ANNUAL REPORT Director of Public Health and Medical Officer of Health London Borough of Islington 1969 CONTENTS SUBJECT PAGE Introduction 1 Social Services and Health Committee 4 Principal Officers of the Department 5 "The First Five Years" 9 General and Vital Statistics 15 Prevalence and Control of Infectious and other Diseases 23 Environmental Health 32 Health Education 61 The Planning of a Health Centre 73 Mental Health 77 Personal Health 81 School Health 101 Services for the Elderly 113 Staff and Premises 117 London Borough of Islington PUBLIC HEALTH DEPARTMENT With the Compliments of the Director of Public Health and Medical Officer of Health 159/167 Upper Street. Islington. N. I. Telephone 01-226 1234. Extension Please ask f or To the Mayor, Aldermen and Councillors of the London Borough of Islington INTRODUCTION The year 1969 may be called "The Year of the Consultants". The Public Health Department in common with the rest of the Council's service was the subject of a review and comprehensive report by Messrs. Booz Allen and Hamilton. The report followed, and indeed reflected, the Government's "Report of The Committee on Local Authority and Allied Personal Social Services" (The Seebohm Report). In accepting the Consultants' recommendations, the Council made them subject to the Government's pronouncement on the Seebohm Report. As this pronouncement was awaited at the end of the year, I am unable to comment on the likely effect on the department. I think it is fair to stress that for the officers concerned with the services the knowledge that review and possible reorganisation are "in the air" is very disturbing, especially as many fears are raised, however groundless they may ultimately prove to be. This was the more so as a similar state of suspense had existed in 1967 when the review by the London Boroughs' Management Services Unit took place, only to be superseded by the Consultants' review. I hasten to say that any disturbance in the mind of the staff did not adversely affect the service rendered to the public. This was due to their loyalty to the Council and pride in their own work. Reference to the following pages will reveal the extent and depth of the service provided. While I appreciate the high standard of work done by my senior officers in planning and controlling the work done, they will I know agree with me in paying tribute to those who at various levels have performed the day-to-day field-work with consistent efficiency and humanity. Under the reorganisation the post of Medical Officer of Health was redesignated Director of Public Health and Medical Officer of Health. A major change was the merging of the former two main committees for Personal Health and Environmental Health in one new committee, the Social Services and Health Committee, which also brought within its ambit the work of the Welfare and Housing Management Services. This change made possible closer consultation and action on matters of common interest. A large measure of delegation to officers was approved. Three large pieces of new work called for attention during the year. Two of these were foreshadowed in my last annual report, viz. the Government's policy outlined in the White Paper "Old Houses into New Homes" which was enacted in the Housing Act, 1969, and the increased concern with the conditions of private child-minding based on the Health Services and Public Health Act, 1968. The third enactment was the Greater London Council (General Powers) Act, 1968, which extended and tightened the regulation of night cafes. These three services called for a large measure of forecasting and planning, visiting and inspecting, and making decisions, with reports to Committee as necessary, to give effect to the relevant legislation. The last two Smoke Control areas came into operation on 1st October, 1969, and the objective of completing the Programme by 1970 will thus be achieved. The results are evident in the vastly improved atmosphere of the whole area. The "pea-soup" fogs of the past are now happily only a memory of the older generation. Over the years much work has been done in inspecting and planning, in interviews and correspondence with the public, and in dealing with grants. It is a pleasure to record this, not only for itself but as being typical of so much of the work which is done by the Council's officers. Works of adaptation were in progress during the year at Isledon Road Civil Defence Centre, Camden Road Training Centre and Finsbury Health Centre. The first named was completed and opened as an Industrial Centre for Mentally Subnormal Adults. The others were near completion at the end of the year. Further links were established with the general medical practitioner service. Seven family doctors agreed to take surgeries at the proposed Health Centre in River Place, N.1, where work on the site had begun at the end of the year, with a completion date early in 1971. Three doctors agreed to co-operate in the 1 Borough's proposal to build a Health Centre on the site of the Woodstock Hotel, Highbury Grange, N.5. Two more will take over specially adapted accommodation at Finsbury Health Centre early in 1970. These schemes were the result of negotiations with the Department of Health and Social Security and the Inner London Executive Council. The Council was able to give the Family Planning Association use of one of the suites at Finsbury Health Centre for clinic and office purposes, free of charge in respect of work done for Islington women. Grant was paid to the Association, who share in the Borough's family planning service, and proposals to extend this joint service were in hand at the end of the year. The standard and extent of facilities for the day care of young children continued to receive close attention. Plans for extending the day nursery provision went forward and the Government's Urban Programme gave grants which enabled work to begin on two new nurseries in Lough Road, N.7 (due in 1970) and Parkhurst Road, N.19 (due in 1971). The Greater London Council commenced building a day nursery for leasing by the Borough as part of a housing block in Bemerton Street, N.1. Assistance by advice and grants was given to private persons and local associations for playgroups, towards which the Urban Programme also contributed. Closer control was exercised over private child minders by the amended Nurseries and Child-Minders Regulation Act, already mentioned. Closer control meant, however, that a number of women ceased to be minders, and although this was often a good thing in stopping unsatisfactory minding, it created the problem of a reduced supply for an increasing demand. The care of young children, and of older children too, involved co-operation with a number of officers and organisations. Special mention may be made of the joint arrangement with the Children's Officer and the National Children's Home to take 20 places at the National Children's Home Family Centre, Legard Road, N.5, for young families of inadequate mothers, where the latter may also receive social advice and health education under group conditions. The opportunity to provide a unique child welfare service was provided by the birth of quadruplets to an Islington resident. Offers of help were made before the birth, and afterwards a full-time nursery nurse and part-time home help were provided continuously. A further description appears later in my report. Unfortunately, the publicity given in subsequent accounts in the Press minimised the help given by the Borough. The Five Year Capital Programme for the development of health service premises was reviewed and agreed as follows:- Health Centres 1. River Place, Essex Road, N.1. 2. Highbury Grange, N.5 (Woodstock Hotel Site). Health Centre and Day Nursery 3. Goodinge Road, N.7. Day Nurseries 4. Aubert Court Community Centre, N.5. 5. Lough Road, N.7. 6. Harvist Estate, N.7. 7. Alsen Road, N.7. 8. Parkhurst Road, N.7. 9. Elthorne Road, N.19. 10. South-east area. Day Nursery and M.C.W. Centre 11. Girdlestone Road, N.19. 2 Mental Health Hostels 12. Hornsey Lane, N.6. (mentally ill) 13. Camden Road, N.7. (mentally subnormal adults) 14. Site to be determined (mentally subnormal young persons) Several changes occurred, or were foreshadowed, in the senior staff of the Department. On the 30th November, 1969, Miss K.E. Harvey retired after 32 years' nursing service. From 1st April, 1965, when on the transfer of the London County Council services she was appointed as Principal Nursing Officer for the Borough, she played an important part in organising the various aspects of the work done for maternal and child welfare, and for the sick and aged in their own homes. She was a wise leader of the staff of about 250 which came under her control. Miss L.K. May, who had been her deputy since 1965, was appointed as her successor. On 31st December, Dr. J.E.J. Hurman resigned to take up the post of Medical Officer of Health for Wallsend Borough Council. He had held the appointment of Principal Medical Officer since 1st June, 1967, and had given valuable assistance in environmental health and housing matters. Appointments were also made towards the end of the year in anticipation of the retirement in 1970 of Mr. W.C. Bartlett, Chief Public Health Inspector, and Mr. F.L. Clark, Chief Administrative Officer. Mr. M. Jacob was appointed to the former post and Mr. E.J. Sharp, Assistant Chief Administrative Officer, was promoted to the latter. As I shall reach retirement age in August, 1970, this will be my last annual report. I have taken the opportunity of including two special summaries in the following pages, the one of the progress made in the department during the first five years of the London Borough of Islington, the other of the steps taken to bring to fruition the proposal to establish the first full-scale Health Centre in the Borough. In conclusion I would warmly repeat the tribute which I have paid in former years to the Chairman and Members of the Social Services and Health Committee, and its predecessors, and to the staff of all grades who have given me such loyal support in the strenuous and sometimes difficult years during which it has been my privilege to lead them. S. KING. Director of Public Health and Medical Officer of Health. SOCIAL SERVICES AND HEALTH COMMITTEE (as at 31st December 1969) Mayor Councillor DONALD WILLIAM BROMFIELD, J.P. Chairman Councillor R. E. CANDLIN, B.Sc., M.B., Ch.B., F.R.C.S. Vice-Chairman Alderman J. R. GOODMAN, J.P., F.I.O.B. Alderman ARTHUR HORACE SIDNEY HULL Councillors MRS. JENNIFER MARGARET BAKER PATRICK DOUGLAS BROMLEY, B.Sc. MISS ANNIE THERESA CALLAGHAN MRS. MAY ELSIE GARNER MRS. MARION JOAN HARVEY, B.A. DONALD BENTLEY HOODLESS, B.A., D.P.A. VERNON MARTINDALE MRS. ROSEMARY JOCELYN MURRAY MRS. ELIZABETH JANE PENTECOST Co-opted Members MRS. J. DONNISON, B.A. J. S. NORELL, M.R.C.S., L.R.C.P., M.B., B.S. MRS. E. SHIELDS, B.A. MRS. E. MACGREGOR, M.B.E. 4 PRINCIPAL OFFICERS OF THE PUBLIC HEALTH DEPARTMENT Director of Public Health and Medical Officer of Health S. KING, M.D., M.R.C.P., D.P.H. Deputy Medical Officer of Health AUDREY K. ARNOLD M.B., B.Ch., B. AO., D.Obst., R.C.O.G., D.P.H. Principal Medical Officers BETTY GROVES M.B., B.S., D.P.H. J. E. J. HURMAN M.B., B.S., D.P.H., D.T.M. & H. (Resigned 31.12.69) Chief Dental Officer and Principal School Dental Officer R.E. HYMAN 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 B.A., L.R.C.P., M.R.C.S., M.B., B.S., D.C.H., D.P.H. Chief Administrative Officer F.,L. CLARK, B.A. Assistant Chief Administrative Officer E.J. SHARP Principal Administrative Officers MISS D. EGGINTON S. GODSTONE R.C. LOCKWOOD, M.A.P.H.I., A.R.S.H. Principal Nursing Officer MISS L.K. MAY S.R.N., S.C.M., H.V., Q.N., Dip.Soc. BERYL H. EVANS M.B., B.Ch., D.Obst., R.C.O.G., D.C.H., D.P.H. Chief Public Health Inspector W.C. BARTLETT, F.R.S.H., M.A.P.H.I. Deputy Chief Public Health Inspector G.S. ADAMS, M.A.P.H.I. Assistant Chief Public Health Inspectors A.J. TRUSLOVE, M.A.P.H.I. T. LAWSON, M.A.P.H.I. Deputy Principal Nursing Officer (Vacant) Assistant Nursing Officers Supervisor of Mid wives MRS. M. TAMBLYN S.R.N., H.V., R.F.N. MISS W.YOUNG S.R.N., S.C.M., H.V., Q.N. MISS V. A. WELLER S.R.N., S.C.M., Q.N. Senior Social Worker MISS M. MACMORRAN Principal Mental Health Social Worker MISS N.E. BRIAN Deputy Senior Social Worker MRS. A. HOSKER Deputy Principal Mental Health Social Worker J.P. QUINN Health Education Officer K.M.N. ROBERTSON, L.M.R.S.H., M.I.H.E., M.R.I.P.H.H. 5 THE FIRST FIVE YEARS A REVIEW THE FIRST FIVE YEARS The London Borough of Islington came into being on 1st April 1965, and its Public Health Department from the same date. Planning was undertaken some six months earlier, in consultation with the former health authorities, the London County Council and the Metropolitan Boroughs of Finsbury and Islington. Much help was given by their Medical Officers of Health and I regret that they are no longer associated with the department. Dr. J.A. Scott died just before 1st April, 1965, and Dr. C.O.S. Blyth Brooke and Dr. V. Freeman retired subsequently. Happily, Dr. A.B. Stewart who succeeded Dr. Scott, was appointed as Medical Adviser to the Inner London Education Authority, and I have continued to work closely with him in my capacity as Principal School Medical Officer. The department's central office at 159/167 Upper Street, N.1 was established, and accommodated all the central administrative and inspectorate staff, except that space did not provide for the mental health team who were based at Finsbury Health Centre. Field staff continued to be employed at various centres throughout the Borough, and a policy of decentralisation was applied to home visitors for the elderly, to home nurses and, for some of their activities, to public health inspectors. A review of premises was undertaken and a development plan drawn up which when completed will include thirteen health centres of varying content, thirteen day nurseries with approximately 750 places, and ten other establishments, mainly for the mentally disordered. The use of a number of small unsatisfactory premises will be discontinued. By the end of 1969, the following new premises had been provided by building or adaptation - — Rosemary Junior Training School for Mentally Subnormal Children, incorporating a small special care unit for multi-handicapped pupils. — Richmond Avenue Day Centre for Mentally III Adults. — Finsbury Day Centre for Mentally III Adults (at Finsbury Health Centre). — Bennett Court Training Centre for Mentally Subnormal Adults. — Blythe Mansions Maternal and Child Health Centre (by expansion of existing sub-centre). — Isledon Road Maternity and Child Welfare Centre. — Isledon Road Industrial Centre for Mentally Subnormal Adults (this and the preceding centre were sited in the former Civil Defence Centre). — Centralised Disinfecting, Bathing and Laundry services at Finsbury Health Centre (basement). — Holloway Special Care Unit for multi-handicapped children (completed but not opened till early 1970). By arrangement with voluntary organisations, to whom grant was paid, new services were instituted - — a day nursery for severely subnormal young children; — a day nursery for children 1-5 years of age, — a centre to help socially isolated or inadequate mothers; — a day centre for mentally disturbed elderly people. The progress towards the completion of the scheme for the River Place Health Centre was a major activity, and is described in detail elsewhere in this report. It is possible only to sketch briefly the other activities of the five-year period . Former services were taken over and in a large measure continued. The opportunity was always taken to review them and to adapt them wherever possible to new needs and new opportunities. At maternal and child health centres, family planning and cytology sessions were introduced. A large expansion of the family planning service was planned, working in close association with the Family Planning Association, to whom the Borough had allocated clinic accommodation and rented offices at Finsbury Health Centre. A domiciliary service was commenced for women in great need, who were unlikely to attend clinics. Measles vaccination of young children was added to the full programme of vaccination and immunisation. 9 Large-scale responsibilities were assumed as a result of legislation regulating the minding of young children in private houses and in nurseries. The home nursing service was taken over from the voluntary association and integrated with the Borough's domicilary services. Advisory health circles for elderly people were started at which health advice was given by medical and nursing staff, in close co-operation with the health education officer. The scope of work done by the mentally handicapped at day centres and training centres was enlarged, in particular by the commencement of an industrial centre designed to undertake work more on the lines of that done in industry. The mental health social work was still in a relatively early stage of development in April.1965, and considerable progress was made, which was reflected in a considerably increased staff organised on a team basis. Co-operation with the hospital service was fostered, and a consultant psychiatrist was attached to the mental health team. A small number of flats were provided to enable patients to rehabilitate themselves for life in the community under the guidance of a social worker. A comprehensive chiropody service was developed by the merging under the Borough of the local health authority and voluntary foot clinics, with extension to domiciliary patients. There was a gradual and fruitful increase of co-operation with general practitioners in all spheres, for mothers and children, for the elderly and for the mentally disordered. Health visitors, midwives, district nurses and mental health social workers were attached to group practices. Surgeries were planned for building in three health centres. The health education programme was greatly expanded to cover all sections of the community, and there was active co-operation with the school authorities. Adult students were attached to various officers for experience and field work training. There was a consistent increase in social work for venereal disease contacts and a decrease for the tuberculosis, in each case reflecting statistical trends. The department acted as co-ordinator of the registers of handicapped persons up to seventeen years of age. Over 2000 children aged 0-5 were included in a'Risk Register'and a similar number above that age on the "Handicapped Register". All were kept under review for medical and social care. The school health and school dental services were continued on behalf of the Inner London Education Authority. Two new special investigation clinics were started. New problems, e.g. in relation to drugs, were met. Liaison was maintained with institutions for higher education in giving advice on student health and on radiological proctection. The meals services for the elderly and for invalids showed substantial growth, and meals were served at weekends to those who need them. An outstanding achievement was the bringing into operation in October, 1969, of the last two smoke control zones, which will complete the Borough's clean air programme by 1970. In the field of housing, the establishment of the new London Borough with its larger scope led to many developments. While concluding the 1961/65 Slum Clearance Programme, a survey was carried out which resulted in the new Programme for 1966/70. An early measure was the representation of the Beaconsfield Buildings, comprising 369 flats; these tenement flats were subsequently acquired by the Greater London Council, with whom there has been close liaison throughout in regard to all proposed clearances. Surveys were undertaken of houses in multiple occupation with a view to improvement under the Housing Acts, 1961 and 1964, and improvement areas were designated. The importance was recognised of enforcing the enactments governing means of escape in case of fire, and a long-term programme was instituted to cover some 25,000 premises. For other action under the 1957 and 1961 Acts, it was found to be economical and effective to define areas for concentrated action. 10 The Housing Act, 1969, opened up new potentialities to the Borough for improving the housing stock in its area. The department undertook a "condition of dwelling" survey as a basis for the designation of "general improvement" areas and for decision on ultimate action under the Act. Public health inspection also merged the functions of the two metropolitan boroughs with certain general public control functions of the London County Council. The Offices, Shops and Railway Premises Act, 1963, had its first full year of operation in 1965; and in following years a number of new statutes and regulations brought new functions to the inspectorate, e.g. in regard to smokeless fuels, tall buildings and industrial emissions, food and drugs, markets and stalls, meat inspection and refreshment houses. The Greater London Council (General Purposes) Act, 1968 tightened the regulation of night cafes and brought a considerable accession of work. The growth of work in the department was shown by the increased number of officers from 507 in 1965 to 569 in 1969, with a parallel increase in the number of hours of manual workers. A corresponding growth was reflected in the cost estimates, which (including the school health service) totalled £1,259,455 in 1969/70 as against £997,420 for 1965/6. 