AC 4361 Ac 14/1/57 1955 ANNUAL REPORT on the HEALTH AND SANITARY CONDITIONS of the METROPOLITAN BOROUGH OF ISLINGTON VICTOR FREEMAN, m.r.c.s., l.r.c.p., d.p.h. Medical Officer of Health ================= E. G. Ellis & Sons, Willow Strett, Chingford, E.4 1 Public Health Department, Town Hall, N.l. To The Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. The public has come to expect, with justification, continued, if unspectacular, progress from year to year in matters of public health. Whilst this is in general true, progress is not necessarily continuous, and new features with perhaps some unfavourable factors have to be reported as well as favourable ones, and new problems arise which have to be dealt with. This will be found to be the case on some of the matters reported in my Fifteenth Annual Report on the health of the Metropolitan Borough of Islington for the year ended 31st December, 1955. In the previous year new low records were established in the total death rate and in the death rate of infants under the age of one year. It was, perhaps, too optimistic to expect that these low records would be repeated or even improved upon. The same observation might also be applied to the death rate from tuberculosis of the lungs which, in 1955, was a little higher than in the previous two years. It would not be right, however, to regard such increases as a reversal of general trends over the past few years and there is no reason to think that all the measures—social, medical and educational—which are believed to have been major factors in health improvement over the past few years, will not enable a resumption to be made in reduced mortalities from disease. For the fourth successive year there has been no death from diphtheria. It is a matter of common knowledge that cancer of the lung (including bronchus) now causes many more deaths than tuberculosis of the lungs, and this has certainly been true in Islington for some years. The Minister of Health has formally accepted the position that there has been shown to be a causal connection between smoking—that is cigarette smoking—and lung cancer. This in itself should be sufficient ground for young people in particular, as well as adults, to pause and consider very seriously as to whether it is worthwhile commencing or accepting cigarette smoking as a social habit. This is, however, not the only ill health charge against the cigarette. In the Annual Report it will be found that 230, or approximately nine per cent of all deaths for the year, were ascribed to bronchitis. Bronchitis is not only a cause of a high proportion of deaths in the Country, but also is responsible for a very considerable amount of chronic invalidism to many people over many years. It is made considerably worse by pollution of the air, whether this is done communally through smoke from the open coal fire or from the factory chimney, or personally by smoking. Evidence is accumulating that smokers are more badly affected by bronchitis than non-smokers, and the effect increases with the amount smoked. It has been estimated that the number of those suffering from bronchitis in this Country is not less than twenty times the proportionate number of similar sufferers in the Scandinavian countries, and this difference is probably almost entirely accounted for by the differences in these factors. Certainly it would be wrong for the public not to be informed of such facts in these matters as we possess at present. Unfavourable records in the borough were also established for deaths due to accidents, both those in connection with motor vehicles and others, and this is referred to in the body of the Report. 2 The three infections which have increased since the war contrary to the general tendency, i.e. dysentery, whooping cough, and poliomyelitis, were also in considerable evidence in 1955. Although the dysentery cases were less than half the number in the previous year there were still over 400. Good standards of hygiene and cleansing in the home which, it is appreciated, may be difficult when there are two, three, or four families in a house, with shared water closet and water supply, and no running warm water, would reduce the number of dysentery cases. Food poisoning outbreaks, unfortunately, increased during the year and brief descriptions of the outbreaks are mentioned in the Report. 1955, unfortunately, must be regarded as a poliomyelitis year; although the early cases were very mild and sometimes extremely difficult to diagnose as definite poliomyelitis cases, the later ones were more severe in type. In my last report I had again to refer to the very considerable and serious deficiency of Sanitary Inspectors on the establishment. This deficiency unfortunately continued throughout the year, and the only favourable circumstance which can be reported in this connection is that, at any rate, the position did not deteriorate still further. It is regretted that, under these circumstances, many complaints and visits of inspection could not be dealt with as expeditiously as is desirable, and the Department greatly regrets any delay or inconvenience which may thereby be caused to members of the public. The local deficiency of Sanitary Inspectors is part of the National deficiency, but it is undoubtedly felt more acutely in areas of old housing than in districts where development has been much more recent. The new legislation referred to in the body of the Report which should be helpful in remedying defects and maintaining standards of hygiene, included matters relating to a more expeditious procedure for the remedying of stopped up or defective drains, and reinstatement of a water-supply, as well as dealing with defective housing ; and also for the first time bringing hairdressers' and barbers' shops within the purview of statutory supervision. The Clean Air Bill was under discussion during the year and although it has now become an Act, it will probably be some considerable time before the effects of its legislation can contribute to a sizeable reduction in atmospheric pollution. However, it is hoped that a foundation has been laid for progress to be made in the future. In the field of housing, which is probably the greatest single social problem in this Borough, the joint proposals of the Borough Council and the London County Council, as required under the Housing Repairs and Rents Act, 1954, were submitted to the Ministry of Housing and Local Government. As mentioned, however, in the Report, it was not possible to complete the survey within the time, that is, by 30th August, 1955, and it is certain that supplementary proposals will have to be considered. However, even in the proposals already submitted it was recommended that in all a total of 834 houses were ripe for demolition within the first five years, and this first instalment will be a most formidable task, particularly in respect of the re-housing of displaced occupants by both Housing Authorities concerned. Health Education is regarded by the Committee, and rightly so, as one of its most important functions. Although a good deal of work is done regularly in connection with the showing of health films, health talks, and the distribution of health publicity matter, the Committee considered during the year the extension of 3 the Department's health education work, and agreed to an additional clerical appointment which would allow increased activity in this field. The very useful services for elderly persons, although limited in some ways, are now becoming quite various. They are described in the body of the Report and it will be noted that, in particular, attention was given to increasing the Chiropody service and also the Cleansing and Laundry service for elderly persons, for whom such facilities are useful. Throughout the year and in all the work of the Department, I have had the fullest assistance and co-operation from the Chief Sanitary Inspector, Mr. W. C. Bartlett, and the staff of Sanitary Inspectors, and Mr. E. J. Sharp, Chief Clerk, and the clerical staff under his direction, and I should like to express my thanks for their work. To the Chairman of the Public Health Committee, Councillor A. J. Rogers, and to the Chairman of the Housing Committee, Councillor F. W. Byrne, as well as to the respective Vice-chairmen and Members of the Committees, being the principal Committees dealing with the work of the Public Health Department, I should again like to express my thanks and appreciation of the very careful consideration and sympathy which has been given to all the many, and sometimes difficult matters I have placed before the Committees during the year. V. FREEMAN, Medical Officer of Health. 4 MEMBERS OF THE PUBLIC HEALTH COMMITTEE (As at 31st December, 1955) Mayor: Councillor H. W. Herrington, J.P. Alderman: Herbert James Lowton Lygoe, J.P., M.S.M. Councillors: George Arthur Ainsworth William Henry Purssord Charles Henry Bowdler Albert John Rogers Frank Ernest Field Lewis Ross George Albert Gardner Mrs. Emily Mary Simms Ernest Charles Gough Terence Patrick Spriggs John James Hawkins Mrs. Bronwen Stradling William Hunter Robert Patrick Walsh William Campbell Lillie Ernest David Ward Chairman : Councillor Albert John Rogers Vice-Chairman: Councillor Mrs. Emily Mary Simms STAFF OF THE PUBLIC HEALTH DEPARTMENT, TOWN HALL, ISLINGTON, N.l (T=Staff on Temporary Establishment). Medical Officer of Health : V. Freeman. M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health : A. L. Thrower, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H., (T. Part-Time.) Public Analyst: Chief Sanitary Inspector: D. F. H. Button, A.R.C.S., F.R.I.C. W. C. Bartlett (b) (c) (d) Deputy Chief Sanitary Inspector: H. Plinston (b) (c) Supervisory Sanitary Inspector: J. S. Ashworth (b) Sanitary Inspectors: (b) J. W. Aiken (b)(c) A. W. Haydock (b) G. A. Reid (b)(c) A. A. Aslamidis (b)(c) H. R. Homewood (b) U. P. Stanton (a)(g)(i) Mrs. G. S. Causton (b) A. R. Kempshall (h) W.T.Stevenson (b) G. D. Couling (b)(c)(d) E. H. Kerridge (b)(c) R. C. Whittaker (b) D. T. Evans (b)(c)(d) N. Lightowlers (b)(c) L. Foxley (b) A. Moxon (11 vacancies) (b)(c) K. L. Garner (b)(c)(e) F. H. W. Pedrick (b)(c)(/)(g)(h) Miss V. M. Goddard (b)(c)(f)(g)(h) Miss S. H. Prentice Chief CIer\: E. J. Sharp Clerical Staff: S. A. Bishop P. Hardwick D. A. Owen W. R. Causton* Miss M. E. Hudson Mrs. E. V. Pelosi (T) E. Conner L. Hummerstone P. L. Regan Mrs. V. E. Cox Mrs. E. Johnson J. Thompson C. J. Cridland* T. W. Johnson L. Turner Mrs. O. Easson Mrs. E. M. Matthews (T) Mrs. F. Underwood Miss D. Francis W. A. McAdam* S. Wright Mrs. J. W. Goodwin Mrs. C. A. McCausland W. H. Goody (T) C. J. Moore* (one vacancy) Old People's Health Officer: Infectious Diseases Visitor: Mrs. B. I. Montaut (f) Mrs. C. M. Burton (f) Disinfecting and Bathing Stations, Seven Sisters Road, 3s(.7. W. G. Jollie (Engineer-in-Charge) Mrs. H. W. H. Godkin (Nurse-in-Charge) (f) 3 Home Visitors 1 Stoker/Handyman 1 Assistant Driver 3 Bathing Attendants 2 Drivers 3 Disinfectors (1 vacancy) 1 Driver/Handyman Rodent Control: C. Jackson (Rodent Officer) 3 Rodent Investigators 6 Rodent Operators (a) = Certificate Sanitary Inspectors' Examination Board. (b) = Certificate of the Royal Sanitary Institute and the Sanitary Inspectors' Examination Joint Board. (c) = Royal Sanitary Institute Meat Inspectors' Certificate. (d) = Royal Sanitary Institute Certificate in Sanitary Science. (e) = Royal Sanitary Institute Smoke Inspectors' Certificate. (/) = State Registered Nurse. (g) = State Certified Midwife. * = Senior Sectional Clerk. (h) = Health Visitors' Certificate. (i) = Health Visitors' Diploma. 5 SECTION A. GENERAL AND VITAL STATISTICS. Area of the Borough 3,092 acres. Population. Registrar-General's estimate of civilian population, Mid-year 1955: 228,800 Live Births. Birth Rate per 1,000 Estimated Resident Population Totals M. F. Islington England and Wales Legitimate 3,605 1,842 1,763 Illegitimate 340 171 169 3,945 2,013 1,932 17.2 15.0 Still Births. Rate per 1,000 Total (Live and Still) Births Islington England and Wales Legitimate 78 35 43 Illegitimate 7 4 3 85 39 46 21.09 23.1 Deaths. Death Rate (Unadjusted) per 1,000 Population Totals M. F. Islington England and Wales 2,591 1,308 1,283 11.32 11.7 Deaths from Puerperal Causes. Deaths. Rate per 1,000 Total Births Islington England and Wales 1 0.25 0.64 Death Rate of Infants under One Year of Age. Islington England and Wales All infants per 1,000 live births 26 24.9 Legitimate infants per 1,000 legitimate live births 24 Illegitimate infants per 1,000 illegitimate live births 38 Notification of Births. For year ending 31st December, 1955 3,969 (corrected figure from L.C.C.). Marriages (Provisional figures). Marriages solemnised in the Borough during the year 2,397 6 COMPARATIVE VITAL STATISTICS—1944 TO 1955 (Compiled from Registrar-General's Returns) 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 Population 228,800 230,500 233,500 235,300 235,800 238,200 239,580 238,200 236,840 227,160 195,770 188,560 Live Births--(Total) 3,945 4,063 3,969 3,897 3,880 4,091 4,389 4,608 5,577 5,284 3,708 3,826 (Illegitimate) 340 336 296 282 285 302 318 331 431 442 438 335 Birth Rate per 1,000 population 17.2 17.6 17.0 16.56 16.45 17.17 18.32 19.34 23.55 23.26 18.94 20.29 Still Birth Rate per 1,000 births 21.09 19.31 22.66 17.89 20.94 17.48 19.87 18.94 18.99 22.20 22.41 25.72 Deaths 2,591 2,425 2,669 2,876 3,131 2,760 2,958 2,682 3,053 2,947 2,856 3,057 Death rate 11.32 10.52 11.43 12.22 13.28 11.59 12.35 11.26 12.89 12.97 14.59 16.21 Maternal Death rate per 1,000 births 0.25 0.48 0.99 1.01 0.50 0.72 0.67 0.85 0.70 1.48 0.26 2.03 Death rate of Infants under 1 year 26 17 24 22 28 29 27 35 32 39 46 48 Marriage rate per 1,000 population 20.95 19.35 19.08 17.85 19.17 18.37 18.61 19.67 19.54 20.21 25.00 18.36 T.B. Notifications per 1,000 population (all forms) 1.97 1.94 2.08 2.03 1.77 2.05 2.20 2.25 2.43 2.18 2.81 3.14 Death-rates per 1,000 population- Pulmonary T.B. 0.20 0.16 0.16 0.30 0.30 0.38 0.52 0.66 0.70 0.64 0.80 0.86 Diphtheria Nil Nil Nil Nil 0.004 0.004 0.008 Nil 0.004 Nil 0.01 0.01 Suicides 0.13 0.13 0.14 0.076 0.15 0.09 0.12 0.15 0.07 0.11 0.06 0.10 Road Traffic Accidents 0.14 0.082 0.077 0.076 0.11 0.10 0.06 0.08 0.11 0.10 0.07 0.16 Other violent causes 0.22 0.17 0.20 0.22 0.26 0.26 0.25 0.43 0.37 0.45 1.05 1.84 7 CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION (REGISTRAR GENERAL'S RETURNS) Cause of Death Age Groups 0— 1— 5- 15- 25— 45— 65— 75— All Ages M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Total 1. Tuberculosis. Respiratory - - - - - - 1 - 5 5 17 2 10 2 1 2 34 11 45 1 2. Tuberculosis, Other — — — — — — - — — — — 1 — 1 — — — 2 2 2 3. Syphilitic diseases — — — - — — - — — — 3 — 7 3 2 — 12 3 15 3 4. Diphtheria — — — — — — - — — — — — — — — — — — — 4 5. Whooping Cough - - - - - - - - - - - - - - - - - - - 5 6. Meningococcal Infection - - - 1 - - - - - - - - - - - - - 1 1 6 7. Acute Poliomyelitis — — — — — 1 - 1 1 - - - - - - - 1 2 3 7 8. Measles - — — — — — - - — — — — — — — — - — — 8 9. Other infective and parasitic diseases - — — — — — - — — — 2 1 — — 1 — 3 1 4 9 10. Malignant neoplasm, stomach - — — — — — - — 2 1 16 5 15 4 9 6 42 16 58 10 11. Malignant neoplasm, lung, bronchus - - - - - - - - 5 — 45 9 40 2 13 6 103 17 120 11 12. Malignant neoplasm, breast - — — — — — - — — 3 — 22 — 14 1 10 1 49 60 12 13. Malignant neoplasm, uterus - — — — — —- - — — 2 — 9 — 3 — 2 — 16 16 13 14. Other malignant neoplasms - — — — 2 — - 1 6 8 40 35 44 31 35 40 127 115 242 14 15. A-and-Leukaemia - — — — — 1 - — 1 3 1 1 1 3 — 1 3 9 12 15 16. Diabetes - — — — — — - — — 1 — 2 1 5 2 1 3 9 12 16 17. Vascular lesions of the nervous system - - - - - 2 3 17 31 23 47 37 80 79 161 240 17 18. Coronary disease, Angina - — — — — — - — 9 1 78 20 70 47 52 79 209 147 356 18 19. Hypertension with heart disease - - - - - - - - - - 3 2 10 7 9 23 22 32 54 19 20. Other heart disease - — — 1 — — - — 7 4 15 18 20 42 59 171 101 236 337 20 21. Other circulatory disease - — — — — — — — — — 6 4 22 18 31 60 59 82 141 21 22. Influenza - — — — — — - — — 1 1 — 3 2 2 6 6 9 15 22 23. Pneumonia 9 7 — 1 — — - — 3 — 7 8 26 18 48 69 93 103 196 23 24. Bronchitis 3 3 — — — — - — — — 40 5 46 28 59 46 148 82 230 24 25. Other disease of the respiratory system - - - - - - - _ 5 - 1 4 3 1 6 4 15 9 24 25 26. Ulcer of stomach and duodenum — — — — — — — 2 1 8 2 10 4 7 5 27 12 39 26 27. Gastritis, enteritis, diarrhœa 2 - - - - - - - - - 3 - - - 1 5 6 5 11 27 28. Nephritis and Nephrosis — — — — — — - — 3 — 3 2 2 4 1 2 9 8 17 28 29. Hyperplasia of prostate — — — — — — - — — — 3 — 2 — 10 — 15 — 15 29 30. Pregnancy, Childbirth and Abortion - - - - - - - - - - - - - - - - - 1 1 30 31. Congenital Malformations 7 5 1 — — — - 2 2 2 2 3 2 — 1 — 15 12 27 31 32. Other defined and ill-defined diseases 47 16 2 2 — 2 2 — 2 5 16 9 13 28 22 28 104 90 194 32 33. Motor vehicle accidents — — 2 — — 1 3 — 7 1 9 — 1 1 4 4 26 7 33 33 34. All other accidents 1 1 — — — — 4 — 7 — 8 2 1 5 7 14 28 22 50 34 35. Suicide — — — — — — — 1 3 5 10 — 2 5 2 1 17 12 29 35 36. Homicide — — — — — — — — — I - 1 — — — — — 2 2 36 All Causes 69 32 5 5 2 5 10 5 72 48 354 198 374 325 422 665 1,308 1,283 2,591 Totals 101 10 7 15 120 552 699 1087 2,591 Percentages 3.89 0.39 0.27 0.58 4.63 21.31 26.98 41.95 100 8 SUMMARY OF INFANT MORTALITY 1955 (Based on Registrar General's Returns) Primary Cause of Death Under 1 day Days Weeks Months 1955 (1954) 1-2 | 2-3 3-4 4—5 | 5-6 6-7 | 1-2 | 2-3 3-4 1-2 2—3 3-4 4-5 5—6 6—7 7—8 8—9 9—10 10-11 11-12 Totals Totals Measles (1) Whooping Cough (-) Meningococcal Infection (-) Tuberculosis—Lungs (-) Tuberculosis-Other forms (1) Bronchitis 1 3 1 1 6 (1) Pneumonia ... 