N.S. Other Cases of fatal tuberculosis not notified before death M. F. M. F. M. F. M. F. M. F. Numbers originally notified Total (All Ages) M. F. Total (All Ages) — — 34 18 91 37 2 — 12 4 5 5 Final numbers after correction Under 1 year — — — — — — — — — — Males Females Final numbers after correction Under 3 months 1 1 17 1 1-year — — — — — — — — — — 3 months — — 2- 4 years — — — — 1 2 1 — 1 — 6 „ — 1 5-9 „ — — 3 2 4 1 — — — — 9 .. — — 10-14 „ — — 2 1 — — — — — — 1 year 1 — 15-19 „ — — 2 3 2 2 1 — 1 — 2-4 years 1 2 20-24 „ — — 6 6 6 6 — — — — 5-9 „ 2 1 25-34 „ — — 8 3 21 8 — — 6 4 10-14 „ — — 35-44 „ — — 6 3 13 4 — — 2 — 15-19 „ — — 45-54 „ — — 3 17 3 — — — — 20-24 „ — — 55-64 „ — — 1 — 15 5 — — 2 — 25-34 „ — — 65-74 „ — — — — 8 2 — — — — 35-44 „ — — 75 and over — — 1 — 2 1 — — — — 45-54 , — — Age unknown — — 2 — 1 3 — — — — 55-64 „ — — 65-74 „ — — Total (All Ages) — — 34 18 90 37 2 — 12 4 75 and over — — Age unknown — — Total (All Ages) 5 5 66 Table 4.—Tuberculosis: New Cases and Deaths At ages— years *NEW CASES DEATHS Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 0—1 — — — — — — — — 1—5 1 2 2 — — — — — 5—15 4 1 — — — — — — 15—25 8 8 2 — — — — — 25—35 22 8 6 4 1 — — — 35—45 14 4 2 — 1 — 1 1 45—55 18 3 — 1 1 — 1 1 55—65 20 5 2 — 1 1 1 — 65 and upwards 17 3 2 — 5 — 2 — Age unknown 1 3 — — — — — — Totals 1970. 105 37 16 5 9 1 5 2 1969 94 45 11 12 9 3 7 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 5.—Specimens Submitted to the Public Health Laboratory Nature of Specimen Number Examined Positive Findings Nasal, throat and hand swabs 104 Haemolytic Streptococci Staphylococcus Aureus 18 6 Faeces 943 Shigella Sonnei 26 Salmonella typhimurium 78 Salmonella Agona 7 Salmonella Isangi 1 Salmonella Enteritidis 1 Salmonella Bredeney 1 Salmonella Senftenberg 6 Salmonella Stanley 29 S. typhi 1 Clostridium Welchii 16 Sputum 1 Blood 3 Urine 42 Total 1,093 (The total number of specimens examined during 1969 was 1,336) 67 Table 6.—Night and out of office hours emergency service— Analysis of calls made to Duty Officers Month 1970 Mental Welfare Mid wives Welfare Department Children's Department Public Health Inspectors District Nurses Miscellaneous Total *W. K. W. K. W. K. W. K. W. K. W. K. W. K. W. K. January 214 97 34 20 20 1 90 27 42 1 298 1 165 9 863 156 February 248 117 32 16 17 2 100 17 37 6 231 2 151 7 816 167 March 204 145 60 33 24 6 103 23 33 3 259 6 124 16 807 232 April 211 130 30 12 21 1 86 23 37 5 260 4 108 7 753 182 May 222 131 39 17 16 5 81 24 51 4 267 1 127 8 803 190 June 221 124 25 13 32 5 95 23 37 5 232 — 122 9 764 179 July 252 110 29 15 26 1 100 30 47 6 247 — 155 15 856 177 August 202 153 56 29 22 3 120 24 59 1 288 — 134 11 881 221 September 216 120 10 11 22 8 120 39 54 3 249 1 187 13 858 195 October 259 107 16 24 21 2 87 32 52 3 259 — 122 4 816 172 November 235 140 26 17 11 6 102 20 56 1 252 1 126 14 808 199 December 213 147 13 18 24 5 82 13 26 3 288 4 113 14 759 204 TOTAL—1970 2,697 1,521 370 225 256 45 1,166 295 531 41 3,130 20 1,634 127 9,784 2,274 1969 2,327 1,567 368 207 272 53 1,049 281 468 20 (included in Miscellaneous) 5,146 77 9,630 2,205 * "W" refers to calls relating to the City of Westminster "K" refers to calls relating to the Royal Borough of Kensington and Chelsea. Table 7.—Dwelling Houses—Reason for Initial Inspection 1970 1969 Complaints 2,812 3,426 Routine 604 898 Smoke Control 112 914 Infectious Disease 305 430 Underground Rooms 165 418 Applications for Grants and Loans 190 239 Housing circumstances 1,342 775 Drainage 964 1,449 Rodent Control 468 501 Miscellaneous 335 551 Table 8.—Dwelling Houses—Nuisances and unsatisfactory conditions found and remedied 1970 1969 Houses, damp, dirty or dilapidated 270 235 Doors, windows, floors, ceilings, firegrates defective 860 618 Insufficient or unsuitable W.C. accommodation 13 26 Drains, W.Cs and waste pipe stoppages 189 199 Drains, W.Cs and waste pipe defective 275 298 Yard, area and washhouse defects 32 35 Roofs, gutters and rainwater pipes defective 278 247 Water supplies absent or insufficient 7 24 Water cisterns dirty or defective 27 33 Ashpits, dustbins, etc., insufficient or defective 56 71 Rubbish accumulations 200 222 Animal nuisances 10 8 Miscellaneous 396 311 68 Table 9.—Summary of visits by public health inspectors 1970 1969 Clean Air Act 1,759 1,511 Drainage and New Developments 12,051 13,017 Dwelling Houses (general matters) 17,212 17,943 Factories (other than building sites) 486 502 Food and Catering Premises 11,723 8,427 Hairdressers' Establishments 69 85 Infectious Disease 878 1,184 Noise 828 1,117 Offices 535 1,591 Pigeons 44 90 Rodent Control 1,417 1,516 Shops 556 658 Smoke Observations 371 607 Town Planning 20 43 Vermin investigations 658 526 Other purposes 1,197 2,403 Table 10.—Statutory Notices Served 1970 1969 Public Health Acts, 1936 and 1961 498 610 Clean Air Act, 1956 15 35 Greater London Council Drainage ByLaws 6 3 Greater London Council Water Closet ByLaws 5 2 Factories Act, 1961 — — Noise Abatement Act, 1960 7 2 Prevention of Damage by Pests Act, 1949 2 4 Greater London Council (General Powers) Act, 1967 3 1 Local ByLaws: Artificial Lighting of Common Staircases 6 7 ByLaw No. 11 of the ByLaws of the Westminster City Council with respect to Good Rule and Government 1 — Table 11.—Summary of Visits by Housing Act Inspectors 1970 ###] Work in connection with the Housing Acts 19611969 442* 1,666 Clearance and development area surveys 2,710* 546 Grant, subsidy and loan applications 325* 480 Hotel inspections 333 417 * Includes action taken in connection with North Westminster Project 69 Table 12.—Summary of Work Carried Out by Public Health Inspectors under the Housing Acts 1961-1969 in connection with Houses in Multiple Occupation 1970 1969 Management Orders made (Section 12) 6 8 Directions given (Section 19) 15 51 Notices served for contraventions of Management Regulations (Section 14) 4 2 Notices served for the provision of amenities (Section 15) 1 13 I nformal notices served (Section 15) 24 78 Notices under Section 14 complied with 2 2 Notices under Section 15 complied with 4 11 Informal notices under Section 15 complied with 14 27 Table 13.—Unfit Premises 1970 1969 Closing orders made on underground rooms 25 (66 rooms) 49 (132 rooms) Closing orders made on upper parts of buildings and mews premises 12 (93 rooms) 12 (37 rooms) Closing orders made on houses in lieu of demolition orders 2 (22 rooms) 2 (21 rooms) Closing orders on underground rooms determined when work carried out 23 (73 rooms) 36 (155 rooms) Closing orders on upper parts and mews premises determined when work carried out 7 (19 rooms) 10 (26 rooms) Table 14.