11 GENERAL AND VITAL STATISTICS GENERAL AND VITAL STATISTICS Area 3,678 acres Population (Estimated Mid-Year) - 235,990 Marriages solemnised in the Borough 2,179 (provisional) BIRTHS Total Male Female Live Births - Legitimate 3,767 1,901 1,866 Illegitimate 569 287 282 4,336 2,188 2,148 Islington England and Wales Live Birth Rate Per 1,000 Population 18.4 16.3 Birth rate after applying 'Area Comparability' Factor of 0.80 14.7 Illegitimate Live Births Per Cent of Total Live Births 13.1 Total Male Female Still Births - Legitimate 42 22 20 Illegitimate 15 8 7 57 30 27 Islington England and Wales Still Birth Rate Per 1,000 Population 0.24 0.22 Still birth rate per 1,000 live and still births 13.0 13.2 Total Male Female Total Live and Still Births - Legitimate 3,809 1,923 1,886 Illegitimate 584 295 289 4,393 2,218 2,175 DEATHS Total Male Female All Causes 2,772 1,425 1,347 Death Rate (Crude) Per 1,000 Population Islington England and Wales 11.7 11.9 Death rate after applying 'Area Comparability' factor of 1.10 12.9 15 Infant Deaths Total Male Female Deaths of Infants under one year of age - Legitimate 88 46 4 Illegitimate 12 9 100 55 4 Islington England and Wales Infant Mortality Rate (per 1,000 live biths) - All Infants 23.1 18.1 Legitimate 23.4 Illegitimate 21.1 Neo-Natal Mortality Total Male Female Deaths of Infants under 4 weeks of age Legitimate 54 29 25 Illegitimate 4 4 58 33 25 Islington England and Wales Neo-Natal Mortality Rate (per 1,000 live births) All Infants 13.4 12.0 Legitimate 14.3 Illegitimate 7.0 Early Neo-Mortality Total Male Female Deaths of Infants under 1 week of age - Legitimate 47 24 23 Illegitimate 3 3 50 27 23 Early Neo-Natal Mortality Rate (per 1,000 live births) Islington England and Wales All Infants 11.5 10.0 Legitimate 12.5 Illegitimate 5.3 Perinatal Mortality Total Male Female Still births and deaths under 1 week combined 107 57 50 Perinatal Mortality Rate Islington England and Wales (per 1,000 total live and still births) 24.4 23.0 Maternal Deaths (including abortion) 3 154 Rate (per 1,000 total live and still births) 0.68 0.19 16 1969: CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION (REGISTRAR GENERAL'S RETURNS) AGE GROUPS CAUSE OF DEATH All Ages Under 4 wks. 4 weeks and under 1 year 1- 5- 15- 25- 35- 45- 55- 65- 75 & over M F Total M F M F M F M F M F M F M F M F M F M F M F Cholera — — — — — — — — — — — — — — — — — — — — — — — — — Typhoid fever - — — — - — - - - - — — — — - — — — — — — — — — - Bacillary dysentery and amoebiasis — — — — — — — — — — — — — — — — — — — — — — — — — Enteritis and other diarrhoeal diseases 1 2 3 — — 1 1 - — - - — — - - - - — — - - - 1 — - Tuberculosis of respiratory system 10 4 14 — — — — — — — — — — — — — — 1 1 7 1 2 — — 2 Other tuberculosis, including late effects — — — — — — — — — — — — — — — — — — — — — — — — — Plague — — — — — — — — — — — — — — — - — — — — — — - - - Diphtheria — — — — — — — — — — — — — — — — — — — — - — — — — Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — — — Streptococcal sore throat and scarlet fever — — — — — — — — — — — — — — — — — — — — — — — — — Meningococcal infection — — — — — — — — — — — — — — — — — — — — — — — — — Acute poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — — Smallpox — — — — — — — — — — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — — — — — — — Typhus and other rickettsioses — — — — — — — — — — — — — — — — — — — — — — — — — Malaria — — — — - — — — — — — — — — — — — — — — — — — - — Syphilis and its sequelae 1 1 2 — — — — — — — — — — — — — — — — — — — 1 1 — All other infective and parasitic diseases 2 2 4 — — — 1 — — — — — — — — 1 — — — 1 — — — — 1 Malignant neoplasm - buccal cavity and pharynx 4 4 8 — — — — — — — — — — — — — — — — 1 1 — 1 3 2 Malignant neoplasm - oesophagus 7 6 13 — — — — — — — — — — — — 1 1 1 — 2 1 2 2 1 2 Malignant neoplasm - stomach 41 28 69 — — — — — — — — — — — — — — 4 3 14 7 16 5 7 13 Malignant neoplasm - intestine 23 36 59 — — — — — — — — — — — 1 — 2 2 2 3 5 13 12 5 14 Malignant neoplasm - larynx 4 1 5 — — — — — — — — — — — — — — — — 1 — 1 — 2 1 Malignant neoplasm - lung, bronchus 160 40 200 — — — — — — — — — — — — 4 2 11 1 63 15 52 10 30 12 Malignant neoplasm - breast — 40 40 — — — — — — — — — — — — — 4 — 5 — 16 — 9 — 6 Malignant neoplasm - uterus - 31 31 — - - — - - - - - - - 1 - 1 - 9 - 15 - 3 - 2 Malignant neoplasm - prostate 16 — 16 — — — — — — — — — — — — — — — — 2 — 8 — 6 — Leukaemia 11 7 18 - — - — - - 2 - - — 1 1 - - 1 1 3 — 2 1 2 4 Other malignant neoplasms, including neoplasms of lymphatic and haematopoietic tissue 63 68 131 — — — — — — — — 1 — 3 2 1 6 10 5 14 14 22 24 12 17 Benign neoplasms and neoplasms of unspecified nature 3 5 8 — — — — — — — — 1 — — — — 2 1 1 — — — — 1 2 Diabetes mellitus 9 18 27 — — — — — — — — — — — 1 1 - 1 2 1 1 5 9 1 5 Avitaminoses and other nutritional deficiency — — — — — — — — — — — — — — — — — — — — — — — — — Other endocrine, nutritional and metabolic diseases 1 5 6 — — — 1 — 1 — — 1 — — — — — — — — — — 1 — 2 Anaemias 4 3 7 — — — — — — — — — — — — — — — — — — 2 - 2 3 Other diseases of blood and blood-forming organs — 1 1 — — — — — — — — — — — — — — — — — — — — — 1 Mental disorders 4 4 8 — - - — - - - — — - - — 1 — - - 2 - 1 1 - 3 Meningitis 1 — 1 — — — — 1 — — — — — — — — — — — — — — — — — Other diseases of nervous system and sense organs 9 12 21 — — — — 1 — — — — — 2 — — 1 1 1 — 2 2 3 3 5 Active rheumatic fever — — — — — — — — — — — — — — — — — — — — — — — — — Chronic rheumatic heart disease 15 39 54 _ _ _ _ — — — — — 1 — — — — 3 3 1 9 3 10 8 16 Hypertensive disease 15 28 43 — — — — — — — — — — — 1 2 2 1 — 2 1 6 7 4 17 Ischaemic heart disease 332 216 548 — — — — — — — — — — — — 5 2 40 5 100 23 111 72 76 114 Other forms of heart disease 91 180 271 - - - 1 - - - - 1 - - 1 - 1 - 2 5 3 27 15 58 157 Cerebrovascular disease 102 106 258 — — — — — — — — — — — 2 1 2 5 5 20 17 30 34 46 — Other diseases of the circulatory system 42 76 119 — — — — — — — — — - 1 - 1 — 3 2 6 6 16 14 16 54 Influenza 13 13 26 — — — — — — — — 1 — 1 1 1 — — — 1 5 8 1 1 6 Pneumonia 94 105 199 1 1 7 6 — — — — 1 — — — 2 1 1 — 10 9 30 12 42 76 Bronchitis, emphysema 150 45 195 — — — — — — — — — — — — 1 1 8 2 36 7 54 11 51 24 Asthma 2 2 4 — — — — — — — — — — — — — — 1 2 1 — — — — — Other diseases of the respiratory system 22 8 30 1 _ 6 2 1 — — — — — — — — — — — 5 1 3 2 6 3 Peptic ulcer 18 2 20 — — — — — — — — — — — — — — 2 - 4 - 9 — 3 2 Appendicitis 1 — 1 — — — — — — — — — — — — — — — — — — — — — — Intestinal obstruction and hernia 5 11 16 — 2 1 1 1 — — — — — — — — — 1 1 — — 1 1 1 6 Cirrhosis of liver 8 2 10 — — — — — — — — — — — — — — 2 — 4 — 2 1 — 1 Other diseases of the digestive system 13 26 39 — — — 2 1 — — 1 — — — — — 2 1 1 5 2 5 6 1 12 Nephritis and nephrosis 5 5 10 — — — — — — — 1 — — — — — 2 I — 3 — 1 1 — 1 Hyperplasia of prostate 4 — 4 — - — — — — — — — - — — — - — - — - 1 - 3 — Other diseases of the genito-urinary system 9 9 18 — — — — — — — — — — — — — — 1 — 1 — 2 3 5 6 Abortion — — — — — — — — — — — — — — — — — — — — — — — — — Other complications of pregnancy, childbirth and puerperium — 3 3 — — — — — — — — — — — 3 — — — — — — — — — — Diseases of the skin and subcutaneous tissue 2 — 2 — — 1 — — — — — — — — — — — 1 — — — — — — — Diseases of the musculoskeletal system and connective tissue 3 13 16 — — — — — — — — — 1 — — — — 3 — — 3 — 1 — 8 Congenital anomalies 18 10 28 8 6 4 2 1 — 1 1 - - — - - - 1 — — - 1 1 2 - Birth injury, difficult labour, and other anoxic and hypoxic conditions 17 7 24 17 7 — — — — — — — — — — — — — — — — — — — — Other causes of perinatal mortality 6 8 14 6 8 — — — — — — — — — — — — — — — — — — — — Symptoms and ill-defined conditions 5 8 13 — — — — 1 — — — — — — — — — — — 1 — — 2 3 6 Motor vehicle accidents 13 16 29 — — 1 — — — 1 _ 5 4 — 1 3 1 I 2 — 2 2 3 — 3 All other accidents 23 24 47 — — — 2 2 2 3 1 3 3 — 2 2 1 4 — 5 2 3 3 1 8 Suicide and self-inflicted injuries 17 9 26 — — — — — — — — 1 1 3 1 4 1 3 2 3 2 2 1 1 1 All other external causes 5 8 13 — 1 1 1 — 1 — — — 1 2 — 1 — - 2 1 1 - - — 1 All Causes 1,425 1,347 2,772 33 25 22 20 9 4 8 4 15 11 13 18 32 35 116 60 328 171 445 284 404 715 Totals 2,772 58 42 13 12 26 31 67 176 499 729 1,119 Percentages 100 2.09 1.51 0.47 0.43 0.94 1.12 2.42 6.35 18.00 26.30 40.37 17 ANALYSIS OF INFANT DEATHS - 1969 (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 2 All other infective and parasitic diseases 1 1 Other endocrine, nutritional and metabolic diseases 1 1 Other forms of heart disease 1 1 Pneumonia 1 1 6 3 1 1 2 15 Other diseases of the respiratory system 1 2 2 2 1 1 9 Intestinal obstruction and hernia 2 1 1 4 Other diseases of the digestive system 1 1 2 Diseases of the skin and subcutaneous tissue 1 1 Congenital anomalies 5 1 2 2 1 2 1 2 1 1 1 1 20 Birth injury, difficult labour, and other anoxic and hypoxic conditions 13 6 1 2 2 24 Other causes of perinatal mortality 8 2 1 1 2 14 Motor vehicle accidents 1 1 All other accidents 1 1 2 All other external causes 1 1 1 3 Totals 29 6 3 3 5 1 2 4 1 4 6 12 6 3 3 3 1 2 1 3 2 100 Estimated Child Population Under 1 year 1-4 Total under 5 5-14 Total under 15 Islington 4,600 17,500 22,100 28,600 50,700 Greater London 122,950 485,650 608,600 1,001,300 1,609,900 COMMENTS ON VITAL STATISTICS DEATHS OF INFANTS UNDER ONE YEAR Twenty-nine 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 forty-two infant deaths in the age group one to twelve months, thirteen were due to pneumonia. 18 MATERNAL MORTALITY In a total of 4,393 live and still births, there were three maternal deaths. Two were due to bronchopneumonia following Caesarean section, whilst the third was due to ruptured ectopic gestation. RESPIRATORY TUBERCULOSIS The death rate for lung tuberculosis in 1969 was 0.06 per 1,000 population, and does not compare unfavourably with previous years. DEATHS DUE TO PNEUMONIA AND BRONCHITIS In 1969 there were 195 deaths ascribed to bronchitis, and 199 to pneumonia. These figures show more bronchitis but less pneumonia deaths than those for 1968, which were 175 and 240 respectively. MALIGNANT GROWTHS OF LUNG AND BRONCHUS I reported last year that lung cancer deaths in males of 145 showed a further fall over 1967 when there were 158 deaths. Unfortunately this trend was not maintained in 1969 when 160 males died from this disease. Female deaths from this cause which showed a fall from 35 in 1967 to 28 in 1968 rose to 40 in 1969. CORONARY DISEASE WITH ANGINA There were 548 deaths (332 male and 216 female) from this cause in 1969. This shows a slight rise over the 1968 figure of 539 (332 male and 207 female). ACCIDENT DEATHS - Comparative table. 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 Motor vehicle accidents 37 32 22 34 28 29 34 34 23 29 Other violent accidents 69 65 69 84 62 60 58 65 38 47 ACCIDENT DEATHS - Analysis by age groups Type under 4 weeks 4 weeks and under 1 year 1- 5- 75- 25- 35- 45- 55- 65- 75+ M F Total Motor Vehicle accidents - 1 - 1 9 1 4 3 2 5 3 13 16 29 Falls - - - 2 2 • • - 2 4 5 6 9 15 Accidental Poisoning (Solid, Liquid Gases and Vapours) - - - - 1 1 - - - 1 1 1 3 4 Fire - 2 4 1 - 1 1 2 4 - 1 7 9 16 Drowning - - - - 3 • - • - - - 1 2 3 Other (Railway Accidents, etc.) - - - 1 • - 2 2 1 1 2 8 1 9 Total - 3 4 5 15 3 7 7 9 11 12 36 40 76 19 PREVALENCE AND CONTROL OF INFECTIONS AND OTHER DISEASES PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES Notifications and deaths recorded during 1969 (Infectious diseases are those that were statutorily notifiable as at 31st December, 1969) 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 1,023 (660) - 29 1,023 - Dysentery 246 (265) - 24 246 138 Scarlet Fever 63 (69) - 2 62 16 Whooping Cough 28 (45) - 2 28 11 Infective Jaundice 133 (112) - 39 131 18 Ac. Meningitis 10 (8) 1 10 9 5 Ac. Encephalitis 4 (4) - 4 4 - Ophthalmia Neonatorum 1 (3) - - 1 - Leptospirosis - (1) - - - - Paratyphoid Fever 1 (-) - 1 1 1 Typhoid Fever 4 (1) - 4 3 1 Food Poisoning 157 (53) - 30 115 10 Malaria 2 (-) - 2 2 - Tuberculosis Lungs 103 (125) 14 - 103 6 Tuberculosis Other Forms 18 (19) - - 18 - * Statutorily notifiable from 15th June, 1968. ** Statutorily notifiable from 1st October, 1968. (Figures in brackets are notifications for 1968) SMALLPOX Of the 26 references for suspected smallpox and supervision of possible smallpox contacts, 23 arrived in this country from declared endemic or locally infected smallpox areas. They were reported to be proceeding to addresses in Islington and were not in possession of valid international Certificates of Vaccination. In accordance with the regulations which came into force on the 1st August 1963, all were visited and kept under surveillance for the required period. 23 Advice was sought from the medical staff of the department in respect of three 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. CERTIFICATES OF VACCINATION AND INOCULATION - AUTHENTICATION - MINISTRY OF HEALTH CIRCULAR 60/48 Applications for authentication dealt with by the Medical Officer of Health numbered 4,045 as against 3,225 for the orevious 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. FOOD POISONING 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 1969 157 1952 84 1958 230 1964 131 There was only one outbreak (summarised below) to be reported in accordance with Memo. 188 Med. of the Ministry of Health. Date No. of No. of No. of No. of Foods involved and organisms Notifi- persons cases deaths responsible cations served reported 18-3-69 Unknown - Frozen Chickens 19-3-69 21 21 - Unknown The above related to an outbreak involving resident staff at a designated "district hospital" in the borough. Advice was received that some 21 members of the staff reported moderate symptoms of vomiting, abdominal colic and also diarrhoea in some cases. In every case these persons had eaten Chicken Pilaff served in the staff restaurant for dinner on Tuesday evening, 18th March, 1969. It was reported that the chickens were delivered on Monday morning, 17th March. They were then thawed in running cold water on Tuesday morning and cooked in a pressure steam oven at approximately 8lbs. pressure for 45 minutes, then when sufficiently cold to handle they were boned in preparation for completion of the dish. It was considered that the explosive nature of the outbreak with a very short period between ingestion and onset of symptoms and the absence of pathogens on laboratory investigation suggest that a bacterial toxin was involved. The hospital favoured a staphylococcal origin but the food source was thought to be more suggestive of c1. welchii being the likely origin. The Department of Health and Social Security agreed that C1. welchii was most probably the cause of this outbreak. 24 LEAD POISONING There was only one reference to the department on the subject of lead poisoning during 1969. This concerned a 23 month old child in hospital with a raised blood lead level. As a result of domiciliary enquiries carried out, a series of samples were submitted to the Public Analyst for examination. Samples of paint taken from (i) the first floor Sitting Room Window sill and (ii) the top floor staircase half-landing wall and (iii) samples of Putty and Paint from the Top Floor staircase half-landing Window showed a lead content of (i) 2.09% (ii) 1.53% and (iii) 1.63% respectively. In the light of the above the Inspector revisited the premises and arranged for all the offending paint to be removed. TYPHOID AND PARATYPHOID FEVER There were 5 confirmed cases of typhoid fever and 2 confirmed paratyphoid fever cases during the year as follows:- The five typhoid fever cases referred to above occurred in two families. In the first a 14 years old Indian boy residing in the N.7. area of the borough was transferred to an isolation hospital after a clinical diagnosis of typhoid fever had been made at a General Hospital. Initial reports had shown that the Widal test was positive and Gram-negative bacilli were present in the blood. As the patient had resided in England for some nine years and no source of infection was apparent, enquiries were made in an endeavour to trace this. As a result of these enquiries and routine bacteriological examination of family and other contacts it was ascertained that the boy's mother was an intermittent excretor of the organism and was thought to be the most probable source of the infecton. A near relative who had also lived with the family but since moved to another part of London was also shown to be carrying the organism. The other incident involved a 11 years old deaf and dumb boy who had recently arrived in this country with his father from India and proceeded to an address in the N.19. area of Islington. He was admitted to a General Hospital on 5th September, 1969 with pyrexia of unknown origin, onset of symptoms occurring 31st August/1st September. Blood cultures and Widal test proved positive for typhoid fever although stools were negative. The patient was transferred to an isolation hospital on 11th September. Bacteriological results of domiciliary contacts initially proved negative and in addition the medical practitioners of all those Islington children discharged from the general hospital who were in the same ward as the patient, were notified. Subsequently the father also developed typhoid fever and was admitted to an isolation hospital on 14th October, date of onset being given as 12th October. On discharge from hospital both father and son returned to India. Of the two confirmed paratyphoid fever cases the first referred to a 60 year old female Islington resident who developed symptoms whilst in a surgical ward of a general hospital. Subsequently organisms of Salmonella Paratyphi 'B' (Phage type "java") were isolated, the source of infection being indeterminate. The remaining case referred to a 21 years old male resident in Islington who went on a Mediterranean cruise between 16th September - 1st October, 1969. He collapsed on his return and was admitted to an isolation hospital on 2nd October, where blood culture proved positive for paratyphoid 'B' fever (Phage type dundee). 25 A friend of the above case residing in another borough who had also been on this cruise became violently ill on 1st October and was admitted to another isolation hospital on the same day. A stool specimen finally proved positive for paratyphoid 'B' fever after 3 previous negatives. Subsequently information was received of several other travellers on this cruise whom were confirmed as cases of paratyphoid fever whilst reports seemed to indicate that most of the crew were ill prior to this person joining the ship. The Department of Health and Social Security was informed. The other references were for 87 contacts of Typhoid and 5 contacts of Paratyphoid - all with satisfactory conculsions. DYSENTERY There were three hundred and eighty-four cases notified and 'coming to knowledge' during the year. Of these, two hundred and ninety-three proved positive whilst ninety-one were clinical cases with negative stools. Roughly two thirds of the positive cases occurred in the first quarter of the year, when, initially, three adjacent schools in the North of the Borough and two day nurseries situated in the East and the South were affected. Subsequently there was family spread with minor outbreaks at several other schools in the Borough. TUBERCULOSIS In 1969, 121 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 - 1 3 2 1 2 4 14 12 13 14 3 1 70 F - 2 2 1 - 1 3 10 4 5 1 2 2 33 Non-Pulmonary M 3 — 2 1 - - 6 F - - - - - - 4 2 2 1 - 2 1 12 Totals - 3 5 3 1 3 11 29 18 21 16 7 4 121 The notification rate of all forms of tuberculosis was 0.51 per 1,000 population as against 0.25 for the whole country. The total number of cases remaining on the register after adjustment for deaths and transfers was, on the 31st December, 1969:- Males Females Total Pulmonary 1,106 795 1,901 Non-Pulmonary 116 162 278 Totals 1,222 957 2,179 There were 14 tuberculosis deaths (all pulmonary) during 1969. The death rate of all forms of tuberculosis was 0.06 per 1,000 of the population, as against the national rate of 0.04. Hostel for homeless tuberculous men, Cromwell Lodge, Chomeley Park, N.6. During the year nine men were discharged from Cromwell Lodge, some to ordinary hostels and some to hospital. Eight men were admitted and the number of men in residence at the end of the year was 25 (26-1968) 20 (21) of these were from other London Boroughs. 1 (2) Islington man was in residence at Hurlingham Lodge Hostel in the London Borough of Hammersmith. Continued efforts to recruit an assistant warden still proved unsuccessful. 26 Home Visiting - by health visitors. Total visits (including contacts,but excluding unsuccessful visits). 