WES 81 ??? AC. 43399 THE HEALTH OF WESTMINSTER 1971 Report of the Medical Officer of Health CONTENTS Introduction 3 Health Committee 6 Staff of the Health Department 8 Health Department Premises 10 Statistics and Social Conditions 11 Environmental Health Services 15 Personal Health Services 41 School Health 62 Dental Service 64 Chest Clinics 65 Statistical Tables 67 — 101 Index 102 J. H. Briscoe-Smith, M.B., Ch.B., D.P.H., Medical Officer of Health and Principal School Medical Officer (Inner London Education Authority) 1971 3 CITY OF WESTMINSTER Telephone: Health Department, 01-828 8070 City Hall, Victoria Street, London, SW1E 6QJ 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 1971. 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. As compared with 1970 there has been little change in the vital statistics shown on pages 11 and 12, except in the case of the infant mortality rate where there has been a marked reduction in deaths of children under one year of age per thousand live births, from 20.98 in 1970 to 13.35 in 1971. This is the lowest figure recorded since the new City came into being in 1965 and it is hoped that this welcome trend will continue. Year Infant deaths Westminster Infant death rate England & Wales Infant death rate 1965 74 18.72 19.0 1966 83 22.73 19.0 1967 75 21.13 18.4 1968 49 15.41 18.0 1969 65 22.42 18.0 1970 58 20.98 18.0 1971 35 13.35 18.0 One maternal death is recorded in the report. The person concerned was not a Westminster resident but had come from France for termination of pregnancy. A constantly occurring anomaly which appears when one examines the statistics over a number of years relates to the adjusted birth rate which is always low when compared with the national average and particularly to the percentage of live births that are illegitimate, which is always approximately double the national figure. I feel that it would be useful to examine these discrepancies in more detail in an effort to determine whether they are more apparent than real. One of the important duties of a Medical Officer of Health is to record births and deaths occurring in the area for which he is responsible. By studying variations over a number of years he is often able to gain useful information about changing local conditions and the success or otherwise of measures designed to combat health hazards and to relate conditions in his own area with what is occurring elsewhere. As a first step towards making a true comparison of one year with another or one area with another the "crude" numbers of births and deaths have first to be converted to "rates", e.g. deaths per thousand population living in the area during the relevant period. In addition account must be taken of variations in the age and sex composition of the populations being compared. As an example, a seaside town with a large proportion of elderly residents would have a high death rate and a low birth rate for this reason alone irrespective of any other factors influencing health or behaviour. Conversely, one of the new towns with a young population containing many women of child-bearing age will have a high birth rate and a low death rate. In order to "iron out" differences due solely to age and sex variations the Registrar General each year provides a figure — an "area comparability factor" — based on the known age structure of all the local authority areas in the United Kingdom. The crude birth rate and death rate are multiplied by the area comparability factor, giving an "adjusted" birth rate and death rate which can then be compared nationally. So far as Westminster is concerned the "crude" figures, area comparability factors, and the adjusted rates are set out in the vital statistics (pages 11 and 12). 4 Unfortunately the Registrar General's area comparability factors do not take account of a very important factor which seriously affects the comparison of some aspects of the incidence of births as between one area and another; namely the marital status of the women of child-bearing age in each. This was recognised by the Registrar General as long ago as 1954, when he wrote: "The A.C.F. simply allows for the varying proportion of women of child-bearing ages in the aggregate local population, but not for many other factors, e.g. the proportion of the women who are married. Adjustment for the latter is required if the object is to compare fertility levels of married women in different areas." Particularly during the last ten years concern has been expressed regarding the number of illegitimate births occurring in London as a whole and especially in Westminster where the proportion of illegitimate to total births has appeared exceptionally high when compared with other areas in London and elsewhere. Many reasons have been adduced to explain this including the assumption that a large number of pregnant unmarried women come to the Metropolis to seek anonymity and because the facilities for care during pregnancy and for confinement are better than elsewhere. There is probably some truth in these assertions, and certainly no one would wish to minimize the problem of illegitimacy. Before, however, one can say that an undue proportion of births are to unmarried mothers, it is necessary to know the proportions of married and single women of child-bearing age in the local population. In September 1971, an interesting and illuminating article dealing with the national proportion of illegitimate births appeared in the Quarterly Bulletin of the Greater London Council Intelligence Unit. The article was written by Mr. Eric J. Thompson who at that time was a member of the Strategy Branch of the GLC Department of Planning and Transportation. In the article Mr. Thompson put forward a suggestion that new Area Comparability Factors which he had formulated should be applied to local crude birth rates to eliminate differences due to variations in both age and marital status within the population. In London, Mr. Thompson suggests that differences in marital status may be even more important than differences in age structure. This is certainly borne out in Westminster. Taking the year 1969, the latest for which Mr. Thompson gives figures, the percentage of births in Westminster recorded as illegitimate (the illegitimacy ratio) was 17.63 compared with 8.41 for England and Wales. When, however, we allow for the very high proportion of the women of child-bearing age in Westminster who are unmarried, we find that the number of illegitimate births is less than would be expected for a comparable number of unmarried women taking the population of England and Wales as a whole. If, therefore, we apply Mr. Thompson's formula we find that for comparison purposes the illegitimacy ratio for Westminster in 1969 ought to be 6.52 which is below the national figure of 8.41 quoted above. Although more work has to be done to validate these new Area Comparability Factors which are necessarily based on census figures which require updating, it is reasonable to assume that the composition of the population in Westminster has not changed so much in the last few years as to render the results they give unacceptable. If, therefore, we apply the same factor to the illegitimacy ratio for 1971 we find once again that the adjusted ratio of 6.3 compares favourably with the national figure of 8.0. In the case of the birth rate the effect of allowing for the low proportion of married women of child bearing age in Westminster, though less dramatic does materially reduce the variation from the national average. Applying Mr. Thompson's Area Comparability Factor (age and marital status) the adjusted birth rate for 1971 instead of being 8.17 would become 12.04 which though still low approaches more nearly to the national average rate of 16.0. I wish to acknowledge the work of Mr. Thompson and to express my appreciation to him for allowing me to quote from his article. A critical examination was also undertaken during the year of another set of statistics. For some years it has been said that the number of children in Westminster immunised against various diseases is low and indeed the lowest in the country. Having regard to the known number of immunisations carried out in the Council's clinics it was felt that considerably more children were being immunised than were shown in the Department of Health's statistics. One of the Council's Area Nursing Officers therefore carried out a thorough examination of the immunisation statistics and I am pleased to include her report in my Annual Report (see page 52). The findings of this examination lead to the conclusion that far from being the lowest in the country the immunisation rate in Westminster is very high. 5 During 1971 the General Nursing Council revised syllabus for nurse training came into operation and now includes community training for student nurses. The City Council is co-operating with two hospitals in Westminster in providing this community training. Two courses have so far been completed. At the end of the first course one of the Department's Area Nursing Officers undertook an evaluation of the course, and submitted her report to me, which I am pleased to include later in this report (see page 48). These reports by senior members of the nursing staff are an interesting sideline on research projects which are frequently undertaken in the department and, more often than not, in the officers' own time. The transfer of certain functions formerly carried on by the Health Department, to the Social Services Department, took place in April 1971. In this connection I would draw attention to the Introduction to the Personal Health Services, written by my Deputy, Dr. Mary T. Paterson, on page 41 which sets out some of the feelings in the department on the reorganisation. So far as staff matters are concerned, there was an improvement in recruiting in some sections although some difficulties again occurred in certain sections, namely the nursing services and dental surgery assistants. Three members of the Department's staff retired in 1971 — Miss R. H. Welford, Centre Superintendent at the Ebury Bridge Maternal and Child Health Clinic; Mr. R. Fowler, public health inspector; and Mrs. I. M. Southernwood, clerk at the Lisson Grove Health Clinic. All these officers had given long and faithful service to the City Council and its predecessors and we wished them every happiness in their retirement which we hope will be a long and healthy one. I record with regret the death of one of the principal officers in the Health Department — Dr. P. T. Horder, Principal Medical Officer, who died suddenly in August 1971. Despite the crippling disease from which he suffered and which would have halted many other men. Dr. Horder felt he was lucky to be able to see disability from the angle of patient as well as doctor. His death at the early age of 36 years was a loss to the department and there is no doubt that if he had lived he would have risen to the top of his chosen profession. I also record with much regret the deaths of Miss K. Wiseman, Assistant Nursing Officer, and Mr. D. Gilkes, Public Health Inspector. Finally, I express my appreciation of the support and encouragement I have received from all Members of the Council and particularly from Members of the Health Committee. The Chief Officers and members of the staff of other departments have continued to give their warmest co-operation and assistance and both I and all the members of my staff are grateful for this. To all the members of the Health Department I express my sincere thanks for the excellent work they have carried out, efficiently and loyally. Notwithstanding the further reorganisation which faces us in the relatively near future I am sure the health services will continue to flourish. June 1972 J. H. BRISCOE-SMITH Medical Officer of Health and Principal School Medical Officer 6 HEALTH COMMITTEE (from July 1971) THE LORD MAYOR (ex-officio): Councillor John Wells THE DEPUTY LORD MAYOR (ex-officio): Councillor G. I. Harley CHAIRMAN: Councillor Dr. Brian Warren VICE-CHAIRMAN: Councillor Mrs. Rachel Trixie Gardner, BDS, GLC, JP. MEMBERS: Councillor The Countess Beatty Councillor Mrs. Barbara Bowles Councillor Mrs. June Bremner Councillor John Bull Councillor Alfred Dubs Councillor Dr. L. Jacobs Councillor Richard May Councillor Mrs. Phoebette Sitwell Councillor Miss Manuela A. Sykes Councillor Miss Alison Tennant CO-OPTED MEMBERS: Mr. R. R. A. Balfe Mrs. R. T. Glenny Miss Margaret Jonathan, SRN, RSCN. Miss Wilhelmina Linford Mr. J. Michael Shersby Mr. J. G. Spriggs Mr. L. F. Squires Mrs. P. L. Veendam Members of the Health Committee were appointed to: Abbey Community Centre Association of Municipal Corporations (Social Services) Christian Union Almshouses City of Westminster District Nursing Association City of Westminster Old People's Welfare Association County Primary Schools — Managers: Barrow Hill, Robinsfield and George Eliot Schools Churchill Gardens School Edward Wilson, Hallfield and Paddington Green Schools Millbank School Greater London Conference on Old People's Welfare Greater London Home Safety Council Inner London Executive Council London Boroughs Children's Regional Planning Committee National Association for Maternal and Child Welfare Primary School Managers: St. Peter's, Eaton Square, C.E St. James's and St. Michael's Schools Royal London Homoeopathic Group (No. 22) Hospital Management Committee . St. Marylebone T.B. Care Committee St. Mary-le-Strand Charity St. Mary's Hospital Board Councillor Mrs. Phoebette Sitwell Councillor The Countess Beatty Councillor Mrs. Barbara Bowles Councillor Mrs. June Bremner Miss Margaret Jonathan Councillor Miss Manuela A. Sykes Mrs. R. T. Glenny Mrs. R. T. Glenny Councillor Miss Manuela A. Sykes Councillor Miss Alison Tennant Mrs. P. L. Veendam Councillor Miss Alison Tennant Councillor Miss Alison Tennant Mrs. P. L. Veendam Councillor Mrs. Barbara Bowles Councillor Miss Alison Tennant Councillor Dr. Brian Warren (Deputy representative) Councillor Mrs. Phoebette Sitwell Mrs. R. T. Glenny Councillor Miss Alison Tennant Mr. J. G. Spriggs Councillor Mrs. R. T. Gardner Mrs. R. T. Glenny Councillor Mrs. Barbara Bowles Councillor Dr. L. Jacobs 7 Samaritan Hospital for Women and Western Ophthalmic Hospital (House Committee) South East Regional Association for the Deaf South West Metropolitan Regional Hospital Board Liaison Committee Southern Regional Association for the Blind (General Council) United Westminster Almshouses Westminster Amalgamated Charity Westminster Community Relations Council Westminster Council of Social Service Westminster Council of Social Service — Harrow Road Project Westminster Hospital Board Westminster Housing Trust Westminster Moral Welfare Council Westminster Youth Committee Mrs. R. T. Glenny Councillor Miss Alison Tennant Councillor Dr. Brian Warren Councillor Mrs. Barbara Bowles Mr. L. F. Squires Councillor The Countess Beatty Councillor Mrs. R. T. Gardner Councillor Alfred Dubs Councillor Miss Alison Tennant Councillor Alfred Dubs Mrs. P. L. Veendam Councillor Dr. Brian Warren Miss Margaret Jonathan Councillor Richard May Councillor Mrs. Phoebette Sitwell Councillor Mrs. Phoebette Sitwell 8 STAFF OF THE HEALTH DEPARTMENT (as at 31 December 1971) 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. Ruth P. Mathers, M.B., B.S., M.R.C.S., L.R.C.P. Senior Medical Officers: Monica M. H. Cogman, M.B., B5„ M.R.C.S.. L.R.C.P. Olga M. Morgan, M.R.C5., L.R.C.P., D.P.H. Deidre R. B. Sullivan, M.R.CS., L.R.C.P., D.P.H. (1 vacancy) Departmental Medical Officers: Full-time — 3.5 Sessional Medical Officers: Part-time 25=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 — 79 Chief Public Health Inspector: E. W. Pike, M.R.S.H., M.A.P.H.I., A.M.B.I.M. 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. Senior Public Health Inspectors — 22 Area or District Public Health Inspectors — 32 (1 vacancy) Student Public Health Inspectors — 17 (4 vacancies) Technical Assistants — 28 (1 vacancy) Chief Dental Officer: D. K. Hardy, L.D.S., R.C.S. Senior Dental Officer: Vacant Dental Officers: Full-time — 2; Part-time — 6 (full-time equivalent 2.4) Dental Auxiliary — 1 Dental Surgery Assistants — 6(1 vacancy) g Chief Nursing Officer: Miss E. A. Evans, S.R.N., S.C.M., H.V. Deputy Chief Nursing Officer: Miss V. M. George, S.R.N., S.C.M., H.V., Queen's Nurse Assistant Nursing Officers — 3 Student Health Visitors — 7 Health Visitors — 59 Clinic Auxiliaries — 9 Clinic and School Nurses — 21.5 Playgroup staff — 9 District Nurses — 55 Home Bathing Attendants — 8 District Midwives — 3 Principal Social Worker (Health Services): Miss I. J. McFarlane, M.A. Social Workers — 13.5 Ancillary Staff: Chief Chiropodist: Miss M. I. Taylor, M.Ch.S. Chiropodists — 17 (full-time equivalent 10.8) Physiotherapist — 1 (full-time equivalent 0.3) Coroner's Court and Mortuary: Superintendent — W. H. Wilshire First Mortician — 1 Mortuary Assistants — 3 (1 vacancy) 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 — 11 Manual and Domestic Staff: 31 (full-time equivalent 28.75) staff of various categories are employed at Maternal and Child Health Centres, the Nurses' Headquarters and Home, and other establishments. 10 HEALTH DEPARTMENT PREMISES ADMINISTRATION City Hall, Victoria Street, S.W.1. Paddirigton Office, 313/319 Harrow Road, W.9. St. Marylebone Office, Council House, N.W.1. MATERNAL AND CHILD HEALTH 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, 20B 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. Note: The above list of premises shows the position as it existed at 31st December 1971. On 1st April 1971 day nurseries and mental health premises which were formerly part of the local authority health services were transferred to the Social Services Department under provisions contained in the Local Authority Social Services Act 1970. 11 STATISTICS AND SOCIAL CONDITIONS 1971 1970 (where applicable) Area (acres) 5,334 Population (Registrar General's Estimate, mid-year 1971) 237,250 234,340 Population, Census, 1971 234,130 Domestic rateable hereditaments 87,649 86,806 Rateable Value (at 1st April, 1971) £112,416,973 £111,473,747 BIRTHS Westminster Greater London England & Wales 1971 1970 1971 1970 1971 1970 Total live births 2,621 2,765 Total live births — males 1,336 1,415 Total live births — females 1,285 1,350 Birth rate per 1,000 of the estimated population (Area Comparability Factor — Births: 0.74) 11.05 11.79 15.2 15.2 16.0 16.0 Birth rate (adjusted) 8.17 8.72 14.1 14.1 16.0 16.0 Total stillbirths 29 25 (legitimate — males 18; females 6; illegitimate — males 4; females 1) Rate of stillbirths per 1,000 (live & still) births 10.94 8.96 11.7 12.0 12.0 13.0 Total live and still births 2,650 2,790 Total illegitimate live births 451 482 Total illegitimate live births — males 219 257 Total illegitimate live births — females 232 225 Illegitimate live births per cent of total live births 17.21 17.43 11.5 11.3 8.0 8.0 Premature births notified — live 164 203 Premature births notified — still 19 18 Total premature births notified 183 221 DEATHS Total number of deaths registered 2,822 2,806 Total number of deaths registered — males 1,461 1,414 Total number of deaths registered — females 1,361 1,392 Death rate per 1,000 of the estimated population (Area Comparability Factor — Deaths: 1.04) 11.89 11.97 11.5 11.3 11.6 11.7 Death rate (adjusted) 12.36 12.45 11.6 11.4 11.6 11.7 MATERNAL MORTALITY Deaths from pregnancy, childbirth, and abortion 1 — Rate per 1,000 total (live and still) births 0.38 — 0.12 *0.17 *0.17 0.18 *(Based on less than 100 occurrences & excluding deaths due to abortion) 12 INFANT MORTALITY Westminster Greater London England & Wales 1971 1970 1971 1970 1971 1970 Total deaths of infants under 1 year 35 58 legitimate 26 45 illegitimate 9 13 Death rate of all infants under 1 year per 1,000 live births 13.35 20.98 17.4 17.8 18.0 18.0 legitimate infants per 1,000 legitimate live births 11.98 19.71 Illegitimate infants per 1,000 illegitimate live births 19.95 26.97 Total deaths of infants under 4 weeks 22 44 legitimate 16 34 illegitimate 6 10 Neo-natal mortality rate (deaths under 4 weeks per 1,000 total live births) 8.39 15.91 11.6 12.3 12.0 12.0 Total deaths of infants under 1 week 19 40 legitimate 13 31 illegitimate 6 9 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 7.25 14.47 9.7 10.7 10.0 11.0 Perinatal mortality rate (stillbirths plus deaths under one week per 1,000 total live and stillbirths) 18.11 23.30 21.3 22.6 22.0 23.0 Details showing causes of infant death according to age group and sex are given in Table 2 page 70. ACCIDENTAL DEATHS Total deaths of residents from accidents of all kinds 91 94 Deaths from motor vehicle accidents 27 36 The total number of deaths shown in Table 1, page 69, 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. INFECTIOUS AND OTHER NOTIFIABLE DISEASES The incidence of infectious disease in the City, in general, continues to show a downward trend. Notifications received (excluding tuberculosis) decreased from 557 in 1970 to 368 in 1971 due largely to fewer cases of measels, 190 as compared with 365 in the previous year. There was also a significant decrease in tuberculosis with 117 cases against 145 in 1970. Table 3, page 71, gives details of notifications received and the age groups concerned. Acute Poliomyelitis, Diphtheria and Smallpox No cases of these diseases occurred in Westminster during 1971. Dysentery The decrease in the number of cases of dysentery observed in 1970 has been maintained. Twenty-five notifications were received during 1971 compared with thirty in the previous year. There were no outbreaks of dysentery in any Hospital in Westminster or City Council Nurseries. Infective Jaundice Fifty notifications (52) of Infective Jaundice were received during 1971, the third full year since the disease became notifiable. 13 Leptospirosis Leptospirosis is an occupational hazard to farmers, sewer workers, veterinarians, abattoir workers, and certain other occupations. The mode of transmission is through contact with water contaminated with urine of infected animals, as in swimming or accidental or occupational immersion, and direct contact with infected animals. Reservoirs of infection are farm animals including cattle, dogs and swine. In addition rats and other rodents together with certain wild animals are frequently infected. Distribution is worldwide, in urban and rural, developed and primitive areas. The only case notified during 1971 was a United States Naval Serviceman, and the diagnosis was made whilst he was in a Military Hospital within the City. This is the first instance of the disease in Westminster since it was made notifiable by the Public Health (Infectious Diseases) Regulations 1968. Malaria The cases of malaria occurring in the City increased from four in 1970 to twelve in 1971. In each instance the disease had been contracted abroad. All the patients were admitted to hospital. Paratyphoid and Typhoid Fever Seven of the eight 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. The other case related to a young man whose father was found to be a chronic carrier of the typhoid organism, and medical evidence suggested that the infection had been contracted from him. There were six cases of typhoid and paratyphoid fever in Westminster in 1970. Tuberculosis Table 3, page 71, gives information regarding primary notifications of pulmonary and non-pulmonary tuberculosis received during the year. Table 4, page 72, 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 regular 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 medical 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 14 notifications being received during 1971 compared with ten in the previous year. MASS MINIATURE RADIOGRAPHY During 1971 the North West and the South West London Mass X-ray Services continued to provide regular public sessions at numerous points in Westminster. X-ray sessions incorporating a special service aimed at the early discovery of lung cancer in men over 45 years of age were provided by the South West London Service for personnel at the Council's Gatliff Road Depot. 14 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 34,230 (25,326) 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 an outbreak of El Tor cholera in Spain. 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 continued 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. The certificates, of which 24 (28) were issued during 1971, 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 previous 14 days. AFTER HOURS EMERGENCY TELEPHONE SERVICE The reorganisation in April 1971 of the Health Departments and the formation of Social Services Departments in the City of Westminster and the Royal Borough of Kensington and Chelsea has not affected the basic operation or increasing use made of the after hours emergency telephone service. Through it a wide range of specialist officers on standby call can be contacted outside normal office hours to deal with emergencies arising in either borough, or the caller can be referred to parallel systems elsewhere. The types of problems dealt with have been described fully in previous Annual Reports (e.g. 1967) and remain as varied as ever. During the period 1st January to 31st December 1971, a total of 13,109 (12,058) calls were received by the Duty Officers — 10,994 (9,784) relating to the City of Westminster and 2,115 (2,274) to the Royal Borough of Kensington and Chelsea. An analysis is given in Table 6, page 73. VISITORS TO THE DEPARTMENT In addition to the practical training provided for various members of the Health Department staff (to which reference is made elsewhere in the Report) no fewer than 421 persons were welcomed during 1971 for visits of observation. Being located close to the central Government departments and near to many Embassies or Legations of other countries, the City Council receives numerous requests to receive visitors comprising officials from central or local government of this country or from abroad; members of foreign municipalities or Commonwealth countries; doctors, students from teaching hospitals, nurses, social workers, etc. Indeed the point has now been reached when it has become necessary to "ration" the number of visitors who can be received without seriously interfering with the day-to-day work of the Department. These visits embrace all the activities of the Health Department and although they may be time-consuming they prove interesting and stimulating to the staff concerned. It is of interest to note that although the majority of visitors to the department came from the United Kingdom, the overseas countries concerned included India, Pakistan, Japan, the United States of America, and the Balkans. 15 ENVIRONMENTAL HEALTH SERVICES Chief Public Health Inspector: E. W. PIKE, M.R.S.H., M.A.P.H.I., A.M.B.I.M. Deputy Chief Public Health Inspector: V. A. BIGNELL, F.A. P.H.I., M.R.S.H. At 31st December 1971 Establishment In Post Public Health Inspectors 59 (59) 58 (56) Student Public Health Inspectors 17 (19) 13 (12) Technical Assistants 28 (28) 27 (28) WORK OF THE PUBLIC HEALTH INSPECTORS The impact of recent legislation particularly in relation to private sector housing, the control of food premises and consumer protection as far as food products are concerned has continued to stretch the resources of the public health inspectorate and has emphasised the necessity to have available in sufficient numbers an experienced and energetic staff. Westminster in common with the majority of the London Boroughs experiences difficulty in recruiting public health inspectors to achieve full establishment and the potential number of officers who are likely to retire during the next few years causes some apprehension, bearing in mind staff availability and work load pattern for the year now under review. Previous reports have made reference to this situation and it would appear for very obvious economic reasons there will be little likelihood of the Inner London authorities attracting applicants for advertised vacancies from provincial areas. For the foreseeable future the City Council's own student training scheme will be virtually the only source of maintaining or strengthening the number of public health inspectors so necessary in west central London. It is estimated that, taking into consideration existing deficiencies in establishment, probable losses due to retirement and resignations, for some time at least four students a year will be absorbed upon qualification. The future of public health inspectors is at present uncertain in the light of the awaited decisions involving the reorganisation of the national health service. The mode of employment of the inspectors remaining with local authorities as the surviving departmental officers responsible for such a variety of functions co-ordinated under the aegis of environmental health will need to be decided. Uncertainty on such vital issues is not conducive to stability in any organisation and this has been reflected in the staff situation at the time of producing this report. Broadly speaking the work of the public health inspectors can be given two classifications, the investigation of matters that are the subject of written or verbal complaint, and routine inspections of premises for the purpose of ascertaining whether or not compliance with current relevant statutes is being effected. It is a fact that prior to and since the amalgamation of the London Boroughs in 1965 it is the routine duties that tend to be neglected where staff shortages make it necessary to apply priorities to the overall work load. Routine visits by public health inspectors are not by their very nature over-popular from the point of view of the inspecting officer or the proprietors of the establishment being 'checked'. Furthermore much tact is needed to give the correct impression that the reason for the inspection is not only a statutory duty but is primarily intended to be in the interests of the proprietors themselves, as members of the public. It is equally true that failure to maintain a reasonable standard of routine control in premises subject to public health legislation has serious repercussions. The friendly co-operation that can be fostered between inspector and proprietor becomes difficult when long intervals occur between inspections. Conditions are permitted to deteriorate, contraventions of legislation of consequence to the life of the community continue to occur, and the inspector when he does visit has to be so critical to the point of invoking the law that his future visits are likely to be regarded by the proprietor with suspicion and his advice, if followed, taken with the attitude I will comply with the letter and not the spirit of the law'. This is of course an entirely wrong premise and one which more regular visits, for which time can be taken to giving advice and assistance aimed at preventing situations occurring calling for direct legal intervention, can avoid. 16 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, referred to later in this report (page 30), (see also Analysis of Legal Proceedings,Table 25, page 81) illustrates the need to continue the arrangement. 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. Four students who completed their studies during the year passed the qualifying examination. A further five students were appointed during the year, bringing the total still in training to thirteen. 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 greater responsibility. The establishment of technical assistants to the public health inspectors in Westminster remained at 28 throughout the year. The ever-increasing scope of the public health inspectors' work, which is of a highly technical nature, and its potential legal involvement make it necessary 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 nevertheless 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. Despite the various aspects of environmental work demanding specialist staff, district duties are essentially the basis of general overall surveillance and control. District Inspectors therefore continue in their full statutory responsibility for their respective areas in all aspects of the work, liaison being maintained with their specialist colleagues as individual circumstances require. A statistical summary of visits by public health inspectors appears in Table 9 on page 74. 