ISL 94 ANNUAL REPORT of the Medical Officer of Health London Borough of Islington 1965 TO THE MAYOR, ALDERMEN AND COUNCILLORS of the LONDON BOROUGH OF ISLINGTON The New Public Health Department On 1st April. 1965 the London Borough of Islington came into being under the London Government Act. 1963. The new department was formed out of the former Public Health Departments of the Metropolitan Boroughs of Finsbury and Islington together with the services formerly provided in these boroughs by the London County Council Public Health Department from its central office at County Hall, and its Divisional Office No.3. Incorporated with them were the Home Nursing Service, previously run by the voluntary District Nursing Association, and some inspectorial duties taken over from the L.C.C. Public Control Department. From 1st January to 31st March, 1965 the services were under their respective Medical Officers of Health - Dr. A. B. Stewart. London County Council; Dr. V. Freeman. Islington and Dr. C.O.S. Blyth Brooke. Finsbury. I am indebted to them for the information in this report relating to the first three months of 1965. It was with great pleasure that I learned that Dr. Freeman and Dr. Blyth Brooke had been appointed as my Associate Medical Officers of Health in the new Borough, and I acknowledge the advice and help which they unstintingly gave me. Dr. Blyth Brooke retired on 14th July, 1965, after a distinguished career, to which I refer later. Dr. A.B. Stewart was appointed Medical Adviser to the Inner London Education Authority and it has been my pleasure as Principal School Medical Officer to work closely with him on the School Health Service. Planning The detailed planning of the new department began in the latter half of 1964, when appointments were made to key posts in the senior grades. The officers themselves remained in the employment of their former authorities and were released for the new work. Although this dual employment received financial recognition, it subjected the individuals concerned to some not inconsiderable strain, in dealing at the same time with the administrative problems of running down the expiring departments and organising the new. The main planning centred on the temporary office set up by the Borough at Club Union House at Highbury Corner. Here, almost literally between four walls the embryo Health, Welfare and Children's Departments took shape, arising from a continuous series of consultations between the three Chief Officers, and the senior members of their own staffs and of the Town Clerk's and Borough Treasurer's Departments. Through the Borough's Group Committees, the principal lines of development were laid down, the staff establishments drawn up and the financial estimates made. The documentary materials for planning were the various reports of Working Parties set up jointly by the Boroughs and the London County Council, supported by the records of conferences and consultations at many levels. Out of these materials, the decision of members on policy and the knowledge and experience of officers fashioned the organisation of the new department which came into operation on 1st April, 1965. Compared with the intense and sometimes feverish activities of the preparatory months, the appointed day passed off smoothly and without incident. That this was so was due in large measure to the staff, especially the field workers, and to the overall concern throughout that the services to the public should be disturbed as little as possible. This does not mean that those within the service were not aware of many difficulties which had still to be overcome. These resulted directly from the deficiencies of the whole plan for the services for the New London. They could have been avoided if each new department had been a working unit properly staffed before the appointed day, and then ready to go immediately into action. Unfortunately the transfer of duties coincided with a disruption of staff. Former London County Council staff elected to be transferred to Boroughs nearer their homes, and a considerable proportion of officers under the County Council and the former Metropolitan Boroughs took up advertised posts under other authorities which offered better prospects or less travelling. The same process continued after 1st April, 1965. The result was that much of the staff establishment had to be built up into a working unit as the year went along. 1 and at the same time many new duties had to be learned and absorbed. None the less, by the end of the year, the department had taken shape and some new developments had been initiated. Organisation It was the intention that from the beginning the department should come to regard itself as one health service, and that the former separate elements should be merged into one functional unit. Such an achievement was not possible overnight, due mainly to the very size of the whole department. A further obstacle was the fact that new offices at 159/167, Upper Street, N.1, were still in the course of renovation and were ready only for partial occupation from 1st September, 1965. For this reason, the former London County Council services remained at the Divisional Health Office at 53 Clerkenwell Road, E.C.I. The mental health team was established at the Finsbury Health Centre, Pine Street. E.C.I. The pattern of organisation was influenced by the committee system, under which two service committees were formed, the Environmental Health Committee and the Personal Health Committee. Two branches of the department were accordingly set up. The one for Environmental Health comprised the former Metropolitan Borough public health functions, including preferential housing and Public Control functions devolved from the London County Council. The one for Personal Health comprised the former London County Council health functions and included the home nursing previously administered voluntarily. On the administrative side an Environmental Health Division and a Personal Health Division were formed, and services common to both were merged in a General Administration Division, e.g. finance, staffing, supplies, premises, transport and committee work. Delegated Authority A valuable contribution to the smooth continuance of the services after the appointed day was the decision of the Committees to delegate to me authority for day-to-day administration. This was done through terms of reference which are printed in Appendix A. In broad outline, they instructed me to continue to administer the transferred services on the same lines as prior to 1st April, 1965, subject to decisions subsequently made by the Council. One good result of this was that, especially with the rapidly developing services inherited from the London County Council, committee reports were in the main confined to policy questions on the introduction of new services and the expansion of existing services. I appreciate the guidance and encouragement, as well as judicious criticism, given by the Committees, and in particular by their Chairmen and Vice-chairmen in and out of committee. This report presents a landmark in the administration of Public Health in Inner London. For the first time, all the main local health functions have been entrusted to one Authority, and as Medical Officer of Health it is my privilege to report on these functions in one volume. I am conscious that it follows in the tradition of a long series of reports of my predecessors under the Metropolitan Boroughs and the London County Council.The volume incorporates my report as Principal School Medical Officer and the report of the Chief Dental Officer. As this is a first report, I have gone into some detail in describing each service. It may not be necessary to do the same in future reports which will describe developments of the basic details in this report. S. KING. Medical Officer of Health. 2 Photograph by Major Robert Whyte PUBLIC HEALTH DEPARTMENT - 159/167 UPPER STREET, N.l. ENVIRONMENTAL HEALTH COMMITTEE PERSONAL HEALTH COMMITTEE (as at 31st December, 1965) MAYOR Councillor ERNEST DAVID WARD, J.P. Aldermen HERBERT JAMES LOWTON LYGOE. O.B.E. .J.P. .M.S.M. ALBERT JOHN ROGERS. J.p. Councillors MRS. ZARA BAGNARI THOMAS ALBERT CLUBB HENRY WILLIAM FRANCIS FORD ALBERT EDWARD LEY HENRY JAMES REID TERENCE CORNELIUS ROONEY MRS. MARGARET MARY SHORT MRS. EMILY MARY SIMMS WALTER SMITH MRS. BRONWEN STRADLING VIVIAN STEWART STRADLING MRS. EDITH JOAN WALKER Co-Opted Members R.J.S. BRYANT. LL. B. . F. C. C. S. . F. H. A. E. COLIN-RUSS. M.R.C.S. ,L. R.C.P. Chairman Alderman A.J. ROGERS, J.P. Vice-chairman Councillor A. E. LEY Counci1lors HARRY BRACK. F. R. I. C. S. CHARLES VICTOR SIDNEY CONNELL LESLIE THOMAS COOMBS HENRY WILLIAM FRANCIS FORD PAUL GRANT GEORGE ALBERT WILLIAM IVES MICHAEL GEOFFREY O' DONOGHUE. L.R. C.P.I. &L.M. . L.R. C.S.I. &L.M. ROBERT JOHN REDRUPP LEWIS ROSS MRS. EMILY MARY SIMMS MRS. DIANA MARGARET STUDDERT SIMPKINS, B. Sc., A. L. A. WALTER SMITH JACK WALKER SAMUEL WILLIAM WITHEY Co-Opted Members J.T. BRUCE, M.B. , B. S. . M. R. C. P. , D. P. M. M.J. FITZGERALD, M.B. ,B.Ch. GEOFFREY RANKIN MISS P. W. REDMAN, S.R.N. D.N. (Lond. ) Chai rman Councillor Mrs. D.M.S. SIMPKINS. B. Sc., A.L. A. Vice-Chai rman Councillor J. WALKER PRINCIPAL OFFICERS OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health and Principal School Medical Officer S. KING, M.D. .M. R.C.P. .D.P.H. Deputy Medical Officer of Health and Deputy Principal School Medical Officer AUDREY K. ARNOLD M.B. . B. Ch., B.A.O. . D. Obst. R. C. 0. G. , D.P.H. 3 Associate Medical Officers of Health V. FREEMAN M.R.C. S. , L.R. C.P. , D. P.H. C.O.S. BLYTH BROOKE M.D. , B. S. , D. P. H. (retired 14.7.65) Principal Medical Officers BETTY GROVES M.B. , B. S. , D.P.H. Chief Pr.ntal Officer & Principal School Dental Officer R. E. HYMAN, L. D. S., R. C. S.. (Eng.) Chief Administrative Officer F.L. CLARK. B. A. Assistant Chief Administrative Officer E.J. SHARP Principal Administrative Officers MISS D. E. EGGINTON S. GODSTONE A. G. HOLMES Principal Nursing Officer MISS K. B. HARVEY S.R.N.. S.C.M.. H.V. Assistant Nursing Officer MRS. M. TAMBLYN, S.R.N. , H.V. . R.F.N. Senior Social Worker MISS M. MACMORRAN Principal Mental Health Social Worker MISS N.E. BRIAN G.C. YOUNG M. D. , M. B. . B. Ch. . B. Sc. . L. M. S. S. A. , D. P. H. Public Analyst D. F.H. BUTTON. A. R.C. S. .F. R. I.C. Chief Public Health Inspector W. C. BARTLETT. F. R. S.H. ,M. A. P.H. I. Deputy Chief Public Health Inspector H. PLINSTON, M.A. P.H. I. (Left Service on 14.7.65) G. S. ADAMS. M.A. P. H.I. (Commenced 13.9.65) Assistant Chief Public Health Inspectors A.J. TRUSLOVE. M.A. P. H.I. T. LAWSON, M.A. P. H.I. Deputy Principal Nursing Officer MISS L.K. MAY S. R. N., S. C. M.,H. V. , Q. N., Dip. Soc. Supervisor of Midwives MISS V.J. BUCKINGHAM, S. R.N. , R. F.N..S. C.M. Deputy Senior Social Worker MRS. A. HOSKER Deputy Principal Mental Health Social Worker J.P. QUINN Health Education Officer K.M.N. ROBERTSON, L.M.R.S.H., M.I.H.E. 4 Dr. C.O.S. Blyth Brooke, O.St. J., M. D. , D. P.H., Barrister at Law - Dr. Blyth Brooke retired on 14th July, 1965, from the post of Associate Medical Officer of Health. From November 1939 until 1st April 1965, he was Medical Officer of Health of the Metropolitan Borough of Finsbury. A Fellow of the Royal Society of Medicine, a Fellow of the Society of Medical Officers of Health, and Chairman of the City Division of the British Medical Association, he was from 1948 a pioneer in the field of old people's services, and was responsible for establishing in 1951 London's first work centre for the elderly; this centre is in Gloucester Way and has been named "Brooke House". He addressed numerous conferences both in this country and abroad on public health matters (particularly geriatrics) and published numerous treatises in professional papers on medical subjects. He was examiner of students in a number of subjects in professional examinations in connection with public health work, Research work which resulted in the production of the drug "Cephorin" was arranged by Dr. Blyth Brooke, who acted as intermediary for Professor Brotzu of Sardinia. Since he first went to Finsbury in 1935 as Tuberculosis Officer and Assistant Medical Officer of Health, Dr. Blyth Brooke took a very real and personal interest in every aspect of the development of public health services in that Borough. Possessed of great ability coupled with energy and enthusiasm, he applied his talents unreservedly to the duties of his office, and his diligence gave an inspiring lead to all who worked with him. He was responsible for instigating many of the schemes and improvements achieved by the former Finsbury Borough Council which will continue for the benefit of the health services in the London Borough of Islington. Staffing The reorganisation of London government precipitated the mammoth task of establishing the staff for the new Department. This involved the fixation of the establishment in numbers and in gradings, the transfer, appointment and assimilation of officers and employees, the formulating of new service conditions, the consideration of the special safeguards enjoyed by "transferred officers", and the reallocation of accommodation and equipment. The total establishment was 507 officers and 312 full time equivalent employees, details of which are set out in Appendix D. Staff Medical Examinations It was decided that the medical examinations of staff which had previously been carried out by medical advisers should be transferred to the Department. This was a long-term measure as, in view of the volume of work involved, it was not possible to undertake the full load of examinations. Commencing in April, 273 examinations were carried out for appointment, superannuation and sickness purposes. General advice was given on medical aspects of staff; a code was laid down for the exclusion of food handlers from duty in the Council's establishments, by reason of infectious disease. Health Service Premises A list of premises is set out in Appendix B. The Borough Architect became responsible for the maintenance of existing premises and for the planning of new accommodation. A close and fruitful co-operation was soon established at all levels between the two departments. Useful links were maintained with the Architect and the Valuer of the Greater London Council on work already in progress on 1st April 1965, and particularly in regard to the large new junior training centre which was still undergoing erection in Prebend Street, N.1 Long-term planning, could only be undertaken tentatively and provisionally. A fiveyear programme was drawn up, incorporating the similar plan prepared by the London County Council. The details weree- 5 1965/6 - new day nursery on G.L.C. Housing Site; - new junior training centre for mentally subnormal pupils completion by G. L.C.; - adaptation of existing property as replacement day centre for mentally ill adults.; 1966/7 - new hostel for mentally ill adults.; - replacement day nursery on G.L.C. Housing Site; - two replacement welfare centres; 1967/8 - new day nursery; - new day centre for mentally ill adults; 1968/9 - new day nursery; - replacement training centre for mentally subnormal women. Apart from the long-term planning, six schemes were introduced for renting or adapting existing premises to remedy deficiencies in existing services. They were - (i) day centre for mentally ill adults (20 places); St. James' Church Hall, Britannia Row, N. 1. (ii) day centre for mentally ill adults (20 places); Lecture Hall, Pinsbury Health Centre, E.C.I. (iii) training centre for mentally subnormal men and women, Community Centre, Bennett Court Housing Estate, Salterton Road, N. 7 (approved in principle); (iv) adaptation as midwives' accommodation (approved in principle), St. Mary Magdalene's Garden Cottage, N. 7.; (v) adaptation as welfare centre (approved in principle), Blythe Mansions Community Centre, Highcroft Road, N.7.; (vi) self-contained flats for discharged mentally ill women (approved in principle), 404 Camden Road, N.7 (first floor). Expenditure Maintenance estimates of expenditure for the year commencing 1st April, 1965, were approved by the Committees as follows:- Total net expenditure Personal Health Committee £680,070 Environmental Health Committee £252,330 In addition, net expenditure of £65,020 was approved for the School Health Service, subject to reimbursement by the Inner London Education Authority. The total gross estimate on the whole service was £1,171,800. 6 Published Papers during 1965 DR. G. C. YOUNG 1. The Aetiology of Enuresis in Terms of Learning Theory (1965) Med. Off. 113 19-22 2. The Physiology of Teething (1965) Mid. & Health Vis. I_ 93-95 3. Childhood Enuresis (1965) Mid. & Health Vis. I_ 173-176 4. Personality Factors and the Treatment of Enuresis (1965) Behav. Res. Ther. 3. 103-105 5. Conditioning Treatment of Enuresis (1965) Develop. Med. Child. Neurol. 7_ 557-562 DR. G. C. YOUNG AND MR. R. K. TURNER CNS Stimulant Drugs and Conditioning Treatment of Nocturnal Enuresis (1965) Behav. Res. Therap. 3_ 93-101. Voluntary Effort The Borough agreed to co-operate with voluntary organisations on the lines suggested in Ministry of Health Circular 18/64, both in using their services and contributing towards their finances. The North Islington Infant Welfare Centre Committee were responsible under formal agreement for the administration of the large Health Centre at Manor Gardens, N. 7 and its two sub-centres. Other voluntary organisations assisted in a wide range of health services, in the prevention of illness, care and after care, mental health and chiropody, and the prevention of break up of families. Of special interest was the acceptance from the Community Service Volunteers of young people with the object of their helping in the community and gaining experience of social problems, and possibly becoming interested in social work as a career. 7 GENERAL AND VITAL STATISTICS Area of the Borough 3.678 acres Population (Registrar-General's estimate Mid-year 1965) 256.610 Births Totals M F Rate per 1,000 Population Islington England & Wales Legitimate 5,201 2,628 2. 573 0.83 (Area Comparability Factor) 19.6 (Adjusted) 18. 0 Illegitimate 874 449 425 Live Births 6.075 3,077 2,998 Rate per 1,000 Total (Live and Still) Births Islington England & Wales Legitimate 93 46 47 15.7 15.7 Illegitimate 4 1 3 Still Births 97 47 50 Total Live and Still Births 6. 172 Illegitimate live births percentage of total live births 14.4 Notifications of Births (year ended 31st December 1965) 5,962 (corrected figure) Marriages (Provisional figures) solemnised in the Borough 2,835 Deaths Rate per 1,000 Population Total M F Islington England & Wales All Deaths 2,935 1,419 1,5116 1.04 . (Area Comparability Factor) 11.9 (Adjusted) 11.5 Infant deaths under 1 year Rate per 1,000 Live Births Total 130 Islington England & Wales 21.4 19.0 Legitimate 21.1 Illegitimate 22.9 Early neonatal mortality (deaths under 1 week) 13.3 Neonatal mortality (deaths under 4 weak) 15.6 Rate per 1,000 Total Live and Still Births Perinatal mortality (still births and deaths under 1 week combined) 28. 28.8 Maternal deaths (including abortion) 3 3.49 0.25 8 1965: CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION (REGISTRAR GENERAL'S RETURNS) Cause of Death AGE GROUPS All Ages Under 4 wks. 4 weeks under 1 year 1- 5- 15- 25- 35- 45- 55- 65- 75 & over M P Total M F M F M F M F M F M F M F M F M F M F M F 1. Tuberculosis, Respiratory 12 4 16 - - - - - - - - - - - - - - 3 1 1 - 6 1 2 2 1 2. Tuberculosis, Other 1 1 2 - - - - - - - - - - - - - - 1 - - - - - - 1 2 3. Syphilitic diseases 1 4 5 - - - - - - - - - - - - - - - - 1 1 - 3 3 4. Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - 4 5. Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - 5 6. Meningococcal Infection - - - - - - - - - - - - - - - - - - - - - - 6 7. Acute Poliomyelitis - - - - - . - - - - - - - - - - - - - - - - - 7 8. Measles - - - - - - - - - - - - - - - - - - - - - - - - 8 9. Other infective and parasitic diseases - 3 3 - - - - - - - - - - - 1 - - - - - 1 - 1 - - 9 10. Malignant neoplasm, stomach 40 35 75 - - - - - - - - - - - - 1 1 8 1 17 5 6 6 8 21 10 11. Malignant neoplasm, lung bronchus 155 36 191 - - - - - - - - - - 1 - 1 - 16 6 63 6 46 10 28 14 11 12. Malignant neoplasm, breast 1 57 58 - - - - - - - - - - - 1 - 6 - 14 1 8 - 13 - 15 12 13. Malignant neoplasm, uterus - 17 17 - - - - - - . - - . - . - 3 - 3 - 4 - 5 - 2 13 14. Other malignant neoplasms 134 133 267 - - - - 1 - 1 1 1 - 2 2 3 10 16 14 24 28 42 32 44 46 14 15. A-and-Leukaemia 4 7 11 - - - - - - - - 1 - - 1 1 - - - - 1 - 2 2 3 15 16. Diabetes 10 8 18 - - - - - - - - - - - - - - 2 1 5 1 1 1 2 5 16 17. Vascular lesions of the nervous system 92 168 260 - - 1 - - - - - - - 2 1 0 - 9 6 17 13 21 41 40 107 17 18. Coronary disease. Angina 321 201 522 - - - - - - - - - - 2 - 9 1 42 7 90 26 87 70 91 97 18 19. Hypertension with heart disease 9 10 19 - - - - - - - - - - - - - 1 - - 3 - 3 4 3 5 19 20. Other heart disease 106 243 349 - - - - 1 - - - - - 3 3 5 2 6 3 12 12 13 30 06 193 20 21. Other circulatory disease 59 129 188 - - - - - - - - - - - - 2 1 1 4 9 5 14 24 33 95 21 22. Influenza - 1 1 - - - - - - - - - - - - - - - - - - - - - 1 22 23. Pneumonia 108 168 276 4 4 11 6 - 2 - - - - - - 1 - 6 4 5 4 18 30 63 118 23 24. Bronchitis 117 66 183 - - - 1 - - - - - - 1 - - 1 4 3 19 4 38 10 55 47 24 25. Other disease of the respiratory system 15 12 27 - - - 1 - - - - - 1 1 - - - 3 - 4 2 4 3 3 5 25 26. Ulcer of stomach and duodenum 9 8 17 - - - - - - - - - - 1 - - - - - 1 1 3 - 4 7 26 27. Gastritis, enteritis, diarrhoea 6 9 15 - - 1 1 - - - - - - - - - - - - - - 1 2 4 6 27 28. Nephritis and Nephrosis 9 4 13 - - - - - - - - 3 - 1 - 1 - 1 1 2 - 1 - - 3 28 29. Hyperplasia of prostate 6 - 6 - - - - - - - - - - - - - - - - - - - - 6 - 29 30. Pregnancy, Childbirth and Abortion - 3 3 - - - - - - - - - 1 - 2 - - - - - - - - - - 30 31. Congenital Malformations 14 8 22 13 2 1 4 - - - 1 - - - - - - - - - - - 1 - - 31 32. Other defined and ill-defined diseases 108 128 236 40 30 2 4 3 - - 1 - - 3 3 4 1 11 8 12 10 16 25 17 16 32 33. Motor vehicle accidents 20 9 29 - - - - - 2 3 1 1 - 4 - 3 - 3 1 2 2 2 - 2 3 33 34. All other accidents 31 29 60 - 2 1 1 1 - 1 - 3 1 3 - 3 3 6 1 4 1 1 4 8 16 34 35. Suicide 28 14 42 - - - - - - - - 1 2 7 1 5 - 5 1 4 3 2 4 4 3 35 36. Homicide 3 1 4 - - - - - - - - - - 1 - 1 - - - - - - - 1 - 36 A11 Causes 1.419 1.516 2.935 57 38 17 6 5 5 4 10 5 32 16 42 30 143 79 295 137 320 329 480 864 Totals 2, 935 95 35 11 9 15 48 72 222 432 646 1350 Percentages 100 3. 24 1.19 0. 37 0.31 0.51 1.64 2. 45 7.56 14.72 22.01 46.00 ANALYSIS OF INFANT DEATHS - 1965 (BASED ON REGISTRAR GENERAL'S RETURNS) Primary Cause of Death Under 1 day Days Weeks Months Tota1s 1 - 2 2 - 3 3 - 4 4 . 5 5 . 6 6 - 7 I - 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 Bronchitis 1 1 Pneumonia 2 2 1 2 1 3 5 5 3 1 25 Enteritis and Diarrhoea 1 1 2 Premature Birth 17 5 1 23 Congenital Malformation, Birth Injury, Atelectasis, Atrophy and Marasmus 32 4 8 1 1 1 5 1 1 3 2 1 60 Suffocation overlying 1 1 Violent Causes 5 1 3 All other causes i 1 2 2 1 2 2 1 1 1 15 Totals 52 10 12 1 2 3 1 7 3 3 9 6 8 6 2 2 1 - 1 - - 130 Estimated Child Population Under 1 year 1 - 4 Total under 5 5 - 14 Total under 15 Islington 6,100 18,800 24,900 29,800 54,700 Greater London 141,500 490,500 632,000 983,700 1,615,700 COMMENTS ON VITAL STATISTICS (Where comparisons are made with previous years, the figures of the former Metropolitan Boroughs of Finsbury and Islington have been combined. Deaths of Infants under one year Forty-one per cent. of all infant deaths occurred within the first twenty-four hours following birth. From one to twelve months the greatest risk to infants was respiratory disease; of a total of thirty-five infant deaths in the age group one to twelve months, seventeen were due to pneumonia. Maternal Mortality In a total of 6,172 live and still births, there were three maternal deaths. One followed Caesarean section; the other two were due to toxaemia of pregnancy and eclampsia. 10 Respiratory Tuberculosis The death rate for lung tuberculosis in 1965 was 0.06 per 1,000 population, and compares favourably with previous years. Deaths due to Pneumonia and Bronchitis In 1965 there were 183 deaths ascribed to bronchitis, and 276 to pneumonia. This showed an increase over the 1964 combined figures of the Metropolitan Boroughs of Islington and Finsbury which were 161 and 190 respectively. These 1964 figures, however, were considerably lower than average, owing to the relatively milder winter. It would seem, therefore, that 1965 did not compare unfavourably with previous years. Malignant Growths of Lung and Bronchus Lung cancer deaths in males have not varied greatly over the past eight or nine years, and 1965 roughly corresponded, with 155 deaths. In previous years the tendency was for female deaths from this cause to increase. 1965 showed a slight fall to thirty-six, but it was not considered that any significant conclusion could be drawn from one year's figures. Coronary Disease with Angina There were 522 deaths (321 male and 201 female) from this cause in 1965. This shows a slight fall from the 1964 figure of 543. Accident Deaths - Comparative table. 