ISL 92 ANNUAL REPORT of the Medical Officer of Health London Borough of Islington 1968 To the Mayor, Aldermen and Councillors of the London Borough of Islington INTRODUCTION In my previous reports, I was able to summarise the steps taken to plan the new Borough Public Health Department in 1965, and to describe measures to consolidate it in the following two years. In 1968, the subject of this my fourth annual report, a number of important outside factors operated during the year. The Municipal Elections resulted in an almost i complete change of membership in the Committees to which the Department is responsible. This led to a re-examination of the policy issues involved. There was, however, no hold-up on essential developments, and that this was due in a large measure to the understanding and initiative of the new Chairmen of the Committees. Indeed, after an inevitable but short transitional period, the progress and growth of the Borough's Health Service continued unabated, as will be seen from the pages of this report. Two factors influenced the Department's activities in the field of housing. The new Committee's policy of reviewing all housing development areas and concentrating on improvement increased the Department's commitments. Concurrently the Government White Paper "Old Houses into New Homes", while dependent for its long-term effect on future legislation and on the Council's policy decisions, called for an assessment of probable lines of action and of an overall strategy for the improvement of older houses. Among other Government decisions, there were two which particularly affected the Department. The inter-Departmental joint circular on the Urban Programme offered financial assistance to certain local authorities with special needs on social and environmental grounds. Islington was one of these, and application was made and granted towards the cost of two day nurseries, the completion of which will thus be expedited in the Borough's FiveYear Capital Programme. The Health Services and Public Health Act, 1968, tightened up the law regulating child-minding by persons in their homes and in private nurseries. The changes were based on representations made by many local health authorities, including Islington. They are referred to in greater detail later in the report, and the general result is that the number of persons to be registered, and the requirements to be imposed in each case, have greatly increased. A notable step forward in the care of old people was the extension of the Meals-on-Wheels Service to provide week-end meals. Parallel with this has been a consistent growth of weekday meals services, with an improved organisation, which reflects the interest of all the staff responsible. A measure of the personal attention shown to old people was provided by a driver (Mr. W. Wood) and a helper (Mrs. Duncan) who were unable to get a reply when delivering a meal, and by forcing their way into a room were able to pull an old man away from the fire, into which he had collapsed. They received an official Commendation for the action. The Department's Development Programme of Capital Expenditure was kept under constant review, in consultation with the Borough Architect and other chief officers. Set in motion in 1965, it has called for patient planning and application. At the end of 1968, it was taking definite shape, so that (subject to the necessary financial sanction) the Borough will have a dozen new establishments by 1972, as a first instalment of the Five-Year Programme. Details are set out later in the report. The Smoke Control Programme was expedited with the objective of completing the whole area of the Borough by 1970. Advantage was taken of the offer of the Civil Defence Centre in Isledon Road, N.7., which with minimum adaptations will provide an industrial centre for mentally subnormal adults and will allow the fuller development of the training facilities for all the mentally subnormal persons in community care, including a new special care unit for severely afflicted young persons in the Camden Road Congregational Church Hall, N.7. For the mentally ill, a part-time day centre for disturbed old persons was provided in co-operation with the Salvation Army at the Archway Citadel, N.19. It was also possible to supplement the Council's day nursery accommodation by an agreement with the National Children's Home to take 20 places at the newly adapted nursery in Legard Road, N. 7. 1 In common with most Boroughs, new assessment scales were adopted for applying charges for local health authority services, where statutorily authorised. The new scales were based on the recommendations of the London Boroughs Association. Another outside factor was the review in depth of the organisation and structure of the whole Department by the London Boroughs' Management Services Unit. This commenced late in 1967 but the main weight was felt in 1968. All facilities were given to the team and much time was spent by officers at all levels and in all sections. Final decisions on the Unit's report had not been made at the end of the year. The addition of a further position of Senior Medical Officer to the Department, established consequent upon the retirement of the Associate Medical Officer of Health was approved. Dr. Beryl Evans was appointed on 1st December 1968. The Department suffered the loss of one of its senior officers in the early death of Mr. A.G. Holmes, a principal administrative officer. Mr. Holmes was prior to 1965 the chief administrative officer for the Finsbury Public Health Department, and since that date he had been in charge of the environmental health section of the new Department. Mr. R. C. Lockwood was appointed in his place. The Department also lost by resignation Mr. A.H. Carter, who had served for 26 years as chief chiropodist under the London County Council and the Borough Council. His immediate charge was the foot clinic at Finsbury Health Centre, and he had also played a large part in the taking over of the chiropody service from the Old People's Welfare Association and extending it in the new Borough. Five Year Capital Programme The Council's Five Year Programme was reviewed to cover the period 1969/74. 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), site to be determined. - New day nursery (60 places), Harvist Estate, 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. - Replacement day nursery (60 places), Elthorne Road, N.19. Area III (N.W.) - New day nursery (60 places) and maternity and child welfare centre (replacing small M.C.centre), Girdlestone Road Area, N. 19. - New day nursery (56 places) Tufnell Park Area, N. 19. Area IV (N.E. Central) - New day nursery (52 places), adaptation of Community centre, Aubert Court, N. 5. - Replacement maternity and child welfare sub-centre, Hurlock Street Area, N.7. Area V (W. Central) - New day nursery (56 places) Lough Road, N.7. - New day nursery (60 places) and replacement health centre, Goodinge Road. N. 7. Area VII (E. Central) - Replacement maternity and child welfare sub-centre, Petherton Road Area, N. 5. Area VIII (S.E.) - New health centre, River Place, N.1. 2 Area IX (S.) - Finsbury Health Centre, Pine Street, E.C.I., adaptation as disinfecting, bathing and laundry station, for transfer of services from Seven Sisters Road Centre. In conclusion, I would pay tribute to the guidance and support given by members of the Council and its Committees, and I would express my thanks to all members of the staff who have helped me to maintain the work of the Department through another year. S. KING Medical Officer of Health 3 ENVIRONMENT. HEALTH COMMITTEE PERSONAL HEALTH COMMITTEE (as at 31st December 1968) MAYOR Councillor RICHARD ERNEST TROTT, J. P. Aldermen Alderman JOHN ROBERT GOODMAN. J.P., F.I.O.R. ARTHUR JAMES COMAN ALBERT JOHN ROGERS. J.P. Councillors MRS. EDNA DAISY BRIDGEWATER JOHN WILLI AM STEVENSON BRIDGEWATER EDWARD FRANCIS BULL MISS ELIZABETH MAY CARLSON MISS PEGGY CARR, B.Sc. (Econ. ) MISS EVELYN ALICE DUDLEY KENNETH McGREGOR. C. B. , C. M.G., M. A. VERNON MARTINDALE MRS. ELIZABETH JANE PENTECOST MRS. BRENDA THOMPSON, B. Sc. (Hons. ) Counci1lors MRS. EDITH HILDA ARCHER PETER HENRY WILLIAM BRITTEN PATRICK DOUGLAS BROMLEY. B. Sc.. M.I.P.S. MISS ANNIE THERESA CALLAGHAN CALVERLEY VERNON CARRUTHERS-WATT WILLIAM MARTIN FINCH MRS. MAY ELSIE GARNER JOHN THACKERAY HANVEY. B. A. MRS. ROSEXARY JOCELYN MURRAY MICHAEL O'HALLORAN HERBERT JOSEPH STANFIELD Co-opted Members Co-opted Members R.J.S. BRYANT, LL. B. , F.C.C.S. , F.H.A. J.J.BRADLEY. M.R.C.P., D.P.M., E. COLIN-RUSS, M.R.C.S. , L.R.C.P. M.J. FITZGERALD, M.B., B.Ch. MISS P.W. REDMAN, S.R.N., D.N.(Lond. ) Chairman Chairman Councillor MISS A.T. CALLAGHAN Councillor Dr.A.P. MORRIS. M.B., B.S., M.R.C.S., L.R.C.P. Vice-Chairman Vice-Chairman Councillor MRS. R.J. MURRAY Councillor MRS. J.M. BAKER 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. 4 Principal Medical Officers BETTY GROVES J.E.J. HURMAN Chief Dental Officer and M.B. , B.S. . D.P.H. M.B., B.S. , D.P.H.. D.T.M. & H. Principal School Dental Officer R.E. HYMAN L.D.S.. R.C.S. (Eng.) Public & Agricultural Analyst R.G. MINOR F.P.S. , F.R.I.C.. M.Chem.A. Senior Medical Officers JOAN M. CLARKE BERYL H. EVANS B.A. . L.R.C.P.. M R.C.S.. M.B., M.B. , B.Ch., D.Obst.. R.C.O.G., B.S., D.C.H., D.P.H. D.C.H., D.P.H. 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 Administrative Officer Deputy Chief Public Health Inspector E.J. SHARP G.S. ADAMS. M.A. P.H.I. Principal Administrative 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. R. C. LOCKWOOD. M.A.P.H.I., A.R.S.H. Principle Nursing Officer Deputy Principal Nursing Officer MISS K. B. HARVEY MISS L.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. A. WELLER S.R.N. , H.V. , R.F.N. S.R.N., S. C.M. , Q.N. Senior Social Worker Deputy Senior Social Worker MISS M. MACMORRAN MRS. A. HOSKER Principal 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. , M. R. I.P.H.H. PUBLIC SHED PAPERS DURING 1968 M. Ashraf. M.B., B.S. (Bombay). D.P.H. Changing patterns of tuberculosis in England and Wales. The Royal Institute of Public Health and Hygiene Journal Vol.31. Nos. 4-6. July Dec. 1968 p.114-124 GRANTS TO VOLUNTARY ORGANISATIONS During 1968 the Council used its powers under the National Health Service Act 1946 (Section 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 1968/69 £ s. Day Nursery West London Mission (Hopedene Nursery) 2,840* Maternity & Child Welfare Crusade of Rescue. 85 Islington Pre-School Playgroup Association 150 London Diocesan Council for Moral Welfare 2,198 North Islington Infant Welfare Centre 20,250* Race Relations Committee of the Religious Society of Friends (Lonsdale Square playgroup) 375* Save the Children Fund (St. Luke's & Holloway Estate Playgroups) 1,180* Prevention of Illness, Care and After Care (Tuberculoses) (General) Chest and Heart Association 10 10 Islington Chest and Tuberculosis Care Committee 250 Central Council for Health Education 231 15 Family Welfare Association 5,600 Family Planning Association (Central London Branch) 3,000* National Association of Voluntary Hostels 250 Mental Health (Day Centres) (General) Salvation Army (Archway Citadel Day Centre) 300* Elfrida Rathbone Committee (Islington & Camden) - General 2, 230 - Playgroup 320 Islington Society for Mentally Handicapped Children 4,500* National Association for Mental Health 100 Miscellaneous Catholic Marriage Advisory Council 375 London Borough of Islington Health Amenities Fund 100 London Marriage Guidance Council 650 *estimated grant, subject to adjustment. VISITS ARRANGED FOR STUDENTS Half or full day visits were arranged for students during the year. A total of 447 students visited various branches of the department during 1968; they included medical students, hospital nurses in training, child care students, matrons of old people's homes, and students from a variety of other disciplines. The importance of the experience gained was appreciated and foundations were laid for good co-operation in the future. Continuing a former practice, local girls taking civic or social service courses in school attended day nurseries and gave voluntary help. 6 CO-OPERATION WITH CHILDREN' S AND WELFARE DEPARTMENTS Residential establishments under the control of the Children's Committee are visited by a Senior Medical Officer. These visits provide the housemothers with an opportunity of discussing any problems relating to individual children. Informal advice on hygiene, the safe keeping of medicines and drugs, and general standards of care is given. Children who are handicapped or are at risk of developing a handicap are followed up closely. Reports of visits are passed to the Children's Officer for his consideration. 59 such visits were made during 1968. The Children's Officer seeks the assistance of this Department in his preliminary enquiries about residents of Islington, who have applied to foster or adopt a child. In each case the health visitor is asked if the family is known to her and, if so, to submit a report. Homes for the elderly which are under the control of the Welfare Committee are visited by a Principal Medical Officer who inspects the hygiene arrangements and the general facilities for the well being of the residents. 7 such visits were paid during 1968. 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 1967 in brackets). Domiciliary midwifery 414 (540) Mental Health 468 (472) Home Nursing 309 (249) Infectious Disease 4 ( 4) Other 44 ( 23) 1,239 (1,288) Midwives and mental health social workers were able to make use of special hired car facilities at night and at weekends. 7 GENERAL AND VITAL STATISTICS Area of the Borough 3,678 acrcs Estimated Mid-Year Homo Populaton - 241,890 Marriages (Provisional figures) solemnised in the Borough 2,392 BIRTHS Total Male Female Live Births - Legitimate 4,191 2,151 2, 040 Illegitimate 710 365 345 4,901 2,516 2,385 Islington England and Wales LIVE BIRTH RATE PER 1,000 POPULATION 20. 3 16.9 Birth rate after applying 'Area Comparability Factor of 0.80 16. 2 ILLEGITIMATE LIVE BIRTHS PER CENT OF TOTAL LIVE BIRTHS 14.5 Total Male Female Still Births - Legitimate 61 37 24 Illegitimate 9 6 3 70 43 27 Islington England and Wales STILL BIRTH RATE PER 1,000 POPULATION 0.29 0.24 Still birth rate per 1,000 live and still births 14.1 14.3 Total Male Female TOTAL LIVE AND STILL BIRTHS - Legitimate 4,252 2,188 2,064 Illegitimate 719 371 348 • 4,971 2,559 2,412 DEATHS Total Male Female ALL CAUSES 2,763 1,413 1,350 Islington England and Wales DEATH RATE (CRUDE) PER 1,000 POPULATION 11.4 11.9 Death rate after applying 'Area Comparability' factor of 1.07 12. 2 INFANT DEATHS Total Male Female Deaths of Infants under one year of age Legitimate 100 66 34 Illegitimate 14 9 5 114 75 39 8  Islington England and Wales INFANT MORTALITY RATE (per 1.000 live births) - All Infants 23.3 18.3 Legitimate 23.9 Illegitimate 19.7 NED-NATAL MORTALITY Total Male Female Deaths of Infants under 4 weeks of age - Legitimate 67 44 23 Illegitimate 8 5 3 75 49 26 NED-NATAL MORTALITY RATE (per 1.000 live births) Islington England and Wales All Infants 15.3 12.4 Legitmate 16.0 Illegitmate 11.3 EARLY NED-NATAL MORTALITY Total Male Female Deaths of Infants under 1 week of age Legitimate 59 37 22 Illegitimate 7 5 2 66 42 24 EARLY NED-NATAL MORTALITY RATE (per 1,000 live births) Islington England and Wales All Infants 13.5 10.5 Legitimate 14.1 Illegitimate 9.9 PERINATAL MORTALITY Total Male Female Still births and deaths under 1 week combined 136 85 51 PERINATAL MORTALITY RATE Islington England and Wales (per 1,000 total live and still births) 27.4 24.7 MATERNAL DEATHS (including abortion) 4 198 RATE (per 1,000 total live and still births) 0.80 0.24 9 ANALYSIS OF INFANT DEATHS - 1968 (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 Enteritis and other diarrhoeal diseases 1 1 Whooping Cough 1 1 All other infective and parasitic diseases 1 1 2 Benign neoplasms and neoplasms of unspecified nature 1 1 Other endrocrine, nutritional and metabolic diseases 1 1 Other diseases of blood and blood forming organs 1 1 Meningitis i 1 Other diseases of the circulatory system 1 1 Pneumonia 1 1 1 3 4 1 2 2 1 16 Other diseases of the respiratory system 3 1 1 2 2 1 10 Intestinal obstruction and hernia 1 1 Congenital anomalies 4 4 1 1 1 2 1 2 1 1 1 2 21 Birth injury, difficult labour, and other anoxic and hypoxic conditions 21 6 2 1 1 1 1 2 35 Other cuases of perinatal mertality 13 2 1 1 1 18 Symptoms and ill-defined conditions 1 1 Accidents (non-motor vehicle) 1 1 All other external causes 1 1 2 Totals 40 6 9 3 3 1 4 4 3 2 8 6 5 4 4 5 1 3 - 2 1 114 Estimated Child Population Under 1 year 1 - 4 Total under 5 5-14 Total under 15 Islington 4, 980 18, 320 23,300 29,100 52, 400 Greater London 128,000 499,700 627,700 982, 300 1,610,000 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-five 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-nine infant deaths in the age group one to twelve months, thirteen were due to pneumonia. 11 MATERNAL MORTALITY In a total of 4,971 live and still births, there were four maternal deaths. Two were due to abortion, one to post partum haemorrhage and one to spontaneous rupture of uterus due to cervical constriction ring. RESPIRATORY TUBERCULOSIS The death rate for lung tuberculosis in 1968 was 0.09 per 1,000 population, and does nol compare unfavourably with previous years. DEATHS DUE TO PNEUMONIA AND BRONCHITIS In 1968 there were 175 deaths ascribed to bronchitis, and 240 to pneumonia. These figures were more than those for 1967, which were 133 and 210 respectively. MALIGNANT GROWTHS OF LUNG AND BRONCHUS I reported last year that lung cancer deaths in males which showed a steep increase of 20% from 155 to 186 in 1966 was, fortunately, not continued in 1967 when 158 males died from this disease. A further fall to 145 was recorded in 1968. Female deaths from this cause which showed a rise from twenty-eight in 1966 to thirtyfive in 1967, fell in 1968 to 28. CORONARY DISEASE WITH ANGINA There were 539 deaths (332 male and 207 female) from this cause in 1968. This shows a considerable rise after falls from the 1965, 1966 and 1967 figures of 522, 503 and 438 respectively. ACCIDENT DEATHS - Comparative table. 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 Motor vehicle accidents 37 37 32 22 34 28 29 34 34 23 Other violent accidents 60 69 65 69 84 62 60 58 65 38 ACCIDENT DEATHS - Analysis by age groups Type 0- 1- 5- 15- 25- 45- 65- 75- M. F. Total Motor Vehicle accidents _ _ _ 4 1 8 6 4 14 9 23 Falls _ 2 1 _ 3 2 _ 8 5 11 16 Accidental Poisoning (Solid, Liquid Gases and Vapours) _ _ _ _ 1 2 _ 3 3 3 6 Fire _ 3 _ _ _ _ 1 4 5 3 8 Inhalation of Stomach contents, ingestion of food etc. _ _ _ _ _ 1 _ _ _ 1 1 Other (Railway Accidents, etc.) 1 _ _ 2 1 2 _ 1 5 2 7 Total 1 5 1 6 6 15 7 20 32 29 61 12 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Notifications and deaths recorded during the year 1968 (Infectious diseases are those that were statutorily notifiable as at 31st December, 1968) Disease Number of notifications Number of deaths Removed to hospital Number of Cases returned to Registrar-General after correction of diagnosis Cases "coming to knowledge" but not notified Measles 660 (1427) _ 12 660 _ dysentery 265 ( 269) 1 25 264 210 Scarlet Pever 69 (89) _ 3 69 14 Whooping Cough 45 (125) 1 8 45 20 Infective Jaundice 112 (-) _ 21 111 76 Ac. Meningitis 8 (-) 3 8 7 15 Ac. Encephalitis 4 (2) _ 4 3 _ Ophthalmia Neonatorum 3 (4) _ _ 3 _ Leptospirosis 1 (-) _ 1 1 _ Paratyphoid Fever * (8) _ _ 1 _ Typhoid Fever 1 (1) _ 1 1 _ Pood Poisoning 53 (90) _ 11 39 25 Tuberculosis Longs 125 (141) 21 _ 124 19 Tuberculosis Other Forms 19 (22) 4 _ 19 1 * Statutorily notifiable from 15th June. 1968. ** Statutorily notifiable from 1st October, 1968. (Figures In brackets are notifications for 1967) SMALLPOX Of the 31 references for suspected smallpox and supervision of possible smallpox contacts, 27 arrived in this country from declared endeaic 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 two patients suffering from rashes of a type where it was desirable to exclude smallpox as a possible cause. These were subsequently diagnosed as chicken pox. The regaining two references concerned contacts of a confirmed smallpox case, a Pakistani boy aged 15 years residing in the City of Westminster. The first was a female Islington resident, a member of the ambulance crew which took the boy to hospital, the other a Westminster resident who was employed in an Islington restaurant as a kitchen hand. Both were kept under surveillance for the requisite period and their medical practitioners informed. CERTIFICATES OF VACCINATION AND INOCULATION - AUTHENTICATION • MINISTRY OF HEALTH CIRCULAR 60/48 Applications for authentication dealt with by the Medical Officer of Health numbered 3,225 as against 3,047 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. 13 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 1968 53 1951 158 1957 160 1963 134 1952 84 1958 230 1964 131 There was only one outbreak during the year to be reported to the Ministry of Health in accordance with Memo. 188 Med. of the Ministry of Health. In accordance with Circular 2/50 of the Ministry of Health, the table summarising this outbreak is as follows:- Date No. of Notifications No. of persons served No. of cases reported No. of deaths Foods involved and organisms responsible 15.7.68 9 Unknown 12 _ Oven ready Chickens 24.7.68 Salmonella enteritis (Phage type 8) OUTBREAK REPORT A series of confirmed Salmonella enteritis infections, phage type 8, between 15th and 24th July and a further case with onset on 25th August, 1968, were reported. On investigation it became evident that, in all cases, chicken was implicated and most of these were of the same brand and although purchased at different shops were, as far as could be ascertained, produced from the same packing station. Symptoms, which lasted between one and five days, varied between moderate to severe and included abdominal pain, diarrhoea and some vomiting. Two samples of chicken and swabs of the interior of six chickens were examined but showed no pathogenic organisms present. Investigations were carried out at the packing station but showed no record of any breakdown in the chlorinating plant and also samples of chicken and chicken livers submitted at this time revealed no pathogenic organisms. This incident was reported to the Ministry of Health who subsequently commented that in previous similar outbreaks, where the impression was gained that low chlorination of water was the cause, washing and chilling water in a packing station almost always becomes contaminated post hoc and a residual concentration of 10 p.p.m. does not sterilise. Although it was agreed that the chickens might be the cause of the incident the Ministry felt that to make the evidence more than circumstantial it would be necessary to isolate Salmonella enteritidis from the birds before their entry to local packing stations. THE PUBLIC HEALTH (INFECTIVE JAUNDICE) REGULATIONS, 1968. These regulations made infective jaundice statutorily notifiable by medical practitioners and came into operation as from 15th June, 1968. A copy of the regulations was sent to all medical practitioners with a request that notification of all cases should be made, to enable the medical officer of health to inquire into the epidemiological background 14 THE HEALTH SERVICES ANDPUBLIC HEALTH ACT. 1968 PUBLIC HEALTH (INFECTIOUS DISEASES REGULATIONS NOTIFICATION OF FOOD POISONING AND INFECTIOUS DISEASES 1.Sections 47 to 49 of the Health Services and Public Health Act 1968 and of the Public Health (Infectious Diseases) Regulations 1968, came into force on 1st October. 1968. Copies of these Regulations were sent to all medical practitioners concerned. 