SL96 ANNUAL REPORT of the Medical Officer of Health London Borough of Islington 1967 To the Mayor, Aldermen and Councillors of the London Borough of Islington INTRODUCTION The year 1967 continued the consolidation of the Borough's health services which were described in my reports for the two previous years. The effects of the national Prices and Incomes Standstill were still felt, but progress was none the less made in many directions, as is shown elsewhere in this report. In November, Dr. Victor Freeman, Associate Medical Officer of Health, retired after a distinguished career in the local government health service, including 24 years as Medical Officer of Health for the Metropolitan Borough of Islington. Many tributes were paid to him, both by the Council and its Committees, and in the Press. I refer to him in fuller detail later in the report. The year closed with tragedy. Miss Kathleen Mary Hilder, a district nurse, died as the result of a road accident whilst on duty, when her moped was in a street collision. ...iss Hilder had been employed by the former North London District Nursing Association since 1963 and was transferred to the London Borough of Islington on the 1st April, 1965. Tributes were paid to her by the Personal Health and Establishment Committees. Once more, I would particularly mention the co-operation at all levels between those connected in any way with the Department's functions. I would also express deep appreciation of the guidance and support given by Members of the Council and its Committees. The Annual Report serves as a reminder of the wide range of services provided by the Department for the health of members of the public, covering the whole span of their lives. Before birth, care is given to mothers at ante-natal clinics. Domiciliary midwives attend at births and undertake the subsequent nursing of the mother and new-born c-hild. Advice on each child's health and dental progress is given at child welfare clinics until the age of five, and then through the school health service, till school leaving. Protection against infectious diseases is offered by planned programmes of vaccination and immunisation during pre-school and school life. For certain age groups and specified diseases, protection may be given to adults, and there is a detailed procedure for investigating notifiable diseases and taking active measures to prevent their spread. The Department co-operates with the Hospital Clinics in the care and after-care of tuberculous persons, and in the follow-up and contact tracing of venereal disease. Visits are paid and services provided in the homes of persons as required, by health visitors, domiciliary midwives, district nurses, home helps, old people's visitors, public health inspectors, rodent staff and other special workers. Adults in priority groups are given treatment in dental and foot clinics. Families are relieved of their pressures by providing day nurseries for children under five, and by co-ordinated assistance to problem families, as well as by family planning advice where this is requested on medical grounds. The Department exercises a wide range of duties in regard to housing with a view to preventing or removing nuisances, remedying abuses and clearing unfit property. It also controls by inspection, licensing and other statutory measures those trading activities which may directly or indirectly affect the health of the Community. This extends to the many aspects of the sale and distribution of food. A further wide field of community care is offered by the mental health service, which beginning with severely subnormal babies and working in close liaison with the ascertainment of subnormality by the school health service, is able to offer advice to parents, training at centres and residential care through life where necessary. The mentally ill receive similar services in consultation with psychiatric hospitals, with the object wherever possible of offering them support in their homes and helping them to live their own lives in the community. The services which the Department can give go on till the end of life. Many of them apply specially to old persons, e.g. home help, district nursing, special visiting, and the meals on wheels service. Advisory health circles for elderly people are held at various centres. Parallel with all the services, health education is given in all aspects of personal and environmental health 1 in centres, schools and to the public at large, with home safety featuring high in the programme. One last function of the Department is that, after death, cremations are subject to certification by my colleagues or myself as medical referees for the Borough. Health Service Premises A new centre came into use on the 3rd April, 1967, when accommodation was made available at the Civil Defence Centre, 76/80 Isledon Road, N.7., for child welfare and food sale sessions. The centre was named the Isledon Road Welfare Centre and operated as a branch of Drayton Park Maternity and Child Welfare Centre. On the 13th March, 1967, after the completion of works of adaptation. Blythe Mansions Welfare Centre, Highcroft Road, N.19., was re-opened with a full range of services. Hitherto it had served only as a branch centre. Richmond Avenue Day Centre for the Mentally 111 was opened on the 10th April, 1967, after considerable works of improvement carried out by the Borough Architect. This gave effect to the proposal inherited from the London County Council on 1st April, 1965, to provide a day centre for thirty persons. It replaced the centre held temporarily in the Baptist Church Hall, Cross Street, N.1. Health Centres Two major projects which received continuous consideration in consultation with the Borough Architect and Borough Valuer related to Health Centres - the existing Finsbury Health Centre, Pine Street, E.C.I, and the proposed River Place Health Centre, Essex Road, N.1. At Finsbury Health Centre, the Council on the 1st April, 1965, took over agreements for the use of accommodation by the North East Metropolitan Regional Hospital Board as a Mass X-Ray Administration Office, and by the North West Metropolitan Regional Hospital Board as a Chest Clinic. The Boards relinquished the premises on the 31st August. 1967, for the Chest Clinic, and the 31st December, 1967, for the Mass X-Ray Office. The premises were offered to the Inner London Executive Council for use by general medical practitioners and to the Inner London Education Authority for use as a child guidance unit. Neither offer was taken up, and other proposals were still under consideration at the end of the year. It was agreed that basement accommodation should be adapted to enable the Borough's disinfecting, bathing and laundry services to be concentrated there, taking in that part of the work done at Seven Sisters Road Treatment Centre, N.7. Plans for this scheme were in preparation at the end of the year. In my last report, I referred to the initial action taken to plan a Health Centre on a site in River Place, Essex Road, N.1., under section 21 of the National Health Service Act, 1946. Further progress was made during 1967. The site was purchased at a cost of £34,570. After consultation with the Inner London Executive Council and the Local Medical Committee, the Borough Architect and I held a series of meetings with the general medical practitioners who had expressed a wish to come into the centre. Generally, the terms under which they would have the use of the centre, and the lay-out of the rooms which they would occupy, were discussed and substantially agreed. With a view to clarifying certain points of principle, the Town Clerk and I met officers of the Ministry of Health, in the course of which they expressed provisional approval of the River Place project and gave very helpful advice on a number of matters of detail, in anticipation of information which was published later. By the end of the year, the Council had approved the sketch plan prepared by the Borough Architect, incorporating the following services - Islington Borough Council Maternity and Child Welfare Health Education 2 Chiropody Dental Unit ) School Treatment ) Audiology ) on behalf Inner London Education Authority Vision ) Accommodation for health visitors, school nurses, district nurses, midwives, old people's visitors. Inner London Education Authority Child Guidance Unit Inner London Executive Council Surgeries for 5 General Medical Practitioners Common Services Administration Records Waiting space Pram store Parking for cars Kitchens Staff rooms Staff and public lavatories Storerooms Lobbies and circulation Oil-fired heating and electrical appliances The estimated capital cost was - site £34,570, works and fees £144,485 and initial equipment £17,000. The submission scheme was in preparation for sending to the Ministry for approval early in 1968. Five Year Capital Programme The Council's Five Year Programme was reviewed to cover the period 1968/73. Its fulfilment would be dependent in each case on approval of loan sanction by the Ministries concerned. The proposals included - Area I (N.E.) - New hostel for mentally subnormal adults (20 places), Seven Sisters Road, N. 7. New industrial unit for mentally subnormal adults (60 places). Seven Sisters Road, N. 7. - Replacement day nursery (60 places), Andover Road, N.7. Area II (N.) - New hostel for mentally ill (20 places), Hornsey Lane, N.6. Area III (N.W.) - New day nursery (60 places) and health centre (replacing small M.C. W. centre), Girdlestone Road Area, N. 19. - New day nursery (60 places) Tufnell Park Area, N. 19. Area IV (N.E. Central) - New day nursery (52 places), adaptation of Community Centre, Aubert Court, N. 5. 3 Area V (W. Central) - New day nursery (60 places) Lough Road, N. 7. Area VIII (S. E.) - New health centre. River Place. N. 1. Area IX (S.) - Finsbury Health Centre, Pine Street, E.C.1., adaptation as disinfecting, bathing and laundry station, for transfer of services from Seven Sisters Road Centre. S. KING Medical Officer of Health 4 ENVIRONMENTAL HEALTH COMMITTEE PERSONAL HEALTH COMMITTEE (as at 31st December, 1967) MAYOR Councillor ARTHUR EDWARD WHITE, J.P. Aldermen Alderman CHARLES ALFRED ALLEN, J.P. CHARLES ALFRED ALLEN, J.P. HERBERT JAMES LOWTON LYGOE, O.B. E., J.P., M. S.M. Councillors ALBERT JOHN ROGERS, J. P. MRS. ZARA BAGNARI Councillors WILLIAM CHARLES COMLEY ARTHUR EDWARD JACK CANNON HENRY CHARLES BEARD LESLIE THOMAS COOMBS. HENRY WILLIAM FRANCIS FORD HENRY WILLIAM FRANCIS FORD ALBERT EDWARD LEY PAUL GRANT HENRY JAMES REID MRS. ELIZABETH HOODLES, B.A., M.I. M.S.W. TERENCE CORNELIUS ROONEY GEORGE ALBERT WILLIAM IVEfe MRS. MARGARET MARY SHORT MRS. VIOLET FLORENCE PRYTHERGCH MRS. EMILY MARY SIMMS ROBERT JOHN REDRUPP WALTER atlTH LEWIS ROSS MRS. BRONWEN STRADLING MRS. EMILY MARY SIMMS VIVIAN STEWART STRADLING WALTER SMITH MRS. EDITH JOAN WALKER JACK WALKER Co-opted Members Co-opted Members R.J.S. BRYANT, LL.B., F.C.C.S. , F.H.A. M.J. FITZGERALD, M.B. , B. Ch. E. COLIN-RUSS, M.R.C.S. , L.R.C.P. GEOFFREY RANKIN MISS P. W. REDMAN, S. R.N. , D.N. (Lond. ) T. C. THOMAS Ctiai rman Chai rman Alderman A.J. ROGERS, J.P. Councillor J. WALKER Vice-Cliainnan Vice-Oiai rman Councillor H.J. RE3D Councillor W. C. COMLEY 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.O.G., D.P.H. 5 Associate Medical Officer of Health V. FREEMAN M.R.C.S., L.R.C.P., D.P.H. (Retired 10.11.67). Principal Medical Officers BETTY GROVES J.E.J. HURMAN M.B., B.S.. D.P.H. M.B., B. S.. D.P.H., D.T.M. & H. (Commenced 1.6.67). Chief Dental Officer & Principal School Dental Officer Public Analyst R.E. HYMAN D. F.H. BUTTON L.D.S., R.C.S. (Ehg. ) A.R.C.S., F. R.I.C. Chief Administrative Officer Chief Public Health Inspector F.L. CLARK, B.A. W. C. BARTLETT F.R.S.H., M.A.P.H.I. Assistant Chief Adninistrative Officer Deputy Chief Public Health Inspector E.J. SHARP G.S. ADAMS. M.A.P.H.I. Principal Acfcninistrative Officers Assistant Chief Public Health Inspectors MISS D. EGGINTON A.J. TRUSLOVE, M.A.P.H.I. S. GODSTONE T. LAWSON, M.A.P.H.I. A. G. HOLMES Principal Nursing Officer Deputy Principal Nursing Officer MISS K.B. HARVEY MISSL.K. MAY S.R.N.. S.C.M., H.V. S.R.N., S.C.M., H. V., Q.N., Dip. Soc. Assistant Nursing Officer Supervisor of Midwives MRS. M. TAMBLYN MISS V.J. BUCKINGHAM S. R.N., H.V.. R.F.N. S.R.N., R. F.N., S. C.M. Senior Social Worker Deputy Senior Social Worker MISS M. MACMORRAN MRS. A. HOSKER Principle Mental Health Social Worker Deputy Principal Mental Health Social Worker MISS N. E. BRIAN J.P. QUINN Health Education Officer K.M.N. ROBERTSON L.M.R.S.H., M.I.H.E. 6 DR. V. FREEMAN, M.R.C. S., L.R.C.P., D.P.H. ASSOCIATE MEDICAL OFFICER OF HEALTH On the 10th November, 1967, Dr. Freeman retired from the position of Associate Medical Officer of Health. From February, 1941, to March, 1965, he was Medical Officer of Health for the Metropolitan Borough of Islington, previously having been its Assistant Medical Officer of Health since 1936. He was a Fellow of the Royal Society of Medicine and a Fellow of the Society of Medical Officers of Health. In February, 1965, in considering reports from its Public Health and Housing Committees, the Council of the Metropolitan Borough of Islington paid tribute to the outstanding services rendered by Dr. Freeman as Medical Officer of Health. The Council appreciated the lively personal interest taken by him in every aspect of the public health services in the Borough and the great ability, energy and enthusiasm applied to the many schemes of improvement which he had been instrumental in initiating. The Council benefited at all times by his keeping them aware of the detailed functioning and degree of effectiveness of the various health services in the Borough. Dr. Freeman gained the confidence of the members of the Council as well as the respect of his staff by applying his talents unreservedly to the duties of his office and by his capacity for grasping problems of his work down to the smallest detail. The Council credited much that had been achieved in the administration of the Council's health services to Dr. Freeman's diligence, which gave an inspiring lead to all who worked with him for the benefit of the people of Islington, and to his own example and personal interest in contemporary health problems, particularly those found in Islington. 7 In November, 1967, the Council of the London Borough of Islington also paid tribute to Dr. Freeman's services, referring particularly to the prominent part he played in the medical administration of the Public Health Department, directing work in the fields of environmental health and infectious disease control. As a member of the Home Safety Committee he specialised in important aspects of safety, including research into the causes and results of accidents, and as the Medical Officer of Health's representative on the Islington Tuberculosis Care Committee he maintained liaison with Chest Physicians in relation to the tuberculosis prevention duties. Dr. Freeman was instrumental in planning the new services for geriatric clinics and for cervical cytology tests and he pioneered schemes whereby the Public Health Department utilised the Council's computer for health service processes. It is my privilege to supplement the foregoing tributes. To the pleasure of knowing Dr. Freeman before the 1st April, 1965, has been added that of working with him as a close colleague since that date. I am most grateful to hiM for the unstinting help and advice he gave in the exacting task of creating a new public Health Department. His close association with the hospital authorities as a member of the North London Group Hospital Management Committee and his many contacts with the general practitioners helped to make co-operation easier with other branches of the National Health Service; and his knowledge of the area and its public health problems proved invaluable to all those members and officers alike concerned in the planning of the new London Borough. PUBLISHED PAPERS DURING 1967. Dr. Audrey K. Arnold. The Newcomers and their Problems in Finsbury, London. Midwife and Health Visitor, July 1966. Vol.2 No.7. pp. 291-298. Miss G. Flack. The Health Visitor's Work in a Group Practice. Principles of Health Visiting. Faber & Faber 1967 Chapter 11(c). pp. 39-47. Meeting the Need from the point of view of the Health Visitor. The Pre-Retirement Association. Aspects of Health in Preparation for Retirement. Promoting Health in Middle Life pp.29-31. GRANTS TO VOLUNTARY ORGANISATIONS During 1967 the Council used its powers under the National Health Service Act, 1946 (Sections 22(5) and 28(3)) and (subject in appropriate cases to Ministerial consent) the Local Government Act 1948 (Section 136), to authorise the payment of the following grants to organisations providing or furthering the development of personal health services. Service Voluntary Organisation Grant 1967/68 £ s. Day Nursery West London Mission (Hopedene Nursery) 2,745* Maternity & Child Claremont Central Mission 900* Welfare Crusade of Rescue 85 London Diocesan Council for Moral Welfare 1,195 North Islington Infant Welfare Centre 20,600* Save the Children Fund (St. Luke's Playgroup) 770* 8 Prevention of Illness, Care and After Care (Tuberculosis) Chest and Heart Association 10. 10s. (General) Central Council for Health Education 235. 8s. Family Welfare Association 5,781 Family Planning Association (Central London Branch) 1,000 National Association of Voluntary Hostels 150 Mental Health Elfrida Rathbone Committee (Islington and Camden) - General 2, 100 " - Playgroup 160* Islington Society for Mentally Handicapped Children 3,400* National Association for Mental Health 100 Miscellaneous Catholic Marriage Advisory Council 375 London Marriage Guidance Council 650 'estimated grant, subject to adjustment. VISITS ARRANGED FOR STUDENTS Half or full day visits were arranged for a total of 699 students during the year. It included medical students, hospital nurses in training, child care students, matrons of old peoples homes and students from a variety of other disciplines. Although time-consuming for the visiting staff concerned, the importance of the kind of experience gained was very much appreciated. Continuing a former practice, local girls taking civic or social service courses, in school, attended day nurseries and gave voluntary help. CO-OPERATION WITH CHILDREN' S AND WELFARE DEPARTMENTS Residential establishments under the control of the Children's Committee are visited once a quarter by the Council's Senior Medical Officer. During these visits informal advice on such matters as general hygiene, the safe keeping of medicines and drugs and general standards of care is given to house-mothers and superintendents. Individual children in the homes who are handicapped or are at risk of developing a handicap are followed up. Reports of visits are passed to the Children's Officer for his consideration. During the year 65 such visits were made. The Children's Officer seeks the assistance of this department in his preliminary enquiries with regard to applications by Islington residents to adopt or foster a child. In each case the health visitor concerned is asked to report on the family if it is known to her. The Children's Officer has also undertaken to seek medical advice from this department in adoption and fostering cases if there is a doubt about the health of the prospective adopters or foster-parents or the medical history of the child. Homes for the elderly which are under the control of The Welfare Committee are visited by a Principal Medical Officer who inspects matters of hygiene and the general facilities for the residents. His reports are passed to the Chief Welfare Officer for his consideration. Six such visits were made during the year. EMERGENCY TELEPHONE ARRANGEMENTS The Council continued to make use of the Admissions and Doctors Inquiry Service (also used by the London Boroughs of Camden and Haringey) operating from the Whittington Hospital for taking and passing on emergency calls outside office hours for the Council's health services. Details of the calls dealt with are as follows (figures for 1966 in brackets) 9 Domiciliary midwifery 540 (688) Mental health 472 (433) Home nursing 249 (385) Infectious disease 4 ( 8) Other 23 ( 9) 1, 288 (1. 523) Midwives and mental health social workers were able to make use of special hired car facilities at night and at weekends. 10 GENERAL AND VITAL STATISTICS Area of the Borough 3,678 acres Estimated Mid-Year Home Population - 254,580 Marriages (Provisional figures) solemnised in the Borough 2,413 BIRTHS Total Male Female Live Births - Legitimate 4,67 2 2,379 2,293 Illegitimate 773 400 373 5,445 2,779 2,666 Islington England and Wales LIVE BIRTH RATE PER 1,000 POPULATION 21.4 17.2 Birth rate after applying 'Area Comparability' Factor of 0.82 17.5 ILLEGITIMATE LIVE BIRTHS PER CENT OF TOTAL LIVE BIRTHS 14.2 Total Male Female Still Births - Legitimate 60 33 27 Illegitimate 19 8 11 79 41 38 Islington England and Wales STILL BIRTH RATE PER 1,000 POPULATION 0.31 0.26 Still birth rate per 1,000 live and still births 14.3 14.8 Total Male Female TOTAL LIVE AND STILL BIRTHS - Legitimate 4,732 2,412 2,230 Illegitimate 792 408 384 5,524 2,820 2,704 DEATHS Total Male Female ALL CAUSES 2,624 1,311 1,313 Islington England and Wales DEATH RATE (CRUDE) PER 1,000 POPULATION 10.3 11.2 Death rate after applying 'Area Comparability' factor of 1.06 10.9 INFANT DEATHS Total Male Female Deaths of Infants under one year of age - Legitimate 80 46 34 Illegitimate 20 9 11 100 55 45 11 Islington England and Wales INFANT MORTALITY RATE (per 1,000 live births) - All Infants 18.4 18.3 Legitimate 17.1 Illegitimate 25.9 NEO-NATAL MORTALITY Total Male Female Deaths of Infants under 4 weeks of age - Legitimate 54 31 23 Illegitimate 13 7 6 67 38 29 Islington England and Wales NED-NATAL MORTALITY RATE (per 1,000 live births) All Infants 12.3 12.5 Legitimate 11.6 Illegitimate 16.8 EARLY NED-NATAL MORTALITY Total Male Female Deaths of Infants under 1 week of age - Legitimate 48 30 18 Illegitimate 11 5 6 59 35 24 EARLY NEO-MORTALITY RATE Islington Ehgland and Wales (per 1,000 live births) All Infants 10.8 10.8 Legitimate 10. 3 Illegitimate 14.2 PERINATAL MORTALITY Total Male Female Still births and deaths under 1 week combined 138 76 62 PERINATAL MORTALITY RATE Islington Ehgland and Wales (per 1,000 total live and still births) 25.0 25.4 MATERNAL DEATHS (including abortion) 4 170 RATE (per 1,000 total live and still births) 0.72 0.20 12 1967: 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 F Total M F M F M F M M F M F M F M F M F M F M F 1 . Tuberculosis, Respiratory ... 10 1 11 1 2 1 1 5 1 1 2 . Tuberculosis, Other 3 1 4 2 - - - 1 - 1 2 3 . Syphilitic diseases 1 5 6 1 1 4 3 4 . Diphtheria 4 5. Whooping Cough - 1 1 _ . _ - _ 1 5 6 . Meningococcal Infections 6 7 . Acute Poliomyelitis 7 8 . Measles 8 9 . Other infective anu parasitic diseases - 1 1 1 9 10. Malignant neoplasm, stomach 31 26 57 1 1 - 2 9 3 12 6 14 10 1 1 . Malignant neoplasm, lung bronchus 158 35 193 2 2 19 5 57 9 59 11 21 8 11 12. Malignant neoplasm, breast _ 45 45 3 . 8 . 9 . 8 17 12 1 3 . Malignant neoplasm, uterus - 15 15 1 - 2 - 5 - 5 2 13 1 4. Other malignant neoplasms 125 130 255 - - 1 1 - - - 2 1 1 1 - 6 2 17 11 28 23 33 40 38 50 14 15. A-and-Leukaemia 3 6 9 - . . . - - 1 1 1 1 1 I 3 15 16 . Diabetes 3 16 19 2 1 1 1 4 1 9 16 17 . Vascular lesions of the nervous system 106 152 258 - - 1 2 1 3 2 8 4 23 24 35 28 35 92 17 18. Coronary disease, Angina 253 185 438 - - - - - - - - - - 1 - 6 1 39 4 64 27 73 45 70 108 18 19. Hypertension with heart disease 9 11 20 1 1 - 1 - 5 4 2 6 19 20. Other heart disease 118 247 365 1 . 2 - 2 - 4 3 8 8 17 24 84 212 20 2 1 . Other circulatory disease 61 66 127 2 - - 1 3 16 9 18 13 19 40 21 22. Influenza . 2 2 _ _ _ . _ _ . _ . _ _ _ _ _ 1 . _ . 1 22 23. Pneumonia 102 108 210 2 1 7 8 1 1 _ _ _ . _ . 4 3 9 5 26 22 53 68 23 24. Bronchitis 102 31 133 - - - 1 - - - - - - 1 - - 2 22 5 46 6 28 16 24 25. Other disease of the respiratory system 10 8 18 - - 1 - 2 - - 1 - - - - 1 - - 3 4 2 3 1 25 26 . Ulcer of stomach and duodenum 19 9 28 1 3 1 6 1 7 6 26 27 . Gastritis, enteritis, diarrhoea 5 12 17 - - 3 1 1 - - - - - - - - 1 - - - - 4 7 27 28 . Nephritis and Nephrosis 6 4 10 - . . . - - 1 1 - - - 1 - 1 1 3 1 1 28 29 . Hyperplasia of prostate 4 - 4 1 - 1 - - 29 30 . Pregnancy, Childbirth and Abortion - 4 4 1 2 - 1 30 3 1 . Congenital Malformations 6 12 18 3 7 1 3 - - - 1 - - 1 - - - - 1 1 - - - - - 31 3 2 . Other defined and ill-defined diseases 97 116 213 33 21 3 - 1 - - 1 2 1 2 5 4 5 7 10 12 11 18 16 15 46 32 33 . Motor vehicle accidents 19 15 34 - - - - 1 - 2 - 2 2 - - 3 1 1 2 5 3 3 4 3 33 34 . 35. All other accidents Suicide 34 20 31 12 65 32 _ _ - 1 3 2 1 3 3 2 1 3 2 2 3 5 2 4 1 3 2 4 3 5 3 4 4 9 2 13 2 34 35 36 . Homicide 6 6 12 - - 1 1 • - - - 2 - 1 - 2 - 2 - - ■ - 3 36 All Causes 1.311 1.313 2,624 38 29 17 16 9 4 4 6 15 10 17 11 38 25 130 67 264 158 376 253 403 7 34 Totals 2.624 67 33 13 10 25 28 63 197 422 629 1. 137 Percentages 100 2. 55 I. 26 0.50 0. 38 0 .95 1.07 2 40 7 . 51 16.08 23 .97 43 .33 13 ANALYSIS OF INFANT DEATHS - 1967 (BASED ON REGISTRAR GENERAL' S RETURNS) Primary Cause of Death Under 1 day Days Weeks Months 1 - 2 2 - 3 3-4 4-5 5-6 6-7 1 - 2 2 - 3 3-4 1 - 2 2-3 3 - 4 4 - 5 5-6 6 - 7 7-8 8-9 9-10 10-11 11 - 12 Totals Bronchitis 1 1 Pneumonia 1 2 4 4 1 1 2 2 1 18 Qiteritis and Diarrhoea Premature Birth 9 2 3 1 1 1 1 4 14 Congenital Malformation, Birth Injury, Atelectasis, Atrophy and Marasmus 21 11 6 2 1 1 4 1 2 1 1 1 1 53 Suffocation overlying Other Violent Causes All other causes ... 3 2 1 1 1 1 1 1 2 7 Totals 33 13 6 2 4 - 1 5 2 1 2 7 6 5 4 4 2 1 - - 2 100 Estimated Child Population Under 1 year 1 - 4 Total under 5 5-14 Total under 15 Islington 5.640 18,760 24. 400 29, 300 53,700 Greater London 135, 500 501.500 637,000 964, 800 1.601,800 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 Thirty-three 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-three infant deaths in the age group one to twelve months, fifteen were due to pneumonia. Maternal Mortality In a total of 5,524 live and still births, there were four maternal deaths. Three were due to abortion and one due to ruptured ectopic gestation. 