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 Motor vehicle accidents 30 25 34 37 37 32 22 34 28 29 Other violent accidents 56 62 42 60 69 65 69 84 62 60 Accident Deaths - Analysis by age groups Type 0- 1- 5- 15- 25- 45- 66- 75- M. F. Total Motor Vehicle accidents - 2 4 1 7 8 2 5 20 9 29 Falls - - - 1 4 3 4 16 14 14 28 Accidental Poisoning (Solid, Liquid Gases and Vapours) - - - - 2 5 - 3 6 4 10 Drowning - - - - - 1 - - 1 - 1 Fire 1 - 1 1 2 - - 3 5 3 8 Inhalation of Stomach contents, ingestion of food etc. - - - 1 - - - - 1 - 1 Other (Railway Accidents, etc.) 3 1 - 1 1 3 1 2 7 5 12 Total 4 3 5 5 16 20 7 29 54 35 89 11 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Notifiable Infectious Diseases and Deaths during the year 1965 Di sease Number of noti fications Number of deaths Removed to hospital Number of Cases returned to Regi strar-General after correction of diagnosis Cases "coming to knowledge" but not noti fi ed Smallpox - (-) - - - . Scarlet Fever 147 (154) - 17 146 37 Diphtheri a 1 (-) - 1 - - Enteric Fever (including Paratyphoi d) 5 (2) 5 5 - Typhus Fever - (-) - - - - Puerperal Pyrexia 181 (313) - 179 181 - Ac. Primary & Influenzal Pneumonia 40 ( 20) - 10 40 . Ophthalmia Neonatorum 18 (55) - 12 17 - Acute Encephalitis 2 (6) _ 2 2 2 Meningococcal Infection 2 (3) _ 2 1 _ Anthrax - (-) - - - - Dysentery 278 (170) - 21 275 227 Malaria 3 (2) - 2 3 - Erysipelas 21 (15) - 1 21 - Measles 2234 (1715) - 45 2228 128 Whooping Cough 62 (136) - 13 60 19 Ac. Poliomyelitis - (-) - - - - Food Poisoning 115 (88) - 13 96 4 Tuberculosis Lungs 183 (261) 16 _ 183 6 Tuberculosis Other Forms 30 (32) 2 - 29 3 (Figures in brackets are notifications for 1964) Saallpox There were twenty-seven references for the supervision of possible smallpox contacts, who were arrivals in this country from declared endemic or locally infected smallpox areas. They were reported to be proceeding to addresses in Islington, and were not in possession of a valid international certificate of vaccination. In accordance with the regulations which came into force on the 1st August, 1963, all the arrivals were visited and kept under surveillance for the required period. An eleven month old child living in Hackney was conveyed by ambulance to a General Hospital in Islington, and subsequently died. It was thought that the child might have been suffering from smallpox, and it was necessary, therefore, to follow up immediately all people who had subsequently been in the ambulance. From subsequent tests and postmortem examination, the diagnosis of smallpox was not confirmed. Certificates of vaccination and Inoculation - Authentication Ministry of Health Circular 60/48. Applications for authentication dealt with by the Medical Officer of Health numbered 2,241 as against 1,939 for the previous year. The applications comprised requests for authentication of International Certificates of Vaccination and Inoculation against smallpox, yellow fever, cholera etc., and constituted a substantial item of work. 12 Food Poisoning Number of Notifications Received 1947 8 1953 270 1959 196 1965 115 1948 13 1954 137 1960 206 1949 62 1955 315 1961 148 1950 109 1956 174 1962 112 1951 158 1957 160 1963 134 1952 84 1958 230 1964 131 There was only one outbreak during the year to be reported to the Ministry of Health in accordance with Memo. 188 Med. of the Ministry of Health. In accordance with Circular 2/50 of the Ministry of Health, the table summarising this outbreak is as follows:- Date No. of Noti fications No. of person s served No. of cases reported No. of deaths Foods involved and Organisms responsible 11.7.65 8 200 10 - Black Pudding Salmonella Typhi Murium Outbreak Report Arising from a notification of a suspected case of food poisoning by a general practitioner, a domiciliary visit was made by a public health inspector. Specimen jars were left, and all three members of the family were found to be suffering from confirmed salmonella typhi murium. On a subsequent re-visit by the public health inspector, it came to light that the probable cause was black pudding consumed at a party in Hackney, on 10th July 1965. A further notification of suspected food poisoning from a general practitioner for another family in this household was investigated, and it was found that the parents were also both cases of salmonella typhi murium. It was then established that this family had also consumed black pudding taken from the party in Hackney by the top floor tenant. All tenants and contacts in this household were then asked to submit specimens and were kept under surveillance. Meanwhile in a third family, two cases of the same food poisoning organism had come to knowledge in another part of the Borough; at this time there was thought to be no connection between this second outbreak and the first outbreak. Further investigations were made and it was established that other cases of salmonella typhi murium in Hackney and Wandsworth had been proved, and all had consumed black pudding in Hackney. It was then discovered that the black pudding was being made in a house in Islington, which was immediately visited by the public health inspector. The woman who made the black pudding submitted several specimens which remained negative. It was found out during the course of investigations that she was a child minder to the third family and so provided a connection between the second outbreak and the original outbreak in the Borough. The source of the foodstuffs used to make the black pudding were investigated, but with negative results. Lead Poisoning There were eight references to the department on the subject of lead poisoning during 1965. 13 Of these, six referred to children who had been admitted to hospital with anaemia and raised blood lead level, and a request was made for domiciliary investigation into the source of the poisoning. In four of the cases evidence was found of paint being chewed, e.g. on cot, dining room table, door etc. In the two remaining cases the source was not determined. Of the other two references, one was an enquiry from the Medical Officer of Health of another area asking for information of the paint being used on plastic toys manufactured in the Borough. It was subsequently confirmed that lead free paint was used by this firm. The final reference occurred shortly before Christmas, when the police brought to the Public Health Department a plastic tool set submitted to them by a parent who stated that he had purchased it at a local store. He had taken this action because he had heard a broadcast regarding a possible danger from such toys which were imported from Hong Kong. The toys were forwarded to the Public Analyst for examination for lead content. The amount of lead was found to vary considerably according to the colour of the toys, but it was understood from discussions with the Home office that none of the findings would be regarded by the Home Office as being at dangerous levels should the toys be chewed by a child, even though in some specimens examined the lead could not be described as negligible. It was understood that following representations by other authorities in the past, the Home Office had been in communication with the Hong Kong Authorities, and that recent consignments of these toys had been found to have a negligible lead content. This matter did not appear to be subject to statutory action and in any event it was not possible to trace the original store stated to have sold the toys. The Home Office was formally notified of the findings of the Public Analyst. Typhoid and Paratyphoid Fever There were three confirmed cases of typhoid fever and two cases suggestive of paratyphoid fever in the Borough during the year as follows:- Typhoid Fever A male Nigerian, aged 23 years, was admitted to hospital on the 11th March, 1965, and reported as a case of typhoid fever, with a positive blood culture. He had arrived in England on the 12th February 1965. Domiciliary enquiries were carried out and routine bacteriological examination of primary contacts proved negative. A male Indian, aged 28 years, was admitted to hospital on the 12th August, and reported as a case of typhoid fever, onset being the 7th August, 1965. He had left Calcutta by plane on the 9th July, 1965. Routine bacteriological investigation of contacts was carried out in each case with negative results, and the medical practitioners were informed. The organism's phage type '0' is more peculiar to Indian communities, and suggested that the illness may have been contracted in India, or through contact with an Indian carrier in this country. A female Islington resident aged 25 years was admitted to an Isolation Hospital on the 9th October, 1965, and reported as a case of typhoid fever, with a positive faeces and blood culture. The patient had recently returned from a fortnight's holiday in Italy, and it was thought that this infection was probably contracted abroad. Extensive enquiries and routine bacteriological investigation of contacts both in this and adjacent Boroughs were carried out with negative results. 14 Paratyphoid Fever A 19 years old Islington housewife attending a hospital outside the Borough had been investigated for abdominal pains and diarrhoea, and a Widal test showed a high titre of paratyphoid *B' . Neither she nor her husband were employed in the food trade and they had no family. Domiciliary enquiries were made and bacteriological examination of contacts proved negative. Notifications were received from an Infectious Diseases Hospital which referred to a mother aged 25 years and daughter aged 2 years living in the Borough. It was reported that whilst all cultures of faeces examined were negative, the Widal reaction showed falling antibody titres consistent with an infection, most probably of paratyphoid fever. In neither instance was there any suggestion of carrier state. Bacteriological examination of residential contacts all proved negative. In addition to the above there were three suspected typhoid cases which were investigated, but were subsequently not confirmed. Seven groups of Islington contacts of Typhoid and Paratyphoid Fever cases not in the area were also followed up during the year as follows:- Information received from the Medical Officer of Health, City of London, that the P & 0 Liner 'Himalaya' which arrived in Tilbury on the 3rd February, landed a sick bell boy at Marseilles, who was subsequently confirmed as a case of typhoid fever. His duties involved the serving of coffee to passengers, and the last date of contact was the 22nd January when the boy first reported sick. Nine passengers and crew were reported proceeding to addresses in Islington. Domiciliary enquiries were made, but in three instances they were not known at the address given, and the Medical Officer of Health. City of London was advised accordingly. Bacteriological examination and surveillance of the remainder was carried out, and their medical practitioners informed. A rural authority outside Greater London reported that there had been a confirmed case of typhoid fever in a patient who was on holiday at a holiday village in Majorca, from the 29th May to the 12th June. Practitioners were asked to keep in mind the possibility of a similar infection in patients who might present themselves, and who had been on holiday at this village. A total of twenty cases of typhoid fever occurred at Friern Hospital, Barnet, during the latter part of the year. All were hospital patients and no staff were reported affected. A total of sixty suspected contacts living in Islington were reported to the department and were kept under routine surveillance. Bacteriological examinations were carried out and all results proved negative. Information was received of a confirmed case of typhoid fever who was a visitor to Butlin's Holiday Camp, Bognor Regis. Domiciliary enquiries and bacteriological investigations of thirty-one Islington residents who visited the camp at the same time as the patient, and three staff who had returned home, were satisfactorily carried out, and the medical practitioners informed. A child who was admitted to a general hospital in Camden was subsequently diagnosed as a case of confirmed typhoid fever. A total of eight Islington Ward contacts were reported. Domiciliary enquiries were made and bacteriological examinations proved negative. Two other references were for isolated contacts of cases of typhoid fever with satisfactory conclusions. Dysentery There were five hundred and two cases notified and coming to knowledge' during the year. Of these, four hundred and twenty-eight proved positive, whilst seventy-four were clinical cases with negative stools. The source of infection was not determined in the greater proportion of these cases, although there were minor outbreaks at several schools in the borough. 15 There were forty-seven cases ascertained at two day nurseries. The usual pattern in these day nurseries is that an initial case develops symptoms, and through routine control, several others (usually symptomless carriers) are discovered. All cases and carriers are excluded and specimen examination is then commenced until three clear rounds are obtained from those remaining in the nursery. Infective illness at a school In early December, 1965, information was received from the Head Teacher of a girls' school in the Highbury area that several pupils and teachers were absent, and also that many of the pupils who attended school that day had to be sent home as they complained of sickness, headache, abdominal pains, etc. During the first few days of this outbreak of sickness, faecal specimens were obtained from 19 pupils and 3 staff, all of which proved negative. Also, a water examination revealed no abnormality, and the general condition of the school and kitchen were satisfactory. A survey was carried out by the department and it was ascertained that a total of 196 persons were affected - 5 staff, 169 pupils and 22 family contacts of the pupils. The symptoms fell mainly under ten headings and, of these, the greater majority (78%)suffered from one or more of the following - vomiting, diarrhoea, nausea and abdominal pain. The period of illness varied from a few hours to 21 days, the average being 3 days. There were no complications and all patients made a complete recovery. Although no organisms were cultured, it was thought that the epidemic was probably caused by a virus, and features of the illness were similar to previously reported outbreaks of epidemic vomiting. It was interesting to note that subsequent to this outbreak in Islington there were press reports of similar outbreaks in other parts of the country which appeared to be confined to children and with symptoms of sore throats, headaches and muscular pains. Tuberculosis In 1965, 213 new notifications were received, with age and sex distribution as follows:- 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 7 5- Total M . 2 2 2 3 2 8 21 11 19 22 9 1 102 Pulmonary F 2 1 3 3 3 3 10 12 19 10 10 2 3 81 M . . - 1 - 1 - 2 4 2 - - - 10 Non-Pulmonary F - - - 1 - 2 3 7 2 1 3 - 1 20 Totals 2 3 5 7 6 8 21 42 36 32 35 11 5 213 The notification rate of all forms of tuberculosis was 0.83 per 1,000 as against 0.34 for the whole country. The total number of cases remaining on the register after adjustment for deaths and transfers was, on the 31st December, 1965:- Males Females Total Pulmonary 1,408 1,057 2,465 Non-Pulmonary 148 176 324 Totals 1,556 1, 233 2,789 16 There were 18 tuberculosis deaths (16 pulmonary and 2 non-pulmonary) during 1965. The death rate of all forms of tuberculosis was 0 07 per 1,000 of the population, as against the national rate of 0.05. Islington Chest Clinic, Whittington Hospital St. Pancras Chest Clinic, Margaret Street, St. Marylebone Finsbury Chest Clinic, Health-Centre, Pine Street, E.C.I Mass X/Ray Unit of the North-West Metropolitan Regional Hospital Board 32 Drayton Park, N. 5 The Borough is well and conveniently served by the above centres to which patients may be referred, or where persons may attend for examination. Cases on Chest Clinic Registers Pulmonary Non-Pulmonary Total Adults Children AduIts Children AduIts Chi1dren M F M F M F M V M F M F Number of definite cases of tuberculosis on Chest Clinic Register as at 31st Dec. 1965 Islington C. C. 1,013 641 47 48 55 89 4 11 1,068 7 30 51 59 St. Pancras C. C. 96 38 11 11 6 6 1 - 102 44 12 11 Finsbury C.C. 138 120 5 5 6 9 2 1 144 129 7 6 1,247 799 63 64 67 104 7 12 1,314 903 70 76 Grand Total . . . 2,363 Tuberculosis in immigrants - year ended 31st December, 1965 COUNTRY where Number of advice* Number of first † Number of pulmonary passport was notes received successful visits tuberculosis issued, as stated during the year paid during the fications subsequently by Port Health from ports and year received relating to Authority airports relating to immigrants who arrived arrival of immigrants during the year Commonwealth Countries Carribean 278 222 India 108 67 Pakistan 71 51 1 Other Asian 27 12 African 178 152 Other 47 33 Non-Commonwealth Countries European 182 115 Other 11 5 TOTAL 902 657 1 * Advice of arrival of immigrant † First successful visit means the first time the local health authority officer established contact with the immigrant. 17 It will be seen from the chart that 657 successful visits were paid to immigrant arrivals to the Borough during 1965. In only one case was a notification of pulmonary tuberculosis subsequently received relating to one of these arrivals. These visits were paid by an officer of the Welfare Department, and I should like to record my thanks to the Chief Welfare Officer. Tuberculosis Care Committees The Borough continued the aid given to these voluntary committees, whose work remained largely unaffected by the change in London government. Islington Chest and Tuberculosis Care Committee Patients or their families were assisted with supplementary nourishment, fuel, holidays, fares, and with advice on mortgages, rent control and a wide range of personal problems. An annual outing to Eastbourne was enjoyed by 49 patients, the cost being met from the proceeds of a concert. At Christmas, food vouchers were distributed to nearly 200 recipients. The funds from which assistance was given were derived from charitable organisations such as the Hospital Friends, the Richard Cloudesley Trust, the St. Patrick's Benevolent Society, and by organised and special efforts, of which the principal was the Christmas Seal Sale. Many firms also contributed gift parcels. The officers of the Committee were:- Councillor Mrs. E.M. Simms - Chairman Councillor Mrs. B. Stradling - Vice-Chairman Dr. V. Freeman - Honorary Treasurer Mr. J. Buckle - Welfare Officer and Secretary of the Islington Chest Clinic The Care Committee also administered an occupational therapy service, two Occupational therapists being employed by the London Borough of Islington. During the year, 36 patients received instruction at home under this service. Finsbury Chest and Tuberculosis Care Committee This Voluntary committee raised most of its funds from the sale of Christmas seals and these funds were used to help patients attached to the Finsbury Chest Clinic and their relatives. Thirty-one people received a Christmas parcel and a grocery voucher and six patients were given grants to purchase new clothing. Holidays for two patients and fares for one patient were also paid for from the funds of the Committee. The officers of the Committee were:- Mrs. A.E. Lamb - Chairman E. G. Crowsley Esq. - Honorary Treasurer Miss A. Phelps - Secretary 18 Hostel for homeless infective tuberculous men. Cromwell Lodge. Cholmeley Park, N.6 Difficulty was experience in staffing this hostel, which requires supervision 24 hours a day. It was largely due to the efforts of the warden that the hostel remained fully operative throughout the year. The assistant warden left the service of the Council in August and, at the end of the year, the post was still vacant in spite of repeated advertisement and a number of abortive appointments. The turnover of staff in the domestic field was very high and added to the difficulties of running the premises. 25 men were in residence at the end of the year, for 20 of whom other London Boroughs were responsible. Two Islington patients were in residence at the Hurlingham Lodge Hostel in the London Borough of Hammersmith. Work of Chest Clinic Welfare Officers Patients assisted for the first time with:- Beds and Bedding 3 Clothing or footwear 19 Patients at the end of the year receiving extra nourishment 85 Home visiting - by tuberculosis health visitors total visits (including contacts; but excluding unsuccessful visits)'.- 4,243 Diversional therapy Total classes held at Cromwell Lodge Hostel 42 Patients receiving instruction in their own homes at end of June quarter 19 Total number of visits made to patients in their homes from 1st July to 31st December 816 Rehabilitation The Council was responsible for one patient at the British Legion Village, Maidstone, who was discharged on 5th April, 1965. Boarding-out of child contacts for segregation during B. C. G. vaccination One child was placed in a foster home during the year and had returned home by the end of the year. 19 Scabies and Vermin Scabies Vermin Children under 5 years Number treated 37 44 Number of baths given 83 4-'. Number of treatments - 44 I.L. E. A. Children Number treated 77 170 Number of baths given 152 - Number of treatments - 173 Adults Number treated 199 160 Number of baths given 366 _ Number of treatments - 162 As will be seen from the table there is still a considerable number of Scabies and also vermin infestations. There was a fall in the numbers treated for scabies in 1965 313 compared with 388 the previous year. The numbers treated for vermin infestations also showed a fall to 374 compared with the previous year's total of 392. These conditions were dealt with at the Council's Treatment Centres. Bacteriological Examinations The number of specimens sent to the Public Health Laboratory, County Hall, S.E.I, for bacteriological examination was 5,526. This compared with a total of 2.236 specimens submitted last year. The large annual fluctuations are due mainly to the extent of dysentery outbreaks in any particular year. Examinations carried out Total Swabs (Diphtheria) .... 207 Sputum (Tuberculosis) ... 9 Faeces & Urin (Enteric Fever) . 507 Faeces (Food Poisoning) . . . 460 Food (Food Poisoning) ... 2 Faeces (Dysentery) .... 4,215 Faeces (Poliomyelitis) ... 5 Swabs (Streptococci) ... 39 Other specimens 82 Total 5,526 SERVICES FOR THE ELDERLY Visits by Principal Medical Officer Twenty-six visits to elderly persons were made by Dr. G. Young, Principal Medical Officer. These calls were made at the request of general practitioners, home visitors, etc. in circumstances where it was felt action might be necessary under Section 47 of the National Assistance Act, 1948. Four cases were dealt with under section 47; three persons subsequently agreed to be admitted to hospital or a welfare home to receive care and attention. In the other cases immediate action was not considered necessary. Home Visiting The Council employed three home visitors (S.R.N.) and four assistant home visitors, to visit elderly persons in the Borough. A small amount of visiting was also carried out by the nursing staff attached to the bathing and treatment centres at Seven Sisters Road and Finsbury Health Centre. 20 A total of 9,655 visits were paid during 1965, of which 572 were to new cases previously unknown to the department. National Assistance Acts, 1948 & 1931 Section 47 Removals Pour elderly persons were removed to hospital during the year, under the provisions of Section 47 of the National Assistance Act, which enables the Council to obtain orders for the compulsory removal of patients for their own good, in accordance with certain specified circumstances. Two of the elderly persons subsequently died, one remained permanently in hospital, and the fourth was transferred to a Welfare Home. Special Cleansing Circumstances arise from time to time when it is found that property occupied by elderly or infirm persons is in such a filthy, verminous or insanitary condition as to warrant special cleansing by the Council's Health Department, prior to the introduction of home help and other services. Fifteen such cases were reported by the public health inspectors, home visitors, hospital authorities, etc. during the year. Eleven special cleansings were carried out. Four cases were subsequently not proceeded with for various reasons. Meals on Wheels Service At the commencement of 1965, the Metropolitan Borough of Islington was providing a two or three day service throughout the Borough, using three vans which serviced different areas from day to day. By the end of the year the London Borough was operating six vans within the old Metropolitan Islington area, and providing a five day service. One van provided a limited service in the Finsbury area throughout the year and was driven by a social worker from the Finsbury Old People's Welfare Committee. Total meals served for the whole borough January - March 9,975 April - June 9,191 July - September 15t195 October - December 16,565 50,926 Invalid Meals Service Figures in respect of the Invalid Meals Service are not available for the first quarter of 1965, as the kitchen was under the control of the London County Council and did not observe borough boundaries. During the nine months from 1.4.65 to 31.12.65, meals were served from the kitchen at 65 Essex Road, as under: Delivered to Islington residents 16,548 Delivered to Camden Residents 21,396 Total meals delivered 37,944 Meals served in restaurant at 65 Essex Road 3,885 Meals delivered to Islington residents by the Hackney kitchen 22,849 21 Laundry Services The laundry service for incontinent persons †most of them elderly) was provided throughout the year from the Treatment Centre at Seven Sisters Road. During the year 3,529 collections of laundry were made (involving 39,196 articles). The service was being provided to about 160 persons at the end of the year. The Finsbury Laundry Service for Elderly Chronic Sick was continued throughout the year. As instructed by the Council, no new cases were added to this service, and the number of recipients fell from 65 at the commencement of the year, to 44 at the end of the year. 2,303 parcels of laundry were collected during the twelve months under review. Bathing Facilities The services provided from the Treatment Centre, Seven Sisters Road and from the Finsbury Health Centre continued throughout the year. 4,404 baths were carried out in the homes of elderly persons under the Domiciliary Service. 