—Housing Act 1969: Qualification Certificates 1970 1969 Improvement cases: Applications for qualification certificates under Section 44(2) under consideration at end of period 52 3 Certificates of provisional approval issued 56 4 Qualification certificates issued under Section 46(3) Nil Nil Standard amenities already provided: Applications for qualification certificates under Section 44(1) under consideration at end of period 141 175 Qualification certificates issued under Section 45(2) 446 1 Exemption for low-income tenants from Section 54: Certificates issued under Section 55 Nil Nil Note: The figures for 1969 relate to the period 25th August, 1969, when the Act came into operation, to 31 st December 1969. 70 Table 15.—Rodent Control 1970 1969 Complaints: Complaints of rats received 517 757 Complaints of mice received 2,193 1,652 Total premises involved 2,710 2,409 Infestations treated by Council's staff: (Including properties inspected for reasons other than notification) Premises rid of rats 527 795 Premises rid of mice 2,195 1,664 Total premises disinfested 2,722 2,459 Inspections by Public Health Inspectors and visits by Rodent Officers to such places 3,613 3,898 Notices: Intimation notices served — — Statutory notices served 2 4 Table 16.—Chemical Examination of Water Supplied to City of Westminster—Average Results Milligrammes per Litre (unless otherwise stated) Analysis Data Source of Supply Stoke Newington R. Thames Derived Ammoniacal Nitrogen 0.008 0.026 Albuminoid Nitrogen 0.061 0.083 Nitrate Nitrogen 5.2 4.8 Oxygen abs. from KMnO44 hrs. at 27°C 0.61 1.02 Hardness (total) CaCO3 305 274 Hardness (non-carbonate) Ca CO3 78 79 Magnesium as Mg 5 5 Sodium as Na 30.9 27.7 Potassium as K 4.9 5.6 Chloride as CI 45 40 Phosphate as PO4 1.9 2.7 Silicate as Si02 9 9 Sulphate as SO4 71 70 Natural Fluoride as F 0.20 0.20 Surface-active material as Manoxal OT 0.02 0.03 Turbidity units 0.0 0.1 Colour (Burgess units) 8 11 pH value 7.9 7.9 Electrical Conductivity (microhms) 620 570 71 Table 17.—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 l. Stoke Newington 258 15.3 — 100.0 100.0 R. Thames-derived 3,710 8.0 — 99.92 99.97 Table 18.—Offices, Shops and Railway Premises Act, 1963 Category of Premises Number Registered in 1970 Total Number Registered at 31st December, 1970 Number of Registered Premises receiving a general inspection during the year Offices 593 12,066 904 Retail Shops 96 3,738 439 Wholesale Shops, Warehouses 16 813 16 Catering Establishments open to the Public (Canteens) 24 1,435 200 Fuel Storage Depots — — — Totals 729 18,052 1,559 Analysis of persons employed in Registered Premises by workplace Offices 286,217 Retail Shops 38,889 Wholesale departments. Warehouses 18,853 Catering Establishments open to the Public 21,224 Canteens 5,853 Fuel Storage Depots — Total 371,036 Total Males 205,137 Total Females 165,899 Inspections and Contraventions Inspections of all kinds 4,788 Premises at which contraventions were found 1,085 Accidents Notifiable accidents 527 Accidents investigated 177 Accidents investigated which revealed contraventions 16 Accidents where a contravention may have been a contributory cause 7 Fatalities — 72 Table 19.—Factories: Inspection for purposes of provisions as to health Number on Register Number of Inspections Written notices Occupiers prosecuted 1970 1969 1970 1969 1970 1969 1970 1969 (i) Factories in which Sections 1, 2, 3, 4 and 6 are enforced by Local Authorities 725 745 101 105 3 1 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2,612 2,754 385 397 21 16 — — (Hi) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 1,556 815 1,727 1,381 — — — — Total 4,893 4,314 2,213 1,883 24 17 — — Table 20.—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 1970 1969 1970 1969 1970 1969 1970 1969 1970 1969 Want of cleanliness (S.1) 9 6 6 6 2 1 4 1 — — Overcrowding (S.2) — — — — — — — — — — Unreasonable temperature (S.3) Inadequate ventilation (S.4) 7 14 6 8 — 1 2 — — — Ineffective drainage of floors (S.6) — — — — — — — — — — Sanitary Conveniences (S.7) — — — — — — — — — — (a) Insufficient 3 5 1 3 — — — — — — (b) Unsuitable or defective 37 29 35 28 — — 1 6 — — (c) Not separate for sexes 2 5 2 4 — — 2 — — — Other offences against the Act (not including offences relating to Out-work) 14 17 9 10 1 1 1 — — — Total 72 76 59 59 3 3 10 7 — — 73 Table 21.—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 1970 1969 1970 1969 1970 1969 1970 1969 1970 1969 1970 1969 Wearing apparel—making, etc. 1,372 1,816 – – – – – – – – – – Household linen 1 10 – – – – – – – – – – Curtains and furniture hangings 8 6 – – – – – – – – – – Furniture and upholstery 1 2 – – – – – – – – – – Lampshades 5 7 – – – – – – – – – – 1,387 1,841 – – – – – – – – – – Table 22.—Estimated Percentage of Compliance of Premises in Westminster with Food Hygiene (General) Regulations, 1960 in relation to (a) Regulation 16— Washing Facilities for use of Staff, and (b) Regulation 19—Provision o1 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 87 87 Restaurants, cafes and snack bars 1,768 97 100 Grocers and provision merchants 505 95 95 Canteens and clubs 1,451 97 97 Public houses 541 96 96 Confectioners 540 85 50* Greengrocers and fruiterers 184 90 75 Schools, nurseries and hostels 85 100 100 Butchers 127 98 98 Off licences 256 80 * Bakers, cake and pastry premises 125 100 82 Chemists 181 80 20† Fishmongers and poulterers 45 97 100 Food factories 21 100 100 Wholesale premises, stores and depots 271 96 77 * Provision not required by Regulation 19 † Maximum percentage required by Regulation 19 74 Table 23.—Premises Registered for Preserved Food, or Manufacture, Storage or Sale of Ice Cream 1970 1969 Preserved food, etc. 183 180 Ice cream : Manufacture, and/or storage and/or sale 707 686 Table 24.—Food Poisoning—Investigation of Incidents and Cases Causative agent General Outbreaks Family Outbreaks Sporadic Cases Total Total Number of separate outbreaks Number of cases notified or ascertained Number of separate outbreaks Number of cases notified or ascertained Notified or ascertained Number of outbreaks and sporadic cases Columns (1+3+5) Number of cases Columns (2+4+5) (1) (2) (3) (4) (5) (6) (7) S. typhimurium 4 84 3 6 2 9 92 Other Salmonellae 1 22 2 6 — 3 28 CI. welchii 4 57 2 9 — 6 66 Staph, aureus 3 32 — — — 3 32 Other causes — — — — — — — Cause unknown 4 18 — — 22 26 40 Total .. 16 213 7 21 24 47 258 75 Table 25.