14 Respiratory Tuberculosis The death rate for lung tuberculosis in 1967 was 0.04 per 1,000 population, and compared favourably with previous years. Deaths due to pneumonia and Bronchitis In 1967 there were 133 deaths ascribed to bronchitis, and 210 to pneumonia. These figures were less than those for 1966, which were 167 and 218 respectively. Both years years enjoyed relatively mild winters and for this reason compared favourably with previous years. Malignant Growths of Lung and Bronchus I reported last year that lung cancer deaths in males which had not varied greatly over the previous eight or nine years, showed a steep increase of 20% from 155 to 186. This, fortunately, was not continued in 1967 when 158 males died from this disease. Female deaths from this cause which showed a fall from thirty-six to twenty-eight in 1966 rose again to thirty-five in 1967. Coronary Disease with Angina There were 438 deaths (253 male and 185 female) from this cause in 1967. This shows a further fall from the 1965 and 1966 figures of 522 and 503 respectively. Accident Deaths - Comparative table. 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 Motor vehicle accidents 34 37 37 32 22 34 28 29 34 34 Other violent accidents 42 60 69 65 69 84 62 60 58 65 Accident Deaths - Analysis by age groups Type 0- 1- 5- 15- 25- 45- 65- 75- M. F. Total Motor Vehicle accidents _ 1 2 4 4 10 6 7 19 15 34 Palls - - 1 1 4 3 5 18 15 17 32 Accidental Poisoning (Solid, Liquid Gases and Vapours) 1 2 6 2 3 9 5 14 Drowning - - 1 - 1 - - - 2 - 2 Fire - 4 - 1 1 2 1 - 4 5 9 Inhalation of Stomach contents, ingestion of food etc. - 1 1 1 Suffocation overlying 1 - - - - - - _ _ 1 1 Other (Railway Accidents, etc.) - - - 2 2 - 1 1 3 3 6 Total 1 6 4 9 14 21 15 29 53 46 99 15 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Notifiable Infectious Diseases and Deaths during the year 1967 Disease Number of notifications Number of deaths Removed to hospital Number of Cases returned to Registrar-General after correction of diagnosis Cases" coming" to knowledge1' but not notified Staallpox - (-) «. _ _ . Scarlet Fever 89 (125) - 8 89 18 Diphtheria - (-) - - - - Biteric Fever (including Paratyphoid) 9 (6) _ 8 9 _ Tophus Fever - (-) - - - - Puerperal Pyrexia 137 (213) - 137 137 - Ac. Primary & Influenzal Pneumonia 30 (36) . 10 30 . Ophthalmia Neonatorum 4 (12) - 2 4 - Acute Encephalitis 2 (1) - 2 2 . - Meningococcal Infection - (2) - - - - Anthrax - (-) - - - - Dysentery 269 (300) - 12 271 192 Malaria - (2) - - - 1 Erysipelas 20 (15) - 3 20 1 Measles 1427(1875) - 33 1426 43 Whooping Oough 125 (118) 1 17 120 48 Ac. Poliomyelitis - (-) - - - - Pood Poisoning 90 (101) - 7 62 23 Tuberculosis Lungs 141 (192) 11 - 139 8 Tuberculosis Other Forms 22 (19) 4 - 22 1 (Figures in brackets are notifications for 1966) Smallpox Of the twenty-four references for suspected smallpox and supervision of possible smallpox contacts, nineteen arrived 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 valid international certificates of vaccination. In accordance with the regulations which came into force on the 1st August, 1963, all were visited and kept under surveillance for the required period. Advice was sought from the medical staff of the department in respect of throe patients suffering from rashes of a type where it was desirable to exclude smallpox as a possible cause. 16 These were subsequently diagnosed as chicken pox; The remaining two references concerned;- (1) A passenger who travelled from Bombay to Frankfurt on Thursday, 23rd March, 1967, by Air India, was subsequently found to be suffering from modified smallpox. The patient, a man, aged 48, who was vaccinated in November, 1966, and again in February, 1967, was in possible contact with smallpox in India at some time during the first ten days of March. After arrival at Frankfurt, he proceeded three hours later by Lufthansa to Hanover. Two pustules developed on the lips. A provisional diagnosis of smallpox was made on 25th March by electron-microscopy. Confirmation by positive egg culture was received on 28th March, 1967. It was understood that the rash was not evident while the patient was on the Air India Flight but all passengers on that flight were regarded as exposed to possible risk of smallpox infection. Twenty-four passengers were disembarked with destinations in the United Kingdom. All were in possession of valid certificates of vaccination against smallpox and all were handed yellow warning cards. As the addresses to which these passengers were going were not known at the time, press and broadcast announcements were made advising any passenger who was on this flight to consult a doctor without delay. Information was requested from local medical practitioners of these passengers who may have reported to their doctor. Only one contact was reported residing in Islington. He was an adult male who travelled on the Lufthansa flight only. He was kept under surveillance for the routine period and his medical practitioner informed. (2) An eighteen month old Nigerian child was admitted to hospital on 11th May, 1967, and was thought to be suffering from vaccinia, although the possibility of smallpox could not be ruled out until the results of bacteriological tests were available. The child had not been vaccinated and, as he had been daily minded at several addresses in the previous few weeks, it was necessary to visit these in an attempt to ascertain the source of the infection. Subsequently it was bacteriologically confirmed that this was a case of vaccinia. Enquiries suggested that the infection was through contact with a recently vaccinated person 12 days prior to onset of symptoms although this was not definitely established. Certificates of Vaccination and Inoculation - Authentication - Ministry of Health Circular 60 Applications for authentication dealt with by the Medical Officer of Health numbered 3,047 as aginst 9,002 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. The large decrease is accounted for by the fact that in 1966 many continental countries required evidence of current vaccination from British travellers consequent upon an outbreak of variola minor in the Midlands. Food Poisoning Number of Notifications Received 1947 ... 8 1953 ... 270 1959 ... 196 1965 ... 115 1948 ... 13 1954 ... 137 1960 ... 206 1966 ... 101 1949 ... 62 1955 ... 315 1961 ... 148 1967 ... 90 1950 ... 109 1956 ... 174 1962 ... 112 1951 ... 158 1957 ... 160 1963 ... 134 1952 ... 84 1958 ... 230 1964 ... 131 17 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 No. of No. of No. of Poods involved and Notifi- persons cases deaths organisms responsible cations served reported 26.4.67 - 400 35 - Roast Lamb Clostridium Welchii Outbreak Report Information was received on 26th April of an outbreak of suspected food poisoning which occurred at a local school some twelve to eighteen hours after consumption of a school dinner which included roast lamb, mashed potatoes, cabbage, baked beans, jam sponge and custard. Two schoolteachers and thirty-three schoolchildren reported symptoms of diarrhoea and abdominal pain, and some with vomiting. It was ascertained that the roast lamb had been cooked on Monday afternoon, 24th April, and refrigerated. On Tuesday morning it was sliced and then re-heated in a steamer. Fresh hot gravy was added. A portion of the lamb remaining was sent for laboratory examination which showed a heat resistant CI. Welchii organism present. This organism was also found in twelve of the twenty-four cases submitting faecal specimens. This outbreak would appear to follow the typical pattern of food poisoning associated with CI. Welchii, i.e. meat cooked on one day. allowed to cool slowly, and subsequently reheated the following day. Due to staff changes, an incorrect procedure had been adopted and meat for this meal was cooked the day before, along with meat for a transported meal to another school, which, incidentally reported no cases of illness. The attention of the kitchen staff was drawn to the correct procedure and meat for this school is now cooked on the day it is to be served. Amongst the many Salmonella outbreaks investigated by the department, the following is mentioned because of the severity of the clinical condition of the patient. A female, 45 years, was admitted to an isolation hospital with a two day history of diarrhoea and vomiting. This was severe, persistent and on admission the patient was seriously ill, temperature 100°F, dehydrated, blood pressure 110/60 Except for an abdominal scar no abnormal physical signs were noted. In hospital diarrhoea persisted and intravenous infusion was required. The patient remained seriously ill for the first week in hospital with persistent diarrhoea from which Salmonella panama was isolated on many occasions, (blood culture did not produce pathogenic organisms). In addition it was considered that the severe anaemia, which this patient also had, was almost certainly related to the malabsorption as a result of an abdominal operation which was carried out seven years ago. She was treated with intramuscular iron and one dose of Vitamin B. 12. 18 The patient's illness was complicated by a deep vein thrombosis affecting the right leg and this required treatment with anticoagulants. The patient subsequently became symptom free, there was minimal residual oedema with no tenderness in the right leg and five consecutive stool samples failed to produce a growth of Salmonella panama. Lead Poisoning There were four references to the department on the subject of lead poisoning during 1967. Of these, the first referred to the high lead content in paint used on the beak of a duck which formed part of a baby's rattle. The M.O.H. of the area in which the toys were manufactured, subsequently reported that the factory had been supplied with lead-free paint for over two years. It appeared, therefore, that the toy was one that had been in stock for longer than that period and it was considered unlikely that there were any more of these in circulation. The second concerned a request from the M.O.H. of a neighbouring borough, for samples of lead toys manufactured in Islington. This was to investigate a case of lead poisoning in a child suffering from Pica, which took the form of wall plaster eating. The original hypothesis for the source of the lead poisoning was thought to be the wall plaster, which, in spite of the low lead content, could produce this form of poisoning simply from the quantity consumed. Subsequently, however, it was suggested that the child had been chewing a lead soldier manufactured in Islington. Finally it was ascertained that the firm had discontinued the production of lead soldiers, and now are concentrating on the plastic and zinc metal side of toy manufacture. The third concerned a 3% year old male child who had been admitted to hospital with a raised blood lead level, and a request was made for a domiciliary investigation into the source of the poisoning. It was ascertained that the child was continually gnawing and licking paint, particularly in the kitchen, W.C. compartment and external window-sills. As a result of these investigations and the analysis report on the sample taken, it was agreed that all lead paint surfaces be removed from the room. The remaining reference concerned a complaint by a member of the public, of the sale of wooden toys from Europe; similar toys had been reported in the National Press as being unsafe by reason of paint with a high lead content. Subsequent sampling showed that the toys in question were in fact contravening the Toys Safety Regulations 1967, by reason of the presence in the dry paint coating of more than 11, 000 parts per million, (1.1 per cent). The toys were manufactured in the U. S. S. R. Typhoid and Paratyphoid Fever There was one confirmed case of typhoid fever and 8 confirmed cases of paratyphoid fever, during the year as follows:- Typhoid Fever Information was received that a female Islington child aged 8& years, who was admitted to an isolation hospital in March, was confirmed subsequently as suffering from typhoid fever. This patient left England in January, for a visit to Karachi, Pakistan, and returned in February. Onset date was some 11 days after return to this country, the child having been in school three days prior to this. Domiciliary enquiries and routine bacteriological investigation of Islington residential, school and other contacts was carried out with negative results, and their practitioner informed. 19 There were 3 other references for typhoid fever. One concerned a carrier living in another borough but working in a food factory in Islington. Investigations were carried out at the factory and the carrier subsequently left his employment. The other 2 references were for contacts with typhoid cases with satisfactory conclusions. Paratyphoid Fever (a) A 31 year old Islington housewife who was an in-patient at a maternity home for a period in April, 1967, had been subsequently notified as suffering from paratyphoid *B' fever. This patient had not been abroad previously and there was no apparent source of infection. Domiciliary enquiries were made, and bacteriological examinations of faecal and urine specimens of the patient since her discharge from hospital, and of her husband who had similar symptoms, all proved negative. Their medical practitioner was informed. (b) A six year old male child of West Indian origin, residing in the N. 19. area of Islington, became ill in August 1967, and was admitted to an Isolation Hospital suffering from gastro enteritis; diarrhoea was slight but fever much more in evidence. Subsequently, Salmonella paratyphi 'B' was isolated from the stool, B.A.0.R. strain. The usual domiciliary enquiries were carried out. There were two other children in this family, a boy 3& years and a girl 4& years. The two elder children attended school in the borough, whilst the youngest was minded locally. As a result of examination of faecal specimens, the remainder of the family was also admitted to Coppetts Wood Hospital, the parents suffering from enteric fever and all excreting organisms except the youngest child. A specimen from this child examined at the Hospital showed pqsitive results. Other contacts were investigated and it was ascertained that the child minder was also positive; she was treated at home. All medical practitioners and medical officers of health of other boroughs concerned, were notified. The source of infection was indefinite although the vehicle was not thought to be food. The family arrived in this country from the West Indies some two years ago and all the children were born overseas. (c) A 19 years old male Islington resident who was admitted to hospital in September 1967, was subsequently confirmed as suffering from paratyphoid 'A' fever. He had recently been on holiday and may have contracted this infection in Turkey. Domiciliary enquiries were carried out, and the medical practitioners informed. (d) There was one other reference for paratyphoid 'A' fever. This concerned the mother and father of the case, who lived in another borough, but who owned a butcher's shop in Islington. Dysentery There were four hundred and sixty-one cases notified and 'coming to knowledge' during the year. Of these, three hundred and seventy-five proved positive, whilst eighty-six were clinical cases with negative stools. Roughly one-third of the positive cases occurred in minor outbreaks at three schools and four day nurseries in the borough. Epidemic Vomiting. Information was received in February 1967, of an outbreak of suspected food poisoning at a large staff canteen dining club in the borough. This was reported to have occurred after the mid-day meal the previous day, which included cauliflower cheese, cold roast beef, salad and braised liver. Three thousand staff used this canteen, and it was ascertained that some forty-three reported symptoms which included vomiting and nausea, and some with diarrhoea. The average interval between ingestion of the suspected food and onset of the symptoms appeared to be ten to twelve hours. 20 Specimens of food remaining, of vomit and faeces, as well as nose and skin swabs from food handling staff, were submitted for examination. CI. Welchii was isolated from two of the faecal specimens, whilst the roast beef showed a staphylococcus aureus organism present. A staphylococcus organism was also found to be present in the swabs submitted from some of the canteen staff. Finally it was concluded that, due to (a) the inconclusive nature of the bacteriological results, (b) the fact that no single item of food was implicated and (c) several patients reporting symptoms some days after the incident, as well as subsequent family spread in at least one case, this outbreak was most probably due to an unknown virus associated with epidemic vomiting. Accidental Hypothermia A communication from the Chief Medical Officer, Ministry of Health, dealing with the above subject, was received together with a report of a Committee on Accidental Hypothermia of the Royal College of Physicians, London. The report summarizes the results of a survey made by 10 widely distributed Hospital Groups in England and Scotland during the months February to April, 1965. Staff whose duties included the well-being of old people and young children were reminded of the dangers of accidental hypothermia and that they should as a first step inform the general practitioner of the patient in any case where this condition was suspected. They and the general practitioners were asked to notify any cases where they considered there was a hypothermia risk in the home and where the health department might be able to assist in ameliorating these conditions. Tuberculosis In 1967, 163 new notifications were received, with age and sex distribution as follows:- 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total M - 1 3 4 1 6 8 26 15 11 18 10 4 107 Pulmonary F--2225158234 - 34 M---1- 2 152- 11 Non-Pulmonary p . 5 1 3 2 - - - n Totals ... 1 5 7 3 13 15 37 28 15 21 14 4 163 The notification rate of all forms of tuberculosis was 0.64 per 1,000 population as against 0.28 for the whole country. The total number of cases remaining on the register after adjustment for deaths and transfers was, on the 31st December, 1967:- Males Females Total Pulmonary 1,310 917 2,227 Non-Pulmonary ... 124 165 289 Totals 1,434 1,082 2,516 There were 15 tuberculosis deaths (11 pulmonary and 4 non-pulmonary) during 1967. The death rate of all forms of tuberculosis was 0.06 per 1,000 of the population, as against the national rate of 0.04. 21 Chest Clinics Patients may be referred, or persons may attend for examination to the following centres:- Islington Chest Clinic, St. Mary's Wing, Whittington Hospital. N. 19. St. Pancras Chest Clinic, Margaret Street, St. Marylebone, W. 1. Mass X-Ray Unit of the North West Metropolitan Regional Hospital Board. 32 Drayton Park, N.5. Cases on Chest Clinic Registers Pulmonary Non-Pulmonary Total Adults Children Adults Children Adults Children M F M F M F M F M F M F No. of definite cases of Tuberculosis on Chest Clinic Register as at 31st December, 1967. Islington C. C. 924 567 42 48 63 81 3 8 987 648 45 56 St. Pancras C. C. 68 31 12 10 7 1 68 38 13 10 Total 992 598 54 58 63 88 4 8 1055 686 58 66 Grand Total 1865 The Chest Clinic at Finsbury Health Centre closed on 31st July by the decision of the North West Metropolitan Regional Hospital Board. Patients were transferred to the Islington Chest Clinic or, if they preferred, to the City of London Chest Clinic at St. Bartholomew's Hospital. The Regional Hospital Board also transferred to the Islington Chest Clinic the out-patient service for tuberculosis patients living in the Hornsey part of the Borough of Haringey, following the closure of Finchley Chest Clinic. Arrangements were made for the welfare and clerical duties to be carried out for the Hornsey patients subject to reimbursement of the cost by the London Borough of Haringey. Islington Chest and Tuberculosis Care Committee During the difficult period of the change-over, with all the work involved, the problems of the patients were dealt with and no appeal went unanswered. 50 patients enjoyed an outing to the sea-side which was paid for mainly by the proceeds of a concert given by the Starliners. 22 Christmas parcels, food and fuel vouchers were distributed to some of the patients. Funds were obtained from charitable organisations and £170 was raised by the sale of Christmas seals. I Throughout the year necessitous patients received supplementary milk, butter and eggs and help was given with fuel, holidays and fares. Patients and their families were advised on financial matters and a wide range of personal problems. The occupational therapy service continued and the two occupational therapists employed by the Borough made 247 more visits to patients at home and held 17 more sessions at Cromwell Lodge hostel for tuberculous men than in 1966. The officers of the Committee were: - Councillor E. M. Simms Chairman Councillor Mrs. B. Stradling Vice-Chairman Dr. H. 0. Williams Honorary Treasurer Mr. J. Buckle Welfare Officer and Secretary to Islington Chest and Tuberculosis Care Committee. Miss A. Phelps Welfare Officer. Hostel for homeless tuberculous men, Cromwell Lodge, Cholmeley Park, N.6. Despite all efforts, it was not possible to appoint an assistant warden, and the warden was obliged to cope on his own. The turnover of domestic staff remained high and I am grateful to the warden for managing so well under so many difficulties. 23(23) men were in residence at the end of the year, 19 (19) of these were from other London Boroughs. 3 (2) Islington patients were in residence at 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 - (1) Clothing or Footwear 5 (9) Patients at the end of the year receiving extra nourishment (Council and Care Committee) 84 (194). Home Visiting - by tuberculosis health visitors Total visits (including contacts; but excluding unsuccessful visits - 3,078 (3,222). Diversional Therapy Total sessions held at Cromwell Lodge Hostel 99 (82) Total number of visits made to patients in their own homes 1,521 (1,274). 23 Visiting of newly arrived immigrants - year ended 31st December, 1967 COUNTRY where passport was issued as stated by Port Health Authority Number of advice* notes received during the year from ports and airports relating to arrival of immigrants Number of first/ successful visits paid during the year COMMONWEALTH COUNTRIES Carribean 293 157 India 133 43 Pakistan 51 23 Other Asian 13 4 African 112 54 Other 75 38 N0N-COMMONWEALTH COUNTRIES European 45 13 Other 4 - TOTAL 726 332 * Advice of arrival of immigrant. / First successful visit means the first time the local health authority officer established contact with the immigrant. It will be seen from the chart that 332 successful visits were paid to immigrant arrivals to the Borough during 1967. These visits were paid by an officer of the Welfare Department, and I should like to record my thanks to the Chief Welfare Officer. Scabies and Vermin Scabies Vermin Children under 5 years - Number treated 123 22 Number of baths given 234 - Number of treatments - 23 I.L. E. A. Children - Number treated 200 192 Number of baths given 456 - Number of treatments - 198 Adults - Number treated 384 182 Number of baths given 790 - Number of treatments - 190 There was an increase in the numbers treated for scabies by some 45% in 1967 - 707 compared with 488 in the previous year. The numbers treated for vermin infestations, however, showed a slight decrease from 475 to 396. Bacteriological Examinations The number of specimens sent to the Public Health Laboratory, County Hall, S.E.I, for bacteriological examination was 5,784. This compared with a total of 4,831 specimens submitted last year. The annual fluctuations are due mainly to the extent of dysentery outbreaks in any particular year. 24 Examinations carried out Total Swabs (Whooping Cough) 107 Swabs (Diphtheria) 52 Sputum (Tuberculosis) 45 Faeces & Urine (Enteric Fever) 162 Faeces (Food Poisoning) 353 Faeces (Dysentery) 4,715 Swabs (Streptococci) 33 Other specimens 317 Total 5,784 SERVICES FOR THE ELDERLY Visits by Medical Officers Six visits to elderly persons were made by Senior Medical Staff of the Department. 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. Two cases were dealt with under Section 47; and two persons subsequently agreed to be admitted to hospital or a welfare home to receive care and attention. Home Visiting The Council employed three home visitors (S.R.N.) and four assistant home visitors to visit elderly persons in the Borough. In addition visiting was also carried out by a Home Visitor who is also the Nurse in Charge of the bathing and treatment centre at the Pinsbury Health Centre. Decentralisation - Pilot Scheme The pilot schemes of decentralisation were commented upon in last year's annual report. In December 1967 a further step in the complete decentralisation of home visiting staff was carried out, when the visitors for the northern area were transferred, with the agreement of the Voluntary Committee of the North Islington Welfare Centre, to Manor Gardens. It was agreed that the final stage of decentralisation should be carried out early in 1968. National Assistance Acts, 1948 & 1951 Section 47 Removals Two 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 in accordance with certain specified circumstances. Both of the elderly persons subsequently died. Special Cleansing Prom time to time it was found that property occupied by elderly or infirm persons was 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. Twenty-one such cases were reported by the public health inspectors, home visitors, hospital authorities, etc. during the year. Fifteen special cleansings were carried out. Six cases were subsequently not proceeded with for various reasons. Meals on Wheels Service During 1967 eight vans were operating within the borough and providing a five day service. 25 A comparison of the total meals served shows a considerable increase in 1967. 