HAC 123 LONDON BOROUGH of HACKNEY ANNUAL REPORT on the HEALTH OF THE BOROUGH for the year 1973 LONDON BOROUGH of HACKNEY ANNUAL REPORT on the HEALTH OF THE BOROUGH for the year 1973 Dr. R. G. Davies Medical Officer of Health & Principal School Medical Officer HEALTH DEPARTMENT, MUNICIPAL OFFICES, 380 OLD STREET, EC1V 9LS Telephone: 01-986 3123 To His Worship, the Mayor, and the Aldermen and Councillors of the London Borough of Hackney Mr. Mayor, Ladies and Gentlemen, In accordance with the wishes of the Health Committee we have endeavoured to put together an Annual Report of sorts for the year 1973. The Report has, of necessity, been hurriedly put together in the time available and I would ask forbearance for some of the inevitable mistakes that must therefore occur in it. The figures given are the uncorrected figures of the department and some of the statistics will not have the normal accuracy as we have been unable to wait for the Registrar General's Statistics which are not normally published until May or June of the following year. The format has also been somewhat changed to fit in with the hurried preparation. As stated in the Report for 1972, the year has been one of apprehension as the department comes nearer to the Reorganisation of the Health Service which is to take place on the 1st April, 1974. A considerable amount of work has had to be taken in restructuring the department so that the Borough would be left with an adequately staffed Environmental Health division after the 1st April, and we hope we have been successful in seeing that the Borough is left with a viable environmental health unit. A considerable amount of work has been put in, particularly by the senior members of the staff, towards helping the new reorganised health service to be put into a working position when it commences in April. The staff have naturally been very worried about their future position and I regret to say that at the date of writing this preface, the last days of January 1974, not one person in the transferable part of the department knows exactly what is to happen to them on the 1st April. Some of the staff at present who have been working in the Personal Health Service Section have transferred either to other authorities, to other departments of the Council, or to the health services that will remain with the Borough. Work commenced during 1973 to prepare the buildings at 205 Morning Lane for the transfer of both the Environmental Section of the department and to prepare premises to be used as part of the District Administration of the Area Health Authority, but to date these are not completed. It is hoped that the transferable section of the Health Department will be able to move to Morning Lane before the 1st April. The senior officers of the department remained the same as those at the 31st December, 1972. The general position as regards staff is much the same as in preceding years. The difficulty of recruiting Public Health Inspectors and Health Visitors remaining the same and we have continued to try to remain up to strength by training our own officers. It will be noted from the Report that the Borough's Dental Service which includes the School Dental Service as well as services for mothers and young children continues to work effectively. Figures for inspection at school and visits for treatment, allowing for the fact that the 1973 figures are for eleven months only, remain much the same. There is a regrettable increase in the number of failed appointments which is irritating for the staff concerned as well as being wasteful in the use of the dental services. In the case of young children there would appear to be a somewhat worsening situation in respect of the dental health of the under 5s, but this worsening may be more apparent than real as the department has arranged to inspect a greater range of children including those at day nurseries informally. The dental work with mentally handicapped persons continues at a high level. With a full year in office of the Health Education Officer, health education projects have been expanded, although there is no effective yardstick. The Cervical Cytology Caravan visited the Borough again during the year and fairly wide publicity for the campaign was obtained. Unfortunately this did not achieve a greater attendance and figures were down on the preceding two years. Results are contained in the body of the Report. The Borough's Family Planning Service has continued as in previous years but extra sessions have been arranged and the number of new cases attending during the year is approximately double that for 1972; the corresponding figures being new cases in 1973 - 4,445: new cases during 1972 - 2,465. The total attendances at the Council's family planning clinics were 16,637. Very roughly, therefore, approximately one woman in five is now attending a Council family planning clinic. The domiciliary visits undertaken increased to 499. The birth rate in accordance with the national trend showed a slight decrease during the year. It is, unfortunately, impossible without the Registrar General's Statistics to give the infant mortality rate, this being a rate that in past years has been of great interest. A crude rate would appear to be 18 per 1,000 which would show a fall on the corrected rate of 23 for the previous year, but too much cannot be read into these rather different figures. The routine work of the Personal Health Services continued much as in previous years. Immunisation against various diseases remaining at approximmately the same level. The department progressed with the provision of health centres during the year. Barton House continued to be built but I regret to say it is still not ready for occupation, but it is hoped that it will be occupied before the end of March 1974. Work commenced and progressed satisfactorily with the new health centres at Fountayne Road and Hedgers Grove (the Wick Centre): it is hoped that the majority of the work on these two centres will be virtually completed before April 1 1974. The department suffered a great disappointment when news was received from the Department of Health and Social Security that money would not be made available during the current financial year for a start to be made on the proposed health centre in Tresham Avenue. This was to have been the most ambitious health centre project that the Borough had put in hand. All the previous health centres have had to be built on restricted sites, mainly parcels of land already in the possession of the department. Tresham Avenue being built as part of a new development would have given us much more of a free hand in planning and design. It can only be hoped that money will be made available for building to commence in 1974 under the new Area Health Authority so that Hackney will not be deprived of this valuable amenity. One must also voice the disappointment of the department and, I feel, of the Borough in general, over the further delay in the implementation of the plans for building the proposed district general hospital on the adjoining site, the possibility of the district general hospital seems to have faded into the dim and distant future. There were no major outbreaks of disease during the year although there was on increase in the number of cases of measles notified to this department. The routine work of the environmental section of the department continued as usual during the year. The statistics are contained in the body of the Report. Housing, as usual, remains possibly the Borough's major problem. In this respect eight clearance areas were declared during the year, and a number of compulsory purchase orders made in the previous year were confirmed. The figures for the various other duties of the Health Department speak for themselves. This will be the last Annual Report produced by myself and the Health Department. It is not known what form, if any, reports of this nature will take in the future. I would reiterate the final paragraph of my Report for 1972, and again express the thanks of the Health Department to the Hackney Borough Council Members and Chief Officers for the co-operation, help and guidance we have received at all times over the past years. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, ROWLAND GWYN DAVIES 1 HEALTH COMMITTEE as at 31st December, 1973 Ez-Officio - Councillor R. E. Owen (Mayor) Chairman - Alderman Mrs. Sally Sherman Vice- Chairman - Alderman Mrs. Jean Heath Alderman Mrs. Lily Hegerty Councillor Mrs. Rose Lipman Alderman L. Layward Councillor J. Lissner Alderman L. Sherman, O.B.E., J.P. Councillor T. S. Pittson Councillor A. Alexander Councillor S. Scott Councillor R. A. Bennett Councillor J. Sweeney Councillor J. W. Bolton Councillor P. G. Sylvester Councillor A. W. Habberley Councillor A. W. Waller Co-op ted Members Miss M. Malcolm Dr. S. Rogol Mr. E. Weissel Representation on Organisations concerned with Health Work Atmospheric Pollution-Investigation of - Standing Conference of Cooperating Bodies City of London and East London Dispensary Fund Easton House Management Committee Hackney & Bethnal Green Chest Diseases Care Committee Hackney Group (No. 6) Hospital Management Committee Inner London Education Authority Inner London Executive Council for the National Health Service London Boroughs Training Committee (Social Services) National Council for the Unmarried Mother and Her Child St. Bartholomew's Hospital Board of Governors Shoreditch Chest Clinic Care Committee Alderman L. Sherman, O.B.E., J.P. Mr. A.S. White Alderman Mrs. Lily Hegerty Councillor T. S. Pittson Dr. J. Denham Alderman Mrs. Lily Hegerty Miss M. Malcolm Councillor S. Scott Dr. R. G. Davies Alderman M. Ottolangui, J. P. Alderman L. Sherman, O. B. E., J. P. Alderman Mrs. Lily Hegerty Councillor S. E. Kelly Alderman L. Sherman, O.B.E., J.P. Alderman L. Sherman, O.B. E., J.P. Councillor Mrs. Rose Lipman Councillor K. G. Wilson (Deputy) Alderman Mrs. Lily Hegerty Councillor R. A. Bennett Miss H. E. Howarth Alderman Mrs. Sally Sherman Councillor J.P. Dowling Councillor A. Super 2 STAFF OF THE HEALTH DEPARTMENT as at the 31st December 1973 Medical Officer of Health and Principal School Medical Officer - R. G. Davies Deputy