AC4361 1956 \ ANNUAL REPORT ON THE HEALTH AND SANITARY CONDITIONS OF THE METROPOLITAN BOROUGH OF ISLINGTON VICTOR FREEMAN, M.R.C.S., LR.C.P., D.P.H. Medical Officer of Health E. G. Ellis ft Soni, Willow Strtet, Chingford. E.4 The Rt. Hon. Aneurin Bevan, P.C., M.P., at the Centenary Health Exhibition, 24th September, 1956 1 Public Health Department, Town Hall, N.l. To The Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. I have the honour to present my Sixteenth Annual Report (which is also the one hundred and first Annual Report of the district) on the health of the Metropolitan Borough of Islington, for the year ended 31st December, 1956. The First Annual Report was presented to the Vestry of the Parish of St. Mary, Islington, by Dr. Edward Ballard for the year 1856. The opportunity was therefore taken during the year to mark this centenary by the holding of an Exhibition, which is referred to in the following pages in this Report. It was also considered appropriate to compile a brief history dealing with health and sanitary conditions in the Borough a century ago and mentioning some of the changes which had taken place since, and this account is included in the Appendix to this Report as " The Public Health Story of Islington." Whilst it is very obvious that we have moved very far within the last one hundred years from the gross and sometimes disgusting insanitary conditions of 1856, the public health story is far from being completed and there is plenty of scope for further advances as will be evident from this Annual Report. Among the most satisfactory health features of the past year are those relating to infants and young children. The infant mortality rate, although not quite as low as the exceptional figure for 1954, is nevertheless a very low one ; the risk of an infant dying before reaching the age of twelve months in the year 1956 was approximately one half that of ten years ago, and no more than a third of the risk twenty years ago. Deaths from tuberculosis of the lungs have again fallen to a record low level, but the position would be far more satisfactory in regard to this infection if the new cases were also reduced in the same proportion, which, unfortunately, is not yet occurring. I referred in last year's Report to the causal connection which is now accepted between heavy and prolonged cigarette smoking and the subsequent development in later life of lung cancer. The evidence of more recent inquiries, not only in this country but also abroad, has all gone to substantiate this relationship. It is to be recorded that the number of lung cancer deaths in 1956 was higher than in any previous year. It was also mentioned in last year's Report that there were other health risks which were in all probability increased by cigarette smoking, such as bronchitis of the more chronic type. In the light of this accumulating evidence of the ill effects of smoking, it is as well that greater publicity is likely to be given in the future to this difficult problem of habit formation and accepted social custom which so intimately affects many millions of people. Unquestioning acceptance of pollution of the atmosphere, both for those who do not smoke as well as those who do, in public places (e.g. public transport and places of indoor amusement) should come to an end in this country, as it has done in many other parts of the world. It is also hoped that a start may be made in the near future to diminish atmospheric pollution due to the burning of raw coal with the increased powers now available through the Clean Air Act of 1956. Reference is also made in the body of the Report to pollution of the atmosphere caused by smoke emission from heavy diesel-engined vehicles passing through the Borough, particularly upon the 2 main arterial route of Holloway Road to Highgate. An interesting experiment was begun of noting some of the vehicles with a particularly heavy emission of dense smoke, and informally communicating with the owners requesting their voluntary co-operation in reducing this nuisance; no other course is possible to this Council since it has no statutory powers in regard to vehicles. It is interesting to note that whilst very excellent co-operation has been obtained, in no single case dealt with has the owner denied the excessive emission at the time of observation when the vehicle passed through this Borough. In view of the almost certain major increase in the number of diesel-engined vehicles which are likely to be placed on the road within the next few years, it would appear evident that much more should be done than hitherto to control these vehicles as possible sources of pollution. The major deficiency of Public Health Inspectors continued throughout the year, to the disadvantage of the public health of Islington. Unless the recruitment position changes very considerably (of which there is no sign at present) it is difficult to visualise when the establishment of Inspectors can be recruited to the full, or even approaching the full establishment. As will be noted from the Report, this Council has for the past few years assisted materially in the training of Inspectors, and there were five pupils in the Department at the end of the year. It will be noted also that the designation of the former Sanitary Inspector has now been changed to Public Health Inspector, to bring this title more into line with the present conception of the wider aspects of the Inspector's place in dealing with environ— mental health and hygiene. Several items of new legislative powers are referred to in the Report, but housing still constitutes a major social and health problem in this Borough. The Council, with very great regret, had most reluctantly to come to the conclusion that the general housing waiting list must be suspended, having regard to the relatively limited amount of new housing likely to become available in the immediate fore— seeable future. Individual unfit houses and parts of houses, including underground rooms, continue to be represented, and the re-housing of the displaced families had, of course to be effected in order that closure or demolition could be carried out. With regard to health education, attention was, of course, centred particularly upon the preparations for the holding of the Centenary Exhibition, which involved much research and work. Whilst those bodies and persons outside the Borough Council's own service are mentioned in the section of the Report dealing with the Exhibition, it is only right to mention also that the staff of the Public Health Department gave most enthusiastic assistance in connection with the Exhibition preparations and voluntarily gave much time, and provided ingenious ideas and contributions to exhibits which helped very materially in increasing the variety and interest of the exhibits. It would be invidious to mention all names, but the Health Department can only function effectively as a team, and I must again express my thanks to the Deputy Medical Officer of Health, Dr. A. L. Thrower, the Chief Public Health Inspector, Mr. W. C. Bartlett, and the Chief Clerk, Mr. E. J. Sharp, and to all other members of the Public Health Department staff who have contributed so effectively to the smooth working of the Department during the past year. The Borough Council's health services now deal very largely with matters of environmental health, but these are closely linked with the more personal health services which are administered by the London County Council. If the public are not to suffer, there must be close co-operation between these two aspects of the 3 domiciliary health services in the Borough, and I have been fortunate in the close and friendly co-operation which has always existed between this Department and that of Dr. B. E. A. Sharpe, Divisional Medical Officer of Health Division 3. Towards the end of the year Dr. Sharpe was selected to take up an appointment as Divisional Medical Officer in another part of the County, and I should like to take this opportunity, therefore, of expressing my personal appreciation of the help and co-operation most willingly offered by Dr. Sharpe during her stay in Health Division 3. Dr. Wilfrid G. Harding was appointed to succeed Dr. Sharpe, and it is anticipated that the excellent relationships between the Health Division and the Borough's Health Department will be fully maintained in the future as in the past. Relationship between the Head of a Department and the Chairmen of Committees with which he has to deal is a most important one in the Local Govern— ment service. Good and understanding relationships are of more than personal importance, because they may affect to a material degree the smooth working of the local services. I have been fortunate in the understanding and co-operation which the two principal Chairmen with whom the Medical Officer of Health has to deal here, namely, Alderman A. J. Rogers, Chairman of the Public Health Committee, and Councillor E. J. W. Bayliss, Chairman of the Housing Committee, have always given. I must express my thanks both to them and to Members of their respective Committees for the very full consideration afforded to the many matters, both in relation to the services themselves and the staff of the Department, which I have placed before them during the past year. V. FREEMAN, Medical Officer of Health. 4 MEMBERS OF THE PUBLIC HEALTH COMMITTEE (As at 31st December, 1956) Mayor: Councillor H. C. Littlewood, J.P., A.C.A., A.C.I.S. Aldermen : Herbert James Lowton Lycoe, J.P., m.s.m., L.C.C. Albert John Rogers Councillors! George Arthur Ainsworth William Henry Purssord Mrs. Francis Marjorie Cole Henry James Reid William Dradey Lewis Ross Frank Ernest Field Mrs. Margaret Mary Short George Albert Gardner Mrs. Emily Mary Simms Ernest Charles Gough Mrs. Bronwen Stradling William Campbell Lillie Vivian Stewart Stradling Raymond John Morley Chairman: Alderman 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 Public Health Inspector: D. F. H. Button, A.R.C.S., F.R.I.C. W. C. Bartlett (b) (c) (d) Deputy Chief Public Health Inspector: H. Plinston (b) (c) Supervisory Public Health Inspector : J. S. Ashworth (b) Public Health Inspectors : (b) J. W. Aiken (b)(c) A. W. Haydock (b) U. P. Stanton (b)(c) A. Aslamidis (b) A. R. Kempshall (h) W. T. Stevenson (a)(g)(i) Mrs. G. S. Causton (b) T. Lawson (b)(c) R. C. Whittaker (b)(c) G. D. Couling (b)(c)(d) N. Lightowlers (b) G. A. Reid (b(c) D. T. Evans (i) Miss M. F. Morris (b)(c) L. Foxley (b) A. Moxon (9 vacancies) (b)(c) K. L. Garner (b)(c)(e) F. H. W. Pedrick (b)(c)(f)(g)(h) Miss V. M. Goddard (b)(c)(f)(g)(h) Miss S. H. Prentice (b)(c) R. T. Govett (b) R. W. Pursglove Chief Cler\: E. J. Sharp Clerical Staff: S. A. Bishop W. H. Goody (T) C. J. Moore* W. R. Causton* P. Hardwick P. F. D. Morgan (T) J. W. Clark Miss M. E. Hudson D. A. Owen E. Conner L. Hummerstone P. L. Regan Mrs. V. E. Cook Mrs. E. Johnson J. Thompson C. J. Cridland* Miss R. L. Keats (T) L. Turner Mrs. O. Easson Mrs. E. M. Matthews (T) Mrs. F. Underwood Mrs. J. W. Goodwin W. A. McAdam* S. Wright Mrs. C. A. McCausland Old People's Health Officer: Infectious Diseases Visitor: Mrs. A. E. Foster (/) Mrs. C. M. Burton (/) Disinfecting and Bathing Station, Seven Sisters Road, N.7. W. G. Jollie (Engineer-in-Charge) Mrs. H. W. 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 of 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. (f) = State Registered Nurse. (g) = State Certified Midwife. * = Senior Sectional Clerk. (h) = Health Visitor®' Certificate. (i) = Health Visitors' Diploma. (j) = Royal Sanitary Association of Scotland. 5 SECTION A. GENERAL AND VITAL STATISTICS. Area of the Borough 3,092 acres. Population. Registrar-General's estimate of civilian population, Mid-year 1956 : 228,300 Live Births. Birth Rate per 1,000 Estimated Resident Population Totals M. F. Islington England and Wales Legitimate 3,920 1,992 1,928 Illegitimate 402 223 179 4,322 2,215 2,107 18.9 15.7 Still Births. Rate per 1,000 Total (Live and Still) Births Totals M. F. England and Islington Wales Legitimate 83 44 39 Illegitimate 12 3 9 95 47 48 21.51 23.0 Deaths. Death Rate (Unadjusted) per 1,000 Population Totals M. F. Islington England and Wales 2,566 1,335 1,231 11.24 11.7 Deaths from Puerperal Causes. Deaths. Rate per 1,000 Total Births 2 Islington 0.45 England and Wales 0.56 Death Rate of Infants under One Year of Age. Islington England and Wales All infants per 1,000 live births 21 23.8 Legitimate infants per 1,000 legitimate live births 22 Illegitimate infants per 1,000 illegitimate live births 12 Notification of Births. For year ending 31st December, 1956 4,239 (corrected figure from L.C.C.). Marriages (Provisional figures). Marriages solemnised in the Borough during the year 2,448 CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION (REGISTRAR GENERAL'S RETURNS) Cause of Death Age Groups 0— i- 5— i^- 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 — — — — 4 3 14 1 6 2 2 1 26 8 34 1 2. Tuberculosis, Other — — — — — — — — 1 — — — — — — — 1 — 1 2 3. Syphilitic diseases — — — — — — — — — — 2 1 4 — 4 2 10 3 13 3 4. Diphtheria — — — — — — — — — — — — — — — — — — — 4 5. Whooping Cough — — — 1 — — — — — — — — — — — — — 1 1 5 6. Meningococcal Infection — 1 — — — — — — — — — — — — — — — 1 1 6 7. Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — 7 8. Measles — — — — — — — — — — — — — — — — — — — 8 9. Other infective and parasitic diseases 1 — — 1 — — — — — — 1 2 — 1 — — 2 4 6 9 10. Malignant neoplasm, stomach — — — — — — — — — — 26 7 9 9 10 6 45 22 67 10 11. Malignant neoplasm, lung, bronchus — — — — — — — — 5 — 69 9 43 7 12 6 119 22 141 11 12. Malignant neoplasm, breast — — — — — — — — — 7 — 20 — 15 — 6 — 48 48 12 13. Malignant neoplasm, uterus — — — — — — — — — 2 — 14 — 6 — 4 — 26 26 13 14. Other malignant neoplasms — — — 3 2 — 1 — 12 7 40 29 36 33 32 30 123 10 225 14 15 A—and-Leukaemia — — — 3 1 — — — — — 1 1 2 — 1 1 5 5 10 15 16. Diabetes — — — — — — — — 2 — — 4 3 4 3 3 8 11 19 16 17. Vascular lesions of the nervous svstem — — — — — 1 — — 1 2 22 29 32 34 35 82 90 148 238 17 18. Coronary disease, Angina — — — — — — — — 4 2 72 23 62 51 80 75 218 151 369 18 19. Hypertension with heart disease . — — — — — — — — — — 4 7 11 15 14 19 29 41 70 19 20. Other heart disease — — — — — — 1 2 8 5 14 13 22 27 63 162 108 209 317 20 21. Other circulatory disease — — — — — — — — 2 1 12 9 20 21 27 29 61 60 121 21 22. Influenza — — — — — — — — — — 2 1 1 1 — 3 3 5 8 22 23. Pneumonia 7 6 3 1 1 1 — 1 1 1 13 7 17 15 43 60 85 92 177 23 24. Bronchitis 3 — 1 — — — — — — 2 62 9 42 12 55 49 163 72 235 24 25. Other disease of the respiratory system — 1 — — — 1 — — 1 1 6 2 4 2 1 2 12 9 21 25 26. Ulcer of stomach and duodenum — — — — — — — — 1 — 9 3 8 8 6 10 24 21 45 26 27. Gastritis, enteritis, diarrhoea 1 1 1 — — — — — — — 1 1 1 2 2 5 6 9 15 27 28. Nephritis and Nephrosis — — — — — — 1 — 2 1 5 1 3 — 2 — 13 2 15 28 29. Hyperplasia of prostate — — — — — — — — — — 1 — 2 — 12 — 15 — 15 29 30. Pregnancy, Childbirth and Abortion — — — — — — — — — 2 — — — — — — — 2 2 30 31. Congenital Malformations 7 7 1 — 1 — — — — — — — — 1 — 1 9 9 18 31 32. Other defined and ill-defined diseases 36 19 — 2 — 1 2 — 7 5 13 21 10 21 21 36 89 105 194 32 33. Motor vehicle accidents — — 2 — 3 1 3 — 5 4 5 — 1 3 1 1 20 9 29 33 34. All other accidents — 1 1 — — — 2 2 7 — 7 1 2 5 9 14 28 23 51 34 35. Suicide — — — — — — 1 — 7 3 8 6 5 1 2 1 23 11 34 35 36. Homicide — — — — — — — — — — — — — — — — — — — 36 All Causes 55 36 9 12 8 5 11 5 70 48 399 221 346 296 437 608 1,335 1,231 2,566 Totals 91 21 13 16 118 620 642 1045 2,566 Percentages 3.55 0.82 0.51 0.62 4.60 24.16 25.02 40.72 100 9 COMPARATIVE VITAL STATISTICS—1945 TO 1956 (Compiled from Registrar-General's Returns) 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 Population 228,300 228,800 230,500 233,500 235,300 235,800 238,200 239,580 238,200 236,840 227,160 195,770 Live Births -(Total) 4,J22 3,945 4,063 3,969 3,897 3,880 4,091 4,389 4,608 5,577 5,284 3,708 (Illegitimate) 402 340 336 296 282 285 302 318 331 431 442 438 Birth Rate per 1,000 population 18.9 17.2 17.6 17.0 16.56 16.45 17.17 18.32 19.34 23.55 23.26 18.94 Still Birth Rate per 1,000 births 21.51 21.09 19.31 22.66 17.89 20.94 17.48 19.87 18.94 18.99 22.20 22.41 Deaths 2,566 2,591 2,425 2,669 2,876 3,131 2,760 2,958 2,682 3,053 2,947 2,856 Death rate 11.24 11.32 10.52 11.43 12.22 13.28 11.59 12.35 11.26 12.89 12.97 14.59 Maternal Death rate per 1,000 births 0.45 0.25 0.48 0.99 1.01 0.50 0.72 0.67 0.85 0.70 1.48 0.26 Death rate of Infants under 1 year 21 26 17 24 22 28 29 27 35 32 39 46 Marriage rate per 1,000 population 21.44 20.95 19.35 19.08 17.85 19.17 18.37 18.61 19.67 19.54 20.21 25.00 T.B. Notifications per 1,000 population (all forms) 1.81 1.97 1.94 2.08 2.03 1.77 2.05 2.20 2.25 2.43 2.18 2.81 Death-rates per 1,000 population— Pulmonary T.B. 0.15 0.20 0.16 0.16 0.30 0.30 0.38 0.52 0.66 0.70 0.64 0.80 Diphtheria Nil Nil Nil Nil Nil 0.004 0.004 0.008 Nil 0.004 Nil 0.01 Suicides 0.15 0.13 0.13 0.14 0.076 0.15 0.09 0.12 0.15 0.07 0.11 0.06 Motor Vehicle Accidents 0.13 0.14 0.082 0.077 0.076 0.11 0.10 0.06 0.08 0.11 0.10 0.07 Other violent causes 0.22 0.22 0.17 0.20 0.22 0.26 0.26 0.25 0.43 0.37 0.45 1.05 L 8 SUMMARY OF INFANT MORTALITY 1956 (Based on Registrar General's Returns) Primary Cause of Death Under 1 day 1 Days Weeks Months Totals 1956 Totals (1955)| 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 Measles (-) Whooping Cough (-) Meningococcal Infection 1 1 (-) Tuberculosis—Lungs (—) Tuberculosis—Other forms... (-) Bronchitis 1 1 1 3 (6) Pneumonia i 2 1 1 1 1 2 1 1 2 13 (16) Influenza . (—) Enteritis and Diarrhoea 1 1 2 (2) Premature Birth 12 8 2 2 24 (41) Congenital Malformation, (—) Birth Injury, Atelectasis (—) Atrophy and Marasmus 15 5 2 4 1 3 4 1 1 1 37 (27) Syphilis (—) Suffocation Overlying (—) Violent Causes 1 1 (2) Koad Traffic Accidents (—) All Other Causes 1 1 2 1 1 1 2 1 10 (7) Totals 29 15 5 8 3 — 1 4 5 3 5 2 4 2 — 1 — 2 2 —j— 91 (101) 9 COMMENTS ON VITAL STATISTICS Births. The post-war increase in the birth-rate reached its peak of 23.55 per thousand population in 1947. In 1948 there was a marked decrease to 19.34, and then a slow and steady decrease until 1951. Since then there has been a tendency for the birth-rate to rise again, and the rate of 18.9 for 1956 represents the highest rate for the past eight years. 9.3 per cent of all 1956 births were classified as illegitimate. Deaths. It was believed at one time that if the births increased, the deaths also increased in proportion. Whether this was correct or not in the past, it is certainly not true today. The death rate is, if anything, fractionally lower than in 1955. Infants under One Year. The lowest infant mortality was recorded in 1954, but the second lowest proportion of infant deaths took place in 1956. It is satisfac— tory to note that the infant mortality in Islington, in spite of many adverse social circumstances—particularly housing—was lower than the average for England and Wales, in spite of the fact that the birth-rate in Islington was substantially higher than that for the whole country. This says much for the standard of maternal care, and the standard also of all the medical and related services available in the area for expectant mothers and their young infants. From the table given of the summary of Infant Mortality on page 8, 29 out of the 91 infant deaths took place within the first twenty-four hours (i.e. 32 per cent). 32 (or 35 per cent) did not survive up to the end of the first week, making a total proportion of 67 per cent of infants who died within seven days of birth. The two major causes of non-survival, as usual, were prematurity, and the group of congenital malforma' tions and birth injuries, etc. Of the thirty infants who died in the succeeding eleven-month period, the principal cause was respiratory infection due to bronchitis or pneumonia in ten cases. Respiratory Tuberculosis. The total of 34 deaths ascribed to pulmonary tuber— culosis was the lowest recorded in the health history of the Borough, the previous lowest figure being 37 in 1954, and is an indication of the increasing control over the course of this disease. 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 1956 119 22 141 The improving position in regard to tuberculosis of the lungs is unfortunately not matched by an improvement in deaths due to lung cancer. On the contrary, these have tended to increase, and the highest figures recorded for the Borough were in 1956. The approximate proportion of five male to one female death appears to remain 10 fairly constant. 59 out of the 119 male deaths, or practically 50 per cent, were in the age group 45-65, so that lung cancer is an affliction rather of late middle age than of the elderly. The relationship between lung cancer and long continued heavy cigarette smoking has been more firmly established within the past year. It is important that the adolescent and young adult should be aware of and be warned of the long-term risk of cigarette smoking. There is evidence also that even for adults with a long established practice, the giving up of the habit of cigarette smoking does reduce to some extent the liability to contract lung cancer. The following table gives the deaths from accidents to Islington residents from 1950 onwards :— 1950 1951 1952 1953 1954 1955 1956 Motor vehicle accidents 24 26 18 18 19 33 29 Other violent accidents 61 61 48 46 40 50 51 In the following table causes of accidental deaths in 1956 are analysed, in their respective age groups. Type 0- 1- 5- 15- 25- 45- 65- 75+ M F Total Motor Vehicle Accidents — 2 4 3 9 5 4 2 20 9 29 Falls — — — — 3 3 5 13 11 13 24 Accidental Poisoning (Solid, — — — — — — — — — — — Liquid Gases and Vapours) — — — — — 2 1 3 3 3 6 Drowning — — — 1 1 — — — 1 1 2 Fire — — — — — — — 5 2 3 5 Inhalation of Stomach contents — — — — — — — 1 1 — 1 Others (Railway Accidents, etc.) 1 1 — 3 3 3 1 1 10 3 13 Total 1 3 4 7 16 13 11 25 48 32 80 11 SECTION B. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES. Notifiable Infectious Diseases and Deaths during the year 1956. 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 171 (216) — 38 163 17 Diphtheria 8 (9) — 8 2 — Enteric Fever (including Paratyphoid) 3 (7) — 2 2 — Typhus Fever — (—) — — —. — Puerperal Pyrexia 299 (430) — 283 299 — Ac. Primary & Influenzal Pneumonia 90 (117) 3 5 92 — Ophthalmia Neonatorum 18 (14) — 15 18 — Acute Encephalitis 7 (2) — 7 9 — Meningococcal Infection 8 (7) 1 8 1 3 Anthrax — (—) — — — — Dysentery 370 (428) — 51 353 93 Malaria 3 (2) — 2 3 — Erysipelas 33 (28) — 8 32 7 Measles 1,997 (2,872) — 74 1,999 121 Whoopmg Cough 529 (363) 1 81 529 60 Ac. Poliomyelitis 24 (85) — 16 11 — Food Poisoning 141 (294) — 15 148 3 4 Tuberculosis—Lungs 378 (405) 34 — 300 — Tuberculosis—Other Forms 36 (46) 1 — 35 — Scabies 57 (65) — 1 57 154 (Figures in brackets are notifications for 1955) Domiciliary Visiting of Infectious Disease Cases and Contacts—No. of Visits Smallpox — Erysipelas 43 Scarlet Fever 171 Measles 2,092 Diphtheria 14 Whooping Cough 562 Enteric Fever (including Typhoid Acute Poliomyelitis 92 and Paratyphoid) 10 Food Poisoning 154 Meningococcal Infection 12 Scabies 221 Dysentery 591 Vermin 226 Malaria 1 Ineffective Visits 910 Acute Encephalitis 6 Others 35 Total 5,140 Smallpox. Although there were no cases and no contacts to be visited in the Borough during the year, the possibility of smallpox arising in an unprotected community 12 still remains a real one, and parents are therefore wise to continue to take advantage for the protection of their children of the vaccination facilities offered by the Local Health Authority. The following is the table of successful vaccinations performed over the past ten years— 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* 1956 2,590*† (Figures from 1948 onwards kindly furnished by Divisional Medical Officer, London County Council.) * Including Re-vaccinations, f Group Sessions for Schoolchildren discontinued. 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 continues to increase and during the year the Medical Officer of Health dealt with 645 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. There having been a high incidence of measles in the previous year, 1955, it might be expected that the 1956 cases would be considerably lower, and this in fact proved to be so, with approximately 900 fewer notified cases than in the previous year. The great majority of the cases occurred, fortunately, during the summer period. 