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 in given in Table 7, page 73 and an analysis of 2,583 (2,613) nuisances and unsatisfactory conditions found and remedied appears in Table 8, page 73. 17 Notices Seven hundred and twelve (728) informal notices and 513 (528) statutory notices were served in 1971, to secure the abatement of nuisances. In addition, 7 (15) notices were served under the Clean Air Act, 1956. An analysis of statutory notices served is given in Table 10, page 74. Legal proceedings The summary of legal proceedings undertaken during 1971 is set out in Table 25, page 81. Noise Public reaction to excessive, unnecessary or obtrusive noise interfering with the comfort and enjoyment it is reasonable to expect and demand at work or leisure continues to be expressed by complaint to the department. Two hundred and forty-two (220) complaints were received and investigated during the year, and 862 (828) visits by public health inspectors were made to secure abatement, or reduction to tolerable levels. Noise occurring by night and at week-ends necessitated investigations out of normal office hours. Demolition and construction of buildings and roadworks involving mechanical power machinery and tools, are the principal sources of complaint. Contractors are advised to embark upon public relations work amongst local residents who may be disturbed by their activities, and particularly in respect of the programming of their projects. On a few long-term demolition operations it was thought appropriate to serve Nuisance Abatement and Prevention Notices, but in none of these cases was it found necessary to take legal proceedings to enforce compliance with the terms of the notices. Without legislative control upon permitted hours of work, such as can be imposed, for example, by a writ of injunction, noise occasioned by late and night operations will continue to present control problems, particularly where on large building sites there are working a number of specialist sub-contractors. Other sources of complaint include noise from extractor fans, from small factories, and from night entertainments and amplified music. In the majority of cases, informal action by way of reasoned advice is effective in abating and preventing nuisance, and no proceedings have been instituted. Self-service coin-operated dry-cleaning establishments With the introduction of a number of new self-service coin-operated dry-cleaning establishments in the City the Health Department has been concerned for some time about the adequacy of safety precautions in these premises, especially when perchloroethylene is in use. Establishments of this type have come into operation during the past few years and are now to be found in many shopping areas, frequently in association with launderettes. At the majority of the establishments no supervisory staff is employed. Notices are prominently displayed in the premises warning users that the dry-cleaning machines must not be overloaded and that after use the clothes must be thoroughly aired preferably by hanging in the open air. Characteristics of Perchloroethylene (a) Perchloroethylene is a non-flammable solvent belonging to the same group of chlorinated hydro-carbons as chloroform. (b) Like other volatile solvents, it evaporates when exposed to the air, and, having a higher density than air, the vapour produced tends to settle. (c) Though classed as non-flammable, the solvent may give rise to another danger when exposed to sources of high temperature in the presence of air as heat from a flame or red-hot surface (e.g. cigarette, electric fire, etc.) decomposes the vapour with the resultant formation of corrosive and toxic gases. 18 Safety Limits The maximum permissible concentration, related to average concentrations for a normal working day, is 100 parts per million (p.p.m.). This refers to air-borne concentrations of the solvent and is related to conditions under which it is believed that nearly all workers may be repeatedly exposed day after day, without adverse effect. In this context it should be noted that perchloroethylene may be detected by smell at 50 p.p.m., which is well below the threshold limit. Solvent Loss Whilst most machines are designed to clarify and recirculate the solvent used, inevitably a certain amount is lost, principally (a) to the atmosphere — during the "aeration" cycle, this loss may be reduced by up to 80% by the use of a solvent recovery unit. Solvent discharged to the atmosphere is, in any event, usually substantially diluted and measurements taken within six feet of the exhaust point of a typical installation have indicated that (even without the use of a carbon recovery unit) a concentration of 25 p.p.m. was rarely exceeded. (b) in the garments cleaned — with an efficient plant, properly operated this should rarely exceed 4 p.p.m. (c) in sludge, lint, etc. from filters. Legal Provisions An unusual anomaly exists whereby similar equipment may be installed in different premises which are subject to varying legal requirements, i.e. (a) the premises may be a FACTORY subject to the requirements of the Factories Act, 1961, or (b) the premises may not be such as to constitute a factory but may be subject to the Offices, Shops and Railway Premises Act, 1963; alternatively (c) the premises may not be subject to the Factories Act, 1961, or the Offices, Shops and Railway Premises Act (i.e. where persons are self-employed or total hours worked are less than 21 per week). The potential hazards are, nevertheless, the same in each case. Dry-cleaners constituting a FACTORY Apart from the general powers available which control factors affecting the health and welfare of employees, specific additional powers exist:- (a) restricting the siting of plant, i.e. processes which are liable to give off fumes may not be sited in underground rooms, (b) to require removal of fumes likely to be injurious or offensive to employed persons. Dry-cleaners constituting a SHOP subject to the Offices. Shops and Railway Premises Act, 1963 No specific powers exist controlling siting of plant or removal of injurious fumes, although the latter may well be dealt with under Section 7, which requires "effective and suitable" ventilation of all rooms in which persons are employed to work. Section 22 of the Act contains, however, strong powers to deal with dangerous conditions and practices. Where an inspector of the enforcing authority considers that any part of premises, or any machinery or appliances in them, or any operations carried out in them, are so dangerous that their continued use is a risk to safety or health, there is provision for a magistrate's court to make an order prohibiting their use or continuance to the extent necessary, until steps have been taken to remedy the source of danger. 19 Dry-cleaners subject to neither the Factories Act nor the Offices. Shops and Railway Premises Act The only form of control available would seem to be contained in Section 92(1) (e) Public Health Act, 1936, which makes any "work place" which is not provided with "sufficient" means of ventilation (or in which sufficient ventilation is not maintained) or which is not kept clean, or not kept free from noxious effluvia, etc. a statutory nuisance capable of being dealt with summarily. Coin-operated establishments may come within this last category, since in the majority the customers operate the machines without assistance. Except in very rare circumstances, no staff work in these premises for a substantial part of the day and therefore they would not be subject to the requirements of the Offices, Shops and Railway Premises Act, 1963, including the statutory obligation to register with the local authority. They could, however, come to the notice of the City Council in one or more of the following ways:- (i) when an application is submitted for planning permission relative to the establishment of a new business; (ii) as a result of a notification to the Health Department of the intention to carry out drainage works or alterations; (iii) by the public health inspector discovering such a business being carried out, during the course of his routine district visits; (iv) as a result of a direct complaint from a member of the general public, concerning the conduct of the business. Further control is available over any external effect of the exhaustion of fumes from such premises under Section 92(1) (d) Public Health Act, 1936, which makes any effluvia caused by any trade, business, manufacture or process and being prejudicial to the health of, or a nuisance to, the inhabitants of the neighbourhood, a statutory nuisance. Neither the Public Control Department of the Westminster City Council nor the Petroleum Officer of the Greater London Council has a statutory interest in such premises (apart from shops' hours) in view of the fact that the flash point of the solvent is above 150°F. Departmental Procedure Whenever the installation of a dry-cleaning establishment comes to the notice of the Medical Officer of Health every effort is made to ensure that the recommendations of the Department of Employment and Productivity, relative to the installation of equipment and to the handling of the solvent are complied with in all respects. Avoidance of Accidents It is difficult to see how human failures on the part of customers using the machines could be avoided unless an attendant were always present, or some form of mechanical safety device could be incorporated in each dry-cleaning machine so that the contents could not be removed until they were safe to handle. At the end of the year, a Code of Practice was being prepared jointly by the Home Office and the Department of Employment in collaboration with the Association of Public Health Inspectors and Trade interests. The intention of the Code is to offer advice on the installation and maintenance of the dry-cleaning plant. It will also set out the precautions to be taken when handling and working with dry-cleaning solvent on launderette premises covering such aspects as the procedure for dealing with bulk deliveries, storage of the solvent and procedure for dealing with spillages. The importance of adequate ventilation of the premises and methods of achieving this will also be dealt with. The Code will stress the need for ensuring that members of the public using the dry-cleaning machines are fully informed of the care which should be taken when operating the machines and that cleaned articles are adequately aired before removal from the premises. As to this, the Code will recommend that suitable instructions and warning notices should be prominently displayed near each machine, set out, preferably with the aid of pictures, in such a way that the subject matter can be easily assimilated by the users of the machine. 20 Drainage and New Developments During the year under review 1201(1044) Notices of Executions of Drainage Works were registered, and a total of 12,631(12,051) 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 455(275) related to large scale development and 223(130) concerned new buildings. The number of houses and flats constructed by private enterprise was 292(467), and at the end of the year 812(998) housing units exclusive of municipal development were in various stages of construction. Sewerage The City's sewerage system is under the control of and maintained by the City Engineer, and discharges at a number of points into the major sewerage system of the Greater London Council, who are the authority for main drainage and sewage disposal. No surcharge of sewers so as to affect premises draining thereto was reported during the year under review. Town Planning Observations were made by the Department on 153(93) 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. Westminster Council House Extension, Upper Montagu Street, W.I. Paddington Office, 313 Harrow Road, W.9. 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. 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. The temporary suspension of 13 of the Council's 38 smoke control orders ended on the 31st March 1971. The suspension had been made because of the rapid decrease in availability of supplies of open-fire solid fuels caused, principally, by the large-scale closure of conventional gas-works. The suspension, having lapsed, was not repeated for the following winter in view of assurances from representatives of solid fuel manufacturers and distributors that the shortages had been overcome. 21 When certain smoke control orders were made the Council exempted, at the request of the Greater London Council, some properties which were shortly due for either demolition or rehabilitation. Of these premises still standing some have been improved and some still await either demolition or rehabilitation, but it was felt the exemptions should not be further prolonged. The following variation orders were made in order to cancel the exemptions contained in the principal orders: Westminster (Harrow Road South) Smoke Control (Variation) Order 1971, Westminster (Readings) Smoke Control (Variation) Order 1971, Westminster (Maida Vale South) Smoke Control (Variation) Order 1971. 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 204(215) visits in connection with complaints received, 461(371) smoke observations and 995(957) 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 smoklessly and (b) the flue gases are discharged so as not to inconvenience persons working and living nearby. During 1971 a total of 56(64) such notifications were received, of which 11(12) included application for the Council's approval of new boilers. Section 6 of the Clean Air Act 1968 gives the Council control over the height of chimneys of 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 (13) such applications were received, of which 1(—) was not approved. North Westminster Project It was reported last year that the process of detailed inspection of houses for rehabilitation had commenced and an outline was given of the methods being employed. The surveys were completed during the early part of 1971 but the follow up with the owners was delayed as a result of the loss of staff and the inability to replace them quickly. The continuing response from owners already contacted had to be given priority, much staff time being required for the necessary discussion and checking of schemes and for involvements with the numerous and genuine difficulties facing the private owner. Some tenants were offered alternative accommodation by the City Council in order that schemes could proceed. This assistance was limited in extent and there was of course no compulsion on the tenants to accept any offer made. Seven tenants actually accepted alternative accommodation. The number of houses with schemes in progress or completed at the end of the year was seventy six representing one hundred and seventy three units of accommodation to the desired standards. Whilst on the face of it this appears to be relatively slow progress, the difficulties attendant upon converting this type of intensely multi-occupied property to satisfactory self contained units must not be underestimated. Again there were many schemes in preparation and many more contemplated so that at this stage it is more important to note that the general response from owners and tenants continued to be favourable to the overall objectives. Thus as the ability to assist in solving the difficulties increases it is reasonable to anticipate that progress will be made in providing satisfactory living conditions for an increasing number of families. During the year surveys were also commenced in the Edbrooke Road, Great Western Road, Coomassie Road North, Coomassie Road South and Shirland Road redevelopment areas preparatory to their acquisition. 22 Slum Clearance During the year, action was taken as follows in respect of premises included in the Council's slum clearance programme for the period 1970-73:- Amberley Road Area: A report on the conditions found in this area indicated that whilst all of the 24 houses were sub-standard in varying degree, only 7 houses were in such condition as to justify representation for clearance area procedure. As 5 of those houses are not contiguous, however, they could not independently be declared a clearance area, and it was considered that no useful purpose would be served by declaring the remaining 2 houses a clearance area. The 24 houses were therefore deleted from the slum clearance programme and appropriate action under the Housing Acts will be initiated in respect of each individual house, with a view to bringing the area as a whole up to an acceptable standard. Brewer Street, Green's Court, Peter Street Area: A compulsory purchase order under Part III, Housing Act 1957, was made by the Council on the 21st December, 1971, and has been submitted to the Secretary of State for the Environment for confirmation. The order is in respect of Nos. 1, 2, 3, 4, 5 (also known as 22A and 23A Peter Street), 8, 9 and 10/11 (also known as 20 Brewer Street) Green's Court, W.1; Nos. 24/25 (also known as St. Peter's Buildings) and 26 Peter Street, W.1; and Nos. 14/16 Brewer Street, W.1 (also known as Pulteney Chambers), and includes as "added lands" Nos. 18 and 22 Brewer Street, W.1. St. Michael's Street, Bouverie Place, Star Street Area: It was decided to delete from the slum clearance programme 16 properties in this area which had been proposed for clearance area procedure. This action was taken as a result of information received from the Inner London Education Authority that it was their intention to extend the site of the St. Michael's Church of England Primary School, and that the extension site of the school, including the proposed slum clearance properties, would be acquired by a compulsory purchase order under the Education Acts, if necessary. A further 15 properties in the general area of St. Michael's Street, Sale Place and Junction Place were also deleted from the slum clearance programme. In the case of 3 of these premises, demolition had been carried out by the owners; 10 of the properties had been found to be almost entirely in business use, and closing order procedure was considered appropriate in respect of 2 houses. Daventry Street/Lisson Street Areas: The premises in these areas are all within a defined school site, and a detailed survey has been undertaken and completed. A comprehensive report on the conditions existing in the areas has been under consideration, and the Council has declared its intention to secure clearance of the areas by the end of 1973. Decisions on the action to be taken to achieve this will be made early in 1972. Archer Street Area: A survey of the premises in this area has been completed and a report is under consideration. It is anticipated that representations pursuant to Part III, Housing Act 1957, will be made in 1972. A further 116 premises in various parts of the City have been deleted from the slum clearance programme for reasons which include private redevelopment, rehabilitation by owners, and clearance procedure not considered appropriate after detailed surveys had been completed. The following areas were also included in the slum clearance programme 1966-70: Merries Street Areas: By the end of the year, the majority of the houses in the North area had been demolished, and further progress was being made in the rehousing of qualifying tenants from the South area. St. Anne's Court/Richmond Buildings Area: All of the properties in this area have been demolished. A summary of visits in connection with slum clearance is included in Table 11, page 74. Unfit Premises Details of action taken during the year in relation to closing order procedure are given in Table 13, page 75. 23 Houses in Multiple Occupation (a) Management Orders, Directions and Notices One senior public health inspector, with technical assistance, has continued the inspection of houses in multiple occupation in the Pimlico area which has been in progress for some time in an effort to inspire improvements by negotiation or, where necessary, apply the appropriate powers available under the Housing Acts 1961/64/69. In addition, the inspector has been responsible for the inspection of premises within the City which have been the subject of applications for loans. As a consequence of the increased number of public health inspectors in post, it became possible during August 1971 to transfer another inspector to the specialist housing section to commence a survey of the tenement dwellings in Westminster which require fundamental improvements to provide amenities and living standards appropriate to the present time. A summary of the work of the inspectorate in connection with multi-occupied houses and tenement dwellings is given in Table 12, page 75. (b) Means of Escape in case of Fire The Director of Architecture and Planning served 30(14) notices under Section 16 of the Housing Act 1961 and 26(14) were complied with during the year. In respect of a further 160(53) premises proper and adequate means of escape were provided as a result of informal action taken by the Director. 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 222(246) (b) Conversions 775(369) Standard Grants 39(43) Subsidies to Housing Associations for the improvement and conversion of properties 221(208) Loans for the acquisition and/or improvement of premises in Westminster 60(16) A summary of visits made is given in Table 11, page 74. Qualification Certificates At the end of the year 628(695) applications for qualification certificates had been received. Details appear in Table 14, page 75. 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 1971, a total of 441 complaints of alleged harassment were received by the Council. Of these, 63 were made direct to the City Solicitor, and 378 were made to the Health Department's Enquiry Officer. Of the total number of complaints, approximately 30% did not reach a concluded state because either the tenant failed to pursue his complaint or disappeared; approximately 50% related to minor issues which the Enquiry Officer settled by conciliation; about 10% were not related to matters within the scope of the Rent Act, and 10% had some basis for complaint within the scope of harassment. In only 5 cases, however, was there adequate evidence to sustain proceedings, and in one of these cases the complainant disappeared before proceedings could be issued. 24 After investigation, 5 summonses were issued against 4 defendants, and the results of the proceedings against 3 of these defendants are awaited. (As regards two summonses issued against the other defendant, convictions were obtained at Bow Street Magistrates' Court on 3rd and 28th January 1972. In respect of one summons the defendant was fined £100 and sentenced to six months' imprisonment suspended for three years and ordered to pay £50 costs to the prosecution, and he was fined £50 and ordered to pay a further £50 costs to the prosecution as a result of the other summons.) In addition, the City Solicitor investigated 28 cases under the Landlord and Tenant Act 1962 for non-provision of rent books (11 of these cases were referred by the Health Department's Enquiry Officer), and 13 cases under the Rent Act 1968 concerning excess rent charges. Overcrowding (1) Number of new cases of overcrowding reported during the year 93(120) (2) Number of cases of overcrowding relieved during the year 35(22) Housing Priority on Medical Grounds During the year under review 1840(1675) medical certificates or claims for priority in respect of applications for re-housing 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 1971 was 12,703 (10,884), exclusive of personal searches and supplementary enquiries. Tourism Those who live or work in Westminster day by day have long become accustomed to the presence of millions of visitors who arrive in the City in the summer months. Each year different elements of the problems of tourism seem to thrust themselves forward. In 1971, they related to young visitors, not because, as was the fashion a year or two ago, they sometimes slept in the parks or around the statue of Eros, but because of the increasing recognition of their difficulties by various organisations and local authorities. The department had a particular concern to prevent the gross overcrowding which appeared to be the inevitable lot of any young visitor who had budgeted his trip to this country on a basis of not more than £1 to £2 per night for a bed and 'breakfast'. Double bunks, sharing with strangers, 'continental breakfast' etc. were each readily accepted by the young people. They complained, however, about queuing for showers and toilets, and sometimes of the lack of cleanliness of rooms and bed linen. One young lady complained that when her room-mates moved on, she arrived back in her accommodation to find that two young men who were strangers to each other had been moved in. The 'creeping hotel' problem received wide publicity and no effective method of resolving it appears to have been found. Bearing in mind the experiences during the year of certain disastrous hotel fires the new Fire Precautions Act will provide much needed and welcome powers. The various studies of different aspects of tourism which are in progress, or reports of which have been published, will, it is hoped, lead eventually to the elimination of many of the problems which continue to give trouble. Care must be taken to ensure that the more mundane environmental problems of tourism, particularly accommodation standards are not lost sight of in the welter of reports which tend to concentrate, perhaps overmuch, on the planning aspect and its relation to new hotels and travel. 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. 25 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 1971. 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. Copies of certificates of registration, authorisation and supplementary provisions, the cancellation or variation of certificates issued by the Minister in respect of users in the City, are received and recorded. Appropriate action is taken in respect of any special precautions so far as they relate to the Department in connection with the conditions specified in the certificates. Rodent Control A staff of eight rodent operatives under the supervision of the Pest Control Officer is based on two centres, namely 313/319 Harrow Road for the northern half of the City and at Bessborough Street M. & C. H. 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 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 76. The increase in the number of complaints relating to mice infestation, to which reference was made in the report for the previous year, continued throughout 1971. Disinfection and Disinfestation The disinfection service 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 disinfestation. During the year 83(85) rooms, 5,566(5,806) articles of bedding and clothing and 208(149) books were disinfected. 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. Seventy-six (86) 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. 26 So far as the disinfestation service is concerned, continued attention is given to methods of insecticidal treatment. The formulations of spray and powder in use are specified with particular regard to recommendations of the Ministry of Agriculture, Fisheries and Food. 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 4,850(3,015) rooms were disinfested, and 54(62) wasp nests destroyed. 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 their congregation in a built-up area. Where pigeons congregate at 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 unfortunately no legislation which can be used to prevent the indiscriminate feeding of birds. Investigation of complaints is carried out by public heaith inspectors and the pest control staff who, depending upon the circumstances of the complaint, either take action themselves or advise the occupier of the premises as to the remedial measures to be taken including where necessary the use of repellents and the employment of suitable commercial pest control organisations in appropriate cases. During the year 43 (85) 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 1971. (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, 1971, was 222,221. (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 from Ashford Common, Hampton, Surbiton and Walton Works. 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 76 and 77. 27 (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. Private Water Supplies — Deep Wells The water from 66 boreholes is used for drinking and domestic purposes in 48 premises. Of these, 16 bores supply water to 15 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 50 boreholes in private ownership, 107(102) samples of water were submitted for bacteriological examination and 41(31) for chemical analysis. Of these, the results of 144 tests were satisfactory. Of the remaining four, 2 samples were taken at a point in the supply line before the chlorination plant, and 2 were taken from an emergency tank, not bacterially clean, which was being used while the main tank was being re-lined. Subsequent samples from both supplies were found to be satisfactory. Swimming Bath Water Examination Monthly examinations were carried out at each of the 11 municipal swimming baths in the City. One hundred and thirteen (112) 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 106 of these examinations were satisfactory. Of the remaining seven, 4 were probably due to the low level of free residual chlorine in the samples, but 3 cannot be explained. Satisfactory samples were subsequently obtained from these pools. 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 New registrations received during 1971 totalled 783, a slight increase over the 1970 total of 729. From the time of the original surveys made under the Act there have been successive reductions in the number of new registrations, and from 1966 to 1970, this decrease has been steady, at the rate of about 300 per annum. An analysis of day to day returns indicates that survey and follow-up work is revealing a proportion of unregistered premises commensurate with changes of occupation and new establishments. The total number of premises registered at the end of the year was 18,230, with 374,195 employees. Accidents must be notified if they occasion absence from work of three days or more, and during the year 467 notifications were received. Of these, 163 were investigated, and in 11 cases minor contraventions of the Act were revealed. The initial impact of the Hoists and Lifts Regulations produced a shortage of labour able to carry out the repairs found to be necessary. There was also a shortage of replacements. This position has improved to some extent, and the greatest cause of difficulty in 1971 was in the justification of heavy expenditure on old installations in buildings with a short life. Statistics which are set out in Table 18 page 77 include some of those contained in the Annual Report to the Department of Employment and Productivity. 28 Factories There were 4,287(4,893) 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 78. Outworkers Returns made by 140(130) employers, together with 126(101) notifications from other local authorities, accounted for a total of 1,362(1,387) outworkers. Of these 630(598) were residing in the City of Westminster. Nearly all were engaged in the tailoring and gown trades. (Table 21, page 79). 