Medical Officer of Health & Deputy Principal School Medical Officer L. M. Pry Principal Medical Officers - J. M. Davies, M. D. Mollison, A. G. Poulsen-HansenDepartmental Medical Officers - Pull time (8), Sessional (38) Chief Dental Officer & Principal School Dental Officer - S. Gelbier Senior Dental Officers (2), Orthodontist (1), Dental Officers - full time (10), Sessional (4), Dental Auxiliary (5), Dental Surgery Assistants (24+2 vacancies) Chi ef Nursing Officer - M. T. Roche 1 Senior Nursing Officer Hospital/community liaison Area Nursing Officers (3), Nursing Officers (8), Health Visitors (28 + 13 vacancies). Tuberculosis Health Visitors (1), Clinic Nurses (23 + 3 vacancies), Clinic Auxiliaries (6), School Nurses (15+2 vacancies), District Nursing and Midwifery Staff (36 + 12 vacancies), District Auxiliaries (6), Nursery Assistants (Playgroups) (13), Special Clinic Officer (1), Special Advisory Officer (1) Chief Public Health Inspector - A. S. White Assistant Chief Public Health Inspectors (3), Principal Public Health Inspectors (6), Senior District Public Health Inspectors (11), District Public Health Inspectors (10 + 11 vacancies), Pupil Public Health Inspectors (15), Technical Assistants (12+1 vacancy). Superintendent, Disinfecting Station (1), Deputy Superintendent (1), Rodent Officers/Drainage Foreman (1), Mortuary Keeper (1), Assistant Mortuary Keeper (1) Chief Administrative Assistant - F. B. Osborn Principal Administrative Assistant (1), Senior Administrative Assistants(7), Administrative & Clerical Assistants (91 + 7 vacancies), Secretary to the Medical Officer of Health (1), typing Supervisor (1), Assistant Typing Supervisor (1), Audio-typists (6 + 3 vacancies) Health Education Officer - G. F. C. Peters Chief Chiropodists- E.V. Gregory, M. Lewis Chiropodists - Full time (2+5 vacancies), Sessional (18) Joint Public Analysts - J. S. Lea, J.H. Shelton PERSONAL HEALTH SERVICES 3 SCHOOL DENTAL SERVICE Introduction Accounts of dentistry for the mentally handicapped, pre-school children, and expectant and nursing mothers will be found elsewhere in the report. Four of our Dental Surgery Assistants are seconded to Executive Council Surgeries. One of the two Senior D. S. As is responsible for training new D. S. As and the other acts as a tutor to girls studying for their National D. S. A. Certificate. Three D.S.As are at present studying for their National Certificate and three were successful in the May examination. In addition to attending evening classes, they are given weekly tutorials prior to the examination. The statistics shown for 1973 are only for 11 months and so should not be fully compared to the 12 months totals for 1972. Nevertheless they are very encouraging. Reorganisation of the National Health Service All our activities have been overshadowed by the N.H. S. reorganisation. In view of the grave anxieties to which staff have been subjected, they are all to be thanked and congratulated on keeping up, and indeed improving, their care for patients. School Dental Inspections Children at all schools were inspected by the end of the year. 20 primary school head teachers have invited us to inspect their children on a twice yearly basis. This is a very encouraging sign of the teachers' concern for the dental health of children in their charge. Mentally Handicapped Children We carried out much prevention at Marsh House School for children with dual mental and physical incapacities. In addition we are just putting a dental chair into Ickburgh School to allow us to restart the rest of our preventive programme. This was felt hy the Dental and Educational staff to be a very worthwhile aspect of our work. Dental Health Education We are eternally grateful to our Dental Auxiliaries for all the time they have spent on this aspect of our work. Together with several dentists and our general health educator they have done much in this field. The latter person has been a welcome additional colleague. Children again queued to have their teeth polished in the mobile clinic at the Hackney Show. Post Graduate Studies Staff have continued to attend post graduate courses, lectures and conferences, including the annual conference of the British Dental Association. One senior dental officer is attending the London University Post Graduate 4 Course in Dental Public Health. The Authority is to be congratulated on its foresight in sending staff on such courses. They are much appreciated by staff, as well as being of benefit to the service. SCHOOL DENTAL SERVICE STATISTICS Total 1972 Jan.-Nov. 1973 1. Number of Sessions Inspections 262. 2 219.2 Treatment - ordinary 6171.9 5214.5 Treatment - general anaesthetic 20. 2 28.1 Treatment - orthodontics 404.9 343.2 Dental Health Education 70. 2 52.0 TOTAL 6929. 4 5867.0 2. First Inspections a) Number of first inspections at school 32069 28100 b) Number of first inspections at clinics 5843 8333 c) TOTAL 37912 36433 d) Percentage of school roll inspected 102. 3 75.8 e) Number found to require treatment 26118 24541 f) Percentage of number inspected found to require treatment 68.9 67. 4 g) Number offered treatment 23010 22426 h) Percentage of number requiring treatment offered treatment 88. 1 91.4 3. Re- Inspections a) Re-inspections at school or clinic 1344 1232 b) Re-inspections as percentage of first visits 12. 3 11.4 c) Percentage of number re-inspected found to require treatment 74.5 65.5 4. Visits for Treatment a) First visits 10918 10770 b) Subsequent visits 27014 34725 c) TOTAL 37932 45495 d) Emergencies 1856 1790 e) Visits for general anaesthetics 179 259 f) Additional courses treatment commenced 1993 2126 g) Total courses treatment (a + f) 12911 12896 h) (f) as a percentage of (a) 18.3 19.7 5. Children made dentally fit 7555 8173 Percentage made dentally fit 58.5 63. 4 5  Total 1971 Jan. -Nov. 1973 6. Failed Appointments Total numbers 16769 17247 7. Orthodontics New cases commenced during the year 168 204 Cases completed during the year 139 141 Cases discontinued during the year 13 4 No. of removable appliances fitted 252 243 No. of fixed appliances fitted 15 18 Pupils referred to Hospital Consultant 1 0 Orthodontic sessions 404.9 343.2 Orthodontic attendances 3322 3993 Teeth extracted for orthodontic reasons - Permanent 164 345 Teeth extracted for orthodontic reasons - Deciduous 448 536 Teeth extracted for orthodontic reasons - Total 612 881 8. Fillings in permanent teeth 21144 19768 Fillings in deciduous teeth 14137 13315 Permanent teeth filled 17470 157 7 4 Deciduous teeth filled 12366 11281 Permanent teeth extracted 1037 1148 Deciduous teeth extracted 2998 3152 Pupils supplied with full upper and/or full lower dentures 0 2 Pupils supplied with other dentures 11 2 Number of dentures supplied 11 4 9. Other Treatment Pupils x-rayed 1370 1717 Prophylaxis 6344 5524 Teeth otherwise conserved 579 847 Number of teeth root filled 239 248 Inlays 1 11 Crowns 134 151 Anaesthetics adninistered by P.S.D.O. 86 0 DENTAL CARE FOR MOTHERS AND PRE-SCHOOL CHILDREN During 1973 a total of 475.2 sessions (399.4 In 1972) were devoted to the dental care of expectant and nursing mothers, and children under the age of 5 years. Children Sixty-six more children were seen than in 1972. On average each child attended on 2.1 occasions. 46. 4 per cent of the children were made dentally fit (41.0 in 1972). The number of failed appointments were again very high. This is a great waste of staff's time. They would rather be treating other patients. The ratio of teeth filled to teeth extracted was 6.1 to 1 (22.2 to 1 in 1972). On the face of it this appears to reflect a worsening situation. But this may not be true. The situation is only worsening for those 6 who actually come to the surgery. But we now inspect children at day nurseries, for example, on a twice-yearly basis. 79 per cent of these were found in a recent survey not to need any treatment at all, which is excellent. Miss D. Smith, one of our senior dental officers, has carried out a full epidemiological survey of children at all our day nurseries in December. Unfortunately the results were not to hand by the time this report had to be written. This valuable survey will provide us with a clear cut picture of dental health in this group of children, immediately prior to the reorganisation of the N.H.S. in 1974. STATISTICS - (COMMUNITY DENTAL SERVICES FOR MOTHERS AND PRESCHOOL CHILDREN) Children Aged 0-4 Years Expectant and Nursing Mothers 1972 1973 1972 1973 1. Inspections (a) Number of inspections 1803 1684 172 153 (b) Number requiring treatment 1315 1430 167 143 (c) Percentages requiring treatment 72.9 84.9 97.1 93.5 (d) Number offered treatment 1301 1430 167 143 2. Visits for Treatment (a) First visits 1230 1296 163 137 (b) Subsequent visits 1306 1389 353 325 (c) Total visits 2536 2685 516 462 (d) Additional Courses of treatment commenced 104 110 7 6 (e) Attendances for general anaesthetic (included in total) 13 30 1 1 (f) Emergencies (included in total) 136 115 22 22 3. Patients made dentally fit 547 653 59 32 4. Analysis of General Treatment (a) Fillings 1965 1852 372 321 (b) Teeth filled 1776 1575 341 290 (c) Teeth extracted 80 236 62 67 (d) Patients X-rayed 13 22 42 39 (e) Scaling, Prophylaxis and Gum treatment 807 637 85 98 (f) Teeth otherwise conserved 237 307 N. A. 72 (g) Teeth root filled N. A. 18 3 7 (h) Crowns and inlays N. A. 0 7 3 5. Prosthetics (a) Patients supplied with full upper and/or lower dentures 2 0 6 0 (b) Patients supplied with partial dentures 2 1 10 8 (c) Number of dentures supplied 4 1 13 9 6. Appointments not kept 801 861 173 130 N. A. - Not Available 7 Children Aged 0-4 Years 1972 1973 7. Sessions (all MCH Patients) (a) Treatment 330.4 351.2 (b) Dental Health Education 69.0 118. 2 DENTAL CARE FOR THE ADULT MENTALLY HANDICAPPED In addition to the surgery already functioning at Homerton, a further one was opened at the new Albion Road senior training centre. The high standard of dental care for the mentally handicapped has been maintained. It was again found necessary to fill less decayed teeth per patient than previously. Hie average patient required 1.7 fillings (2.9 in 1972). We have therefore continued to concentrate on the prevention of both tooth decay and gum disease. Although slightly more patients were treated, they attended for less sessions and visits than in 1972. The ratio of teeth filled to teeth extracted was 3.4 to 1 (8.0 to 1 in 1972). 