13 The following table shows the age-groups of the notified cases during 1956 :— 5 years and upwards No. of Notifications in 1956 Under 1 year 1—5 years 63 1,135 799 Percentage of total notifications 3.2 56.8 40.0 No. of Deaths Whooping Cough. With 529 cases, whooping cough showed a substantial increase over the figures for the previous year, which were in themselves greater than average. The proportions in the different age groups were much the same as previously. 5 years and upwards Under 1 year 1—5 years No. of Notifications in 1956 61 270 198 Percentage of total notifications 11.5 51.1 37.4 No. of Deaths 1 14 Fatality Rates per 1,000 notifications each age group (1947—1956) Percentage of notifications (1947—1956) Under 1 1—5 5 & upwards Under 1 1—5 5 & upwards Measles 3.75 0.29 — 4.5 58.6 36.9 Whooping Cough 12.75 1.84 — 12.4 57.1 30.5 Over the ten-year period 57.1 per cent of all cases of whooping cough and 58.6 per cent of all cases of measles were in children one to five years of age. Whooping Cough Prophylaxis. Whooping cough immunisation is carried 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 8,463 Completed cases 2,927 15 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 No. of Ineffective Measles Whooping Cough Visits Re-visits 2,089 558 306 7 Acute Poliomyelitis There were relatively few confirmed poliomyelitis cases in the borough during the year, the incidence being less than a quarter of the 1955 total. Although poliomyelitis is normally a summer infection rather than a winter one, it is not invariably so, and it will be seen from the table below that there were no cases at all during the four summer months, but a few during the autumn and early winter. This supports what we know is the unpredictability within our present knowledge of the behaviour of poliomyelitis. The cases reported for each of ten years are set out as under :— No. Reported No. CONFIRMED 1956 34 13* 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. Sep t. Oct. Nov. Dec. 1956 1 — 1 1 1 — — — — 2 3 4* 1955 2 1 — — — 1 5 11 15 9 3 1954 — — — — — — 1 3 2 3 2 1 195 3 1 — — — 2 2 6 2 3 1 — — 1952 — — — — 1 — 2 8 — 2 1 1 1951 1 — — 1 1 2 — 2 1 — — — 1950 I — 1 — 2 2 10 10 1 2 2 — 1949 — — — — — — 9 6 17 18 — 4 1948 — 1 — 2 — 1 — 2 — 1 1 1 t947 — — 1 1 — 2 3 5 4 4 3 1 Age distribution : Under I vr. 1— 5 - 15— 25 and over *1956 — 4 5 2 2 1955 5 19 15 5 12 1954 — 7 2 1 2 1953 — 6 5 1 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—1956—Nil. 1955—3 (17½ years; 30 years; and 5 years-—the latter contracted outside the borough, and not included in above tables). 16 1954—1 (27 years). 1953—3 (4 vears ; 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. * Two cases, with onset in December, 1956, were notified in 1957, and are included in the above returns. Encephalomyelitis One case of encephalomyelitis, a male, was reported, with onset in December. Diphtheria Cases and Deaths—1927-1956 Year Notified Cases Deaths Year Notified Cases Confirmed Cases Deaths Year Notified Cases Confirmed Cases Deaths 1927 720 25 1938 595 Not Available 23 1949 55 17 2 1928 760 25 1939 254 10 1950 50 19 1 1929 1,008 34 1940 101 2 1951 43 17 1 1930 1,248 42 1941 174 11 1952 23 1931 714 15 1942 201 2 1953 12 1 1932 601 20 1943 188 9 1954 6 1 1933 551 33 1944 94 38 2 1955 9 1 1934 815 32 1945 86 45 3 1956 8 2 1935 760 13 1946 137 50 — 1936 583 31 1947 72 19 1 1937 623 20 1948 44 7 — 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 1956 63 11 2 The two diphtheria cases were both adults, being respectively, a young house— wife, age 20 years, and a hospital nurse, age 25. Both cases were clinically mild so far as diphtheria symptoms were concerncd, but bacteriological confirmation was obtained in both patients. 17 Diphtheria Cases and Immunisation state 1947-1956 (inclusive) Year Immunised Non-Immunised Unknown Total Deaths Age Groups Aee Groups 0—5 5—15 15 + 0—5 5 —15 15 + 1956 1 1 2 Nil 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 J 4 years 6 year Not immunised6 years J 1948 1 2 1 1 — 2 — 7 Nil 1947 — 5 1 2 4 5 2 19 16 years—Not immunised Totals 3 17 3 16 24 17 4 84 5 deaths (Noneimmunised) 23 57 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, 1956 Dr. Wilfrid G. Harding, 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. 56 i.e. born in year Under 1 1956 1—4 1955-52 5—9 1951-47 10—14 1946-42 Under 15 Total Last complete course (whether primary or boost) 1952-56 497 8,704 7,502 3,664 20,367 Mid-year population 4,160 13,140 30,500 47,800 Immunity Index 11.95 66.24 36.61 42.61 Food Poisoning ., , Number or notifications received 1947 7 1948 10 1949 55 1950 104 1951 148 1952 58 1953 243 1954 104 1955 294 1956 141 18 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. 27. 9.56 21 unknown 32 — Cream pastries comprising chocolate eclairs, cream sponge and cream buns :—Small numbers of coagulase positive staphylococci were isolated from samples of the above. Examination of another chocolate eclair showed Salmon— ella typhi murium present. 2. 20.11.56 — 15 9 — Roast Mutton :Heat resistant CI. Welchii isolated. As set out in the tables above, there were two outbreaks of food poisoning of any size in the Borough during the year, as compared with eight listed for 1955, and 141 cases of food poisoning, as against 294 for the previous year. In connection with outbreak 1, information was first received from a practitioner in the Borough regarding two families where there was illness resembling food poisoning, with abdominal pain and diarrhoea. One member of the family in one case was employed at a bakery, and brought home chocolate cakes ; the other family affected had also consumed the same type of cream pastry. Reports continued to be received over the next few days of other cases who had contracted symptoms of food poisoning, the common factor in all these cases being the consumption of cream pastries, comprising chocolate eclairs, cream sponge and cream buns, baked at the same bakery. As a result of further investigation, six members of the bakery staff were found eventually to be affected. Samples of pastries and material used in their preparation, and also specimens from the persons affected, were forwarded for bacteriological examination and a food poisoning organism known as Salmonella Typhi Murium was found in a considerable number of those examined. The same organism was also found in a chocolate eclair sent for examination, and it was therefore presumed that this was the one organism responsible for the out' break. The firm concerned co-operated fully with all measures advised, and the manufacture of cream pastries was temporarily discontinued. The cream used was artificial cream, but it was not possible to say precisely how the organism was introduced. It is conceivable that the organism was present in the imported egg albumen normally used in the making up of the cream. The egg albumen concerned in this particular outbreak was imported from Colonial sources which, in general, have been found reliable, but with a product of this nature it is quite impossible to say that a particular batch could not have been infected. Although the patients recovered within a matter of days, some of those concerned continued to carry the organism for several weeks, including some members of the bakery staff who, with the full Co-operation of the proprietor, did not return to their occupation until completely clear. 19 The second outbreak affected factory staff who had dined at a works canteen. Bacteriological examinations of the food consumed, and specimens from those taken ill, showed that the food poisoning organism was heat-resistant Clostridium Welchii. This was found to be present in the meat and also in seven of those affected. This organism is particularly difficult to deal with because of its resistance to normal cooking procedures, and the fact that it may be present on meat which is otherwise perfectly sound, and it therefore remains undetectible. Only general safeguards can be advised in the form of thorough cooking of meat and avoidance of meat left over being kept at room temperature awaiting further consumption. Typhoid Fever Typhoid fever, now being a somewhat rare disease in this Country, may therefore warrant special mention if a confirmed case occurs. A woman was admitted to hospital for observation, and a diagnosis of typhoid fever was subsequently confirmed. Although not subject to confirmation bacteriologically, it is considered highly probable that the source of infection in this case was due to the consumption of infected oysters. These were purchased in another area, but although further enquiries were made no information was obtained as to the occurrence of any other cases ; the patient's family and other contacts of this case were kept under observation, but, fortunately, this remained an isolated case. Dysentery In accordance with experience in previous years, dysentery did not increase during the warm summer months. It will be seen from the table on page 20 that the greater number of cases occurred during the last three months of the year. Most of the November and December cases were in children attending a school, and cases at home and their contacts were dealt with in full co-operation with the Divisional Medical Officer. It will be noted from the table that a substantial number of dysentery contacts were engaged in occupation as food handlers, and were either kept under observation, or excluded from work, as required. All notified cases were visited by a Public Health Inspector or Infectious Disease Visitor, and stool specimens were examined at the Public Health Laboratory Service Bacteriological Laboratory, County Hall, S.E.I. DYSENTERY IN ISLINGTON—1956 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 1956 January 29 M F 9 15 3 2 12 2 — 5 6 — 3 1 1 3 5 — 2 1 — 1 3 3 12 14 February 17 M F 10 6 1 — 6 1 1 4 — 2 1 — 2 2 2 — — 2 — 1 1 — 8 8 March 44 M F 19 18 1 6 34 — 5 5 9 12 4 5 3 1 — — — 1 6 — 14 28 April 16 M F 7 5 3 1 8 1 — — 5 2 3 — — 1 3 — 1 — — — — — 4 12 May 42 M F 22 13 1 6 26 1 — 9 7 10 3 — — 2 2 2 1 4 — 1 1 4 — 18 21 June 26 M F 11 15 — — 18 2 — 2 3 3 6 1 2 3 1 — 2 — 1 — 1 — 18 7 July 13 M F 7 4 1 1 6 2 — 3 2 3 — — 1 — 1 — 1 — — 2 4 2 8 5 August 25 M F 14 7 2 2 12 3 1 2 1 — 3 3 — 6 3 2 1 — — 1 3 — 17 6 September 19 M F 6 12 1 — 11 1 — 3 5 1 — — 1 1 4 1 2 — — 1 1 — 9 1 October 41 M F 9 27 4 1 26 — — 3 10 8 7 — 3 1 3 — 3 1 2 — 4 — 20 9 November 100 M F 35 35 16 14 72 2 1 11 10 32 27 1 3 4 5 1 2 1 2 13 5 58 38 December . 83 M F 23 33 12 15 53 6 13 13 14 20 2 1 3 5 2 3 1 2 13 — 44 37 Total 455 M F 172 190 45 48 284 15 9 65 64 85 82 8 20 31 37 8 21 5 5 12 53 10 230 186 20 TUBERCULOSIS 1956 PRIMARY NOTIFICATION OF PULMONARY CASES 21 Scabies and Vermin It was reported in the 1955 Annual Report that the Department's Cleansing and Disinfecting Station, Seven Sisters Road, had been closed on account of works in connection with the installation of a new boiler, large and small sterilizers, together with appropriate modern recording equipment. The work was completed and the Centre re-opened for Islington cases on 1st April, 1956. During the period of closure cases were referred for treatment to the Finsbury Health Centre, and the Council were very appreciative of the assistance afforded by the Medical Officer of Health, Finsbury, and his staff, during this time. Scabies Vermin Children under S years Number treated 26 17 Number of baths given 51 — Number of treatments — 18 L.C.C. Children Number treated 43 185 Number of baths given 89* — Number of treatments — 186 Adults Number treated 86 J 5 Number of baths given 185* — Number of treatments — 40 * Baths were also given to 8 Scabies Contacts and 116 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 Ineffective Visited Revisits Visits Total Scabies 149 8 81 238 Vermin 185 5 143 333 Tuberculosis. It will be seen from the table given below that there were 419 new cases of pulmonary tuberculosis (an increase of 13 over the previous year), and a decrease in the number of deaths to 34 as compared with 45. The number of deaths is the lowest recorded in the history of the Borough. New cases reported during the year in males numbered 272, an increase of 27 over last year. The female new cases of pulmonary tuberculosis were, at 157, less than the previous year by 14. It has been mentioned previously in these Annual Reports that the greatly improved outlook in connection with the treatment of tuberculosis has enabled a much longer survival of patients, with a consequent steep fall in the death-rate. If the new cases do not fall correspondingly, this results in an increase in the total number of patients suffering from, or under observation for tuberculosis, and this position is confirmed in the Borough by the rise to over 3,000 on the register of the department, and an increase, although a smaller one, in the number of cases on the Chest Clinic registers. It therefore remains true, unfortunately, as mentioned in last year's Report, that pulmonary tuberculosis is still the most serious major infection with which we have to deal, since the majority of new cases are between the ages of 15 and 55 years and working capacity both of men and women is very seriously affected for very long periods, with all the family, social and financial repercussions entailed by such longterm sickness and complete or partial incapacity. 22 New Cases and Mortality during 1956 Ages New Cases Deaths Respiratory N on-Respiratory Respiratory Non-Respiratory M. F. M. F. M. F. M. F. 0 — — — — — — — — 1 6 3 1 — — 1 — — 5 10 7 3 1 — — — — 15 46 46 1 8 — — — — 25 58 39 6 12 2 1 — — 35 43 26 4 2 2 2 1 — 45 37 18 2 1 3 — — — 55 26 5 — — 11 1 — — 65 and upwards 36 13 — 3 8 3 — — Total for all ages 262 157 17 27 26 8 1 — 463 35 Rates per 1,000 population— New cases—pulmonary 1.84 non'pulmonary 0.19 Deaths— pulmonary 0.15 non-pulmonary 0.004 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 Regula— tions, 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, 1956 was :— Pulmonary-— Males 1,506 Females 1,234 Non-Pulmonary—Males 144 Females 164 3,048 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 1955 2,945 Islington Chest Clinic, Whittington Hospital Cases on Chest Clinic Registers Number of definite cases of tuber— culosis on Chest Clinic Register as at 31st December, 1956 Pulmonary Non-Pulmonary Total Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F. 1375 1041 109 88 52 85 9 13 1427 1126 118 101 Grand Total 2,772 23 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 1955 2,751 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 Commitfee is able to assist patients in many ways, and the Care Organiser, reports that an average of 124 cases per quarter were helped with extra nourishment during the year, while loans of beds and bedding and medical appliances were made to 29 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 continues to carry out most useful service in the Borough. Over 15,000 Islington residents were seen by the Unit, as well as nearly 17,000 non-residents, most of whom work in the Borough. From information kindly furnished by Dr. G. Z. Brett, Physician-in-Charge of the Unit, the number of cases of active pulmonary tuberculosis found among Islington residents through the Mass X-Ray Unit examination was 69 in males, out of a total of 6,630 examined, and 45 females out of a total of 8,804. Bacteriological Examinations All specimens for bacteriological examination dealt with through the Department are submitted to the Public Health Laboratory Service, County Hall, S.E.I. Examinations carried out Total Swabs (Diphtheria) 166 Sputum (Tuberculosis) 22 Faeces (Enteric Fever) 12 Blood (Enteric Fever) — Faeces (Food poisoning) 759 Food (Food poisoning) 5 Faeces (Dysentery) 2,676 Faeces (Poliomyelitis) 46 Swabs (Streptococci) 31 Swabs (Pertussis) 4 Swabs (Influenza) 8 Smears (Variola) — Scrapings (Variola) — Other Specimens 18 Total 3,747 (I am indebted to Dr. Wil/rid G. Harding, Divisional Medical Officer, London County Council, for the 1956 figures in connection with vaccination diphtheria and whooping cough inoculations, and shest clinics). 24 SANITARY CIRCUMSTANCES OF THE AREA SECTION C (In conjunction with Mr. W. C. Bartlett, Chief Public Health Inspector) The appointment of Islington's first Sanitary Inspectors is referred to in the historical appendix to this Report. They, were not required to pass qualifying examinations, and it was not until 1877 that the Royal Sanitary Institute endeavoured to remedy this situation by promoting examinations. In 1895, the possession of Certificates of competency was made obligatory for all new appointments in London. In 1922, the possession of a Qualifying Certificate became compulsory for the rest of the Country. A new Examination Board has now been set up as recommended in the Report of the Working Party on the Recruitment, Training and Qualification of Sanitary Inspectors which was submitted to the Minister of Health in 1953. With regard to the qualifications of the sanitary inspector, one cannot do better than quote from the Report of the Working Party, paragraph 106, which states, " A sanitary inspector is a local government officer whose duty it is to secure compliance with certain laws designed to protect the public health. To do this, he needs to have a good working knowledge—in many cases a detailed knowledge—of certain techniques and sciences. The number and variety of these is the outstanding feature of his work. Thus while not himself practising medicine, architecture, engineering, or building, he must know something of all of them, and all this calls for a very special type of training, but first and last he is an executive officer, exercising control over the public in accordance with the law of the land, a control which often touches the pocket of the individual and could in wrong hands be very galling. It is here that the modern sanitary inspector has developed his own special skill over and above those he borrows from other callings. The public health code is a vast and complicated one and it is the sanitary inspector's function within his own field to translate it into terms intelligible to the common man and so enable him to see clearly what he must do and how he can do it with least inconvenience and expense. The sanitary insector must needs be familiar with many trades but he must also be master of one—a most important one in a free community—that of interpreting the requirements of the law to the citizen and enlisting his willing co-operation." The Government, upon considering the duties at present carried out by this officer, decided this year to re-designate the Sanitary Inspector who in future will be known as the Public Health Inspector. Under proposals made by the Minister of Health in agreement with interested Bodies, arising out of the recommendations of the Working Party on the Recruitment, Training and Qualification of Sanitary Inspectors, the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board has been reconstituted as the Public Health Inspectors' Education Board. The objects of the new Board may be summarised as follows :— (I) to examine for and issue a Diploma in Public Health Inspection as the basic qualification to be recognised by the Minister ; (II) to examine for other Certificates it may consider necessary for Public Health Inspectors ; (III) to approve courses for instruction for all of its examinations ; (IV) to approve local authorities for the purposes of practical training ; and (V) to keep under review all questions relating to the recruitment, training and examination of Public Health Inspectors. 25 Paid Pupillage The Report of the Working Party mentioned above recommended that the system of paid pupillage for Public Health Inspectors should be extended with the prospect of its ultimately becoming the normal avenue of entry, except for ex-Service candidates, and that practical training for student inspectors should be obtained in the service of local authorities approved for the purpose. This Council has for some years appreciated the basic importance of encouraging the training of student inspectors and has offered full training facilities. The Council commenced its own training scheme for student inspectors in 1948, and since that time 17 students have been fully trained, all of whom have been successful in passing the qualifying examination. The number in training at the end of this year was 5. During their training the students receive payment on an agreed basis as if they were members of the general clerical staff, and they are given full facilities for attending lectures, demonstrations, etc., as well as being given comprehensive training within the Department. While progress has continued throughout the century, the work of the Public Health Inspectors has increased. A large proportion of the property in the Borough is more than a hundred years old and in many cases obsolescent, is in marked degree of disrepair and deterioration, and lacks the amenities and comforts of modern housing. The current problems of the department are aggravated by a national shortage of Public Health Inspectors. In common with other Metropolitan Boroughs, Islington has suffered from the lack of Inspectors over a long period, and whilst every endeavour is made to cope with routine and day-to-day matters, a depleted staff is bound to have effect both on the department and the residents in the Borough. Legislation is increasing and the already onerous responsibilities devolving on the Council are being added to continuously. It was, therefore, only the co-operation and diligence of the Inspectorate that allowed the work to be carried out as satisfactorily as it was. In August the London County Council (General Powers) Act, 1956, came into operation, Section 63 of which empowers Metropolitan Borough Councils to make byelaws with respect to tenement houses and flats for the adequate artificial lighting of common staircases. To some extent the powers under Section 61 of the London County Council (General Powers) Act, 1927, which were revoked by the Public Health (London) Act, 1936, and the Tenement House Byelaws, which were rendered inoperable by the passing of the Housing Repairs and Rents Act, 1954, have been restored, but byelaws have yet to be made. Consequent upon the exceptionally heavy rains which fell during July, surcharging of certain sewers in the Borough occurred and caused a number of premises to be flooded. This was particularly serious in at least one area. After the storms had abated a layer of crude sewage remained under the floor boards and in the rooms. Everything possible was done by the Department to alleviate the distress of the residents concerned. Complaints of noise nuisance continue to be received and are usually resolved by informal action. In this age of mechanisation the problem of noise is a real one. Power sewing machines installed at home can be a source of nuisance to residents in other parts of the house, particularly if the machines are operated without due care and outside normal working hours. During the year, complaints were received in respect of nuisance from pigeons at two schools, certain factories and areas in the Borough. In accordance with the 26 provisions of Section 121 of the Public Health (London) Act, 1936, the Council engaged a pigeon catcher in order that such nuisances may be kept to a minimum. This action by the Council has been appreciated. The conversion of the refuse disposal arrangements to the Paladin system at one block of tenement buildings in the Borough was completed, and a great improvement has resulted. It is hoped that the owners will commence work on the remaining blocks in the near future. • The factory situated in a densely populated area of the Borough in which animal blood was processed, as mentioned in my last Report, has now ceased to operate, the premises are vacant and the effluvium nuisance has, of course, ceased. There was a considerable increase in the number of prosecutions which were necessary this year, both in respect of non-compliance with nuisance notices, and failure to comply with abatement orders. An appeal was lodged against the Magistrate's decision in one case, and two appeals against the service of nuisance notices. All were dismissed with costs against the appellant. Summary of Work done by District Public Health Inspectors. During the year 30,670 inspections or revisits were made by the District Sanitary Inspectors. In connection with visits to dwelling-houses, 40,014 inspections or re-inspections of separate lettings were made. Routine Inspections, etc. Houses Inspected (on complaint, etc.) 7,623 do. Separate Lettings in above 13,737 Inspections re Schools 6 do. Licensed Premises 31 do. Hairdressers 1 do. Child Life Protection 1 do. Stables, Manure Pits 33 do. Courts, Mews 138 do. Rag and Bone Dealers 3 do. Bombed Sites 168 do. Derelict Buildings 114 do. A.R.P. Shelters, Static Water Tanks 66 do. Fairgrounds, Caravans 5 Nuisances dealt with by Notice 12,433 do. informally 908 Houses Reinspected 14,864 do. Separate Lettings in above 25,907 Other revisits 1,059 Notices Served—Intimation 5,292 do. Statutory 2,968 Notices Complied with—Intimation 2,320 do. Statutory 1,782 do. By Local Authority in default 104 Requisitioned Properties—Inspected 52 do. Separate Lettings in above 79 do. Reinspected 61 do. Separate Letings in above 91 Land Charges Act, 1925. Enquiries received 2,164 Properties involved 2,763 Investigations 2,763 27 Rational Assistance Act (Section 47).