2,951 (2,953) Diversional Therapy:- Total sessions held at Cromwell Lodge Hostel 124 (75) Total number of visits made to patients in their own homes 1,495 (1,474) 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. Mass X-ray Unit of the North West Metropolitan Regional Hospital Board, 32 Drayton Park, N.5. Islington Chest and Tuberculosis Care Committee Mr. J. Buckle, Secretary of the Committee for the previous 6 years, resigned from the post of Welfare Officer on 27th April, 1969 and was replaced as Secretary by Miss A. Phelps, Welfare Officer. Since 1st April 1958, some Islington patients had attended the St. Pancras Chest Clinic under an arrangement by the North West Metropolitan Hospital Board which worked satisfactorily; but because of hospital re-organisation in June 1969 all Islington patients who attended there were transferred to the Islington Chest Clinic. TheStarliners kindly gave a Variety Show providing not only a most enjoyable evening for patients and friends of the Committee, but also raising money for a most successful summer outing to Eastbourne. The Committee was able to give gift vouchers for food and fuel at Christmas of £4 to single people and of £5 to married people or those with children. The Officers of the Committe were:- Mrs. B. Stradling Chairman Mrs. M. Ward Vice-Chairman Dr. H.O. Williams Honorary Treasurer Miss A. Phelps Welfare Officer and Secretary to the Islington Chest and Tuberculosis Committee. CASES ON CHEST CLINIC REGISTER No. of definite cases of Tuberculosis on Chest Clinic Register as at 31st December 1969. Pulmonary Non-Pulmonary Total Adults Children Adults Children Adults Children M F M F M F M F M F M F ISLINGTON CHEST CLINIC 795(828) 475(513) 48(43) 55(50) 65(60) 88(83) 5(6) 4(6) 860(888) 563(596) 53(49) 59(56) ST. PANCRAS CHEST CLINIC - (61) - (29) - (13) - (8) GRAND TOTAL 1535 (1700) 27 VISITING OF NEWLY ARRIVED IMMIGRANTS - YEAR ENDED 31st DECEMBER, 1969 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 firsł successful visits paid during the year COMMONWEALTH COUNTRIES Carribean 120 110 India 165 103 Pakistan 62 39 Other Asian 55 30 African 158 125 Other 29 19 NON-COMMONWEALTH COUNTRIES European 107 74 Other 37 27 TOTAL 733 527 * Advice of arrival of immigrant. ł First successful visit means the first time the local health authority officer established contact with the immigrant. It will be seen from the chart that 527 successful visits were paid to immigrant arrivals to the Borough during 1969. These visits were paid by an officer of the Welfare Department, and I should like to record my thanks to the Chief Welfare Officer. SCABIES AND VERMIN Scabies Verm in Children under 5 years - Number treated 95 49 Number of baths given 161 — Number of treatments — 49 I.L.E.A. Children - Number treated 206 244 Number of baths given 385 — Number of treatments — 250 Adults - Number treated 363 159 Number of baths given 673 — Number of treatments 169 There was a slight increase in the numbers treated for scabies by some 3% in 1969 - 664 compared with 642 in the previous year. The numbers treated for vermin infestations, also showed an increase from 405 to 452 (12%). 28 Examinations carried out Total Swabs (Diphtheria) 63 Sputum (Tuberculosis) 15 Faeces & Urine (Enteric Fever) 352 Faeces (Food Poisoning) 1,407 Faeces (Dysentery) 3,621 Swabs (Streptococci) 25 Other specimens 360 Total 5,843 BACTERIOLOGICAL EXAMINATIONS The number of specimens sent to the Public Health Laboratory, County Hall, S.E.1, for bacteriological examination was 5,843. This compared with a total of 5,867 specimens submitted last year. Annual fluctuations are due mainly to the extent of dysentery outbreaks in any particular year. 29 ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH On 1st October 1969 the last two Smoke Control Orders came into operation, thus completing the smoke control programme for the Borough. In the same month a comprehensive report was submitted to the Ministry of Housing and Local Government on action taken by the Council during the previous two years to combat industrial noise under the Noise Abatement Act 1960. The Public Health Inspectorate continued to carry out its routine statutory functions in spite of staff shortages and there was increased activity in the registration of night cafes and work under the Consumer Protection Act 1961 and associated Regulations. The Council's Training Scheme for Public Health Inspectors continued to be a valuable means of obtaining qualified staff. Three students passed the Diploma examination during 1969 and were appointed as Public Health Inspectors. AIR POLLUTION COMPLETION OF SMOKE CONTROL PROGRAMME Very soon after the Clean Air Act 1956 was placed on the Statute Book, smoke control programmes were prepared with completion targets of 1967 (Finsbury) and 1975 (Islington). The Councils supported wholeheartedly the implementation of the programmes and it is a pleasure to report that the whole of the present Borough, with the exception of a number of exempted areas, became smoke-controlled in October of this year, i.e. six years before the target date. Thus Islington has made a very substantial contribution to the clean air of London. The powers of Local Authorities were enhanced by the Act and for the first time they were able to make the areas the subject of smoke control orders and to make reasonable expenditure on the adaption of domestic appliances, to avoid their contravention. The Exchequer contribution was 40%; the Borough Council paid 30% and the owner, or occupier, paid the remaining 30%. It is not possible at this stage to give the final cost of the programme, but at the end of the year the Council had paid £112,676. 2s. 6d. in grants, the total cost of conversions being £164,914. 6s. 3d. The duties in connection with the programme were allocated to the Public Health Inspectorate with administrative and clerical support. It is due to the diligence, interest and co-operation of all staff concerned that the programme, which was scheduled for completion in 1975, was finished this year. The Department of Scientific and Industrial Research set up the Standing Conference of Co-operating Bodies with a view to obtaining uniformity of practice and to discuss the various problems which arose. The Conference met every six months and was attended by a member of the Council, the Medical Officer of Health and the Chief Public Health Inspector. The Council was similarly represented at meetings of the London and Home Counties Clean Air Advisory Council until its last meeting in 1968; subsequently the Council has become associated with the National Society for Clean Air. In order to keep the Department supplied with up-to-date information, the Council subscribes to the Clean Air Information Service (which supplies data regarding atmospheric pollution, furnaces and other relevant material) and is represented at various local and national meetings of importance. Since the implementation of smoke control, there has been a steady fall in smoke pollution and it is hoped that this downward trend will continue. There has also been a slight general decline in the sulphur dioxide content but much more research is necessary before this particularly difficult problem is solved satisfactorily. It is pleasing to record the appreciation of all concerned for the advice and co-operation received from the officials of the Ministry of Housing and Local Government who at all times were in liaison with this Department. There have been some difficult problems upon which discussions with the Ministry were essential and their willing co-operation and guidance has always been a source of encouragement and stimulus. 32 Thanks are also due to representatives of Warren Springs Laboratory, Ministry of Technology; National Coal Board, Coal Utilisation Council, Gas Council, London Electricity Board, National Society for Clean Air, Clean Air Information Service, National Institute of Fuel Efficiency Service, fuel and oil undertakings, the manufacturers of appliances, other Departments of this Council, the Greater London Council and local builders who have at all times co-operated and given valuable assistance and advice throughout the period, without which the programme would have been long delayed. CLEAN AIR ACT, 1956 Applications received for prior approval of plans and specifications for new furnaces (Section 3(2)) 4 Applications for prior approval granted 4 Notifications of intention to install furnaces 18 Inspections by Clean Air inspectors and assistants 2,419 Re-inspections 3,719 Complaints received 101 Smoke observations 667 Contraventions found 64 Adaptations completed (domestic) 2,698 Notices served 106 Notices complied with 83 Prosecutions - CLEAN AIR ACT, 1968- Section 6 Applications received for approval of chimney heights 4 Applications approved 4 COMPLAINTS In last year's report, reference was made to Smoke and Fume nuisance from an economic oil fired boiler on heavy oil with a short stack terminating level with the third floor of a twelve storey block of flats. This has been replaced by two smaller boilers housed in the basement of the factory and using 35 sec. oil and connected to a brick chimney terminating above the roof of the building. From observations carried out, the installation is satisfactory and no further complaints have been received from the residents. Avery high block of flats is being built on a site which is approximately 60 yards from a large laundry, the chimney of which terminates at approximately 75 feet and was satisfactory as far as the former houses in the vicinity were concerned. The boiler plant, although using heavy oil, is maintained to comply with the Clean Air Act. Complaints were received from the builders that their operators on the eighth and ninth floors on the structure were being affected by fumes from this chimney. From inspections carried out the nuisance at this level was confirmed, a report was sent to the Borough Architect and the matter resolved. INDUSTRIAL NUISANCES Cellulose spraying 3 Fumes from silk screen printing processes 2 Fumes from dry cleaning plant 1 Smell from humidifier 1 Fumes from stove enamelling 1 Dust nuisanse from silver polishing works 1 Petrol fumes from leaking tank at adjoining garage 1 (referred to Petroleum Officer) Fumes from coffee and fig roasting 1 Fumes from assayer's laboratories 1 Dust nuisance from demolition sites 4 Fumes from Photo Litho Printing 1 33 MEASUREMENT OF AIR POLLUTION The average monthly pollution figures for the Borough are shown in the form of two graphs. The graphs compare the 1969 concentrations with those of 1968, both for smoke and sulphur dioxide. The concentrations of smoke in the Borough have shown a general decrease indicating the success of the Council's smoke control areas accompanied by a continuing trend away from solid fuels and an increase in the use of gas and electricity. On the other hand, the average monthly concentrations of sulphur dioxide have increased slightly. 34 35 CONSUMER PROTECTION AND PUBLIC CONTROL FUNCTIONS CONSUMER PROTECTION ACT, 1961 Under this Act the Secretary of State may, by Regulations, specify conditions to be observed for any prescribed class of goods. To date, Regulations are in force for heating appliances (gas, electric and oil) nightdresses, carrycot stands, electric appliances and toys. Visits by the inspectors during the year totalled 5,139. Heating Appliances - Heating appliances have been a subject of special concern in this Borough. New appliances, as one would expect, usually comply, but there is a real danger in the sale of second-hand appliances. During the year proceedings were instituted in five cases, all were successful and resulted in fines and costs totalling £44, including a £3 fine for obstructing the inspector in the course of his duties. Nightdresses - The Regulations for nightdresses specify that the materials should be flameproof or clearly marked with a warning notice to keep away from fire. The inspectorate has found that these regulations are often contravened. There were five cases brought to the Courts in the year resulting in fines and costs totalling £55 being imposed. Of thirteen suspect samples purchased twelve were found to be unsatisfactory. Carrycots - The requirements have generally been complied with by manufacturers. Toys - The Regulations for toys specify that with the exception of table tennis balls, no toy shall contain cellulose nitrate (celluloid). They further specify the maximum amount of lead, soluble antimony, barium, cadmium, and chromium that may be contained in the paint on toys. These Regulations are causing serious concern to this and other Authorities. It is true to say that toys can quite easily be purchased which contain celluloid and which have greatly excessive amounts of lead in the paint. Of 46 samples taken in the year, 23 were found on analysis to be unsatisfactory (12 on lead content and 11 containing celluloid). When infringements were found, the toys were traced back to the wholesaler and a list obtained of retailers supplied. All authorities having such retailers in their area were then notified in order that they might investigate. This information service was reciprocal and considerable investigation and correspondence was involved. Obviously, it is not easy for individual retailers to be sure that their stocks comply and it is a defence for them to prove that they had reasonable cause to believe that all the requirements were satisfied. The inspectors advise the retailers in their own interest to obtain a warranty with their goods but the majority still do not do so and, as a result, when infringements are found they render themselves liable to prosecution. Proceedings were taken in six cases; one case was adjourned, one withdrawn and the other four all proven. Fines and costs totalled £51. The offending toys were all imported and the inspectorate feel that these serious risks to the health of children could best be prevented by action at the source of supply rather than by each authority having to prosecute retailers. SHOPS ACT, 1950 SHOPS (EARLY CLOSING DAYS) ACT, 1965 YOUNG PERSONS (EMPLOYMENT) ACTS 1938 AND 1964 These Acts govern the hours of opening for shops and the conditions for employment of staff. 36 There are special trading provisions in force for the Chapel Market area and for non-food shops in the Nag's Head, Holloway Road, district. During the year an application was received and granted for the suspension of the general closing hours for shops for the seven weekdays immediately prior to Christmas Day. Visits during year 5608 Prosections 5 (Total fines and costs - £29.0.0.) EXPLOSIVES ACTS, 1875 AND 1923 FIREWORKS ACT, 1951 THE KEEPING OF FIREWORKS ORDER, 1959 The main duty imposed on the Authority is to ensure that explosives are stored in safe conditions. There are four premises in the Borough that store explosives other than fireworks and these were inspected frequently and found to be satisfactorily maintained. Fireworks are also classed as explosives and persons selling them are required to register their premises. These premises are inspected to ensure that the fireworks are (i) stored safely and (ii) not sold to young children. Four cases were taken by the Council for offences and fines and costs totalling £8. 10s. Od. imposed. The fines do not appear to reflect the serious consequences that can ensue from improper storage of fireworks and, in particular, the risk to young children when they are sold fireworks. Registrations durng year 188 Visits 480 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1920 PART IV (AS AMENDED) ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT It is an offence for any person to carry on this type of business unless a current licence is held from the local authority. The licences are issued annually, and there were no infingements found that necessitated revocation of the licence or the institution of proceedings. Licences issued during year 15 Licensed establishments at end of year 15 Visits/Revisits 56 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1921 - PART III (AS AMENDED) EMPLOYMENT AGENCIES Inspections are carried out on receipt of applications and at other times to ensure that the agencies are being correctly managed and that the proper records are being kept. There were no serious infringments in the current year and for minor difficulties advice was given and warning letters sent to the licence holders. Licences issued during year 55 Licensed establishments at end of year 55 Visits/Revisits 216 37 FERTILISERS AND FEEDING STUFFS ACT, 1926 This Act and the Regulations made thereunder specify conditions to be observed in the sale of fertilisers and feeding stuffs, and prescribe standards. 113 visits were made under the Act; 3 formal samples were taken of which two proved unsatisfactory, 1 being referred to the authority in whose area the supplier was situated as the retailer pleaded warranty. The other retailer was prosecuted and a fine and costs totalling £6 were imposed. NURSES AGENCIES ACT, 1957 Licensed agencies at end of year1 THEATRICAL EMPLOYERS REGISTRATION ACTS 1925 & 1928 Registered employers at end of year 44 CELLULOID & CINEMATOGRAPH FILM ACT, 1922 Premises used for storage 1 (3 occupiers) 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 a Public Health Inspector and was found to be satisfactory. REFRESHMENT HOUSES ACTS, 1860 TO 1967 Licences issued 43 (1 prosection - £105 fine and costs) GREATER LONDON COUNCIL (GENERAL POWERS) ACT, 1968 PART VIII - NIGHT CAFES. Applications:- Received 96 Granted 23 Refused 11 Pending 28 Withdrawn 34 (2 prosecutions - £33 fines and costs) DISINFECTION AND DISINFESTATION DISINFECTION Infectious Disease Rooms treated 138 Clothing for export Staff of the department supervised the disinfection by formaldehyde gas of clothing for export. 38 Visits 9 Clothing treated on factory site 19 tons at disinfecting station 2.4 tons DISINFESTATIOIM Rats and Mice The total number of complaints of rodent infestations during the year rose from 2,667 in 1968 to 3,095 of which 1,289 referred to rats and 1,806 to mice. Mice are now proving difficult to eradicate since they have developed almost total immunity to Warfarin based baits. We have now reverted to the use of direct poison for control. This method is, of course, more timeconsuming than when Warfarin was effective. We are fortunate that, as yet, there is no evidence of Warfarin resistance to rats in this area. There were 16,900 visits made by Rodent Operatives dealing with infestations found during the year. 70 smoke tests of suspected defective drains were carried out. Due to a severe shortage of staff there was only one poison baiting of the sewers undertaken during the year. Type of Property Local Authority Premises Dwelling Business Houses Premises Total 1. Complaints received (including repeats) 117 2416 562 3095 2. No. of properties inspected as a result of a) Notification - initial complaint only; 39 570 516 1125 b) Block survey 28 429 139 596 3. No. of properties found to be infested by rats (including NIL ship rats) 41 239 158 438 4. No. of properties found to be infested by mice 12 615 300 927 5. Completed treatments during year 61 1672 280 2013 6. No. of business agreements dealt with 356 VERMIN Rooms treated1,599 PIGEONS Treatments by authorised catcher 12 39 DISTRICT INSPECTION DOMESTIC PREMISES Houses/Flats inspected under Public Health Acts 1936-61 6,237 Separate lettings 9,665 Revisits Houses/flats 11,806 Separate lettings 18,385 OTHER INSPECTIONS AND VISITS Miscellaneous 3,237 Prevention of Damage by Pests Act, 1949 289 Infectious Diseases 88 Derelict Buildings and Vacant Sites 1,439 Pigeon Nuisances 129 Drainage 1,764 Hairdressers and Barbers 193 National Assistance Acts, 1948 and 1951 (Aged & Infirm) 60 Factories Act, 1961 - Outworkers 148 Pet Animals Act, 1951 15 Consumer Protection Act, 1961, and Regulations 3 Noise Nuisances 133 Food Premises and Vehicles 87 Non-effective visits 1,992 PUBLIC HEALTH ACTS 1936 - 61 NUISANCES AND NOTICES Notices served - (a) Intimation 2,033 (b) Statutory 1,642 Notices complied with - (a) Intimation 2,020 (b) Statutory 1,276 Number of houses repaired 2,621 LEGAL PROCEEDINGS Information prepared 91 Proceedings instituted 55 Nuisances Orders made by Magistrate 17 Further proceedings for failure to comply with Nuisance Orders 9 DRAINAGE Plans examined 324 Examinations and Tests 274 COMPLAINTS Outstanding (at end of 1968) 143 Received during the year 5,443 plus 305 repeated complaints 40 Dealt with during year 5,533 Outstanding (At end of 1969) 53 LAND CHARGES ENQUIRIES Enquiries received 5,203 Properties involved 5,947 Investigations 5,947 RENT ACT, 1957 - APPLICATIONS 1. Certificates of Disrepair (i) Applications for certificates during 1969 2 Brought forward from 1968 1 Carried forward to 1970 — Total applications receiving attention 1969 3 (ii) Decisions not to issue certificates — Undertakings on Form 'K' accepted — (iii) Decisions to issue certificates (a) in respect of some but not all defects 3 (b) in respect of all defects — (iv) Undertakings given by landlords under paragraph 5 of the First Schedule — (v) Undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule — (vi) Certificates issued where undertakings not accepted — 2. Cancellation of Certificates (i) Applications by landlords for cancellation of certificates 2 Brought forward from 1968 — Carried forward to 1970 1 Total applications receiving attention 1969 1 (ii) Objections by tenants to cancellation of certificates 1 (iii) Decisions to cancel in spite of tenant's objections — (iv) Certificates cancelled — P H. ACTS, 1936 - 1961, G.L.C. (G.P.) ACT, 1967 WORKS IN DEFAULT Number of cases 286 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Premises on register (Section 2, for Upholstery) 32 Samples taken 3 Samples satisfactory 3 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 (235,990.) No houses were permanently supplied by a stand-pipe and the Director of Water Examination, Metropolitan Water Board, 41 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. The action taken regarding domestic, well water and swimming bath water is as follows:Domestic - mains supply. 4 samples were taken for bacteriological examination and 3 samples were taken for chemical analysis; all were found to be satisfactory. Well Water There are 42 bore holes and wells in the Borough, of which 35 are unused. 