89 per cent of patients treated during the year had a subsequent course of treatment. Mr. D. Stone, the senior dental officer who has undertaken the dental care of these patients since our scheme commenced is to be congratulated and thanked for all he is doing for them. In order to fully evaluate the situation prior to reorganisation of the N.H. S. in 1974, a full epidemiological survey is just being carried out. DENTAL STATISTICS (ADULT MENTALLY HANDICAPPED) 1972 1973 1. Sessions (a) Treatment 93 91 (b) Dental Health Education and Preventive 87 50 2. Visits for Treatments (a) First Visits 90 114 (b) Subsequent Visits 472 339 (c) Total Visits 562 453 (d) Emergencies 27 11 (e) Patients made dentally fit 110 111 (f) Additional courses commenced 56 102 3. Analysis of General Treatment (a) Fillings 257 196 (b) Teeth filled 223 166 (c) Teeth Extracted 28 49 (d) Scaling and polishing visits 238 212 (e) Teeth otherwise conserved 29 24 (f) Teeth root filled 1 0 (g) Crowns/Inlays 0 0 8  1972 1973 3. Analysis of General Treatment (Contd.) (h) Patients fitted with full dentures 1 3 (i) Patients fitted with partial dentures 1 0 (J) Total dentures fitted 4 5 4. Inspections (a) First inspections 126 125 (b) Requiring treatment 90 121 (c) Offered treatment 90 121 (d) Re-inspections 63 109 (e) Requiring treatment 56 102 HEALTH EDUCATION Health Education activities continued to progress during the year. The Health Education Working Party under the Chairmanship of the Health Education Officer met on five occasions during the year and the Policy and Planning Committee, under the Chairmanship of the Deputy Medical Officer of Health, met on 22nd October. Schools - Illustrated talks on health topics including Dental Health, Food Health, Hygiene, Pood Hygiene, Child Development, Parentcraft, Venereal Diseases, Drugs, Pood and Nutrition, were given in 37 schools in the area. 9,490 children were seen and the talks were undertaken by the Health Education Officer, Medical Officers, Dental Officers and Auxiliaries, Public Health Inspectors, the Senior Chiropodist and Health Visitors. Talks were also given to adult community groups in the area including Mothers' Clubs, Parent/Teacher Associations and students in colleges for Further Education. The Health Education Officer with representatives from the Medical and Nursing Officers have advised on health courses for senior pupils in Grammar Comprehensive schools in the area. Projects - Main projects during the year were (a) the Hackney Show which was held in Clissold Park in June. The Department undertook a display on Pollution Control, Foot Health and Dental Health. A mobile caravan on loan from the Inner London Education Authority, was located at the side of the Health Department's display and children under 7 years of age were able to have their teeth polished free in the caravan. Approximately 200 children visiting the Hackney show were treated in this way. Cervical Cytology - (b) Annual Visit of the Womens National Cancer Control Campaign's caravan was in July/August of the year with the caravan located in the four different areas in the Borough. Publicity for the caravan's visit was in the form of a poster and matching leaflet together with a notice giving details of the sessions and location maps. A short cine film was made of the caravan and is still awaited from the Film company. Shoreditch Health Centre- (c) The Health Education Officer collaborated with the Public Relations Officer to stage a small display on Health topics for the 50th Anniversary Celebrations at Shoreditch Health Centre. The theme of the static exhibition was 'Then and Now' with a photographic record of the past and present health services in the clinic. 9 Community Film Shows - New educational films were screened in two of the Department's maternal and child health centres for professional staff in the Health and Social Services Departments. General Practitioners in the area and hospital staff were also invited to attend. The success of this venture has resulted in the request for further film screenings of new educational films as and when they become available. New Posters were produced on the Smokers' Advisory Clinic with a matching leaflet, on Pram Safety, Venereal Diseases (circular fablon notice) Pood Hygiene, Pollution Control and First Aid. Courses - Community Nurses' Option Course held regularly in the Metropolitan Hospital have had the use of visual and other teaching aids from the Health Education section of the Department. The following Health Education themes are projected each month in the Maternal and Child Health Centres;- January - Family Planning February - Dental Health March - Smoking and Health April - Venereal Diseases May - Foot Health June - Food and Nutrition July - Summer Safety August - Immunisation and Preparation for School September - Oil Heaters October - Exposure to Cold and Hypothermia November - Safety Toys December - Safety in the Home MENTAL HEALTH Co-operation with Hospital Staff The Principal Medical Officer responsible for mental illness, mentally handicapped and the elderly was accepted in the Psychiatric Cogwheel Committee at Hackney Hospital and attended the meetings regularly. Mental Health Liaison Committee With the social services establishing Health Care Working Groups itself in area offices the attendance of staff from the social services department became impracticable and this Committee faded out at the beginning of 1973. However, it was felt that there was a need for some kind of co-operation in the different fields. This was expressed by social workers and hospital staff as well as by one or two organisations, so at the beginning of 1973, Health Care Working Groups for the Mentally Ill, Mentally Handicapped and the Elderly were established. One of the subjects discussed was the Assessment Clinic for the Elderly at Hackney Hospital that was established at the middle of the year. This was done in agreement with all bodies concerned with the Elderly, an achievement on the part of the Geriatric Department at Hackney Hospital. 10 Policy Group This Group have met three times during the first half of the year. The Mentally Handicapped All mentally handicapped adults attending the Training Centre at Homerton had a medical/social interview with the Principal Medical Officer responsible for Community Care. Parents were firmly advised to allow grown-up sons and daughters to take interest in domestic activities at home and social activities outside. A new centre at Albion Road opened towards the end of the year and the supervisor hopes to develop the Centre on the most modern lines. Assistance has also been given for assessment and placing of multi-handicapped children of school age. The Elderly All the Old People's Homes have been visited at least once during the year and the staff advised on the best way of ensuring co-operation with the staff of the Health Department. RE-HOUSING ON MEDICAL GROUNDS Re-housing of families in need of 4 or more bedrooms eased the situation a bit. Twelve families were re-housed to 4-bedroomed houses and 2 families to 5 or more bedroomed accommodation. The families re-housed had been given their medical priority during 1970/73. There remains 15 families for 4-bedroomed and 10 families for 5-bedroomed accommodation for re-housing. Most of these have been given the priority during 1973. This is all a great improvement over 1972 when practically no one was re-housed to larger accommodation. STAFF MEDICAL SERVICE Normally new entrants to the Council's service are required to complete a Medical Questionnaire only, but certain officers, mainly those who will be house parents and day nursery nurses are required to undergo a medical examination before taking up duties, on the insistence of the Social Services Department, although its value from an epidemiological point of view is rather doubtful, when the Medical Questionnaire has been completed and scrutinized. In addition, students intending to go to Teacher Training Colleges and persons living in the borough but who prop (Be to work for another authority are also medically examined by staff of this department. The total number of Medical Questionnaire processed (1,221) was 10% lower than in 1972, probably because the Social Services Department had completed their intake of new officers. The number of medical examinations as mentioned above was 174, as compared to 100 during 1972. The increase may be caused by the request from the Social Services Department that now also the Nursery Nurses and pupils, who were not examined when they worked for the Health Department, also must have the full medical examination. If there is any 11 doubt as to some condition mentioned in the questionnaire, the applicant's Q.P. or the treating Consultant is asked for a confidential report. If there is any doubt as to whether the applicant would be suitable for the position because of medical reasons the person has an interview with the Principal Medical Officer concerned. This happened twice in 1973. Cases of long term illness, sick absence, and accident are assessed by a Principal Medical Officer. This can be very time consuming because it is important in order that the correct assessment can be made, that the fullest details be obtained. The final assessment is thus based on medical reports from the employee's G.P. and/or from the treating Cbnsultant, and a sociomedical interview in depth. The number of such assessments were 138, of these 102 were for long term illness and 16 accident cases. The setting up of the Administration Sub-committee dealing with high absenteeisms because of illness was welcome although it has increased the number of difficult cases to be assessed; during 1973 20 such cases were dealt with. Provision is made for recommending employees found permanently unfit to carry out their normal duties to be offered employment in certain designated light duty posts, which they are considered capable of occupying. It would be an advantage for many employees returning to work after a long term illness to be allowed to work part time for a period before taking up full-time employment, but this has not yet been possible. During the year 30 heavy goods vehicle drivers were examined in accordance with the Traffic Legislation. There were 117 sessions held in 1973. HEALTH VISITING Recruitment throughout the year was well below the replacement level and it was impossible to maintain the establishment. This was very largely due to the lack of adequate housing within the borough and the expense, and difficulty of travelling to and from the Borough. Shortages of staff meant that individual case loads rose to between 600 and 700. Hitherto the main responsibilities had been for expectant and nursing mothers, and children under five years of age, but responsibilities have widened to include all health risk groups. Throughout the year health visitors have carried out their liaising functions with the psychiatric, maternity, geriatric and general maternity units at Hackney Hospital and Queen Elizabeth Hospital for Children. One health visitor attends the Child Health Clinic at the Mothers' Hospital once a week. The position with regard to district nursing is similar to that of health visiting. The case loads are very heavy and are mainly for the elderly. Arrangements are in progress to decentralise the service and it is hoped to complete this by January 1st, 1974. It is thought that this should assist with the development of the primary care teams. 