—Aged and Infirm Persons Cases investigated 17 Cases revisited 104 (See also Section on Services for Elderly Persons). Miscellaneous. Other Visits or Inspections not specified 1,023 Non-effective Visits 5,215 Total Nuisances and Contraventions Reported (all sources) 13,481 *Food & Drugs Act, etc.—Wee^ End (Saturday—Sunday) Duty. Retail Shops and Food Purveyors Inspected 12 Street Markets Visited 74 * See also Section E. Housing Repairs and Rents Act, 1954 Certificates of Disrepair. Section Sections 26 26/27 Applications brought forward from 1955 1 4 Applications in 1956 20 24 Total 21 28 Certificates issued in 1956 20 24 Certificates refused in 1956 1 1 Balance to 1957 — 3 Total 21 28 Appeals Lodged Nil Nil Revocation Certificates. Applications brought forward from 1955 10 1 Applications in 1956 19 21 Total 29 22 Certificates issued in 1956 17 9 Certificates refused in 1956 4 9 Balance to 1957 8 4 Total 29 22 Appeals Lodged Nil Nil 28 Improvements effected as a result of Service of Notices under the Public Health (London) Act. 1. Brickwork—walls repaired or rebuilt 8 2. Drains cleared, repaired, etc 426 3. Dampness remedied 2,467 4. Fireplaces and ranges repaired/renewed 353 5. Floors repaired 456 6. Flues repaired 195 7. Internal walls repaired 1,177 8. Ceilings repaired 729 9. Rainwater pipes/gutters repaired 492 10. Roofs repaired 1,695 11. Rooms cleansed 169 12. Sinks provided 59 13. Soil pipes repaired and renewed 93 14. Staircases or passages cleansed 19 15. Staircases repaired 129 16. Waste pipes repaired 283 17. Water Closet Apartments cleansed 45 18. Water Closet Pans and Traps renewed 174 19. Water Closets—flushing apparatus repaired or renewed 209 20. Water Closets—general repairs 592 21. Water supply provided 64 22. Water service pipes repaired 283 23. Window cords renewed 1,611 24. Windows repaired or renewed 645 25. Miscellaneous improvements 791 Total 13,164 Total number of houses improved 4,573 Total number of separate lettings improved 5,200 Total number of nuisances abated 11,979 Public Health (London) Act, 1936—Sections 40 and 109. London County Council (General Powers) Act, 1955, Sections 25, 26 and 27. Consequent upon Notices served by the Public Health Inspectors, the Council, in pursuance of their powers under the above Acts to undertake works in default, carried out works to a total cost of £1,652 4s. 5d. during the period under review. This amount is apportioned as follows under the appropriate Acts and Sections :— . £ s. d. Public Health (London) Act, 1936, Section 40 1,103 12 6 Public Health (London) Act, 1936, Section 109 466 13 6 London County Council (General Powers) Act, 1955, Section 25 5 5 5 London County Council (General Powers) Act, 1955, Section 27 76 13 0 £1,652 4 5 29 Legal Proceedings. Public Health (London) Act, 1936. Failure to comply with Statutory Notices contrary to Section 82 (No. of Cases : 140) Date Address Magistrate's Decision 12.1.56 183, Offord Road Fined £2. Defendant to pay £1 Is. Od. costs. do. 52, Windsor Road Fined £2. Defendant to pay £1 2's. Od. costs. do. 29, North Road Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 29, North Road Not separately dealt with. do. 2, Corporation Street Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 2, Corporation Street Not separately dealt with. do. 2, Corporation Street Not separately dealt with. do. 79, Benwell Road Defendant to pay £1 4s. 6d. corts. do. 118, Barnsbury Road Fined £1. Ordered to abate within 21 days. Defendant to pay £1 15s. 6d. costs. do. 32. Brooksby Street Fined £1. Defendant to pay £1 6s. Od. costs. do. 19, Kinlock Street lustices discharged defedant absolutely. do. 37a, Lowman Road Fin^d £2. Ordered to abate within 14 days. Defendant to pay £1 15s. 6d. costs. do. 22, Mayton Street Fined £3. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 27, North Road Fined £2. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 29, North Road Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 122, Northchurch Road Fined £3. Ordered to abate within 21 days. Defendant to pay £1 15s. 6d. costs. do. 7, Queensland Place Fined £2. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 11, Queensland Place Fined £1. Ordered to abate within 28 days, defendant to pay £1 9s. 6d. costs. do. 12, Queensland Place Fined 10s. Od. Defendant to pay £1 2s. Od. do. 2, Queensland Road Fined £5. Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. do. 150, Offord Road Ordered to abate within 21 days. Defendant to pay £1 14s. 6d. costs. do. 6A. Highbury Crescent Fined £1. Defendant to pay £1 6s. costs. 9.2.56 5, Canonbury Lane Ordered to abate within 14 days. Defendant to pay £2 5s. 6d. costs. do. 364A, Camden Road Ordered to abate within 28 days. Defendant to pay £l 14s. 6d. costs. do. 39, Clephane Road Fined £10. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 90, Sussex Way Ordered to abat2 within 28 days. Defendant to pay £l 14s. 6d. costs. 8.3.56 254, Tufnell Park Road Ordered to abate within 35 days. Defendant to pay £1 14s. 6d. costs. do. 461, Caledonian Road Defendant absolutely discharged and to pay 5s. Od. costs. do. 118. Lofting Road Fined £l. Ordered to abate within 21 days. Defendant to pay £1 9s. 6d. costs. do. 2, Melville Street Ordered to abate within 14 days. Defendant to pay £1 14s. 6d. costs. Fined £2. Ordered to abate within 7 days. Defendant to pay £1 15s. 6d. costs. do. 27. Pleasant Buildings, Vale Royal, York Way do. 21, Tremlett Grove Adjourned sine die. 12.4.56 18, Queensland Road Defendant to pay 5s. Od. costs. do. 39, Queensland Road Fined £3. Ordered to abate within 21 days. Defendant to pay £1 9s. 6d. costs. do. 237, Tufnell Park Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 241, Tufnell Park Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 218, York Way Fined £2. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. 24.5.56 18, Ferntower Road Defendant to pay 5s. Od. costs. do. 16, Lennox Road Defendant to pay £1 lis. Od. costs. do. 39, Hanley Road Ordered to abate within 28 days, (see p.32 concerning further legal proceedings). do. 24, Hornsey Rise Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 35. Camden Dwellings, York Way Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. 30 Public Health (London) Act, 1936. Failure to comply with Statutory Notices contrary to Section 82 (No. of cases : 140).—contd. Date Address Magistrate's Decision 24.5.56 42, Camden Dwellings, York Way Fined £5. Defendant to pay £1 Is. Od. costs. do. 22, Mayton Street Fined £20. Defendant to pay £1 Is. Od. costs. do. 13, Instow Place Ordered to abate within 21 days. Defendant to pay £1 14s. 6d. costs. do. 11, Instow Place Ordered to abate within 21 days. Defendant to pay £1 14s. 6d. costs. do. 61, Queensland Road Ordered to abate within 28 days. Defendant to pay £I 14s. 6d. costs. do. 63, Queensland Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 41, Mildmay Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 76, Grosvenor Avenue Defendant to pay £1 6s. Od. costs. do. 75, Bride Street Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 35, St. Clement Street Defendant to pay £l Us. Od. costs. do. 222, York Way Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 181, Otford Road Defendant to pay £1 6s. Od. costs. do. 33, Huntingdon Street Fined £2. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 21, Richmond Avenue Defendant to pay £1 lis. Od. costs. do. 15, Pooles Park Defendant to pay £1 lis. Od. costs. do. 11, Oakley Road Ordered to abate within 28 days. Defendant to pay £l 14s. 6d. costs. do. 11, Oakley Road Ordered to abate within 14 days. Defendant to pay £1 14s. 6d. costs. do. 72, Oakley Road Ordered to abate within 28 days. Defendant to pay 13s. 6d. costs. do. 80, St. Paul's Street Defendant to pay £1 6s. Od. costs. 21.6.56 32, Highbury Place Fined £1. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 71, Queen Margaret's Grove Fined £1. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 6, Instow Place Fined £l. Ordered to abate within 21 days. Defendant to pay £1 9s. 6d. costs. do. 20, Queensland Road Fined £1. Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. do. 3 3, Queensland Road Fined £1. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 51, Queensland Road Fined £2. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 89, Queensland Road Fined £1. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 84, Windsor Road Fined £1. Defendant to pay £1 Is. Od. costs. Fined £1. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. Fined £1. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. 1.7.56 23. Camden Dwellings, York Way do. 24. Camden Dwellings, York Way do. 62, Gladsmuir Road Defendant to pay £1 6s. Od. costs. do. 48. Ponder Street Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs do. ?9, Baring Street Case withdrawn—works completed. do. 11, Charlesworth Street Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 31, Mitchison Road Ordered to abate within 14 days. Defendant to pay £1 14s. 6d. costs. 19.7.56 5 Oldershaw Road Ordered to abate within 7 days. do. 17. Oldershaw Road Defendant to pay £1 lis. Od. costs. do. 17, St. Paul's Street Fined £1. Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. do. 24, Wh'tehall Mansions, Arch— way Road Fined £1. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 218. York Wav Fined £5. Defendant to pay £1 Is. Od. costs. do. 72, Hungerford Road Fined £5. Defendant to pay £1 Is. Od. costs. do. 42. Brecknock Road Defendant to pay £1 6s. Od. costs. do. *79. Liverpool Road Defendant to pay £1 6s. Od. costs. do. 16, Chalfont Road Defendant to pay £1 6s. Od. costs. 31 Failure to comply with Statutory Notices contrary to Section 82 (No. of cases : 140).—contd. Date Address Magistrate's Decision 19.7.56 5, Enkel Street Defendant to pay £1 6s. Od. costs. do. 107, Marlborough Road Fined £5. Defendant to pay £1 Is. Od. costs. do. 109, Marlborough Road Fined £5. Ordered to abate within 42 days. Defendant to pay jE1 9s. 6d. costs. 6.9.56 58, Chatterton Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 8, Barnsbury Square Ordered to abate within 28 days. 4.10.56 7, Barnsbury Square Defendant to pay £l 14s. 6d. costs. Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 20, Arlington Avenue Fined £10. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 20, Arlington Avenue Fined £10. Ordered to abate within 28 days. Defendant to pay £l 9s. 6d. costs. do. 16, Rees Street Fined £10. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 178, Liverpool Road Defendant to pay £1 6s. Od. costs. do. 52, Lough Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 368, Camden Road Defendant to pay £1 Is. Od. costs. do. 2, Ellington Street Defendant to pay £1 6s. Od. costs. do. 1, Caedmon Road Fined £3. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 5, Enkel Street Fined £2. Defendant to pay £1 Is. Od. costs Fined £10. Ordered to abate within 21 days. Defendant to pay £1 9s. 6d. costs. do. 21, Crown Mansions, Liverpool Road 24, Barbara Street Fined £10. Ordered to abate within 21 days. Defendant to pay £1 9s. 6d. costs. do. 4, Hides Street Fined £5. Defendant to pay £1 Is. Od. costs. do. 95, Tabley Road Fined £5. Ordered to abate within 7 days. Defendant to pay £1 15s. 6d. costs. do. 95, Tabley Road Fined £10. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. do. 48, Blundell Street Fined £10. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. do. 29, Blundell Street Fined £10. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. Fined £2. Defendant to pay £1 ls. Od. costo. Fined £6. Ordered to abate within 21 days. Defendant to pay £1 9s. 6d. costs. do. 41. Camden Dwellings, York Way 8.11.56 7 Benwell Mansions, Benwell Road do. 13, Bewdley Street Fined £2. Ordered to abate within 21 days. Defendant to pay £l 9s. 6d. costs. do. 96, Newington Green Road Fined £5. Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. do. 64, Brecknock Road Fined £5. Defendant to pay £1 Is. Od. costs. do. 102, Bride Street Fined £l. Defendant to pay £1 Is. Od. costs. do. 1. Bromfield Street Fined £3. Defendant to pay £1 Is. Od. costs. do. 39, Gibson Square Ordered to abate within 21 days. Defendant to pay £1 14s. 6d. costs. do. 1, Lesly Street Case withdrawn. do. 1, Lesly Street Ordered to abate within 14 days. Defendant to pay 13s. 6d. costs. do. 33, Lesly Street Ordered to abate within 21 days. Defendant to pay 13s. 6d. costs. do. 310, Liverpool Road Fined £4. Defendant to pay £1 Is. Od. costs. do. 151, Offord Road Fined £3. Defendant to pay £1 Is. Od. costs. do. Pleasant Bnildings. Va'e Royal, Yoi'k Wav (Blocks 6-9, 10-15, 16-27) Fined £10. Ordered to abate within 90 days. Defendant to pay £1 15s. 6d. costs. do. 38, Pulteney Street Fined £2. Ordered to abate within 7 days. Defendant to pay £1 9s. 6d. costs. do. 38, Pulteney Street Fined £2. Defendant to pay £1 Is. Od. costs. do. 31, Roman Way Fined £5. Ordered to abate within 21 days. Defendant to pay £1 15s. 6d. costs. do. 216, York Way Fined £2 Defendant to pay £1 Is. Od. costs. do. 216, York Way Fined £2. Ordered to abate within 28 days. Defendant to day £1 19s. 6d. costs. 13.12.56 31, Roman Way Fined £10. Ordered to abate within 21 days. Defendant to pay £1 Is. Od. costs. 32 Failure to comply with Statutory Notices contrary to Section 82 (No. of cases : 140).—contd. Date Address Magistrate's Decision 13.12.56 73, Bride Street Fined £2. Ordered to abate within 21 days. Defendant to pay £1 9s. 6d. costs. do. 24, Camden Dwellings, York Way Case dismissed. do. 43, Camden Dwellings, York Way Fined* £1. Ordered to abate within 7 days. Defendant to pay £l 15s. 6d. costs. do. 21, Charlesworth Street Fined £2. Ordered abatement within 14 days. Defendant to pay £1 9s. 6d. costs. do. 40, Copenhagen Street Defendant to pay £1 6s. Od. costs. Absolute discharge. do. 103, Essex Road Fined £1. Ordered to abate within 7 days. Defendant to pay £1 9s. 6d. costs. do. 118, Lofting Road Fined £2. Ordered abatement within 21 days. Defendant to pay £1 9s. 6d. costs. do. 4, Milner Place Fined £1. Ordered to abate within 21 days. Defendant to pay £1 9s. 6d. costs. do. 16, Northampton Grove Fin-d £10. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. do. 28, Ponder Street Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. I5, Pooles Park Fined £10. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. do. 132, St. Paul's Road Fined £l. Defendant to pay £1 Is. Od. costs. do. 358, York Way Fined £2. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. Failure to comply with Magistrate's Abatement Order—(No. of cases: 21) Date Address Magistrate's Decision 12.1.56 91, Cloudesley Road Fined £5. Defendant to pay £1 ls. Od. costs. do. 39, Hanley Road Defendant to pay £1 5s. Od. costs. 9.2.56 118. Gillespie Road Fined £15. Defendant to pay £1 Is. Od. costs. 8.3.56 55, Corinne Road Fined £2. Defendant to pay £1 Is. Od. costs. do. 52, Mackenzie Road F ned £50. Defendant to pay £1 Is. Od. costs. 24.5.56 118, Gillespie Road Fined £15. Defendant to pay £1 Is. Od. costs. 21.6.56 5, Mackenzie Road Fined £2. Defendant to pay £1 Is. Od. costs. do. 254, Tufnell Park Road Fined £5. Defendant to pay £l Is. Od. costs. do. 52, Mackenzie Road Fined £2. Defendant to pay £1 Is. Od. costs. 4.10.56 118, Gillespie Road Work done—case dismissed. do. 22, Mayton Street Fined £20. Defendant to pay £l Is. Od. costs. do. 13, Instow Place Fined £10. Defendant to pay £1 Is. Od. costs. do. 218, Yotk Way Fined £5. Defendant to pay £1 Is. Od. costs. do. 42, Camden Dwellings, York Way Fined £25. Defendant to pay £1 Is. Od. costs. do. 24, Hornsey Rise Fined £10. Defendant to pay £1 Is. Od. costs. do. 63, Queensland Road Fined £10. Defendant to pay £1 Is. Od. costs 13.12.56 23, Camden Dwellings, York Way Fined £2. Defendant to pay £1 Is. Od. costs. do. 24, Camden Dwellings, York Way Fined 12. Defendant to pay £1 Is. Od. costs. do. 11, Charlesworth Street Fined £2. Defendant to pay £1 Is. Od. costs. do. 39, Hanley Road Fined £l. Defendant to pay £l Is. Od. costs. do. 218, York Way Fined £17 5s. Od. Defendant to pay £1 Is. Od. costs. Appeal against service of Abatement Order Date Address Magistrate's Decision 20.6.56 364a, Camden Road Appeal dismissed. Council awarded 20 guineas costs. Appeal against service of Statutory Notice Date Address Magistrate's Decision 1.7.56 39, Hanley Road Appeal dismissed. 3 guineas costs awarded against appellant. 12.9.56 39, Hanley Road Hearing of case restored—appeal dismissed. 3 guineas costs awarded against appellant. 33 Disinfection and Disinfestation. The replacement of the boiler and disinfecting plant was completed in April of this year. The Co-operation of the Finsbury Boirough Council, its Medical Officer of Health and staff, who carried out disinfection expeditiously during the period when the Islington plant was dismantled, was much appreciated. Upon the request of the respective hospital authorities, a number of wards were disinfected in two hospitals. Staff from the hospitals concerned carried out most of the manual work and the disinfection was completed with minimum of delay. 617 rooms were disinfected after cases of infectious or other disease. A total of 753 rooms were treated for vermin, of which 254 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 334 families were treated with D.D.T. as a precautionary measure. In addition one bombed site was treated for fly infestation. The Public Health Inspector paid 69 visits to a factory to supervise the treatment of 672 bales of stockings or other materials for export. The total weight of bales treated was 234 tons 11 cwts. 1 qtr. 13 lbs. Steani Disinfection. 6,316 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 Public Health Inspector. In certain cases warning notices were displayed under the War Damaged Sites Act, 1949, drawing the attention of the public to the fact that the depositing of rubbish is an offence. The following action was taken :— Visits to bombed sites 168 Visits to air-raid shelters and static water tanks 66 Vacant land cleansed 28 Vacant land enclosed 5 Derelict buildings enclosed 1 Static water tanks cleansed 3 War Damaged Sites Act, 1949—notices displayed 5 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 and Other Infestations. Anti-fly treatment at Ashburton Grove Depot commenced on 14th May and continued through the summer months. Upon investigation into complaints the disinfestation staff dealt with a number of wasp nests during the year. A red mite infestation was experienced on one of the Council's Housing sites. After treatment no further action was necessary. Atmospheric Pollution. Public Health (London) Act, 1936—Part V. Clean Air Act, 1956. The Minister of Housing and Local Government indicated in Circular 64/56 that certain provisions of the Clean Air Act, 1956, would come inco force on the last day of the year. New powers and duties will, therefore, be given to local 34 authorities. The provisions which come into force deal with the installation of furnaces, the height of chimneys, smoke control areas, research and publicity, and the making of building byelaws. The implementation of this Act will considerably increase the work of this Department. By virtue of the Smoke Control Areas (Authorised Fuels) Regulations, 1956, certain fuels were declared to be authorised fuels for the purposes of the Act. These are :— anthracite ; briquetted fuels carbonised in the process of manufacture ; coke ; electricity ; gas ; low temperature carbonisation fuels ; low volatile steam coals. The Standing Conference of Co-operating Bodies for investigating Atmospheric Pollution met on two occasions during the year. The Council, being aware of the harmful effects of air pollution and in order to keep the knowledge and experience of its officers as up-to-date as possible, approved the attendance of eight Inspectors at a Course on Atmospheric Pollution held by the Department of Applied Chemistry, Northampton Polytechnic. The Chief Public Health Inspector also attended the two day Conference on Domestic Heating of the Institute of Fuel when papers were presented dealing with fuels, heating methods and appliances, design of dwellings and planning and administration of smoke control areas. One of the Inspectors who is engaged on the prevention of atmospheric pollution was sent to the two day conference sponsored by the Institution of Mechanical Engineers on the Mechanical Engineers' Contribution to Clean Air. The experience and information thus gained by the Inspectors are of invaluable assistance to them in the performance of their duties. Although courses exist which are designed to educate stokers and others engaged in steam raising plants, the results obtained by Inspectors giving technical advice on the spot and demonstrating to stokers how the furnaces operated by them can be stoked efficiently with the fuel supplied, without causing a nuisance cannot be over-estimated. Such visits and practical demonstrations are much appreciated by the persons directly concerned, including factory owners. The number of complaints received and the number of observations necessary were considerably less than last year. The Council is also concerned about the possible pollution of the atmosphere by diesel smoke, and towards the end of the year when diesel-engined lorries passing through the Borough were seen by the Inspectors to be emitting dense smoke, the owners were written to informally drawing attention to the fact and seeking their co-operation in reducing atmospheric pollution from this source. Those concerned have expressed their regret and willingness to do all possible to keep the nuisance to a minimum. In this connection, the Council is concerned that the London Transport Executive have formulated proposals for a full scale replacement of trolley-buses with diesel engined buses, beginning in 1958, to spread over a period of four years. Although representation, supported by the Metropolitan Boroughs Standing Joint Committee, was made to the Executive asking them to reconsider their decision on the ground of the possible effect of diesel engine fumes on health, the Executive have issued a public statement in which they stated that an order has been placed for the purchase of 850 " Routemaster " diesel-engined buses, delivery of which is to start in 1958. 35 The Council considers that this is a retrograde step and one that does not support the principles of the Clean Air Act, 1956. Number of complaints received during year 36 Number of observations 335 Number of inspections and revisits 341 Number of notices served 10 Number of notices complied with 5 Recording of Atmospheric Pollution. A summary of the observations at the three stations in the Borough is as follows :— Monthly Deposits recorded by the Deposit Gauges and Sulphur-Dioxide by the Lead-Peroxide Method. Month Site No.