3 2 1 1 1 1 2 2 1 1 1 16 (7) Influenza (-) Enteritis and Diarrhœa 1 1 2 (2) Premature Birth 29 4 5 1 1 1 41 (12) Congenital Malformation, (—) Birth Injury, Atelectasis (-) Atrophy and Marasmus ... 12 2 4 1 1 2 3 1 1 27 (31) Syphilis (—) Suffocation Overlying (—) Violent Causes 1 1 2 (—) Road Traffic Accidents (-) All Other Causes 1 1 1 1 1 2 7 (15) Totals 45 8 10 2 1 1 3 - 3 8 4 3 2 1 2 1 3 — — 2 101 (70) 9 COMMENTS ON VITAL STATISTICS Births. Following the post-war increase in the birth-rate, which reached its peak of 23.55 per thousand population in 1947, there was a drop in each succeeding year until 1951, when the rate was 16.45. Since then the rate has remained fairly steady, with a figure this year of 17.2, as against the 1954 rate of 17.6. The proportion of births classified as illegitimate remains at approximately the same level, at 8.6 per cent of all the 1955 births. Principal Causes of Death. The death-rate was 11.32 per thousand population, as compared with 10.52 for the pervious year, which was the lowest rate ever recorded. Principal causes of death are discussed below. Infants under One Tear. The 1954 infant mortality rate of 17 per thousand live births was not maintained for 1955, and the mortality rate of 26 was in the same range as in the five years prior to 1954. From the Summary of Infant Mortality, 1955, on page 8, it will be seen that the principal increase in infant deaths was in the group associated with premature birth. 29 premature infants did not survive the first twenty-four hours, and prematurity was also ascribed as the primary cause of deaths in another 11 infants under four weeks old, as against six infants in each of these groups in the previous year. Without more detailed information it is not possible to comment further on the increased figures for infant deaths from this cause. There was also an increase in infant deaths due to pneumonia and bronchitis, there being 22, as against eight only in 1954. Deaths from Other Causes. Respiratory Tuberculosis. The record low figure of 37 in the previous two years was, unfortunately, not maintained in 1955 when there were 45 deaths from this cause. The increase was due entirely to more deaths in males of all age groups from 25 to 75 years. Malignant Growths of Lung and Bronchus. Male Deaths Female Total 1950 115 14 129 1951 104 23 127 1952 107 20 127 1953 114 19 133 1954 98 25 123 1955 103 17 120 From the above table it will be seen that although the numbers have not increased over the past few years, it cannot be said on the other hand that there is any marked tendency to a lessening of those who contract and die of malignant diseases of the respiratory system. The increase in deaths due to this cause over the past few years is, of course, part of the national increase and, as mentioned in my previous reports, the principal cause is ascribed to heavy cigarette smoking, practised over many years. Evidence contrary to this view has still to be demonstrated and it 10 is therefore extremely important that young people, above all, should refrain from taking up smoking rather than run this potential risk which may develop from middle age onwards. Diseases of the Respiratory System. Deaths due to influenza, pneumonia and bronchitis were considerably up in 1955 in comparison with the previous year, the total from these combined causes being 441 and 298 respectively. Accidents. The following table gives the deaths from accidents to Islington residents from 1950 onwards :— 1950 1951 1952 1953 1954 1955 Motor vehicle accidents 24 26 18 18 19 3i Other violent accidents 61 61 48 46 40 50 It will be seen from the table that the highest number of fatal motor accidents to Islington residents occurred in 1955. The increase was accounted for almost entirely by a greater number of deaths in males, the majority of these being adults, 25-65 years. In the following table there is an analysis of the causes of accidental deaths in 1955 in their respective age groups, and it will be noted that fatal accidents due to falls also increased, again, mainly among elderly men. Type 0- 1- 5- 15- 25- 45- 65- 75 + M F Total Motor Vehicle Accidents — 2 1 3 8 9 2 8 26 7 33 Falls — — — 1 3 3 4 16 14 13 27 Accidental Poisoning (Solid, Liquid Gases and Vapours) - — 1 2 1 2 2 4 6 Drowning — — — — 1 1 — — 2 — 2 Fire 1 — — 1 1 2 1 2 5 1 8 Inhalation of Stomach contents - - - - - 1 - - - 1 1 Others (Railway Accidents, etc.) 1 — — 2 1 1 — 1 5 1 6 Total 2 2 1 7 15 19 8 29 54 29 83 The above fatalities refer to accidents to persons domiciled in Islington, but irrespective of the location of the accident. Suicides. Suicide deaths, at 29, remained at much the same level as in the previous year, the highest incidence being in males, 2 5'45 years. 11 SECTION B. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES. Notifiable Infectious Diseases and Deaths during the year 1955. Disease Number of Notifications Number of Deaths Removed to Hospital Number of Cases returned to RegistrarGeneral after correction of Diagnosis Cases "coming to knowledge" but not Notified Smallpox - (—) - - - - Scarlet Fever 216 (201) — 57 212 11 Diphtheria 9 (6) — 7 1 — Enteric Fever (including Paratyphoid) 7 (1) — 3 2 Typhus Fever — (-) — — — - Puerperal Pyrexia 430 (311) — 413 431 9 Ac. Primary & Influenzal Pneumonia 117 (104) 4 5 118 _ Ophthalmia Neonatorum 14 (17) — 10 14 — Acute Encephalitis 2 (1) — 2 2 1 Meningococcal Infection 7 (9) 1 7 2 1 Anthrax — (1) — — — —. Dysentery 428 (1,168) — 72 407 64 Malaria 2 (2) — 2 2 — Erysipelas 28 (37) — 4 28 — Measles 2,872 (1,191) — 153 2,886 55 Whooping Cough 363 (263) — 58 360 12 Ac. Poliomyelitis 85 (19) 3 76 55 1 Food Poisoning 294 (104) — 36 303 47 Tuberculosis—Lungs 405 (419) 45 — 308 — Tuberculosis—Other Forms 46 (28) 2 — 42 — Scabies 65 (59) - - 66 126 (Figures in brackets are notifications for 1954) Domiciliary Visiting of Infectious Disease Cases and Contacts—No. of Visits Smallpox 29 Erysipelas 29 Scarlet Fever 227 Measles 3,003 Diphtheria 10 Whooping Cough 357 Enteric Fever (including Paratyphoid) 32 Acute Poliomyelitis 204 Typhus — Food Poisoning 174 Meningococcal Infection 8 Scabies 171 Dysentery 547 Vermin 180 Malaria 2 Enteritis — Pneumonia — Ineffective Visits 1,364 Anthrax Others 281 Total 6,618 Smallpox. No cases of smallpox were recorded. Three suspect cases were visited by the Medical Officer of Health on requests by medical practitioners. These were not 12 confirmed, but follow-up visits were paid. Visits were also paid to fourteen smallpox contacts who landed at the Port of London from a ship in which a case had occurred and were living at an address in this Borough. They were all found to be in good health, and where necessary Medical Officers of Health in other districts were notified. Successful vaccinations:— 1947 3,345 1st January—3rd July, 1948 1,124 5th July—31st December, 1948 702 1949 1,628 1950 2,307 1951 3,291 1952 2,450 1953 3,055 1954 4,052* 1955 5,942* (Figures from 1948 onwards kindly furnished by Divisional Medical Officer, London County Council.) * Including Re-vaccinations. The Vaccination Acts were rescinded under the National Health Service Act, 1946, as from 5th July, 1948. Certificates of Vaccination and Inoculation—Authentication—Ministry of Health Circular 60/48. The number of applications for authentication continued to increase rapidly, and during the year the Medical Officer of Health dealt with 480 requests for authentication of International Certificates of Vaccination and Inoculation against smallpox, cholera, typhoid, etc. Measles and Whooping Cough. Measles and Whooping Cough became generally notifiable in London at the end of 1939. Prior to this there was only a limited notification. Measles. I reported that 1954 was a low incidence year for measles, with 1,191 notifications. 1955 followed the normal course with high incidence, the number of measles cases notified being 2,872. The following table shows the age-groups of the notified cases during 1955:— Under 1 year 1—5 years 5 years and upwards No. of Notifications in 1955 99 1,603 1,170 Percentage of total notifications 3.5 55.8 40.7 No. of Deaths — — — 13 The course of the measles outbreak, which was one of the most extensive for several years, is shown in the block chart which follows, from which it will be seen that the number of cases began to rise materially in October, 1954. From then onwards there was a regular increase to the end of the year, a relative drop in the early part of 1955, and then again an increase, with a major peak in April, when over 800 cases were notified. During the outbreak, which extended over some eleven months, approximately 4,000 young children were notified as having contracted measles. Only in the most exceptional circumstances were measles cases removed to hospital. 14 Whooping Cough. Whooping Cough in 1955 showed an increase, at 363 notifications, as compared with 263 for 1954. The distribution of whooping cough cases according to their ages was as follows:— 5 years and Under 1 year 1-—5 years upwards No. of Notifications in 1955 49 171 143 Percentage of total notifications 13.5 47.1 39.4 No. of Deaths — — — The following chart shows the measles and whooping cough position since 1946 :— Fatality Rates per 1,000 notifications each age group Percentage of notifications (1946—1955) (1946—1955) Under 1 1—5 5 upwards Under 1 1—5 5 upwards Measles 5.44 0.29 — 4.7 58.9 36.4 Whooping Cough 18.58 2.24 — 12.6 58.2 29.2 Over the ten-year period 58.2 per cent of all cases of whooping cough and 58.9 per cent of all cases of measles were in children one to five years of age. 15 Whooping Cough Prophylaxis. Whooping cough immunisation is carried out in the local Health Authority Clinics and by general practitioners. The Divisional Medical Officer has kindly made available the following information in regard to Islington children:— Whooping cough Prophylaxis Total attendances 6,374 Completed cases 2,045 London (Measles and Whooping Cough) Regulations, 1938. Home visiting of measles and whooping cough cases was carried out by the Home Visitors as under:— No. of Investigations Measles Whooping Cough No. of Ineffective Visits Re-visits 2,979 354 595 27 Acute Poliomyelitis 1955 must be counted as a poliomyelitis year, with 56 confirmed cases, out of 97 reported. This is the second highest number of confirmed cases recorded in the borough, being exceeded only in 1949, when there were 62. The first significant increase during the year was in July, rising to a peak in September, and cases were reported right through the autumn until December, an exceptionally high proportion (12 out of the total 56), being adults over the age of 25 years. The Islington outbreak was in accordance with the general trend in the country. In the early part of the period, i.e. in July and August, the majority of the cases were very mild and, in fact, not easy to confirm as definite cases of poliomyelitis. For example, of eleven confirmed cases in July and August, only two developed paralysis. During September, however, the position changed, and of fifteen confirmed cases, thirteen had varying degrees of paralysis, two children had to be treated in iron lungs, and in the early part of October, one adult male, aged 30 years, unfortunately died. Medical Practitioners in the area were kept informed of the progress of the outbreak and certain types of non-urgent operations and inoculation procedures were deferred. The cases reported for each of nine years are set out as under:— No. Reported No. CONFIRMED 1955 97 56 1954 35 12 1953 47 17 1952 30 15 1951 21 8 1950 54 31 1949 88 62 1948 11 9 1947 35 24 Onset dates Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. 1955 2 1 — — — 1 5 11 15 9 9 3 1954 - - - - - - 1 3 2 3 2 1 1953 1 - — — 2 2 6 2 3 1 — — 1952 - - - - 1 — 2 8 — 2 1 1 1951 I — — 1 1 2 — 2 l — — — 1950 I — 1 — 2 2 10 10 l 2 2 — 1949 - - - - - - 9 6 17 18 8 4 1948 — 1 — 2 — 1 — 2 — 1 1 1 1947 — — 1 1 — 2 3 5 4 4 3 1 16 Age distribution : Under 1 yr. 1— 5— 15— 25 and over 1955 5 19 15 5 12 1954 — 7 2 1 2 1953 — 6 5 3 3 1952 — 1 5 4 5 1951 — 2 2 2 2 1950 1 11 12 4 3 1949 3 35 17 2 5 1948 — 2 5 1 1 1947 1 7 6 7 3 Deaths—1955— 3 (17½ years; 30 years; and 5 years—the latter contracted outside the borough, and not included in above tables). 1954 1 (27 years). 1953 3 (4 years; 15 years; 24 years). 1952 Nil. 1951 Nil. 1950 2 (6 years; 12 years). The onset of the disease of the 6-year-old was in 1949. 1949 2 (2 years; 26 years). 1948 Nil. 1947 4. Encephalomyelitis Two cases of encephalomyelitis were reported, with onset respectively in August and October. Both patients were women. Diphtheria Cases and Deaths—1927-1955 Year Notified Cases Deaths Year Notified Cases Deaths Year Notified Cases Confirmed Cases Deaths 1927 720 25 1936 583 31 1945 86 45 3 1928 760 25 1937 623 20 1946 137 50 1929 1,008 34 1938 595 23 1947 72 19 1 1930 1,248 42 1939 254 10 1948 44 7 1931 714 15 1940 101 2 1949 55 17 2 1932 601 20 1941 174 11 1950 50 19 1 1933 551 33 1942 201 2 1951 43 17 1 1934 815 32 1943 188 9 1952 23 1935 760 13 1944 94 2 1953 12 1 1954 6 1 1955 9 1 Corrected Notifications Year England and Wales London Islington 1944 23,199 758 38 1945 18,596 801 45 1946 11,986 747 50 1947 5,609 451 19 1948 3,575 335 7 1949 1,881 221 17 1950 962 81 19 1951 699 30 17 1952 101 5 1953 267 13 1 1954 176 8 1 1955 169 17 1 17 From the previous tables it will be seen that the remarkable record continued, as compared with only a few years ago, of no more than one case of diphtheria occurring in the year in a population approaching a quarter of a million. Diphtheria is now a rare disease, but the position can only be maintained by a continuing high level of immunisation in children. In certain other countries where immunisation has not been done so effectively, the level of diphtheria incidence is many times higher than in this country, and comparable to the position here ten or fifteen years ago. Diphtheria Cases and Immunisation state 1947-1955 (inclusive) Year Immunised Non-Immunised Unknown Total Deaths Age Groups Age Groups 0—5 5—15 15 + 0—5 5—15 15 + 1955 - - - - - - 1 1 Nil 1954 - - - - - - 1 1 Nil 1953 - - - - - 1 - 1 Nil 1952 - - - - - - - - 1951 1 2 — 8 5 1 — 17 7 years—Not immunised 1950 5 3 7 4 19 7 years—Not immunised 1949 1 3 — 2 8 3 — 17 4 years Not immunised 6 years 1948 1 2 1 1 — 2 7 Nil 1947 — 5 1 2 4 5 2 19 16 years—Not immunised Totals 3 17 2 16 24 16 4 82 5 deaths (Noneimmunised) 22 56 No. of Islington Children Immunised against Diphtheria—1939-1953 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 525 89 3,261 5,734 6,321 3,165 3,688 3,425 4,563 5,387 3,185 2.604 3.073 3.019 2,654 Diphtheria Immunisation, 1955 Dr. B. E. A. Sharpe, Divisional Medical Officer, London County Council, has kindly supplied the following figures in respect of Islington children for the current year. As immunity tends to wane with the passage of time, the Immunity Index relates only to children who have been inoculated during the last 5 years. This is consonant with the Immunity Index given by the Ministry of Health. Age at 31.12. 55 Under 1 1—4 5—9 10—14 Under 15 i.e. born in year 1955 1954-511950-46 1945-41 Total Last complete course (whether primary or boost) 1951-55 267 8,367 7,273 2,516 18,423 Mid-year population 3,990 13,110 28,700 45,800 Immunity Index 6.7 63.8 34.1 40.2 18 Food Poisoning Number of notifications received 1947 7 1948 10 1949 55 1950 104 1951 148 1952 58 1953 243 1954 104 1955 294 In accordance with Circular 2/50 of the Ministry of Health, the following table summarises the outbreaks of food poisoning and the character of each outbreak. Date No. of Notifications No. of persons served No. of cases reported No. of deaths Foods involved and Organisms responsible 1. 