—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— 2 cases — 4 2 0 G.L.C. Drainage Bylaws— 4 cases — 4 0 0 Housing Act. 1961 (Sec. 13(4)) Housing (Management of Houses in Multiple Occupation) Regulations, 1962— 3 cases 70 0 0 5 0 0 Housing Act. 1961 (Sec. 19) Permitting new persons to reside in premises when overcrowded— 3 cases 30 0 0 2 0 0 Food & Drugs Act. 1955 (Sec. 2) Selling food not of substance or quality demanded— 7 cases 160 0 0 50 5 0 Food & Drugs Act, 1955 (Sec. 8) Selling or exposing for sale food unfit for human consumption— 9 cases 310 0 0 67 0 0 Food Hygiene (General) Regulations 1960 17 cases 260 0 0 51 5 0 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations. 1966— 329 cases 1292 10 0 37 13 0 1970 £2122 10 0 £221 5 0 1969 £1346 5 0 £214 16 0 Table 26.—Verminous Persons—Number of Persons cleansed at Lissonia and Wedlake Street Baths Adults Children Total Men Women Total Boys Girls Total 1965 883 124 1,007 96 229 325 1,332 1966 520 111 631 45 185 230 861 1967 428 141 569 43 198 241 810 1968 507 122 629 61 136 197 826 1969 564 154 718 64 193 257 975 1970 418 153 571 51 106 157 728 76 Table 27.—Scabies—Number of Persons treated at Lissonia and Wedlake Street Baths Adults Children Total Men Women Total Boys Girls Total 1965 96 74 170 27 50 77 247 1966 115 93 208 25 62 87 295 1967 138 174 312 32 108 140 452 1968 129 114 243 40 139 179 422 1969 137 183 320 63 191 254 574 1970 123 55 178 35 38 73 251 Table 28.—Coroner's Court and Mortuary 1970 1969 Bodies received in the Mortuary on Coroner's Warrants, etc 1,247 1,244 Bodies deposited to await burial 8 12 Inquest cases 366 365 Non-inquest cases 889 891 Post-mortem examinations held 1,247 1,227 The verdicts returned by H.M. Coroner in the going cases were as follows:—* Accidental drowning 5 7 Found drowned 2 5 Suicide by drowning 4 3 Suicide by other means 123 116 Accidents: Street 51 35 Domestic 26 38 Others 57 68 Natural causes 887 903 Misadventure 8 6 Murder 5 5 Miscellaneous causes 67 61 Awaiting proceedings at Central Criminal Court 12 9 * Excluding bodies brought in to await burial. 77 Table 29.—Maternal & Child Welfare Centres—Activities held as at December 1970 Note: The following Table sets out the sessions held at the various Centres in December, 1970. Changes occur from time to time to meet the need. CENTRE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. 283A Harrow Road, W.9. Dental (School) Discussion Group (Psychiatric) Special Investigation Chiropody Child Health Occ. creche Dental (School) Chiropody Family Planning Clinic (I.U.D.) Evening:— Child Wel. Ante-natal Child Health Dental (School) Ante-natal (exercises) Chiropody Child Health Immunisation Home Advice Dental (School) Child Health Dental (School) Special Investigation Chiropody Ante-natal Child Health 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 Child Health Chiropody (also evening) Dental (M.C.W.) Evening:— Family Planning Chiropody Dental (School) Cytology Special Investigation Child Health Chiropody Dental (School) Special investigation (2nd and 4th Friday in month) Family Planning Hallfield, Pickering House, W.2. Cytology Dental (School) Child Health Dental (School) Playgroup Mothercraft Child Health Dental (School) Evening:— Youth Advisory Clinic Ante-natal Dental (School) (Gas Sess. 4th Wed. in month) Playgroup Child Health Dental (School) Dental (M.C.W.) Playgroup Dental (School) Child Health Evening:— Mothercraft Immunisation and Vacc. Dental (School) Occ. creche Mothers' Club Dental (School) Queens Park, 66 Lancefield Street, W.10. Home Advice Group Evening:— Infant Wel. Child Health Ante-natal Immunisation and Vacc. Child Health Evening:— Family Planning Child Health Child Health Special Assessment (1st and 3rd week) Child Health 78 Table 29.—Maternal & Child Welfare Centres—Activities held as at December 1970—(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. Child Health St. David's St. Mary's Terrace, W.2. Child Health Child Health (1st and 3rd) Linnet House, Charlbert Street, N.W.8. Toddlers (2nd and 4th weeks in month) Child Health Child Health 217 Lisson Grove, N.W.8 Dental (M.C.W. and School) Playgroup Special Investigation as required Toddlers (1st and 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 Child Health Chiropody (a/so Evening) Dental (School) Relaxation and Mothercraft Chiropody Dental (School) Playgroup Discussion Group Chiropody Dental (School) Occ. creche Chiropody Speech Therapy Dental (M.C.W. and School) Playgroup Child Health Dental (School) Cleansing (School children) Chiropody Speech Therapy Chiropody Ante-natal (alternate weeks) Dental (School) Gas Sess. 3rd Friday in month Chiropody Westminster, Council House Extension, W.1. Dental (School) Playgroup Dental (School) Diathermy Child Health Dental (School) Cervical Cytology Playgroup Toddlers (1st and 3rd weeks) Dental (School) Mothers' Club & Creche Immunisation and Vacc. (1st and 3rd weeks) Dental (School) Special Investigation Child Health 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) Child Health Dental (School) 79 Table 29.—Maternal & Child Welfare Centres—Activities held as at December 1970—(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 Child Health Mothercraft Child Health Bessborough Street, S.W.1. Chiropody Ante-natal Chiropody Vaccination and Immunisation (alt. weeks) Chiropody Child Health Chiropody Occ. creche Sewing class Evening:— Family Planning Family Planning Chiropody Family Planning Chiropody Evening:— Family Planning Mentally & Physically handicapped children (1st Fri. in month) Chiropody Child Health Chiropody Ebury Bridge Road, S.W.1. Child Health Child Health Sewing Occ. creche English language class for foreign mothers Occ. creche Cytology Mothers" Club Occ. creche Ante-natal Mothercraft Child Health Marshall Street, W.1. Toddlers' Club Child Health Vaccination and Immunisation Toddlers' Club Family Planning Toddlers' Club Chiropody (alt. weeks) Toddlers' Club Chiropody Child Health Vaccination and Immunisation Toddlers' Club Sewing Occ. creche 121 Marsham Street, S.W.1. Chiropody Sewing Occ. creche Child Health Immunisation and Vaccination Chiropody Relaxation and Mothercraft Chiropody Ante-natal Sewing Occ. creche Chiropody Child Health 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) Special Investigation (alt. weeks) Dental (School) Dental (School) 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. 80 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 Midwives Medical Officer Sessions Midwives Sessions 1970 825 898 354 30 3,322 48 1969 922 1,067 402 45 4,574 92 Table 31.