* Rainfall in Inches Insoluble Deposit Soluble Deposi( Total Solids Mg.of SO j/day collected by 100 sq. cm. of Batch A Lead-Peroxide. (Louvered Box) (Tons per square mile) January 1 3.19 10.64 19.45 30.09 5.67 " 2 3.43 14.18 21.74 35.92 5.01 " 3 3.35 8.55 14.42 22.97 3.83 February 1 0.24 5.80 5.20 11.00 5.02 2 0.20 5.63 4.07 9.70 4.14 " 3 0.35 9.04 5.73 14.77 1.53 March 1 0.87 15.83 6.59 22.42 3.98 " 2 0.95 15.86 9.01 24.87 3.89 „ 3 0.95 15.04 6.46 21.50 2.62 April 1 1.14 12.39 7.62 20.01 3.21 " 2 1.14 15.33 10.20 25.53 3.09 " 3 1.14 13.18 7.09 20.27 2.11 May 1 0.35 6.82 2.68 9.50 1.75 " 2 0.43 10.80 3.71 14.51 1.73 " 3 0.47 9.74 2.45 12.19 0.96 June 1 2.52 7.75 4.74 12.49 1.49 " 2 2.48 13.78 4.64 18.42 1.62 " 3 2.84 10.40 4.93 15.33 0.83 July 1 5.63 10.63 18.22 28.85 1.43 " 2 6.15 22.65 96.71 119.36 1.50 " 3 5.00 10.63 11.69 22.32 0.61 August 1 5.04 6.76 4.57 11.33 1.44 " 2 5.04 19.21 13.74 32.95 1.72 „ 3 5.67 9.41 6.62 16.03 0.62 September 1 1.50 8.88 3.18 12.60 3.01 " 2 1.97 14.11 6.49 20.60 2.27 „ 3 2.32 11.66 6.82 18.48 0.96 October 1 1.81 8.31 6.99 15.30 3.54 " 2 1.65 16.10 8.64 24.74 3.43 " 3 1.70 9.97 5.80 15.77 1.84 November 1 0.32 9.34 5.63 14.97 4.07 " 2 0.32 11.79 5.93 17.72 4.19 " 3 0.35 7.52 4.14 11.66 2.98 December 1 2.28 10.66 9.34 20.00 5.32 " 2 2.60 11.86 15.56 27.42 4.26 " 3 2.76 11.49 11.00 22.49 3.54 * These sites are situated at the following places in the Borough :— 1.—Town Hall roof. 2.—York Way Court (Caledonian Road area). J.—Disinfecting Station at Seven Sisters Road. 36 Requisitioned Properties. The number of requisitioned properties on 1st January, 1956 was 1,091. 484 (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 occurring in requisitioned properties, in order to ensure the premises being reasonably nuisance-free. 97 such references were made. WORK OF PUBLIC HEALTH INSPECTORS ADMINISTERING FACTORIES ACT, 1937, FOOD AND DRUGS ACT, 1955, AND OTHER RELEVANT ACTS. Inspections and Re-Visits. 4,230 inspections and 3,169 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 940 420 Stalls (Refreshment and Food) 79 46 Factories (Mechanical) 982 1,141 Factories (Non-mechanical) 122 54 Factories (Public Health (London) Act, 1936) 893 944 Fish curers 52 30 Fishmongers 7 6 Fried Fish Shops 86 42 Noise Nuisances 67 102 Outworkers 55 75 Provision Shops 332 86 Bakehouses (Level) . 81 49 Confectioners 154 45 Fruiterers/Greengrocers 206 57 Preserved food premises 174 72 4,230 3,169 (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 398 Number of contraventions remedied 600 Notices served 111 Notices complied with 139 (b) Food and Drugs Act. 1938. Number of contraventions found 733 Number of contraventions remedied 900 Notices served 142 Notices complied with 114 (c) Public Health (London) Act, 1936. Number of contraventions found 206 Number of contraventions remedied 283 Notices served 106 Notices complied with 115 (d) Shops Act, 1950. Number of inspections under this Act 29 Number of revisits 45 Number of exemption certificates applied for 10 Number of certificates granted 2 37 Complaints received. Number of complaints (General) 312 Number of complaints (Home Office) 18 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 Public Health Inspectors). Premises Number on Register Inspections Number of Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 241 122 6 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,614 982 105 — (iii) Other Premises in which Section 7 is enforced by the Local Authority* (excluding out-workers' premises) 11 — — — Total 1,866 1,104 111 — 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) 8 2 Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — 4 — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 17 45 — — — (b) Unsuitable or defective 379 527 — 15 — (c) Not separate for sexes 2 16 — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 398 600 — 17 — *i.e. Electrical Stations (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 38 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 unwhole* some premises (6) Notices served (7) Prose cutiont (8) ( Making, etc. Wearing •! Cleaning and apparel 1 washing J 583 — — — — — Making of files 4 — — — — — Brass and brass articles — — — — — Fur pulling 5 — — — — — Umbrellas, etc 5 — — — — — Artificial flowers 59 — — — — — The making of boxes or other receptacles or parts thereof made wholly or partially of paper 83 — — — — — Brush making 18 — — — — — Feather sorting 12 — — — — — Carding, etc., of buttons etc 42 — — — — — Stuffed toys 56 — — — — — Cosaques, Christmas crackers, Christmas stockings, etc. 9 — — — — — Textile Fabrics 4 — — — — — Lampshades 46 — — — — — Total 929 — — — — — 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. Details of the work carried out under this section are as follows :— Number of routine inspections 55 Number of re-visits 35 Number of notices served 3 Number of notices complied with 3 39 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 21 Number of inspections 67 Number of revisits 102 Number of notices served — Number of notices complied with 2 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 6s? Co. Ltd. (c) 1 Fur Sl{in Dresser : 24, Bracey Street-—Messrs. J. & A. Fischer Ltd. (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 & Co. Ltd. 15, Old Slaughterhouses—Messrs. Wm. Menzies Ltd. 5 Tileyard Road—Messrs. C. Edwards 6? 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. Menries Ltd. 30 inspections and 7 revisits were made at the above premises and appropriate action taken where necessary. (f) 1 Slaughterer: 180, York Way—Messrs. Harrison Barber & Co. Ltd. This slaughterhouse was the subject of 151 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 (i Co. Ltd. 40 Shops Act, 1950—Applications for Exemption. There were 4 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 3 Refused 1 ♦ 26 Certificates, previously issued under the Shops Act, 1934, and subsequent legis' lation, were no longer applicable in view of special circumstances and the Public Health Committee authorised their cancellation. Pharmacy and Poisons Acts, 1933/1941. Number of Listed sellers of Part II Poisons other than registered pharmacists 189 Number of initial registrations during the year 12 Number of visits and inspections 28 Number of samples taken 3 Number of samples reported satisfactory 3 Rag Flock and other Filling Materials Act, 1951. Number of premises on Register (Section 2 for Upholstery) 39 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 94 London County Council (General Powers) Act, 1954. Hairdressers and Barbers. With certain exceptions, it is an offence for any person to carry on the business of a hairdresser or barber on any premises in the Borough unless he, and the premises, are registered by the Borough Council. As mentioned in the last Report, Byelaws under Section 18 of the London County Council (General Powers) Act, 1954, were made by the Council and approved by the Minister of Housing and Local Govern— ment last September, and came into operation on 1st January this year. These byelaws were framed to secure (a) the cleanliness of premises registered and of instruments, towels, materials and equipment used therein ; and (b) the cleanliness of persons employed in such premises in regard both to themselves and their clothing. A copy of the certificate of registration and of the byelaws must be displayed in the premises registered under this statute. At the end of the year 136 premises were so registered. The following information may be of interest : Number of Gentlemen's Hairdressers 64 Number of Ladies' Hairdressers 53 Number of Ladies' and Gentlemen's Hairdressers 19 Number of Hairdressers' establishments situated in base— ments 4 Number of Hairdressers' situated in dwelling houses 3 Number of Establishments where no assistants are employed 51 Number of inspections carried out 186 Number of revisits 60 41 Prevention of Damage by Pests Act, 1949. The following is a summary of the work carried out during the year. Notices Served : 20 Intimations and 7 Statutory Notices. Type of Property Local Authority Premises Dwelling Houses Business Premises TOTAL I. Complaints received (including repeats) 21 1,242 180 1,443 2. Number of properties inspected as a result of: (a) Notification (initial complaint only) (a) 18 1,036 160 1,214 (b) Block Survey *(b)145 604 66 815 3. Number of properties found to be infested by rats (nil by ship rats) 17 612 100 729 4. Number of properties found to be infested by mice 2 396 58 456 5. Re-visits by Investigators *948 3,249 68 4,265 6. Non-cffective visits by Investigators — 866 8 874 7. Number of infested properties treated (new jobs commenced) *574 1,034 134 1,742 8. Continuation or post-bait treatment *496 2,527 446 3,469 9. Visits by Operators *3,157 10,983 1,032 15,172 10. Still being baited at end of year 2 27 6 35 11. Completed during the year *1,056 2,017 228 3,301 12. Number of Business Agreements dealt with : 118. 13. Members of the Rodent Staff assisted in the application of smoke machine in respect of 164 drainage tests carried out by Public Health Inspectors. * Includes Sewer Maintenance Treatments 23 6? 24 (1,367 manholes). NOTE :—For the purpose of completing Sections 2, 3, 4 and 7, each property is entered once only in respect of inspections, infestations and treatment*. It is the object of this Section to bring every case to a satisfactory conclusion. Whilst the majority were disposed of without much trouble, patience and perseverance were required in a number of instances. At one address, after numerous visits had been paid, and several drain tests applied, it was found that two branch drains were connected to the main drain between the interceptor and the sewer. Since completion of the necessary repairs no further rat infestation has occurred. In another case the lead pipe, between the soil pipe and the pedestal pan, had been gnawed through by rats. The need to ensure that traps are kept sealed or the drains sealed off was emphasized in another instance where the water had evaporated in approximately twelve water closet traps in an unoccupied block of buildings, and from which in every case there was definite evidence of rats emerging and entering the premises. An unusual case occurred during the year where rats were emerging at the bottom of a garden about 30 ft. from any known drain. With the co-operation of the Borough Engineer's staff a defective sewer was found. At some time previously a heavy brick wall had been built over the sewer, which in time had collapsed under the weight, and allowed rats to escape. The sewer was repaired and no further trouble has been experienced. It is interesting to note that no infestation by ship rats were recorded during the year. 42 The Public Health Inspector and the Rodent Officer made joint quarterly inspections of four hospitals in the Borough and the Hospital Management Committee was informed of any matters requiring attention, Representatives of the Public Health Department attended four meetings of the Workable Area Committee during the year. Having regard to wage increases and the increased cost of material it became necessary to review the charge made in respect of the treatment of business premises, and in August this was increased to lis. Od. per hour. This is an inclusive charge covering the time of the staff engaged and the cost of the materials used. 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 follows :— Treatment No. Manholes Baited Showing Complete Takes Showing pre-bait Takes Showing No Takes 2) 655 324 503 152 24 638 398 514 124 Water Supplies. The Metropolitan Water Board continues to be the responsible authority for the supply of water to this Borough. Two chemical and three bacteriological samples of drinking water taken by the Public Health Inspectors were found to be satisfactory. Public Health (London) Act, 1936—Section 95. (1) Water supplies to tenement houses. 57 notices were served under this section requiring the provision of water supplies to tenement houses. 64 water supplies were provided. 3 prosecutions were taken for failure to comply with statutory notices, details of which are as follows :— Date Address Magistrate's Decision 12.1.56 2, Queensland Road Defendant to pay £1 6s. Od. costs. 12.4.56 241, Tufnell Park Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. 4.10.56 5, Enkel Street Fined £.1. Defendant to pay £l Is. Od. costs. (2) 56 applications were received for water certificates, and 51 certificates were issued in respect of 525 separate dwellings. Well Water. The annual examination of underground water supplies in the Borough was undertaken. Nineteen of the twenty-eight bore holes and wells known to exist have been abandoned and effectively sealed. Five of the remaining wells were found to be out of use. 43 Samples of water taken from the four wells in use were sent for examination. The bacteriological reports were satisfactory but results of chemical analysis indicated that the water could not be regarded as free from pollution. None of the water, however, is used for dietetic purposes. Water Samples—Miscellaneous. One sample of sub'soil water was taken. Ten samples of water were taken in connection with the new Cemetery at Trent Park. Swimming Bath Water. The number of samples of swimming bath water taken during the year is a« follows :— Satisfactory Unsatisfactory Chemical Bacteriological Chemical Bacteriological Chemical Bacteriological 3 34 3 33 — 1 SECTION D HOUSING (In conjunction with Mr. W. C. Bartlett, Chief Public Health Inspector). During the last century the population of the Borough has more than doubled, although the conditions under which the majority of residents have to live are far from satisfactory and fall far short of modern standards of fitness. The face of Islington is changing rapidly and the results of the unceasing efforts of both the Borough Council and L.C.C. can be seen. Most of the houses in the Borough were built 100 years ago and lack the amenities which are provided in up-to-date construc— tion. Both the Borough and the County Council are unavoidably restricted in their housing programme in such a built-up area as Islington. The number of Flats and Houses erected during the year is : Borough Council 295 London County Council 263 Private enterprise 54 The number of Municipal Flats and Houses erected in the Borough since the war is :— Borough Council 2,706 London County Council 2,460 The total dwellings in the Borough at the end of the year numbered 44,144. The survey of the Borough as required by Section 1 of the Housing Repairs and Rents Act, 1954, continued, but was not completed during the year because of staffing difficulties. The re-housing situation having become so acute during the year, it became necessary for the Council to reconsider the question of the allocation of housing accommodation having regard to its statutory commitments, and, with deepest regret, the Council decided most reluctantly to suspend the general waiting list and no further names were to be added to the list of approximately 16,000 families. Cases of overcrowding continued to be reported. More and more property is falling into the hands of landlords who let furnished accommodation to as many families as possible without regard to the permitted number or to the requirements of Sections 11 and 12 of the Housing Repairs and Rents Act, 1954. A typical case is given below. 44 This is a four'Storied (including cellar) semi-detached type house comprising ten living rooms. Each letting consists of furnished accommodation and the rooms are occupied as follows :— Rooms by floors Permitted Number Units Occupying Weekly Rent Second, East 2 1 30/' Second, West 2 1 30/' Second, back 2 1 50/- Second, back addition 1½ 2 50/- First, front 2 2 50/- First, back 2 2 60/- First, back addition VACANT Ground, front 2 1 50/- Ground, back 2 3 70/' Ground, back addition 11 2 50/- As far as possible an endeavour is made by the Public Health Inspectors to obtain compliance with the standard of overcrowding informally and 23 such cases were resolved satisfactorily. Clearance Areas. The following areas were represented under Part III of the Housing Act, 1936, for clearance, vis.:— I, 2, 3, 4 and 5, Dibden Street. II, 13, 15, 17 and 19, Pickering Street. 1, 2, 3, 4, 5 and 6, Pierrepont Row. In January the Minister of Housing and Local Government gave consent to the Council's Underground Room Regulations. These are in certain instances to the advantage of the owners who will be able to comply more easily and with less expense than would have been the case under the previous regulations. The problem of unfit underground rooms still remains, however. The L.C.C. (General Powers) Act, 1956, received Royal Assent on 2nd August this year, Section 63 of which authorises a Borough Council to make Byelaws as to satisfactory lighting of common staircases in tenement houses and flats. The Council appointed two member delegates and the Chief Public Health Inspector to attend a Housing Conference arranged by the Society for the Promotion of Health. Having regard to the damage done to houses by the frost which occurred in the early months of the year and the fact that nearly 18 per cent of the large number of Council houses investigated were affected, the Minister of Housing and Local Government issued Circular No. 51/56. In this Circular the Minister made certain recommendations, including (1) the revision of byelaws under the Water Act, 1945, for safeguarding pipes, etc., from the effects of frost ; and (II) the protection of plumbing systems against frost with particular reference to new houses. The following were published during the year :— Housing Subsidies Act, 1956, and Circular No. 33/56 relating thereto. Slum Clearance (Compensation) Act, 1956, and Circular No. 43/56 relating thereto. Circular No. 44/56 re Slum Clearance—Simplification and acceleration of administrative procedure. The seventh report of the Housing Management Sub-Committee of the Central Housing Advisory Committee, entitled " Moving from the Slums." 45 During the period January/March 46 notifications of intending immigrants were received from the Commissioner of Cyprus. 15 were acceptable on housing grounds in the first place, but 24 applications could not be recommended. No action could be taken in a further 34 outstanding cases because a wrong address was given, or applications were cancelled. The 46 applications refer to 87 persons, comprising 28 men, 31 women and 28 children. The 15 cases accepted included 23 persons, of whom three were children. As this scheme was discontinued by the Cyprus Government at the end of March, no action could be taken in connection with the seven outstanding cases. Notifications are also received from the Government of Malta where immigrants propose to take up residence in this Country. Six applications were received during the year in respect of 16 persons comprising 3 men, 4 women and 9 children. Four of these applications were approved, one applicant removed from address and one was not recommended but referred to the L.C.C. for final decision as the address was under the jurisdiction of that Council. The 4 approved applications included 2 men, 2 women and 3 children. Re-housing. Number of dwellings erected by this Council during year 295 Number of dwellings in the course of erection at end of year by this Council 291 Number of new applications (L.C.C.) referred to this Department during year 444 Number of above families in respect of whom over— crowding forms have been issued 53 Number of above families not living in overcrowded conditions 40 Number of overcrowded families re-housed by the Islington Borough Council during the year 171 Number of overcrowded families re-housed by the London County Council during the year 1 In addition, 101 families have been re-housed by the Borough Council and 30 families by the London County Council from sites acquired for re-development in connection with the Council's Housing Schemes, and 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 (January-March, 1956) 46 Number of letters sent concerning housing conditions during the year 1,017 Housing Act, 1936. Housing Consolidated Regulations 1925/32. During the year the following action was taken under the Housing Act, 1936 :— dumber Section 9. Houses rendered fit after service of formal notices 1 46 dumber Section 11. Houses which on inspection were considered to be unfit for human habitation 1,760* „ Houses represented 19 „ Demolition Orders made 9 „ Closing Orders—Section 11 as amended by the Local Government (Miscellaneous Provisions) Act, 1953 16 * This figure refers to houses inspected pursuant to action under Section 1 of the Housing Repairs and Rents Act, 1954. Premises Section 11. Houses in respect of which an Undertaking was accepted 3 „ Houses demolished 10 Section 12. Representations made with a view to the making of Closing Orders : (a) underground rooms 76 (b) parts of buildings 8 „ Closing Orders made : (a) underground rooms 65 (b) parts of buildings 7 „ Undertakings accepted 9 „ Closing Orders determined or part deter— mined upon the completion of necessary work 14 „ Undertakings cancelled or part cancelled upon the completion of necessary work 4 Housing Repairs and Rents Act, 1954. Houses let in lodgings— (a) Houses made fit for occupation by number of families accommodated (Section 11) 1 (b) Overcrowding abated (Section 12) 2 (cases) Licences authorising temporary overcrowding. Five licences were granted under Section 61 of the Housing Act, 1936, authorising overcrowding ; 2 for a period of six months and 3 for a period of 3 months. In 4 cases these constituted renewals of licences which had expired. One application for a licence, was referred to the London County Council requesting the expediting of applicant's rehousing. The total number of dwellings affected was 4. Town and Country Planning (Housing Accommodation) Direction 1952. In accordance with this Direction the Council is consulted by the Lonaon County Council before consideration is given to applications received for a change of user from a dwelling to another purpose. In this connection 22 investigations were carried out by this Department. SECTION E SUPERVISION OF FOOD (in conjunction with Mr. W. C. Bartlett, Chief Public Health Inspector) Since the commencement of the year under review the Food and Drugs Act, 1955, which is mainly a consolidating statute, and the Food Hygiene Regulations made thereunder have been in force. Additional powers are given under this Act, including Section 14, which gives power to a Court, on the application of the Local 47 Authority, to make an order disqualifying a Caterer from using the premises for a period up to two years where the Court thinks it expedient so to do having regard to the gravity of the offence or to the unsatisfactory nature of the premises. Section 47 prohibits, inter alia, the sale or exposure for sale for human consumption of :— (a) any substance which resembles cream in appearance but is not cream, or (b) any article of food containing such substance, under a description or designation which includes the word " cream " (whether or not as part of a composite word). Section 13 of the Food and Drugs Act, 1938, is no longer in force, having been replaced by the Food Hygiene Regulations, 1955, made under Section 13 of the new Act. The Regulations also replace certain provisions of the Public Health (Meat) Regulations, 1924, relative to the transport and carrying of meat. The new Regulations modify and extend the requirements of Section 13 of the Food and Drugs Act, 1938. Most of the Regulations came into force at the beginning of the year, but some which may require alteration to premises or equipment or substantial changes in procedure were deferred until 1st July. The definition, " business," includes the undertaking of a Canteen, Club, School, Hospital or Institution whether carried on for profit or not and any undertaking or activity carried on by a public or local authority. Thus all places where food is handled, including Clubs, come within the scope of Regulations and the uncertainty that Canteens should conform to the same requirements as other food places has been removed. Regulation 5 prohibits the carrying on in or at any unsanitary premises, stall or place or in or at any premises, stall or place the use of which because of the