C4361 Ach. 1957 ANNUAL REPORT ON THE HEALTH AND SANITARY CONDITIONS OF THE METROPOLITAN BOROUGH OF ISLINGTON VICTOR FREEMAN, M.R.C.S., L.R.C.P„ D.P.H. Medical Officer of Health E. G. Ellis & Sons. Willow Street. Chingford. E.4 1 Public Health Department, Town Hall, N.l. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Islington. The Annual Report which I have the honour to present on the health of the Metropolitan Borough of Islington for the year 1957 records steady if unspectacular and unco-ordinated advances in the environmental health services contributing to the health and welfare of the people. New Acts and new Regulations, such as those mentioned in the body of this Report, not only affect the work of the staff of the Public Health Department but also the well-being of citizens in ways of which they are probably not normally aware until an event occurs which affects them personally, bringing this Department into action, or less frequently, unfortunately, they take a deliberate interest in what may appear to be the somewhat humdrum health or other services of the local authorities. The vital statistics for the year continued the favourable trend, with exceptions. The birth-rate has continued to increase slightly, the death-rate to decrease slightly and the infant mortality rate remains at the same low level as last year, although as indicated in the comments on vital statistics there is still scope for the further saving of infant life. Deaths due to tuberculosis of the lungs were also fewer in number than ever previously recorded, although this in itself should be no reason for complacency—still less should there be complacency yet in regard to the number of new cases of pulmonary tuberculosis. These, unfortunately, are not lessening as speedily as the reduction of deaths from this cause. Although modern forms of treatment give much better hope of recovery, especially when the disease is diagnosed in the early stages, treatment is still long-term and the disturbance in the normal life of the patient, and probably his family, remain a problem. Prevention, therefore remains the main objective and there is no one single answer to this. All possible means of prevention and early diagnosis must be employed, including Mass X-ray (and Islington is fortunate in having had a Static Mass X-ray Unit in the Borough for several years now), inoculation with B.C.G. to groups considered to be at more than average risk (carried out by the London County Council, and Chest Physicians of the Regional Hospital Board), and, of course, personal attention to good hygiene, nutrition and housing. The outlook when we come to consider deaths due to malignant growths of the lung and bronchus, however, can only be termed disquieting. The number ascribed to this cause for 1957 was the highest on record so far, at 152. The Minister of Health formally accepted some time ago the conclusion that there was a causal relationship between the development of lung cancer and heavy cigarette smoking, and although no-one is prepared to state that there would be no lung cancer cases in the absence of tobacco smoking, there is increasing evidence that a high proportion, perhaps two-thirds or even three-quarters of all lung cancers are preventable Pollution of the atmosphere may contribute in some smaller degree to lung cancer, but no evidence has so far been brought forward which seriously contraverts cigarette smoking as the principal factor responsible for the increase over a long term. Another major group of deaths in Islington is ascribed to bronchitis and the Islington and London rates are well above the National average. Evidence is accumulating that bronchitis incidence is closely related to atmospheric pollution and this being the case, much bronchitis should be preventable with an improvement 2 in air cleanliness. When there is a combination of local dirty atmospheric conditions together with the additional personal pollution and irritation of the respiratory system caused by smoking, conditions are most favourable for the development of bronchitis which may eventually become chronic, irreversible and distressing to the patient himself and those around him. It should therefore be possible to reduce and avert these two major causes of death and invalidism by the same kinds of means which are, or should be, well within our reach as individuals and as members of the community. The rate at which progress is made will depend very largely on the rate which is demanded by the public. So far as atmospheric pollution is concerned, the first steps by the Council have been taken under the Clean Air Act, 1956, which should eventually lead to two substantial areas in the Borough becoming Smoke Control Areas. However, Islington is a large Eorough and although it is hoped that from this beginning there will be a constant succession of Smoke Control Areas, nevertheless many years must elapse before this Borough (and adjacent Boroughs) can become substantially smokeless. Deaths due to accidents are another considerable group which it should be possible to influence for the better by the concerted efforts of all concerned, and this, of couse, includes almost everyone except perhaps those who are still too young and for whom others must take responsibility. The fatal accidents include those due to motor vehicles and also those occurring in the home and elsewhere. The number of those injured by accidents, whether they suffer major disablements and disfigurements or relatively trivial injuries, vastly outnumber the dead and comprise a tremendous amount of avoidable suffering. The number of fatal accidents showed little signs of diminishing although it may well be that the Road Safety Campaign has at least made an impression, especially on safety for children, and that possibly the casualty lists would be even greater without road safety propaganda. The London County Council (General Powers) Act, 1957, gave Borough Councils specific authority to carry out home safety publicity and it is hoped that advantage will be taken of this to bring to the public a greater awareness of the necessity for the avoidance of many needless accidents in the home by the exercise of a little forethought. This applies not only to the citizens themselves in their own homes, but also to those who have some responsibility for the construction, layout and planning of dwellings, for the production of non-flammable clothing materials, for the packaging of pills and medicines or other dangerous substances so that they are clearly distinguished and stored where there is minimum risk, and many other features of a similar nature. It is therefore obvious that there is a wide scope for prevention in this field. These are only a few of the possibilities where greater attention to environmental measures, including health education itself, can be made to pay great dividends in the prevention of sickness, suffering and premature death, and it is to these fields that the public health service of the future will have to pay increasing regard. The first century of public health began with an onslaught upon the infections through environmental control—by the end of the century the major dangers had been disposed of or brought under a high measure of control in this country and others outside Asia and Africa. The second century of public health may well begin by ushering in the early stages of a broad environmental attack upon some of the major non-infectious groups of diseases and mishaps. Turning now to the personnel side, reference must again be made to the continuing establishment deficiency of Public Health Inspectors, averaging approvimately 33 per cent. An Inspector is essentially a field officer, and it cannot be 3 expected that it is possible under these circumstances to carry out all the necessary visiting and other work under the Public Health, Housing, Factories, Food & Drugs, Shops and other Acts which are mentioned in the body of this Report and for which the responsibility for inspection and enforcement has been placed upon the Inspectors. New Parliamentary legislation does not diminish the work of the Department but tends to increase it year by year. This is welcome insofar as hygiene and sanitary standards are being raised all the time, but it becomes more difficult for the staff available to carry out their duties as comprehensively as they would desire. In the section of the Report dealing with old persons, the considerable and useful work done has been recorded, as hitherto. Although there are many aged persons living in unsatisfactory circumstances where the Department's visitors are called upon to visit, it is only necessary to take compulsory action in a very small proportion of such cases. These must be reckoned the hard-core of failures and they have been recorded in detail year by year, as required by the Ministry of Health. The great majority of elderly persons visited, however, co-operate either willingly, or are persuaded to co-operate after a time, with the Department's visitors and the organisations which are available to help, and it has been decided to include reports on some quite representative cases where the most useful improvements were effected on a voluntary basis and which really comprise by far the greater part of the work. It must be appreciated from the content of the Report that the Department's officers work closely and in liaison with officers of many other authorities and bodies, both statutory and voluntary, as well as members of the public. It is inevitable that the London County Council, as the local health authority and responsible for the personal health services under the National Health Service Act, 1946, and also as the housing authority for the County of London, must be the Authority most frequently referred to and I should like to express my thanks for the co-operation always so willingly given by the Divisional Medical Officer, Dr. Wilfrid G. Harding, and all members of the staff of Health Division 3. The latter part of the year was made somewhat difficult for the Medical Officer of Health by the resignation of the part-time Deputy, Dr. A. L. Thrower, following his appointment as Deputy Divisional Medical Officer, L.C.C., Health Division 7 (Camberwell and Lewisham), which post he took up at the end of July. It was not possible for a successor to Dr. Thrower to be appointed during the remainder of the year. In this connection also thanks are due to Dr. Harding for his services as Acting Medical Officer during the absence of the Medical Officer of Health on annual leave in August. Once again I should like to express my appreciation to Mr. W. C. Bartlett, Chief Public Health Inspector, and to Mr. E. J. Sharp, Chief Clerk, and, in fact, to all members of the staff of the Public Health Department. Reference was made in the last Report to the relationship between the Chief Officer of a Department and the Chairman of the Committee, which is most important in the smooth running of local government. I have been fortunate in the continued assistance and co-operation of the two principal Chairmen with which a Medical Officer of Health has to deal in this Borough, viz. the Chairman of the Public Health Committee, Alderman A. J. Rogers, and the Chairman of the Housing Committee, Councillor E. J. W. Bayliss, and my thanks are also due to their respective Committees for the consideration and courtesy which they have always afforded me. V. FREEMAN, Medical Officer of Health. 4 MEMBERS OF THE PUBLIC HEALTH COMMITTEE (As at 31st December, 1957) Mayor: Councillor D. J. Lewis, J.P. Aldermen : Herbert James Lowton Lygoe, M.B.E.J.P., L.C.C. Albert John Rogers Councillor :* George Arthur Ainsworth Henry James Reid Mrs. Frances Marjorie Cole Lewis Ross William Dradey Mrs. Margaret Mary Short Frank Ernest Field Mrs. Emily Mary Simms George Albert Gardner Mrs. Bronwen Stradling Ernest Charles Gough Vivian Stewart Stradling Ernest George Hills Miss Janet Edith Woodhall 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.) (Resigned 31st July, 1957) Public Analyst: Chief Public Health Inspector : D. F. H. Button, A.R.C.S., F.R.I.C. W. C. Bartlett, M.A.P.H.I., M.R.S.H. (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) G. A. Reid (b)(c) A. Aslamidis (b)(c) E. Jephcott (b)(c)(d)(e)(j) K. E. Sewell (a)(g)(i) Mrs. G. S. Causton (b) A. R. Kempshall (b) U. P. Stanton (b)(c) D. T. Evans (b)T. Lawson (b)(C) W. T. Stevenson (b)(c) L. Foxley (b)(c)(d) N. Lightowlers (b)(c)R. T. Whittaker (b)(c) K. L. Garner (b) A. Moxon (b)(c)(/)(g)(h) Miss V. M. Goddard (b)(c)(e) S. A. Muggeridge (b)(c) R. T. Govelt (b)(c)(e) F. H. W. Pedrick (9 vacancies) (b)(c)(f)(g)(h) Miss S. H. Prentice Chief Clerk: E. J. Sharp Clerical Staff: S. A. Bishop P. Hardwick P. F. D. Morgan E. P. Brewer Miss M. E. Hudson D. A. Owen W. R. Causton* L. Hummerstone P. L. Regan E. Conner Mrs. E. Johnson Mrs. I. R. Teteris Mrs. V. E. Cook Mrs. E. M. Matthews J. Thompson C. J. Cridland* W. A. McAdam* L. Turner P. Dymond Mrs. C. A. McCausland Mrs. F. Underwood Mrs. O. Easson C. J. Moore* S. Wright Old People's Health Officer: Infectious Diseases Visitor: Mrs. A. E. Foster (f) 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 2 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. (n) = Health Visitors' Certificate. (i) = Health Visitors' Diploma. (j) = Royal Society of Health Certificate for Inspection of Water and drainage installations. (k) = Royal Society of Health, Meat and other rood Inspectors' Certificate. 5 SECTION A. GENERAL AND VITAL STATISTICS. Area of the Borough 3,092 acres. Population. Registrar-General's estimate of civilian population, Mid-year 1957 : 227,800 Live Births. Birth Rate per 1,000 Estimated Resident Population Totals M. F. Islington England and Wales Legitimate 4,115 2,086 2,029 Illegitimate 467 236 231 4,582 2,322 2,260 20.1 16.1 Still Births. Rate per 1,000 Total (Live and Still) Births Totals M. F. Islington England and Wales Legitimate 80 34 46 Illegitimate 12 8 4 92 42 50 19.68 22.4 Deaths. Death Rate (Unadjusted) per 1,000 Population Totals M. F. Islington England and Wales 2,457 1,228 1,229 10.79 11.5 Deaths from Puerperal Causes. Deaths. Rate per 1,000 Total Births Islington England and Wales 3 0.64 0.47 Death Rate of Infants under One Year of Age. Islington England and Wales All infants per 1,000 live births — 21 23 Legitimate infants per 1,000 legitimate live births 21 Illegitimate infants per 1,000 illegitimate live births 17 Notification of Births. For year ending 31st December, 1957 4,569 (corrected figure from L.C.C.). Marriages (Provisional figures). Marriages solemnised in the Borough during the year 2,361 6 CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION (REGISTRAR GENERAL'S RETURNS) Cause OF Death Age Groups 0— 1- 5- 15- 25— 45— 65— 75— All Ages M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Total 1. Tuberculosis, Respiratory - - - - - - - - 1 4 8 1 9 2 2 1 20 8 28 1 2. Tuberculosis, Other — — - - - - - - 1 - - - 1 1 — — 2 1 3 2 3. Syphilitic diseases - - - - - - - - 1 - 4 - 5 1 2 2 12 3 15 3 4. Diphtheria - - - - - - - - - - - - - - - - - - - 4 5. Whooping Cough - - - - - - - - - - - - - - - - - - - 5 6. Meningococcal Infection 2 - - - - - - - - - - - - - - - 2 - 2 6 7. Acute Poliomyelitis — — - - 1 - - - - - - - - — — 1 - 1 7 8. Measles — — - — - - - - - - - - - - — — - — - 8 9. Other infective and parasitic diseases 1 — 1 - - - - - 1 — — 1 1 — — 1 4 2 6 9 10. Malignant neoplasm, stomach — — - - - - - - 1 1 20 8 12 7 13 8 46 24 70 10 11. Malignant neoplasm, lung, bronchus - - - - - - - - 3 2 65 9 46 6 13 8 127 25 152 11 12. Malignant neoplasm, breast — — - - - - - - - 3 - 15 - 6 — 10 — 34 34 12 13. Malignant neoplasm, uterus — — - - - - - — — 5 — 15 — 5 — 2 — 27 27 13 14. Other malignant neoplasms — — - 1 1 - 1 — 3 2 37 34 37 36 33 39 112 112 224 14 15. A-and-Leukaemia — — - - - - 1 - 1 1 1 1 1 1 1 1 5 4 9 15 16. Diabetes - - - - - - - - - - 2 - 1 2 - 2 3 4 7 16 17. Vascular lesions of the nervous system - - - - - - - - 2 1 18 28 22 29 32 75 74 133 207 17 18. Coronary disease, Angina — — - - - - - — 10 2 78 25 50 49 70 95 208 171 379 18 19. Hypertension with heart disease — — - - - - - - - - 3 4 6 7 9 26 18 37 55 19 20. Other heart disease — — - - - - - - 6 5 12 18 20 33 63 130 101 186 287 20 21. Other circulatory disease — — - - - - - — — — 8 6 16 29 24 58 48 93 141 21 22. Influenza — — - - - - - - 1 3 5 4 3 4 — 7 9 18 27 22 23. Pneumonia 7 5 1 1 - - 1 - 2 1 14 9 19 14 34 52 78 82 160 23 24. Bronchitis 1 2 - 1 - - - - 3 5 36 11 47 26 48 45 135 90 225 24 25. Other disease of the respiratory system - - - 1 - - - - - 2 5 2 1 2 1 3 7 10 17 25 26. Ulcer of stomach and duodenum — — - - - - - - 2 - 7 2 7 3 9 6 25 11 36 26 27. Gastritis, enteritis, diarrhoea 1 - - - - - - - - - 4 - - 4 1 1 6 5 11 27 28. Nephritis and Nephrosis — — - - 1 - - 1 1 2 1 1 2 — 1 2 6 6 12 28 29. Hyperplasia of prostate — — - - - - - — — — — - 5 - 7 — 12 — 12 29 30. Pregnancy, Childbirth and Abortion - - - - - - - 1 - 2 - - - - - - - 3 3 30 31. Congenital Malformations 10 7 1 2 - - - 1 - 1 1 1 - 1 — 1 12 14 26 31 32. Other defined and ill-defined diseases 37 21 2 3 1 - 1 1 7 3 12 18 13 17 19 28 92 91 183 32 33. Motor vehicle accidents — — - — - - 2 - 2 - 6 1 2 3 4 1 16 5 21 33 34. All other accidents — — 1 1 - - 1 - 8 1 8 5 5 5 4 13 27 25 52 34 35. Suicide — — — — - - - - 2 - 12 2 2 1 4 2 20 5 25 35 36. Homicide — — — — - - — — — — — — — — — — — — — 36 All Causes 59 35 6 10 4 — 7 4 58 46 367 221 333 294 394 619 1,228 1,229 2,457 Totals 94 16 4 11 104 588 627 1,013 2,457 Percentages 3.83 0.65 0.16 0.45 4.23 23.93 25.52 41.23 100 7 COMPARATIVE VITAL STATISTICS—1946 TO 1957 (Compiled from Registrar-General's Returns) 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 Population 227,800 228,300 228,800 230,500 233,500 235,300 235,800 238,200 239,580 238,200 236,840 227,160 Live Births—(Total) 4,582 4,322 3,945 4,063 3,969 3,897 3,880 4,091 4,389 4,608 5,577 5,284 (Illegitimate) 467 402 340 336 296 282 285 302 318 331 431 442 Birth Rate per 1,000 population 20.1 18.9 17.2 17.6 17.0 16.56 16.45 17.17 18.32 19.34 23.55 23.26 Still Birth Rate per 1,000 births 19.68 21.51 21.09 19.31 22.66 17.89 20.94 17.48 19.87 18.94 18.99 22.20 Deaths 2,457 2,566 2,591 2,425 2,669 2,876 3,131 2,760 2,958 2,682 3,053 2,947 Death rate 10.79 11.24 11.32 10.52 11.43 12.22 13.28 11.59 12.35 11.26 12.89 12.97 Maternal Death rate per 1,000 births 0.64 0.45 0.25 0.48 0.99 1.01 0.50 0.72 0.67 0.85 0.70 1.48 Death rate of Infants under 1 year 21 21 26 17 24 22 28 29 27 35 32 39 Marriage rate per 1,000 population 20.73 21.44 20.95 19.35 19.08 17.85 19.17 18.37 18.61 19.67 19.54 20.21 T.B. Notifications per 1,000 population (all forms) 1.51 1.81 1.97 1.94 2.08 2.03 1.77 2.05 2.20 2.25 2.43 2.18 Death-rates per 1,000 population— Pulmonary T.B. 0.12 0.15 0.20 0.16 0.16 0.30 0.30 0.38 0.52 0.66 0.70 0.64 Diphtheria Nil Nil Nil Nil Nil Nil 0.004 0.004 0.008 Nil 0.004 Nil Neoplasm of Lung, Bronchus & Trachea 0.67 0.62 0.52 0.53 0.57 0.54 0.54 0.54 Nil Nil Nil Nil Suicides 0.11 0.15 0.13 0.13 0.14 0.076 0.15 0.09 0.12 0.15 0.07 0.11 Motor Vehicle Accidents 0.092 0.13 0.14 0.082 0.077 0.076 0.11 0.10 0.06 0.08 0.11 0.10 Other violent causes 0.23 0.22 0.22 0.17 0.20 0.22 0.26 0.26 0.25 0.43 0.37 0.45 8 SUMMARY OF INFANT MORTALITY 1957 (Based on Registrar General's Returns) Primary Cause of Death Under 1 day Days Weeks Months 1957 (1956) 1-2 2-3 3—4 4-5 5-6 6—7 1-2 2-3 3—4 1-2 2—3 3-4 4-5 5—6 |6—7 |7-8 |8-9 9—10 |10-11 |11-12 Totals Totals Measles (-) Whooping Cough (-) Meningococcal Infection 1 1 2 (1) Tuberculosis—Lungs (—) Tuberculosis—Other forms (—) Bronchitis 1 1 1 3 (3) Pneumonia. 