—Mothercraft and Ante-Natal Exercises 1970 1969 Total number of women who attended during the year 474 740 Total number of attendances during the year 2,295 2,897 Total number of sessions during the year 255 311 Table 32.—Family Planning City Council Clinics: Number of patients seen 904 (884 female; 20 male) Total number of attendances 3,305 Total number of sessions 247 These figures relate to 9 months period ended 31 st December 1970 Family Planning Association Clinics: Number of Westminster residents seen—2,300 Table 33.—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 1970 Born in 1969 Born in 1965-8 Total 2,146 2,401 2,703 7,250 2,146 39,835 14,115 363 1969 8,209 2,195 43,486 16,301 385 81 Table 34.—Handicap Register Year Total live births Total on register Number of children on Handicap Register as % of live births 1965 3,952 43 1.09 1966 3,651 70 1.90 1967 3,550 60 1.68 1968 3,180 66 2.07 1969 2,899 42 1.44 1970 2,765 82 2.98 Total 363 Analysis of action taken in respect of children on the Handicap Register Year 1965 1966 1967 1968 1969 1970 Total 43 70 60 66 42 82 Recommended for:— Ordinary School 29 22 3 1 - - Educationally Sub-normal School 5 3 - - - - Training School 1 4 - - - - Physically Handicapped School 3 5 - - - - Other Special Education 3 1 - - - - Residential Home or Hospital 2 6 3 1 - - Day Nursery - 7 11 13 3 - Special Care Unit - 12 19 10 - - Is now attending Senior Medical Officer's Clinic - 25 44 31 10 1 Has at some time attended Senior Medical Officer's Clinic - 19 1 - - - Table 35.—Health Visiting Cases visited by Health Visitors Number of cases 1 Children born in 1970 2,454 2 Children bom in 1969 2,073 3 Children born in 1965-68 4,456 4 Total number of children in lines 1-3 8,983 5 Persons aged 65 or over 1,280 6 Number included in line 5 who were visited at the special request of a G.P. or hospital 600 7 Mentally disordered persons 74 8 Number included in line 7 who were visited at the special request of a G.P. or hospital 31 9 Persons, excluding maternity cases, discharged from hospital (other than mental hospitals) 96 10 Number included in line 9 who were visited at the special request of a G.P. or hospital 58 11 Number of tuberculous households visited 32 12 Number of households visited on account of other infectious diseases 42 13 All other cases 3,198 14 Number of tuberculous households visited by tuberculosis visitors 1,418 82 Table 36.—Vaccination of Persons under age 16 completed during 1970 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 1970 1969 1968 1967 1963-66 At Clinics By G.P.s 1. Quadruple D.T.P.Po. - - - - - - - - 2. Triple D.T.P. 426 1,154 108 8 7 3 1,706 1,592 114 3. Diphtheria/Pertussis - - - - - - - - - 4. Diphtheria/Tetanus 7 23 13 13 120 41 217 202 15 5. Diphtheria - - - - - - - - - 6. Pertussis - - - - - - - - - 7. Tetanus - - - - 7 13 20 1 19 8. Salk - - - - - - - - - 9. Sabin 434 1,170 148 26 140 36 1,954 1,803 151 10. Measles - 595 447 137 277 25 1,481 1,330 151 11. Rubella - - - - - 289 289 289 - Lines 1+2+3+4+5 (Diphtheria) 433 1,177 121 21 127 44 1,923 1,794 129 Lines 1+2+3+6 (Whooping cough) 426 1,154 108 8 7 3 1,706 1,592 114 Lines 1+2+4+7 (Tetanus) 433 1,177 121 21 134 57 1,943 1,795 148 Lines 1+8+9 (Polio) 434 1,170 148 26 140 36 1,954 1,803 151 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 1970 1969 1968 1967 1963-66 At Clinics By G..P..s. 1. Quadruple D.T.P.Po. - - - - - - - - - 2. Triple D.T..P. 16 939 448 27 69 17 1,516 1,387 129 3. Diphtheria/Pertussis - - - - - - - - - 4. Diphtheria/Tetanus - 60 59 49 1,099 404 1,671 1,547 124 5. Diphtheria - - 2 - 14 3 19 16 3 6. Pertussis - - - - - - - - - 7. Tetanus - 2 - - 3 15 20 4 16 8. Salk - - - - - - - - 9. Sabin 16 958 472 66 1,118 256 2,886 2,658 228 Lines 1+2+3+4+5 (Diphtheria) 16 999 509 76 1,182 424 3,206 2,950 256 Lines 1 +2+3+6 (Whooping Cough) 16 939 448 27 69 17 1,516 1,387 129 Lines 1+2+4+7 (Tetanus) 16 1,001 507 76 1,171 436 3,207 2,938 269 Lines 1+8+9 (Polio) 16 958 472 66 1,118 256 2,886 2,658 228 D=Diphtheria Po = Poliomyelitis T =Tetanus Salk = Poliomyelitis vaccine P - Pertussis (Whooping cough) Sabin=Poliomyelitis vaccine (oral) Table 37.—Smallpox Vaccination of Persons aged under 16 Age at date of Vaccination Number vaccinated Number Revaccinated 1970 1969 1970 1969 0-2 months 3 - - - 3-5 months 8 4 - - 6-8 months 9 16 - - 9-11 months 12 25 - 1 1 year 785 794 - 3 2-4 years 294 334 21 17 5-15 years 66 38 216 93 TOTAL 1,177 1,211 237 114 83 Table 38.—Home Nursing 1970 1969 Total number of persons nursed during the year 3,192 3,319 Number of persons who were aged under 5 at first visit in year 161 196 Numberof persons who were aged 65 or over at first visit in year 2,296 2,264 Table 39.—Domiciliary Midwifery Domiciliary Midwives employed by Administrative and Supervisory Staff District Nurses/Midwives Whole-time Part-time Whole-time equivalent of (2) Whole-time Part-time Whole-time equivalent of (5) (1) (2) (3) (4) (5) (6) City Council - - - - 2 0.5 Hospital Management Committee or Board of Governors - - - 3 - - Number of Midwives approved as teachers included in above 1 OTHER MIDWIVES (not included in Table above) Number practising in the City Council's area (excluding those in N.H.S. Hospitals) 56 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 - 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 Number of cases delivered in hospitals and by Midwives under N.H.S. arrangements other institutions but discharged and atten- ded by Domiciliary Midwives before tenth Doctor not booked Doctor booked Total day 1970 1 42 43 324 1969 4 54 58 216 84 Table 40.—Chiropody Service A. Number of persons treated By City Council By City of Westminster Old People's Welfare Association Total 1970 1969 1970 1969 1970 1969 *Persons aged 65 and over 2,027 2,042 2,237 2,004 4,264 4,046 Expectant mothers 4 6 - 8 4 14 Others 147 135 - - 147 135 Total 2,178 2,183 2,237 2,012 4,415 4,195 * Includes women over 60. B. Number of treatments given By City Council By City of Westminster Old People's Welfare Association Total 1970 1969 1970 1969 1970 1969 In clinics 9,264 8,035 2,448 3,625 11,712 11,660 In patients' homes 313 1,035 4,833 3,708 5,146 4,743 In old peoples' homes 911 1,128 618 199 1,529 1,327 In chiropodists' surgeries - 7 3,158 3,429 3,158 3,436 Total 10,488 10,205 11,057 10,961 21,545 21,166 Table 41.