situation, construction, or condition thereof, exposes food to the risk of contamina' tion. Regulation 8 makes it obligatory upon any person who engages in the handling of food to take such steps as may be reasonably necessary while so engaged to protect the food from risk of contamination. Wash-hand basins with adequate supply of hot and cold water, or hot water at a suitably controlled temperature, together with adequate supplies of soap, nail brushes and clean towels or other drying facilities, must be provided for the use of all persons engaged in the handling of food on or about food premises. Where no open food is handled, however, a cold water supply is sufficient. In addition to the personal washing facilities all food premises must be provided with suitable and sufficient sinks and adequate supply of hot and cold water. Cold water is sufficient it the sinks are used exclusively for the washing of fish, tripe, animal casings, fruit or vegetables. The Regulations require the provision and maintenance of first aid materials and accommodation for clothing and footwear not used during working hours. They also require persons engaged in the handling of food to :— (1) keep any cut or abrasion on any exposed part of his person covered with a suitable washable dressing ; (2) refrain from spitting ; (3) in certain instances to refrain from the use of of tobacco (including snuff). Adequate lighting, which was not included in Section 13 of the Food and Drugs Act, 1938, has now been covered by Regulation 20. Regulation 25 is an entirely new and important piece of legislation. Time and temperature are vital factors, in the multiplication of bacteria, and as emphasized in 48 the Report of the Working Party on Manufactured Meat Products issued in 1950, it is essential that made-up food products be cooled as soon as possible. All foods consisting of meat (including game and poultry), fish, gravy or imitation cream, or prepared from any of these substances, or any egg or milk which is brought into any food premises on or from which is supplied food for immediate consumption should, unless exposed for sale without any unavoidable delay, after arrival either be brought to a temperature of not less than 145° F. or, unless it is already at a temperature below 50° F., be brought to a temperature below 50° F. When any of these articles of food have been cooked or partly cooked on the premises and are not exposed for sale the same requirements must be complied with until the food is served or re-heated for service. Part 5 of the Regulations deals with the requirements relating to stalls, which definition includes any stand, marquee, tent or mobile canteen and any vehicle whether moveable or not. These must bear the name and address of the persons carrying on the business, shall be kept clean and in good order and repair, and provided with suitable and sufficient means of lighting. When open food for immediate consumption is supplied from a stall there shall be provided and maintained an adequate supply of clean and wholesome water, being a supply of either hot and cold water or hot water at a suitably controlled temperature, adequate supply of soap or other detergents, nail brushes and clean towels and suitable and sufficient sinks or other facilities for washing food, and equipment used in the food business. With the exception of shrimps, prawns and onions, the giving out of food for preparation or packing for the purposes of a food business, on or about domestic premises is prohibited. Provision is made for the issue of Exemption Certificates by the Local Authority where compliance cannot reasonably be required. This provision is included for exceptional use to meet cases of special character, e.g., temporary mess huts on building or engineering sites and temporary measures while alterations are in progress to comply with the Regulations. Maximum higher penalties are provided. In order to assist in encouraging hygienic conditions in food establishments the Council supply " No Smoking " and " Now Wash Your Hands " notices for display. In addition, the Inspectors are always ready to give talks to food handlers on the spot and to distribute information and posters for display issued by the Ministry of Health, the Borough Council and the Central Council of Health Education. The Council agreed to the attendance of a Member and an Inspector at a Food Hygiene Conference held at Caxton Hall by the Royal Society of Health. During the year the following statutory instruments were either issued or came into operation :— (1) The Labelling of Food (Amendment) Regulations, 1955, imposing require— ments as to the labelling, marking and advertising of margarine and margarine cheese. (2) The Food Standards (Butter and Margarine) Regulations, 1955, describing the limits of water content for butter and water and fat content for margarine. (3) The Mineral Oil in Food (Amendment) Regulations, 1955, which relate to chewing compounds. (4) The Flour (Composition) Regulations, 1956. (5) The Food Standards (Tomato Ketchup) (Amendment) Regulations, 1956, which provide for a maximum copper content of 20 parts per million instead of the present maximum of 50 parts per million in tomato ketchup. 49 (6) The Food Standard (Curry Powder) (Amendment) Regulations, 1956, which increase the maximum lead content from 10 parts per million to 20 parts per million. (7) The Milk and Dairies (Channel Islands and South Devon Milk) Regulations 1956, prescribing a minimum content of 4 per cent milk fat. The report of the Food Standards Committee on sausages was published during the year. This Committee was set up in 1947 to review the composition of food and advise on measures for preventing danger to health, loss of nutritional value or otherwise protectinng customers. The Committee recommended that regulations should be made laying down standards for sausages, and the type of meat to be permitted. Inspection of food undertakings continued, and the food prepared, manufactured, stored or sold was subjected to routine inspection and sampling. Complaints relating to food are investigated immediately. Complaints were received in respect of (lllcEfcd •— Foreign matter in milk bottle. Weevil infested soup powder. Earwig in loaf of bread. Chocolate gnawed by rodents. Cornish Pasty containing foreign matter. Nail in bath bun. Nail in small loaf. Matchstick in loaf of bread. Hair in loaf of bread. Mould in sausage roll. Mould in jam sandwich. Mould in meat pie. Glass in bottle of sweets. Nail in apple turnover. Details of the action taken under the Food and Drugs Act, 1955, the Food Hygiene Regulations, 1955, and the Labelling of Food Order, 1953, appear on pages 50, 51 and 52. As provided for in Section 92(3) of the Food and Drugs Act, 1955 samples may be submitted to the Public Analyst from a person not being an officer of a Food and Drugs Authority. In acordance with the decision of the Southwark Borough Council notification was received from the Public Analyst, who is an Officer of that Council, and also the Public Analyst for Islington, to the effect that the minimum charge for samples submitted by private individuals for analysis would be £3 3s. Od. per sample. Food and Drugs Act, 1955. Number of food premises in the area, and type of business. Bakehouses—level 33 „ —basement 20 Bakers' retail shops 71 Butchers 143 „ Continental 1 Cafes and Restaurants 270 Canteens and Clubs 126 Chemists 75 Coffee stalls 3 Fish curers 26 „ depot 1 50 Food and Drugs Act, 1955-—cont. Number of food premises in the area, and type of business—cont. Fish friers 62 „ shops 25 Food factories 33 Food stalls (street traders) 87 Food storage premises for street traders 86 Greengrocers and Fruiterers 181 Grocers and Provision merchants retailers 464 „ „ „ wholesalers 6 Off-licences 106 „ selling other food (included in above) 57 Public houses 225 „ „ catering (included in above) 221 „ „ beerhouses 35 Sugar and chocolate confectionery 101 Preserved Food Premises Registered under Section 16(1 )(b) of the Food and Drugs Act, 1955. (Included in foregoing list.) Total No. of Preserved Food Premises 217 No. of Butchers 94 No. of Grocery and provision shops 94 No. of Cafes 1 No. of Bakers, etc. (meat pies) 7 No. of Food Factories 17 No. of Cooked meat shops 4 Total No. of inspections and visits made by Inspectors to Preserved Food Premises 246 Legal Proceedings. Details of the action taken by the Council under the Food and Drugs Act, 1955, and the Food Hygiene Regulations made thereunder, are as follows :— Date Offence Magistrate's Decision 10.9.56 Food and Drugs Act, 1955. Selling food, namely meat which was unfit for human consumption contrary to Section 8(1) (a) of the above Act at 16, Durham Road. Food Hygiene Regulations, 1955. Fined £5. Defendant to pay £12 12s. Od. costs. 10.9.56 Failing to keep clean Refrigerator in which food intended for human consumption is stored contrary to Regulation 6(1) of the above Regulations at 16, Durham Road. Fined £3. 10.9.56 Failing to keep clean the walls, ceiling and floor of cutting and washroom, to pre— vent infestation of rats, mice and insects and the entry of birds contrary to Regu— lation 23 of the above Regulations, at 16, Durham Road. Fined £3. 10.9.56 Failing to keep in good order, repair and condition the floor of the cutting and washroom to prevent infestation by rats, mice and insects and the entry of birds contrary to Regulation 23 of the above Regulations at 16, Durham Road. Fined £2. 51 Date Offence Magistrate's Decision 10.9.56 Food Hygiene Regulations, 1955—cont. Failing to affix and maintain a clearly legible notice requesting users to wash their hands after using the convenience contrary to Regulation 14(5) of the above Regulations at 16, Durham Road. Conditionally discharged. 10.9.56 Failing to provide bandages, dressings and antiseptics for first aid treatment in a readily accessible position for the use of persons engaged in the handling of food contrary to Regulation 17 of the above Regulations at 16, Durham Road. Dismissed. 10.9.56 Placing food, or permitting it to be so placed thereby involving risk of contamination with unsound food contrary to Regulation 8 of the above Regulations at 16, Durham Road. Conditionally discharged. 10.9.56 Failing to provide soap, nailbrushes and clean towels for the use of persons engaged in the handling of food con' trary to Regulation 16(3) of the above Regulations at 16, Durham Road. Fined £1. 10.9.56 Failing to keep clean overalls worn personally whilst engaged in the handling of food contrary to Regulation 9 of the above Regulations at 16, Durham Road. Fined 10s. Defendant to pay 10s. costs. 2.10.56 Food & Drugs Act, 1955. Selling food, namely oxtail soup powder, intended for, but unfit for human consumption contrary to Section 8(1) (a) of the above Act at 34, Highbury Park. Absolute discharge. Defendant to pay £1 costs. 2.10.56 Selling food, namely a sausage roll, intended for, but unfit for human consumption contrary to Section 8(1) (a) of the above Act at 122, Seven Sisters Road. Absolute discharge. Defendant to pay £2 2s. Od. costs. 2.10.56 Selling food, namely a meat pie, intended for, but unfit for human consumption contrary to Section 8(1) (a) of the above Act at 156, Essex Road. Absolute discharge. Defendant to pay £6 costs. 18.10.56 Having in possession for purpose of sale certain foods, intended for, but unfit for human consumption, contrary to Section 8(1) (a) of the above Act at 239, Caledonian Road. Guilty. Absolute discharge. 18.10.56 Having in possession for purpose of sale certain foods, intended for, but unfit for human consumption, contrary to Section 8(1) (a) of the above Act at 128, Essex Road. Guilty. Absolute discharge. Defendant to pay £9 9s. Od. cost 22.10.56 Selling certain food, namely bread, which was not of the quality demanded, contrary to Section 2(1) of the above Act at Loreburn House, Holloway Road. Fined £10. Defendant to pay £5 5s. Od. costs. 22.10.56 Selling certain food, namely bread, which was not of the quality demanded, contrary to Section 2(1) of the above Act at Whistler Street. Dismissed. 23.10.56 Selling certain food, namely a cheese roll, which was not of the quality demanded, contrary to Section 2(1) of the above Act at Greenman Street. Guilty. Fined £i. Defendant to pay £4 8s. Od. costs. 23.10.56 Selling certain food, namely bottle of milk, which was not of the quality demanded, contrary to Section 2(1) of the above Act at Tyndale Works, Tyndale Lane, Upper Street. Guilty. Fined £4. Defendant to pay £4 4s. Od. costs. 52 In addition one case was dealt with during the year under the Labelling of Food Order, 1953. Details are as follows :— Date Offence Magistrate's Decision  8.10.56 Selling food contrary to the provisions of Article 7(1) (a) Part IV of the Labelling of Food Order, 1953, namely a tin of processed peas at 98, Essex Road. Absolute discharge. Defendant to pay £2 2s. Od. costs. Unsound Food. The total amount of. food condemned during the year was :— 30 tons, 0 cwts., 2 qrs., 27 lbs., 4 ozs. details of which are given in the following table :— Description Tons Cwts. Qtrs. Lbs. Oza  Tinned Goods . 18 13 1 18 8 Fish — 9 1 20 — *Meat 8 15 1 9 8 Othera 2 2 2 7 4 Total 30 — 2 27 4 * Includes 7 tons 13 cwts. 0 qrs. 7 J lbs., Harrison, Barber & Co. Ltd. The number of condemnation certificates issued was 1,182. Most of the above food was condemned upon request by the respective owners, but on seven occasions it was necessary for the Inspector to seize food and remove it in order to have it dealt with as provided for by Section 9 of the Food and Drugs Act, 1955. Details of the result of subsequent legal action taken appear on page 51. 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 the 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. Condemned meat is used for animal feeding or industrial purposes. Sampling. During the year 477 food samples, including milk, were submitted to the Public Analyst for examination. Of these 149 were Formal and 328 Informal samples. Adverse reports were received in respect of 39 samples (8.17%) as shown in the following summary, most of them being in respect of food concerning which complaints had been received. 53 Formal Informal Ceylon Cream 1 Apple Turnover 1 (misleading description) Backache and Kidney Pills 1 Kidney and Bladder Pills. 1 Bath Bun 1 Bread 4 Bread Rolls 1 Canned Liver Soup 1 Ceylon Cream 1 (misleading description) Cream Slice 2 (contained no cream) Currants 1 Daisy Powder 1 (incorrectly labelled) French Jam Sandwich 1 Ground Almonds 2 Malt Loaf 1 Meat Pie 1 Milk „„ 4 Milk, sugar and puffed wheat 1 Milk Bottles 3 Oxtail Soup 1 Pearl Barley 1 " Pirate Treasure Bag " 1 (incorrectly labelled) Processed Peas 1 (incorrectly labelled) Raisins 1 Sausage Roll 1 Seidlitz Powder 1 Shredded Wheat 1 Split Peas 1 Stew 1 Total 37 A sample of margarine was examined for vitamin content and found to be satisfactory. 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 :— 54  Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Horses  Number killed (if known) 63 569 27 147 11 953 Number inspected 63 569 27 « 147 11 953 All d'seasex except Tuberculosis if Cvsticerci Whole carcases condemned 1 18 — — — — Carcases of which some part or organ was condemned 14 241 — 33 4 28 Percentage of the num— ber inspected affected with disease other than tuberculosis and cysticerci 23.80 45.52 — 22.45 36.36 2.94 Tuberculosis only: Whole carcases con— demned — 6 — — — — Carcases of which some part or organ was condemned 3 30 — — 1 — Percentage of the num— ber inspected affected with tuberculosis` 4.76 6.33 — — 9.09 — Cysticercosis : Carcases of which some part or organ was condemned — — — — — — Carcases submitted to treatment by refri— geration — — — — — 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 953 horses slaughtered for human consumption, 856 were intended for export. Slaughter of Animals Act, 1933. Slaughter of Animals (Amendment) Act, 1954. Slaughtermen's Licences. During the year four new Licences were issued and thirteen Licences renewed. Seventeen slaughtermen held current Licences at 31st December. Merchandise Marks Acts, 1887/1953. Agricultural Prcduce (Grading and Marking) Acts, 1928/31. Routine inspections are carried out by the Inspectors to ensure compliance with the requirements of these statutes. A warning letter was sent to one shopkeeper, whose assistant had supplied Spanish tomatoes for English. Although the stock displayed was labelled " English " each tomato was wrapped in paper bearing the words " Produce of Spain." 55 Inspection of Refreshment and Coffee Stalls. Nine evening inspections of refreshment and coffee stalls were carried out by Public Health 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 21 21 22 20 21 27 29 24 15 17 18 22 21 Women 35 23 43 43 54 69 59 43 61 64 59 49 50 ParkhurstRd.— Men 49 41 45 48 44 45 45 43 32 70 66 69 50 Women 24 26 38 17 26 28 23 45 38 18 17 20 27 Finsbury Pk.— Men 59 75 70 75 68 64 74 69 64 48 49 66 65 Women 10 11 13 16 22 20 22 20 23 23 40 28 21 Highbury ( r.— Men 13 18 12 14 13 14 16 14 15 17 18 12 15 Women 4 17 16 14 18 19 16 16 22 14 11 14 15 Offord Rd.— Men 7 9 9 8 9 9 9 10 10 8 7 5 8 Women 6 3 2 2 3 o 2 3 3 1 — — 2 Islington Gr.— Women 13 8 10 12 10 11 12 16 12 12 10 10 11 High St.— Men 39 38 45 40 55 50 42 34 38 40 44 54 48 280 290 325 309 343 358 349 337 333 332 339 349 Ice-Cream. Ice-Cream (Heat Treatment, etc.) Regulations, 1947-52. Supervision of the Manufacture and Distribution of Ice-Cream. During the year 190 visits were paid to ice-cream premises and vehicles. Number of premises registered :— (a) for manufacture, sale and storage 79 (b) for sale and storage 200 (c) for sale only 243 (d) for storage only 4 526 Bacteriological Examinations. —— Sixty-four samples of ice-cream were sent for bacteriological examination. Those subjected to Methylene Blue tests were graded as follows :— Grade I 36 Grade II 12 Grade III 5 Grade IV 9 62 56 The plate counts of the remaining two samples were satisfactory. Samples falling within grades I or II of the Methylene Blue Test are considered satisfactory and those within III or IV unsatisfactory. Fifteen ice lollies sent to the Bacteriologist were reported to be satisfactory. In addition seventeen ice-cream lollies were examined. Faecal coli were isolated in eight of these samples, but most of these adverse samples came from the premises of one manufacturer. Following talks with the staff' and close supervision by the Public Health Inspector, a satisfactory standard was then maintained as confirmed by subsequent sampling. Chemical Examinations. Seventeen samples of ice-cream and two ice lollies were submitted for chemical analysis and no adverse report was received. Details of the fifteen 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 4 2 1 7 Milk Samples. The total number of samples taken during 1956 was 261. Samples submitted for Chemical Analysis :— Genuine Adulterated Total Formal 139 — 139 Informal 41 4 45 184 Routine samples of the milk supplied to schools, hospitals, institutions and day nurseries were taken during the year. A report to the effect that patients in one hospital were receiving poor quality milk was found, upon investigation by the Inspector, to be due to the inadequate mixing in bulk of the milk by the person employed in the kitchen. There are fourteen major suppliers of milk into the Borough, the suppliers of which have been subjected to periodical sampling. Samples submitted for Bacteriological Examination Class of Milk Results Phosphatase Methylene blue Turbidity Total No. of Samples  Pasteurised Satisfactory 65 *59 — — Unsatisfactory — — — 65 Sterilised Satisfactory — 9 9 Unsatisfactory — — — Tuberculin Tested (Pasteurised) Satisfactory 3 3 — 3 Unsatisfactory — — — Total 77 * 2 Samples void—Shade temperature exceeded 65 °F. History of the Public Health Department The Care of the Elderly Safety in Food Rodent Pest Control The Care of the Sic\ The History of Islington's Hospitals Disposal of Waste Control of Infectious Disease 57 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 distributors' premises inspected 341 The following licences were granted :— Pasteurised 221 Pasteurised (supplementary) 23 Tuberculin Tested 132 Tuberculin Tested (supplementary) 23 Sterilised 282 Sterilised (supplementary) 25 706 Milk and Dairies Regulations, 1949 to 1954. Number of Dairies Registered in the Borough 22 Number of Distributors registered in the Borough 274 Number of Registered Distributors dealing from registered premises outside the Borough 32 Summary of visits by Inspectors. (a) Dairies—Routine Inspections 22 Miscellaneous visits 11 (b) Where the occupier is registered for the sale of milk in sealed containers only— Routine Inspections 133 Miscellaneous visits 81 Total number of inspections and miscellaneous visits 247 Number of Notices served 20 SECTION F—MISCELLANEOUS SERVICES HEALTH PUBLICITY Centenary Exhibition. In order to mark the centenary of the appointment of the first Medical Officer of Health and first Sanitary Inspector, as decided by the Vestry of the Parish of St. Mary, Islington in 1956, the Council authorised the holding of a Centenary Exhibition. This Exhibition was opened by The Right Hon. Aneurin Bevan, P.C., M.P., on 24th September, and remained open until 6th October. It was decided that the Exhibition should demonstrate the development of the health services in Islington, irrespective of the authorities concerned, and therefore give an opportunity to the public not only to learn something of the historical aspect of conditions of living and treatment of sickness in the past, but also to demonstrate something of the services being provided at the present time. The authorities concerned were approached ; they agreed without hesitation to take part and assist in the holding of the Exhibition, also to plan their exhibits in such a manner that they would include the historic. In some cases this necessitated a good deal of research and inquiry, but this was willingly undertaken and many exhibits of considerable 58 interest in the history of public health were shown. The Exhibition was arranged in conjunction with the Ministry of Agriculture, Fisheries and Food, who provided the stands and themselves arranged a comprehensive exhibit which included history of rodent infestation as well as demonstrations of the problems involved in connection with the protection of foodstuffs. The other stands included in the Exhibition comprised the following :— Public Health Department:— Disposal of Waste. History of the Public Health Department. Housing. Safety in Food. Public Health Department in collaboration with the London County Council :— Care of Mother and Child. Care of the Elderly. Control of Infectious Disease. Other Authorities :— Royal Free Hospital (illustrating the Liverpool Road Branch, formerly the London Fever Hospital). Royal Northern Hospital. Whittington Hospital. Metropolitan Water Board. British Dental Association. Emergency Medical Service. In addition to the Ministry of Agriculture, Fisheries and Food providing a newlydesigned stand, which Islington was privileged to have on show for the first time, it included a cinema unit with selected health films shown at various times through— out the day. Help was also given by the Ministry in the form of contributions towards the cost of exhibition publicity. In addition to the stands, various exhibits for the different stands were obtained from the Building Research Station, Hackney Borough Council, Imperial Chemical Industries, Lead Sheet and Pipe Council, London School of Hygiene and Tropical Medicine, Mr. Ritchie Calder of the News Chronicle, North Islington Welfare Centre, John Peck 6? Co., of Liverpool, the Pharmaceutical Society, Southwark Borough Council, the Royal Society of Health, and the Wellcome Historical Medical Museum, among many others. Whole-hearted co-operation was given by the exhibitors, and the result was a most exceptional exhibition as well as one which was considered to be most enlightening on the progress of public health services in the past century. An Exhibiton Handbook was prepared with contributions from those exhibiting and a brief account of the Public Health Department, first under the Vestry, then under the Borough Council, which is reproduced in the form of an appendix to this Report. Film Shows. The Department continued with the policy of health publicity film shows for the general public. Eleven such shows were given, at various Borough Council Libraries during the year, and the practice of including a full-length feature film in each programme was retained. On each occasion a member of the Public Health Committee was in the Chair, and the audience was addressed by the Medical Officer of Health or Deputy Medical Officer of Health. 