1,611 baths were given to persons attending the two centres, the department's ambulance being used to assist those unable to travel on their own. Task Force A local office of Task Force, (an organisation set up to encourage and foster voluntary effort among the younger citizens), opened their Islington office in September 1965. Twenty-four cases were referred to them by the Aged and Infirm Section of the Health Department during the remainder of the year. I should like to place on record my sincere thanks for the sterling work that is being undertaken by this organisation and I know that I am also speaking for the elderly people of the Borough when I say that it is very much appreciated. Islington Crematorium The Medical Referees certified a total of 829 applications for cremation at the Council's Crematorium, East Finchley. SANITARY CIRCUMSTANCES OF THE AREA New legislation brought added duties and responsibilities to the Department. The Public Health (London) Act, 1936. was replaced by the Public Health Acts. 1936 and 1961. This brought some disadvantages, however, as in certain instances the powers given to previous Metropolitan Boroughs were lost. These included:- 1. the power to unstop or repair a drain in default, at a cost not exceeding £100. The limit was reduced to £50, which was undoubtedly too low; 2. the power to execute works to restore a defective water service cut off by the Metropolitan Water Board; 3. the power to abate nuisances requiring urgent attention, in default; 4. the power to require a sufficient supply of water within a tenement house; 5. the power to require an adequate and readily accessible supply of water for drinking purposes direct from the main supply to any building or part of a building occupied as a separate tenement; 6. the power to require the registration of Barbers and Hairdressers. It is hoped that these powers will be reinstated as soon as possible. Certain public control functions carried out by the former London County Council were transferred to the Inspectorate. Details of these and the work done under the appropriate legislation are given on Page 48-49 Both the Inspectorate and the Administrative staff were quick to adapt themselves to the changed conditions although difficulties were encountered in the transition period. The establishment of inspectors remained under strength throughout the year. There were ten vacant positions at the close of the year in question. A new section dealing with the administration of the Offices, shops and Railway Premises Act, 1963, and the various Shops Acts was set up. A full report of the work carried out is given on pages 37-45 Vacant sites and derelict buildings continued to be a problem throughout the year. Numberous complaints were received of refuse being deposited on sites and of the misuse of buildings by vagrants and children. Experience showed that as soon as these nuisances ware abated they recurred. The answer is the speedy redevelopment of sites. Difficulty of access - in many cases both husband and wife being at work frequently caused inspectors to make further fruitless visits to properties. It was then necessary for a further visit to be made outside working hours. There were indications that the number of immigrants from all parts of the world, but particularly from the Commonwealth, continued to rise. Due to their circumstances, they gave rise to a high proportion of complaints in relation to their numbers, particularly in such matters as over-crowding and the absence or mis-use of essential amenities. There was also the problem of communication which was not only a question of language but also the difficulty of words being given different meanings. The presence, in the Department of an inspector who speaks fluent French, Spanish and Greek was of considerable assistance in overcoming these difficulties. Summary of Work done by District Public Health Inspectors (i) Inspections Houses/flats inspected under Public Health (London) Act, 1936 and Public Health Acts 1936 - 61 5,689 Separate lettings 10,310 Revisits Houses/flats 11,219 Separate lettings 20,513 23 (ii) Other inspections and visits Miscellaneous 3,876 Prevention of Damage by Pests Act, 1949 28 Infectious Diseases 261 National Assistance Acts, 1948 and 1951 (Aged & Infirm) 29 Factories Act, 1961 - Outworkers 20 Pet Animals Act. 1951 31 Consumer Protection Act, 1961, and Regulations 22 Noise Nuisances 107 Pood Premises 249 Non-effective visits 3, 379 (iii) Nuisances and Notices Public Health (London) Act, 1936 and Public Health Acts 1936 - 61 Notices served- (a) Intimation 3,770 (b) Statutory 1,474 Notices complied with- (a) Intimation 1,697 (b) Statutory 658 Nuisances found 6,719 Nuisances abated 5,992 Number of houses repaired 2,727 Separate lettings in above 2,784 Total number of repairs to dwelling houses 6,131 (iv) Legal Proceedings Informations prepared 70 Abatement Orders made by Magistrate 8 Abatement Orders complied with 3 Further proceedings for disobedience of Abatement Orders . (v) Drainage Plans examined 373 Examinations and Tests 544 (vi) Complaints Outstanding (at end of 1964) 186 Received during the year 4,797 plus 446 repeated complaints Dealt with during year 4, 588 Outstanding (at end of 1965) 209 (vii) Land Charges Act, 1925 Enquiries received 4,007 Properties involved 4,978 Investigations 4,978 (viii) Rent Act, 1957 Applications for Certificates of Disrepair (1) Number of applications for certificates during 1965 2 Number of applications brought forward from 1964 - Number of applications carried forward to 1966 - Total number of applications receiving attention 1965 2 (2) Number of decisions not to issue certificates 1 Number of Undertakings on Form *K' accepted - (3) Number of decisions to issue certificates 1 (a) in respect of some but not all defects 1 (b) in respect of all defects - (4) Number of Undertakings given by landlords under paragraph 5 of the First Schedule - (5) Number of Undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule - (6) Number of certificates issued where undertakings not accepted Applications for Cancellation of Certificates (7) Applications by landlords to Local Authority for cancellation of certificates 3 Number of applications brought forward from 1964 - Number of applications carried forward to 1966 - Total number of applications receiving attention 1965 . 3 (8) Objections by tenants to cancellation of certificates (9) Decisions by Local Authority to cancel in spite of tenant's objection - (10) Certificates cancelled by Local Authority 3 Applications by Overseas Companies for Certificates of Repair Applications received - Certificates issued - (ix) Repairs effected as a result of Service of Notices under the Public Health (London) Act, 1936 and Public Health Acts 1936-61 1. Brickwork - walls repaired or rebuilt 35 2. Drains cleared, repaired, etc. 589 3. Dampness remedied 1,067 4. Fireplaces and ranges repaired/renewed 52 5. Floors repaired 332 6. Flues repaired 30 7. Internal walls repaired 477 8. Ceilings repaired 369 9. Rainwater pipes/gutters repaired/renewed 278 10. Roofs repaired 544 11. Rooms cleansed 21 12. Sinks provided/renewed 44 13. Soil pipes repaired and renewed 69 14. Staircase or passages cleansed 7 15. Staircase repaired 123 16. Waste pipes repaired/renewed 247 17. Water Closet Apartments cleansed 40 18. Water Closet Pans and Traps renewed 93 19. Water Closets - flushing apparatus repaired or renewed 119 20. Water Closets - general repairs 172 21. Water supplies provided 22 22. Water service pipes repaired 79 23. Window sash cords renewed 424 24. Windows repaired or renewed 347 25. Miscellaneous improvements 551 Total 6,131 Works in Default Public Health (London) Act, 1936 - sections 40 and 109 London County Council (General Powers) Act. 1955. Sections 25. 26 and 27 Public Health Act 1936 - Sections 39. 44. 45. 275 and 290 Public Health Act 1961 - Sections 17 and 18 Work required to be done to Drains, Sanitary Conveniences and Premises Consequent upon Notices served by the Public Health inspectors, the Council in pursuance of their powers under the above Acts carried out works in default in 161 cases. Legal Proceedings Legal proceedings were taken in respect of two cases for failure to comply with notice under Section 82 of the Public Health (London) Act, 1936, and one case for failure to comply with Notice under Section 95. Two cases were taken for failure to comply with a Magistrate's Abatement Order and seven for failure to comply with notice under Section 93 Public Health Act. 1936. There was one prosecution under the Noise Abatement Act 1960. Public Health (London) Act 1936 Failure to comply with Statutory Notices contrary to Section 82 Date Address Magistrates' Decision 2.2.65 11 Devonia Road Absolute discharge. Ordered Abatement 56 days. Defendant to pay £3 0. Od. costs. 6.7.65 10 Medina Road Ordered abatement 21 days. Defendant to pay £3 10. Od. costs. Failure to comply with Statutory Notice - Section 95 11.3.65 11 Devonia Road Ordered abatement 14 days Fined £2 0. 0. Defendant to pay £1 0. 0. costs. Failure to comply with Magistrate's Abatement Order 2.3.65 23 Cross Street Fined £20. 0. 0. Defendant to pay £5 0. 0. costs. 1.12.65 10 Medina Road Fined £5. 0. 0. Defendant to pay £2. 0. 0. costs. Public Health Act 1936 Failure to comply with Section 93 Public Health Act. 1936 Date Address Magistrate's Decision 10.8.65 5 Salisbury Road Summons not served Work completed in interim 8.9.65 19 Hillmarton Road Ordered abatement 14 days No penalty. 26 Date Address Magistrates Decision 3.11.65 3 Tyndale Avenue Ordered abatement 28 days Defendant to pay £2 0. 0. costs 1.12.65 18 Barnsbury Road Ordered abatement 28 days Defendant to pay £2 0. 0. costs 1.12.65 88 Blundell Street Ordered abatement 28 days Defendant to pay £2 0. 0. costs 1.12.65 446 Caledonian Road Ordered abatement 56 days Defendant to pay £2 0. 0. costs 1.12.65 425 Liverpool Road Summons not served Noise Abatement Act 1960 Date Offence Magistrate's Decision 3.11.65 Operating a loud-speaker Fined £6. 0. 0. in Ockendon Road, Defendant to pay £2 0. 0. costs, contrary to Section 2 (ice cream chimes) DISINFECTION AND DISINFESTATION (a) General The services formerly operated by Islington and Finsbury were to a very large extent integrated. As a result the bulk of the steam disinfection was undertaken at Finsbury Health Centre, and disinfection and disinfestation of premises was in the main carried out by staff operating from the Islington Treatment Centre. The Council reconsidered the charges made in regard to the treatment of verminous premises. Whereas in the past disinfestation was free in exceptional cases particularly where hardship would be caused - it was decided to carry out all D. D.T. treatments free, and thus encourage disinfestation and eliminate as far as possible the number of verminous premises in the Borough. Number of rooms disinfected after cases of infectious disease 250 Number of rooms treated for vermin 1,125 Upon request a full-scale disinfection of one of the children's wards in a hospital in the Borough was carried out following a persistent infection by S.Brandenburg, A team of six working all day systematically scrubbed all floors, walls, ceilings, partitions etc., and then sprayed everything in the ward. Apparently the treatment was quite successful since there were no further cases reported from the ward in question. Sixteen visits were paid by the Public Health Inspector to a factory to supervise the treatment of clothing and other materials for export. The total weight of bales treated was 30 tons 10 cwts. In addition, 18 oven loads were steam disinfected at the Treatment Centre for the Company concerned. (b) Steam Disinfection During the year 4,870 articles of clothing or bedding were steam disinfected. 27 (c) Fly and other Infestations Because of the use of diesel locomotives on the sidings serving the Council's refuse disposal depot at Ashburton Grove the permanent way, sleepers, etc., became heavily coated in diesel oil and this resulted in the virtual elimination of fly nuisance. Regular inspection was carried out but no special treatment has been found necessary. Twenty-three wasp nests were eliminated during the course of the year and no special heavy infestations of other insects were reported. Pigeons There appeared to be an increase in the pigeon population. Complaints continued to be received of the nuisances caused by pigeons on houses, estates, and other parts of the Borough by fouling and defacing buildings, windows, courtyards, footpaths. etc. and thus occasioning annoyance. Apart from the mess produced by their excreta, pigeons can transmit disease and do much damage to property. They congregated wherever they could find food. It became necessary therefore to draw the attention of tenants in areas affected by pigeon nuisance to these facts and to request them to refrain from feeding pigeons by throwing out food or allowing it to fall on the ground. In a number of cases the Council engaged an authorised pigeon catcher in order that the nuisance might be kept to a minimum Caravan Sites - Control of Development Act, 1960 One caravan was sited in the Borough throughout the year and was occupied by the caretaker of a factory. This was a temporary arrangement pending the completion of building works, which had been delayed until a road widening problem had been resolved. The caretaker was eventually to be rehoused in permanent accommodation. The site was maintained in a satisfactory condition. CLEAN AIR ACT, 1956 Smoke Control Areas Up to the time of amalgamation, 14 Smoke Control Orders had been made by the Metropolitan Borough of Islington and 5 by the Metropolitan Borough of Finsbury,making a total of 19 orders. It was decided that all future smoke control areas should be numbered accordingly and be designated "Islington". The following Smoke Control Orders were made by the Council during the year:Islington No.20 Order made 29/6/65 ) Islington No.21 Order made 29/6/65 ) confirmed by the Ministry on 16th September 1965 Islington No.22 Order made 29/6/65 confirmed by the Ministry on 30th September 1965 Islington No.23 Order made 17/9/65 confirmed by the Ministry on 8th December, 1965 The detailed surveys of proposed Areas 24, 26 and 27 commenced during the autumn period and were well in progress at the end of the year. The Finsbury (No.5) Smoke Control Order came into operation on 1st October and over 200 grants had been approved since the 1st April. A Variation Order known as:"Finsbury (No.5) Smoke Control (Variation) Order 1965" was made on 23rd November, 1965, to exclude Farringdon Road Buildings, Corporation Buildings and Compton flats from the terms of the Finsbury (No.5) Order. 28 Detailed Survey of Smoke Control Areas Since 1st April the hand-book issued by the Council was completely revised and brought up-to-date. As far as possible when carrying out surveys, a 100% contact was made and a complete record of potential hardship cases obtained. This personal approach was much appreciated and encouraged good public relations. In recent surveys it was found that approximately 45% of dwellings burn no solid fuel. The North Islington No.7 Smoke Control Order (136 acres) The following, which is typical, is a list of adaptations carried out in the area during the qualifying period. Approved grates with Gas Ignition 518 Approved grates with Back boilers and Gas Ignition 2 Free standing or inset solid fuel room heaters 30 Electric fires (allowed at that time) 56 Gas Fires 175 Electric 13 amp power points 95 Gas points 271 Electric off-peak night storage heaters 4 Electric fire lighters 24 Tiled surrounds 150 Brick sets 12 Gas pokers only 20 Gas coppers 1 Gas cookers 1 Approved oil heaters 5 Hardship grants (0. A. P.'s) 140 Statistics Number of applications received for prior approval by local authority of plans 5 and specifications for new furnaces (Section 3(2)) Number of applications for prior approval granted 5 Number of notifications of intention to install furnaces 12 Inspections by Clean Air inspectors and assistants 10,731 Re-visits 1,919 Non-effective visits 4,755 Complaints received 57 Smoke observations 288 Contraventions found 42 Adaptations completed (domestic) 738 Notices served 46 Notices complied with 22 Prosecutions - Regulations and Circulars The following Regulations and Circulars were issued by the Ministry of Housing and Local Government during the year in relation to Smoke Control Areas - 1. Circular No. 13/65 - 13 th March, 1965 - Supplies of solid smokeless fuel It was considered by the Ministry that provided the producers increased their production of premium fuels at a steady rate and made supplies available and that freedom of choice regarding fuels and appliances was allowed to continue to operate when future smoke control areas were established, there would be enough premium fuel to meet demand; 29 2. Circular No. 51/65 - 28th June, 1965 This was a guide to Local Authorities setting out in Appendix I cost limits for various appliances, while in Appendix II a revised memorandum was given on the principles for determining what types and standards of works are reasonably necessary when considering grants for adaptations to fireplaces. 3. The Smoke Control Areas (Authorised Fuel) Regulations 1965 - No. 1508/1965 These regulations came into force on 1st September, 1965, and listed another / authorised fuel for the purpose of the Clean Air Act. 1956. This is 'phurnacine briquettes, which has anthracite as a main constituent, and is manufactured by the National Coal Board. 4. Circular No. 69/65 - 18th October 1965 - Tall Buildings & Industrial Emissions This circular drew the attention of Local Planning Authorities to the need to give especially careful consideration to proposals for the erection of very tall new buildings in situations where they might be affected by emissions from existing chimney stacks which serve large industrial installations burning solid or liquid fuel at a rating of 450,000 lbs of steam per hour. In such situations the upper parts of the building may in certain circumstances be subjected to undesirable high peak concentrations of sulphur dioxide. Moreover, the building, by reason of the down draughts it creates, may interfere with the normal disposal of the plume from the stack. As a rough guide, it was suggested that both eventualities should be considered whenever the proposed new building would be more than two-thirds the height of the existing stack. Local Authorities were recommended to take both eventualities into account in considering proposals for buildings to be erected by them and also in considering planning applications from developers. 5. Circular No. 77/65 - 31st December 1965 - Estimates and Final Costs This circular, revised the procedure and simplified the handling of Smoke Control Orders and the arrangements for the submission of information regarding the cost of fireplace adaptations to the Ministry. Recording of Atmospheric Pollution As part of the national survey of atmospheric pollution, there were 3 sites in the Borough where the daily measurement of smoke and sulphur dioxide present in the atmosphere was determined, using standard apparatus: - Site 1 - The Treatment Centre, Seven Sisters Road, N. 7 Site 2 - The Health Department, Upper Street, N.1 Site 3 - The Health Centre, Pine Street, E.C.I Two 8-port valve automatic recorders were installed and eliminated the necessity for daily replacement of the smoke filter paper and hydrogen peroxide bubbler, by automatically switching the air intake once every 24 hours to pass through a different filter and bubbler. This allowed 24-hourly samples to be obtained without attendance at the site and operated for 8 days. The method proved particularly useful for week-end and Bank Holiday periods. On the advice of the Warren Spring Laboratory, the use of the Deposit Gauges and Lead Peroxide candles was discontinued. 30 Recording of Atmospheric Pollution A summary of the recordings from the Borough Council sites is set out in the following tables: Monthly Deposits recorded by the Deposit Gauges and Sulphur-Dioxide by the Lead-Peroxide Method Month Site No. Rain fal1 in inches (Tons per square mile) Mg. of 303/ day collected by 100 sq. cm. of Batch. A lead peroxide (Louvered Box)  Insoluble Deposit Soluble Deposit Total Solids January 1 1.85 7.55 7.35 14.90 3.55 2 1.66 7.22 5.93 13.15 2.21 3 1.81 6.50 8.75 15.25 - February 1 0.43 6.74 4.03 10.77 3.55 2 0.47 1.65 3.15 4.80 1.93 3 0.43 6.46 3.38 9.84 - March 1 1.69 13.73 4. 56 18. 29 3.46 2 1.69 1.75 5.70 7.45 1.99 3 1.58 8.97 6.76 15.73 - April 1 1.58 27.05 6.31 33.36 2.40 2 1.34 45.44 9.67 55.11 1.26 3 1.77 7.58 5.10 12.68 - May 1 1.50 10.27 5.17 15.44 1.79 2 1.81 19.21 10.47 29.68 0.98 3 1.85 8.88 6.06 14.94 - June 1 1.38 14.06 3.73 17.79 1.13 2 + 1.14 7.75 7.42 15.17 0.82 3 1.58 7.32 6.36 13.68 - July 1 2.92 10.24 8.29 18.53 0.66 2 3.43 12.59 6.42 19.01 0.90 3 3.11 7.48 4.64 12.12 - August 1 1.62 8.29 4.16 12.45 1.24 2 1.73 12.95 7.55 20.50 0.77 3 2.91 8. 15 8.68 16.83 - September 1 4.10 6.01 4.49 10.50 . 2 4.41 8.35 9.97 18.32 . 3 2.60 4.87 7.42 12. 29 - • There was no obvious contamination which would account for the abornormally high figures. + Some water spilt in transit to laboratory. 31 32 Concentration of Smoke and Sulphur Dioxide recorded by the Volumetric method at the three sites in this Borough Station Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec. The Treatment Centre, Seven Sisters Road. Smoke (micrograms per cubic metre) Monthly average 124 176 150 110 70 36 28 34 71 125 155 148 Highest recording 446 492 410 284 191 66 63 68 157 350 275 468 Health Department, Upper Street Snoke (micrograms per cubic metre) Monthly average 142 108 122 85 63 33 26 40 69 150 149 183 Highest recording 446 362 424 210 124 66 48 90 190 396 278 439 Health Centre, Pine Street Smoke (micrograms per cubic metre) Monthly average 125 93 89 84 67 42 31 43 89 135 135 175 Highest recording 285 199 248 124 360 73 69 74 162 324 256 438 The Treatment Centre, Seven Sisters Road. Sulphur Dioxide (micrograms per cubic metre) Monthly average 305 251 354 231 137 108 81 96 146 275 260 390 Highest recording 716 897 567 418 407 291 178 314 275 729 476 7 38 Health Department, Upper Street Sulphur Dioxide (micrograms per cubic metre Monthlv average 303 241 321 247 152 114 70 106 115 27 2 264 297 Highest recording 837 740 605 578 499 374 247 299 241 802 595 820 Health Centre, Pine Street Sulphur Dioxide (micrograms per cubic metre) Monthly average 639 298 389 251 204 113 102 143 152 370 327 425 Highest recording 1028 716 790 807 487 290 158 284 280 974 788 838 Work of Public Health Inspector Administering Factories Act, 1961, and other legislation Factories Act, 1961 Number of inspections 818 Number of re-visits 389 Notices served 94 Prosecutions instituted - Defects found 404 Defects remedied 331 Defects referred to H.M. Inspectors 9 Defects referred by H.M. Inspectors 51 Complaints received 90 Notices complied with 92 Public Health Act, 1936 Factories visited 211 Contraventions found 53 Contraventions remedied 45 Notices served 29 Notices complied with 15 Factory Nuisances Apart from routine inspections under Section 7 of the Factories Act, 1961 many visits were made for complaints of nuisances such as:- 1. Cellulose spraying 2 Paint spraying 3. Stove enamelling 4. Smells given off in industrial processes 5. Dust and nuisance from the buffing 6. Fluff given off from drying and polishing of metal and silverware tumblers in cleaning works. Such complaints are received year after year in various parts of the Borough. The installation of a water spray booth for cellulose spraying and paint spraying or renewal of the paper filter,however, usually overcomes this problem. In the case of nuisance from dust and fumes from polishing processes of metal, the installation of a silent mechanical extract fan generally eliminates any further cause of complaint. Part I of the Act Prescribed particulars on the administration of the Factories Act, 1961 1. Inspections for the purposes of provisions as to Health (including inspections made by Public Health Inspectors.) 33 Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections, 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 125 83 9 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2,545 610 67 _ (iii) Other Premises in which Section 7 is enforced by the Local Authority* (excluding out-workers premises) 67 125 18 Total 2,737 818 94 * i.e. Electrical Stations (Section 123(1)), Institutions (Section 124) sites of Building Operations and Works of Engineering Construction (Section 127), Slaughterhouses, (Section 175(l)(d) and (e)) and Railway Running Sheds (Section 175(2) and (10) ) Cases in which Defects were found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S. 1) 15 1 - 6 Overcrowding (S. 2. ) . - - - - - Unreasonable temperature(S. 3) 1 - - - - Inadequate ventilation (S.4). 11 - - 2 - Ineffective drainage of floors (S. 6) - - - - - Sanitary Convenience (S. 7) (a) Insufficient 3 3 - 1 - (b) Unsuitable or defective 371 327 7 30 - (c) Not separate for sexes. 2 - - 4 - Other offences against the Act (not including offences relating to Outwork) 1 - 2 8 - Total 404 331 9 51 - Outwork (Sections 133 and 134) SECTION 133 SECTION 134 No. of outworkers in August list required by Sec. 133 (l)(c) No. of cases of default in sending lists to the Counci1 No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing ) Making apparel ) etc., Cleaning & Washing 1508 - - - - - Household linen 39 - - - - - Lace, lace curtains and nets - - - - - - Curtains and furniture hangings - - - - - - continued. 