4 wells are used for all purposes and 3 for industrial purposes only. 12 samples were taken for bacteriological examination and 8 samples were taken for chemical analysis; all were found to be satisfactory. Swimming Bath Water 26 samples were taken for bacteriological examination and 1 sample was taken for chemical analysis; all were found to be satisfactory. FACTORIES AND OUTWORK FACTORIES ACT, 1961 Inspections for the purposes of provisions as to health (including those made by public health inspectors.) Premises Number on Number of Inspections Written Occupiers (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4, 6 and 7 are to be enforced by Local Authorities 25 109 6 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2,545 771 95 - (iii) Other Premises in which Section 7 is enforced by the Local Authority* (excluding outworkers premises) 68 104 - - Total 2,638 984 101 - *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 Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) Want of cleanliness (S.1.) 82 52 - 1 Overcrowding (S.2.) 1 1 - - Unreasonable Temperature (S.3.) - - - - Inadequate ventilation (S.4.) 32 19 - - Ineffective drainage of floors (S.6.) - - - - Sanitary Convenience (S.7.) (a) Insufficient 15 15 - 1 (b) Unsuitable or defective 396 351 - 13 (c) Not separate for sexes 18 3 - - Other offences against the Act (not including offences relating to outwork) 45 24 - 1 589 465 - 16 Re-inspections 537 Complaints recieved 2 Notices complied with 72 Basement Bakehouses (Section 70) The quinquennial inspections of the seven basement bakehouses were carried out and notices served to bring these premises up to the standard required under the Act. 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 type of outwork and number of workers were as follows:- Wearing Apparel - Making, etc. Cleaning and Washing 961 Household Linen 10 Umbrellas, etc 35 Artificial flowers 54 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 68 Brush making 2 Carding of buttons, etc 26 Cosaques, Christmas Stockings, etc 9 Not specified above , 113 Total 1,278 43 PUBLIC HEALTH ACT, 1936 Factories inspected 395 Contraventions found 65 Contraventions remedied 56 Notices served 9 Notices complied with13 Offensive Trades The four remaining offensive trades in the Borough are as follows:- (1) Tripe Boiler J.L. Henson Ltd., 26/40Vale Royal) Establishment Order extended for a (2) Fat Melter " " " ) further period of seven years. (3) Gut Scraper Tracey & Co., 5 Tileyard Road (4) Fur Skin Dresser J.A. Fisher Ltd., 440a Hornsey Road, N.19. Routine inspections were carried out during the year and notices served when found necessary. FOOD AND DISEASES OF ANIMALS FOOD HYGIENE (GENERAL) REGULATIONS 1960/2 Because of the shortage of Public Health Inspectors one of the Inspectors normally engaged on food inspection was seconded to the District Inspectors Section for six months, thereby reducing the number of routine food hygiene visits. The provisions of the Greater London Council (General Powers) Act, 1968 relating to "Night Cafes" which are now in force, have demanded a significant proportion of the Inspectors' time, necessitating their working all night on several occasions. However, this work has considerably improved the facilities available for customers, and achieved a reduction in fire risk in registered premises. FOOD STALLS AND MARKETS Pressure of work on the Food Section has resulted in the curtailment of routine visits to food stalls in established markets. However, on several occasions outside normal working hours. Food Inspectors visited the Hot Dog and Hamburger vendors in the vicinity of Arsenal Stadium on match days and 8 summonses were issued under the Food Hygiene (Markets,Stalls and Delivery Vehicles) Regulations 1966, details of which appear under "Legal Proceedings". Exemptions granted 11 Exemptions refused 1 Exemptions withdrawn 5 FOOD FACTORIES 119 visits were 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. FOOD COMPLAINTS 84 food complaints were received during the year, an increase of 2 over the previous year. These complaints were dominated by those foods found to contain foreign matter of various natures. Complaints of alleged unfitness were received in respect of the following:- 44 Bread, cakes & biscuits 27 Meat & meat products 19 Canned goods 12 Miscellaneous 26 Details of proceedings taken in respect of these complaints are shown later. FOOD AND DRUGS ACT, 1955 (a) Number of food premises etc. in the area, type of business and number of inspections made and action taken. Premises Visits by Inspector Bakehouses (basements) 9 35 Bakehouses (others) 35 191 Bakers (Bread & cake shops) 77 22 Butchers 229 516 Chemists — 11 Confectioners 418 86 Fried Fish shops 51 348 Fish depots 1 167 Fish curers 9 62 Fishmongers 65 18 Greengrocers & fruiterers 214 65 Grocery and provisions 545 529 Wholesale food stores 71 501 Food Manufacturers 49 119 Public Houses 391 166 Off Licence premises 116 14 Catering establishments (including clubs) 462 974 Canteens 228 106 Food storage for street traders 78 14 Food vehicles - 59 Food stalls 232 226 Milk distributors and dairies 429 88 Food examination (others) - 459 Meat inspection at licensed slaughterhouse ) 1 435 Inspection of slaughterhouse ) 76 Night visits - night cafes - 240 Night visits - others - 24 Miscellaneous visits & revisits - 4,519 OTHER ACTION TAKEN Contraventions found 302 Contraventions remedied 177 Notices served (Food & Drugs Act) 96 Notices complied with (Food & Drugs Act) 39 Food Poisoning enquiries 145 Legal proceedings, attendances at Court 60 45 (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) 274 Visits by inspectors 34 LEGAL PROCEEDINGS A summary of the action taken by the Council for offences under the Food & Drugs Act, 1955 and Regulations made thereunder is as follows:- No. of cases Total fines & costs Food & Drugs Act, 1955 25 £458 Food Hygiene (General) Regulations, 1960 7 £292 Preservatives in Food Regulations, 1962 ) 1 £ 7 and Soft Drinks Regulations 1964 ) Milk & Dairies (General) Regulations, 1959 1 £ 12 Food Hygiene (Markets, Stalls & Delivery Vehicles) Regulations, 1966 8 £ 74 Total £843 In addition to the above, 15 cases were withdrawn or dismissed. UNFIT FOOD During the year the total amount of food surrendered was:- Description Tons Cwts. Qtrs. Lbs. Meat 97 4 3 20 Offals 45 3 3 15 Tinned Goods 8 6 2 22 Fish 7 13 3 9 Others 7 10 3 21 Total 166 0 1 3 910 condemnation certificates were issued and 209inspections were necessary in connection with this work. Condemned food received from traders was removed to the Council's refuse disposal depot at Ashburton Grove to await conveyance, under supervision, to the refuse tip. Condemned meat from the slaughterhouse was used for animal feeding or industrial purposes. Other meat and offal etc. from the Smithfield Market area was collected under contract for manufacture for technical purposes. SAMPLING 747 samples, (18 formal and 729 informal) were submitted to the Public Analyst for examination. Adverse reports were received on 114 of these (15%). 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. Special attention is still being given to exotic imported foods. One sample of Cox's Orange Pippins marked "compost grown and not sprayed" was submitted for examination for residual pesticides. The levels found were not inconsistent with such a label, but traces of residual insecticides were found. 104 samples were sent for bacteriological examination, mainly ice-cream and milk. 46 EXPORT CERTIFICATES - FOOD 374 export certificates were issued; the food which consisted mainly of animal casings, meat, tinned and bottled meats and soups was exported to 39 countries. The majority went to South Africa, Italy, Portugal, Belgium, U.S.A., Germany, Spain, Malta, Sweden, France, Switzerland and Holland. CE CREAM (HEAT TREATMENT, ETC.) REGULATIONS, 1959 Supervision of the manufacture and distribution of Ice Cream. During the year 70 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 19 (b) for sale and storage 560 (c) for sale only 114 (d) for storage only 3 696 Bacteriological Examination 57 samples of ice cream were sent for bacteriological examination and following Methylene Blue tests, were graded as follows:- Grade I 23 Grade II 11 Grade III 16 Grade IV 7 57 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. Chemical Analysis 3 samples were sent for chemical examination and all found to be satisfactory. MILK SAMPLES Bacteriological Examination Class of Milk Results Phosphatase Methylene Blue Total Number of samples Pasteurised Satisfactory 13 9 13 Unsatisfactory — 4 Chemical Examination 22 informal samples were submitted for chemical analysis and all were found to be satisfactory. MILK (SPECIAL DESIGNATION) REGULATIONS, 1963 (AS AMENDED) Licences in force 427 47 MILK AND DAIRIES (GENERAL) REGULATIONS, 1959 Dairies registered in the Borough 11 Distributors registered in the Borough 418 MILK SUPPLIES - BRUCELLA ABORTUS No samples were taken during the year. THE LIQUID EGG (PASTEURISATION) REGULATIONS, 1963 There are on egg pasteurisation plants in the Borough. PHARMACY & POISONS ACT, 1933 Listed sellers of Part II poisons other than pharmacists 132 Initial registrations during the year 10 Visits and inspections 25 SLAUGHTER OF ANIMALS ACT, 1958 Slaughtermen's Licences During the year 9 Licenced were issued and were current at 31st December. 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 Daily slaughtering continued at the private slaughterhouse until the end of November, requiring the attendance of 2 Inspectors on most days. At the beginning of December, regular slaughtering ceased but the occasional slaughter of horses continued. MEAT INSPECTION REGULATIONS 1963/1966 At the private slaughterhouse referred to 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 Goats Horses Number killed Number inspected 168 168 2,018 2,018 134 134 10 10 3 3 430 430 All disease except tuberculosis & cysticercus bovis:- Whole carcases condemned 14 85 8 1 - - Carcases of which some part or organ was condemned 116 1,675 67 5 3 224 Percentages of the number inspected affected with disease other than tuberculosis and cysticercus bovis 77.4% 87.2% 56% 60% 100% 52.1% No animals were found to be affected with tuberculosis or cysticercus bovis. 48 Of the 430 horses slaughtered for human comsumption, 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 wholsale butcher establishments, food warehouses and bacon factories in that part of the Borough adjacent to Smithfield Meat Market. Apart from meat, offals and bacon, which were both imported and home killed, the Inspector was engaged in examining poultry, game, rabbits, sausage casings and canned goods. DISEASES OF ANIMALS ACT, 1950 The Corporation of the City of London, through its Veterinary Officer, continued to implement the Diseases of Animals Act and allied legislation on behalf of the Council. Bi-weekly visits were made to the private slaughterhouse and quarterly visits to Chapel Market in connection with the possible sale of live poultry. During the year, regular visits were also paid to the two Kosher poulterers' shops concerning the evisceration of the poultry. A visit was made to a private house regarding a suspected case of Psittacosis. Under the terms of the Animals (Miscellaneous Provisions) Order, 1927 the following Orders were advertised in the national press:- Equine Animals (Importation) Order, 1969 Foot and Mouth Disease (Amendment) Order, 1969 Foot and Mouth Disease (Infected Areas Restrictions) (Amendment) Order, 1969 Foot and Mouth Disease (Controlled Areas Restrictions) (Amendment) Order, 1969 Exotic Animals (Importation) Order, 1969 Importation of Dogs and Cats (Amendment) Order, 1969 HOUSING HOUSING ACT, 1957 Section 9. - Repair of unfit properties A number of houses was inspected under the provisions of this section, but in every case the cost of repair was considered to be unreasonable having regard to the valuation of the property. In consequence these properties had to be represented for closure under the provisions of Section 16 of the Housing Act. Section 9 of the Housing Act 1957 has now been amended by the provisions of the Housing Act 1969 and it is anticipated that far more use will now be made of this particular section to secure the repair and maintenance of properties, which at the present time may not be unfit for habitation but in varying states of disrepair. Sections 16, 17,18 & 27. - Unfit houses or parts of houses. Closing/Demolition Orders made with respect to unfit houses 19 Closing Orders made on parts of premises :- 56 Closing Orders determined on whole properties or parts of properties after the premises had been made fit ."-10 These figures show a considerable improvement on those in the 1968 Report. Sections 78 & 90 - Overcrowding Many cases of overcrowding were the subject of complaint or were found during the inspection of houses for other purposes. 49 It was felt that owing to the degree of housing stress in the Borough no useful purpose would be served by initiating action in every case to enforce the strict provisions of these sections. In general, severe cases of penal overcrowding were investigated and the persons in control of such lettings and the tenants concerned were interviewed by the Senior Inspectors in order to determine in what manner the living conditions of the tenants could be improved. Altogether some 30 cases of severe penal overcrowding were investigated and of these it was found possible to persuade the person in control to allocate a further room to tenants, or in some cases tenants obtained satisfactory accommodation by moving to larger premises. It was found possible to relieve the overcrowding of the tenants of 16 such cases. SLUM CLEARANCE 1966-70 Programme It was reported last year that five slum clearance areas were outstanding in the current programme. The undermentioned areas were represented during 1969. Asteys Row — 3 houses. Epping Place — 9 houses. Sussex Way — 9 houses. Gordon Close — 4 houses. Inspections have been completed of the remaining area (Eden Grove - 3 properties) and the representation prepared for early submission to the Committee. In addition to the above areas a further two clearance areas were added to the current programme. One area has already been represented (Highbury New Park 4 houses) and the representation of (Burder Road 71 houses) has been prepared for submission in due course. Orders confirmed. Meredith Street, Whiskin Street and Elliotts Place were confirmed by the Minister of Housing and Local Government during the year. The number of premises within Slum Clearance Orders demolished during the year was 143 houses. Demolitions of houses related to slum clearance areas and included in Part V Orders amounted to 583. 1970-1975 Proposed Programme. This programme is in the course of preparation and to date comprises a total of some 1,000 properties. It is still uncertain whether or not the Greater London Council will continue to be involved in the Islington Slum Clearance programme. There are advantages in the future programme being dealt with solely by the London Borough of Islington, subject to the Greater London Council co-operating in the rehousing of persons affected by Slum Clearance. There has been close liason with the G.L.C., particularly with regard to local public enquiries concerning slum clearance areas and with regard to Part V Orders dealt with by that authority. HOUSING ACT, 1957 PART V The inspection of properties in proposed redevelopment areas in co-operation with other interested departments continued. The number of areas surveyed was 13, houses inspected totalled 972, occupied by 2,024 families. Close co-operation was maintained with the Borough Architects' and Valuation Departments, and joint reports were prepared on the areas surveyed for submission to the Committee. 50 HOUSING ACT, 1961 Section 12 - Management Orders A further 7 houses were made subject to management orders. None of the orders made previously was determined, but all houses subject to a management order were regularly visited to ensure that the provisions of the order were complied with. Section 15 - Provision of amenities. In accordance with the instructions of the former Housing Committee this section was not generally implemented in view of the implications of the Housing Act, 1969 which came into operation on the 25th July, 1969. This new Act amends the definition of Multiple Occupation and provides grant-aid for the provision of amenities in common in houses which are multi-occupied. In consequence only 28 Notices were served to provide amenities, but routine visiting by technical assistants continued where work was in progress to provide amenities in accordance with Notices previously served. Section 16. - Means of escape in case of fire. It will be noted that with the increase of three additional Fire Inspectors to the establishment of this section there has been a notable increase in the surveys made, notices served and means of escape provided. The work has been concentrated in those areas of houses where it is considered that the need for the provision of escape is most needed. In addition, the Fire Inspectors have co-operated with both the Valuation and the Borough Architects Departments by the preparation of schedules of work to provide adequate means of escape to properties the subject of Council mortgages and proposals for the conversion of houses into separate units. The incidence of fires in which portable paraffin oil heaters have been involved has averaged 40% of the total fires in dwelling houses within the Borough during the last three years. One cannot help but feel that although this form of heating is popular and widely used, powers are needed to forbid or to restrict the use of portable paraffin heaters in houses in multiple-occupation. Experience has shown that in too many cases large numbers of people are at risk from heating sources whioh may be completely outside of their means of control. Section 19 - Houses in multiple occupation- This section regulates the maximum number of individuals who are permitted to live in a house or part of a house in multiple occupation. The Housing Act 1969 amends this section to include the number of individuals or the number of households or both, permitted to occupy a house or part of a house in multiple occupation. In addition the new Act defines more concisely the term "family" contained in the Housing Act 1957 and also the definition of multiple occupation in the Housing Act 1961 which now reads"a house which is occupied by persons who do not form a single household". Unfortunately the term "household" is not defined, and this may well lead to complications in applying the provisions of Section 19. Housing Act 1964 - Section 19. Tenement Blocks. A report on tenements in Category II (tenement blocks capable of improvement to a reasonable standard) was made to the Committee in October, 1968. There have been further consultations with owners, agents, and builders on the possible imporvement to several such tenements during the past year. 51 In particular the Samuel Lewis Trust Estate, Liverpool Road, which comprises five large blocks and one smaller block, containing in all 323 flats, is in course of rehabilitation. Block 'A' which originally contained 60 sub-standard dwellings has been rehabilitated to produce 45 modern flats. The work on block 'B' has commenced and again the existing 60 dwellings will have to be reduced to 45 flats to obtian the desired standard of improvement. In the case of other tenements in Category II, plans have been submitted and applications made for grant-aid in order to carry out the agreed work of rehabilitation. BOROUGH SURVEY Following the publication of the Government's White Paper "Old houses into new homes" in April 1968, a report on this subject was made to the Committee. The Committee agreed that a survey of the houses in the Borough should be undertaken by the Housing Section of the Public Health Department. This survey commenced at the beginning of the year and, although the Establishment Committee increased the establishment of the Housing Section by the transfer of two vacant posts from the District Inspectorate, it was not found possible to recruit Inspectors with the necessary experience and ability to carry out the work involved. Therefore in order to get the survey off the ground, the work was allocated to two of the established Housing Inspectors. Unfortunately,this had a detrimental effect on the work in connection with houses in multiple occupation on which these Inspectors were normally engaged. At the end of the year, some 22,660 houses had been classified and recorded by means of a colour code on a large scale map of the Borough which had been prepared with the co-operation of the Borough Architects' Department. Of the houses inpsected some 3,687 had been surveyed in detail, a percentage of 16% which was in excess of the 10% target set at the begining of the survey. It is anticipated that the survey will be completed by the end of February 1970. AREA IMPROVEMENT - INSPECTION OF HOUSES The survey of houses in the above category has continued. The number of houses in these areas and the density of families per house is as follows:- Houses Families Pop: Family density per houses Northchurch Rd. (extension) 70 203 483 2.9 Claremont Square 65 103 431 1.6 Kiver Road 80 101 366 1.26 Ockenden Road 143 416 959 2.9 Total 358 823 2,239 HOUSING ACTS - STATISTICS Housing Act 1957 Section 5 Control of back to back dwellings Certificates issued 1 Section 9 Repair of unfit houses Houses inspected 9 Re-inspections 7 Representations to Committee Nil 52 Section 16 Individual unfit houses Inspections 154 Revisits 351 Houses