59 The following health films were shown during the series Title Supplied by " Human Factor " Royal Society for the Prevention of Accidents. " Body Building Foods " Central Film Library. " Another Case of Poisoning" do. " His Fighting Chance" do. " The Life of Reilly" do. " Keep Your Teeth" do. " Surprise Attack" do. " Why Won't Tommy Eat ?" do. " Care of the Feet " Encyclopaedia Britannica Ltd. " Body Defences Against Disease do. " Grip on the Nation " British Rheumatic Association. " The Housefly " Army Kinema Corporation. " How to Catch a Cold " Foote, Cone and Belding. " Brushing Your Teeth " Sound Services on behalf of Dental Board. " Guilty Chimneys" The Gas Council. Home Safety Week. A campaign similar to that carried out in 1954 was organised by the London County Council for the first week of November and the co'operation of Borough Councils throughout London was requested. As before, arrangements were made for publicity material such as bookmarks and leaflets to be distributed through the Islington Borough Council's various Departments, mainly the Public Libraries, posters were also displayed, and adhesive publicity stamps were affixed to envelopes. All the necessary material was provided by the London County Council. Posters, leaflets and publications. Distribution of leaflets, purchased mostly from the Central Council for Health Education and the Royal Society for Prevention of Accidents, and dealing with various subjects according to season and circumstances, continued to be made from the counters of the Public Health Department, and also occasionally through other Departments of the Council. The monthly journal of the Central Council for Health Education, " Better Health," was also distributed, at the rate of 1,000 copies a month, from the Public Libraries, and Town Hall counters. Food Hygiene Regulations, 1955. In order to assist shopkeepers and the occupiers of any premises where food is sold, prepared or manufactured, two helpful publications, " Your Guide to the Food Hygiene Regulations" and " Refrigerator Storage," both published by the Central Council for Health Education, have been and continue to be widely distributed. In addition, two forms of notice, dealing separately with the prohibition of smoking and the washing of hands, are being issued to occupiers of food premises as required. Health Education Courses. A Seminar for Medical Officers on " Public Relations," organised by the Central Council for Health Education was attended by Dr. Thrower, Deputy Medical Officer of Health, from 28th February to 2nd March, and Mr. Causton, as Health Publicity Assistant, attended the Central Council's Summer School from the 14th to 24th August. 60 SERVICES FOR ELDERLY PERSONS Valuable work continues to be done for elderly persons in a variety of ways, the Health Officers concerned have visited a very considerable number and have arranged, where necessary, for the services of home-helps, " meals-on-wheels," domiciliary personal cleansing by the Department's staff, laundry service for incontinent persons, recommendations for holidays or chiropody treatment at either the London County Council chiropody sessions or at a Chiropody Centre arranged through one of the voluntary organisations in receipt of a grant from the Borough Council. The Health Officer and her assistants visited 538 new cases during the year, and re-visits totalled 3,818. Three cases were dealt with under the National Assistance Acts, 1948 and 1951, and these are described below. 2,400 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 3 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 subsection (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." Details of the statutory action taken are given in the following statement which has been compiled in the form required by the Ministry of Health :— 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) Mr. 0. (81 years) Despite the efforts of a home-help and a grand— daughter, the home con— ditions and health of Mr. O. gradually deteriorated, and the householders, two elderly ladies, became very concerned about his wellbeing. Mr. O., who had been on our register of elderly persons since March, 1955, suffered from a heart condition and refused hospital treatment which, in his Doctor's opinion, was necessary. An Order was obtained from a Justice of the Peace. Not exceeding three weeks General Hospital Remained in hospital as a voluntary patient after 3 weeks expired. Deceased one month after admission. (2) Mrs. T. (79 years) Mrs. T's plight was brought to our notice by her doctor, who was of the opinion that it was necessary for her to go to hospital. This Not exceeding three weeks General Hospital Remained in hospital as a voluntary patient. 61  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)  aged person, who was suf— fering from senility and malnutrition and was un— able to care for herself in any way, refused all help other than that of a friend who could no longer care for her. She even refused to permit any other person to have a key to her room. A Justice of the Peace made an Order following a visit by the Deputy Medi— cal Officer of Health. A cousin, the only known relative, agreed with this action. (3) Miss S. (83 years) The niece of Miss S. was very worried about her aunt who was under— nourished, senile, unable to help herself in any way, and refused all offers of help. She was in urgent need of medical attention which she refused. She occupied one furnished room which was in a generally dirty and ver— minous condition. Follow— ing a visit from the patient's doctor, who was of the opinion that the home conditions were quite the worst he had ever seen, a visit was made by the Deputy Medical Officer of Health and, with the con— sent of the relative, an Order was obtained from a Justice of the Peace. Not exceeding three weeks General Hospital Deceased 3 weeks after admission. 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 continues to provide this most valuable help in delivering a warm mid-day meal to homebound elderly persons. Maintenance of adequate nutrition in the elderly is as essential as for any other persons, and the " Meals-on-Wheels " service may make just that difference in preventing deterioration which will result in inevitable removal to hospital. 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 538 Number recommended to W.V.S. 89 Number of meals delivered during the year 6,630 Weekly average 127 62 Holidays for Elderly Persons. By means of a scheme administered through the Old People's Welfare Council, 543 persons were able to enjoy a holiday by the sea, or in the country, at greatly (educed 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 The Council has continued to support voluntary organisations in the provision of a chiropody service for elderly persons. There has been found to be a very wide demand for treatment and by the end of the year the following clinics were established, as the result of grants made to the Islington Old People's Welfare Council. Address Days and Times Clinic Held Date commenced  Islington Medical Centre, 303 Upper Street, N.l (near St. Mary's Church). Monday 2 p.m. to 5 p.m. Thursday 9.30 a.m. to 12.30 p.m. 31.10.55 Gilford Hall Mission, Gifford Street, Caledonian Road, N.l. (near Rail— way Bridge). Tuesday 9:30 a.m. to 12"30 p.m. Fridayj 24. 1.56 Junction Road Congregational Church Hall, Junction Road, N.19 (near Odeon Cinema). Wednesday 9.30 a.m. to Friday 12.30 p.m. 1. 8.56 At the outset arrangements for appointments at some of these clinics were made by the Public Health Department, and by the end of the year, for the purpose of Co-ordination, it was decided that all should be dealt with in the same manner. In addition, a session for members of an old peoples club continues to be held once a month at the Caxton House Settlement, Fonthill Road, N.4. Applications for foot treatment for pensioners are received from many sources and consideration is being given to further extension of the service. By arrangement with the Divisional Medical Officer of the London County Council, housebound persons requiring treatment were referred to the London County Council Health Services Foot Clinic at Finsbury Health Centre, Pine Street, E.C.I., with a view to treatment there, with conveyance by L.C.C. ambulance. Before being referred in this way a domiciliary call is made by a visitor from this Department. Public Health (London) Act, 1936—Section 122 Cleansing and Laundry Service 1. Incontinent Elderly Persons in the Borough. This free service has proved to be of great benefit to those recommended for it. 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 63 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 34 No. of washings carried out 1,102 No. of articles cleansed 8,770 2. Holborn Borough Council. The agreement whereby clothing and bedclothes of incontinent elderly persons in Holborn Borough can be dealt with at the Islington laundry, has continued. This scheme commenced in December, 1955, and during 1956 four recipients had 17 washings comprising 110 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 they 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 840 No. of persons concerned 46 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 440 applications for cremation at the Council's Crematorium, East Finchley. 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. Wilfrid G. Harding, Divisional Medical Officer, for the information given overleaf in respect of these services :— 64 Welfare Centres. WELFARE CENTRE Children's Ante-Natal and Post — Natal Immunisation Dental Vaccination Toddlers North Islington Infant Welfare Centre (Voluntary) _ 6'9, Manor Gardens, N.7. Mon. to Fri. 1.45 p.m. Mon. 1.45 p.m. Thurs. midwives Tues. Wed. 9.30 a.m. Thurs. Wed. 1.45 p.m. Wed. 2.0 p.m. Tues. 9 a.m. and 2.45 p.m. Wed. 2.0 p.m Tues. 9.30 a.m. Fri. 1.45 p.m. 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.1 Mon. 1 30 p.m. Wed. 1.30 p.m. Fri. 9.30 a.m. & 1.30 p.m. Tues. 1.30 p.m. Thurs. 9.45 a.m. & 1.30 p.m. (midwives) Wed. 10.30 a.m. Wed. 10.30 a.m. Wed. 9.30 a.m. West Branch Clinic Tenants Clubroom, Hilldrop Estate, N.7. Tues. 1.30 p.m. Thurs. 9.30 a.m. & 1.30 p.m. Sonth Islington Welfare Centre 6, Clephane Road, Essex Road, N.l. Mon. 1.30 p.m. Wed. 9.30 a.m. & 1.30 p.m. Thurs. 1.30 p.m. Mon. 9.30 a.m. Fri. 9.30 a.m. Tues. 1.30 p.m. Fri. 2.0 p.m. Wed. 2.0 p.m. Fri. 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. Fri. 1.30 p.m. Mon. 9.0 a.m. Wed. 1.30 p.m. (midwives) Thurs 1.30 p.m. Mon. 2.0 p.m. Fri. 10.0 a.m. Mon. 3.0 p.m. Wed. 9.30 a.m. Eeast Branch Clinic 6, Hurlock Street, N.5. Thura. 1.30 p.m. Total Attendances at Infant Welfare Centres. Infants North South East West Archway 0—1 years 12,928 9,612 7,463 9,013 2,371 1—2 years 1,889 1,324 948 1,122 495 2—5 years 1,381 738 251 597 255 Ante-Natal and Post — Natal combined 5,855 2,889 2,444 3,186 — Child Life Protection. The table of foster-mothers and foster-children being cared for is as follows : 31.12.56 Number of persons on register prepared to receive children 29 Number of foster-children being cared for 39 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 Day Nursery (Stoke Newington). 65 APPENDIX THE PUBLIC HEALTH STORY OF ISLINGTON (Extracted from Handbook of Centenary Health Exhibition 24th September to 6th October, 1956) The beginnings of the Public Health Department of the Borough in its present form date back to 1856. The Metropolis Local Management Act and the Nuisances Removal Act for England in 1855, established the Vestry as the Local Authority, required the appointment of a Medical Officer, and authorised the appointment of a Sanitary Inspector and Inspector of Nuisances. The Vestry of the Parish of St. Mary, Islington, on 18th January, 1856, approved the appointment of a Medical Officer and a Sanitary Inspector in accordance with these Acts. The appointment was duly advertised at a salary (after some disagreement among the members of the Vestry) of £250 per annum, and the Vestry were fortunate to appoint Dr. Edward Ballard as their first Medical Officer. At that time, although Medical Officers of Health had been appointed respectively to the City of Liverpool and the City of London, there was very little public health legislation, and although in general the scope of the job to be done appeared fairly obvious, the manner in which such duties were carried out under statutory controls had not yet been fully established. It was, in fact, left to individual Medical Officers of Health to lay down their own paths to a very considerable extent and to guide not only their Authorities but also point the way to the Central Government Authority as to how the administrative basis of the prevention of illhealth could best be laid down. Therefore the individual personalities and vision of the early Medical Officers of Health were very important and it was indeed fortunate that in the Parish of St. Mary, Islington, Dr. Ballard was not only an enthusiast in preventive medicine but also had the administrative ability to lay down the foundation of such work for the future—and, in fact the foundation which he laid continued in a relatively unchanged form for about forty years after he was appointed. Health conditions in Islington and in London certainly warranted special attention. In fact, it was the particular circumstances of London which made it necessary for the Government of the time to pass legislation for the appointment of Medical Officers and Sanitary Inspectors to the Vestries of the Metropolis before they were appointed in general to the remainder of the County. The population in Islington in 1856 was estimated at 123,130. The birth rate was high, there being 4,306 births, representing a rate of 35 and if the birth rate was high, the death rate was also high at 22 per thousand, although Dr. Ballard remarks that it appeared favourable in comparison with that of the Metropolis generally. Distinguishing features at this time were the high proportion of deaths due to the zymotic or infectious diseases, which were responsible for a quarter of all deaths, as against approximately one in two hundred now. Since most (approximately 70 per cent) of the zymotic deaths occurred in young children, a very high proportion of the total deaths from all causes were due to deaths under five years of age. In fact, in 1856, 46} per cent of all deaths were in those under five years, and of these deaths half took place in the first year of life. Even in his first Annual Report, Dr. Ballard pointed to the effect of social conditions on the zymotic mortality. He made the following comment in the 1856 Report :— "Not only are the houses inhabited by the poorer classes smaller in the East Sub'district than in the West, but more persons occupy the same houses, and as if this were insufficient to spread and aggravate disease, the houses altogether are in a very much worse condition as to airiness and ventilation ... This condition, as a fact, operated remarkably in the instance of the mortality from 66 croup (diphtheria), measles, scarlatina, diarrhoea, and hooping cough. It is further to be observed, that the streets, &c., inhabited by the lower classes in the East Sub-district, are closer, narrower, and less airy, on the whole, than in the West." Sanitary conditions at this time were primitive to a high degree. Although Islington was being rapidly built up, creating high population densities, water-supply, refuse and waste disposals had not advanced to cope with the congestion which was being created. The first Annual Report mentions among the sanitary improvements accomplished during the year, the filling up and abandonment of 760 cesspools, laying on of water to 812 privies, and the supply of water cisterns to the inhabitants of two courts who were previously dependent on a temporary flow from a stand-pipe. Dr. Ballard recommended the construction of sewers in several instances and also favoured the abolition of the Hackney Brook as an open sewer where it ran into Highbury Vale at a distance of a few feet from a number of houses of a low class. Dr. Ballard was not content with studying the returns, or accepting existent conditions because they were part of the general picture of the time. As he said in 1857 " Some of you . . . may have imagined that the infant mortality you have read of, must have been confined to less healthy localities than Islington. But here it is at your own threshold each death representing the hovering between life and death of many more children, of whom some, at that very time, receive the sentence which dooms them, after a sickly existence, to become early prey to the maladies which await them in advancing life. Does it not become us to think of all this, and to ask how it is that so many who must be believed to be born, that they may become useful to their generation, are thus lost to that object for which they appear in the world ? It is irrelevant to reply as some do when such facts are urged upon them, that the race is improved by the death of the weakly ones. What makes them weakly ? Do none but the weakly thus succumb ? How many of these children might have been preserved to a useful life, if poverty had not engendered apathy and ignorance neglect ? How much infant mortality throughout the country might in future be avoided, were the poor man's dwelling pervaded by a sweeter atmosphere ? how much were the daughters of the poor not merely instructed in our schools, but educated—educated to refuse the evil and choose the good ; educated to the homely work of that station of life to which each future wife and mother is destined ? how much, if the State were to withdraw its patronage from the nostrum-monger, and to discountenance the sale of infant poisons ? If ever this opprobium of our civilisation is to be wiped off, the clergyman, the district visitor and, the schoolmistress, must join in the efforts of the professional sanitarian." Outbreaks of smallpox were prevalent in these years, and Dr. Ballard reported 23 deaths in 1859. In the two years 1859-60 there were 272 cases of smallpox of whom 46 died. Deaths from violence were frequent, 72 were registered in 1860, of which 43 were attributed to accident or negligence, 10 to suicide, and 12 to murder, the last group being mainly infants. The path was hard for children in those days. In 1860, there were 67 deaths of illegitimate and deserted children, and Dr. Ballard mentions specifically that some were downright murdered—one having its throat cut. Unwholesome courts and alleyways were well described in the 1863 Annual Report. Those mentioned in particular were Irish Court, Rose and Crown Court, 67 Smiths' Buildings, Swan Yard, and Water's Court. Typical of these is Water's Court of which Dr. Ballard wrote :— "None of the houses have any ventilation through them. The rooms are very small ; they vary in capacity from about 830 to 1,600 cubic feet, but however small, we almost constantly find each room occupied by a family. The rooms in Nos. 6 and 7, and No. 15 appear the smallest of any, and during the past year we have found in single rooms of these houses families numbering from four to six persons, exclusive of friends now and then accommodated for the night At the further end of the South side of the court is the common privy, than which I can conceive of nothing more disgusting. It consists of an iron tank intended to hold water, but never containing any, and seats of the ordinary character are dispensed with as a luxury the low Irish of this court did not appreciate. The population of the court is about 130. Above the privies is placed the water tank for the supply of the court, in which I have been credibly informed the boys of the court have been seen bathing in the summer time From time to time, during the past eight years, these courts have been visited and reported upon by myself to the Sanitary Committee, and, bad as they are now, their condition is not so bad as they were when first I took them in hand There was more smallpox in 1863, when 509 cases were reported, of whom 108 died. Dr. Ballard comments in regard to vaccination :— "So far, then as Islington is concerned, one thing is quite clear, namely that although vaccinated persons suffered from the epidemic smallpox appeared in them in a mild form, and not one who had passed satisfactorily through the protective malady died of smallpox." There was also an epidemic of scarlet fever, which was then even more dangerous than smallpox. There were 672 cases with a total mortality of 392. Islington, in spite of the high death rate, was growing rapidly in the 1860's. Dr. Ballard remarked in 1864:— "Not only have we an excess of young people in Islington, but we have, as compared with the whole Metropolis, a smaller proportion of old people. Our elderly persons over 60 years of age form 85 per thousand of the population." (1951—Persons over 65 years of age numbered 110 per thousand.) As might be expected with the increase in new housing, a large immigration into Islington, mainly of young people, was going on. Of the occupations of these persons Dr. Ballard mentions :— "We have among us an excess of Law Clerks, Commercial Clerks, Schoolmasters, Printers, Goldsmiths, Jewellers, Watchmakers, Butchers, Carpenters and Joiners, Bricklayers, Plasterers and Brickmakers. In the remaining five we stand more or less below London generally as to number namely Publicans, Bakers, Tailors, Shoemakers and Labourers. In the case of the females we have a slight excess of Schoolmistresses, Dressmakers and Milliners, Washerwomen and Domestic Servants. The class of Needlewomen (a poverty-striken and most heterogeneous class of persons) is, with us a comparatively small one." Deaths in infants were a continual concern. Dr. Ballard, naturally, was not satisfied with the rate of progress which was being made, and he complained in the following terms " And if many of the circumstances which I have shown to influence the mortality of young children be not in your power to remove now, yet as 68 popular sanitary knowledge advances, and as confidence in the teaching of sanitary science becomes more established, Parliament will not fail to follow the lead of popular opinion, and furnish you with levers which it will be your duty to employ. The Labouring Classes Lodging House Act has been in your hands for a long period of time, but for some cause or other, that it is not my business to inquire into, it has failed in being adopted. Two or more Bills are now before Parliament, which appear well calculated to promote a similar object, and it is much to be hoped that should they pass into law the Islington Vestry will be amongst the first to avail themselves of their admirable provisions." In 1866, there was an outbreak of cholera, beginning in July and finishing in November. There were 341 cases and 75 deaths. Most of the cases seem to have been in the Essex Road area. Arrangements were made for the reception of cholera cases with the London Fever Hospital and the Great Northern Hospital. The New River Company arranged to give a continuous supply of water for drinking purposes during the ensuing six months in any places where it should be considered necessary, and inexpensive stand-pipes were erected in the two principal foci of epidemic eruption, namely at each end of the Elder Walk, in Water's Court, and in Madras Place, opposite Palmer Street. Smallpox continued to increase and caused 71 deaths in 1867. Dr. Ballard remarked on vaccination :— " The Vaccine disease, as produced by most practitioners now by arm to arm vaccination, is a much less virulent disease than it was when first inoculated by Dr. Jenner, or that it has proved itself where new sources have been opened, on the occasional discovery of natural cases of cow-pox. ... In Paris, all the public vaccinations are performed from the heifer. We have no arrangements for this here as yet. A paternal government presides there for the protection of its people. That we have no national provision of the sort here is part of the price we pay for our liberties." In 1869 there were four Sanitary Inspectors, including Mr. Collingwood, who was appointed as Superintendent Inspector in 1867. The year 1870 was characterised by an outbreak of typhoid fever. 