34 Continued. No. of outworkers in August list required by Sec. 133 (1) (c) No. of cases of default in sending lists to the Counci1 No. of prosecutions for failure to supply lists No. of in stances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Furniture and upholstery - - - - - - Electro-plate - - - - - - File making 2 - - - - - Brass and brass articles 13 - - - - - Fur pulling 5 - - - - - Iron and steel cables and chains - - - - - - Iron and Steel Anchors and grapnels - - - - - - Cart gear - - - - - - Locks, latches & keys - - - - - - Umbrellas, etc. 38 - - - - - Artificial flowers 140 - - - - - Nets, other than wire nets - - - - - - Tents - - - - - - Sacks - - - - - - Racquet and tennis balls - - - - - - Paper bags - - - - - - The making of boxes or other receptacles or parts thereof made wholly or partially of paper 127 - - - - - Brush making 28 - - - - - Pea picking - - - - - - Feather sorting - - - - - - Carding, etc. of buttons etc. 39 - - - - - Stuffed toys 15 - - - - - Basket making - - - - - - Chocolates and sweetmeats - - - - - - Cosaques, Christmas stockings, etc. - - - - - - Textile weaving - - - - - - Lampshades 3 - - - - - Not specified above 138 - - - - - Total 2115 - - - - - Factories Act, 1961, Section 70 - Basement Bakehouses There were 12 basement bakehouses in the Borough in respect of which certificates of suitability continued in force. Routine inspections were carried out and action taken where necessary to maintain the standards laid down by the Pood Hygiene (General) Regulations, 1960. Public Health Act 1936, Sections 107-108 Offensive Trades The following is a summary of the records:- 35 Type of Business Number No. of Inspections No. of Revisits Total No. of visits Tripe Boiler 1 4 6 10 Fur Skin Dresser 1 7 1 8 Gut Scraper 1 3 - 3 Pat Melter 1 1 4 5 *Knacker 1 2 5 7 * This business ceased to operate from 1st November, 1965. Food & Drugs Act, 1955 Section 62 Slaughterhouses Act, 1958 The Slaughterhouses (Hygiene) slaughterhouses Regulations, 1958/9 The Slaughter of Animals ) (Prevention of Cvielty) Regulations) 1958/9 One private slaughterhouse in the Borough is licensed by the Council at 180 York Way - 14/16 Vale Royal. A total of 51 inspections were made of the premises during the year. The owners co-operated in complying with the Council's requirements under the relevant legislation. Diseases of Animals Act, 1950 The administration of the Diseases of Animals Act, 1950, was one of the functions transferred from the former London County Council to this Council on 1st April. Arrangements were made for the Corporation of London, who have the essential veterinary staff, to enforce all the necessary provisions of the Act as agents of the London Borough of Islington. No formal action under the Act or Orders made thereunder was necessary during.the year. Public Health (London) Act, 1936 London County Council (General Powers) Act, 1937 Noise Abatement Act, 1960 Noise Nuisances Complaints of noise nuisances of various types were received during the year including noise from clubs, private parties and homeworkers using power-driven sewing machines. In addition, noise from compressors on building sites, extraction fans, panel beating of crashed cars in small garages, circular saws, a tubular steel scaffolding yard and chimes from ice cream vehicles were also the subject of complaints. In many instances it was necessary to carry out evening visits of investigation. Consulting accoustic engineers were called in by firms in several instances and, in one case, greatly reduced to an acceptable level the noise caused by the starting up of an oilfired boiler by lining the boilerhouse with accoustic tiles. Where from the Town Planning aspect, it was considered that unauthorised industrial use was being made of the premises, the matter was referred to the Borough Architect. Number of complaints 175 Number of inspections 366 Number of confirmed cases abated 41 36 Pharmacy & Poisons Act, 1933 During the year the following legislation was issued by the Home Secretary - (a) The Poisons List Order 1965 (b) The Poisons Rules, 1965 The Order added, inter alia, certain substances to the poisons list and rules. Number of listed sellers of Part II poisons other than pharmacists 161 Number of initial registrations during the year 10 Number of visits and inspections 26 Rag Flock and other Filling Materials Act,1951 Number of premises on register (Section 2, for Upholstery) 56 Number of Licences issued (under Section 7 for the Storage of Rag Flock Number of inspections and visits 20 Number of samples taken 2 Number of samples satisfactory 2 Consumer Protection Act, 1961 Oil Heater Regulations, 1962 There appeared to be no diminution in: the popularity of these heaters and, although much publicity was given to the dangers associated with their use, a number of fires occurred during the year attributed to this source. These were referred by the London Fire Brigade to the department to ascertain any contraventions of the regulations. In many cases the fire had destroyed the evidence. Where the heater was still reasonably intact it was found that the date or circumstances of the purchase precluded legal action. Offices, Shops and Railway Premises Act, 1963 1965 being the first full calendar year for the operation of this statute, the annual report on the operation of the Offices, Shops and Railway Premises Act for the year ended 31st December, 1965, which was required to be submitted to the Minister of Labour, may be of interest. This is given below and includes a special report on lighting standards requested by the Minister in L. A. Circular No.9. REPORT ON THE OPERATION OF HE OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 FOR THK YEAR 1st JANUARY to 31st DECEMBER, 1965. During the first Quarter of 1965, the Metropolitan Boroughs of Finsbury and Islington were the responsible Authorities for work under this Act. It had been found possible in the area of the latter Authority for most of the registered premises to have received a general inspection at the date of transfer to the London Borough, but a more difficult problem was presented in the former Borough of Finsbury, in which area there were many very large office blocks amongst other premises to be covered by the Act. Some office buildings, particularly those adjacent to the City of London, presented formidable tasks of inspection, since one block alone, comprising hundreds of rooms and with working accommodation for thousands of employees, took several days to inspect. As a result of re-organisation and resignations the section of the department engaged in inspectorial duties was under establishment for the greater part of the year; for 6 months only one Public Health Inspector was fully engaged on these duties. Happily, since November 1965, the section has been fully staffed, and this allowed for re-visits to be pursued as well as increasing the number of initial, basic inspections. 37 Up to and including the 31st December 1965, occupiers of 2921 premises had registered with the local authority as required under the provisions of the Act. In the same period, 2303 premises have received a general inspection. In the current year 4084 visits including 955 general inspections have been made and as a result, 897 letters were sent to owners and occupiers, detailing the 2,877 deficiencies found at the premises. Table "G" details the deficiencies found related to the type of premises registered and inspected. Revisits showed that 2,054 deficiencies had been remedied during the current year. As from January 1st, 1966 nearly all the requirements of the Act and the Regulations made thereunder are in force. Up to this date premises could only be brought up to the proposed standards by co-operation and persuasion. Though the greater proportion of owners and occupiers have been co-operative it may be necessary in ensuing years for some recalcitrant owners and occupiers to have proceedings instituted against them. Comments on enforcement of the Act Cleanliness In general the standard of cleanliness in premises was found to be good, particularly in office premises. The places most frequently neglected were the sanitary accommodation, staircases and passages. Overcrowding The statutory requirements for existing premises become operative on 1.8.67; the standards apply immediately to new businesses. There have been several instances of overcrowding in offices despite the minimal standards prescribed by the Act. The commonest place to be overcrowded is the room occupied by the telephone switchboard operators. These rooms are usually only cubicles designed to secure minimal disturbance to the operator and as a result are usually badly ventilated as well as below the required space standard. The specific standards only apply for persons who are Tiabitually employed' in the rooms. There are many offices where employees are away from their offices for the greater part of the working day, yet for 2-3 hours per day the offices may be occupied well in excess of the minimal prescribed standards. The only remedy would be to say that the premises must not be 'so overcrowded as to cause risk of injury to health' . Experience under other Public Health legislation has shown that this would be difficult to prove in the Courts. Temperature One of the commonest failures of occupiers is the provision and conspicuous display of thermometers at their premises. Particular objection is made when thermostatically controlled central heating systems are provided. Some occupiers in large office blocks object to displaying thermometers when the heating system is under the exclusive control of the owners of the property. In general, offices were found to be adequately heated. Shops, however, are often inadequately heated and several occupiers have stated their opinion that the prescribed temperature of 16°C cannot be maintained. 38 A particular problem of heating arises in the Smithfield Market area. There are many meat warehouses where, becauses of the nature of the trade, it would be impracticable to heat the premises to the prescribed standard. The Act allows for this, but inspections revealed that there is very little provision made at these premises for employees to warm themselves at all. ventilation Many modern shops have been found without adequate provision for their ventilation, and securing the premises against burglary often conflicts with the provision of opening windows. In offices generally ventilation is adequate but difficulties have been found in lower ground floor offices where windows could not be opened because dirt and fumes would then enter the premises. Water closet compartments are often inadequately ventilated as are the intervening spaces between the sanitary accommodation and the workrooms. Lighting A special report on lighting is included in this year's annual report. Sanitary and Washing Accommodation The main deficiencies have been found in small premises where it has become necessary to provide separate accommodation for the sexes. Many small shops and some older offices have not been provided with hot or warm running water. External water closets are often not provided with artificial lighting. Drinking Water Where practicable a mains supply of drinking water has been required. Some larger offices provide exchangeable water containers with paper cups and one office has considered adapting a coffee dispensing machine to dispense drinking water as well as hot drinks. Clothing Accommodation Generally the provision of clothing accommodation has been adequate. In larger office blocks, where clothing accommodation is provided in one central place, some employees prefer to keep their outdoor clothing with them, in the office in which they work; these individual offices usually have no clothing accommodation. The Act prescribes provision 'at suitable places' - the substitution of 'conveniently accessible to the employees' as is elsewhere prescribed, may remedy this particular problem. Seating A few cases of insufficient seating accommodation have been found in shops and warehouses. Floors, passages and stairs The application of this part of the Act still reveals that the condition of floors, passages and staircases constitute the greatest threat to the employees' welfare. Open and unguarded floor traps and lift spaces, missing handrails, broken stair treads and nosings are all too common in shops, warehouses and catering premises. Some occupiers have deliberately removed existing handrails to facilitate the moving of goods from one floor to another. Several butchers' premises have vertical cast-iron ladders. These ladders become covered with grease, and as they are rarely provided with a handhold become very dangerous. 39 It is pertinent to point out that of the two accidents in which warning letters were sent to occupiers in the current year, one was due to a missing handrail and the other to defective flooring. In another accident the condition of the staircase may well have been a contributory factor. A particular problem in shops and warehouses with storage problems e.g. SelfService stores, is obstruction of staircases and passages with stock. Dangerous machines Action has been taken for inadequate guarding of machinery. The difficulties experienced with the adequate guarding of gravity feed machines is only just begining to be resolved. The Ministry have arranged with most manufacturers to fit satisfactory guards but the installation is proceeding very slowly. Second-hand machines can still be purchased without adequate guards. These machines are usually not serviced by the manufacturer and consequently are unlikely to have guards fitted. First Aid Most premises had first aid boxes, though they were often not up to the prescribed standard. As the standard required varies, according to the number of persons employed or the nature of the business, it has been found helpful to supply on request a list of the first aid contents required at any particular premises. The Inspector recommends that the list be given to the person in charge of the first aid facilities so that the contents can be readily checked against the list and kept up to the standard. In the larger office blocks (with more than 150 employees) a qualified first aider must be available at all times. Most occupiers of large offices are not aware that this inevitably means two qualified persons so as to allow for the absence of one at times of sickness or annual leave. Accidents During the year 70 accidents have been noitiified to the local authority. 30 of these accidents warranted further investigation to see if they were the result of non-compliance with the Act or to see if advice could be given to prevent a recurrence. As a result of the investigations 6 letters were sent giving advice on accident prevention and in two of the six cases, letters were sent pointing out the duty of occupiers to ensure that their premises complied at all times with the provisions of the Act. To ensure that occupiers are aware of their responsibility to report accidents they are told at the time of the Inspector's initial visit and a duplicated Notice is enclosed with the letter sent to them after the initial visit. Special Report on Lighting Standards As requested by the Ministry of Labour, in the last three months of 1965 particular attention has been paid to lighting conditions in premises inspected under the Act. 1. General impressions Generally the lighting in modern office blocks appeared to be satisfactory. In the older blocks bad arrangement made for poor natural lighting and dark decorations tended to make the premises gloomy even when artificial lighting was in use. 40 In shops the public areas were usually better lighted than the rear stock rooms, and warehouses generally are only partially lighted. Staircases are often poorly lit, particularly in multi-occupied old office blocks. Artificial lighting is often not provided in sanitary accommodation, particularly in external water closet accommodation. 2. Many premises are still lit by shaded filament bulbs which give a most unsatisfactory light and a very local one. Old offices, the rear of shops and warehouses are the main culprits. In warehouses one or two filament bulbs were often expected to provide adequate lighting throughout the premises whereas in fact, parts of the premises were very dark In parts of shop premises away from public view windows have often been dirty or obstructed with goods. In stock rooms and warehouses generally the light fitments are often covered with dust so as to exclude much of the light power. Some staircases are only lit by one bulb and this is often controlled by one switch situated at the top or bottom of the staircase. This means that often people have to ascend or descend the staircase without lighting. 3. In the absence of any prescribed standard no specific standard has been recommended to occupiers in advice given by the Inspectors. Requests have been made for lighting, both artificial and natural, to be provided, or improved. Occupiers have also been asked to repair and maintain existing fittings, to remove obstructions impeding natural light and to clean windows and various light fittings. 4. The only real instance of excessive glare that has been noted is from unshaded fluorescent tubes in shops and offices. This is quite common and in modern premises light colours and gloss surfaces accentuate the glare. No scientific standards of assessment have been used but notice has been taken of staff complaints and the Inspector's personal impression when he has visited the premises. During November light meter readings were taken at all premises inspected. (1) Number of office premises where lighting, either natural or artificial, in lumens per square foot, measured at the working surface was:- Lumens per sq. ft. No. of Offices (a) less than 5 12 (b) more than 5 but less than 10 46 (c) more than 10 but less than 15 45 (d) more than 15 but less than 25 130 (e) more than 25 136 (2) Standard of lighting in lumens per square foot in the working areas of shops etc.. compared with standard of lighting in selling areas. 41 Working Area Selling Area 20 35 6 20 20 45 12 30 10 36 15 25 35 35 5 8 18 10 8 8 30 30 10 25 15 30 10 30 25 30 100 100 38 38 26 50 7 8 8 8 26 50 10 20 40 30 10 20 15 15 15 15 (Table A) Registrations and General Inspections (Table B) Number of Visits of all kinds by Inspectors to Registered Premises (Table C) Analysis of Persons employed in Registered Premises by Workplace (Table F) Inspectors (Table G) Deficiencies found Exemptions - No applications for exemptions were granted and none was in force during 1965. Prosecutions - No prosecutions were undertaken during the year. 42 43 o C/l W (5160) M741200 3203 27,000 11/64 TS&Co.Ltd. Gp.636 THE OFFICES, SHOPS AND RAILWAY PREMISES ACT 1963 Name of LONDON B0E0U&H OP Local Authority ISLINGTON To The Minister of Labour, This form contains the prescribed particulars to be included in the annual report to be submitted under section 60 of the Act. [signed) P.L. Croft 15/2/66 Town Clerk {Date) YEAR 1965. TABLE A REGISTRATIONS AND GENERAL INSPECTIONS TOTALS 424 2.921 955 Offices 179 1,265 580 Retail shops 173 1,165 203 Wholesale shops, warehouses 43 222 97 Catering establishments open to the public, canteens 29 269 75 Fuel storage depots - - 0) Class of premises (2) Number of premises registered during the year (3) Total number of registered premises at end of year (4) Number of registered premises receiving a general inspection during the year TABLE B—NUMBER OF VISITS OF ALL KINDS BY INSPECTORS TO REGISTERED PREMISES 4,084 Box for Ministry of Labour use. 1. TABLE c ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of workplace Number of persons employed (1) (2) Offices 32,229 Retail shops 6,176 2. Wholesale departments, warehouses 4,681 Catering establishments open to the public 1,674 Canteens 740 Fuel storage depots - Total 45,500 3. Total Males 25,801 Total Females 19,699 44 TABLE D—EXEMPTIONS f TABLE E—PROSECUTIONS Prosecutions instituted of which the hearing was completed in the year M/c. Line No. Class of premises No. of exemptions current at 31st Dec. No. of exemptions granted or extended during year No. of applications refused or exemptions withdrawn during year No. of cases in cols. (3) and (4) where employees opposed application Appeals to Court against refusal to grant or extend an exemption or against the withdrawal of an exemption M/c. Line No. Section of Act or title of Regulation or Order No. of persons or companies prosecuted No. of informations laid f informations leading to a convictioin (1) (2) (3) (4) (5) (6) (7) 1 Offices Part I—Space (Sec. 5(2) ) 1 2 Retail shops 2 3 Wholesale shops, warehouses 3 4 Catering establishments open to public, canteens 4 5 Fuel storage depots 5 Part II—Temperature (Sec. 6) / 11 Offices 11 / 12 Retail shops 12 13 Wholesale shops, warehouses 13 14 Catering establishments open to public, canteens 14 No. of complaints (or summary applicati made under sectior °r22 Nil 15 Fuel storage depots 15 No. of interim orders granted... Nil Part Ill Sanitary Conveniences (Sec. 9) TABLE F -INSPECTORS 21 Offices 21 22 Retail shops 22 23 Wholesale shops, warehouses 23 No. of inspectors appointed under Section 52 (1) or (5) of the Act 6 24 Catering establishments open to public, canteens 24 25 Fuel storage depots 25 (1 Chief Public Health Inspector. (2 Public Health Inspector. (3 Technical Assistants. ) X Part IV—Washing Facilities (Sec. 10) 31 Offices 31 No. of other staff employed for most of their time on work in connection with the Act ... 1 32 Retail shops 32 33 Wholesale shops, warehouses 33 34 Catering establishments open to public, canteens 34 35 Fuel storage depots 35 TABLE "G" Annual Report of Action under the Offices, Shops & Railway Premises Act, 1963 - Year 1965 Offices Shops r Sale W" Houses Catering Premises Canteens Fuel Storage Total Def cies Def cies Def' cies Def' cies Def' cies Def cies Def cies Fnd Rem Fnd Rem Fnd Rem Fnd Rem Fnd Rem Fnd Rem Fnd Rem Cleanliness 19 3 12 11 9 2 - - - - - - 40 16 Overcrowding 37 1 1 1 4 - - - - - - - 42 2 Heating 4 2 9 19 1 4 1 - - - - - 15 25 Provision of Therm 305 103 105 373 48 18 57 39 1 - - - 516 533 Ventilation 86 9 48 74 12 - 10 - - - - - 156 83 Lighting 13 4 13 34 1 1 - - - - - - 27 39 Insufficient sanitary accommodation 29 2 7 8 2 1 5 - - - - - 43 11 Deficient sanitary accommodation 124 24 35 82 31 4 12 5 - - 202 115 Insufficient washing facilities 19 9 5 11 4 1 2 - - - - - 30 21 Hot water/warm water required 71 27 52 126 15 7 2 1 - - - - 140 161 Other deficient washing accommodation 18 5 4 27 9 - 1 - - - - - 32 32 Drinking water 13 1 3 10 4 1 - - - - - - 20 12 Clothing accommodation 19 - 8 18 2 1 - 2 - - - - 29 21 Seating facilities 1 - 2 5 1 - - 1 - - - - 4 6 Eating facilities - - 1 - - - - - - - - - 1 - Dangerous machinery 19 11 65 5 9 - 16 5 2 - - - 111 21 Floors and Staircases 102 58 91 188 33 13 29 37 - - - - 255 296 Noise and vibration - - - - - - - - - - - - - - First Aid 323 103 114 445 48 20 47 43 1 - - - 533 611 Abstract of Act 430 20 130 26 69 1 50 2 2 - - - 681 49 Totals 1632 382 705 1463 302 74 232 135 6 - - - 2877 2054 INTIMATIONS SERVED 528 201 1 )0 7( 89 7 Prevention of Damage by Pests Act, 1949 Rodent Infestations The Rodent Officer and his staff were accommodated at Finsbury Health Centre very shortly after the amalgamation of Islington and Finsbury in April. A considerable amount of administrative work was involved in the changeover, including the gradual run-down of the former Finsbury business contracts. There were 269 in operation on 1st April but the number had been reduced to 116 at the end of the year. In respect of the new London Borough, 1,753 complaints of rodent infestation were received during the year under review, an increase of 236 compared with the total for the two Metropolitan Boroughs for 1964. Details of inspections and visits by the rodent investigators and operators are recorded below. 45 Eighteen infestations were found to be caused by defect drains, one by a disused drain and one by a defective sewer. Five hospitals were inspected by the Rodent Officer and minor outbreaks were dealt with at three housing estates during the year. Regular inspection of open sites was carried out but few infestations were discovered. No infestations by ship rat were recorded. There was one meeting of the Workable Area Committee in March which was attended by the Chief Public Health Inspector and the Rodent Officer. (a) General The following is a summary of the work carried out during the year: Note - For the purpose of completing Sections 2, 3, 4 & 7 each property is entered once only in respect of inspections, infestations and treatments. Type of Property Local Authority Premises Dwelling Houses Business Premises Total 1. Rodent complaints received (including repeats) 68 1, 386 248 1,702 2. Number of properties inspected as a result of (a) Notification (initial complaint only) 68 817 213 1,098 (b) Block survey 26 217 60 303 3. Number of properties found to be infested by rats (including Nil ship rats) 65 331 77 473 4. Number of properties found to be infested by mice 19 531 103 654 5. Re-visits by Investigators 172 1,920 238 2,330 6. Non-effective visits by Investigators 122 122 7. Number of infested properties treated (new jobs commenced) 76 909 258 1,243 8. Continuation or post-bait treatment 378 4,985 1, 522 6,885 9. Visits by Operators 738 11,289 1,875 13,902 10. Still being baited at end of year 23 408 94 525 11. Completed during the year 55 701 206 962 12. Number of Business Agreements dealt with 119 13. Members of the Rodent Staff assisted in the operation of the smoke machine in respect of 78 Drainage tests carried out by Public Health Inspectors. (b) Sewer Treatments Three sewer treatments were carried out during the year. The first was in two parts; one by Finsbury Borough Council using 1080 (sodium fluoracetate) and the other by Islington Borough Council using 1081 (Fluorakil) which was preceded by a test bait. The following are the details:- 46 Pre-bait laid March, 1965 : Islington M.B. No. of Manholes Manholes showing Baited Not Baited Pre-bait taken No take 806 46 560 246 Direct Poison Laid Pinsbury M.B. Islington M.B. London Borough of Islington February 1965 March, 1965 July 1965 September 1965 No. of Manholes: Baited Not Baited Baited Not Baited Baited Not Baited Baited Not Baited 619 52 560 301 1450 83 1428 110 Difficulty is often experienced in gaining access to manholes in busy thoroughfares for various reasons, including moving and stationary traffic and the re-surfacing of roads. This accounts for the high figure of unbaited manholes in certain cases. Water Supply The Metropolitan Water Board is the responsible Authority for the supply of water to Islington. The supply is satisfactory both in quality and quantity. There were 54,816 dwellings in the Borough supplied directly from water mains serving the entire population of the Borough (256,610). (a) Well Water Of the 52 bore holes or wells known to exist in the Borough 45 were unused. Eight samples were taken for bacteriological examination and eight for chemical analysis. The results were considered satisfactory. (b) Water Supplies - Miscellaneous Three samples of sub-soil water were taken, two for chemical analysis and one for bacteriological examination. The results in two cases indicated contamination. (c) Swimming Bath Water Eight samples were taken for bacteriological examination and all were reported as being satisfactory. Three samples were taken for chemical analysis and a satisfactory report was received in each case. Common Lodging Houses There is one Common Lodging House for men in the Borough situated at 88 Old Street, E.C.I, which is owned by the Salvation Army. The common bedrooms comprise large dormitories on the five upper floors, with toilet facilities. Additional sanitary accommodation is provided on the ground floor. The kitchen, dining room and office are situated on the ground floor and the washing facilities, including baths, in the basement. Separate accommodation is provided for the staff. The premises are registered for 275 men and the registration was renewed subject to improved hot water supplies being provided for personal washing. An application by the Salvation Army for a grant towards the cost of additional improvements was still under consideration at the end of the year. The lodging house register is inspected periodically to ensure that it is kept accurately and up-to-date. 47 Sewerage and Sewage Disposal Arrangements for sewerage and sewage disposal in the Borough were reasonably adequate. Flooding of basements occurred occasionally, however, in certain areas when the sewers were surcharged with storm water. At the end of the year arrangements were made for a meeting with representatives of the Borough Engineer and the Greater London Council to examine the problem and the possible remedies. National Assistance Acts 1948 and 1951 In several cases the assistance of the inspector was required in the removal of elderly persons to suitable premises. This gave an opportunity to carry out works of cleansing and repair to the rooms which were temporarily or permanently vacated by the tenant. DETAILS OF PUBLIC CONTROL FUNCTIONS TRANSFERRED ON 1st APRIL 1965 Refreshment Houses Act, 1860 (as amended) No. of licences issued 132 Explosives Acts, 1875 & 1923 Fireworks Act, 1951 The Keeping of Fireworks Order, 1959 No. of registrations during year 283 No. of visits 463 London County Council (General)Powers Act, 1921 - Part III (as amended) Employment Agencies No. of licences issued during year 5 No. of licensed agencies at end of year 35 No. of visits 44 No. of revisits 40 Nurses Agencies Act, 1957 Nurses Agencies No. of licensed agencies at end of year 1 London County Council (General Powers) Act, 1920 - Part IV (as amended) Establishments for massage or special treatment No. of licences issued during year 19 No. of licensed establishments at end of year 19 No. of visits ... 