—Home Help Service A. Applications received during year Area Aged 65 and Over Aged under 65 Total T.B. Chronic Sick Mentally Disordered Maternity Others 1970 1969 Paddington 455 - 53 8 8 64 588 643 St. Marylebone 331 1 44 1 4 26 407 433 Westminster 475 3 18 - 7 58 561 548 Total 1,261 4 115 9 19 148 1,556 1,624 B. Number of cases in which help was given during the year Paddington 990 3 87 7 - 53 1,140 1,265 St. Marylebone 500 1 48 1 3 14 567 583 Westminster 866 7 40 - 5 49 967 962 Total 2,356 11 175 8 8 116 2,674 2,810 C. Cases receiving service as at 31 st December, 1970 Paddington 664 - 62 5 - 13 744 749 St. Marylebone 309 - 23 - - 1 333 335 Westminster 540 7 21 - - 7 575 590 Total 1,513 7 106 5 - 21 1,652 1,674 85 Table 42.—Mental Health Service—Number of Patients referred to City Council during year ended 31st December, 1970 Referred by Mentally III Mentally Handicapped Severely Mentally Handicapped *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. 1970 1969 (a) General practitioners - - 31 71 - - - 1 - - - - 103 98 (b) Hospitals, on discharge from in-patient treatment - - 80 238 - - 6 3 - - - 1 328 283 (c) Hospitals, after or during out-patient or day treatment - - 34 65 - - 2 1 - - - - 102 98 (d) Local education authorities - - 6 1 2 2 11 10 7 4 - - 43 43 (e) Police and courts - - 9 5 - - 1 - - - - - 15 24 (f) Other sources - - 187 313 6 5 10 11 5 5 4 1 547 469 Total - - 347 693 8 7 30 26 12 9 4 2 1,138 1,015 Excludes referrals for the purpose of obtaining admission to hospital. Numbers so admitted are shown in the following table. Table 43.—Number of Patients for whom Hospital Admissions were arranged SECTION OF MENTAL HEALTH ACT Total Informal Sec. 25 Sec. 26 Sec. 29 Sec. 136 Sec. 60 1970 189 183 5 232 5 18 632 1969 157 180 9 263 11 50 670 Table 44.—Mental Health Service—Number of cases in community care at end of year Mentally III Mentally Handicapped Severely Mentally Handicapped 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. 1970 1969 (a) (i) Attending workshop/day centre or training centre - - 26 22 3 4 1 5 33 20 14 22 150 138 (ii) Awaiting entry thereto - - - - - - - - 2 3 4 - 9 11 (b) (i) Receiving home training - - - - - - 1 - - - - 1 2 3 (ii) Awaiting home training - - - - - - - - - - - - - - (c) (i) Resident in L.A. home/ hostel - - 4 3 - - 6 4 - 1 1 - 19 13 (ii) Awaiting residence in L.A. home/hostel - - 1 - - - 1 - - - - - 2 4 (iii) Resident at L.A. expense in other residential homes/hostels - - 14 30 7 5 4 8 17 13 7 10 115 104 (iv) Resident at L.A. expense by boarding out in private household - - - - - - - - - - - - - 1 (d) Receiving home visits and not included under (a) to (c) - - 220 440 5 5 45 51 7 9 20 16 818 719 Total number — - 265 495 15 14 58 68 59 46 46 49 1,115 993 86 Table 45.—Number of patients admitted for temporary residential care during the year (e.g. to relieve the family) Number of admissions Mentally III Mentally Handicapped Severely Mentally Handicapped 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. 1970 1969 To N.H.S. Hospitals - - - - - - - 2 3 8 - - 13 6 Elsewhere - - - 1 - - - 2 7 4 3 6 23 46 Total - - - 1 - - - 4 10 12 3 6 36 52 Table 46.—Terrace Day Centre—1970 (Day Centre for the Mentally III, 1 St. Mary's Terrace, W.2) Total attendance Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. 1970 1530 1969 (1453) 1210 (1317) 1205 (1343) 1386 (1396) 1500 (1353) 1697 (1348) 1582 (1456) 1269 (1393) 1552 (1370) 1510 (1726) 1444 (1627) 1431 (1692) Average attendance 1970 34 30 30 32 37i 38 34 32 35i 34 34 32i 1969 (31½) (33) (32) (34) (32) (32) (32) (34) (33) (37½) (41) (42) Percentage attendance 61% 61% 65% 70% 75% 71% 67% 64% 71% 65% 66% 63% Roll at beginning of month 61 56 46 43 46 54 54 53 51 50 54 59 1969 (47) (46) (47) (51) (50) (45) (51) (64) (57) (57) (57) (60) Admissions 8 3 3 11 12 6 4 5 3 10 13 7 (5) (8) (6) (7) (4) (9) (11) (6) (6) (3) (6) (5) Discharges:- 13 13 6 8 4 6 5 7 4 6 8 10 (6) (6) (2) (5) (9) (3) (8) (7) (6) (13) (3) (4) To: Work 5 4 3 4 2 5 - 2 1 - 3 2 Further training 2 1 - - - - - - 1 1 - - Hospital 2 3 - 2 2 1 3 1 1 2 1 4 Non-co-operation 3 - 3 - - - 2 4 1 2 4 3 Moved away - 2 - 1 - - - - - - - - Not suitable - 3 - - - - - - - - - - Relieved 1 - - - - - - - - - - - Self-discharge - - - 1 - - - - - - - - Physically ill - - - - - - - - 1 - 1 87 Table 47.—Venereal Diseases Cases treated in Westminster — 1 st January-31 st December, 1970. Hospital M. F. Total 1970 Total 1969 Middlesex Hospital, W.1. Syphilis 158 37 195 133 Gonorrhoea 1,517 533 2,050 2,009 Other conditions 6,500 4,947 11,447 8,813 Total 8,175 5,517 13,692 10,955 St. George's Hospital. S.W.1. Syphilis 31 5 36 40 Gonorrhoea 369 99 468 473 Other conditions 1,611 715 2,326 2,466 Total 2,011 819 2,830 2,979 St. Mary's Hospital. W.2. Syphilis 262 28 290 302 Gonorrhoea 3,433 688 4,121 4,189 Other conditions 9,666 4,800 14,466 13,374 Total 13,361 5,516 18,877 17,865 Westminster Hospital, S.W.1. Syphilis 29 5 34 29 Gonorrhoea 316 101 417 477 Other conditions 1,400 851 2,251 2,025 Total 1,745 957 2,702 2,531 Venereal Diseases - Contact Notifications Number of notifications received from American Forces, from abroad(through the Department of Health & Social Security) and from other Local Authorities 107 (142) Number traced and brought to treatment 65 60.7% (82) (58%) 88 Table 48.—Medical Suite at City Hall: Work Undertaken 1970 1969 1968 Medical questionnaires scrutinised in respect of persons entering the Council's service 1,264 1,303 1,280 Persons leaving the Council's service 1,010 1,023 1,203 Interviews and examinations re medical questionnaires 83 89 120 Medical examinations of staff (special categories) 200 96 154 Examinations regarding extended sick leave 55 77 58 Retired on health grounds 37 31 24 Advice on First Aid 877 766 823 Referrals to general practitioner or hospital 85 62 68 Parking Meter Exemptions 141 121 208 F.F.I. examinations 24 26 22 Vaccinations—Smallpox 76 95 148 Vaccinations—Influenza 7 15 - Immunisation—Tetanus 16 26 37 Immunisation—Poliomyeltis 7 - - Antihistamine injections 8 - - Table 49.—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 1970 1969 (i) Number of skin tested 412 472 (ii) Number found positive 261 276 (iii) Number found negative 151 196 (iv) Number vaccinated 138 149 B. School Children and Students (i) Number of skin tested 1,280 1,574 (ii) Number found positive 162 181 (iii) Number found negative 1,028 1,146 (iv) Number vaccinated 1,028 1,146 89 Table 50.—School Health Service The table below shows the grades and numbers (full-time equivalents as at 31 December, 1970) 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, 1970 IN: City of Westminster Inner London Education Authority 1970 Inner London Education Authority 1969 Medical—M.O's. & G.P's. (excluding for the boroughs, centrally-directed Consultants and Specialists) 5.9 98.8 93.00 Nursing (all categories of staff) 12.5 253.6 268.70 Speech Therapists (centrally-directed) 0.8 29.4 29.50 Social Workers 5.7 71.5 62.10 Physiotherapists - 2.7 17.60 Remedial Gymnasts - 0.5 1.00 Occupational Therapist - 1.00 1.00 Dental Officers 4.30 85.84 81.10 Dental Auxiliaries . 