24. 3.55 - 310 18 - Salt beef, luncheon meat, cabbage, white beans, tomato puree, boiled potatoes and gravy:—No pathogenic organisms isolated. The chemical analysis of the tomato puree:— Free from preservative and metallic contamination. 2. 7. 5.55 7 65 7 — Minced beef and gravy:— no food samples available. 3. 29. 6.55 7 295 7 Ham, tomatoes, potatoes and semolina pudding:— No pathogenic organisms isolated. 4. 10. 7.55 73 863 73 — Cold beef:— Scanty growth Cl. Welchii found on culture. 5. 21. 8.55 15 27 15 - Roast beef :—Large numbers of gram positive rods and moderate growth of Cl. Welchii found from sample. 6. 28. 8.55 11 17 11 — Roast beef:— Small numbers of staphylococcus present. 7. 12.11.55 15 unknown 35 — Pease pudding:— Salmonella bovis morbificans present. 8. 21.11.55 26 800 approx. 26 Beef and rice:— No pathogenic organisms isolated. It will be seen from the above record of notifications received in 1955 that the year was, unfortunately, characterised by the highest number of food poisoning notifications recorded so far. Further particulars in regard to the above outbreaks are given respectively, as under:— 1. This outbreak occurred in connection with a local school. The salt beef in the suspected meal was boiled, refrigerated until the following day, and then re-heated before being served. Luncheon meat was served from a tin which was opened on the same day as consumed, and the tomato puree was also cooked on the same day. Scholars, teachers, and one member of the kitchen staff were affected, symptoms of food poisoning being nausea, abdominal pain and diarrhoea, which commenced about six hours after the meal and continued for about twenty-four hours. None was severly ill. Bacteriological examinations were carried out both on the food samples and pathological specimens from the patients, but no food poisoning organisms were found. 19 It will be noted that only a small proportion of those taking the meal on this day was affected. The kitchen premises and equipment were new, the general standard of cleanliness was good, and the health records of staff satisfactory. The general kitchen routine appeared to be satisfactory, and although the cause of the outbreak could not be pinpointed in this case, the advice was given that as far as possible, meat, including gravy, should be cooked and eaten on the same day. Although this might not be a hundred per cent safeguard, it is considered that it would undoubtedly increase the safety margin. 2. This outbreak, which occurred in hospital, affected only a small number and, as is frequently the case, presents the apparently insoluble problem of why only a few show symptoms, when a very considerable number have had the same meal in the same circumstances as far as is known. No food poisoning organisms were isolated from those affected and, unfortunately, no food remained for sampling, as it had all been consumed or otherwise disposed of. Again, the suspected food, beef, had been cooked the day prior to the final meal in which it was consumed, although it had been stored in a refrigerator in the meantime. 3. Here again, only a very small number out of a very large number who might be considered equally at risk, comprised an outbreak also reported from a hospital. No food poisoning bacteria could be isolated either from those affected or from food samples, but it was thought that prolonged storage and pre-cooking of meats with further storage until completely consumed increased the possibilities of multiplication of bacteria. 4. A considerable number of persons living in an old people's home were affected in this outbreak, the cause in this case being Clostridium Welchii. This food poisoning organism was found both in a number of patients examined and also in the suspected food. The difficulty with this particular type of organism is that it may be present in the original carcase meat, as the organism is found naturally in the animal and is not necessarily subsequently added by human carriers handling food. This organism is difficult to deal with, as it is extremely resistant, even to normal cooking temperatures. The principal symptom, diarrhoea, took 12—18 hours to develop in most cases, none of those affected was severely ill and, in general, recovery was complete within 48 hours. 5. This outbreak occurred at a hostel for girls. As m outbreak 4 above, Clostridium Welchii was the responsible organism, and these bacteria were found to contaminate the suspected meat. 6. Another outbreak occurred at a hostel for mothers and babies, and again, the suspected food was roast beef. It was thought probable, although it could not be definitely confirmed, that the outbreak was due to a staphylococcal organism, possibly originating from a member of the kitchen staff, who unwittingly carried the organism and permitted contamination through food handling. The duration of illness was short, and recovery complete within 24 hours. 7. This food poisoning outbreak was of unusual interest. First information was received from a medical practitioner who had been called in to attend patients apparently suffering from food poisoning. The common factor in these cases was found to be food purchased at a butcher's shop in the borough. Further reports were received from other practitioners in regard to additional patients who had also purchased foods at the same shop. Cases were reported from 20 other boroughs until, in all, information was received of 35 persons who were affected from this source. The principal symptoms were nausea, abdominal pain, severe in a number of cases, sickness and diarrhoea, and the duration of the illness was between two and seven days. The suspected foods included faggots, saveloys and pease pudding, which were supplied by wholesalers in another borough. Each reported case was, of course, followed up, and the staff of the premises concerned also agreed to voluntary examination. Some members of the staff, a considerable number of the consumers concerned, and the pease pudding were all found to have the same organism, known as Salmonella Bovis Morbificans. This organism is normally harboured by cattle, and it was not possible to explain how, under the circumstances, the pease pudding became contaminated. Presumably the organisms were introduced into the pease pudding by a human carrier who had at some time previously been infected by consuming contaminated meat. The supply of suspected foods was, of course, immediately suspended, and food handlers who were found to be carriers were immediately excluded and kept excluded until clear. The greatest co-operation was afforded by the owners of the premises concerned. The number of those who consumed these affected foods is unknown, but it is understood that this outbreak of food poisoning due to Salmonella Bovis Morbificans is the second largest outbreak due to this organism, after a very extensive outbreak which occurred in the North of England a few years ago. 8. The last outbreak was another institutional one, but no food poisoning organism could be definitely identified. The illness was not severe and recovery of those affected was complete in about twenty-four hours. Dysentery Although there was a very considerable number of dysentery notifications (428), during the year, this was less than half the number during the previous year. It will be seen from the table on page 21, that dysentery is an infection which tends to increase in the cooler months, whereas food poisoning outbreaks, on the whole, are more likely to occur in warm weather periods. In the great majority of dysentery cases there is no evidence that this is a food-borne infection, and it would appear more likely that hygiene precautions, particularly in connection with the toilet, would reduce the spread of cases. It will also be seen from the table that a high proportion of those affected were children between the ages of one and five years. Although the great majority of dysentery cases were due to Bacillus Sonne—and the illness is not a severe one—there was a smaller number of cases (mostly in a day nursery) caused by the Flexner organism. Home enquiries in connection with dysentery cases were always directed to include information as to whether either the patient or a member of the household was connected in any way with food handling in his or her work. It will be noted from the table that a substantial number of such persons were found to be either cases or food handler contacts, and appropriate precautions were taken, and advice given when such circumstances were discovered in order that the public could be suitably protected against possible spread of dysentery through food contamination. All notified cases were visited by a Sanitary Inspector or Infectious Disease Visitor, and stool specimens were examined at the Public Health Laboratory Service Bacteriological Laboratory, County Hall, S.E.I. 21 DYSENTERY OUTBREAK IN ISLINGTON—1955 Month No. of Cases Sex Notified Coming to knowledge Confirmed Cases Age Groups Case employed as a food handler Food Handler Contacts Water Closet Accommodation 0- 1 - 5- 15 - 25- 45- 65 + Same family Separate family Separate Shared 1955 January 25 M 9 1 14 1 4 4 - 1 - - - - - 12 9 F 15 - 1 4 2 3 3 1 1 - February 21 M 11 1 12 1 3 1 2 1 1 3 - 2 2 7 11 F 9 - 3 4 1 - - - 1 - March 75 M 34 2 56 - 20 9 1 5 1 - 1 8 15 30 40 F 35 4 1 12 10 3 11 2 - 2 April 45 M 17 6 29 2 8 5 - 7 1 - 1 8 17 7 34 F 20 2 - 11 3 - 4 2 2 1 May 63 M 22 3 45 2 9 8 1 3 1 1 2 14 - 26 37 F 31 7 2 19 4 3 8 2 - 3 June 44 M 22 3 24 - 12 4 2 3 2 2 1 8 5 22 15 F 16 3 3 11 1 - 2 2 - - July 50 M 15 5 36 - 11 2 2 2 1 2 - - 1 30 18 F 21 9 1 14 7 3 2 3 - 1 August 30 M 16 - 6 - 3 3 - 6 3 1 1 1 - 16 12 F 12 2 2 2 - - 6 4 - 1 September 27 M 16 - 4 1 5 7 1 2 - - - 4 2 12 14 F 11 1 - 3 1 3 2 l 1 October 29 M 16 - 14 1 1 9 2 2 1 - - 3 1 12 13 F 9 4 - 3 4 2 2 2 - - November 15 M 8 1 8 1 2 4 - 1 1 - - - - 5 10 F 6 - 1 - 4 1 - - - - December 77 M 30 6 53 6 20 5 - 1 1 3 - 8 3 28 47 F 36 5 - 22 6 5 8 - - - Total 501 M 216 28 301 15 98 61 11 34 13 12 6 56 46 207 260 F 221 36 15 102 45 21 49 20 5 9 22 Scabies and Vermin Treatment for scabies and vermin during the year was carried out at the Finsbury Public Health Centre, Pine Street, E.C.I, on account of the temporary closure of this Department's own Station, Seven Sisters Road, for renewal of plant, which included installation of a new boiler and sterilizers. The co-operation and assistance given by the Medical Officer of Health and staff of the Finsbury Health Department in agreeing to take Islington cases during the year is very greatly appreciated. Scabies Vermin Children under 5 years Number treated 13 9 Number of baths given 29* — Number of treatments — 9 L.C.C. Children Number treated 5 10 Number of baths given 10 — Number of treatments — 10 Adults Number treated 79 31 Number of baths given 160* — Number of treatments — 31 *Baths were also given to 19 Scabies Contacts and 75 Special Cleansing Cases. Home Visiting. Follow-up home visiting for cases of scabies and vermin was carried out by the Home Visitors of the Cleansing Station as under:— Families Visited Revisits Ineffective Visits Total Scabies 113 7 110 230 Vermin 139 16 177 332 Tuberculosis. It will be seen from the table given below that there were 406 new cases of pulmonary tuberculosis, and an increase in the number of deaths to 45, from 37 in each of the previous two years. With a total approaching 3,000 persons on the Tuberculosis Register in the borough, pulmonary tuberculosis remains the mos: serious major infection with which we still have to deal. Of the 235 new cases in males, no fewer that 171 were between the ages of 15 and 55 years; thus their working capacity is very seriously affected for long periods in what should be the most favourable part of their working lives. Of the 171 new cases of lung tuberculosis in women no less than 128 were between the ages of 15 and 45, again, with serious implications not only on their personal working capacity but also in the case of married women, the possible effects on their families. Being a long-term illness, tuberculosis gives rise to serious social problems and, although there are very many families in the Borough for whom re-housing is urgently necessary, the question of adequate accommodation is even more important in the case of a tuberculous household because of the necessity for separate sleeping arangements for the patient. Both the Borough Council and the London County Council give special consideration to "ihe re-housing of tuberculous households where the patient is in an infective condition, but with the great deficiency of new accommodation in proportion to the demand, undesirably long delay may occur before a re-housing offer can be made to a family where the need is even more pressing on account of pulmonary tuberculosis. Whilst new forms of treatment have succeeded in prolonging the lives of many sufferers from lung tuberculosis, this has had the effect of increasing the total number of persons in the community suffering from this infection. The work of TUBERCULOSIS-PRIMARY NOTIFICATIONS 1955 LACK:PULMONARY CASES WHITE:OTHER FORMS 23 supervision and continued examination has therefore increased, and it may also be that the potential risks of infection can be similarly increased unless great care is taken by those affected. New Cases and Mortality during 1955 Ages New Cases Deaths Respiratory Non-Respiratory Respiratory Non-Respiratory M. F. M. F. M. F. M. F. 0— 1 — — - - — — - 1— 7 5 1 — — — - - 5— 8 8 5 1 — — — - 15— 34 48 7 11 1 — — — 25— 58 60 6 9 2 5 — — 35— 39 20 2 1 3 — — — 45— 40 16 2 2 9 1 — __ 55— 20 6 — 1 8 1 — 1 65 and upwards 28 8 1 2 11 4 — 1 Total for all ages 235 171 24 27 34 11 — 2 457 47 Rates per 1,000 population— New cases—pulmonary 1.77 non-pulmonary 0.22 Deaths— pulmonary 0.20 non-pulmonary 0.009 Public Health (Tuberculosis) Regulations, 1952 Although information in regard to the coming and going of tuberculous patients under these Regulations is not as complete as it was under the Tuberculosis Regulations, 1930, every effort is made to confirm the correctness of the Register still maintained in the Department. The total number of cases on the Register of the Department as at 31st December, 1955 was:— Pulmonary— Males 1,430 Females 1,204 Non-Pulmonary—Males 148 Females 163 2,945 The corresponding figures for previous years are:— 1948 2,401 1949 2,490 1950 2,368 1951 2,404 1952 2,575 1953 2,802 1954 2,922 Islington Chest Clinic, Whittington Hospital Cases on Chest Clinic Registers Pulmonary Non-Pulmonary Total Adults Children Adults Children Adults Children Number of definite cases of tuber- culosis on Chest Clinic Register as at 31st December, 1955 m. f. m. f. m. f. m. f. m. f. m. f. 1337 1053 103 78 62 90 12 16 1399 1143 115 94 Grand Total 2,751 24 The corresponding figures for previous years are:— 1949 2,127 1950 2,238 1951 2,443 1952 2,575 1953 2,738 1954 2,851 Tuberculosis Care Committee. The London County Council is responsible for care work under the National Health Service Act, 1946, but the Islington Tuberculosis Care Committee remains in being, working in conjunction with the Islington Chest Clinic, and Members of the Borough Council and the Medical Officer of Health serve on this Committee. The Tuberculosis Care Committee is able to assist patients in many ways, and Miss Greenaway, the Care Organiser, reports that an average of 150 cases were helped with extra nourishment during the year, while loans of bedding and medical appliances were made to 24 patients; others were referred to various organisations for assistance. Tuberculosis—Mass X-Ray Unit of the North-West Metropolitan Regional Hospital Board, 32, Drayton Park, N.5. The Mass X-Ray Unit continued to function throughout the year. Between 15 and 16,000 Islington residents were examined by the Unit, as well as a large number of others who work in the Borough. Close liaison is maintained between Dr. G. Z. Brett, Physician-in-charge of the Unit, and medical practitioners in the area. A large number of organised groups of volunteers also attended for X-Ray examination. Virus Infections During the autumn of the year reports were received in regard to a number of children in a primary school who were suffering from an illness, showing similar symptoms, but not quite typical of the usual forms of respiratory illness. The symptoms in general were malaise, sore throat, enlargement of the glands at the back of the neck, some abdominal pain or intestinal upset, and a mild conjunctivitis (inflammation of the eyes), temperature was moderately raised and continued to be raised in a number of children after the initial symptoms