1965 50,926 1966 79,057 1967 96,379 Invalid Meals Service Five vans operated throughout the borough for the Invalid Meal Service during 1967, and lunches were also served at the restaurant attached to the kitchen at 65 Essex Road. The total meals served were as under: Delivered 50,490 Restaurant 4,405 Total 54,895 It is not possible to give comparative figures for previous years, as 1967 was the first complete year the Invalid Meals operated exclusively in Islington. Geriatric Preventive Clinics The two Geriatric Preventive Clinics (known for publicity purposes as "The Health Advisory Circle for Old People") at Pine Street and Drayton Park continued during the year, and following agreement with the Inner London Local Medical Committee and the North Western Metropolitan Regional Hospital Board, Ministerial approval was given for the setting up of an additional Geriatric Preventive Clinic in October, 1967, at the Blythe Mansions Welfare Centre. Various Medical Officers of the department conducted the medical examinations at the clinic at Pine Street during the early part of the year, and Dr. J. Clarke, Senior Medical Officer, took over the duties from September onwards. Dr. D. E. Sharland, the Consultant Geriatrician of Whittington Hospital, who kindly volunteered his services for this work at the inauguration of the clinics, continued to conduct the medical examinations at Drayton Park Clinic until September 1967, when he transferred to the newly opened clinic at Blythe Mansions. Dr. J. E. Hurman, Principal Medical Officer, then undertook the work at Drayton Park. Applications were received direct from some pensioners, others were referred by the area visitor, their general practitioner, etc. The health education sessions, set up in September at each of the clinics, assisted in no small measure in encouraging the elderly to attend for medical examination. A total of 208 applications was received during the year, 47 subsequently withdrawing their requests for a variety of reasons. When a request is received for an appointment at one of the clinics, the medical practitioner is informed and is invited to submit details of any relevant medical history which may be of interest to the examining Doctor. At the examination the patient is interviewed and medical and social history forms are completed. The examining doctor then completes a me.dical examination, including the arranging of tests for audiometry, chest x-ray, and haemoglobin, if required. In all cases the medical practitioner is given a full report on the examination. Facilities for chiropody and chest x-ray are conveniently available in premises adjoining the two clinics. 26 Councillor Arthur E. White, J.P., Mayor of Islington, opened Islington's third Health Advisory Circle at Blythe Mansions, Highcroft Road, on Wednesday, 27th September. Laundry Services The laundry service for incontinent persons (most of them elderly) was provided from the Treatment Centre at Seven Sisters Road. During the year 3,995 collections of laundry were made (involving 37,270 articles). The service was being provided to about 155 persons at the end of the year. The Pinsbury 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 31 at the commencement of the year, to 25 at the end of the year. 996 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. 4,471 baths were carried out in the homes of elderly persons under the Domiciliary Service. 1,642 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 The local office of Task Force (an organisation set up to encourage and foster voluntary 27 effort among the younger citizens) was opened in September 1965. Their work was continued during 1967, and 130 cases were referred to them by the Aged and Infirm Section of the Health Department. I should again 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 838 applications for cremation at the Council's Crematorium, East Finchley. 28 SANITARY CIRCUMSTANCES OF THE AREA The Public Health Inspectorate continued to be under strength. The three students who sat the qualifying examination were successful in obtaining the diploma and were immediately appointed as inspectors. Two of the existing inspectors retired, one senior inspector was transferred to another section and another senior inspector obtained an appointment as Chief Public Health Inspector in another borough. The shortage of inspectors coupled with the lack of continuity gave rise to many problems and placed additional responsibilities upon the senior members. Mention was made in last year* s report of the loss of powers which resulted from the implementation of the London Government Act, 1963. The Greater London Council (General Powers) Act reinstated the power to deal with defective premises when unreasonable delay would be occasioned by following the normal procedure. The Act empowered the Council to deal quickly with defective waste water services and fittings as a result of which the water supply had been cut off. The Act laid down that no person shall carry on the business of a hairdresser or barber on any premises in the Borough after the appointed day - in Islington 1st January, 1968 - unless registered by the Borough Council. In view of the importance of regulations made under the Consumer Protection Act, 1961, the Council decided to appoint an additional General Purposes Inspector who would also be jointly responsible for the duties under the Shops Act, 1950 and other legislation. Public Health Inspectors played an active part in health education. Talks were given to various groups including students, and others interested in environmental hygiene. The Chief Public Health Inspector or his representative was a member of the health education panel. The inspectors inspected the three main market areas in the Borough and other stalls licensed by the Council to ascertain what was required to bring them up to the standard required by the Pood Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966. Early in the year the stallholders, with their Association representatives and other interested persons were invited to a discussion at which the Chairman of the Environmental Health Committee presided, supported by the Chairman of the Cleansing & Baths Committee. The meeting was well attended and the provisions of the regulations explained. A cordial but lively discussion ensued followed by questions and answers. Co-operation was promised in carrying out the legislative requirements as quickly and as smoothly as possible. Models of stalls designed to comply with the regulations were demonstrated. It became increasingly necessary for the technical staff to perform duties outside normal working hours, as many people were at work during the day and the only contact was during the evenings or at weekends. The investigation of certain complaints, including noise and smoke nuisances, the supervision of clubs and food undertakings, the transport of meat and duties under the Shops Act 1950 required inspectors to be on duty at various times every week. Owing to the many immigrants living in the Borough, the language problem continued to present difficulties. This was partly overcome by an inspector who could act as an interpreter. His services were not only of value to the Department but also to the Court when legal action was taken Summary of Work done by District Public Health Inspectors (i) Inspections Houses/flats inspected under Public Health Acts 1936 - 61 7,158 Separate lettings 10,058 Revisits Houses/flats 12,874 Separate lettings 20,741 29 (ii) Other inspections and visits Miscellaneous 2,565 Prevention of Damage by Pests Act, 1949 528 Infectious Diseases 183 Derelict Buildings and Vacant Sites 1,599 Pigeon Nuisances 311 Drainage 1,204 Hairdressers and Barbers 224 National Assistance Acts, 1948 and 1951 (Aged & Infirm) 43 Factories Act, 1961 - Outworkers 422 Pet Animals Act, 1951 20 Consumer Protection Act, 1961, and Regulations 82 Noise Nuisances 423 Food Premises and Vehicles 1,763 Noneffective visits (iii) Nuisances and Notices Public Health Acts 1936 - 61 Notices served - (a) Intimation 2,731 (b) Statutory 1,764 Notices complied with - (a) Intimation 1,796 (b) Statutory 964 Nuisances and contraventions found 6,834 Nuisances and contraventions abated 5,609 Number of houses repaired 2,949 Separate lettings in above 3,007 Total number of repairs and improvements 6,220 (iv) Legal Proceedings Information prepared 141 Nuisance Orders made by Magistrate 115 Further proceedings for failure to comply with Nuisance Orders 29 (v) Drainage Plans examined 177 Examinations and Tests 118 (vi) Complaints Outstanding (at end of 1966) 89 Received during the year 4,931 plus 305 repreated complaints Dealt with during year 4,822 Outstanding (at end of 1967) 198 (vii) Land Charges Enquiries Enquiries received 5,142 Properties involved 6,605 Investigations 6,605 30 (viii) Rent Act, 1957 Applications for Certificates of Disrepair (1) Number of applications for certificates during 1967 2 Number of applications brought forward from 1966 2 Number of applications carried forward to 1968 1 Total number of applications receiving attention 1967 4 (2) Number of decisions not to issue certificates 1 Number of Undertakings on Form 'K' accepted - (3) Number of decisions to issue certificates (a) in respect of some but not all defects 2 (b) in respect of all defects - (4) Number of Undertakings given by landlords under paragraph 5 of the First Schedule 1 (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 2 Number of applications brought forward from 1966 - Number of applications carried forward to 1968 - Total number of applications receiving attention 1967 2 (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 2 Applications by Overseas Companies for Certificates of Repair Applications received Certificates issued (ix) Repairs and improvements effected as a result of Service of Notices under the Public Health Acts 1936-61 1. Brickwork - walls repaired or rebuilt 34 2. Drains cleared, repaired, etc. 518 3. Dampness remedied 779 4. Fireplaces and ranges repaired/renewed 40 5. Floors repaired 318 6. Flues repaired 11 7. Internal walls repaired 462 8. Ceilings repaired 487 9. Rainwater pipes/gutters repaired/renewed 304 10. Roofs repaired 699 11. Rooms cleansed 32 12. Sinks provided/renewed 42 13. Soil pipes repaired and renewed 45 14. Staircase or passage cleansed 4 15. Staircase repaired 101 16. Waste pipes repaired/renewed 188 17. Water Closet Apartments cleansed 10 18. Water Closet Pans and Traps renewed 59 19. Water Closets - flushing apparatus repaired or renewed 113 31 20. Water Closets - general repairs 190 21. Water Supplies provided 10 22. Water service pipes repaired 65 23. Window sash cords renewed 512 24. Windows repaired or renewed 277 25. Miscellaneous improvements 920 Total 6,220 Works in Default Public Health Act 1936 - Sections 39, 44, 45 and 275 Public Health Act 1961 - Sections 17 and 18 Consequent upon notices served by the public health inspectors for work to be done to drains, sanitary conveniences and premises, the Council in pursuance of their powers under the above Acts carried out works in default in 219 cases. Legal Proceedings Proceedings were instituted in 115 cases under Section 94 of the Public Health Act, 1936, for failure to comply with abatement notices. As a result 86 nuisance orders were made, and further proceedings were taken in 29 cases for failure to comply with these orders. DISINFECTION AND DISINFESTATION General Disfection and disinfestation services were provided, mainly free of charge:- No. of rooms treated for vermin (mainly bed bugs and fleas) 1,304 No. of rooms disinfected following infectious disease 113 No. of articles of clothing or bedding subjected to steam disinfection 218 Officers of the department paid 22 visits to a factory to supervise the disinfection of 25'/4 tons of clothing etc., for export. In addition 7 oven loads were subjected to steam disinfection at the treatment centre for the same company. Pigeons This problem continued and the authorised pigeon catcher carried out fifteen treatments in the Borough. These dealt with many of the worst affected areas but some became rapidly re-populated. Circular letters and notices were used in an attempt to dissuade people from feeding the birds on the Council's and other estates. The Council, through its appropriate Committee, agreed that notices be displayed on seats in public gardens and open spaces in the Borough asking the public not to feed birds. Caravan Sites - Control of Development Act, 1960 During the year complaints were received regarding three caravans parked in the Borough. Upon investigation it was found that none was lived in except during weekends and other periods when they were towed to places outside this area. CLEAN AIR AND ATMOSPHERIC POLLUTION Smoke Control Areas The Islington Nos. 24 and 25 Smoke Control Orders came into operation on 1st October. 32 The Islington No.26 Order, which covers 507. 4 acres, and the Islington No.27 Order, covering 420 acres, were made by the Council in July and were confirmed by the Ministry of Housing and Local Government in November. An objection to Order No.26 had, however, to be overcome to the satisfaction of the Ministry. This delayed its confirmation. The preliminary survey of the proposed Nos.28 and 29 Smoke Control Areas was well under way by the end of the year. Subject to the Council making these Orders and their being confirmed by the Ministry, they could come into operation on 1st October 1969. This would complete the Smoke Control Programme for the Borough. Clean Air Progress in Islington The atmosphere in Islington was much cleaner, and there was a noticeable reduction in smoke emission generally. Episodes of high smoke pollution, exceeding 1,000 microgrammes per cubic metre of air, were rare. No 'smog' has been recorded for several years. This thick, often yellow, acrid smog which used to hang over the Borough for days at a time, causing disruption to traffic, distress to elderly people and the use of smog masks, disappeared. There was no appreciable reduction in the sulphur dioxide content of the atmosphere. Considerable research was carried out on a national scale in regard to this serious pollutant. During the year the Minister of Housing and Local Government issued Circular 25/27 by virtue of which the advice to Local Authorities about the supply of smokeless fuels was co-ordinated. Comprehensive advice covering the whole range of solid smokeless fuels was now obtainable from one representative. CLEAN AIR ACT, 1956 Statistics Number of applications received for prior approval by local authority of plans and specifications for new furnaces (Section 3(2)) 2 Number of applications for prior approval granted 2 Number of notifications of intention to install furnaces 3 Inspections by Clean Air inspectors and assistants 1309 Re-inspections 3753 Complaints received 27 Smoke observations 320 Contraventions found 48 Adaptations completed (domestic) 2146 Notices served 47 Notices complied with 34 Prosecutions - 33 34 Recording of Atmospheric Pollution As part of the national survey of atmospheric pollution, three sites were maintained 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. Work of Public Health Inspectors Administering Factories Act, 1961, and Other Legislation Factories Act, 1961 Number of inspections 1,070 Number of re-inspections 591 Notices served 89 Prosecutions instituted - Defects remedied 650 Defects referred to H.M. Inspectors 1 Defects referred by H.M. Inspectors 32 Complaints received 16 Notices complied with 64 Public Health Act, 1936 Factories inspected 317 Contraventions found 50 Contraventions remedied 31 Notices served 7 Notices complied with 14 Other Factory Nuisances During the year several complaints of a varying nature were received from inhabitants concerning industrial processes alleged to be causing nuisance. Of these, a number related to noise from machinery, the loading of vans and parking of lorries and involved some visits by the Public Health Inspector during late evenings. Such action as was possible under the Noise Abatement Act was taken. Fumes from various chemical processes were the subject of a number of complaints to the Department and, where necessary, appropriate action was taken under the Public Health Acts to abate the nuisances. The third type of complaint related to dust nuisances, including sawdust. Here again, abatement action was taken where this was justified. The Borough Architect was notified of several cases where it -was considered that planning legislation was contravened. 35 Factories Act, 1961 Inspections for the purposes of provisions as to health (including inspections made by public health inspectors.) Premises (1) Number on Register (2) Number of Inspections (3) Written Notices (4) Occupiers Prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4, 6 and 7 are to be enforced by Local Authorities 25 99 8 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2545 869 72 - (iii) Other Premises in which Section 7 is enforced by the Local Authority* (excluding outworkers premises) 69 102 9 - Total 2639 1070 89 - * i.e. Electrical Stations (Section 123(1)), Institutions (Section 124), sites of Building Operations and Works of Engineering Construction (Section 127), Slaughterhouses, (Section 175(d) and (e) and Railway Running Sheds (Section 175(2) and (10)). Defects were found in the following cases. No prosecutions were instituted. Particulars (1) Number of cases in which defects were found Found (2) Remedied (3) Referred To H. M. Inspector (4) By H.M. Inspector (5) Want of cleanliness (S. 1) 9 3 1 - Overcrowding (S. 2) - - - - Unreasonable temperature (S. 3) - - - - Inadequate ventilation (S. 4) 4 4 - - Ineffective drainage of floors (S. 6) - - - - Sanitary Convenience (S. 7) - - - - (a) Insufficient 20 28 - - (b) Unsuitable or defective 256 537 - 31 (c) Not separate for sexes 69 76 - - Other offences against the Act (not including offences relating to Outwork) 2 2 - 1 360 650 1 32 Outwork (Sections 133 and 134) Visits were made to the homes of persons notified as outworkers. In no case was it found that work was being undertaken in unwholesome premises. The types of outwork and number of workers were as follows:- 36 Wearing Apparel - Making etc., Cleaning & Washing 1.050 Household Linen 14 Brass and brass articles 16 Umbrellas etc. 60 Artificial flowers 36 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 32 Brush making 16 Carding etc. of buttons etc. 31 Not specified above 139 TOTAL 1,394 Basement Bakehouses (Section 70) There were 11 basement bakehouses in the Borough in respect of which certificates of suitability continued to be in force. Routine inspections were carried out and action taken where necessary to maintain the standards laid down by the Food Hygiene (General) Regulations, 1960. Public Health Act, 1936, Sections 107-108 Offensive Trades The following is a summary of the records:- Type of Business Number No. of Inspections No. of Revisits Total No. of Visits Tripe Boiler ... 1 6 2 8 Fur Skin Dresser ... 1 4 2 6 Gut Scraper ... 1 4 2 6 Fat Melter ... 1 3 1 4 Slaughterhouses Foods and Drugs Act, 1955 - Section 62 Slaughterhouses Act, 1958 Slaughterhouses (Hygiene) Regulations, 1958-1966 The Slaughter of Animals (Prevention of Cruelty) Regulations 1958/59 The licence for the one private slaughterhouse in the Borough was renewed for a further year. During 1967 a total of 25 inspections were made of the premises in addition to the inspection of the carcases following slaughter. Periodic inspections were also made by the Divisional Veterinary Officer of the Ministry of Agriculture, Fisheries and Food. The requirements of the relevant legislation were complied with. Diseases of Animals Act, 1950 The Corporation of the City of London continued through its Veterinary Officer to act as agent for this Council in the implementation of the Diseases of Animals Act, 1950, and the Regulations made thereunder. Weekly visits were made to the private slaughterhouse in the Borough and an inspection made of any vehicles used for the conveyance of cattle etc. Kosher Butchers and Poulterers received periodical visits. Chapel Market was kept under observation from time to time with a view to the possible sale of live poultry. 37 All premises were found in a reasonable condition and it was not necessary to make any adverse reports. Orders of the Ministry of Agriculture, Fisheries and Food were published in the National Press as and when necessary. During the latter part of the year a most serious epidemic of foot and mouth disease occurred in Shropshire and the Northern Counties. The whole of England, Scotland and Wales became a controlled area and cattle, sheep, calves and pigs etc. could only be moved by licence issued by the Local Authority of the area receiving the animals. From 18th November, when the Order cajne into force, until 31st December, 17 licences were issued permitting movement of animals to Harrison, Barber and Co.'s premises in York Way for the purpose of slaughter. Noise Nuisances Public Health Act, 1936 Noise Abatement Act, 1960 The number of complaints relating to noise dropped considerably. Number of complaints 79 Number of visits made by Public Health Inspectors 671 Number of confirmed nuisances abated 56 Complaints were received regarding noises arising from many sources. These included one in which structure-borne noise and vibration was alleged in the operation of printing works situated in the basement of the building. Repeated evening visits were made, the machines operated at various speeds and appropriate action was teken to minimise the nuisance. Other complaints were investigated, including those arising from tyre fitting and re-treading, the all-night loading of vans and the all-night washing down of taxi cabs. The inspectors carried out observations during all periods of the day and night. The co-operation of the persons concerned was usually forthcoming and upon the necessary work being carried out the nuisances were abated. Pharmacy & Poisons Act, 1933 Number of listed sellers of Part II poisons other than pharmacists 145 Number of initial registrations during the year 14 Number of visits and inspections 6 Rag Flock and other Filling Materials Act, 1951 Number of premises on register (Section 2, for Upholstery) 56 Number of inspections and visits 45 Number of samples taken 1 Number of samples satisfactory 1 Consumer Protection Act 1961 - Oil Heaters Regulations 1962 Thirty-seven fires which were attributed to the use of oil heaters occurred during the year. Publicity regarding dangers arising from the use of such heaters and advice on safety precautions was continued. In each case, where a fire occurred, the premises were visited. It was not possible to take any action under the regulations, either because the evidence had been destroyed by the fire or because the information as to purchase was vague or inconclusive. 38 Visits to shops selling oil heaters continued with special emphasis on second-hand dealers. Five cases of such dealers having in their possession oil fires which did not comply with the regulations were discovered. In each case the dealer voluntarily surrendered the heaters and destruction was carried out under the inspector's supervision. A warning was given that a second offence might lead to legal proceedings being taken. Offices, Shops and Railway Premises Act, 1963 All the requirements of the Act and the regulations made thereunder were now in force and, with a few special exceptions, all premises to which the Act applies have received a general inspection to ascertain to what extent, if any, they fell short of the standards prescribed. 4349 premises have been inspected. Although there was a duty imposed on occupiers to register with the local authority some still failed to do so. This technicality did not prevent the premises from being recorded, inspected and brought up to the requisite standard. In the early days of implementation it was the exception to find any premises which complied entirely with the prescribed standards. Recently it was noticed that more of the newer premises complied with the legislation thus indicating a greater awareness of the statutory requirements by the employers. At the end of the year it could be said that the massive task of inspecting the thousands of premises which had never been inspected before, had been accomplished. Inspections and revisits were now carried on as a regular routine in the same way as other premises which were regularly visited by the Environmental Health Services. Legal Proceedings Once the provisions of the Act were drawn to their attention, the majority of owners and occupiers were quick to bring their premises up to a satisfactory standard. A few were reluctant to carry out works without coercion. During the year 47 cases were referred to the Council's Legal Division for consideration as to whether proceedings should be instituted. Most of these cases, after further approach by the Town Clerk, were abated but there remained a hard core in respect of which proceedings might be instituted. Accidents Investigation was carried out in every case where there was serious injury; where the requirements of the Act were not complied with; or if there were some unusual aspect. During the year out of 105 accidents notified only 26 required investigation. Some reported and investigated accidents 1. A butchery assistant was using a band saw for cutting joints of meat and cut his hand. Although safety precautions were taken by the occupiers of the premises an accident occurred. It is questionable whether this type of saw can be safely used for the cutting of small joints of meat. It is difficult to guard and there is very small clearance between the unguarded area of the fast moving saw blade and the operative's hand. 2. A shop assistant tripped over some defective floor covering and injured her back. The floor covering was found to be worn, uneven and holed in places contrary to Section 16. The occupiers, on instructions, had the floor covering renewed. 3. A van driver slipped on a staircase injuring his heel which became septic. The steps of the staircase were found to be in a poor condition and the handhold inadequate contrary to 39 Section 16. The occupiers upon being instructed had these matters attended to immediately. 