represented to Committee 22 Closing Orders made 18 Demolition Orders made 1 Undertakings accepted Nil Houses demolished 3 Section 18 Unfit parts of buildings Inspections 614 Revisits 2,371 Representations to Committee 47 Closing Orders made 56 Undertakings accepted Nil Section 24 Reconstruction of house subject to Demolition Order Houses 2 Revisits 76 Demolition Orders Determined 1 Section 27 Closing Orders or undertakings determined on completion of works. Whole houses Nil Parts of buildings 10 Permitted use of premises subject to Closing Orders Applications submitted to Committee 4 Applications granted 4 Section 28 Closing Order - Substitution of Demolition Order Orders substituted Nil Reports to Committee Nil Section 42 Clearance Areas Areas surveyed 8 Houses in above areas 139 Areas represented to Council 4 Total houses in areas represented 20 Inspections 361 Revisits 415 Sections 78 & 90 Overcrowding Inspections 104 Revisits 53 Overcrowding abated 16 Section 81 Permitted numbers Inspections 342 Housing Act Part V Possible C.P.O.s other than Clearance Areas Areas surveyed 12 Houses in above areas 900 Inspections made 820 Housing Act 1961 Section 12 Management Orders Reports on individual houses submitted to Committee 6 53 Section 12 Lettings in above houses or tenements blocks 45 Inspections and revisits 164 Management Orders made 7 Management Orders determined Nil Section 15 Provision of amenities Houses inspected 195 Revisits etc 1,898 Informal notices served 4 Formal notices served 24 Notices complied with 57 Section 16 Means of escape in case of fire Houses inspected 2,185 Separate lettings 6,555 Family density per house 3 Informal notices served 1,228 Formal noices served 777 Notices complied with 535 Nurseries & Child Minders Visits 203 Section 19 Directions to prevent overcrowding Visits etc 377 Directions made 62 Variation of Direction Nil Section 21 Possible improvement of tenement blocks Tenement blocks - improvements in progress 2 Dwellings in above blocks 120 Inspections and revisits 466 Housing Act, 1964 Section 13 Improvement Areas New areas surveyed Nil Revisits re Declared Areas 313 Areas represented Nil Preliminary improvement notices served 34 Immediate improvement notices served 7 Suspended improvement notices served 1 Informal undertakings accepted Nil Section 19 Improvement of Individual Houses Formal applications received from tenants 9 Informal applications 17 Dwellings inspected 26 Revisits etc 91 Housing (Financial Provisions) Act 1958 & Housing Act 1969 Improvement and Standard Grants Inspections and revisits 784 Special Grants-Inspections and Revisits 172 Qualifications Certificates-Inspections and Revisits 68 54 House Purchase Scheme London Borough of Islington Inspections and revisits 95 Greater London Council Inspections and revisits 12 Town and Country Planning Visits and revisits 54 Miscellaneous Inspections Other miscellaneous visits including medical preference inspections, meat and food inspections, nurseries and child minders, etc 2,811 Interviews with owners, surveyors, builders, tenants, etc. 1,841 Non-effective visits 1,588 PROSECUTIONS & COURT PROCEEDINGS DURING 1969 Housing Act 1957 Section 18 Appeal against Closing Orders 2 Section 22 Contravention of Demolition Orders 2 Section 27 Contravention of Closing Orders 5 Section 78 Overcrowding Nil Section 170 Failure to give information as to ownership 70 Housing Act 1961 Section 13 Breach of Regulations of Housing (Management of Houses in multiple occupation) 3 Section 19 Failure to comply with a Direction to prevent or reduce overcrowding 4 Housing Act, 1964 Section 65 Section 15 Failure to comply with Notices served 19 Section 16 Failure to comply with Notices served 58 Section 15 Appeal against Notice 1 Section 16 Appeal against Notice 3 Total 167 NOISE In response to Circular No. 36/39 a report was submitted to the Ministry of Housing and Local Government regarding the action taken by the Council during the previous two years to combat industrial noise under the Noise Abatement Act, 1960. A detailed summary of the various types of noise complaints received and the action taken was given. The report referred to difficulties encountered in dealing with noise nuisances when acoustic specialists employed by the Council and owners of premises have different opinions on methods required to resolve a nuisance. It was suggested that maximum sound levels should be required when giving permission for industrial and commercial development. The fact that statutory undertakers and Crown properties are exempt from the provisions of the Noise Abatement Act often produces an accusation of unfairness from occupiers required to mitigate their own noise. A great deal of 55 the industrial noise created in the borough merges into the general level of that caused by road traffic which is probably the greatest noise factor in the Central London area. The number of noise complaints received during 1969 showed a slight increase over the previous year. Details are set out below:- Complaints received 121 Visits made by Public Health Inspectors 464 Types of complaint: (a) Industrial Machinery 35 Vehicles 15 Car repairs 6 (b) Domestic Sewing machines 15 Radio/Television 3 Musical instruments 5 General noisy behaviour 24 Animals 3 (c) Clubs/Restaurants Music 6 (d) Road Works Pneumatic drills 7 (e) Chimes from Ice Cream Vans 2 Total: 121 Detailed investigations, including evening and week-end visits where necessary, were made into all complaints and appropriate steps taken. Often informal action only was needed, but where complaints were substantiated notices were served. Towards the end of the year two cases were referred to the Legal Division with a view to legal proceedings. Remedy of nuisances was possible in a few instances by action in accordance with the Council's Bye-Laws as to Wireless Sets, Gramophones etc. A sound level meter was acquired during the year, and the Deputy Chief Public Health Inspector attended a special course of training at the Institute of Sound and Vibration Research at Southampton University. Other Inspectors attended part-time courses on noise control. Thanks are again due to the Scientific Branch of the Greater London Council for valuable assistance in connection with noise complaints. OFFICES AND SHOPS As in previous years, the most common infringements under the Offices, Shops and Railway Premises Act, 1963 were defective floors and floor coverings, staircases without handrails or with defective treads and risers, and failure to supply proper first aid materials and wall thermometers. In supermarkets the storage of goods is often a problem and the passages, stairways, and in some instances sanitary accommodation have all been found to be stacked with goods. As the Act has now been in force for some years, most premises are provided with the basic amenities and there has been, in consequence, a drop in the number of these deficiencies found at the time of inspection. Conversely, there has been an increase in maintenance items such as lack of cleanliness and items of disrepair. 56 It is gratifying to be able to report again that the great majority of occupiers are quick to comply with any requirements brought to their attention. In 1969 only eighteen cases were passed to the Council's Legal Division and in no case was Court proceedings found to be necessary. The willing co-operation and assistance of Her Majesty's Factory Inspectorate and, in particular, the appointed Authorised Officer of the Department of Employment and Productivity is gratefully acknowledged. Tables attached to this report give details of the premises inspected, the number of visits made and a summary of the deficiencies found and remedied during the year. REGISTRATION AND GENERAL INSPECTIONS Class of premises Premises newly registered during the year Total number of registered premises at end of year Registered premises receiving one or more general inspections during the year Offices 112 1,559 276 Retail shops 62 1,347 308 Wholesale shops, warehouses 18 249 59 Catering establishments open to the public, canteens 16 335 66 Fuel Storage depots - - - TOTALS 208 3,490 709 57 Visits of all Kinds to Registered Premises4944 ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED IN REGISTERED PREMISES Class of workplace Persons employed Offices 38,944 Retail shops 6,370 Wholesale departments, warehouses 4,702 Catering establishments open to the public 1,662 Canteens 835 Fuel Storage depots 2 TOTAL 52,515 MALES 31,379 FEMALES 21,136 DEFICIENCES FOUND AND REMEDIED TOTAL Found Remedied Cleanliness 141 199 Overcrowding - 3 Heating 7 5 Provision of Thermometer 146 182 Ventilation 63 107 Lighting 34 64 Insufficient Sanitary Accommodation 16 7 Deficient Sanitary Accommodation 72 95 Insufficient Washing Facilities 8 5 Hot Water/Warm Water Required 23 41 Other Deficient Washing Accommodation 52 57 Drinking Water - 2 Clothing Accommodation 14 21 Seating Facilities 1 • Eating Facilities - - Dangerous Machinery 73 85 Floors and Staircases 229 317 Noise Vibration - - First Aid 228 242 Abstract 331 494 TOTALS 1,438 1,928 Intimations Served 573 58 HEALTH EDUCATION HEALTH EDUCATION SERVICE "MEN AT SOME TIME ARE MASTERS OF THEIR FATES: THE FAULT, DEAR BRUTUS, IS NOT IN OUR STARS, BUT IN OURSELVES" Julius Caesar. Act 1 Sc.2.— William Shakespeare. It would seem that when Shakespeare wrote those words he might have had Health Education in mind, had he ever heard of it. In spite of the fact that man has survived until now he is not always ready and willing to listen to the voice of reason when it comes to taking such action as will preserve him from harm, lengthen his days and make his life more enjoyable. He often tends to think that bad things only happen to other people and couldn't possibly affect him. The whole purpose of health education is to enable man to enjoy life to the full and avoid the many pitfalls which can beset him on his journey through life, and remove some of the so-called quirks of fate. Many of the active preventive measures which are readily accepted today as part of normal living, came about by the practice of health education. Pure water supplies, sanitation, immunisation, maternity and child welfare, to mention a few, are the results of persuasion and education. It can be said that health education is aimed at four sections of the community, (i) The expectant mother and the mother who initially commences a child's educational training, (ii) the schoolchild and students at further education establishments, (iii) the adult population and (iv) the retired. It will be noted that a contrast has been made between the adult and the retired. This is purely arbitrary but it should be remembered that when the age of retirement is reached the individual does, in fact, need to change his habits because of the new circumstances. It will thus be seen that health education carries out its important task from the very beginning until the last days of the citizen. Each of these groups must be communicated to in a way which is acceptable to it, and within these areas of course there are additional difficulties of communication which are peculiar to Islington. These are our immigrant groups who must be approached within the framework of their own social customs, and in addition the many language barriers must be surmounted. STAFFING It is now nearly five years since the Health Education service was inaugurated and,with the ever-growing demand for the service, it has been necessary to increase the staff to meet the constant calls made upon it. The staff now comprises Health Education Officer. Assistant Health Education Officer. Driver/Projectionist. Clerical Assistant. For the future, perhaps in an improved economic climate, a further expansion of staff towards meeting the full health education needs of the borough's over a quarter of a million people and 104 schools plus further education establishments, might be considered, including the appointment of a full-time home safety officer and a female assistant health education officer. HEALTH EDUCATION CENTRE In order to give the Health Education Officer further scope, part of the former midwives hostel at Scholefield Road was allocated for use as a health education centre, comprising: (a) a conference room, used for in-service training, minor conferences and health education meetings; (b) a display and exhibitions room where many of the exhibits created by the health education section are on display. Also many of the audio-visual aids, models, charts, flannelgraphs, etc., are available for inspection by departmental staff requiring aids and assistance for talks and lectures they may be giving; 61 (c) a workshop where the exhibition pieces and visual aids, essential for the general publicity work of the section, are made; and (d) a combined office and studio for art work. It will be seen that the technical facilities now offered as part of the health education service have greatly expanded, and many methods which previously could not be applied, are now readily available to departmental staff. Disposable publicity material - leaflets, booklets, posters, etc. - have now been carefully catalogued, and many hundred of pieces of printed matter are available for immediate despatch when required. In addition, many new film strips have been acquired and converted into slide sets. This enables speakers to select the slide content of any talks which they wish to give and allows them to edit to their own satisfaction any standard talks which accompany film strips. A number of sound films have been added to the film library, but one must always be cautious in the selection of this material as the content can often date. This does not necessarily apply to the factual information, but to fashion styles and statistical summaries. Many other Council departments are now making use of the audio-visual aids which are held by the health education service, as well as of slide and sound film projectors and the trained projectionists. THE HEALTH EDUCATION ADVISORY PANEL The panel, comprised of representatives of the department's medical staff, health visiting and other nursing staff, inspectorate, social workers and administrative staff, continues to meet regularly to discuss the furtherance of health education, and to view the new material which is constantly being produced both nationally and within the department by the service. The following projects and campaigns were promoted in addition to the general health education work during the year. January — Winter Illness, Fire, Hypothermia. February — Dental Health. March — Prophylaxis. April — Child Minding. May — Infestation - Insects and Vermin. June — Watch your Weight. July — Summer Safety. August — Preparation for School. September — Smoking. October — Fire Safety - Fireworks, Home Safety. November — Winter Hazards - Safe Toys. December — Good Neighbours. Some of these topics arise regularly at certain times during the year. This, of course, is standard practice and unless this continued surveillance is applied, the individual may tend to forget the hazards which surround him. The four areas to which health education should be directed have already been mentioned. The expectant mother takes part in many of the health education activities which are presented at maternity and child health clinics, and the health visitors and other nursing staff are constantly engaged in promoting health in this field. In order to do this their work is backed by the resources of the service by means of exhibitions, displays, and the provision of audio-visual aids, and sound film. After her delivery the mother will still attend the welfare centre to take part in post-natal activities and join in the activities of the mothers' club where she learns about the patterns of family life, and the best ways of utilising the amenities within her environment. She thus learns not only the essentials of child rearing but how to prepare her children for entry into school. 62 FAMILY PLANNING WEEK A Family Planning Week was held during November when the Family Planning Association, in conjunction with the department, presented a number of "open days" at family planning clinics and, with the assistance of the health education service, a number of film shows throughout the Borough. In addition, a new leaflet about family planning methods, which also gave full details of clinics held in the Borough, was published by the service. HEALTH EDUCATION IN SCHOOLS AND FURTHER EDUCATION ESTABLISHMENTS. The health education service continued to maintain its close association with schools in the Borough, and the health education officer presented many talks on various health education topics. He continued to make fresh contacts, one of which was Dame Alice Owen's Boys' School, where he presented a series of lunchtime sessions for the sixth form. This activity was especially gratifying as grammar schools particularly are geared to a high pressure syllabus, and very often find it difficult to include outside speakers. It is hoped that further grammar school liaison will develop from this beginning. The link with the Edward Seguin special school is still maintained, and a course of health education topics of interest to school leavers was presented by the Health Education Officer. Many more teachers are making use of the facilities offered by the service, some of whom are now actively engaged in presenting their own health education programmes and, to this end, the service is able to assist with the loan of sound films, slides, models and audio-visual aids. It will thus be seen that health education is now becoming an accepted part of the day-to-day school curriculum. PARENT TEACHER ASSOCIATIONS Many Parent Teacher Associations seek the services of the Health Education Officer to talk at their meetings. This enables a better understanding of many of the topics presented by the service to be maintained between parent and pupil. DENTAL HEALTH CAMPAIGN Every year a very active dental health campaign is mounted in the Borough, and this year a most novel wayof presenting dental health education to primary schoolchildren was devised. The Inner London Education Authority appointed a Dental Health Educator who, with the collaboration of the Health Education Officer and the approval of the Chief Dental Adviser to the I.L.E.A., produced a puppet show with such characters as "Jimmy Germ",*Katy Carrot", "Andrew Apple", "Mr. Toothbrush and Mrs. Toothpaste", "Peter and Paul Molar" and, of course, the Dentist, which was presented at 34 primary and infant schools in Islington. The Dental Health Educator and the Health Education Officer were the willing puppeteers and gave more than 50 performances to nearly 8,000 delighted children. There is little doubt that this form of dental health education had the required impact. Many children will never forget the antics of wicked Jimmy Germ and his final defeat by Mr. Toothbrush and Mrs. Toothpaste, and the words of wisdom of Mr. Dentist as he said his fond farewells. As a follow up to the puppet shows, to see if they had made a lasting impression, the children in many of the schools were asked by their teachers to write stories and paint pictures of what they had seen, the results were truly startling (some typical efforts are shown). Y.M.C.A. The contact with the Central Y.M.C.A. was maintained and the Health Education Officer continued to give talks on human relationships to Islington school leavers, as part of a course presented by the Association YOUTH CLUBS Many other youth groups and clubs also requested talks, particularly those dealing with venereal disease, drugs and human relationships. 