mentioned above had subsided after a few days. A very considerable number of children were affected and although the illness was confined to the younger children at first, junior schoolchildren in the same building were affected later. Close watch was kept on the children, in conjunction with the School Health Service of the London County Council, and, in view of the probability that this was a virus infection, the Central Public Health Laboratory, and the Public Health Laboratory, County Hall, also co-operated in the enquiries. Selected children were seen by consultant staff at the Royal Free Hospital, and general practitioners were informed and asked to co-operate in observing the children, and transmitting any further information to the Department. No serious cases were reported, and although a few adults were reported sick with similar symptoms, on the whole, it appears that the outbreak was confined to children. Information was subsequently received of a similar outbreak in a County Borough outside London. Although a primary and junior school in one building were first affected, a number of cases occurred also at another primary and junior school in the Borough, 25 as well as a very few isolated cases in other schools, but the remainder were free from the infection as far as can be ascertained. Information was received of approximately 500 children in the first school and 300 in the second. The Ministry of Health was, of course, kept informed. New virus infections of the respiratory tract have been reported from time to time recently, and this outbreak—fortunately of a mild nature—might well have been one of this group. Bacteriological Examinations All specimens for bacteriological examination dealt with through the Department are submitted to the Public Health Laboratory Service, County Hall, S.E.1. Examinations carried out Total Swabs (Diphtheria) 174 Sputum (Tuberculosis) 22 Faeces (Typhoid) 20 Blood (Typhoid) — Faeces (Food poisoning) 436 Food (Food poisoning) 23 Faeces (Dysentery) 2,682 Faeces (Poliomyelitis) 104 Swabs (Streptococci) 45 Swabs (Pertussis) 2 Swabs (Influenza) 26 Smears (Variola) 2 Scrapings (Variola) 2 Other Specimens 9 Total 3,547 (I am indebted to Dr. B. E. A. Sharpe, Divisional Medical Officer, London County Council, for the 1955 figures in connection with vaccination, diphtheria and whooping cough inoculations, and chest clinics). SANITARY CIRCUMSTANCES OF THE AREA SECTION C (In conjunction with Mr. W. C. Bartlett, Chief Sanitary Inspector) Whilst every opportunity is being taken to improve the conditions under which residents of the borough live, much of the property in Islington, by reason of its age and disrepair, is far from satisfactory. The problem is further aggravated by the fact that, because of the National shortage of Sanitary Inspectors, the Department has been required to carry out its statutory duties with a depleted staff. It is only due to the Co-operation and good-will of the Inspectors in the employ of this Council that the work has proceeded as satisfactorily as it has done. The attention of the Public Health Committee was drawn to the unhygienic and very unsatisfactory refuse storage facilities at certain blocks of tenement buildings in the borough and, in consultation with the Cleansing Superintendent, the owners agreed to carry out work in order that the "Paladin" system may be installed. As an experiment, work on one block of flats commenced late in the year. Upon its completion in 1956 consideration will be given by the owners to the conversion of the chutes and storage chambers at the remaining blocks. A very considerable improvement will be achieved upon the completion of this scheme. 26 Arising out of complaints received concerning a nuisance from pigeons at a school in the borough arrangements were made for the premises to be cleared by an authorised pigeon catcher. The ready co-operation of the owners of a nearby factory was obtained and the pigeon nuisance reduced to a minimum. As a result of repeated complaints being received alleging that nuisance from effluvia emanated from a factory situated in a densely populated area of the borough, and in which animal blood was processed, the Sanitary Inspectors kept observations over a long period and confirmed the existence of a nuisance which affected residents over a considerable area. Legal proceedings were taken under the appropriate section of the Public Health (London) Act, 1936, and at the time of the hearing the Company gave an undertaking to the Court that steps would be taken to ensure that the nuisance would not recur. Fines were imposed and the Council awarded costs. In December of this year the London County Council (General Powers) Act, 1955, received Royal Assent and came into operation immediately. This statute, inter alia, considerably strengthens the power of Metropolitan Borough Councils in relation to stopped up or defective drains. It also gives power to these authorities to reinstate a water supply where the Metropolitan Water Board, by reason of a defective state of the supply pipe or the absence or defective state of fittings, cease to supply with water specified buildings used for human habitation of a place where persons are employed, and to recover the costs incurred. Additional powers are also given to the sanitary authority to remedy defects where a house is in such a state as to be a nuisance or injurious or dangerous to health and, having regard to all the circumstances, unreasonable delay in remedying the defects stated would be occasioned by following the normal statutory procedure. By virtue of Section 18 of the London County Council (General Powers) Act, 1954, the Council is empowered to register hairdressers and barbers and their premises and to make byelaws for hygienic conditions in such premises. Local byelaws were approved by the Ministry of Housing and Local Government during the year and came into operation on 1st October. The appointed day for registration is 1st January, 1956. Summary of Work done by District Sanitary Inspectors. During the year 32,642 inspections or revisits were made by the District Sanitary Inspectors. In connection with visits to dwelling-houses, 38,143 inspections or re-inspections of separate lettings were made. Routine Inspections, etc. Houses Inspected (on complaint, etc.) 7,524 do. Separate Lettings in above 13,687 Inspections re Schools 12 do. Licensed Premises 24 do. Child Life Protection 3 do. Stables, Manure Pits 9 do. Courts, Mews 14 do. Bombed Sites 161 do. Derelict Buildings 44 do. A.R.P. Shelters, Static Water Tanks 61 do. Fairgrounds, Caravans 12 Nuisances dealt with by Notice 9,443 do. informally 1,057 27 Routine Inspections, etc.—cont. Houses Reinspected 12,509 do. Separate Lettings in above 21,782 Other revisits 1,042 Notices Served—Intimation 3,797 do. Statutory 1,793 Notices Complied with—Intimation 1,651 do. Statutory 1,239 do. By Local Authority in default 40 Requisitioned Properties—Inspected 99 do. Separate Lettings in above 165 do. Reinspected 156 do. Separate Lettings in above 281 Land Charges Act, 1925. Enquiries received 2,042 Properties involved 2,970 Investigations 4,163 Rational Assistance Act (Section 47).—Aged and Infirm Persons Cases Investigated 31 Cases Revisited 38 (See also Section on Services for Elderly Persons). Housing Acts. Sections 57/62, etc.—Inspections and Revisits 428 Survey of Areas—Preliminary Investigations 1,118 Sections 9, 11, 12, etc., Inspections and Revisits 2,008 do. Separate Lettings in above 2,010 Miscellaneous. Other Visits or Inspections not specified 1,588 Non-effective Visits 5,594 Total Nuisances and Contraventions Reported (all sources) 10,720 *Food & Drugs Act, etc.—Week End (Saturday—Sunday) Duty. Retail Shops and Food Purveyors Inspected 61 Street Markets Visited 100 * See also Section E. Housing Repairs and Rents Act, 1954 Certificates of Disrepair. Section Sections 26 26/27 Applications brought forward from 1954 55 7 Applications in 1955 133 35 Total 188 42 Certificates issued in 1955 185 38 Certificates refused in 1955 2 — Balance to 1956 1 4 Total 188 42 Appeals Lodged — — 28 Revocation Certificates. Applications brought forward from 1954 1 3 Applications in 1955 66 18 Total 67 21 Certificates issued in 1955 44 3 Certificates refused in 1955 13 17 Balance to 1956 10 1 Total 67 21 Appeals Lodged — — Improvements effected as a result of Service of Notices under the Public Health (London) Act. 1. Brickwork—walls repaired or rebuilt 22 2. Drains cleared, repaired, etc. 301 3. Dampness remedied 2,182 4. Fireplaces and ranges repaired/renewed 298 5. Floors repaired 395 6. Flues repaired 181 7. Internal walls repaired 925 8. Ceilings repaired 615 9. Rainwater pipes/gutters repaired 313 10. Roofs repaired 1,151 11. Rooms cleansed 124 12. Sinks provided 41 13. Soil pipes repaired and renewed 56 14. Staircases or passages cleansed 22 15. Staircases repaired 90 16. Waste pipes repaired 199 17. Water Closet Apartments cleansed 35 18. Water Closet Pans and Traps renewed 114 19. Water Closets—flushing apparatus repaired or renewed 165 20. Water Closets—general repairs 390 21. Water supply provided 46 22. Water service pipes repaired 64 23. Window cords renewed 937 24. Windows repaired or renewed 532 25. Miscellaneous improvements 674 Total 9,872 Total number of houses improved 3,414 Total number of separate lettings improved 3,984 Total number of nuisances abated 9,090 29 Public Health (London) Act, 1936—Sections 40 and 109. Consequent upon Notices served by the Sanitary Inspectors under Sections 40 and 109 respectively, of the Public Health (London) Act, 1936, the Council, in pursuance of their powers under this Act to carry out urgent sanitary and drainage work in default, executed work amounting to a total of £934 12s. 2d. Legal Proceeding's. Public Health (London) Act, 1936. Failure to comply with Statutory Notices contrary to Section 82 (No. of Cases: 62). Date Address Magistrate's Decision 13.1.55 93, Bemberton Street Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 89, Mildmay Grove Case withdrawn. do. 93, Pembroke Street Case not proceeded with. do. 32, Gainford Street Fined £2. Ordered to abate within 14 days. Defendant to pay £1 15s. 6d. costs. 10.2.55 48, Hornsey Road Defendant to pay £1 5s. costs. do. 25, Pulteney Street Defendant to pay £1 5s. costs. do. 22, Gainford Street Fined £5. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. do. 81, Hanley Road Fined £2. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 8, Barbara Street Ordered to abate within 56 days. Defendant to pay 11/6d. costs. do. 15, Herrick Road (a) Ordered to abate with 14 days. Defendant to pay 16/6d. costs. do. 15, Herrick Road (b) Ordered to abate within 14 days. do. 66, Ockendon Road Fined £5. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. 10.3.55 52. Windsor Road Fined £1. Defendant to pay £1 1s. costs do. 19, Newington Green Fined £3. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 7, Grange House, Highbury Grange Fined £2. Ordered to abate within 28 days. Defendant to pay £l 9s. 6d. costs. do. 103, Essex Road Fined £3. Ordered to abate within 28 days. Defendant to Day £l 9s. 6d. costs. do. 31, Lough Road Adjourned sine die. do. 9, Boxworth Grove Fined £5. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. do. 88, Fonthill Road Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. 14.4.55 19, King Henry Street Defendant to pay £1 6s. costs. do. 21, King Henry Street Defendant to pay £1 6s. costs. do. 31, King Henry Street Defendant to pay £1 6s. costs. do. 14, Newhall Street Defendant to pay £1 11s. costs. do. 26, Mildmay Street Case withdrawn. do. 35, Beresford Road Defendant to pay £1 6s. costs. do. 20, Gainford Street Fined £2. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. do. 20, Keystone Crescent Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. 19.5.55 27A, Wilton Square Adjourned sine die. do. 48, Copenhagen Street Ordered to abate within 56 days. Defendant to pay 1 14s. 6d. costs. do. 50, Copenhagen Street Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 1, Pyrland Road Adjourned sine die with a view to Council carrying out the necessary works. do. 10, Leconfield Road Defendant to pay £1 11s. 0d. costs. do. 65, Bride Street Defendant to pay £1 11s. 0d. costs. do. 52, Mackenzie Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. 23.6.55 18, Chillingworth Road Defendant to pay £1 11s. 0d. costs. do. 13. Ardilaun Road Adjourned sine die. do. 11, Reid Street Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 21, Tremlett Grove Ordered to abate within 28 days. 21.7.55 132, Caledonion Road Defendant to pay 10/- costs do. 9, Canonbury Lane Fined £5. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. 30 Public Health (London) Act, 1936. Failure to comply with Statutory Notices contrary to Section 82 (No. of cases:62).—contd. Date Address Magistrate's Decision 21.7.55 147, Southgate Road Ordered to abate within 56 days. Defendant to pay £1 14s. 6d. costs. do. 35, Aberdeen Road Case withdrawn. do. 39, Hornsey Street Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. 6.10.55 91, Cloudesley Road Fined £1. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 55, Corinne Road Ordered to abate within 56 days. Defendant to pay £1 14s. 6d. costs. do. 118, Gillespie Road Ordered to abate within 56 days. Defendant to pay 13/6d. costs. do. 39, Hanley Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. 10.11.55 146, Offord Road Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 48, Blundell Street (a) Fined £2. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. do. 48, Blundell Street (b) Fined £3. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. do. 10, Coleman Fields Fined £1. Defendant to pay £1 2s. costs. do. 11, Hanley Road Fined £5. Ordered to abate within 14 days. Defendant to pay £1 15s. 6d. costs. do. 147, Petherton Road Ordered to abate within 56 days. 15.12.55 175, Offord Road Fined £1. Defendant to pay £1 2s. costs. do. 7, North Road Fined £2. Defendant to pay £1 2s. costs. do. 10, Stradbroke Road Fined £2. Defendant to pay £1 2s. costs. do. 33. Ripplevale Grove Fined £2. Defendant to pay £1 2s. costs. do. 21, Oakley Road Fined £4. Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. do. 42, Camden Dwellings Fined £3. Ordered to abate within 28 days. do. Defendant to pay £1 9s. 6d. costs. do. 28, Medina Road Fined £1. Defendant to pay 1s. costs. do. 71, Benwell Road Fined £5. Defendant to pay £1 3s. costs. do. 3, Chatterton Road Fined £l. Defendant to pay 8/6d. costs. 31 Section 137(1) Effluvium Nuisances—(No. of Summonses 11) Legal proceeding were heard on the 13th December concerning Nos. 1.3 Highbury Station Road under Section 137(1) of the Public Health (London) Act, 1936 for using these premises on specified dates for a process causing effluvia contrary to the above Section. The specified dates and the Magistrate's decisions are as follows:- Date Fine Costs 27.8.55 (Absolute discharge) £2 30.8.55 do. £2 12.9.55 £2 £5 15.9.55 £2 £5 18.9.55 £2 £5 24.9.55 £2 £5 27.9.55 £2 £5 28.9.55 £2 £5 29.9.55 £2 £5 9/10.11.55 (Absolute discharge) £2 15.11.55 do. £2 Disinfection and Disinfestation. During the year under review the work usually carried out at the Disinfecting and Bathing Stations was dealt with at the Pine Street Health Centre, Finsbury, as the replacement of the boiler and disinfecting plant at Seven Sisters Road was not completed. Thanks are due to the Finsbury Borough Council, its Medical Officer of Health and Staff for the facilities placed at the disposal of this department, which enabled the disinfection of articles and the treatment of verminous and other cases from Islington to be carried out expeditiously. 969 rooms were disinfected after cases of infectious or other disease. A total of 989 rooms were treated for vermin, of which 320 were disinfested free of charge. The majority of free cases were on behalf of elderly or infirm persons. The Council continued to make a charge of 7/6d. for the first room and 5/- for every additional room treated for verminous conditions. The effects of 139 families were treated with D.D.T. as a precautionary measure. In addition five treatments for flies were carried out on static water tanks, bombed sites, etc. * The Sanitary Inspector paid 54 visits to a factory to supervise the treatment of 267 bales of stockings or other materials for export. The total weight of bales treated was 95 tons 17 cwts. 3 qtrs. 14 lbs. 32 Steam Disinfection. 