4. An office worker caught his fingers between the feed rollers of a paper folding machine. This resulted in a crushed and badly cut finger. The inspector found upon investigation that cleaning of the machine had commenced by an assistant on the previous evening under the supervision of a mechanic. The assistant arrived early next morning and started on his own, without supervision, to complete the cleaning. Three factors caused the accident - the machine was inadequately guarded in front of the high speed rollers; the machine was cleaned whilst in motion; and an unskilled and unsupervised operative was cleaning the machine. As a further precaution large notices were displayed stressing the instructions to the staff on these points, and extra safety devices were provided including a guard over the entrance to the high speed rollers. General comments on particular aspects of enforcement Ownership and responsibility Under the provisionsof the Act the responsibility for compliance is generally laid upon the occupier of premises but in multi-occupied buildings certain matters become the responsibility of the owner. These provisions have presented more difficulties than any other. With numerous occupiers, ground leases, freeholds, sub-lettings and various interpretations of the term "building" it is difficult, if not impossible, to determine accurately the person responsible for ensuring that works are carried out. Even with co-operation it is difficult to establish the persons having an interest in a particular property because often the occupier of the part to which the Act applies cannot provide such information and when letters are sent to owners it is almost impossible to convince them that the remedying of deficiencies has been correctly deemed their responsibility. Lighting In 1965 a special survey was carried out to assess lighting standards in premises to which the Act applied. This information, it was hoped, would result in minimal standards being prescribed by statute. It is understood that instead, an advisory booklet is to be supplied to enforcing authorities which will recommend standards. These will not be legally enforceable. Lifts and hoists Regulations have been proposed but have not, to date, been issued. Detailed guidance on these particular duties would be appreciated by the local authority inspectorate as they are a new aspect of their work in which their experience is limited. Conclusions Tables attached to this report give details of the premises inspected, the number of visits made and a summary of the deficiencies found and remedied during the year. 40 Statistics REGISTRATIONS AND GENERAL INSPECTIONS Class of Premises Number of premises registered during the year Total number of registered premises at end of year Number of registered premises receiving a general inspection during the year Offices 234 1596 321 Retail shops 171 1485 214 Wholesale shops, warehouses 35 272 51 Catering establishments open to the public, canteens 62 356 90 Fuel storage depots 2 2 — TOTALS 504 3711 676 NUMBER OF VISITS OF ALL KINDS BY INSPECTORS TO REGISTERED PREMISES 7069 ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of Workplace Number of persons employed Offices 35,790 Retail shops 6,860 Wholesale departments, warehouses 5,256 Catering establishments open to the public 1,883 Canteens 879 Fuel storage depots 7 Total 50,675 Total Males 28,8 23 Total Females 21,852 41 DEFICIENCIES POUND AND REMEDIED TOTAL Found Remedied Cleanliness 70 209 Overcrowding 8 25 Heating 17 25 Provision of Thermometer 346 773 Ventilation 118 307 Lighting 31 115 Insufficient Sanitary Accommodation 23 53 Deficient Sanitary Accommodation 253 237 Insufficient Washing facilities 23 54 Hot Water/Warm Water Required 67 242 Other Deficient Washing Accommodation 67 73 Drinking Water 14 32 Clothing Accommodation 28 53 Seating Facilities 1 8 Eating Facilities 1 - Dangerous Machinery 57 116 Floors & Staircases 330 580 Noise & Vibration - - First Aid 374 780 Abstract 496 1001 TOTAL 2,324 4,683 Intimations Served 654 Prevention of Damage by Pests Act, 1949 Rodent Infestations The number of recorded complaints rose to 2,271 during the year compared with 2,021 in 1966, resulting in 8,042 visits by Rodent Investigators and 22,577 by Rodent Operators. No ship rat infestations were recorded. Two meetings of the London No. 1(Northern) Pest Control Committee were attended by the Rodent Officer. Mr. W. C. Bartlett, Chief Public Health Inspector, acts as Chairman of the Committee. Type of Property Local Authority Premises Dwelling Houses Business Premises Total 1. Cbmplaints received (including repeats) 91 1,767 413 2,271 2. No. of properties inspected as a result of a) Notification (initial complaint only) a) 72 1,442 323 1,837 b) Block Survey b) 70 435 142 447 3. No. of properties found to be infested by rats (including Nil ship rats) 97 557 177 831 4. No. of properties found to be infested by mice 24 1, 103 181 1,308 5. Completed treatments during the year 124 1,728 217 2,069 6. No. of Business Agreements dealt with 247 42 Sewer Treatments Three sewer treatments were carried out during the year. The treatment in March was preceded by test baiting. Poison was laid in all manholes which showed a take of prebait. An additional eight manholes were installed by the Borough Engineer's Sewer Department and the number at the end of the year was 1,550. For a variety of reasons, i.e. volume of traffic, road repairs, parking on or over manholes, sewer works, etc., a number of manholes were inaccessible for baiting. In all treatments sodium monofluoracetate (1080) was the poison used. Details are:- Month No. of Manholes Baited Not Baited *March (Prebait) 1,212 338 March 908 642 June 1,448 102 September 1,450 100 *There were 732 takes and 480 no takes. Because of staff shortage, No December treatment was carried out. The co-operation of the Borough Engineer and his staff was appreciated. Water Supply The Metropolitan Water Board is the responsible Authority for the supply of water in Islington. The supply is satisfactory both in quality and quantity. There were 55,176 dwellings in the Borough supplied direct from water mains serving the entire population of the Borough (254,580). The action taken regarding domestic, well water and swimming bath water is as follows:- A. Domestic Bacteriological Sampling Satisfactory Unsatisfactory Mains supply 9 9 Nil Tanks 8 5 3 Subsoil 1 Nil 1 18 Chemical Sampling Mains supply 22 22 Nil Subsoil 1 Nil 1 23 B. Well Water 52 bore holes and wells 45 unused Bacteriological Sampling 3 3 Nil 43 C. Swimming Bath Water During the year 230 bacteriological and 47 chemical samples were obtained and submitted to the Bacteriologist and Public Analyst respectively. There were some slightly sub-standard samples, but conditions improved after an approach was made to the Managers of the respective establishments. The only pool which gave rise to considerable concern was that operated by the Corporation of London at their Golden Lane Housing Estate. During July and August the chlorination plant broke down, with the result that there were wide fluctuations in the amount of free chlorine available in the water. This gave rise to very high bacterial counts on one day, due to the almost total absence of free chlorine, but on the following day, three swimmers were taken to St. Bartholomews Hospital for eye treatment, caused by an excessive quantity of chlorine in the water. The manufacturers of the equipment were called in and the necessary work carried out, after which the condition of the water improved. Common Lodging House The one common lodging house in the Borough at 88 Old Street comprised dormitories on five floors, with toilet facilities. The premises were registered for 275 men and were inspected regularly. The register was kept up to date and the common lodging house maintained satisfactorily. Sewerage and Sewage Disposal The problem of flooding due to the surcharging of sewers in certain areas has not been resolved. As mentioned in last year's report the solution may well lie in alterations to the sewer system in those parts of the Borough affected. DETAILS OF PUBLIC CONTROL FUNCTIONS Refreshment Houses Acts, 1860 to 1967 No. of licences issued 127 Explosives Acts, 1875 & 1923 Fireworks Act, 1951 The Keeping of Fireworks Order, 1959 No. of registrations during year 233 No. of visits 352 At the time of inspection several shopkeepers had to be reminded of the serious consequences which could result from improper storage of fireworks or from the sale of fireworks to young children. London County Council (General Powers) Act, 1921 - Part III (as amended) Employment Agencies No. of licences issued during year 44 No. of licensed agencies at end of year 43 No. of visits 106 No. of re-visits 60 The year saw the first prosecution by the council under this act. The Inspector interviewed an applicant for an Employment Agency Licence and, not being satisfied with some of the answers given, instituted further inquiries of the police. As a result of these enquiries, proceedings were instituted against the applicant for making wilful misrepresentation to obtain a licence.The applicant on being found guilty was fined £50 with £10 costs. 44 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 17 No. of licensed establishments at end of year 17 No. of visits 37 No. of re-visits 20 As a result of visits made by the Inspector several contraventions of a minor character were found. These were all rectified after verbal cautions had been given. Theatrical Employers Registration Acts, 1925 & 1928 No. of registrations during year 2 No. of registered employers at end of year 43 Performing Animals (Regulation) Act, 1925 No. of current registrations Nil Shops Act, 1950 Shops (Early Closing Days) Act, 1965 Young Persons (Dnployment) Acts, 1938 & 1964 No. of visits during year 5070 (i) During the year nearly two thousand infringements were found. Most were of a minor character and were rectified after explanations and verbal or written cautions had been given. There remained, however, a minority of recalcitrant occupiers. The papers on these cases were passed to the Legal Division for consideration as to whether proceedings should be instituted. (ii) In the summer of 1967 the Council made an Early Closing Day Exemption Order in respect of all non-food shops in the Nags Head area. This area is defined in the Order and shown in the plan on page 47. Under the Shops Act 1950 the sale of certain foods was already exempted from the half day closing provisions and this, in conjunction with the Council's Order, means that there are only a few articles of food which cannot now be sold in the Nags Head area on six days of the week. Knowing which articles they could not sell on the half day has been a problem for some of the larger shops and many explanatory visits have had to be made. Most of the shops have now re-grouped their stock so that all prohibited articles are together. On the half day these counters are then covered over to prevent sales. The Riding Establishments Act, 1964 No. of establishments Nil Fertilisers & Feeding Stuffs Act, 1926 No. of samples taken One 45 Celluloid & Cinematograph Film Act, 1922 No. of premises used for storage 1 (6 occupiers) Legal proceedings were instituted against one company for failing to furnish a statement as required under the provisions of the Act and a fine of £10 with £3 costs was imposed. Fabrics (Misdescription) Act, 1913 Nil Diseases of Animals Act, 1950 See separate paragraph on page 37. Public Health Act, 1936 - Part VI Nursing Homes Act, 1936 Mental Health Act 1959 - Part III Nursing Homes Two registered nursing homes both non-profit making and run by charitable organisations received routine visits by a Medical Officer and a Public Health Inspector and were found to be satisfactory. 46 THE LONDON BOROUSH OF ISLIHSTON EARLY CLOSING DAY EXEMPTION ORDER. 1967. 47 HOUSING Housing Act, 1957 - Section 9 For the reasons mentioned in last year's Annual Report, little use was made of this Section. Four houses which were unfit and which seemed likely to be repairable at reasonable expense were examined. Detailed inspection and costing of necessary repairs, however, showed that the estimated cost exceeded the valuation. The nuisance abatement clauses of the Public Health Acts were again freely used to enforce essential repairs. Discussions took place with the Ministry of Housing and Local Government and elsewhere on the possibility of new powers to enforce property repair and maintenance which would have regard only to the age, character and location of the house. Such a power would be much welcomed, not only in getting unfit houses repaired, but in preventing unfitness in the first place. Housing Act, 1957 - Sections 16, 17, 18 and 27 The number of Closing Orders decreased from last year, to five Orders in respect of individual unfit houses, and forty-two Orders in respect of unfit parts of buildings. In general, only one-third of houses, or parts of houses, which were closed were subsequently rehabilitated and returned to use. Some parts of buildings were incapable of rehabilitation, principally because of the lighting factors, for example, basement rooms with no proper areas and rooms over-shadowed by tall adjoining buildings. Houses, or parts subject to closing orders were included in clearance areas. Even allowing for both of these factors, there was a drain on valuable housing resources and for this reason also, the proposed new powers referred to above would be welcomed. The shortage of one-bedroom accommodation continued and thus restricted closure action where rehousing in this type of unit was required. Three houses and thirteen parts of buildings were rehabilitated and the closing orders determined. Use of premises subject to closing orders, for purposes other than human habitation, was permitted in four cases. Housing Acts, 1957 - Slum Clearance (a) 1961/65 Slum Clearance Programme The Minister of Housing and Local Government confirmed the following Slum Clearance Orders which were submitted to him at the end of last year:- 1. 58 - 62 White Lion Street 1-13 Godson Street 2. 34a, 34 - 41 White Lion Street 1 and 2 Penton Grove 3. 83 - 89 White Lion Street 7 and 8 Northwest Passage 4. 1-5 Dallington Street* 5. 91 - 101 (odd) Central Street* * Local Inquiry held. 48 Rehousing in these areas is proceeding. In addition, 14 - 15 Sebastian Street, 21, 22 & 23 Sebastian Street, and 161 - 163 (Odd) Goswell Road, which were represented last year and deferred, were re-represented, and at the end of the year were awaiting the Minister's decision. 24 and 26 Normans Buildings were represented and at the end of the year were awaiting the Minister's decision. 164 - 176 Liverpool Road fell within an area being dealt with by the Greater London Council. By agreement this area was transferred to the Greater London Council. This left 17 - 18 Meredith Street and 39 Whiskin Street outstanding from this programme. This area was represented last year, but the representation was deferred due to the shortage of one-bedroom units, for which there was a particular demand in this area. It is now hoped that it will be dealt with next year. (b) 1966/70 Slum Clearance Programme The policy of acquisition by agreement, referred to last year, was continued, where the Council was interested in a site for housing re-development purposes and the number of unfit houses was small in relation to the number included in the re-development area. As a result it was not necessary to represent any houses under this programme during the year. The Playford Road, Pooles Park, Durham Road, Carville Street Areas, mentioned in the 1966 Report, were confirmed by the Minister after a Public Inquiry. At the end of the year, the following areas were outstanding:- Gordon Close - four dwellings. Bavaria Road/Sussex Way Area - three houses in Sussex way, 235 - 239 (odd) were outside the boundaries of the Housing Development Area. Asteys Row - three dwellings Elliotts Place - three dwellings. Dagmar Passage - four dwellings. Carleton House and Pembroke House - thirty dwellings. Lorenzo Street - three dwellings. Attneave Street - three dwellings. Javens Chambers, Clerkenwell Road - six dwellings. (c) Future Slum Clearance Programme Consideration was given to thirteen areas containing 248 dwellings for possible inclusion in future slum clearance programmes. Close liaison with the Greater London Council was maintained and the Department's inspectors gave supporting evidence at a number of public inquiries into areas proposed by the Greater London Council. Housing Act 1957 - Part V Two areas of houses, not of slum clearance standard, were surveyed for possible acquisition under Part V. 49 Section 170 This section gives a Local Authority power to require information as to the ownership of premises. This information is necessary for the fulfilment of the appropriate procedures both with regard to action on unfit houses under the 1957 Act and also action under the 1961 Act, to which reference is made later, i.e. management orders, notices under sections 15 and 16 and direction orders. Great difficulty is frequently experienced in obtaining adequate replies to these requests for information. During the year a large number of presecutions (41) were taken for failure to supply information. Although penalties are small (maximum fine £5), this had the desired affect in the majority of cases and the required information was obtained. Housing Act 1961 - Section 12 - Management Orders These orders apply to individual houses the Housing (Management of Houses in Multiple Occupation) Regulations 1962. During the year it was necessary to represent only six houses for management order. In fact, eleven orders were made which represented an inroad into the back log referred to last year. This was possible due to the successful action taken under Section 170 of the Housing Act 1957. In two cases it was possible to rescind orders as conditions had improved to an acceptable standard. Section 15 - Provision of Amenities The increased use of this section referred to last year was continued. 307 informal and 112 formal notices were served. The resistance on the part of owners to compliance with these notices continued due, no doubt, to the high cost of the necessary works. Forty prosecutions were taken during the year for non-compliance with these notices. This resulted in a more co-operative attitude on the part of the owners and agents. Section 16 - Means of Escape in Case of Fire in Houses in Multiple Occupation The powers contained in this section were again freely used, 354 informal and 178 formal notices were served. Follow-up visits were made to premises which had previously been dealt with under this section and also which had been dealt with under section 35 of the London Building Acts (Amendment) Act, 1939, to check that the means of escape provided was being properly maintained. Because of the importance of this work it was agreed to increase the number of staff employed and the addition of three posts of Fire Inspector to the establishment was authorised. Section 19 - Direction Orders This section gives the power to regulate the number of persons who can live in a house, or part of a house, in relation to the amenities which are available. This proved a most useful tool in controlling the number of persons living in houses in multiple occupation. Although only 24 direction orders were made during the year, it was hoped in view of the successful prosecutions under section 170, previously referred to, that this number would be increased markedly in the future. This work was time-consuming in the number of visits required to ensure compliance, particularly in view of the high turnover of tenancies in the very houses which lend themselves to this type of action. Seven prosecutions for contraventions of direction orders were taken during the year. 50 Areas of Improvement Where action under the 1957 and 1961 Acts was being concentrated in areas, these were designated as 'areas of improvement', as distinct from 'improvement areas' as defined in the 1964 Housing Act. This method of working was economical in inspectors' time and minimised antagonism on the part of owners who, were their houses to be separately dealt with, would feel that they had been unfairly singled out. In addition to the areas referred to last year, the following areas received attention: Thornhill Square - 64 houses. Granville Square - 43 houses. In addition a number of areas were at an advanced stage of survey at the year end. Tenement Blocks As reported last year, all tenement blocks were classified into three groups: 1. those which had been brought up to reasonable modern standards; 2. those which appear capable of and worth being improved to those standards: 3. those for which the only satisfactory treatment would be demolition (whether or not immediately practicable). This grouping was agreed at officer level between the Greater London Council and the London Borough of Islington, and subsequently ratified by both Authorities. In general, the London Borough of Islington would have the responsibility of securing improvement of those blocks classified within Group 2. There are, however, two exceptions to this. First, a number of blocks which are capable of improvement will, in fact, not be improved as their life expectancy is affected by various road, school and housing development proposals. Second, the Greater London Council have acquired or are acquiring the following blocks in this group: Alsen Mansions, Alsen Road. Northampton Buildings, Rosoman Street. Springfield Court, Coldbath Square Highbury Mansions, Upper Street. Premier Buildings, Waterloo Terrace. As the owners of these blocks they will themselves be responsible for their improvement. The responsibility for dealing with tenements within Group 3 in divided between the Greater London Council and the London Borough of Islington. The London Borough of Islington will deal with 981 dwellings, not in the slum clearance programme, plus 295 which are in the slum clearance programme. The Greater London Council will deal with 793 dwellings, not in the slum clearance programme and 473 which are in the slum clearance programme. Four tenement blocks were surveyed in connection with the preparation of possible improvement schemes. In three cases it was decided that the blocks were not worth improving (Bartholomew Buildings, Pickering Street Dwellings, Dibden Street Dwellings) and these blocks were included in Category 3. In the fourth case, Liverpool Buildings, the survey was overtaken by events when the site of this block was affected by the proposed North Cross Route. 51 Housing Act, 1964 - Improvement Areas Rickthorne Road A further improvement area consisting of Rickthorne Road, Stanley Terrace, and parts of Kingsdown Road, Cornwallis Road and Landseer Road was declared during the year. Again the number of "seperate dwellings" as defined in the Act was small (10) in relation to the total number of houses (91). The other houses were largely divided between owner occupation (11) and multiple occupation (64). The houses in multiple occupation were dealt with in accordance with Sections 15 and 16 of the 1961 Act to secure the provision of amenities and of means of escape in case of fire in accordance with the adopted Codes of Practice. With regard to the 10 seperate dwellings included in the area, immediate improvement notices were served in three cases and suspended improvement notices in two cases as the tenants refused consent to the work. The work was completed in one case and the house was vacant in another. The remaining three cases were still subject to negotiation at the year end. Kingsdown Road This area was also surveyed during the year and it was found that there were a number of seperate dwellings as defined which lacked one or more of the standard amenities which could be provided at reasonable expense. The houses were fit for habitation and after improvement were expected, subject to normal maintenance, to remain so for at least 15 years. It is hoped to represent this area early in the new year. Greater London Council - Condition of Dwellings Survey 1967 This was a 4% sample survey which was carried out in two parts. The private dwellings scheduled for survey within the Borough were inspected by the Public Health (Housing) Inspectors. This constituted a total of 1,827 inspections, the survey was completed in 1,774 cases. This survey took up a great deal of the inspectors' time for a period of almost three months. The findings of the survey have not yet been published. 52 SUMMARY OF INSPECTIONS MADE, REPORTS SUBMITTED NOTICES SERVED & NOTICES COMPLIED WITH Housing Act 1957 Section 5 Control of back to back dwellings Number of certificates issued 1 Section 9 Repair of unfit houses Number of houses inspected 4 Re-inspections 11 Representations to Committee Nil Section 16 Individual unfit houses Number of inspections 330 Number of revisits 330 Houses represented to Committee 12 Closing Orders made 5 Demolition Orders made 2 Undertakings accepted Nil Houses demolished 13 Section 18 Unfit parts of buildings Number of inspections 1421 Number of revisits 1421 Representation to Committee 31 Closing Orders made 42 Undertakings accepted Nil Section 24 Reconstruction of house subject to Demolition Order Number of inspections 10 Number of revisits 10 Reports to Committee 1 Section 27 Closing Orders or undertakings determined on completion or works Whole houses 3 Parts of buildings 13 Section 27 Permitted use of premises subject to Closing Orders Number of applications submitted to Committee 5 Number of applications granted 4 Section 27 Contravention of Closing Orders Number of cases reported to Committee 2 Section 28 Closing Order - Substitution of Demolition Order Number of orders substituted 1 Reports to Committee 1 Section 42 Clearance Areas Number of areas surveyed 16 Total houses in those areas 258 Areas represented to Council 3 53 Total houses in areas represented 10 Inspections 439 Revisits 439 Section 78 Overcrowding Inspections 189 Revisits 189 Cases reported to Committee 12 Overcrowding abated 27 Section 81 Permitted numbers Inspections 594 Re-inspections 594 Section 90 Overcrowding in houses let in lodgings Inspections 10 Re-inspections 10 Housing Act Part V Possible C.P.O. s other than Clearance Areas Number of areas surveyed 2 Number of houses in above areas 283 Number of inspections made 293 Housing Act, 1961 Section 12 Management Orders Reports on individual houses submitted to Committee 6 Tbtal of lettings in above houses or tenement blocks 357 Inspections and revisits 588 Management Orders made 11 Management Orders determined 2 Section 15 Provision of amenities Houses inspected 659 Revisits etc. 4196 Informal notices served 307 Formal notices served 112 Notices complied with 138 Section 16 Means of escape in case of fire Houses inspected 782 Revisits etc. 3790 Informal notices served 354 Formal notices served 178 Notices complied with 225 Section 19 Directions to prevent overcrowding Reports on individual houses submitted to Committee 10 Total of lettings in above houses 52 Revisits etc. 212 Directions made 24 Letting density in houses reported 5. 