11. 08 10.47 Dental Surgery Assistants 4.50 95.50 90.59 Dental Technicians . 8.60 8.40 Dental Health Education Officers . 1.00 1.00 Table 51.—School Medical Inspections (excluding Dental and Health Surveys)—1970 City of Westminster Inner London Education Authority 1970 1969 SCHOOL ROLL - MAY 1970 21,810 423,578 421,925 ROUTINE INSPECTIONS Number inspected 7,168 160,516 159,217 Number found not to warrant examination (7 plus special scheme) 39 674 604 PERCENTAGE OF No. INSPECTED OF:- Parent present 46.6 52.4 53.1 Care Committee present 74.7 61.7 70.7 No. vaccinated against smallpox 71.9 69.1 71.7 No. immunised against diphtheria 89.7 88.9 88.1 No. immunised against whooping cough 81.9 82.1 81.2 No. vaccinated against poliomyelitis 89.4 88.5 87.6 Physical condition unsatisfactory 0.6 0.7 0.4 Referred for treatment of defects 16.1 16.5 14.7 Referred for treatment of defects other than vision 8.3 8.9 7.3 NON-ROUTINE INSPECTIONS (i) Specials 2,177 48,096 48,050 (ii) Re-inspections 3,936 69,513 69,448 Total (i) and (ii) 6,113 117,609 117,498 No. of routine inspections as percentage of school roll 32.9 37.6 37.8 No. of non-routine inspections as percentage of school roll 28.0 27.8 27.8 90 Table 52.—Routine Medical Inspections 1970—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 7,168 1970 1969 160,516 159,217 DEFECTS ‡ SKIN T 7.67 10.55 9 .65 o 14.09 11.24 12.61 EYES (a) Vision T 85.38 85.12 73.56 o 47.57 48.25 55 .09 (b) Squint T 7.95 10.74 8 .62 o 6.14 4.68 5.61 (c) Other T 2.37 1.58 1.43 o 1.67 1.81 2.54 EARS (a) Hearing T 3.91 7.21 6.35 o 5.02 6.67 7.90 (b) Otitis Media T 2.09 2.43 1.71 o 3.21 3.37 3.98 (c) Other T 0.70 0.93 0 .80 o 0.56 1.20 0.96 NOSE AND THROAT T 7.11 5.96 5.41 o 21 .07 23.93 27.03 SPEECH T 5.16 4.98 4.55 o 7.39 7.62 7.81 LYMPHATIC GLANDS T 1.12 0.74 0.61 o 11.16 7.73 8 .22 HEART *Congenital T *1 .81 † 1 .26 *2.63 †0.88 *1.58 †0.52 † Acquired o *4.05 †1.26 *4.67 †2.26 *5.98 †2.70 LUNGS T 9.77 7.65 5 .28 o 9.07 9.09 12.86 DEVELOPMENTAL (a) Hernia T 1.53 1.-41 1.09 o 1 .81 2.40 3 .25 (b) Other T 2.65 2.59 1.43 o 6.70 5.10 6. 56 ORTHOPAEDIC (a) Posture T 1.26 1.16 0.79 o 4.32 3.75 4.72 (b) Feet T 4.46 4.80 3.68 o 6.70 13.17 13.98 (c) Other T 2.79 2 .60 2.09 o 5.16 3.93 4 .83 NERVOUS SYSTEM (a) Epilepsy T 1.53 2.24 1.63 o 0.70 1.03 1.53 (b) Other T 1.67 1 .21 0.52 o 0.98 1.35 1 .71 PSYCHOLOGICAL (a) Development T 1.26 2.08 1.64 o 6.56 5.81 6.17 (b) Stability T 2.93 3.49 2 .52 o 17.02 11.13 11.81 ABDOMEN T 0.84 0.93 0.52 o 2.51 1.73 1.64 OTHER T 18.94 21.45 17.72 o 26.51 35.16 38.13 ‡T = Treatment O = Observation 91 Table 53.—School Health Service—Findings at Health Surveys 1970 SCHOOL ROLL—May 1970 City of Westminster Inner London Education Authority 21,810 1970 423,578 1969 421,925 1. Comprehensive Surveys (a) Number examined 21,283 303,077 299,878 (b) Number (occasions) found verminous 190 4,031 2,945 (c) Percentage found verminous 0.89 1.33 1.01 2. Selective Surveys (a) Number examined 6,960 147,553 130,756 (b) Number (occasions) found verminous 151 4,508 3,763 (c) Percentage found verminous 2.17 3.06 2.88 3. (a) Total times vermin found (1 (b) + 2 (b)) 341 8,539 6,708 (b) Total percentage found verminous (3 (a) as percentage of 1 (a) + 2 (a)) 1.21 1.89 1.59 (c) Number of individual pupils found verminous 170 5,511 5,062 (d) Percentage of individual pupils found verminous (of school roll) 0.78 1.30 1.20 4. Action taken with verminous cases (a) Advice and/or Lorexane 288 7,292 5,675 (b) Further action 53 1,247 1,033 (c) 4 (b) expressed as a percentage of 4 (a) 18.40 17.10 18.20 Analysis of 4 (b) cases—referrals of hardcore cases to bathing centres Voluntary attendance at bathing centres Number of pupils 16 1,260 863 Number of Statutory notices issued - - 15 Number cleansed at centres following statutory notices Voluntarily - - 15 Compulsorily - - - 5. Communicable disease surveys Number examined for: Athlete's foot 194 18,469 23,521 Plantar Warts 438 Dysentery 5 890 1,811 Other communicable diseases 113 22,026 20,056 Total of (5) 750 41,385 45,388 92 Table 54.—School Health Service—Non-Routine Medical Inspections 1970 Type of Inspection City of Westminster Inner London Education Authority 1970 1969 Re-inspections 3,936 69,513 69,448 Bathing Centre Inspections—Scabies 5 27 55 Bathing Centre Inspections—Other 18 90 130 Employment certificates 173 3,251 3,901 Theatre children - 481 442 School Journeys 1,099 25,015 22,869 Recuperative holidays—pre-departure 61 1,128 982 Recuperative holidays—on return - 1 - Secondary school annual surveys 142 340 681 Candidates for higher awards - 90 114 Nautical school entrants - 1 15 Outward bound courses 6 108 138 Infectious disease investigation - 703 158 T.B. contacts - 4 12 Boarding Schools for the delicate pre-departure 1 178 196 Boarding Schools for the delicate on return - 11 98 Handicapped Pupils—Statutory examination 61 2,010 2,048 Handicapped Pupils—Periodic special defect examination 81 5,258 5,603 Research investigations and enquiries 12 219 168 Sub-Total 1,659 38,915 37,610 SPECIALS—At request of: Head Teacher—Child's name entered in special book 65 1,504 1,541 Head Teacher—Others 147 3,051 3,297 School Nurse following health survey 58 419 579 School Nurse—Others 41 612 855 Divisional Education Officer 40 527 772 District Care Organiser or Care Committee 24 257 295 Parent 61 1,064 1,077 School Medical Officer 76 1,503 1,647 Sub-Total 513 8,937 10,063 Other—Accident on School premises - 12 38 Boxing—Reference from schools A.B.A. or similar association - 45 25 For free travel 1 3 1 Reference: (i) connected with remedial exercises foot classes - 32 126 (ii) by gymnast or physiotherapist Referred by hospital - 4 5 Referred by speech therapist - 5 3 Referred by general practitioner - 3 2 Miscellaneous 4 140 177 Sub-Total 5 244 377 Total of all Non-Routine Medical Inspections 6,113 117,609 117,498 93 Table 55.—School Health Service—Routine Medical Inspections 1970—Vision Number Tested PERCENTAGE OF NUMBER TESTED Percentage of total number tested and noted for treatment A—Not Wearing Glasses 8—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 3,653 2,909 73.3 75.7 8.6 8.0 5.5 6.1 4.7 5.2 6 .4 6.4 3.8 1.9 2.4 2.0 4.2 4.6 9.3 I.L.E.A. 1970 74,861 70,891 81.6 79.9 6.0 6.5 4.8 5.3 4.7 5.3 4.1 4.4 1.7 1.9 1.7 2.0 3.8 4.9 9.4 I.L.E.A. 1969 71,571 69,361 82.5 80.6 6.9 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 94 Table 56.