19 No. of revisits 4 Theatrical Employers Registration Acts, 1925 & 1928 No. of registrations during year 1 No. of registered employers at end of year 38 Shops Act, 1950 ) No. of visits 2981 Shops (Early Closing Days) Act, 1965 ) No. of informations laid 1 Young Persons (Employment) Acts, 1938 & 1964) No. of warning letters sent 8 Performing Animals (Regulation) Act, 1925 No. of current registrations Nil 48 The Riding Establishments Act, 1964 No. of establishments Nil Fertilisers & Feedings Stuffs Act, 1926 No. of samples taken Nil Celluloid & Cinematograph Film Act, 1922 No. of premises used for storage 1 Fabrics (Misdescription) Act, 1913 Nil Diseases of Animals Act, 1950 See separate paragraph on page 36 HOUSING Housing Act, 1957 - Sections 16 and 18 The inspection of individual houses and parts of houses resulted in closing orders being made in respect of six whole houses, forty-four parts of buildings, in addition one demolition order was made. There are still considerable numbers of individual unfit houses and parts of buildings in various parts of the Borough, but owing to the shortage of alternative accommodation for displaced families action under these sections of the Housing Act must be somewhat limited at the present time. Pour houses and seventeen parts of buildings which were subject to closing orders were brought up to Housing Act standard during the year, and the closing orders determined. Housing Act, 1957 - Part III At the beginning of the year there remained to be dealt with a numberof properties in the current (1961-65) Slum Clearance Programme. With the amalgamation of the two Boroughs in April the outstanding joint programme amounted to 20 Areas - 3 within the old Islington boundaries and 17 within the Finsbury area. During the year two areas in this programme were represented: - 1. Christie Street/Roads Place comprising 23 houses. 2. Epping Place/Offord Road comprising 9 houses. The Borough was surveyed during the year and the new Slum Clearance Programme for the five-year period 1966-70 produced and jointly agreed with the Greater London Council. Hie programme consisted of 52 areas comprising in all 1.679 dwellings (including Beaconsfield Buildings) and 25 of these areas comprising 617 dwellings fall to be dealt with by this Council. Three areas which had been included in this programme (1966-70) were also represented:- 1. Beaconsfield Buildings comprising in all 369 flats, (these blocks of tenement flats subsequently being acquired by the Greater London Council). 2. Bishop's Grove/Hawthorne Street consisting of 38 houses. 3. Playford Road/Pooles Park comprising 73 houses. Close liaison was maintained with the Greater London Council in respect of clearance areas represented by that Authority, and housing inspectors attended public enquiries in order to provide supporting evidence. A survey was also made of tenement blocks within the Borough. Many of these were found to have unsatisfactory features, viz. the sharing of water closets, inadequate refuse storage and disposal arrangements, water closet compartments opening directly into kitchens, inadequate natural light and ventilation to rooms, and bad arrangement generally. Many of the tenement blocks so affected did not warrant inclusion in the Slum Clearance Programme but were not capable of improvement. Housing Act, 1957 - Section 9 The work of repair and improvement to 5 unfit houses, subject to Section 9 notices was satisfactorily completed during the year. In addition to these houses made fit under formal procedure, other unfit houses were dealt with informally and repaired to Housing Act standard. This applied particularly to two areas, Haverstock Street/Remington Street and 50 Moon Street/Studd Street. Initially these areas were considered for slum clearance. This action was deferred on the undertaking of the various owners to bring the property up to the required standard. Hie first area comprised a total of 58 unfit houses and the second area 30 unfit houses. As the end of the year, 15 houses had been made fit in Haverstock Street and Remington Street and 17 houses in Moon Street and Studd Street. All of these houses had been converted into one or more self-contained dwellings, each complete with all the standard amenities. Work was in progress in other houses in these two areas and specifications of work had been agreed in respect of further houses. Hie repair and improvement of such houses was necessarily a slow process, as the extent and nature of the work required that vacant possession be obtained by owners before undertaking work of this scope. It is of interest to note that over 50% of the dwellings produced by these conversions are tenanted and not owner/occupied. Many enquiries were received in respect of improvement work proposed by owners and architects to individual houses and to flats. Hiis type of enquiry was welcomed by the housing inspectors as it ensured that the work complied with the provisions of the Housing Acts and the byelaws, and that a high standard of improvement and workmanship was maintained. Housing Acts, 1961 and 1964 These two Acts were particularly applicable to this area, where many houses or parts lack modern amenities, as they dealt generally with the improvement of houses in multiple occupation or houses divided into separate dwellings. Hie survey of houses in multiple occupation continued during the year and, in addition, an area of houses bounded by Essex Road, Northchurch Road, Englefield Road and Southgate Road, a total of 196 properties divided into 637 lettings, was surveyed under the provisions of Part II of the 1964 Housing Act as a possible 'Improvement Area.' Such an area must contain dwellings lacking one or more of the standard amenities and of these at least one half must be so constructed that it is practicable to improve them to the full or reduced standard, at reasonable expense. After improvement they must be fit for human habitation and, subject to normal maintenance, remain in that condition and available for use as dwellings for a period of not less than 15 years. Hie survey in this area showed that very few of the houses could be regarded as being occupied as separate dwellings as defined in the Act. Hiey were generally in multiple occupation and so, whilst the area could not be dealt with as an 'Improvement Area' , those houses which were in multiple occupation could be dealt with under the 1961 Housing Act and amenities provided in accordance with the Council's Code of Practice. A second area consisting of 37 houses in Affleck Street was also surveyed. Hiese houses were found to have sub-standard basement rooms and all were occupied by two or more families, and falling far below the standard required by the Council's Code of Practice. A scheme was produced for the conversion of the basement rooms to bathrooms and for the provision of hot and cold water supplies, sinks and food stores for those lettings lacking these amenities. Experience showed it to be more economical of man-power and better for public relations to deal with these multi-occupied houses in areas rather than individually. Hie application of the provisions of Section 16 of the 1961 Housing Act dealing with means of escape in case of fire, previously dealt with by the Borough Engineer, was transferred to this Department on the 1st April, 1965. Hie Housing and Fire Inspectors' work was co-ordinated, and schedules of works necessary for the provision of amenities andthe means of escape, both at the informal and formal stages, were served together. Hie 1961 Housing Act provided for the making of a Management Order on any premises in multiple occupation should the condition of the house not comply with Regulations laid down for the management of such houses. Provision was also made for the making of a Direction to limit the number of persons who may occupy premises in multiple 51 occupation. Increasing use was made of these very useful powers and during the year six Management Orders and seven Directions were made. Housing (Financial Provisions) Act, 1958 Hie Borough Council and also the Greater London Council required that applicants for mortgages for the purchase of houses should undertake that all such property must be made to conform to the Council's regulations relating to underground rooms and also the provisions of the Housing Acts relating to multi-occupation and means of escape in case of fire. In this connection 553 inspections and re-inspections were carried out. Inspections and re-visits concerned with Improvement Grants numbered 67. SUMMARY OF INSPECTIONS AND NOTICES SERVED Housing Act 1957 Section 5 (Prohibition of back to back houses) Number of certificates issued 1 Section 9 (Repair of unfit houses) Inspections 22 Section 16 (Individual unfit houses) Inspections and revisits 153 Houses represented 9 Section 17 (Individual unfit houses) Closing Orders made 6 Demolition Orders made 1 Houses demolished 12 Section 18 (Unfit parts of buildings (including basement rooms)) Inspections and revisits (a) Basement rooms 982 (b) Other parts of buildings 120 Representations made (a) Basement rooms . 50 (b) Other parts of buildings 4 Closing Orders made (a) Basement ro 41 (b) Other parts of buildings 3 Section 27 (Closing Orders determined or part determined on completion of works) (a) Whole houses 4 (b) Basement rooms 14 (c) Other parts of buildings 3 Permitted use of rooms subject to Closing Orders 6 Section 90 (Houses let in lodgings) Inspections and revisits 58 Section 80 Licence authorising temporary overcrowding 1 Section 42 (Clearance areas) Areas represented 5 Initial detailed surveys 232 52 Section 42 (Clearance areas) (continued) Further inspections 918 Premises demolished 13 Housing Consolidated Amendment Regulations, 1932 (House to house inspections) Number of inspections 629 Housing (Financial Provisions) Act, 1958 (Improvement grants) Inspections and revisits 67 House Purchase - Inspections and revisits 53 Council Housing (Repair conversion) Inspections 2 (Council purchase) Inspections 71 Housing Acts 1961 - 64 Part II - Sections 12 to 21 - 1961 Act Part II - Sections 13 to 20 - 1964 Act Inspections and revisits 4,011 Section 12 Management Orders made 6 Section 15 (Provision of amenities) Informal notices served 220 Formal riotices served 9 Section 16 (Fire precautions) Informal notices served 210 Formal notices served 6 Section 19 (Directions) Number of directions made 7 Amenities provided as a result of Service of Section 15 Notice and/or requirements of mortgage advance (i) Natural lighting to rooms improved 27 (ii) Artificial lighting to rooms improved 4 (iii) Ventilation of rooms improved 27 (iv) Cold water supplies provided 44 (v) Hot water supplies provided 125 (vi) Sinks provided . 43 (vii) Water closets provided 3 (viii) Food storage facilities provided 120 (ix) Cooking facilities provided 11 (x) Baths provided 35 (xi) Means of space heating provided 5 Section 16 Notices complied with 88 Miscellaneous Inspections Interviews with owners, surveyors, builders and tenants (Housing Act) 1637 53 Miscellaneous Inspections (continued) Inspections and revisits under Public Health Acts 365 Other inspections 355 Non-effective visits 2.078 SUPERVISION OF FOOD Legislation enacted during the year had effect as indicated: Milk (Special Designation) (Amendment) Regulations, 1965: This was necessary to give a legal standard to the new long keeping milk officially designated as Ultra Heat Treated Milk (UHT). Meat Inspection (Amendment)' Regulations, 1965: These extended for a year the provision in the previous regulations which permitted the removal of uninspected meat from a slaughterhouse. Dried Milk Regulations, 1965: These specify principally the composition of dried milk products. The Cheese Regulations, 1965: This deals with the composition and labelling of specified cheeses. The date of operation is 1st February, 1967. Eggs (Marketing and Storage) Regulations, 1965: The storage of eggs in cold store and by other chemical methods and the marking of such eggs is controlled by these regulations. The Milk & Dairies (General) Regulations, 1959: Approved Chemical Agents: Circulars giving particulars of these approved chemical agents were published during the year. Public Health (Imported Food) Regulations, 1937 and 1948: Several circulars were received giving particulars of official certificates from many exporting countries throughout the world. Food Hygiene (General) Regulations 1960 Owing to shortage of staff it was not possible for routine inspections of food premises to be carried out. The education in food hygiene of the many nationalities who operate these businesses can only be by continual contact and regular inspections of the premises. In spite of staff difficulties, an attempt was made to deal with this problem and such work invariably resulted in an improved standard. An endeavour was made to require all newly established food businesses to comply with the Food Hygiene Regulations before they commenced operation. Experience showed that having attained this objective subsequent supervision was easier because the basic requirements of the regulations had been complied with. Licensing or registration, which would require notice to be given before a person opens a food establishment, would considerably speed the work of the inspectors in this section. Food Factories These were inspected regularly during the year and the requirements of the Pood Hygiene (General) Regulations, 1960, were enforced where found necessary. During the transition period consequent upon the merger of the two Boroughs, the need to co-ordinate the respective systems and the fact that the inspectorate was under establishment made it impossible to carry out some of the duties devolving upon this sectionJ It is anticipated that, provided there is no reduction in the number of inspectors engaged in this work, the position may improve during the coming year. 54 'Street Markets The Department became responsible for the hygiene of food stalls and shops in three street markets which were previously in the Borough of Finsbury. Inspections were made during the week, including Sundays, to secure compliance with the relevant legislation. The co-operation of the street traders was normally forthcoming. It is hoped that increased powers to deal with food stalls in market areas will be given in the near future. Food Complaints Hie number of complaints regarding foodstuffs purchased in the Borough showed a slight decrease compared with last year. One of the commonest complaints was in respect of bread and cakes, particularly wrapped bread. Complaints of mouldy bread, however, showed a decrease. No doubt this was due to research carried out by trade laboratories into the possible reduction of mould growth in wrapped bread. Complaints regarding meat products affected by mould still continued to be received. Some of the larger manufacturers introduced a system of coding, reference to which, on investigation, invariably showed that the condition was due to stocks not being sold in strict rotation. Milk bottles containing foreign matter, constituted another type of complaint. Although every care was taken to eliminate these defective bottles at the filling station some were misused by the employees engaged in the inspection of the bottles as they passed through the plant. The inspectors were only too pleased to advise on any aspect of the work under the Pood and Drugs Act and the Regulations made thereunder. 53 Complaints of alleged unfitness were received in respect of the following:- Bread and cakes Canned fruits, vegetables etc. Foreign matter in loaf 6 Foreign matter in creamed rice 1 Mouldy wrapped bread 4 Insects in butter beans 1 Foreign matter in roll 1 2 Abnormal smell and taste 1 Insects in bread 2 Milk Insects in cakes 1 Mouldy cakes 1 Foreign matter in bottled milk 4 16 Dirty milk bottle 1 Sour cartoned milk 1 Canned meats Miscellaneous 6 Mouldy 5 Foreign matter in strawberry iara 1 Fbreign matter 1 Foreign matter in non- alcoholic drink 2 Foreign matter in sandwiches 2 Meat Products Maggots in rolled oats 2 Foreign matter in pork pie 2 Insect in coconut ice 1 Mouldy pork pie 2 Beetles in hair lotion 1 Mouldy cornish pasty 2 Maggots in brie cheese 1 Mouldy sausage rolls 1 10 Foreign matter in sausage roll 1 Mouldy steak and kidney pie 1 Maggotty beef sausages 1 Mouldy sausages 2 Unsound shoulder of lamb 1 13 Details of the proceedings taken in respect of the above complaints, and other action by the Inspectors appear on pages 56 - 59. 55 Food and Drugs Act, 1955 Number of food premises in the area, and type of business Bakehouses - basement 12 Bakehouses - others 26 Bakers' retail shops 77 Bacon factories 7 Breweries 11 Butchers (retail) 183 Butchers (wholesale) 46 Cafes and restaurants 398 Canteens 228 Cheese importers 13 Coffee stalls 11 Continental food shops 54 Fish shops (wet) 65 Fish curers 25 Fish depot 1 Fish friers 60 Food factories 38 Food stalls 261 Food storage premises for street traders 76 Greengrocers and fruiterers 214 Grocers and provision merchants (retail) 487 Grocers and provision merchants (wholesale) 49 Horseflesh dealers (wholesale) 2 Licensed clubs 58 Off-licences 116 Poultry dealers (wholesale) 6 Public houses and beerhouses 389 Public cold stores 6 Milk depots 8 Milk machines 29 Food machines 8 Sausage casing merchants 3 Sugar and chocolate confectionery 418 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 211 No. of Butchers 142 No. of Grocery and provision shops 43 No. of Food Factories 16 No. of Cooked meat shops 1 No. of Jellied Eels and Pie Shdps 4 No. of Bakers (meat pies) 1 No. of Fishmongers 4 Total No. of inspections and visits made by Inspectors to Preserved Pood Premises 124 Details of the inspections etc. by the Inspectors are given below Bakehouses - basement 43 Bakehouses - others 228 Bakers (bread and cake shops) 144 Butchers 1, 375 Chemists 30 Confectioners 170 Fried fish shops 227 Fish curers 103 Fishmongers 95 Greengrocers & Fruiterers 186 Grocery & Provisions 1.288 Wholesale Food Stores and Depots 597 Markets 64 Food Storage for Street traders 28 Other Flood Premises 40 Vehicles 96 Stalls 1.066 Public Houses and Off Licences 275 Restaurants, Eating Houses and Canteens 1,924 Meat inspections at Licensed Slaughterhou 376 Food examinations (other) 314 Ice Cream premises 165 Preserved Food Premises 124 Dairies (milk distributor) 276 Contraventions found 153 Contraventions remedied 172 Notices served (Food and Drugs Act) 107 Notices complied with (Food and Drugs Act) 32 Infectious diseases 8 Food poisoning enquiries 21 56 General Legal proceedings attendances at Court 10 Miscellaneous 611 Legal Proceedings Details of the action taken by the Council under the Pood and Drugs Act, 1955, and the Food Hygiene Regulations made thereunder are as follows:- Date Offence magistrates' Decision 2.3.65. Section 2(1) Selling food, namely an apple tart, not of the quality demanded, at 67/83 Seven Sisters Road. Pined £3. 0. Od. Defendant to pay £3. 0. Od. costs 2.3.65. Pood Hygiene (General) Regulations 1960Regs. 5 and 33. Carrying on a food business in insanitary premises thus exposing food to the risk of contamination, at 151 Essex Road, N.1. Pined £5. 0. Od. Defendant to pay £2. 0. Od. costs 2.3.65. Section 2 (1) Selling food, namely a cream sponge, not of the quality demanded, at 470 Holloway Road Fined £5. 0. Od. Defendant to pay £3. 0. Od. costs 2. 3.65. Pood Hygiene (General) Regulations 1960. Regs. 5 and 33, Carrying on a food business in insanitary premises thus exposing food to the risk of contamination at 636 Holloway Road Pined £10. 0. Od. Defendant to pay £2. 0. Od. costs 2.3.65. Section 8. Having in possession for purpose of sale food, namely 10 lbs. of butter and 4 lbs^ creamery butter intended for but unfit for numan consumption, at 361 New North Road Pood Hygiene (General) Regulations 1960 Regs. 5 and 33. Carrying on a food business in insanitary premises thus exposing food to risk of contamination, at 361 New North Road Pined £25. 0. Od. Defendant t,o pay £5. 0. Od. costs Pined £50. 0. Od. Defendant to pay £10. 0. Od. costs 11.3.65. Section 2 (1) Selling food, namely a bottle of milk, not of the quality demanded, at St. Joan of Arc's School, Northholme Road. Pined £10. 0. Od. Defendant to pay 10s. costs 11.3.65. Section 2(1) Selling food, namely a bottle of mineral water, not of the quality demanded, at 2 Crouch Hill, N.4. Pined £25.' 0. Od. Defendant to pay £7.15. Od. costs 11.3.65. Section 2 (1) Selling food, namely a meat pie not of the quality demanded, at 97, Newington Green Road. Pined £10. 0. Od. No order as to costs. Unfit Food During the year the total amount of food surrendered was:- Description Tons Cwts. Qtrs. Lbs. Tinned goods 18 9 3 23 Meat 67 2 0 9 Fish 5 10 3 22 Poultry - - - - Others 11 17 0 15 TOTAL 103 0 0 13 57 1951 condemnation certificates were issued, and 320 inspections were necessary in connection with this work. Condemned food received from traders is either taken to the Council's refuse disposal depot at Ashburton Grove, awaiting conveyance, under supervision, to the refuse tip or 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 605 samples (8 formal and 597 informal) were sent to the Public Analyst for examination. 32 of these samples, or 5%, were subject to adverse reports as shown in the summary below. It should be noted, however, that a number of these were not routine samples but samples taken after a complaint. Formal Pood colouring 1 Informal Bread 5 Pork luncheon meat 1 Butter 1 Pork pies 2 Corned Beef 1 Rice and beef (canned) 1 Cream cake 1 Rolls (cheese and tomato) 1 Condensed milk, cream etc. Sausages 1 2 Sausage rolls 3 Canned fish 1 Soft drink 2 Jam 1 Skin lotion 1 Milk 5 Vegetables 1 Milk bottles 1 27 samples were sent for bacteriological examination, mostly in connection with food for exportation. Meat Inspection In accordance with the requirements of the Public Health (Meat) Regulations, 1924/52 and the Meat Inspection Regulations 1963, notices were received during the year in respect of the intended slaughter of animals for human consumption. Details of action taken are as follows:- Cattle Excluding Cows Cows Calves Sheep Pigs Horses Number killed (if known) 256 1277 123 35 - 368 Number inspected 256 1277 123 35 368 All diseases except Tuberculosis & Cyst ice reus Bovis Whole carcases condemned 11 29 5 3 - 1 Carcases of which some part or organ was condemned 133 965 43 18 156 Percentages of the number inspected affected with disease other than tuberculosis and cysticercus bovis 56. 25% 77.84% 39.02% 60.00% 42. 66% Tuberculosis only Whole carcases condemned - 1 - . . _ Carcases of which some part or organ was condemned 1 Percentage of the number inspected affected with tuberculosis 0. 16% 58 Cattle Excluding Cows Cows Calves Sheep Pigs Horses Cysticercus Bovis Carcases of which some part or organ was condemned . 5 _ _ _ Carcases submitted to treatment by refrigeration _ 5 _ _ _ _ Generalised and totally condemned All diseased or unfit meat was disposed of for use as knacker's meat or in the manufacture of animal feeding preparations. Of the 368 horses slaughtered for human consumption, the majority were intended for export. Slaughter of Animals Act, 1958 Slaughtermen's Licences During the year 6 Licences were renewed and were current at 3lst December. Export Certificates - Food 309 Export Certificates were issued; the food consisted mainly of animal casings, bacon, meat and meat extracts, tinned and bottled meats and soups (ox tongue, chicken etc.). The food was exported to 27 countries, including Germany, U.S.A., Malta, Italy, Sweden, Canada, Ascension isles, Ceylon, Lebanon, Trinidad, Belguim. Holland, Bermuda, Austria, British Guiana, Prance and Bahamas. Merchandise Marks Act, 1887/1953 Agricultural Produce (Grading and Marking) Act, 1928/31 Details of the Inspections carried out by the Inspectors are as follows:- Merchandise Marks Acts Inspections 37 Contraventions found 4 Agricultural Produce (Grading and Marking) Acts Inspections 5 Contraventions found - Licensed Clubs Number of applications received ... 14 Number of applications objected to - Number of visits to Licensed Clubs 70 Ice Cream Ice Cream (Heat Treatment, etc.) Regulations, 1959 Supervision of the manufacture and distribution of Ice Cream During the year 157 visits were paid to ice cream premises and vehicles. The number of premises registered: (a) for manufacture, sale and storage 19 (b) for sale and storage 531 (c) for sale only 130 (d) for storage only 2 682 59 Milk Samples 1. Bacteriological Examination Class of milk Results Phosphatase Methylene Blue Turbidity Biological Total number of Samples Pasteurised Satisfactory 14 14 _ _ 14 Unsatisfactory - _ _ - - Sterilised Satisfactory 5 - 5 - 5 Unsatisfactory - - - - - Ultra Heat Treated Satisfactory - - - - - Unsatisfactory - - - - - Untreated Satisfactory - - - - - Unsatisfactory The Milk (Special Designation) (Amendment) Regulations, 1965, which came into operation on 1st October, 1965, amended the Milk (Special Designation) Regulations, 1963, and prescribed a new special designation Ultra Heat Treated', in relation to milk which has been treated by the ultra high temperature method. 