2. The principal changes affecting medical practitioners attending patients who are suffering from or suspected to be suffering from notifiable infectious disease or from food poisoning are:- (a) All provisions governing the notification of infectious disease and food poisoning are now to be found in Sections 47 to 49 of the Health Services and Public Health Act, 1968 and the Public Health (Infectious Diseases) Regulations 1968. (b) The infectious diseases now to be notified to the medical officer of health are:- Acute encephalitis Ophthalmia neonatorum Acute meningitis Paratyphoid fever Acute poliomyelitis Plague Anthrax Relapsing fever Cholera Scarlet fever Diphtheria Smallpox Dysentery Tetanus (amoebic or bacillary) Tuberculosis Infective jaundice Typhoid fever Leprosy Typhus Leptospirosis Whooping cough Malaria Yellow fever Measles (c) Notification of the diseases listed below is no longer required:- Acute influenzal pneumonia Erysipelas Acute primary pneumonia Membranous croup Acute rheumatism Puerperal pyrexia (d) Responsibility for notifying a case or suspected case of food poisoning or infectious disease rests exclusively on the medical practitioner attending the patient unless he believes that another practitioner has already notified the case. 3. Notification fee payable to practitioners. By an order made under Section 50 of the Act of 1968 the notification fee was increased to 5s. as from 1st October, 1968. New books of notification forms as prescribed under Schedule 3 of the Regulations were subsequently sent to medical practitioners. LEAD POISONING There were four references to the department on the subject of lead poisoning during 1968. Of these the first concerned a three year old child in hospital with a raised blood lead level. On domiciliary enquiry it was reported that all the painted surfaces appeared satisfactory with no evidence of their being bitten or chewed. All paint brushes and paint cans were kept locked in a cupboard. The only significant factor which emerged was a statement by the mother that her husband had sprayed the garden with a weed killer some six months before. As the child had been seen to have eaten soil from time to time, a sample of soil was taken and subsequently the public analyst reported a total lead content of 300 parts per million. Incidentally, a sister of this child attended hospital in 1963 also on account of lead poisoning. Samples of recently painted surfaces taken at the time showed 34 15 per cent. of lend. All these surfaces were subsequently cleaned off and repainted under the public health inspector's supervision. The report also mentioned that this child, as a baby, was in the habit of eating dirt lying inside and outside the house. The second reference concerned a 3½ year old child also in hospital with a raised blood lead level and a story of licking the paint from the walls of her home. The public health inspector made his investigation of the premises and confirmed evidence of some surfaces being bitten or chewed. As a result numerous samples were taken and the public analyst reported as follows:- Paint scrapings from bannisters 0.33% lead Wall plaster 0.07% lead Yellow paint from wooden toy trolley 2.75% lead Soil 0.07% lead In the light of the above, the inspector revisited the premises and arranged with the owner to remove all the paintwork which was considered to be the most probable cause of the lead poisoning. The paint was removed by burning, and satisfactorily repainted. The third concerned a reference from another Authority regarding the purchase of a humming top, painted in red and supplied bv a wholesaler in Islington. This showed on analysis that the proportion of lead in the paint substantially exceeded the maximum prescribed by the regulations. As a result of investigations it was ascertained that the tops were made in West Germany. Subsequently, all those Local Authorities with retailers in their areas who had been supplied with these toys were informed. The final reference concerned information received from the Home Office regarding a high lead content found in two brands of eye cosmetics, imported from India and Pakistan and popular among Indian and Pakistani women. It was also reported that these substances were used on childrens' eyes as an ointment. Lead poisoning could result if these products found their way into the body in food. Whilst the Home Office were to ensure, with the co-operation of importers, that the importation from India and Pakistan of cosmetic compounds containing lead ceased, people in possession of these cosmetics were advised to stop using and dispose of them. All medical practitioners were advised of this warning. All sampling of oriental cosmetics carried out by the Pood Inspectors gave negative results. LEPTOSPIROSIS AND ANKYLOSTOMIASIS Information was received of a male aged 36 years who was admitted to hospital in October suffering from Jaundice, onset being two days previously. Laboratory tests showed that he was suffering from leptospirosis and ankylostomiasis. Domiciliary investigations were carried out by the public health inspector and it was ascertained that the patient, his wife and six children occupied the whole of a terraced house. Reports of rat infestation in this house had been received on various occasions and treatment had been carried out by the Council's rodent operative some 3 months previously. It is possible that infestation may have been associated with the keeping of hens in an adjacent property. These are no longer kept and no evidence of rat infestation was apparent at the time of the visit. The patient, who had never been abroad apart from Eire, had been employed as a general labourer on a casual basis by a number of civil engineering contractors. The source of the infections remained undetermined. TYPHOID AND PARATYPHOID FEVER There was (a) one confirmed case of typhoid fever and (b) one confirmed paratyphoid fever case during the year as follows:- (a) A 24 years old Islington housewife was admitted to hospital on 14th April 1968 diagnosed as suffering from typhoid fever and subsequently transferred to an isolation hospital on 27th April. The hospital reported that present with her clinical story a four -fold rise of typhi 0 16 antibodies, together with the appearance of Vi antibodies, confirmed the diagnosis beyond dispute. This was in spite of the source of infection remaining undiscovered and the fact that all bacteriological tests were negative. (b) This case of Salmonella paratyphi 'B' - phage type " Battersea" was in respect of a three years old female child and was discovered after the examination of a precautionary faecal specimen submitted at the request of a general practitioner. The patient was treated at home. Subsequently it was ascertained, in consequence of information received from the Public Health Laboratory, County Hall, S.E.1., that the patient kept two terrapins (a type of tiny tropical turtle) as pets.Specimens of their faeces and of water from the tank were examined and Salmonella paratyphi 'B' was isolated. It is of Interest to note that similar cases in London and other parts of the country received publicity in a National newspaper. In both (a) and (b) bacteriological examination of all contacts proved negative; the respective medical practitioners being kept informed. The other references were for 12 contacts of typhoid fever all with satisfactory conclusions. DYSENTERY There were four hundred and seventy-five cases notified and 'coming to knowledge' during the year. Of theae, four hundred and twelve proved positive, whilst sixty-three were clinical cases with negative stools. Roughly three-quarters of the positive cases occurred in the latter part of the year. Two schools were mainly affected with subsequent spread to family groups and some other adjacent schools. TUBERCULOSIS In 1968, 144 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 Pulmonary M- — 4 2 3 5 4 20 6 11 13 9 3 80 F- — 3 1 5 1 7 7 9 3 3 3 3 45 Non-Pulmonary M- — — — — 2 2 3 3 1 — — — 11 F- 2 — — — — — 1 2 1 2 — — 8 Totals — 2 7 3 8 8 13 31 20 16 18 12 6 144 The notification rate of all forms of tuberculosis was 0.60 per 1,000 population as against 0.27 for the whole country. The total number of cases remaining on the register after adjustment for deaths and transfers was. on the 31st December, 1968:- Males Females Total Pulmonary 1,241 867 2,108 Non-Pulmonary 121 160 281 Totals 1,362 1,027 2,389 There were 25 tuberculosis deaths (21 pulmonary and 4 non-pulmonary) during 1968. The death rate of all forms of tuberculosis was 0.1 per 1,000 of the population, as against the national rate of 0.04. ISLINGTON CHEST AND TUBERCULOSIS CARE COMMITTEE Patients transferred from the Finsbury and Hornsey districts settled in well and the Finsbury Tuberculosis Care Committee amalgamated with the Islington Chest and Tuberculosis Care Committee. 17 Mrs. E. M. Simms, Chairman for many years, resigned and Mrs. B. Stradling became Chairman. It was found possible to increase the amount given for food and fuel and many "Thank you" letters were received from needy patients expressing their deep appreciation. The mid-summer outing to Eastbourne, made possible by the generosity of the "Starliners", who donated the proceeds of their Variety Show, was again a great success. The officers of the Committee were:- Councillor Mrs. B. Stradling Chairman Councillor Mrs. M. Ward Vice-Chairman Dr. H. 0. Williams Honorary Treasurer Mr. J. Buckle Welfare Officer and Secretary to the Islington Chest and Tuberculosis Care Committee. Miss A. Phelps Welfare Officer HOSTEL FOR HOMELESS TUBERCULOUS MEN, CROMWELL LODGE, CHOMELEY PARK, N.6. The warden managed alone during the whole of 1968 as it proved impossible to recruit an assistant warden. In spite of this, the number of men in residence at the end of the year was 26 compared with 23 at the end of 1967, 21 (19) of these were from other London Boroughs. 2 (3) Islington patients were in residence at Hurlingham Lodge Hostel in the London Borough of Hammersmith. Patients assisted for the first time with:Beds and bedding 1 (-) Clothing or Footwear 12 (5) Patients at the end of the year receiving extra nourishment (Council and Care Committee) 92 (84). HOME VISITING - by health visitors Total visits (including contacts; but excluding unsuccessful visits) 2953 (3078). DIMENSIONAL. THERAPY:- Total sessions held at Cromwell Lodge Hostel 75 (99) Total number of visits made to patients in their own homes 1,474 (1,521) CHEST CLINICS Patients could be referred, or persons could 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. 18 CASES ON CHEST CLINIC REGISTER No. of definite cases of Pulmonary Non-Pulmonary Total Tuberculosis on Chest Clinic Adults Children Adults Children Adults Children Register as at 31st December 1968 M F M F M F M F M F M F ISLINGTON CHEST CLINIC 828(924) 513(567) 43(42) 50(48) 60(63) 83(81) 6(3) 6(8) 888(987) 596(648) 49(45) 56(56) ST. PANCRAS CHEST CLINIC 61( 68) 22( 31) 12(12) 8(10) — — 7( 7) 1(1) — — 61 ( 68) 29( 38) 13(13) 8(10) TOTAL 889(992) 535(598) 55(54) 58(58) 60(63) 90(88) 7(4) 6(8) 949(1,055) 625(686) 62(58) 64(66) GRAND TOTAL 1,700 (1.865) VISITING OF NEWLY ARRIVED IMMIGRANTS - YEAR ENDED 31st DECEMBER, 1968 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 218 209 India 147 98 Pakistan 66 56 Other Asian 69 45 African 130 120 Other 75 51 NON-COMMONWEALTH COUNTRIES European 57 49 Other 27 17 TOTAL 789 645 * Advice of arrival of immigrant. First successful visit means the first time the local health authority officer established contact with the immigrant. 19 It will be seen from the chart that 645 successful visits were paid to immigrant arrivals to the Borough during 1968. Those 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 76 32 Number of baths given 138 — Number of treatments — 32 I.L.E.A. Children - Number treated 192 223 Number of baths given 408 — Number of treatments — 228 Adults - Number treated 374 150 Number of baths given 720 — Number of treatments — 159 There was a slight decrease in the numbers treated for scabies by some 9% in 1968 - 642 compared with 707 in the previous year. The numbers treated for vermin infestations, however, showed a slight increase from 396 to 405. BACTERIOLOGICAL EXAMINATIONS The number of specimens sent to the Public Health Laboratory, County Hall, S.E.I, for bacteriological examination was 5,867. This compared with a total of 5,784 specimens submitted last year. Annual fluctuations are due mainly to the extent of dysentery outbreaks in any Examinations carried out Total Swabs (Diptheria) 81 Sputum (Tuberculosis) 27 Faeces & Urine (Enteric Fever) 153 Faeces (Food Poisoning) 381 Faeces (Dysentery)4,882 Swabs (Streptococci) 8 Other specimens 335 Total 5,867 20 SERVICES FOR THE ELDERLY VISITS BV MEDICAL OFFICERS Nine visits to elderly persons were made by senior medical staff of the department 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. One case was 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 Finsbury Health Centre. DECENTRALISATION The decentralisation of the home visitors was completed in March, 1968, when the remaining staff at headquarters were transferred to the Barnsbury, Hilldrop and Clephane Road Welfare Centres. NATIONAL ASSISTANCE ACTS, 1948 & 1951 SECTION 47 REMOVALS One elderly person was 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. The elderly person subsequently died. SPECIAL CLEANSING From 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. Nineteen such cases, reported by the public health inspectors, home visitors, hospital authorities, etc, were dealt with during the year, MEAL SERVICES At the commencement of 1968, eight vans were operating the Meals on Wheels Service, and five vans the Invalid Meals Service, throughout the Borough. As the need for "Meals on Wheels' consistently increased, and requests fordietary meals dropped slightly, careful consideration was given to the re-organisation of both services in order to provide a more economic service. Following reports to Committee, the Invalid Meals vans were re-equipped with movable hotlocks, instead of the existing fixed type; areas for both services were re-routed; the helpers hours were increased by & an hour per day; and one of the Invalid Meals vans was transferred to the Meals on Wheels Service. These alterations were commenced in September 1968, and enabled the combined services to serve up to 100 extra meals a day, without the purchase of an additional vehicle or the employment of extra staff. A comparison of the total meals served for the last three years is given below:- Meals on Wheels Invalid Meals Delivery Restaurant 1966 79,057 48,193 4,472 1967 96,379 50,490 4,405 1968 103,463 47,739 4,195 21 WEEKEND MEAL SERVICE A weekend meals on wheels service was inaugurated in April, 1968, to operate on Saturdays, Sundays and Bank Holidays throughout the year. The service is limited to a maximum of 200 meals on each day, which are supplied from the kitchen at Hillside'. All other kitchens which normally prepare meals for the delivery services are closed at the weekend, and as kitchen staff were not prepared to work it was not possible to provide dietary meals, or a higher number. Only cases in urgent need, recommended by tiio Council's home visitors, can therefore be provided with the weekend service. No difficulty was found in obtaining delivery staff. A total of 11,932 meals were provided during the period April to December, 1968. GERIATRIC PREVENTIVE CLINICS The three Geriatric Preventive Clinics (known for publicity purposes as "The Health Advisory Circle for Old People") at Pine Street, Drayton Park and Blythe Mansions continued during the year. Dr. J. Clarke, Senior Medical Officer conducted the medical examinations at the Pine Street clinic which were held on a weekly basis in the early part of the year, but from May onwards on the second and fourth Tuesdays of each month only. 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 Blythe Mansions until April, 1968, when he indicated that he was no longer able to attend on a regular basis. Dr. Sharland, has, however, continued to attend at six-monthly intervals, both at Drayton Park and Blythe Mansions, for the purpose of following up the cases originally seen by him. Dr. J. E. Hurman, Principal Medical Officer, carried out weekly clinics at Drayton Park in the early part of the year. After Dr. Sharland ceased regular attendance, it was arranged that Dr. Hurman should undertake both Drayton Park and Blythe Mansions clinics, on the basis of one session per week, clinics being held at either centre, depending on the waiting list. 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 1967 at each of the clinics, assisted in no small measure in encouraging the elderly to attend for medical examination. A total of 144 applications was received during the year, 35 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 medical 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 are conveniently available in premises adjoining the three clinics, and any chest x-rays are carried out at Drayton Park (patients from Pine Street and Blythe Mansions being taken by transport if necessary.) 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 3,883 collections of laundry were made (involving 37,509 articles). The service was being provided to about 144 persons at the end of the year. The Finsbury Laundry Service for elderly chronic sick was continued throughout the year. As instructed by the Council, no new cases were added to this service, and the number of recipients fell from 25 at the commencement of the year, to 19 at the end of the year. 638 parcels of laundry were collected during the twelve months under review. 22 BATHING FACILITIES The services provided from the treatment centre. Seven Sisters Road, and from the Finsbury Health Centre continued throughout the year. 4,827 baths were carried out in the homes of elderly persons under the Domiciliary Service. 1,969 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 effort among the young citizens) was opened in September 1965. Their work was continued during 1968 and many cases were referred to them. 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 1 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 866 applications for cremation at the Council's Crematorium, East Finchley. 23 Domiciliary bathing service. Chiropody at a Council Clinic. Photos by Camera Talks Ltd. 24 Special spray chair for the elderly in use at, council's bathing centre. Welfare foods for the elderly. Vital for an adequate diet. Photos by Camera Talks Ltd. 25 Geriatric Home Visitor speaking to brother and sister who are both deaf. Meals on Wheels delivery under trying conditions. Photos by Camera Talks Ltd. 26 Home Nursing Service. Photos by Camera Talks Ltd. 27 SANITARY CIRCUMSTANCES OF THE AREA It is with regret that I again record deterioration in the strength of the Public Health Inspectorate. Five Public Health Inspectors left the Council's service during the year and another Inspector transferred to other duties. Two Inspectors were recruited from outside and one of the Council's students sat the examination successfully and was appointed. Because of the depletion in Inspectoral establishment many important functions are either being neglected or receiving less attention than they should. The Committee being aware of this position called for a special report upon the work of the Inspectors with particular reference to the duties which are not being carried out or are adversely affected. To carry out its housing functions efficiently, a Local Authority must have a proper assessment of the general housing conditions in its district. It needs to know what the net shortage of dwellings is, the number of existing houses which ought to be demolished and replaced and those which are in need of repair. It must also know the extent of overcrowding in the district. In consequence of this need for proper information concerning housing conditions, Local Authorities have been given certain statutory duties with regard to the inspection of their districts. The duty of inspecting dwelling houses is placed on Local Authorities by the Provisions of Section 3 of the Housing Act 1957, viz., 'It shall be the duty of every Local Authority to cause an inspection of their district to be made from time to time with a view to ascertaining whether any house therein is unfit for human habitation'. In addition the Public Health Act 1936 places a clear duty on every Local Authority to cause their district to be inspected from time to time for the detection of nuisances (Section 91). Breaking this down into everyday language, we are speaking basically of the need to carry out fairly regular house to house unspections. The present commitments of the department and the number of staff available to meet these commitments, do not allow for any such plan of house to house inspections to be carried out. In this context the requirements which are clearly laid down by statute cannot be implemented. At present, the vast majority of visits to premises by the District Inspectors are as a result of complaints made by members of the public. However, this can only be viewed as the 'tip of the iceberg'. There is a vast unknown quantity of public health nuisances, mainly housing defects, which are not brought to light, simply due to the fact that tenants are not prepared to involve the Local Authority. With a systematic house to house inspection, many of these defects would be brought to to light and the logical outcome of this action would be that in the long run, the life of these properties would be extended. Thus there is a real need for such inspections to be carried out. The estimated number of private dwellings in the Borough is 34,676. The number inspected as a result of house to house surveys during 1967 was 2,634. With regard to atmospheric pollution, there will obviously be a need for routine reinspections, when the Borough becomes completely smoke controlled, to ensure that the , requirements of the Clean Air Acts are complied with. There is a spate of new legislation which is delegated to the Inspectors. During the year, twenty-two new items including acts, circulars, amendments, etc. were issued. Particular mention must be made of the burden of work which will fall on the Inspectorate in connection with the implementation of the new legislation relating to night cafes and also the Imported Fbod Regulations. It should be pointed out that these are absolute increases in work, and, whilst every endeavour is made to absorb these continual Increases, the task of Implementing the requirements becomes more and more difficult with the continuing depleted staff. 28 SUMMARY OF WORK DONE BY DISTRICT PUBLIC HEALTH INSPECTORS (i) Inspections Houses/flats inspected under Public Health Acts 1936-61 6,982 Separate lettings 10,345 Revisits Houses/flats 12,815 Seperate lettings 20, 277 (ii) Other inspections and visits Miscellaneous 1,404 Prevention of Damage by Pests Act, 1949 406 Infectious Diseases 131 Derelict Buildings and Vacant Sites 1,173 Pigeon Nuisances 232 Drainage 1,231 Hairdressers and Barbers 407 National Assistance Acts, 1948 and 1951 (Aged & Infirm) 33 Factories Act, 1961 - Outworkers 136 Pet Animals Act, 1951 31 Consumer Protection Act, 1961, and Regulations 7 Noise Nuisances 249 Food Premises and Vehicles 483 Non-effective visits 2,960 (iii) Nuisances and Notices Public Health Acts 1936-61 Notices served - (a) Intimation 2,644 (b) Statutory 1,983 Notices complied with - (a) Intimation 1,773 (b) Statutory 1,126 Nuisances and contraventions found 7,963 Nuisances and contraventions abated 6,385 Number of houses repaired 3,117 Total number of repairs and improvements 5,661 (iv) Legal Proceedings Information prepared 144 Nuisances Orders made by Magistrate 57 Further proceedings for failure to comply with Nuisance Orders 17 (v) Drainage Plans examined 195 Examinations and Tests 216 (vi) Complaints Outstanding (at end of 1967) 198 Received during the year 5,559 plus 262 repeated complaints Dealt with during year 5,654 Outstanding (At end of 1968) 143 29 (vii) Land Charges Enquiries Enquiries received 4,756 Properties involved 5,857 Investigations 5,857 (viii) Rent Act, 1957 Applications for Certificates of Disrepair (1) Number of applications for certificates during 1968 3 Number of applications brought forward from 1967 1 Number of applications carried forward to 1969 1 Total number of applications receiving attention 1968 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 – (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 to Local Authority for cancellation of certificates 2 Number of applications brought forward from 1967 – Number of applications carried forward to 1969 – Total number of applications receiving attention 1968 2 (8) Objections by tenants to cancellation of certificates 1 (9) Decisions by Local Authority to cancel in spite of tenant's objections . – (10) Certificates cancelled by Local Authority 1 Applications by Overseas Companies for Certificates of Repair Applications received – Certificates issued – (ix) Repairs and improvements effected as a result of Services of Notices under the Public Health Acts 1936-61 1. Brickwork - walls repaired or rebuilt 22 2. Drains cleared, repaired, etc. 546 3. Dampness remedied 724 4. Fireplaces and ranges repaired/renewed 37 5. Floors repaired 228 6. Internal walls repaired 464 7. Ceilings repaired 387 8. Rainwater pipes/gutters repaired/renewed 247 9. Roofs repaired 806 10. Rooms cleansed 36 11. Sinks provided/renewed 18 12. Soil pipes repaired and renewed 78 13. Staircase or passage cleansed 11 14. Staircase repaired 58 15. Waste pipes repaired/renewed 164 16. Water Closet Apartments cleansed 7 17. Water Closet Pans and Traps renewed 60 30 18. Water Closets - flushing apparatus repaired or renewed 88 19. Water Closets - general repairs 193 20. Water Supplies provided 31 21. Water service pipes repaired 49 22. Window sash cords renewed 463 23. Windows repaired or renewed 290 24. Miscellaneous improvements 654 Total 5,661 WORKS IN DEFAULT Public Health Act 1936 - Sections 39, 45, 79 and 93. Public Health Act 1961 - Sections 17, 18 and 26. Greater London Council (General Powers) Act, 1967, Section 23. 