20 Section 19 Variation of Direction Reports to Committee 1 54 Section 19 Contravention of Direction Reports to Committee 2 Section 21 Possible improvement of tenement blocks Number of tenement blocks surveyed 4 Total number of dwellings in above blocks 733 Number of blocks subject to report to Committee 3 Dwellings in above blocks 457 Inspections and revisits 805 Housing Act, 1964 Section 13 Improvement Areas Number of areas surveyed 4 Number of houses in above areas 275 Inspections and revisits 333 Areas represented 1 Preliminary improvement notices served 12 Immediate improvement notices served Nil Suspended improvement notices served 2 Informal undertakings accepted Nil Non-agreement by tenants to allow improvements 2 Section 19 Improvement of Individual Houses Formal applications received from tenants 5 Informal applications Nil Dwellings inspected 5 Revisits etc. 24 Section 20 Improvement of dwellings in tenement blocks Number of tenement blocks surveyed 11 Seperate dwellings in above blocks 422 Inspections and revisits 167 Reports and proposals submitted to Committee 1 Number of dwellings in report submitted 323 Housing (Financial Provisions) Act 1938 Improvement and Standard Grants Inspections and revisits 60 House Purchase Scheme London Borough of Islington Inspections and revisits 315 Greater London Council Inspections and revisits 91 Town and Country Planning Visits and revisits 109 55 Housing Acts 1957-64 G. L. C. "Condition of Dwelling Survey 1967" Total number of dwellings scheduled for survey within the Borough 2464 Number of private dwellings scheduled for survey by Housing Inspectors 1827 Number of dwelling surveys completed 1774 * Miscellaneous Inspections Other miscellaneous visits including medical preference inspections, meat and food inspections, nurseries and child minders, etc. 1455 Interviews with owners, surveyors, builders, tenants, etc. 1761 56 PROSECUTIONS DURING 1967 Housing Act, 1957 - Section 27 Contravention of Closing Orders 9 Housing Act, 1957 - Section 78 Overcrowding 5 Housing Act, 1957 - Section 160 Obstructing Public Health Inspector in course of duty 1 Housing Act, 1957 - Section 170 Failure to give information as to ownership 41 Housing Act, 1961 - Section 13 Breach of Regulations of Housing (Management of Houses in multiple occupation) 34 Housing Act, 1961 - Section 19 Failure to comply with a Direction to prevent or reduce overcrowding 7 Housing Act, 1964 - Section 65 Section 15 - Failure to comply with Notice served 39 Section 16 - Failure to comply with Notice served 39 Liable for offence as Director or Secretary of Company 9 Total: 184 SUPERVISION OF FOOD The following legislation was introduced during the year:- 1. Cheese (Amendment) Regulations 1966. 2. Food (Control of Irradiation) Regulations 1967. 3. Meat Pie and Sausage Roll Regulations 1967. 4. Canned Meat Product Regulations 1967. 5. Sausage and Other Meat Product Regulations 1967. 6. Slaughter of Animals (Prevention of Cruelty) Regulations (Appointed day No. 2) Order 1967. 7. Slaughterhouses (Hygiene) Regulations (Appointed day No.2) Order 1967. 8. Artificial Sweeteners in Food Regulations 1967. 9. Slaughter of Poultry Act 1967. 10. Solvents in Food Regulations 1967. 11. Solvents in Food (Amendment) Regulations 1967. 12. Labelling of Food Regulations 1967. 13. Coffee and Coffee Product Regulations 1967. 14. Ice Cream Regulations 1967. 15. Margarine Regulations 1967. 16. Merchandise Marks (Imported Goods) No.7 Order 1934 Amendment Order 1967. 17. Refreshment Houses Act 1967. Food Hygiene (General) Regulations 1960 An increase in staff during the year enabled some of the outstanding work on food hygiene to be carried out, but there was still a serious backlog. It was satisfactory to find that in a number of premises there had been a marked improvement. Licensing or registration of all food premises, particularly of catering establishments, with power for the Council to refuse or revoke licence or registration, would do much to secure the rapid improvement of premises with poor standards. Food Factories A total of 180 visits was paid to the food factories in the Borough by the inspectors concerned. Action was taken where necessary to enforce compliance with the Food Hygiene (General) Regulations, 1960 and other relevant legislation. Street Markets As mentioned previously in this report the Chairman of the Environmental Health Committee and the Cleansing & Baths Committee, together with the appropriate officers, held a meeting with street traders and representatives of their Associations to explain requirements of the new Food Hygiene (Markets, Stalls & Delivery Vehicles) Regulations, 1966. Subsequently most of the 242 market stalls in the Borough were inspected and were notified what they must do to comply with the regulations. Co-operation by the stall holders was generally good. 58 Food Complaints The number of food complaints received during the year was 88 showing an increase of 47% over the previous year. These complaints were dominated by those foods found to be mouldy. In almost every case this was due to the food being kept too long before sale, particularly during the warmer summer months. A number of foreign objects was also found in food, ranging from a 3d. piece in some chocolate drops, to an adhesive wound dressing in a loaf of bread. The complaints of alleged unfitness were received in respect of the following:- Bread, cakes & biscuits Canned goods Foreign matter in bread 12 Mouldy canned meat 2 Mouldy bread 7 Foreign matter in corned beef 1 Mouldy cake 3 Stained corned beef 1 Insects in bread 2 Unusual taste of corned beef 1 Insects in biscuits 2 Fly in peaches 1 Foreign matter in cake 2 Discoloured apples 1 Rodent droppings in cookies 1 7 Rodent droppings in bread 1 Insects in cake 1 Milk & Milk bottles Stale cake 1 Dirty milk bottles 7 Burnt biscuits 1 Foreign matter in milk 1 33 Excess water in milk 1 9 Meat and meat products Miscellaneous Mouldy meat pies & pasties 11 Rancid butter 1 Sour sausages 3 Slug in peas 1 Mouldy sausages 2 Skin on potato chips 1 Sour meat pies 2 Foreign matter in baby food 1 Foreign matter in sausages 1 Bad taste of salad cream 1 Maggots in bacon 1 Beetles in potato crisps 1 Bad taste of beef 1 3d. piece in chocolate buttons 1 Unsound chicken 1 Beetles in baby food 1 Chicken alleged to be other meat 1 Mouldy tea 1 23 Mildew on pickled onions 1 Stale fried fish 1 Insect in butter beans 1 Stale cheese spread 1 Chestnuts alleged to be "conkers" 1 Glass in tomato juice 1 Rodent droppings in rice 1 16 Details of proceedings taken in respect of these complaints are shown on page 61. 59 Food and Drugs Act, 1955 (a) Number of food premises etc. in the area, type of business and number of inspections made, and action taken. Premises Visits by Inspectors Bakehouses - basement 11 36 Bakehouses - others 35 107 Bakers' retail shops 77 59 Bacon factories 6 11 Breweries, Distilleries & Distributors 11 9 Butchers (retail) 183) 746 Butchers (wholesale) 46) Cafes and restaurants 420 801 Canteens 228 103 Fish curers 9 33 Fish depot 1 156 Fish friers 80 198 Fish shops (wet) 65 30 Food factories 38 180 Food stalls 242 2284 Food storage premises for street traders 78 42 Greengrocers and fruiterers 214 75 Grocers and provision merchants (retail) 541 783 Slaughterhouse 1 25 Horseflesh dealers (wholesale) 1 Ice cream premises 695 120 Licensed clubs 42 60 Meat Inspection at Licensed Slaughterhouse 1 482 Milk depots 8 8 Milk distributors 412 73 Milk machines 16 16 Pood machines 8 8 Off-Licences 116 7 Poultry dealers (wholesale) 6 8 Public cold stores 6 9 Public houses and beerhouses 389 193 Sausage casing merchants 5 5 Sugar and chocolate confectionery 418 64 Wholesale food stores & depots 53 692 Chemists - 26 Vehicles - 149 Food examinations (other) - 410 Miscellaneous visits and revisits - 1214 OTHER ACTION TAKEN Contraventions found 267 Contraventions remedied 201 Notices served (Food & Drugs Act) 157 Notices complied with (Food & Drugs Act) 115 Food Poisoning enquiries 91 Legal proceeding - attendances at Court 20 60 (b) Preserved Food Premises Registered under Section 16 (I) (b) of the Food and Drugs Act, 1955 Included in foregoing list Premises No. of Butchers 139 No. of Grocery and provision shops 44 No. of Pood Factories 16 No. of cooked meat shops 1 No. of Jellied Eels and Pie shops 4 No. of Bakers (meat pies) 1 No. of Fishmongers 4 Total number of Preserved Pood premises 209 Visits by Inspectors 110 Legal Proceedings Details of the action taken by the Council under the Food and Drugs Act, 1955, and the Regulations made thereunder are as follows: - DATE OF HEARING OFFENCE MAGISTRATES DECISION 18. 4. 67 Sections 2 (1) and 113 (3) Selling food, namely a mince pie, not of the quality demanded, in that it contained an elastic rubber band. Fine of £10 Council awarded £3 costs. 18.4.67 Section 2 (1) Selling food, namely a walnut iced sponge cake, not of the quality demanded, in that it contained a wasp. Fine of £10 Council awarded £3 costs. 27. 4.67 Section 2 (1) Selling food, namely a pork pie, not of the quality demanded, in that it was mouldy. Fine of £5 Council awarded £2 costs. 27.4.67 Sections 2 (1) and 113 (3) Selling food, namely a wrapped sliced loaf, not of the quality demanded, in that it contained a wasp. Fine of £5 Council awarded £1 costs. 27.4.67 Sections 2 (1) and 113 (3) Selling food, namely a wrapped loaf of bread, not of the quality demanded, in that it contained a fly. Fine of £5 Council awarded £1 costs. 3. 5.67 Section 2 (1) Selling food, namely a chicken and ham pie, not of the quality demanded, in that it contained a fly. Fine of £10 Council awarded £5 costs. 28.6.67 Section 2 (1) Selling food, namely pork sausages, not of the quality demanded in that they were mouldy. Fine of £20 Council awarded £5 co6ts. 3. 5. 67 Section 2 (1) Selling food, namely a bottle of milk, not of the quality demanded, in that it contained a piece of wood. Fine of £15 Council awarded £5 costs. 61 62 5.6.67 Section 2 (1) Selling food, namely a cornish pasty, not the quality demanded, in that it was mouldy. Fine of £5 Council awarded £1 costs. 21.6.67 Section 2 (1) and 113 (3) Selling food, namely chocolate covered dates, not of the quality demanded, in that one contained a piece of iron. Fine of £10 Council awarded £10 costs. 4.7.67 Section 2 (1) Selling food, namely biscuits not of the quality demanded, in that they contained insects and larvae. Fine of £10 Council awarded £2 costs. 13.6.67 Section 2 (1) Selling food, namely custard tart, not of the quality demanded, in that it was mouldy. Fine of £10 Council awarded £3. 3. costs. 22.6.67 Section 113 (1) Selling food, namely a custard tart, not of the quality demanded, in that it contained a fly. Fine of £5 Council awarded £7. 10 costs. 26. 10.67 Pood Hygiene (General) Regulations 1960. (Reg. 5) Carrying on a cafe in insanitary premises thus exposing food to the risk of contamination. 13 summonses £20 fine on first summons Council awarded £5 costs. (No separate penalty on other summonses.) 5. 10. 67 Section 2 (1) Selling food, namely a packet of cheese biscuits, not of the quality demanded, in that it contained insects. Fine of £5 Council awarded £3 costs. 5.9.67 Section 113 (1) Selling food, namely a packet of fresh frozen peas, not of the quality demanded, in that in contained a slug. Fine of £5 Council awarded £3 costs. 26. 10.67 Sections 2 (1) and 113 (3) Selling food, namely a small wrapped loaf, not of the quality demanded, in that it was mouldy. Fine of £10 Council awarded £5 costs. 7.11.67 Sections 2 (1) and 113 (3) Selling food, namely coconut cookies, not of the quality demanded, in that one of the cookies contained a rodent dropping. Fine of £25 Council awarded £3 costs. 7. 11.67 Section 2 (1) Selling food, namely minced beef loaf, not of the quality demanded, in that it was deficient in meat content. Fine of £5 Council awarded £3 costs. 30. 11.67 Preservatives in Fbod Regulations 1962. Regs. 5 (1) and 8. Selling food, namely sausages which contained added preservatives not being so indicated by label or notice. Fine of £3 Council awarded £1 costs. 63 Formal Fruit drink concentrates 4 Sausages 2 Cream cakes 2 Cut mixed peel 1 Canned meat 1 Canned pudding 1 Strawberry concentrate 1 12 Informal Bread and rolls 21 Fish fingers 1 Meat pies and pasties 13 Fruit lollies 1 Cakes and biscuits 9 Milk product 1 Canned vegetables 8 Cheese 1 1502 condemnation certificates were issued and 383 inspections were necessary in connection with this work. Condemned food received from traders was removed to the Council's refuse disposal depot at Ashburton Grove to await conveyance, under supervision, to the refuse tip. Condemned meat from the slaughterhouse was used for animal feeding or industrial purposes. Other meat and offal etc. from the Smithfield Market area was collected under contract for manufacture for technical purposes. Sampling 772 samples (19 formal, 753 informal) were sent to the Public Analyst for examination. 123 of these (or 16%) were subject to adverse reports as shown in the summary below. Some sampling followed complaints, but the remainder was routine. A number of the adverse reports concerned labelling. Particular attention has been paid this year to imported continental food-stuffs and similar foods popular with immigrants. The Public Analyst now has equipment to examine foods by gas chromatography, and although Islington is not included in the scheme set up by the Ministry of Agriculture, Fisheries and Food for the routine examination of foods for the presence of residual pesticide, two samples included in the above mentioned number, one of meat and one of runner beans, were submitted to the Public Analyst for this purpose. Only minute traces of residual pesticide were found - levels beine well below those which might cause concern. Unfit Food During the year the total amount of food surrendered was:- Description Tons Cwts. Qtrs. Lbs. Meat 53 13 0 23 Offals 35 1 2 15 Tinned Goods 6 1 3 12 Fish 4 6 3 9 Others 21 18 0 19 Total 121 1 2 22 Fruit flavoured drinks, Chicken 1 extracts and syrups 8 Bacon 1 Confectionery 6 Baby food 1 Cooking essences 6 Spice 1 Milk and milk bottles 6 Canned fruit 1 Canned meat 5 Jam 1 Sausages 3 Wine 1 Salad cream and oil 3 Canned fish 1 Drink concentrate 3 Tea 1 Potato chips and crisps 2 Dried fruit 1 Pickles 2 Total 111 Coffee 2 66 samples sent for bacteriological examination were mainly of cheese manufactured in the Borough and imported meat products. These were in addition to milk and ice cream samples referred to later in this report. Meat Inspection Regulations 1963/1966 Meat Inspection At the private slaughterhouse referred to elsewhere in this report, slaughtering is normally carried out daily, involving the attendance of one or more public health inspectors. The following is a summary of action taken during the year:- Cattle excluding Cows Cows Calves Sheep Pigs Horses Number killed Number inspected 161 161 1203 1203 120 120 48 48 - 380 380 All disease except tuberculosis & cysticercus bovis:- Whole carcases condemned 8 38 9 14 - 1 Carcases of which some part or organ was condemned 113 1039 40 15 - 207 Percentages of the number inspected affected with disease other than tuberculosis and cysticercus bovis 75.16% 89.53% 40.83% 60.42% 54.74% No carcase was condemned for tuberculosis, and there were two cow carcases of which some part or organ was condemned because of cysticercus bovis. Of the 380 horses slaughtered for human consumption, the majority were intended for export. In addition to the inspection of carcases at the slaughterhouse, a large amount of time was spent by the Senior Meat Inspector in inspecting meat and other foods in the many wholesale butcher establishments, food warehouses and bacon factories in that part of the Borough adjacent to Smithfield Meat Market. Apart from meat, offals and bacon, which were both imported and home killed, the Inspector was engaged in examining poultry, game, rabbits, sausage casings and canned goods. 64 65 Slaughter of Animals Act, 1958 Slaughtermen's Licences During the year 9 Licences were issued and were current at 31st December. Export Certificates - Food 309 export certificates were issued; the food which consisted mainly of animal casings, bacon, meat and meat extracts, tinned and bottled meats and soups was exported to 44 countries, the majority to Germany, Canada, Ceylon, Malta, U.S.A. Lebanon, Belgium, Italy, Bermuda, Trinidad; other countries included France, Sweden, Austria, Holland, Switzerland, Ascension Isles. Merchandise Marks Act, 1887/1953 Inspections 53 Licensed Clubs Number of licensed clubs 42 Number of applications referred to the Department 4 Number of visits 60 Ice Cream Ice Cream (Heat Treatment, etc.) Regulations, 1959 Supervision of the manufacture and distribution of Ice Cream. During the year 152 inspections were made of ice cream premises and vehicles. The number of premises registered: (a) for manufacture, sale and storage 24 (b) for sale and storage 542 (c) for sale only 126 (d) for storage only 3 695 Ice Cream Samples 1. Bacteriological Examination 116 samples of ice cream were sent for bacteriological examination and following Methylene Blue tests, were graded as follows:- Grade I 49 Grade II 19 Grade III 21 Grade IV 27 116 Samples falling within Grades I or II are considered satisfactory. Where results were not satisfactory, and the ice-cream was made outside the Borough, the appropriate Local Authority was notified. In the cases of locally made ice-cream, or where faulty handling by the retailer was suspected, follow-up visits were made and advice given. Further samples were then taken until satisfactory results were obtained. 2. Chemical Analysis One sample was sent for chemical examination and was found to be satisfactory. Milk Samples 1. Bacteriological Examination Class of Milk Results Phosphatase Methylene Blue Turbidity Biological Total Number of samples Untreated Satisfactory - - - - - Unsatisfactory - 10 - - 10 2. Chemical Examination Details of samples submitted. Satisfactory Unsatisfactory Total Formal - - - Informal 41 3 44 Milk (Special Designation) Regulations, 1963 (as amended) Number of Licences in force 416 Milk and Dairies (General) Regulations, 1959 Number of Dairies registered in the Borough 11 Number of Distributors registered in the Borough 409 Milk Supplies - Brucella Abortus 2 samples were taken during the year, with negative results. The Liquid Egg (Pasteurisation) Regulations, 1963 There are no egg pasteurisation plants in the Borough. 66 67 HEALTH EDUCATION SERVICE The Health Education Service continued to expand by offering further facilities to the public. Health Education is one of the most vital factors in the area of preventive medicine, it has many facets which are presented to the public by most members of the department, particularly those who are in the field. Its main features are the dissemination of information about the health services and the important aspects of promoting mental and physical health, particularly in an endeavour to change many "bad habits" such as smoking and over-eating, which are taken for granted. It encourages support for "community action" clean air, fluoridation etc., and "individual action", immunisation, cervical cytology, etc. It should be remembered that knowledge alone has no value, it must be applied and backed by action not only by the educator but by those who receive the information. HEALTH EDUCATION IN SCHOOLS AND FURTHER EDUCATION ESTABLISHMENTS More headteachers took advantage of the facilities offered to them in the form of specialised films and talks on a number of health topics given by the Health Education Officer and members of the nursing staff. In some schools Public Health Department staff became virtually part of the school staff and thus enjoyed the particularly happy position of being recognised as specialist visitors to the schools but at the same time a degree of acceptance was created with the pupils which enabled a more spontaneous flow of questions and answers to be given at the appropriate times. The subjects covered a very wide spectrum and were directed towards living and enjoying life to the full. The old ideas of sex education alone were superseded by courses on human relationships. Whilst approaching the subject of reproduction other relative subjects were also discussed, these included growth and development, diet and nutrition, venereal disease, alcoholism and drugs, smoking, health hazards and the growth of social awareness. The nursing service continued with its part of the health education programme by conducting mothercraft classes. Liaison with Holloway Prison was maintained and the Health Education Officer regularly visited and gave talks on various health topics. Another link was forged with the Central Y.M.C.A. who provided specific courses on "Citizenship and Integration into Working Life", for young people. The Health Education Officer was asked to take an active part in these courses, many of which were directed towards school children from Islington. IEALTH EDUCATION ADVISORY PANEL The departmental Health Education Advisory Panel met every month under the chairmanship of the Deputy Medical Officer of Health to examine new material and visual aids which were published or produced and also to discuss ways in which health education could be furthered in the Borough. In addition, monthly themes were selected for special projects and campaigns; the topics covered during 1967 were:- January - Fire Protection and Hypothermia February - Smoking March - Foot and Personal Hygiene April - Food Hygiene and Storage 68 May - Dental Health June - Mental Health July - Home & Water Safety ) With additional August Holiday Activities ) outside publicity to stress water safety. September - Prophylaxis October r Fire Safety and Fireworks ) With additional ) outside publicity November - Are you a slave? )to stress oil December - Good Neighbours ) Heater Safety. Many ideas and suggestions came from the Panel and wherever possible these were put to practical use. HEALTH GET-TOGETHERS FOR OVER 60s In 1966 two geriatric preventive clinics were set up in the Borough. Arising from this it was felt that health education sessions specifically directed towards our "senior citizens" would be useful in attempting to assist our retired persons to obtain more from their retirement. Three weekly sessions were commenced at Blythe Mansions Welfare Centre, East Islington Welfare Centre and Pine Street Welfare Centre. The first of these sessions was formally inaugurated by His Worship the Mayor, Councillor A.E. White, at Blythe Mansions on 27th September. They proved to be a tremendous success as they not only enabled our older folk to obtain advice on a varied selection of health and social topics but also enabled a social discourse to take place which is not always available to the elderly, and thus they had something to look forward to each week. SMOKING ADVISORY CLINIC It is pleasing to note that the smoking advisory clinic continued to function with the same degree of success. Attendances during 1967 increased slightly. One would, of course, like to have an even better attendance but it would appear that the public is still apathetic in its attitude to smoking. A film unit from the American Television Education Service filmed the proceedings of a typical clinic in progress and this was shown on the American Education Television Network. In addition film units from the B.B.C. visited the clinic and included some of its work in a programme on smoking which was featured in the "Horizon" series on B.B.C.2; subsequently the programme was repeated on B.B.C.1, and aroused much interest and comment. MENTAL HEALTH WEEK Once again the department co-operated in publicising and actively took part in National Mental Health Week. This year a more ambitious and extensive programme was carried out. Film Shows with a speaker from the Mental Health Section were given at a number of churches, and other interested organisations, including The British Legion and The Finsbury Rotary Club, also accepted these facilities. In addition, many schools were visited for the purpose of showing a film and receiving a talk on this vital subject. There was also an exhibition of handwork done by the young men and women who attend our training centres for the mentally handicapped. This was displayed in the foyer of the Town Hall as well as an exhibition of "Art Therapy" together with interpretations of art work which is done by the mentally ill at the Springfield Hospital, Tooting. This aroused much interest and comment from the public who are now begihning to understand that mental illness is something not to be ashamed of. HOME SAFETY This very vital subject which requires constant attention was continually brought to the notice of the public, so few of whom realise that more deaths are caused in the home through accidents than occur on the roads. In order to publicise this problem and in celebration of the Golden Jubilee of the Voluntary Accident Prevention Movement, the Royal Society for the Prevention of Accidents organised a Greater London Home Safety Competition and invited all London Boroughs to take part. The Health Education Service gladly co-operated in their suggestion and indeed the Home Safety Committee suggested that a local Islington home safety competition should be run at the same time and that entries for the Greater London competition should be automatically entered in our own local competition. Many local commercial organisations very kindly donated prizes for the Islington competition in which more than 2,500 people took part. It is pleasing to note that an entrant from Islington won a prize in the Greater London competition in the under 12 age group. Fireworks In an endeavour to press home the need for caution in the handling of fireworks a display which depicted a typical bonfire night scene was displayed in the Public Health Department window, and headteachers of primary and secondary schools in the area were asked to draw the attention of their pupils to accidents that can occur through misuse or careless handling of fireworks. The request was accompanied by appropriate posters and leaflets for distribution to the children and display in the schools. 