4,084 articles of clothing or bedding were subjected to steam disinfection. Static water tanks, air-raid shelters, bombed sites, etc. Complaints were again received concerning the tipping of refuse, the accumulation of water and other nuisances arising in respect of static water tanks and on bombed or vacant sites in the Borough. With the co-operation of the Council's Cleansing Superintendent, putrescible matter was removed by his department upon receipt of a request from the Sanitary Inspector. The following action was taken :— Visits to bombed sites 161 Visits to air-raid shelters and static water tanks 61 Vacant land cleansed 24 Vacant land enclosed 2 Derelict buildings enclosed 1 Static water tanks cleansed 6 Thanks are also due to the London Fire Brigade for the co-operation of its staff in pumping out stagnant water from water tanks. Fly Infestation. The anti-fly treatment at the Council's Ashburton Grove Depot commenced on 3rd June and continued during the summer months. It was considered that particular attention should be paid to this area during the railway strike which occurred during the year and the Sanitary Inspector concerned kept the depot under active observation. The quantity of refuse dealt with at this depot has, however, been considerably reduced and, therefore, the commencement of the treatment was found not to be of such an urgent nature as it otherwise might have been. Atmospheric Pollution. Public Heal:h (London) Act, 1936—Part V. The Committee in 1953 appointed the Medical Officer of Health, or deputy nominated by him, as its representative to the Standing Conference of Co-operating Bodies relating to Atmospheric Pollution set up by the Department of Scientific and Industrial Research. The Conference met on two occasions and the Committee was informed of the proceedings. During the year the Government considered the Clean Air Bill, which was published in July. It was not, however, placed on the Statute Book by the end of the year under review. The Bill, which has as its object the implementation of the 33 principal recommendations in the report of the Committee on Air Pollution, has four main purposes :— (1) to prohibit the emission of dark smoke from chimneys, railway engines and vessels, subject to certain qualifications ; (ii) to prohibit the installation of new industrial furnaces unless they are capable, so far as practicable, of being operated without emitting smoke ; (iii) to require that the emission of grit and dust from existing industrial furnaces shall be minimised, and that new industrial furnaces burning pulverised fuel or large quantities of other solid fuel shall be provided with grit-arresting equipment; (iv) to empower local authorities by Order, subject to confirmation by the Minister concerned, to declare "smoke'control areas" in which the emission of smoke from chimneys will constitute an offence. The Bill has been the subject of much discussion. Until new legislation is made the powers given to the Council in the Public Health (London) Act, 1936, are being implemented. Inspectors are well aware of the harmful effects of a smoke laden atmosphere. Technical and practical advice is given to stokers, factory owners and other staff concerned, in order that furnaces may be fired efficiently without giving rise to a smoke nuisance. These visits and the advice given are appreciated by the factory staff, who have co-operated with this department in no small way, in order to keep the air clean and free from smoke pollution. This view is supported by the fact that, although more complaints were received and the Inspectors made more observations and visits than the previous year, the number of notices required to be served was less. Number of complaints received during year 54 Number of observations 477 Number of inspections and revisits 368 Number of notices served 8 Number of notices complied with 10 Recording of Atmospheric Pollution. A summary of the observations at the three stations in the Borough is as follows:— 34 Monthly Deposits recorded by the Deposit Gauges and Sulphur-Dioxide by the Lead-Peroxide Method. Month Site No.* Rainfall in Inches Insoluble Deposit Soluble Deposit Total Solids Mg.of S03/day collected by 100 sq. cm. of Batch A Lead-Peroxide. (Louvered Box) (Tons per square mile) January 1 2.76 17.80 16.50 34.30 5.40 „ 2 2.60 22.90 56.80 79.70 4.38 „ 3 2.84 20.31 14.68 34.99 3.41 February 1 1.46 10.41 9.11 19.52 5.10 „ 2 1.50 11.73 26.91 38.64 4.03 „ 3 1.58 11.14 6.79 17.93 3.63 March 1 0.87 10.34 8.19 18.53 4.00 „ 2 0.99 13.02 8.75 21.77 3.69 „ 3 1.10 13.82 6.66 20.48 2.66 April 1 0.28 6.73 4.04 10.77 1.82 „ 2 0.43 5.63 13.09 18.72 1.53 „ 3 0.39 9.98 2.75 12.73 1.22 May 1 3.97 13.99 12.26 26.25 1.18 „ 2 4.53 24.29 34.13 58.42 1.14 „ 3 4.53 16.57 12.06 28.63 0.89 June 1 2.48 10.27 5.93 16.20 1.22 „ 2 2.36 17.63 17.53 35.16 1.42 „ 3 2.21 10.44 4.84 15.28 0.68 July 1 0.08 5.80 5.40 11.20 0.95 „ 2 0.20 7.72 5.53 13.25 1.11 „ 3 0.20 8.15 3.98 12.13 1.02 August 1 1.06 4.18 4.14 8.32 1.16 „ 2 1.02 5.53 5.60 11.13 1.39 „ 3 1.26 4.08 4.54 8.62 0.68 September 1 2.28 8.78 8.82 17.60 1.79 „ 2 2.28 19.25 21.97 41.22 1.83 „ 3 2.01 10.04 5.17 15.21 0.82 October 1 2.48 7.95 10.61 18.56 3.66 „ 2 2.72 13.82 9.21 23.03 2.03 „ 3 2.68 9.64 5.50 15.14 3.15 November 1 0.55 9.18 5.93 15.11 5.12 „ 2 0.59 15.15 7.22 22.37 4.59 „ 3 0.59 10.21 5.40 15.61 3.17 December 1 1.77 11.33 10.44 21.77 5.00 „ 2 2.05 13.72 11.63 25.35 4.75 „ 3 2.05 8.95 7.92 16.87 3.45 * These sites are situated at the following places in the Borough :— 1.—Town Hall roof. 2.—York Way Court (Caledonian Road area). 3.—Disinfecting Station at Seven Sisters Road. It will be observed by reference to the above summary that in January and December the figures for deposit and sulphur dioxide are considerably higher than for the summer months. This is general experience. Since industrial and non-domestic pollution does not vary a great deal according to the season of the year the increase in winter pollution must be ascribed very largely, if not entirely, to the increase of domestic pollution due to open fires. The increase in deposit and sulphur-dioxide in the winter is, therefore, a measure of the increased pollution caused by the inefficient combustion of raw coal in the ordinary domestic grate. The Council approved the attendance of one of its senior Inspectors to a three day course on modern domestic fuel appliances arranged by the Coal Utilisation 35 Council which is an impartial and non-trading organisation. The syllabus had regard to the obligations proposed to be placed upon local authorities by Clause 9 of the Clean Air Bill which relates to the adaptation of fireplaces in private dwellings. Requisitioned Properties. The Requisitioned Houses and Housing (Amendment) Act, 1955, came into operation on 6th June. The purpose of this statute is to enable local authorities to wind up the use of requisitioning for housing purposes by 31st March, 1960. The number of requisitioned properties on 1st January, 1955 was 1204. 113 (including parts of premises) were de-requisitioned during the year. This department has drawn the attention of the Council's Housing Estates Manager to any nuisances or major defects arising from the occupation of requisitioned properties, in order to ensure the premises being reasonably nuisancefree. 100 such references were made. WORK OF SANITARY INSPECTORS ADMINISTERING FACTORIES ACT, 1937, FOOD AND DRUGS ACT, 1938, AND OTHER RELEVANT ACTS. Inspections and Re-Visits. 6,358 inspections and 3,957 re-visits were made by the Inspectors. These are summarised as follows :— Inspections Revisits Coffee and dining rooms, hotel and restaurant kitchens and refreshment rooms 1,337 611 Stalls (Refreshment and Food) 62 31 Factories (Mechanical) 1,613 1,262 Factories (Non-mechanical) 185 109 Factories (Public Health (London) Act, 1936) 1,380 1,183 Fish curera 78 38 Fishmongers 13 8 Fried Fish Shops 174 57 Noise Nuisances 49 47 Outworkers 31 87 Provision Shops 488 178 Bakehouses (Level) 130 48 Confectioners 263 71 Fruiterers/Greengrocers 284 85 Preserved food premises 271 142 6,358 3,957 (See separate section for underground bakehouses and offensive trades.) Defects, nuisances or contraventions found. Nuisances and Notices. (a) Factories Act, 1937. Number of contraventions found 609 Number of contraventions remedied 457 Notices served 169 Notices complied with 127 (b) Food and Drugs Act, 1938. Number of contraventions found 914 Number of contraventions remedied 741 Notices served 162 Notices complied with 129 (c) Public Health (London) Act, 1936. Number of contraventions found 301 Number of contraventions remedied 276 Notices served 159 Notices complied with 124 36 (d) Shops Act, 1950. Number of inspections under this Act 57 Number of revisits 39 Number of exemption certificates applied for 16 Number of certificates granted 6 Complaints received. Number of complaints (General) 402 Number of complaints (Home Office) 10 Factories Act, 1937. Prescribed particulars on the administration of the Factories Act, 1937. 1.—Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 270 185 10 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,809 1,413 159 — (iii) Other Premises in which Section 7 is enforced by the Local Authority* (excluding out-workers' premises) — — — — Total 2,079 1,598 169 — 2.—Cases in which Defects were Found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.l) 6 2 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) 4 — — — — Inadequate ventilation (S.4) — 1 — — — Ineffective drainage of floors (S.6) Sanitary Conveniences (S.7) 6 — — — — (a) Insufficient 6 8 — 1 — (b) Unsuitable or defective 570 404 — 6 — (c) Not separate for sexes 17 10 — — — Other offences against the Act (not including offences relating to Outwork) — 32 — — — Total 609 457 — 7 — * i.e. Electrical Stations (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 37 Outwork. (Sections 110 and 111). Nature of Work (1) Section 110 Section 111 No. of outworkers in August list required by Sec. 110(1) (c) (3) No. of cases of default in sending lists to the Council (4) No. of prosecutions for failure to supply lists (5) No. of instances of work in some premises (6) Notices served (7) Prosecutions (8) Wearing apparel Making, etc. Cleaning and washing 556 - — — — — Brass and brass articles 5 — — — — - Fur pulling 8 — — — — - Umbrellas, etc 6 - — — — — Artificial flowers 105 — — — — - The making of boxes or other receptacles or parts thereof made wholly or partially of paper 64 - - 1 - - Brush making 21 — — — — — Feather sorting 20 — — — — — Carding, etc., of buttons etc. 34 - - - - — Stuffed toys 120 — - — — - Cosaques, Christmas crackers, Christmas stockings, etc. 23 - - - - - Lampshades 62 — - — — - Chocolates and sweetmeats 3 — — — — — Total 1,027 — — 1 — — Factories Act, 1937—Section 54. Underground Bakehouses. Certificates of Suitability, as required by Section 54 of the Factories Act, 1937, continued to be in force in respect of 20 underground bakehouses at the following addresses :— 52 Balls Pond Road, N.l 146, Blackstock Road, N. 76 Caledonian Road, N.l 3 Cardwell Terrace, N. 299 Caledonian Road, N.l 144 Elthorne Road, N. 8 Danbury Street, N.l 132 Holloway Road, N. 68 Essex Road, N.l 27 Hornsey Rise, N. 350 Essex Road, N.l 7 Junction Road, N. 121 Packington Street, N.l 59 Junction Road, N. 52 Stanmore Street, N.l 239 Junction Road N. 54 Archway Road, N. 77 Newington Green Road, N. 84, Ashbrook Road, N. 123 Newington Green Road, N. 38 Underground Bakehouses—continued. The certificate of Suitability in respect of 69, St. Peter Street ceased to have effect during the year, the basement being no longer used as a bakehouse. Details of the work carried out under this section are as follows :— Number of routine inspections 106 Number of re-visits 84 Number of notices served 7 Number of notices complied with 3 Public Health (London) Act, 1936. London County Council (General Powers) Act, 1937. Noise Nuisances. Details of the action taken in respect of complaints received of alleged noise nuisances during the year are as follows :— Number of complaints of noise nuisances 26 Number of inspections 49 Number of revisits 47 Number of notices served 2 Number of notices complied with 1 In one case a petition was received from a number of residents in the vicinity of a factory, complaining of noise nuisance during the night and at weekends. After protracted negotiations with the management alterations to the plant were recommended. These recommendations were adopted, with the Co-operation of the Company and this has resulted in a considerable reduction in the noise. In two other cases where complaints were received of excessive noise during night time Inspectors of the department kept observation during the night on the business premises concerned and found that no statutory nuisance existed in either case. Public Health (London) Act, 1936 (Part IV). Offensive Trades. Details of the respective offensive trades in the Borough are as follows :— (a) 2 Tripe Boilers : 14/18, Market Road—Messrs. J. L. Henson (Wholesale) Ltd. 22/24, Vale Royal—Messrs. Edmund Martin Ltd. (b) 1 Knacker: 18/20, Vale Royal—Messrs. Harrison Barber §Co. Ltd. (c) 1 Fur Skin Dresser : 24, Bracey Street—Messrs. J. § A. Fischer Ltd. 39 (d) 7 Gut Scrapers : 3. Old Slaughterhouses—Casings Ltd. 4, Old Slaughterhouses—Home Killed Meat Association Ltd. 12, Old Slaughterhouses—Universal Casings Co. Ltd. 13, Old Slaughterhouses—Messrs. Armour 6? Co. Ltd. 15, Old Slaughterhouses—Messrs. Wm. Menzies Ltd. 5 Tileyard Road—Messrs. C. Edwards & Son Ltd. Tileyard Road—Messrs. Tracey 6? Co. Ltd. (e) 2 Fat Melters: 4, Old Slaughterhouses—Home Killed Meat Association Ltd. 16, Old Slaughterhouses—Messrs. Wm. Menzies Ltd. 79 inspections were made of the above premises and appropriate action taken where necessary. (/) 1 Slaughterer: 180, York Way—Messrs. Harrison Barber 6? Co. Ltd. This slaughterhouse was the subject of 127 inspections or visits. (g) The Council approved the issue of a licence under Section 145 in respect of the receiving of carcasses of dead horses for human consumption at:— 14/16, Vale Royal—Messrs. Harrison, Barber § Co. Ltd. Shops Act, 1950—Applications for Exemption. There were nine applications received for exemption from the provisions of Section 38 relative to the provision of suitable and sufficient sanitary conveniences. These were dealt with as follows :— Granted 8 Refused 1 Pharmacy and Poisons Acts,. 1933/1941. Number of Listed sellers of Part II Poisons other than registered pharmacists - — — 190 Number of initial registrations during the year .— 15 Number of visits and inspections - - 47 Amendments to the Poisons List and Poisons Rules were made during the year by virtue of the Poisons List Order, 1955, and the Poisons Rules 1955. Rag Flock and other Filling Materials Act, 1951. Number of premises on Register (Section 2 for Upholstery) 38 Number of Licences issued (under Section 7 for the storage of Rag Flock) 1 Pet Animals Act, 1951. Number of licences issued during year 27 Number of inspections and revisits 93 40 Prevention of Damage by Pests Act, 1949. The following is a summary of the work carried out during the year. Notices Served : 12 Intimations and 8 Statutory Notices Type of Property Local Authority Premises Dwelling Houses Business Premises Total 1. Complaints received (including repeats) 19 1,458 187 1,664 2. Number of properties inspected as a result of: (a) Notification (initial complaint only) (a) 18 1,156 163 1,337 (b) Block Survey *(b) 140 352 49 531 3. Number of properties found to be infested by rats (including 5 by ship rats) 13 616 82 711 4. Number of properties found to be infested by mice 5 448 49 502 5. Re-visits by Investigators *733 3,373 109 4,215 6. Non-effective visits by Investigators 1 702 8 711 7. Number of infested properties treated (new jobs commenced) *542 1,064 96 1,702 8. Continuation or post-bait treatment *530 2,275 369 3,174 9. Visits by Operators *3,497 11,885 977 16,359 10. Still being baited at end of year — 25 7 32 11. Completed during the year *1,061 2,099 194 3,354 12. Number of Business Agreements dealt with : 98. 