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 260 cases. LEGAL PROCEEDINGS Proceedings were instituted in 92 cases under Section 94 of the Public Health Act, 1963, for failure to comply with abatement notices. As a result 57 nuisances orders were made, and further proceedings were taken in 17 cases for failure to comply with these orders. DISINFECTION AND DISINFESTATION Disinfection and Disinfestation services were carried out during the year, mainly free of charge. There was a significant rise during the year of flea infestations throughout the borough. The species was identified as Ctenocephalides Felis, the cat flea; there was no apparent reason for this outbreak, infestations being confirmed in all types of homes and business premises. Staff of the Department made fifteen visits to a local factory and supervised the disinfection by formaldehyde gas of 22.75 tons of secondhand clothing for export, the same factory sent 14 tons of clothing to the Disinfecting Station for steam disinfection prior to export. No. of rooms treated for vermin during the year - 1,644 No. of rooms disinfected after infectious disease 102 PIGEONS This problem continued and the authorised pigeon catcher carried out twelve treatments in the Borough. CARAVAN SITES - CONTROL OF DEVELOPMENT ACT, 1960 There was no caravan problem during the year. CLEAN AIR AND ATMOSPHERIC POLLUTION LEGISLATION The Clean Air Act 1968 received the Royal Assent in October. This Statute increases the powers of local authorities in regard to the emission of dark smoke, the emission of grit and dust from furnaces, the control of chimney heights and the acquisition and sale of unauthorised fuel in a smoke control area. As from 1st April 1969 it is an offence for any person to buy or otherwise acquire any unauthorised solid fuel intending it to be used either in a building or in a boilder or plant situated in a smoke control area. It is also 31 an offence to deliver unauthorised solid fuel to a building or premises in a smoke control area for use for domestic or industrial purposes. These provisions, however, do not apply to premises which have been exempted from a Smoke Control Order. SMOKE CONTROL AREAS The Islington Smoke Control Orders Nos. 26 and 27 came into operation on 1st December 1968. They comprise 507.4 acres and 420 acres respectively and, to date, are by far the largest areas dealt with since the inception of the smoke control programme. The total number of premises in the two areas exceeded 23,000 and the staff in the Clean Air Section have been under severe pressure in dealing with the many applications for grants towards the cost of adaptation or conversion of fireplaces to comply with the Orders. In the early part of the year Smoke Control Orders were made by the Council in regard to the last two areas to be covered i.e. Nos. 28 and 29. Both were confirmed by the Minister and come into operation on 1st October 1969. The size of these areas are 450 and 360 acres respectively. Apart from very minor mopping up operations in regard to earlier Orders, the Council's Smoke Control Programme will be completed before 1970. During the year several warnings were given to occupiers in smoke control areas where it was established that bituminous coal was still being burned in domestic premises. A notice was served upon the occupiers of a factory in Goswell Road in respect of a contravention of the Finsbury (No.4) Smoke Control Order. Following a report to the Environmental Health Committee and correspondence with the Secretary, the Company agreed to install a modern boiler with a higher chimney. 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 13 Inspections by Clean Air inspectors and assistants 3,866 Re-inspections 3,211 Complaints received 70 Smoke observations 398 Contraventions found 52 Adaptations completed (domestic) 1,750 Notices served 20 Notices complied with 30 Prosecutions – 33 RECORDING OF ATMOSPHERIC POLLUTION As part of the National Survey three sets of instruments for recording smoke and S02 are maintained by this department, positioned at 1. Finsbury Health Centre, Pine Street, E.C.1. 3. Treatment Centre, Seven Sisters Road, N.7. 5.* Public Health Department, Upper Street, N. 1. In addition, the G.L.C. has similar recording instruments maintained at "Hillside", St. Johns Way, N. 19. This replaced the one situated in the Town Hall known as No. 2 site and which ceased to operate in October, 1965. Since the "smog" of 1952, with its disastrous results as indicated by the increased death rate for that and the ensuing year, the Government and indeed the public have become very conscious of the possible effects of atmospheric pollution. The Government in placing the Clean Air Act, 1956 on the Statute Book provided the Council with effective means to secure as far as possible the minimum of atmospheric pollution by smoke. The Councils proceeded vigorously in the implementation of this Act and the first two smoke control orders became operative in the Metropolitan Borough of Islington in September 1960 and in Finsbury in June 1962. At the end of next year, it is anticipated that the programme will be completed and the whole of the London Borough will be subject to smoke control. During the year, the Clean Air Act 1968 has been issued and will, inter alia, give the Council control of chimney heights and the acquisition and sale of unauthorised fuels. The effect of the smoke control programme is shown on the following graphs from which it will be seen that the levels of smoke pollution as well as the sulphur dioxide content since 1958 has declined steadily. It is hoped that still further improvements will be effected during the course of time. Thanks are due to the technical and administrative staff who have been engaged in the very heavy burden of additional work which has been carried out so satisfactorily. Every endeavour has been madeto promote and maintain good public relations and the fact that the programme has run so smoothly and no Public Inquiries have been required is indicative of the understanding and tact of the officers concerned. The Senior Inspector and the technical staff under his control have been required to work considerable periods outside normal working hours particularly in the evenings and weekends. This has enabled applications for grants in regard to adaptations under the Clean Air Act to be finalised with the minimum of delay. 34 35 MONTHLY AVERAGES OF SMOKE POLLUTION TREATMENT CENTRE (N°1) SITE. SEVEN SISTERS ROAD N.7 1958-1968. 36 MONTHLY AVERAGES OF SMOKE POLLUTION PINE STREET E.C.I.(N°-3) SITE 1 9 58 - 1968. 37 MONTHLY AVERAGES OF SMOKE POLLUTION PUBLIC HEALTH DEPARTMENT (N°5I SITE. UPPER STREET. N.I. 1958 - 1968. 38 MONTHLY AVERAGES OF SULPHUR DIOXIDE PUBLIC HEALTH DEPARTMENT (N°5) SITE. UPPER STREET N1 1958-1968. 39 40 MONTHLY AVERAGES OF SULPHUR DIOXIDE TREATMENT CENTRE (N°-1.) SITE. SEVEN SISTERS ROAD. N.7. 1958 -1968. LEAD CONTAMINATION With the increase in traffic in Upper Street it was considered desirable to carry out an exercise to ascertain if possible the atmospheric lead concentration and whether there was any danger to people living or working in the area, having regard to the fact that lead is a cumulative poison. An 8-port valve semi-automatic instrument was set up in the front of the Health Department building facing Upper Street, N. 1. on the second floor and daily filter paper recordings were taken. The monthly totals were sent to the Public Analyst who reported on the amount of lead found, expressed in microgrammes per cubic metre of air for the month, as follows: TABLE OF ATMOSPHERIC LEAD CONTAMINATION Lead in Microgrammes per cubic metre of air per month 1968 Average lead content of the filter for one day in microgrammes 1968 January 1.3 January 2.56 February 0.9 February 1.75 March 0.85 March 1.66 April 0.85 April 1.68 May 0.74 May 1.44 June 0.49 June 0.93 July 0.52 July 0.97 August 0.20 August 0.36 September 0.21 September 0.39 October 1.04 October 1.92 November 1.14 November 2.10 December 1.05 December 2.02 The amount of lead in the atmosphere in Upper Street shown by the recordings given above is not considered harmful. A great deal of work has been carried out on lead emissions but in no case has an unduly high concentration of lead in the atmosphere been found. There is as yet no evidence that lead additives in petrol give rise to toxic lead emissions in the exhaust of motor vehicles. The maximum recommended concentration in 8 hour daily exposure in industry is 200 microgrammes per cubic metre. It is, of course, necessary that the amount of lead concentration in the atmosphere continues to be kept under study. WORK OF PUBLIC HEALTH INSPECTORS ADMINISTERING FACTORIES ACT, 1961, AND OTHER LEGISLATION FACTORIES ACT, 1961 Number of inspections 880 Number of re-inspections 450 Notices served 53 Prosecutions instituted – Defects remedied 404 Defects referred to H. M. Inspectors – Defects referred by H.M. Inspectors 16 Complaints received 7 Notices complied with 58 PUBLIC HEALTH ACT, 1936 Factories inspected 244 Contraventions found 44 Contraventions remedied 44 Notices served 10 Notices complied with 8 OTHER INDUSTRIAL NUISANCES Owing to the very mixed development which occurred in various parts of the Borough before Town Planning control operated, complaints were frequently received from residents of nuisances alleged to emanate from industrial or commercial sources. All were investigated and action was taken under Public Health legislation for nuisance where possible. Apart from noise, dealt with elsewhere, complaints were made during the year of nuisances caused by car breakers and the parking and repair of motor vehicles in the roadway. Nuisances from dust and fumes, another common cause of complaint, were somewhat less in 1968. FACTORIES ACT, 1961 Inspections for the purposes of provisions as to health (including inspections made by public health inspectors.) Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1. 2, 3, 4, 6 and 7 are to be enforced by Local Authorities 25 110 6 – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2,545 639 39 – (ill) Other Premises in which Section 7 is enforced by the Local Authority* (excluding outworkers premises) 40 131 8 – Total 2,610 880 53 – •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)). 42 Defects were found in the following cases. No prosecutions were instituted. Particulars Number of cases in which defects were found Pound Remedied Referred To H. M. Inspector By H. M. Inspector (1) (2) (3) (4) (5) Want of cleanliness (S.1) 5 5 – – Overcrowding (S.2) – – – – Unreasonable temperature (S.3) – – – – Inadequate ventilation (S.4) 1 – – – Ineffective drainage of floors (S.6) – – – – Sanitary Convenience (S.7) (a) Insufficient 13 13 – 1 (b) Unsuitable or defective 387 372 – 4 (c) Not separate for sexes 4 6 – – Other offences against the Act (not including offences relating to Outwork) 8 8 – 11 418 404 – 16 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:– Wearing Apparel - Making etc., Cleaning and Washing 1,026 Household Linen 26 Umbrellas etc 38 Artificial flowers 92 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 58 Brush making 9 Carding etc. of buttons etc 30 Stuffed toys 19 Cosaques, Christmas Stockings, etc 16 Not specified above 86 Total 1,400 BASEMENT BAKEHOUSES (SECTION 70) Two basement bakehouses were closed as a result of redevelopment by the Greater London Council, i.e. 54 Archway Road, N.19. and 3 Moreland Street, E.C.1. Certificates of suitability remained in force in respect of 9 basement bakehouses. Routine inspections were carried out in connection with the Food Hygiene (General) Regulations 1960. PUBLIC HEALTH ACT, 1936, SECTIONS 107-108 OFFENSIVE TRADES The following is a summary of the records:- 43 Type of Business Number No. of Inspections No. of Revisits Total No. of Visits Tripe Boiler 1 6 4 10 Fur Skin Dresser 1 5 4 9 Gut Scraper 1 5 4 9 Fat Melter 1 1 2 3 SLAUGHTERHOUSES Food 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 in respect of the private slaughterhouse in the Borough was renewed and 32 inspections were made in addition to visits for the inspection of carcasses after slaughter. Inspections were also carried out by the Divisional Veterinary Officer of the Ministry of Agriculture, Fisheries and Food. The appropriate legislation was complied with. DISEASES OF ANIMALS ACT, 1950 The Diseases of Animals Act and allied legislation is implemented on behalf of the Council by the Corporation of the City of London through its Veterinary Officer. Visits were made by the Veterinary Officer each week to the private slaughter-house in the Borough. (&iarterly visits were made to Chapel Market in connection with the possible sale of live poultry, and also to Kosher Butchers and Poulterers. In accordance with the Animals (Miscellaneous Provisions) Order, 1927, the following Orders made by the Ministry of Agriculture, Fisheries and Food were advertised in the National Press:- Foot and Mouth Disease (Controlled Areas Restrictions) (Amendment) Order 1968. Foot and Mouth Disease (Imported Meat) Order, 1968. Foot and Mouth Disease (Controlled Areas) Special Orders Nos. 2, 3, 4, and 5. Foot and Mouth Disease (Imported Meat) (No.2) Order, 1968. NOISE NUISANCES Public Health Act, 1936 Noise Abateaent Act, 1960 The number of complaints relating to noise increased during the year. Number of complaints received 117 Number of visits made by Public Health Inspectors 542 The following summary indicates the various types of noise which were the subject of complaint to this Department. a) Industrial Premises Noisy machinery 34 Noisy vehicles 12 Car repairs 4 Workers singing/shouting 2 44 b) Domestic Premises Use of sewing machines 17 Noisy radio/television 4 Musical instruments 3 Noisy behaviour generally 25 Noisy animals 2 c) Clubs/Restaurants Music 8 Patrons leaving/car door slamming etc 3 d) Road Works Pneumatic drills 3 Total 117 Each complaint was investigated and visits made if necessary during evenings and late at night. If a complaint was substantiated, formal notice was given to the persons responsible and generally co-operation was forthcoming leading to the abatement of the nuisances. It was interesting to note that no complaints were received in respect of noisy chimes from icecream vehicles. Assistance has been sought from and readily given by the Scientific Branch of the Greater London Council in connection with the investigation of certain noise complaints of a complex nature. The reports and recommendations received proved most helpful in determining nuisances. A Senior Public Health Inspector attended a special course of training at the Institute of Sound and Vibration Research at Southampton University concerning Noise Control. PHARMACY & POISONS ACT. 1933 Number of listed sellers of Part II poisons other than pharmacists 136 Number of initial registrations during the year 11 Number of visits and inspections 30 RAG FLOCK AND OTHER FILLING MATERIALS ACT. 1951 Number of premises on register (Section 2, for Upholstery) 32 Number of inspections and visits 1 Number of samples taken 1 Number of samples satisfactory 1 CONSUMER PROTECTION ACT, 1961 The responsibility for duties under this Act was passed to the General Purposes Inspectors at the beginning of the year. The Secretary of State is empowered to make regulations under this statute and regulations are in force for heating appliances, including oil heaters, nightdresses, stands for carry cots and toys. 2,346 visits were made and 72 warning letters were sent to traders. The letters explained the relevant provisions of the Act and specified the contraventions found. 12 formal samples were submitted, 2 of which did not comply with the statutory requirements. Legal proceedings were instituted in three cases. Two were heard in 1968. One concerned the Heating Appliances (Fireguards) Regulations 1953, and the other was in respect of the Nightdresses (Safety) Regulations 1967. The defendants were fined £5 and £10 respectively, and the Council awarded a total of £7. 5s. 0d. costs. There is considerable interchange of 45 information between Local Authorities which assists in efficient enforcement of this Act. When stock is found that does not comply, all sources are traced and each local authority with a retail outlet is enformed of the facts so that they can take the necessary action. OFFICES, SHOPS & RAILWAY PREMISES ACT. 1963 General inspections of premises now consist of the inspection of newly registered premises and of those premises which have not received an inspection for some time. Following inspections, letters are sent to those owners and occupiers whose premises do not comply with the statutory requirements specifying the inadequate facilities, defects and other matters requiring their attention. It will be noted from the attached tables that since the last Report the enforcing inspectorate has been reduced by one Public Health Inspector and one Technical Assistant. This was considered a reasonable economy in that once the initial inspections were carried out, inspections and re-visits would establish a regular pattern which could effectively be dealt with by a smaller establishment. The effect of this reduction of staff is reflected in the current figures as compared with 1967. 1967 General inspections 676 Total visits 7,069 1968 General inspections 589 Total visits 5,330 With the present establishment and a total of 3,553 registered premises to which the Act applies, it is estimated that each will receive a general inspections once every six years. There are now nearly 50,000 employees in the London Borough of Islington who come under the Health Welfare and Safety provisions of the Offices, Shops and Railway Premises Act. LEGAL PROCEEDINGS As in previous years, it is gratifying to be able to report that once matters requiring attention are drawn to the notice of the persons responsible, the majority of premises are quickly brought up to a satisfactory standard. The recalcitrant minority are sent warning letters and if this does not result in the works being carried out, the cases are passed to the Council's legal division. After a further approach by the Town Clerk most cases are finalised but, in a few, legal proceedings have to be instituted. In the current year four informations were laid which led to three convictions. In the fourth, the court adjourned the case sine die to allow the works, which had been started, to be completed. ACCIDENTS The investigation of notifiable accidents is one of the most important aspects of this work. An accident is notifiable to the Local Authority if it occurs in premises over which they have jurisdiction and if it causes the death of an employee,or disables an employee from doing his normal work for more than three days. All occupiers are notified of their responsibility to notify such accidents at the time of the first general inspection. An investigation is carried out in every case where there is a serious injury; where the requirements of the Act may not be complied with; if there is some unusual aspect requiring investigation or where the occupier has a poor record of compliance. Most accidents are fortunately of a minor character and during the year in question, 103 accidents were notified of which 23 required further investigation. There were two fatalities in the year. In the first case an office worker fell down a lift shaft. The matter was investigated but at the resulting inquest a verdict of suicide was returned. 46 In the other, a builder's young labourer was removing a window when the glass shattered and a piece of glass penetrated his chest. At the inquest a verdict of accidental death was returned. SOME OTHER REPORTED AND INVESTIGATED ACCIDENTS 1. A young shop assistant had his arm crushed in a goods conveyor. A slat had been missing from the moving belt and the youth put his hand in this gap. A more serious injury was avoided by the belt being immediately switched off. A warning letter in strong terms was sent to the owners. 2. A warehouseman got his head jammed between the roof of a lift and the floor on which he was standing. Holes had been broken in the woodwork surrounding the lift frame so that the gate mechanism could be operated irrespective of the lift position. Normally the lift gates will only open when the lift floor coincides with the floor level. The warehouseman had operated the lift mechanism in this dangerous manner and on opening the gate found that the lift was below floor level. He then lay on the floor and put his head and arm into the lift to reach the gripper mechanism inside the lift. The lift then moved down, not up, as he hoped, and his head was trapped. He released the gripper mechanism almost immediately and as a result the lift stopped and his head was only slightly crushed. Another worker had the presence of mind to wedge a porter's trolley under the lift and levered it sufficiently for the warehouseman to be dragged out. The victim was lucky to escape with a bruised head, the loss of some teeth and shock. The lift, on inspection, was found to be in a very bad condition, partly due to abuse by employees and partly due to poor maintenance. All works necessary to make the lift safe were immediately carried out. New Regulations laying down strict requirements for lifts and hoists come into force in 1969 and will, it is hoped, obviate this kind of accident. (See later notes on lifts and hoists). 3. A warehouseman had three fingers severed by a fork lift truck. Uneven distribution of a load caused the forks of a lifting truck to tilt. The warehouseman saw this happening and instinctively put out his hand to steady the forks. The small fork wheels retracted on pressing the ground and his hand was pressed onto the platform with the dead weight of the forks and their load. Three fingers were severed. As all fork lift drivers were fully instructed in the proper use of their equipment by the company concerned, no action was taken over this accident other than informal advice. OCCUPATIONAL HAZARDS Certain occupations have a high accident ratio. This is revealed by the annual accident figures. Most accidents are due to falls, but during the year there were three accidents due to cellar flaps falling on to hands or feet; four cutting accidents to butchers boning meat; and no less than thirteen accidents involving loading or unloading of goods from delivery lorries. The latter figures exclude numerous other accidents from loading goods at places other than lorries. GENERAL COMMENTS ON PARTICULAR ASPECTS OF ENFORCEMENT RESPONSIBILITY FOP COMPLIANCE This aspect of the work still causes more administrative difficulty than any other. Where a building is in single occupation the responsibility for compliance is generally laid upon the occupier. In an area like Islington, there are a large number of premises in multioccupation. Shops are often situated beneath dwelling accommodation and offices often share premises with factories and other businesses. In this type of building it is often difficult to find out who is responsible for ensuring that the works necessary under the Act are carried out. A shop manager, for example, may have no idea who is the owner of the property; whilst in office blocks, there are often ground leases, sub-leases and dual occupation of the same office accommodation. 