175 persons were attacked, of whom 30 died. Dr. Ballard says that the enquiry occupied him unremittingly for several months and eventuated in a discovery which imparted a serious public warning. This discovery was that the fever was confined to persons who had consumed milk from one particular dairy and that the typhoid poison was distributed with the milk. He had arrived at the conclusion that the contagion got into the milk from a water tank on the premises of the dairyman. The tank was a wooden one, sunk into the earth, it had become decayed and a portion of it had given way. From this point a rat burrow communicated with some old drains and Dr. Ballard came to the conclusion that matter from the drains had reached the contents of the tank. Dr. Ballard had no high opinion at this time of the honesty of milk traders, and he makes the following observation :— " The practice of watering milk is all but universal among milk sellers in London." He stated also that he kept at his office a record of the names, and the results of analyses, which any of the practitioners might inspect. Dr. Ballard was succeeded in 1871 by Dr. Corfield, who reported on the removal of dust and house refuse. From 1865 to 1868 contractors paid the Vestry for the privilege of removing refuse, but apparently the sale of refuse became 69 unprofitable and after 1869 the Vestry paid contractors considerable sums for its removal. Owing to the fall in the value of the refuse, the standard of dustmen deteriorated and boys or lads were later employed instead of men. All of them were allowed to engage in the practice known as " Totting," that is picking out from the dust any saleable refuse such as rags, bones, glass, etc. to receive which bags were usually hung on their carts. There were complaints that the contractors were neglecting their work and to check collections the Vestry appointed an Inspector of Dust, whose duty it was to do house-to-house inspections in those districts most likely to be neglected by the contractors. Cards with the letter D were distributed, which the contractors were bound under their contracts to take notice of under penalties. Dr. Corfield did not stay long in Islington and he was succeeded the following year by Dr. Charles Meymott Tidy, who was not only Medical Officer of Health but also appointed Food Analyst for the Parish. He was therefore particularly interested in food adulteration and, in the first place gave his attention mostly to milk. Out of 70 samples submitted, 11 were found to be watered. He congratulated himself also upon the fact that out of 20 samples of bread, alum was found in only 4. There were a great number of small private slaughterhouses in the Parish and control and inspection of carcases was quite impossible. Dr. Tidy therefore advocated in 1872 the following :— " There is no doubt that a public abattoir would be a great public advantage. Cruelty in killing would be kept in check, a proper and complete supervision of the animal and of the carcase prepared for sale would follow as a matter of course. The diseased animal would be condemned by authority and got rid of." 1873 was marked by the opening of the Mortuary and the Coroner's Court and Dr. Tidy said that he hoped before long the Vestry would permit the erection of a disinfecting chamber. (Delayed for 20 years !) The Artizans' and Labourers' Dwellings' Improvement Act, 1875, came into force in 1875 and immediately Dr. Tidy and Mr. Collingwood, as Superintendent Inspector, decided to make official representations that 308 houses situated in various courts and alleys and other places in the Parish were unfit for human habitation. An extremely severe epidemic of smallpox began in September, 1876 and continued throughout 1877. "The disease broke out with great severity in the Thornhill Ward, and especially among the poorer portion of the Bemerton district. It was in this Ward that it first prevailed extensively following in this respect the course of former epidemics." During the first seven weeks there were 163 cases in this Ward alone, and the disease subsequently spread to many other parts of the Parish. At the end of 1877 the tally could be made up to 1,000 cases of whom 181 died, giving a fatality rate of 18.1 per cent. The streets most severely affected were Bemerton Street, Gifford Street, Storey Street, Freeling Street and Queensland Road. Cases of infectious disease were not notifiable by law at this time to the Medical Officer of Health. Dr. Tidy first proposed in 1877 "that so that the Sanitary Authority should not be ignorant of cases, I would support a plan laid before the President of the Local Government Board by a deputation of Medical Officers of Health that legislation should require the householder to give notice to the Sanitary Authority of any case of infectious disease in the house under his control within twenty-four hours of being informed of the same by the medical attendant." 70 Difficulty was also mentioned in regard to hospital accommodation. The Metropolitan Asylums Board was a Poor-Law Authority, not required to take cases of infectious disease who were not paupers. Dr. Tidy expressed gratitude for the friendly action of the Board who, without being compelled by law, nevertheless had not refused to accept any patient sent to them by order of the Sanitary Authority. He did not think, notwithstanding, it was a good thing that this should be done by an act of grace and stated, quite reasonably, that such hospitals were urgently required and should be placed under the management of a central board and placed at the disposal of the Sanitary Authorities. He considered that such hospitals could not be self-supporting, and insofar as patients were not able to pay their quota to the full, he did not think this would be an unfair charge on the Metropolitan rate considering that the public generally would benefit from the removal of such cases from their midst. Another severe outbreak of smallpox occurred in 1880 and 1881. Over a period of approximately 14 months there were 797 cases with 129 deaths, giving a fatality rate of 16.2 per cent. Still there was no hospital accommodation for these cases except the pauper hospitals of the Asylums Board. However, apparently Islington and St. Pancras each formed a temporary camp hospital upon portions of adjacent vacant lands at Finchley and Dr. Tidy reported that the experiment was a great success, the mortality among patients being exceptionally low. Two Sanitary Inspectors were originally appointed by the Vestry in 1856 and these were increased to 4 Inspectors in 1866. Owing to the continuance of rapid increase in population and increasing legislation the work of the Sanitary Inspectors had increased very considerably. It was necessary in 1885 to appoint an additional four temporary Inspectors and Dr. Tidy now recommended that these four temporary appointments should be made permanent so that the outdoor staff would consist of eight Inspectors, including the Inspector of Dust. It was also recommended that Inspectors be appointed at a commencing salary of 34/per week with annual increases of 4/- per week to a maximum of 50/-. The maximum salary at that time was 40/- per week. It was further recommended that the salary of the Sanitary Superintendent, Mr. Collingwood, be raised from £4 to £5 per week and the Committee also expressed the high value they placed on Mr. Collingwood's services over a period of 19 years. 1887 was distinguished by a severe outbreak of scarlet fever, there being 588 cases with 63 deaths. Dr. Tidy's hope that infectious diseases would become compulsorily notifiable was realised in 1889 by the passing of the Infectious Diseases Notification Act. Apparently it was made compulsory in London for the London Vestries, but remained adoptive only outside London, although the majority of Sanitary Districts did, in fact, agree to adopt the Act. The first Sanitary Superintendent, Mr. Collingwood died in this year, remaining on duty almost to the last. Dr. Tidy died in 1891 and was succeeded by Dr. Alfred Edwin Harris who remained Medical Officer of Health for 30 years. The Parish was now almost completely built up with a Census population of 319,430, an increase of over 36,000 or 11.3 per cent since 1881. There was an estimated number of 8.3 inhabitants to each house. Infant mortality had hardly improved since earlier years, and summer diarrhoea was still a major infantile risk. Measles, on account of the pulmonary complications came next as a risk and over a period of years, Dr. Harris pointed out that measles was ten times more 71 fatal than smallpox, three times more fatal than diphtheria and nearly twice as fatal as scarlet fever, etc. It was followed very closely by whooping cough, so that although very much taken for granted, measles, whooping cough and diarrhoea killed in such numbers because they were neglected and look upon as slight ailments which required hardly any care and attention. When the medical attendant was called in it was usually too late for good to be done. Dr. Harris pointed out in 1892 that the character of the Parish was changing rapidly and that houses formerly occupied by single families of the wealthier classes were now being occupied by two or more families in inferior positions. Dr. Harris was anxious that the best type of person should become a Sanitary Inspector and that he should be paid according to his worth. He wrote :— " It is folly to think because a man is a good mechanic, whether he be a plumber, a mason or a carpenter, that he must, therefore, be a good Sanitary Inspector. It seems to me that education comes first, and everything else afterwards ; that the educated men can only be procured by offering sufficient salaries, by raising the dignity of the office, and by making their positions secure. I write thus because I know from long experience that many persons in the public boards all over the country, and Islington is no exception, are of opinion that the work of these men can be done by anyone. This is absolutely erroneous, and I trust that before long it will have disappeared. And I also sincerely hope that the Vestry of this great Parish will be one of the first to recognise these facts, and offer to their future Inspectors such inducements as will attract the best men, and when they have attracted them, incite them to remain." Dr. Harris had very strong views on the right to health as is shown by the following :— " Nevertheless, this fact remains that not a few of the London districts lag a long distance behind many of the large provincial towns in matters of sanitation. " But since the passing of the Public Health (London) Act, 1891, there has been a steady forward movement in the Metropolis, and possibly nowhere more than in Islington, where sanitation is so active, that one now constantly hears of the persecution of the ' poor property owner.' That owner who for long years had everything his own way, and who did as little as he could to make things healthy for his tenants, knowing well that there were plenty of persons ready to occupy any or every house. Property has rights, but so has flesh and blood ; and if it be right that property should be protected from unnecessary exactions, it is surely righteous that the health and lives of human beings should be safe-guarded in every way. Insanitary property owners have had their day." The Sanitary Inspectors were increased to 14 in this year and Mr. J. R. Leggatt was appointed first as Superintendent of the Public Health Department and then re-designated Chief Sanitary Inspector. 1893 was also notable for the approval of a scheme for the fixing of a site at the rear of Hornsey Road Public Baths for the erection of a Disinfecting Station and Shelter House. This was constructed and opened in 1894. (Recommended by Dr. Tidy in 1873 !) Dr. Harris also persuaded the Committee to add a laundry to the Disinfecting Station, so that clothing and bedding that had been soiled would not be returned to the owners' homes before they had been " thoroughly cleansed at the hands of a careful laundress." He felt that this Station would be found the best of its kind when opened, not only in London, but in the United Kingdom. 72 Dr. Harris always felt keenly the terrible loss of infant life which he considered so unnecessary. He mentions in 1906 that it was nearly 30 years then since he, as a young practitioner, first drew attention to the waste of infant life, but although the subject was afterwards commented on by "The Lancet" and other medical papers, nothing was done. He set out the causes of death of 1,083 infants who died in 1906 and said, "Its careful study will show that many of the deaths there recorded are entirely preventable and would not have occurred if only the mothers knew and understood the duties of maternity and method of rearing children." Dr. Harris was now, apparently, becoming almost desperately anxious that some action should be taken to deal with infant mortality. He made a special report on "The Prevention of Infant Mortality " which was placed before the Public Health Committee and printed by order of the Committee. He dealt with the subject very fully, analysing the causes of deaths, the ages and the results of enquiries about infants who died from diarrhoea as to the health of the mothers, the methods of feeding, the hygienic state of feeding utensils, the character of the dwellings, etc. He dealt also with accident or neglect in the case of young children, and with the effects of the principal infectious diseases, and rickets, thrush, etc. He mentioned the importance of maternal nutrition and also the effects of poverty, exercise, employment and housing. He then went on to say, "How are we to deal with the question ? " and pointed out that a number of Authorities had appointed Health Visitors to instruct the mother with regard to the nursing and care of her child. He went into a prolonged discussion of whether there should be official and paid Health Visitors or whether there should be unpaid voluntary Visitors, and came down emphatically in favour of the paid Health Visitors. He then made the following recommendations :— 1. The adoption of the Notification of Births Act, 1907. 2. The appointment of three Health Visitors and one Clerk. 3. The encouragement of Voluntary Associations to assist the Health Visitors. How strongly he felt is shown by the following concluding sentence from his report :— "My duty is now done. My responsibility has ceased; I had felt it for a long while. The attempt to save these lives now remains in your hands. The law of the land allows you to spend money for this purpose, and the unwritten law must surely prompt you to do so." However, the Council refused to accept Dr. Harris' recommendations, and very sadly he wrote the following :— "The Borough Council in their wisdom have, however, declined to adopt their Medical Officer of Health's recommendation with respect to the prevention of the excessive infantile mortality in the borough so far as the appointment of trained, qualified, and paid lady health visitors is concerned, and therefore, the undue mortality among infants must continue unchecked. It is a sad thought, and one to cause serious reflection, that a body of business men could arrive at the conclusion, with the report of the Medical Officer of Health on the Prevention of Infantile Mortality before them, that there was no need for paid health visitors. It has been said by one or at most two members of the Council that if that report had put before them facts and figures, and had not been an appeal to their sentiment, they would have considered them as business men. But surely this statement is incorrect and, therefore, misleading, for the Report literally teems with facts and figures respecting the deaths of infants, and traces back nearly all their ailments to their original and most probable causes." 73 That there was need for some strong action in 1907 was indicated by the 996 infant deaths, giving an infantile mortality rate of 117, and of these infants 131 died of the associated causes of diarrhoea, enteritis and gastritis ; 236 from bronchitis and pneumonia ; another 10 deaths were somehow ascribed to dentition ; 35 to debility and 28 to suffocation. The population of the Borough continued to increase, but more slowly, and it was estimated in 1908 to be over 349 thousand. This gave an overall density of 113 persons per acre. The highest Ward density was in St. Peter's, with the astonishing figure of 213 per acre, followed closely by Thornhill, with 195 ; and the lowest densities were Tufnell with 83 and Mildmay with 85 per acre respectively. Dr. Harris noted differences in infantile mortality in the different districts of the Borough and in general terms expressed what was statistically verified many years later. He said :— " It is noticeable that in those districts where the people are well-to-do and prosperous, and therefore presumably educated, the mortality is lowest, while in the low class districts where also, presumably, the people are badly educated and more or less ignorant, the mortality is highest." However, Dr. Harris did believe that conditions were improving slowly among the poorer classes. The death rates were steadily, if slowly decreasing, and Dr. Harris' impression of the population is expressed as follows " There is no question that the better conditions which prevail among the working classes have worked good with them, for higher wages have enabled them to procure better clothes, better food, and better housing than in the olden days, when shoe-less boys and girls were the rule, just as now they are the exception. Even during the winter which has passed, one could not but notice that the crowds of men who were out of work and demonstrated in processions in Islington and elsewhere in London were well clothed." " In nearly every way the conditions under which they live have improved, because their welfare has become the concern of the State ; and it is well that it should be so because, after all, they are the State's first asset, and this being so, it is right that the State should see that the houses that they occupy are habitable to health, that the food that they eat is wholesome, nutritious and pure, and the conditions under which they work are as favourable as can be reasonably desired." Evidently there is nothing very new about the conception of a Welfare State ! Milk depots where mothers could obtain cheap milk for their infants were also being discussed about this time, but Dr. Harris recognised that milk should also be safe. He quoted with approval the following safeguards which had been adopted in some places on the Continent with regard to milk supply :— 1. It must be from cows that have been tested for tuberculin ; 2. It must not contain more than 30,000 bacteria per cubic centimetre ; 3. It must be sent out in sealed bottles kept in ice ; 4. It must be sold at the latest 36 hours after milking ; 5. The bottles must be filled and sealed at the farm. 50 years after these recommendations, the greater part of the milk supply of this Country still does not come up to the standard just mentioned. Notification of Tuberculosis of the Lungs was made compulsory in 1908, and Dr. Harris recommended the establishment of Tuberculosis Dispensaries for the Borough at which persons in the very early stages of the disease were encouraged to seek advice and where they could receive instruction of great educational value 74 as to how they should behave in their relationship to the public and with others living in their own homes. Housing conditions in Campbell Road (later Whadcoat Street) off Seven Sisters Road, were also a source of anxiety to Dr. Harris and, in fact, he mentioned in 1908 that as far back as 1896 he had inspected and found that nearly every room in the road was overcrowded, sanitary accommodation was insufficient, and the houses themselves infrequently and irregularly cleansed. He had, however, through the Inspectors, been able to effect an improvement, but whilst he was able to say that Campbell Road was better than in 1896, it was still far from perfection. Although the houses were well built and of good external appearance, probably erected for the large numbers of workmen and labourers who were employed in the building of the Great Northern Railway in the neighbourhood, later on many of the houses became common lodging houses or houses let in furnished lodgings, which deteriorated in standard. The 79 houses let in furnished and unfurnished lodgings contained 1,273 persons of whom 486 were children under 12 years of age. Queensland Road was also the subject of a special inspection and conditions were found to be similar, in that there were 27 houses containing 169 rooms let out in furnished lodgings and in which were living 341 persons of whom 94 were children. With regard to food adulteration, butter and margarine sampling was very much in evidence about this time. In 1910, 200 samples of butter were analysed by the Public Analyst, out of which ten samples, or 5 per cent were adulterated. Practically all these adulterations were actually substitutions of margarine for butter, for which, of course, the very great difference in the prices of these foods was responsible. Dr. Harris, as on most things, felt very strongly about food adulteration and expressed himself in a Report in the following terms :— " Similar sophistications are taking place with respect to other foods, so that one never knows nowadays when a prosecution is undertaken what mine may be sprung. Indeed, it may be that the defendants may boldly put forward the plea that what has been done is ' the custom of the trade ' which in the eyes of lawyers covers a multitude of offences, although the public may all the time have imagined they are getting under a specific name the same article that they knew in their childhood, and which their parents and grand-parents before them had consumed." Such an attitude is not entirely out of date. Diphtheria anti-toxin was becoming increasingly used over the past few years for the treatment of diphtheria and in 1910, Dr. Harris recommended that a supply of anti-toxin be kept at the Town Hall and another supply at the Great Northern Hospital, so that doctors would be able to obtain a supply of anti-toxin, day or night, with a minimum of delay or formality. The population of Islington had passed its maximum and the Census of 1911 showed for the first time since Census Returns began a decrease as compared with 1901, although the decrease was small. Dr. Harris mentioned that the character of the Borough was also changing, he said, "different classes of people are now occupying houses in Highbury, Canonbury and Barnsbury, they aforetime were rented by carriage people and similar wealthy folks or good middle class persons." The present problems which we have with underground rooms were noted by Dr. Harris in 1911 :— " In their greed to build as much as they could on a given piece of land, builders, who were for the most part of the speculative class, erected houses with 75 basements, which in the older buildings were almost, if not entirely, below the level of the street. These answered very well so long as there was no servant difficulty, but as it increased so did basements become unpopular ; particularly as the mistresses then found it necessary to be more and more in their kitchens. The servants, themselves, too, objected to them, and many flatly refused to take situations in houses with them. The result of this agitation was to increase the demand for non-basement houses, which could not be fully met in Islington, nor for the matter of that in many of the metropolitan boroughs." Dr. Harris was a firm believer in prevention being better than cure. He said that to encourage people to be healthy, and to improve the conditions in which they lived would "bring about true economy ; that there could be no doubt that the amount of money spent on saving lives by improving sanitary conditions never even approximates the money value of the lives that have been saved, or the cost of those things which the loss of lives represents, e.g. funerals, sickness, medicine, loss of wages, pauperism." He was even so bold as to calculate that if a human life were valued at £400, then as the result of sanitary work done by Islington since 1903 (as shown by the death rates to 1911) there was a saving which represented a money value of £794,000. A detailed report on the setting up of Tuberculosis Dispensaries for the Borough, with the appointment of medical and nursing staff was presented in 1912 and, following a joint meeting of representatives of the Islington Health League, the Islington District Insurance Committee, and the Islington and St. Pancras Branch of the British Medical Association, the following letter was sent to the Council— Ladies and Gentlemen, I am instructed by the Provisional Committee, composed of members of the Borough Council, the District Insurance Committee, the Medical Profession of the Borough, the Islington Health League, and the Central Fund for the establishment of Tuberculosis Dispensaries, to request you to lay before your Public Health Committee, the following resolutions passed at a meeting held on the 6th November, 1912 ; a previous meeting having been held on the 16th October, 1912. RESOLUTION 1 : That in the opinion of this provisional committee the Borough Council should formulate a scheme for the establishment of a Tuberculosis Dispensary. RESOLUTION 2 : That the Committee of Management of the Tuberculosis Dispensary should be constituted as follows :— The Borough Council (7 representatives). The District Insurance Committee (2 representatives). The Medical Profession of the Borough (adequate representation). The Medical Officer of Health for the Borough. Agreed unanimously. RESOLUTION 3 : That a copy of the foregoing resolution should be forwarded to the Public Health Committee of the Borough of Islington. Agreed. Nem.con. I have the honour to remain, Yours faithfully, VICTOR HORSLEY, Late Chairman of the Provisional Committee. 