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 such basement bakehouses in Westminster. Food and Catering Premises — Inspection The estimated number of food and catering premises in Westminster on the 31st December, 1971 was 6,803 categorised as shown in Table 22, page 79. During the year 13,201(11,723) visits were made by the public health inspectors and 1,002(1,007) informal notices were served in respect of matters requiring attention. During the year 896(753) complaints were received concerning general matters affecting foodstuffs, food premises, food handlers etc. Appropriate action was taken in each instance. Catering Establishments The public health inspectors employed in visiting catering premises throughout the year have continued to press management and staff alike to maintain clean conditions in respect of the premises, utensils and equipment in use, and have also stressed the importance of personal hygiene. Soho remains the most concentrated area of small restaurents of many nationalities established in former dwellings fundamentally unsuitable for adaptation. One apparent and obvious shortcoming is the inadequacy of refuse storage accommodation. Dependent extensively on the normal daily collections, the least disruption of this service creates difficulties which are not readily overcome by the resumption of collection. The Food Hygiene (General) Regulations 1970 emphasise the necessity of places set apart for the reception and storage of refuse—a means to segregate unfit food from that intended for human consumption. In the absence of this facility, refuse has still to be left on frontage pavements and subject to the abuse of passers-by. It has been mentioned in previous reports that adverse conditions frequently stem from lax or remote management. Indifferent management is evidenced in the casual approach of employees to their daily task, and particularly to routine cleansing of premises and utensils, and it is in this sector that much of the inspectors' time is absorbed. Unhygienic conditions are further encouraged by the inaccessibility of areas where dirt can accumulate, and by inability to retain suitable permanent staff who will consistently effect thorough cleaning with vigour and application. Lack of proper ventilation can also contribute where the efficient discharge of cooking vapours is not maintained and the interior of the kitchen and the equipment becomes coated with fat to which dirt adheres. Frequently the original brick chimneys which are quite unsuitable are used with the assistance of a fan, for the discharge of fumes. Sound advice given on the design of an acceptable ventilation system is not always acted upon on grounds of cost. The discharge of cooking vapours and fumes at inadequate heights gives rise to nuisance to persons in the locality. Another matter for concern is the overcrowding which occurs in some kitchens further contributing to the inability to maintain clean and satisfactory conditions. This is exacerbated by the extension of cooking facilities beyond the capacity of the kitchen. Some businesses commence with the sale of sandwiches and drinks, then soup is prepared, with hot pies, sausages, fried eggs and bacon, and these are accompanied by chipped potatoes. Eventually there is the addition of a joint, and a selection of main meals with a variety of cooked vegetables. It is not infrequent that all this is achieved without the addition of a single foot to the area of the food preparation space. The consequent congestion presents a situation whereby much of the kitchen becomes inaccessible for really efficient cleaning. 29 In all new proposals prospective restaurateurs are reminded of the provisions of the Offices, Shops and Railway Premises Act 1963 where a legal standard of working space of 400 cu. ft. per person is stipulated. However, this standard does not apply to part-time workers (i.e. persons not working more than 21 hours during each week) and all restaurateurs at some time or other assert that such people are employed in the kitchen. It would be difficult to challenge this assertion. Many of the new premises which have opened in Westminster in late years, and also established premises, have taken advantage of modern equipment now available, and also have made use of extensive cold storage facilities and incorporated adequate structural finishes. However, there still remain those premises which open without adequate finance, but nonetheless engage in full catering from the start. The kitchen is often equipped with a collection of old and worn cookers, sinks and other equipment some of which would seem to have been discarded from domestic use, and not even designed for commercial premises. The adaptation of these premises often amounts to only the essential repairs and to the acceptance of the minimum standard of structural suitability. In such cases, inevitably, it is not long before conditions deteriorate and contraventions of the Regulations occur. A present weakness in food hygiene legislation is that a local authority is unable to prevent a person opening an unsatisfactory catering business. There is no legal requirement to obtain prior approval of the premises by the local authority. Only when a business is in operation can positive action be taken. The sub-standard condition of some old properties used as catering establishments makes it virtually impossible for the full requirements of the legislation to be met. Caterers often lack the financial resources for a long lease on new property and in consequence there is a great demand for short term leases on older buildings. These are likely to be included in development plans and the leases frequently include six month 'breaking clauses'. In these circumstances there is a reluctance to lay out capital on works required to make the premises comply with the Food Hygiene Regulations. The Chronically Sick and Disabled Persons Act 1970 has now been in operation for a full year. In so far as catering premises are concerned the application of the Act has been tentative. In all new proposals and those involving major alterations, the caterer is reminded of the intent of the Act which is to facilitate access to premises and sanitary accommodation for disabled persons. The view has been expressed that the requirements of the Act appear to be unjustified by demand, and moreover involve the use of valuable floor space for the provision of passenger lifts to each upper section of the premises where sanitary accommodation is, or is intended to be situated. The application of the Act to hotels would seem to be more appropriate and in a number of cases its provisions have been implemented. So far no complaint or enquiry has been received in the department concerning the lack of facilities of catering premises in Westminster. Licensing Act 1964 Inspections were made during the year of all premises in respect of which applications for licences to sell intoxicating drinks had been made to the Licensing Justices, or where alterations were proposed which affected the food preparation areas or sanitary accommodation. Appropriate reports were made to the Justices at the respective meetings. Where works requested by the Health Department were outstanding at the time of the application, or the structural adaptation of the premises was not sufficiently advanced to permit opening for business, the Justices in some cases withheld their consent to a licence, or granted the licence provisionally until subsequent inspection showed that the works had been satisfactorily undertaken. In one case during the year the Justices refused at three hearings to grant a renewal of a liquor licence in view of the poor conditions maintained at the establishment. The premises were eventually sold and re-licensed under different ownership after extensive improvements. The support given by the Justices to the Health Department in matters concerning hygiene at catering premises where liquor licences are under consideration has been much appreciated. Inspections were also made throughout the year at those premises where application had been made to the Magistrates' Court for a Club Registration Certificate, or for the renewal of an existing Certificate for a further period. No objections were raised to the applications received. 30 Licensed Street Traders The anticipated adaptation of the street traders' barrow by the inclusion of a fibre glass attachment to ensure compliance with the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 referred to in last year's report, has been extended to include a completely new purpose-built fibre glass unit on rubber tyres. The prototype was examined by the Public Health Inspectors (Food Control), and some alterations were suggested to the manufacturer. At the close of the year, these were in hand. A washing unit for use with the vehicle has been demonstrated, and whilst it appeared to be of worthwhile construction, certain features required re-appraisal with a view to increasing its efficiency, and discussions are in progress. The routine examination of stalls selling foodstuffs in the street markets has been carried on through the year. Difficulties in this type of trading are associated with lack of storage space, with facilities for washing food and equipment in close proximity to the market, for keeping the stall and the stocks of food, together with the lack of sufficient working area therein for the preparation and sorting of food and setting up the stall and its display. When all traders have been provided with satisfactory storage arrangements this department will require each food trader, where appropriate, to replace or adapt the outmoded wooden stall at present in use, by a modern enclosed unit made from material which provides a smooth, easily cleaned surface with an open front (or back) for serving. It should house the goods (and assistants) if desired and be fitted with washing facilities, a refuse receptacle and first aid equipment. Sanitary accommodation, personal washing facilities, clothes lockers and bulk refuse compartments are additional requirements which can be provided communally. Facilities in the style of purpose-built stores of satisfactory design are already available to traders in Church Street Market. Here the tenancies, which are the responsibility of the City Valuer, are linked to the Traders' Association, who accept responsibility for general supervision, and ensure that the shared facilities such as staff wash room etc. are cleaned. Unauthorised Street Traders The activity by public health inspectors of the Food Control Group in enforcing the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 in relation to unauthorised street trading reported in last year's Report has not been as sustained as it was in the previous year. This has been due to staff movement to other duties, other calls on the inspectors' time and the undoubted improvement in the standard of hygiene evident amongst those who engage in this form of trading. Many of the stalls observed to be used for trading during the year were found to be in a satisfactory condition, although the provision of suitable washing facilities is still a matter which gives concern. Most of the stalls now have stainless steel working surfaces with suitable storage facilities for rolls, frankfurters etc. The galvanised iron construction formerly used, and which was virtually impossible to maintain in satisfactory condition, is seldom seen. Washable overclothing has been adapted by most traders, in compliance with the Regulations, as has the provision of soap, towel, nailbrush and first aid kit. Several approaches have been made by traders to the Health Department requesting advice as to the manner in which the requirements of the Regulations can be met. To give such advice to unlicensed traders might be construed as helping them to continue to trade illegally in contravention of street trading legislation. However refusal to give advice and help would not deter the trader from continuing his business and in these circumstances it is best that he should do so under the most acceptable conditions. Twenty-nine traders were proceeded against for offences under the Regulations during the year. In two of these the defendant did not appear at the subsequent court hearing, and in a further seven cases the summonses could not be served. The Police dealt with six of the cases which concerned matters not directly related to matters of hygiene. The Medical Officer of Health would once again record the thanks of the department to the police for their valued assistance. Food Hygiene etc. Lectures The department continued to meet requests during the year for lectures to various catering organisations, and persons qualifying for professional appointments, including student public health inspectors, and at the request of Government Departments and training establishments' accredited visitors from overseas. 31 This activity imposes an additional burden on the already fully extended inspectorate, but the importance of the hygienic aspects of handling food and personal hygiene cannot be sufficiently stressed, and such lectures serve a useful purpose. During the year members of the Hamburg Central District of the Social Democratic Party of West Germany visited the City Hall to carry out a fact-finding examination of elements of the City Council's responsibilities in the Soho district. A lecture was given to the members of the party by a public health inspector on the general topic of the enforcement of the Food Hygiene Regulations in the Soho area. This was followed by a motor tour of the district. It was of considerable interest to the party members to learn that a countryman of theirs, a Frederick Accum, born in Buckeburg, Germany, in 1769, later established a laboratory for the chemical examination of food at 11, Old Compton Street in the heart of Soho in 1800. Food Sampling and Analysis The development of the modern food industry has vastly increased the variety and availability of pre-packed foods. There has been a corresponding decrease in the amount of food sold in the traditional manner. Estimates based on the National Food Survey show an increase in pre-packed food from some 50 per cent in 1960 to around 60 per cent in 1970. This has had the advantage at the retail level of removing the opportunity for adulteration which formerly existed and reducing open food handling. There is the disadvantage that the condition of the food cannot be determined without removing the wrapper; also the physical conditions created by the wrapping can in some circumstances be favourable to certain types of spoilage. Failure in distribution and sales systems has given rise to the sale of stale food and the demand for open date marking of pre-packed food continues to secure considerable support. Most of such food on sale in this country is already marked with a code, but the codes so differ from one another and in some cases are so complicated that they are unintelligible to staff who could use the information in order to undertake satisfactory rotation of stock, and to the public who buy the food. Only a few companies use an open date code, which both staff and customer can read at a glance. During the year a total of 1,269(1,626) samples of foodstuff were submitted to the Council's Public Analyst by routine or on complaint. Of this number 178(13.2%) (148: 9.1%) were reported upon adversely and appropriate action taken. The following includes a selection of these reports together with other matters concerning samples brought to the department on complaint: Milk contained in a plastic bag for use in a dispenser machine at a canteen was alleged to have been watered. A sample submitted to the Public Analyst confirmed the presence of not less than 60.6 per cent of added water. The dairy company stated that the added water could have been the residue of a final rinse remaining in the filling line following cleansing. The residue was normally pushed out by the milk, and it was for this reason that the first two cartons filled were usually discarded. If, however, one of the cartons was inadvertently distributed it could have been the source of the adulterated sample. It appeared that the Company's established procedure laid down and prominently displayed at the dairy had not been carried out by an employee. Maggots were found in a packet of dates and later identified as an Indian Meal Moth. The retail company imported some 1% tons of dates once a year which they stored at their premises and packs were made up from stock as required. The period the dates remained in store would be conducive to the growth of larvae, if present. The company concerned agreed in future to import stocks half yearly, and that careful scrutiny would be undertaken, as far as was possible, to ensure they were not infested. Apple slices were alleged by the purchaser to contain rodent faeces. The foreign material was found to consist of sugar and burnt material which probably originated from the baking tin used in the bakery. A piece of chewing gum was found in a packet of cornflakes. The packers carried out an intensive examination of their corn flake lines but were unable to explain how the specimen entered their product. The gum had not been through the corn flakes processes which involved rolling and toasting. The time between final toasting and packaging was only about one minute's duration, and the operation was under constant supervision. Eating by staff was strictly prohibited in the plant and warning notices to this effect were prominently displayed. There appeared to be no valid explanation of this incident other than malicious intent. The packers were cautioned. 32 On opening a tin of baby food the complainant noted the presence of an insect resembling the leather-jacket. The tin and contents were examined by the Public Analyst and he confirmed the insect had not been cooked in the can. It appeared that the insect gained access to the can after it was opened. On drinking a gin and tonic at licensed premises the complainant noted a burning sensation in her mouth. The remainder of the tonic was submitted for analysis and it was reported to be strongly alkaline. Samples of cleaning fluids obtained from the licensed premises and the bottling factory were submitted for comparative analyses but it was not possible to discover where or how the soapy material gained access to the tonic. In a gift box of imported chocolates each chocolate contained an attachment which appeared to be gold wire in the form of a handle. The complainant considered this was a hazard, particularly so if the chocolate were consumed in the dark. Analysis disclosed that the handle attachment was a piece of plastic and the "gold" comprised harmless colourings. No action was required. A bottle of lager when opened was found to contain "foreign matter" which comprised growth of yeast and mould. The condition had arisen through a fracture at the neck of the bottle beneath the crown cap which permitted air to enter the bottle. The fracture probably occurred at the time of the capping. The local authority in whose area the bottling factory was situated was informed in order that any necessary investigation could be made. Beetles were found in a packet of suet. A further packet similarly affected was found at the retail shop. The proprietor had failed to rotate his stock with the result that the suet was nearly 18 months old — the shelf life of this type of product is 6 months. The shop proprietor was cautioned, and action was taken to control the infestation. A fly was found in a steak and kidney pie purchased from a large multiple store. An investigation followed at the factory where the pie was manufactured, and a representative of the company was interviewed. The plant was of modern design and the entire factory premises were proofed against flies, including meshed windows, doors with air curtains and insectocutor units. In addition the premises were specially treated outside production hours for insect pests and a search made thereafter for any dead or dying insects which may have previously escaped detection. It was not possible to discover how the fly gained access to the plant, but it was suggested that this occurred through an air curtain, either when this was not properly directed, or on goods passing through the curtain. The manufacturers were cautioned. Legal Proceedings — Food and Food Premises During the year legal proceedings were taken in respect of unhygienic conditions in seven catering premises. Four of these further included contraventions of the Offices, Shops and Railway Premises Act 1963. Fines totalling £1,124 with £124 costs were imposed. In another case where legal proceedings were authorised the owner died before the case came to Court and in a further case the premises closed and the summonses could not be served. The following matters arising from complaints also resulted in legal proceedings:- Sale of shredded beef suet infested with beetles. Also insanitary conditions in male sanitary accommodation. Fined £50. Costs £10. Offering for sale food unfit for human consumption. The food had been contaminated and gnawed by mice. Also insanitary conditions present and exposing food to risk of contamination. Fined a total of £100. Costs £5. Offering for sale food unfit for human consumption — the food had been gnawed and contaminated by mice. Also insanitary conditions at premises. Fined £450 with £5 costs. Sponge cakes contaminated by mould growth and biscuits contaminated by mice droppings. Insanitary conditions at premises. Fined £150 with £20 costs. Sale of sponge cake mix affected by insect infestation. Fined £15 with £7 costs. Sale of a chocolate bar affected by insect larvae. Fined £40 with £10 costs. Sale of milk adulterated with water. Fined £10 with £5 costs. 33 Sale of unfit and contaminated food in insanitary premises. Fined £126. Costs £20. Placing food likely to be affected by street debris, and failing to protect food. Use of a delivery vehicle on which no name and address was displayed. Fined £100 with £10 costs. Further reference to legal proceedings will be found in the analysis in Table 25, page 81. Milk and Dairies (General) Regulations 1959 Under these Regulations a local authority is required to keep a register of persons carrying on the trade of distributor of milk at or from premises within their district whether or not such premises are occupied by the distributor. As at the 31st December 1971, 306 distributors of milk were registered. Milk (Special Designation) Regulations, 1963 (as amended) The City Council is responsible for the granting on application of Dealers' Licences in relation to pre-packed milks sold under the special designations "Untreated", "Ultra Heat Treated", "Pasteurised" and/or "Sterilised". A Dealer's Licence permits the sale of milk both outside as well as inside the area of the licensing authority. The numbers of such licences current in the City at the end of 1971 were:- Untreated 49 U Itra Heat Treated 119 Pasteurised 270 Sterilised 186 Milk Supplies — Brucella Abortus Brucella abortus is the organism associated with contagious abortion in cattle and its transmission to man occurs through drinking raw milk. As almost the entire supply of milk sold and consumed in Westminster is heat-treated, no tests to determine the presence of this organism were carried out during the year. Food and Drugs Act 1955—Section 16 The number of premises registered with the City Council at 31 December 1971 is shown in Table 23, page 80. Food Poisoning During the year information was received of 120 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:- Five members of a sales promotion team staying at a local hotel suffered illness. Staff were also alleged to have previously suffered similar symptoms, but had recovered by the time the matter was first brought to the notice of this department. Food specimens, and swabs from the slicing machine used in the kitchen were bacteriologically examined and staphylococcus aureus in small numbers was isolated from all the food specimens except one. The origin of the infection could not be traced. Information concerning eight persons who were ill following a meal at a restaurant was not received until eight days later. Thirteen attended the function. Faecal specimens from those affected revealed that six were excreting non-haemolytic C1. welchii type 4. No food remained from the suspected meal, but food specimens from subsequent menus were bacteriologically examined with negative result. Temperature control requirements were discussed with the management, and subsequent visits assured these were being practised. No indication of the origin of the infection was found. 34 Fifteen members of a social organisation were ill after consuming steak and kidney pie, with potatoes, which was followed by ice cream and apple tart. On the day of the meal, 18 containers of steak and kidney pie were received from the company's production kitchen (not in Westminster), and following defrosting were re-heated in two lots for 1½ hours. The pies were then cut into portions and plated. This was completed by 6 p.m. when the vegetables were added, and the plates inserted into the hot plate for service at 7 p.m. The symptoms and circumstances relating to the preparation of the meal were suggestive of C1. welchii outbreak, and this was supported by the bacteriological examination of faecal specimens obtained from those affected. The company concerned was advised as to effective safeguards to be introduced including the techniques of temperature control. Two unconnected persons had salmon sandwiches at a snack bar. Later both vomited. Both were admitted to hospital, but specimens taken there did not reveal any causative organism. Specimens of salmon and mayonnaise obtained from the establishment concerned revealed the presence of staph, aureus in small numbers in the tinned salmon. Swabs from the staff were negative, but the symptoms of both patients together with the ingestion onset period were typical of a staphylococcal food poisoning occurrence. C1. welchii organism was isolated in specimens from two patients who had consumed curried lamb. Temperature control requirements were emphasised to the management, and later visits to the premises confirmed these were being maintained. Beef curry with pilau rice was the only dish common to five persons who were ill. Two were positive for C1. welchii. The investigation revealed that the temperature of prepared food on the hot plate ready for service was inadequate. Appropriate advice was given. A further instance involving three persons who were ill after consuming meat pies was also the result of improper temperature control. One was positive for Salmonella enteritidus. Pies used were cooked the day prior to being eaten and then cooled and refrigerated. They were warmed the following day before being placed in the hot plate pending purchase. The temperature in the hot plate was below the statutory requirement. Suitable advice was given. Two outbreaks of C1. welchii followed one another at a restaurant. The vehicle of infection was the sauce used as a base for curried dishes. Adequate refrigerated space was not available, and the practice of cooking the sauce on the day prior to use, and thereafter leaving it in the kitchen temperature to cool, induced the growth of the C1. welchii organism. Late night and early morning visits were made to the premises (which remained open all night), to ensure that instructions regarding temperature control were being followed. Some eleven days after the occurrence, information was received of five persons who consumed a meal of chicken curry at office premises in Westminster. The meal was supplied by caterers from premises outside Westminster. Salmonella enteritidus was isolated from a specimen of one of those affected. The symptoms described, the ingestion onset period, together with the identification of the salmonella organism in an associated outbreak (which occurred outside Westminster) where chicken curry was also prepared by the same caterers, pointed to this organism being the causative agent, and the curry the vehicle of infection. A family of six were ill shortly after their return from a holiday abroad where they did their own catering. Meals were obtained from a variety of sources. There was evidence that one of the children had been ill while on holiday. The mother and three of the four children were all excreting a salmonella typhimurium organism. No conclusion could be reached but the infection was obviously incurred abroad. Four persons were ill after consuming pizzas. One was admitted to hospital with a suspected salmonella infection. The pizzas were manufactured at premises outside Westminster and an investigation by the local authority concerned did not disclose any possible cause of the infection. Two outbreaks occurred following social functions involving 24 persons. None of the food remained from either of the suspected meals. At both functions oysters were consumed by most of those who were ill and while this was considered as the possible vehicle of infection insufficient evidence was available to reach a conclusion in either case. 35 Metal Drink Pourers Arising from an investigation into illness suffered by two children following the consumption of diluted orange juice at licensed premises, it was found that the acidic action of the fruit drink on the inside of the chrome plated copper delivery tubes of the metal pourers in the neck of the bottles had resulted in an accumulation of copper salts. The patients were sick five minutes after drinking the juice. Specimens of drink were examined by the Public Analyst and high concentrations of copper were found. The danger of this occurring at other premises where the same type of metal pourer might be in use was immediately apparent and accordingly a News Bulletin was issued by the Council's Press Officer. Subsequent publicity in the national press, on the radio and from a feature in a popular Saturday evening television programme resulted in enquiries being received in the department from many sources, including catering companies, brewery organisations and other local authorities, for further information and advice. Premises in Westminster where such pourers might be in use were visited and a large number were found to be affected. Action was taken to discontinue their use and advice given regarding substitution by plastic or porcelain pourers which were suitable for use in dispensing 'acid' drinks. 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 has in his possession or under his control any article of food which is unsound, unwholesome or unfit for human consumption, may, by notice to the local authority, specifying and identifying the article, request its removal as if it were trade refuse. During the year some 361 tons of unsold or unsaleable foodstuffs were voluntarily surrendered for disposal. Included in this amount were two consignments of onions, totalling 72 tons, which were decomposed and rotting, one ton of meat and 4½ tons of miscellaneous goods, rendered unsaleable through fire or smoke damage. 459 requests were received in the department during the year for inspections to be made of out-of-condition foodstuffs. 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 source of manufacture or examined on importation. Imported Food Regulations 1968 Most of the food imported into the United Kingdom is examined at the port of entry by the Port Health Authority through an 'authorised officer' (i.e. public health inspector). As much food is containerised, examination is sometimes deferred until the food reaches the place of destination where it is examined by an inland local authority (such as Westminster). In the latter case notification of the release of the food without examination will have been given. During the year 45 notifications were received of imported foodstuffs coming into Westminster which had not been examined at the port of entry. Immediately notification was received a visit was made to the premises and an examination made of the consignment. Export Certificates Applications for Certificates of Export received in the Health Department during the year in respect of foodstuffs to be despatched abroad numbered 7(15). 