47 Even when the ownership or responsibility is finally determined, it is difficult to convince the persons concerned that the responsibility for ensuring compliance has been rightly attributed to them. FIRE RISKS Fire precautions are the responsibility generally of the Greater London Council. The main provisions deal with the issue of fire escape certificates for larger premises. This has meant a great deal of work for the fire authority who has had to give priority to the larger premises where the risk is normally greater. The Local Authority are, however, able to assist by bringing to their attention particular fire hazards in premises which may not normally be inspected by the fire authority for some time. This has been done on several occasions this year. A typical example was the stacking of waste paper in a boiler house. There was one serious warehouse fire this year in which several people died. HOISTS AND LIFTS During the year the Hoists and Lifts Regulations, 1968 were issued. These come into force in May 1969 and impose requirements as to the construction, maintenance and examination of hoists and lifts in premises to which the Offices, Shops and Railway Premises Act applies. They require, among other things, the provision of gates fitted with devices which will prevent them opening unless the lift is at the landing and so that the lift cannot be moved away from the landing unless the gates are closed. LIGHTING The Department of Employment and Productivity have during the year issued general guidance on lighting standards for premises covered by the Offices, Shops and Railway Premises Act. They give both a minimal standard and a good lighting standard. These standards are, however, only advisory and ultimate decisions can only be given by the courts. IMPROVEMENTS UNDER THE ACT With a lot of legislation it is difficult to assess the actual benefits which result from enforcement. This Authority has kept continuous records of the work done and details are attached to this report. In the year to which this report relates, there were, inter alia, 103 premises provided with hot water for personal washing and 320 cases of repairs to floors and staircases. To assess the improvement in the well-being of the 50,000 employees engaged in office and shop premises in the Borough is difficult but these figures do show the effect which this Act is having in improving their working conditions. CONCLUSION Tables following this report give details of the premises inspected, the visits made and the deficiences found and remedied during the year. 48 REGISTRATION AND GENERAL INSPECTIONS Class of premises Number of premises newly registered during the year Total number of registered premises at end of year Number of registered premises receiving one or more general inspections during the year (1) (2) (3) (4) Offices 73 1,550 244 Retail shops 66 1,411 279 Wholesale shops, warehouses 7 251 30 Catering establishments open to the public, canteens 21 341 36 Puel storage depots - - - TOTALS 167 3. 553 589 NUMBER OP VISITS OF ALL KINDS TO REGISTERED PREMISES 5, 330 ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED IN REGISTERED PREMISES Class of workplace Number of persons employed (1) (2) Offices 34,874 Retail shops 6, 585 Wholesale departments, warehouses 4, 824 Catering establishments open to the public 1,782 Canteens 798 Fuel storage depots 2 Total 48, 865 Total Males 27,855 Total Females 21,010 49 DEFICIENCIES POUND & REMEDIED TOTAL Fnd Rem Cleanliness 100 163 Overcrowding 7 20 Heating 3 9 Provision of Thermometer 105 288 Ventilation 43 203 Lighting 36 65 Insufficient Sanitary Accommodation 10 21 Deficient Sanitary Accomodation 29 103 Insufficient Washing Facilities 7 15 Hot Water/Warm Water Required 26 103 Other Deficient Washing Accommodation 21 29 Drinking Water 1 8 Clothing Accommodation 14 24 Seating Facilities 1 1 Eating Facilities - - Dangerous Machinery 38 95 Floors & Staircases 147 320 Noisp & Vibration - - First Aid 162 269 Abstract 277 611 TOTALS 1,027 2, 347 Intimations Served 464 PROSECUTIONS Prosecutions Instituted of which the bearing was completed in the year Section of Act or title of Regulations or Order No. of informations laid No. of informations leading to a conviction (1) (2) (3) 6, 7. 9, 10.24. 4 3 50 PREVENTION OF DAMAGE BY PESTS ACT, 1949 In order that the Implementation of this statute may be performed in a uniform and satisfactory manner, it is very necessary that the officers of the respective authorities co-operate, exchange information regarding experiences in the field and be kept up to date with modern poisons and techniques. With these objects in view the Greater London area has been divided into three and the London No.1 (Northern) Post Control Conmittee covers Islington, This Committee supersedes what was known as the Workable Area Committee which functioned since the coming into force of the Infestation Order 1943. The present Committee, of which Mr. W.C. Bartlett, Chief Public Health Inspector, is Chairman is composed of representatives from the Ministry of Agriculture, Fisheries and Food, 10 London Boroughs, the City of Westminster, the City and Port of London, the Greater London Council, the British Railways Board, London Transport Board and the Army. The Committee met on two occasions during the year, on each of which the Rodent Officer attended. In addition the Chairman of the three London Committees meet annually. RODENT INFESTATIONS The number of recorded complaints rose during the year to 2,667 compared with 2,271 during 1967. Visits to premises by rodent control staff numbered 23,078. There were no ship rat Infestations during 1968. Due to a severe staff shortage there were only three sewer treatments carried out during the year Instead of the usual four. Type of Property Local Authority Premises Dwelling Houses Business Premises Total 1. Complaints received (Including repeats) 75 2. 142 450 2,667 2. No. of properties inspected as a result of a) Notification - initial complaint only; 80 1,688 ' 418 2. 186 b) Block survey 49 470 146 665 3. No. of properties found to be infested by rats (including NIL ship rats) 83 603 182 868 4. No. of properties found to be infested by Bice 27 1. 248 271 1,546 5. Completed treatments during year 53 1,525 246 1,824 6. No. of business agreements dealt with Dlsinfection/Dlslnfestation 247 WATER SUPPLY The Metropolitan Water Board is the responsible authority for the supply of water in Islington. The supply was satisfactory both as to quality and quantity. There were 55,000 dwellings in the Borough supplied direct from mains serving the entire population of the Borough (241,890). No houses were permanently supplied by a stand-pipe and the Director of Water Examination, Metropolitan Water Board, states that no artificial fluoride was added. On account of their hardness content and alkaline reaction, the Board's river and well water supplies are not considered to be plumbo-solvent. One large block of offices, however, obtains its supply of water exclusively from artesian wells and is not supplied with water by the Metropolitan Water Board. 51 The action taken regarding domestic, well water and swimming bath water is as follows:- A. Domestic Bacteriological Sampling Satisfactory Unsatisfactory Mains supply 1 1 - Tanks 13 9 4 14 10 4 Chemical Sampling Mains supply 1 1 - Tanks 1 1 - Subsoil 4 - 4 6 2 4 B. Well Water 52 bore holes and wells 46 unused Bacteriological Sampling 16 15 1 Chemical Sampling 24 21 3 40 36 4 C. Swimming Bath Water During the year 131 bacteriological and 24 chemical samples were sent to the Bacteriologist and Public Analyst respectively. Nine bacteriological samples were unsatisfactory but after adjustment of the treatment plant, further samples were taken, when it was found that the condition had been remedied. COMMON LODGING HOUSES The one registered common lodging house at 88 Old Street was closed during the year. There are therefore no registered common lodging houses remaining in the Borough. SEWERAGE AND SEWAGE DISPOSAL There was no problem of flooding during the current year which called for special attention. DETAILS OF PUBLIC CONTROL FUNCTIONS REFRESHMENT HOUSES ACTS, 1860 to 1967 No. of licences issued 126 EXPLOSIVES ACTS. 1875 & 1923 FIREWORKS ACT. 1951 THE KEEPING OF FIREWORKS ORDER. 1959 No. of registrations during year 215 No. of visits 380 The main duty imposed on the Local Authority is to ensure that explosives are stored in a safe manner. There are six establishments in the Borough that store explosives other than fireworks, and these are inspected frequently. Fireworks are also classed as explosives and shops selling them have to be registered for this purpose. Registered premises are inspected and an explanatory leaflet is left with the trader in order to ensure that fireworks are stored safely and not sold to young children. 52 Proceedings were instituted against the occupiers of four premises for offences under the Act, The cases will be heard next year. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1921 - PART III (AS AMENDED) EMPLOYMENT AGENCIES No. of licences issued during year 50 No. of licensed agencies at end of year 50 No. of visits 146 No. of re-visits 118 Under the provisions of the London County Council (General Powers) Act 1921 (as amended), Employment Agencies have to be licensed by the Local Authority. Minor infringements were found and reaedied upon appropriate advice or warning being given. 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 41 No. of re-visits 18 The main purpose of licensing and inspection is to ensure that only suitable, and if applicable, qualified persons carry on such businesses, to ensure that equipment is properly maintained, and that the premises are conducted in a proper manner. Infringements found were not such as to necessitate revocation of licences or the institution of legal proceedings. THEATRICAL EMPLOYERS REGISTRATION ACTS. 1925 & 1928 No. of registrations during year 1 No. of registered employers at end of year 44 PERFORMING ANIMALS (REGULATION) ACT. 1925 No. of current registrations Nil SHOPS ACT, 1950 SHOPS (EARLY CLOSING DAYS) ACT. 1965 YOUNG PERSONS (EMPLOYMENT) ACTS. 1938 & 1964 No. of visits during year 7, 353 Prosecutions 4 (Total fines £16 and costs of £5 were imposed) These Acts govern the closing hours of shops and the conditions of employment of the staff engaged therein. There is an Early Closing Day Exemption Order in force in the Borough in respect of all non-food shops in the Nag's Head shopping area. During the year applications were received from the Camden Passage Traders' Association and the Hackney and District Chamber of Commerce for temporary suspension of general closing 53 hours. Camden Passage Traders' Association withdrew their application after discussion but as a result of the application from the Chamber of Commerce the general closing hours were suspended for the seven days immediately prior to and including the 24th December but excluding the 22nd December, 1968. THE RIDING ESTABLISHMENTS ACT, 1964 No. of establishments Nil FERTILISERS ft FEEDING STUFFS ACT, 1926 No. of samples taken 2 The responsibilities for these duties were passed to the General Purposes Inspectors at the beginning of 1968. The Act and the Regulations made thereunder specify conditions and prescribe certain standards to be observed. 14 visits were made and two informal samples were taken and contraventions were found in relation to both. One offence related to the improper marking of flaked maize and the occupier of the premises was given a verbal warning. In the other, a sample of bone meal, there was a nitrogen deficiency. This case will be finalised in 1969. CELLULOID ft CINEMATOGRAPH FILM ACT, 1922 No. of premises used for storage 1 (4 occupiers) Legal proceedings were instituted against one company for failing to furnish a statemen as required under the provisions of the Act and a fine of £10 with £3 costs was imposed. PUBLIC HEALTH ACT, 1936 - PART VI NURSING HOMES ACT, 1936 MENTAL HEALTH ACT 1959 - PART III NURSING HOMES One registered nursing home, non-profit making and run by a charitable organisation, received routine visits by a Medical Officer and Public Health Inspector and was found to be satisfactory. 54 HOUSING OLD HOUSES INTO NEH HOMES This White Paper was published in April and it was felt that the legislation proposed would be of great importance in a Borough of the nature of Islington. The effect was immediate in the need both to prepare for the proposed new powers and to amend existing procedure in anticipation. The Housing Committee ageed the following interim policy:- 1. That generally Notices under Section 15 of the Housing Act 1961 (which requires the provision of amenities) be not served, except when conditions make this a matter of urgency. This was because of the new grant proposed, which would be available in respect of houses in multiple occupation. Section 16 Notices (which require the provision of means of escape in case of fire) would continue to be served. In so far as such Notices may conflict with Section 15 requirements, in each case where a Section 16 Notice is served the person in receipt of the Notice is to be advised informally of Section 15 requirements. An opportunity would therefore be given for this work to be done simultaneously; thus any conflict could be resolved. 2. That other work under the Housing Act 1961 should be continued and the number of Direction Orders increased to cover cases where previously Section 15 Notices would have been served. The object is to prevent any worsening of conditions, i.e. any increases of occupancy in relation to the amenities available, and if possible to obtain a reduction in occupancy levels so that when the new powers are available there would be space to enable the satisfactory provision of amenities. 3. That a "condition of dwelling" survey should be carried out to enable (a) the designation of General Improvement Areas and the utilisation of other powers on a planned basis, and (b) a decision to be made as to whether it would be necessary or appropriate to propose the use of powers to regulate or prevent multiple occupation in any areas in the Borough. Three pilot scheme General Improvement Areas were proposed. Tibberton Square Corbyn Street area Mitchison Road area HOUSING ACT 1937, SECTION 9 In view of the remarks made under this head in last year's annual report, the proposal in the White Paper to extend the power to require repair was welcomed. In so far as houses need not be unfit before this power can be used, this should go a long way to prevent property deteriorating. HOUSING ACT 1937, SECTION 16. 17, 18 and 27. 13(12) houses were represented as unfit, 9(5) Closing Orders and 3(2) Demolition Orders were made. 37(31) parts of buildings were also represented, but only 16(42) Closing orders were made, a considerable reduction on last year, (figures given in brackets). This was due particularly to delays by interested parties in returning Section 170 information, the necessary prerequisite to the service of time and place Notices. A general check was made during the year of all properties or parts subject to Closing Orders, as a result of which there were 17 prosecutions for contraventions. 55 SLUM CLEARANCE (a) 1961/65 SLUM CLEARANCE PROGRAMME Slum clearance orders covering 14, 15 Sebastian Street, 21, 22, 23 Sebastian Street, 161, 163, Goswell Road, 24, 26 Norman's Buildings. were confirmed by the Minister of Housing and Local Government. This left 17, 18 Meredith Street and 39 Whiskin Street outstanding from the London Borough of Islington's share of this Programme. This area was represented last year and deferred. A further report was submitted in June and the area was declared as a Slum Clearance Area in July. The Minister of Housing and Local Government's confirmation is awaited. (b) 1966 70 SLUM CLEARANCE PROGRAMME It was reported last year that at the end of 1967 there were eight small and one medium sized slum clearance areas outstanding. During 1968 progress was made as follows:- 1. Elliotts Place - three dwellings represented and declared as a Slum Clearance area. The Minister of Housing and Local Government's confirmation is awaited. 2. Lorenzo Street. This area was deleted from this Slum Clearance Programme, after report to the Housing Committee, as the condition of these houses had improved considerably. 3. Attneave Street - these three houses are already in the ownership of the Borough Council and a report was sent to the Housing Manager advising that they were ripe for demolition. One house was already vacant. (c) FURTHER SLUM CLEARANCE PROGRAMMES The process of checking properties which appeared likely to warrant inclusion in the next programme continued. At the year end there were some four hundred properties listed which in the opinion of the Public Health Inspectors should be included. It is still not known whether the Greater London Council will continue its operations in the Slum Clearance field after 1970. While the completion of the Greater London Council's work in respect of current and previous agreed programmes is anticipated, there are advantages in future programmes being dealt with solely by the London Borough of Islington, although help with rehousing by the G.L.C. would continue to be essential. HOUSING ACT 1957 - PART V Twelve areas of houses, which were proposed as Housing Development Areas, were inspected by the Public Health Inspectors to ascertain the condition of the property, the occupancy and the Standard of Amenities. HOUSING ACT 1957 - SECTION 170 Delays were again caused in the making of Closing Orders, Demolition Orders, Management Orders, Direction Orders and in the service of Section 15 and Section 16 Notices due to failure to return promptly the necessary information stating interests in properties. Many prosecutions (37) were again undertaken but the 56 penalty (Maximum fine £5) was small. Although generally this had the desired effect, it does waste a great deal of the officers' time. Representations were made to the Minister of Housing and Local Government for the increase in this penalty in the new Housing Bill. HOUSING ACT 1961, SECTION 15 The number of Informal Notices fell to 204 (307 in 1967) due to the new policy referred to earlier " Old Houses into New Homes". The number of Formal Notices increased slightly to 128 (112 in 1967) as cases already in the "pipeline" were followed through. The number of prosecutions (49) for failure to comply with Notices was again high. SECTION 16 The three additional posts of Fire Inspector, previously authorised, were filled during the year. This accounts in part for the marked increase in inspections. Notices served and OGaplied with. A further increase in output can be expected with the benefit of the full year* s working in respect of these new posts. SECTION 19 As a result of the new policy referred to under "Old Houses into New Homes" it was hoped to increase markedly , the number of Direction Orders to some three to four hundred in a full year. This policy came into effect in the last quarter of the year, during which period 108 recommendations for Direction Orders were made by the Inspectors. It was agreed with the Town Clerk's Department that my Department should obtain Chairman's authority and Section 170 information. At the year end 74 sets of case papers had been passed to the Towi Clerk's Department for the service of Time and Place Notices, i.e. these Notices specify the time irtien consideration will be given by the appropriate Committee regarding the making of Direction Orders. TENEMENT BLOCKS Reference has been made in my Annual Report for the last two years to the classification of these blocks into three categories, (1) those which have been brought up to reasonably modern standard, (2) those which appear capable of and worth being improved to these standards and (3) those for which the only satisfactory treatment would be demolition (whether or not imnediately practicable). With reference to the blocks in group 2, which are the particular responsibility of this Council, progress was made in persuading owners to improve to modern standards. This approach was preferred to the service of Formal Notices which could result in the owner serving a Purchase Notice on the Council. It was found that certain of the blocks in this group, though substantially built, did not lend themselves readily to a satisfactory conversion either by reason of the dwellings' layout or because an excessive decant of tenants would be necessary. These blocks, while lacking the provision of all the desired amenities, do provide living accommodation of a better standard than that enjoyed by the average tenant in a house in multiple occupation and few of the tenants interviewed expressed dissatisfaction with their accommodation. It was proposed, therefore, that this group be divided into sub-categories 2a, those tenements which it was considered should be improved and 2b, those tenements which, because of layout, high decant and/or cost of improvement, should not be improved, but which can provide reasonable accommodation for a period of up to fifteen years. A full report on this further sub-division and on progress to date was submitted to the Housing Cbnmittee in October 1968. With reference to the blocks in group 3 progress has also been made in acquisition, in rehousing and in clearance as listed below. 57 GROUP THREE TENEMENT DWELLINGS Salisbury Buildings, Clerkenwell Close. Cleared P0PHAM STREET FLATS, (HOUSING DEVELOPMENT AREA 21) Albany Cbttages 34% of flats still occupied Cornwall Cbttages 39% of flats still occupied Edinburgh Cottages 32.5% of flats still occupied Qjeens Cbttages 30% of flats still occupied Acquired by the Council 28.11.66 QUINNS BUILDINGS (HOUSING DEVELOPMENT AREA 21) 38.5% of flats still occupied Acquired by the Council 1.1.68 CAMDEN DWELLINGS Consideration is being given to acquisition for temporary use as short stay accommodation, 100% occupied at present. PICKERING STREET DWELLINGS (HOUSING DEVELOPMENT AREA 21) Council acquiring - expected completion early in 1969 - 100% occupied. DIBDEN BUILDINGS (HOUSING DEVELOPMENT AREA 21) Cbuncil acquiring - expected completion early in 1969 - 100% occupied. COMPTON FLATS (COUNCIL OWNED) Blocks C, D and E. 49-291 - all flats vacant except for one family. Block F. 292-371 about 50 families occupying 50 of the 80 flats as short stay accomodation. IMPROVEMENT AREAS Three additional areas were proposed as Improvement Areas pursuant to the provisions of the Housing Act 1964. These were (1) Theberton Street Area 97 houses, 136 lettings, (2) Remington Street Area 82 houses, 136 lettings, (3) Kingsdown Road Area 168 houses, 313 lettings. Tibberton Square, Corbyn Street and Mitchison Road Areas were proposed as pilot scheme General Improvement Areas as envisaged in the White Paper "Old Houses into New Homes". Proposals have been prepared in respect of Tibberton Square and improvements discussed with the owners, resulting in a large measure of agreement. The Public Health Inspectors have conpleted their survey work on the Corbyn Street and Mitchison Road Areas and various suggestions for improvements have been made. The reports of other Departments are awaited in respect of the Corbyn Street Area and the views of the Greater London Council, who are the owiers, in respect of the Mitchinson Road Area. The following areas are also receiving attention as areas of improvement, where concentrated use is being made of powers (repair, provision of amenities, means of escape in case of fire, etc.) available under the 1957 and 1961 Housing Acts, there being insufficient seperate dwellings to justify action under the Housing Act 1964. 58 Northchurch Road Extension Area Claremont Square Area Thornhill Crescent Area Kiver Road Area Ockendon Road Area Elmore Street Area Plimsoll Road Area Wbrk is proceeding satisfactorily in the improvement areas listed in my Annual Reports for 1966 and 1967. 59 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 9 Re-inspections 36 Representations to Committee Nil Section 16 Individual unfit houses Number of inspections 233 Number of revisits 411 Houses represented to Oommittee 13 Closing Orders made 9 Demolition Orders made 3 Undertakings accepted Nil Houses demolished 26 Section 18 Unfit parts of buildings Number of inspections 198 Number of revisits 2 .072 Representation to Oommittee 37 Closing Orders made 16 Undertakings accepted Nil Section 24 Reconstruction of house subject to Demolition Order Number of inspections 3 Number of revisits 52 Reports to Committee 3 Section 27 Closing Orders or undertakings determined on completion or works Whole houses 1 Parts of buildings 15 Section 27 Permitted use of premises subject to Closing Orders Number of applications submitted to Committee 3 Number of applications granted 3 Section 28 Closing Order - Substitution of Demolition Order Number of orders substituted Nil Reports to Oommittee Nil Section 42 Clearance Areas Number of areas surveyed 4 Total houses in those areas 12 Areas represented to Council 2 Total houses in areas represented 6 Inspections 41 Revisits 61 60 Section 78 Overcrowding Inspections 38 Revisits 100 Overcrowding abated 32 Section 81 Permitted numbers Inspections 598 Section 90 Overcrowding in houses let in lodgings Inspections 4 Re-inspections 4 Housing Act Part V Possible C.P.O. s other than Clearance Areas Number of areas surveyed 12 Number of bouses in above areas 690 Number of inspections made 1.035 HOUSING ACT. 1961 Section 12 Management Orders Reports on individual houses submitted to Ooinnittee 3 Total of lettings in above houses or tenement blocks 19 Inspections and revisits 28 Management Orders made 2 Management Orders determined 3 Section 15 Provision of amenities Houses inspected 1, 232 Revisits etc. 4. 