1 3 1 1 2 1 1 1 1 12 (13) Influenza (—) Enteritis and Diarrhoea 1 1 (2) Premature Birth 6 1 2 1 1 1 12 (24) Congenital Malformation, (-) Birth Injury, Atelectasis (—) Atrophy and Marasmus 20 13 5 4 1 1 1 1 1 2 5 3 1 1 59 (37) Syphilis (-) Suffocation Overlying (—) Violent Causes (1) Road Traffic Accidents (—) All Other Causes 4 1 5 (10) Totals 31 17 7 6 1 2 1 2 — 2 6 6 4 3 1 1 1 — 1 1 1 94 (91) 9 COMMENTS ON VITAL STATISTICS Births. The peak of the post-war increase in the birth-rate was 23.55 per thousand population in 1947. After a sharp drop in 1948, there was a slow but steady decline up to 1951, at the rate of 16.45. The rate varied little until 1955, although there was a slight tendency to increase, but in 1956 the birth-rate jumped to 18.9 per thousand and there was a further increase to 20.1 in 1957. This is the highest birth-rate since 1947. 10.2 per cent of all 1957 births were classified as illegitimate. Population. In view of the interest in the post-war "bulge," the following table (extracted from the Registrar General's Returns) gives the estimated number of children under the age of 15 years in the County of London and in Islington:— Under 1 year 1 — 4 Total under 5 5 — 14 Total under 15 London, Admin. County 51,800 178,200 230,000 425,000 655,000 Islington 4,190 13,410 17,800 30,600 48,400 Deaths. The death-rate of 10.79 per thousand population continued the downward trend for the third year running. The reduction in the deaths was spread evenly through most of the major causes and through the different age groups. There were, however, a few increases to which special reference will be made. Infants under One Year. The infant mortality rate, at 21 per thousand live and stillbirths, was the same as the previous year, but from the summary of infant mortality on page 8 it will be noted that out of the total of 94 deaths of infants under the age of 12 months as many as 59, or 63 per cent, were returned as deaths in the same grouped causes, i.e. congenital malformations, birth injury, atelectasis, atrophy and marasmus. Deaths from these causes are closely associated with the course of pregnancy and the confinement itself, and by far the greater number occurred within seven days of birth, and as many as one-third within twenty-four hours of birth. Infant mortality within this group was higher for 1957 than for any previous year, but there are no known factors to indicate the reasons for such an increase, since a period of one year is insufficient for adequate enquiry to enable firm conclusions to be arrived it. Observation from this aspect will be continued. Respiratory Tuberculosis. The welcome reduction in deaths due to tuberculosis of the lungs which has continued throughout the post-war period has again given a new low record for 1957, with a total of only 28 deaths, comprising 20 males and 10 8 females. Further observations in connection with tuberculosis of the lungs will be found in the Infectious Diseases section of this Report, but in spite of what has just been mentioned, the proportion of deaths due to this cause in Islington remains higher than the rate for England and Wales. Death-rate per million population Males Females England and Wales 146 47 Islington 186 67 Malignant Growths of Lung and Bronchus : Deaths Male 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 1957 127 25 152 Again it must be said that malignant growth of the lungs, etc., continue to increase whilst tuberculous decreases. The table on page 7 shows an increase for the second successive year following a period when the rates, although high, were relatively stationery. 152 deaths from cancer and other malignant disease of the lungs is the highest number ever recorded. The proportion of males to females remains approximately five to one and, of the 127 male deaths 65, or a little over 50 per cent, were in the age group 45—65 years. It has again to be recorded that Islington rates compare very unfavourably with the rates for England and Wales as returned by the Registrar General. Death-rate per million population Males Females England and Wales 759 116 Islington 1,181 208 It has been mentioned in a previous Report that the principal contributory cause of lung cancer appears to be well established as due to prolonged cigarette smoking. The evidence of the Medical Research Council has been accepted by the Ministry of Health, and Local Health Authorities have been advised by the Ministry in regard to health education of the public on the risks of smoking. It is not apparent so far that any impression of consequence has been made upon the public. 11 Accidents. The following table gives the deaths from accidents to Islington residents from 1951 onwards :— 1951 1952 1953 1954 1955 1956 1957 Motor vehicle accidents 26 18 18 19 33 29 21 Other violent accidents 61 48 46 40 50 51 52 In the following table causes of accidental deaths in 1957 are analysed, in their respective age groups. Type 0- 1- 5- 15- 25- 45- 65- 75+ M F Total Motor Vehicle Accidents — — — 2 2 7 5 5 16 5 21 Falls — — — 1 3 3 4 12 11 12 23 Accidental Poisoning (Solid, Liquid Gases and Vapours) — — — — 1 5 3 3 6 6 12 Drowning — — — — 2 — 1 — 2 1 3 Fire — — — — — 1 2 — — 3 3 Inhalation of Stomach contents — — — — — — — — — — — Others (Railway Accidents, etc.) — 2 — — 3 4 — 2 8 3 11 Total —. 2 — 3 11 20 15 22 43 30 73 12 SECTION B. PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES. Notifiable Infectious Diseases and Deaths during the year 1957 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 — (-) 1* — — 1* Scarlet Fever 203 (171) — 35 199 22 Diphtheria 9 (8) — 9 1 — Enteric Fever (including Paratyphoid) 9 (3) - 9 7 — Typhus Fever — (-) — — — — Puerperal Pyrexia 361 (299) — 347 367 — Ac. Primary & Influenzal Pneumonia 170 (90) — 5 171 — Ophthalmia Neonatorum 17 (18) - 15 17 — Acute Encephalitis 3 (7) 1 3 3 — Meningococcal Infection 4 (8) 2 4 2 — Anthrax 1 (—) — 1 1 — Dysentery 385 (370) - 54 390 60 Malaria — (3) - - - — Erysipelas 31 (33) - 6 31 — Measles 1,766 (1,997) - 72 1,757 108 Whooping Cough 431 (529) — 46 427 50 Ac. Poliomyelitis 45 (24) 1 40 27 — Food Poisoning 150 (141) - 14 131 14 Tuberculosis—Lungs 316 (378) 28 — 255 — Tuberculosis—Other Forms 29 (36) 3 - 29 — Scabies 70 (57) - 2 70 129 (Figures in brackets are notifications for 1956) Domiciliary Visiting of Infectious Disease Cases and Contacts—No. of Visits Smallpox 534 Measles 1,865 Scarlet Fever 227 Whooping Cough 482 Diphtheria 14 Acute Poliomyelitis 160 Entric Fever (IncludingTyphoid and Paratyphoid 50 Food Poisoning 69 Meningococcal Infection 5 Scabies 182 Dysentery 687 Vermin 374 Malaria - Influenza 147 Acute Encephalitis 1 Ineffective Visits 1,159 Erysipelas 31 Others 42 Total 6.129 Domiciliary Visiting of Infectious Disease Cases and Contacts—No. of Visits Smallpox 534 Measles 1,865 Scarlet Fever 227 Whooping Cough 482 Diphtheria 14 Acute Poliomyelitis 160 Enteric Fever (including Typhoid and Paratyphoid) 50 Food Poisoning 169 Meningococcal Infection 5 Scabies 182 Dysentery 687 Vermin 374 Malaria — Influenza 147 Acute Encephalitis 1 Ineffective Visits 1,159 Erysipelas 31 Others 42 Total 6,129 13 *Smallpox. Information was received from the Medical Officer of Health of another London Borough that a German business man stayed in a hotel in his area and was subsequently confirmed as a smallpox case. A member of the staff of the hotel was a contact of this case and resident in Islington. On investigation he was found to be in good health and was kept under observation for the usual period. The Medical Officer of Health was also notified by the Royal Northern Hospital that a Nursing Sister who was a contact of smallpox cases in Gibraltar had returned to this Country by air. As it was her intention to travel to her home in Warwickshire, information was transmitted to the appropriate Local Authority. Nine visits were paid by the Medical Officer of Health, or Deputy Medical Officer of Health to suspect cases on requests by family practitioners. Eight of these were not confirmed, but the remaining case was most exceptional and some serious consequences ensued. The Medical Officer of Health was called in to see a patient with a haemorrhagic rash. He was extremely ill and, although admitted to hospital almost immediately, died within a few hours of admission. Following a postmortem examination, he was diagnosed as acute leukaemia. Some five weeks later, a six-year-old child in a neighbouring borough was diagnosed as a case of smallpox, from which, unfortunately, he died ; he was unvaccinated. The only possible source of infection appeared to be his grandmother who was doing domestic work in the hospital where the post-mortem examination of the patient first referred to was carried out and who herself contracted a rash which was thought to be chicken-pox. Another relative of this family also contracted an illness which was diagnosed as smallpox, but both the adult cases had been vaccinated in childhood and recovered. Retrospective enquiries elicited information that the Islington patient had, about a fortnight before becoming ill, visited a relative in another area who had a sick child, vaccinated in infancy, and thought to be suffering from chicken-pox. Her father, who was well vaccinated, had previously had a slight illness following his recent return by air to this Country from Nigeria. This possible chain of transmission, found retrospectively, appeared to be the only one which accounted for the introduction and spread of the infection. Although very fortunately the cases were few, extensive enquiries and precautionary measures were necessary in the areas affected. All possible contacts living in the Borough were offered vaccination through the Divisional Medical staff of the County Council and family practitioners. 88 persons were vaccinated by Dr. Simpson of the London County Council ; 60 by their family practitioners ; 23 at hospitals, and 16 others at their places of employment or at a clinic. Precautionary vaccination or re-vaccination was offered to the Public Health Department staff exposed to infection risk, and the Deputy Medical Officer of Health carried out 54 vaccinations, making a total, in all, of 241 vaccinated persons. Daily domiciliary follow-up visiting of all contacts was arranged and close liaison made with practitioners concerned. The staff of the Department carried out over 600 visits and rotas for emergency calls and evening visits were in operation during the quarantine period. The following is the table of successful vaccinations performed over the past ten years— 14 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*† 1957 3,624* (Figures kindly furnished by Divisional Medical Officer, London County Council.) * Including Re-vaccinations. † 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. Applications for authentication to be dealt with by the Medical Officer of Health numbered 1,045 as against 645 for the previous year. The applications com' prise requests for authentication of International Certificates of Vaccination and Inoculation against smallpox, cholera, typhoid, etc., and this major increase, which is now a substantial item for verification, arises presumably from the greatly increased amount of foreign travel 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. The incidence of measles was lower in 1957 than for any of the post-war years, with the exception of 1947 and 1954 but notwithstanding, the total number of children affected was still quite substantial. Since there is no inoculation against this infection the incidence of measles continues as a natural infection uncontrolled to a high degree. In the absence of active control measures there appears to be no reason why epidemic figures should not recur in any future year. The following table shows the age-groups of the notified cases during 1957:— Under 1 year 1—5 years 5 years and upwards No. of Notifications in 1957 71 1,000 695 Percentage of total notifications 4.0 56.6 39.4 No. of Deaths — — - 15 MEASLES—MONTHLY INCIDENCE, 1957 Whooping Cough. With 431 cases, whooping cough showed a decrease over the figures for the previous year. Under 1 year 1—5 years 5 years and upwards No. of Notifications in 1957 64 194 173 Percentage of total notifications 14.8 45.1 40.1 No. of Deaths - — 16 The following chart shows the measles and whooping cough position since 1946 :— Fatality Rates per 1,000 notifications each age group (1948—1957) Percentage of notifications (1948—1957) Under 1 1—5 5 & upwards Under 1 1—5 5 & upwards Measles 2.90 0.22 — 4.4 58.4 37.2 Whooping Cough 8.90 1.71 — 12.3 55.8 31.9 Over the ten-year period 55.8 per cent of all cases of whooping cough and 58.4 per cent of all cases of measles were in children one to five years of age. Whooping Cough Prophylaxis. Whooping cough immunisation is carried out in the Local Health Authority Clinics and by general practitioners. The Divisional Medical Officer has kindly made available the following information in regard to Islington children :— Whooping cough Prophylaxis Total attendances 8,961 Completed cases 3,090 17 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 1,862 478 340 7 Acute Poliomyelitis Although the poliomyelitis figures in 1957 were rather higher than in the previous year it was not, as compared with some other years, one of high incidence, there being 25 confirmed poliomyelitis cases in the Borough as against 13 in the previous year. 1957 was the first full year in which poliomyelitis inoculation was offered to the public through the Local Health Authority to selected groups as part of the National Campaign. Dr. Harding, Divisional Medical Officer, has informed me that 5,082 inoculations were completed in Islington during the year, in almost all cases of children. The cases reported for each of ten years are set out as under :— No. Reported No. CONFIRMED 1957 55 25 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 Onset dates Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. 1957 2 — — 2 1 2 5 4 5 2 2 — 19561 — 1 1 l -- - - 2 34* 1955 2 1 — — — 1 5 11 15 9 9 3 1954 - - - - - - 1 3 2 3 2 1 1953 1 — — — 2 2 6 2 3 1 — - — 1952 — — — — — 1 —2 8 — 2 1 1 1951 1 — — 1 1 2 — 2 1 — — — — 1950 1 — 1 — 2 2 10 10 1 2 2 — — 1949 — — — — — 9 6 17 18 8 4 4 1948 — — 1 — 2 — 1 — 2 — 1 1 1 1 Age distribution: Under 1 yr. 1— 5 — 15— 25 and over 1957 1 6 12 2 4 *1956 — 4 5 2 2 1955 5 19 15 5 12 1954 — 7 2 1 2 1953 — 6 5 3 3 1952 — 1 5 4 5 1951 — 2 2 2 2 1950 1 11 12 4 3 1949 3 35 17 2 5 1948 — 2 5 1 1 18 Deaths—1957—1 (7 years). 1956—Nil. 1955—3 (17½ years; 30 years; and 5 years—the latter contracted outside the borough, and not included in above tables). 1954—1 (27 years). 1953—3 (4 years ; 15 years ; 24 years). 1952—Nil. 1951—Nil. 1950—2 (6 years ; 12 years). The onset of the disease of the 6-year-old was in 1949. 1949—2 (2 years ; 26 years). 1948—Nil. 1947—4. * Two cases, with onset in December, 1956, were notified in 1957, and are included in the Above Return Diphtheria Cases and Deaths—1927-1957 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 — 1957 9 1 - 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 1957 40 4 1 Diphtheria, fortunately, continues to be a rare disease. It will be seen from the table above that there has been an average of not more than 1 confirmed case per year since 1952, and no deaths. This does not signify, however, that an outbreak could not still occur in an unprotected population, as happens from time to time in this Country, and is certainly the position in some countries abroad. 19 Diphtheria Cases and Immunisation state 1947-1957 (inclusive) Year Immunised Non-Immunised Unknown Total Deaths Age Groups Age Groups 0—5 5—15 15 + 0—5 5—15 15 + 1957 - 1 - - - - - 1 Nil 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 4 years immunised 6 years 1948 1 2 1 1 — 2 — 7 Nil 1947 — 5 1 2 4 5 2 19 16 years—Not immunised Totals 3 18 3 16 24 17 4 85 5 deaths (None immunised) 24 57 Diphtheria Immunisation, 1957 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. 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. 57 i.e. born in year Under 1 1957 1—4 1956-53 5—9 1952-48 10—14 1947-43 Under 15 Total Last complete course (whether primary or boost) 1953.