36 Trades Descriptions Act, 1968 During the year some 26 complaints alleging contraventions of the Act were received in the department. These included matters relating to cheese, eggs, fish, bread, meat and biscuits. This Act has now been in operation for over three years and has been seen to be a valuable contribution to the enforcement powers of local authorities, although its provisions overlap in some respects those of other specialised legislation, such as the food and drug laws. The Board of Trade (now the Department of Trade and Industry) was aware that such a situation would arise when the Act was introduced and hoped that where prosecutions were undertaken in such cases of overlapping offences they would be taken under the appropriate specified legislation rather than the Trades Descriptions Act. None of the matters referred to the department during the year reached the stage of legal proceedings, but informal action was taken under the appropriate food legislation. Advice on Labelling of Pre-Packed Food During the year a large number of enquiries was received by the Food Control Section requesting advice on the labelling of pre-packed foods. These enquiries were mostly in anticipation of the new Labelling of Food Regulations 1970, which come into effect on 1st January, 1973. Enquiries are often received from manufacturers abroad who intend to market their products in the United Kingdom; some have personally attended at the Health Department to discuss their proposals. In many cases the proposals have involved an outlay of considerable expenditure in presentation alone, and it is sometimes difficult to explain to enquirers that although specimen labels, which are often produced without prior consultation, may provide an attractive display both pictorially and descriptively, they fail to comply with the statutes. The requirement with which manufacturers most often find difficulty in compliance is that relating to the declaration of the appropriate designation or common or usual name of the food — which is intended to indicate to a prospective purchaser the true nature of the food in the pack. The complex Regulations and ancillary legislation require special study and the Senior Public Health Inspector of the Food Control Section has acquired a comprehensive knowledge of the legislation involved which is invaluable to those seeking advice and guidance. There is, of course, no central agency which provides this service and views and opinions expressed by the Health Department can only be for purposes of guidance; any authoritative interpretation of the relevant acts and regulations governing the labelling of pre-packed food must rest, of course, with the Court. Non-Returnable Plastic Milk Bottles Several enquiries were received during the year concerning the use of non-returnable milk containers. The Health Department's food control section has followed the development of this innovation with interest as returnable glass bottles are frequently subjected to mis-use with the result that the normal methods of bottle washing may in some cases be ineffective, and unless "spotted" on the filling line the bottles could be supplied to the public in a dirty condition. The situation is aggravated by the increasing automation of bottle washing plants with filling rates of up to 400 bottles per minute on each line. This renders sighting of individual dirty bottles almost impossible, and this is evidenced by the fact that during the year several incidents of this nature were referred by this department to the local authority for the area where the milk had been bottled in order that appropriate action could be taken. The Milk and Dairies (General) Regulations require that every vessel for containing milk shall be in a state of thorough cleanliness before use, and establish that the offence occurs at the place where the milk is bottled. From a hygienic aspect, non-returnable plastic containers would offer definite advantages, although questions have been raised as to the disposal problem which would result from their use. It is understood that providing their number did not increase at such a rate as seriously to raise the percentage of plastic in relation to other constituents of refuse, at present between 1-2 per cent, no unusual problem is likely to be encountered in dealing with such containers. 37 Plastic containers are at present in use for milk in Westminster in retail shops only. The present trend towards the replacement of glass bottles by plastic containers, as in the case of soft drinks etc., may eventually make the transition universal, although it may not be acceptable by all consumers. Canned Soup Information was received in the department during the year of an incident of botulism which occurred abroad where the source of infection had been traced to a consignment of canned soup manufactured by a company who also distributed many other brands of soup under various labels. From information available in the department it was known that the brand of imported soup was on sale at premises in Westminster, together with other brands of the same Company's products. Immediate steps were taken to withdraw these soups from sale. Further information was also sought from the Embassy of the country concerned where it was learned that none of the tins of the affected batch had been imported into the United Kingdom. Nonetheless the canners had requested that all stocks of their soups should be returned regardless of whether they were of the affected variety. Botulism is caused by a toxin produced by Clostridium botulinum. The mode of transmission is by ingestion of contaminated food from jars or cans inadequately processed during canning and eaten without subsequent adequate cooking. Incidents of botulism are rare in this country as relatively little home canning is performed. The disease is usually fatal. The Department of Health & Social Security was aware of the occurrence and was informed of the action taken in Westminster. 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 was renewed during the year. Applications are also received from time to time from the Royal Society for the Prevention of Cruelty to Animals for Slaughterman's Licences to be issued to probationary inspectors. Twenty-five 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. One annual licence was renewed for an instructor at the Society's Headquarters. Diseases of Animals Act 1950 and Other Acts Relating to Animals Under an arrangement entered into in 1965 the Corporation of the City of London acts on an agency basis on behalf of the Westminster City Council in connection with duties under the Diseases of Animals, Riding Establishments, Performing Animals, Pet Animals, and Animal Boarding Establishments Acts where veterinary services are involved. Veterinary officers of the Corporation of London undertake routine inspection of animals in transit and inspections for licensing purposes under the Riding Establishments Act, together with inspections specially requested by the Medical Officer of Health of Westminster. All other necessary inspections are made by the public health inspectors. The Corporation issues any notices and advertisements which may be required under these Acts but licensing and registration of residents of premises in Westminster is undertaken by the City Council. Pharmacy and Poisons Acts 1933 and 1941 At the end of the year the names of 109(114) traders were on the Council's list of persons entitled to sell poisons included in Part II of the poisons list, the number of premises concerned being 146(153). 38 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 721(728) verminous persons: adults 507(571)—men 405(418), women 102(153); children 214(157)—boys 60(51), girls 154(106). (Table 26, page 81). Scabies The two establishments mentioned in the foregoing paragraph treated 235(251) scabies patients; adults 151(178) — men 114(123), women 37(55); children 84(73)—boys 36 (35), girls 48(38). 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. In 1970 there was a sudden decrease in numbers attending and the decrease continued into 1971, so far as adults were concerned, although there was a slight increase in attendances by children. (Table 27, page 82). 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 request or with their consent. During the year 394(396) baths were given, 322(336) to women and 72(60) to men, under a scheme for bathing old persons at the Lisson Grove Centre. The old people are conveyed between their homes and the Centre by a Health Department vehicle. Special Laundry Service The Department continues to operate a service for laundering bed linen and clothing of the acutely ill, incontinent or very dirty and verminous old people. In certain cases a certificate is given by the Medical Officer of Health under the provisions of Section 84 of the Public Health Act 1936. The work 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 11,325(11,182) 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 excellent way in which they carry out this work which is not only hard but also unpleasant. Disposable Incontinence Pads Under Ministry of Health Circular 14/66 a service is provided for patients residing in Westminster (on written application by a general practitioner or district nurse) whereby the patient is 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 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 water-proof 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 156(136) new cases arose, making a total of 274(258) persons who received deliveries of supplies in their homes, whilst 14(18) arranged for them to be collected from Centres. It is of interest to note that in 1971 145,100 disposable incontinence pads and 152 pairs of protective pants were issued. Establishments for Massage or Special Treatment The City Council is responsible for the licencing and regulation of establishments for massage or special treatment in the City. 39 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. The number of such enquiries referred to the Health Department during the year was 34 (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 persons employed to give other than non-remedial treatment can produce evidence that by examination or experience they are suited to give such treatments. At the end of the year 261 (273) 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. 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. 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, 3 Mortuary Assistants and 2 cleaners. Details of the work of the Mortuary during the year are set out in Table 28, page 82. 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 not only necessary to arrange their funeral, but 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 accommodation for housing purposes as early as possible and occasionally to enable the proceeds to be applied towards the cost of the funeral. 40 During 1971 a total of 117 (122) burials or cremations were arranged by the Health Department as follow:- Burials at City of Westminster Cemetery, Hanwell 14 (26) Paddington Cemetery, Mill Hill, N.W.7 14 (10) St. Marylebone Cemetery, East Finchley, N.2 3 (8) Morden Cemetery 1 (-) Islington Cemetery 1 (-) Cremations at City Council's Crematorium, East Finchley, N.2 84 ( 78) The two burials which took place at cemeteries other than those of the City Council were so arranged to enable the bodies to be interred in family graves. In addition to the cases summarised above, a further 17 were referred; however, action by my officers resulted in private funerals being carried out either by relatives or other responsible persons. Requests for burials or cremations were received from the following sources:- H.M. Coroner 56 (49) Relatives or friends of the deceased 51 (47) Hospitals in the City 10(26) Age Groups 0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 6 3 1 - 2 1 3 1 11 2 19 6 28 3 14 9 - 6 2 — CREMATION - WORK OF THE MEDICAL REFEREE The Medical Officer of Health is Medical Referee for the Council's Crematorium, which is situated at the St. Marylebone Cemetery, East Finchley. During the year 2,013 (2,058) certificates authorising cremation were issued. Since December, 1937 when the crematorium was opened 41,753 cremations have taken place. 41 PERSONAL HEALTH SERVICES MARY T. PATERSON, M.B., B.S., D.P.H. Deputy Medical Officer of Health Community health services as we know them today have grown up during the past 120 years or so to meet the needs of the population. In the last century the most obvious needs were for the control of infectious disease, for the relief of poverty and malnutrition, for the provision of adequate housing, for improvement in working conditions especially for women and young children. Local authorities were gradually empowered to provide services to meet many of these needs, which are now included in the environmental health services. Personal health as the name suggests is the promotion of health of the individual, the prevention of disease and the relief of suffering. Most of these personal services were pioneered by philanthropists and voluntary bodies, and once established taken over by local authorities empowered to do so by Acts of Parliament. Home nursing, health visiting and maternal and child welfare are important examples: provision for destitute or neglected children, for unmarried mothers, for the elderly and chronic sick are others. Post-war legislation, the National Health Service Act, the National Assistance Act and the Children Act set up a new method of organising the services and divided responsibilities between different bodies and departments. The larger local authorities were designated health authorities, but had powers to delegate some functions to sanitary authorities. Those hospitals previously administered by local health authorities were transferred to Regional Hospital Boards. The care of children deprived of a normal home life became the responsibility of the new children's departments of local authorities. As a result of these changes the health services previously provided by local authorities were to some extent fragmented and those services remaining the responsibility of the health department were divided into environmental and personal. There is no doubt that there was a great improvement in all the services. Part III of the National Health Service Act included the personal health services already provided by the local authorities such as care of mothers and young children, health visiting, domiciliary nursing and midwifery; it also empowered them to provide home helps and day nurseries. Section 28 under the heading "Care and After Care" enabled the health departments to provide a wide variety of new services such as the care of infirm old people, care after illness, recuperative holidays, and social work with unmarried mothers and problem families. The Mental Health Act 1959 added community care of the mentally ill and mentally handicapped to the personal health services. When in 1965 the City of Westminster took over the personal health services from the London County Council, they were well-established and flourishing. But to keep pace with current developments considerable expansion was necessary. During the ensuing six years 1965-1971 day nursery facilities for handicapped children were provided, mostly by voluntary effort with financial support from the Council; a hostel for mentally subnormal men, a day centre for mentally ill adults, and a training school and special care unit for mentally subnormal children were all opened; social work associated with V.D. clinics was expanded; a special youth advisory service was set up and a social service for unmarried mothers and their children was instituted. The Local Authority Social Services Act 1970 which came into operation in April 1971 was designed to unify the social services. It did have the inevitable effect of again fragmenting the personal health services. Although the health department still has responsibilities for the health and welfare of the community it no longer directly controls the means of providing that care. Child health is an important responsibility of a health department but day care of children and social work for families is undertaken by the social services department. The detection and assessment of need of old people and the care and nursing of the infirm is still undertaken by the health department, but residential care, social visiting, clubs and day centres and home helps are the responsibility of the social services department. All social work connected with the mentally ill and mentally handicapped is provided by the social services department with medical officers acting as advisers when required. In the chest clinics, which had previously been an example of co-operation between local health authority and hospital services, the social workers have been transferred to the social services department, although the health visitors undertaking contact tracing remain part of the health department. 42 When the new department has had time to settle down to its duties it is hoped that the resulting benefit to the public will prove these changes to have been worthwhile. In the meantime, however, it must be recognised that the latter half of 1971 was a period of frustration, confusion and disappointment for members of the Health Department who have experienced three major changes in organisation and duties in the past 25 years, and are now having to carry on the service as best they can under the threat of further changes in 1974. INFANT AND CHILDHOOD DEATHS Because of a fall in births one would naturally expect some fall in the number of infant deaths, but this year the decrease has been considerably greater than would be expected from this cause alone. Consequently both the perinatal and the infant mortality rates have now reached the lowest point of 18 and 13 respectively. Deaths occurring in the first week of life amounted to 19 and of these 12 were due to prematurity and allied causes. There was a total of 35 deaths of infants under 1 year during 1971. The causes are classified in Table 2, page 70. There were 3 unexpected sudden deaths in infancy; two occurred in hospital and the other at home. All infants had previously been making good progress and were well cared for. There were five infants who died from bronchitis or pneumonia — in one of them there was also cerebral palsy. Nine infants died from congenital malformation, six of them malformations of the heart and great vessels. Interestingly enough, all the four children born alive suffering from spina bifida/hydrocephalus survived the first year. There were 7 deaths in the age group 1-5 years. Five were due to congenital heart disease, one complicated by hydrocephalus. Four of these children were resident abroad and brought to London for treatment. One death in this age group was from leukaemia. One tragic death occurred in a boy of 2½ who had been admitted to hospital with unexplained injuries. Shortly after his discharge home he received further injuries which proved fatal. A charge of manslaughter was brought against a co-habitee. There were 12 deaths in children in the 5-15 age group — 2 from leukaemia, 2 from other neoplasms, 5 from congenital abnormalities, 2 as a result of accidents and 1 from cerebrovascular disease. It is perhaps interesting to note that apart from bronchitis and pneumonia there were only three deaths from infection in the under one group and no deaths from infection in those between one and fifteen. (Table 2, page 70). MATERNAL MORTALITY There was unfortunately one maternal death during 1971. The person concerned was not a resident of Westminster. A multigravida, domiciled in France, came to England to have a 15 week pregnancy terminated. The operation was performed in a private nursing home approved for the purpose. The patient collapsed four hours after the operation and in spite of intensive treatment died six hours later from haemorrhage due to perforation of the uterus. MATERNAL AND CHILD HEALTH Antenatal and Postnatal Care 97% of births in the area are booked for hospital delivery. Antenatal care is undertaken mainly by the hospital units with intermediate examinations by General Practitioner Obstetricians or at the local health clinics. The number of attendances at the clinics has continued to decline, but it is interesting to note some increase in the number attending mothercraft and exercise classes. The number of postnatal attendances has been maintained, chiefly because at one large maternity unit these examinations have been combined with family planning advice and have been held in the local authority clinic. 43 Child Health The fall in the number of births and of children under 5 in the area has continued. This is the main reason for a decrease in the number of visits by health visitors. Another reason is the increasing use of the telephone. More and more mothers telephone centres to ask for advice and many visits are therefore unnecessary. The number of attendances at child health centres shows the same downward trend. Because of the relatively small numbers it has been possible to institute a policy of serial developmental screening of the total child population. This has involved a re-distribution of work load as between nursing and medical staff. The Health Visitors have been required to assume greater responsibility for general advice on infant feeding and child management, thus freeing the doctors to concentrate on the more time consuming, but vitally important, examinations involved in developmental screening and to devote more time to parent counselling. A special survey was undertaken in 1971 to see how far total screening of children under 5 years of age was being achieved, records being kept of the actual work done by medical officers in the clinics. The number of children screened at key ages were as follows:- Age No. Screened Estimated No. in Population About 6 weeks 2,024 2,596 About 6 months 1,870 2,360 About 1 year 1,646 2,100 About 2 years 1,320 1,900 About 3 years 833 1,600 About 4 years 671 1,500 In addition to these examinations carried out in child health clinics, serial screening was undertaken by some G.Ps. in their surgeries, by medical officers in day nurseries and nursery schools and in two hospital paediatric departments. It can be concluded therefore that at least 90% of children under 1, and 80% aged 1-2 were screened, but after that age the proportion fell to about 50%. For a variety of reasons mothers have always been less anxious to bring their children to the clinics after the first year. Screening of the total population in 1-5 age group is not practicable and some selection has to be made in order to ensure that the vulnerable, those most likely to have developmental defects, are brought forward. These are the children that health visitors make a point of following up; children with deprived home backgrounds, and children who fail to thrive. Health visitors are usually successful in persuading the mothers of such children of the value of a developmental examination, and of the need to attend when necessary for a special appointment. As a result of developmental screening, children who are retarded or who show any other deviation from the normal are placed on the register of handicapped children for special observation and follow up. Many of them will benefit from a period of training in a special nursery or from admission to an ordinary day nursery. There are others who display behaviour disorders, or who are understimulated at home who may be recommended for admission to play groups, or to part-time observation nursery groups run by the health department in the health clinics. The selection of children for special nurseries and nursery groups is one of the primary objects of developmental screening and one which, as is shown in the next section, may make a significant contribution to the child's development and adaptation to school entry at 5 years. Educational classes of all kinds, child management, home management, sewing, cookery, mothers' and fathers' clubs continue to be run at the health clinics, chiefly by health visitors with help from the ILEA who provide specialist teachers. The educational and social opportunities provided in the centres are well recognised by the mothers and in some areas these are becoming increasingly popular. Lessons in English language for non-English speaking mothers are held at some clinics, and these are again well supported. Tribute must be paid to interpreters, many of them voluntary, who assist in the clinics. In Westminster with its embassies, consulates and trade missions, there are many staff families in need of help. Hotels, restaurants and hospitals are largely staffed by foreign workers so that provision must be made for Indians, Pakistanis, Italians, Spaniards, Portugese, Maltese and Chinese as well as English speaking immigrants from the West Indies and Africa. At one centre a group of mothers with their children meet weekly to discuss their problems with a psychiatrist. This arrangement has been running for some years and has proved to be an admirable opportunity for preventive psychiatry; not only do the individual mothers receive help in the management and understanding of their children, but the local authority staff also learn how to handle the many emotional difficulties that arise. 44 Handicapped Children A register is kept of all children who are handicapped by a developmental defect, by illness or by adverse environmental conditions. Children are entered on this register as a result of hospital reports, including those notified at birth as having congenital malformations, those admitted or investigated because of acute illness, trauma or failure to thrive, or as a result of serial screening when the medical officer finds some deviation from the normal. During 1971 a total of 121 children were placed on the register, tabulated as ollows:- Mentally retarded Physically handicapped Born Notified by Hospitals Serial screening by medical officer Recommended for training Notified by Hospitals Serial screening by medical officer Recommended for training 1971 1 9 - 53 5 - 1970 1 5 — 6 4 - 1969 — 13 11 1 — 1 1968 — 15 15 3 - - 1967 - 3 3 2 - 2 Totals 2 45 29 65 9 3 From these figures it is clear that the majority of the babies under 1 are placed on the register as a result of physical handicaps reported by hospitals. From the age of 2 most of the children are placed on the register because of mental retardation discovered by clinic medical officers as a result of serial screening. Furthermore a high proportion of these mentally retarded children are recommended for special nursery training. Westminster is fortunate in having 70 special nursery places available for handicapped children and in addition many of the less severely handicapped are admitted to ordinary day nursery places. It is not easy to assess the effects of admission to special nurseries, since a properly controlled experiment is not possible. But an analysis of handicapped children reaching school age in 1971 shows that the majority were able to enter ordinary schools. The actual figures are as follows:- Children born in 1966 on handicap register in 1971 Mentally retarded: Physically handicapped: Recommended for OS 49 Recommended for OS 15 Recommended for ESNS 7 Recommended for Special school 6 Recommended for SSNS 11 Recommended for Hospital 3 21 70 Many of the children found to be handicapped at 2-3 years of age had been given special training and in particular 44 of the more severely mentally retarded children had received training in special nurseries or classes. Of these, 25 were able to enter ordinary schools, 5 entered schools for ESN and 13 were recommended for schools for SSN or hospital. This is surely a justification for providing the maximum help to selected children at the very important ages 2-5, help which can make a great contribution to their future development and well being. Assessment of Handicapped Children Assessment is undertaken at two levels. Westminster City Council runs special clinics for handicapped children staffed by specialist medical officers trained in developmental assessment. Parents attend Dy appointment and time is allowed for complete examination with psychometric testing and for parent counselling. 45 At two of the teaching hospitals in the area, assessment clinics are held in the paediatric departments. At both, a principal medical officer from the health department attends to undertake psychometric testing and to co-ordinate further training and parent guidance. It will therefore be seen that Westminster provides a complete and comprehensive service for handicapped children of which it may well be proud. MANAGEMENT STRUCTURE OF THE LOCAL AUTHORITY NURSING SERVICES By Circular 13/70 from the Department of Health and Social Security, the Secretary of State for the Social Services requested all local health authorities to consider their senior nursing structure in the light of the report of the Government Working Party set up to review senior management structure in the Community Nursing Services. The Working Party in formulating their subsequent recommendations took into consideration the principles of the Salmon Report on the senior staff structure and improved management training recommended for the hospital nursing services. It was their view that a sound management structure should be established in the local authority nursing services on a comparable basis. The Working Party pointed out that with growing pressures on the hospital service, and on hospital nursing manpower in particular, and the closer ties with general practitioners, demands on the community services were bound to increase. Indeed, the health visiting and district nursing services are facing continually increased demands on their time in the care of the steadily growing numbers of elderly persons who require their advice and assistance; the situation is aggravated by the early discharge of patients from hospital. Following a comprehensive report by the Medical Officer of Health to the Health Committee in November 1971 which detailed the Working Party's findings and recommendations the City Council approved a three-tier management structure for the City of Westminster's nursing service composed of top, middle and first line managers. The Chief Nursing Officer will be responsible for policy and co-ordination at top management level with the City divided into four geographical areas each containing approximately the same number of staff, health establishments and general practitioner attachments. A middle management officer will be in charge of each area, with overall responsibility for all nursing services in her area; in addition certain of these officers will specialise in matters connected with district nursing, health education, supervision of midwifery and co-ordination of training. Two first line officers will be appointed in each area to deal with the day-to-day management of the field personnel in health visiting and district nursing respectively. The revised management structure was brought into operation early in 1972, senior nursing appointments being made in March of that year. THE HEALTH VISITING SERVICE Miss E. A. Evans, S.R.N., S.C.M., H.V. Chief Nursing Officer This service is provided by a staff of trained nurses who also hold a post registration qualification, the aim being to bring a continuing service to families and individuals in the community. The health visitors are responsible for a geographical area in which they carry out the full range of duties covering the whole spectrum of preventive care, which includes all age groups. This is achieved by constant home visiting, and in doing this the health visitor builds up, over a period, using her special skills and knowledge, useful information about the needs of the community and the groups at risk. 46 Service is also given in the clinics held weekly e.g. child health, ante-natal, family planning and cervical cytology, some of which are held in the evenings to enable working mothers to attend. Teams of nursing staff have attended cytology sessions held in health clinics and at various business premises and the large stores in the City; they have also attended lunch time family planning sessions held in a health centre. Provision of care includes support during periods of stress in the family, advice and guidance in cases of illness as well as the care and management of children. Visiting the elderly has become an important function, and continues in co-operation with the City of Westminster Old People's Welfare Association; the difficulty in tracing old people who need services remains, but constant enquiries and follow-ups are organised. Some health visitors continue to work with general practitioners and the happy and co-operative understanding remains; extension of attachments has not been easy due to the continual change and turnover of health visitors. Arrangements for attachment are encouraged by the senior nursing staff whenever possible but it was not possible to increase the number of attachments during 1971 due to staffing difficulties. The health visitors are assisted by teams of trained nurses and clinic auxiliaries, but here again the constant change and turnover of staff created difficulties and resulted in instances in which service could not be provided. Organisation The work carried out by the nursing staff is organised from the ten Maternal and Child Health Centres in Westminster. This arrangement cuts out travelling time for the staff and gives all members of the community a base to contact when they require help and advice. During the first three months of 1971 meetings were held at the Centres with the area teams of the Social Services Department in preparation for the changes in the administration of mental health and day nursery services. These meetings encouraged co-operation and understanding at field level so that all field workers would know each other and make useful contacts, to the benefit of the families served. The meetings have been continued following transfer of functions from the Health Department to the Social Services Department and every effort is made to encourage the staff concerned and to foster close co-operation. In-service Training, Refresher and Management Courses One Nursing Officer attended a middle-management course. Two senior staff attended first-line management courses. Two health visitors were trained to become field work instructors for health visitor training. Six health visitors had refresher courses during the year. Two senior health visitors had management appreciation courses. Fifty staff attended Study Days and In-service Training Courses. Liaison with Hospitals Members of the nursing staff attend weekly sessions with consultant geriatricians and their staff at two teaching hospitals to ensure all necessary services can be laid on when the patients return to their homes. A nursing officer also attends all wards in one hospital to ensure district nursing and social follow-up for all patients discharged to homes within the City. This experiment started in 1971, and it is hoped to extend it to other hospitals in Westminster in due course. Student nurses from hospitals within the City continue to make observation visits, which involves members of the staff from various sections of the Department. 