191 Informal notices served 204 Formal notices served 128 Notices complied with 95 Section 16 Means of escape in case of fire Houses inspected 1, 208 Revisits etc. 4, 475 Informal notices served 681 Formal notices served 373 Notices complied with 295 Section 19 Directions to prevent overcrowding Visits, etc. 464 Directions made 20 Variation of Direction 1 Section 21 Possible improvement of tenement blocks Number of tenement blocks surveyed 35 Total number of dwellings in above blocks 982 Number of blocks subject to report to Oommittee 35 Dwellings in above blocks 982 Inspections and revisits 1,073 61 HOUSING ACT. 1964 Section 13 Improvement Areas Number of areas surveyed 10 Number of houses in above areas 872 Inspections and revisits 1,307 Areas represented 3 Preliminary improvement notices served 8 Immediate Improvement notices served 10 Suspended improvement notices served 5 Informal undertakings accepted Nil Section 19 Improvement of Individual Houses Formal applications received from tenants 3 Informal applications Nil Dwellings inspected 54 Revisits etc. 66 HOUSING (FINANCIAL PROVISIONS) ACT 1958 Improvement and Standard Grants Inspections and revisits 60 HOUSE PURCHASE SCHEME London Borough of Islington Inspections and revisits 161 Greater London Council Inspections and revisits 25 Town and Country Planning Visits and revisits 190 Miscellaneous Inspections Other miscellaneous visits Including medical preference inspections, meat and food inspections, nurseries and child minders, etc 581 Interviews with oners, surveyors, builders, tenants, etc 2, 569 Non effective visits 3,704 HOUSING BILL Number of areas surveyed 3 Number of houses in above 501 Number of Inspections 751 62 PROSECUTIONS DURING 1968 Housing Act, 1957 - Section 27 Contravention of Closing Orders 17 Housing Act, 1957 - Section 78 Overcrowding 3 Housing Act, 1957 - Section 170 Failure to give information as to ownership 37 Housing Act, 1961 - Section 13 Breach of Regulations of Housing (Management of Houses in multiple occupation) 6 Housing Act, 1961 - Section 19 Failure to comply with a Direction to prevent or reduce overcrowding 6 Housing Act, 1964 - Section 65 Section 15 - Failure to comply with Notice served 49 Section 16 - Failure to comply with Notice served 63 Ttotal: 181 63 SUPERVISION OF FOOD FOOD HYGIENE (GENERAL) REGULATIONS 1960/1962 The year has seen the continuation of systematic inspections under these regulations, and it is considered that real progress has been made. Almost all the premises inspected have required some work to bring them up to the necessary standard but only in a few cases has prosecution been necessary. Certain food undertakings such as cafes and clubs which are open after 11 p.m. will be under much more effective control after 1st April 1969 when the legislation affecting night cafes comes into force. POOD FACTORIES A total of 134 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 The initial inspection of market stalls under the Pood Hygiene (Market Stalls and Delivery Vehicles) Regulations 1966 is now almost completed. Many stalls have been made to comply with these regulations; summonses have been served in four cases for failure to comply with the requirements. Five summonses were heard against the owner of a meat delivery vehicle, details of which appear under "Legal Proceedings" on page 66 Exemptions granted 24 Exemptions refused 1 FOOD COMPLAINTS The number of food complaints received during the year was 82 showing a decrease of 7% over the previous year. These complaints were dominated by those foods found to contain foreign matter of various natures. The complaints of alleged unfitness were received in respect of the following:- Bread, cakes & biscuits Milk & milk bottles Foreign matter in bread 10 Dirty milk bottles 4 Mouldy bread 4 Foreign matter in milk 2 Foreign matter in cakes 4 T Mouldy cakes Foreign matter in biscuits 1 Miscellaneous Insects in bread 1 Foreign matter in flour 1 Bad taste and smell of food and drink 6 ~24~ Foreign matter in sugar, fish finger, apple juice and milk powder 4 Meat and meat products Unsound chicken 2 Foreign matter in sausages 5 Sour drink concentrate 1 Mouldy meat pies 4 Disinfectant in mineral water 1 Bad taste of meat 2 Coloured stain in butter 1 Salt bag in collar of bacon 1 Wasp in marmalade 1 Decomposing bacon 1 Maggots in walnuts 1 Dirt on meat 1 Unsound bottle of wine 1 Foreign matter in meat pie 1 Mouse in cornflakes 1 Lead content of printing on sausage meat casing 1 Badly peeled chips 1 Insects in water cress 1 m 64 Canned goods Miscellaneous (continued) Foreign matter in meat 4 Stale yam 1 Unusual smell of loganberries 1 "Buttered" roll containing Mouldy vegetable soup 1 margarine 1 Decomposed rice 1 Decomposing jellied eels 1 Foreign matter in soup 1 Mould in porridge oats 1 Stale corned beef 1 Food poisoning symptoms after Mouldy baked beans 1 consumption of milk beverage 1 10 26 Details of proceedings taken in respect of these complaints are shown on page 66. POOD AND DRUGS ACT, 1935 (a) Number of food preaises etc. in the area, type of business and number of inspections made and action taken. Estimated percentage of compliance with Food Hygiene (General) Regulations 1960:- Premises Visits by Inspectors Reg. 16 Reg. 19 Bakehouses (basementp) 9 37 100 100 Bakehouses (others) 35 108 100 100 Bakers (Bread & cake shops) 77 56 98 98 Butchers 229 800 85 85 Chemist - 12 100 100 Confectioners 418 166 70 70 Fried Fish shops 51 248 100 100 Fish depots 1 194 100 100 Fish curers 9 44 100 100 Fishmongers 65 42 95 100 Greengrocers & fruiterers 214 125 95 100 Grocery and provisions 541 725 80 95 Wholesale food stores 71 317 90 100 Food Manufacturers 49 134 100 100 Public Houses 389 189 100 100 Off Licence preaises 116 28 100 100 Catering establishments (including clubs) 462 820 85 100 Canteens 228 146 100 100 Food storage for street traders 78 42 Food vehicles - 125 Food stalls 242 739 Milk distributors and dairies 419 87 Food examination (others) - 864 Meat inspection at licensed slaughterhouse) 1 540 Inspection of slaughterhouse ) 32 Miscellaneous visits and revisits - 2.666 65 OTHER ACTION TAKEN Contraventions found 345 Contraventions remedied 224 Notices served (Pood & Drugs Act) 236 Notices complied with (Pood & Drugs Act) 90 Pood Poisoning enquiries 86 Legal proceeding - attendances at Court 42 (b) Preserved Food Premises Registered under Section 16 (1) (b) of the Food and Drugs Act, 1955. Total number of Preserved Food Premises (included in foregoing list) 256 Visits by inspectors 315 LEGAL PROCEEDINGS A summary of the action taken by the Council for offences under the Pood & Drugs Act, 1955 and Regulations made thereunder is as follows:- Pood ft Drugs Act, 1955 No. of cases Total fines ft costs Sections 2(i), 6(i), 113(i) & (iii) 30 £550 Pood Hygiene (General) Regulations, 1960 Regulations 5,6,9, 14, 16.19. 21, 23, 24, 33 & 34 4 £148 Preservatives in Pood Regulations, 1962 Regulations 3 ft 8 2 £ 42 Colouring Matter in Pood Regulations, 1966 Regulation 4 1 £ 30 Pood Hygiene (Markets, Stalls ft Delivery Vehicles Regulations, 1966 * Regulations 4,7, 13, 16, 18. 25 ft 26 1 £ 33. 3s. Od. TOTAL £803. 3s. Od. In addition to the above, 3 cases were dismissed by the magistrates and 1 defendant was conditionally discharged. UNFIT FOOD During the year the total amount of food surrendered was:- Descrlptlon Tons Cwts. Qtrs. Lbs Meat 52 15 2 24 Offals 42 3 2 14 Tinned Goods 8 15 2 12 Pish 8 8 2 3 Others 16 0 3 22 Total 128 4 1 19 1,572 condemnation certificates were issued and 864 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 Stoithfield Market area was collected under contract for manufacture for technical purposes. SARPLING 738 samples, (13 formal and 725 informal) were submitted to the Public Analyst for examination. Adverse reports were received on 118 of these (16%). These are summarised below. Again this year, many of the adverse reports refer to labelling, and with recently passed legislation on composition and labelling still to come into operation, this aspect of food control must continue to receive special attention. 66 One sample was submitted for examination for residual insecticides. This was beef fat from an animal slaughtered in this borough. Traces found were well below that which might alarm. There will always be the need, however, for continued vigilance. FORMAL Fruit drink concentrates 5 Junior food 1 Beef in jelly 1 7 INFORMAL Soft drinks & Tomato paste 9 fruit concentrates 20 Sugar confectionery 6 Bread & rolls 13 Vegetables 5 Canned foods 10 Milk bottles 5 Cakes & biscuits 9 Others 34 111 54 samples sent for bacteriological examination were mainly of meat products, some of which were intended for export. 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 196 1. 311 167 367 - 381 Number inspected 196 1, 311 167 367 - 381 All disease except tuberculosis & cysticercus bovis:- Whole carcases condemned 13 32 2 18 - 1 Carcases of which some part or organ was condemned 141 1, 116 84 193 _ 184 Percentages of the number inspected affected with disease other than tuberculosis and cysticercus bovis 78.6% 87.6% 51.5% 57. 5% 48.6% One cow carcase was condemned for tuberculosis, 0.08% of the number inspected. There was one whole cow carcase condemned and one cattle carcase of which some part or organ was condemned, because of cysticercus bovis. Of the 381 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 Staithfield 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. 67 SLAUGHTER OF ANIMALS ACT, 1958 Slaughtermen's Licences During the year 9 Licences were issued and were current at 31st December. EXPORT CERTIFICATES - FOOD 340 export certificates were issued; the food which consisted mainly of animal casings, meat, tinned and bottled meats and soups was exported to 36 -countries. The majority went to Belgium, South Africa, U.S.A., Germany, Italy, Canada, Malta, Spain, Sweden, Ceylon, and Lebanon. Other countries included Bahamas, Brazil, Portugal, Kenya, Holland, Cyprus, Bermuda and Argentine. MERCHANDISE MARKS ACT, 1887/1953 Inspections 11 LICENSED CLUBS Number of licensed clubs 46 Number of applications referred to the Department 4 Number of visits 86 ICE CREAM ICE CREAM (HEAT TREATMENT, ETC.) REGULATIONS, 1959 Supervision of the manufacture and distribution of Ice Cream. During the year 154 inspections were made of ice cream premises and vehicles. The number of premises registered under Section 16 of the Food and Drugs Act, 1955. (a) for manufacture, sale and storage 18 (b) for sale and storage 544 (c) for sale only 119 (d) for storage only 3 684 ICE CREAM SAMPLES 1. BACTERIOLOGICAL EXAMINATION 78 samples of ice cream were sent for bacteriological examination and following Methylene Blue tests, were graded as follows:- Grade I 29 Grade II 25 Grade III 6 Grade IV 18 78 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, which was the subject of a complaint, was sent for chemical examination and found to be of poor quality. 68 MILK SAMPLES 1. BACTERIOLOGICAL EXAMINATION Class of Milk Results Phosphatase Methylene Turbidity Biological Blue Total Number of samples Pasteurised Satisfactory 6 6 6 Unsatisfactory - - - Untreated Satisfactory . 1 1 Unsatisfactory - - - 2. CHEMICAL EXAMINATION Details of samples submitted. Satisfactory Unsatisfactory Total Formal - - - Informal 23 1 24 MILK (SPECIAL DESIGNATION) REGULATIONS, 1963 (AS AMENDED) Number of Licences in force 415 MILK AND DAIRIES (GENERAL) REGULATIONS, 1959 Number of Dairies registered in the Borough 11 Number of Distributors registered in the Borough 408 XILK SUPPLIES - BRUCELLA ABORTUS No samples were taken during the year. THE LIQUID EGG (PASTEURISATION) REGULATIONS, 1963 There are no egg pasteurisation plants in the Borough. 69 HEALTH EDUCATION SERVICE Plato once said that education is a life-long business. The business of Health education is education for long life. Health Education has a two-fold aim. Firstly to inform and secondly to persuade to action. The main object of any form of education is to communicate and it is only by making this communication work that education can find its true target. We must know that the individual with whom we are communicating understands what we mean. It is not good enough for the educator to know what he is saying - he must know that what he is saying has been understood. In addition we also have the problems of the foreigner or immigrant who either cannot speak Qiglish or has communication problems and he should be approached within the framework of his own customs and social structure. To-day the public is more informed than it has ever been before, due to the sophisticated methods of communication which are available, and it is pleasing to note that members of the public are fast becoming aware of the fact that information and advice on many health topics is available at so many points in the Borough. The health education service continued to carry out its many varied functions during the past year and a number of new experiments were undertaken. DENTAL HEALTH It will be remembered that in 1966 many of the Borough's primary schools were visited by the famous circus personality Pierre the Clown who gave his talks on dental health education. These proved to be so popular that he was asked once again to tour the Borough and visited a further 41 primary and infant schools giving talks to another 10,000 children. HEALTH EDUCATION CONFERENCE In an endeavour to make members of teaching staff of schools situated in the Borough more aware of health education, the Inner London Education Authority, in conjunction with the Public Health Department, held a very informative Health Education Study Day at the I.L.E.A. Teachers Conference Centre. This was attended by representatives of every school in the Borough and a number of interesting papers dealing with some of the current problems in the health education field were presented by distinguished speakers. These were as follows:- MORNING SESSION Drugs - Dr. David T. Wilson, St. Bernard's Hospital. Sex Education - Dr. A. J. Dalzell-Ward, Medical Director, Central Council for Health Education. General Health - Mrs. M. Holmes, Senior Lecturer in Health Education, London University Institute of Education. AFTERNOON SESSION APPLICATION TO THE CURRICULUM Mr. C. A. P. Noseworthy, Headmaster, Islington Green School. Mr. S. Temple, Headmaster, Edward Seguin School. Mr. K. M. N. Robertson, Health Education Officer, London Borough of Islington. Final Forum with Dr. S. King, Principal School Medical Officer, Islington. 70 MENTAL HEALTH WEEK Once again the health education service was very actively engaged in the promotion of the third of the mental health weeks which were started in 1966. Further reference to this will be found in the report of the Principal Mental Health Social Worker. A special programme was designed by the health education service for distribution to the public, with a wide selection of leaflets and booklets dealing with many aspects of mental health. A number of film shows were staged in churches and club rooms of other interested bodies including the British Legion and the Rotary Club of Finsbury. They were accompanied by members of the mental health section who answered questions on mental health put to them by members of the public. Many schools were also visited and similar programmes presented. In addition, open days were held at the training centres which are run by the department. Special displays of articles made by patients at the training centres were devised by the health education staff and exhibited in the foyer of the Town Hall and Finsbury Health Centre. In addition exhibitions of art therapy by patients at the Springfield Hospital, together with interpretations of the meaning of the paintings, were exhibited with the exhibits from the training centres. One of the highlights of mental health week was a Brains Trust under the chairmanship of the Medical Officer of Health which was held in the Council Chamber of the Town Hall. A number of eminent speakers associated with Mental Health were on the panel:- • Dr. J. J. Bradley, M.R.C. S., L.R.C.P., Consultant Psychiatrist, Friern Hospital M. B., B. S. * Dr. A. Brook, M.R.C.S., L.R.C.P. Consultant Psychiatrist, Cassell Hospital and Islington Borough Council Dr. A. Shapiro, M.R.C.S., L.R.C.P., Medical Superintendent and Consultant M.B., B.S., M.D. Psychiatrist, Harperbury Hospital Mrs. P. Strauss Deputy Director, London Boroughs Training Committee Mr. S. Temple Headmaster, Edward Seguin School, N.1. Miss A. Terrington, A.A.P.S.W. Senior Social Worker, Richmond Fellowship GERIATRIC CLINICS The health education service was asked to increase its contribution to the geriatric health education advisory circles which are now held at three welfare centres, and at a group practice. It is often forgotten that when the age of retirement is reached, the individual does in fact need to change his habits because of the change in circumstances. Men. when they retire frequently think that they have now done their bit but it should be remembered that a woman never retires! Dr. V. Freeman, former Associate Medical Officer of Health, and the Health Education Officer, in association with Messrs. Camera Talks Ltd., produced a film strip entitled "Keeping Well in Old Age", which deals very fully with the problems of retirement and readjustment. The film strip was very well received by their professional colleagues and has received some good reviews in the professional journals. Y.M.C. A. Courses on human relationships were provided for pre-school leavers at the Y.M.C. A. Central Headquarters. 71 WOMEN'S NATIONAL CANCER CONTROL CAMPAIGN The Health Education Officer was invited to lecture to this body on some of the aspects of presenting cancer education and publicity, and he has since been invited to be a member of the health education committee of the campaign. SMOKING ADVISORY CLINIC The clinic continues to go from strength to strength. It is interesting to note that Islington is the only local authority in the country which has a permanent smoking advisory clinic. This has carried on continously without a break since 1962 and the degree of success is most encouraging. Out of a total of 276 Persons attending during the year 33.85% gave up smoking completely and were still not smoking one year after their initial stopping. Accurate figures concerning the remainder are not available although follow-up is made of those who only 'cut down' ; it is usually impossible to contact those who have moved away from the district but it is hoped that there is a degree of success in this area. Unfortunately 30.43% attended only once and were not seen again. It is felt that these people do not, in fact, wish to stop smoking themselves but have a desire for someone else to accomplish this task for them. The following reasons for wishing to stop smoking were given:- Health 56.5% Financial 13% Health & Finance 11% Other reasons 8% Not known 11.5% HEALTH EDUCATION IN SCHOOLS AND FURTHER EDUCATION ESTABLISHMENTS The Health Education service continued to liaise with many schools in the Borough and a number of health talks were given and courses on human relationships were arranged. Many teachers are now calling upon the health education service for further information and are being supplied with visual aids, films, posters and leaflets etc., for their own programmes. It is very heartening to note that the facilities offered by the service are being used more frequently. Advice was given to head teachers who wished to plan their own health education programmes and activities. A number of Parent-Teacher Associations were shown films which would be used during term time in health education programmes in schools. Thus the minds of many parents were put at ease when topics covering human relationships, sex instruction and V.D. were discussed, as they themselves saw and approved the material which was being used at the schools. Special courses for school leavers at the Edward Seguin School were continued. The Holloway Institute for Further Education ran groups for older people and the Health Education Officer was able to attend and give talks on a number of topics which were of interest to them. The Northern Polytechnic Students' Union received a lecture on the services provided for students by the Public Health Department: they were very surprised to learn of the many facilities which are extended to the public. The City Day College continues to make use of materials in the form of posters, leaflets, visual aids and films which are provided by the health education service for their various health education programmes. The Public Health Department has been visited by a number of groups of secondary schoolchildren, who have been given a conducted tour and a lecture on the many services which the department offers to the public. This enables them to get first hand knowledge of the various functions which are carried out for them. 72 HEALTH EDUCATION ADVISORY PANEL The Panel continued to meet to discuss the furtherance of health education and during the year projects and campaigns on the following topics were presented:- January Winter Illness, Fire, Hypothermia February Dental Health March Prophylaxis April Teenage Health May Smoking June Mental Health July Summer Safety August Preparation for School September Balanced Diet October Fire Safety November "Are you a Slave?" December Good Will to All HEALTH VISITOR STUDENTS TRAINING Many student health visitors from the North Western Polytechnic were advised in the preparation of health education material and also in the content and method of health education techniques. IN SERVICE TRAINING, Student public health inspectors also received advice and practical training in health education as part of their examination course. ST. MARK' S HOSPITAL The Health Education Officer was invited to take part in a study day for senior nursing staff at St. Mark's hospital where he presented a paper on "Drug dependence in today's society." CHURCHES AND YOUTH ORGANISATIONS Liaison is maintained with church groups on various health aspects particularly in the home safety field. The Health Education Officer acted as examiner for the Duke of Edinburgh's Award Scheme during the year. OIL HEATERS One of the perenial problems which had to be dealt with by the health education service was the education of the public in the safe use of oil heaters, and to this end a number of displays were presented in various parts of the borough and a continuous appeal to the public to make themselves conscious of potential danger was made. 73 74 75 76 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 of the Medical Adviser's department of the I.L.E.A., the local Divisional Education Officer and Head Teachers of the schools in the Borough has been of great assistance. MEDICAL EXAMINATIONS Arrangements were made for children at all schools in the Borough to be medically examined as a routine as soon as possible after admission to infant school, after transfer to secondary school and as early as possible in the term before the one in which they reached statutory school leaving age. Pupils who were still in attendance after attaining 15 years of age were examined as early as possible in the term prior to that in which they would be leaving school. Nursery school children were medically inspected on admission and annually thereafter. Most pupils were seen just after transfer to junior school but when this borough took over from the former London County Council on the 1st April 1965, selective medical examinations, where only selected pupils are seen, were carried out in 38 schools in the Borough. Many head teachers now seem to prefer the routine medical examinations, and at the end of 1968 only 15 schools were continuing selective examinations. During 1968 13,784 (13,543) routine medical examinations were carried out in the borough. This resulted in 39.5% (38.6%) of children on the school roll being examined as a routine. It was gratifying to find that only 0.1% (0.3%) of the children examined were thought to be in an unsatisfactory physical condition.4. 5% (4.4%) of the children seen were referred for treatment other than for vision. The largest number of children noted for treatment at routine medical inspections was for vision - 56.22 (64.09) per 1,000 inspected, the next being for defects of the skin 5.15 (3.17) per 1,000 inspected. ROUTINE MEDICAL INSPECTIONS - DEFECTS Number of children noted for treatment or observation expressed as a rate per 1,000 inspected DEFECTS 1968 1967 Treatment Observation Treatment Observation SKIN 5.15 9.65 3.17 8.05 EYES - (a) Vision 56.22 66.96 64.09 65.72 (b) Squint 4.50 6.02 4.06 6.05 (c) Other 0.80 2.10 0.59 1.62 EARS - (a) Hearing 4.64 6.53 4.65 4.58 (b) Otitis Media 1.23 8.13 0.89 5.09 (c) Other 0.44 1.60 0.22 1.33 NOSE AND THROAT 2.83 30.11 2.51 23.33 SPEECH 2.76 6.67 2.81 6.28 LYMPHATIC GLANDS 0.15 13.93 0.15 8.05 HEART 0.94 8.13 1.62 7.01 LUNGS 1.52 12.84 1.85 12.63 77 DEFECTS 1968 1967 Treatment Observation Treatment Observation DEVELOPMENT - (a) Hernia 0.44 3.92 0.81 3.25 (b) Other 0.65 4.35 0.52 4.36 ORTHOPAEDIC - (a) Posture 0.51 11.46 0.89 8.49 (b) Feet 1.89 11.24 2.07 6.42 (c) Other 1.52 6.24 0.44 6.13 NERVOUS SYSTEM - (a) Epilepsy 0.44 1.74 0.81 1.77 (b) Other 0.15 2.03 0.15 1.48 PSYCHOLOGICAL - (a) Development 1.01 5.22 1.03 5.61 (b) Stability 1.16 9.65 1.40 6.57 ABDOMEN - 1.01 0.15 1.03 OTHER 15.16 41.50 15.80 43.05 SPECIAL MEDICAL EXAMINATIONS Requests that children be examined at times other than the normal routine examinations, were received from the Education Officer, head teachers etc. 3,207 (3,999) of these examinatioi were carried out in 1968. Some of these were held at school but a large number of them were carried out in the children's own homes. 