-57 605 9,233 8,709 6,317 24,864 Mid-year population 4,390 13,410 30,600 48,400 Immunity Index 13.7 68.8 49.1 51.37 Food Poisoning Number of notifications received 1947 7 1948 10 1949 55 1950 104 1951 148 1952 58 1953 243 1954 104 1955 294 1956 141 1957 150 20 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 8.8.57 Nil 125 9 Nil Steak and Kidney: No food samples available. CI. Welchii isolated from faeces of 4 cases. As set out in the table above, there was only one outbreak of food poisoning of any size in the Borough during the year, as compared with two listed for 1956, but 150 cases of food poisoning, as against 141 for the previous year. A number of members of a concern in the Borough, totalling nine in all, reported sick with symptoms of food poisoning. Enquiries were instituted as soon as the information was received, and particular attention was given to a meal which had included steak and kidney pie. The steak and kidney were supplied on the day prior to cooking, and preparation consisted of one-and-a-half hours boiling followed by two hours baking. A small amount of the meat was not used in the pies but placed in a hot cupboard after the preliminary boiling and left there until served with some portions at lunch time. Pathological specimens from those affected were sent to the Laboratory and Clostridium Welchii was found to be present; this organism is heat resistant to a considerable degree, it may be present in cattle, so that the meat itself may be infected, although the appearance and smell may be perfectly normal. If the organisms were not killed during the first boiling, it is presumed that there was sufficient time for the organisms to multiply to a degree which might cause food poisoning in the surplus meat which was allowed to remain in the hot cupboard for a matter of two hours or more. Kitchen practice was found to be good, but the staff were advised to discontinue allowing meat to remain in the hot cupboard after preparation, even for only a few hours. It was not possible to confirm the presence of the organism in the meat itself as none remained after the meal. The total number of those who took the lunch was estimated at 125, so that only a small proportion was affected. Some had severe symptoms for a time, but recovery appeared to be complete in one to four days. Typhoid Fever Information was received that a person normally resident in St. Pancras had been under observation in a private nursing home in this Borough, and was found to be suffering from typhoid fever. It appeared that the typhoid fever was probably contracted during the patient's holiday in Spain. It was therefore necessary to regard the nursing home staff and some of the patients as typhoid fever contacts, and medical practitioners in attendance on patients and staff were informed, as were Medical Officers of Health in other boroughs in respect of some non-resident staff. In collaboration with County Hall Laboratory, bacteriological investigations were carried out over a period on all contacts who might be suspect. Fortunately, no further cases occurred. 21 Dysentery Upon receipt of information from the Divisional Medical Officer that a number of children attending a County Council school in the Borough were suffering from enteritis or diarrhoea, domiciliary visiting was carried out in conjunction with Divisional staff, and it became apparent that the symptoms were due to a fairly widespread infection with Sonne dysentery. Arrangements were made with the Head Teacher for exclusion of children with recent symptoms, and they were followed up at home by this Department's visitors, when family and household contacts were also enquired into. A considerable number of specimens were forwarded to the Public Health Laboratory, County Hall, and confirmation of Sonne dysentery was obtained in the majority of cases. Although most of the cases occurred in children attending one school, a few children attending other schools were affected, as were some adults and children under school age. It was not possible to ascertain how the infection arose. The School Meals Service was not responsible for the spread, but full precautions were taken in regard to kitchen staff in order to check and avoid such possible mode of spread. Sanitary accommodation at the school was of a good standard, but in conjunction with the London County Council Health Department special issues of disinfectant were distributed for use in the sanitary annexes by the caretaker staff of the school, under instruction. 54 children were affected at the school mentioned, together with one teacher and one canteen worker. 16 children at three other schools were also found to be suffering from Sonne dysentery. 22 DYSENTERY IN ISLINGTON—1957 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 1957 January 43 M 15 2 19 2 5 3 2 - 3 2 1 3 1 21 20 F 24 2 2 3 7 1 7 5 1 February 21 M 12 - 3 2 1 2 1 2 2 2 — 1 - 11 6 F 9 — 1 3 2 - 2 - 1 March 26 M 14 2 15 - 4 3 3 4 1 1 3 3 6 16 5 F 9 1 — 3 - 2 3 2 - April 29 M 12 1 20 2 4 4 1 1 1 - 1 3 2 14 15 F 13 3 1 4 4 2 3 1 1 May 34 M 13 - 21 - 5 4 1 1 1 1 3 12 4 20 12 F 18 3 1 4 7 1 7 - 1 June 41 M 24 2 30 2 21 1 1 1 - - — 1 4 8 19 F 14 1 - 8 2 3 1 - 1 July 8 M 6 - 1 1 2 1 - - 1 1 — — - 3 5 F 2 — — 1 - - - - 1 August 8 M 1 3 6 1 1 1 - 1 - - — 2 4 3 5 F 4 — - 2 - - 2 - - September 6 M 4 - 4 - 2 2 - - - - — — — 3 3 F 2 — — 1 1 - - - - October 19 M 5 3 12 - 1 1 1 4 1 - 1 2 — 8 9 F 5 6 — 4 2 2 2 1 - November 85 M 43 3 69 2 19 16 1 5 2 1 — 3 8 28 52 F 35 4 1 16 12 - 8 2 - December 145 M 64 11 126 2 23 42 1 4 1 2 2 8 13 91 44 F 57 13 2 18 36 2 8 3 1 Total 465 M 213 27 326 14 88 80 12 23 13 10 11 38 42 226 195 F 192 33 8 67 73 13 43 14 7 23 Anthrax A case of anthrax was notified by a practitioner in March, and the patient was a worker on refrigeration plant at a cold store. Human anthrax infection is not common, the last case in this Borough being notified about two years previously— also in a worker in similar employment. Cattle may be infected with anthrax, and germs could be carried on infected meat, on the hides or other products of the animal. Anthrax in animals comes within the purview of the Control Department of the County Council in London, but notification in regard to patients is made to the Medical Officer of Health, and information of cases is normally passed to the Ministry of Health. The patient was admitted to hospital for observation and treatment. The diagnosis was complicated by the administration of penicillin before the diagnosis could be established. This will control several forms of infection, including anthrax, and it is not always possible to confirm in such circumstances, whether a case was due to anthrax or not. Influenza In common with other parts of the Country, the Borough suffered an outbreak of influenza in the autumn of the year. Information was received during the summer from the Ministry of Health regarding the possible occurrence of Asiatic influenza and this was circulated to all practitioners. By August a few cases had occurred of an illness resembling influenza, but of a mild type. During September there was a very considerable increase in the number of cases of influenza. Since influenza as such is not notifiable, exact figures are not available of the extent of the sickness due to this cause. Most of those affected in the early part of September were school children, and a few schools reported a considerable degree of absenteeism due to an illness resembling influenza. On information furnished by the Divisional Medical Officer, domiciliary visits were arranged by the Department's infectious disease visitors in a proportion of the cases, and it was possible in this way to observe the spread to adult contacts. The incubation period was two to three days in the majority of cases, the illness was fairly mild, some of the children being able to return to school within four to five days. By the end of September, approximately two and half thousand children were reported as absentees due in the main to influenza, the incidence being distributed throughout the Borough. Information was also received from local offices of the Ministry of Pensions and National Insurance that sickness claims had risen to more than 200 per cent of the average figures, and the majority of the claims had been certified as due to or connected with influenza. The position was confirmed by information gathered informally from practitioners, and although at the beginning of the outbreak many more children than adults were affected, in the later stages adult cases increased porportionately more than children, and at one stage sickness claims were over 300 per cent above the average. Although the outbreak was relatively mild, it should be mentioned that influenza cases, and certainly notifications of influenzal pneumonia, are most unusual in early autumn and, in fact, it is not possible to trace such an outbreak in previous records for September. During September there were no pneumonia cases notified, but as the outbreak proceeded the notifications increased each week, reaching a maximum 24 of 14 in the week ended 18th October. In the same week there were five influenza and influenzal pneumonia deaths included in the returns, the respective ages being 52, 39, 82, 55 and 58 years. Check observations were made in a selected number of adult cases in conjunction with family practitioners and the Public Health Laboratory, and the infection was confirmed by the Laboratory as due to Group. A. Influenza virus, this being the same as the so-called Asian' flu type. Scabies and Vermin The number of treatments for both scabies and vermin was greater in 1957 than in 1956, but during the latter year the Council's Treatment Centre was closed for a time on account of the installation of a new boiler and sterilizers for the Disinfecting Station and most of the treatment of Islington residents was carried out at the Finsbury Health Centre. The figures for the two years are not, therefore strictly comparable. Scabies Vermin Children under 5 years Number treated 23 33 Number of baths given 50— Number of treatments — 33 L.C.C. Children Number treated 55 300 Number of baths given 157* — Number of treatments — 302 Adults Number treated 83 56 Number of baths given 205* — Number of treatments — 62 * Baths were also given to 10 Scabies Contacts and 121 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 125 1 88 214 Vermin 288 3 198 489 Tuberculosis. It will be seen from the table given below that there were 420 new cases of pulmonary tuberculosis, which is one more than in the previous year. The number of deaths due to this cause, however, decreased, at 28, to a new record low level figure, the previous year's having been 34, which was the lowest to that time. It will be seen that the new cases are not diminishing in the same proportion as the deaths, and the better outlook for the tuberculous person gives rise to its own problems, because unless the number of new cases diminishes rapidly the total pool of tuberculous infection, or potential tuberculous infection, due to improved survival may well increase. This in itself would give rise to possible increased exposure for non-infected persons. The observation in previous Reports that pulmonary tuberculosis is still the most serious major infection with which we have to deal, and that the majority of new cases are between the ages of 15 and 55 so that the working capacity of men and women is very seriously affected over a long time, still, unfortunately, remains a true statement of the position. TUBERCULOSIS 1957 PRIMARY NOTIFICATION OF PULMONARY CASES 25 New Cases and Mortality during 1957 Ages New Cases Deaths Respiratory Non-Respiratory Respiratory Non-Respiratory M. F. M. F. M. F. M. F. 0— 1 2 — — — — — — 1— 8 11 2 — — — — — 5— 3 5 — 4 — — — — 15— 43 31 6 3 — — — — 25— 49 51 3 9 1 4 1 — 35— 40 24 2 3 — — — — 45— 39 15 2 1 6 1 — — 55— 44 12 — 1 2 — — — 65 and upwards 34 8 — 2 11 3 1 1 Total for all ages 261 159 15 23 20 8 2 1 458 31 Rates per 1,000 population— New cases- pulmonary 1.84 non-pulmonary — 0.17 Deaths— pulmonary 0.12 non-pulmonary 0.013 Public Health (Tuberculosis) Regulations, 1952 Although information in regard to the coming and going of tuberculous patients under these Regulations is not as complete as it was under the Tuberculosis Regulations, 1930, every effort is made to confirm the correctness of the Register still maintained in the Department. The total number of cases on the Register of the Department as at 31st December, 1957, was:— Pulmonary— Males 1,551 Females 1,240 Non-Pulmonary—Males 145 Females 172 3,108 The corresponding figures for previous years are:— 1949 2,490 1950 2,368 1951 2,404 1952 2,575 1953 2,802 1954 2,922 1955 2,945 1956 3,048 Islington Chest Clinic, Whittington Hospital Cases on Chest Clinic Registers Number of definite cases of tuberculosis on Chest Clinic Register as at 31st December, 1957 Pulmonary Non-Pulmonary Total Adults Children Adults Children Adults Children M. F. M. F. M. F. M. F. M. F. M. F 1405 1074 97 78 54 91 7 12 1459 1165 104 90 Grand Total 2,818 26 The corresponding figure 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 1956 2,772 Tuberculosis Care Committee. The London County Council is responsible for care work under the National Health Service Act, 1946, but the Islington Tuberculosis Care Committee remains in being, working in conjunction with the Islington Chest Clinic, and Members of the Borough Council and the Medical Officer of Health serve on this Committee. The Tuberculosis Care Committee is able to assist patients in many ways, and the Care Organiser, reports that an average of 118 cases per quarter were helped with extra nourishment during the year, while loans of beds and bedding and medical appliances were made to 18 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. Dr. G. Z. Brett, Physician in Charge of the Unit, has kindly supplied the following information in respect of Islington residents examined during the year:— Men Women Total No. X-Rayed 6,410 8,831 15,241 No. of cases of tuberculosis 70 41 111 Rate per 1,000 10.9 4.6 7.2 In addition, a large number of others who work in the Borough were seen, and arrangements were made for many organised groups of volunteers to attend for examination at the Unit. Bacteriological Examinations All specimens for bacteriological examination dealt with through the Department are submitted to the Public Health Laboratory Service, County Hall, S.E.1. Examinations carried out Total Swabs (Diphtheria) 187 Sputum (Tuberculosis) 34 Faeces (Enteric Fever) 81 Blood (Enteric Fever) — Faeces (Food poisoning) 369 Food (Food poisoning) 1 Faeces (Dysentery) 2,573 Faeces (Poliomyelitis) 138 Swabs (Streptococci) 65 Swabs (Pertussis) 11 Swabs (Influenza) 24 Smears (Variola) 4 Scrapings (Variola) — Other Specimens 25 Total 3,512 (I am indebted to Dr. Wilfrid G. Harding, Divisional Medical Officer, London County Council, for the 1956 figures in connection with vaccination, diphtheria and whooping cough inoculations, and chest clinics). 27 SANITARY CIRCUMSTANCES OF THE AREA SECTION C (In conjunction with Mr. W. C. Bartlett. Chief Public Health Inspector) During the year the Housing Act and the Rent Act, were placed on the Statute Book. Both of these are important measures. In certain cases it is now possible for landlords to increase rents. The Minister stated that the essence of the Rent Act is to put on the Statute Book some practical means of stopping the deterioration of millions of houses throughout the country. As far as this borough is concerned the decrease since last year in the number of complaints received and the number of prosecutions where owners have defaulted in complying with the requirements of the Council is very noticeable. Against that, however, representations in regard to unfit houses and parts of houses have increased considerably. It has been the experience that owners are more willing to spend money on property to bring it up to a satisfactory standard of fitness. Pursuant to the Clean Air Act, 1956, two areas in the borough were the subject of preliminary survey with a view to a subsequent establishment of Smoke Control Areas. It is anticipated that both the areas concerned will be represented to the Minister of Housing and Local Government and, upon approval in principle being received, a detailed survey of the areas will proceed. Consequent upon the implementation of the respective section of the Public Health (London) Act, 1936, and the London County Council (General Powers) Act, 1955, the work carried out by the Council in default, in respect of defective or stopped drains and nuisances requiring urgent attention, has increased considerably during the year. The Council were represented at the Conference of the Royal Society of Health by Councillor Field and the Medical Officer of Health, and at the Conference of the Association of Public Health Inspectors by Councillor E. C. Gough and the Chief Public Health Inspector. The shortage of Public Health Inspectors still continues and it is with difficulty that the department has endeavoured to carry out the numerous statutory duties devolving upon it. Summary of Work done by District Public Health Inspectors. During the year 25,402 inspections or revisits were made by the District Public Health Inspectors. In connection with visits to dwelling-houses, 30,068 inspections or re-inspections of separate lettings were made. Routine Inspections, etc. Houses Inspected (on complaint, etc.) 5,132 do. Separate Lettings in above 9,443 28 Inspections re Schools 5 do. Licensed Premises 117 do. Child Life Protection 4 do. Stables, Manure Pits 6 do. Courts, Mews 3 do. Bombed Sites 179 do. Derelict Buildings 8 do. A.R.P. Shelters, Static Water Tanks 5 Nuisances dealt with by Notice 6,711 do. informally 349 Houses Reinspected 12,601 do. Separate Lettings in above 20,369 Other revisits 1,099 Notices Served—Intimation 2,079 do. Statutory 1,126 Notices Complied with—Intimation 1,923 do. Statutory 1,739 do. By Local Authority in default 59 Requisitioned Properties—Inspected 30 do. Separate Lettings in above 36 do. Reinspected 47 do. Separate Letings in above 53 Land Charges Act, 1925. Enquiries received 2,586 Properties involved 3,646 Investigations 3,646 National Assistance Act (Section 47).