69 70 IN-SERVICE TRAINING It is appreciated that Health problems which arise from time to time whether they be local or national should be discussed and, if possible, training on the recognition and handling of these problems given to members of field staff. The problem of drug addiction has now reached national proportions and it was felt that a special training session should be given to selected members of staff. Dr. S. Caruana, Deputy Medical Director of the Central Council for Health Education presented a most interesting insight into the problem as it is now known, and from this, because of the great interest evoked, it was decided that a whole day in-service training course entitled "The Aspects of Drug Addiction" be held. The experts who gave papers on this subject during the morning session were, L.J. Ackroyd, Esq., B. Sc., one of H. M. Inspectors (Dangerous Drugs) of the Home Office, Dr. D. T. Wilson, M. B., B. S., of St. Bernard's Hospital and Dr. S. Caruana, 0. StJ., M. D., B. Sc., D. P.H., D. T. M. & H., M.R. S. H. , Deputy Medical Director of the Central Council for Health Education, and the afternoon session was devoted to the screening of two films and discussing the papers and proceedings. More than 160 interested persons attended and included in this group were members of medical and nursing staff, headteachers, the Pro Vice Chancellor of the City University, youth officers, ministers of religion, health education officers from other Boroughs, social workers, etc. Much was gained from this exercise and new knowledge and ideas were exchanged. It will be seen from the varied activities of the Health Education Service that this area of preventive medicine is now being expanded and greater use is being made of the facilities which are available. It is hoped that the desire for knowledge and its subsequent implementation will continue so that happier and healthier lives are led and the World Health Organisation definition of good health, which is, "a state of complete physical, mental, and social well-being and not simply the absence of disease or infirmity," be carried out to its realisation. SCHOOL HEALTH SERVICE The Inner London Education Authority is responsible for the School Health Service, but by virtue of an agreement required by Section 32 of the London Government Act 1963 there is joint use by the Authority and the Borough of professional staff, premises and equipment. The Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area and is responsible to that Authority for the day to day running of the Service. During the year the co-operation received from the Medical Adviser's Department of the Inner London Education Authority, the local Divisional Education Officer and, especially from headteachers in fitting in medical examinations, dental inspections, immunisation sessions and health education sessions into an already crowded time-table, was very much appreciated. The School roll decreased from 36,106 in 1966 to 35,123 in 1967. Special Schools A new school for partially sighted children, called New River School was opened in Hackney on 27th February 1967. Pupils from Harborough School in Islington were transferred there on 1st March 1967. A new school for maladjusted (autistic) children was opened in the Harborough School premises, starting with small numbers and building up gradually. Medical Examinations 13,543 routine, 3,999 special and 8,324 re-inspection medical examinations were held in schools in the Borough during 1967 and a total of 30,561 health surveys were made by school nurses. In July 1967, arrangements were made for statistics of health surveys and children referred for cleansing to be recorded by sex in future. Statutory examinations Arrangements were made for children for whom special secondary educational treatment might be required, to be recommended for statutory examinations at least 12 months before they reached the age of 11+, so that a final decision could be made six months before transfer. This was to avoid interviews at and acceptance by secondary schools, purchase by the parents of school uniforms etc, while in the background was the possibility that at a very late stage in the school year, a recommendation for day E.S.N, school would be made, thus making negotiations with the parents all the more difficult. Selective Medical Examinations During the year, at the request of the headteachers concerned, arrangements were made for eleven schools in the Borough to discontinue the Selective Medical Examination scheme whereby only selected children of 7 years were medically examined after the forms completed by parents had been discussed. At these eleven schools, the normal routine examination of all children of this age were resumed. 22 schools in the Borough were still participating in this scheme at the end of the year. School Journey Medical Examinations During 1967, medical examinations by a medical officer were arranged for 62 school journey parties and 31 parties were examined by a school nurse. All children in the Borough 71 72 who were going on school journeys were examined at least 96 hours before the date of departure in order to ascertain whether they were physically fit to go away; but the 31 parties seen by the school nurses only were going to Inner London Education Authority camps where a school nurse was in attendance. The number of medical examinations by a medical officer increased from 1,919 in 1966 to 2,014 in 1967. Transfer of Medical Records Headteachers were asked to supply school nurses with a list of any new entrants at the beginning of each term (or whenever possible at least at the end of the previous term) so that arrangements might be made to transfer child welfare records to the school before the child's first medical examination. Survey of Heights and Weights The follow-up of the heights and weights survey which commenced in 1966 was carried out in 4 secondary schools and 2 primary schools in the Borough. This survey of London schoolchildren, which includes children in schools in this Borough, was the latest in a survey which began in 1904-5 and which has provided unique large-scale information on the changing standards of children's physique. The reports on the survey have achieved a world-wide reputation and are regarded as authoritative standards on the subject. The Department of Education and Science, the Ministry of Agriculture, Fisheries and Food, and the Ministry of Health have all taken a keen interest both in the planning of the surveys and in the results. The follow-up is a new feature of the surveys provided by Dr. Tanner as a guide to rate of growth. This follow-up may produce information never previously available on such a reliably large scale, and may make a unique contribution to medical knowledge. Audiology 6,562 sweep tests and 771 pure tone tests were carried out by school nurses on children in schools in the Borough. Of these, 335 found to have defective hearing were referred for further investigation. 244 attended the audiology sessions held during the year. There was a total attendance of 511 at the 40 sessions. In addition, the otologist paid regular visits to Frank Barnes School for the Deaf and to the Partially Hearing Unit at Hargrave Park School. Special Investigation Clinics School children who were enuretic, obese or a minority suffering from poor nutrition were referred to one of the special investigation clinics. At the beginning of the year, sessions were being held at 6 different centres in the Borough; but from 31st October 1967, the weekly session at East Islington Welfare Centre was decreased to a fortnightly session, and a fortnightly session commenced at Leage Street Welfare Centre on 7th November 1967. 85 children were discharged during the year compared with 80 in 1966 and total attendances increased from 1,972 in 1966 to 2,031 in 1967. Mr. Turner, non-medical assistant psychologist from the Maudesley Research Unit, attended one of the special investigation clinics every week until March 1967. He carried out intelligence and psychological tests on the enuretic children as further research following the paper published by him and Dr. Young entitled "CNS Stimulant Drugs and Conditioning Treatment of Nocturnal Enuresis (1965)". Physiotherapy The last physiotherapy session for schoolchildren at Finsbury Health Centre was held on 29th August 1967. After that time children needing foot exercises were referred to their general practitioners unless remedial exercises were held at their school. Those needing breathing exercises were sent to their general practitioners for referral to the nearest hospital out-patients' department. Survey of School Treatment Centres On behalf of the Medical Adviser, a comprehensive statement was prepared of data relating to all school health services clinics in the Borough. This necessitated visits in May 1967 to all premises where minor ailments, special investigation, vision, audiology, school dental, and school physiotherapy clinics were held and speech therapy was provided. Drug taking amongst schoolchildren In order that staff at schools should be fully aware of what might be possible evidence of drug taking, letters and booklets were sent to headteachers of all secondary schools giving information on symptoms. They were asked to contact the school doctor if they were suspicious that a boy or girl was taking drugs. The school doctor could examine the child if he or she did not object; but the parent's consent should be obtained if there was any objection from the child. Dr. Arnold, Deputy Medical Officer of Health, acted as co-ordinator for all matters concerning drug taking in schools, all information being sent to her. A full day course on the subject for staff, head teachers and other interested teaching staff in the Borough was held at Finsbury Town Hall in October. Health Education Officers and staff of other Boroughs were also invited. Only three suspected cases of drug taking were reported from schools in the Borough during 1967 and in none of these cases was the doctor able to find any evidence. Although I wish to do everything possible to discourage drug taking, I am glad to say that from my experience this problem amongst school children is, in my opinion, not as great as the widespread publicity in the press etc. has made it out to be. Tuberculosis Incidents A notification was received during the year that an 18 year old schoolboy was suffering from pulmonary tuberculosis. Following investigation of child contacts, ten children were found to be in need of treatment. One of these was found to be suffering from tuberculosis of the cervical glands. B.C.G. Vaccination Four more schools were visited this year resulting in 1,879 schoolchildren being Mantoux tested (600 more than in 1966) at 23 schools. 1,697 of these children were given B.C.G. vaccination, 79 were x-rayed and of these 47 were found to need treatment. Prophylaxis Sessions in Schools The number of immunisation sessions held in primary schools in the Borough increased from 34 in 1966 to 43 in 1967. Of these 32 compared with 26 in 1966 were first visits and 3,172 children compared with 2,285 last year received complete courses of immunisation. A further number of children started courses of immunisation at these sessions and were referred to local welfare centres for completion. It is estimated that the average percentage of children protected by immunisation in the schools was raised by 15%. 73 74 Medical Treatment for Schoolchildren The number of sessions, new cases and total attendances at schoolchildren*s clinics during 1967 (including sessions held in hospital premises) were as follows:- Type of clinic No. of sessions New Cases Attendances Minor Ailments (Nurses) 304 (301)* 1041 (975) 6349 (6958) Special Investigation 270 (270) 301 (351) 2031 (1972) Dental 2082 (2272) 12991 (7006) 17375 (19426) Vision 249 (361) 941 (1653) 4649 (6541) Orthoptic - (49) - (13) - (195) Audiology 40 (42) 244 (401) 511 (596) * figures in brackets refer to 1966 Bathing Centres No. attendances for treatment of scabies 164 (93) No. of attendances for treatment of vermin and nits 170 (152) Visits by schoolgirls to Mental Health establishments Two 17 year old girls from Highbury Hill School spent one afternoon a week during the autumn term at mental health establishments as part of their social service. S. KING Principal School Medical Officer REPORT OF THE CHIEF DENTAL OFFICER AND PRINCIPAL SCHOOL DENTAL OFFICER In writing the report on this service which is run on behalf of the Inner London Educa- , tion Authority and in which the Borough collaborates, it is gratifying to be able to say that the joint efforts have resulted in a continued improvement in the re-equipment of the dental surgeries and that items ordered in 1966, such as new spotlights and air-rotors, are now in position in the respective clinics. The number of dentists employed (whole time equivalent) was .3 less than last year. This resulted in a decrease in the total number of sessions held from 2,272 to 2,104. There were more inspection sessions and less treatment sessions because of the new dental scheme. This also resulted in the number of first inspections at school increasing from 2,228 to 4,963; the percentage needing treatment found at inspections had decreased and at re-inspections increased, but both figures were higher than the area average. The average number of fillings per session of permanent teeth was slightly less than last year and of temporary teeth the same. The average number of extractions per session of both permanent and temporary teeth was 0.1 less than last year. It has proved to be a very difficult year from the point of view of staffing as although the nursing situation gradually sorted itself out, there were resignations of dental staff which resulted in a smaller volume of work and contributed to a late start in the reinspection scheme. This problem has continued and the prospect for 1968 does not seem bright if we cannot recruit staff. Every effort is being made in this direction but it seems to be part of a larger problem in which salary plays a considerable part. Despite this the average attendances have remained consistently good and it is obvious that 1968 will show that the momentum of inspections will have gathered pace and there are good grounds for optimism in this direction. The number of fillings of permanent teeth was 1,850. The number of fillings of temporary teeth was 1,292. The number of extractions of permanent teeth was 70 and of temporary teeth was 566. Other dental operations were 1,837. These figures represent a fair average and are only smaller in as much as they relate to a depleted staff. One can only hope that the staff position will improve during the coming year. A survey of decayed, missing extracted and filled teeth of the five year olds was conducted in the schools at the instigation of the Authority, it being found that the position was much the same as in the other boroughs. Finally a word of thanks must be given for the co-operation received from all sections of the staff during the year. As far as the Maternity and Child Welfare Service is concerned, this has proceeded on much the same lines as the previous year with the same problem as then - a diminishing number of people using it at Pine Street due to the shrinkage in the number of families. Changing patterns of housing will, of course, affect this in the future. The number of sessions both Borough Council and Voluntary Committee equalled 274. The total attendances of expectant and nursing mothers were 286 and of children under five years of age 913. R. E. Hyman, Principal School Dental Officer. Chief Dental Officer. 75 76 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN Maternity and Child Welfare Centres The local welfare centres are the focal points to which members of the community come for information and help. At all centres health visitors are available for some part of each day, to those who wish to see them, as well as attending clinic sessions. Records kept during a typical week in November 1967 showed that there were 126 callers at welfare centres, other than those who attended for clinic sessions. One of the main aims of the work carried out at welfare centres is to safeguard the health of the expectant mother because on her health depends, in a large measure, the wellbeing of her baby, and to supervise the health of the baby during infancy and early childhood. Particular attention is paid by medical officers and health visitors to the diagnosis of abnormalities in the early months and years of life, (see below on handicap and observation register). In November 1967 Circular 23/67 was received from the Ministry of Health. This drew attention to the particular importance of welfare foods to mothers and young children particularly those in the lowest income groups. Field staff were accordingly instructed to advise families who were eligible for free supplies. Further steps were taken to decentralise the work of home visitors to the elderly. By the end of the year, four home visitors were based at three welfare centres. The number of occasional creche sessions was increased during the year and sessions held at 7 centres. The children of women attending clinic activities are admitted free of charge, as are the children of women who have appointments at hospitals. Two new establishments were opened during the year. Blythe Mansions The voluntary committee responsible for the organisation of North Islington Welfare Centre also ran a sub-centre in the community centre Blythe Mansions, Highcroft Road, N.19. Soon after the formation of the Borough it was realised that there was scope for increasing the use made of this centre. It is well sited in the North East of the Borough near a new development in Hornsey Lane. The voluntary committee agreed to the services being taken over by the Borough. Various adaptations were made and on 13th March, the premises were re-opened as a full-scale centre providing the complete range of maternity and child welfare services. A most successful open day was held on 19th April which was attended by the Chairman of the Personal Health Committee and other members of the Council. This centre undoubtedly fulfills a need and provides local services in a densely populated area. Isledon Road Sub-Centre Towards the end of 1966 the Personal Health Committee decided that it would be desirable to open a sub-centre to East Islington Welfare Centre to cover the area south of Seven Sisters Road. Suitable premises were found in the Civil Defence Centre in Isledon Road. The subcentre was opened in April 1967 with 2 infant welfare sessions a week (with vaccination and immunisation for children under 5) and a monthly toddlers session. In September two occasional creche sessions were started to coincide with the infant welfare sessions. An "At Home" at the Centre was held on 1st May. Summary of maternity and child welfare attendances Child welfare - Total attendances 60,064 (65,636) Toddlers - Total attendances 5,059 ( 5,884) A/N & P/N - Total attendances (excluding GPO sessions) 6,838 ( 9,294) Grand total 71,961 (80,814) No. of occasional creche sessions per week 8 (3) Total attendances during 1967. 2,306 (794) Cervical Cytology The North London Local Co-ordinating Committee for Population Screening for Cancer of the Cervix set up at the end of 1966 under the Chairmanship of the Medical Officer of Health of the London Borough of Islington, held four meetings during 1967. Members of the Committee included representatives of local general practitioners, hospital medical officers and the Medical Officers of Health of the adjoining Boroughs of Camden and Haringey. The provision of cytology kits and the use of the national standard record form referred to in Ministry of Health Circular 18/66 and HN(66)67 were items discussed by the Comnittee, and arrangements were agreed for these to be provided by the Supplies Officer of the North London Group Hospital Management Committee to local doctors and to borough clinics without charge, commencing end of April 1967. Two day-time clinics were provided during 1966 for the collection of cervical smears from well women for cytological investigation by the Pathologist at the Royal Northern Hospital. These continued to be held at Drayton Park and at Pine Street Welfare Centres, where the sessions were increased during 1967 from one to two per week which included an evening session at each Centre. In addition, another weekly day-time session commenced in June 1967 at the Blythe Mansions Welfare Centre and plans were in hand for a weekly session to be held at the Barnsbury Welfare Centre commencing early in 1968. All these sessions were combined, 3 with Family Planning clinics and 2 with ante-natal clinics. Attendances were all by appointment. The total number of smears sent for examination increased from 263 in 1966 to 953 during 1967. Cytological statistics to 31.12.67 Total number of cases 953 909 Normal 42 Other gynecological disorders (excluding cancer) which required treatment. These women were referred either to their general practitioner or directly for gynecological advice and treatment. 2 Doubtful cases referred for repeat examination. Age Grows Under 25 60 25 - 34 290 35 - 44 321 77 45 - 54 210 Over 55 72 Day Care of Children Day Nurseries There are five Council day nurseries providing a total of 299 places for children under 5. Pour of these are training nurseries, and twenty students were in training during the year. Seven students sat the N.N.E.B. examination in 1967, and all were successful. The demand in the Borough for the day care of young pre-school children with consequent pressure on the Council's day nursery accommodation continued. This is partly due to the relatively high proportion of unsupported mothers in the borough. It was possible to admit only children in the highest priority groups (i.e. where there was one parent, or where the health of the mother or of the child was suffering, or a handicapped child needed to mix with normal children). In common with the home help service, the nursery service contributes to the prevention of children being taken into residential care. The following table illustrates the high demand for places: Average daily attendance during the year 269 Average rate of occupation 90% Waiting list at the end of the year Priority cases 104 Non-priority cases 85 Total 189 Child Minding Child minders are in two categories (i) those women registered by the Council under the provision of the Nurseries and Child Minders Regulation Act 1948, to mind three or more children and (ii) those voluntarily registered by the Council to mind less than three children and who receive a weekly fee of 6/- from the Council. Regulations laid down by the Council for these voluntarily registered minders include taking the child regularly to the local welfare centre. Before registration under either of these schemes the Council had to be satisfied about the suitability of the minder to care for young children and that there were adequate facilities in her home to meet their needs. All minders were visited regularly in their homes by the Council's medical officers or health visitors. Statistics for 1967 are as follows, with comparative figures for 1966 shown in brackets:- Statutorily registered child minders at end of 1967 16 (17) Total number of children actually minded at 31.12.67 59 (69) Voluntarily registered child minders at end of 1967 45 (60) Total number of children actually minded at 31.12.67 65 (99) There were also two private day nurseries registered under the Nurseries and Child Minders Regulation Act 1948, providing a total of 34 places. One of these nurseries is for mentally handicapped children. 78 Unsatisfactory or illegal minding of children continued to give cause for concern. Health visitors diligently followed up all cases discovered by them or referred by other agencies. Senior medical and nursing staff visited all applicants for statutory registration and those who continued their illegal activities against advice. Many women were found to be minding more children than was permitted under the Nurseries and Child Minders Regulation Act, 1948, and in unsuitable conditions; but as the children were stated to be relatives legal action could not be taken. Others were reluctant to disclose the fact that they were minding children out of fear that their activities would be stopped thus leading to loss of income. Domiciliary Midwifery Service The number of domiciliary confinements declined during 1967 although there was a slight increase in the number of planned early discharges. The decline in the birth rate, the increase in available hospital beds and planned early discharge all account for the changing pattern of domiciliary midwifery care. In addition to the 507 confinements 77 other patients were booked for domiciliary confinement but subsequently transferred before delivery to the hospital service:- 16 due to complications of pregnancy 20 in premature labour 41 in labour at term. There were 19 calls for the services of the emergency obstetric unit. The Planned Early Discharge Scheme from Hospital, continued to maintain its popularity. 542 assessments of home conditions were made during the year, 71 were found to be unsuitable. 