12 The Senior Nursing Officers have in addition to their normal work schedule attended committees and compiled reports for the re-organised National Health Service. CERVICAL CYTOLOGY Mobile Cytology Unit Publicity The Department reproduced two double crown posters, one with dates of the caravan's visit over-printed across the bottom section of the poster. A matching leaflet was also printed and a small notice giving details of the four locations of the caravan during it's time in Hackney. All this material was distributed to Council establishments and displayed on the Council's poster stands throughout the Borough. In addition to this a Press Release was issued to the local Press and appeared in the Hackney Gazette at the start of the campaign. Posters, leaflets and notices were distributed to approximately 200 firms in the area employing large numbers of women. A short 8 mm film was taken of the Caravan while it was located outside the Town Hall in Mare Street. Site - It was decided to use the Town Hall site for two weeks this year in view of the disappointing attendances made when the caravan was situated at the Toc H site last year. The remaining two sites were retained as previously, as the attendances were encouraging during 1972. Attendances - The total number of vromen who attended during the four weeks was 417 and the response to individual sites is shown below:- Dates Site Attendances July 30th - August 3rd Hackney Town Hall (Forecourt) Mare Street, E. 8 122 August 6th - August 10th St. Paul's Church (Forecourt) Evering Road, N. 16 87 August 13th - August 17th Geffrye Court, Stanway Street, N. 1 46 August 20th - August 24th Hackney Town Hall (Forecourt) Mare Street, E. 8 162 The poor attendance figures for the Geffrye Court site indicate that most women residing in the immediate vicinity and interested in attending, were screened during last year's visit. A comparison of attendances with previous years is shown below:- 13  Attnedance Length of Visit Average Weekly Attendance 1973 417 4 weeks 104 1972 475 4 weeks 119 1971 491 4 weeks 123 1970 387 5 weeks 79 1969 1064 9 weeks 118 Sources of Information The women attending the unit obtained details of the visit from the following sources:- Posters or leaflets 110 Saw caravan 146 Press 59 Publicity at Health or Information Centre 25 Told by friend or relative 27 Referred by General Practitioner 18 Radio 3 Hospital 7 Not stated 22 Results of Medical Examination A total of 87 abnormalities were found on examination as follows:- Breast 12 Genital System Vulva 3 Vagina 17 Cervix 28 Uterus and Ovaries 5 Abdomen and Perineum 8 Urinary System 3 Miscellaneous 11 Sixty-three of these abnormalities did not warrant referral to the general practitioner but the women concerned received advice from the doctor at the Mobile Unit at the time of the visit. In the cases of the 24 abnormalities which warranted referral the general practitioners concerned were contacted and 18 replies were received, confirming the following diagnoses:- Cancer of the left breast with 1 secondaries in L5 Mastitis 1 Cervical polyp 1 14 Cervical erosion 7 (2 Cauterised 3 Awaiting cauterisation 1 Symptomless) Chronic cervicitis 1 Uterine fibromyoma 1 Haemorrhoids 1 Anal prolapse 1 Refused treatment 1 No apparent defect 3 Results of Smears One case of malignant squamous cells was found and the woman was referred to her general medical practitioner for advice. Two cases of atypical squamous cells were found and repeat smears were recommended by the pathologist to be taken after a period of three months. Arrangements were made for the women concerned to receive the smears at one of the local cytology clinics. Fourteen women were found to have trichomonas vaginalis present, eight women were found to have mycetia present and one woman was found to have senile vaginitis. All these women were referred to their own general medical practitioners for advice and treatment. No abnormalities were detected in 378 women and 11 women received breast examination only (post hysterectomy, etc.) For technical reasons 2 women were required to have the smears repeated and were referred to their local cytology clinics for these to be carried out again. Age Range Age of Women No. of Attendances Under 20 6 20 - 25 46 26 - 30 49 31 - 35 41 36 - 40 58 41 - 45 51 46 - 50 53 51 - 55 45 56 - 60 21 61 and over 47 Social Class The social class of the married women who attended the Mobile Unit was analysed according to the husband's occupation using the Registrar General's Classification of Occupation 1966. 15 Socio-Economic Group Professional Workers 6 Employers and managers in central and local government, industry, commerce, etc. 24 Own account workers 17 Foremen and supervisors (manual), skilled manual workers 72 Intermediate and junior non-manual workers in offices, etc. 20 Personal service and semi-skilled manual workers 103 Unskilled manual workers, armed forces and agricultural workers 42 STAFF TRAINING Apart from the statutory requirements to provide training for pupil midwives, the Council has arrangements for training other nursing staff for specific duties. District Nurses The Council continued the course of practical training for State Enrolled Nurses approved by the Department of Health and Social Security and 2 nurses successfully completed the course. Three State Registered Nurses have also been trained and passed the District Nurses Examination. The practical instruction for training nurses from St. Matthews Hospital and fourteen nurses from St. Bartholomews Hospital continued and these nurses have now completed the first part of the Integrated District Nursing Training Course. Pour student nurses from St. Bartholomew and four from the Kingsland School (Metropolitan and St. Leonards) andthirty six from the Hackney Hospital have completed the Community Care Course. Health Visitors Six qualified nurses who have midwifery or obstetric training and who were accepted by Colleges of Further Education to undertake a course in Health Visiting Training have been sponsored by the Council, for the duration of the course being held in the academic year 1972/73. The course, leading to the Health Visitors Certificate, involves one year's full time study including both theoretical and practical training and is based on the syllabus of the Council for the Training of Health Visitors. During the academic year 1972/73 six students were sponsored, five of whom were successful at their final examination. Public Health Inspectors Fifteen pupil Public Health Inspectors are currently undergoing course of training leading to the examination for the Diploma of the Public Health 16 Inspectors Education Board, They are receiving their theoretical training at the Tottenham and South East London Technical Colleges and practical training is undertaken within the Department. Admini strative and Clerical Staff During the year seven Administrative and Clerical Officers in the Department undertook various courses of study leading to the Ordinary National Certificate in Public Administration and the Chartered Institute of Secretaries and Administrators, etc. Such staff are granted day release by the Council for the purpose of attending classes and the Council met all fees and expenses in connection with these studies. At times it is not easy to release staff from their ordinary duties in the Department as the fixed establishment does not allow for this, but in the majority of cases, the Department is able to make arrangements and, in fact, encourages staff to take these examinations, which it is hoped will be of long term benefit to the Council. Reciprocal Arrangements In addition to ensuring that staff receive adequate training, the Department provides practical training facilities for other organisations. For instance, nursing, and social and medical students from Hospitals visit the Maternal & Child Health Centres as part of their training. I am pleased to offer these facilities as it enables students in all the fields of Health Services to learn something from each other and so foster the first liaison which is so necessary to their work. In-Service Training Throughout the year staff in all grades continued to attend refresher and training courses held by the various professional organisations. A large proportion of the fees for these courses is reimbursed to the Council by the Local Government Training Board. NURSING HOMES There are three Nursing Homes registered in the Borough. St. Margaret's Nursing Home, 262 Victoria Park Road, E.9 Until 1971, St. Margaret's provided two beds for maternity cases and nine beds for chronic sick. However, owing to the fall in demand for its maternity service this home now concentrates wholly on providing care for twelve chronic sick or fragile elderly patients. It has been re-registered accordingly. 