—Aged and Infirm Persons Cases investigated 18 Cases revisited 72 (See also Section on Services for Elderly Persons). Miscellaneous. Other Visits or Inspections not specified 1,941 Non-effective Visits 4,005 Total Nuisances and Contraventions Reported (all sources) 7,142 29 *Food & Drugs Act, etc. —Week End (Saturday—Sunday) Duty. Retail Shops and Food Purveyors Inspected 49 Street Markets Visited 81 * See also Section E. Housing Repairs and Rents Act, 1954—Period 1st January, 1957 to 5th July, 1957. Certificates of Disrepair. Section Sections 26 26/27 Applications brought forward from 1956 — 3 Applications in 1957 11 4 Total 11 7 Certificates issued in 1957 10 6 Certificates refused in 1957 1 1 Total 11 7 Appeals Lodged Nil Nil Revocation Certificates. Applications brought forward from 1956 8 4 Applications in 1957 11 8 Total 19 12 Certificates issued in 1957 10 7 Certificates refused in 1957 9 5 Total 19 12 Appeals Lodged Nil Nil Rent Act, 1957—Period 6th July, 1957, to 31st December, 1957. Applications for Certificates of Disrepair (1) Number of applications for certificates 374 (2) Number of decisions not to issue certificates 109 (3) Number of decisions to issue certificates 118 (a) in respect of some but not all defects 96 (b) in respect of all defects 22 30 (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 106 (5) Number of undertakings refused by Local Authority under proviso to paragraph 5 of the Schedule 6 (6) Number of Certificates issued 5 Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 22 (8) Objections by tenants to cancellation of certificates 7 (9) Decisions by Local Authority to cancel in spite of tenants' objection 3 (10) Certificates cancelled by Local Authority 11 Applications by Overseas Companies for Certificates of Repair Applications received 4 Certificates issued Nil Certificates refused 4 Improvements effected as a result of Service of Notices under the Public Health (London) Act. 1. Brickwork—walls repaired or rebuilt 12 2. Drains cleared, repaired, etc. 309 3. Dampness remedied 2,114 4. Fireplaces and ranges repaired/renewed 178 5. Floors repaired 415 6. Flues repaired 122 7. Internal walls repaired 981 8. Ceilings repaired 613 9. Rainwater pipes/gutters repaired 424 10. Roofs repaired 1,254 11. Rooms cleansed 80 12. Sinks provided 23 13. Soil pipes repaired and renewed 58 14. Staircases or passages cleansed 10 15. Staircases repaired 80 16. Waste pipes repaired 238 17. Water Closet Apartments cleansed 19 18. Water Closet Pans and Traps renewed 150 19. Water Closets—flushing apparatus repaired or renewed 134 20. Water Closets—general repairs 294 31 21. Water supply provided 29 22. Water service pipes repaired 92 23. Window cords renewed 1,331 24. Windows repaired or renewed 554 25. Miscellaneous improvements 898 Total 10,412 Total number of houses improved 3,411 Total number of separate lettings improved 3,662 Total number of nuisances abated 9,690 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 £4,471 18s. 6d. 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 2,547 7 8 Public Health (London) Act, 1936, Section 109 735 18 6 London County Council (General Powers) Act, 1955, Section 25 41 2 2 London County Council (General Powers) Act, 1955, Section 26 33 14 3 London County Council (General Powers) Act, 1955, Section 27 1,113 15 11 £4,471 18 6 32 Legal Proceedings. Public Health (London) Act, 1936. Failure to comply with Statutory Notices contrary to Section 82 (No. of cases: 70) Date Address Magistrate's Decision 8.1.57 48 Benwell Road Ordered to abate within 21 days. Defendant to pay £1 14s. 6d. costs. do. 24 Pulteney Street Fined £5. Defendant to pay £1 1s. 0d. costs. do. 23 Belitha Villas Not separately dealt with (see also entry under 12.2.57). do. 7/12 Benwell Mansions, Benwell Road Defendant to pay £1 6s. 0d. costs. do. 24 Camden Dwellings, York Way Fined £5. Ordered to abate within 7 days. Defendant to pay £1 9s. 6d. costs. do. 44 Camden Dwellings, York Wav Fined £5. Ordered to abate within 7 days. Defendant to pay £1 15s. 6d. costs. do. 3 Corporation Street Fined £5. Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. do. 44 Halton Road Fined £5. Defendant to pay £1 1s. 0d. costs. do. 22 Newington Green Adjourned sine die (see also entry under 3.12.57). do. 73 Offord Road Fined £5. Ordered to abate within 21 days. Defendant to pay £1 1s. 0d. costs. 12.2.57 23 Belitha Villas Ordered to abate within 21 days. Defendant to pay 13s. 6d. costs. do. 72 Hungerford Road Defendant to pay £1 6s. 0d. costs. do. 18 Bedford Terrace . Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 42 Hazellville Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 378 Hornsey Road Fined £2. Defendant to pay £1 1s. 0d. costs. do. 6 Instow Place Fined £10. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 11 Instow Place Fined £10. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 27 North Road Defendant to pay £1 6s. 0d. costs. do. 47 Queensland Road Fined £10. Defendant to pay £1 1s. 0d. costs. do. 63 Queensland Road Fined £10. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 100 Queensland Road Fined £10. Defendant to £1 1s. 0d. costs. do. 7 Thornhill Crescent Case withdrawn. do. 1 Witherington Road Fined £10. Ordered to abate within 28 days. Defendant to pay £1 15s. 6d. costs. 12.3.57 75 Cleveland Road Fined £1. Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. do. 42 Halton Road Fined £1. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 46 Highgate Hill Fined £3. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 46 Highgate Hill Not separately dealt with. do. 13 Mildmay Park Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 13 Mildmay Park Not separately dealt with. do. 78 Ockendon Road Fined £5. Order to abate within 14 days. Defendant to pay £1 9s. 6d. costs. do. 23 Parkfield Street Defendant to pay £l 6s. 0d. costs. 9.4.57 20 Alsen Road Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 96 Newington Green Road Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 6 Marriott Road Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 58 Lambton Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 40 Salisbury Road Defendant to pay £1 11s. 0d. costs. do. 3 Queensland Place Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 16 Baxter Road Fined £5. Ordered to abate within 28 days. Defendant to pay £l 15s. 6d. costs. 14.5.57 10 Nicholay Road Fined £10. Defendant to pay £1 1s. 0d. costs do. 152 Liverpool Road Fined £10. Ordered to abate within 21 days. Defendant to pay £1 9s. 6d. costs. do. 152 Liverpool Road Not separately dealt with. do. 18 Barnsbury Road Fined £10. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. 33 Failure to comply with Statutory Notices contrary to Section 82 (No. of cases: 70).—contd. Date Address Magistrate's Decision 11.6.57 19 Pooles Park Case withdrawn on payment of disbursements. do. 13 Moon Street Fined £5. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 40 Freeling Street Fined £5. Defendant to pay £1 1s. 0d. costs. 9.7.57 231 New North Road Defendant to pay 14s. 6s. costs. do. 7 Furlong Road Defendant to pay £1 1s. 0d. costs. do. 12 Lennox Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs do. 4 Lennox Road Ordered to abate within 28 days. Defendant to pay £l 14s. 6d. costs. do. 56 Fonthill Road Case withdrawn (see entry for 30.7.57). do. 54 Grosvenor Avenue Ordered to abate within 7 days. Defendant to pay 11s. 6d. costs. 30.7.57 56 Fonthill Road Ordered to abate within 28 days. Defendant to pay £1 14s. 6d. costs. do. 38 Fonthill Road Fined £10. Ordered to abate within 28 days. Defendant to pay £1 9s. 6d. costs. do. 17 Oldershaw Road Fined £2. Defendant to pay £1 1s. 0d. costs. do. 25 Enkel Street Fined £2. Defendant to pay £1 1s. 0d. costs. 3.9.57 150 Offord Road Fined £5. Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. 17.9.57 28 Athelstane Road Fined £l. Defendant to pay £1 1s. 0d. costs. do. 49 Hanley Road Absolute discharge. Defendant to pay £1 1s. 0d. costs. 8.10.57 60 Grenville Road Fined £3. Ordered to abate within 14 days. Defendant to pay £1 9s. 6d. costs. do. 80 Drayton Park Fined £3. Defendant to pay £1 1s. 0d. costs. do. 11 Aberdeen Road Ordered to abate within 56 days. Defendant to pay 13s. 6d. costs. 22.10.57 23 Parkfield Street Withdrawn. do. 8 Eddington Street Withdrawn. 87 Benwell Road Withdrawn. 26.10.57 369 Liverpool Road Ordered to abate within 14 days. Defendant to pay £2 2s. 0d. costs. 5.11.57 1 Yonge Park Ordered abatement within 14 days. Defendant to pay £1 9s. 6d. costs. do. 1 Yonge Park Not separately dealt with. do. 18 Almington Street Fined £10. Defendant to pay £1 1s. 0d. costs. 3.12.57 22 Newington Green Dismissed. do. 7 Rees Street Defendant to pay £1 6s. 0d. costs. Failure to comply with Magistrate's Abatement Order—(N.o. of cases: 14) Date Address Magistrate's Decision 8.1.57 11 Oakley Road Fined £5. Defendant to pay £1 1s. 0d. costs. 12.2.57 42 Camden Dwellings, York Way Fined £5. Defendant to pay £1 1s. 0d. costs. do. 7 Barnsbury Square Fined £25. Defendant to pay £1 1s. 0d. costs (see next table for second offence). do. 21 Crown Mansions, Liverpool Road Fined £15. Defendant to pay £1 1s. 0d. costs. do. 3/4 Corporation Street Ordered to abate within 14 days. Defendant to pay £1 14s. 6d. costs (see also details of appeal given on next page). do. 39 Gibson Square Absolute discharge. do. 89 Queensland Road Fined £25. Defendant to pay £1 1s. 0d. costs. do. 216 York Way Fined £10. Defendant to pay £1 1s. 0d. costs. do. 218 York Way Fined £10. Defendant to pay £1 1s. 0d. costs. 12.3.57 16 Northampton Grove Fined £10. Defendant to pay £1 1s. 0d. costs. 9.7.57 16 Rees Street Fined £11 15s. Od. Defendant to pay £1 1s. 0d. costs. 17.9.57 96 Newington Green Road Fined £25. Defendant to pay £1 1s. 0d. costs. 19.11.57 12 Lennox Road Fined £2. Defendant to pay £1 1s. 0d. costs. do. 4 Lennox Road Fined £2. Defendant to pay £1 1s. 0d. costs. Failure to comply a second time with Magistrate's Abatement Order—(No. of cases: 1) Date Address Magistrate's Decision 11.6.57 7 Barnsbury Square Fined £50. Defendant to pay £1 1s. 0d. costs. 34 Appeal against Magistrate's Decision to Quarter Sessions—(Ho. of cases: 1) Date Address Magistrate's Decision 7.3.57 3 and 3/4 Corporation Street Appeal dismissed. Defendant to pay £15 15s. 0d. costs. Appeal against Notice served under Section 40 of the Public Health (London) Act, 1936, as amended by the L.C.C. (General Powers) Act. 1951—(No. of cases: 1) Date Address Magistrate's Decision 18.2.57 19 Barnsbury Park Appeal dismissed. Disinfection and Disinfestation (a) General Whilst it is the experience of the Department that vermin infestation is decreasing, the public are becoming more conscious of other insect pests and the advice of the Inspectors is often sought to identify the insect in question and to help in its eradication. Disinfection of wards in a number of hospitals continued. 816 rooms were disinfected after cases of infectious or other disease. A total of 717 rooms were treated for vermin, of which 286 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/d. for every additional room treated for verminous conditions. The effects of 118 families were treated with D.D.T. as a precautionary measure. In addition, one static water tank was treated for fly infestation. The Public Health Inspector paid 55 visits to a factory to supervise the treatment of 377 bales of stockings or other materials for export. The total weight of bales treated was 155 tons 1 cwt. 0 qrs. 19 lbs. (b) Steam Disinfection 3,700 articles of clothing or bedding were subjected to steam disinfection. (c) Fly and Other Infestations Anti-fly treatment at Ashburton Grove Depot commenced on 30th April and continued during the summer months. Complaints continued to be received concerning wasps nests and the disinfestation staff dealt with a number of cases during the year. The infestation of the Council's housing estates by red clover mite increased during the year and appropriate action was taken to keep this to a minimum. Static water tanks, air-raid shelters, bombed sites, etc. Complaints continued to be received in relation to the tipping of refuse, accumulation of water and other nuisances occurring in static water tanks and on bombed or vacant sites in the borough. By arrangement with the Council's Cleansing Superintendent putrescible matter was removed by his department upon Atmospheric Pollution. Public Health Inspector demonstrates efficient firing of Boiler Furnaces to stokers. Measuring Atmospheric Pollution by Smoke Filter and Volumetric Sulphur Dioxide Apparatus. Reproduced by permission of the North Thames Gas Board 35 receipt of a request from the Public Health Inspector. The co-operation of the London Fire Brigade in pumping out stagnant water from water tanks where requested is appreciated. In certain cases warning notices can be displayed under the War Damage Sites Act, 1949, drawing the attention of the public to the fact that depositing of rubbish is an offence. Visits to bombed sites 179 Visits to air-raid shelters and static water tanks 5 Inspection of derelict buildings 8 Derelict buildings enclosed 1 Vacant land cleansed 24 Vacant land enclosed 3 Static water tanks cleansed 4 War Damage Sites Act 1949, Notices displayed 1 Atmospheric Pollution. Public Health (London) Act, 1936—Part V. Clean Air Act, 1956. Certain sections of the Clean Air Act, 1956, came into operation on 31st December last year and consideration was given to the making of Smoke Control Areas. Upon the preliminary surveys being completed, the Public Health Committee agreed to recommend to the Council that the Minister of Housing and Local Government be approached for approval in principle to the making of two Smoke Control Areas in the borough. It is anticipated that the proposals will be forwarded to the Minister early next year. In the memorandum on Smoke Control Areas issued by the Minister the implications and procedure relating to such areas are very fully explained. In premises to which Smoke Control Orders apply it will be necessary for stool bottom grates and the solid fuel appliances in which smokeless fuel cannot be burned satisfactorily to be altered or replaced. In private dwellings other than new dwellings, the greater part of the cost of the adaptations will be borne by the local authority and the Exchequer. In addition to the requirements relating to Smoke Control Areas other provisions, including those relating to smoke from furnaces, the extension of the Alkali and Works Regulations Act, 1906, to cover the emission of smoke, grit and dust from premises controlled or to be controlled under that Act, colliery spoil banks and the constitution of the Clean Air Council also came into operation on the 31st December, 1957. The Standing Conference of Co-operating Bodies for investigating atmospheric pollution met on two occasions during the year. During the year two petitions were received in respect of smoke nuisance from a factory, which affected tenants of one of the Council's Housing estates. Upon investigation and obtaining the co-operation of the Company concerned, the nuisance from smoke ceased. Over a considerable period complaints were received regarding the emission of smoke from a laundry in the borough and although the management was most co-operative the nuisance persisted. The company, at considerable expense, has now demolished the chimney stack and installed modern oil-fired furnaces, and no complaints have since been received and no nuisance observed. The practice of sending letters to the owners of diesel engined lorries in cases where dense smoke was emitted whilst the vehicle passed through the Borough was continued. It is of some interest that 35 such letters were sent during the year and in no single instance has the statement made by this Department as to smoke 36 emission been contested and, in fact, those responsible have been most co-operative in taking action to remedy defects in their vehicles. Number of complaints received during year 42 Number of observations 290 Number of inspections and re-visits 308 Number of notices served 6 Number of notices complied with 9 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 (Tons Soluble Deposit per square Total Solids mile) Mg.of SO3/day collected by 100 sq. cm. of Batch A Lead-Peroxide. (Louvered Box) January 1 1.22 9.04 7.95 16.99 4.22 ,, 2 1.46 15.07 9.74 24.81 4.12 ,, 3 1.50 9.94 6.46 16.40 3.07 February 1 2.68 7.09 5.33 12.42 5.35 ,, 2 2.88 14.51 7.48 21.99 4.73 ,, 3 2.84 10.40 5.53 15.93 3.68 March 1 0.91 10.83 8.58 19.41 3.63 ,, 2 1.02 16.59 11.82 28.41 3.74 ,, 3 1.02 14.18 9.27 23.45 2.33 April 1 0.16 5.76 3.51 9.27 2.33 ,, 2 0.16 9.57 3.31 12.88 2.30 ,, 3 0.20 9.27 2.68 11.95 1.65 May 1 1.42 9.17 3.31 12.48 1.79 ,, 2 1.50 13.65 4.80 18.45 1.88 ,, 3 1.18 12.92 4.83 17.75 0.83 June 1 0.55 6.46 3.05 9.51 1.28 ,, 2 0.51 16.79 2.45 19.24 1.28 ,, 3 0.63 9.37 2.39 11.76 0.71 July 1 3.03 7.45 5.90 13.35 1.20 ,, 2 3.15 15.63 12.59 28.22 1.50 ,, 3 4.22 10.60 6.79 17.39 0.63 August 1 1.93 6.59 3.74 10.33 1.50 ,, 2 2.05 18.02 7.88 25.90 1.74 ,, 3 2.09 8.48 4.77 13.25 0.67 September 1 2.09 7.19 4.20 11.39 1.94 ,, 2 2 25 15.30 7 29 22 59 2.11 ,, 3 2.60 10.14 4.80 14.94 0.94 October 1 1.81 9.44 9.07 18.51 3.65 ,, 2 1.93 15.13 8.15 23.28 3.20 ,, 3 1.85 7.95 8.11 16.06 1.77 November 1 2.05 10.13 6.03 16.16 4.11 ,, 2 2.28 13.51 7.22 20.73 3.75 ,, 3 2.36 8.68 5.56 14.24 2.79 December 1 1.54 11.72 9.51 21.23 6.08 ,, 2 1.58 14.61 8.71 23.32 5.73 ,, 3 1.73 10.66 4.67 15.33 3.74 * These sites are situated at the following places in the Borough:— 1.