—School Health Service Comparison of Defects noted at 7-Plus Routine and 7-Plus "Special" Medical Inspections in 1970 Number of Children Noted for Treatment and Observation expressed as a rate per 1,000 inspected City of Westminster Inner London Education Authority 1970 1969 Number inspected at 7-plus routine inspections 412 38,375 37,692 Number inspected at 7-plus experimental scheme inspections 668 1,880 1,421 Defects * A † B * A † B * A † B Skin 24.3 31.4 23.8 29.3 23.2 20.4 Eyes— Vision 92.2 125.7 146.6 143.6 137.3 147.0 Squint 26.7 15.0 17.9 17.6 15.5 11.3 Other 4.9 3.0 3.3 3.7 2.8 5.6 Ears— Hearing 12.1 19.5 19.8 19.7 19.0 23.2 Otitis media - 9.0 6.3 5.9 5.9 7.7 Other 2.4 — 2.8 2.7 2.0 2.1 Nose and throat 29.1 47.9 36.9 30.9 37.6 37.2 Speech 17.0 12.0 12.5 19.7 12.3 12.7 Lymphatic Glands 7.3 10.5 10.0 10.1 9.8 17.6 Heart 12.2 18.0 11.0 18.1 11.0 12.7 Lungs 19.5 31.5 18.9 28.2 18.4 28.8 Developmental—Hernia 2.4 4.5 4.3 2.7 4.9 2.8 Other 4.9 13.5 9.7 12.8 10.5 4.2 Orthopaedic— Posture 7.3 4.5 6.0 3.7 5.7 4.2 Feet 7.3 15.0 18.9 8.0 17.8 14.8 Other 2.4 3.0 5.7 2.7 6.2 5.6 Nervous System— Epilepsy 4.9 1.5 3.7 2.1 3.2 2.8 Other - 3.0 3.0 1.6 2.4 1.4 Psychological— Development 2.4 21 .0 11.4 20.7 10.1 21 .1 Stability 60.7 22.5 18.6 26.6 17.3 27.4 Abdomen 4.9 1.5 2.5 1.6 2.1 0.7 Other 55.7 79.3 66.0 80.3 63.4 92.9 * Column 'A' refers to 7-plus routine medical inspections. †Column 'B' refers to 7-plus experimental scheme inspections. 95 Table 57.—School Dental Service Statistics 1970 (Statistics, 1969 shown in brackets) NUMBER OF SESSIONS Inspection Ordinary treatment Anaesthetic TOTAL 87 (91) 1,882 (2,034) 26 (41) 1,995 (2,166) INSPECTIONS First inspection at school First inspection at clinic Percentage found to require treatment 9,054 (8,098) 4,163 (3,514) 63 0 (63.5) Re-inspection at school or clinic 1,332 (960) 85.6 (80.7) NUMBER OF VISITS FOR TREATMENT Number of 1st visits 4,291 (4,208) Number of subsequent visits 6,764 (6,993) Emergencies 361 (404) Total (including emergencies) 11,416 (11,605) FILLINGS AND EXTRACTIONS Fillings Permanent teeth Temporary teeth 5,739 (5,658) 6,413 (6,709) Extractions 287 (322) 1,279 (1,382) Other operations (prophylaxis, X-ray, inlays, crowns, etc.) 4,831 (4,638) Number of dentists employed (effective whole time equivalent) 4.8 (5.9) 96 Table 58.—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 1970 1969 1970 1969 First Visit 455 317 63 59 Subsequent Visits 269 351 81 101 Total Visits 724 668 144 160 Number of Additional Courses of Treatment other than the First Course commenced during year 46 43 3 8 Treatment provided during the year— Number of Fillings 659 867 192 190 Teeth Filled 466 546 124 115 Teeth Extracted 36 39 7 12 General Anaesthetics Given 15 15 - 3 Emergency Visits by Patients 26 43 5 21 Patients X-rayed 9 2 9 5 Patients Treated by Scaling and/or Removal of Stains from the Teeth (Prophylaxis) 225 193 43 84 Teeth Otherwise Conserved 102 126 - - Teeth Root Filled - - 6 5 Inlays - - - - Crowns - - - 1 Number of Courses of Treatment completed during the year 237 200 32 40 Part B.—Prosthetics 1970 1969 Patients supplied with F.U. or F.L. (first time) — 2 Patients supplied with other Dentures 1 - Number of Dentures supplied 1 4 Part C.—Anaesthetics 1970 1969 General Anaesthetics administered by Dental Officers - - Part D—Inspections Children 0-4 (incl.) Expectant and Nursing Mothers 1970 1969 1970 1969 Number of Patients given First Inspections during year (a) 556 (a) 274 (d) 56 (d) 54 Number of Patients in (a) and (d) above who required Treatment (b) 388 (b) 217 (e) 50 (e) 49 Number of Patients in (b) and (e) above who were offered Treatment (c) 383 (C) 214 (f) 50 (f) 49 Part E.—Sessions 1970 1969 Number of Dental Officer Sessions (i.e. Equivalent complete half-days) devoted to Maternity and Child Welfare Patients— For Treatment 126 94 For Health Education - 11 97 Table 59.—Tuberculosis—Care and After Care Paddington Chest Clinic Marylebone Chest Clinic Westminster Hospital Chest Clinic 1970 1969 1970 1969 1970 1969 T.B.patients on Register of Chest Clinics at 31st December 478 623 447 441 970 950 T.B. Visitors—Visits to homes 1,600 2,582 908 1,008 - - After-Care Work (Social Worker): Number of patients in receipt of extra nourishment at end of year 6 7 11 8 8 14 Patients assisted for the first time with bed or bedding 1 8 1 1 - - Patients assisted for the first time with clothing or footwear 38 25 - 2 - - B.C.G. Vaccinations during the year in accordance with City Council scheme 88 105 15 21 35 23 Rehabilitation Hostels: Patients in residence at end of year - - - - 2 2 Hostels for Homeless tuberculous men : Patients in residence at end of year - - - - 13 20 Child contacts boarded out during the year - - - - - - 98 INDEX Page Accidental Deaths 12 AGUte Poliomyelitis 13 Advice on labelling 31 After Hours Emergency Telephone Service 14 Analysis of Calls made to Duty Officer 67 Animals, Slaughter of 32 Ante-natal Exercises, Mothercraft and 80 Ante-natal and Post-natal Clinics 80 Area of the City 11 Assessment of Children 39 Attachment of Health Visitors to Medical Practitioners 43 Attendances at M. and C.W. Clinics 77 Basement Bakehouses 25 Bathing Service for Old People 33 BCG Vaccination 60 Betting Shops 34 Births 11,12 Blind and Partially Sighted Persons 56 Brucella Abortus, Milk Supplies 29 Burial or Cremation of the Dead 35 Catering Establishments 25 Catering Premises and Food, Inspection 25,73 Certificates of Disrepair 21 Cervical Cytology 58 Chest Clinics 61,97 Child Minders 41 Childhood, Infant and, Deaths 38 Children under five years. Day Care of 40 Child Welfare Centres 80 Chiropody Service 58 City of Westminster District Nursing Association 57 Clean Air 17 Committees, Appointment of Members of Health and Social Services Committees to 6 Common Lodging Houses 21 Consumer Protection 32 Control Orders, Houses let in Multiple Occupation 20 Co-ordination 49 Coroner's Court and Mortuary 34,76 Cremation, Work of Medical Referee 35 Day Care of Children underfiveyears 40 Day Nursery Service 40 Deaths 11,12 Deaths, Accidental 12 Deaths, Causes of. According to Age Group and Sex 63 Deaths, Infant Mortality 12,64 Deep Wells 24 Dental Services 60 Diphtheria 13 Diseases of Animals Act 1950, and other Acts relating to Animals 33 Disinfection 22 Disinfestation, Insect Pest Control 22 Disposable Incontinence Pads 34 Disposal of Unsound or Unsaleable Food 30 