47 Health Visitor Training Sponsorship Seven students came forward for sponsorship and were successful in the examination held in the summer of 1971. Whilst this was a useful source of recruitment it did not keep pace with normal wastage. It is intended therefore in 1972 to increase the number of sponsored students to ten which will be some added assistance to recruitment. HOME NURSING The Home Nursing Service is provided to give nursing care in the community to the sick and disabled of all ages. The establishment of bathing attendants was increased by two during the year to help meet the needs of the frail elderly. Teams of state registered and state-enrolled nurses with auxiliaries care for patients who are the medical responsibility of the family doctor. Liaison schemes with general practitioners are developing when full attachment is not appropriate. Close contact is also maintained with hospitals in the area. Although a 24 hour service is not yet available, arrangements are made through voluntary associations to provide night nursing when urgently required. Organisation Requests for home nursing can be received at all times, including weekends, at City Hall. Direct contact between doctor and nurse is frequently possible at the surgeries or at the district nursing centres which are now situated at 117 Sutherland Avenue, W.9, 36 Great Smith Street, S.W.1, and the M. & C.H. Centres at 20B Lancefield Street, W.10 and the Council House Extension, Upper Montagu Street, W.1. Visits to patients are made between 8.30 a.m. and 5.30 p.m. with a late-call nurse working until 10 p.m. An early evening clinic for ambulant or working patients is held at 117 Sutherland Avenue. Training During the year eight state registered nurses and six state enrolled nurses qualified for the respective National Certificates in District Nursing. Half of that total were nurses from hospitals with integrated nurse training schemes who were not members of the City Council's staff. Further groups from the integrated courses started their district nurse training, to be completed during the next two years. Observation visits Three ward sisters, twelve diploma of nursing students and twenty four medical students from the Middlesex Hospital each spent a day observing the work of the district nurse. Fourteen pupil nurses from Westminster Hospital each spent two weeks working with the district nurses. Although the department continued to take student nurses for short periods of observation the numbers were decreased in 1971 due to an experimental implementation of the 1969 General Nursing Council syllabus. This recommended that all student nurses should have community experience as one of four options and by 1974 one of two options. Accordingly in 1971 it was agreed that small groups of student nurses from Westminster and Middlesex Hospitals should spend six weeks observing the community services; the first week of this period was spent with the district nurses. Nineteen girls came from the hospitals for this experience during the year and all expressed their great appreciation of the knowledge gained. (See further report, page 48). Courses One senior district nurse attended a first-line management course, two undertook the practical work instructors' course and three attended refresher courses. Several nurses attended study days. The organisations used for courses were the Queen's Institute of District Nursing, Chiswick Technical College and the London Boroughs Training Committee. Paediatric Home Care Unit A qualified district nurse works with the paediatric home care unit at St. Mary's Hospital, visiting sick children at home to help and advise on their nursing care. An increasing number of children are being discharged early from hospital into the care of the unit, and in a number of cases admission to hospital is avoided altogether. 48 Buckingham Palace Mews A district nurse, resident in the Royal Mews, provides nursing care for members of the staff. The cost is re-imbursed to the Council. District Nursing Association This voluntary association is active in providing amenities for patients and staff and administers various charities which benefit the sick and elderly in the area. A new departure has been the provision of television sets including installation and licence costs, with the patient paying a small weekly rental when possible. 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 and whose social conditions permit planned early discharge. Westminster Hospital provides the service on an agency basis for the City Council in the SW1 area, and discussions continued during 1971 with St. Mary's Hospital W2 to negotiate a similar arrangement with that hospital to cover the remainder of the City. It is hoped that a decision will be reached early in 1972. In addition to the home confinements, ante natal and post natal nursings, the midwives took 225 blood tests from babies for the Guthrie Test screening service to detect Phenylketonuria besides those taken routinely on babies discharged from hospital before their seventh day of life. Details relating to the number of domiciliary confinements and early discharges nursed in 1971 are set out in Table 38, Page 89. Training Nurses from the Middlesex Hospital again spent a day with the City Council's midwives as part of the obstetric training. AN EVALUATION OF THE SIX WEEK COMMUNITY TRAINING PROGRAMME FOR STUDENT NURSES Miss P. A. Slack, S.R.N., S.C.M., H.V. Cert., Dip. Health Education Area Nursing Officer General background Since 1948 the General Nursing Council Nurse Training syllabus has recommended that nurses should have some knowledge of the community service. Until 1971 this generally took the form of a lecture followed by a one day attachment to a Health Visitor and possibly a further lecture or discussion. The new 1969 syllabus has laid down that from January 1st 1971 all nurses should have an option of psychiatric nursing or geriatric nursing or obstetric nursing or community care. From January 1st 1975 they should have an option of psychiatric or geriatric nursing and aspects of community care or obstetric nursing. Originally the Community Care Option was a suggested 12 weeks that would lead to the National Certificate in District Nursing. This was, however, immediately reviewed by the Panel of Assessors in the training of District Nurses and the result was a suggested six weeks during which time they would get experience of the various services in the Community and only if the local authority were willing to provide a further four weeks in full-time district nursing would this then reduce the post certificate training by four weeks. 49 In January 1971 the G.N.C. circulated a directive covering, broadly, the aspects of community care of which the nurse should have experience. It was left to individual Training Schools and local authorities to come to amicable arrangements and plan their courses. No precise objectives were given, and it was not stated how the nurse is expected to use this experience. There is however a general feeling that, as undoubtedly patients will be discharged earlier from hospital, and with the coming of "Best Buy" hospitals, this experience will be useful. It will not of course qualify them to work in the community and whether in fact it will be taken into consideration by the other multiple bodies responsible for post-registration training, remains to be seen. The content of the Final Examination will not be changed before 1974. How community experience will be tested is not yet known and there appears to be no formal machinery for assessment other than comparisons of proposed programmes submitted by the individual training schools to the G.N.C. The City of Westminster is responsible for providing community experience for 3 large training hospitals in the area and early in 1971 discussions commenced between the hospitals and the local authority as to the form the training should take. A 6-week programme was agreed on. Each hospital would send 2-4 students at a time and students from all hospitals would commence their community experience at the same time. It was decided that services in the area surrounding each hospital should be used for the training of their own students and the Community Nursing Officers would undertake tutorials as far as possible. The first hospital started their students in June 1971 and the second in October 1971. The third hospital has not pursued the matter any further as yet, although an area has been allocated and arrangements can be made at any time. The programme has now been running for one year and this would seem an appropriate time to attempt to answer the following questions:— (a) How effective is the planned programme? (b) Has the extra burden on local authority staff altered the service to the community in any way? (c) How much does it cost the local authority to provide the training? In an attempt to answer the first question a Scheme of Internal and External Validation was drawn up. Plan (a) Each nurse at the commencement of her Community Care Programme will be asked to complete a personal questionnaire. (b) She will be given a copy of the Course Objectives and be expected to use them for reference throughout the programme. (c) She will be given a Personal Action Plan Book in which she should state at the end of each session how she feels it can be used in relation to her hospital work. At the end of each week a carbon copy of the Action Plans will be given to the Nursing Officer for use in discussion. They will then be attached to the students' Personal Questionnaire and filed. (d) At the end of her Nurse Training period she will be sent a short test paper which it is hoped she will complete and return. This will be added to her file. A personal Questionnaire is necessary to give some indication of the student's previous experience as the effectiveness of training will be influenced by the student's basic attitude, skill and knowledge patterns acquired from past experience. It is assumed that she should have a copy of the Course Objectives so that she can see clearly how in fact she is meant to apply her training to her job and what exactly she will ultimately be expected to do with the experience. The Action Plan Book will provide an incentive for her to think constantly about the application of the training and the objectives of the course. It will indicate to the Nursing Officer the student's understanding of each session and provide a basis for discussion geared to the needs of the individual student. It should also be a guide to the usefulness of particular sessions and possibly to the ability of the instructor or teacher involved with each session. 50 The test paper at the end of the training period should indicate whether in fact the course has been effective and the objectives achieved, i.e. if she can apply it to her job. Unfortunately it will not indicate whether she actually does apply it or not; this kind of testing is not feasible here. A study of 64 completed student files (1 year's students) should give some indication as to the stage of training at which community experience is most effective and what previous experience would seem most beneficial. The weakest areas of our programme should be highlighted and it should be possible to assess the influence of a good or poor impression of training e.g. a poor impression may sometimes act as a stimulus. Pre-testing of questionnaires and instructions is important to ensure that they are acceptable and understood before adopting them as a method of assessment. The final questionnaire was pre-tested, using the first group of students who took part in the course in 1971 as they could not be included in this study. Four completed the questionnaire in a group situation and eight by postal method. The former was the faster method but owing to the difficulty of making these arrangements it would be too difficult to adopt as a regular feature. The postal method was slower but, due to the efforts of the tutors, all questionnaires were returned. This pre-testing showed the need for some adjustments. Students were in some cases reluctant to complete test papers and it is felt that in future some assurance must be given that the test papers will in no way be used as part of their hospital assessment. Some of the wording was not understood and had to be altered. I am not entirely happy about the use of test papers as a means of long term evaluation since if sent by post they are not completed under examination conditions and it is doubtful whether if this method were used as a routine a sufficient proportion of the students would voluntarily return completed test papers. It would therefore be preferable if such an evaluation could form part of the State Final Examination. There are certain limitations in any scheme in that to be effective it must be simple to execute and interpret as well as acceptable to the tutors, staff and students, together with being practicable within the organisation structure. The Plan already outlined would seem at the moment to fulfil these requirements. Effect on the service Although the programme has been in action for one year I think it is still a little early to attempt to answer whether the service has been changed in any way. The novelty of having the student nurse may not as yet have worn off, producing a possible reaction. However, it is worth looking at the areas that may be affected and in what way this might happen. First, there is the effect on the client. This may vary according to the service they are receiving. Certain nursing procedures e.g. lifting, bathing, may be more comfortable for the patient because the District Nurse has help, whereas a client wishing to discuss a personal problem with the Health Visitor may be unwilling to take the opportunity to do so because of the presence of a stranger. The client may benefit by some overall improvement of procedure instituted as a result of direct feedback from the student who, after all, is an informed and often critical observer. There may in fact be an overall improvement in the service to the client, other than the inconvenience of having another stranger in their home. Secondly, there is the effect on the staff. The main complaint is the feeling of strain imposed by constantly having to explain one's actions, and in planning the work to fit in with the student's requirements. There is a general feeling that the work is considerably slowed; however, looking at the Health Visitors' returns which can be taken as a measure, it would seem that the actual number of home visits remains constant and in some cases is probably higher. This of course gives no indication of the quality of visiting, however it would seem inevitable that anyone demonstrating their work to an observer is forced, perhaps unconsciously, to look at their job more closely and to think about its efficiency, quality and usefulness, thereby automatically attempting to improve its standard. Finally there is the effect on the administrative staff. There is considerable strain and many are the headaches which result from the endless arranging and re-arranging of programmes, particularly where this involves asking help from other departments and outside services. The constant renewal of contacts and goodwill is essential and it is important here to consider at what level of management this is most useful to other aspects of the work and not alone to the student programmes. The first line manager in her day to day contact with other field disciplines would seem to be in a position to benefit most directly and in my view this is the level at which programme arrangements should be placed. 51 The students provide a good source of feedback as to the service, e.g. multiplicity of visiting has been highlighted where students have been to the same family with a number of different workers. They also provide a degree of in-service training for some of the staff in that they hear something of modern hospital techniques from the students. There is now a closer association with the hospital tutorial staff than previously and we are learning more about each others' functions through the medium of the students. Finally this provides a new opportunity for younger members of the staff to gain teaching experience, and for staff planners to assess potential ability in this field. The cost to the local authority Eight nurses attend each six-week course. The total cost of one course was calculated and divided by 8, giving the cost per student which is £30.21. Claims for reimbursement are being sent to the individual Hospitals on the basis of the fee of £10 per nurse per course as recommended by the General Nursing Council. Conclusion A scheme of evaluation has been set out in the following way: — (a) Personal Questionnaire (b) Objectives (c) Internal Validation (Action Plan Book) (d) External Validation (Test Paper) This has been instituted and should ultimately indicate (a) the optimum time for training, (b) the most desirable prior experience, (c) weakest areas of the programme, and (d) the effect of good or poor experience. Although perhaps too early to do more than discuss the possible effects on the service it would seem overall that the advantages may outweigh the disadvantages. Two important points do emerge. First, that programme arrangements are, properly, a task of first line management, providing contacts useful to them in other areas of their work. Secondly, that Field Staff acting as instructors should be thoroughly briefed as to the needs of the students and the necessity of planning ahead, particularly where a student is attached for one whole week. LOAN OF HOME NURSING EQUIPMENT The service provided by the city council under the scheme for the free loan of home nursing equipment continues to fulfil the needs of Westminster residents and to ease the burden of those who have the problem of nursing sick relatives at home. The provision of this equipment often enables the ailing to be nursed at home and thereby postpone or obviate hospital admission; also by the provision of essential nursing aids many patients are able to be discharged home from hospital earlier than would be possible otherwise. Items requested tend to follow the pattern of previous years. All requests are dealt with by the Supplies Section who are also responsible for the issuing of aids and equipment for the disabled and handicapped — a responsibility of the Social Services Department. This has resulted in a strong link of liaison between the two Departments. I should again like to express my gratitude to the British Red Cross Society (Westminster Division) for continuing their help in the distribution of smaller items of equipment. 52 The following items were issued during the year in addition to equipment already on loam:- Air rings 18 Fracture boards 42 Back rests 62 Hospital beds 17 Bed cradles 55 Penryn hoists 17 Bed pans 21 Quadrupeds 4 Bed tables 1 Ripple mattresses 17 Carri chairs 1 Toilet seat 1 Commodes 239 Tripods 15 Cot sided beds 3 Urine bottles 22 Dunlopillow matresses 2 Walking frames 109 Easi carri hoists 6 Wheelchairs 51 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 health 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; 93 adults were vaccinated in 1971 in addition to 38 at maternal and child health centres. Immunisation against poliomyelitis and tetanus is also provided for adults on request. The Chief Medical Officer to the Department of Health and Social Security in mid-1971 advised all Medical Officers of Health and General Practitioners of the conclusions reached by the Joint Committee on Vaccination and Immunisation on the subject of vaccination against smallpox and recommended that routine vaccination be discontinued. Accordingly smallpox vaccination is only provided on request for children who are going abroad and require an international certificate. The programme of rubella vaccination started in 1970 was continued in 1971 and extended to include all girls aged 11-13. Special sessions were arranged in senior schools and 647 girls were given protection. With the commencement of the academic year a campaign was launched in September 1971 to inform students entering universities and technical colleges of the dangers of tetanus, especially to those who in the course of their studies would be associating with machinery and materials. Some 30,000 explanatory letters were distributed to the students via the college authorities asking those interested to complete a form provided and to take it to their general practitioners or to send it to the Health Department where appropriate arrangements would be made. The response was extremely disappointing; only 500 students replied requesting vaccination. Special vaccination sessions were arranged at the respective colleges and in the event 186 of the 500 failed to attend. AN INVESTIGATION INTO WESTMINSTER IMMUNISATION STATISTICS Miss A. H. Kane, S.R.N., S.C.M., H.V.Cert., Dip. Sociology Area Nursing Officer In 1968 the average primary diphtheria immunisation course rate for England and Wales was 81%. For the London Boroughs as a whole it was 74%. For the City of Westminster alone it was 54%, the lowest rate for any area in England and Wales. The Medical Officer of Health requested that an investigation be made into why the immunisation rate was low, and to find methods by which it could be improved. The enquiry was carried out on the 1969 births since these were the statistics which were due to be published later this year. Investigations were carried out and the following facts emerged: — 1. For a hundred per cent Primary Diptheria Immunisation success rate the total number of children immunised in a given birth year must be equal to the total number of notified live births in that year. 53 In Westminster the number of notified completed Primary Diphtheria Immunisation courses (i.e. those notified by the local authority or general practitioner) for 1969 births were: In 1969 417 babies were immunised against Dip/Tet/W.C. 3 babies were immunised against Dip/Tet. In 1970 1154 babies were immunised against Dip/Tet/W.C. 23 babies were immunised against Dip/Tet. In 1971 128 babies were immunised against Dip/Tet/W.C. 17 babies were immunised against Dip/Tet. Therefore total Dip/Tet Immunisation figures for 1969 births = 1742 The live birth notifications in 1969 for Westminster totalled 2899 so the immunisation rate according to the Department of Health and Social Security's calculation would be: 1742 x 100 = 60% 2899 However the removals of 1969 births out of Westminster in 1969 were 460 more than the removals in during the same period (716 removals out + 45 deaths — 301 removals in = 460); therefore a truer reading would be based on a birth rate of 2439 which would be: 1742 x 100 = 71% 2439 Since the first injection is not given until six months of age or over and the second two months later, transfers of 1969 births in 1970 should also be taken into account. Here again the outward transfers exceeded inward transfers by 261 so the 71% could be under-estimated by 7% assuming that the outward transfers exceed the inward transfers at an average of 21 per month (261)/(12) and that immunisation is not completed until the child is nine months. An investigation was carried out in a Maternal and Child Health Centre situated in one of the poorer parts of the City. A complete breakdown of 1969 immunisation statistics was undertaken by using the immunisation records kept in the centre, taking into account the removals in and out of the centre which were checked with the Maternal and Child Health records at City Hall. The results of this enquiry showed the primary immunisation rate for the area to be 76%. Two other points emerged from this enquiry — (a) A Health Visitor at the centre who is attached to a general practitioner reported that out of 25 children born in 1969 at present on her area, all of whom had been given the primary immunisation course by the general practitioner, there are no Department of Health Immunisation Forms EC73 (forwarded via the Executive Council to local authorities showing completion of immunisations) for five of them. It is presumed they were lost while being forwarded to or returned from the Department of Health. (b) The EC73 is kept with the child's medical records until the other immunisations are completed. Thus if a child has completed his primary diphtheria course but fails other immunisations the form is not sent to the Department of Health. The above are examples of how other discrepancies can occur in the immunisation statistics. A third investigation was carried out at another maternal and child health centre, in an area where some of the families attend a doctor privately (i.e. not under the National Health Service). In this type of area the immunisation rate is very high but does not appear so on the Department of Health's returns as the doctors do not fill in E.C.73 forms for private patients. Thus the 1969 immunisation statistics for that area according to the returns will be as follows:— Number of children born in 1969 now in area — 141 Number of immunisation notifications of these — 103 54 Therefore percentage of children immunised according to the Department of Health and Social Security's statistics will be:— 103 x 100 = 73% 141 However, 34 other children were immunised privately and therefore no notifications of these will have been sent to the Department of Health, so the true immunisation figure for the area is:— (103+34) x 100 =97% 141 In another centre out of 74 immunised children born in the period 1st July 1969 to 30th June 1970, the health visitor reports that there are no EC73 forms for 24 children whose parents attend private doctors and therefore are presumably immunised by them. There are other centres in Westminster with similar areas to the two mentioned above, which again shows that the true immunisation figure is much higher than that given by the Department of Health. In September 1970 all health visitors in Westminster were asked to forward the number of children living in their area born between 1st July 1969 and 30th June 1970, and the number of these children who had completed their primary immunisation. In this survey 82% of the children were reported as immunised. The conclusions reached by these four surveys point to the fact that the true immunisation rate for the City of Westminster appears to be at least 20% higher than that given by the Department of Health. CRECHES Creches are held in 9 of the City's child health centres, 37 sessions each week catering for 210 children. In some of these the purpose is to mind children while their mothers attend clinics or classes. Many of the sessions however have a more positive role — they are designed as observation and treatment nurseries. Children who are understimulated at home or who for any other reasons are failing to make satisfactory progress are recommended for admission by doctors or health visitors. For children living under adverse environmental conditions this not only provides an opportunity for the expansion of social experience, but also gives them training in social and other skills which are essential before entering school. MOBILE HEALTH CLINIC The Health Department took delivery of the newly built Mobile Health Clinic in November 1971. Pending the recruitment of a driver/attendant in the new year, it was used for extra chiropody sessions when parked at the rear of Harrow Road Centre W.9. Discussions are currently being held on the first planned venues for clinic sessions; they are in the Maida Vale and Covent Garden/Drury Lane areas. Members of the Health Committee viewed the mobile clinic at City Hall at their meeting on 27th March 1972. 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, six 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. 