—Town Hall roof. 2.—York Way Court (Caledonian Road area). 3.—Disinfecting Station at Seven Sisters Road. 37 In addition to the deposit gauges and lead peroxide candles which are sited at three positions in the Borough, the results from which are recorded monthly as shown in the above table, the Council has installed volumetric apparatus at the Town Hall and the Disinfecting Station, Seven Sisters Road, respectively.The concentration of smoke and sulphur-dioxide in the atmosphere is recorded daily and such information is not only advantageous locally, but the daily findings are forwarded to the Fuel Research Station for collation and comparison with other Metropolitan Boroughs, in order that an overall picture may be obtained for the whole of London. The measurement of smoke and sulphur-dioxide, respectively, is given in the following table. It will be seen that the highest recordings were obtained in December, this being due to the dense fog which occurred during the 2nd to 5th of that month. At one time during this period visibility at Kew was down to 12 yards. It is interesting to note, however, that during the four days in question very light winds were present. 38 Concentration of Smoke and Sulphur Dioxide recorded by the Volumetric Method at the two stations in the Borough Station Jan. Feb. Mar. April May June July August Sept. Oct. Nov. Dec. SMOKE. (Milligrams per 100 cubic metres.) Public Health Office, Town Hall. Monthly average 28.0 33.7 27.0 13.0 7.7 4.6 3.9 7.5 7.0 25.9 23.9 43.6 Highest daily average 77.0 86.0 71.0 42.0 32.0 19.0 9.0 35.0 22.0 81.0 77.0 289.0 Shelter House Disinfecting Station. Monthly average 27.8 37.5 27.4 16.5 7.9 4.4 3.8 7.4 7.7 27.2 29.0 44.3 Highest daily average 76.0 84.0 66.0 62.0 28.0 15.0 16.0 30.0 20.0 82.0 70.0 253.0 SULPHUR DIOXIDE (Parts per 100 million parts of air). Public Health Office, Town Hall. Monthly average 9.2 12.7 11.0 5.5 4.5 3.6 2.8 3.5 4.2 10.3 10.1 18.7 Highest daily average 16.0 29.0 30.0 19.0 11.1 9.2 7.8 10.2 8.7 24.4 27.9 100.7 Shelter House Disinfecting Station. Monthly average 8.3 11.7 9.5 5.5 4.0 2.8 2.3 3.0 3.5 8.7 9.3 14.5 Highest daily average 15.4 25.4 23.4 24.0 10.2 8.0 5.3 9.3 7.9 19.4 26.1 75.4 39 Requisitioned Properties. The number of requisitioned properties on 1st January, 1957 was 607. 107 (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. 59 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 3,669 re-visits were made by the Inspectors. These are summarised as follows:— Inspections Revisits Coffee and dining rooms, hotel and restaurant kitchens and refreshment rooms 1,016 493 Stalls (Refreshment and Food) 88 19 Factories (Mechanical) 911 1,258 Factories (Non-mechanical) 94 116 Factories (Public Health (London) Act, 1936) 736 991 Fish curers 26 60 Fishmongers 20 9 Fried Fish Shops 50 93 Noise Nuisances 79 152 Outworkers 107 91 Provision Shops 325 102 Bakehouses (Level) 48 84 Confectioners 122 34 Fruiterers/Greengrocers 199 63 Preserved food premises 409 164 4,230 3,669 (See separate section for underground bakehouses and offensive trades.) Nuisances or contraventions found and complaints received. Nuisances and Notices. (a) Factories Act, 1937. Number of complaints received—all sources 81 Number of contraventions found 1,226 Number of contraventions remedied 1,232 Notices served 298 Notices complied with 240 (b) Food and Drugs Act, 1938. Number of complaints received 33 Number of contraventions found 1,362 Number of contraventions remedied 814 Notices served 323 Notices complied with 208 (c) Public Health (London) Act, 1936. Number of complaints received 228 Number of nuisances or contraventions found 749 Number of nuisances or contraventions remedied 969 Notices served 265 Notices complied with 247 40 (d) Shops Act, 1950. Number of complaints received 38 Number of inspections under this Act 55 Number of revisits 60 Number of exemption certificates applied for 3 Number of certificates granted Factories Act, 1937. Prescribed particulars on the administration of the Factories Act, 1937. 1.—Inspections for the purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 237 94 35 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 1,851 910 262 - (iii) Other Premises in which Section 7 is enforced by the Local Authority* (excluding out-workers' premises) 16 1 1 — Total 2,104 1,005 298 — 2.—Cases in which Detects were round. 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) 29 9 5 1 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 8 — — — — Ineffective drainage of floors (S.6) 1 — — — — Sanitary Conveniences (S.7)— (a) Insufficient 16 5 — — — (b) Unsuitable or defective 1,154 1,207 1 27 — (c) Not separate for sexes 8 3 — 3 — Other offences against the Act (not including offences relating to Outwork) 10 6 5 1 — Total 1,226 1,230 11 32 - * i.e. Electrical Stations (Section 103 (1)), Institutions (Section 104) and sites of Building Operations and Works of Engineering Construction (Sections 107 and 108). 41 Outwork. (Sections 110 and 111). Nature of Work Section 110 Section 111 No. of outworkers in August list required by Sec. 110(l) (c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwhole- some premises Notices served Prosecutions (1) (3) (4) (5) (6) (7) (8) Wearing apparel Making, etc. Cleaning and washing 626 — — — — — Making of files 2 — — — — - Brass and brass articles 3 — — — — - Fur pulling 4 — — — — - Umbrellas, etc 4 — — — — - Artificial flowers 57 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 43 - - - - - Brush making 19 — — — — - Feather sorting 8 — — — — - Carding, etc., of buttons etc. 27 - - - - - Stuffed toys 61 — — — — - Cosaques, Christmas crackers, Christmas stockings, etc. 19 - - - - - Lampshades 37 — — — — - Basket making 1 - - - - - Total 911 - - — - - 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. * The use of these bakehouses was discontinued during the year. Details of the work carried out under this section are as follows :— Number of routine inspections 23 Number of revisits 62 Number of notices served 8 Number of notices complied with 8 42 Public Health (London Act, 1936. London County Council (General Powers) Act, 1937 Noise Nuisances Complaints of noise nuisances are on the increase. A petition was received regarding the noise from a sawmill in the borough and upon the Inspector interviewing the Company's representative, and obtaining his co-operation, the factory wall was lined and the machine in question surrounded by 1,350 square feet of acoustic tiling. This has resulted in keeping the noise nuisance to a minimum. Investigations have often to be made into complaints from power machines operated in domestic premises after normal working hours and during weekends. An endeavour is made to get the machines sited on rubber pads near to an outside wall and the owners to operate them within reasonable hours. 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 35 Number of inspections 79 Number of revisits 152 Number of Notices served 2 Number of Notices complied with ... Public Health (London) Act, 1936, Section 121. Pigeon Nuisances. During the year several complaints were received concerning nuisances caused by ownerless pigeons. The Council, in implementing the powers given under this Section, engaged an authorised pigeon catcher who dealt with a large number of these birds which congregated in a square and also in two schools, causing nuisance or annoyance to the occupants or residents in the vicinity. 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 fe? Co. Ltd. (c) 1 Fur S\in Dresser: 24, Bracey Street—Messrs. J. 6? A. Fischer Ltd. (d) 6 Gut Scrapers: 3, Old Slaughterhouses—Casings 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 & Son Ltd. Tileyard Road—Messrs. Tracey & Co. Ltd. (e) 1 Fat Melter: 16, Old Slaughterhouses—Messrs. Wm. Menzies Ltd. 46 inspections and 53 revisits were made at the above premises and appropriate action taken where necessary. 43 (f) 1 Slaughterer: 180, York Way—Messrs. Harrison Barber & Co. Ltd. This slaughterhouse was the subject of 175 inspections or visits. (g) The Council approved the issue of a licence under Section 145 in respect of the receiving of carcasses of dead horses for human consumption at: — 14/16, Vale Royal—Messrs. Harrison, Barber & Co. Ltd. Shops Act, 1950—Applications for Exemption. There were 3 applications received for exemption from the provisions of Section 38 relative to the provision of suitable and sufficient sanitary conveniences, all of which were granted Pharmacy and Poisons Acts, 1933/1941, Number of Listed sellers of Part II Poisons other than registered pharmacists 188 Number of initial registrations during the year 7 Number of visits and inspections 49 Number of samples taken 5 Number of samples reported satisfactory 5 Diseases of Animals Acts, 1894-1927. Anthrax Order, 1938. During one week-end early in the year information was received to the effect that a cow which had been slaughtered outside this area and had been conveyed to a knacker's yard in the borough had been in contact with another carcase, both being suspect cases of anthrax. The London County Council Inspector, who is the officer authorised to deal with such cases, visited the knacker's yard and issued a Notice under the Anthrax Order declaring and defining the slaughterhouse as an infected place. The suspect carcase was destroyed and after full disinfection was carried out the Notice was withdrawn. In the case of the second cow, which did not come into Islington, anthrax was confirmed but in the case of the one conveyed to the knacker's yard an indeterminate result was obtained, owing to penicillin treatment during the life of the animal. Later the same month information was received that a Jersey cow hide consigned to a hide market in the borough was possibly anthrax infected. The London County Council Inspector was informed and issued the usual Notice under the Anthrax Order, 1938. After identification of the probably infected hide this was seized, together with two others in contact with it, and removed for destruction. 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 26 Number of inspections and revisits 76 Heating Appliances (Fireguards) Act, 1952. Number of inspections 49 Number of revisits 8 44 London County Council (General Powers) Act, 1954. Hairdressers and Barbers. At the end of the year, 161 premises were registered. Details relating to the same are as follows :— Number of Gentlemen's Hairdressers 78 Number of Ladies' Hairdressers 62 Number of Ladies' and Gentlemen's Hairdressers 16 Number of premises where hairdressing ceased 5 Number of Establishments situated in basements 2 Number of Establishments situated in dwelling houses 3 Number of Establishments where no assistants are employed 47 Number of inspections carried out 200 Number of re-visits 147 Prevention of Damage by Pests Act, 1949. (a) General. The following is a summary of the work carried out during the year. Notices Served : 12 Intimations and 8 Statutory Notices. Type of Property Local Authority Premises Dwelling Houses Business Premises TOTAL 1. Complaints received (including repeats) 32 1,161 153 1,346 2. Number of properties inspected as a result of : (a) Notification (initial complaint only) (a) 25 998 129 1,152 (b) Block Survey *(b)193 512 50 755 3. Number of properties found to be infested by rats (nil by ship rats) 17 624 76 717 4. Number of properties found to be infested by mice 4 413 44 461 5. Re-visits by Investigators *1,015 3,445 44 4,504 6. Non-effective visits by Investigators 2 976 3 981 7. Number of infested properties treated (new jobs commenced) *535 1,000 101 1,636 8. Continuation or post-bait treatment — *624 2,992 360 3,976 9. Visits by Operators *3,358 11,334 806 15,498 10. Still being baited at end of year 2 39 10 51 11. Completed during the year *1,086 2,116 151 3,353 12. Number of Business Agreements dealt with : 72. 13. Members of the Rodent Staff assisted during the application of smoke machine in respect of 156 drainage tests carried out by Public Health Inspectors. * Includes sewer maintenance treatments 25/26 (1,372 manholes). NOTE :—For the purpose of completing Sections 2, J, 4 and 7, each property is entered once only in respect of inspections, infestations and treatments. There has been a slight decrease in the number of complaints received regarding rats and the number of properties found to be infested. For the second year there has been no infestation of ship rat recorded. 45 It is interesting to note that 68 infestations were traced to defective house drains and 10 infestations to unsealed disused drains. The bringing of an infestation to a satisfactory conclusion often presents considerable difficulty. The Inspectors and the Rodent Control Staff are trained in modern methods of tracing and ridding premises of rodents. The presence of disused and obsolete drains cause considerable difficulty and result in much time being spent in order to find the source of infestation. At one particular address what appeared to be a Mason's dipstone trap was exposed and upon this being removed and the drain repaired, no further trouble has been experienced. In two other cases large rat holes appeared in the lawns of housing estates. After smoke testing two unsealed disused drains were found to be connected to the sewer. Upon these being sealed off, the infestation ceased. The Public Health Inspector and the Rodent Officer carried out the usual quarterly inspection of four hospitals in the borough and the Hospital Management Committee was informed of any matter requiring attention. One of these hosiptals, however, closed during the year under review. Representatives of the Department attended three meetings of the Workable Area Committee. The Council, having given the Rodent Officer facilities to attend a three year course, this Officer passed the final examination of the City and Guilds of London Institute in Pest Control this year. The Co-operation of the Borough Engineer, who has made available the services of his sewer, highways and drainage staff on numerous occasions is appreciated. (b) Prosecutions. Failure to give the local authority forthwith notice in writing that rats were living on or resorting to land in substantial numbers contrary to Section 3:— Date Address Magistrate's Decision 22nd October, 1957 89 Upper Street Fined £5 (c) Sewer Treatments. Two sewer maintenance 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. and date Manholes Baited Showing Complete Takes Showing pre-bait Takes Showing No Takes 25 lst/9th April, 1957 666 313 525 141 26 14th/15th Oct., 1957 650 302 468 182 Water Supplies. (a) 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. 46 Public Health (London) Act, 1936—Section 95. (1) Water supplies to tenement houses. 22 notices were served under this section requiring the provision of water supplies to tenement houses. 29 water supplies were provided. (2) 31 applications were received for water certificates, and 34 certificates which included some in respect of applications received last year were issued in respect of 326 separate dwellings. (b) Well Water. As a result of the annual examination of known underground water supplies in the borough, it was found that 19 of the 28 boreholes and wells continued to be unused and were effectively sealed. 5 of the remaining wells were found to be out of use. During the year 20 samples of water were taken, 9 for chemical and 11 for bacteriological examination. 4 of the bacteriological samples were unsatisfactory and the chemical analyses indicated that the water could not be regarded as free from pollution. The water from these wells, however, is used only for industrial purposes. (c) Water Samples—Miscellaneous. One sample of sub-soil water was taken. (d) Swimming Bath Water. The number of samples of swimming bath water taken during the year is as follows :— Satisfactory Unsatisfactory Chemical Bacteriological Chemical Bacteriological Chemical Bacteriological — 35 — 35 — — SECTION D HOUSING (In conjunction with Mr. W. C. Bartlett, Chief Public Health Inspector.) During the year under review a number of areas in the borough were redeveloped and the erection of houses and flats proceeded. For some time to come the numerous individual unfit houses and parts of houses will require attention and appropriate repair, closure or demolition action to be taken. It is a fact that there are still many thousands of underground rooms which do not come up to the requisite standard. Both the County and the Borough Councils have continued to clear areas of unfit houses where possible and in this connection Orders were confirmed by the Minister of Housing and Local Government during the year in relation to the following areas :— Metropolitan Borough of Islington, Dibden Street Clearance Area 5 houses. Metropolitan Borough of Islington, Pickering Street Clearance Area 5 houses. Metropolitan Borough of Islington, Pierrepont Row Clearance Area 6 houses. In addition the following were represented under Part III of the Housing Act, 1957, for clearance, viz : 13, 15, 17, 19, 21, 23, 25, 27, 29, 31 and 33 Provence Street. 