158 remained in hospital for nursing. Of the 471 patients accepted, 313 were subsequently discharged home. In addition 166 other mothers who were delivered in hospital were nursed in the district following unplanned early discharges. Group attachment of a domiciliary midwife In March a domiciliary midwife was attached to a group practice of four doctors. During the nine months 20 domiciliary confinements were booked and subsequently delivered. In addition 17 planned early discharge patients were given ante and post-natal care. The midwife attached to the group practice relieved off duty with two colleagues. Maternal Deaths Confidential enquiries in accordance with Ministry of Health instructions were initiated into the deaths of four women who had been Islington residents; in no case has the Council's staff been concerned in care or treatment given. Stillbirths 2 domiciliary stillbirths occurred during the year; 1 case had been booked for domiciliary delivery by a Council midwife and the other was an emergency to which the Council's midwife was called. In both cases the infant was born before the midwife arrived. Training Of the Council's full-time midwives, 11 were approved by the Central Midwives Board as district teaching midwives to train pupil midwives for the three months district experience that is required in the second period of their training. The Council accept pupil midwives from the City of London Maternity and Paddington General Hospitals. During 1967, 36 pupils 79 completed their district experience, and a further 9 were in training at the end of the year. Health Visiting Problems experienced by families of all kinds are often brought to the health visitor, either during her work in the welfare centres or when home visiting. Through her training, she has special knowledge and competence to recognise deviation from the normal in any family's circumstances, and her constant endeavour is to assist in the provision of the sound environment children need for normal development. She aims to achieve this by giving advice and support either herself or through other statutory and voluntary agencies, and by health education. Health visitors teach in Colleges for Further Education, in a number of schools, in welfare centres, and lecture to voluntary agencies of various kinds. The "Health Education Circles for the Elderly" were consistently well attended and talks were given on safety in the home, the Ministry of Social Security and the help it can give to the elderly, aids to living which the welfare department can provide, the dangers of smoking, the work of the public health inspector. The lively discussions that follow each talk show clearly how much mental stimulus our older citizens derive from these meetings. Accidents in the home continue to occur, and the follow-up by health visitors of cases of fire in the Borough increased considerably, amounting to more than five times the number investigated during 1966. Statistics are as follows:- 1. Total number of Fires notified 85 2.(A) Number of Fatalities (Total) 8 (9.4%) (B) Number of Fires involving fatalities 5 (C) Number of children involved 4 3.(A) Number of injuries (Total) 6 (B) Number of Fires involving injuries 3 4. Number of Fires involving oil heaters 62 (73%) During the year health visitors took part in several surveys sponsored by other agencies, including a "Burn Study" by Prof. Wilkinson at the Hospital for Sick Children, Great Ormond Street; the Medical Research Council's Measles Vaccination Follow-up; and a survey on Law and Poverty by the London School of Economics. As many more mothers with young children are out at work, more evening visiting by health visitors was necessary. This ensured that working wives and their children were not deprived of the services of a health visitor and interviews with both parents could take place. Five student health visitors were sponsored by the Borough during 1967 and all were successful in gaining the Health Visitor Certificate. Liaison with general practitioners was maintained. Five health visitors were attached to general practice, two working full-time with doctors in a group practice, and three part-time, visiting the surgeries concerned to assist at infant welfare clinics and on a fixed day each week for joint consultation with the doctors. 80 Cases visited by health visitors in 1967 (1966 figures in brackets) Children born between 1962 and 1967 20,819 (21,853) Persons over 65 216 (323) Mentally disordered persons 198 (204) Persons (excluding maternity cases) discharged from hospitals (other than mental hospitals) 254 (247) T.B. Households visited 26 (15) Households visited on account of other infectious illnesses 244 (154) Total effective visits 57,343 (59,236) Total ineffective visits 13,418 (13,855) Home Nursing Service During the year the system of nurses working in groups and being partially decentralised was continued. It is felt that this has improved the service given to the patients and is liked by them, as well as having increased the job satisfaction for the nurses. Most of the senior nurses, who act as leaders of the groups and have responsibility for training student district nurses in the field, attended a practical work instructor's course to equip them more fully to undertake their new responsibilities. Attachment to and liaison with general practitioners continued to be successful. The Marie Curie Memorial Foundation continued their help to patients with cancer either by paying for extra nourishment or for a night nurse to relieve relatives of the burden of continuous night nursing. The Queen Mary's Needlework Guild were generous in providing clothing for the needy at Christmas. Pupil nurses at St. Matthew's Hospital, Shepherdess Walk, attended for district nurse training within the Borough, this training being integrated with their hospital training. It included working on the district for 2 weeks in their first year and for 8 weeks at the end of their hospital training, after which they took the examination of the Queen's Institute Assessment for State Enrolled Nurses. Three schools from St. Matthew's Hospital attended during 1967, two of which completed the training and were successful. This is another scheme which is proving successful and is providing the hospital nurse with a chance to see the home and social conditions of hospital patients. During 1967 a total of thirteen students successfully completed their district nursing training in the borough and of these five came from countries outside the United Kingdom. Home Nursing Statistics (1966 figures shown in brackets) Total No. of patients being nursed at 1.1.67 637(650) do. do. 31.12.67 629(637) do. nursed during the year 2533(2634) do. visits made do. 98601(98265) do. do. to persons aged over 65 79158(77814) Proportion of visits made to persons aged over 65 80.2%(79%) Nursing treatments completed during the year 1894(2016) do. commenced do. 1896(2003) 81 Loan of Equipment The scheme for the loan of equipment, free of charge to persons being nursed (irrespective of whether by district nurse, relative or friend) in their own home, continued during the year. The items loaned included the following:- Equipment Total number loaned during 1967 Air and sorbo rings 49 Bed blocks 14 Bed cradles 45 Bed and back rests 89 Bed pans 65 Commodes 264 Dunlopillo mattresses 14 Fracture boards 21 Mackintosh sheets 138 Special beds and hoists 31 Walking aids 58 Wheel chairs and other special chairs 95 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. Where appropriate, the consent of the landlord was obtained to any necessary work being carried out to fix the guard in position. 108 fireguards were loaned in 1967. Incontinence pads Incontinence pads were supplied, mainly through district nurses and home visitors, as requested during the year. In addition, disposable knicker linings and other protective equipment were supplied on the recommendation of a medical practitioner. By arrangement with the Council's Cleansing Department, polythene bags were provided with incontinence pads and other disposable articles, which could be sealed and placed in dustbins for collection and disposal. Prophylaxis All children attending maternity and child welfare centres continued to receive a full course of protection except in cases where there were contra-indications, or where the parents refused or elected to go to their own general practitioner. Children attending the Council's day nurseries were also given protection by the medical officers who visit the nurseries. Although parents were urged to take their children who were nearing school age either to a welfare centre or to their own general practitioners for booster doses it was found that a number of children in primary schools were not fully protected. Special arrangements were 82 made to protect these children by calling them up at routine medical inspections, by arranging appointments at Welfare Centres or, where the numbers justified, by arranging special sessions in primary schools. These sessions are staffed by a doctor and a nurse with clerical assistance. During 1967 forty-three immunisation sessions were held in primary schools in the Borough. Of these thirty-two were first visits and 3,172 children received completed courses of immunisation. Children who started courses were referred to local welfare centres for completion. It is estimated that the average percentage of children protected by iirnunisation in the schools was raised by 15%. B.C.G. Vaccination Twenty-three secondary schools in the Borough were visted and 1,879 schoolchildren were Mantoux tested. 1,697 of these children were given B.C.G. vaccination, 83 children showed positive reactions and were referred to chest clinics, 79 were X-rayed and of these 47 were found to need treatment. Tuberculosis incidents A notification was received of an eighteen year old schoolboy who was suffering from pulmonary tuberculosis. Following investigation of child contacts, ten children were found to be in need of treatment, and one of these was found to be suffering from tuberculosis of the cervical glands. Primary courses completed Year of birth others aged under 16 total 1967 1966 1965 1964 1960/63 Diphtheria 2007 2109 146 88 362 334 5046 Whooping cough 1999 2088 139 74 69 28 4397 Tetanus 2007 2109 146 88 357 397 5104 Poliomyelitis 1910 2520 305 135 337 427 5634 Measles 4 139 97 51 31 2 324 Booster Diphtheria - 1496 1335 186 2547 1764 7328 Whooping cough - 1378 1278 151 303 31 3141 Tetanus - 1496 1335 187 2549 1231 6798 Poliomyelitis - 417 299 83 2454 1350 4603 Smallpox primary courses completed under 1 yr 1- 2 yrs 2-4 yrs 5-15 yrs over 16 yrs Total 61 1842 1211 117 26 3257 re-vaccination - 25 74 170 269 Measles vaccination During the year the Council expanded the scheme for vaccination against measles, vaccination being offered instead, as before, of being only on request. Supplies of vaccine All vaccines (except measles vaccine) continued to be supplied on request free of charge to general practitioners. Up to 31st March 1967 the Council paid a fee of 5/- to general 83 practitioners for each record of a completed course of immunisation providing that this record was received within three months of completion of the course. On 1st April 1967 the new arrangements outlined in the Minister of Health's circular 3/67 came into operation whereby the payments are made by the Executive Council. Chiropody Services The long waiting list of patients for domiciliary chiropody taken over from the Islington Old People's Welfare Association on 1st October, 1966, had been reduced to a waiting period for new cases of only four weeks. This was largely due to the untiring efforts of the Chief Chiropodist, both in organising and carrying out additional treatments. Patients were visited again when further treatment was required. Patients attending clinics were normally reappointed at six weekly intervals but owing to shortage of staff they had to wait for eight weeks during part of the year. Cases of special urgency were fitted in when treatment was necessary. The demand for chiropody treatment continued to grow, thanks mainly to the increasing awareness of the services available. Geriatric clinics and talks to elderly folks at welfare centres led to more referrals being made. Prior to the co-ordination of the service the Council was responsible for foot clinics at five centres whereas at the end of the year it was responsible for chiropody services at 10 centres and for all domiciliary chiropody. Although there may have been some slight reduction in the services given at the Finsbury Health Centre, the services in the borough as a whole were substantially improved. Statistical Summary, 1967 Total No. of sessions held at clinics (chiropodist sessions) 4197 (3926) Total No. of appointments booked 31893 (30707) Total attendances 28745 (28331) Analysis of attendances Children 0-4 years 9 (3) 5 - 14 years 1996 (1495) Adults Male 4789 (4945) Female 21951 (21888) TOTAL 28745 (28331) 84 Total No. of sessions held at old people's homes (chiropodist sessions) 26 (27) Total No. of appointments booked 215 (257) Total attendances 215 (257) Total No. of domiciliary appointments booked 3711 (1016) Total No. of treatments given 3498 (968) Total No. of transport appointments booked 247 (190) Total attendances 214 (169) Home Help Service Home helps continued to provide a worthwhile service in the home, the value of which cannot be over-emphasised. Apart from the help and comfort afforded to the lonely, elderly and infirm and the chronic sick, the service was also used in twenty-five instances to provide early morning and evening help in households which were motherless for various reasons (death, illness in hospital, desertion, etc.). Young children were prepared for school and escorted to and from day nurseries. The service provided a positive contribution to the prevention of children being taken into residential care and in keeping families together. Instances of the kindly help given by individual home helps beyond the service for which they were paid were numerous and were illustrated by the following two cases. A home help was provided for an elderly deaf and dumb and blind woman who was discharged from hospital with no one able to make real contact with her. The home help had not previously known anyone with such major disabilities, but she set about learning the deaf and dumb alphabet and succeeded in helping the person concerned with the result that there is a marked improvement in every way in this household. Another home help dealing with a family of husband, wife and three children all under nine years of age, showed kindness and resourcefulness over and above her official duties following the admission of the mother to a mental hospital. Her services enabled the father of the family to continue to work. During school holidays she took the children out at her own expense and in her own time. Unfortunately, the father attempted suicide following a road traffic offence and as soon as the home help heard of this (on a Sunday afternoon) she left her own family and went at once to comfort her "adopted" family. At the beginning of the year the Council authorised the payment of an allowance towards the cost of outdoor clothing for whole-time and part-time home helps with a minimum of three months service. This is in addition to the supply of indoor overalls. Statistics for the year are as follows (1966 shown in brackets):- Aged 65 or over on first visit in 1967 Aged under 65 on first visit in 1967 Chronic sick & Tuberculous Men t al ly Disordered Maternity Other Total No. of cases 2,203 (2,280) 161 (167) 10 (5) 57 (96) 213(285) 2,644 (2,833) No. of home helps employed at end of 1967 (whole-time equivalent) 188 (176) Observation and Handicap Register The Ministry of Health has asked all local health authorities to keep a register of children with a physical or mental handicap (either acquired or congenital) and of children who, because of adverse maternal factors or for other reasons, may be at risk of developing a handicap. The progress and development of the children at risk is reviewed at regular intervals until a diagnosis can be made or until it is established that no handicap is present. The screening of these children is carried out by medical officers in the welfare centres who specialise in the field of developmental paediatrics. S5 A central index of the names of all known handicapped children and young persons from the ages of 0 - 18 is being compiled and maintained at the central office. The aim of this register is to ensure that it contains the names of all handicapped children living in the Borough and that information is quickly and readily available on individual children and groups of children. Regular reviews are undertaken of medical, educational and social factors in the interest of the child, and the family. The aim is to ensure that there is co-operation in the case of every handicapped child and that essential information about the existence of a handicap, its nature and degree, and the family situation, is available to all departments and services which may have a contribution to make. Notifications of handicap come from birth notifications (form MCW 1), discharge notes of mother and baby from hospital (form MCW 28), school and clinic doctors, hospitals, schools, general practitioners, mental health social workers, other departments of the Council and other local health authorities (for children moving into the Borough). Information Plow Information from Information to Children under the age of five years, or before they are admitted to a special school, are reviewed at frequent intervals by the principal medical officer. A constant watch is kept on their progress by medical officers and health visitors, and information is obtained from and passed to hospital consultants. As each child approaches school age he or she is assessed to determine any need for special educational treatment. Schoolchildren are under the care of the school doctor. Each child's case is reviewed centrally based on reports from school medical officers received annually or more frequently where necessary. For social problems the School Care Committees and the I.C. A. A. provide links with the Public Health Department. Social workers (Health Services) are attached to the three special schools, Frank Barnes (deaf), Hargrave Park (partially hearing unit) and Cloudesley (physically handicapped). Case workers from the Elfrida Rathbone Committee visit the families of children attending the three chools for the educationally sub-normal. A social worker employed by the Inner London Education Authority based on the Public Health Department, is attached to the unit for autistic children at the Horizon school and to the Harborough School for autistic children. For school leavers there is a well established arrangement for co-ordination between the Borough services and the Handicapped Young Persons section of the Youth Qnployment Service. The principal mental health social worker or her representative, attends the sub-committee meetings on handicapped children of the Youth Qnployment Bureaux. A separate register of deaf children of all ages is maintained by the senior social worker (Health Services). Close follow-up of all children is undertaken by social workers in conjunction with the principal medical officer. Handicapped children in care who are in homes managed by the children's officer are seen by the senior medical officer on her visits to the homes. Hospital reports on individual children 86 are obtained as appropriate. Close liaison is maintained ith the Children's Officer on individual cases. In 1966 the Research and Intelligence Unit of the Greater London Council asked for cooperation in a survey of the incidence of cases of spina bifida in Greater London. This survey covered children born between 1st October 1966 and 30th September 1967. During 1967 5 children were born with spina bifida, (2 were stillbirths, one child died within a few hours of birth, one died at the age of 12 days, and one died at the age of 7 months). At the end of 1967, the number of children on the central handicap register and the observation register at Welfare Centres was:- Handicapped Register - children 0-17 years 1902 (1362 - to 16 years) Observation Register - children 0 - 5 years 2236 (1937). Prevention of break up of families The Co-ordinating Committee has continued to meet at two-monthly intervals. During the year conferences on individual families were held on 14 occasions and 69 families were considered. These figures are more than double those for 1966. Students of social work Four students from the London School of Economics came to the department during the year. Two came for experience of family casework and two for general observation of the services provided by the department. Venereal disease The Social Worker attached to the special clinic at Holloway Prison comments appreciatively on the fact that her office is now incorporated in the new clinic premises. The privacy afforded by this arrangement has made it easier for her to establish good relationships with the patients. She finds that the basic problems of her work remain the same and one of these is the deeply ingrained habit of secrecy found in those who live outside the law. The Social Worker goes on to say: "The saddest visit I have ever made was to a well-known shelter in search of a contact shortly before Christmas. There, lying on the floors and ledges, were what appeared to be bundles of very old clothes. The realisation that these bundles were people came as a shock. Surrounding them but oblivious of their presence were many other people, men and women of all ages in varying conditions of cleanliness and well-being. Some were talking, some just staring into space. Some were drug addicts, some drifters, some just tramps. The young girl to whom I spoke commented bitterly on the hopelessness of her life as a drug addict. I left acutely aware of the disinterest of the hurrying crowds in the streets. Almost beneath their feet the detritus of our society, above their heads the coloured lights of the Christmas Tree. "The most difficult case this year was trying to find the very pregnant "wife" of a male prisoner in a Remand Centre who was the contact of our patient, his "girlfriend" . I visited his family in Deptford three times before tracing the lady. Each time I was confronted by his dragon of a mother who denied any knowledge of the whereabouts of her daughter-in-law. This was true as his legal wife had deserted him some time previously. Fortunately her fiercely protective attitude to her delinquent family gave me the key to the situation. She became most helpful when I admired her dexterity in keeping her family's secrets. She gave me the girl's address and we 87 parted on splendid terms. I was able to take the "wife" to the local clinic where she received the necessary treatment in good time: the male patient was treated in the Remand Centre and the "girl-friend" was treated in Holloway." The Social Worker at the Royal Northern Hospital reports that she finds that patients generally are becoming more co-operative in attending for treatment and giving information about their contacts. Much of her time is spent in tracing contacts and sometimes escorting them to the clinic. This is particularly necessary when parents with young children are involved. On one occasion a father and his six children had to be taken to the clinic for examination. Family Planning The Council's family planning service continued to provide contraceptive advice and supplies to Islington women referred on medical/health grounds, i.e. those women likely to suffer detriment to health as a result of pregnancy. This service was provided at sessions administered directly by the Council and at those held by the Central London Branch of the Family Planning Association, grant-aided by the Council for this purpose. At the commencement of the year, two Council family planning sessions were already in being, one at Drayton Park Welfare Centre and one at Pine Street Welfare Centre. A third clinic was opened in June, 1967, at Blythe Mansions, N.19., to serve the northern part of the borough. All three clinics held weekly sessions, and referrals were made by clinic medical officers, general practitioners and hospital doctors. Attendances were by appointment. No charge was made in these medical cases at both Council and at Family Planning Association Clinics for examination, advice and supplies. Attendances at the Council's family planning clinics during 1967 totalled 401 (compared with 293 during 1966) The National Health Service (Family Planning) Act, 1967, came into force on the 28th June, 1967, extending the then existing powers of local health authorities enabling them to provide, or arrange for other bodies to provide, family planning advice on social grounds and not, as hitherto, only in medical cases. The implications of this new Act, and proposals to expand the Council's family planning service in the light of Ministry of Health Circular No.15/67 were under active consideration in co-operation with the Central London Branch of the Family Planning Association, with a view to their implementation during 1968. Recuperative Holidays The total number of recuperative holidays arranged during the year was almost the same as were arranged in 1966. These holidays were provided in suitable cases for persons recommended on medical grounds as being in need of rest, fresh air and good food to aid recovery from recent illness. Those requiring supervision, medical and nursing care, were not eligible but were referred for treatment to the appropriate Hospital Board. Recommendations on behalf of schoolchildren were mostly referred to the Inner London Education Authority which maintains two holiday homes. Recuperative holidays arranged 1966 1967 Expectant & Nursing Mothers 2 2 Tuberculous adults 17 14 Other adults 87 89 Psychiatric patients 13 17 Accompanied children 20 16 Unaccompanied children (placed by I.L.E.A.) 116 119 Total 255 257 88 MENTAL HEALTH 1. Social Work In 1967 the growth and development of the Borough mental health service continued, the majority of the mental health social workers having been working together as a team for 3 years or more and closer links having gradually developed with the general practitioners and the various agencies in the Borough and with catchment hospitals. Following the experiment referred to in previous annual reports four of the mental health social workers were linked with general practitioners and attended their surgeries for one session a week to assist with psychological problems for selected cases. This extension of the service in the preventive field is taking place under the guidance of the Borough's consultant psychiatrist who continues to spend two sessions a week in the mental health section. Student supervision was a regular feature of the expanding work, and in addition to social work student placements in the mental health section, medical students from two London Teaching Hospitals continued to spend a day each month with a mental health social worker as part of their psychiatric training. Each mental health social worker carried a mixed case load of mentally ill and mentally subnormal patients providing case work support or practical help (such as arranging short term residential care, recuperative holidays, hostel accommodation or attendance at outpatient departments) according to need and also had some special responsibility for the development of a particular day centre clinic or other project. In addition to these activities the mental health social workers continued to be available for emergency admission of patients to hospitals both day and night, on a rota basis still sharing the night and weekend work alternatively with their colleagues in the neighbouring Borough of Hackney. The total number of persons referred to the mental health section by general practitioners, local education authorities, police etc. was as follows:- Mentally ill Sub-normal and severely subnormal Total Males 410(403) 65(72) 475(475) Females 657(588) 51(54) 708(642) Totals 1,067(991) 116(126) 1,183(1,117) The total number in community care at the end of the year was 799 (829) 43(42) mentally subnormal patients were provided with short term residential care,19(20) at the Council's expense and 24(22) 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 59(37), 28(17) mentally ill and 31(20) mentally subnormal and severely sub-normal. The second National Mental Health Week proved most successful in Islington and the mental health social workers again gave talks at a variety of clinics and to senior classes in schools, church groups and other organisations throughout the Borough, the highlight of the week was a very well attended symposium at the Town Hall in which several eminent psychiatrists and Mrs. O.M. Dyke of the Women's Royal Voluntary Services (Friern Hospital) participated. 