55 No new nursing homes were registered during 1971. However, the demand for beds steadily increases and during the year work proceeded on the construction of two further private nursing homes which are expected to be opened in 1972 — one in adapted premises and the other in a purpose-built building. A Principal Medical Officer and a Public Health Inspector regularly visit the nursing homes to inspect the premises, check the service provided, and give advice on alterations and improvements. By this means all the nursing homes are maintained to the required standards. HEALTH EDUCATION The special Health Education project for 1971 was a Dental Health Campaign in all primary schools in Westminster. The plans for the campaign were fully endorsed by the Divisional Education Officer and Head Teachers at a meeting in the City Hall in November 1970 and the campaign was undertaken for five weeks from 1st March 1971. A team of Health Educators under the direction of the Principal School Dental Officer, visited every Primary School in the area to give illustrated talks to the children. The number of sessions undertaken and the personnel involved were: Sessions Principal School Dental Officer: 30 Dental Officers: 22 I.L.E.A. Dental Health Educator: 33 City Council Assistant for Health Education: 36 Oral Hygiene Service Educator: 5 School Nursing Staff: 14 Dental Clinic staff: 2 142 As a follow-up to the successful campaign, the Fruit Producers Council very kindly arranged for Pierre Picton, the clown, to visit all infant schools to talk to the 5-year-old children and distribute apples to them. The apples were given by Apples for Schools Ltd., and the entire campaign was very well received by approximately 8,000 children and their teachers. A total of 123 educational films were screened during the year in City Council establishments. New educational films and slides were obtained and screened in the City Hall for appropriate staff working in the southern part of Westminster and at Lisson Grove maternal and child health centre for those working in the northern part of the area. The new films and slides included: — Distributor A film on Swedish childbirth entitled "Barnet". Films dealing with child development entitled "Mother and Child", "Making Sense", "One Step at a Time", "Power of Speech" and "All in the Game". A film explaining the Mobile Screening Unit entitled "Put to the Test". Slides on Venereal Diseases, Family Planning and Smoking and Health. Foundation Film Library BBC Television Library Granada Television Film Library British Medical Association Visual Aids Centre Appropriate staff from the Social Services Department were invited to all the screenings. 56 The Department's visual aids were increased by the purchase of a Bell and Howell 651 TQ self-lacing film projector for use in the southern part of Westminster. All the visual aids in the Department were used to illustrate talks given by assistant nursing officers in hospitals, by health visitors in the child health clinics and by school nursing sisters to children and the Parent and Teachers Associations in schools and Colleges for Further Education. In addition public health inspectors addressed their talks to staff of catering establishments. Further talks followed by discussions were given by medical and dental officers, social workers and the assistant for health education. Topics included food hygiene, nutrition, home safety, ante-natal care and parentcraft, venereal diseases, general hygiene and dental health. ILLEGITIMACY The City Council has always been aware of its special responsibilities regarding the prevention of unwanted pregnancies and the care of the unmarried and unsupported mother. Family planning advice has been freely available to unmarried as well as married women and a special youth advisory service has been set up to offer not only help with psychosexual and family planning difficulties but also to assist in a wide variety of the other problems of teenagers. With the co-operation of the social services department this service was able to continue after April 1971, the doctor being provided by the health department and the two social workers from the social services department seconded for this work. For the care of the unmarried mother the health department had developed prior to 1971 a comprehensive service. In addition to the support given by health visitors and arrangements for ante-natal care, including an evening session, two social workers were allocated to this field and provided a comprehensive case work service not only during the ante-natal period but also in the difficult years after the birth of the baby. Unfortunately with the introduction of the social services department this specialised work had to be discontinued pending the formation of area teams. FAMILY PLANNING In February 1968, the City Council 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; 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 services 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. This arrangement is especially valuable to the public. It is a common practice of patients to choose a clinic not necessarily in their home area and this especially affects the City of Westminster since large numbers of young girls and women travel from the suburbs into the City to work and seek the anonymity of clinics in the area. At the end of the year 12 family planning sessions were being held weekly. In addition a youth advisory service with counselling as the main object is available at two centres; details of this service are set out in the next section. The City Council also gives financial assistance towards family planning clinics run at the Westminster and St. Mary's Hospitals and the Samaritan Hospital for Women. Payment by the Council is made in respect of services provided to Westminster residents who attend the hospital clinics and is in the form of a yearly grant or of sessional fees of the medical officer or nursing staff as appropriate. 57 A domiciliary family planning service has been in existence in the Paddington area of the City for many years. Experience showed however that it was difficult in practice for doctors and nurses adequately to carry out the necessary physical examination, fitting and instruction in the use of contraceptive appliances in the homes of the patients concerned, particularly as these were often members of problem families. Moreover, it was largely because of problems arising from their families and home conditions that they had difficulty in attending the clinic. As an alternative, therefore, arrangements were made for health visitors to visit these mothers to persuade them of the need for family planning and then to make such arrangements as might be necessary — for example, by the provision of baby sitters and transport to bring them to the appropriate clinic for family planning advice and service. This arrangement has worked extremely well and since its institution it has not been necessary in any case for the doctor and nurse to carry out the initial examination and instruction in the chosen method in the home. The need has therefore been established for a domiciliary service on the lines of these later arrangements and the time was considered ripe for an extension of this modified service over the rest of Westminster. The Health Committee agreed that an application should be made under the Urban Aid Programme — Fourth Phase— for an adequate amount to enable this to be done and the Department of Health and Social Security's approval was subsequently received. Youth Advisory Service In 1968 when the Health Committee were considering the family planning services to be provided under the National Health Service (Family Planning) Act, 1967, it was decided that a counselling service should be provided for young persons seeking family planning advice who would benefit from counselling, or who requested it. The Youth Advisory Service accordingly started in May 1968 with one evening session per week being held at the Hallfield clinic. The session is run by a medical practitioner who has specialised in counselling, adolescent problems and family relationships. A social worker assists the medical officer and undertakes follow-up work. A Health Department secretary acts as receptionist at the clinic sessions. The demand for the service led to a second session per week being started in 1969 in the consulting rooms of the medical practitioner situated near Baker Street. In April 1971 the social worker was transferred to the Social Services Department, as part of the general reorganisation of the social services at that time, but she continues to work in close association with the Health Services, assisting with the Youth Advisory Service. During 1971, because of increasing demand, a second social worker was allocated by the Director of Social Services for work with the Youth Advisory Service. The appointment of this additional social worker has enabled the service to be provided for more young people and to improve liaison with clubs and other agencies. At the present time there are some 300 young people currently making use of the service; attendances at the weekly session average 8-10 persons at the Hallfield clinic, and a similar number at the second clinic. A considerable amount of follow-up work has been found to be necessary because of the nature of the problems presented and the unhappiness and disturbance found in many of the young people. This service is an example of the close collaboration which exists between the departments in providing health/social services for Westminster residents. Vasectomy With the presentation of the National Health Service (Family Planning) Amendment Bill before Parliament early in 1972, it is of interest to note that payment for vasectomy was raised by my department with the Department of Health and Social Security in May 1970. The advice received from the Department was that vasectomy was only available under the National Health Service if it was necessary on clinical grounds and that local health authorities were not empowered to pay for vasectomy operations. The present Bill, if it reaches the statute book, will reverse this situation and its progress through Parliament is watched with interest. 58 VENEREAL DISEASES There are four special clinics for the treatment of sexually transmitted diseases in Westminster. All the clinics show an increase in attendances from the previous year and generally the increase has been in patients who attend for non-specific conditions. The special clinic at Westminster Hospital has been re-designed and modernised, sessions are now held each weekday afternoon and on Wednesday and Friday mornings. Resulting from this the annual attendances increased by 1,730 from the previous year. Six social workers provided by the City Council work in pairs at three of the four special clinics in the area. They trace contacts of confirmed cases and persuade them to attend for examination and possible treatment. In addition to their normal clinic duties, two of the social workers at St. Mary's Hospital, Praed St. W.2, are also responsible for tracing contacts notified by American Service bases in and around London; from abroad as forwarded through the Department of Health and Social Security and from local authorities outside London. During 1971 122 such notifications were received and 78 (64%) contacts were traced and brought to treatment. This remarkably high success rate is due to the astute work of the social workers concerned, particularly as some of the notifications have few relevant details of the contacts. All the social workers give help of a practical nature as well as casework support. Close liaison is maintained with other agencies. During 1971 5,552 patients attending special clinics were interviewed and 1,773 home visits undertaken. The City Council has since 1965 maintained a Public Enquiry Telephone Service (928 3401) which is manned day and night to provide information relating to venereal diseases to any enquirer. During 1971, 1,012 calls were received; 724 (71%) were requests for clinic information — details of addresses, times of sessions and directions; 252 (25%) were requests for literature on venereal diseases and 36 (4%) were calls from prospective bridegrooms for a 'check-up' before marriage. Apart from the telephone requests for literature, some 237 letters were received from persons requesting lists of clinics and other relevant literature. In response to this the City Council produced in leaflet form a notice giving details of all venereal disease clinics in the Greater London area. Owing to the frequent changes in session times at the London hospitals special clinics, a revised large notice is being produced for all the City Council public lavatories. Smaller notices on ceramic tiles, giving the address of the Medical Officer of Health and the V.D. telephone number, are continuing to be installed in all new or reconditioned W.C. cubicles in public lavatories in Westminster. This work is being phased over a three year period. Appropriate staff of the Health Department participated in a number of talks on venereal diseases at various outside establishments. The Medical Officer of Health, a Principal Medical Officer and the Assistant for Health Education participated in a BBC Radio London broadcast on this topic in February 1971. This was an "open ended" discussion lasting some 2½ hours in which members of the public were invited to telephone the studio and put questions to the panel. The programme aroused considerable interest. Some of the Health Department social workers also took part in television broadcasts on Independent and BBC Television during the year. (Table 40, page 90). RECUPERATIVE HOLIDAYS Arrangements are made under the City Council's scheme for adults who have been suffering from a recent illness, expectant mothers and mothers with babies or children under five years who cannot be left at home, to receive recuperative holidays, usually of a fortnight's duration. 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. 59 The total number of applications received during 1971 was 278 (276 in 1970) of which 175 received holidays. The remaining 103 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 scheme. The 175 holidays were arranged for:— 1971 1970 Expectant and nursing mothers 3 5 Tuberculous adults Nil 5 Other adults 76 65 Accompanied children 12 11 Unaccompanied children under 5 years .... 1 12 School children 83 78 175 176 Of the "other adults" 6 were psychiatric cases. Recipients of the holidays are accommodated in voluntary or private homes and in ordinary boarding houses. Homes for special types of patients, for example the more elderly, psychiatrics and mothers and babies, are extremely limited. It is possible however to arrange some holidays in a few homes normally used by hospitals for convalescent patients and this proved to be a great help in placing some of the more elderly patients. Generally the overall number of suitable homes remains the same but the increasing demands for places by all local authorities makes for greater difficulty each year in finding appropriate 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; not only do they benefit by rest, fresh air and good food but they can relax in congenial and happy surroundings. BLIND AND PARTIALLY SIGHTED PERSONS Services for registered blind and partially sighted persons are provided under the provisions of the National Assistance Act 1948 by the City Council's Social Services Department. On behalf of that department the Health Department during 1971 carried out 125 examinations (127 in 1970) of such persons in respect of certification under the Act. Of these 37 were new cases and 88 were re-examinations. In addition 44 (56) certificates were received from hospitals and other local authorities. CHIROPODY SERVICES 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. During 1971 the service was operated by a Chief Chiropodist, two Senior Chiropodists and eleven sessional chiropodists providing treatment in eleven centres in the City Council area, nine residential homes for the elderly situated both in the City and in outlying boroughs and at a convent in Paddington. In addition three private chiropodists provided treatments on a fee per treatment basis in their own surgeries, and on a similar financial arrangement, seven private chiropodists undertook treatments of housebound patients. During the year a directly run domiciliary service was introduced into the Paddington and Westminster areas and the full time chiropodists were giving up to 27 treatments each week at patients' homes. The City Council also has an amicable arrangement with the Chelsea School of Chiropody, Samford Street, N.W.8., whereby chiropody treatment is provided to approximately 25 patients each week, the patients being conveyed to and from the school by City Council Transport. The Medical Officer of Health would take the opportunity to express his appreciation of the assistance given by the Principal and his staff. 60 1971 saw the introduction of a monthly service to the elderly resident nuns at the Tyburn Convent and was a weekly session at Dora House, a home for the elderly run by a housing trust. An arrangement was entered into with the London Borough of Camden for the provision of foot appliances for patients to prescriptions prepared by the City Council chiropodists. The programme of re-equipping the clinics as necessary with modern equipment has continued, and in centres catering for the handicapped, the latest type of hydraulic chair has been installed for the patients. City Council transport is extensively used to convey suitable semi-ambulant persons to six centres for treatment, thus avoiding the necessity of using the domiciliary service and also giving the patients the opportunity of visiting the centre and mixing with other residents. At the end of the year a total of 54 sessions per week were being worked at centres, approximately 65 treatments were provided in chiropodists' own surgeries each week, and approximately 115 treatments were provided in the homes of patients each week. (Table 39, page 89). CERVICAL CYTOLOGY During the year cervical cytology was carried out at four Council clinics and also at four large department stores in the West End. All together 1665 new patients were examined and a further 511 repeat examinations were carried out making a total of 2176 — approximately the same number as in the previous year. The service is available to all women under the age of 65 living or working in the City of Westminster and in 1971 56% of the women attending were over 35. Positive smears were found in eight women whose ages ranged from 25 to 50 and four of those were under 35. A total of 618 women were referred to their general practitioners for treatment of various gynaecological conditions detected on clinical examination thus ensuring prompt investigation and treatment where necessary. The department is once again grateful to Dr Bate and his staff at the Samaritan Hospital for the assistance so generously given in undertaking Laboratory examinations. STAFF MEDICAL SERVICE A medical suite is provided in the Health Department, staffed by a doctor and a trained nurse. A staff medical service is available for all persons who work in the City Hall and the use made of the service increases yearly. The City Council has adopted a medical questionnaire system in lieu of a physical examination of new entrants. The number of new members of the staff in 1971 was greater than in the previous year. Correspondingly the number of applicants interviewed concerning their medical questionnaires also increased although the number of physical examinations carried out were slightly fewer. The number of members of staff attending for advice or first aid increased considerably during the year — out of a total of 1185 patients, 86 were referred to their own general practitioner or to hospital. One hundred and fifty persons were examined in connection with applications for exemption from parking meter charges. As parking areas extend to other parts of Westminster the number of applications for exemption on medical grounds increases. As part of the staff medical service medical examinations of drivers are carried out for suitability for heavy goods vehicles driving licences. The number of vaccinations and immunisations carried out increased considerably during the year. Statistics relating to the work undertaken in the medical suite during 1971 are set out in Table 41 page 91. 61 SOCIAL WORK (PERSONAL HEALTH) Miss I. J. McFarlane, M.A., Principal Social Worker Under the Local Authority Social Services Act, 1970, certain social work functions previously undertaken by the Health Department were transferred on 1st April 1971 to the newly formed Social Services Department. Notwithstanding these changes, some social workers remained in this section of the Health Department. The School Health Social Workers, the social workers responsible for tracing contacts of venereal disease and the social workers who work with elderly persons with special emphasis on health aspects, continue to work in the Health Department under the Principal Social Worker (Health Services). Much of the time of the Principal Social Worker was spent during 1971 in acting as a liaison officer between the two departments. In addition to the social work functions carried out by the above members of the Health Department staff, visits for assessment are often needed by members of the medical staff. Frequently, urgent case work help may be needed which cannot be provided by the Social Services Department. In the City of Westminster there are many voluntary bodies in which the Health Department has always had the closest co-operation. This important link is being maintained by the Principal Social Worker as also is the vital co-ordination between the school medical service and the education welfare service. In reviewing the work undertaken during 1971 the social workers in the Health Department comment on the increasing complexity of problems with which they deal. It is essential that they are kept up-to-date with social legislation and with relevant developments as they are often asked for general advice and information. In some cases they assist people to use the services to which they are entitled by right. In other cases, however, the people who ask for help are experiencing serious personal problems and in need of long-term support. During the year members of the staff attended various seminars and conferences and much benefit has been derived from the London Boroughs' Training Committee programme of activities. Requests have been received from Universities and Colleges for Further Education to take students for practical training periods of up to two months. In connection with the work at Special Investigation Clinics an interesting development took place during the year when regular weekly seminars were introduced, led by the Council's Psychiatrist. There are now six of these clinics, each of which is run by a team consisting of a medical officer and a social worker. These teams meet together for group discussion and are sometimes joined by colleagues from other departments, e.g. Educational Psychologists, Psychiatric Social Workers, Education Welfare Officers, etc. At these seminars much useful discussion takes place concerning the treatment of cases and ways in which the medical and social worker staff can develop the work. There has been an expansion in the number of these clinics and there is no doubt of their value. The numbers attending are deliberately kept small in order that adequate time may be allocated to each parent and child. Some children may later need the support of child guidance clinics whereas others may have temporary difficulties and they can be given support during a period of anxiety. Children attend for help in connection with enuresis and obesity and failure to make satisfactory physical and educational progress. A considerable number are referred because of emotional and minor behaviour problems. These conditions are often associated with disturbed home backgrounds and sometimes it is necessary for the social worker to provide help and support over a considerable period. The social worker co-operates with the medical officer in the treatment of the child's condition by working with the whole family towards the solution of the practical and emotional problems. It is found that families are often more constructively helped if referral is made at the earliest signs of breakdown and the importance of early detection of such families who are "at risk" cannot be over-emphasised. In 1971 there were 146 new referrals and 799 attendances were made at 232 sessions. There were 705 home visits and 58 interviews with clients at City Hall. It sometimes happens that the presenting problem at the time of referral may clear up after a comparatively short time but the social worker continues to be involved in case work with the family. The number of such cases at the end of the year was 46, and 464 home visits were made. There were 94 interviews with clients at City Hall. (These numbers include certain cases referred for specialised help which are not connected with Special Investigation Clinics.) 62 One of the members of the staff has a special responsibility for the needs of handicapped children and she has been able to develop this work during the year. It is felt very strongly that many parents need support in adjusting to the reality of having a handicapped child. The social worker was in touch with 11 families at the end of 1971, and made 80 home visits. There were 7 interviews with clients at City Hall. In connection with the social work undertaken for children who are deaf or partially hearing, the social worker concerned made 28 visits during the year to the child's home or school, in addition to her regular attendance at the audiology clinic. As with other types of handicaps it has been found that parents appreciate the interest that is taken in their children. The number of attendances at the local audiology clinic was 320. In all their duties the school health social workers co-operate very closely with the Education Welfare Officers and the voluntary school care workers, as well as with other statutory and voluntary agencies. There are three social workers concerned with the care of old people, many of whom are frail and housebound and require intensive supervision. They arrange for the visits of home helps and district nurses and ask for the assistance of public health inspectors in relation to tenants in unsatisfactory housing accommodation. They also arrange for the loan of nursing equipment where necessary. Special attention is given to old people who move into accommodation in the City so that all the relevant services are alerted in order to ensure that they settle down as easily as possible. Every effort is made to keep the old people in the community if this is their wish and every encouragement is given to them to make full use of the wide range of services available to them. With the increasing proportion of old people in the community, the importance of adequate social services for them cannot be too highly stressed. There is close co-operation with general practitioners and hospital staff and statutory agencies as well as with the City of Westminster Old People's Welfare Association and other voluntary organisations. In 1971 there were 315 new referrals; the case load at the end of the year was 697. There were 5776 home visits and 100 interviews in the office. Six social workers are employed at three hospitals which have special clinics for the treatment of venereal diseases. They trace contacts and follow up defaulters and persuade them to attend for examination and possible treatment. In difficult cases an endless amount of persuasion, health education, tact and perseverance is required. It is essential that a good relationship is formed with the patients who are frequently frightened and distressed and are suspicious of any efforts being made to help them. The social workers report that they have been dealing with an increasing variety of problems both from a practical and case work point of view. Help of a practical nature is given such as arranging accommodation, obtaining financial assistance and arranging referrals to appropriate agencies. Many patients do not feel able to discuss their difficulties outside the hospital setting and the Venereologist and/or the social worker is often the only person to whom the patient feels free to talk. During 1971 the social workers interviewed 5552 patients in the clinics and made 1773 home visits. CO-ORDINATION Since April, 1971, co-ordinating case conferences have been held in the same manner as in previous years, with the exception that the Chairman is now the Principal Social Services Officer (Social Services Department). The Secretary is still the Principal Social Worker in the Health Department and her duties include co-operation and co-ordination between the relevant statutory and voluntary agencies. During the year 31 case conferences were held at which 116 families were discussed. 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; 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 1971: 63 The usual arrangements have been made for sessions in schools to cover health surveys by school nurses and audiological sweep testing, school medical inspections, re-inspections and special medical examinations. Extra sessions have been arranged for medical examinations prior to school journeys and for immunisation as and when required. At most of the schools the accommodation for medical examinations is inadequate, and if the recent recommendations from the Department of Education & Science that the school entrant's examination should include complete neurological examination, performance tests and tests of special senses are to be properly carried out, it is vital that better arrangements should be made. In fact to overcome the difficulty in one school, arrangements are now made for the children to be taken to a child health centre next door. School Medical Officers Out of the total of 56 schools in Westminster, seven are attended by local general practitioners, fourteen by sessional medical officers and thirty-five by whole-time medical officers. Some difficulty is experienced in recruiting medical officers for school work. Only four general practitioners are now helping in this way. Most of them are too busy in their practices to undertake regular sessions. It is also becoming increasingly difficult to find suitable sessional medical officers and only four are undertaking school work on a regular basis. Fortunately one of them is a man and able to look after three senior boys' schools but he cannot undertake any more work. Handicapped children Five full time medical officers are approved to undertake the statutory examination of children thought to be educationally subnormal. During the year 32 examinations were arranged as a result of which 21 children were recommended for ESN schools. This represents a great reduction compared with 1970 and is due to the more flexible arrangements that can now be made for handicapped children to be admitted to special schools or to receive educational help in ordinary schools. A register is maintained of handicapped children of all ages. Of the 91 born in 1966, 16 were recommended for ESN schools (10 severe), 3 for hospital care and 6 for other types of special schools. The remaining 69 were all able to enter ordinary schools. A special follow-up is arranged for all handicapped children in ordinary schools. Visual Defects Special ophthalmic sessions are held in the north and south of the City. At the Western Ophthalmic Hospital a weekly session is held, staffed by four ophthalmologists from St Mary's Hospital with clerical assistance from the Health Department. At a treatment centre in Pimlico, where a session is also held once a week, it has proved to be extremely difficult to find a permanent ophthalmologist. The present consultant is employed by the South West Metropolitan Regional Hospital Board. Immunisation Parents are encouraged to have their children fully immunised before entering school but for a variety of reasons a number of school entrants have not been protected. Arrangements therefore have sometimes to be made to hold special sessions in the schools in order to get immunisation against diphtheria, tetanus, poliomyelitis and measles completed. In secondary schools rubella vaccination is offered to girls in their first and second year and BCG vaccination is offered to all children in their second and third year. Diathermy Diathermy clinics for the treatment of plantar warts are held twice a week and 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. During 1971 there were 111 new referrals and 783 attendances were made at 217 sessions. In addition there were 705 home visits and 58 interviews with clients at City Hall. (See also section "Social Work (Personal Health)", page 61). 