1, 2, 3, 4, 5, 6, 7, 8,9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19 and 20 Dillon Place. Part of Whadcoat Street Slum Clearance Area. Haden Court: Flats built on Whadcoat Street Site. 47 The number of flats and houses erected during the year is :— Borough Council 134 London County Council 170 Private enterprise 42 The number of municipal flats and houses erected since the war is :— Borough Council 2,840 London County Council 2,630 The total dwellings in the borough at the end of the year numbered 44,028. The Rent Act, which came into operation on 6th July this year, freed from rent control houses and flats above certain levels of rateable value and allowed limited increases in the rents of houses and flats still under rent control. It is anticipated that owners will be more ready to repair their properties with a view to obtaining the rent increases and thus improve the living conditions of their tenants. This is a landlord and tenant Act and the Council is required, upon application being submitted, together with the appropriate fee and subject to the necessary procedure being complied with, to issue or revoke certificates of disrepair under this statute and details of these cases are given on page 29-30. The Housing Act, 1957, which came into operation on 1st September this year is a consolidating statute. It simplifies and consolidates various housing enactments of recent years. It has repealed and substantially re-enacted the Housing Act, 1936, together with many provisions of subsequent housing legislation, including in particular the Housing Act, 1949, the Housing Repairs and Rents Act, 1954, and the Slum Clearance (Compensation) Act, 1956. The effect of the decision of the Court of Appeal delivered in May this year in relation to Section 18 of the Housing Act, 1957, remains to be seen. The appeal was heard concerning action taken by another Metropolitan Borough Council under Section 12 of the preceding Act and the Court of Appeal held that for the making of a Closing Order in respect of part of a building the local authority shall, in considering whether the part of a building in quest ion is fit for human habitation, have regard to the matters set out in Section 9(1) of the Housing Repairs and Rents Act, 1954—now Section 4 of the Housing Act, 1957. It would appear that no regard is to be had in future to regulations made by a local authority. Consequent upon the Borough or County Council, sanctioning improvement grants in respect of a number of flats on at least two estates considerable work was carried out, the improvements including the enlargement of the flats in certain cases and the provision of bathroom and other modern amenities. Prosecutions. Housing Repairs and Rent Act, 1954. Failure to comply with notices served under section 11(1). Date Address Magistrate's decision 25.2.57 216 York Way Fined £5. Defendant to pay £5 5s. 0d. costs. 25.2.57 218 York Way Fined £5. Defendant to pay £5 5s. 0d. costs. 22.10.57 216 York Way Fined £25. Defendant to pay £10 10s. 0d. costs. 22.10.57 218 York Way Fined £25. Defendant to pay £10 10s. 0d. costs. 48 Notifications are received from the Government of Malta where immigrants propose to take up residence in this country. Eight applications were received during the year in respect of 19 persons comprising 4 men, 4 women and 11 children. One of these applications was approved, one cancelled, one was not recommended but referred to the L.C.C. for final decision as the address was under the jurisdiction of that Council, and one was outstanding at end of year. The 1 approved application included 1 man, 1 woman arrd 4 children. Re-housing. Number of dwellings erected by this Council during year 134 Number of dwellings in the course of erection at end of year by this Council 538 Number of new applications (L.C.C.) referred to this Department during year 109 Number of above families in respect of whom overcrowding forms have been issued 28 Number of above families not living in overcrowded conditions 10 Number of overcrowded families re-housed by the Islington Borough Council during the year 161 Number of overcrowded families re-housed by the London County Council during the year 7 In addition, 49 families have been re-housed by the Borough Council and 140 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 letters sent concerning housing conditions during the year 452 Housing Act, 1936 and Housing Act, 1957. Housing Consolidated Regulations 1925/32. During the year the following action was taken under the Housing Act, 1936 and Housing Act, 1957 :— Section 9. Number Houses rendered fit after service of formal notices 2 Section 11, Housing Act, 1936 and Section 16, Housing Act, 1957. Houses which on inspection were considered to be unfit for human habitation 222 Houses represented 66 49 Section 11, Housing Act, 1936 and Section 17, Housing Act, 1957. Number Demolition Orders made — Closing Orders—Section 11, Housing Act, 1936, as amended by the Local Government (Miscellaneous Provisions) Act, 1953 and Section 17, Housing Act, 1957 30 Section 11, Housing Act, 1936 and Section 16, Housing Act, 1957. Premises Houses in respect which an Undertaking was accepted Section 11, Housing Act, 1936 and Section 17, Housing Act, 1957. Houses demolished 11 Section 12, Housing Act, 1936 and Section 18, Housing Act, 1957. Representations made with a view to the making of Closing Orders :— (a) underground rooms 54 (b) parts of buildings 6 Closing Orders made :— (a) underground rooms 69 (b) parts of buildings 6 Undertakings accepted 1 Section 12, Housing Act, 1936 and Section 27, Housing Act, 1957. Closing Orders determined or part determined upon the completion of necessary work 30 Section 12, Housing Act, 1936 and Section 18, Housing Act, 1957. Undertakings cancelled or part cancelled upon the completion of necessary work 7 Sections 11 &. 12, Housing Repairs and Rents Act, 1954 and Section 36 & 90, Housing Act, 1957. Houses let in lodgings :— (a) Houses made fit for occupation by number of families accommodated — (b) Overcrowding abated — Licences authorising temporary overcrowding. One licence was granted under Section 61 of the Housing Act, 1936, authorising overcrowding for a period of six months. Town and Country Planning (Housing Accommodation) Direction, 1952. In accordance with this Direction the Council is consulted by the London County Council before consideration is given to applications received for a change of user from a dwelling to another purpose. In this connection 18 investigations were carried out by this Department. 50 SECTION E SUPERVISION OF FOOD (in conjunction with Mr. W. C. Bartlett, Chief Public Health Inspector) Included in the legislation which came into operation this year are the following :— Public Analyst Regulations, 1957—these revoke and supersede the Regulations made in 1939 and control the appointment of a Public Analyst and the form of certificate to be given by him pursuant to Section 92 of the Food and Drugs Act, 1955. The Colouring Matter in Food Regulations, 1957, which revoke and re-enact, with modifications, the provisions of the Public Health (Preservatives, etc., in Food) Regulations, 1925-53, relating to colouring matter in food, comes into full effect by stages. The Regulations prescribe a list of permitted food colours. They prohibit the importation and sale of food containing colouring matter not on the permitted list and, subject to an exception in the case of citrus fruit, if the fruit is clearly marked on the skin with the words " colour added," the addition of colouring matter to certain natural foods sold in a raw and unprocessed state. Colouring matter and colouring and flavouring compounds sold for use in food are subject to special labelling requirements. The Food Hygiene (Amendment) Regulations, 1957—these provide that after 1st June, 1958, the giving out of shrimps and prawns and onions for peeling on domestic premises shall be permitted if the premises are registered with the local authority for the preparation of the food in question and certain other requirements are complied with. These include :— 1. A periodic check by the person giving out the food that proper standards can be maintained. 2. The cleanliness of equipment and premises. 3. The provision of water supply and wash hand basin. 4. The protection of food from risk of contamination. 5. The observance of cleanly practices by the persons engaged. In addition to the above the following were issued during the year :— Circular FSH 3/57 by the Ministry of Agriculture, Fisheries and Food making certain amendments to Memo 3/Meat in relation to post mortem examination for the detection of cysticercus bovis. Circular FSH 6/57 issued by the Ministry of Agriculture, Fisheries and Food setting out the recommended minimum standards of construction, layout and equipment for slaughterhouses. Advisory Note No. 11 issued by the Department of Scientific and Industrial Research on the Control of Flies in Fishmongers' Shops is a most useful and practical publication, giving information on the various flies which are attracted to fishmongers'' shops and the control measures which should be taken both inside and outside the premises. Particular mention may be made of the recommendation to scrub out fish boxes with a detergent solution as soon as they are empty, rinse with a hypochloride solution, stack on end and allow to dry. Empty boxes should be disposed of as soon as possible. It is strongly recommended that at each shop one person should be made responsible for all control measures. In this connection the Inspectors of this department are always ready to give shopkeepers every assistance and advice in getting rid of this most undesirable pest. Hygienic Display of Food. 51 The inspection of food undertakings continued and the food prepared, manufactured, stored or sold was subject to routine inspection and sampling. With certain exceptions the standard of hygiene, both in relation to food premises and food handling, is improving. An increasing number of those responsible for food undertakings have responded to the requirements of the Food Hygiene Regulations and seek to comply voluntarily not only with the Regulations but to maintain standards higher than those which can be enforced by statute. The Inspectors, when inspecting food premises, endeavour to bring home to the management and assistants not only the requirements of the Regulations but the reason why such Regulations were made. The talks on the spot are appreciated in the majority of cases and are supplemented by pamphlets and other helpful printed material at the time of the Inspector's visit. There are of course others who are not so co-operative and whose standards fall far short of the Regulation requirements. Prosecutions have had to be taken and in one case the Magistrate visited the premises on two occasions before giving his decision. A temporary improvement resulted but was not maintained. It was, therefore, necessary to issue further summonses. Owing to the deplorable conditions existing at this address an Order disqualifying the proprietor from using the premises for six months was obtained, in addition to a number of convictions in relation to other offences. The proprietor appealed against the foregoing decisions but his appeal was dismissed. In another case information was received in respect of premises used for the sale of meat and possibly for illicit slaughtering and it was necessary for two Inspectors to keep the premises under observation from about midnight until 6 a.m. The proprietor, upon being interviewed, afforded the Inspectors every facility and apart from the fact that meat had been seen stored on benches in the open yard at the rear and one or two contraventions of the Food Hygiene Regulations were found, there was nothing to which exception could be taken. These particular premises were being used temporarily and their use was discontinued shortly afterwards. An interesting case occurred during the year when a general practitioner in the Borough reported on the breakage of a fluorescent lighting tube in a canteen kitchen at a local works and enquired as to the possible harmful contamination of exposed food. The food preparation room concerned was thoroughly cleansed and none of the works personnel suffered any ill effects from consumption of food which may have been affected. Enquiries were made, however, of leading electrical manufacturers regarding the possible presence of deleterious materials in fluorescent elements and information was obtained that beryllium has not been used in the manufacture of such elements since 1947. In a 5 ft. 80 watt tube there would be approximately 5 grammes of powder made up mainly of calcium halophosphate with about 1% antimony as an activator. The opinion was expressed that the danger from a broken tube would not lie in the chemicals released but in the fragments of broken glass. The danger from chemicals used would be at its highest at the place of manufacture, or at the site where faulty tubes are destroyed ; even this risk, however, was stated to be extremely small. When persons were seen to be smoking whilst engaged in a food room where there is open food the Inspector gave a verbal warning of the contravention. These warnings were followed up by written confirmation. The persons concerned expressed regret in each case and from subsequent observations the warnings appear to have the desired effect. 52 During a night duty carried out by two Inspectors observations were kept at 22 retail milk premises when it was found that supplies of milk had been delivered between 1.0 and 5.30 a.m. In each case the milk had been left on the public highway, which practice contravenes Regulation 30(a) of the Milk and Dairies Regulations, 1949. Each of the distributors were communicated with, as well as the four suppliers concerned. It is hoped that alternative arrangements may be made in order to secure compliance with the Regulation concerned. Complaints were received in respect of alleged :— Foreign matter in bottles of milk. Foreign matter in sausage roll. Foreign matter in loaves of bread. Foreign matter in rice. Foreign matter in bun. Foreign matter in jar of marmalade. Foreign matter in tin of apricots. Foreign matter in chocolate eclair. Dirty milk bottle. Dirty bottle of orange drink. Glass in bottle of milk. Glass in jam tart. Cigarette end in loaf. Cigarette stub in milk. Beetle in packet of popcorn. Beetle in canned fruit. Beetle in tin of plums. Fly in cream bun. Mould in cream puff. Mould in steak and kidney pie. Mould in cheese spread. Mould in sausage roll. Metal in jar of pickles. Grubs in nuts and raisins. Unsound chicken. Unsound meat pies. Unfit birthday cake. Unfit liver. Infested broad beans. Rancid butter. Details of the action taken under the Food and Drugs Act, 1955 and the Food Hygiene Regulations, 1955, appear on pages 53-55. 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 accordance with the decision of the Southwark Borough Council the Public Analyst, who is an Officer of that Council, and also the Public Analyst for Islington, charges for samples submitted by private individuals for analysis a minimum fee of £3 3s. Od. per sample. Food and Drugs Act, 1955. Number of food premises in the area, and type of business. Bakehouses—level 30 „ —basement 19 Bakers' retail shops 68 Butchers 128 „ Continental 1 Cafes and Restaurants 243 Canteens and Clubs 117 Chemists 59 Coffee stalls 3 Fish curers 31 „ depot 1 53 Food and Drugs Act, 1955—cont. Number of food premises in the area, and type of business—cont. Fish friers 55 „ shops 21 Food factories 37 Food stalls (street traders including 30 shop extensions) 177 Food storage premises for street traders 48 Greengrocers and Fruiterers 144 Grocers and Provision merchants retailers 426 „ „ „ wholesalers 12 Off-licences 106 „ selling other food (included in above) 57 Public houses 225 „ catering (included in above) 221 „ „ beerhouses 35 Sugar and chocolate confectionery 421 Preserved Food Premises Registered under Section 16(l)(b) of the Food and Drugs Act, 1955. (Included in foregoing list.) Total No. of Preserved Food Premises 165 No. of Butchers 121 No. of Grocery and provision shops 32 No. of Food Factories 11 No. of Cooked meat shops 1 Total No. of inspections and visits made by Inspectors to Preserved Food Premises 573 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 7.1.57 Food and Drugs Act, 1955. Food Hygiene Regulations, 1955. Failure to take all such steps as may be reasonably necessary to protect food from risk of contamination whilst engaged in the handling of food at 66/68, Andover Road, N.7. Fined £10. Defendant to pay £10 10s. Od. costs. 7.1.57 Food and Drugs Act, 1955, Sec. 8(l)(a). Having in possession unsweetened chocolate, muscatels, peanut chips, etc., for the purpose of sale, or preparation for sale, intended for but unfit for human consumption at 66/68, Andover Road, N.7. Summons dismissed. (12 other summons under Food Hygiene Regulations adjourned sine die.)' 26.2.57 Food Hygiene Regulations, 1955. Regulation 5. Unsanitary food premises at 89, Upper Street, N.l. Conditional discharge for 12 months. (12 other summons under Food Hygiene Regulations not separately dealt with). Defendant to pay £10 10s. Od. total costs. See also entry for 22.10.57. 54 Date Offence Magistrate's Decision 12.3.57 Food and Drugs Act. 1955. Sec. 2(1). Selling food, namely bread, not of the quality demanded at 347a, Holloway Road, N.7. Fined £10. Defendants to pay £3 3s. 0d. costs. 12.3.57 Selling food, namely bread, not of the quality demanded at 167, Junction Road, N.19. Fined £5. Defendants to pay £2 2s. 0d. costs. 12.3.57 Selling food, namely bread, not of the quality demanded at 77/79, Newington Green Road, N.l. Food Hygiene Regulations, 1955. Regulation 5. Fined £3 3s. 0d. Defendants to pay £1 3s. 0d. costs. 12.3.57 Unsanitary food premises at 77/79, Newington Green Road, N.l. Food and Drugs Act, 1955. Sec. 2(1). Fined £10 10s. 0d. Defendants to pay £3 3s. 0d. costs. 9.6.57 Selling food, namely bread, not of the quality demanded at 335, Camden Road, N.7. Fined £20. Defendant to pay £1 1s. 0d. costs. 9.6.57 Selling food, namely a sausage roll, not of the quality demanded at 1 37, Newington Green Road, N.l. Fined £1. Defendant to pay £1 1s. 0d. costs. 9.7.57 Selling food, namely half a chicken, not of the quality demanded at 438, Holloway Road, N.7. Food and Drugs Act, 1955. Sec. 2(1). Fined £2. Defendant to pay £2 2s. 0d. costs. 30.7.57 Selling food, namely a packet of nuts and raisins, not of quality demanded at 161/169, Essex Road, N.l. Makers fined £10 and to pay £1 1s. 0d. costs. 