'Crossways' Mother and Baby Home, (Salvation Army), Lanark House, 13 Laura Place, E. 5 Run by the Salvation Army, 'Crossways' offers accommodation for twenty expectant or nursing mothers and ten babies. Here too the declining number 17 of girls applying for admission to such homes reflects a change in social climate regarding the unmarried mother. St. Joseph's Hospice, Mare Street, E. 8 This nursing home is in essence a hospital and has 102 beds. Half of the beds are for the care of the chronic sick and half are devoted to terminal cases. The Regional Hospital Board undertakes financial responsibility for sixty beds. The Health Department is responsible for licensing these homes and each is periodically inspected by an Officer from the Department. HEALTH CENTRES Clapton Park Health Centre renamed Sorsby Health Centre to recognize the important contribution Dr. Max Sorsby has made to community health in the Borough over the last 40 years. The situation at the end of the year with regard to the provision of new Health Centres is as follows: - Barton House Work proceeded on this Centre throughout the year and completion is anticipated early in 1974 although some delays have occurred. Fountayne Road A start was made in May and it is hoped that this Centre will be completed by the middle of next year. Wick Centre (Hedgers Grove) Throughout the year work has proceeded very well on this particular Centre and there is every likelihood that it should be finished during the first half of 1974. Tresham Avenue This project received a major setback in June, when the Department of Health and Social Security wrote saying that it was not possible to give approval in principal which would lead to loan sanction until after 1973/74. The Council have since been in correspondence with the Department of Health and Social Security stating the case in favour of an early start on this Centre. It was emphasized that the Health Centre is to be developed as a part of the Council's general housing development of the whole area, and any delay in commencing the Health Centre construction would mean the sterilisation of the land which oould result in the normal difficulties associated with vacant sites. 18 Bearing in mind the urgent need for housing land in the Borough the Department of Health and Social Security was informed that if the project is not approved for commencement in 1974/75 then consideration will be given to the site being retained hy the Council for housing purposes. No reply had been received by the end of the year. STATISTICS FOR HIE YEAR ENDED 31/12/1973 Vital Statistics Notification - Live Births 3, 425 Still Births 48 Deaths 2, 510 Deaths under 1 year 64 (including deaths under 28 weeks gestation). 9 Midwifery Number of domiciliary confinements 98 Hospital cases discharged before 10th day 618 Maternal and Child Health Health visiting - first visits this year 21, 393 Child Health and toddlers clinics - attendances 35, 591 Ante-natal and post-natal attendances 1, 147 Mothercraft and relaxation 450 Cervical Cytology - number of smears taken - clinic 3, 265 Family Planning - new cases - Council 4,445 Total attendances Council 16,637 Domiciliary Visits (New Service) 499 General Health Services Foot Clinics - treatments - clinic 27 , 468 domiciliary 4,705 Prophylaxis Smallpox Primary Courses 168 Re-vaccination 509 Diphtheria Primary Courses 3,061 Reinforcing doses 4,741 Whooping Cough Primary Courses 2,858 Reinforcing doses 2, 551 Tetanus Primary Courses 3,099 Reinforcing doses 4,806 Poliomyelitis Primary Courses 3,066 Reinforcing doses 4,731 Measles 2, 173 Rubella 1,625 19 Home Nursing Total number of persons nursed 5,382 Total visits 102,633 School Health Service Surveys Annual comprehensive 29,571 Selective 8,671 Communicable diseases 343 Audiometry - number given sweep test 5,085 Attendances Vision 3,762 Orthoptics 496 Audiology 276 Special Investigation 986 Minor Ailments 807 Bathing Centres 1,085 Vision errors of refraction and squint 2,046 Spectacles prescribed 1,077 Tuberculosis Number on chest clinic register at 30/6/73 1,364 Number of contacts given B.C.G. at 30/6/73 46 Number in receipt of extra nourishment 90 Notifications Pulmonary 83 Non-Pulmonary 31 Environmental Health Notices served Public Health Acts, 1936 & 1961 1,902 London Government Act, 1963 (Drainage, etc.) 162 Clean Air Act, 1956 5 Factories Act, 1961 7 Food and Drugs Act, 1955 71 Offices, Shops and Railway Premises Act, 1963 116 Prevention of Damage by Pests Act, 1949 7 General Inspection Public Health Acts, 1936 and 1961 19,129 Pood and Drugs Act, 1955 2,399 Clean Air Act, 1956 1,012 Housing Acts, 1957 and 1969 Demolition and Closing Orders 797 Clearance Areas 693 Houses in Multiple Occupation 3,376 Improvement standard grants, etc. 4,227 Factories Act, 1961 1,295 Offices, Slops and Railway Premises Act, 1963 714 Drainage (General) 6,116 Miscellaneous 6,275 Housing Act, 1961 Management Orders served 13 Directions given and served 125 Section 15 Notices served 53 20 Complaints General 7, 343 Rodent Control 3,965 Disinfestation 970 Food 85 ENVIRONMENTAL HEALTH SERVICES 21 INFECTIOUS DISEASES Details of infectious and contagious diseases notified in 1973 were as follows:- Anthrax Nil Meningitis (acute) 11 Cholera Nil Opthalmia Neonatorum 3 Diphtheria Nil Plague Nil Dysentery 12 Poliomyelitis (acute) Nil Encephalitis (acute) Nil Scarlet Fever 26 Enteric (typhoid or para-typhoid fever) 2 Smallpox Nil Tetanus Nil Pood Poisoning 94 Tuberculosis 136 Infective Jaundice 37 Typhus Fever Nil Leptospirosis Nil Whooping cough 25 Malaria 2 Yellow Fever Nil Measles 586 Measles shows in natural areas with a static population epidemic extension in alternate years. In Hackney this pattern has not appeared for several years, perhaps partly because of a non-static population and partly in later years because of the immunisation programme that was initiated in 1968. Over the years there has been a steady decline in the incidence of measles. In 1955 2,446 cases were notified; in 1968, the year the immunisation programme started, the number dropped to 398; in 1969-1970 it was more than 1,000, and in 1972 it was an all-time low at 281. In 1973 it had doubled to 586, about the same as in 1971, and it could be the alternate years epidemic extension. Year after year the number of notifications of whooping cough showed wide variation. The reason for this may be that sure diagnosis of whooping cough can only be made if confirmed bacteriologically, and nowadays many virus infections and plasmocytosis may give the same symptoms and then be notified as whooping cough. This year the number was 24 as compared with 8 last year and 117 in 1970. Eleven cases of acute meningitis were notified and of these three were of meningococcal origin. Two cases of para-typhoid appeared in the Borough, both contracted abroad. The number of dysentery notifications dropped from 57 to 12; on the otherhand food poisoning increased by cases, from 86 to 94. Both infections are food borne and cause gastro-enteritis. Public Health Laboratory Service Bacteriological specimens are sent to the Public Health Laboratory at County Hall and at Whipps Cross. An analysis of the specimens submitted for examination is set out below:- 22 Specimens Number Organisms Results Negative Positive Throat and 26 Diphtheria Bacilli 26 - Nose Swabs Haemolytic Streptococci 17 8 Vincent's Angina 26 - Faeces and Rectal 414 Pathogens 373 Nil Salmonella Enteritidis - Nil Salmonella Paratyphi B - Nil Salmonella Typhimurium - 32 Shigella Sonnei - 4 Bact. E. Coli - 5 Urine 3 Pathogens 3 - 4 - Ear Swab 4 4 - HOUSING ACT 1957 Eight Clearance Areas were declared, involving 42 properties and 42 families comprising 109 persons, including 18 children under ten years. During the year the following Compulsory Purchase Orders were confirmed without modification hy the Secretary of State for the Department of the Environment:- Barretts Grove Compulsory Purchase Order, 1973. Chalgrove Compulsory Purchase Order, 1972. Langbourne Buildings Compulsory Purchase Order, 1972. Shepherdess Walk Compulsory Purchase Order, 1972. The Secretary of State refused to confirm the undermentioned Compulsory Purchase Orders. Although agreeing that the houses were correctly represented as unfit, he felt that other means should be found of dealing with the conditions. Malvern Road Compulsory Purchase Order, 1971. Mapledene Road No. 2 Compulsory Purchase Order, 1971. Queensbridge Road Compulsory Purchase Order, 1971. In addition the Victoria Buildings, Mare Street Clearance Order 1970, was not confirmed on the grounds that it would entail the loss of four shops which it was felt should continue to function and a recommendation was made that a 23 Closing Order should be made instead. The Closing Order was made and has been included in the following figures. Most of the tenants from the 16 flats concerned have been rehoused. Individual Unfit Premises Nine Notices under Section 9 of the Housing Act 1957, requiring repairs to unfit houses were served during the year. Closing Orders were made in respect of 18 underground rooms and 8 entire houses during the year. During the same period nine Orders were determined, the premises having been made fit. Legal proceedings were instituted in respect of contraventions of three Closing Orders and resulted in the defendants incurring penalties and costs totalling £145. HOUSING ACT 1961 Management Orders Management Orders were made in respect of 12 houses where proper standards of management had not been maintained, bringing the existing number of Management Orders to 168. Generally compliance with the Housing (Management of Houses in Multiple Occupation) Regulations 1962, was secured as a result of informal action. Two Management Orders were revoked and others have been withdrawn as the houses were demolished. Legal proceedings were instituted for contravention of a Management Order and resulted in penalties and costs amounting to £80. Directions During the year 125 Directions were given and there are now 2,160 houses in the Borough which are subject to Directions. Directions in respect of five houses were varied so as to Increase the number of individuals and/or households who could occupy the houses concerned, the owners having provided additional amenities. During the year two Directions were revoked and many were withdrawn as the houses concerned had been demolished. Provision of Amenities During the year 31 Notices were served under Section 15 of the Housing Act 1961, as extended by Section 67 of the Housing Act 1964, for works to render properties suitable for occupation by a smaller number of individuals and households than the number accommodated at that time on the premises. 