64 Colleges for Further Education At the London College of Fashion a medical officer attended for 33 sessions, and examined 196 students. For other Colleges for Further Education arrangements are made for social workers to refer students about whom they are worried to the Principal Medical Officer at City Hall for examination and investigation. Arrangements are made each year for a medical examination of the students completing their training at Sidney Webb College. In the summer of 1971 nine sessions were arranged at which 126 students were seen. School milk When the Education (Milk) Bill was published there was an immediate public outcry. In consequence in June 1971 the Inner London Boroughs were asked to investigate the practicability under the Local Government (Financial Provisions) Act 1963 of paying for the continuation of supplies of milk to children in junior schools. Most of these boroughs ultimately arranged to provide the milk but the City of Westminster decided not to use this power. The Education (Milk) Bill was passed late in the summer term and received Royal Assent on 5th August 1971. The Provision of Milk and Meals (Amendment No. 2) Regulations 1971, made under the Act, were laid before Parliament on 25th August 1971 and came into effect on 1st September 1971. During the passage of the Bill through Parliament and in anticipation of approval, the Education Officer to the Inner London Education Authority sent a letter on 19th July 1971 to the Heads of junior schools with a request that they consult their school doctor about the likely number of pupils to be recommended on health grounds for free milk, and to make a provisional order for September deliveries. It was however much too late for such action to be taken. The school nurses in Westminster were therefore asked during the school holidays to examine the medical records and select, if possible in consultation with the Heads, those children who might require school milk. As a result of this, out of 7213 children on the roll, 1024 were identified, i.e. 14%. The proportion recommended varied between 100% in one school and 0% in eleven schools. During the first weeks of the autumn term the School Medical Officers were asked to examine those 1024 children and any others brought to their notice and to sign certificates for those who in their opinion required milk on health grounds. As there are no clear medical criteria on which this need could be assessed, the task was an extremely difficult one, especially in the case of new entrants and where the school health staff and Educational Welfare Officers were new to the area. They must be congratulated on the way in which they coped with an unwelcome duty, especially against a background of intense political activity. Thirty school medical sessions had to be entirely devoted to this task. There was a consequent disruption of the school health programme and routine and special examinations had to be postponed. Certificates were ultimately signed in respect of 713 children. This represents 10% of the school roll which was in line with what the Department of Education & Science anticipated. Statistics relating to the School Health Service are set out in Tables 43-49, pages 93-97. DENTAL SERVICE D. K. Hardy L.D.S., R.C.S.(Eng). Chief Dental Officer and Principal School Dental Officer During 1971 there was a slight change in our attitude to the dental needs of children in schools within the City of Westminster. The foundation for this change was laid in 1970 with a meeting of head teachers at City Hall who endorsed the idea that Dental Health Education should be brought into the schools. The reason for launching such a plan was that there seemed to be no diminution of the caries problem and it was felt that a campaign to get the co-operation of the children in cleaning their teeth was essential. The campaign was planned to take teams of trained personnel into the classrooms of all the infant and junior schools. The children in such schools were then assembled to see films, either "Johnnie and the D.K. Robot" or "No Toothache for Eskimos" or both. The theme of the campaign was "if you must eat a sweet — why not an apple" and to this end we were able to distribute boxes of apples kindly supplied free. The schools were also provided with posters and leaflets. 65 The campaign took place in March 1971 and lasted five weeks. A team of 14 speakers consisting of 5 Dental Officers, 1 Health Education Assistant, 1 I.L.E.A. Dental Health Educator, 1 Oral Hygiene Service Health Educator, 1 Dental Surgery Assistant and 5 Health Visitors took part, giving the equivalent of 142 Dental Health Education Sessions. A follow-up campaign lasting one week was undertaken at the end of May 1971 when Pierre Picton, the well-known clown, visited primary schools in Westminster and distributed apples and posters obtained through the auspices of the Apple and Pear Council. I must place on record my appreciation of the wholehearted co-operation of all the Head Teachers and other members of the schools who participated in these campaigns. There will be no dramatic improvement in the dental health of the children from these campaigns but it is hoped in the long term these efforts will bear fruit. This year saw the implementation of a new grade on the dental staff, namely, a Dental Auxiliary. These are personnel trained at New Cross Dental Auxiliary School on a two-year course. Their work is limited to children and certain items of treatment but one of their greatest uses is in dental health education. This is reflected in the number of dental health education sessions undertaken by the dental staff, namely 94 sessions. Despite the inevitable shortage of dental surgery assistants referred to in previous Annual Reports due to a great extent to the low salary scale, the Dental Officers and Auxialiary have made a remarkable achievement of higher numbers of sessions, the total sessions being just short of the 2000 mark. It is disappointing to see that the percentage requiring treatment from school inspections is still high and, in fact, slightly higher than in 1970. Fluoridation of the water supply could do a lot to alleviate this problem. The City's School Dental Service was able to inspect just over 55% of the school population. Expansion of the service is still required but is made very difficult by our inability to recruit Dental Surgery Assistants. The Dental Officers must be congratulated for maintaining the service despite staffing difficulties. The expectant and nursing mothers' service shows a decrease in the numbers of first inspections and first visits for treatment. I do not feel this need cause concern since there is an excellent service provided by the General Dental Service which is free to the expectant and nursing mother. The general anaesthetic sessions show a very marked reduction which is due to the efforts of the Dental Officers to carry out many operations under local anaesthesia and, with the accent on preservation, more teeth are retained. I wish to thank the Dental Officers, Dental Auxiliary and Dental Surgery Assistants for their efforts in maintaining a first class dental service and to all who have assisted in any way. 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 50 and 51 on pages 99 and 100. 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 1971. 66 Paddington Chest Clinic — Dr. P. A. Zorab, Consultant Physician Chest disorders in the Paddington area continued at a high level in 1971, in particular, lung cancer proved to be an increasing anxiety. As the danger of smoking becomes more widely accepted, it is hoped that the anti-smoking advice given to patients at this clinic will be generally accepted. Research projects and teaching continue to be important but subsidiary to the main function of the clinic, which is patient care. Close contact with local practitioners is maintained and there was a large attendance of practitioners at the Clinical Meeting here on "Lung Cancer". Paddington After-Care Committee were most successful in their fund-raising efforts and were able to help a number of our patients. In addition, the old-age pensioner patients were given a first-class Christmas Party in the home of one of the Committee members. St. Marylebone Chest Clinic — Dr. G. Shneerson, Consultant Physician The past year has seen an appreciable drop in the number of newly notified cases of tuberculosis as compared with the previous three years. The number of deaths from lung cancer has continued to increase. The diagnostic facilities remain unchanged. Westminster Hospital Chest Clinic — Dr. P. A. Emerson, Consultant Physician The total number of patients attending the Clinic in 1971 remained the same as the previous year and the number of newly diagnosed cases of tuberculosis decreased considerably compared with 1970. Only sixteen new cases of tuberculosis were notified; 9 were males and 7 females. Of the tuberculous patients referred to the Clinic, three were sent by their general practitioners, nine were discovered by the South West London Chest X-ray Service and the remainder were notified by various hospitals and mass X-ray units. The research project studying the effects of atmospheric conditions and air pollution on the condition of patients with bronchitis and asthma living in Westminster has been completed. The effects of changes in the atmospheric condition has proved much less than was expected — probably because the levels of atmospheric pollution have fallen since the introduction of the Clear Air Act. Statistics relating to notifications of tuberculosis in Westminster, and deaths, during 1971 are set out in Table 4, page 72, 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 52, page 101. 67 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 Act 1961 (as amended) in connection with Houses in Multiple Occupation. 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 Health Centres. 30 Clinic services — ante-natal and post-natal clinics. 31 Mothercraft and ante-natal exercises. 32 Family Planning. 33 Child Health Centres. 34 Handicap Register. 35 Health Visiting. 36 Vaccination of persons under age 16 completed during 1971 at Maternal and Child Health Centres and by general practitioners. 37 Home Nursing. 38 Domiciliary Midwifery. 39 Chiropody service. 40 Venereal diseases — cases treated in Westminster during 1971. 41 Medical suite at City Hall — work undertaken, 1971. 42 Tuberculin test and B.C.G. vaccination of school-children and students. 43 School Health service — full-time equivalent employees. 44 School medical inspections, 1971. 45 Routine medical inspections in schools, 1971 — defects found. 46 School health service — findings at health surveys, 1971. 47 School health service — non-routine medical inspections, 1971. 48 School health service — routine medical inspections, vision — 1971. 49 School health service — comparison of defects noted at 7-plus routine and 7-plus special medical inspections, 1971. 50 School dental service statistics, 1971. 51 Dental services for expectant and nursing mothers and children under 5. 52 Tuberculosis — care and after-care — work at Chest Clinics in Westminster. 69 Table 1. — DEATHS — According to Age-Group and Sex CAUSE OF DEATH 1970 1971 Net Deaths at the sub-joined ages of residents (Male and Female) whether occuring within or without the City Totals All Ages All Ages Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards M F M F M F M F M F M F M F M F Enteritis and other diarrhoeal diseases 2 2 — 1 — — — — — — — — — 1 — — — Tuberculosis of respiratory system 10 12 2 — — — — — — — — 2 — 7 1 3 1 Other tuberculosis, including late effects 7 — — — — — — — — — — — — — — — — Malaria — 1 1 — — — — — — — 1 1 — — — — — Syphilis and its sequelae 2 — 3 — — — — — — — — — — — 1 — 2 Other infective and parasitic diseases 4 2 3 — — — — — — — 1 — — 1 1 1 1 Malignant neoplasm, buccal cavity etc. 9 6 7 — — — — — — — — 1 — 5 3 — 4 Malignant neoplasm, oesophagus 19 13 4 — — — — — — — — 2 — 7 1 4 3 Malignant neoplasm, stomach 54 27 24 — — — — — — — — — 1 10 4 17 19 Malignant neoplasm, intestine 79 33 36 — — — — — — — — — — 15 10 18 26 Malignant neoplasm, larynx 7 — 2 — — — — — — — — — — — 1 — 1 Malignant neoplasm, lung, bronchus 203 151 44 — — — — — — — — 5 1 68 21 78 22 Malignant neoplasm, breast 68 1 68 — — — — — — — — — 6 — 3/ 1 25 Malignant neoplasm, uterus 23 — 36 —- — — — — — — — — 1 — 18 — 17 Malignant neoplasm, prostate 21 15 — — — — — — — — — — — — — 15 — Leukæmia 23 10 12 —— — 1 — — 2 1 — 1 — 4 2 3 8 Other malignant neoplasms 206 98 98 —- — — — 1 1 — 1 12 5 34 34 51 57 Benign and unspecified neoplasms 7 3 — —- — — — — — — — 1 — 1 — 1 — Diabetes melitus 23 8 3 — — — — — — — — — — 1 1 7 2 Avitaminoses, etc. 1 2 2 — — — — — — — — — — 1 — 1 2 Other endocrine etc. diseases 12 4 6 —— 1 — — — — — — 1 1 3 — — 4 Anaemias 11 1 1 — — — — — — — — 1 — — — — 1 Other diseases of blood, etc. 2 2 2 —— 1 — — — — 1 — — — — 1 1 — Mental disorders 7 11 5 — — — — — — 2 — — 1 4 1 2 3 Meningitis 1 2 2 —- 1 — — — — — — 1 — 1 — — 1 Multiple sclerosis 5 — 5 —— — — — — — — — — — — 5 — — Other diseases of nervous system 22 16 9 1 — — — — — 2 1 2 3 2 9 5 Chrohic rheumatic heart disease 60 21 20 — — — — — — 1 2 — 3 8 2 10 13 Hypertensive disease 57 19 18 — — — — — — — — 1 — 10 1 8 17 Ischæmic heart disease 638 401 270 — — — — — — — — 8 2 159 33 234 235 Other forms of heart disease 110 45 78 —- — 1 — — — 1 — 4 2 10 4 29 72 Cerebrovascular disease 267 106 169 —- — — — — 1 — — 5 2 24 29 77 137 Other diseases of circulatory system 115 60 70 — — — — — — — — 4 — 16 6 40 64 Influenza 8 2 1 —— — — — — — — — — 1 — — 2 — Pneumonia 206 84 125 2 1 — — — — 1 — — 1 13 10 68 113 Bronchitis and emphysema 103 93 33 — 1 — — — — — — 1 — 20 3 72 29 Asthma 8 5 5 — — — — — — — 1 2 — 1 — 2 4 Other disease of respiratory system 27 13 15 1 1 — — — — — — — — 3 4 9 10 Peptic ulcer 20 18 11 — — — — — — — — 2 — 6 1 10 10 Appendicitis — 1 — — — — — — — — — — — — — — — Intestinal obstruction and hernia 14 5 12 1 — — — — — — — — — 2 1 2 11 Cirrhosis of liver 12 16 11 — — — — — — — — 3 1 9 6 4 4 Other disease of digestive system 30 10 19 — — — — — — — — 2 2 4 3 4 14 Nephritis and nephrosis 18 7 10 — — — — — — — — 3 1 1 1 3 8 Hyperplasia of prostate 1 4 — — — — — — — — — — — — — 4 — Other diseases, genito-urinary system 22 10 10 1 — — — — — — — 2 — 1 1 6 9 Abortion — — — — — — — — — — — — — — — — — Diseases of skin, subcutaneous tissue — 2 1 — — — — — — — — — — — — 2 1 Diseases of musculo-skeletal system 13 4 9 — — — — — — 1 1 — 1 — 2 3 5 Congenital anomalies 13 18 8 3 2 3 1 3 2 4 — — 1 2 1 3 1 Birth injury, difficult labour, etc. 23 5 4 5 4 — — — — — — — — — — — — Other causes of perinatal mortality 16 5 1 5 1 — — — — — — — — — — — — Symptoms and ill defined conditions 10 4 5 1 1 — — — — 1 — — — — — 2 4 Motor vehicle accidents 36 14 13 — — — — — — 5 — 1 2 4 4 4 7 All other accidents 58 29 35 — — — — 1 1 4 2 7 4 11 12 6 16 Suicide and self-inflicted injuries 69 22 23 — — — — — — 5 4 5 6 9 7 3 6 All other external causes 24 18 9 — — 1 — — — 6 3 5 3 3 3 3 — 1,461 1,361 21 14 6 1 5 7 35 16 90 51 482 278 822 994 Totals 2,822 35 7 12 51 141 760 1,816 1970 2,806 — 58 9 10 40 125 718 1,846 70 Table 2 — Infant Mortality — 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 Prematurity and allied causes 8 4 — — — — — — — — — — 8 4 Birth injury 2 — — — — — — — — — — — 2 — Rhesus incompatibility — 1 — — — — — — — — — — — 1 Congenital malformations: Heart & Great vessels 1 2 1 — — — 1 1 — — — — 3 3 Bilary artesia — — — — — — 1 — — — — — 1 Adreno-genital — syndrome — — — — — — — 1 — — — — — 1 Multiple 1 — — — — — — — — — — — 1 — Sudden death in infancy — — — — 2 1 — — — — — — 2 1 Bronchitis and pneumonia — — 1 — 1 1 — 1 — — 1 — 3 2 Meningitis — — — 1 — — — — — — — — — 1 Gastro-enteritis — — — — 1 — — — — — — — 1 — Epiglottitis — — — — — — — 1 — — — — — 1 Totals - (1970 in brackets) 12 7 2 1 4 2 2 4 — — 1 — 21 14 19 3 6 6 1 35 (40) (4) (7) (5) (1) (1) (58) Number of deaths of illegitimate infants included in above 6 — 2 1 — — 9 (9) (1) (1) (1) (1) (—) (13) 71 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 90 100 13 12 6 13 — — — — 2 — 1 — — — — — Final numbers after correction Under 1 year 7 4 — — — — — — — — — — — — — — — — 1 year 10 13 1 — — — — — — — — — — — — — — — 2 years 8 9 4 — — — — — — — — — 1 — — — — — 3 „ 17 7 2 1 — — — — — — — — — — — — — — 4 ,, 12 22 — — — 1 — — — — — — — — — — — — 5-9 „ 30 37 — 4 4 7 — — — — — — — — — — — — 10-14 ,, 3 2 — — 1 4 — — — — — — — — — — — — 15-24 „ 3 1 4 2 1 1 — — — — — — — — — — — — 25 & over — 3 2 4 — — — — — — 2 — — — — — — — Age unknown — 2 — — — — — — — — — — — — — — — — Total (All ages) 90 100 13 1 1 6 13 — — — — 2 — 1 — — — — — 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: — Infective Post infectious M F M F M F M F M F M F M F — — — — 1 — — 1 4 3 14 32 6 6 Final numbers after correction Under 5 years — — — — — — — — — 1 3 4 — 1 1971 485 1970 703 5—14 years — — — — — — — 1 2 1 1 — — 2 15-44 „ — — — — 1 — — — 2 — 5 12 3 3 45-64 „ — — — — — — — — — 1 1 2 3 — 65 and over — — — — — — — — — — — — — — Age unknown — — — — — — — — — — — — — — Total (all ages) — — — — 1 — — 1 4 3 10 18 6 6 Cases of Smallpox, Anthrax, Ophthalmia neonatorum, Yellow fever, Plague, Cholera, Typhus fever, Relapsing fever and any other disease notifiable 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 Opthalmia neonatorum Yellow fever — — — — — — — — — — — — — — — — Numbers originally notified Tetanus Infective Jaundice Tuberculosis Whooping cough Respiratory Meninges & C.N.S. Other Cases of fatal tuberculosis not notified before death Numbers originally notified TotaI (All Ages) M F M F M F M F M F M F Total (All Ages) — — 31 19 73 27 - - 8 9 7 7 Final numbers after correction Under 1 year — — — — — — — — — — Males F emales Final numbers after correction Under 3 months — — 8 — 1 —year — — — — — — — — — — 3 months — — 2— 4 years — — 1 1 — 1 — — — — 6 „ — — 5- 9 „ — — 2 3 — — — — 1 — 9 ,, — — 10-14 „ — — 2 2 — — — — — — 1 year 1 — 15-19 „ — — 2 1 3 1 — — 2 1 2—4 years 3 3 20-24 ,, — — 11 8 4 7 — — 1 2 5-9 „ 3 4 25-34 ,, — — 8 — 13 6 — — 2 4 10-14 „ — — 35-44 „ — — 2 2 12 5 — — 2 — 15-19 ,, — — 45-54 „ — — 2 2 12 5 — — — 1 20-24 ,, — — 55-64 „ — — — — 15 2 — — — 1 25-34 ., — — 65-74 ,, — — 1 — 9 — — — — — 35-44 „ — — 75 and over — — — — 4 — — — — — 45-54 ,, — — Age unknown — — — — 1 — — — — — 55-64 ,, 65-74 „ — — Total (all ages) — — 31 19 73 27 — — 8 9 7 5 and over — — Age unknown — — Total (All Ages) 7 7 72 Table 4.—Tuberculosis: New Cases and Deaths At ages- +NEWCASES DEATHS Pulmonary NonPulmonary Pulmonary NonPulmonary years M F M F M F M F 0-1 — — — — — — — — 1-5 — 1 — — — — — — 5-15 — — 1 — — — — — 15-25 7 8 3 3 — — — — 25 -35 13 6 2 4 — — — — 35 - 45 13 5 2 — 2 — — — 45 -55 15 5 — 1 3 1 — — 55-65 16 2 — 1 4 — — — 65 and upwards 16 — — — 3 1 — — Age unknown 1 — — — — — — — Totals 1971 81 27 8 9 12 2 — — 1970 105 37 16 5 9 1 5 2 †lncluding 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 Ex—Specimens Submitted to the Public Health Laboratory Nature of Specimen Number Examined Positive Findings Nasal, throat and hand swabs 72 Hæmolytic Streptococci 19 Staphylococcus Aureus 2 Candida Albicans 3 Vincents Organisms 1 Faeces 557 Shigella Sonnei 36 Salmonella typhimurium 30 Salmonella Blockley 1 Salmonella Reading 7 Salmonella Indiana 3 Salmonella Bredeney 4 Salmonella Senftenberg 1 Salmonella Stanley 3 Salmonella Hadar 1 Salmonella St. Paul 1 Salmonella Heidelberg 4 Salmonella Johannesburg 1 Salmonella typhi 11 Clostridium Welchii 24 E. Coli 026 1 Giardia Intestinalis 1 Urine 58 Total 687 (The total number of specimens examined during 1970 was 1,093) 73 Table 6.—Night and out of office hours emergency service—Analysis of calls made to Duty Officers Month 1971 Social Services Departments Health Departments Miscellaneous Total Mental Health Child Care Welfare Public Health Inspectors Midwives District Nurses *W K W K W K W K W K W K W K W K January 209 105 138 31 31 6 46 4 18 22 273 2 127 11 842 181 February 255 126 85 21 30 3 30 1 18 31 242 3 90 10 750 195 March 255 149 97 42 21 2 50 1 17 32 242 1 114 9 796 236 April 241 128 138 44 47 10 26 1 20 7 255 — 146 11 873 201 May 281 137 112 42 35 5 47 1 26 15 276 1 149 11 926 212 June 199 137 106 28 34 1 32 1 19 19 252 — 100 8 742 194 July 261 90 120 48 47 4 59 5 17 7 347 1 176 27 1,027 182 August 262 37 135 41 43 2 59 5 19 16 400 1 228 8 1,146 110 September 203 33 131 24 38 3 43 1 21 17 342 3 171 7 949 88 October 257 48 135 26 38 3 51 2 30 10 415 1 199 6 1,125 96 November 230 88 101 28 29 13 50 3 28 28 389 — 118 12 945 172 December 177 154 86 34 21 6 24 2 21 28 380 2 164 22 873 248 Total - 1971 2,830 1,232 1,384 409 414 58 517 27 254 232 3,813 15 1,782 142 10,994 2,115 1970 2,697 1,521 1,166 295 256 45 531 41 370 225 3,130 20 1,634 127 9,784 2,274 * "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 1971 1970 Complaints 2,784 2,812 Routine 737 604 Smoke Control 200 112 Infectious Disease 499 305 Underground Rooms 127 165 Application for Grants and Loans 303 190 Housing circumstances 938 1,342 Drainage 2,797 964 Rodent Control 216 468 Miscellaneous 658 355 Table 8.—Dwelling Houses—Nuisances and unsatisfactory conditions found anti remedied 1971 1970 Houses, damp, dirty or dilapidated 215 270 Doors, windows, floors, ceilings, firegrates defective 1,051 860 Insufficient or unsuitable W.C. accommodation 36 13 Drains, W.C.S and waste pipe stoppages 117 189 Drains, W.C.s and waste pipe defective 225 275 Yard, area and washhouse defects 12 32 Roofs, gutters and rainwater pipes defective 291 278 Water supplies absent or insufficient 6 7 Water cisterns dirty or defective 19 27 Ashpits, dustbins, etc., insufficient or defective 47 56 Rubbish accumulations 169 200 Animal nuisances 16 10 Miscellaneous 379 396 74 Table 9.—Summary of visits by public health inspectors 1971 1970 Clean Air Act 1,805 1,759 Drainage and New Developments 12,631 12,051 Dwelling Houses (general matters) 13,431 17,212 Factories (other than building sites) 139 486 Food and Catering Premises 13,201 11,723 Hairdressers' Establishments 62 69 Infectious Disease 1,164 878 Noise 862 828 Offices 1,153 535 Pigeons 37 44 Rodent Control 770 1,417 Shops 633 556 Smoke observations 461 371 Town Planning 11 20 Vermin investigations 331 658 Other purposes 1,604 1,197 Table 10.—Statutory Notices Served 1971 1970 Public Health Acts, 1936 and 1961 476 498 Public Health (Recurring Nuisances) Act 1969 2 — Clean Air Act, 1956 7 15 Greater London Council Drainage Bylaws 2 6 Greater London Council Water Closet Bylaws 2 5 Greater London Council (General Powers) Act 1967 2 3 Factories Act, 1961 — — Noise Abatement Act, 1960 3 7 Prevention of Damage by Pests Act, 1949 13 2 Local Bylaws: Artificial Lighting of Common Staircases 11 6 Cleansing of Cisterns 1 — Bylaw No. 11 of the Westminster City Council with respect to Good Rule and Government 1 1 Table 11.—Summary of visits by Housing Act Inspectors 1971 1970 Work in connection with the Housing Acts 1961 - 1969 495* 442* Clearance and development area surveys 1965* 2710* Tenement dwellings survey 97 — Grant, subsidy and loan applications 663* 325* Hotel inspections 314 333 * Includes action taken in connection with North Westminster Project 75 Table 12.—Summary of work carried out by Public Health Inspectors under the Housing Act 1961 (as amended) in connection with Houses in Multiple Occupation 1971 1970 Management Orders made (Section 12) 2 6 Management Orders revoked 3 — Notices served for contraventions of Management Regulations (Section 14) 2 4 Notices under Section 14 complied with 1 2 Informal notices served (Section 14) 6 2 Informal notices under Section 14 complied with 2 2 Notices served for the provision of amenities (Section 15) 4 1 Notices under Section 15 complied with 1 4 Informal notices served (Section 15) 30 24 Informal notices under Section 15 complied with 4 14 Directions given (Section 19) 10 15 Directions varied 8 10 Directions revoked 12 5 Table 13.—Unfit Premises 1971 1970 Closing orders made on underground rooms 33 (84 rooms) 25 (66 rooms) Closing orders made on upper parts of buildings and mews premises 20 (63 rooms) 12 (93 rooms) Closing orders made on houses in lieu of demolition orders 1 (12 rooms) 2 (22 rooms) Closing orders on underground rooms determined when work carried out 29 (88 rooms) 23 (73 rooms) Closing orders on upper parts and mews premises determined when work carried out 1 (5 rooms) 7 (19 rooms) Table 14.—Housing Act 1969: Qualification Certificates Improvement cases: 1971 1970 Applications for qualification certificates under Section 44(2) under consideration at end of period 59 52 Certificates of provisional approval issued 90 56 Qualification certificates issued under Section 46(3) 14 Nil Standard amenities already provided: Applications for qualification certificates under Section 44(1) under consideration at end of period 226 141 Qualification certificates issued under Section 45(2) 253 446 Exemption for low-income tenants from Section 54: Certificates issued under Section 55 10 Nil 76 Table 15.—Rodent Control Complaints: 1971 1970 Complaints of rats received 449 517 Complaints of mice received 2,815 2,193 Total premises involved 3,264 2,710 Infestations treated by Council's staff: (Including properties inspected for reasons other than notification) Premises rid of rats 451 527 Premises rid of mice 2,802 2,195 Total premises disinfested 3,253 2,722 Inspections by Public Health Inspectors and visits by Rodent Officers to such places 3,782 3,613 Notices: Intimation notices served — — Statutory notices served 13 2 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 0.027 0.029 Albuminoid Nitrogen 0.064 0.084 Nitrate Nitrogen 6.3 6.1 Oxygen abs. from KMn02 4 hrs. at 27°C 0.61 1.04 Hardness (total) CaC03 304 281 Hardness (non-carbonate) CaC03 85 90 Magnesium as Mg 5 5 Sodium as Na 30.3 23.5 Potassium as K 5.2 5.1 Chloride as CI 42 34 Phosphate as PO4 1.9 2.3 Silicate as SiO2 9 10 Sulphate as SO4 62 64 Natural Fluoride as F 0.20 0.15 Surface-active material as Manoxal OT 0.02 0.02 Turbidity units 0.1 0.1 Colour (Burgess units) 9 13 pH value 75 7.8 Electrical Conductivity (microhms) 630 580 77 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 100 ml. Stoke Newington 258 23.2 — 100.0 100.0 R. Thames-derived 3,901 8.4 — 99.51 99.97 Table 18.—Offices, Shops and Railway Premises Act, 1963 Number Registered in 1971 Total number Registered at 31st December, 1971 Number of Registered Premises receiving a General Inspection during the year Offices 556 12,236 1,881 Retail Shops 164 3,733 861 Wholesale Shops, Warehouses 25 811 33 Catering Establishments open to the Public (including canteens) 38 1,450 458 Fuel Storage Depots — — — Totals 783 18,230 3,233 Analysis of persons employed in Registered Premises by workplace Offices 288,071 Retail Shops 40,040 Wholesale Departments, Warehouses 18,616 Catering Establishments open to the Public 21,593 Canteens 5,875 Fuel Storage Depots — Total 374,195 Total Males 206,617 Total Females 167,578 Inspections and Contraventions Inspections of all kinds 7,799 Premises at which contraventions were found 1,450 Accidents Notifiable accidents 467 Accidents investigated 163 Accidents investigated which revealed contraventions 11 Accidents where a contravention may have been a contributory cause 6 Fatalities — 78 Table 19.—Factories: Inspection for purposes of provisions as to health Number on Register Number of Inspections Written notices Occupiers prosecuted Factories Act 1961 1971 1970 1971 1970 1971 1970 1971 1970 (i) Factories in which Sections 1,2,3, 4, and 6, are enforced by the Local Authority 725 725 89 101 1 3 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2,591 2,612 132 385 9 21 — — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 971 1,556 1,101 1,727 — — — — Total 4,287 4,893 1,322 2,213 10 24 — — Table 20.—Factories: Defects Found Number of cases in which defects were found Number of cases in which prosecutions were instituted Remedied Referred to H.M. Inspector By H.M. Inspector Factories Act 1961 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 Want of cleanliness (S.1.) 8 9 5 6 — 2 3 4 — — Overcrowding (S.2.) — — — — — — — — — — Unreasonable temperature (S.3.) 3 — 2 — — — — — — — Inadequate ventilation (S.4.) 2 7 2 6 — — — 2 — — Ineffective drainage of floors (S.6.) — — — — — — — — — — Sanitary Conveniences (S.7.) (a) Insufficient 5 3 3 1 — — 2 — — — (b) Unsuitable or defective 22 37 19 35 — — — 1 — — (c) Not separate for sexes 5 2 5 2 — — 1 2 — — Other offences against the Act (not including offences relating to Out-work) 10 14 9 9 — 1 — 1 — — Total 55 72 45 59 — 3 6 10 — — 79 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 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 1971 1970 Wearing apparel—making, etc. 1,306 1,372 — — — — — — — — — — Household linen 4 1 — — — — — — — — — — Curtains and furniture hangings 15 8 — — — — — — — — — — Furniture and upholstery 1 1 — — — — — — — — — — Lampshades — 5 — — — — — — — — — — 1,362 1,387 - - - - - - - - - - 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 of sinks for Cleansing of Equipment and Food Preparation Type of Premises to which Sections 16 & 19 apply Number Estimated percentage of compliance with Regulation 16 Estimated percentage of compliance with Regulation 19 Hotels and boarding houses (Estimated) 700 95 95 Restaurants, cafes and snack bars 1,805 1OO 1OO Grocers and provision merchants 485 95 95 Canteens and clubs 1,441 97 97 Public houses 547 98 98 Confectioners 539 85 5O * Greengrocers and fruiterers 183 9O 75 Schools, nurseries and hostels 87 1OO 1OO Butchers 124 98 98 Off licences 258 8O -* Bakers, cake and pastry premises 118 100 95 Chemists 181 80 20 + Fishmongers and poulterers 45 97 100 Food factories 22 1OO 100 Whole premises, stores and depots 268 96 77 * Provision not required by Regulation 19 + Maximum percentage required by Regulation 19 80 Table 23.—Premises Registered for Preserving Food, or Manufacture, Storage or Sale of Ice Cream 1971 1970 Preserved food etc. 188 183 Ice Cream: Manufacture, and/or storage and/or sale 721 707 Table 24.—Food P0is0ning 1971—Investigati0n 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 - - 1 4 5 6 9 OTHER Salm0nellae 4 14 - - 11 15 25 Cl.welchii 6 35 - - 1 7 36 Staph, aureus 2 7 - - - 2 7 OTHER causes 1 2 - - 16 17 18 Cause unkn0wn 3 25 - - - 3 25 Total 16 83 1 4 33 50 120 81 Table 25.—Analysis of Legal Proceedings Fines Costs £ £ Public Health Act, 1936 (Sec. 92) Premises in such a state as to be prejudicial to health or a nuisance 2 cases 10.00 15.00 Food & Drugs Act, 1955 (Sec. 2) Selling Food not of substance or quality demanded 2 cases 30.00 5.00 Food & Drugs Act, 1955 (Sec. 8) Selling or exp0sing for sale Food unfit for human c0nsumpti0n 10 cases 325.00 77.00 Food & Drugs Act, 1955 (Sec. 16) Using premises not registered for the preparati0n and manufacture of preserved Food 1 case 5.00 25.00 Food and Drugs Act, 1955 (Sec. 105) obstructing an authorised officer in the course of his duty 1 case 5.00 5.00 Food Hygiene (General) Regulati0ns 1970 132 cases 1651.00 124.00 Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulati0ns, 1966 60 cases 391.90 10.00 offices, Sh0ps and Railway Premises Act, 1963 7 cases 43.00 - 1971 £2.460.90 £261.00 1970 £2,122.50 £221.25 Table 26.—Vermin0us Persons—Number of Persons cleansed at Liss0nia 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 1971 405 102 507 60 154 214 721 82 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 1971 114 37 151 36 48 84 235 Table 28.—Coroner's Court and Mortuary 1971 1970 Bodies received in the Mortuary 0n Cor0ner's Warrants, etc. 1,192 1,247 B0dies dep0sited to await burial 5 8 Inquest cases 289 366 Non-inquest cases 908 889 Post-mortem examinations held 1,184 1,247 The verdicts returned by H.M. Cor0ner in the foreg0ing cases were as follows:—* Accidental drowning 3 5 Found dr0wned 5 2 Suicide by drowning 5 4 Suicide by OTHER means 101 123 Accidents Street 22 51 Domestic 20 26 Others 49 57 Natural causes 906 887 Misadventure 3 8 Murder 20 5 Miscellane0us causes 52 67 Awaiting pr0ceedings at Central Criminal Court 6 12 'Excluding b0dies br0ught in to await burial 83 Table 29.