10.9.57 Selling food, namely fresh orange drink, not of the quality demanded at Rotherfield Street, N.l. Food and Drugs Act, 1955. Sec. 8(l)(a). Fined £3. Defendant to pay £2 2s. 0d. costs. 24.9.57 Selling food, namely an iced birthday cake, unfit for human consumption at 9 Campdale Road, N.7. Food and Drugs Act. 1955. Sec. 2(1). Fined £2. Defendant to pay £1 1s. 0d. costs. 19.11.57 Selling food, namely milk, not of the quality demanded, at 74, Myddleton Buildings, Islington High Street, N.l. Food and Drugs Act, 1955. Sec. 8(l)(a). Fined £2. Defendant to pay £2 2s. 0d. costs. 19.11.57 Having in possession for the purpose of sale, food, namely two beef steak pies, intended for, but unfit for, human consumption at 21, Canonbury Lane, N.l. Fined £1. Defendant to pay £1 1s. 0d. costs. 22.10.57 Food and Drugs Act. 1955. Sec. 14. Application for disqualification of 89, Upper Street, N.l. Food Hygiene Regulations. 1955. Regulation 5. Disqualified from using premises for six months. Order made to above effect. 22.10.57 Unsanitary food premises at 89, Upper Street, N.l. Food Hygiene Regulations. 1955. Regulation 16(3). Fined £25. Defendant to pay £15 15s. 0d. costs. (See also appeal as tabled under.) 22.10.57 Failure to provide washing utensils at 89, Upper Street, N.l. Fined £25. 55 Date Offence Magistrate's Decision 22.10.57 Food Hygiene Regulations, 1955. Regulation 14(1). Defective sanitary convenience at 89, Upper Street, N.l. Food Hygiene Regulations, 1955. Regulations 16(1) & (2). Fined £25. 22.10.57 Failure to provide wash hand basins and hot water at 89, Upper Street, N.l. Food and Drugs Act, 1955. Sec. 2(1). Fined £25. 17.12.57 Selling food, namely a steak and kidney pie, not of the quality demanded at 84, Offord Road, N.l. Food and Drugs Act, 1955. Sec. 2(1). Fined £10. Defendant to pay £2 2s. 0d. cost 17.12.57 Selling food, namely a sausage roll, not of the quality demanded at 217, Sussex Way, N.19. Fined £5. Defendant to pay £1 1s. 0d. cost Appeal against Magistrate's Decision to Quarter Sessions (No. of cases: 1) Date Address Remarks. 9.12.57 89, Upper Street, N.l Appeal dismissed. Unsound Food. The total amount of food condemned during the year was :— 42 tons, 12 cwts., 3 qrs., 18 lbs., 4 ozs. details of which are given in the following table :— Description Tons Cwts. Qtrs. Lbs. Ozs. Tinned Goods 17 17 1 23 8 Fish — 3 2 14 8 *Meat 16 15 1 20 12 Others 7 15 3 15 8 Total 42 12 1 18 4 * Includes 15 tons 11 cwts. 3 qrs. 18 lbs., Harrison, Barber & Co. Ltd. The number of condemnation certificates issued was 1,151. 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 pages 53-54. 56 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. 493 samples (126 formal and 367 informal) were submitted to the Public Analyst for examination. Of these 37 (or 7.5 per cent) were adulterated as shown in the following summary. A number of the adverse reports relate to samples which were the subject of complaint and not taken in routine sampling :— Formal Informal Cream Doughnuts 1 Beans 1 Bread 4 Bun 1 Butter 1 Cake (iced) 1 Cheese (Mozzarella)2 Cheese Spread 1 Chocolate eclair 1 Condensed Machine Skimmed Milk 1 Cream bun 1 Kidney and Backache Pills 1 Lemon and Orange Peel 1 Marmalade 1 Milk 3 Mixed Nuts and Raisins 1 Orange Drink 1 Piccalilli 1 Prunes 1 Puffs (wtih cream filling) 2 Rice 1 Sausage Rolls 2 Tomato Juice (Canned) 1 Tomato Puree (Canned) 3 Steak & Kidney Pie 1 Soups 2 Total 36 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 :— 57  Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Horses Number killed (if know) 61 700 19 9 13 1,019 Number inspected 61 700 19 9 13 1,019 All diseases except Tuberculosis & Cysticerci Whole carcases condemned 2 39 2 2 — 1 Carcases of which some part or organ was condemned 12 366 — — 2 100 Percentage of the number inspected affected with disease other than tuberculosis and cysticerci 22.96 57.86 10.53 22.22 15.38 9.91 Tuberculosis only: Whole carcases condemned 2 9 — — — — Carcases of which some part or organ was condemned 1 36 — — — — Percentage of the number inspected affected with tuberculosis 4.92 6.43 — — — — Cysticercosis: Carcases of which some part or organ was condemned — 1 — — — — Carcases submitted to treatment by refrigeration — — — — — — Generalised and totally condemned — 1 — — — — All diseased or unfit meat was disposed of for use as knacker's meat or in the manufacture of animal feeding preparations. Of the 1,019 horses slaughtered for human consumption, 958 were intended for export. Slaughter of Animals Act, 1933. Slaughter of Animals (Amendment) Act, 1954. Slaughtermen's Licences. During the year one new Licence was issued and fourteen Licences renewed. Fourteen slaughtermen held current Licences at 31st December. Merchandise Marks Acts, 1887/1953. Agricultural Produce (Grading and Marking) Acts, 1928/31. Routine inspections are carried out by Inspectors to ensure compliance with the requirements of these statutes. Number of inspections—80. 58 Inspection of Refreshment and Coffee Stalls. Evening inspections of refreshment and coffee stalls were carried out by Public Health Inspectors as found necessary. 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 40 28 32 25 25 27 25 36 27 39 41 42 32 Women 56 51 56 58 66 66 59 67 78 81 80 39 63 ParkhurstRd.— Men 54 61 65 68 72 70 57 48 67 68 68 43 62 Women 32 37 44 44 44 67 67 65 58 64 44 56 52 Finsbury Pk.— Men 68 65 77 103 95 93 74 91 77 75 61 59 78 Women 14 21 17 16 16 23 17 15 17 14 15 14 17 Highbury Gr.— Men 13 14 13 15 20 17 23 17 15 17 13 11 16 Women — 10 13 9 11 19 11 14 20 12 4 11 11 Offord Rd.— Men 6 8 10 12 10 10 11 12 10 10 9 10 10 Women 1 2 2 2 5 1 3 4 4 6 3 3 Islington Gr.— Women 9 5 10 11 11 20 14 16 18 12 10 11 12 High St.— Men 63 73 66 66 60 67 62 58 47 47 42 44 58 355 374 405 429 432 484 421 442 438 443 393 343 Ice-Cream. Ice-Cream (Heat Treatment, etc.) Regulations, 1947-52. Supervision of the Manufacture and Distribution of Ice-Cream. During the year 726 visits were paid to ice-cream premises and vehicles. Number of premises registered :— (a) for manufacture, sale and storage 57 (b) for sale and storage 221 (c) for sale only 208 (d) for storage only 3 489 Bacteriological Examinations. Eighty-seven samples of ice-cream was sent for bacteriological examination and Methylene Blue tests were graded as follows :— Grade I 51 Grade II 12 Grade III 14 Grade IV 10 87 59 Samples falling within grades I or II of the Methylene Blue Test are considered satisfactory and those within III or IV unsatisfactory. Fifty-three ice lollies were sent to the bacteriologist for examination and of these eleven were found to be unsatisfactory. Chemical Examinations. Seven samples of ice-cream and three ice lollies were submitted for chemical analysis and no adverse report was received. Details of the seven samples of icecream examined for fat content are as under:— Fat Content Less Than 6% 7% 8% 9% 10% 11% 12% 13% 14% 15% 1 — — 2 — 1 1 1 — — Milk Samples. The total number of samples taken for chemical and bacteriological examination during 1957 was 200. Samples submitted for Chemical Analysis:— Genuine Adulterated Total Formal 108 — 108 Informal 21 3 24 132 There are fourteen major suppliers of milk into the Borough, the supplies 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 Unsatisfactory 42 - 42 - — - 42 Sterilised Satisfactory Unsatisfactory — - - 16 - 16 Tuberculin Tested (Pasteurised) Satisfactory Unsatisfactory 3 - 3 - — - 3 Total 61 Five samples of tuberculin tested raw milk were taken for biological test for tuberculosis. The result in each case was negative. Other samples were goat's milk which passed Methylene Blue test and a sample of machined skimmed milk which failed Turbidity test. 60 Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949 to 1953, and Milk (Special Designation) (Raw Milk) Regulations, 1949 to 1954. The following licences were granted:— Pasteurised 253 Pasteurised (supplementary) 24 Tuberculin Tested 146 Tuberculin Tested (supplementary) 24 Sterilised 320 Sterilised (supplementary) 26 793 Milk and Dairies Regulations, 1949 to 1954. Number of Dairies Registered in the Borough 20 Number of Distributors registered in the Borough 301 Number of Registered Distributors dealing from registered premises outside the Borough 33 Summary of visits by Inspectors. Routine Inspections 329 Miscellaneous visits 359 Total number of inspections and miscellaneous visits 688 Number of Notices served 45 SECTION F—MISCELLANEOUS SERVICES HEALTH PUBLICITY AND HEALTH EDUCATION Elderly Persons' Welfare Services. From time to time it had become apparent that the many health and welfare services available for elderly persons were not very generally known within the borough. The Public Health Committee, concerned that in these circumstances there might be many old people not receiving the care they needed, authorised the printing and distribution of an information card on these services. Copies of the card were supplied to all members of the Borough Council, all local general practitioners, local clergy, welfare and social organisations; and the information so provided has been widely appreciated. Posters, Leaflets and Publications. During the year the Council entered into agreement with a billposting company for a number of sites throughout the borough to be reserved for the Council's billposting requirements, and the Public Health Committee arranged for the exclusive use of seven of these sites, wholly or in part, by the Public Health Department. By this means, health publicity is now reaching additional areas of the borough, and further scope is provided for special campaigns. 61 The distribution of leaflets through the Public Health Department, and from time to time through other Departments of the Council, continued, and the monthly journal of the Central Council for Health Education, "Better Health," also continued to be distributed, from the Public Libraries and Town Hall counters at the rate of 1,000 copies a month. Film Shows. Five remaining film shows of the 1956/57 autumn/winter series were given during the first three months of the year. At each of these an introductory talk was given by the Medical Officer of Health or Deputy Medical Officer of Health, and the practice of including a full-length feature film in the programme was continued. The health films shown were as follows:- Title Supplied by " Surprise Attack " Central Film Library. " Why Won't Tommy Eat ? " do. " Body Building Foods " do. " A Modern Guide to Health " do. " Another Case of Poisoning " do. " His Fighting Change " do. "Old Wives Tales" do. " Care of the Feet " Gaumont British Film Division. " Prevention is Better " National Association for the Preven tion of Tuberculosis. Later in the year the Public Health Committee decided, in view of the falling off in audience numbers, that the shows be discontinued in favour of concentrating on other forms of publicity. Handbills for Cypriot Residents. For some time the Medical Officer of Health worked in co-operation with the Commissioner for the Government of Cyprus in connection with the welfare of Cypriot residents in Islington. One result of this was an arrangement with the Commissioner for translations of the National Association for the Prevention of Tuberculosis leaflet "A Warm Welcome to a Cool Climate" to be made available for distribution to Greek and Turkish speaking residents in the borough. Distribution was effected through the Department's Public Health Inspectors and domiciliary visitors, and copies were supplied for use by the Islington Chest Clinic, the Mass X-ray Unit, Drayton Park, and the London County Council Health Visitors. It is understood that the leaflets were also being distributed by the Government of Cyprus. Co-operative publicity. During the year the co-operation of the Borough Council was requested in special campaigns initiated by the Ministries and the London County Council. These campaigns and the action taken by the Public Health Department, were as follows Action arranged by Public Health Department Campaign " Coughs & Sneezes " Organised by Ministry of Health Posters displayed in all Council Departments. Filmlets shown in local cinemas. " Colorado Beetle" Ministry of Agriculture, Fisheries and Food. Leaflets distributed and posters displayed through all Council Departments. " Home Safety Week " London County Council. do. 62 In June, at a Trade Fair organised by the Islington Chamber of Commerce, the Public Health Department arranged an exhibit dealing with elderly persons' welfare services and food hygiene, on a section of a stand which had been allocated to the Borough Council. Talk by Deputy Medical Officer of Health. In response to a request from the Hon. Secretary of the Young Wives' Club, Caledonian Road Methodist Church, the Deputy Medical Officer of Health gave a talk to the Group on "The Public Health Services." The talk was very greatly appreciated. Health Education Conferences and Courses. In February the Medical Officer of Health, together with Councillor Ross, attended a one-day Conference, arranged by the Central Council for Health Education, on Education of the Public regarding Cancer, and in October attended the Home Safety Session of the National Safety Congress. Members of the staff also attended special Training and Refresher Courses as follows:— Course Attended by B.M.C. Diesel Engine Instructional Course (Austin Service School, Birmingham). One Public Health Inspector. London County Council In Service T raining Courses. (London County Council in collaboration with Central Council for Health Education). Chief Clerk. Old People's Health Officer. Assistant Old People's Health Officer. Refresher Course for Public Health and Smoke Inspectors. (College of Fuel Technology). Chief Public Health Inspector. One Public Health Inspector. One-day Courses of Study on Heating by Gas and Coke. (North Thames and South-Eastern Gas Boards). Chief Public Health Inspector. Deputy Chief Public Health Inspector. Two Public Health Inspectors. Course on Scientific Study of Air Pollution (University of London). Two Public Health Inspectors. SERVICES FOR ELDERLY PERSONS The work of the Department on behalf of elderly persons is done both directly and indirectly, and it will be seen from the information to follow that the total volume of work done in this section is quite considerable. The Department's Old People's Health Officers carry out each year a large number of visits and re-visits and on the circumstances found have been the means of obtaining, or recommending assistance for old persons. They effect close liaison between the Public Health Department's own facilities and those which can be given through the Local Health Authority, in particular the Home Help service, and also with voluntary organisations in respect of Meals-on-Wheels, chiropody, and holidays. The Health Officer and her assistants visited 597 new cases during the year, and re-visits totalled 3,962. Four cases were dealt with under the National Assistance Acts, 1948 and 1951, and these are described below. 63 4,577 references were made to other Authorities and to voluntary organisations in connection with the provision of "Home-helps," National Assistance, "Meals-onWheels," etc. National Assistance Acts, 1948 and 1951. In 4 instances it was necessary to invoke the procedure for the removal of persons to suitable premises without delay, in accordance with the provisions of the National Assistance (Amendment) Act, 1951. "An order under subsection (3) of section forty-seven of the National Assistance Act, 1948, for the removal of any such person as is mentioned in subsection (1) of that section may be made without the notice required by 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 under these Acts are given in the following statement which has been completed in the form required by the Ministry of Health:— Aged and Infirm—Action under Statutory Powers Case No. 1 Name and age. Reason for Council's action. Period named in Order. Type of accommodation to which removed. Ultimate result. Case No. 2 Name and age. Reasons for Council's action. Mrs. D., 74 years. Mrs. D. had been known to our Visitors since 1954, and, with a view to improving the state of the home, disinfestation work was carried out in her two rooms which were cluttered with furniture and in a verminous condition. When an Order was obtained from a Justice of the Peace Mrs. D. was suffering from broncho-pneumonia and hypertension and was incontinent. She refused hospital treatment, which was considered necessary by the Deputy Medical Officer of Health and her own doctor. Upon her removal further disinfestation work was carried out. This aged person stated at first that she had no relatives but later a brother was traced who did what he could to assist. Not exceeding three weeks. General hospital. Settled down in her home after return. Mr. B., 88 years. Mr. B.'s plight was first brought to the notice of the Department by another person in the house who was worried early in the year when Mr. B. walked about the house with ulcerated legs covered with bread wrappings. He had been in and out of hospital several times, discharging himself on each occasion against medical advice. The home conditions were bad and Mr. B. had difficulty in caring for himself even with help given by another tenant. At the time of removal, following a visit by the Deputy Medical Officer of Health and the patients own doctor, this aged person was suffering from ulcerated legs and a heart condition and refused medical treatment either at home or in hospital. An Order was obtained from a Justice of the Peace. 