24 18 Notices were served to provide amenities sufficient for the number of occupants accommodated in the houses concerned. In 13 cases the owners applied for Special Grants to provide the additional amenities. 24 Notices were complied with. HOUSING ACT 1964 Five Notices under the provisions of Section 19 were served on owners requiring the improvement of dwellings to the full standard as defined in Section 43 of the Act. During the year three premises were provided with the full standard amenities as a result of Notices served in previous years. A Notice was served under Section 20 on the owners of a block of flats requiring the improvement of six of the flats to the full standard. All 64 flats were surveyed in the 8 blocks on this estate. HOUSING ACT 1969 Applications for Improvement Grants and applications for Qualification Certificates entailed well over 1,000 inspections by Public Health Inspectors during the year. The Department carried out surveys of houses in the Borough during the year in conjunction with the Borough Architect and Planning Officer's Department in respect of the following areas:- Rectory Road (comprising houses in Bayston Road, Brooke Road, Darville Road, Evering Road, Manse Road, Rectory Road). Millfields Road (comprising houses in Colenso Road, Elmcroft Street, Hilsea Street, Lawley Street, Mayola Road, Millfields Road, Powerscroft Road, Rushmore Road, Saratoga Road). The approximate number of properties involved amounted to 542, entailing 1,000 visits. Registration of Houses in MultipIe Occupation Informatory and Regulatory Scheme, 1971 The combined informatory and regulatory scheme for the registration of houses in multiple occupation has been in operation since 1st February, 1971. Vigorous efforts were made to continue the work of registration during the year and significant progress was achieved in spite of the difficulties encountered. About 2,000 properties were approached regarding registration and over 400 properties were registered under the Scheme as compared with 25 303 during the year 1972. By December 31st 1973, 1,112 properties had been registered in Part I and 14 in Part 2 of the Registration Scheme. However there still remains a large number of properties which have to be brought within the Scheme, and steps are being taken to accelerate the progress of registration. Besides augmentation of staff, legal proceedings are being initiated for contravention of the Registration Scheme. FOOD AND DRUGS The control of food supplies by inspection and sampling, and food hygiene work generally forms an appreciable proportion of the Environmental Health Section's duties. FOOD COMPLAINTS Following investigation into complaints that articles of food purchased by members of the public were unwholesome, legal proceedings were instituted in 22 instances resulting in the vendors being fined a total of £190 with £71 costs. The offences included foreign bodies in bread, cake, and cereals, dirty milk bottles, glass in bottles, Insects in meat pies and sweets, and hair in sausages. FOOD TRADES Details of food trades carried out in 2,263 premises situated in the Borough are set out below:- Aerated Water Manufacturers 1 Greengrocery 146 Bakehouses, (basement) 4 Grocery and Provisions 398 Bakers Shops & Bakehouses 82 Ice cream-manufacture & Sales 595 Beer Bottlers 1 Milk Distributors 228 Butchers 172 Public Houses and Off Licenses 370 Confectionery (sweet shops) 487 Preserved Food Premises 231 Fish, wet, fried & curing 91 Restaurants & Cafes 286 Food Importers 9 Wholesale Food Storage 17 Total:3,118 Section 16 of the Pood and Drugs Act requires the registration or premises upon which ice cream is manufactured, stored or sold by retail and also premises upon which preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale is carried on. The preparation if food includes the cooking of fish and chips and also Chinese food prepared for consumption off the premises. Two applications for the registration of premises for the preparation or manufacture of preserved food were granted as was an application for registration of premises for the sale of Ice Cream. 26 FOOD HYGIENE (GENERAL) REGULATIONS 1970 Regular visits were made to premises selling food to ensure that the Pood Hygiene (General) Regulations 1970 are being complied with. Contraventions totalling 476 were found at 87 premises. Following informal approach to the occupiers of the premises concerned, it was necessary to institute legal proceedings in only three cases resulting in penalties totalling £119.00 with £18.00 costs being imposed. Regulations Contravened Regulation No. Food Hygiene (General) Regulations 1970 Total 6 Pood premises not to be carried on at insanitary premises or place 14 7 Cleanliness of articles of equipment 60 9 Pood to be protected from risk of contamination 12 10 Personal cleanliness 3 11 Persons handling open food to wear over clothing etc., 6 14 Soil drainage systems 1 16 Sanitary conveniences 57 17 Water supply to be provided 1 18 Wash hand basins to be provided 77 19 First aid materials to be provided 30 20 Accommodation for clothing etc., 4 21 Facilities for washing food and equipment 33 22 Lighting of food rooms 8 23 Ventilation of food rooms 7 25 Cleanliness and repair of food rooms 141 26 Accumulation of refuse etc., 20 27 Temperature at which certain foods are to be kept 2 476 An analysis of food premises found to be contravening the Pood Hygiene (General) Regulations 1970, showed the following:- Bakers 16 Butchers 2 Cafes & Restaurants 18 Confectioners 2 Fishmongers 3 Grocery & Provisions 21 Off Licences 22 Public Houses Wholesale Food Premises 3 87 FOOD HYGIENE (MARKETS, STALLS AND DELIVERY VEHICLES) REGULATIONS 1966 The position in regard to street traders licensed to engage in the sale of food at 31st December 1973, was as follows:- 27  Place of Trading Hoxton St. Ridley Road Chatsworth Road Well St. Broadway Other sites Total No. of stalls Fruit & Vegetables 38 55 29 22 30 18 192 Fish (wet, dry and shell) 5 11 4 3 5 2 30 Poultry 1 7 - - - - 8 Meat & Poultry 2 3 1 - 1 - 7 Grocery & Provisions 8 1 4 - 2 - 15 Sweets & Ice cream 4 2 5 2 1 - 14 Cakes & Biscuits 3 1 2 1 5 - 12 Refreshments (Coffee Stalls) - - 1 - - 1 2 Eggs 4 2 2 1 2 - 11 West Indian Foods - 7 - - - - 7 Totals: 65 89 48 29 46 21 298 ANALYSIS OF FOOD AND DRUG SAMPLES This form of sampling is designed to prevent the sale of articles of food to which any improper addition has been made or from which a natural or essential constitutent had been removed or which is not of the nature, substance or quality demanded by the purchaser. A wide range of formal food samples were taken by the Public Health Inspectors during the year and results are set out in the table below:- Number Taken Number non-genuine Acetic Acid 2 1 Baby Foods 6 - Baking Powder 1 - Beverage (Instant Postum) 1 1 Biscuits 6 - Bread 40 - Butter 17 - Cake and Cake Mixtures 9 - Callaloo 1 - Cereals 10 - Cheese 20 1 Chewing Gum 1 - Chocolate and Chocolate Products 5 - Coconut 4 - Coffee and Coffee Products 9 - Confectionery 30 - Cooking Fat 19 - Cooking Oil 1 - 28  Number Taken Number non-genuine Cream 5 - Custard 4 - Drinks, Alcoholic 27 - Drinks, Soft 38 1 Pish and Pish Products 31 2 Flour 7 - Fruit and Fruit Products 29 - Glace Cherries 1 - Gravy Products 6 - Herbs, Spices and Condiments 23 1 Honey 1 1 Iikan Bilis 1 - Isinglass 1 - Jellies 4 - Linseed Oil 1 - Low Fat Spread 2 - Margarine 10 - Meat and Meat Products 29 1 Milk 17 - Milk Products 7 1 Olives 1 - Pasta Products 13 - Pastry Products 8 - Peanut Butter 2 - Pulses 10 - Pickles 3 - Pigeon Peas 1 - Potato and Potato Products 3 1 Preserves, flavoured 11 - Puddings and Desserts 18 - Rice 16 - Salad Cream 5 - Salad Dressings 9 2 Sauces, fruit and spiced 15 - Sausages 29 1 Soups and Soup Powders 27 - Sandwich Spreads 8 - Suet 1 - Sugar 6 - Syrups 4 - Tea 13 - Tomatoes and Tomato Products 7 - Vegetables and Vegetables Products 24 - Vinegar and Products 10 - Totals: 670 14 In addition to the above, 51 Imported Pood and 14 Export Certificate samples were taken. 29 Samples taken from two shipments of Herrings, imported from West Germany, were found to contain preservative, which is not permitted. The first consignment was surrendered by the Importer to this authority for destruction. The second shipment was returned to the country of origin. A detailed analysis of non-genuine samples and the action taken is set out below:- Analysts Report Action taken H488 Canned Mackerel Contained mackerel, water and spices. The can was labelled Mackerel in Natural oil, Chilli added' and bore no list of ingredients. Under the labelling of Pood Regulations 1970, this product should more correctly be labelled 'Spiced Mackerel in Brine' and a list of ingredients should be displayed in the appropriate manner. Referred to Borough Solicitor. H92 Gourmet Powder Contained Monosodium Glutomate 92.0% Salt 8.0%. Under the Labelling of Pood Regulations 1970, this product should bear the 'appropriate designation'. the Analyst was of the opinion that the words 'Gourmet Powder' are not sufficiently specific to indicate the true nature of the food. Referred to Borough Solicitor. H107 Low Calorie Vinegar & Oil Dressing Contained Vegetable Oil 11.23% Egg Yolk Solids were absent. Under the Salad Cream Regulations 1966, Salad Cream or Salad Dressing is required to contain not less than 25% of edible vegetable oil and not less than 1.35% egg yolk solids. The Analyst was of the opinion that this product is a Salad Dressing and that it should comply with the requirements of these Regulations. Further sample Taken. S.N.25. Lemon Flavoured Honeygel. This sample was labelled with a list of ingredients which read Honey, pectin, royal jelly, nicacinamide 20 mgm; Vitamins B, 2 mgm. B6. 