6,231 (8,324) children were called up by the school doctors for re-inspection after the routine medical examination. 27.1% (35.1%) of the children on the school roll were seen at these non-routine medical inspections. NON-ROUTINE MEDICAL INSPECTIONS TYPE OF INSPECTION No. seen in 1968 No. seen in 1967 Re-inspections 6, 231 8,324 Bathing centre inspections - scabies - 2 Bathing centre inspections - others 3 6 Employment certificates 231 310 Theatre children 23 106 School journeys 1,652 2,014 Recuperative holidays - pre-departure 106 94 Outward Bound Courses - 14 Boarding schools for the delicate - pre-departure 26 39 Boarding schools for the delicate - on return 2 6 Handicapped pupils - statutory examinations 237 245 Handicapped pupils - periodic special defect examination 157 235 Research investigations and enquiries 2 - SUB-TOTAL 2, 439 3,071 SPECIALS - at request of:- Head Teacher - child's name entered in special book 138 148 Head Teacher - others 228 323 School nurse - following health survey 49 47 School nurse - others 35 41 Divisional Education Officer 45 57 District Care Organiser or Care Committee 25 56 Parent 49 64 School Medical Officer 149 171 SUB-TOTAL 718 907 78 No. seen in 1968 een in 1967 OTHERS:- Accident on school premises 5 3 Connected with remedial exercises, foot classes or by gymnast or physiotherapist 1 - Referred by general practitioner 2 1 Miscellaneous 42 17 SUB-TOTAL 50 21 TOTAL OF ALL NON-ROUTINE MEDICAL INSPECTIONS 9,438 12, 323 RECOMMENDATIONS FOR SPECIAL SCHOOLING After special medical examinations recommendations may be made for pupils to attend special schools which are more suitable for them than ordinary schools. During 1968 ten pupils were recommended for day schools for the physically handicapped, three for boarding open-air schools and ten for day schools for the delicate. Three children were recommended for home tuition. 237 (245) statutory examinations were carried out by special medical officers in this borough, and vetted by a Principal Medical Officer, who decided whether pupils who appeared backward should continue at their ordinary school, possibly with extra help in reading and arithmetic etc, or whether they should be recommended for a special school for educationally sub-normal children. If these children were just leaving school recommendations as to suitable employment were made to the Youth Employment Officer or for special care after leaving school, (i.e. attendance at a training centre, referral to the Principal Mental Health Social Worker, etc). During the year 103 children were recommended for day E.S.N, schools, 3 to boarding E.S.N, schools and 79 to continue at ordinary schools. Children at E.S.N, schools were seen regularly by a specially trained Medical Officer to ascertain whether they had improved sufficiently to return to ordinary schools. Advice was also given to the Youth Employment Officer as to suitable employment for children leaving schools for the physically handicapped. Arrangements were also made for some children living in or attending schools in this borough to be examined at County Hall. DAME ALICE OWEN'S SCHOOL From the beginning of the Autumn term 1968 a Medical Officer and a school nurse were provided for medical examinations at Dame Alice Owen's School. Hitherto the Board of Governors had made their own arrangements for a doctor to undertake these, but this doctor retired at the end of the summer term. ASSESSMENT OF CHILDREN WITH MORE THAN ONE HANDICAP IN NEED OF SPECIAL EDUCATION The Burnham Committee decided that the salaries of head teachers of special schools and members of graded posts for teachers should be determined by the types of handicap of the children attending their schools, instead of by the type of handicap with which the school was designed to deal. Arrangements were therefore made for reports of children said to have another handicap to be sent to the Medical Advisor, so that the decision could be made centrally as to whether the child should be deemed to have that handicap. 79 SCHOOL JOURNEY MEDICAL EXAMINATIONS All children in the borough going on school journeys, except those going to I.L.E.A. camps, were medically examined at least 96 hours before the date of departure to ascertain whether they were physically fit to go away. Those going on Adventure Courses and winter expeditions were looked at especially carefully, to ensure whether they could stand up to the rigorous conditions. The total number of medical examinations by a medical officer was 1,652 (2,014) for 61 (62) school journey parties. 1,477 pupils from 29 (31) schools going to I.L.E.A. camps where a school nurse is in attendance were seen by the school nurse only. SCHOOL NURSES' INSPECTIONS Most pupils were seen by the school nurse annually at a comprehensive health survey. During 1968 21,195 (22,228) of these surveys were carried out, when 1.24% (1.73%) were found verminous. 6,292 (8,333) selective health surveys were also carried out during the year when 1.53% (2.66%) were found verminous. 0.85% (1.36%) of individual pupils on the school roll were found verminous. Of the 296 (477) individuals found verminous the majority were cleansed at home by their parents using a special shampoo issued by the Council, but 39 (46) attended the bathing centre and were cleansed there. 517 (264) pupils were examined specifically for athlete's foot, 588 (608) for plantar warts, 1,032 (1,140) for dysentery and 2,718 (1,786) for other communicable diseases. REMEDIAL FOOT CLASSES Foot classes for children with flat feet, valgus ankles etc, were held in 11 schools in the borough three to four times a week by teachers who volunteered for this work, and had attended a course. Classes lasted 15 - 20 minutes and some children only needed to attend for one term while bad cases needed two or even three terms. Parental consent was obtained before a child could enter the class. Classes were visited by a Medical Officer twice a term, at the beginning to select suitable children, and at the end to decide which could be discharged. Without the co-operation of the head teachers who made the necessary arrangements to enable the teachers to take the classes, it would not have been possible for the work to succeed, and their help and that of the teachers was much appreciated. AUDIOLOGY 7,647 (6,562) sweep tests and 166 (771) pure tone tests were carried out by school nurses on children in schools in the borough. Of these, 163 (335) were found to have defective hearing and were referred for further investigation. 134 (244) attended the audiology sessions held during the year. There was a total attendance of 435 (511) at the 38 (40) sessions. In addition, the audiologist paid regular visits to Frank Barnes School for the Deaf and to the Partially Hearing Unit at Hargrave Park School. SPECIAL INVESTIGATION CLINIC During the year special investigation clinics for enuretic and obese children, or for those found suffering from poor nutrition, were held at seven different centres in the borough. 71 (85) children were discharged cured during the year, and total attendances were 1,736 (2,031). MEDICAL TREATMENT FOR SCHOOLCHILDREN The number of sessions, new cases and total attendances at school children's clinics during 1968 (including sessions held in hospital premises) were as follows:- 80 Type of clinic No. of sessions New Cases Attendances Minor Ailments (Nurses) 326 (304) 952 (1,041) 5,872 (6,349) Special Investigation 252 (270) 292 (301) 1,736 (2,031) Dental 1,981 (2,104) 8,961 (12,991) 15,360 (17,375) Vision 255 (249) 837 (941) 4,450 (4,649) Audiology 38 (40) 134 (244) 435 (511) BATHING CENTRES No. of attendances for treatment of scabies 299 (164) No. of attendances for treatment of vermin and nits 187 (170) ANTI-DIPHTHERIA PRECAUTIONS. ACCESSIBILITY TO CLASS REGISTERS AND MEDICAL RECORDS In the event of an out-break of diphtheria, emergency swabbing must be carried out on all known contacts. When schools are in session, this is normally done in the schools with special arrangements for absentees. During the holidays it is vital that school medical staff are able to trace contacts speedily. Arrangements were made for class registers to be collected and placed in the same room as the children's medical records before any holiday of a week's duration or more. The school keeper and the Divisional Education Officer were to be informed where registers and records were to be found. • B.C.G. VACCINATION Twenty-one secondary schools in the Borough were visited and 1,752 school children were Mantoux tested, 1,521 of these children were given B.C.G. vaccination. 100 children were found to have positive reactions and were referred to Chest Clinics. 89 children were X-rayed and of these 5 were found to need treatment and 38 were kept under supervision by the Chest Physician. TUBERCULOSIS INCIDENTS During 1968, notifications were received that five schoolchildren in Islington (three boys and two girls) were suffering from pulmonary tuberculosis. A sixth notification was that of a member of school staff teaching in Islington. Six different schools were involved. Following investigation of the school contacts one child was found to be suffering from tuberculosis, and 24 required supervision by the Chest Physician. HYGIENE AND SANITARY ARRANGEMENTS IN SCHOOLS Arrangements were made for the school medical officer of each school to walk round the school with the head teacher or deputy once during the year to report on the sanitary conditions there and to see if they met the regulations laid down by the Department of Education and Science. Where defects were found the Education Officer was notified in order that they might be rectified wherever possible. PRIOR WESTON SCHOOL This new school, which will eventually have 280 Junior Mixed and Infant children, opened on the 9th September 1968 in the Golden Lane Estate, Whitecross Street, E.C.I. RESEARCH BY TOE EDUCATION RESEARCH UNIT OF THE INSTITUTE OF PSYCHIATRY Research facilities were offered to the Institute of Research Psychiatry to study the behaviour of the children of alcoholic parents who were patients of the Maudesley hospital. 81 If parental consent was obtained, the children's school was approached and information collected from the children's teachers. STUDENT HEALTH SERVICE In June 1968 approaches were made to the Principal of the North London College of Further Education, who kindly agreed that a male doctor and a female doctor should attend approximately alternate weeks during term time, to undertake a student health service. When students were accepted for a course at the college they were asked to complete a questionnaire about the state of their health and the extent to which they had been protected against infectious diseases. A letter was also sent telling the students that a doctor attended the college regularly and would be pleased to discuss any problems of a medical nature, pointing out that this service was not intended to take the place of the General Practitioner service, and that no National Health Service prescriptions could be issued. The students were also advised to register with a local doctor if they had not already done so. Early in each term the doctor studied the questionnaires and the school medical records (if available) for new admissions, and made a note of any student whose medical history made it particularly desirable to keep an eye on him. Where no report of a recent medical examination was available, or where any report indicated the need, a routine medical examination was arranged, sufficient time being allowed for a short conversation of a general nature. The Medical Officer also arranged for new admissions to receive, as appropriate in the light of their records, a mass X-ray, a Tuberculin test with B.C.G. inoculation if necessary, and immunisation against poliomyelitis. The medical officer saw students other than new admissions whom he wished to keep under surveillance and was available also to see students, their relatives or members of the staff, attending at their own request, and students referred by any member of the staff. He also sent letters to General Practitioners, hospital consultants or other persons about the needs of individual students. The scheme started in October 1968 and by the end of the term 28 students had been seen, 16 had been medically examined, 13 given advice and 6 referred to their General Practitioners. 82 REPORT OF THE CHIEF DENTAL OFFICER AND PRINCIPAL SCHOOL DENTAL OFFICER This report on the dental service which is run on behalf of the Inner London Education Authority in concert with the Borough dental service, presents a somewhat similar pattern to the year preceding. One main pre-occupation present as ever in this service is the struggle to obtain the necessary staff for its continuity. The number of dental officers employed rose from 3.7 to 3.8 Another is school dental inspection. Because of the reintroduced scheme for dental inspections, the number of, sessions devoted to this increased from 61 to 123 and it followed therefore that the number of treatment sessions decreased from 2,006 to 1,806. Fourteen sessions were used for health education. The number of first inspections at school increased from 4,963 to 13,955. Because of the new dental scheme the number of first visits for treatment decreased from 6,512 to 4,230, and subsequent visits from 10,274 to 7,399. The number of emergencies increased slightly as did the number of additional courses of treatment commenced. The number of failures was much higher than last year - a phenomenon experienced also by other boroughs. More permanent teeth and less temporary teeth were filled. One encouraging feature was that the number of extractions of both permanent and temporary teeth was lower than in 1967. The average number 6f fillings in permanent teeth was a little higher than last year although that in temporary teeth was a little lower. The ratio of temporary teeth filled to temporary teeth extracted was a little below the general average, but that of permanent teeth filled to permanent teeth extracted much lighter. One other item which must be mentioned is the improvement to the dental surgeries at Thornhill Road, where two new units were installed, and where new linoleum has enormously improved their appearance. The service was also assisted by the appearance of Pierre the Clown who completed a tour of a number of schools. This is referred to in that part of the Medical Officer of Health's Report which deals with Health Education. All in all this was a year of some progress. MATERNITY AND CHILD WELFARE This service proceeded along the same lines as 1967 with a similar pattern of sessions and attendances except that it was decided to institute some lectures at the welfare clinics in order to stimulate interest in dental care. R. E. Hyman, Principal School Dental Officer. Chief Dental Officer. 83 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN MATERNAL AND CHILD HEALTH CENTRES Local welfare centres continued to be busy during the year with a variety of clinic sessions, and the supervision of expectant mothers, babies and children. Many members of the public come to the local centre first of all when in need of advice, or because of stress in the family or neighbourhood. The health visitors are usually available part of the day and give necessary advice or information freely. The decentralisation of home visitors to the elderly was completed, and 8 home visitors are now based at six welfare centres. This is intended to provide a more easily accessible service in the area for both medical practitioners and for members of the public. A total of 8 occasional creche sessions are held each week at the centres. These are of great benefit to mothers and young children. Blythe Mansions centre, which opened in 1967 as a full-scale centre, is becoming a very active centre and has filled a long-felt need for services in the area. There was a reduction in the total number of maternity and child welfare sessions held, and a consequential reduction in total attendances. The falling birth rate is a contributing factor in this. On the other hand there was a sharp increase in the number of attendances at occasional creche sessions. SUMMARY OF MATERNAL AND CHILD WELFARE ATTENDANCES:- (1967) Child welfare - Total attendances 54,549 (60,064) Toddlers - Total attendances 4,373 (5,059) A/N & P/N - Total attendances 5,327 (6,838) (excluding GPO sessions) Grand Total 64,249 (71,961) No. of occasional creche sessions per week 8 (8) Total attendances during 1968 4,102 (2,306) CERVICAL CYTOLOGY Pour day-time clinics were held each week for the collection of cervical smears from well women for cytological investigation by the Pathologist at the Royal Northern Hospital. All these were combined with Family Planning clinics. Attendances were by appointment, and the total number of smears sent for examination increased from 953 in 1967 to 1,107 in 1968. CYTOLOGICAL STATISTICS TO 31.12.68. Total number of cases 1, 107 1, 045 Normal 55 Other gynaecological disorders (excluding cancer) which required treatment. These women were referred either to their general practitioner or directly for gynaecological advice and treatment. 5 Doubtful cases referred for repeat examination. 2 Positive - referred to own doctors. 84 AGE GROUPS Under 25 95 25- 34 408 35- 44 331 45- 54 206 Over 55 67 DAY CARE OF CHILDREN DAY NURSERIES There are five Council day nurseries providing a total of 299 places for children under five. Four of these are training nurseries, and twenty students were in training during the year. Twelve students sat the N.N.E.B. examination in 1968 and ten were successful. The demand for the day care of pre-school children continued to be high and there were consistently long waiting lists. Children from the highest priority groups only were admitted (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). At one of the nurseries, a 2-year old child, both deaf and blind, was admitted to the baby room, with his mother initially, to assess whether day nursery care would help to realize his full potential. After a period of time, be began to sit up and eventually pull himself up to a standing position. He became more confident and adventurous and began to explore his surroundings. He was encouraged to wear his glasses and it was thought that he was able to see to a very small extent. This child benefited considerably from being with other children. He has since been admitted to a Sunshine Home for Blind Babies. In October a voluntary organisation opened a private day nursery in the Highbury area which was registered under the Nurseries and Child Minders' Regulation Act 1948, to accommodate eventually 30 children aged 2-5 years. The Council accepted the offer of twenty places in this nursery at an agreed daily rate. Children are admitted to these places from the Council's priority waiting list on exactly the same conditions as admissions to Council day nurseries, the first twelve being admitted by the end of the year. STATISTICS COUNCIL DAY NURSERIES Average daily attendance during the year 270 Average rate of occupation 90% Waiting list at the end of the year (Priority) 128 (Others) 194 Total 322 CHILD MINDING Unsatisfactory and illegal minding of children continued to give cause for concern. Minders known to the department were followed up and advice on health and home safety measures was given by health visitors and senior medical and nursing staff. The health visitors and health education section co-operated in producing a pamphlet which is handed to child minders - Hints on Minding Children'. Other agencies, i.e. Department of Health and Social Services, expressed interest in this leaflet. In 1965 local health authorities were asked by the Minister of Health to report to him their arrangements for registration and supervision under the Nurseries and Child-Minders' Regulation Act, 1948. In the light of these reports and following the Minister's subsequent discussions with his professional advisers the 1948 Act was amended by Section 60 of the Health Services and Public Health Act, 1968, which came into operation November 1968. This strengthens local health authorities' powers with regard to registration. 85 Towards the end of the year all women known to be daily minding were circularised and made aware of new legislation requiring them to register with the local health authority. The Personal Health Committee decided at their meeting in December 1968 to discontinue payment of registration fees to voluntarily registered child minders as from 1st February 1969. STATISTICS AS AT 31.12.68 PLAYGROUPS There were 15 part-time playgroups in the Borough run by voluntary organisations and private persons, providing accommodation for approximately 300 children between 2-5 years. Three were grant-aided by the Council for the service provided. All these playgroups are visited regularly by health visitors. These have not been statutorily registered under the 1948 Act but consideration will now be given to their registration under the amended Act. NURSERIES There were 3 registered private day nurseries in Islington providing places for 64 children. One is run by the Islington Society for Mentally Handicapped Children; one is attached to a hostel for unmarried mothers and admits only children of the residents; the third has allocated 20 of its 30 places to the Council and children are admitted from the Council's priority waiting list for day nurseries. STATUTORILY REGISTERED CHILD MINDERS - 16 providing 97 places. VOLUNTARILY REGISTERED CHILD MINDERS - 41 providing 64 places. DOMICILIARY MIDWIFERY The trend for hospital confinements continued during 1968 resulting in an increase of planned and unplanned early discharges. The decline in the birth rate made it easier for patients to book for hospital confinement. In addition to the 325 home confinements 80 other patients were booked for domiciliary confinement but subsequently transferred before delivery to the hospital service:- 58 due to complications of pregnancy 9 in premature labour 13 in labour at term There were 8 calls for the services of the emergency obstetric unit. The planned early discharge scheme from hospital resulted in 563 assessments of home conditions being made 125 homes were found to be unsuitable. 497 patients were nursed at home following hospital delivery. This number includes unplanned early discharges. GROUP ATTACHMENT OF A DOMICILIARY MIDWIFE In February 1968 a domiciliary midwife was attached to a group of three doctors. From this date until December 1968 there were 38 domiciliary confinements and 10 planned early discharges. The midwife attached to the group shared off-duty relief with two colleagues. MATERNAL DEATHS Confidential enquiries in accordance with the Department of Health and Social Security instructions were initiated into the deaths of 5 women who had been Islington residents; in no case was the Council's staff concerned in the care or treatment given. 