13. Members of the Rodent Staff assisted in the application of smoke tests in respect of 138 drainage tests carried out by Sanitary Inspectors. * Includes sewer maintenance treatments Nos. 21 and 22. NOTE :—For the purpose of completing Sections 2, 3, 4 and 7, each property is entered once only in respect of inspections, infestations and treatments. The duties required to secure that premises are rodent free calls for patience and persistence so that each case may be brought to a satisfactory conclusion. A number of cases of infestation arose due to unsealed disused drains each of which take a considerable time to trace. At one address which was seriously infested and which engaged the attention of this department over a long period it was finally discovered that there were two drainage systems to the premises, both of which were defective. Since the drains have been relaid there has been no re'infestation. In another case a very heavy rat infestation occurred which failed to respond to continuous baiting and poisoning. Drains were tested and found to be satisfactory. Eventually a disused drain was discovered leading into these particular premises ; this was sealed off and the nuisance was abated. The Sanitary Inspector and the Rodent Officer made joint quarterly inspections of four hospitals in the borough and the attention of the Hospital Management Committee was drawn to any matters requiring attention. Representatives of the Public Health Department attended four meetings of the Workable Area Committee during the year. 41 Sewer Treatments. Two routine sewer treatments were carried out, in connection with which the co-operation of the Borough Engineer and his staff was appreciated. Details of the treatments are as folows :— Treatment No. Manholes Baited Showing Complete Takes Showing pre-bait Takes Showing No Takes 21 648 106 341 307 22 643 219 426 217 It is noted that the number of pre-bait takes is increasing, which indicates a spread of infestation. Water Supplies. The Metropolitan Water Board continues to be the responsible authority for the supply of water to this Borough. Public Health (London) Act, 1936—Section 95. (1) Water supplies to tenement houses. 39 notices were served under this section requiring the provision of water supplies to tenement houses. 46 water supplies were provided. 2 prosecutions were taken for failure to comply with statutory notices, details of which are as follows:— Date Address Magistrate's Decision 10.2.55 47, St. John's Villas Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. 21.7.55 132, Caledonian Road Ordered to abate within 28 days. Defendant to pay £2 5s. 6d. costs. (2). 51 applications were received for water certificates, and 51 certificates were issued in respect of 565 separate dwellings. Well Water. The annual examination of the twenty-eight bore holes and wells known to exist in the borough was carried out. Nineteen have been abandoned and effectively sealed, leaving nine capable of being used, but five of these are temporarily out of commission. Samples of water for chemical and bacteriological examination have been taken from the four wells at present in use and the results show that no exception can be taken to their continued use for domestic or washing purposes. In no case is the water used for dietetic purposes. 42 Swimming Bath Water. The number of samples of swimming bath water taken during the year is as follows :— Satisfactory Unsatisfactory Chemical Bacteriological Chemical Bacteriological Chemical Bacteriological 6 6 6 6 • — — In addition four samples of subsoil water were taken. SECTION D HOUSING (In conjunction with Mr. W. C. Bartlett, Chief Sanitary Inspector). The clearance of unfit areas and individual houses continues. The number of flats and houses erected during the year was :— Borough Council 144 London County Council 308 Private enterprise 36 (includes new and rebuilt) The number of flats and houses erected in the Borough since the war is :— Borough Council 2,411 London County Council 2,197 As mentioned in the report for last year, the Housing Repairs and Rents Act, 1954, placed an obligation upon the Council to submit within 12 months, for the Minister's approval, proposals for dealing one way or another with the houses in the area which appear to be unfit for human habitation and with any other houses within the district which are, or ought to be, included in clearance areas. The Council, whilst making every endeavour to carry out its responsibilities by engaging additional staff, were unable to complete the survey within the prescribed period. In the Metropolitan area the proposals must be submitted jointly by the London County Council and the local Council. The following joint return was submitted for this borough:— Total number of permanent houses in area Estimated number of unfit houses Action in first 5 years Number of houses to be demolished Individual houses Houses in clearance areas Total number of houses to be demolished 45,357 834 400 (a) 342 834 (b) 92 (a) by London County Council. (b) by Metropolitan Borough Council. As the survey of the borough is not yet completed it will be necessary for supplementary proposals to be submitted to the Minister, and discussions with the London County Council are pending, in order that agreement may be reached. Whilst every effort is made by the Council to clear or improve unfit property, and much has been done, there still remains a very large number of sub-standard, obsolescent houses which require appropriate Housing Act action. 43 It is extremely difficult in a built up area such as Islington to deal with individual unfit property or the clearance of areas as one would wish. It is, however, gratifying to see the redevelopment which has, in some measure, taken place and the flats which it has been possible for the Borough Council and the London County Council, to erect. The problem of unfit underground rooms remains. With very limited accommodation available to the Council, extreme difficulty is experienced in rehousing families from unfit rooms or premises. Thanks are due to the London County Council for very valuable assistance given in this respect. Revised Underground Room Regulations were forwarded to the Minister of Housing and Local Govern' ment during the year, which, if approved, will repeal the existing ones and make it easier in certain respects for owners to carry out work to make such rooms comply with the Council's requirements. The Council during the year declared the remaining portion of Whadcoat Street, viz. that portion between Biggerstaff Street and Seven Sisters Road and defined as " Metropolitan Borough of Islington. Whadcoat Street (Part II) Clearance Areas (a) and (b) " to be clearance areas in accordance with the provisions of Part III of the Housing Act, 1936. Upon the Compulsory Purchase Orders being confirmed by the Minister of Housing and Local Government, arrangements were commenced to re-house the occupants prior to clearance of the area. The Minister of Housing and Local Government, being anxious that intending house purchasers did not, in ignorance of the Council's intentions, buy houses likely to be included in clearance areas in the next five years or so, or likely to be the subject of Demolition Orders, requested the Council to make from time to time such statements as it thought proper to draw attention to their slum clearance proposals and advise all intending house purchasers to enquire at the Town Hall whether the property in which they are interested is, or is likely to be, affected by any such proposals. The rate of re-housing by the London County Council from overcrowded rooms or unfit houses has decreased considerably due to the increased demands upon the available accommodation arising from slum clearance activities. In a number of cases action has had to be taken under Sections 11 and 12 respectively of the Housing Repairs and Rents Act, 1954, where houses have been let in single rooms and gross overcrowding has arisen. Such houses are a source of considerable income to owners who have little, if any, regard to the requirements of Public Health. During the year 108 notifications of intending immigrants were received from the Commissioner of Cyprus. 40 were acceptable on housing grounds in the first place, but 31 applications could not be recommended. No action could be taken in 15 cases because a wrong address was given, or applications were cancelled. At the end of the year 22 applications were still under consideration. The 108 applications refer to 284 persons, comprising 58 men, 82 women and 144 children. The 40 cases accepted included 103 persons, of whom 52 were children. Notifications are also received from the Government of Malta where immigrants propose to take up residence in this Country. Twelve applications were received during the year in respect of 32 persons comprising 3 men, 9 women and 20 children. Seven of these applications were approved, one was withdrawn, three were not recommended, and one was still under consideration at the end of the year. The 7 approved applications included 2 men, 6 women and 10 children. 44 Re-housing. Number of dwellings erected by this Council during year 144 Number of dwellings in the course of erection at end of year by this Council 391 - • Number of new applications (L.C.C.) referred to this Department during year 850 Number of above families in respect of whom over- crowding forms have been issued 96 Number of above families not living in overcrowded conditions 70 Number of overcrowded families re-housed by the Islington Borough Council during the year 88 Number of overcrowded families rehoused by the London County Council during the year 32 In addition, a number of families have been re-housed from sites acquired for re-development in connection with the Council's Housing Schemes. Further families have been re-housed from properties in respect of which Closing or Demolition Orders have been made. Number of applications referred to the Department from the Commissioner, Cyprus Government, for acceptance of immigrants from Cyprus 108 Number of letters sent concerning housing conditions during the year 1,582 Housing Act, 1936. Housing Consolidated Regulations 1925/32. During the year the following action was taken under the Housing Act, 1936 :— Nmher Section 9. Houses the defects in which were remedied in consequence of informal action 1 ,, Representations made with a view to the serving of notices requiring the execution of works 2 Notices served requiring the execution of works 1 ,, Houses rendered fit after service of formal notices — 45 Number Section 11. Houses which on inspection were considered to be unfit for human habitation 559* „ Houses represented 35 „ Demolition Orders made 2 „ Closing Orders—Section 11 as amended by the Local Government (Miscellaneous Provisions) Act, 1953 9 * This figure refers to houses inspected pursuant to action under Section 1 of the Housing Repairs and Rents Act, 1954, and includes houses suitable for proceedings under Section 3 of this Act and Section 9 of the Housing Act, 1936. Section 11. Houses in respect of which an Undertaking was accepted 6 „ Houses demolished 5 Section 12. Representations made with a view to the making of Closing Orders : (a) underground rooms 135 (b) parts of buildings 12 „ Closing Orders made : (a) underground rooms 47 (b) parts of buildings 5 „ Undertakings accepted 3 „ Closing Orders determined upon the comple— tion of necessary work 2 „ Undertakings cancelled upon the completion of necessary work 3 Licences authorising temporary overcrowding. Five licences were granted under Section 61 of the Housing Act, 1936, authorising overcrowding ; 1 for a period of six months and 4 for a period of 3 months. In 4 cases these constituted renewals of licences which had expired. One application for a licence was not granted. The total number of dwellings affected was 3. Town and Country Planning (Housing Accommodation) Direction 1952. In accordance with this Direction the Council is consulted by the London County Council before consideration is given to applications received for a change of user from a dwelling to another purpose. In this connection 19 investigations were carried out by this Department. 46 SECTION E SUPERVISION OF FOOD (in conjunction with Mr W. C. Bartlett, Chief Sanitary Inspector) Although the Food and Drugs Act, 1955, was placed on the Statute Book during the year, it does not come into operation until 1st January, 1956. This Act is a consolidating measure. It repeals the Food and Drugs (Amendment) Act, 1954, and consolidates it with the Food and Drugs Act, 1938, the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950, and certain other enactments, including and supplementing Part V of the 1938 Act relative to Slaughterhouses and Knackers' Yards. The Food Hygiene Regulations, 1955, which will replace Section 13 of the 1938 Act, also come into force on 1st January next, with certain exceptions, the date of operation of which is postponed to 1st July, 1956. The Transfer of Functions (Food and Drugs) Order, 1955, provided for the transfer of certain food hygiene functions from the Ministry of Agriculture, Fisheries and Food to the Minister of Health. The Transfer of Functions (Ministry of Food) Order, 1955, has terminated the Ministry of Food as a separate Department. The work done during and since the war by the Ministry of Food in promoting food hygiene and in encouraging local authorities and their officers to pay increasing attention to the problems of securing clean and safe food has been outstanding. The good work and close co-operation with local authorities will no doubt be continued by the new Ministry. The Labelling of Food (Amendment) Regulations, 1955, which impose requirements as to the labelling, marking and advertising of margarine and margarine cheese, and the Food Standards (Butter and Margarine) Regulations, 1955, which prescribe limits of water content for butter, and water and milk food content for margarine, do not come into force until next year. Circular MF1/55 was issued by the Ministry of Food as it was considered that myxomatosis in rabbits and hares must be considered as making the carcase unfit for human food and the disease must be added to Section A of Part IV of memo 3/Meat. Concern was occasioned by the importation of Chinese egg albumen during the year, some batches of which were proved to be in an unsatisfactory bacteriological condition. The substance either in powder or crystallised form has been found to contain salmonellae of various types and occasional S. Paratyphosus has been isolated. The principal outlet for the commodity in this Country is the bakery and confec tionery trades. As soon as the Department is informed that consignments of Chinese egg albumen have been delivered in the borough the distribution is closely supervised and, if necessary, samples taken and distribution postponed until a satisfactory result has been obtained. During the year the following were issued :— 1. Food Standards (Table Jellies) Amendment Order, 1955. 2. Slaughter of Animals (Prevention of Cruelty) (Amendment) Regulations. 1955. 3. Food Standards Committee Supplementary Report on Colouring Matter. 4. The Report of the Interdepartmental Committee on Slaughterhouses. 47 Inspection of food premises continued, and the food prepared, manufactured, stored or sold was subjected to routine inspection and sampling. Complaints were received from time to time and investigated by the Sanitary Inspector without delay. Complaints received by the Department included:— Foreign matter in bottles of milk. Foreign matter in loaves of bread. Wasp in Nutty Bar. Bread cereals affected by mould. Maggots in chocolate cream. Maggots in chocolate. Nail in loaf of bread. String in coconut slice. Beetle in loaf of bread. Foreign matter in bottle of orange juice. Loaf pecked by sparrows. Glass in loaf. Foreign matter in bun. When the evidence was sufficient to justify legal proceedings, such action was taken, details of which are given on page 48. In other cases a warning letter was considered adequate. The Council, being aware of the necessity for the Inspectors to be kept fully informed and experienced in meat inspection, approved the attendance of' four Inspectors at a refresher course arranged by the Sanitary Inspectors' Association. The object of this course was to give Inspectors further training in this important section of their duties. Food and Drugs Act, 1938. Number of food premises in the area, and type of business. Bakehouses—level 33 —basement 20 Food factories 35 Fish friers 53 Fish curers 29 Fish depot 1 Cafes and restaurants 283 Public houses (catering) 218 Canteens and clubs 136 Coffee stalls 7 Off-licences selling food 57 Greengrocers 243 Grocers 407 Confectionery 292 Chemists 64 Fish shops 37 Continental Butchers 1 Food stalls (street traders) 135 Food storage premises for street traders 133 Bakers retail shops 52 Butchers 145 48 Preserved Food Premises Registered under Section 14(1)(b) of the Food and Drugs Act, 1938. (Included in foregoing list.) Total No. of Preserved Food Premises 213 No. of Butchers 94 No. of Grocery and provision shops 85 No. of General shops 10 No. of Cafes 1 No. of Bakers, etc. (meat pies) 8 No. of Food Factories 13 No. of Cooked meat shops 3 Total No. of inspections and visits made by Inspectors to Preserved Food Premises 413 Legal Proceedings. Details of the action taken by the Council under the Food and Drugs Act, 1938, are as follows:— Date Offence Magistrate's Decision 4.1.55 Selling food, namely an apple turnover, intended for but unfit for human consumption, contrary to Section 9 of the above Act at:- Fined £10. Defendant to pay £3 15s. costs. 