—Maternal & Child Health Centres—Activities held as at December 1971 note: The following Table sets 0ut the sessi0ns held at the vari0us Centres in December, 1971. Changes 0ccur fr0m time to time to meet the need. CENTRE M0NDAY 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) Discussi0n Gr0up (Psychiatric) Special Investigati0n Chiropody Child Health 0cc. creche Dental (School) Special Investigati0n Family Planning Clinic (I.U.D.) Evening: — Child Wel. Ante-natal Chiropody Dental (School) Ante-natal (exercises) Chiropody Child Health Immunisation Home Advice Dental (School) Chiropody Evening:— Cath0lic Marriage Advice (once monthly) Dental (School) Special Investigati0n Chiropody Ante-natal Child Health Chiropody Dental (M.C.W.) 0cc. creche Chiropody Dental (M.C.W. and School) (Gas sess. 1st Thurs. in month) Mentally handicapped children Post-natal Family Planning Child Health Chiropody Dental (M.C.W.) Evening:— Family Planning Chiropody Dental (School) Cytology Special Investigati0n Child Health Chiropody Dental (School) Family Planning H a I If ield, Pickering H0use, W.2. Cytology Dental (School) Child Health Dental (School) Playgr0up Child Health Dental (School) Evening:— Y0uth Advisory Clinic Ante-natal Dental (School) (Gas Sess. 4th Wed. in month) Playgr0up Child Health Dental (School) Dental (M.C.W.) Playgr0up Dental (School) Child Health Immunisation and Vacc. Dental (School) 0cc. creche MOthers' Club Dental (School) Queens Park, 20B Lancefield St., W.10. H0me Advice Group Evening:— Child Health Child Health Ante-natal Immunisation and Vacc. Child Health Evening:— Family Planning Child Health Child Health Special Assessment (1st and 3rd week) 84 Table 29.—Maternal & Child Health Centres—Activities held as at December 1971— (c0ntinued) CENTRE M0NDAY 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 H0use, Maida Vale, W.9. Child Health St. David's St. Mary's Terrace, W.2. Child Health Child Health (1st and 3rd) Linnet H0use, Charlbert Street, N.W.8. Child Health Child Health 217 Liss0n Gr0ve, N.W.8. Dental (M.C.W. and School) Playgr0up Special Investigati0n as required toddlers (1st 2nd & 3rd weeks only) Sewing 0cc. creche Physiotherapy Cleansing (School children) Special Investigation (as required) Dental (M.C.W.) Evening:— Family Planning Speech Therapy Chiropody Dental (School) Special I nvestigati0n (as required) Playgr0up Speech Therapy Child Health Chiropody (als0 E vening) Dental (School) Relaxati0n and M0thercraft Chiropody Dental (School) Playgr0up Discussi0n Gr0up Chiropody Dental (School) 0cc. creche Chiropody Speech Therapy Dental (M.C.W. and School) Play gr0up Child Health Dental (School) Cleansing (School children) Speech Therapy Evening Chiropody Chiropody Playgr0up Ante-natal (alternate weeks) Dental (School) Gas. Sess. 3rd Friday in month Evening:— Chiropody Westminster, Council House Extensi0n, W.1. Dental (School) Playgr0up Dental (School) Diathermy Child Health Dental (School) Cervical Cytology Playgr0up toddlers (1st and 3rd weeks) Dental (School) MOthers' Club & Creche Dental (School) Special Investigati0n Playgr0up Child Health Dental (School) toddlers (by appt.) Dental (M.C.W.) Playgr0up Sewing Dental (School) Diathermy Creche Evening:— Family Planning Dental (School) (Gas Sess. 2nd Fri. in month) Playgr0up Child Health Dental (School) 85 Table 29.—Maternal & Child Health Centres—Activities held as at December 1971—(c0ntinued) 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 M0thercraft Bessbor0ugh Street, S.W.1. Chiropody Ante-natal Chiropody Chiropody Child Health Chiropody 0cc. 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 R0ad, S.W.1. Ante-natal Child Health Child Health Sewing 0cc. creche English language class for foreign mOthers 0cc. creche Cytology MOthers' Club 0cc. creche Child Health Marshall Street, W.1. toddler's Club Child Health Vaccination and Immunisation T 0ddlers' Club Family Planning toddlers' Club Chiropody (alt. weeks) toddlers' Club Chiropody Child Health toddlers' Club Sewing 0cc. creche 121 Marsham Street, S.W.1. Chiropody Sewing 0cc. creche Child Health I mmunisati0n and Vaccination Chiropody Ante-natal Relaxati0n and M0thercraft Chiropody Ante-natal Sewing 0cc. 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) Visi0n Dental (School) Special Investigati0n (alt. weeks) Dental (School) Dental (School) Visi0n Dental (School) Dental (School) Immunisation and Poliomyelitis Vaccination is available at all child health sessi0ns Minor ailments sessi0ns are held M0nday to Friday fr0m 8.45 a.m. to 1 0 a.m. at: Alderney Street Harrow Road Liss0n Grove Westminster Council House Extensi0n 86 Table 30.—Clinic Services Ante-Natal and Post-Natal Clinics Number of women Attended Number of sessions held by Total Attendances For Ante-natal Examinati0n For Post-natal Examinati0n Medical officers Midwives Medical officer Sessi0ns Midwives Sessi0ns 1971 583 897 353 43 2,634 100 1970 825 898 354 30 3,322 48 Table 31.—M0thercraft and Ante-Natal Exercises 1971 1970 Total number of women wh0 attended during the year 582 474 Total number of attendances during the year 2,433 2,295 Total number of sessi0ns during the year 353 255 Table 32.—Family Planning 1971 1970* City Council Clinics: Number of patients seen 1175 female 68 male 884 female 20 male Total number of attendances 5107 3305 Total number of sessi0ns 357 247 Family Planning Association Clinics: Number of Westminster residents seen— 3078 2300 * period April to December 1970 in relation to Council sessi0ns only 87 Table 33.—Child Health Centres Number of children wh0 attended during the year Total number of sessi0ns Total number of attendances Total medical examinati0ns Number of children 0n Handicap Register at end of year Born in 1971 Born in 1970 Born in 1966-69 Total 2,025 1,978 2,681 6,684 1,948 35,677 12,910 484 1970 7,250 2,146 39,835 14,115 363 Table 34.—Handicap Register Year Total live births 0n register Number of children 0n 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 1971 2,621 121 4.61 484 Table 35.—Health Visiting Cases visited by Health Visitors Number of cases 1 Children born in 1971 2,315 2 Children born in 1970 1,71 3 3 Children born in 1966-69 3,594 4 Total number of children in lines 1-3 7,622 5 Persons aged 65 or 0ver 1,301 6 Number included in line 5 wh0 were visited at the special request of a G.P. or Hospital 631 7 Mentally disordered Persons 73 8 Number included in line 7 wh0 were visited at the special request of a G.P. or Hospital 22 9 Persons, excluding maternity cases, discharged fr0m Hospital (OTHER than mental Hospitals) 53 10 Number included in line 9 wh0 were visited at the special request of a G.P. or Hospital 28 11 Number of tuberculous households visited 28 12 Number of households visited 0n acc0unt of OTHER infecti0us diseases 10 13 All OTHER cases 2,077 14 Number of tuberculous households visited by tubucul0sis visitors 1,187 88 Table 36.—Vaccination of Persons under age 16 c0mpleted during 1971 at Maternal and Child Health Centres and by General Practiti0ners Table A.—C0mpleted Primary C0urses—Number of Persons under age 16 Type of Vaccine or D0se Year of Birth Others under age 16 Total Total C0mpleted 1971 1970 1969 1968 1964-67 At Clinics By G.P.s 1. Quadruple D.T.P.P0 — — — — — — — — — 2. Triple D.T.P. 490 1,043 128 18 18 — 1,697 1,559 138 3. Diphtheria/Pertussis — — — — — — — — — 4. Diphtheria/Tetanus 20 37 17 22 126 37 259 235 24 5. Diphtheria — — — — — — — — — 6. Pertussis — — — — — — — — — 7. Tetanus — — — — — 13 13 7 6 8. Salk — — — — — — — — — 9. Sabin 504 1,092 164 41 157 50 2,008 1,837 171 10. Measles 5 556 354 131 161 9 1,216 1,060 156 Lines 1 + 2 + 3 + 4 + 5 (Diphtheria) 510 1,080 145 40 144 37 1,956 1,794 162 Lines 1 +2 + 3 + 6 (Wh00ping c0ugh) 490 1,043 128 18 18 - 1,697 1,559 138 Lines 1 +2 + 4 + 7 (Tetanus) 510 1,080 145 40 144 50 1,969 1,801 168 Lines 1+8 + 9 (Polio) 504 1,092 164 41 157 50 2,008 1,837 171 Table B. — Reinforcing D0ses—Number of Persons under age 16 Type of Vaccine or D0se Year of Birth Others under age 16 Total Total C0mpleted 1971 1970 1969 1968 1964-67 At Clinics By G.P.s 1. Quadruple D.T.P.P0 — — — — — — — — — 2. Triple D.T.P. 43 885 420 54 41 — 1,443 1,251 192 3. Diphtheria/Pertussis — — — — — — — — — 4. Diphtheria/Tetanus 10 34 31 48 1,423 133 1,679 1,590 89 5. Diphtheria — — — — — — — — — 6. Pertussis — — — — — — — — — 7. Tetanus — — 1 — 26 21 48 38 10 8. Salk — — — — — — — — — 9. Sabin 52 913 448 107 1,441 220 3,181 2,880 301 Lines 1 + 2 + 3 + 4 + 5 (Diphtheria) 53 919 451 102 1,464 133 3,122 2,841 281 Lines 1 +2 + 3 + 6 (Wh00ping C0ugh) 43 885 420 54 41 - 1,443 1,251 192 Lines 1 +2 + 4 + 7 (Tetanus) 53 919 452 102 1,490 154 3,170 2,879 291 Lines 1+8 + 9 (Polio) 52 913 448 107 1,441 220 3,181 2,880 301 D = Diphtheria T = Tetanus P = Pertussis (Wh00ping c0ugh) P0 = Poliomyelitis Salk = Poliomyelitis vaccine Sabin = Poliomyelitis vaccine (oral) 89 Table 37.—H0me Nursing 1971 1970 Total number of Persons nursed during the year 3,495 3,192 Number of Persons wh0 were aged under 5 at first visit in year 207 161 Number of Persons wh0 were aged 65 or 0ver at first visit in year 2,459 2,296 Table 38.—D0miciliary Midwifery DELIVERIES ATTENDED BY DomiciliarY MIDWIVES Number of Domiciliary C0nfinements attended by Midwives under N.H. arrangements Number of cases delivered in Hospitals and OTHER instituti0ns but discharged and attended by Domiciliary Midwives before tenth day Doctor not booked Doctor booked Total 1971 20 17 37 473 1970 1 42 43 324 Table 39—Chiropody Service A. Number of Persons treated By City Council By City of Westminster 0ld Pe0ple's Welfare Ass0ciati0n Total 1971 1970 1971 1970 1971 1970 * Persons aged 65 and 0ver 1,761 2,027 2,849 2,237 4,610 4,264 Expectant mOthers - 4 - - - 4 Others 145 147 26 - 171 147 Total 1,906 2,178 2,875 2,237 4,781 4,415 * Includes women 0ver 60. B. Number of treatments given By City Council By City of Westminster 0ld Pe0ple's Welfare Ass0ciati0n Total 1971 1970 1971 1970 1971 1970 In clinics 10,988 9,264 3,094 2,448 14,082 11,712 In patients' homes 493 313 5,506 4,833 5,999 5,146 In 0ld peoples' homes 852 911 701 618 1,553 1,529 In chiropodists' surgeries - - 3,182 3,158 3,182 3,158 Total 12,333 10,488 12,483 11,057 24,816 21,545 90 Table 40.—Venereal Diseases Cases treated in Westminster —1st January—31st December 1971 Hospital M F Total 1971 Total 1970 Middlesex Hospital, W. 1. Syphilis 155 26 181 195 Gonorrhoea 1,393 507 1,900 2,050 OTHER Genital Infecti0ns 4,698 4,514 9,212 11,447 OTHER conditions 3,198 1,953 5,151 Total 9,444 7,000 16,444 13,692 St. George's Hospital S.W. 1. Syphilis 39 2 41 36 Gonorrhoea 306 46 352 468 OTHER Genital Infecti0ns 925 255 1,180 2,326 OTHER conditions 782 537 1,319 Total 2,052 840 2,892 2,830 St. Mary's Hospital, W.2. Syphilis 194 29 223 290 Gonorrhoea 3,347 700 4,047 4,121 OTHER Genital Infecti0ns 6,398 3,518 9,916 14,466 OTHER conditions 4,521 3,177 7,698 Total 14,460 7,424 21,884 18,877 Westminster Hospital S. W. 1. Syphilis 44 7 51 34 Gonorrhoea 383 154 537 417 OTHER Genital Infecti0ns 1,095 1,619 2,714 2,251 OTHER conditions 847 283 1,130 Total 2,369 2,063 4,432 2,702 Grand Totals 28,325 17,327 45,652 38,101 VENEREAL DISEASES—Contact notificati0ns Number of notificati0ns received fr0m American Forces, fr0m abr0ad (thr0ugh the Department of Health & S0cial Security) and fr0m OTHER L0cal Authorities 122 (107) Number traced and br0ught to treatment 78 63.9% (65) (60.7%) 91 Table 41.—Medical suite at City Hall — Work undertaken in 1971 1971 1970 Medical Questionnaires scrutinised in respect of Persons entering the Council's service 1,410 1,264 Persons leaving the Council's service-withdrawal of records 1,019 1,010 Retired 0n health grounds 27 37 Medical Examinati0ns (special categories of staff) 162 200 Interviews re Medical Questi0naires 135 83 Examinati0ns re extended sick leave 95 55 Parking meter exemptions 150 141 Advice and First Aid 1,185 877 Referred to general practiti0ners or Hospitals 86 85 F.F.I. examinati0ns 18 24 Vaccinations (smallpox) 93 76 Anti-tetanus vaccine 19 16 Influenza vaccine 52 7 Poliomyelitis vaccine 4 7 T.A.B. Cholera vaccine 8 - Cholera vaccine 17 - T.A.B. vaccine 19 - Anti-histamine injecti0ns 20 8 92 Table 42.—Tuberculin Test and B.C.G. Vaccination Number of Persons vaccinated thr0ugh the Authority's appr0ved arrangements under Section 28 of the Nati0nal Health Service Act 1946. A. Contacts 1971 1970 (i) Number of skin tested 411 412 (ii) Number Found p0sitive 251 261 (iii) Number Found negative 160 151 (iv) Number vaccinated 121 138 B. School Children and Students (i) Number of skin tested 1,661 1,280 (ii) Number Found p0sitive 459 162 (iii) Number Found negative 1,137 1,028 (iv) Number vaccinated 969 1,028 93 Table 43.—School Health Service The table below shows the grades and numbers (full-time equivalents as at 31 December, 1971) of staff empl0yed 0n School health work in the City of Westminster together with the Totals for the Inner London Education Authority as a wh0le Grade FULL-TIME EQUIVALENT EMPL0YEES AS AT 31 DECEMBER, 1971 IN: City of Westminster Inner London Education Authority 1971 Inner London Education Authority 1970 Medical — M.0.'s & G.P.'s (excluding for the bor0ughs, centrally-directed C0nsultants and Specialists) 3.53 94.39 98.80 Nursing (all categories of staff) 10.79 265.16 253.60 Speech Therapists (centrally-directed) 1.10 37.50 29.40 S0cial Workers 5.60 54.68 71.50 Dental officers 4.94 85.68 85.84 Dental Auxiliaries 1.00 17.81 11.08 Dental Surgery Assistants 4.57 105.45 95.50 Dental Technicians — 7.50 8.60 Dental Health Education officers — 2.00 1.00 Table 44.—School Medical inspections (excluding Dental and Health Surveys) 1971 City of Westminster Inner London Education Authority 1971 1970 School roll - MAY 1971 22,358 424,890 423,578 routine inspections Number inspected 8,216 157,966 160,516 Number Found not to warrant examinati0n (7 plus specials scheme) ø ø 674 PERCENTAGE of N0. INSPECTED of:- Parent present 42.7 52.7 52.4 Care C0mmittee present 78.7 54.5 61.7 N0. vaccinated against smallpox 73.6 67.9 69.1 N0. immunised against diphtheria 90.5 89.4 88.9 N0. immunised against wh00ping c0ugh 84.7 83.9 82.1 N0. vaccinated against Poliomyelitis 90.6 89.4 88.5 Physical c0nditi0n unsatisfactory 0.5 0.6 0.7 Referred for treatment of defects 16.1 16.0 16.5 Referred for treatment of defects OTHER than Vision 6.8 8.1 8.9 Non-routine inspections (i) Specials 2,631 47,816 48,096 (ii) Re-inspections 4,489 69,718 69,513 Total (i) and (ii) 7,120 117,534 117,609 N0. of routine inspections as percentage of School roll 36.7 37.6 37.6 N0. of Non-routine inspections as percentage of School roll 31.8 27.7 27.8 ø Figures not available 94 Table 45.—routine Medical inspections 1971—Defects NUMBER of CHILDREN notED For TREATMENT or 0bservation EXPRESSED AS A RATE PER 1,000 INSPECTED Number inspected City of Westminster Inner London Education Authority 8,216 1971 157,966 1970 160,516 DEFECTS † SKIN T 6.21 10.57 10.55 0 10.10 10.25 11;24 EYES (a) Vision T 100.66 86.95 85.12 0 48.20 46.03 48.25 (b) Squint T 10.10 9.86 10.74 0 6.45 4.47 4.68 (c) 0ther T 1.10 1.56 1.58 0 2.19 1.69 1.81 EARS (a) Hearing T 4.26 7.71 7.21 0 5.96 6.51 6.67 (b) 0titis Media T 0.49 2.27 2.43 0 4.87 3.15 3.37 (c) 0ther T 0.49 1.18 0.93 0 0.24 0.86 1.20 N0SE AND THR0AT T 3.77 5.36 5.96 0 18.14 20.40 23.93 SPEECH T 4.14 5.25 4.98 0 6.57 7.14 7.62 LYMPAHATIC GLANDS T 0.85 0.72 0.74 0 6.69 6.19 7.73 HEART *C0ngenital T *2.31 +0.85 *2.53 +0.84 *2.63 +0.88 +Acquired 0 *3.16 +2.43 *4.62 +2.23 *4.67 +2.26 LUNGS T 5.97 7.92 7.65 0 7.31 8.66 9.09 Developmental (a) Hernai T 0.97 1.33 1.41 0 2.56 2.69 2.40 (b) OTHER T 2.92 2.85 2.59 0 5.36 4.95 5.10 orTH0PAEDIC (a) Posture T 1.46 1.19 1.16 0 2.07 3.28 3.75 (b) Feet T 1.46 4.13 4.80 0 4.26 10.72 13.17 (c) 0ther T 3.65 2.98 2.60 0 3.04 3.30 3.93 NERV0US SYSTEM (a) Epilepsy T 1.58 2.06 2.24 0 1.22 1.23 1.03 (b) OTHER T 1.10 1.48 1.21 0 1.58 1.35 1.35 Psychological (a) Devel0pment T 2.31 2.09 2.08 0 8.76 6.36 5.81 (b) Stability T 5.60 3.32 3.49 0 13.02 11.62 11.13 ABD0MEN T 1.95 0.86 0.93 0 2.07 1.54 1.73 OTHER T 0.24 0.91 21.45 0 0.73 1.37 35.16 †T = Treatment 0 = 0bservation 95 Table 46.—School Health Service-Findings at Health Surveys 1971 School R0ll City of Westminster Inner London Education Authority 1971 22,358 1971 424,890 1970 423,578 1. C0mprehensive Surveys (a) Number examined 16,059 304,431 303,077 (b) Number (0ccasi0ns) Found vermin0us 297 4,994 4,031 (c) Percentage Found vermin0us 1.85 1.64 1.33 2. Selec tive Surveys (a) Number examined 4,900 145,573 147,553 (b) Number (0ccasi0ns) Found vermin0us 113 5,771 4,508 (c) Percentage Found vermin0us 2.31 3.96 3.06 3. (a) Total times vermin Found (1 (b) + 2 (b)) 410 10,765 8,539 (b) Total percentage found verminous (3 (a) as percentage of 1 (a) + 2 (a)) 1.96 0.39 1.89 (c) Number of individual pupils Found vermin0us 298 7,053 5,511 (d) Percentage of individual pupils found verminous (of school roll) 1.33 1.66 1.30 4. Action taken with vermin0us cases (a) Advice and/or Lorexane 383 8,844 7,292 (b) Further Action 27 1,921 1,247 (c) 4 (b) expressed as a percentage of 4 (a) 7.05 21.72 17.10 Analysis of 4 (b) cases — referrals of hardcore cases to bathing centres Voluntary attendance at bathing centres Number of pupils 12 1,737 1,260 Number of Statutory notices issued — — — Number cleansed at centres following statutory notices Voluntarily - - - Compulsorily — — — 5. C0mmunicable disease surveys Number examined for: Athlete's f00t 86 21,807 18,469 Plantar Warts 61 Dysentery — 90 890 OTHER c0mmunicable diseases 162 17,239 22,026 Total of (5) 309 39,136 41,385 96 Table 47.—School Health Service—Non-routine Medical inspections 1971 Type of Inspecti0n City of Westminster Inner London Education Authority 1971 1970 Re-inspections 4,489 69,718 68,513 Bathing Centre inspections — Scabies - 33 27 Bathing Centre inspections — 0ther 2 90 90 Empl0yment certificates 160 2,851 3,251 Theatre children 15 572 481 School J0urneys 1,225 26,325 25,015 Recuperative h0lidays — pre-departure 55 934 1,128 Recuperative h0lidays — 0n return 2 5 1 Sec0ndary School annual surveys 53 136 340 Candidates for higher awards 2 100 90 Nautical School entrants - 1 1 0utward b0und c0urses 7 108 108 Infecti0us disease investigati0n — 50 703 T.B. Contacts — 4 4 B0arding Schools for the delicate-pre-departure — 125 178 B0arding Schools for the delicate-0n return — 13 11 Handicapped Pupils — Statutory examinati0n 32 1,842 2,010 Handicapped Pupils — periodic special defect examinati0n 37 5,063 5,258 Research investigati0ns and enquiries — 268 219 Sub-Total 1,590 38,520 38,915 SPECIALS — At request of: Head Teacher — Child's name entered in special b00k 46 1,352 1,504 Head Teacher — Others 152 3,195 3,051 School Nurse following health survey 34 529 419 School Nurse — Others 67 699 612 Divisi0nal Education officer 33 479 527 District Care organiser or Care C0mmittee 34 289 257 Parent 56 1,038 1,064 School Medical officer 52 1,715 1,503 Sub-Total 474 9,296 8,937 OTHER — Accident 0n School premises — — 12 B0xing — Reference fr0m Schools A.B.A. or similar Association 21 114 45 For free travel - 2 3 Reference: (i) c0nnected with remedial exercises f00t classes 8 30 32 (ii) by gymnast or physi0therapist Referred by Hospital — 4 4 Referred by speech therapist - 1 5 Referred by general practiti0ner - - 3 Miscellane0us 538 3,500 140 Sub-Total 567 3,651 244 Total of all Non-routine Medical inspections 7,120 121,185 117,609 97 Table 48.—School Health Service—routine Medical inspections 1971—Visi0n Number Tested PERCENTAGE of NUMBER TESTED Percentage of Total number tested and noted for treatment A — not Wearing Glasses B — Wearing Glasses 6/6 6/9 6/12 or worse noted for Treatment 6/6 6/9 6/12 or worse noted for Treatment Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys and Girls City of Westminster 4,040 3,606 75.5 76.1 7.6 8.2 6.2 6.4 5.5 6.4 5.8 5.5 2.4 1.9 2.5 2.0 6.1 3.6 10.8 I.L.E.A. 1971 73,418 71,489 82.7 80.9 6.1 6.6 5.1 5.3 5.1 5.6 3.0 3.3 1.5 1.8 1.5 1.9 3.6 4.6 9.5 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 98 Table 49.—School Health Service C0mparis0n of Defects noted at 7-Plus routine and 7-Plus "Special" Medical inspections in 1971 Number of Children noted for Treatment and Observation expressed as a rate per 1,000 inspected City of Westminster Inner London Education Authority 1971 1970 Number inspected at 7-plus routine inspections 350 ø 38,375 Number inspected at 7-plus experimental scheme inspections 848 1,880 Defects * A † B * A † B * A † B Skin 14.3 17.7 23.8 29.3 Eyes— Visi0n 125.7 95.5 146.6 143.6 Squint 17.1 24.8 17.9 17.6 OTHER 0.0 1.2 3.3 3.7 Ears— Hearing 11.4 13.0 19.8 19.7 0titis media 2.9 5.9 6.3 5.9 OTHER 0.0 0.0 2.8 2.7 N0se and thr0at 20.0 36.6 36.9 30.9 Speech 22.9 15.3 12.5 19.7 Lymphatic Glands 17.1 10.6 10.0 10.1 Heart 8.6 14.2 11.0 18.1 Lungs 25.8 21.2 18.9 28.2 Developmental—Hernia 5.7 4.7 4.3 2.7 OTHER 2.9 15.3 9.7 12.8 orth0paedic— Posture 8.6 5.9 6.0 3.7 Feet 0.0 8.3 18.9 8.0 OTHER 2.9 8.3 5.7 2.7 Nerv0us System—Epilepsy 5.7 2.4 3.7 2.1 OTHER 2.9 5.9 3.0 1.6 Psychological— Development 17.1 27.1 11.4 20.7 Stability 45.7 43.6 18.6 26.6 Abdomen 0.0 7.1 2.5 1.6 OTHER 45.7 83.8 66.0 80.3 ø Figures not available * C0lumn 'A' refers to 7-plus routine medical inspections, † C0lumn 'B' refers to 7-plus experimental scheme inspections. 99 Table 50.—School Dental Service Statistics 1971 (Statistics, 1970 shown in brackets) NUMBER OF SESSIONS Inspection Ordinary treatment Health Education Anaesthetic Total 76.6 (87) 1,819.3 (1,882) 114.1 (-) 6.8 (26) 2,016.8 (1,995) INSPECTIONS First inspection at school First inspection at clinic Percentage found to require treatment 8,703 (9,054) 3,392 (4,163) 64.5 (63.0) Re-inspection at school or clinic 1,008 (1,332) 86.3 (85.6) NUMBER OF VISITS FOR TREATMENT Number of 1st visits 3,992 (4,291) Number of subsequent visits 7258 (6,764) Emergencies 429 (361) Total (including emergencies) 11,679 (11,416) FILLINGS AND EXTRACTIONS Permanent teeth Temporary teeth Fillings 7,225 (5,739) 6,269 (6,413) Extractions 134 (287) 712 (1,279) Other operations (prophylaxis, X-ray, inlays, crowns, etc.) 4,256 (4,831) Number of dentists and auxiliaries employed (effective whole time equivalent 4.4 (4.8) 100 Table 51.—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 1971 1970 1971 1970 First Visit 386 455 53 63 Subsequent Visits 421 269 63 81 Total Visits 807 724 116 144 Number of Additional Courses of Treatment other than the First Course commenced during year 82 46 6 3 Treatment provided during the year— Number of Fillings 658 659 125 192 Teeth Filled 517 466 78 124 Teeth Extracted 25 36 4 7 General Anaesthetics Given 2 15 — — Emergency Visits by Patients 32 26 12 5 Patients X-rayed 35 9 12 9 Patients Treated by Scaling and/or Removal of Stains from the Teeth (Prophylaxis) 165 225 35 43 Teeth Otherwise Conserved 114 102 — — Teeth Root Filled — — 1 6 Inlays — — — — Crowns — — — — Number of Courses of Treatment completed during the year. 246 237 25 32 Part B.— Prosthetics Patients supplied with F.U. or F.L. (first time) — — — — Patients supplied with other Dentures — — — 1 Number of Dentures supplied — — — 1 Part C.— Anaesthetics General Anaesthetics administered by Dental Officers — — Part D. —Inspections Number of Patients given First Inspections during year (a) 557 (a) 556 (d) 36 (d) 56 Number of Patients in (a) and (d) above who required Treatment (b) 366 (b) 388 (e) 35 (e) 50 Number of Patients in (b) and (e) above who were offered Treatment (c) 354 (c) 383 (f) 34 (f) 50 Part E.— Sessions 1971 1970 Number of Dental Officer Sessions (i.e. Equivalent complete half-days) devoted to Maternal and Child Health Patients— For Treatment 151 126 For Health Education — — 101 Table 52.—Tuberculosis—Care and After Care Paddington Chest Clinic Marylebone Chest Clinic Westminster Hospital Chest Clinic T.B. patients on Register of Chest Clinics at 31st December 1971 1970 1971 1970 1971 1970 429 478 438 447 987 970 T.B. Visitors— Visits to homes 1721 1600 1026 908 — — After-Care Work (Social Worker): Number of patients in receipt of extra nourishment at end of year 5 6 11 11 8 8 Patients assisted for the first time with bed or bedding 2 1 1 — Patients assisted for the first time with clothing or footwear 22 38 — — — — B.C.G. Vaccinations during the year in accordance with City Council Scheme 80 88 11 15 30 35 Rehabilitation Hostels: Patients in residence at end of year — — — — 2 2 Hostels for Homeless tuberculous men: Patients in residence at end of year — — — — 7 13 Child contacts boarded out during the year — — — — — — 102 INDEX Page Acute Poliomyelitis 12 Advice on labelling 36 After Hours Emergency Telephone Service 14 Analysis of Calls made to Duty Officer 73 Animals, Slaughter of 37 Ante-natal Exercises, Mothercraft and 86 Ante-natal and Post-natal Clinics 10, 86 Area of the City 11 Assessment of Children 44 Attachment of Health Visitors to Medical Practitioners 46 Attendances at M. and C.H. Clinics 86 Basement Bakehouses 28 Bathing Service for Old People 38 BCG Vaccination 13,92 Betting Shops 39 Births 11 Blind and Partially Sighted Persons 59 Brucella Abortus, Milk Supplies 33 Burial or Cremation of the Dead 39 Catering Establishments 28 Catering Premises and Food, Inspection 28 Cervical Cytology 60 Chest Clinics 65 Childhood, Infant and, Deaths 42 Child Health Clinics 10,87 Chiropody Service 59, 89 City of Westminster District Nursing Association 48 Clean Air 20 Committees, Appointment of Members of Health Committee to 6 Common Lodging Houses 24 Community Training programme for student nurses 48 Control Orders, Houses let in Multiple Occupation 23 Co-ordination 62 Coroner's Court and Mortuary 39, 82 Creches 54 Cremation, Work of Medical Referee 40 Deaths 11, 12, 69 Deaths, Causes of. According to Age Group and Sex 69 Deaths, Infant Mortality 12 Deep Wells 27 Dental Services 64, 100 Diphtheria 12 Diseases of Animals Act 1950, and other Acts relating to Animals 37 Disinfection 25 Disinfestation, Insect Pest Control 25 Disposable Incontinence Pads 38 Disposal of Unsound or Unsaleable Food 35 District Inspection, Public Health Inspectors 16 District Nursing Association 48 Domestic Rateable Hereditaments 11 Domiciliary Midwifery 48, 89 Drainage and New Developments 20 Dry cleaning establishments 17 Duty Officer, Calls made to 14,73 Dwelling Houses 11 Dwelling Houses, Inspections 16 Dwelling Houses, Nuisances and Unsatisfactory Conditions 73 Dysentery 12 Emergency Telephone Service 14,73 Environmental Health Services 15 Page Establishments for Massage or Special Treatment 38 Eviction, Unlawful, Harassment and Provision of Rent Books 23 Export Certificates 35 Factories 28 Factories, Inspections 78 Factories, Defects 78 Family Planning 56, 86 Food and Drugs Act 1955 — Section 16 33 Food Hygiene, etc.. Lectures 30 Food Hygiene (General) Regulations 1960 79 Food, Legal Proceedings 32 Food Poisoning 33, 80 Food Premises, Legal Proceedings 32 Food Premises, Number of 77 Food Premises, Registration of 77 Food Sampling and Analysis 31 Food and Catering Premises, Inspection 28 Food, Unsound or Unsaleable, Disposal of 35 Fumes from dry cleaning establishments 17 Grants, Subsidies and Loans 23 Handicap Register 44, 87 Handicapped Children 44, 63 Harassment, Unlawful Eviction and Provision of Rent Books 23 Health Committee 6 Health Department, Premises 10 Health Education 55 Health Visitors, Attachment to Medical Practitioners 46 Health Visiting Service 45, 87 Home Nursing 47, 89 Home Nursing Equipment, Loan of 51 Houses in Multiple Occupation, Management Orders and Directions 23 Houses in Multiple Occupation, Control Orders 23 Houses in Multiple Occupation, Means of Escape in Case of Fire 23 Houses in Multiple Occupation, Summary 25 Housing Acts, Visits by Public Health Inspectors 75 Housing Acts 1961-1969, Work carried out by I nspectors 74, 75 Housing Priority on Medical Grounds 24 Ice Cream, Premises Registered 80 Illegitimacy 56 Imported Food Regulations, 1968 35 Immunisation and Vaccination 52,88 Incontinence Pads 38 Infant and Childhood Deaths 42 Infant Mortality 12,70 Infectious and Other Notifiable Diseases 12,71 Infective Jaundice 12 Insect Pest Control, Disinfestation 25 Inspection of Dwelling Houses 73 International Certificates of Vaccination and Inoculation 14 Introduction 3 Labelling, Advice on 36 Laundry Service, Special 38 Legal Proceedings 17,81 Legal Proceedings, Food and Food Premises 32 Licensing Act 1964 29 Liquid Egg (Pasteurisation) Regulations 1963 35 103 Page Loan of Home Nursing Equipment 51 Loans, Grants and Subsidies 23 Local Land Charges 24 Lodging Houses, Common 24 Management Orders, and Directions — Houses in Multiple Occupation 23 Management Structure of Local Authority Nursing Service 45 Mass X-ray 13 Massage and Special Treatment Centres 38 Maternal and Child Health Centres 10,83 Maternal Mortality 11,42 Measles 12 Medical Referee, Work of 40 Metal Drink Pourers 35 Midwifery 48 Milk and Dairies (General) Regulations, 1959 33 Milk, Dealers' Licences 33 Milk (Special Designation) Regulations, 1963 33 Milk Supplies, Brucella Abortus 33 Mobile Health Clinic 54 Mothercraft and Ante-natal Exercises 86 National Assistance Act 1948, Section 50 39 New Developments, Drainage 20 Noise 17 North Westminster Project 21 Notices 17,74 Notifications of Infectious Diseases 12,71 Nursing Homes 54 Offices, Shops and Rail way Premises Act 1963 27,77 Old Persons'Bathing Service 38 Outworkers 28, 79 Overcrowding 24 Paediatric Home Care Unit 47 Paratyphoid Fever 13 Partially Sighted and Blind Persons 59 Personal Health Services 41 Pharmacy and Poisons Acts 1933 and 1941 37 Pigeon Control 26 Plastic Milk Bottles 36 Poliomyelitis, Acute 12 Population 11 Poultry Processing Premises 37 Premises Registered, Preserved Food or Manufactured 24 Premises Registered, Ice Cream 80 Preserved Food or Manufactured, Premises Registered 80 Priority on Medical Grounds, Housing 24 Private Water Supplies, Deep Wells 27 Public Health Inspectors, District inspection 16 Public Health Inspectors, Night and Weekend Duties 16 Public Health Inspectors, Summary of Visits 74 Public Health Laboratory, Specimens Submitted to 72 Qualification Certificates 23, 75 Radioactive Substances Act 1960 25 Rag Flock and Other Filling Materials Act 1951 38 Rateable Value 11 Recuperative Holidays 58 Rent Books, Provision of 23 River Thames Flood Precautions 27 Rodent Control 25, 76 Page Sampling and Analysis, Food 31 Scabies 38,82 School Dental Service 64 School Health Service 62, 93 School Health Service, Number employed in 93 School Medical Inspections, Defects found 98 School Medical Inspections, excluding Surveys 93 School Medical Inspections, Health Surveys 95 School Medical Inspections, Non-routine Inspections 96 School Medical Inspections, Routine Medical Inspections 94,97 School Medical Inspections, Comparison of Defects found 98 Sewerage 20 Slaughter of Animals 37 Slaughterman's Licences 37 Slum Clearance 22 Smallpox 12 Smallpox Vaccination 52, 91 Social Work (Personal Health Service) 61 Special Laundry Service 38 Special Counselling Service, Family Planning 56 Specimens Submitted to Public Health Laboratory 72 Staff of Health Department 8 Staff Medical Service 60, 91 Statistical Tables, List of 67 Statistics and Social Conditions 11 Statutory Notices served 17,74 Street Traders, Licensed 30 Street Traders, Unauthorised 30 Student Health Visitors 47 Student Public Health Inspectors 16 Subsidies, Loans and Grants 23 Swimming Bath Water Examination 27 Technical Assistants 16 Tourism 24 Town Planning 20 Trade Descriptions Act 1968 36 Tuberculin Test and B.C.G. Vaccination 13,92 Tuberculosis, New Cases and Deaths 13,72 Typhoid Fever 13 Unauthorised Street Traders 30 Unfit Premises 22,75 Unlawful Eviction, Harassment and Provision of Rent Books 23 Unsound or Unsaleable Food, Disposal of 35 Vaccination against Smallpox 52,91 Vaccination and Immunisation 52,88 Vaccination and Inoculation, International Certificates of 14 Vaccinations performed 88 Vasectomy 57 Venereal Diseases 58, 90 Verminous Persons 38, 81 Water 26 Water, Bacteriological Examination 77 Water, Chemical Examination 76 Water Supplies, Private Deep Wells 27 Whooping Cough 13 Youth Advisory Service 57 Printed by Obelisk Press Limited, London