86 STILLBIRTHS There were no domiciliary stillbirths during the year. TRAINING All of the Council's ten full-time midwives are approved by the Central Midwives Board as teaching district midwives to train pupil midwives for the three months'district experience that is required in the second period of their training. The Council accepts pupil midwives from the City of London Maternity Hospital and St. Mary's Hospital, Paddington. During 1968, 35 pupils completed their district experience and a further 8 were in training at the end of the year. Owing to the decline in domiciliary confinements some difficulty was experienced in obtaining the required number of home confinements for pupil midwives. As a result of this, the Central Midwives Board introduced a new scheme of training requiring pupils to have six domiciliary confinements plus a programme of social services and community care - these were arranged by the Borough. The programme includes visits to day nurseries, training schools, a mother and baby home, a magistrate's court, the headquarters of the London Ambulance Service and the Citizens' Advice Bureau. Talks are given by representatives of the Chief Welfare Officer and of the Children's Officer on the work of their departments, also by the senior social worker (Health Services), the principal mental health social worker, the deputy principal nursing officer, a home help organiser and a public health inspector. HEALTH VISITING Health Visitors have continued their work with families of all social classes. There has been a great deal of movement of families during the year and tracing these families is difficult and time-consuming. In certain instances we use the "lost families circular" which is circulated to all London boroughs. Accidents in the home are still being followed up, particularly fire cases (statistics hereunder):- 1. Total number of fires notified 77 2. (a) Number of fatalities (total) 9 (11.7%) (b) Number of fires involving fatalities 6 (c) Number of children involved 4 3. (a) Number of injuries (total) 15 (b) Number of fires involving Injuries 8 4. Number of fires involving oil heaters 31 (40.2%) For some years now we have known of the "battered baby syndrome". With greater awareness by hospitals, general practitioners and health visitors, more of these distressing cases come to notice year by year. They need a great deal of investigation to begin with and careful vigilance for quite a time afterwards. The hospitals, general practitioners and health visitors are working in close contact with each other here. During the year 1968, triplets were born in Islington in a family where there were three children already. The children were all over five pounds in weight and developed normally. The mother, however, felt exhausted although she had some private domestic help. The health visitor, therefore, arranged for the services of a home help to give two hours help daily and both father and mother expressed the view that without frequent visits by the health visitor and the home help service, routine in their full and active household could never have been established. The family have since moved from the Borough. The health visitors took part in a number of surveys. Ten health visitor students were trained in the Borough and all passed. The Borough sponsored eight health visitor students during the year. 87 Co-operation with general practitioners continued, three further health visitors working in liaison with three different practices. CASES VISITED BY HEALTH VISITORS IN 1968 (1967 FIGURES IN BRACKETS) Children born between 1963 and 1968 18,574 (20,819) Persons over 65 389 (216) Mentally disordered persons 140 (198) Persons (excluding maternity cases) discharged from hospitals (other than mental hospitals) 306 (254) T.B. Households visited 21 (26) Households visited on account of other infectious illnesses 963 (244) Total effective visits 54,503 (57,343) Total ineffective visits 14, 361 (13,418) HOME NURSING SERVICE Schemes for group attachments initiated in 1967 continued to flourish and more are under consideration. The Council arranged for several senior district nursing sisters to take a course for Practical Work Instructors to give them an insight into practical teaching in the field and management of staff, before becoming Group Leaders. This proved beneficial to all staff concerned. The Queen's Institute of District Nursing ceased to award their certificate in May 1968, and the Council was therefore unable to take students for training. Consequently it was necessary for the Borough to make alternative arrangements for the theoretical training necessary for students, and plans were under discussion for this to be provided at the North Western Polytechnic. Pupil state enrolled nurses from St. Matthew's Hospital continued to be taken for a course of integrated training. The Marie Curie Foundation continued to provide generous help for patients with all types of cancer. This enabled extra nursing help to be provided to a number of patients and also to provide some with extra nourishment. With this assistance one patient was provided with a folding bed and was thus enabled to be nursed in the sitting-room during the day. Queen Mary's Needlework Guild provided some very useful clothes for the necessitous, and the Beal Girls Grammar School, Ilford, Essex sent several hand-knitted blankets for distribution amongst elderly patients. HOME NURSING STATISTICS (1967 FIGURES SHOWN IN BRACKETS). Total No. of patients being nursed at 1. 1. 68 629 (637) do. do. 31. 12. 68 649 (629) do. nursed during the year 2,423 (2,533) do. visits made do. 92,974 (98,601) do. do. to persons aged over 65 75,982 (79,158) Proportion of visits made to persons aged over 65 81.7% (80.2%) Nursing treatments completed during the year 1,774 (1,894) Nursing treatments commenced during the year 1,784 (1,896) 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:- 88 Equipment Total number loaned during 1968 Air and sorbo rings 72 Bed cradles 60 Bed and back rests 85 Bed pans 61 Commodes 265 Cots with sides 6 Dunlopillo mattresses 9 Fracture boards 11 Mackintosh sheets 87 Special beds and hoists 30 Urinals 26 Walking aids 51 Wheel chairs and other special chairs 107 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. 54 fireguards were loaned in 1968. 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 Ad hoc vaccination and immunisation sessions continued to be held at all the main maternal and child health centres, amounting to a total of eight sessions weekly. In addition, the basic course of protection is offered to all infants attending child health sessions, unless already being given protection by their own doctors. Despite untiring efforts by all concerned, the percentage of young children fully protected before they reach school age falls short of the optimum. For this reason it is still necessary to arrange sessions in schools to offer "booster" doses and, in many instances, full basic courses to the unimmunised. During 1968, 23 such sessions were held in primary schools, and we continue to be most grateful for the co-operation of school staff in making this possible. 1,419 children completed basic courses of immunisation. It is estimated that as a result of these sessions the average percentage of children protected in these schools was raised by 7%. Discussions were held towards the end of 1968 at meetings of the Inner London Group of the Association of London Borough Medical Officers of Health about the revised schedules of immunisation procedures recommended by the Joint Committee on Vaccination and Immunisation (Ministry of Health Circular 29/68), with a view to obtaining uniformity of action at least throughout the Inner London area. The revised schedule recommends delaying the commencement of the basic course until 6 months of age (instead of at 3 months), and extending the intervals between doses to 6-8 weeks (instead of 4). In addition, the recommended schedule is extended 89 to include re-vaccination against smallpox at 4½-5 years, and a "booster" dose against poliomyelitis and tetanus at school-leaving age, plus re-vaccination against smallpox one month later. Whilst agreeing with the extentions to the schedule, the concensus of opinion in London was that because of the high mobility of families in Inner London, it is preferable to continue to commence the basic course of protection at an early age, and also to give the doses at reasonably short intervals. It was agreed by nine of the London Boroughs, including Islington, to adopt the following schedule:- Diph/Tet/Pert/Polio 3 months „ 4 months „ 5 months Measles 12 months Smallpox 17 months Diph/Tet/Pert/Polio (Boost) 18 months Diph/Tet/Polio Pre-school entry Smallpox re-vaccination Pre-school entry B.C.G. 13+ years Polio/Tet/Smallpox Re-Vaccination School leavers at 15 - 19 years MEASLES VACCINATION In 1966, this Council, with the approval of the Minister of Health, initiated a scheme offering measles vaccination at clinics for children aged 10 months and over whose parents requested it. During 1967 (the first full year of operation of the scheme) 309 children were protected against measles. In February 1968, the Minister asked all local health authorities to make arrangements for this protection to be offered to all children up to and including the age of 15 who were susceptible to an attack of measles because they had neither been immunised nor had natural measles. On account of the limited supply of measles vaccine, the Minister requested that during the months of May, June and July 1968, measles vaccination was to be offered only to susceptible children between their fourth and seventh birthdays, and those-attending day nurseries and nursery schools, or living in residential establishments, who were between their first and 7th birthdays. Despite widespread publicity, which included sending a letter to parents of all the children believed to be 'at risk' in the age group concerned and a vaccinating team visiting all the forty-six infant schools in Islington, the response was very disappointing. B.C.G. VACCINATION Twenty-one secondary schools in the Borough were visited and 1,752 schoolchildren were Mantoux tested. 1,521 of these children were given B.C.G. vaccination. 100 children were found to have positive reactions and were referred to Chest Clinics. 89 children were X-rayed and of these 5 were found to need treatment and 38 were kept under supervision by the Chest Physician. TUBERCULOSIS INCIDENTS During 1968, notifications were received that five schoolchildren in Islington (three boys and two girls) were suffering from pulmonary tuberculosis. A sixth notification was that of a member of school staff teaching in Islington. Six different schools were involved. Following investigation of the school contacts, one child was found to be suffering from tuberculosis and 24 required supervision by the Chest Physician. 90 STATISTICS (1967 FIGURES IN BRACKETS) IMMUNISATION AND VACCINATION PRIMARY COURSES COMPLETED Diphtheria 4,407 (5,046) Whooping Cough 3,988 (4,397) Tetanus 4,473 (5,104) Poliomyelitis 4,614 (5,634) Measles 2,909 (324) BOOSTER DOSES Diphtheria 5,381 (7,328) Whooping Cough 2,619 (3,141) Tetanus 5,332 (6,798) Poliomyelitis 5,278 (4,603) SMALLPOX VACCINATION Primary Courses 3,363 (3. 257) Re-vaccinations 399 (269) TOTAL OF IMMUNISATION SESSIONS HELD IN SCHOOLS 23 (43) B.C.G. ROUTINE VACCINATION Total No. of schools visited 21 (23) No. of children tested 1,752 (1,879) No. of children vaccinated 1,521 (1,697) CHIROPODY SERVICES I have referred elsewhere to the resignation of the chief chiropodist, whose last day of service was 20th October, 1968.In view of the extreme difficulty in recruiting a replacement and the continued shortage of senior and sessional chiropodists, it proved necessary to close temporarily five sessions a week at two centres in the Borough. In spite of this, it was gratifying that the total number of sessions held, and the total attendances, were higher than in 1967. CHIROPODY Total No. of sessions held at clinics (chiropodist sessions) 4,855 (4,197) Total No. of appointments booked 33,971 (31,893) Total attendances 30,394 (28,745) ANALYSIS OF ATTENDANCES Children: 0- 4 years 7 (9) 5-14 years 1,128 (1,996) Adults: Male 5,371 (4,789) Female 23,888 (21,951) Total attendances 30,394 (28,745) Total No. of sessions held at old people's homes (chiropodist sessions) 25 (26) Total No. of appointments booked 198 (215) Total attendances 198 (215) Total No. of domiciliary appointments booked 4,742 (3,711) Total No. of treatments given 4,357 (3,498) 91 Total No. of transport appointments booked 315 (247) Total attendances 293 (214) HOME HELP SERVICE This service operates from three area offices, each staffed by a home help organiser, an assistant organiser and a clerk. There is considerable fluctuation in the number of home helps employed in each area throughout the year. Recruitment of suitable persons for this work continues to be difficult so that it is frequently impossible to provide more than the minimum service. The demand for this service for aged persons is reflected in a report from one organiser that during 1968 she provided home helps to 36 persons who are over 90 years of age, which included the household of one couple where the wife was aged 95 and the husband 94 years. The service also continued to provide early morning and evening help in households which were motherless for various reasons, and thus provided a positive contribution to the prevention of children being taken into residential care and also in keeping families together. Many home helps give much kindly help beyond the service for which they are paid, and in one such instance five motherless children were given a most successful party by the home help, which was enjoyed by all concerned including the father of the children. STATISTICS FOR THE YEAR ARE AS FOLLOWS (1967 FIGURES SHOW IN BRACKETS): - Aged under 65 on first visit in 1968 Aged 65 or over on first visit in 1968 Chronic sick & Tuberculous Mentally Disordered Maternity Other Total No. of cases 2,254 (2,203) 140 (161) 7 (10) 39 (57) 205 2,645 (213) (2,644) No. of home helps employed at end of 1968 (whole-time equivalent) 153 (188) OBSERVATION AND HANDICAP REGISTER As outlined fully in the 1967 report, an index of known handicapped children and young persons (0-17+ years) is maintained centrally under the personal supervision of a principal medical officer who reviews individual cases at frequent intervals. Every effort is made to co-operate with those likely to be involved with the development and future welfare of those included in the index. In addition, an observation register is maintained at welfare centres. This includes the names of children who for various reasons may be at risk of developing a handicap. The responsibility for keeping these 'at risk' children under regular review rests with the medical and health visitor staff at the centres under the general supervision of the principal medical officer. As a general rule a child's name is removed from the observation or 'at risk' register at the age of two years if development is entirely normal. 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 Invalid Children's Aid Association 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 schools 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. 92 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 Employment Service. The principal mental health social worker or her representative, attends the subcommittee meetings on handicapped children of the Youth Employment 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 are obtained as appropriate. Close liaison is maintained with the Children's Officer on individual cases. At the end of 1968, the number of children on the central handicap register and the observation register at Welfare Centres was:- Handicap Register - children 0 - 17+ years 1,832 (1,902) Observation Register - children 0-5 years 2,139 (2,236) FAMILY PLANNING The National Health Service (Family Planning) Act 1967 extends the previous powers of local health authorities enabling them to provide, or arrange for other bodies to provide, advice on contraception and supplies for any person who needs them on social grounds, and not. as hitherto, only in medical cases. The Council's service is 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, and the service has now been expanded in conjunction with the Family Planning Association. Advice, examination and supplies continue to be provided without charge to Islington women referred on medical grounds, to Council clinics and to Family Planning Association clinics. In addition Islington women referred to these clinics on social grounds are also seen and advised free of charge but are ordinarily required to pay for supplies unless genuinely unable to do so. This also applies to Islington residents who receive family planning advice on social grounds from their general practitioner; if necessitous, they may be referred by the general practitioner to a Council clinic to obtain supplies at a reduced charge or free of charge. In all cases seen at clinics, the patient's general practitioner is consulted initially where it is proposed to prescribe oral contraceptives. The Family Planning Association hold a weekly special advice clinic for young people; unmarried Islington persons under 18 years of age referred to this special clinic are seen and advised free of charge, the Council accepting financial responsibility. Those who do not come within the medical or social need categories referred to above are not seen at Council clinics. These persons are advised to consult their own doctor or to apply to the Family Planning Association. During 1968 the Council's clinics were increased from four to six per week. Total attendances at these clinics were 838. DOMICILIARY FAMILY PLANNING The Family Planning Association undertook to provide a domiciliary birth control service in Islington for the benefit of those women where family restriction is deemed advisable but where the mother is not willing or able to attend a clinic. This small pilot scheme for approximately 50 cases is financed by charitable monies, which the Association is able to use specifically for this purpose. If the pilot scheme proves successful it is proposed that continuation of the service will be undertaken by the Borough. 93 Initially all referrals are made by health visitors, and the types of cases referred generally come within the category of social need. The scheme started on 1st October 1968 and by the end of the year 11 cases had been referred to the Association. PREVENTION OF BREAK-UP OF FAMILIES The Co-ordinating Committee has continued to meet at two-monthly intervals. During the year there was a further increase in the number of case conferences held on individual families. Meetings were held on 22 occasions to consider a total of 103 families. Some of these families were considered several times because of the complexity of their problems. STUDENTS OF SOCIAL WORK Four students from the London School of Economics came to the department during the year. Two came for short periods of general observation of the services provided and two for experience of family casework. VENEREAL DISEASE The social workers attached to the Special Clinics at Holloway Prison and the Royal Northern Hospital have commented on the large part played by public ignorance of the dangers of promiscuity in the spread of venereal disease. There is still a great need for education using all modern means of communication to bring the facts before the public. RECUPERATIVE HOLIDAYS The recuperative holiday scheme provides holidays at approved homes 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. The total number of recuperative holidays arranged during the year was lower than were arranged for 1967. A number of letters were received stating how beneficial the holidays had been and expressing gratitude to all responsible for arranging them. The greatest decrease was in those arranged for unaccompanied children and was probably due to the large number of school journeys, and to the fact that more parents can now afford to take their children away on holiday themselves. Recommendations on behalf of school children were mostly referred to the Inner London Education Authority which maintains two holiday homes. RECUPERATIVE HOLIDAYS ARRANGED Expectant and Nursing Mothers 1 (2) Tuberculous adults 7 (14) Other adults 96 (89) Psychiatric patients 10 (17) Accompanied children 13 (16) Unaccompanied children (placed by I.L.E.A.) 80 (119) 207 257 MENTAL HEALTH There is evidence of a more positive approach towards mental health emerging throughout the country and this has been reflected during 1968 by trends in Islington's mental health programme, and by its emphasis on prevention as well as cure. LIAISON WITH GENERAL PRACTITIONERS Four mental health social workers are still attached to general practitioners' surgeries, and we hope to increase this number as soon as staffing permits. These weekly sessions in the surgeries afford considerable opportunities for preventive work. 94 All general practitioners in the Borough now have an open invitation to share with the mental health staff in a lunch-hour case conference on the first Wednesday in each month. Those general practitioners who have come, have expressed appreciation of the value of meeting to discuss mutual problems with their colleagues in the mental health field, and we are hoping that more doctors will respond to this invitation during the coming year. YOUNG PEOPLE'S COUNSELLING SERVICE With the help of the Borough's consultant psychiatrist, a counselling service for young people with emotional problems was launched during the year - a further activity in the preventive field, which is aimed at helping young people to achieve and maintain mental health in adult life. LIAISON WITH FRIERN HOSPITAL Closer links are developing all the time with our catchment hospitals, and during the year two combined meetings have taken place when our Islington consultant psychiatrist and social work team have met with Frien Hospital consultants, social workers and senior nursing staff. As well as these general meetings, which contribute much towards understanding and co-operation, small combined meetings at a senior level have taken place quarterly to discuss matters of mutual concern. Four Islington social workers have regularly attended ward rounds at Friern to maintain contact with patients and advise on the borough's psychiatric services. This ward round commitment has now Extended to Halliwick Hospital. HOSPITAL ADMISSION In spite of developments in social services for the mentally disordered there are unfortunately still a number of cases of sudden breakdown. Mental health social workers continue to provide a twenty-four hour service - weekends and public holidays included to make provision for those who. because of their acute illness, are in urgent need of treatment in a psychiatric hospital. SUBNORMALITY The principal medical officer, who specialises in this field, acts as consultant to the mental health team 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. The special assessment and advisory clinics which have now been extended to three centres in the Borough have continued regularly throughout the year. At the clinics the needs of mentally and physically handicapped children under school age are assessed and plans are made for their future education. Parents receive counsel and support and, when desirable, the children are seen in their own homes for assessment in familiar surroundings. Each month throughout the year an average of three children were seen in their own homes and twelve in clinics. SOCIAL WORK WITH TOE MENTALLY HANDICAPPED Included in the wide variety of activities in this field is supportive work for a number of mentally handicapped adults who can barely manage their own affairs. An example is the case of a man whose aged mother died during the year. The mental health social worker, with the help of the Islington Society for the Mentally Handicapped and the Borough's Home Help and Home Nursing Services, has managed to keep the man going in his own home, adequately clothed and nourished and, most difficult of all, free from debt. 95 DAY CENTRES AND TRAINING CENTRES The Borough has been able to develop and expand the plans of the former London County Council for the day care of mentally ill and mentally subnormal persons. This has meant planning and organising new centres, and introducing teaching methods for children, and suitable work and recreation for adults. Mental health social workers have co-operated closely with the centre staff. At the end of 1968, there were 274 places in six centres, and the Council also grant-aided a 24-place day nursery for mentally handicapped children. The reports which follow have been contributed by the Centre Supervisors:- ROSEMARY JUNIOR TRAINING SCHOOL Rosemary School has attracted its usual stream of visitors, but staff and pupils have long since come to regard this as a normal part of the day, and the work of the school has gone steadily on. The five classrooms now accommodate a total of ninety children in addition to twelve (with a waiting list) in the Special Care Unit. Seven boys and girls and one member of staff joined the Inner London Boroughs' holiday camp at St. Mary's Bay, Kent. Weekly swimming sessions have continued at the local baths throughout this year, and a certificate has been obtained by one of our senior boys, making a total of four certificates for the school to date. Parties of children have been taken out from time to time to assist in their social training, and an excellent puppet show was given to the school in connection with road safety. Our deputy principal left us at Easter to take charge of a new junior training centre in another London borough. One member of staff returned to us, having obtained his diploma as teacher pf the mentally handicapped, and another left the centre temporarily in the autumn for secondment to the two-year course