76 Dr. Harris reported in 1913 that before long two Tuberculosis Dispensaries would be at the service of the people who most required them—one of the Dispensaries would find its home within the Borough at the Great Northern Hospital, and the other without the Borough at the City Road Chest Hospital. These Dispensaries carried on their work through the Borough Council until they were transferred to the Hospital Authority in 1948. At long last, in 1914, Dr. Harris was able to report, " during the past 18 months a School for Mothers has been voluntarily instituted in North Islington at No. 9, Manor Gardens, which it is most heartening to know is doing really good, solid work, and where the mothers of North Islington are availing themselves of the teaching and instructing that the Institution offers." ..." It is thus becoming a model for Schools for Mothers, and its only need is funds to enable it to do more, and it is sincerely hoped that the Borough Council of Islington will give it support morally and pecuniarily to enable it to continue its usefulness." . . . " It is good tidings to learn that the success of the School for Mathers, in connection with which the name of Mrs. Florence Keen will always be associated, has induced a number of ladies who always have the welfare of children at heart, to band themselves together to establish a similar School in South Islington." The standard of personal cleanliness does not seem to have been high, and lousiness was, unfortunately, widespread. In 1914 it was found necessary to give 2,496 baths to 1,043 children. From information received from the London County Council, 3,600 children were found to be in a more or less verminous condition during the year. The first World War spot-lighted the importance of avoiding human wastage, and Dr. Harris quoted in 1916 from a leading article in the " Daily Telegraph," the following :— " The value of population has never been so appreciated as it is today. If we had been more careful for the last fifty years to prevent unheeded wastage of infant life, we should now have at least half a million more men available for the defence of the Country." The Notification of Births Extension Act, 1915, not only extended notification of births throughout the Country, but required the appointment of Health Visitors by Local Authorities and so, in 1916, the Borough Council appointed, at long last, the first two Health Visitors. There were now three Voluntary Welfare Centres in Islington, the North, South and West, and their work was recognised by the Borough Council, which gave a grant of £200 to each Centre. The North Islington Welfare Centre was already a well-established concern with many associated activities, which included a sewing class, home visiting, health talks, and there was even a " home-help " scheme with a " home-help club," towards which mothers paid a small contribution to secure the services of one of the four women employed as home-helps. The London County Council also held a Dental Clinic for school children in the Welfare Centre premises. The East Islington Welfare Centre was commenced in 1918, so that Welfare Centre Clinics were now generally available throughout the Borough. By 1919, 40 per cent of all infants under one were being taken to the Welfare Centres and, in commenting upon the figure of 83 per thousand infants born, the lowest infantile mortality rate ever registered in the Borough—(the present figure is approximately 20)—Dr. Harris said " that the time was fast approaching when we would not look upon a rate of 40 per thousand births as anything unusual, but as one that ought not to be exceeded." Dr. Harris must have felt indeed that his main task had been largely accomplished but not completed. He said— 77 " The days of your Adviser as Medical Officer of Health are numbered, for the time must soon arrive when he must seriously think of handing over his most anxious and responsible duties to a younger and more vigorous man, who, when the day comes, will be able to start with a Borough well equipped to. secure good results in fighting the battle of the infants and young children under one. Dr. Harris had indeed fought a stout fight in a good cause. Dr. Harris was succeeded in 1921 by Dr. G. Clark Trotter, who fortunately, is still living following his retirement in 1941. In 1920, five additional Health Visitors were appointed, making seven in all, and these were increased to eight in 1921. Mr. J. R. Leggatt, the Chief Sanitary Inspector, died in this year, after 31 years' service with the Council and Vestry, and was eventually succeeded by Mr. G. J. Bridel, who retired in 1941 and is happily still alive. As the Census of 1921 showed, the Borough was continuing to change in character—it was become more and more a factory and workshop area, and small workshops were being established in the mass of congested housing, so that complaints became inevitable. The population was still over 330,000, giving an overall density of over 107 persons per acre. Islington was now well and truly a Borough with multiple occupation of the majority of its houses. Of the 36 thousand odd structurally separate houses, 73 per cent were occupied by two or more familes, and over 14,000 of the houses were occupied by three or more families. By 1927 the Borough Council were contributing nearly £5,000 to the Voluntary Welfare Centres and there were three Day Nurseries—the Lower Holloway, St. Luke's and South Islington—which received a total grant of £220 from the Council. The special problems of foster-children were also receiving attention, and one of the Council's Health Visitors, Miss Gweneth Sarah Lewis, was given a special responsibility as to infant protection visiting, to deal with mothers who were anxious to obtain homes for their babies and with foster-mothers, and to superintend homes where children were being fostered. She was thus the precursor of the Children's Care Officer and Visitor. Developments in the late 1930s proceeded more rapidly. The Overcrowding Survey which had to be carried out in 1936 showed that out of a total of over 89,000 separately occupied dwellings, nearly 19,000 were overcrowded according to the standard of the Housing Act, 1935. The appointment of an Assistant Medical Officer (the present Medical Officer of Health), enabled a beginning to be made with large-scale diphtheria immunisation; diphtheria was still a dangerous disease with a considerable number of cases and deaths every year. The response to the immunisation facilities offered by the Council to the people of Islington was almost immediate and in 1937, the first full year, 300 children were immunised, and in 1938, over a thousand. The Municipal " Home-help " scheme was also approved, the principal duties being to do domestic work in the home about the time of a confinement. 1937 also saw the completion and opening of the first Municipal Day Nursery built for the purpose (the Voluntary Day Nurseries having been sited in adapted houses) ; and the establishment of the most valuable service for many years—an " Obstetric Flying Squad." This was an emergency maternity unit established in conjunction with University College Hospital, which sent out a Specialist Obstetrician and nurses equipped for dealing with obstetric emergencies in the home where it was not possible or practicable for the mother to be taken immediately to hospital. The cost of any calls made to the Unit by the doctor or midwife was borne by the Borough, and 78 in the years to follow, there is no doubt that this Unit saved many mothers' lives. By this time also the Day Nurseries were receiving over £1,000 as a Council grant, and St. Luke's Day Nursery and Guest House in Penn Road functioned as a temporary residential nursery when exceptionally difficult circumstances arose at home which made it imperative for the child to be cared for elsewhere. There is still a very great need for such accommodation. A hydrogen cyanide chamber was built by the Council in 1938 for the disinfestation of bug infested furniture, other forms of disinfestation in the home not being one hundred per cent efficient. This chamber was in use until the advent of D.D.T. as an insecticide made the use of the dangerous hydrogen cyanide no longer necessary. Although the Maternity and Child Welfare Services, Tuberculosis Services and other Health Services were now extensive and well integrated, much of 1939 was inevitably taken up with preparations in the event of war breaking out, and after war commenced, the greater part of the staff were temporarily placed on the organisation of Casualty Services. Dr. Clark Trotter retired in the early part of 1941 and was succeeded by the present occupant, with Dr. Katherine M. Hirst as Deputy Medical Officer of Health, she having been appointed as Assistant Medical Officer concerned with maternity and child welfare work in 1938. Much mixed public health work arising out of war circumstances had to be dealt with, the evacuation of mothers and children, and the supervision of shelter life. The Milk Scheme of the Ministry of Food commenced in 1940, including the distribution of National Dried Milk and vitamin supplements, falling in the first place upon the Public Health Department, and the Medical Officer of Health was appointed Milk Officer for a time. Epidemics were feared, but, fortunately, did not eventuate. The Ministry of Health decided to make a wholesale effort in regard to diphtheria immunisation. Gladly taking part in this National Campaign, diphtheria protection work in the Borough was stepped up, so that even with limited staff, over 3,000 children were completely immunised in 1941, and even more in the following years until the majority of the children in the Borough were protected, and the unprotected ones constituted only a minority. This, indeed, was a position which would have astonished and no doubt pleased Dr. Harris. All through the period of the war and in the post-war period the infant mortality rate was steadily being reduced, new low records being established year by year. The Casualty Services during the war constituted a major part of the work of the Public Health Department. In the early part of the War close on 1,000 Civil Defence personnel (both whole and part-time) for Casualty Services were enrolled, and First Aid Poets, Mobile First Aid Units, Stretcher Parties, Gas Cleansing Centres, and Light and Heavy Rescue Units were established. There was close liaison with hospitals receiving casualties, and a whole-time Medical Officer was appointed for the first-aid training of Civil Defence personnel, while Medical Officers for First Aid Posts and the superintendence of Shelter Health were appointed from among Medical Practitioners in the Borough. One Medical Officer in charge of a Mobile Unit was honoured with the M.B.E. Others were appointed to each First Aid Post and Civil Defence Post, and many lives were saved by the Light and Heavy Rescue Parties' personnel in the extraction of trapped casualties who often had to be extracted under arduous and dangerous conditions. As a result of enemy action, there were 958 deaths in Islington, and nearly 3,000 seriously injured, as well as another 3,000 who were less seriously injured. 79 In spite of much damage to water mains and sewers, there were no cases of infectious disease due to contaminated water supplies, thanks to the effectiveness of the measures taken by the Metropolitan Water Board. The destruction and damage of housing, however, caused great problems which persisted for years after the war and which have still not been solved. After the official evacuation of mothers and children in the early stages of the war, many returned and, to provide for mothers who went out to work, mostly on work connected with the special war effort, the largest number of Day Nurseries in the history of the Borough had to be established. At one time there were in all fifteen war-time Day Nurseries, with over 800 children. In 1944 all the Health Visitors employed by the Voluntary Welfare Centres became members of the Borough Council's staff, as well as the Municipal Health Visitors, in order that their work might be more equitably organised and the Health Visitors placed to the best advantage. This, one feels, was a change which Dr. Harris himself would definitely have approved. Dr. Katherine Hirst, in 1945 and 1946 was acting Medical Officer of Health during the temporary absence of Dr. Freeman, who was released for service in the R.A.M.C. with Allied Military Government on the Continent. In 1945 the death occurred of the Honorary Secretary of the South Islington Welfare Centre, Mrs. Waley Joseph, the co-founder with Lady Andrews, of the South Islington Welfare Centre, and both ladies had carried out most valuable work in this part of the Borough. A major change took place in 1948, when, with the implementation of the National Health Service Act, 1946, maternity and child welfare work was transferred to the London County Council, and the Tuberculosis Dispensaries to the Hospital Authorities. Present outlook and some problems for the future. This now brings the Public Health history of the Borough to modern times. Summer diarrhoea which was formerly the greatest single danger to infants under twelve months was now practically unknown in the form in which it had originally occurred. Measles, whooping cough, bronchitis and pneumonia, although still a risk, have been very considerably reduced as dangers. Diphtheria is becoming a rare disease, and although there is much still to be done, it is now possible to give some protection against whooping cough. Although we have subdued many, we have not yet conquered all groups of infectious disease. Poliomyelitis is one of the infections which have increased in the last few years, but it still does not affect great numbers, and inoculation against poliomyelitis which has just commenced will, it is hoped, reduce the risks. Dysentery and bacterial food poisoning, are widespread, and even appear to be increasing. They can be dangerous, but in the main they have a nuisance value which, however, it is important to reduce. Tuberculosis, although reduced in mortality, is the major infectious disease problem which we have not yet succeeded in solving satisfactorily. There are still close on 3,000 persons in the Borough who are suffering from or are under observation on account of Tuberculosis, mainly Tuberculosis of the lungs, and many of whom act as possible sources of infection to others. There must also be a considerable number who, probably unknowingly, have contracted Tuberculosis and who will have to seek medical advice later on. The rapid build-up of Housing in Islington referred to by the early Medical Officers of Health, who clearly foresaw the congestion and trouble it would cause, 80 now constitutes a problem which has to be dealt with by this generation and the next. It is not possible, unfortunately, to dispose so easily of out-of-date buildings as it seems to be of many diseases now made out-of-date. There is still great housing congestion in the Borough, in spite of the comparison with 50 years or even 25 years ago, and many problems of mental ill-health arise which are associated with congested housing conditions. As the proportion of elderly persons in the Borough increases, health and social problems are created, as young children created related problems to our predecessors. The Borough Council, together with the health and welfare departments of the County Council, the local hospitals, the local representatives of the Assistance Board, and many voluntary organisations are co-operating to help elderly persons maintain their health, useful activities and happiness as long as possible. The Borough Council has borne its share by appointing special visitors to keep in touch with elderly persons most needing advice and help, setting up a substantial disinfecting and laundering service for elderly persons with incomplete physical control, and by granting considerable financial help to many voluntary bodies for a "Meals-onWheels " service, chiropody clinics, and for enabling elderly persons to take holidays when they could not otherwise have them. Although we no longer have to face major hazards from the principle infectious diseases of a century ago, such as smallpox, cholera, typhoid fever and even diphtheria and measles, there are non-infectious diseases which are increasingly coming to the fore as a cause of death and which appear to be related to social conditions and environmental circumstances including personal habits, and which are, therefore, preventable. Such diseases are lung cancer, certain types of heart and circulatory disease such as coronary thrombosis and high blood pressure ; chronic catarrh of the respiratory system, especially chronic bronchitis (which is unduly prevalent in this Country), mental ill-health and deaths and injuries due to accidents on the road and in the home. Although the Medical Officer of Health has not the same statutory obligations at present in regard to the prevention of these causes of ill-health and death as he has for infectious diseases, they constitute problems of prevention which must be faced if progress in health is to be continued. There is still great work to be done, and only the Medical Officer of Health and his preventive team, including the Health Visitor and Public Health Inspector (former Sanitary Inspector), have been trained in the preventive outlook. They must, surely, therefore, have as large a part to play in the future as they have done in the past and are doing at present. Humanitarian considerations apart, the economic saving that could be effected by the prevention of ill-health and avoidance of premature death is no less important now than it was when Dr. Harris made his calculations in 1911. The nation may yet decide that prevention is cheaper than cure. V. FREEMAN, Medical Officer of Health. September, 1956. 81 INDEX Accidents 6, 7, 8, 10 Acute Encephalitis 11 Acute Poliomyelitis 6, 11, 15-16, 23 Aged and Infirm Persons 60-63 Ante-Natal Clinics 64 Anthrax 11 Atmospheric Pollution 33-35 Bacteriological Examinations 19, 23, 43, 55-56 Births 5, 7, 9 Blow-Fly Infestation 33 Cancer—Lung 9-10 Certificates of Disrepair 27 Chemical Examinations 43 Child Life Protection 26, 64 Child Welfare Centres 64 Chiropody for Elderly Persons 60, 62 Clean Air Act, 1956 33-35 Cleansing Station 21 Cleansing, Elderly Persons 60, 63 Crematorium 63 Day Nurseries 64 Deaths 5, 6, 7, 9, 11, 14, 15-16, 17, 21, 22 Dental Clinics 64 Diphtheria 6, 7, 11, 16-17, 23 Diphtheria Immunisation 17 Disinfection 33 Disinfestation 33 Disinfestation of Sewers 41,42 Dysentery 11, 19, 20,23 Elderly Persons, Services for 60-63 Encephalitis, Acute 11 Encephalomyelitis 16 Enteric Fever 11, 23 Erysipelas 11 Exhibitions 57-58 Export Certificates 33 Factories Act—Complaints 37 Factories Act—Contraventions 36, 37 Factories Act—Inspections 36, 37 Factories Act—Notices served 36, 37 Film Publicity 58-59 Fly Infestation 33 Fog and Smoke 33-35 Food and Drugs Act 27, 36, 46-47, 49-50 Food Hygiene Regulations 47-48, 59 Food—Inspection and Supervision 46-57 Food—New Legislation 47-49 Food Poisoning 11, 17-19, 23 Food Sampling 19, 49, 52-53, 55-56 Food, Unsound 49, 52 Foster Mothers and Children 64 Hairdressers 6? Barbers 40 Health Publicity 57-59 Holidays for Elderly Persons 62 Home Visiting—Scabies and Vermin 11, 21 Housing 43-46 Housing Repairs and Rents Act 1954 25, 27, 43, 46 Ice Cream 55-56 Illegitimate Infants—Births and Deaths 5, 7 Immigrants 45 Infant Mortality 5, 7, 8, 9 Infectious Diseases 11-23 Influenza, Pneumonia and Bronchitis 6, 8, 11, 23 Inoculation, etc., Certificates 12 Laundry Services 62-63 Legal Proceedings 29-32, 50-52 Live Births 5 Loral Government (Miscellaneous Provisions) Act, 1953 46 L.C.C. (General Powers) Acts 25, 28, 39, 40, 44, 63 M. 6? C.W. Services 63-64 Malaria 11 Marriages 5-7 Mass X-Ray 23 Maternal Mortality 5, 7 "Meals on Wheels" 60, 61 Measles 6, 8, 11, 12-13, 14, 15 Meat 53-54 Meningococcal Infection 6, 8, 11 Merchandise Marks 54 Metropolitan Cattle Market 53 Milk 56-57 Milk and Dairies Regulations 57 Milk (Special Designations) 57 Miscellaneous Services 57-64 Mortuary 63 National Assistance Acts 27, 60-62 Neoplasms, Malignant 6, 9 Noise Nuisance 25, 36, 39 Nurseries—Day 64 Offensive Trades 39 Ophthalmia Neonatorum 11 Outworkers 36,38 Overcrowding 43-44, 45, 46 Pet Animals Act 40 Pharmacy and Poisons Acts, etc. 40 Pneumonia 6, 8, 11 Poliomyelitis 6, 11, 15-16, 23 Population 5, 7 Post-Natal Clinics 64 Premature Infants 8 Preserved Food Premises 50 Prevention of Damage by Pests Act and Orders 41-42 Prosecutions 29-32, 50-52 Public Health Committee 4 Public Health Inspectors—District Work 26-36 Public Health Inspectors—Special Work 36-43 Public Health (London) Act—Improvements effected 28, 36 Public Health (London) Act, Sections 40 and 109 28 Public Health Officers 4 Public Health Story of Islington 65-80 Public Health (Tuberculosis) Regulations, 1952 22 Publicity 57-59 Puerperal Pyrexia 5, 11 Rag Flock and Other Filling Materials Act 40 Rats and Mice 41-42 Refreshment and Coffee Stalls 36, 55 Requisitioned Property 36 82 Sampling 43 Sanitary Circumstances 24-43 Scabies 11, 21 Scarlet Fever 11 Sewer Treatments 41, 42 Shops Act 36, 40 Slaughtermen's Licences 54 Slum Clearance 44, 45, 46 Smallpox 11-12, 23 Smoke 33-35 Staff 4 Static Water Tanks, etc 26, 33 Statistics—General 5-10, 11-23 Statistics—Vital 5-10, 11-23 Still-Births 5, 7 Swimming Baths 43 Toddlers' Clinics 64 Town & Country Planning 46 Tuberculosis 6, 7, 8, 9, 21-23 Tuberculosis—Beds and Bedding 23 Tuberculosis—Care Committee 23 Tuberculosis—Chest Clinics 21, 22-23 Tuberculosis—Deaths 6, 7, 8, 9, 11, 21, 22 Tuberculosis Notifications 7, 11, 21, 22 Typhoid Fever 11, 19 Underground Bakehouses 38 Vaccination 12 Vermin 11, 21 Washing Facilities, Free 55 Water Supplies 42-43 Welfare Centres 64 Whooping Cough 6, 8, 11, 12, 13-15, 23