2. Chemical Examination Details of samples submitted Satisfactory Unsatisfactory Total Formal - - - Informal 87 2 89 Milk (Special Designation) Regulations, 1963 (as amended) Number of Licences in force 374 Milk and Diaries (General) Regulations, 19 59 Number of Dairies registered in the Borough Number of Distributors registered in the Borough 11 365 Milk Supplies - Brucella Abortus No samples were taken during the year. The Liquid Egg (Pasteurisation) Regulations, 1963 There are no egg pasteurisation plants in the Borough. 60 Photograph by Major Robert Whyte FINSBllRY HEALTH CENTRE - PINE STREET, N.l. PERSONAL HEALTH SERVICES Finsbury Health Centre (Section 21 National Health Service Act, 1946) These premises which were transferred to the Borough on the 1st April, 1965, were previously used as the administrative centre of the Public Health Services of the former Metropolitan Borough of Finsbury, and by the Regional Hospital Board and the former London County Council for services transferred to those bodies under the National Health Service Act, 1946. As a result of the London Government re-organisation, certain changes took place in the use of the premises and, at the aid of the year under review, the user was as follows: - The Regional Hospital Board continued to occupy the portions of the building in which were housed the department of physical medicine, the pathological laboratory and the chest clinic. The Inner London Executive Council continued to occupy the portion of the building in which was situated the general dental service clinic. The remainder of the premises were occupied by the London Borough of Islington for the purpose of a foot clinic, school dental clinic, mental health section (including a 'day centre' for the mentally ill), bathing and cleansing stations, and disinfection and disinfestation services, including rodent control. Care of Mothers and Voung Children (Section 22, National Health Service Act, 1946) Maternity & Child Welfare Centres The welfare centre continued to be the focal point of the services for the care of mothers and young children. Ante-natal clinics providei care throughout pregnancy and advice was given whether home or hospital confinement was arranged. Domiciliary midwives attended patients booked for home confinement throughout their pregnancies. At 6 centres, 14 G.P.O's attended regular sessions at which they saw their own booked patients and others with the consent of their doctors. At another centre, an ante-natal session for patients booked for St. Bartholomew's Hospital was taken by a consultant from the hospital. After confinement mothers were invited to attend post-natal clinics unless they preferred to be examined by their own doctors. The children were seen regularly by the doctor and health visitor. For the benefit of working mothers, evening ante-natal and child welfare sessions were held at two centres. The full range of national welfare foods was available, and simple medicaments and nutrients were provided according to an approved list on the doctor's recommendation. Immunisation and vaccination were arranged (see page65). If at any time any condition was noted in mother or child which called for treatment referral was made to the family doctor or hospital as appropriate. Attendances at the clinic during the first months of a child's life were generally maintained, but decreased after the first birthday. From the age of one year to school entry every child was given the opportunity to attend a toddlers' session, at regular intervals. From the very beginning a close watch was kept for the early detection of any actual err potential handicap, either physical or mental, in all children. Fuller details of the attention given to handicapped children are set out later in this report (p. 70 ). Dental statistics are included in the Chief Dental Officer's report (p. 75 - 76). The number of maternity and child welfare attendances were:- Welfare Centres First Quarter (L. C. C.) Last three quarters (L.B.I.) Child Welfare - Total Attendances 17,398) Toddlers - 58,028 Total Attendances 1.426 Ante-natal & Post Natal Total Attendances 4, 525 9,356 61 Day Accommodation for Children Council Day Nurseries The Council took over five day nurseries. One of these (Springdale) was located just across the Borough Boundary in the neighbouring Borough of Hackney, but by agreement between the two Councils, its administration fell to Islington, where most of its children resided. The five nurseries provided a total of 299 places for children under five years of age. Admission was regulated by a scale of priorities (see Appendix C ) and payment assessed by a scale of charge related to income. During the year there was continuous pressure on the accommodation, the average daily attendance being 294 during the period 1st April to 31st December 1965. The high average rate of occupation (over 98%) placed a heavy load on the matrons and their staff. The Council agreed to provide one extra nursery nurse at each nursery to release the matron for some administrative duties. In more recent years pressure on the nurseries has increased through the children of immigrants coming into the Borough. A permanent waiting list existed in the order of 250. The obvious remedy to build more nurseries would be a long term measure. Meantime, there were repercussions on child-minding arrangements, to which reference is made in this report below. A few handicapped children were admitted to each nursery, including deaf and mentally handicapped who would benefit from nursery care in the company of normal children. In most instances attendance was for part of the day only either free or at a reduced charge. In addition, three occasional creches were held weekly at welfare centres for children under 5 years for short periods to allow their mothers some free time, e.g. to attend hospital or clinic, to go shopping etc. A charge of Is. 9d. a session was made in these cases, but where the mother attended an educational activity at the centre no charge was made. 527 attendances were made between 1st April and 31st December, 1965. Supplementary to the day nursery service were the various arrangements for the daily minding of children. Because of the shortage of places in the Council's day nurseries many mothers who wanted to go to work or otherwise needed to have their children looked after during the day, were obliged to use private minders. The Council had two official means of regulating private minding. Under the Nurseries and Child Minders Act, 1948, persons minding three or more children would be registered by the Council through its Personal Health Committee, providing their homes were suitable and they complied with the prescribed number and ages of children. The minder subsequently became subject to regular visitation by the Council's officers. At 31st December, 1965, there were 18 registered minders authorised to mind a total of 103 children. There were also three private day nurseries with a total of 46 children registered under the same Act. For persons who minded less than three children the Council adopted a voluntary scheme of registration under which the minder, if considered suitable, received a weekly fee of 6s., in return for which she agreed to be visited by the health visitor and to take the children regularly to the welfare centre. 58 persons were registered in this way to mind 98 children. Detailed arrangements for each child were a matter to be decided between the parents and the private minders, including payment; but the Council was able to recommend mothers to minders on its register. The official schemes provided for the care of 550 children by nurseries and minders. This failed to meet the needs of the population as a whole. Many mothers made what arrangements they could with "unofficial minders'. Many of these women, either through ignorance or in defiance of the statutory regulations for child minding, took in bhildren in such numbers and under such conditions as were unsuitable for the care of children. Unfortunately the exceptions in the Act, which were intended to safeguard arrangements within the same family or household, provided loopholes for those who did not wish to conform to the regulations, and at the same time made it difficult for the Council's officers to enforce these regulations. There was much concern about the standard of minding by "unofficial minders', especially for the children of immigrants, and every effort was made by visiting, publicity, and legal action to put a stop to unsatisfactory minding. One person was prosecuted by the Council for failing to apply for registration as a child-minder and was fined. A full report was submitted to the Minister of Health in reply to his circular No. 5/65 on the day care of children in nurseries and in private homes. 62 Domiciliary Midwifery Service - Section 23, National Health Service Act, 1946 For the first time since the operation of the Midwives Act, 1936, the Borough became the local supervising authority for all midwives practising in its area. This entailed the statutory supervision of some 190 midwives, 15 of whom were directly employed by the Council in the domiciliary service. Domiciliary Confinements 231 confinements took place within the Borough between January and March and 367 from April until December. 60 other patients were transferred to hospital in labour, due to complications, and 13 calls were made to the emergency obstetric unit. In addition to the nursing of delivered patients, 1,329 ante-natal visits were made at welfare centres, 22 ante-natal clinics were held weekly, 13 conducted by Domiciliary Midwives and 9 for patients booked for Hospital confinement. Home Assessments Owing to the limited number of maternity beds available to the area, not everyone who would like a hospital confinement could be accommodated. Medical classifications were prescribed as essential for admission to hospital. Those who did not qualify were visited at home with a view to booking for domiciliary confinement if the conditions were suitable. 623 of these visits were made during the nine months period; at least 50% of the homes proved to be unsuitable. The Early Discharge Scheme This scheme helped to relieve the pressure on hospital accommodation. Separate figures were not available for the first three months; but during the ensuing nine months, 550 home assessment visits were made, as a result of which 367 mothers were accepted home after 48 hours for nursing by the Council's midwives. Two part-time midwives (later increased to three) were employed especially for this work. The immigrant population within the borough presented a special problem to the maternity service as their living conditions were so often unsuitable for either domiciliary confinement or an early discharge from hospital. Maternal Deaths 6 maternal deaths were investigated of women who had lived within the borough. All occurred in hospital. Stillbirths 5 domiciliary stillbirths occurred between April and December, three of which were attended by a Council midwife, two of these were macerated; no obvious cause could be found for the third. Accommodation The Council took over accommodation for midwives in the hostel and in various housing properties, and the former charges to the midwives continued. A proposal to adapt a cottage to take a midwife was subsequently agreed. Health Visiting - Section 24, National Health Service Act, 1946 The Council for the Training of Health Visitors in a pamphlet published in 1964 defined a health visitor and her duties thus - 'A health visitor is a member of the public health nursing team, concerned in teaching the principles of healthy living and in counselling all members of the family. As a member of the staff of a local health authority she may work from a central office or clinic, or from her own home. She has contact with family and clinic doctors, midwives, home nurses, home helps and other staff concerned with the provision of welfare services, and members of many voluntary organisations. Much of the work of the health visitor is undertaken in the homes, where she can talk with individuals in their own environment. Families which include a handicapped member of any age may receive advice and help, as may patients recently 63 discharged from hospital and their relatives. She also works in clinics (such as ante-natal and child health clinics)where her advice may be sought. In addition to her work with the individual, she may initiate group discussion in formal or informal classes. Within the school health service the health visitor acts as the chief link in health and social matters between the school and the home. She also has close contact with the teaching staff and undertakes the health supervision of children of all ages. The health visitor is mainly concerned with health education and social advice to encourage and promote the attainment of complete health within the family group.' One of the first duties of the new Department was to consider Ministry of Health circular 8/65 on the training of health visitors with a view to meeting demands forecast for the next ten years. It was agreed to sponsor nine students for training. The establishment of 39 health visitors was accordingly increased by 9 student health visitors. Approved allowances were paid to health visitors acting as field work instructors with the students, and the training of health visitors as field work instructors continued. Good liaison was maintained with general practitioners, including the attachment of a health visitor to a group practice. Health Visiting First Quarter Last three (L. C. C.) Quarters (L.B.I.) Total Visits 14,333 46,242 Health Visitors at end of period 44.7 40.3 Home Nursing Service - Section 25, National Health Service Act 1946 The district nursing service (now re-titled home nursing service), was provided in the Borough by the North London District Nursing Assocation, a voluntary organisation grant-aided by the former London County Council. On the re-organisation of London Government, agreement was reached between the Association and the new London Borough of Islington, for the service to be transferred entirely to the Borough Council on 1st April 1965, after which date the voluntary nursing association ceased to function. Due to the efforts of all concerned the change was effected smoothly without inconvenience to patients and nurses. It is fitting in this report to place on record the Council's appreciation for the work so ably undertaken in Islington for those requiring nursing services at home by the North London District Nursing Association, which was formed in 1877, the second nursing association in London. The former superintendent of the service resigned in September 1965 and was replaced by her deputy who thus became the first male home nursing superintendent in London. Close liaison continued with general practitioners and hospital staff and with other field workers both voluntary and statutory. Over 60% of new cases were referred by general practitioners and over 30% by hospitals. A total of 2,476 patients were treated during the year and more than half of these were over 65 years of age when first referred. The trend reflected from previous years was for the service to be required by more patients needing rehabilitation and long-term care. An increasing use was made of disposable equipment (syringes, forceps etc) and this contributed to the saving of valuable nursing time. Additional services provided by the Borough and by voluntary organisations continued to be used extensively for the benefit of both parents and patients, including meals on wheels, loan of home nursing equipment, incontinent laundry service etc. The Marie Curie Memorial Foundation continued to provide invaluable help by means of a financial grant used mainly to provide a night attendant to relieve relatives nursing at home a case of terminal cancer. Gifts of clothing and bed linen were received from the Richard Cloudesley Fund and the Queen Mary's London Needlework Guild. Statistical Table Total number of patients being nursed at 1. 4. 65 706 Total number of patients being nursed at 31.12.65 650 Total number of patients nursed during the year 2. 562 Total number of visits made during the year 106. 150 Nursing treatments completed during the year 2.003 Nursing treatments commenced during the year 1.954 Staffing Hie number of staff employed at 31st December is given below - Superintendent 1 Assistant Superintendent (Acting) 1 Full-time Nurses 33 Part-time Nurses 4 Students 6 A total of 17 students completed their district nurse training with the Islington Home Nursing Service during 1965. Of these 14 came from countries outside the United Kingdom. Vaccination and Immunisation - Section 26, National Health Service Act, 1946 Every child attending a child welfare clinic received a full course of protection, except where there were medical contra-indications or parental refusal. Before and after admission to school a check was made to make good any deficiencies in every pupil, and booster doses were given where necessary. General practitioners shared equally in the scheme and received the approved payments for records submitted. Hie Council became responsible, (in accordance with Ministry of Health circular 19/65), for the vaccination of workers at risk of contracting anthrax. Only three small firms with six employees were involved. During the year, the Medical Research Council completed the investigation into measles vaccine commenced in 1964. 820 children were offered the course of two injections with a follow-up three weeks later. STATISTICS FOR PERIOD 1. 4. 65 - 31.12.65 Others under Primary Course completed Year of Birth Age 16 Total 1965 1964 1963 1962 1958/61 Diphtheria 2152 822 74 58 154 105 3365 Whooping Cough 2129 825 73 58 52 25 3162 Tetanus 2152 822 76 57 152 93 3352 Polio 788 1661 179 106 299 109 3142 Reinforcing doses completed Diphtheria 55 1573 466 114 915 75 3198 Whooping Cough 54 1542 451 100 240 5 2392 Tetanus 55 1566 465 113 2199 Polio 19 94 25 26 842 113 1119 Snallpox Vaccination - Primary Course completed Under 1 yr. 1 yr. 2-4 yrs 5. 5-15 yrs. Total 26 1164 555 21 1766 Re-vaccinations - 3 8 49 60 65 Prevention of Illness, Care and After-Care - Section 28, National Health Service Act, 1946 Tuberculosis Reference is made to the services provided under Section 28 of the National Health Service Act, 1946, on pages 16 - 19. Chiropody Services During 1965 the chiropody services in the Borough continued to be provided both directly by the Council, mainly at foot clinics (though some domiciliary treatments were arranged) and by the Old People's Voluntary Welfare Associations, grant-aided by the Council (clinics and domiciliary). Towards the end of the year consideration was being given to the possibility of co-ordinating the services to bring them all within the direct administration of the Council. The Council's staff included a chief chiropodist, responsible for the organisation of the service, four full-time senior chiropodists and thirteen parttime sessional chiropodists. The main foot clinic #as at the Finsbury Health Centre where there were both day-time and evening sessions. Sessions were also held weekly at four maternity and child welfare centres, and approximately one session a week was devoted to treating residents at the Council's hostel for tuberculous men and at a Church Army rest home. Great improvements were made in the oomfort of the elderly by the use of the Public Health ambulance vehicle which enabled some patients to be treated who would otherwise have found it impossible to attend. It was possible to arrange for an additional transport session during the year, bringing the total to three a month. Statistical Summary 1965 Total number of sessions 4,039 Total appointments booked 29,992 Total attendances 28,205 Analysis of Attendances Children 5-14 years 1,427 Adults Male 4.661 Female 22,117 Venereal Disease The Borough took over the social worker attached to the special clinic in Holloway Prison for women suffering from venereal disease. Because of their previous associations, many of them touching on the underworld of vice and crime, much difficulty was experienced in tracing their contacts. Despite strenuous efforts and the studious avoidance of any officialdom, only 52 contacts could be traced out of a possible 146. In 94 cases the information was refused or insufficient details were given. For patients leaving the prison before treatment could be completed or, in some short remand cases before it could be started, arrangements were made for their transfer to other clinics. Of 107 so transferred 56 were known to have made at least one attendance. The social worker comments:- "The more I think about it the more I realise that the brief encounters between promiscuous people represent risks which are not realised by an uninformed public ... Anything which will open the eyes of the public to the dangers of promiscuity is to be encouraged." 66 Towards the end of the year, at the request of the Venereologist at the Royal Northern Hospital, the Council agreed to appoint a social worker for work with patients and their contacts. Prevention of Break-up of Families On 1st April, 1965 the Borough reconstituted the former London County Council Co-ordinating Committee. Under my terms of reference I acted as Chairman, and the Children's Officer as Vice-chairman. The Borough Housing and Welfare Departments, the loner London Education Authority and the Greater London Council Housing Department were represented on the Committee which met every two months. Case conferences were held at the request of the statutory or voluntary agency concerned to discuss individual families and were attended by the appropriate workers. In this way problems which might lead to the break-up of a family came to light, concerted action could be taken and the available services used to the best advantage. Action to evict families with dependent children was not taken by the Housing Departments without prior consultation through co-ordinating machinery. Because of the changes under the London Government Act, the Co-ordinating Committee thought that there was a need for the field staff in the different departments to meet and exchange information about the work done by each department and how it is carried out. A small committee of officers was appointed to draw up a programme of talks. Health Amenities Fund This fund originally derived substantially from the London Sunday Cinematograph Fund and proved a valuable source of financial help to families and children. Although the cinemas' contributions were drastically decreased, other contributions from voluntary sources remained and a voluntary committee was formed to administer them as "The London Borough of Islington Health Amenities Fund'. Loan of Equipment A scheme for the loan of essential items of home nursing equipment had been in existence for some years in London, and together with other health and welfare services contributed to the nursing at home of an increasing number of sick and handicapped persons. There was no charge for the service, and items loaned included the following:- Equipment Total Number loaned during year 1965 Special beds and hoists 22 Air and sorbo rings 42 Bed cradles 35 Bed and back rests 44 Dunlopillo mattresses 12 Bed Pans (including rubber bedpans) 31 Commodes, toilet seats etc. 246 Wheel chairs and other special chairs 116 Walking aids 35 Fireguards In order to reduce accidents in the home through unguarded fires, the Council loaned fireguards to necessitous families with children under 12 years of age, and to necessitous elderly, handicapped or blind persons. In each case, the consent of the landlord was obtained to any necessary work being carried out to fix the guard in position. 58 fireguards were loaned during 1965. 67 Incontinence Pads A scheme for the provision of incontinence pads, mainly through the Home Nursing Service, was commenced in 1965, and during the year some fifty patients being nursed at home were provided with them. Arrangements were agreed with the Borough's Cleansing Superintendent for their disposal with ordinary household refuse, each pad being provided with a polythene bag and a wire strip for sealing. Mental Health During the year under review, the mental health service in Islington developed considerably. At 1st April 1965, the number of social workers in the Mental Health team, including the Principal and her Deputy, totalled 12, and by the end of the year, this increased to 14. Most of the social workers carried a mixed case load of mentally ill and subnormal patients and 2 part-time occupational therapists visited mentally disturbed patients at home. A social worker attended the surgery of a group practice of general practitioners for one session weekly to interview and give case work support to selected patients. There was closer liaison with the main catchment hospital for psychiatric patients, the Council's social workers paying regular weekly visits to the hospital to see patients and attend ward rounds. An increasing number of patients are being referred for community care. The total number in community care at the end of the year was 697. Two day centres for psychiatric patients were opened during 1965, one at the end of May and the other in October, providing a total of 50 places. One of these was run on industrial lines with sub-contract work being the main activity. The other, which was under the direction of a qualified occupational therapist, had a rather more permissive approach geared to the needs of individual patients, most of whom are disturbed adolescents. Total attendances at these centres in 1965 were 1,805. There were two senior training centres for the mentally subnormal in the Borough, the Camden Road and Archway centres, providing accommodation for 40 female and 40 male adult trainees. Total attendances at these centres during the period 1st April to 31st December 1965, were 7,708. The Council approved in principle plans to adapt a disused Community Centre on a housing estate to provide more suitable premises for the Archway Senior Training Centre which is inadequately accommodated in a Church Hall. Junior subnormal boys and girls attended training centres in the Borough of Hackney. Work on a new purpose-built junior training centre, to be called the Rosemary Junior Training School, planned and started by the former London County Council, was however nearly completed by the end of 1965 for opening early in 1966. This centre is planned to accommodate 112 children, including a special unit for 12 severely handicapped children. Two special assessment and advisory clinics, providing approximately three sessions monthly, were conducted by one of the Principal Medical Officers, who specialised in mental subnormality, and who also sometimes visited young children at home who. for various reasons, were unable to attend the clinics. Although the clinics were mainly for mentally backward children under 5 years of age, arrangements were occasionally made for children with other handicaps to attend for assessment purposes. The total number of sessions held in the nine months ended 31st December 1965 was 18, and attendances totalled 41. During the year arrangements were made for 46 mentally sub-normal patients to be provided with short term residential care, 22 at the Council's expense and 24 in National Health Service hospitals, and at the end of the year the number of patients supported financially by the Council in various residential homes and hostels totalled 37 (15 mentally ill and 22 mentally sub-normal and severely sub-normal). The Council arranged an emergency service jointly with the neighbouring Borough of Hackney for dealing with urgent cases at night time and at weekends. This is referred to in more detail elsewhere in this report. The number of mental health emergency calls dealt with through these arrangements in the nine months ended 31st December 1965 totalled 109. 