64 Period named in Order. Type of accommodation to which removed. Ultimate result. Case No. 3 Name and age. Reasons for Council's action. Period named in Order. Type of accommodation to which removed. Ultimate result. Case No. 4 Name and age. Reasons for Council's action. Period named in Order. Type of accommodation to which removed. Ultimate result. Not exceeding three weeks. General hospital. Returned home after expiration of period specified in Order. District Nurse and Home Help went in to help. Subsequently removed to hospital voluntarily where patient died. Mrs. R., 75 years. Mrs. R. lived alone in a large house which gradually, through neglect, was falling into a state of disrepair. A neighbour, who was her only contact with the outside world, appealed to the Department in July for help after Mrs. R. started losing her sight. A relative, when contacted, stated that she was herself 82 years of age, was unable to help, and did not know of any relative who could give assistance. After this aged person was seen by the Deputy Medical Officer of Health and her own doctor the appropriate certificates were signed and an Order obtained from a Justice of the Peace. At the time of removal Mrs. R. was almost completely blind in addition to being very senile. There was a grave fire risk in the home. Not exceeding three weeks. General hospital. Settled down in hospital and was very co-operative. After discharge home subsequently entered welfare home voluntarily. Mrs. S., 74 years. Towards the end of the year a niece was worried about the state of Mr. and Mrs. S. and got in touch with the Department. The niece stated that Mr. S. was not capable of caring for his wife who was suffering from an inflamed leg with a running abscess and refused a visit from her medical adviser. The Council's Health Officer for Elderly Persons confirmed that this couple were obstinate in their refusal of offers of help. The condition of the home was bad, as offensive odours were prevelant in the room occupied, which was in a dirty condition. After consultation with the patient's medical adviser a visit was made by the Medical Officer of Health and following the appropriate certification, an Order was obtained from a Justice of the Peace. Not exceeding three weeks. General hospital. Deceased two days after admission. The husband subsequently went to another hospital as a voluntary patient. 65 The cases reported previously, where Statutory action had to be taken under the National Assistance Acts, 1948 and 1951, have shown some distressing circumstances and it will be apparent also that a very great deal of personal endeavour on the part of the Department's staff and other social and voluntary workers was necessary before the final solution through the Courts became necessary and inevitable. It would be wrong to conclude from the above cases that they were typical. The greater part of the work of the Department's visitors in particular is concerned with improving unsatisfactory sanitary and social circumstances on a voluntary basis so far as this can be done, and the final resort to the Court must be a confession of failure of voluntary action. A vast amount of repeated visiting, patiently done, liaison with the Home Help service of the London County Council, and reference to other organisations, where necessary, including, of course, discussion of the case with the family practitioner where this is appropriate, constitute by far the greater part of the work of the Old People's Visitors. A voluntary and happier solution has been found in many instances and, in order that the cases in which compulsory removal has to be effected can be compared with those where some measure of rehabilitation was successfully accomplished, it is thought only right to mention briefly the following cases which are more typical of the work done. CASE No. 1 Mrs. H. (76 years). In June, 1956, Mrs. H. was reported as being very dirty and neglected, with a tendency to fall about. Her room contained a large accumulation of papers and general rubbish, causing mice infestation. She herself appeared to lack clothing, bed linen etc. although on subsequent enquiries it was found that the National Assistance Board had made several grants. Repeated offers of help or services were consistently refused but by the determined efforts of the Old People's Health Officer, Mrs. H. was eventually persuaded to accept home bathing. This gave reasonable access to the premises so that the accumulated rubbish in the room was removed and the mice complaint dealt with. The Council's Special Laundry Service was arranged and County Council home help assistance was requested and supplied. In April, 1957, Mrs. H. fell out of bed, injured her spine and was admitted to hospital. She was discharged home wearing a spinal jacket but, in spite of this handicap, it was still possible for her to be well-cared for at home with the resumption of the above-mentioned services. CASE No. 2 Mrs. C. (67 years). A reference was made to the Public Health Department in July, 1956, as Mrs. C. was a source of constant concern to everyone. She was active but confused and forgetful, and, whilst apparently willing to accept help, was frequently out when calls were made, or refused to open the door to anyone. A foul smell always pervaded her room, from her own incontinence and her tendency to leave the gas jets on but unlighted. By frequent visits the Old People's Health Officer and other Public Health Department Staff became familiar with Mrs. C.'s movements and it was possible, although always with some difficulty, to persuade her to open the door when at home, or to know where to find her in the locality. In this way Mrs. C. received home bathing, was provided with clothing, and her soiled linen was dealt with through the Council's Special Laundry Service. The home help service was able to operate in a similarly erratic manner. 66 Whenever the Department's visitors called on Mrs. C. every endeavour was made to interest her in entering a Welfare Home as her general health was deteriorating. Eventually she was persuaded to enter a Welfare Home voluntarily in December, 1957, and was conducted to the Home by a member of the Public Health Department staff. CASE No. 3. Miss H. (83 years). This case has similar features to the one previously quoted in that there was a general deterioration resulting in self-neglect, due in this instance to old age rather than mental incapability. The Council's Health Officer tried to persuade Miss H. to enter either a private or a County Home, without success. Difficulty was experienced in supplying essential services owing to inability to gain access to the premises. Eventually home bathing was arranged and a Council's nurse dealt with soiled linen through the Special Laundry Service and made essential food purchases for Miss H. The health of this old lady gradually deteriorated and, although she was adamant about not going away, the Health Officer eventually persuaded her to enter Hospital. After treatment Miss H. was transferred to the "long stay" annexe of the Hospital and, at the end of the year was still there, showing an improvement in health. CASE No. 4. Mr. P. (84 years). This is an example where only the untiring efforts of the Public Health Department Staff, an excellent home help and frequent visits from parishioners of the local church, made it possible for this old man to remain in his own home. Mr. P.'s wife was at first reasonably capable of caring for her husband, who had had a Stroke and was bedfast and also partially sighted. Following Mrs. P.'s admission to hospital (where she still remained at the end of the year), Mr. P. was found to require urgent care and attention. With the assistance of the above-mentioned services however there was no necessity for his removal from his own home. CASE No. 5. Mrs. E. (80 years). Two attempts were made to rehabilitate this old lady. Early in 1956, following the receipt of a complaint, her flat was found to be in an insanitary and verminous condition. With the Co-operation of the Public Health Inspector and the owners of the property, Mrs. E. was moved to adjacent accommodation and supplied with new bed, bedding and floor covering by the National Assistance Board. However, Mrs. E. reverted to her previous habits. Her home became verminous, she herself was filthy and, from the appearance of her room, it seemed as if she had continuously eaten out of tins and strewn these and every other type of rubbish around her. The Old People's Health Officer persuaded Mrs. E. to attend the Council's Treatment Centre for bathing purposes and, having gained her confidence, obtained consent for access to her premises for the purpose of disinfestation and clearance of rubbish. Mrs. E. continued to attend the Centre regularly where she was given clean clothes on each occasion and her soiled linen dealt with through the Special Laundry Service. Mrs. E. also eventually agreed to accept the London County Council Home Help Service. Cooking and cleaning utensils were provided, and the National Assistance Board again helped with a new mattress and floor covering. As a point of interest, when the Home Help commenced operating, a number of torn and filthy pieces of one pound notes was found. On presentation to the Bank of England (and after the prescribed period of six months) the sum of £25 was allowed for the benefit of Mrs. E. 67 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. 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 Departments 597 Number recommended to W.V.S 95 Number of meals delivered during the year 6,909 Weekly average 132 Holidays for Elderly Persons. By means of a scheme administered through the Old People's Welfare Council, 518 persons were able to enjoy a holiday by the sea, or in the country, at greatly reduced cost, where their circumstances were such that it would not have been possible for them to take a holiday at their own expense. A substantial grant was provided by the Borough Council for this scheme. Chiropody. 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 during the year two additional clinics were established, as the result of grants made to the Islington Old People's Welfare Council. At the end of the year the following clinics were held :— Address Days and Times Clinic Held Date commenced Islington Medical Centre, 303 Upper Street, N.l (near St. Mary's Church). Gifford Hall Mission, Gifford Street, Caledonian Road, N.l (near Railway Bridge). Junction Road Congregational Church Hall, Junction Road, N.l9 (near Odeon Cinema). Monday, 2 p.m. to 5 p.m.} Thursday, 9.30 a.m. to} 12.30 p.m}. Friday, 1.30 p.m. to 4.30 p.m.} Tuesday} Friday} 9.30 a.m. to} 12.30 p.m.} Thursday, 2 p.m. to 5 p.m. Wednesday} Friday} 9.30 a.m. to 12.30 p.m. 31.10.55 25.7.57 24.1.56 4.4.57 1.8.56 Appointments at these clinics are made by the Public Health Department. In addition, a session for members of an old people's 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 the introduction of domiciliary treatment on a limited basis. 68 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 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 65 No. of washings carried out 1,200 No. of articles cleansed 10,404 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 1957 sixteen recipients had 157 washings comprising 1,619 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 1,016 No. of persons concerned 66 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 496 applications for cremation at the Council's Crematorium, East Finchley. MATERNITY AND CHILD WELFARE SERVICES The London County Council, as the Local Health Authority, is responsible for the Maternity and Child Welfare Services in the Borough, which, together with the Boroughs of Finsbury and Holborn, constitute Division 3. I am indebted to Dr. Wilfrid G. Harding, Divisional Medical Officer, for the information given overleaf in respect of these services :— 69 Total Attendances at Infant Welfare Centres. Infants North South East West Archway 0—1 years 12,937 10,315 7,254 11,882 2,487 1—2 years 1,987 1,299 777 1,849 432 2—5 years 1,442 678 234 1,120 313 Special Toddlers' Clinics 632 386 529 610 — Ante-Natal and Post-Natal combined 5,615 2,905 2,813 3,343 — Child Life Protection. The table of foster-mothers and foster-children being cared for is as follows 31.12.57 Number of persons on register prepared to receive children 46 Number of foster-children being cared for 37 At present there 3 Day Nurseries open in Islington :— Scholefield Road 58 places Canonbury Place 64 „ Mitford Road 68 „ 190 There are also 50 places for Islington children in Springdale Day Nursery (Stoke Newington). 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. midwives Wed. 2.0 p.m. Tues. 9 a.m. and 2.45 p.m. Wed. 2.0 p.m Wed. 1.45 p.m. (2nd wk.) Thurs.} Tues.} 9.30 a.m. Wed.} Thurs.} Thurs. 9.30 a.m. Wed. 1.45 p.m. (1st wk.) 1.45 p.m. (4th wk.) North Branch Clinic - Blythe Mansions, Hornsey Rise, N.19. Mon. 1.45 p.m. Fri. 1.45 p.m. Fri. 1.45 p.m. North Branch Clinic - Cooperative Hall, 129, Seven Sisters Road, N.4. Wed. 1.45 p.m. Archway M. & C.W. Centre Congregational Church, Junction Road, N.19. Thurs. 9.30 a.m. 1.45 p.m. Thurs. 10 a.m. 2 p.m. Thurs. 10 a.m. 2 p.m. West Islington Welfare Centre 42 & 44, Richmond Avenue, N.l Mon}. 2.0 p.m. Tues. 10.0 a.m. Wed. 10.30 a.m. Wed. 10.30 a.m. Wed. 10.0 a.m. Tues.} Thurs. 10.0 a.m. & 2.0 p.m. (midwives) Wed.} 10.0 a.m. 2.0 p.m. West Branch Clinic - Tenants Clubroom, Hilldrop Estate, N.7. Tues.} 2.0 p.m. Wed.} Thurs.} South Islington Welfare Centre Mon. 2.0 p.m. Mon. 10.0 a.m. Fri. 2.0 p.m. Fri. 2.0 p.m. Fri. 2.0 p.m. Wed. 10.0 a.m. Fri. 10.0 a.m. 6, Clephane Road, Essex Road, N.l. 2.0 p.m. Thurs. 2.0 p.m. Tues. 2.0 p.m. South Branch Clinic Tues.} 2.0 p.m. Union Chapel, Compton Avenue, N.l. Thurs.} East Islington Welfare Centre 32, Drayton Park, N.5. Tues. 2.0 p.m. Mon. 10.0 a.m Mon. 2.0 p.m. Mon. 3.0 p.m. Tues. 10.0 a.m. Wed. 10.0 a.m. Wed. 2.0 p.m. (midwives) Fri. 10.0 a.m. 'Fri. 2.0 p.m. Thurs. 2.0 p.m. Fri. 10.0 a.m. East Branch Clinic 6, Hurlock Street, N.5. Thurs. 2.0 p.m. 70 INDEX Accidents 6, 7, 8, 11 Acute Encephalitis 12 Acute Poliomyelitis 6, 12, 17-18 Aged and Infirm Persons 28, 60, 62-68 Ante-Natal Clinics 69 Anthrax 12, 23, 43 Atmospheric Pollution 35,-38 Bacteriological Examinations 20, 26, 59 Births 5, 8, 9 Blow-Fly Infestation 34 Cancer—Lung 6, 7, 10 Certificates of Disrepair 29-30 Chemical Examinations 59 Child Life Protection 28, 69 Child Welfare Centres 69 Chiropody for Elderly Persons 67-68 Clean Air Act, 1956 27, 35-38 Cleansing Station 24 Cleansing, Elderly Persons 68 Closing Orders 49 Crematorium 68 Day Nurseries 69 Deaths 5, 7, 9, 18 Dental Clinics 69 Diphtheria 6, 7, 12, 18-19 Diphtheria Immunisation 19, 69 Disinfection 34 Disinfestation 34 Disinfestation of Sewers 45 Dysentery 12, 21-22 Elderly Persons, Services for 60, 62-68 Encephalitis, Acute 12 Enteric Fever 12 Erysipelas 12 Exhibitions 62 Export Certificates 34 Factories Act—Complaints 39, 40 Factories Act—Contraventions 39, 40 Factories Act—Inspections 39, 40 Factories Act—Notices served 39, 40 Film Publicity 61 Fly Infestation 34 Fog and Smoke 35-38 Food and Drugs Act 29, 39, 52-53 Food Hygiene Regulations 51, 53-55 Food—Inspection and Supervision 29, 39, 50-60 Food—New Legislation 50 Food Poisoning 12, 19-20 Food Sampling 56, 59 Food, Unsound 52 Foster Mothers and Children 69 Hairdressers and Barbers 44 Health Publicity and Health Education 60-62 Heating Appliances (Fireguards) Act, 1952 43 Holidays for Elderly Persons 67 Home Visiting 12, 24 Housing 46, 49 Housing Repairs and Rents Act, 1954 29, 47 Ice Cream 58, 59 Illegitimate Infants—Births and Deaths 5, 7 Immigrants 48, 61 Infant Mortality 5, 7, 8, 9 Infectious Diseases 12-26 Influenza, Pneumonia and Bronchitis 6, 8, 12, 23-24 Inoculation, etc., Certificates 14 Laundry Services 68 Legal Proceedings 32-34, 45, 47, 51-52, 53-55 Live Births 5, 7 Local Government (Miscellaneous Provisions) Act, 1953 49 L.C.C (General Powers) Acts 27, 31, 42, 44, 68 M. & C. W. Services 68-69 Malaria 12 Marriages 5, 7 Mass X-Ray 26 Maternal Mortality 7 "Meals on Wheels" 67 Measles 6, 8, 12, 14-17 Meat 56-57 Meningococcal Infection 6, 8, 12 Merchandise Marks 57 Metropolitan Cattle Market 56 Milk 59-60 Milk and Dairies Regulations 60 Milk (Special Designations) 60 Miscellaneous Services 60-69 Mortuary 68 National Assistance Acts 28, 63-64, 67 Neoplasms, Malignant 6, 7, 10 Noise Nuisance 42 Nurseries—Day 69 Offensive Trades 42-43 Ophthalmia Neonatorum 12 Outworkers 39, 41 Overcrowding 48, 49 Pet Animals Act 43 Pharmacy and Poisons Acts, etc 43 Pigeon Nuisances 42 Pneumonia 6, 8, 12 Poliomyelitis 6, 12, 17-18 Population 5, 7, 9 Post-Natal Clinics 69 Premature Infants 8 Preserved Food Premises 39, 53 Prevention of Damage by Pests Act and Orders 44-45 Prosecutions 32-34, 45, 47, 51-52, 53, 55 Public Health Committee 4 Public Health Inspectors—District Work 27-39 Public Health Inspectors—Special Work 39-46 Public Health (London) Act—Improvements effected 30-31, 39 Public Health (London) Act, Sections 40 and 109 31 Public Health Officers 4 Public Health (Tuberculosis) Regulations, 1952 25 Publicity 60-62 Puerperal Pyrexia 5, 12 Rag Flock and Other Filling Materials Act 43 71 Rats and Mice 44-45 Refreshment and Coffee Stalls 58 Rent Act, 1957 29-30 Requisitioned Property 39 Sampling 46, 56, 59 Sanitary Circumstances 27-46 Scabies 12, 24 Scarlet Fever 12 Sewer Treatments 45 Shops Act 40, 43 Slaughtermen's Licences 57 Slum Clearance 46-47, 48 Smallpox 12, 13-14 Smoke 35-38 Staff 4 Static Water Tanks, etc. 34-35 Statistics—General 5-11 Statistics—Vital 5-11 Still-Births 5, 7 Swimming Baths 46 Toddlers' Clinics 69 Town & Country Planning 49 Tuberculosis 6, 7, 8, 9-10, 12, 24-26 Tuberculosis—Beds and Bedding 26 Tuberculosis—Care Committee 26 Tuberculosis—Chest Clinics 25-26 Tuberculosis—Deaths 6, 7, 24-25 Tuberculosis Notifications 7, 25 Typhoid Fever 12, 20 Underground Bakehouses 41, 52, 55-56 Vaccination 13-14, 69 Vermin 12, 24 Washing Facilities, Free 58 Water Supplies 45-46 Welfare Centres 69 Whooping Cough 6, 8, 12, 14-17