3 mgm. B12 5ug. Flavouring per one oz.' This Referred to Borough Solicitor. 30  Analysts Report Action taken declaration does not comply with requirements of the Labelling & Pood Regulations 1970 in the following respects:- 1. The list was not headed 'Ingredients' Regulation 5 (5). 2. The list is not given in correct order Regulation 5(4). 3. The position of the list does not comply with Schedule 5(6) (1). 4. The vitamin content is not declared in the manner required by Part 1 of Schedule 4. Furthermore, the label carried the statement 'supplies extra strength and energy' without the declaration of calorie content required by Regulation 21(1) (ii). S. N. 26 Instant Postum Cereal Beverage The sample was labelled with a list of ingredients which read 'Made from Bran, Wheat and Molasses'. Regulation 5(5) of the Labelling of Pood Regulations 1970 requires the list of ingredients to be headed 'Ingredients'. The sample satisfied the tests applied to it. Referred to Borough Solicitor. Formal Samples H494 Ikan Biliss (Dried Fish) This was a sample of Dried Pish and contained total Volatile Nitrogen 361 milligrams per 100 grams equivalent to 108 milligrams per 100 grams on the undried fish. The total volatile Nitrogent of fresh fish does not usually exceed 30 milligrams per 100 grams. Therefore the fish had undergone considerable spoilage during or before drying. Letter sent to Importer. H528 Pure Grape Juice Contained total dissolved solids 17.0%; Potassium 480 parts per million; Phosphorous 57 parts per million. Natural Grape Juice has a much higher potassium and Referred to Borough Solicitor. 31  Analysts Report Action Taken phosphorous content therefore the description is incorrect. H608 Low Calorie Vinegar and Oil Dressing Contained Vegetable Oil 12.34% Egg Yolk Solids absent. Under the Salad Cream Regulations 1966, Salad Cream or Salad Dressing is required to contain not less than 25% of edible Vegetable Oil, and not less than 1.35% Egg Yolk solids. The Analyst is of the opinion that this product is a Salad Dressing, and that it should comply with the requirements of these Regulations. Referred to Borough Solicitor. H590 New Potatoes This sample was labelled New Potatoes canned in Brine with added sugar'. Under the Labelling of Pood Order, the appropriate designation of this product is 'New Potatoes in Water' (Salt and Sugar added). This was agreed to by the Fruit and Vegetables Canners Association. Referred to Borough Solicitor. H634 Acetic Acid 18% Contained Acetic Acid 30.6% which is 70.0% in excess of the declared amount. The Analyst was of the opinion that this excess could be prejudicial to the purchaser. Referred to Borough Solicitor. H628 Chicken Spread Contained meat, including fat 47. 0%. Under the Fish and Meat Spreadable Products Regulations 1968, Chicken Spread is required to contain not less than 70% of meat. The sample is deficient, therefore to the extent of 23.0% or 32.9% of the minimum required amount. Referred to Borough Solicitor. H 243 Hot Dog Sausages Contained meat including fat 56.4% (calculated on drained weight). The Analyst was of the opinion that this product should comply with the Sausage and Other Meat Product Regulations 1967. 'Frankfurters in Brine' are required to have a meat Referred to Borough Solicitor. 32  Analysts Report Action taken content of not less than 70% calculated on the drained weight of the sausage. H 264 Snowcrest Medium Pat Soft Cheese On examination the sample complied with the requirements of the Cheese Order 1970, but contained in addition a proportion of onion which was not declared on the list of ingredients, but was indicated on a separate sticky label. This was not clearly visible. The Public Analyst was of the opinion that the correct description for this product is Medium Pat Soft Cheese with Onion' and that onion should be included in the list of ingredients. Letter sent to Manufacturer. H393 Dried Skimmed Milk Contained milk fat 0.81%. The label on the tin containing this product which contains milk fat, bore the declaration 'Instant Non Fat Milk (Skimmed)' . The Analyst was of the opinion that the product should more correctly be described as 'Instant Low Pat Milk (Skimmed')' . Referred to Borough Solicitor MILK AND DAIRIES Treated and prepacked milk comes into the Borough from three sources only, and sampling has again followed a pattern of control considered adequate to safeguard the purchaser or consumer:- Type of Test Roundsmen and Shops Schools Vending Machines Milk Dispensers Hospitals Total Chemical 22 - - - - 22 Bacteriological 22 - 1 - - 23 All samples for chemical analysis were taken formally. No adverse chemical or bacteriological reports were received. There are no milk bottling plants in the Borough. 33 Details of Dealers' Licences for pre-packed milk:- Ultra Heat Treated 110 Untreated 43 Pasteurised Milk 231 Sterilised Milk 222 ICE CREAM The reports on the 30 samples of ice cream which were submitted to the Public Health Laboratory Service for grading tests were as follows: - Grade 1-14 Grade2-1 Grade3-5 Grade 4-10 POULTRY PROCESSING PREMISES There are no such establishments situated in the Borough. BACTERIOLOGICAL FOOD CONTROL This form of sampling is designed to prevent the sale of food which is diseased, unsound, unwholesome or unfit for human consumption. In particular it establishes whether or not food is free from infective organisms which could cause disease. It also checks for the excessive growth of organisms (not necessarily pathogens) which could indicate contamination of the food before sale, or excessive age. The following samples and specimens were submitted for bacteriological examination to the Public Health Laboratory Service, County Hall and Whipps Cross, whose co-operation throughout the year was greatly appreciated: - Ice Cream 28 Milk 23 Manufactured foods 80 Imported foods 305 Drinking Water 6 442 SWIMMING BATHS Regular routine samples are taken of the water in the four Public Swimming Baths in the Borough, and no action was necessary in respect of the 12 taken for chemical and bacteriological examination during the year. 34 PUBLIC HEALTH ACTS The number of drainage applications received during the year totalled 441. Each application and the accompanying drawings were carefully scrutinised and in a number of cases Architects, Surveyors or Builders had to be interviewed or communicated with and the application amended before final approval could be given. CLEANSING, DISINFECTION, DISINFESTATION A total of 69 adults and 23 children under 5 years were treated for scabies and 23 adults and 71 children under 5 years of age were treated for vermin at the Shoreditch Health Centre. Normally 2 treatments are required to clear a case of scabies and one for vermin. Arrangements have been made with other areas for treatment at the Bathing Centre of residents from their areas. The Department is also responsible for the disinfestation of verminous rooms and articles and a total of 1,663 rooms and 2,793 articles were treated. Certain foreign countries prohibit the importation of second hand clothing unless a Certificate that the articles have been disinfected can be produced. A charge is made to private firms wishing to have second hand clothing disinfected for this purpose. OFFENSIVE BUSINESS Pur skin dressing is the only offensive business in the Borough and was in operation in 2 factories. COMMON LODGING HOUSES There are none in the Borough. MORTUARY The Council's mortuary adjoins the churchyard of the Parish Church of St. John at Hackney and provides refrigerated accommodation for fifteen bodies. There is an arrangement with the London Borough of Tower Hamlets for receiving bodies from the Bethnal Green area, the cost being shared on a population basis. Details are set out below:- 35  Residence Total 1973 Total 197 2 Hackney Bethnal Green Elsewhere Number of bodies received 147 100 46 293 645 Number to await postmortem examination 147 100 46 293 642 Number of inquest cases - - - - 3 During the year extensive works have been carried out to eradicate dryrot in the mortuary and accommodation used by the Coroner's Officers. During the execution of this work which is now complete post mortem examinations were carried out at Poplar Mortuary, Tower Hamlets, by arrangement with Tower Hamlets Council, During the period of repairs, the Coroner's Officers were housed in a temporary 'Porta Kabin' unit which was sited in the appraoch road to the mortuary, The mortuary was again in commission during the first week of December. CLEAN AIR CONTROL OF SULPHUR CONTENT IN OIL In June 1972 the Health Committee informed the Council that the City of London had obtained powers to require new furnace installations to burn oil with a sulphur content of 1% or less and also to require existing furnace installations to change over either on renewal or within a fixed period. On the recommendation the Council agreed that the London Boroughs Association should be asked to consider including similar powers in a future Greater London Council (General Powers) Bill. The Council were informed that as the Department of the nvironment were not prepared to support an extension of the powers which operate in the City, the London Boroughs Association decided that no attempt should be made to proceed with the proposal. However, as a result of an approach from the European Economic Community, the Department of the Environment are themselves now considering including the power to make regulations on the subject in the forthcoming Protection of the Environment Bill although there would be no immediate intention to use them. RODENT CONTROL This Council is represented on the No.1 Pest Control Committee of the Ministry of Agriculture, Fisheries and Ftiod, the Chairman of the Committee being the Chief Inspector of Hackney. The Ministry carried out a rodent control survey during the year and this Council supplied Information thereafter. 