63 "Our friend the Dentist by a 5yr old" 64 Jimmy Germ as seen through the eyes of a 5yr old 65 66 The Heroes and Heroine of the Dental Health Puppet show drawn by a 5yr old 67 Some of the characters from the Dental Health Puppet play Poster reproducted by permission of the Inner London Education Authority INNER LONDON EDUCATION AUTHORITY CLOSED CIRCUIT TELEVISION The Headquarters of the I.L.E.A. Closed Circuit Television Centre is situated within a few hundred yards of the Department building. A number of teachers employed by the I.L.E.A. are seconded for training as T.V. producers and presenters of educational programmes. T.V. being the ideal medium for the presentation of health education, many of the students approach the service for practical advice and the loan of equipment when producing their programmes. It is hoped that in the not too distant future, regular health education features will be shown on the I.L.E.A. educational T.V. network. OIL HEATER SAFETY CAMPAIGN The health education service publicises its war on killer oil heaters, and the Cleansing Department cooperates by removing free-of-charge unwanted oil heaters. A massive poster campaign is regularly promoted advising the members of the public that the service is available. The heaters are subsequently destroyed so that they cannot fall into the wrong hands and thus be the source of further fires. The Council is very conscious of the great danger which is inherent in the misuse of oil heaters and continually presses home its campaign. This is done not only in English but also by the distribution of material in many foreign languages including Greek, Turkish, Hindi, Bengali and Urdu. The Community Relations Officer has willingly co-operated in this campaign and was provided with many hundreds of these leaflets for distribution to the various communities. ILLEGAL CHILD-MINDING New Posters and leaflets, in English and Greek, were devised and distributed to remind child-minders and mothers of the dangers and the penalties attached to illegal child-minding. This is another social problem which has been forcefully approached by the department, and the publicity material used in the campaign has been very effective. SMOKING ADVISORY CLINIC Islington is fortunate not only in being a pioneer in this field but in having maintained its smoking clinic since 1962. The clinic is under the direction of Dr. H.O. Williams, Chest Physician at Whittington Hospital, and the Health Education Officer. The results are most encouraging and the method of assessing success is most stringent as a patient is not counted as a successful non-smoker until able to declare that he or she has not smoked for 12 months. It is disappointing to note, however, that approximately 30% attended only once. It would appear that these people were looking for a magic panacea to cure all ills, including the habit of smoking, but forget that personal application and determination to this task are the major requirements. The clinic was featured in a broadcast on Radio 4 in the "In Practice" programme. Dr. H. O. Williams and the Health Education Officer contributed to the programme with many eminent figures in the antismoking world. WHITTINGTON HOSPITAL The Health Education Officer was asked to give a talk to staff about the dangers of smoking and as a result of this a number of hospital personnel registered for a course at the smoking advisory clinic. GERIATRIC CLINICS The service continues to supply and maintain the geriatric clinics with audio-visual aids and speakers. Among the many topics discussed at these lively and enjoyable sessions were:- Exercises for the over 60's. Home Safety. Care of the Eyes. Alcoholics Anonymous. The use and misuse of Drugs. The work of the W.R.V.S. Special foods. The English Disease (Bronchitis). Smoke Control. When to go to the doctor. Social Security Benefit and YOU. 68 The end of a killer oil heater Photo Hamilton Studios Display used to publicise dangerous oil heaters Photo K. Robertson 69 These clinics have proved so successful that in August another health education advisory circle was opened at Hilldrop Welfare Centre and is gradually building up its own enthusiastic membership. In addition to the health education advisory circles, there are many old people's clubs and organisations situated in the borough and the Health Education Officer was actively engaged in giving health talks to these groups. In addition he lectured to the Allegro Club, a further education class for the elderly, organised by the Holloway Adult Education Institute. IN-SERVICE TRAINING Student public health inspectors continued to receive advice and practical training in health education as part of their examination course. Health visitors received practical training from the assistant health education officer in the use of slide and sound film projectons. A number of student health visitors visited the health education centre and were given practical instruction and advice in the use of audio-visual aids and the design and promotion of display. The Health Education Officer was invited to lecture to groups of students taking the health visitor course at the Northern Polytechnic on "The method and content of health education". Student state enrolled nurses receive practical training from the superintendent of home nursing and the health education service assisted in this connection. Medical officers of the Public Health Department had regular staff meetings, and the Health Education Officer provided a number of sound films of particular professional interest to them. HEALTH EDUCATION CONFERENCE AT HACKNEY In 1968 a Health Education Conference was promoted, in conjunction with the I.L.E.A., in order that teaching staff might be made aware of health education and its possibilities in the school curriculum. The London Borough of Hackney held a similar conference this year and invited the Health Education Officer to present a paper on "The Organisation of Health Education". LONDON BOROUGHS'TRAINING COMMITTEE The Health Education Officer was asked to give a paper at a study day for health education officers presented by the London Boroughs' Training Committee on "The Training of Health Education Officers". It can be seen that the work of the health education service has again increased, and will no doubt continue to do so every year, for health education is a continuing process. It can never be said that any particular campaign has been successful at any given point,as further success and stimulation is required each year until what may appear initially to be the impossible - the complete physical, mental and social wellbeing of the individual - can be achieved. 70 THE PLANNING OF A HEALTH CENTRE THE PLANNING OF A HEALTH CENTRE Work began ori the site in River Place, Essex Road, N.1. in December, 1969. This was the culmination of a long sequence of discussion and planning, and it would, I think, be useful to have in this annual report a brief summary of the various steps taken. On 1st April, 1965, the Borough inherited the London County Council's capital programme, which included a centre to replace existing small centres in the N.1. district for maternal, child health and school treatment services. By September 1965, informal discussion with local general medical practitioners suggested that they would welcome the extension of the scheme to full health centre status, in order to include surgeries for their use. In May, 1966, the health centre became a firm proposal, and the search for a suitable site began. In December, 1966, the Council accepted the policy of providing a health centre on a site in River Place, Essex Road, N.1. Negotiations were put in hand with the Inner London Executive Council to approach local general medical and dental practitioners. The Inner London Education Authority was asked to consider the inclusion of a child guidance service to meet the needs of Islington schoolchildren. The new centre would also serve as a replacement for maternal and child health centres and a school treatment centre scheduled for demolition in housing development schemes. At this stage, it was necessary to ascertain Ministerial policy in regard to health centres as no express direction had yet been issued, although advice had been received that such a centre would receive consideration if loan sanction were sought. In February, 1967, the Town Clerk and the Medical Officer of Health met officers of the Ministry of Health who welcomed the Council's proposal and made available information which was later to be incorporated in the Ministry circulars and building notes which have served as the basis of national policy. The helpfulness of the officials was greatly appreciated, and it enabled the Borough's officers to make their preliminary plans. Concurrently discussions with the doctors showed that several were ready to express an interest in the proposal. The hospital authorities also expressed willingness to co-operate, but none wished to include hospital services in the centre. In April, 1967, loan sanction was received from the Ministry of Housing and Local Government to the purchase of the site. The proposal thus became a definite project. In July of the same year, the preliminary brief was forwarded to the Borough Architect to enable him to prepare drawings and estimate costs. On the basis of his sketch plans, a series of discussions were inaugurated with the Executive Council and the doctors and with the Inner London Education Authority in regard to the dental and child guidance units. These provided a full exchange of information, not only about the geography of the centre but also the general running of the various services and their inter-relationship. The fact of their being in the same building offered opportunities for new or extended co-operation at many levels. In March, 1968, a submission scheme was sent to the Ministry of Health in accordance with Circular 7/67. The basic scheme was for a centre to serve a population of 45,000, to include local health authority services ( maternal and child health, chiropody), school health services (dental and child guidance) and general practitioners' surgeries, with accommodation for a full range of field workers (health visitors, school nurses, and home nurses). General agreement was received from the Ministry in April, 1968, subject to the reconsideration of various points of detail. These called for further consultation which followed the pattern of the preliminary discussions, and as a result revised plans were approved by the Council in October, 1968, and by the Department of Health and Social Security in December, 1968. A formal proposal under Section 20 of the National Health Service Act, 1946, was later approved. During 1969 the professional and technical officers completed their negotiations for tenders and contracts, and the administrative officers prepared estimates of staffing and costs which would serve as the basis of the formal agreements to be entered into for their respective services with the Inner London Education Authority and the Inner London Executive Council (on behalf of the doctors who will use the seven surgeries). 73 Work commenced on the site in December, 1969, with a target date for opening the centre in February, 1971. It is understood that the River Place Health Centre would then be the first "full-scale" health centre to be completed in Inner London since the reorganisation of April, 1965. (A centre opened in 1968 was limited to accommodation for general practitioners only). The estimate of cost as included in the Council's latest Five Year Capital Programme is £191,520, made up of £40,000 for site, £141,320 for building, and £10,200 for equipment. 74 MENTAL HEALTH MENTAL HEALTH SERVICE 1969 has been a time of growth and development of mental health provisions in the Borough, both in the field of social work and in its day care programme. During the year it was possible to implement previous recommendations for the expansion of the social work service. Two new senior posts were created and additional social work positions added to the establishment. By the end of the year all new posts were filled and a total of 19 fieldworkers formed two separate teams. As in past years, very many home visits were paid. In addition there was a striking increase in the number of clients who chose to call at Finsbury Health Centre for regular casework interviews during the day, or, in a large number of cases, on their way home from work in the evenings. For many people quiet sessions with a social worker away from home distractions are far more therapeutic than interviews in their own homes. The consultant psychiatrist continued his regular weekly advisory sessions for staff at the Mental Health office. The Principal Medical Officer is available at all times for advice on assessment and placement of the mentally handicapped, and her special assessment and advisory clinics continued to be held regularly throughout the year. At these the needs of mentally and physically handicapped children under school age are assessed and their parents receive advice and support. The number of children with their parents seen at these clinics totalled 59. In addition, 47 children were seen in their own homes and 20 in day nurseries. LIAISON WITH HOSPITALS Our links with Friern and Halliwick Hospitals have been maintained. During the year a social worker and a day centre supervisor have joined in a discussion group at Friern Hospital held on a fortnightly basis for hospital and local authority personnel. Sometimes, at the request of a hospital psychiatrist, a local authority social worker will begin working with someone who is still an in-patient in one or other of these hospitals, and then continue to work with him on discharge thus easing the passage from hospital to life in the community. The mental health staff is also co-operating in a piece of research at Friern Hospital, which began during the year under the auspices of the National Institute for Social Work Training. Two psychiatric social workers, jointly appointed by the Council and the psychiatric department of St. Bartholomew's Hospital, have helped to develop the friendliness and close collaboration between the two departments. During the year the head psychiatric social worker at the hospital worked part-time in our mental health section for a period of three months in order to gain some first hand experience of the work. LIAISON WITH GENERAL PRACTITIONERS General practitioners are now making more use of the social work service and a number joined the social workers at the monthly seminar run by Dr. Alexis Brook, consultant psychiatrist, at which the case for discussion is jointly presented by a general practitioner and a social worker. There continued to be a demand for the regular attachment of mental health social workers to general practitioners in order to work weekly in their surgeries. Through this work it is sometimes possible to reach people with psychiatric problems at a very early stage. This is a small though positive contribution towards preventive work, which aims at maintaining mental health rather than working exclusively in the field of after-care. The increased extent to which this service has been used by general practitioners during the year suggests that there is likely to be a demand for many more of these social worker attachments in the future. HOSPITAL ADMISSION In spite of development in community care, it is still necessary to provide a 24 hour emergency rota in which most of our social workers share once they have acquired the necessary skill and experience to participate in this service. 77 SOCIAL WORK WITH THE MENTALLY HANDICAPPED Each social worker's time is divided between work in the field of mental illness and of mental handicap. The finding of suitable vacancies for short-term care of the mentally handicapped in times of family crises has become increasingly difficult. With a decreasing number of vacancies available, particularly for the more severely handicapped, parents are forced to carry on for many months in almost impossible conditions thus endangering their own mental and physical health. This can result in the handicapped child having to leave home permanently, whereas if short-term care could be provided when needed, a family might, after a suitable break, continue to care for their handicapped member for perhaps many years. This absence of suitable vacancies has caused great distress to parents and much frustration to social workers who can spend days of their time in fruitless search for a suitable vacancy. RESIDENTIAL ACCOMMODATION Islington has two purpose built hostels in the planning stage. At present the extent of residential accommodation is five bed-sitting rooms for women recovering from mental illness (which are rented by the Council from the Islington Society for Mentally Handicapped Children) and privately-run accommodation which accepts educationally subnormal men. The Council contributes towards the cost of board and lodging in suitable cases. Both schemes are closely supported by mental health social workers and two of the social workers run an evening group at the men's "hostel". STUDENTS The training aspect of the work has increased during 1969, making a heavy demand on our social workers' time. A large number of students from both basic and professional social work courses have been received in the section. Their length of stay may be as long as six months or, for some purely observational placements, as short a time as two weeks. Medical students from nearby hospitals continue to visit for one day a month in order to go out with mental health social workers and see something of the day-to-day activities of the section. A newer development is the regular visits from student psychiatric nurses from Friern Hospital, two nurses coming in the spring and two in the autumn to spend two weeks in the section. They accompany social workers on home visits and assist in emergency admissions as well as seeing something of our day centres and other mental health activities. We are very glad to welcome these visitors to the department and social workers find student training a most interesting and stimulating part of their work. TRAINING CENTRES FOR THE MENTALLY HANDICAPPED A new centre, the Isledon Road industrial training centre, opened on 3rd November 1969 in premises previously used for Civil Defence purposes. This centre has accommodation for 40 young men and women who are capable of fairly advanced industrial work and who in some cases may later qualify for work in open industry. Bennett Court training centre now has an almost equal number of men and women. It is a lively 60 place centre with a mixed programme which includes industrial work, carpentry, cookery and education classes, with outings and other activities to further social training. The Isledon Road and Bennett Court centres join forces for regular visits to the local swimming baths. The modern, light church hall vacated by the former Camden Road Adult training centre is to be opened as the new Holloway special care unit, to cater for a group of 10 children from five years upwards with a physical as well as a mental handicap. This unit is necessary because of the long waiting list for the Rosemary special care unit. The Rosemary junior training school with its capacity for 102 children from 5-16 years (including 12 in the special care unit) had 93 children on the roll by the end of the year. Good progress was maintained in spite of staff changes and the fact that two teachers have been seconded for two-year training courses 78 Trainess from all Islington centres for the mentally handicapped joined once again with other Inner London Boroughs in the organised holiday at St. Mary's Bay, Kent. Both parents and trainees benefit considerably from this welcome break from routine. The day nursery for mentally handicapped children under 5 years of age is a joint venture between the Islington Society for Mentally Handicapped Children and the Council. It continues to prove highly successful with a very happy working relationship between us. DAY CENTRES FOR PSYCHIATRIC PATIENTS The three day centres have continued steadily. Richmond Avenue, which is run on industrial lines and caters for 40 patients capable of sticking to a fairly steady work routine, was almost full by the end of the year. The Finsbury centre (20 places), which is less structured, aims at short-term rehabilitation run on group lines. The patients are responsible for cooking their own mid-day meal and organising the daily programme. Experience has confirmed the need for both types of centre and a number of individuals have been helped back to normal working life through attendance at one or other centre. For the more chronic patients long-term attendance is indicated and centre attendance can help patients to live fuller and happier lives and it also affords support and relief to their relatives. The third day centre, the Archway Citadel (opened at the end of 1968 and run in collaboration with the Salvation Army) is for 16 psycho-geriatric patients. The numbers built up quickly during 1969 and it is now a happy and flourishing centre. Many elderly people can, through regular attendance, be maintained in reasonable mental health thus preventing, or at least delaying, their re-admission to a psychiatric hospital. It is almost five years since the birth of the Islington Mental Health Service and in spite of a necessarily limited budget, each year has shown some expansion and readjustment according to current need. Much still awaits to be done, particularly in the field of residential services, and we look forward to further growth and development. STATISTICS The total number of persons referred to the mental health section by general practitioners, local education authorities, police etc. was as follows (1968 figures in brackets) Mentally ill Subnormal and severely subnormal Total Males 397 (399) 43 (62) 440 (441) Females 641 (688) 27 (48) 668 (736) Totals 1,038 (1,017) 70 (110) 1,108 (1,127) The total number in community care at the end of the year was 775 (817). 45 (34) mentally subnormal patients were provided with short term residential care during the year. Of these 22 (18) was at the Council's expense and 23 (16) 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 62 (47), 35 (19) mentally ill and 27 (28) mentally subnormal and severely subnormal. Training Centres Junior Senior Centres 1 Places 102 100 Attendances 13,054 (15,335) 12,920 (12,528) 79 Day Centres for the Mentally III Centres 2 (2) Places 60(50) Attendances 8,452 The Archway Citadel day centre, held in Salvation Army premises, has 16 places and the total attendances during the year was 799. 