136, Essex Road „ Selling food, namely bread, intended for but unfit for human consumption, contrary to Section 9 of the above Act at:- Fined £10. Defendant to pay £4 2s. costs. 7.2.55 136, Essex Road Selling food, namely bread, intended for but unfit for human consumption, contrary to Section 9 of the above Act at:— Fined £10. Defendant to pay £6 15s. costs. 26.7.55 298, Holloway Road Selling food, namely milk, not of the nature demanded contrary to Section 3 of the above Act at:— Fined £5. Defendant to pay £3 3s. costs. 4, Tufnell Park Road Unsound Food. The total amount of food condemned during the year was :— 45 tons, 18 cwts., 0 qrs., 14 lbs., 8 ozs. details of which are given in the following table :— details of which are given in the following table:— 49 Description Tons Cwts. Qtrs. Lbs. Ozs. Tinned Goods 16 13 2 15 4 Fish — 5 1 21 — Meat 6 1 2 6 8 Others 22 17 1 27 12 Total 45 18 — 14 8 Number of condemnation certificates issued was 1,569. Most of the above food was condemned upon request by the respective owners. Condemned food received from traders is taken to the Council's refuse disposal depot at Ashburton Grove awaiting conveyance, under supervision, to the refuse tip. Small quantities of food which may be subject of complaint by householders are surrendered to the Inspector, who ensures that there is no possibility of use for human consumption. Foods such as cereals are disposed of for animal feeding, under supervision, and if the food is conveyed to another borough, the Medical Officer of Health for that borough is informed accordingly in order that he may arrange for the supervision of its ultimate disposal. Where possible all other condemned food is dyed in order to make it impossible for it to be re-sold or used for human consumption. Con— demned meat is used for animal feeding or industrial purposes. Sampling. 494 samples (89 formal, 405 informal) were submitted to the Public Analyst for examination. Of these 29 (or 5.87%) were adulterated as shown in the following summary :— Formal Informal Non-brewed condiment 1 Bread 6 Sweets: Butter Pats 1 Bread Crumbs 1 Extract of Meat and Cod Total 2 L.ver 0il l Milk 1 Milk bottles containing :— 1. Deposit of cement. 2. Deposit of moulds 2 Non-Brewed condiment 1 Potato Chips 1 Porage Oats 1 Sausages 1 Shredded Suet 1 Sterilised Cream 2 Sweets : Buttered Brazils 1 Butter Mints 1 Butter Pats 1 Coconut Slice 1 50 Formal Informal Nutty Bar 1 Chocolates 1 Chocolate Cream 1 Milk Chocolate 2 Total 27 Meat and Other Foods. No visits by Officers of this Department were made during the year for the purpose of inspecting home killed or imported meat at the Metropolitan Cattle Market. In accordance with the requirements of the Public Health (Meat) Regulations, 1924/52, notices were received during the year in respect of the intended slaughter of animals for human consumption. Details of action taken are as follows :— Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Horses Number killed (if known) 96 329 14 44 97 501 Number inspected 96 329 14 44 97 501 All diseases except Tuberculosis & Cysticerci Whole carcases condemned — 3 — 2 — — Carcases of which some part or organ was condemned 7 238 — 2 13 10 Percentage of the number inspected affected with disease other than tuberculosis and cysticerci 7.29 72.34 — 4.5 13.4 2 Tuberculosis only: Whole carcases condemned — 3 — — — — Carcases of which some part or organ was condemned — 36 — — 2 — Percentage of the number inspected affected with tuberculosis — 10.94 — — 2 — Cysticercosis: Carcases of which some part or organ was condemned — — — — — — Carcases submitted to treatment by refrigeration — — — — — — Generalised and totally condemned — — — — — — All diseased or unfit meat was disposed of for use as knacker's meat or in the manufacture of fertiliser. Of the 501 horses slaughtered for human consumption, 257 were intended for export. 51 Slaughter of Animals Act, 1933. Slaughter of Animals (Amendment) Act, 1954. Slaughtermen's Licences. The Corporation of the City of London continues to be the local authority for the purpose of enforcing the provisions of the Slaughter of Animals (Amendment) Act, 1954, in relation to the Metropolitan Cattle Market and for this purpose this market is taken to be within the area of the City Corporation. During the year eight new Licences were issued and twelve Licences renewed. The Licences are now issued for a period not exceeding one year, expiring on the 30th September. Fifteen slaughtermen held current Licences at 31st December. Inspection of Refreshment and Coffee Stalls. Eleven evening inspections of refreshment and coffee stalls were carried out by Sanitary Inspectors. No complaints relative to such stalls were received during the year, and the conditions found to exist at the time of the Inspectors' visits were generally satisfactory. Free Washing Facilities in Public Conveniences. The Council continued to provide free washing facilities in public conveniences in order to encourage cleanliness amongst food handlers and, particularly, street traders who have no convenient personal facilities. The following table given through the courtesy of the Cleansing Superintendent provides details of the weekly average number of persons who availed themselves of the Council's facilities. Convenience Jan. Feb. Mar. Apr. May Jun. July Aug. Sep. Oct. Nov. Dec. Approx. weekly average through -out year Archway— Men 22 15 12 16 14 20 24 28 28 20 15 15 19 Women 35 39 34 35 38 44 44 64 57 46 48 61 45 Parkhurst Rd.— Men 45 71 43 43 48 41 37 49 58 39 52 46 48 Women 23 24 12 29 25 28 23 37 38 33 31 20 27 Finsbury Pk.— Men 50 58 51 62 53 63 70 71 68 67 73 68 63 Women 6 9 9 10 9 10 12 13 11 12 9 13 10 Highbury— Men 30 28 29 28 33 35 29 42 47 34 23 15 31 Women 9 10 9 11 9 7 39 23 18 6 9 - 13 Offord Rd.— Men 10 11 11 9 5 8 10 12 12 8 9 7 9 Women 3 1 3 3 3 3 2 7 2 2 3 3 3 High St.— Men 40 40 41 52 42 45 47 43 29 32 47 44 42 Islington Gr.— Women 9 6 9 10 11 10 12 18 12 13 10 10 11 282 311 263 308 290 314 349 407 380 312 329 302 32 Ice-Cream. Ice-Cream (Heat Treatment, etc.) Regulations, 1947-52. Supervision of the Manufacture and Distribution of Ice-Cream. During the year 196 visits were paid to ice'cream premises and vehicles. Number of premises registered :— (a) for manufacture, sale and storage 82 (b) for sale and storage 201 (c) for sale only 261 (d) for storage only 8 552 Bacteriological Examinations. 41 samples of ice-cream were sent for bacteriological examination. The gradings of the methylene blue test were as follows :— Grade I 33 Grade II 4 Grade III 3 Grade IV 1 41 The samples graded in I or II of the methylene blue test are considered satisfactory, and samples graded III or IV unsatisfactory. 6 ice lollies and 4 milky lollies were submitted for bacteriological examination, the report in each case was satisfactory. Chemical Examinations. Twenty-seven samples of ice cream and three ice lollies were submitted for chemical analysis and no adverse report was received. Details of the twenty-five samples examined for fat content are as under:— Fat Content Less Than 6% 7% 8% 9% 10% 11% 12% 13% 14% 15% 1 1 2 1 3 3 9 4 — 1 Milk Samples. The total number of samples taken during 1955 was 387. Samples submitted for Chemical Analysis :— Genuine Adulterated Total Formal 55 — 55 Informal 163 1 164 219 53 Samples submitted for Bacteriological Examination:— Class of Milk Results Phosphatase Methylene blue Turbidity Total No. of Samples Pasteurised Satisfactory *115 †115 — 117 Unsatisfactory — — — Sterilised Satisfactory — — 20 20 Unsatisfactory — - — Tuberculin Tested (Pasteurised) Satisfactory 26 26 26 Unsatisfactory — — — Tuberculin Tested (Raw) Satisfactory — 4 — 4 Unsatisfactory - - - Total 167 * 2 Samples subjected to Aschaffenburg test, † 2 Samples void—Shade temperature exceeded 65°F. A total of five samples of Tuberculin Tested (Raw) Milk were examined and found to be satisfactory. Of the four subjected to biological test for tuberculosis, three were found to be negative and in the other test the guinea pig died before the completion of the test. Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949 to 1953, and Milk (Special Designation) (Raw Milk) Regulations, 1949 to 1954. The number of dairies and milk shops inspected 120 The following licences were granted :— Pasteurised 207 Pasteurised (supplementary) 22 Tuberculin Tested 125 Tuberculin Tested (supplementary) 22 Sterilised 280 Sterilised (supplementary) 25 681 Milk and Dairies Regulations, 1949 to 1954. Number of Dairies Registered in the Borough — 22 Number of Distributors registered in the Borough 308 Number of Registered Distributors dealing from registered premises outside the Borough 26 Summary of visits by Inspectors. Dairies—Routine Inspections 10 Miscellaneous visits 21 Milkshops—(Milk sold in sealed containers only)— Routine Inspections 106 Miscellaneous visits 45 Total number of inspections and miscellaneous visits 182 Number of Notices served 1 54 SECTION F—MISCELLANEOUS SERVICES HEALTH PUBLICITY Film Shows. Eleven Film Shows for exhibition to the general public were held during the year. The practice of including a full-length feature film in the programme was continued and, on the whole, the shows were well attended. Arrangements were made on each occasion for the Chair to be taken by a Member of the Public Health Committee and the audience was addressed by the Medical Officer of Health or Deputy Medical Officer of Health. The shows were held in various Borough Council Libraries. The health films exhibited were provided by :— Central Film Library Gas Council Gaumont'British Film Division Imperial Chemical Industries Sound Services for Dental Board Foote, Cone and Belding National Association for the Prevention of Tuberculosis British Rheumatic Association and were entitled :— " Another Case of Poisoning " " Creatures of Comfort " " Something to Chew on " " Defeat Tuberculosis " " Your Children and You " " His Fighting Chance " " The Good Housewife in her Kitchen " " The Fight Against Disease " " The Bed Bug " " Brushing Your Teath " " Energy Foods " " How to Catch a Cold " " Prevention is Better " " Grip on the Nation." " Guilty Chimneys " Lectures and Demonstrations At the request of the Head of the Department of Catering and Domestic Science, Northern Polytechnic, arrangements were made for a party of students to attend a lecture at the Town Hall, to visit the Council's Refuse Disposal Plant, and old and new Housing Estates. The lecture was given by the Medical Officer of Health, the subjects covered being the Health Services and food hygiene. In October, the Deputy Medical Officer of Health and the Deputy Chief Sanitary Inspector were guest speakers at the Islington Literary and Debating Society, the subject matter of their talk being " Some Aspects of Food Hygiene." Chamber of Commerce meeting—Food Hygiene The Islington Chamber of Commerce arranged a lecture-demonstration on the subject of Hygiene in Food Handling in the Public Hall of the Town Hall on the evening of Monday, 22nd November. The Medical Officer of Health was invited to take part in the proceedings, together with Dr. Charles Hill, then the Parliamentary Secretary. Ministry of Food, and Mr. A. H. Walters, a Bacteriologist and well-known lecturer on the bacteriology of food hygiene. The Chamber of Commerce invited food trading concerns in Islington, and also extended invitations to neighbouring Chambers of Commerce. It is considered that this effort by the Chamber of Commerce to improve traders' hygiene standards is a step in the right direction. 55 The Chief Sanitary Inspector also took part in the proceedings, and the Chief Clerk was able to assist the Secretary of the Chamber of Commerce with arranging certain exhibits. Exhibition at the Astoria Theatre In September the Astoria Theatre, Finsbury Park, organised an exhibition entitled " Twenty-five Years Progress in the Borough of Islington." The exhibition was open for one week, and the Public Health Department displayed panels on food hygiene and food poisoning. Pamphlets and Posters The Council contributes annually to the Central Council for Health Education, and its poster and pamphlet publicity material is obtained chiefly from this source. Various subjects were covered in this way during the year, as appropriate to the season and circumstances. The Ministry of Health once again asked for the co-operation of Local Authorities in the display of posters in connection with their Venereal Diseases Educational Campaign, and the London County Council offered to overprint these posters with the addresses of local clinics. 270 copies of each of four different posters were obtained and distributed to all the public houses in the Borough and to the Superintendent of the Cleansing Department for display in the Council's public conveniences. Accidents in the Home—London County Council Campaign Week In November the London County Council held a Campaign Week on Accidents in the Home. They offered publicity material free of cost and arrangements were made for a generous distribution of bookmarks and pamphlets through the Public Libraries, where special displays were shown during the Campaign Week. Posters were also displayed in suitable positions in the Council's premises and adhesive publicity stamps were attached to correspondence. " Smog " Warning Leaflets Dr. B. E. A. Sharpe, Divisional Medical Officer, London County Council Health Division 3, asked for the Department's co-operation in the distribution of warning leaflets regarding " Smog " to old people in the Borough. 1,000 copies of the leaflet were obtained for distribution from the counter in the Public Health Department, by the Council's Old People's Health Officer, and through Miss D. Church, Hon. Secretary, Islington Old People's Welfare Council. " Better Health " For a number of years the Council has distributed, free of charge, 500 copies per month of the Central Council for Health Education publication " Better Health." This has proved very popular, and the Public Health Committee agreed to increase the number of copies to 1,000 per month. Distribution is from the Public Libraries and Town Hall counters. Health Publicity Assistant With a view to increasing and developing health publicity in the Borough, the Public Health Committee recommended the appointment of a Health Publicity Assistant in the Public Health Department, and the Council implemented the recommendation in November by increasing the establishment of the Records and Administration Section by one general clerk and by adding the responsibilities of Health Publicity Assistant to those of the Sectional Senior Clerk. 56 SERVICES FOR ELDERLY PERSONS Approximately 26,000 Islington residents, or just under eleven per cent of the total population, are estimated to be over the age of 65 years. Although the great majority of these people live their normal lives as others do, difficulties may arise when elderly persons, especially those living on their own, begin to fail in health or become sick, and are thereby rendered unable to go out. perform their shopping, keep their accommodation clean and tidy, and prepare their meals. Apart from medical care given by their own doctors where necessary, the Home-help service of the London County Council is a very valuable one for elderly persons. The Borough Council's Health Officers carry out valuable service by visiting elderly folk and, where the maintenance of normal home standards becomes difficult, by arranging for help and advice to be given as may be found necessary and calling in the assistance of various services, whether Borough Council, London County Council, National Assistance Board, National Health Service, etc. The Borough Council's visitors also work in close conjunction with these Authorities, including the various organisations represented on the Islington Old People's Welfare Council. The Health Officer and her assistant visited 572 new cases during the year, and re-visits totalled 3,612. Five cases were dealt with under the National Assistance Acts, 1948 and 1951, and these are described on pages 57 and 58. 