Disrepair, Certificates of 21 District Inspection, Public Health Inspectors 16 District Nursing Association 57 Domestic Rateable Hereditaments 11 Page Domiciliary Midwifery 57,83 Drainage and New Developments 17 Duty Officer, Calls made to 67 Dwelling Houses 16 Dwelling Houses, Inspections 16 Dwelling Houses, Nuisances and Unsatisfactory Conditions 67 Dysentery 13 Emergency Telephone Service 14 Environmental Health Services 15 Establishments for Massage or Special Treatment 34 Eviction, Unlawful, Harassment and Provision of Rent Books 20 Export Certificates 31 Factories 25 Factories, Inspections 72 Factories, Defects 72 Family Planning 44 Fertilizers and Feeding Stuffs 33 Food and Drugs Act 1955—Section 16 29 Food Hygiene, etc.. Lectures 27 Food Hygiene (General) Regulations 1960 73 Food, Legal Proceedings 75 Food Poisoning 29 Food Premises, Legal Proceedings 28,75 Food Premises, Number of 25,73 Food Premises, Registration of 74 Food Sampling and Analysis 27 Food and Catering Premises, Inspection 25,73 Food, Unsound or Unsaleable, Disposal of 30 Grants, Subsidies and Loans 20 Handicap Register 81 Handicapped Children 39,43 Harassment, Unlawful Eviction and Provision of Rent Books 20 Health Committee 6 Health Department, Premises 10 Health Education 44, 55 Health Visitors, Attachment to Medical Practitioners 37 Health Visiting Service 43 Home Help Service 46,84 Home Nursing 56 Home Nursing Equipment, Loan of 57 Houses in Multiple Occupation, Management Orders and directions 19 Houses in Multiple Occupation, Control Orders .. 20 Houses in Multiple Occupation, Means of Escape in Case of Fire 20 Houses in Multiple Occupation, Summary 69 Housing Acts, Visits by Public Health Inspectors 69 Housing Acts 1961-1969, Work Carried out by Inspectors 69 Housing Priority on Medical Grounds 21 Ice Cream, Premises Registered 74 Imported Food Regulations, 1968 31 Immunisation and Vaccination 45 Incontinence Pads 34 Infant and Childhood Deaths 38 99 Page Infant Mortality 12 Infectious and Other Notifiable Diseases 13 Infective Jaundice 13 Insect Pest Control, Disinfestation 22 Inspection of Dwelling Houses 67 International Certificates of Vaccination and Inoculation 14 Introduction 3 Labelling, Advice on 31 Laundry Service, Special 34 Legal Proceedings 17 Legal Proceedings, Food and Food Premises .. 28,75 Licensing Act 1964 26 Liquid Egg (Pasteurisation) Regulations 1963 31 Loan of Home Nursing Equipment 57 Loans, Grants and Subsidies 20 Local Land Charges 21 Lodging Houses, Common 21 Management Orders, and Directions—Houses in Multiple Occupation 19 Mass X-ray 14 Massage and Special Treatment Centres 34 Maternal and Child Welfare Centres 80 Maternal Mortality 12,39 Measles 13 Medical Referee, Work of 35 Mental Health 49 Mental Health, Community Care 85 Mental Health, Hospital Admissions 85 Mental Health, Patients referred in 1970 85 Mental Health, Services 49 Mental Health, St. Jude's Hostel 51 Mental Health, Temporary Residential Care 86 Mental Health, Terrace Day Centre 52 Mental Health, Training Centres 52 Midwifery 83 Milk and Dairies (General) Regulations, 1959 28 Milk, Dealers' Licences 28 Milk (Special Designation) Regulations, 1963 28 Milk Supplies, Brucella Abortus 29 Mobile Health Clinic 45 Mothercraft and Ante-natal Exercises 80 National Assistance Act 1948, Section 50 35 New Developments, Drainage 17 Noise 17 North Westminster Project 18 Notices 16 Notifications of Infectious Diseases 65 Nurseries and Child Minders' Regulation Act, 1948 41 Nursing Homes 46 Offices, Shops and Railway Premises Act 1963 24 Old Persons' Bathing Service 33 Outworkers 25,73 Overcrowding 21 Paediatric Home Care Unit 57 Paratyphoid Fever 13 Partially Sighted and Blind Persons 56 Personal Health Services 36 Pharmacy and Poisons Acts 1933 and 1941 33 Pigeon Control 23 Play Groups and Occasional Creches 42 Poliomyelitis, Acute 13 Page Population 11 Poultry Processing Premises 32 Premises Registered, Preserved Food or Manu- tured 74 Premises Registered, Ice Cream 74 Pre-school Playgroups 41 Preserved Food or Manufactured, Premises Registered 74 Priority on Medical Grounds, Housing 21 Private Water Supplies, Deep Wells 24 Public Health Inspectors, District Inspection 16 Public Health Inspectors, Night and Weekend Duties 15 Public Health Inspectors, Summary of Visits 68 Public Health Laboratory, Specimens submitted to 66 Qualification Certificates 20 Queen's Park M & CW Clinic Replacement 45 Radioactive Substances Act 1960 21 Rag Flock and Other Filling Materials Act 1951 33 Rateable Value 11 Recuperative Holidays 47 Rent Books, Provision of 20 RiverThames Flood Precautions 24 Rodent Control 22 Sampling and Analysis, Food 27 Scabies 33 School Dental Service 60 School Health Service 59,89 School Health Service, Number employed in 89 School Medical Inspections, Defects found 90 School Medical Inspections, excluding Surveys 89 School Medical Inspections, Health Surveys 91 School Medical Inspections, Non-routine Inspections 92 School Medical Inspections, Routine Medical Inspections 90 School Medical Inspections, Comparison of Defects found 94 Sewerage 17 Slaughter of Animals 32 Slaughterman's Licences 33 Slum Clearance 19 Smallpox 13 Smallpox Vaccination 82 Social Services Committee 6 Social Work (Personel Health Service) 47 Special Laundry Service 34 Special Counselling Service, Family Planning 44 Specimens Submitted to Public Health Laboratory 66 Staff of Health Department 8 Staff Medical Service 59,88 Statistical Tables, List of 62 Statistics and Social Conditions 11 Statutory Notices served 68 Street Traders, Licensed 26 Street Traders, Unauthorised 27 Student Health Visitors 43 Student Public Health Inspectors 16 Subsidies, Loans and Grants 20 Swimming Bath Water Examination 24 Technical Assistants 16 Terrace Day Centre 52,86 100 Page Tourism 21 Town Planning 17 Trade Descriptions Act 1968 31 Training Centres 49 Tuberculin Test and B.C.G. Vaccination 88 Tuberculosis, New Cases and Deaths 13,61 Typhoid Fever 13,30 Unauthorised StreetTraders 27 Unfit Premises 19 Unlawful Eviction, Harassment and Provision of Rent Books 20 Unsound or Unsaleable Food, Disposal of 30 Urban Programme 43 Page Vaccination against Smallpox 82 Vaccination and Immunisation 45 Vaccination and Inoculation, International Certificates of 14 Vaccinations performed 82 Venereal Diseases 54,87 Verminous Persons 33 Voluntary child minders 41 Water 23 Water, Bacteriological Examination 71 Water, Chemical Examination 70 Water Supplies, Private Deep Wells 24 Whooping Cough 13 VAIL a CO. LTD.. LEEKE STREET. LONDON. WC1X 8HU