80 PERSONAL HEALTH PERSONAL HEALTH SERVICE CARE OF MOTHERS AND YOUNG CHILDREN MATERNAL AND CHILD HEALTH CENTRES These centres have continued to be a focal point for the citizens of Islington during the past year. All the usual functions such as child health, toddlers and ante and post-natal clinics have continued. Some new activities have been started, as illustrated in the item on health visiting. The geriatric visitors are now an integral part of the Public Health Nursing team and this has been beneficial to the public and to the staff concerned. The demand for creche facilities continues to increase and all sessions are well attended. There are now nine such sessions. During the year further decentralisation of nursing staff to centres has taken place. A start was made on basing home nurses in the centres, and so far this has been successful. Many educational sessions have been held in the centres for a variety of groups of all ages and it is hoped to increase these further in the future. There is no doubt that the attendance figures at Council child health clinics are affected by the increased number of such clinics held at general practitioners' surgeries at which health visitors are in attendance. Attendances 1968 Child Health 50,557 (54,549) Toddlers' 3,079 (4,373) Ante and Post Natal 4,864 (5,327) (excluding G.P.O. sessions) Total 58,500 (64,249) Occasional creche: sessions per week 9 (8) attendances 5,293 (4,102) DAY CARE OF CHILDREN DAY NURSERIES - COUNCIL There are five day nurseries providing 299 places for children under five years. A new nursery is being built to open early in 1970. Twenty-two students were in training during the year. Six students sat the N.N.E.B. examination and all were successful. One student, in her second year of training, was awarded an Enthoven Memorial Prize for writing a true account of one of her early experiences in such a way that it could be related as a story to a young child. The demand for nursery places remained high with consistently long waiting lists for all nurseries. Only children from the highest priority groups were admitted. One staff nursery nurse was allocated full-time to parents who had quadruplets early in the year. One of the Nursing Officers is frequently invited to schools to talk to leavers about nursery training or to take part in Careers Conventions. These visits to schools are of great value in recruiting nursery students. During the year, Dr. Stephen of the Department of Health and Social Security made a study of rickets and subclinical vitamin D deficiency in children between the ages of one and three. She investigated children of the appropriate ages in the Council's day nurseries. Parental consent was obtained in all cases. 83 Average daily attendance during the year 268 Average rate of occupation 90% Waiting list at the end of the year Priority 154 Others 318 Total 472 DAY NURSERIES - PRIVATE There are four full-time day nurseries in the Borough registered under the Nurseries and Child-Minders Regulation Act, providing places for 73 children. One is attached to a hostel and admits only the children of residents; one is run by the Islington Society for Mentally Handicapped Children; one has allocated 20 of its 30 places to the Council, and children are admitted from the Council's priority waiting list for day nurseries; the fourth nursery is run by the Spanish Sisters of Charity who give priority to children from the Spanish community. NURSERIES AND CHILD-MINDERS-NEW LEGISLATION In November 1968 Section 60 of the Health Services and Public Health Act, 1968, came into force; it drastically amends the Nurseries and Child-Minders Regulation Act, 1948, and strengthens the powers of the local health authority. Under the 1948 Act, registration was necessary only for those premises where children were received for the day or a substantial part thereof. Now premises used for this purpose for two hours or more a day must be registered. Also, persons did not need to be registered unless minding more than two children from more than one household for the day of a substantial part thereof. Now a person minding for reward one child under five years of age to whom she is not related, for two hours or more in a day must be registered. Thus, all part-time nurseries, including playgroups, and all persons minding for reward a child under five years of age, to whom they are not related must apply for registration. Requirements may now be imposed on child-minders in line with the requirements imposed on private nurseries under the 1948 Act; a person authorised by the Council has the right of entry, at reasonable hours, to the homes of registered child-minders; the maximum penalties have been increased; all applicants for registration must sign a declaration stating if, for any reason, she would be disqualified under Section 6 of the Children's Act, 1958, from taking foster children or if an Order had been made against her under Section 43 of the Adoption Act, 1958. The volume of work arising from the amendments to the 1948 Act greatly increased the work of the department and an Assistant Nursing Officer was appointed with specific responsibility for supervising childminders and playgroups. CHILD MINDERS Most applications for registration as child-minders were received from women referred by health visitors, but a number contacted the department as a result of the wide publicity given to the amended Act. All enquiries were investigated and during the year the department was in touch with some 800 women, many of whom received at least one visit. All applicants for registration as child-minders living in multi-occupied houses were visited by the Council's Fire Inspectors who advised on fire precautions and means of escape in case of fire. In a considerable number of cases registration was deferred until the premises were made safe. The number of children daily-minded above the first-floor of a house was severely restricted as a safety precaution, and applicants who had two children of their own under five years were not allowed registration in these circumstances. Many prospective daily minders withdrew their applications because they were unwilling to provide such things as fixed fire guards to heating appliances. 84 A number of cases of illegal child-minding were referred by members of the public. Many disquieting cases of "baby farming" were brought to light - in one case 13 children of various ages were found to be daily minded in one room - and in another case of illegal minding two children were said to be cared for, but the sound of children talking brought to light another four children hidden under the bed! Where unsatisfactory care or unsafe conditions were found, the illegal minder was asked to stop child minding (a follow up visit being paid to ensure that she complied) and in other cases the minder was encouraged to apply for registration. There is no room for complacency about the child-minding situation in the Borough. There may still be a hard core of illegal child-minding which will be difficult to eradicate, but with co-operation from members of the public and the continued vigilance of the health visitor it is hoped to improve the situation. PLAYGROUPS Established playgroups were visited during the year with a view to registration and several new playgroups were started. The Assistant Nursing Officers concerned were invited to address a group of the Islington Playgroup leaders in the summer. At the beginning of 1969 there were 15 playgroups in the borough providing part-time day care for approximately 300 children. All these playgroups were visited during the year. In addition a number of enquiries were received from voluntary bodies and private persons who wished to start playgroups. In February 1969, a meeting was arranged between the Chairman of the Personal Health Committee and organisers of playgroups at which requirements for registration and standards of accommodation and equipment were discussed. STATISTICS (as at 31.12.69.) Full-time nurseries registered 4 Children permitted 73 Part-time playgroups registered 12 Children permitted 260 Child-minders registered 62 Children permitted 180 HEALTH VISITING As can be seen from the statistics below, the number of visits by health visitors has decreased. This does not mean however, that the people of Islington have received less advice and education by health visitors. The figures reflect the actual reduction in the number of children in the Borough, due to the general fall in the birth rate and the increased knowledge of family planning services. The figures may also reflect the fact that within a modern community a variety of problems may be present at any one visit, which conrequently becomes more time-consuming. The health visitors are well accepted by all strata of society and have become adept at coping with differing languages and cultures. Visits 1969 1968 Children born between 1964 and 1969 18,048 (18,574) Persons over 65 265 389) Mentally disordered persons 106 140) Persons (excluding maternity cases) discharged from Hospitals (other than mental hospitals) 236 306) 85 T.B. Households 58 (21) Households-other infectious illnesses 800 (963) Total effective visits 47,775 (54,503) Total ineffective visits 12,989 (14,361) The health visitors are constantly on the alert to ensure new needs of families are met. The following two examples are illustrations of this:- LEGARD ROAD FAMILY CENTRE After thorough discussions between the Children's Department, National Children's Home and Public Health Department, it was decided to use vacant accommodation in the Legard Road premises of the National Children's Home as a joint project for a Family Centre. The venture commenced in September and provides a service for socially isolated mothers and their young children. Health visitors have referred mothers of young families who would benefit from mixing within a group, and who may not want to attend that kind of activity at a Maternal and Child Health centre. Health visitors are present at most of the sessions held and have given informal health education to the whole group irrespective of the original source of referral. DRAYTON PARK CENTRE An experimental group for mothers with physically handicapped children (some of them may also be "retarded") commenced in November. Having a physically handicapped child in a family causes special problems. The aim of the group is to get the mothers to discuss their specific difficulties fully. The group has deliberately been kept small so that mothers may talk without constraint. The development of this group has been slow, but the mothers who attend appear to benefit. QUADRUPLETS During the year quadruplets (two boys and two girls) were born in Islington; they were the first children of the parents and born prematurely. On the return of the mother and babies from hospital, the health visited regularly, at least once a fortnight. Home help service was arranged and a full time nursery nurse was seconded from one of the day nurseries. This nursery nurse helped the mother in the care of the children and in the great task of coping with four babies. The babies were followed-up medically at home and hospital and by the age of nine months their development was that of normal children. The nursery nurse reports "I found looking after the quads good experience and great fun; I also learnt some things from the babies, especially how four babies can all have such individual characteristics and need different kinds of care and affection". STUDENT TRAINING Eight health visitor students were sponsored for training by the Borough and all were successful in their examinations. Eight health visitor students from other boroughs were given practical training. FIRE CASES The follow-up by health visitors of fire cases continued. This involves a great deal of home visiting of the families concerned for advice and health education. Fires notified 85 Fatalities 12 (14.12%) Fires involving fatalities 9 Children involved 7 (in 5 fires) Injuries 37 (43.53%) Fires involving injuries 18 Fires involving oil heaters 28 (33%) 86 LIAISON WITH G.Ps AND HOSPITALS, ETC. Co-operation with other agencies particularly hospitals and general practitioners developed satisfactorily. The attachment and liaison arrangements of health visitors to general practitioners continued, and it was possible to attach one further health visitor full time to a group practice during the year. Health visitors took part in a number of surveys during the year. PUBLISHED PAPERS 1. Nursing Times. Vol.65. No.24. 29.5.69. "New Health Visitors and Students - their difficulties" - Miss L.K. May. 2. Health Visitor. Vol.42. July 69. "Difficulties of Health Visitor Students" - Miss L.K. May. DOMICILIARY MIDWIFERY The pattern of domiciliary midwifery in 1969 continued with the same trend as the previous year resulting in a decline in home confinements; planned and unplanned early discharges from hospitals remained the same. In addition to 254 home confinements, 67 other patients were booked for domiciliary confinement but subsequently transferred to the hospital service before delivery for the following reasons:- Complications of pregnancy 38. Premature labour 5. In labour at term 24 There were 7 calls for the services of the emergency obstetric unit. The planned early discharge scheme from hospital resulted in 468 assessments of home conditions being made; 96 homes were found to be unsuitable. 477 patients (including unplanned early discharges) were nursed at home following hospital delivery. MATERNAL DEATHS Confidential enquiries in accordance with 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 involved. STILLBIRTHS There was 1 domiciliary stillbirth during the year. Foetal heart was not heard at the ante-natal clinic on day of confinement; an appointment was made for the patient to see a consultant but she went into spontaneous labour in the evening and delivered at home. TRAINING The Council's eight domiciliary midwives continued to train pupil midwives from the City of London Maternity Hospital and St. Mary's Hospital, Paddington. During 1969, 30 pupils completed their district experience and a further 5 were in training at the end of the year. In November, the training facilities for pupil midwives were inspected by the Central Midwives Board and found to be satisfactory. GUTHRIE TESTING At the end of 1969, domiciliary midwives commenced screening tests for phenylketanuria by the Guthrie Blood Test method. All babies born at home, those discharged home before the sixth day and any discharged from hospital without having the test performed were visited by the Council's midwives. 87 HOME NURSING The number of patients requiring home nursing decreased in 1969 but there were more patients needing intensive nursing. The provision of a more frequent service to the very ill and the incontinent patients has always been a primary aim of the service. With this in mind, two part-time state registered nurses were employed during 1969 to work on Monday - Friday evenings. Both car drivers, they are able to cover the whole of the Borough. The very ill and incontinent patients can now be visited 3 or 4 times a day and patients can also be visited in the late evening to help them to bed if they have no relatives to do this. Two district nursing sisters were sent on a Practical Work Instructors course to the North Western Polytechnic for two weeks and have since been appointed senior nurses in charge of a group. Nine pupil nurses from St. Matthew's Hospital completed the Integrated Course of District Nurse training by December 1969; eight were successful and received the Queen's Institute Certificate. Ten student district nurses undertook the course of training at the North Western Polytechnic for the National Certificate; eight passed at the first attempt and two on resitting. Eight patients with terminal carcinoma received nursing help from the Marie Curie Memorial Foundation and seven received extra nourishment. There is a difficulty in finding nursing staff to do this type of nursing. During the year the Council took part in a pilot study of domiciliary care in terminal illness, carried out by the Institute of Community Studies (financed by the Department of Health and Social Security). District Nurses and other field workers were interviewed and completed questionnaires for the Institute. Once again Queen Mary's Needlework Guild sent us clothing for the needy, always very acceptable. 1968 Patients being nursed at (a) 1. 1.69. 649 (629) (b) 31.12.69. 709 (649) Total nursed 2,380 (2,423) Total visits 93,870 (92,974) Visits to persons over 65 74,310 (75,982) Proportion of visits to persons aged over 65 79.2% (81.7%) Nursing treatments completed 1,671 (1,774) Nursing treatments commenced 1,731 (1,784) 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: (P.88) Equipment 1968 Air and sorbo rings. 48 (72) Bed cradles. 53 (60) Bed and back rests 74 (85) Bed pans 37 (61) Commodes. 214 (265) Cots with sides 2 (6) Dunlopillo mattresses. 6 (9) Fracture boards 14 (11) Mackintosh sheets 0 (87) Special beds and hoists 15 (30) 88 Urinals. 0 (26) Walking aids 44 (51) Wheel chairs and other special chairs 80 (107) 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, which could be sealed and placed in dustbins for collection and disposal, were provided with incontinence pads and other disposable articles. PROPHYLAXIS VACCINATION AND IMMUNISATION All infants attending child health sessions are offered the basic course of immunisation unless they are already being given this protection by their own doctors. In addition, ad hoc vaccination and immunisation sessions (7½ weekly) continued to be held at most of the main maternal and child health centres. Primary courses completed 1968 Diphtheria 4,102 (4,407) Whooping Cough 3,738 (3,988) Tetanus 4,160 (4,473) Poliomyelitis 4,173 (4,614) Measles 1,739 (2,909) Booster Doses Diphtheria 5,961 (5,381) Whooping Cough 2,699 (2,619) Tetanus 5,691 (5,332) Poliomyelitis 5,727 (5,278) Smallpox Vaccination Primary Courses 2,759 (3,363) Re-vaccinations 191 (399) Despite constant follow-up efforts by all concerned, some children still reach school age not fully protected and for this reason it is still considered desirable to arrange immunisation sessions in schools. Nineteen sessions were held in primary schools, and we continue to be most grateful for the co-operation of school staff in making this possible. 469 children completed basic courses of immunisation and 1,484 received booster doses. It is estimated that as a result of these sessions the average percentage of children protected in these schools was raised by 9%. MEASLES VACCINATION The number of children protected against measles during 1969 fell considerably from 2,909 during 1968 to 1,739 in 1969. This was mainly due to the withdrawal during March of the measles vaccine being used, following adverse reactions to this strain. Alternative supplies of vaccine fell short of requirements. Fortunately, towards the end of 1969 the Department of Health notified local health authorities that increasing quantities of an alternative vaccine would be available for distribution. 89 RUBELLA VACCINATION The Medical Adviser to the Inner London Education Authority invited my co-operation in arranging sessions in June 1969 at two secondary schools in Islington for trials of rubella vaccine which was offered to girls between 11½ to 13½ years, with the consent of the parents and the co-operation of the Head Teachers of the schools concerned. A paper relating to these trials will be published in due course in the medical press. B.C.G. VACCINATION 21 secondary schools were visited in the Borough. 1,763 children were Mantoux tested, 1.568 of these were given B.C.G. vaccination; 88 children were found to have positive reactions and were referred to Chest Clinics. 61 children were x-rayed; one was found to need treatment and 15 were kept under supervision by the Chest Physician. T.B. INCIDENTS During 1969 notifications were received that 5 schoolchildren (3 girls and 2 boys) were suffering from pulmonary tuberculosis. A sixth notification was that of a member of staff teaching in Islington. 7 schools and one pre-school playgroup were involved. Following investigation of school contacts, 12 children required supervision by the Chest Physician. I referred in my last report to the resignation of the Chief Chiropodist whose last day or service was 20th October 1968. Extreme difficult was experienced in recruiting a replacement, and it was 1st July 1969 before the new Chief Chiropodist commenced duty. The shortage of senior chiropodists continued, but more sessional chiropodists were engaged. CLINICS There were 213 fewer failures to attend the clinics than in the previous year. Arrangements were made for schoolchildren requiring varruca pedis treatments to attend minor ailments clinics. 1968 Sessions 4,792 (4,855) Appointments booked 31,191 (33,971) Attendances Children 0 - 4 years 6 (7) 5-14 years 109 (128) Adults Male 4,990 (5,371) Female 22,691 (23,888) Physically Handicapped 31 - 27,827 (29,394) CHIROPODY 90 DOMICILIARY The Chief Chiropodist assessed all new applications for domiciliary chiropody treatment to ensure that the people concerned were unable to attend a clinic. In spite of this the service expanded, 985 more treatments being carried out than in 1968. 