2,302 references were made to other Authorities and to voluntary organisations in connection with the provision of " Home-helps," National Assistance, " Meals-onWheels," etc. National Assistance Acts, 1948 and 1951 In 4 instances it was necessary to invoke the procedure for the removal of persons to suitable premises without delay, in accordance with the provisions of the National Assistance (Amendment) Act, 1951. " An order under subsection (3) of section forty-seven of the National Assistance Act, 1948, for the removal of any such person as is mentioned in subsection (1) of that section may be made without the notice required by sub-section (7) of that section if it is certified by the medical officer of health and another registered medical practitioner that in their opinion it is necessary in the interests of that person to remove him without delay." A Magistrate's Order made in 1954 under the National Assistance Act, 1948, was extended, under Section 47(4), for the further detention and maintenance of an aged person in a Welfare Home for a period not exceeding three months. " (4) An order under the last foregoing subsection may be made so as to authorise a person's detention for any period not exceeding three months, and the court may from time to time by order extend that period for such further period not exceeding three months, as the court may determine." Details of the statutory action taken under these Acts are given in the following statement which has been compiled in the form required by the Ministry of Health:— 57 Aged and Infirm—Action taken under Statutory Powers Name and Age Reasons for Council's Action Period Named in Order Type of accommodation to which removed Ultimate Result (1) (2) (3) (4) (5) (1) Miss B. (72 years) Miss B. has been the subject of previous statutory action in 1953 and 1954, and in January, 1955 was in a Welfare Home as the result of an extended Order. She was in a frail state of health and her home of one room was insanitary with a serious fire risk from an oil stove used for cooking. It was obvious that if released from the Welfare Home, Miss B. would not be able to care for herself adequately. Not exceeding three months Transferred to mental hospital. A Magistrate, upon hearing evidence from the Deputy Medical Officer of Health, further extended the terms of the Order (as amended) for a period of three months. (2) Miss B. (95 years) Since 1950 this aged person had been regularly visited by Officers of the Department and had been the subject of sustained efforts to assist in her well-being. It became evident that, despite the good work from a home help, Miss B. had difficulty in caring for herself. Late in the year she had a fall in the street and it was considered inevitable that she should be moved to hospital, but she still refused to leave home. An Order was eventually obtained from a Justice of the Peace but the patient entered hospital voluntarily before this Order could be formally served. Not exceeding three weeks General Hospital Returned home and entered welfare home on own volition. Deceased three weeks after admission. (3) Mr. I. (94 years) This man and his wife had been known to the Department for a long time. The Department, through the Council's Health Officer for Old People, endeavoured to organise action towards this couple's well-being and, amongst other things, contacts had been made with relatives, the general practitioner, National Assistance Board, L.C.C. Home Help Service and a neighbour. The wife, becoming seriously ill. entered hospital, leaving Mr. I. alone, confined to bed. He had fallen out of bed several times and it was considered expedient he should go to suitable premises where he Not exceeding three weeks General Hospital Deceased day after admission. 58 Name and Age (1) Reasons for Council's Action (2) Period Named in Order (3) Type of accommodation to which removed (4) Ultimate Result (5) would receive proper care and attention. As he refused to leave home, the appropriate certificates were signed by the Deputy Medical Officer of Health and the patient's doctor and an Order obtained from a Justice of the Peace. (4) Mrs. M. (78 years) Mrs. M. had been on the Department's register of aged persons for about four months when a telephone call was received from the police to the effect that she was ill, non co-operative and refused to leave home. The Deputy Medical Officer of Health visited and found Mrs. M. in bed seriously ill and in a neglected state. The home was in an insanitary condition. Offers of help were refused. The only known relative was also aged, lived some distance away and was unable to give any assistance. An Order was obtained from a Justice of the Peace, after the appropriate certification. Not exceeding three weeks General Hospital Deceased on day of admission. (5) Mrs. A. (78 years) This aged person, whose circumstances were brought to the notice of this Department by a representative of the National Assistance Board, lived alone in an attic room with two chairs put together as a bed. She had suffered from bronchitis for years and was a source of concern to relatives, who stated she would not eat. Mrs. A. was non-co-operative towards those who wished to help her including relatives, home help and the landlady of the house. When visited by the Deputy Medical Officer of Health she was found to be ill and undernourished. Mrs. A. refused to leave home and after contacting the relatives, who agreed to support any action initiated by the Islington Borough Council, an Order for removal was obtained from a Justice of the Peace. Not exceeding three weeks General Hospital Deceased four days after admission. 59 National Assistance Act, 1948, Section 31. " Meals-on-Wheels " This section of the Act permits local authorities to make contributions to the funds of any voluntary organisation whose activities include the provision of recreation or meals for old people. A grant was again approved for the purpose of the " Meals'On-Wheels" service operated by the Women's Voluntary Service which, although limited in the number of meals it can supply, through lack of volunteers who can spare the appropriate time, performs a most valuable function in delivering a hot mid-day meal to home-bound elderly persons, and thereby assists materially in maintaining their nutrition and consequently, their health. The number of meals supplied, etc., during the year, is given in the following table : Total number of names brought to the notice of the Department 572 Number recommended to W.V.S. 99 Number of meals delivered during the year 6,587 Weekly average 127 Holidays for Elderly Persons. By means of a scheme administered through the Old People's Welfare Council, 511 persons were able to enjoy a holiday by the sea, or in the country, at greatly reduced cost, where their circumstances were such that it would not have been possible for them to take a holiday at their own expense. A substantial grant was provided by the Borough Council for this scheme. Chiropody Service Many elderly persons, although able to get about, are handicapped by the need for foot treatment by a Chiropodist. Voluntary chiropody sessions have been arranged for some time at the Islington Medical Centre, and a similar session for club members was also commenced at the Caxton House Settlement. The Council decided that, in view of the usefulness of this work, support should be given to the extension of chiropody work done for elderly persons through voluntary organisations, and agreed to give a grant for this purpose. During the latter part of the year discussions were proceeding from which it was hoped that it would be possible to provide for chiropody sessions also at the Gifford Hall Mission, Gifford Street, in addition to the extension of the services mentioned above. Arrangements were made for the Public Health Department to give assistance in co-ordinating appointments where necessary, for visiting by the Council's Old People's Health Officer, and for the giving of information regarding dates and times of chiropody sessions to all Local Authorities, medical practitioners, and voluntary organisations concerned. Public Health (London) Act, 1936—Section 122 Cleansing and Laundry Service 1. Incontinent Elderly Persons in the Borough. 1955 was the first full year in which this free service was in operation and it has proved to be of great benefit to 60 the persons concerned. Bed-clothing and bed-linen are collected and delivered to Essex Road Baths by this department's vehicle and are there cleansed by the Department's bathing attendants in plant on hire from the Baths and Washhouses Department. Requests for assistance come from the North London District Nursing Association, General Practitioners, Hospitals, etc., and are investigated by the Old People's Health Officer. As provided in Section 122 of the Public Health (London) « Act, 1936, cases dealt with are those where it is considered that the soiled articles are filthy, dangerous or unwholesome, and that health might be affected or endangered thereby. Relevant statistics for the year are as follows:— No. of recipients approved 82 No. of washings carried out 1,028 No. of articles cleansed 7,953 2. Holborn Borough Council. Following an enquiry from the Holborn Borough Council an agreement was reached whereby the clothing and bedclothes of incontinent elderly persons from that Borough could be dealt with at the Islington laundry. This scheme commenced on 17th December, 1955. The one recipient had three washings comprising thirty articles. London County Council (General Powers) Act, 1953—Section 43. Cleansing of Elderly Persons. As recorded in my last Annual Report, arrangements were made in accordance with Section 43 of the above Act for domiciliary cleansing of aged persons where Ithey were so enfeebled as to be unable to avail themselves of facilities at the Cleansing Station. Details of this service for the year are as follows :— No. of baths given at home 727 No. of persons concerned 38 The work was carried out under the supervision of the Nurse-in-Charge of the Council's Cleansing Station. PUBLIC MORTUARY By agreement with the St. Pancras Borough Council the use of the Council's Mortuary was discontinued as and from 31st March, 1949, all bodies being received at the St. Pancras Mortuary, Camley Street, N.W.I, after that date. ISLINGTON CREMATORIUM The Medical Referee or the Deputy Medical Referee certified a total of 405 applications for cremation at the Council's Crematorium, East Finchley. 61 MATERNITY AND CHILD WELFARE SERVICES The Maternity and Child Welfare services are, of course, the responsibility of the London County Council as the Local Health Authority. Islington is included in Division 3 of the L.C.C. Services and I am indebted to Dr. B. E. A. Sharpe, Divisional Medical Officer, for the information given below in respect of these services :— Welfare Centres. WELFARE CENTRE Children's Ante-Natal and Post-Natal Immunisation Dental Vaccination Toddlers North Islington Infant Welfare Mon. to Fri. 1.45 p.m. Mon. 1.45 p.m. midwives 1.45 p.m. Wed. 2.0 p.m. Tues. 9 a.m. and 2.45 p.m. Wed. 2.0 p.m. Tues & Fri. 1.45 p.m. Thurs. Wed. Centre (Voluntary) 6.9, Manor Gardens, N.7. Tues. 9.30 a.m. Thurs. North Branch Clinic Blythe Mansions, Hornsey Rise, N.19. Fri. 1.45 p.m. Mon. 1.45 p.m North Branch Clinic New Court Church Hall, Tollington Pk., N.4. Wed. 1.45 p.m. Archway M. & C.W. Centre Congregational Church, Junetion Road, N.19. Thurs. 9.30 a.m. 1.45 p.m. Thurs. a.m. p.m. Thurs. a.m p.m. West Islington Welfare Centre 42 & 44, Richmond Avenue, N. l Mon. 1 30 p.m. Tues. 1.30 p.m. Wed. 10.30 a.m. Wed. 10.30 a.m. Wed. 9.30 a.m. Wed. 1.30 p.m. Thurs. 9.45 a.m. & 1.30 p.m. Fri. 9.30 a.m. & 1.30 p.m. West Branch Clinic St. Luke's Mission Hall, Goodinge Rd., N.7. Thurs. 9.30 a.m. & 1.30 p.m. South Islington Welfare Centre 6, Clephane Road, Essex Road, N.l. Mon. 1.30 p.m. Mon. 9.30 a.m. Fri. 2.0 p.m. Wed. 2.0 p.m. Fri. 1.30 p.m. Wed. 9.30 a.m. Fri. 9.30 a.m. & 1.30 p.m. Tues. 1.30 p.m. Thurs. 9.30 a.m. &1.30 p.m. South Branch Clinic Union Chapel, Compton Avenue, N.l. Tues. 9.30 a.m. & 1.30 p.m. East Islington Welfare Centre 32, Drayton Park, N.5. Tues. 9.30 a.m. & 1.30 p.m. Mon. 9.0 a.m. Mon. 2.0 p.m. Mon. 3.0 p.m Wed. 9.30 a.m. Wed. 1.30 p.m. Fri. 10.0 a.m. Fri. 1.30 p.m. Thurs 1.30 p.m. East Branch Clinic Congregational Church Hall, Highbury Quadrant, N.5. Thurs. 1.30 p.m. Total Attendances at Infant Welfare Centres. Infants North South East West Archway 0—1 years 12,432 9,628 7,051 8,421 2,604 1—2 years 2,128 1,422 1,081 1,031 425 2—5 years 1,639 1,035 806 938 435 Ante-Natal and Post-Natal combined 4,792 2,304 1,904 2,586 — Child Life Protection. The table of foster-mothers and foster-children being cared for is as follows : 31.12.55 Number of persons on register prepared to receive children 24 Number of foster-children being cared for 33 62 At present there are 4 Day Nurseries open in Islington :— Scholefield Road 65 places Canonbury Place 70 „ Windsor Street 68 „ Mitford Road 68 „ * 271 There are also 50 places for Islington children in Springdale Road Nursery (Stoke Newington). 63 INDEX Accidents 6, 7, 8, 10, 55 Meat 50,51 Acute Encephalitis 11 Meningococcal Infection 7, 8, 11 Acute Poliomyelitis 7, 11, 15-16, 25 Metropolitan Cattle Market 51 Aged and Infirm Persons 27, 56-60 Milk and Cream 52-53 Ante-Natal Clinics 61 Milk and Dairies Regulations 53 Anthrax 11 Milk (Special Designations) 53 Atmospheric Pollution 32-35, 55 Miscellaneous Services 54-62 Bacteriological Examinations 25, 52 Mortuary 60 Births 5, 6, 9 National Assistance Acts 27, 56-59 Blow-Fly Infestation 32 Neoplasms, Malignant 7, 9-10 Certificates of Disrepair 27-28 Noise Nuisance 35, 38 Chemical Examinations 52 Nurseries Day 62 Child Life Protection 26, 61-62 Offensive Trades 31, 38-39 Child Welfare Centres 61 Ophthalmia Neonatorum 11 Chiropody for Elderly Persons 59 Outworkers 35, 37 Cleansing Station 22 Overcrowding 43, 44, 45 Cleansing, Elderly Persons 59-60 pet Animals Act 39 Crematorium 60 Pharmacy and Poisons Acts, etc 39 Day Nurseries 62 Pneumonia 7, 8, 11 Deaths 5, 6, 7, 8, 9, 11, 14, 16-17, 22-23 Poliomyelitis 7, 11,' 15,16, 25 Dental Clinics 61 Population 5, 6 Diphtheria 6, 7, 11, 16-17, 25 Post-Natal Clinics 61 Diphtheria Immunisation 17, 61 Premature Infants 8, 9 Disinfection 31-32 Prevention of Damage by Pests Act and Disinfestation 31-32 Orders 40 Disinfestation of Sewers 41 Prosecutions 29-31, 48 Dysentery 11, 20-21, 25 Public Health Committee 4 Elderly Persons, Services for 27, 56-60 Public Health (London) Act — Improve- Encephalitis, Acute 11 ments effected 28 Encephalomyelitis 16 Public Health (London) Act, Sections 40 Enteric Fever 11, 25 and 109 29 Erysipelas 11 Public Health Officers 4 Exhibitions 55 Public Health (Tuberculosis) Regulations, Export Certificates 31 1952 23 Factories Act—Complaints 36 Publicity 54.55 Factories Act—Contraventions 35, 36 Puerperal Pyrexia 11 Factories Act—Inspections 35 Rag Flock and Other Filling Materials Act 39 Factories Act—Notices served 35, 36 Rats and Mice 40-41 Film Publicity 54 Refreshment and Coffee Stalls 35, 51 Fog and Smoke 32-35, 55 Requisitioned Property 27, 3 5 Food and Drugs Act 27, 35, 46-53 Sampling 47, 52.53 Food—Inspection and Supervision 35, 46-53 Sanitary Circumstances 25.42 Food—New legislation 46 Sanitary Inspection—District Work 26.28 Food Poisoning 11, 18-20, 25 Sanitary Inspection—Special Work 35.42 Food Sampling 47, 49-50 Scabies 22 Food, Unsound 47, 48-49 Scarlet Fever 11 Foster Mothers and Children 26, 61 Sewer Treatments 41 Health Publicity 54-55 Shops Act 36, 39 Holidays for Elderly Persons 59 Slaughtermen's Licences 51 Home Visiting—Scabies and Vermin 11, 22 Slum Clearance 42, 43, 44 Housing 27, 42-45 Smallpox 11-12, 25 Housing Repairs and Rents Act, 1954 Smoke 32-35, 55 27-28, 42, 43 Staff 4 Ice Cream 52 Static Water Tanks, etc 26.32 Illegitimate infants-Births and Deaths . 5, 9 Statistics—General 5.10, 11.25 Immigrants 43,44 Statistics—Vital 5-10,11-25 Infant Mortality 5, 6, 8, 9 Still-Births 5, 6 Infectious Diseases 11-25 Swimming Baths 42 Influenza, Pneumonia and Bronchitis Toddlers Clinics 61 7, 8, 9, 11, 25 Town & Country Planning 45 Inoculation, etc., Certificates 12 Tuberculosis 11, 22'24, 25 Laundry Services 59-60 Tuberculosis—Beds and Bedding 24 Lectures 54 Tuberculosis—Care Committee 24 Leii.il Proceedine* 29.31 , 48 Tuberculosis Chc-.t Clinics 23-24 Uve Births 5 Tuberculosis—Deaths 6, 7, 8, 9, 11, 22-23 Local Government (Miscdian^''"Provi." Tubercubsis Notifications 6, 11, 22*23 ions) Act, 1953 45 TyPhold Fever 25 L.C.C. (General Powers) Acts 38, 60 Underground Bakehouses 37-38 M. 8? Q. W. Services 61-62 Vaccination 12, 61 Malaria 11 Vermin 11, 22 Marriages 5, 6 Virus Infections 24-25 Mass X-Ray 24 Washing Facilities, Free 51 Maternal Mortality 5, 6 Water Supplies 41 "Meals on Wheels" 59 Welfare Centres 61 Measles 7, 8, 11, 12-13, 14, 15 Whooping Cough 7, 8, 11, 12, 14-15. 25