2. Day Centres and Training Centres There have been noteworthy developments at the day centres for psychiatric patients, the total attendances increasing from 5,773 in 1966 to 7,760 in 1967 and at the training 89 school and centres for the mentally subnormal. Richmond Avenue Day Centre Islington's first Day Centre, originally housed in a Church hall in Britannia Row, moved in April 1967 to improved premises in Richmond Avenue, where it has gone from strength to strength and by the end of the year there was a waiting list for admission. Those who attended were on the whole people who, due to the effects of their illness, were unlikely to return to full time work in the community, at least for some considerable time. Nevertheless, for a few of those attending, return to open employment proved possible after only a short period at this centre. Sub-contract work of the packing and light assembly variety and the repainting of nursery furniture were the main activities. Regular art classes were also available for those who were interested. Every effort was made to restore self-respect and to achieve some measure of social rehabilitation. It was possible for patients who lack adequate facilities at home to bath and shave at the centre, wash and set their hair and do their personal laundry. Towards the end of the year arrangements were made on an experimental basis for three long-stay patients from the local catchment hospital to attend Richmond Avenue Centre daily, travelling unescorted by public transport and returning to Friern Hospital at night. The aim is gradual return to full life in the community. It seems a worthwhile venture and so far results are encouraging though it is too early to reach any firm conclusions. A further development was the formation of a discussion group for relatives of day centre patients. Hie group met at the centre in the evening at regular intervals to share with one another, with the centre staff and with the mental health social worker attached to the centre, some of the problems which are common to those who live with mentally disabled relatives. Certainly the first two and half years' life of this Centre has been a time of rapid growth and development and the need for more day centre places in the Borough has become abundantly clear. Pine Street Day Centre This centre opened in January 1967 as a short term psychiatric day centre, having previously been used as a centre for E.S.N, school leavers and people who needed long term part-time support. Hie aim of this centre is to provide short term rehabilitation, the average length of stay being six months. Rehabilitation here is in the broadest sense with the emphasis on relationships and re-socialisation in both working and informal situations. The establishment has facilities for twenty patients with a staff of two, the supervisor being a trained occupational therapist. One of the Borough mental health social workers is attached to the centre and a meeting of all staff with Dr. Brook acting as psychiatric adviser is held each week. Patients are referred through the mental health social workers in community care, or direct from social workers in hospital or agencies in the area. To ensure that patients who are not suited to this type of centre are not referred, each case is discussed at the weekly staff meeting. Hie social worker presenting the case fills in a detailed form giving the history, work records, and family, situation so that the staff can assess whether or not the patient will benefit from this kind of treatment, and whether they will fit in with the present group of patients. 90 Accommodation consists of an activities room, a kitchen and an office and meeting room. The centre is run as an interdependent group, the patients being expected to contribute to the running of the group as far as their problems will allow them. One of the aims of this group structure is to encourage a sense of responsibility both towards individuals and the group as a whole. Organisation Patients and staff plan a weekly programme and job rota on a Friday and discuss the day's activities at a morning meeting. Over the year the activities have extended from industrial work, car washing, printing, craft work, art, painting nursery school chairs, to include working as a group for Task Force (decorating, cleaning windows, gardening, visiting for old people), and going on weekly outings. An important feature has been the introduction of a weekly group meeting at which individual and group problems are discussed. A weekly report by the staff covers "Admissions and discharges, attendances, psychological state of the group, and staff feelings". The patients have their own meeting, at which they write a section on the week's events and activities. Over the past few months the staff and social worker attached have been running a monthly evening group for patient's relatives. This enables them to discuss and share as a group common problems in having a relative who is mentally ill. The staff in turn can learn more of the family situation and try to help the relatives understand and cope with some of the common difficulties. Attendance In January 1967 there were five educationally subnormal school leavers, and three parttime long term patients. All but one of the school leavers have since been discharged, three to work, one as unsuitable. Since January thirty-five patients have been admitted, nine of whom are now working successfully. Three patients are currently in hospital and they are expected to return here when well enough, as has happened with four other patients previously. Twelve patients have been discharged, or discharged themselves after trial periods of varying lengths, as being unsuitable or unable to benefit at this centre. At the end of 1967 there was an attendance of eleven patients. Examples of those helped by Day Centre attendance 1. Young woman in mid twenties, with a previous history of drug addition and psychopathic behaviour. She attended the day centre regularly from April 1967 until her discharge to work in December of that year. At first she was hostile, resentful and attention seeking, isolating herself from the group, and feeling full of envy and anger towards the staff. Gradually after several months of a tolerant, accepting, but firm approach, a short spell as an in-patient in hospital, her behaviour and attitude improved. Continual liaison and meetings were held between the staff concerned to prevent manipulation through interaction with the group and staff. This girl gained insight into her emotional problems, more confidence in herself and a determination to try and accept help instead of rejecting. She made steady progress towards becoming a more mature person able to use her many capabilities and left in December to take a 91 post as a staff nursery nurse which she was still holding three months after her discharge. 2. A young nan in his late twenties attended the day centre for 7 months. He had been in a mental hospital for a short while suffering from an anxiety state which prevented him from working. When he first attended he was quiet, passive, showing little initiative or emotion, and unwilling to accept responsibility. During his time at the centre he showed a noticeable increase in self-confidence and the ability to make use of his potential working qualities. The Task Force project proved an ideal working situation for him to test out his confidence and ability as a leader. It was felt that his previous job was below his capabilities and had contributed to his breakdown so with the help of the D. R.O. he was offered a place at an Industrial Rehabilitation Centre. There he was assessed in different kinds of work and left to take a job which has since proved successful. Examples of cases where the Day Centre has been unable to help 1. 28 year old girl suffering from schizophrenia. This young woman attended the centre for several weeks and eventually left because she became too anxious. She was unable to make more than superficial contact with the group or gain any support because she was so frightened of mental illness and unable to bear hearing of other people's problems or admitting that she had any herself. The social worker worked with the patient and family at home but the girl felt too anxious to return and shortly after took an overdose and was admitted for hospital care. 2. A young man, recently discharged from hospital after his first schizophrenic breakdown. This boy is an example of the destructive influence of a mother-child relationship. He himself obviously gained much help from the centre and the group, but was torn by his mother's possessiveness and insistence that he was mad. He rapidly fitted into the group, began to express himself and become more of an individual. His conflict with his mother increased as his personality strengthened, and resulted in him attacking her one week and being admitted to hospital. The day centre kept a place for him on his discharge but his mother fetched him away prematurely, and in spite of all efforts on the part of his social worker refused to let him return to the centre. Rosemary Junior Training School This school, with its special care unit, has made steady progress and is now well established. The school participates in the training of teachers from the NAMH Training courses and from the courses run by the Training Council for Teachers of the Mentally Handicapped. A wide variety of visitors, from many parts of the world, has continued to visit to observe the activities of the children and to admire the building, and many have commented on the cheerful atmosphere which prevails. Selected boys and girls were allotted a weekly session at the local swimming bath, which was an extremely popular activity. A group from The Rosemary Junior Training School joined in a holiday at St. Mary's Bay holiday camp organised by the Inner London Boroughs. We were most fortunate in receiving generous gifts of toys for the school from local voluntary organisations. 92 The Mayor, Councillor A.E. White accompanied by the Mayoress, Mrs. G.L. White, with some of the children at the Christmas Open Day at Rosemary Junior Training School after accepting the gift of a climbing frame generously presented to the school by the Court of Scarlet Cedar of the Independent Order of Foresters and toys bought from money collected by customers of George IV Public House, Goswell Road, E.C.I. Bennett Court and Camden Road Senior Training Centres These two centres concentrated on social training. Independence was encouraged and a large number of trainees made their own way to and from the centres by public transport. In May the then Archway Training Centre moved to adapted premises, a former community centre on the Bennett Court Estate, Axminster Road, N.7, where it is able to cater for 60 trainees, both men and women. It took its new name and was officially opened by His Worship the Mayor of Islington during Mental Health Week. From the start the residents on this estate were most friendly and helpful and many near neighbours accepted invitations to the centre's first Open Day and came in with their young families to meet the trainees and see the type of work they were carrying out. Bennett Court Centre had a flexible da ily programme under the direction of the supervisor and his four assistants, training being geared to individual needs so that each trainee might be helped to reach his or her full potential, to be less of a burden to parents and to make some contribution to the community. Light assembly work, some of a very intricate type, and carpentry were the most popular activities, though a variety of other craft work is undertaken. There is a well equipped small laundry and an attractive modern kitchen designed to develop domestic skills amongst male as well as female trainees. In addition there is a school-room where small groups of trainees gathered regularly for further education classes of a practical nature. Selected trainees were able to test acquired skills by going shopping, telephoning and paying visits by public transport to places of interest. The Camden Road Centre also had a varied programme and the Centres were closely linked, the trainees mixing freely in the evenings at Gateway Clubs run by the Islington Society for Mentally Handicapped Children. 93 An enthusiastic party of young men and women from the Bennett Court and Camden Road Centres also participated in the organised holiday camp at St. Mary's Bay. For some trainees this is without doubt one of the most exciting events of the year. Attendances at the training school and centres were as follows:- Junior Senior No. of centres 1 2 No. of places 112 80 Total attendances 11.714 (8,826 from March 1966) 12,349 (12,207) Nursery School and Clubs for the Mentally Handicapped The Islington Society for Mentally Handicapped Children,grant-aided by the Borough, continued to run an excellent day nursery for children under 5 years and also a variety of clubs which have given great pleasure to mentally handicapped people of all ages. 3. Special Advisory Clinics Advice on the placement of mentally handicapped persons of all ages in the Council's training centres, the nursery for mentally handicapped children, day nurseries and in various residential homes or hostels for short or long term care has been given by a principal medical officer who has specialised in the field of subnormality. Two special assessment and advisory clinics have also been held regularly throughout the year by this principal medical officer with a mental health social worker in attendance. The aim of these clinics has been to provide the full assessment of the needs of mentally and physically handicapped children under school age and to plan their future educational needs. Many children who could not be brought to the clinics were visited in their own homes for advice and assessment in a familiar environment. * Figures in brackets relate to 1966. 94 APPENDIX "A" Establishment of Officers (as at 31.12.1967) Medical Officer of Health and Principal School Medical Officer 1 Deputy Medical Officer of Health and Deputy Principal School Medical Officer 1 Associate Medical Officer of Health 1 Principal Medical Officers 2 Senior Medical Officer 1 Medical Officers 8 14 ADMINISTRATION Chief Administrative Officer 1 Assistant Chief Administrative Officer 1 Principal Administrative Officers 3 Health Education Officer 1 Senior Administrative Officers 8 Administrative Officers 4 Administrative Assistants 14 Secretary 1 Senior Clerks 30 Clerks (one part-time) 36 Telephonist 1 Attendant Telephonists 2 Senior Typist 1 Clerk/Shorthand Typists 6 Clerk typists 2 Assistant - (Health Education) 1 Senior Supervisor (Invalid Meals Service) 1 Supervisor " " " 1 Office Attendants 2 116 INSPECTORATE AND TECHNICAL Chief Public Health Inspector 1 Deputy Chief Public Health Inspector 1 Assistant Chief Public Health Inspectors 2 Senior Public Health Inspectors 11 Public Health Inspectors 29 Senior Housing Inspector (Fire) 1 Fir e Inspectors 2 Inspectors (General Purposes) 2 Technical Assistants 9 Student Public Health Inspectors 11 Rodent Officer 1 Rodent Investigators 4 Superintendent Disinfector and Resident Caretaker 1 Superintendent of Laundry & Disinfecting Station 1 75 95 NURSING AND MIDWIFERY Principal Nursing Officer 1 Deputy Principal Nursing Officer 1 Assistant Nursing Officer 1 Centre Superintendents 9 Health Visitors 37 Student Health Visitors 9 Tuberculosis Visitors 2 Clinic Nurses (full-time equivalent 16.3) 17 School Nurses 18 95 DAY NURSERIES Matrons 5 Deputy Matrons 5 Staff Nursery Nurses 21 Nursery Wardens 5 Nursery Assistants 19 Nursery Students 22 Creche Assistant 1 78 GERIATRIC SERVICES Home Visitors 5 Assistant Home Visitors 5 Ward Sisters at Hillside Home for the Retired 10 20 DOMICILIARY MIDWIFERY Non Medical Supervisor of Midwives 1 Superintendent Midwife 1 Domiciliary Midwives 14 Domiciliary Midwives (part-time) 3 Physiotherapist (part-time) 1 20 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 96 MENTAL HEALTH Principal Mental Health Social Worker 1 Deputy Principal Mental Health Social Worker 1 Senior Mental Health Social Workers 8 Mental Health Social Workers 5 Psychiatric Social Worker 1 Senior Occupational Therapist 1 Supervisor (Junior Training Centre) 1 Deputy Supervisor (Junior Training Centre) 1 Supervisors (Training Centre) 2 Assistant Supervisors (Training Centre) 13 Supervisors (Day Centre) 2 Assistant Supervisors 3 Trainee 1 40 CHIROPODY Chief Chiropodist (Grade II) 1 Senior Chiropodists 6 Chiropodists(Sessional) (Full-time equivalent -5.1) 17 24 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 (School Health Services) (full-time equivalent 4.6) 6 Welfare Officer (V. D.) 2 11 DENTAL Chief Dental Officer and Principal School Dental Officer 1 Dental Officers 2 Dental Officers (Sessional) (full-time equivalent - 2.1) 5 Dental Surgery Assistants 7 Supernumary Dental Surgery Assistant 1 16 TOTAL NUMBER OF OFFICERS 568 (in addition lists are maintained of doctors, dentists and chiropodists who are prepared to work on a sessional basis.) 97 Establishment of Manual Workers ENVIRONMENTAL HEALTH Bathing Attendants 9 Plant Attendant 1 Washing machine attendants (male) 2 Driver/Disinfectors 5 Stoker/Handyman 1 Handyman/Drivers 4 Porter/Cleaners 2 Female Cleaner, Supervisor 1 Female Cleaners (160 hours p.w.) Foreman Rodent Operative 1 Rodent Operatives 12 MEALS-ON-WHEELS SERVICE Drivers 8 (20 hours each) Helpers 8 (17½ hours each) INVALID MEALS SERVICE Head Cook 1 (32½ hours) Assistant Cooks 2 (x 32½ hours) Kitchen Helpers 4 (3 x 32½: 1 x 20 hours) Driver/Porters 5 (4 x 20: 1 x 15 hours) Van Helpers 6 (3 x 15: 3 x 17½ hours) HOME HELP SERVICE Total Home Helps (8400 hours) HEADQUARTERS AND PERSONAL HEALTH Attendants 130 hours per week Cleaners 1094 hours per week Cooks 304 hours per week Guides 328 hours per week Kitchen Helpers 171 hours per week Laundresses 132 hours per week Needlewoman 40 hours per week Porter/Cleaner 24 hours per week Handyman Driver 1 hour per week Stoker/Handymen 4 hours per week 98 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.1 Mental Health Service Pinsbury Health Centre, Pine Street, E.C.1 Rodent Control 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 15A Springdale Road, N. 16 Disinfection and Cleansing Stations 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 Pinsbury Health Centre, Pine Street, E.C.1 Richmond Avenue 42/44 Richmond Avenue, N.1 Mental Health Adult Training Centres Archway (Male) Congregational Church Hall, Junction Road, N. 19 Camden Road (Female) Camden Road Congregational Church Hall, 577 Caledonian Road, N.7 99 Mental Health Junior Training School Rosemary (Mixed) 75 Prebend Street, N.1 (includes special unit for children with dual defects.) Midwives Hostel Scholefield Road, N.19 Chest Clinics Pinsbury Health Centre Pine Street, E.C.I (closed 31.7.67) Islington St. Mary's Wing, Whittington Hospital, Highgate Hill, N. 19 School Treatment Centres Islington 37 Uiornhill Road, N.1 Manor Gardens 6 Manor Gardens, N.7 Popham Road 26 Popham Road, N.1 Health Centre Finsbury Pine Street, E.C.1 Chest (closed 31.7.67): Chiropody; Dental and Physiotherapy Clinics; Mental Health Day Centre; Disinfection and Cleansing Station Welfare Centres Archway Congregational Church Hall, Child Welfare; Chiropody Junction Road, N.19 Barnsbury Carnegie Street, N.1 Maternity & Child Welfare; Chiropody; School Health (special investigation) Blythe Mansions Highcroft Road, N.19 Maternity and Child Welfare; Chiropody; Elderly Persons. East Islington 32 Drayton Park, N.5 Maternity and Child Welfare; Chiropody; Elderly Persons; Smoking Advisory Clinic. East Islington (Branch) 6 Hurlock Street, N.5 Child Welfare East Islington (Branch) Civil Defence Training Child Welfare Centre, 76/80 Isledon Road, N.7 Hilldrop Tenants' Clubroom Maternity and Child Welfare Hilldrop Estate, N.7 Leage Street 24 Leage Street, E.C.1 Maternity and Child Welfare Pine Street 13 Pine Street, E.C.1 Maternity and Child Welfare; Elderly Persons; School Health (minor ailments) South Islington 6 Clephane Road, N.1 Maternity and Child Welfare; Chiropody 100 South Islington (Branch) Union Chapel, Child Welfare Compton Avenue, N.1 Other Chiropody Clinics Caxton House Settlement 59 Andover Road, N.7 Gifford Hall Mission Giffond Street, N.1 Islington Medical Centre 303 Upper Street, N.1 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) Holloway Hall, Child Welfare 129 Seven Sisters Road,N.7 101 INDEX Addresses of Health Service Establishments 99-101 Audiology 72,74 Bacteriological Examinations.... 24,25,43,65,66 Basement Bakehouses 37 B. C. G. Vaccination 73,83 Bathing facilities 27,74 Caravan Sites 32 Care of mothers and young children 76-81 Cervical Cytology 77,78 Chemical Examinations 43,66 Child Minding 78,79 Chiropody Services 84 Clean Air and Atmospheric Pollution 32-35 Common Lodging House 44 Consumer Protection 29, 38, 39 Co-operation with Children's and Welfare Departments 9 Cremations 28 Day Care of Children 78-79 Day Centres & Training Centres 89-94 Day Nurseries 78, 94 Dental Services 75 Diseases of Animals Act 37, 38 Disinfection and Disinfestation 25, 32 Domiciliary Midwifery Service 79,80 Drug Addiction 70,73,87 Elderly Persons' Welfare 25-28,68,80,84 Emergency telephone arrangements after hours with Whittington Hospital 9,10 Environment Health Committee Members 5 Establishments - Addresses 99-101 „ - Officers 95-97 „ - Manual Workers 98 Factories Act 35-37 Family Planning 88 Fire Hazards 38, 39, 50, 80, 82 Fireworks 44,69 Five Year Capital Programme 3,4 Food and Drugs Administration 58-66 Food complaints 59 Food samples 63,64 Freeman, Dr. - Retirement 7,8 General and Vital Statistics 11-15 Geriatric Preventive Clinics 26,27 Grants to Voluntary Organisations 8,9 Handicapped Children & Register 85,86,87 Health Education Service 29,67-70,80 Health Centres - projects re 2-4 Health Service Premises 2,99-100 Health Visiting 23,80,81 Home Help Service 85 Home Nursing Service 81,82 Home Safety 69 Housing 48-57 Ice Cream 65,66 Immigrants 24, 29 Incontinence Pads 82 Infectious and Other Diseases - Prevalence & Control of 16-22 Junior Training School 92 Laundry Services 27 Legal Proceedings 32,39,44,45,46, 50, 57,60,61,62 Liaison with General 2,3,17,18,19, Practitioners 20,26,70,72,73, 77,79,80,81,82, 86,88,89. Loan of Equipment 82 Lung Cancer Deaths 15 Maternal Deaths 79 Meals on Wheels & Invalid Meals Service 25, 26 Meat Inspection 64,65 Medical Treatment for Schoolchildren 74 Mental Health 68,74,86,89-94 Midwifery 79,80 Milk 66 Noise Nuisances 38 Nurseries & Child Minders 78-79 Nursing Homes 46 Offensive Trades 37 Oil Heaters 38, 39 Offices, Shops & Railway Premises Act 39-42 Outworkers 36, 37 Personal Health Committee Members 5 Personal Health Services 76-88 Pharmacy & Poisons 38 Physiotherapy 72,73 Pigeons 32 Population 11 Prevention of break-up families 87 Prevention of Damage by Pests Act 42,43 Principal Officers of the Public Health Department 5,6 Prophylaxis 73,82,83 Public Control 44-47 Public Health Inspectors - Work during year 29-66 Published Papers during 1967 8 Public Analyst 63,64 Rag Flock 38 Rats and Mice 42,43 Recuperative Holidays 88 Sampling 63,64 Sanitary Circumstances of the Area 29-47 Scabies and Vermin 24,74 School Health Service 71-74 School Treatment Centres-Survey 73 Senior Training Centres 93,94 Sewerage & Sewerage Disposal 44 Shops Act 45,47 Slaughterhouses 37 Smoke Control Areas 32, 33 102 Snoking Advisory Clinic 68 Special Investigation Clinics 72 Sfrina Bifida 87 Statistics, General & Vital 11-15 Stillbirths 79 Street Markets 29, 58 Students & Schoolchildren's Visits 9,74,87 Supervision of Pood58-66 Task Force 27, 28 Training: - Day Nurseries 78 District Nursing 81 Health Education 70 Health Visiting 80 Mental Health 92 Midwifery 79,80 Tuberculosis 15, 21-23,73,83 Unfit Food 63 Vaccination & Immunisation 83,84 Venereal Disease 87, 88 Vital Statistics 11-15 Voluntary Organisations 8 , 9 , 25, 27 , 28, 76,88,89,93,94, 101. Water Supply 43, 44 Welfare Department - Oo-operation with Children's & Welfare Departments 9 Whittington Hospital - Emergency telephone arrangements after - hours 9,10 Works in default 32 103 PRINTED BY THE LONDON BOROUGH OF ISLINGTON