68 The North London Society for Mentally Handicapped children, which is grantaided by the Council, opened a private Day Nursery, registered under the Nurseries and Child Minders' Regulation Act 1948, for severely subnormal children under 5 years. Originally the accommodation provided was for six children but following alterations to the premises the number of places was later increased to 24 children between the ages of 2 and 5 years. The Elfrida Rathbone Committee,, which also received a Borough grant for its work amongst educationally subnormal children and their families, ran an extremely successful club for educationally subnormal school leavers of both sexes, and a Mothers Club where E.S.N! housewives receive instruction in simple cookery and household management. The mental health social workers worked closely with both these voluntary organisations. Recuperative Holidays (Sections 22 & 28 - National Health Service Act, 1946, and Education Act, 1944) Recuperative holidays were arranged on medical recommendations, approved by a senior medical officer, for persons not needing medical treatment or nursing care, but who would benefit from rest, food and fresh air. Placings were made either direct or through the Inner London Education Authority. The latter maintained a recuperative holiday home, Roland House, for 36 children from 2 to 8 years of age and leased another home, Cambridge House, for 44 children from 8 years of age to school leaving age. Children who could not be accommodated in these homes and all adults were placed in homes under private ownership or maintained by voluntary organisations. During the year the Inner London Education Authority placed 144 school and nursery school children and 6 pre-school children from Islington. Admissions to Recuperative Holiday Homes (Including Holborn figures from 1.1.65 - 31.3.65.) Expectant and nursing mothers 3 Other Adults 172 Children under 5 not at school 14 School and nursery school children 10 Total 199 Family Planning (Section 22 & 28 - National Health Service Act, 1946) Local health authorities are empowered to make arrangements at their own clinics or at clinics run by voluntary organisations,for family planning advice to be given to married women for whom further pregnancies would be dangerous or detrimental to health The Borough grant-aided the Family Planning Association's one clinic in Islington, in Spencer Street. E.C 1., and also paid on a per capita basis the Association's consultation fee for each Islington woman who attended for family planning advice on health grounds on the recommendation of the Borough Council's medical officers. During the period 1st April to 31st December, 1965, 204 women were referred for this advice on medical grounds and 136 actually attended. Arrangements were also made during the year for a family planning clinic to be run directly bv the Borough Council to give family planning advice to women referred on medical grounds by general practitioners and the Council's medical officers; these arrangements were completed by the end of the year, the clinic starting at the East Islington Welfare Centre, Drayton Park, in January, 1966. Cervical Cytology Proposals were approved in principle by the Council for the establishment of a cervical cytological clinic as early as possible in 1966. linked with the family planning clinic at the East Islington Welfare Centre, subject to Ministry of Health approval. 69 Home Help Service - Section 29, National Health Service Act, 1946 This service operated from three area offices, and the staff at each office included a home help organiser, an assistant organiser and a clerk. The organisers worked in co-operation and attended regular conferences with the senior staff of the Department. The number of home helps employed in each area fluctuated considerably, and although there was no acute shortage, the service was always fully extended to keep pace with the growing demand. Recruitment of suitable women was always difficult. The pattern of demand for the service followed that of the Inner London area as a whole, and the majority of recipients were the elderly, infirm and the chronic sick. In addition to domestic assistance in the home, home helps did shopping and collected pensions, and many did voluntary acts of kindness to their patients outside their official duties. There were also a few specially trained helps who helped in the rehabilitation of problem families. A useful service was also provided in taking children to and from school or day nursery when no parent was able to do this. Statistics for the Year 1965 Aged 65 or over on first visit in 1965 (1) Aged under 65 on first visit in 1965 Total (6) Chronic sick & Tuberculous (2) Mentally disordered (3) Maternity (4) Others (5) No. of Cases 2.240 182 10 96 254 2,782 No. of home helps at end of 1965:- (a) Whole-time 50 (b) Part-time 177 (c) Whole-time equivalent of (b) 120 Handicapped Children Three registers were maintained in the central office of the Department. The first contained the names of children under 5 years of age, based on the information supplied on birth notifications or on hospital discharge reports, together with details of infants detected at welfare centres. A close individual watch was kept at the centres on any infants considered to be 'at risk' of some handicap and detailed records held there: they were then transferred to the central register when a handicap was confirmed. The second register was for school children, consisting of transfers from the under 5 register on attaining school age, with any new children reported from school medical examinations or other sources. Each case on these registers was regularly reviewed by a Principal Medical Officer. A third register specialised in deaf children in all age groups. It was under the supervision of the Senior Social Worker and its cases were regularly reviewed by the Principal Medical Officer, who thus had all three registers under her control. Mentally handicapped children were also recorded in the mental health index of cases. Exchange of information was encouraged between the various workers concerned. There was often lack of information about children moving into the Borough, especially those of immigrants. Health of Immigrants Reference is made elsewhere in this report to the repercussions of a large and growing immigrant population on the various services. The radical problem of the standard of health of those coming into the country was raised in Ministry of Health Circular 3/65. Arising from this, the Council pressed for the X-ray examination of all immigrants in the country of origin. 70 Health Education The Borough appointed a health education officer and a technical assistant. A Health Education Advisory Panel met regularly under the chairmanship of the deputy medical officer of health. The panel represented every branch of the Department! It chose new material and selected monthly themes for publicity in the whole Borough area, linked where possible with national campaigns. The themes covered - Summer Safety. Preparation for School. Clean Pood. Oil Heaters and Fireguards. Winter Illness and Immunisation. Accidents in the Home. Liaison was made with other departments to display appropriate posters and leaflets in libraries, toilets and on refuse vehicles. The Education Officer and Youth Officer co-operated in arranging entry into schools and youth clubs for displays and talks. The range of subjects covered Drugs and Stimulants, Smoking, Venereal Disease and Human Relationships. A public smoking advisory clinic was held weekly with medical officers in attendance from the Council's staff and from the Chest Clinic. Cinemas showed anti-smoking films at their children's sessions, and the local Press published articles. A special activity dealt with the publicising of the dangers of illegal child minding. The equipment for audio-visual aid was reviewed and brought up to date. A van was allocated and adapted for health education purposes. Plans were agreed with the Inner London Education Authority for teachers to attend at welfare centres to take classes for immigrant women to help improve their English speaking. The classes would be drawn from, but not restricted to, mothers attending at the centres. Visits arranged for Students During the year 609 students (including 482 student nurses) visited Public Health Department establishments as part of their training to gain an insight into services of a local health authority. Members of the Department's nursing staff gave talks to student nurses at hospitals, and programmes were arranged to enable these students to gain practical experience. Periods of attachment within the Department were also provided for health visitor students from the Royal College of Nursing and the University of London (Institute of Education). Miscellaneous visitors included parties of student dietitians, district nurses. child care officers, social workers and several doctors from overseas. In addition facilities were also resumed during the year for medical students from the Royal Free Hospital to pay visits of observation to the Council's day nurseries and infant welfare clinics. Co-operation with Children's and Welfare Departments Residential establishments under the management of the Children's and Welfare Committees are visited at regular intervals by the Council's medical officers, who advise on hygiene and standards of care generally. The medical officer is usually accompanied by a public health inspector when visits are made to Welfare establishments for the aged and infirm. Where there are handicapped children, their progress and needs are discussed with the staff concerned. Advice is given to the Children's Department with regard to boarding-out placements in special cases, and in adoption cases. Blind and Partially-Sighted Persons During the year arrangements were made for examinations by a Consultant 71 Ophthalmologist for the certification under the National Assistance Act, 1948, of blind or partially-sighted persons. Certificates were also accepted from other local authorities and hospitals. As a result, 79 persons were registered or re-registered as blind, 32 as partially-sighted and 15 were found to be not blind or partiallysighted. Nursing Homes The Department assumed responsibility for the registration and inspection of nursing homes under Part VI of the Public Health Act, 1936, the Nursing Homes Act, 1936 and Part III of the Mental Health Act, 1959. There were 2 nursing homes in Islington, both non-profit making and run by charitable organisations. They were inspected by the Council's medical officers and public health inspectors during the period 1st April to 31st December, 1965. One home was re-registered to permit the reception of mentally disordered patients. The accommodation provided at the end of the period was as shown below. For medical or For mentally Chronic sick disordered Total 53 6 59 Emergency Telephone Arrangements The reorganisation of the London health services meant that it was necessary to inaugurate for Islington an organisation to receive and deal with the calls arising at any hour of the day or night to meet the emergency needs of mental health, domiciliary midwifery, home nursing and infectious disease. During office hours these were covered by the appropriate professional staff on duty. Out of office hours, advantage was taken of the Admissions and Doctors Inquiry Service operating from Whittington Hospital which was extended to take and pass on calls on the Council's behalf. The scheme was shared financially with the London Boroughs of Camden and Haringey, and worked very satisfactorily. Special hired car facilities were made available to midwives and mental welfare officers at night and weekends, when unable to use their own cars. 72 ANNUAL REPORT ON SCHOOL HEALTH SERVICE National Child Development Study - As agreed with the Inner London Education Authority, arrangements were made for assistance to be given to Dr. Butler and Dr. Ball in their National Child Development Study. The purpose of this Study is, in brief, to determine the present physical, sociological and educational status of children who are survivors of the 1958 Perinatal Mortality Survey and to relate the findings to the existing birth data. The homes of the 59 children concerned who attended schools in this Borough were visited by a Health Visitor and, where the parents' consent was obtained, a Parental Questionnaire was filled in. Medical Questionnaires (involving an examination by a School Medical Officer and a urine test for protein and glucose) are also being completed. Special Investigation Clinic - An additional weekly special investigation clinic was opened at East Islington Welfare Centre on 6th July, 1965. One of the Senior Medical Officers took this clinic and an Assistant Psychologist from Maudesly Research Unit attends every week for research purposes. He undertakes intelligence and psychological tests on the eneuretic children and brings eneuretic alarm sets which he has loaned out as requested by the medical officer. There were 88 attendances at the 20 sessions. held in 1965 and two eneuretic children were discharged cured. (It will be appreciated that children are rarely discharged cured before approximately 6 months* attendance). The special investigation clinic at Barnsbury Welfare Centre which was taken over by the same Senior Medical Officer on 7th May, 1965 was successful there being 18 eneuretic children discharged cured. The five other special investigation clinics continued throughout the year, there being a total of 97 discharges. Audiology - A closer watch was kept on those children who had any hearing loss and this has resulted in a increase in the number of children tested and found to have a hearing defect. It was necessary to increase the otologist's sessions from one to four each month. Tuberculosis incident - As a result of the notification in 1964 of a teacher at an Islington school found to be suffering from tuberculosis, the follow-up of contacts in the whole school carried on into early 1965. 226 children were skin-tested and 40 children X-rayed. Two children were found to be suffering from tuberculosis and received treatment. There were 20 adult contacts, 9 of whom were examined and found normal. The remaining 11 had left the school and were referred to the Medical Adviser's Department. B.C.G. Vaccination - During 1965, 2,264 school children were Mantoux skin tested at 32 schools. 2,011 of these were vaccinated with B. C. G., 80 were X-rayed and 43 were found to need treatment. Special Schools - There are six special schools in Islington and a seventh (Horizon School for Educationally Sub-Normal Children) which is just outside the Borough boundary, remained under the Education Officer, Division 3 and as agreed by the Medical Adviser, the Principal School Medical Officer of Islington is responsible for School Health in this school. Of these, three are for educationally sub-normal children where, in addition to the normal routine medical examinations, a specially trained medical officer reviewed their progress every year. One is a school for physically handicapped children where the Cardiologist and Rheumatism Consultant to the Inner London Education Authority and the Authority's 73 Consultant Orthopaedic Surgeon have visited once a term, whilst the school nurse has attended every morning. There is one school for partially-sighted children which was visited by the Authority's consultant ophthalmologist once a term. The school for deaf children was visited three times each term by the otologist accompanied by a social worker, and parents attended by invitation when necessary. Each child's hearing was tested at least once a year. There is also a school in the Borough for maladjusted children. Recuperative Holidays - In addition to the 144 school and nursery school children from Islington placed by the Medical Adviser's Department during this year, recuperative holidays were arranged by this Borough for 10 school and nursery school children. At Bathing Centres the number of attendances for treatment of scabies was 115 and for vermin and nits 174. Medical treatment of school-children - The number of sessions, new cases and total attendances at school children's clinics during 1965 (including sessions held in hospital premises) were as follows:- Type of Clinic No. of sessions New cases Attendances Minor ailments (doctor) 134 1,189 12,018 Minor ailments (nurse) 303 1,576 Special investigation 277 326 1,849 Dental 2, 298 5,673 18,452 Vision 662 2,745 10,542 Orthoptic 144 76 653 Ear, nose & throat 2* 11* 13* Audiology 16 65 93 * Only held during the March quarter. S. KING. Principal School Medical Officer. 74 REPORT OF THE CHIEF DENTAL OFFICER AND PRINCIPAL SCHOOL DENTAL OFFICER School Dental Service As I did not take up my appointment until November 1965. I must confine myself to saying something about the general picture as I found it adding some observations and my hopes for the future. The establishment of dental officers was as complete as the accommodation allowed, and the supporting staff of dental surgery assistants was adequate. 1965 was a year of transition and also saw the implementation of the scheme for examination of new entrants into the schools. It is difficult to comment upon this until it has run for a longer period, and in any case, opposing views exist as to whether it should remain or whether reversion to the old system of regular school dental inspections should take place. Perhaps ideally a combination of both would give the best of both worlds. Suffice it to say that the revisional appointments have on the whole met with a good response and a satisfactory flow of patients has continued at all the clinics over the year. It is almost impossible to present a truly accurate picture of the state of the teeth of the whole school population anywhere, because an increasingly large number of children appear to be treated in private practice, and it is this factor which leaves a large gap in any sensible attempt at statistical information. The important thing to ascertain (and this can only be done at school inspection) is that the children who opt to have private treatment do in fact seek it, so that the school dental service and private practice are truly complementary. It is however in the school dental service that something more can be done in the field of education, and it is to this end that I hope the introduction into the schools of short films and accompanying talks on dental hygiene will be of great assistance. I am most grateful to the Health Education Officer for his help with Dental Health propaganda. It is also pleasing to record that the Borough has accepted the principle of fluoridation and this is a hope for the future as it is through this medium that a new and fresh attack on dental decay can and should be made. From the mass of statistics available. I have endeavoured to break down into simple terms the most important items, namely the operations performed and what they really mean. Children aged 5-9 years had 3,083 permanent teeth filled and 4,343 temporary teeth filled. They had 94 permanent teeth extracted and 1,744 deciduous teeth extracted. Children aged 10 - 14 had 4,795 permanent teeth filled and 1,423 temporary teeth filled. They also had 270 permanent teeth extracted and 858 temporary teeth extracted. This is more or less the pattern one would expect because deciduous teeth are in the mouth for a more limited time and their need for fillings would drop as the children reach the age of ten. What, however, is alarming is that between the 5 to 9 and the 10 to 14 year age groups, the number of extractions increased from 94 to 270, and there is also a 25% increase in the need for fillings in the permanent teeth. The number of fillings and extractions in the group of 15 years and over is possibly lower because other factors emerge such as school examinations and perhaps an increased tendency to seek treatment privately, because it is more grown up to do so. But what does emerge is the vulnerability of the 10 - 14 year age groups and this must underline the necessity for treating the children's teeth as early in life as possible. 75 As far as orthodontics are concerned the present arrangements seem to have proved adequate for the somewhat limited demand which appears to exist in this Borough at the moment. Whether a different pattern would emerge upon the re-introduction of school dental inspections it is difficult to say now. Some comment must be added upon the general position with regard to the equipment in the surgeries. It was my view that considerable benefit would derive from the addition of spot lights in every case, and this, together with the addition of high speed drills (without which no modern surgery is complete), and an X-ray machine for Manor Gardens School Treatment Centre, were recommended in a survey of the dental clinics. Further, I did not like the look of the anaesthetic machines, both being obsolete models., and I am pleased to learn now in 1966 that the British Oxygen Co., has recommended their replacement. In conclusion I would like to put on record my thanks for the co-operation I have received from all sections whether they be dental or administrative. Maternity and Child Welfare Dental Service Attendances and treatments of maternity and child welfare patients from 1st April, 1965:- Number of Sessions 345 Number of appointments offered 1,387 Attendances - by appointment 1,184 other 319 Silver nitrate treatment 573 Fillings 695 Extractions 288 Dentures supplied - new full 18 new partial 18 Number made dentally fit 358 These figures are very encouraging even if one looks only at the ratio of acceptances to appointments offered. Since much of this work is derived in the main from the clinics at Manor Gardens and Pine Street, it is my hope that future expansion will extend this further, particularly to embrace some of those centres of treatment where a dental service does not at present exist. R. E. HYMAN. Chief Dental Officer & Principal School Dental Officer. 76 APPENDIX A Delegation of Authority to the Medical Officer of Health for Services under the Personal Health Committee 1. Generally To continue to administer the services transferred from the London County Council on the same lines (apart from adjustments of a routine nature) as prior to 1st April 1965, subject to the decisions made by the Council or its appropriate Committee from time to time. 2. Maternity and Child Welfare (a) To approve lists of proprietary brands of dried milk and nutrients for sale at appropriate charges (section 17 below), and of drugs and medicaments for issue free of charge on the recommendation of the clinic doctor. (b) To arrange admissions to the Violet Melchett Centre, Chelsea, for mothers and babies with feeding difficulties, on payment by the Council of the approved maintenance rates and subject to assessed charges on the parent (section 17 below). (c) To make a payment of 17s. 6d. to the Family Planning Association for each patient advised at the Association's clinics on referral on medical grounds by the Council's Medical Officers. 3. Day nurseries, child minders etc. (a) To arrange admissions to the Council's day nurseries subject to the priorities and charges (section 17 below) for children under five years from Islington and other Boroughs. (b) To receive applications for registration under the Nurseries and Child Minders' Regulation Act, 1948; to report to the Committee thereon; to sign orders and take other action necessary to give effect to the Committee's decisions; and to maintain the register required by the Act. (c) To register persons considered suitable for voluntary registration as minders of less than three children and to pay a registration fee of 6s. a week to each such minder, subject to compliance with the Medical Officer of Health's instructions in regard to the care of the children. (d) To arrange admissions to occasional creches for the minding of children, normally from the ages of two to five years, subject to the appropriate charge (section 17 below). 4. Domiciliary midwifery (a) To suspend any midwife from practice in accordance with section 17(1)(c) of the Midwives Act 1951, if such suspension appears necessary to prevent the spread of infection, and to convey suspension in writing in each case. (b) To arrange courses of post-certificate lectures and demonstrations for midwives who have notified their intention to practice in the Borough. (c) To pay within the limit of the maintenance votes the annual financial deficit of the Central Midwives' Board apportioned under section 23(2) of the Midwives Act, 1951. (d) To meet the cost of electric bells where necessary at residences of domiciliary midwives. (e) To arrange for officers concerned with the maternity services to serve on local maternity liaison committees and to attend clinical meetings at local hospitals. 