for this diploma. We enjoy having students from the diploma course at Chiswick Polytechnic and the National Association of Mental Health Diploma course, who were placed with us for their teaching practice. Regular visits of observation were paid to the school by medical students from three of the London teaching hospitals, and by many doctors and nurses, and a variety of social work students and others. Two senior girls from a local secondary school came once a week to help with the children. Two successful open days were held,one in June to coincide with Mental Health Week, and one at Christmas time when a variety of activities were presented, every child in the school taking some part. These open days were well supported by parents, friends and officials and were much enjoyed by the children themselves. The usual Christmas party took place at the school, and the staff and senior girls from a local senior school very kindly invited our two top classes to a party at their own school. They provided transport to and fro and gave our boys and girls a very happy time, which was very much appreciated by everyone. We cannot finish our account of the year's activities without a "Thank you" to our many friends and specially to Mr. & Mrs. Lawrence and customers from the "George IV", Goswell Road, for the really delightful Wendy House which they had specially made as a gift to Rosemary School. CAMDEN ROAD TRAINING CENTRE This has been a year which viewed from outside could be regarded as uneventful as much of our work is unspectacular and consists of establishing personal relationships with 96 trainees and giving individual assistance with their social and temperamental difficulties. With understanding and encouragement many of our trainees can be helped to become more adult and so to fit in more easily at home and, in one or two cases, able to work in open industry. The variety of our industrial work has been much wider than in previous years. Trainees have been responsible for the assembling of toys, making up cowboy and indian sets, packing farm animals, etc, also packing sets of handkerchiefs and ties for the Christmas trade, labelling and packing scarves, covering collecting boxes, and sticking "Green Shield" stamps in books, to enumerate some of the jobs which have been tackled with enthusiasm by our trainees. A group from our Centre has joined with Bennett Court for weekly swimming sessions at the local baths, an activity which has been much enjoyed by all participants. Our annual open day, during Mental Health Week, was very well supported by parents and others and by a large number of professional workers; this opportunity to meet with our interested friends in the community is an encouragement to both staff and trainees. During the year we were fortunate in obtaining a qualified assistant, part of whose time was to be devoted to organising a fuller social training programme. So far, due to limited staffing, it has not been possible to put this programme fully into operation, but we look foward to implementing it in the coming year, when we hope to be able to appoint our third member of staff. Our year ended,merrily with the usual Christmas party and conjuring show. We anticipate further steady progress in 1969. BENNETT COURT TRAINING CENTRE It is now nearly two years since we moved to Bennett Court from the Church Hall at Junction Road, and the experiment of having adult female and male trainees working together has proved very successful. A comprehensive programme has been developed for the social training of the trainee and also for industrial work and handicrafts. As a result of this programme four of our trainees (male) have now obtained work in open employment and I think we can look foward to others doing so in the future. Our close contact with the Disablement Resettlement Officer has helped in this respect. The Centre is in an ideal position amid a block of flats, which gives the trainees good contact with the local residents, who come into the Centre regularly to buy or ask for articles to be made. The pleasanter working conditions have resulted in far greater output of industrial work and handicrafts and we have been able to double the maximum payment to trainees; competent workers are now eligible to receive pocket money allowances of up to thirty shillings a week, which they receive in addition to their social security grants. This increased output has continued despite the fact that there is always a group of six trainees taking part in social training, simple laundry and cooking, and others paying visits to places of interest in the London Area (i.e. Houses of Parliament, Westminster Abbey, Natural History Museum, Science Museum, a tour of the new Euston Station). Although social training has for some time been recognised as a "must" in any progressive training centre, the response made by a particular young man or woman to the social training programme can sometimes be quite striking; the increased self-confidence and social competence has frequently been noted with enthusiasm by the parents of a trainee. This has been an enjoyable and encouraging year. 97 RICHMOND AVENUE DAY CENTRE This thirty place centre has been full to capacity throughout the year. Although a large number of our clients are long-stay there is always a certain amount of turnover, so it is possible for new applicants to be fitted in from time to time. There have been twenty-seven new admissions during the year and, out of the twenty-four who have left for various reasons, thirteen have returned to full-time work. The arrangement has continued whereby three places have been set aside for the use of long-stay patients from Friern Hospital. Although one or two of these patients have, after a trial, proved unsuitable for a community based day centre, some have managed to persevere with the daily journey by public transport to and from hospital; five of these Friern patients have now left us to take up outside employment. One Friern patient has, after a period at Richmond Avenue, managed to leave hospital and cope with life in a hostel. This is quite an achievement after nearly twenty-five years in hospital. As this is largely an industrial centre, every effort is made to introduce as much variety of work as possible. In addition to our usual packing and assembly work we have recently been fortunate in obtaining a catalogue despatch job for one of the large London stores. This involves working in close co-operation with the G.P.O. It is a rush job which will occur regularly for a short period three times a year. Everyone in the centre is able to participate and the general feeling is that although it would be unacceptable to work continually under pressure, it is stimulating to have three short periods in the year when maximum effort is required; morale is high during these periods. Day centres still being something of a novelty, we have had our usual stream of visitors, doctors, medical students, social workers and others; the interest taken in the centre's activities is an encouragement to both staff and clients. Occasional outings have been arranged including two visits to the coast during the summer months which were well attended and there was 100% attendance at the annual party at Christmas. A successful jumble sale was held at the centre, the proceeds of which were used to purchase a snooker table. This is very popular during the lunch hour and at, the evening club. A social club is run on the premises weekly from 4.30 to 9.00 p.m. for those clients and relatives who feel the need for social activity connected with the centre. In addition to this, patients' relatives have the opportunity to meet one another regularly at the centre on one evening a month. They seem to derive some support and encouragement from these gatherings, which help them to realize that others besides themselves have the problem of caring for a mentally sick relative. The centre supervisor and mental health social worker are present at the meetings. Very close contact is maintained between the day centre and the mental health social workers, one particular social worker acting as liaison officer and working closely with the supervisor. She visits the centre weekly to discuss new entrants and any special problems that may arise. There is usually a waiting list for this centre, and it is planned to admit extra patients as soon as an additional member of staff can be appointed. PINE STREET DAY CENTRE This short-term psychiatric day centre opened in January, 1967, as part of the development in community mental health resources. It was conceived as an experimental treatment unit to provide rehabilitation in terms xxf working and social relationships and to make full use of the group setting. The first year was largely spent in setting up and organising the centre, working out a suitable referral system and building up our communications with referral sources. This was a 98 testing year to prove that the centre was viable, and working through the anxieties and changes inevitable in the setting up and acceptance of such a unit. 1968 has been a more settled year. The centre is being regularly used by hospitals and other social work agencies in the Islington area. The turnover of patients is regular and the original aim of the average length of stay being set at 6 months has proved a realistic and useful one. This prevents the staff from accepting those who obviously needed a lengthier time for rehabilitation and provides a more immediate goal to work towards for those who may be inclined to get too dependent. It has been interesting to note that the centre has contained a considerable diversity of types of patients and we are still unable to predict what category of patient we would be most likely to be able to help. In order to have some clearer picture of this, and therefore be able to provide a better service, we hope to enlist the aid of the Greater London Council's Research and Intelligence Unit to work out some assessment. It has also been noticed that there seem to be a group of patients who are referred but never reach the centre, and some who stay a few days but then leave. We hope the research project may also give us some insight into what causes this 'drop out'. The organisation of the centre has varied throughout the year according to the fluctuations in the type of group attending over a certain period. Their involvement and sense of responsibility can vary and be built up, but this fluctuation always means that there has to be some flexibility over the degree of staff support. A meeting is held each morning from 9.45 - 10.00 presided over by a chairman who is elected by the group each month. This meeting is in general a practical one to organise the'day and the tasks and responsibilities to be undertaken by the group and individuals. The more complicated relationship problems within the group are discussed at the group meetings now held twice weekly. These hourly meetings provide an opportunity for the discussion and understanding of difficulties of working and living together as a group, relating these to similar situations to be coped with at home and on discharge, work etc. Various activities and projects which have been worked at over the year have included further work for Task Force, some industrial work, taking over the cleaning of our rooms from the domestic staff and seeing that as our responsibility. There has been some painting of chairs for nursery schools in the Borough and next year we expect to be making and mending toys for these schools as a regular commitment. The interest and group involvement in active work for Task Force drops noticeably when the average age of the group increases. The younger group are always keener to help in an active way, the older ones preferring to visit and talk to the old people. We have encouraged visitors, and contacts from other centres and the patients are used to showing medical and social work students, as well as other interested people, around the centre and describing it's aims in their own terms. Over the past year there has been an average daily attendance of 12, the numbers varying from 7 to 16. 42 patients were admitted over the year, 4 of these being readmittances. 10 patients have been discharged. ARCHWAY CITADEL DAY CENTRE The aim of this Centre is to help elderly psychiatric patients to lead a more normal life in the community and, where possible, to prevent or postpone admission to hospital. The centre is run in conjunction with the Salvation Army who supply the premises and arrange transport and meals, while the Borough provides the staff. As a beginning there are places for twelve patients and the centre is open on three days a week. As it did not open until the end of the year, a progress report cannot yet be given. 99 STATISTICAL SUMMARY The total number of persons referred to the mental health section by general practitioners, local education authorities, police etc., was as follows:- (1967 figures in brackets) Mentally ill sub-normal and severely subnormal Total Males 399 (410) 62 (65) 391 (475) Females 688 (657) 48 (51) 736 (708) Totals 1,017 (1,067) 110 (116) 1, 127 (1, 183) The total number in community care at the end of the year was 817 (799). 34(43) mentally subnormal patients were provided with short term residential care during the year. Of these. 18(19) was at the Council's expense and 16(24) in National Health Service Hospitals. At the end of the year the number of patients supported financially by the Council in various residential homes and hostels totalled 47(59), 19(28) mentally ill and 28(31) mentally subnormal and severely sub-normal. DAY CENTRES AND TRAINING CENTRES - ATTENDANCES TRAINING CENTRES Junior Senior No. of centres 1 2 No. of places 102 100 Total attendances 15,335 (11,714) 12,528 (12,207) DAY CENTRES FOR THE MENTALLY ILL No. of centres *2 No. of places 50 Total attendances 8,844 * a third part-time day centre opened at the end of the year with 12 places. APPENDIX "A" Establishment of Officers (as at 31.12.1968) Medical Officer of Health and Principal School Medical Officer 1 Deputy Medical Officer of Health and Deputy Principal School Medical Officer1 Principal Medical Officers 2 Senior Medical Officers 2 Medical Officers 9 15 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 13 Secretary 1 Senior Clerks 31 Clerks 37 Telephonists (one supervisor) 2 Attendant Telephonists 2 Senior Typist 1 Shorthand Typists 5 Clerk typists 2 Assistant - (Health Education) 1 Supervisor (Invalid Meals Service) 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 26 Senior Housing Inspector (Fire) 1 Fire Inspectors 5 Inspectors (General Purposes) 2 Technical Assistants 9 Student Public Health Inspectors 11 Rodent Officer 1 Rodent Investigaeors 4 Superintendent Disinfector and Resident Caretaker 1 Superintendent of Laundry & Disinfecting Station 1 76 101 NURSING AND MIDWIFERY Principal Nursing Officer 1 Deputy Principal Nursing Officer 1 Assistant Nursing Officer 1 Centre Superintendents 9 Health Visitors 38 Student Health Visitors 9 •Tuberculosis Visitors 2 Clinic Nurses (full-time equivalent 16.3) 17 School Nurses 18 •additionally one supernumary Tuberculosis Visitor held temporarily against vacancy in Health Visitors*establishment. 96 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 11 Domiciliary District Nurse Midwife 1 Physiotherapist (part-time) 1 15 HOME NURSING Superintendent 1 Assistant Superintendent 1 District Nurses 37 Student District Nurses 6 45 DOMESTIC HELP Home Help Organisers 3 Assistant Home Help Organisers 3 6 102 MENTAL HEALTH Principal Mental Health Social Worker 1 Deputy Principal Mental Health Social Worker 1 Mental Health Social Workers (7 retained personal designation of Senior Mental Health Social Worker) 12 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 (Day Centre) 4 Trainee 1 40 CHIROPODY Chief Chiropodist/Administrative officer 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) 5 Welfare Officers (V.D.) 2 10 DENTAL Chief Dental Officer and Principal School Dental Officer 1 Dental Officers (Full-time and sessional) (Full-time equivalent - 5.3) 9 Dental Surgery Assistants 17 TOTAL NUMBER OF OFFICERS 564 (in addition lists are maintained of doctors, who are prepared to work on a sessional basis.) 103 Establishment of Manual Workers ENVIRONMENTAL HEALTH Bathing Attendants 9 Plant Attendant 1 Hashing machine attendants (male) 2 Driver/Disinfectors 5 Stoker/Handym 1 Handyman/Drivers 4 Porter/Cleane 2 Female Cleaner, Supervisor 1 Female Cleaners (160 hours P. w.) Foreman Rodent Operative 1 Rodent Operatives 12 MEALS SERVICE Head Cook 1 (32½ hours) Assistant Cook 2 (x 32½ hours) Kitchen Helpers 4 (3 X 32½: 1 x 20 hours) Drivers (part-tjme) 9 (20 hours each) Helpers (part-time) 9 (20 hours each) HOME HELP SERVICE Total Home Helps (8,400 hours) HEADQUARTERS AND PERSONAL HEALTH Attendants 130 hours per week Cleaners 1,094 hours per week 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 40 hours per week Stoker/Handymen 3 (x 40 hours per week) 104 APPENDIX B HEALTH SERVICE ESTABLISHMENTS Establishment Administrative Offices Central Office Home Help Service - Central Area North Area South Area Address 159/167 Upper Street, N.1. Drayton Park Welfare Centre, 32 Drayton Park, N.5. North Islington Welfare Centre, 6 Manor Gardens, N.7. Barnsbury Welfare Centre, Carnegie Street, N.1. 28 Cowcross Street, E.C.I. Finsbury Health Centre, Pine Street, E. C.1. do. Meat Inspector's Office Mental Health Service Rodent Control Service Day Nurseries Canonbury Place Lloyd Square Mitford Road Scholefield Road Springdale Disinfection and Cleansing Stations Finsbury Treatment Centre 8 Canonbury Place, N.1. 14 Lloyd Square, W.C.I. 1 Mitford Road, N.19. Scholefield Road, N.19. 15A Springdale Road, N.16. Health Centre, Pine Street, E.C.I. 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 Archway Citadel (Voluntary) Finsbury Richmond Avenue 30, Junction Road, N 19. Health Centre, Pine Street, E.C.I. 42/44 Richmond Avenue, N.1. Mental Health Adult Training Centres Camden Road (Female) Bennett Court (Mixed) Camden Road Congregational Church Hall, 577 Caledonian Road, N.7. Bennett Court Community Centre, 25a Axminster Road, N.7. 105 Mental Health Junior Training School Rosemary (Mixed) (includes special unit for children with dual defects.) 75 Prebend Street, N.1. Midwjves Hostel Scholefield Road, N.19. School Treatment Centres Islington Manor Gardens Popham Road 37 Thornhill Road, N.1. 6 Manor Gardens, N.7. 26 Popham Road, N.1. Health Centre Pinsbury Pine Street, E.C.1. Chiropody; Dental and Physiotherapy Clinics; Mental Health Day Centre; Disinfection and Cleansing Station Welfare Centres Archway Congregational Church Hall, Junction Road, N. 19. Child Welfare; Chiropody Bamsbury 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. Clephane Road 6 Clephane Road, N.1. Maternity and Child Welfare; Chiropody Clephane Road (Branch) The Baptist Church Hall, Cross Street, N.1. (Entrance in Fowler Road) Child Welfare Drayton Park 32 Drayton Park, N. 5. Maternity and Child Welfare; Chiropody; Elderly Persons; Smoking Advisory Clinic. Drayton Park (Branch) Drayton Park (Branch) Hilldrop Leage Street Pine Street 6 Hurlock Street, N.5. 76/80 Isledon Road, N.7. Tenants' Clubroom Hilldrop Estate, N.7. 24 Leage Street, E.C. 1. 13 Pine Street, E.C.I. Child Welfare Child Welfare Maternity and Child Welfare Maternity and Child Welfare Maternity and Child Welfare; Elderly Persons; School Health (minor ailments) 106 Other Chiropody Clinics Caxton House Settlement Gifford Hall Mission Islington Medical Centre 59 Andover Road, N.7. Gifford Street, N.1. 303 Upper Street, N.1. Voluntary Welfare Centres Claremont Central Mission North Islington North Islington (Branch) White Lion Street, N.1. 6 Manor Gardens, N.7. Holloway Hall, 129 Seven Sisters Road, N.7. Child Welfare Maternity and Child Welfare Child Welfare 107 INDEX Addresses of Health Service Establishments 105-107 Anti Diphtheria Precautions 81 Audiology 80,81 Bacteriological Examinations 20,52,67,68,69 Basement Bakehouses 43 B.C.G. Vaccination 81,90,91 Bathing Facilities 23,81 Caravan Sites 31 Care of Mothers and Young Children 84,85 Celluloid and Cinematograph Film Act 54 Cervical Cytology 84,85 Chemical Examinations 52,68,69 Chest Clinics 18,19,81,90 Child Minding 85,86 Children's Department - Co-operation with 7,93 Chiropody Services 91,92 Clean Air and Atmospheric Pollution 31-41 Common Lodging House 52 Consumer Protection Act 45,46 Cremations 3 Cromwell Lodge Hostel for Homeless T.B. Men 8 Day Care of Children 85,86 Day Centres 4 Training Centres 6,96,97,98,99,100 Day Nurseries 6,85,86 Deaths 8-12,17 Dental Services 70,83 Diseases of Animals Act 44 Disinfection & Disinfestation 31 Domiciliary Midwifery Service 86 Dysentery 17 Elderly Persons' Welfare 21 -27,71,84,92 Emergency telephone arrangements after hours with Whittington Hospital 7 Employment Agencies 53 Environmental Health Committee Members 4 Establishments - Addresses 105-107 Establishments - Officers 101-103 Establishments - Manual Workers 104 Export Certificates - Food 68 Factories Act 42,43 Fertilisers and Feeding Stuffs Act 54 Family Planning 6,93,94 Fire Risks 48,58,59,73,87,89 Fireworks 52,53 Five Year Capital Programme 2,3 Food & Drugs Administration 649 Food Complaints 4,65 Food Poisoning 14,15 Food Samples 66,67 Freeman Dr 71,74-76 Friern Hospital, Liaison with 95,98 General A Vital Statistics 8-12 Geriatric Preventive Clinics 22,71 Grants to Voluntary Orgnisations 6 Handicapped Children & Register 78,79,85,92,93 Health Education Service 70-76,83 Health Centres - Projects re 2,3 Health Service Premises 05-107 Health Visiting 18,84,85,86,87,88,92 Home Help Service 87,92 Home Nursing Service 88 Home Safety see under Fire Risks Housing 55-63 Ice Cream 68 Immigrants 19,20,70 Incontinence Pads 89 Infectious & Other Diseases - Prevalence & Control of 13-27,81 International Certificates of Vaccination and Inoculation 13 Islington Chest Clinic 18,19 Islington Chest & T.B. Care Committee 17,18 Junior Training School 96 Laundry Services 22 Lead Poisoning 15,16 Legal Proceedings 29,31,45,46,50,53,57,63,65,66 Leptospirosis & Ankylostomiasis 16 Liason with General Practitioners 15,22,82,84,86 87,88,89,93^94,95,100 Licensed Clubs 68 Loan of Equipment 88,89 Lung Cancer Deaths 12 Massage or Special Treatment Establishments 53 Mass X-Ray Unit 18 Maternal Deaths 9,12,86 Meals on Wheels & Invalid Meals Service 21,22 Measles Vaccination 90 Meat Inspection 67,68 Medical Treatment and Examination for School Children 77-79,80,81 Mental Health 6,70,71,94,95,96,97,98,99,100 Merchandise Marks Act 68 Midwifery 86,87 Milk 69 Noise Nuisances 44,45 Nurses Agencies Act Nurseries & Child Minders 85,86 Nursing Homes 54 Offensive Trades 43,44 Oil Heaters 73 Offices, Shops & Railway Premises Act 46-50 Old Houses into New Homes 55,57 Outworkers 43 Performing Animals (Regulation) Act 53 Personal Health Committee Members 4 Personnal Health Services 84-100, Pharmacy & Poisons 45 Pigeons 31 Playgroups 86 Population 8,11 Prevention of Break-up Families 87,94 Prevention of Damage by Pests Act 16,51 Principal Officers of the Public Health Department 4-5 Prophylaxis 89-91 Public Analyst 15,52,66-67 Public Control 52-54 Public Health (Infective Jaundice) Regulations 14 Public Health Inspectors - Work during year28-69 Public Health Laboratory - County Hall S.E.I17,20 Published Papers during 1968 6 Rag Flock and Other Filling Materials Act 45 Rats and Mice 16,51 Recuperative Holidays 94 Remedial Foot Classes 80 St. Pancras Chest Clinic18,19 Sampling 45,52.66-67,68,69 Sanitary Circumstances f the Area 28-54 Scabies and Vermin 20,78,80,81 School Health Service 77-82 Senior Training Centres 96-97 Sewerage & Sewerage Disposal 52 Shops Act 53,54 Shops (Early Closing Days) Act 53 Slaughterhouses 44.67 Slaughter of Animals Act 68 Smallpox - International Certificates of Vaccination and Inoculation 13 Smoke Control Areas32,33 Smoking Advisory Clinic72 Special Investigation Clinic 80 Statistics, General and Vital 8-12 Stillbirths 8,87 Street Markets 64 Students and Schoolchildren's Visits Students Health Service 82 Students of Social Work 94 Supervision of Food 64-69 Task Force 23,99 Theatrical Employers Registration Acts 53 Training:- Day Nurseries 85 District Nursing 88 Health Education 73 Health Visiting 73,87,88 Mental Health 96 Midwifery 87 Student Public Health Inspectors 73 Tuberculosis 6,12,17,18,67,81,90,91 Typhoid and Paratyphoid Fever 16,17 Unfit Food 66,67 Vaccination & Immunisation 13,89-91 Vencral Disease 94 Vital Statistics 8-12 Voluntary Organisations 6.54.71,73,85,86,87,92,93,95,99 Water Supply 17,51,52 Welfare Department - Co-operation with 7,20 Whittington Hospital - Emergency telephone arrangements after hours 7 Works in default 31 Young People's Counselling Service 95 Young Persons (Employment) Acts 53