36 Infested Premises Cleared of Vermin Business Premises Dwelling Houses Total Rats 75 361 436 Mice 446 3,086 3,532 Total: 521 3,447 3,968 A total of 3,968 complaints were received and 3,854 inspections carried out. RAG, FLOCK AND OTHER FILLING MATERIALS ACT, 1951 This Act requires the registration of premises upon which specified materials are used in the process of upholstering furniture, the stuffing or lining of bedding or toys. There are twenty-five premises registered in the Borough. There are two premises where these specified materials are actually manufactured, stored or offered for sale and these are licensed annually. MASSAGE AND SPECIAL TREATMENT Under the provisions of the London County Council (General Powers) Act 1920, as continued in force by the London Government Act 1963 ten establishments were licensed to carry out massage and special treatments. PHARMACY AND POISONS ACT 1933 The names of 77 persons and the addresses of their business were entered in the Authority's register for the sale of Part II poisons at the end of the year. FERTILISER AND FEEDING STUFFS ACT, 1926 Six formal samples were taken during the year, the results of which were found to be satisfactory. REGISTRATION OF HAIRDRESSERS AND BARBERS At the end of the year, 178 hairdressers had been registered with the Council under the Greater London Council (General Powers) Act 1961. 37 NOISE A survey has been commenced to cover the whole of Hackney to ascertain the general level of noise throughout the Borough and to try and pinpoint those areas where noise nuisance is likely to occur. This work is being done in conjunction with the architects, planners, and highways engineers of the Council. HACKNEY MARSHES SUMMER CAMP Due to the better weather and more extensive advertising this camp was used to a greater extent during this summer than the previous year. No complaints of the conduct of the camp were received from residents living in the area and no adverse comment was made by the Officers of the Council. FACTORIES ACT 1961 Details of inspections carried out in accordance with Sections 1 to 7 of the Factories Act 1961, are set out in the table below:- Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3,4 & 6 are to be enforced by Local Authorities 79 3 - - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authority 2,344 245 4 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers premises) 20 2 — - Total: 2,443 250 4 Nil 38 Particulars Number of cases in which defects were found No. of cases in which prosecutions were instituted Pound Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1) - - - - - Overcrowding (S. 2) - - - - - Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S. 4) - - - - - Ineffective drainage of floors (S. 6) - - - - - Sanitary Conveniences (S.7) - - - - - (a) Unsuitable or defective 2 3 - 3 - (b) Not suitable for sexes 2 2 - 2 - Other offences against the Act (not including offences relating to outwork) - - - - - Total: 4 5 - 5 Nil OUTWORKERS The occupier of every factory or contractor employed by any such occupier in the business of the factory is required to submit to the local authority during February and August in each year, a list showing all the outworkers employed by him during the previous six months. The current list showed 69 Hackney firms as having employed 711 outworkers of whom 213 worked in Hackney:- Nature of Work No. of outworkers in August list Stationery 8 Light Engineering 3 Wearing apparel 634 Making of boxes 19 Carding of buttons 39 Toy making 8 Total: 711 39 There were no instances of an employer failing to send a list nor of work being done in unwholesome premises. If an outworker appearing on this list works from premises situated in another area, the local authority concerned is informed by the authority receiving the list from the factory. In this way it is possible to ascertain how many residents in Hackney are doing outwork. Lists received from other local authorities show 507 Hackney outworkers employed by firms outside the Borough. The type of home work carried out by outworkers is listed below: - Wearing Apparel 616 Making of Boxes 26 Curtains and Furniture Hangings 3 Household Linen 29 Artificial Flowers 1 Umbrella Making 3 Carding of Buttons 24 Iron and Steel Chains 9 Toy Making 9 Total: 720 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Statistics relating to registration and general inspections are set out below:- Class of Premises Number of premises registered during the year Total Number of registered premises at end of year Number of registered premises receiving a general inspection during the year Offices 14 909 380 Retail shops 5 1570 679 Wholesale shops and Warehouses 4 381 75 Catering establishments open to the public and canteens 5 286 84 Fuel storage depots — 5 - Total: 28 3,151 1,218 40 During the year 44 notifications of accidents were received, all of a minor nature. In no instance was it found that the accident resulted from a breach of the Act. 79 Notices were served upon occupiers of premises who failed to comply with the requirements of the Act. The Public Health Inspectors made a total of 2,186 visits. Analysis of Persons employed in registered premises by workplace Class of Workplace Number of persons employed Offices 18,885 Retail shops 10,664 Wholesale departments, warehouses 7,095 Catering establishments open to the public and Canteens 2,718 Fuel storage depots 98 Total: 39,460 Total Males: 22,313 Total females: 17,147 Flooding Relief During the evening of the Bank Holiday on the 27th August a heavy storm seriously affected a number of properties in the Borough, causing the surcharging of main sewers and the overflowing of road gullies and house drains. It was estimated that a storm of this intensity had not occurred for 25 years. About 30 streets were involved and many houses were flooded in the basement or ground floor rooms to a depth of a few inches. A number of basement rooms however were affected to a depth of more than 3 feet when water gushed from roadways into front areas and poured through windows. Many people had not returned from holiday outings when the storm broke and reached home to find their rooms awash. During the following days 98 complaints of defective roofs and damaged ceilings were received and 90 requests for assistance in drying out soaked bedding and carpets were made. To assist in the dry-out of houses, commercial 'hot-air' blowers and a dehumidifier were obtained on loan from firms specialising in this equipment and following the dry-out process it was necessary to spray, disinfect and deodorise the affected rooms, many of which had been contaminated with sewage when drains overflowed. 41 A number of people in the Stoke Newington area complained that a similar occurrence happened in 1965 when serious flooding affected them and that on a number of occasions since then the roads had become flooded after heavy rain. Many of the old sewers in this area are inadequate to deal with abnormal rain-fall and the Council's long-term plans for re-sewering this area have been outlined to them by Officers of the Council at a public meeting. Work on the bore-holes for a new £10,000,000 storm-water relief sewer has already begun and it will be the responsibility of the new Thames Water Authority to implement this scheme over the next few years. SUMMARY OF VISITS BY PUBLIC HEALTH INSPECTORS AND TECHNICAL ASSISTANTS Visits Re-visits On Complaint 12,906 4,856 House to House 65 8 Infectious Disease 161 32 Verminous Conditions 351 93 Housing Surveys 1,149 85 Advances for House Purchase 290 87 Demolition Orders 219 85 Closing Orders 500 182 Clearance Areas 651 462 Houses in Multiple Occupation 2,346 653 Improvement Grants 814 1,046 Standard Grants 195 134 Special Grants 57 52 Qualification Certificates 73 28 Dairies and Milk Distributors' Premises 131 125 Public Houses and Off Licences 130 82 Night Cafe Registrations 25 5 Registered Pood Premises 255 77 Other Pood Premises 421 350 Stalls and Vehicles 38 22 Markets 55 6 Imported Pood Premises 35 19 Imported Pood Samples Taken 626 710 Pood Samples Taken 219 26 Pood Complaints 260 69 Pood Poisoning Cases 67 23 Consumer Protection) 86 47 Samples Taken ) 81 44 Trades Description ) 5 4 Samples Taken ) 10 3 Effluent Samples Taken 14 2 Fertilisers and Feeding Stuffs 84 37 Samples Taken Rag Flock Samples Taken 50 6 42  Visits Re- visits Planning Applications 236 43 Builders' Notices - Supervision of Work 678 563 Drainage (General) 1,922 3,244 Drainage (Rat Infestations) 216 153 Factories 155 95 Boiler Installations 56 49 Smoke Observations 408 123 Noise Investigations 1, 161 212 Offensive Trades 4 0 Outworkers 1,023 0 Hairdressers' and Barbers' Premises 6 0 Chiropodists and Massage Establishments 17 2 Council, GLC and Other Private Nursing or Nursery Establishments 69 6 Offices, Shops and Railway Premises 144 187 Child Minders 198 48 Pet Shops 13 7 Vacant Sites and Houses 241 259 Attendances at Court 95 48 Attendances at Meetings 57 7 Appointments and Interviews 682 380 Pest Control 250 62 Removal of Rubbish 111 68 Atmospheric Pollution 531 30 Civic Amenities 28 13 NOTICES SERVED DURING THE YEAR Public Health Act 1936 - Abatement of Nuisances 1,272 Public Health Act 1936 - Section 75 53 Notice Requiring Drainage Work123 G.L.C. Drainage By-Laws 89 G.L. C. Water Closet By-Laws 35 Notice to Repair Defective Closet 56 Artificial Lighting of Common Staircases in Tenement Houses and Plats 9 Prohibition and Abatement Notice in Respect of a Recurring Nuisance 96 Clean Air Act 1956 4 Notice to Remedy Defective State of Premises 9 Notice of Entry 12 Notice to Remedy Stopped up Drain, Private Sewer, Water Closet or Soil Pipe 41 Notice to Owner of Premises of Proposed Work of Maintenance on Sewer 4 Pood Hygiene (General) Regulations 79 Offices, Shops and Premises Act 1963 79 Factories Act 4 43 Notice to Remedy Premises Which are in a Filthy or Unwholesome Condition or are Verminous 6 Prevention of Damage by Pests Act 5 Public Health Act 1936 - Section 23 1 Notice Before Entry 1 Offices, Shops & Railway Premises, Hoists&Lift Regulations 12 Public Health Act - Section 24 6 Notice to Remove Noxious Matter 2 Q.L.C. Drainage and Water Closet By-Laws 2 Pood Hygiene (Market, Stalls, Delivery Vehicles) 2 Notice to Provide Closets 1 Notification of Offence or Nuisance 1 Public Health Act 1936 - Certificate that Immediate Work of Maintenance on Sewer is necessary 1 PRINTED AND PRODUCED BY LONDON BOROUGH OF HACKNEY