77 (f) To administer the midwives' hostel attached to Scholefield Road day nursery. (g) To pay fees equal to those presented for similar services in the Medical Practitioners' (Fees) Regulations 1948, as amended from time to time, to medical practitioners who are called in by booked patients or their relatives to give medical aid when one of the domiciliary midwives of the Council is not available. 5. Nursing homes To deal administratively with routine matters arising from the supervision of nursing homes, subject to report to committee when any amendment of the certificate of registration is required or where there is serious infringements of the Acts. 6. Vaccination and immunisation (a) To arrange for the payment of fees to general practitioners in accordance with conditions laid down by the Minister of Health. (b) To make emergency provision as required for vaccination and immunisation, including the emergency scheme for oral poliomyelitis vaccination. (c) To undertake the scheme for B.C.G. vaccination of school pupils against tuberculosis, and associated epidemiological advice and investigations. 7. Tuberculosis (a) To arrange for the boarding out of child tuberculosis contacts at maintenance rates agreed in consultation with the Borough Treasurer and subject to voluntary contributions from the parents. (b) To authorise the supply of extra nourishment (e.g. milk, eggs and butter) to persons recommended by the chest physicians, subject to assessed charges (section 17 below). (c) To arrange for maintenance during rehabilitation at voluntary village settlements at rates agreed in consultation with the Borough Treasurer and free of charge to the recipients. (d) To arrange payments to hospital authorities in accordance with existing financial arrangements. (e) To arrange recuperative holidays . (f) To regulate admissions from Islington and other boroughs to Cromwell Lodge Hostel Hornsey, subject to charges to patients on an assessed scale (section 17 below). (g) To make an additional allowance for extra fare at Christmas for the residents, and to incur expenditure on Christmas decorations, at the Hostel. 8. Recuperative holidays (a) To arrange recuperative holidays for persons on medical grounds in accordance with sections 22 and 28 of the National Health Service Act, 1946, subject to the appropriate charges (section 17 below) and to school pupils under the Education Act. free of charge. (b) In consultation with the Borough Treasurer to pay maintenance rates for accommodation used for recuperative holidays. 9. Home help service (a) To provide domestic help in the following categories - ordinary home help; morning and evening help; night help; child help; special help for problem families. 78 (b) Subject to the discretion of supervisory staff in appropriate cases, to supply ordinary home help in the following normal order of priority - confinement; acute or chronic illness; the aged, infirm and blind; households which include a mentally defective person or comprise a large family of children under compulsory school age. (c) In exceptional circumstances, to engage relatives as home helps, if the provision of official help is not practicable and if the relation accepts engagement on the normal conditions for the period of duty (which shall not exceed the number of hours service that would have otherwise been officially provided.) 10. Mental health (a) To regulate admissions to training centres for the subnormal from Islington and other Boroughs, to arrange for the supply and routing of transport for junior pupils and women, for the provision of guides and for holiday schemes at centres and camps. (b) To arrange for the services of mental welfare officers to be available to perform the duties and functions under the Mental Health Act 1959, and for a twentyfour hour service for evening, night and week-end emergency rota, including a general index of patients. (c) In regard to persons who on 31st March 1965 are boarded out or otherwise maintained in homes by the L.C.C., or are in the guardianship of the L. C. C. to receive the allocation made by the County Medical Officer of Health and to undertake responsibility when the last known addresses of the patients or their parents were in the area of the London Borough of Islington, andto negotiate with other local health authorities when any question of settlement is in doubt, and to make new placings on the same principles. (d) To arrange for the approval, under the Mental Health Act 1959, of doctors whose surgeries are in Islington, to give recommendations for the compulsory removal of mentally disordered persons to hospital or reception into guardianship, and to inform neighbouring Boroughs of names on the approved list. (e) To arrange for the home teaching of mentally subnormal children and adults unsuitable for attendance at training centres because of an additional physical handicap, including the use of teachers employed by other Boroughs. (f) To engage escorts to take mentally disordered persons to and from hospital. (g) To pay such allowances (e.g. pocket money, clothing and incidental expenses) for persons placed in residential accommodation, as may from time to time be prescribed. (h) To make an additional allowance for extra fare at Christmas for persons maintained by the Council at hostels or under guardianship. 11. Specialist services Tor co-operate as necessary with the Inner London Education Authority in psychiatric services for (i) the special education of maladjusted children (ii) child guidance units and in specialist medical services for (i) the ascertainment of educationally subnormal children and of children who may be unsuitable for education at school (ii) mental subnormality (iii) applications for beds in psychiatric hospitals for long and short term care of the mentally subnormal. 12. Medical and nursing services for the Children's and Welfare Services (a) To provide medical services at residential establishments of the Children's Department (including the review of medical arrangements and advising on medical aspects of child welfare, hygiene and prevention of infection) and similarly at residential establishments of the Welfare Department. 79 (b) In agreement with the Children's Officer, to carry out visits of inspection and advice to private residential nurseries in the Borough. (c) To advise the Children's Officer on the placing of children with handicaps, subject if necessary to an initial arrangement with the I.L.E. A. for a medical officer to advise in the case of children of school age. (d) To keep a register of handicapped children. (e) At the request of the Chief Welfare Officer to arrange for medical examinations for the registration of blind and partially sighted persons. (f) To provide relief nursing staff at Welfare Establishments and residential schools, requests for agency nurses being made through the I.L.E. A. (g) At the request of the Children's Officer to seek statutory medical reports on children before being placed for adoption (Adoption Agencies' Regulations 1959) or for boarding out (Boarding Out of Children Regulations 1955), and to obtain additional information in the interests of the children and the prospective adopters, and to co-operate in the continuance of a central index. 13. Home Nursing (a) To administer the Borough Home Nursing Service (b) To loan, as equipment for patients being nursed at home, large items and articles which by their nature are unlikely to be in frequent demand, and to arrange for articles to be supplied by the Home Nursing Service or British Red Cross Society. 114. Priority Housing In consultation as necessary with the Housing Manager, to deal with the allocation of accommodation offered by the Greater London Council for rehousing of families on preferential medical grounds. 15. Prevention of break-up of families (a) In co-operation with the Chief Welfare Officer and the Children's Officer and other statutory and voluntary agencies to set up a Borough Co-ordinating Committee to continue in the Borough the work of the L. C. C. Divisional Co-ordinating Committee, with subsidiary intermediate case conferences, for the prevention of the break-up of families and of the neglect or ill-treatment of children in their homes. (The Medical Officer of Health will be Chairman, and the Principal Social Worker will act as Secretary of the Committee, maintaining a confidential index of families). (b) To circulate in conjunction with the Chief Welfare Officer and the Children's Officer, to interested persons and agencies a directory of organisations undertaking social casework in the Borough. 16. Payment for residential accommodation In consultation with the Borough Treasurer, to negotiate and pay maintenance rates for accommodation used in the provision of personal health services, and of allied services under the Education Act. 17. Charges to users To apply charges in accordance with approved scales to the recipients of services provided under the National Health Service Acts, subject to Committee approval for the provision of service without payment of the assessed charge in any particular case. 80 18. Poisons To secure that arrangements for the care and control of poisons at establishments conform to and comply with the relevant statutory requirements and Poisons Rules. *19. Finance To incur expenditure up to £50 on routine items, and up to £250 on emergency items. *20. Health education and publicity To continue, co-ordinate aid develop the activities hitherto carried out by the Metropolitan Boroughs and the London County Council. (* Common to environmental and personal health services.) Delegation of Authority to Medical Officer of Health For Services under the Environmental Health Committee 1. Generally to continue the administration of the services transferred from the Islington and Pinsbury Metropolitan Borough Councils on the same lines (apart from adjustments of a routine nature) as prior to 1st April, 1965, subject to the decisions made by the Council or its appropriate Committee from time to time. 2. To administer the Invalid Meals Service, in co-ordination as far as possible with the Meals on Wheels Service. 3. To administer the services transferred to the Public Health Department from the London County Council Public Control Committee. *4. To incur expenditure up to £50 on routine items, and up to £250 on emergency items. *5. To continue, co-ordinate and develop the health education and publicity activities hitherto carried out by the Metropolitan Boroughs and the London County Council. (* Common to environmental and personal health services) 81 APPENDIX B Health Service Establishments Establishment Address Administrative Offices Central Office 159/167 Upper Street, N. 1. Home Help service - Central Area East Islington Welfare Centre, 32 Drayton Park, N. 5, North Area North Islington Welfare Centre, 6 Manor Gardens, N. 7. South Area Barnsbury Welfare Centre, Carnegie Street, N. 1. Meat Inspector's Office 28 Cowcross Street, E.C.I. Mental Health Service Finsbury Health Centre, Pine Street, E. C. 1. Rodent Service do. Day Nurseries Canonbury Place 8 Canonbury Place, N. 1. Lloyd Square 14 Lloyd Square, W.C.1. Mitford Road 1 Mitford Road, N.19. Scholefield Road Scholefield Road, N.19. Springdale Springdale Road, N.16. Disinfection and Cleansing Station Finsbury Health Centre, Pine Street, E. C. 1. Treatment Centre 131a Seven Sisters Road, N.7. Hostel for Tuberculous Men Cromwell Lodge 55 Cholmeley Park, N. 6. Invalid Meals Kitchen and Restaurant 65 Essex Road, N.1. Mental Health Day Centres Finsbury Health Centre, Pine Street, E.C.1. Islington St.James' Church Hall, Brittania Row, N. 1. Mental Health Training Centres Archway Congregational Church Hall, Junction Road, N. 19. Camden Road Congregational Church Hall, Camden Road, N.7. Chest Clinics Finsbury Health Centre Pine Street, E.C.1. Islington St. Mary's Wing, Whittington Hospital, Highgate Hill, N.19. School Treatment Centres Islington 37 Hiornhill Road, N. 1. Manor Gardens 8 Manor Gardens, N.7. Popham Road 26 Popham Road, N. 1. 82 Establishment Address Services Health Centre Finsbury Pine Street, E. C. 1. Chest, Chiropody, Dental and Physiotherapy Clinics; Mental Health Day Centre; Disinfection and Cleansing Station. Welfare Centres Archway Congregational Church Hall, Junction Road.N. 19. Child Welfare, Chiropody. Barns bury Carnegie Street, N.l. Maternity & Child Welfare, Chiropody, School Health, (special investigation) East Islington 32 Drayton Park, N. 5. Maternity & Child Welfare, Snoking Advisory Clinic. East Islington (Branch) 6 Hurlock Street, N. 5. Child Welfare. Hi11drop Tenants' Clubroom, Hilldrop Estate, N.7. Maternity and Child Welfare. Leage Street 24 Leage Street, E.C.I Maternity and Child Welfare. Pine Street E. C. 1. Maternity and Child Welfare, School Health,(minor ailments.) South Islington 6 Clephane Road, N. 1. Chiropody, Maternity and Child Welfare. South Islington (Branch) Union Chapel, Compton Avenue, N. 1. Child Welfare. Voluntary Welfare Centres Claremont Central Mission White Lion Street, N. 1. Child Welfare North Islington 6 Manor Gardens, N. 7. Maternity and Child Welfare. North Islington (Branch) Blythe Mansions, Highcroft Road, N. 7. Child Welfare. North Islington (Branch) Holloway Hall, 129 Seven Sisters Road, N.7. Child Welfare. 83 APPENDIX C Day Nurseries - Scheme of Priorities (a) The first priority for admission is given equally, subject to the other rules, to the children (including adopted children) of:- (i) mothers who are widows, separated or divorced wives, or wives whose husbands are totally disabled or in prison, or unmarried mothers, provided they are maintaining an independent home and are employed at least 35 hours a week including meal times; (ii) parents where the mother is in ill-health and cannot care adequately for the children, or during the mother's confinement; (iii) parents who are living in housing conditions detrimental to health, or where other environmental factors are such that it is desirable for the health of the child that it should be admitted to a day nursery; and (iv) widowers or where the mother has left the home. (b) The second priority for admission is given, subject to other rules, to children where the mother is compelled to go to work as an economic necessity because the father is unemployed or his net income (i.e., his gross income less rent and an allowance of £1 for each child after the first, and at discretion, any unavoidable expense of an exceptional kind) does not exceed £7 a week, provided that the mother is employed for at least 35 hours a week, including meal times. (c) Vacancies not required for children in the first and second priority classes shall be offered to other children in a third priority class whose parents are both working provided that the mother is employed for at least 35 hours a week, including meal times. (d) In assessing applications for all admissions an overriding consideration shall be that the parent(s) is/are unable to make other satisfactory arrangements for the care of the children. (e) The Medical Officer of Health, with the approval of the Chairman of the Personal Health Committee, is authorised, at his discretion, to admit, in appropriate cases, the children of mothers working fewer hours than stipulated in the foregoing rules, (a), (b) and (c). (f) Places offered to children in the third priority class referred to in rule (c), shall be initially for six months (unless a temporary admission for a shorter period is required), subject to review after that time as in rule (h) below and renewals for subsequent periods of six months shall be permitted, provided that vacancies are not required at the time of review for children in the higher priority classes. (g) The Medical Officer of Health has overriding discretion to admit any other cases presenting special features and any appeal from his decision would be referred to the Chairman of the Personal Health Committee. (h) A review of the circumstances of the parents of all children admitted to day nurseries, including, where appropriate, verification of parents' incomes, is made at six-monthly intervals from the date of admission. Where a child no longer falls within the first or second priority classes, a third priority vacancy is offered wherever possible in accordance with the rules. (i) Anrangements for all admissions are made by the Medical Officer of Health and not by individual nurseries. The Medical Officer of Health has discretion to allow children of non-working mothers to spend a shorter period than the full day nursery day in the day nurseries. Deaf children or children of deaf parents whom it is thought would benefit from a hearing' environment, may be admitted to day nurseries for up to three hours a day or fifteen hours a week without charge, except for any meals taken. 84 APPENDIX D Establishment of Officers Medical Officer of Health and Principal School Medical Officer 1 Deputy Medical Officer of Health and Deputy Principal School Medical Officer 1 Associate Medical Officers of Health 2 Senior Medical Officers 1 2 Medical Officers 7 13 ADMINISTRATION Chief Administrative Officer 1 Assistant Chief Administrative Officer 1 Principal Administrative Officers 3 Health Education Officer 1 Senior Administrative Officers 7 Administrative Officers 4 Administrative Assistants 14 Senior Clerks 30 Clerks 32 Caretaker 1 Telephonist 1 Senior Typist 1 Clerk/Shorthand Typists 5 Clerk typists 2 Assistant (Health Education) 1 104 INSPECTORATE AND TECHNICAL Chief Public Health Inspector 1 Deputy Chief Public Health Inspector 1 Assistant Chief Public Health Inspectors 2 Senior Public Health Inspectors 12 Public Hearth Inspectors 29 Chief Fire Inspector 1 Fire Inspectors 2 Inspector (General Purposes) 1 Technical Assistants 10 Student Public Health Inspectors 6 Rodent Officer 1 Assistant Rodent Officer 1 Rodent Investigators 4 Superintendent of Laundry & Disinfecting Station 1 72 NURSING AND MIDWIFERY Principal Nursing Officer 1 Deputy Principal Nursing Officer 1 Assistant Nursing Officer 1 Centre Superintendents 6 Health Visitors 39 Tuberculosis Visitors 2 Clinic Nurses 16 School Nurses 18 84 85 DAY NURSERIES Matrons 5 Deputy Matrons 5 Staff Nursery Nurses 16 Nursery Wardens 5 Nursery Assistants 19 Nursery Students 22 Creche Assistants (Part-time) 1 73 GERIATRIC SERVICES Home Visitors 5 Assistant Home Visitors 5 Ward Sisters at Hillside Home for the Retired 10 20 DOMICILIARY MIDWIFERY Supervisor of Midwives 1 Superintendent Midwife 1 Domiciliary Midwives 14 Domiciliary Midwives (Part-time) 2 Physiotherapist (Part-time) 1 19 HOME NURSING Superintendent 1 Assistant Superintendent 1 District Nurses 38 Student District Nurses 6 46 DOMESTIC HELP Home Help Organisers 3 Assistant Home Help Organisers 3 6 MENTAL HEALTH Principal Mental Health Social Worker 1 Deputy Principal Mental Health Social Worker 1 Senior Mental Health Social Workers 7 Mental Health Social Workers 3 Senior Occupational Therapist 1 Supervisors (Training Centre) 2 Assistant Supervisors 3 Senior Craft Instructor (Day Centre) 1 Craft Instructor 1 Psychiatric Social Worker 1 21 CHIROPODY Chief Chiropodist (Grade II) 1 Senior Chiropodists 3 Chiropodists (Sessional) (Full-time equivalent - 4½ 14 18 86 TUBERCULOSIS Welfare Officers (Chest Clinic) 2 Senior Occupational Therapists 2 Warden (T. B. Hostel) 1 Assistant Warden (T. B. Hostel) 1 6 SOCIAL CASEWORK Senior Social Worker 1 Deputy Senior Social Worker 1 Family Case Worker 1 Social Workers 4 Welfare Officer (V.D.) 1 8 DENTAL Chief Dental Officer & Principal School Dental Officer 1 Dental Officers (Sessional) (Full-time equivalent - 4) 9 Dental Surgery Assistants 6 Supernumary Dental Surgery Assistant 1 17 TOTAL NUMBER OF OFFICERS 507 (In addition lists are maintained of doctors, dentists and chiropodists who are prepared to work on a sessional basis.) 87 Establishment of Manual Workers ENVIRONMENTAL HEALTH Bathing Attendants 9 Plant Attendant 1 Driver/Disinfectors 2 Disinfector/Scooter Drivers 3 Stoker/Handyman 1 Handyman/Drivers 3 Van Driver 1 Porter/Cleaners 2 Female Cleaner, Supervisor 1 Female Cleaner (160 hours) Porter Telephonists 2 Foreman Rodent Operative 1 Rodent Operatives 12 MEALS-ON-WHEELS SERVICE Drivers 6 (20 hrs. each) Helpers 6 (17½ hrs. each) INVALID MEALS SERVICE Head Cook 1 (32½ hrs) Assistant Cooks 2 (x 32½ hrs.) Kitchen Helpers 4 (3x32½: 1x20 hrs) Driver/Porters 5 (4x20: 1x15 hrs) Van Helpers 6 (3x15: 3x17½ hrs) HOME HELP SERVICE Total Home Helps (8400 hours) HEADQUARTERS AND PERSONAL HEALTH Attendants 130 hours Cleaners 1011 hours Cooks 304 hours Guides 208 hours Kitchen Helpers 171 hours Launderesses 132 hours Needlewoman 40 hours Porter/Cleaner 24 hours Handyman/-Driver 1 Office Attendants 2 Stoker/Handymen 4 88 INDEX Accident Deaths 11 Acute Encephalitis 12 Acute Poliomyelitis 12 Acute Primary and Influenzal Pneumonia 12 Addresses of Health Service Establishments 82,83 Agricultural Produce 59 Anthrax 12 Area of Borough 8 Atmospheric Pollution 28,32 Audiology 73 Bacteriological Examinations 20 Bathing Facilities 22 Basement Bakehouses 35 B.C.G. Vaccination 19,73 Blind and Partially Sighted Persons 67,71,72 Blythe Brooke, Dr. C.O. S. 5 Caravan Sites 28 Care Committee (Tuberculous) 18 Case Conferences 67 Certificates of Disrepair 24 Cervical Cytology 69 Chest Clinics 17,82 Child Minders 62 Children's Department & Welfare Department - Co-operation with 71 Chiropody Services 66 Clean Air Act, 1956 28-32 Cleansing - Special 21 Clearance Areas 50,52,53 Common Lodging Houses 47 Community Service Volunteers 7 Consumer Protection Act, 1961 24,37 Co-ordinating Committee (Problem Families) 67 Cremations 22 Cromwell Lodge Hostel for Tuberculosis Men 19,82 Day Nurseries 6,62,69,82 Day Nurseries - Priorities for Admission 84 Day Centres for Psychiatric Patients 68,82 Deaf Children 68,84 Deaths - See Vital Statistics Delegation of Powers to Medical Officer of Health 2,77-81 Dental Services - Report of Chief Dental Officer 75,76 Development - See under Planning Diphtheria 12 Diseases of Animals Act, 1950 36,49 Disinfection and Disinfestation 27,82 District Nursing - see Home Nursing Domiciliary Midwifery Service 63 Dysentery 12, 15, 16 Egg Pasteurisation 60 Elderly Persons - Services for 20-22 Elfrida Rathbone Committee 69 Emergency telephone arrangements after-hours 72 Emergency Service - Mental Health arrangements with London Borough of Hackney 78 Enteric Fever (including Paratyphoid) 12 Enuretic Children 73 Environmental Health Committee - Members 3 Erysipelas 12 Establishment addresses 82,83 Establishments - Officers 5,85-87 Establishments - Manual Workers 5,88 Expenditure - Estimates of 6 Export Certificates - Food, etc. 59 Factories Act, 1961 33-35 Finsbury Chest Clinic 17 Finsbury Health Centre 2,17,21,30,61,82,83 Family Planning 69 Flies 28 Fluoridation 75 Food - Complaints 55,57 Food - Poisoning 12,13 Food - Supervision 54,60 General Practitioners - Liaison 61,64 65,68 Handicapped Children & Handicap Register 61,70 Health Amenities Fund 67 Health Education 71,75 Health Visiting 63,64 Health Service Establishments - Details of 82,83 Home Help Service 70,82 Home Nursing Service 1,64,65 House Purchase - Inspections re 52 Houses in Multiple Occupation 51 Housing 50-54 Ice Cream 59 Immigrants 14, 17,18,23,62,70,71 Immunisation and Vaccination 61,65 Incontinence Pads 68 Infant Mortality 8, 10 Infective Illness at School 16 Infectious & Other Diseases - Prevalence & Control of 12,20 Inner London Education Authority, School Health Service 73,74 Inoculation & Vaccination - Certificates of 12 Invalid Meals Service 21,82 Islington Crematorium 22 Islington Chest Clinic 17 Junior Training Centre 6,68 Land Charges Act, 1925 24 Laundry Services 22 Lead Poisoning 13,14 Legal Proceedings 21,24,26,27,57,62 Loan of Equipment 67 Lung Cancer 11 Malaria 12 Marie Curie Foundation 64 Mass X-ray Unit 17 Maternal Deaths 8, 10 Meals-on-Wheels Service 21 Measles 12,65 Meat 55,58,59 Medical Officer of Health - Delegation of Powers to 2,77-81 Medical Examinations of Staff 5 Meningococcal Infection 12 Mental Health 68,69,73,82 Merchandise Marks 59 Midwifery Service - Domiciliary 63 Milk 59,60 National Assistance Act, Section 47, as amended 20,21,24,48 National Child Development Study 73 Noise Abatement Act, 1960 24,27 , 36 North Islington Voluntary Welfare Centre 7,83 North London District Nursing Association 64 North London Society for Mentally Handicapped Children 69 Nursing Homes 72 Offensive Trades 35,36 Offices, Shops & Railway Premises Act, 1963 33,37-45 Oil Heater Regulations, 1962 37 Ophthalmia Neonatorum 12 Paratyphoid Fever 15 Perinatal Mortality 8 Personal Health Committee - Members 3 Personal Health Services 61-72 Pet Animals Act, 1951 24 Pharmacy & Poisons Act, 1933 37 Pigeons 28 Planning 1,5,6 Population 8 Population - Estimated Child 10 Premises - See under Establishments Prevention of Damage by Pests Act, 1949 45-47 Prevention of Ilness - Care and After-Care 66-68 Principal Officers of the Public Health Department 3,4 Problem Families 67 Public Analyst 58 Public Control 48,49 Public Health Inspectors - Work during year 23-60 Published Papers during 1965 7 Puerperal Pyrexia 12 Psychiatric Services - see Under Mental Health Queen Mary London Needlework Guild. 64 Rag, Flock & Other Filling Materials Act, 1951 37 Rats & Mice 45-47 Recuperative Holidays 69,74 Refuse Disposal 28 Rent Act, 1957 24 Richard Cloudesley Fund 64 Rosemary Junior Training School 68 St. Pancras Chest Clinic 17 Sampling 58,60 Sanitary, Circumstances of the Area 23-49 Scabies & Vermin 20,74 Scarlet Fever 12 School Dental Service 75,76 School Health Service 73,74 School Treatment Centres 82 Schools - Special in Borough 73 Senior Training Centres 68,82 Services for the Elderly 20-22 Sewerage & Sewerage Disposal 48 Shops Act, 1950 - see under Public Control Slaughter Houses 36 Slaughter of Animals Act, 1958 - Slaughtermen's Licences 59 Smoking Advisory Clinic 71 Smoke Control 28-32 Special Investigation Clinics 73 Staff - see under Establishments Staff Medical Examinations 5 Statistics - General & Vital 8-11 Steam Disinfection 27 Street Markets & Food Stalls 55 Students - Visits Arranged for 71 Task Force 22 Telephone - Emergency arrangements 72 Training - Health Visitors 64 Treatment Centre, Seven Sisters Road, N. 7 22,30 Tuberculosis 11,12,16-19,58,66,7 3 Typhoid Fever 14 Typhoid & Paratyphoid Fever 14 Typhus Fever 12 Unsound Food 55,57,58 Vaccination & Immunisation 65 Vaccination & Inoculation - Certificates of 12 Venereal Diseases 66,67 Vermin - Treatment for 27,74 Vital & General Statistics 8-11 Voluntary Organisations 7,64,67,69,83 Water Supply 47 Welfare Centres 83 Welfare Department & Children's Department - Co-operation with 71 Whooping Cough 12 Works in Default 26