125 appointments were not kept compared with 280 in the previous year. Between 1st July and 31st December, 250 names were added to the list and 139 were taken off for various reasons, giving a total addition of 111 to be treated. Appointments booked 5,467 (4,742) Treatments given 5,342 (4,357) OLD PEOPLE'S HOMES Sessions 14 (25) Appointments booked 94 (198) Attendances 94 (198) TRANSPORT Appointments booked 330 (315) Attendances 288 (293) FAMILY PLANNING CLINICS The Council's family planning service continued to be provided at sessions administered directly by the Council and at those held by the Central London Branch of the Family Planning Association, grantaided by the Council for this purpose. Advice, examination and supplies were provided without charge to Islington women referred on medical grounds to both Council and Family Planning Association clinics. Islington women referred on social grounds were also seen at these clinics and advised free of charge but were ordinarily required to pay for supplies unless genuinely unable to do so.. This also applied to Islington residents who received family planning advice on social grounds from their general practitioner who may refer necessitous persons to a Council clinic to obtain supplies at a reduced charge or free of charge. The general practitioner is always consulted initially about persons seen at Council clinics when it is proposed to prescribe oral contraceptives. The Family Planning Association held a weekly "Advice for Young Persons" clinic, and unmarried persons under 18 years of age referred to this special clinic were seen and advised free of charge, the Council accepting financial responsibility. During 1969, the Council's clinics increased from six to seven per week and attendances at these clinics totalled 1,881 (838 in 1968). DOMICILIARY Towards the end of 1968, a pilot scheme commenced to provide domiciliary birth control service for the benefit of Islington women where family restriction is deemed advisable, but the mother is not willing or able to attend the clinic. This pilot scheme continued to be administered by the Family Planning Association during 1969, referrals being made by the Council's health visitors. By the end of 1969, a total of 30 referrals had been made to the Association for this service. 91 CERVICAL CYTOLOGY Cervical Cytology sessions for well women continued to run in conjunction with family planning sessions. By the end of the year five sessions were being held each week. Attendances were by appointment, and the total number of smears sent for examination was 931, a slight decrease compared with 1968. The results were as given below: — Normal 861 Other gynaecological disorders (excluding cancer) which required treatment. These women were referred either to their general practitioner or directly for gynaecological advice and treatment. 67 Doubtful cases referred for repeat examination 23 Positive NIL Under 25 199 35-44 219 25-34 351 45-54 115 Over 55 47 RECUPERATIVE HOLIDAYS As in previous years, a number of letters were received from residents in the Borough expressing gratitude for recuperative holidays arranged for them and saying how much their health had improved as a result. Only suitable persons recommended on medical grounds as being in need of rest, fresh air and good food to aid recovery from recent illness could be considered. Those requiring supervision, medical and nursing care were referred for treatment to the appropriate hospital board and elderly persons who had not recently been ill were referred to the Welfare Department. Recommendations on behalf of school children were mostly referred to the Inner London Education Authority which maintains two holiday homes. As shown below, although the number of recuperative holidays arranged for children decreased again this year, the number for adults increased, resulting in a rise in the total number. Holidays arranged 1968 Expectant and Nursing Mothers 2 (1) Tuberculous adults 10 (7) Other adults 124 (96) Psychiatric patients 8 (10) Accompanied children 22 (13) Unaccompanied children (placed by I.L.E.A.) 60 (80) Total 226 (207) RENAL DIALYSIS ADAPTATIONS There has been a recent increase in the use of artificial kidney machines in paients' homes for the treatment of renal failure. 92 Hospital authorities will provide and maintain intermitten haemodialysis equipment and provide the relative medical services. They will also pay for the extra cost of electricity and for the installation and rental of a telephone where necessary. Hospital authorities have not, however, power to make adaptations to the home. Adaptations required in the home preparatory to the installation of dialysis equipment can be carried out by Local Health Authorities under Section 28 of the National Health Service Act 1946, subject to the approval of the Minister of Health. Circular 2/68 from the Ministry of Health offers further guidance to local authorities on the measures to be taken in assisting patients for whom hospitals are able to provide home dialysis. Three patients referred from the Royal Free Hospital and one from the London Hospital have been assisted with adaptations to their homes prior to the installation of home dialysis equipment during the year. HOME HELP This service continues to operate from three area offices, each staffed by a home help organiser, an assistant organiser and a clerk. The year under review was particularly difficult with regard to recruitment of suitable home helps, despite a small increase in the hourly rate of pay from the end of September 1969. Demands for the service are constant and, owing to the shortage of staff, it is unfortunately often only possible to provide a minimum amount of help to some of the elderly folk. One organiser reported that in her area there had been a lot of movement of recipients of the service, with new flats opening and old property being cleared. New housing improves the situation for the home help, but many of the elderly do not appreciate moving and there are initial "teething" troubles in the flats which create problems. In this same area, the family referred to in my report for 1968 continued to receive regular service from the same home help who is now a valued friend of the family. This is a family of father and five children deserted by their mother. The home was dirty, the children had few clothes and the father was left with many debts. With the assistance of the home help all the debts have been cleared, the flat is now clean and well furnished and the family really happy, clean and well dressed. In addition to this family, the home help also copes each day with three old people, one completely bedridden and she has displayed a devotion to service beyond that which could be reasonably demanded. All the organises pay tributes to the loyalty and hard work of the majority of their home helps who, despite many emergencies arising from outbreaks of illness, including the influenza epidemic, have given unstinted service, including, in many instances, additional help, to elderly folk and to children in their own time. STATISTICS 65 or over on Under 65 on first visit in 1969 first visit in 1969. Chronic sick & Tuberculous. Mentally Disordered. Maternity Other Total Cases 1969. 1968. 2,252 130 5 34 196 2,617 (2,254) (140) (7) (39) (205) (2,645! Home Helps employed at end of 1969 (whole-time equivalent) : 135.5 (153) 93 GRANTS TO VOLUNTARY ORGANISATIONS. During 1969 the Council used its powers, under the Health Services and Public Health Act 1968, to authorise the payment of the following grants to organisations providing or furthering the development of of personal health services. SERVICE VOLUNTARY ORGANISATION. Grant 1969/70 £ s Maternal and Crusade of Rescue. 85 Child Health. London Diocesan Council for Moral Welfare. 2,300 North Islington Infant Welfare Centre. 20,860* Day Nursery and West London Mission (Hopedene Nursery). 3,500* Playgroups. Caxton House Settlement — (Martin Luther King Playgroup). 250* Islington Pre-School Playgroup Association 300 Race Relations Committee of the Religious Society of Friends. (Lonsdale Square Playgroup). 1,000* (Lough Road Playgroup). 350* Save the Children Fund. (St. Lukes, Holloway Estate and Golden Lane Playgroups). 1,890* St. Andrew's Mission. (Goodinge Rd., Playgroup) 100* Stroud Green (Holly Park Church Hall Playgroup). 175* Upper Holloway Baptist Church Playgroup. 50 Prevention of Illness Chest & Heart Association. 10 10 Care and After-Care. Islington Chest & Tuberculosis Care Committee. 250 (Tuberculosis). (General). Catholic Marriage Advisory Council. 375 Family Welfare Association. 5,790 Family Planning Association (Central London Branch). 2,000* Health Education Council 374 19 London Borough of Islington. (Health Amenities Fund). 100 London Marriage Guidance Council. 670 National Association of Voluntary Hostels. 150 Mental Health Salvation Army (Archway Citadel Day Centre). 1,220* (Day Centres) (General). Elfrida Rathbone Committee (Islington and Camden). — General. 5,000 — Playgroups. 500* Islington Society for Mentally Handicapped Children. 5,000* National Association for Mental Health. 100 "Estimated grant, subject to adjustment. 94 OTHER ITEMS OBSERVATION AND HANDICAP REGISTER A Central Index of known handicapped children 0—21 years continued to be maintained centrally under the general supervision of a principal medical officer. The register was transferred, during the year, to the Kalamazoo Factfinder system which facilitates the extraction of information relating to, among other things, particular handicaps, age groups, types of school, and ethnic groups. The development and welfare of those on the register is kept under constant review. An observation register is maintained at welfare centres of those children who for various reasons may be at risk of developing a handicap. At the age of two years children are usually removed from the register if development is normal. School children on the handicap register are reviewed annually or more frequently if necessary. School Care Committees and the Invalid Children's Aid Association continue to provide useful links with this department on social problems. Social workers are attached to Frank Barnes (deaf), Hargrave Park (partially hearing unit) and Cloudesley (physically handicapped) schools. Case workers from the Elfrida Rathbone Committee visit the families of children attending the three schools for educationally sub-normal children. A social worker employed by the Inner London Education Authority, based on this department, is attached to the unit for autistic children at Horizon School. 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 sub-committee meeting 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 followed-up 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 1969 the number of children on the central handicap register and the observation register at welfare Centres was:— 1968 Handicap Register — 0—21 years 2084 (1832) Observation Register 0— 5 years 2050 (2139) BATTERED BABIES During December medical, nursing and social work staff of the department, together with the Children's Officer and representatives of the National Society for the Prevention of Cruelty to Children, attended a meeting convened by the consultant paediatricians at the Wittington Hospital. An agreed procedure was laid down for the co-ordination of the activities of the various departments and agencies concerned in the care and management of babies reported to have been battered or thought to be at risk of being battered. 95 PREVENTION OF BREAK-UP OF FAMILIES. There were six meetings of the Co-ordinating Committee during the year. Case Conferences were held on 26 occasions and a total of 195 families considered. STUDENT VISITS A total of 471 students visited various branches of the department during the year. The students came from a variety of disciplines and it was felt that by providing a knowledge of the function of the Public Health Department we were laying a foundation for co-operation with workers in other fields in the future. As in former years, we were pleased to welcome girls from local schools into the Council's day nurseries where they gave voluntary help. VENEREAL DISEASE Social Workers employed by the Council are attached to the special clinics at Holloway Prison and the Royal Northern Hospital. Their time is fully occupied in tracing contacts and endeavouring to ensure that any necessary treatment is obtained. They also follow-up patients who fail to complete treatment. EMERGENCY TELEPHONE ARRANGEMENTS The Council continued to use the Admissions and Doctors' Inquiry Service situated in the Whittington Hospital. The service deals with calls for health services after office hours, at week-ends and during bank holidays. This service is shared with the London Boroughs of Camden and Haringey. Details of the calls dealt with are given below. 1968 Domiciliary Midwifery - 318 (414) Mental Health - 596 (468) Home Nursing - 263 (249) Infectious diseases - 2 (4) Other - 42 (44) Total - 1221 (1239) EMERGENCY TRANSPORT Midwives and mental health social workers were able to make use of special car hire facilities. CO-OPERATION WITH THE CHILDREN'S AND WELFARE DEPARTMENTS Residential establishments under the control of the Children's Committee are visited regularly by a senior medical officer. The premises and the children's medical records are inspected and informal advice is given to the house-parents on hygiene and other related matters. Children who are handicapped or are at risk of developing a handicap are followed-up and, where appropriate, a report from a hospital consultant is obtained. The senior medical officer's reports on the homes are passed to the Children's Officer for his consideration. 96 61 visits were made during 1969. The Welfare Departments' old peoples' homes are visited quarterly by a senior medical officer accompanied by a senior public health inspector. 9 visits were paid in 1969. The Children's Officer seeks the assistance of this department in his preliminary enquiries about Islington residents who have applied to adopt or foster a child. The Health visitor for the district is asked if she knows the family and if so to submit a report. 97 SCHOOL HEALTH 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 Director of Public Health and Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area and is responsible to the Authority for the day to day running of the service. The co-operation, during the year, of the Medical Adviser's department of the I.L.E.A., the local Divisional Education Officer and his staff and Head Teachers of the schools in the Borough has been much appreciated. HEALTH OF THE SCHOOL CHILDREN During the year 40.8% (39.5%) of children on the school roll were examined as a routine and only 0.2% (0.1%) of the children examined were thought to be in unsatisfactory physical condition. MEDICAL INSPECTIONS The following classes of pupils were called up during the year for medical inspections to which parents were invited:- (a) "Entrants" to infants' schools (as soon, as possible after admission) (except at 2 schools in the Borough where Pre-entry medical examinations are held.) (b) "7 plus" - pupils seen after their transfer to a junior school except at 10 schools in the Borough where only selected pupils were seen. (c) "11 plus" - pupils seen after their transfer to a secondary school. Boys were tested for colour vision at this inspection. (d) "14 plus" - these pupils were seen as early as possible in the term before the one by the end of which they would reach statutory school leaving age. This was the "leaver" examination for those pupils who intended to leave school at 15 years of age, at which the medical report to the Careers Service was completed. (e) Older "leavers" - pupils who were still in attendance after attaining 15 years of age were inspected again as early as possible in the term prior to that in which they would be leaving school, when their medical report to the Careers Service was completed. (f) Any pupils who were due for examination in 1968, but who were not seen. NURSERY SCHOOLS AND NURSERY CLASSES All pupils were medically inspected on admission and annually thereafter. Each pupil was examined by the school nurse each term in which a medical inspection was not carried out. School nurses visited weekly; but made more frequent visits in emergencies. SPECIAL SCHOOLS In addition to the routine medical examinations all pupils at special schools were seen by the school doctor, specialist or consultant (as was appropriate) at least once a year in respect of their "special defect". PRE-ENTRY MEDICAL EXAMINATIONS As previously stated, medical examinations of infant school children normally took place as soon as possible after their admission to school. However, at two schools in the Borough medical examinations were arranged, as an experiment, to take place before actual admission to school. Of course,the pre-school medical examination could not be regarded as a condition of entry to the schools concerned and some children were admitted to school before their medical examination could be arranged. 101 These arrangements resulted in a higher than average percentage of mothers attending with their children, better histories and other necessary details being obtained. It was also possible to do more to ensure completion of immunisation and dental treatment before the child started school. It was, therefore, agreed that these two schools could continue to hold pre-sntry medical examinations until further notice. ROUTINE MEDICAL INSPECTIONS - DEFECTS Number of children noted for treatment or observation expressed as a rate per 1,000 inspected. Treatment Observation SKIN 6.30 (5.15) 13.38 (9.65) EYES (a) Vision 55.40 (56.22) 75.37 (66.96) (b) Squint 4.72 (4.50) 8.59 (6.02) (c) Other 1.57 (0.80) 2.51 (2.10) EARS (a) Hearing 4.37 (4.64) 9.45 (6.53) (b) Otitis Media 1.57 (1.23) 6.37 (8.13) (c) Other 0.64 (0.44) 1.15 (1.60) NOSE AND THROAT 4.08 (2.83) 29.63 (30.11) SPEECH 3.01 (2.76) 7.01 (6.67) LYMPHATIC GLANDS 0.36 (0.15) 13.31 (13.93) HEART 1.36 (0.94) 9.59 (8.13) LUNGS 3.22 (1.52) 16.61 (12.34) DEVELOPMENT (a) Hernia 0.79 (0.44) 4.80 (3.92) (b) Other 1.29 (0.65) 7.44 (4.35) ORTHOPAEDIC (a) Posture 0.79 (0.51) 9.59 (11.46) (b) Feet 1.72 (1.89) 16.32 (11.24) (c) Other 1.50 (1.52) 9.66 (6.24) NERVOUS SYSTEM (a) Epilepsy 0.64 (0.44) 1.86 (1.74) (b) Others 0.07 (0.15) 2.08 (2.03) PSYCHOLOGICAL (a) Development 0.93 (1 01) 7.16 (5.22) (b) Stability 0.93 (1.16) 11.95 (9.65) ABDOMEN 0.64 ( - ) 2.51 (1.01) OTHER 13.46 (15.16) 53.46 (41.50) SPECIAL MEDICAL EXAMINATIONS Head teachers also brought before the school doctor any pupil about whose well-being (physical or mental) the parents, school nurse, care committee or teaching staff were in doubt and pupils whose performance raised doubts concerning their physical or mental fitness for whom special education treatment might 102 be necessary. Requests that children be examined at times other than the normal routine examinations were also received from the Education Officer, etc. 3,101 (3,207) of the examinations were carried out in 1969, either at school (where the pupils' parents were invited to attend) or in the pupils' own homes. RE-INSPECTIONS Pupils who at previous inspections were referred for treatment or observation were brought forward for re-inspection as required by the school doctor. 6,287 (6,231) children were called-up for re-inspections in 1969. ACTION TAKEN ON SPECIAL RECOMMENDATIONS BY SCHOOL DOCTORS Head Teachers or other responsible teachers were asked to carry out special recommendations sometimes made by the doctor (e.g. position in class because of hearing and vision limitations, restrictions of physical training activities) and were asked to ensure that children with defective vision wore the spectacles prescribed for them and children with hearing aids used them. EMPLOYMENT OF SCHOOL CHILDREN Many school children aged 13 years and over were employed part-time delivering milk, newspapers, in shops, etc. Within 14 days of the date their employment commenced and every 12 months thereafter arrangements were made for them to be medically examined. This was to ensure that such employment was not prejudicial to their health and physical development and would not render them unfit to obtain proper benefit from their education. During 1969 181 (231) of these examinations were carried out and the necessary certificates issued. SCHOOL JOURNEY MEDICAL EXAMINATIONS School nurses checked the medical records of all children known to be going away on school journeys and arranged for any treatments to be given to make them fit to go, referring where necessary to the school doctor. The fitness of the children was considered in relation to the type of journey. For instance, children with plantar warts might not be able to walk far, delicate children might not be fit for strenuous expeditions, etc. and other children might present special problems. Any information regarding a child's physical condition mentioned on the parental consent form and about medicine or tablets being taken, was brought to the notice of the school doctor. Inspections by a school doctor to determine whether the child had been in contact with infectious disease and whether he was fit to go were arranged for 2,110 (1,652) children within 96 hours of departure. At this inspaction one of the accompanying teachers was at the school so that the medical officer could discuss any restrictions which should be placed on the activities of any of the children. This has been found by experience to reduce the risk not only to individual children, but to the party as a whole. 852 (1,477) pupils gDing to Inner London Education Authority camps where a school nurse was in attendance were seen by the school nurse only. 103 NON-ROUTINE MEDICAL INSPECTIONS TYPE OF INSPECTION No. SEEN RE-INSPECTIONS 6,287 (6,231) Bathing centre inspections - scabies 1 ( - ) Bathing centre inspections - others 11 ( 3) Employment certificates 181 ( 231) Theatre children 45 { 23) School journeys 1,660(1,652) Recuperative holidays - pre-departure 103( 106) Outward Bound Courses 14 ( - ) Infectious disease investigation 1 ( - ) Boarding schools for the delicate - pre-departure 45 ( 26) Boarding schools for the delicate - on return - ( 2) Handicapped pupils - statutory examinations 228 ( 237) Handicapped pupils - periodic special defect examination 124 ( 157) Research investigations and enquiries - ( 2) SUB-TOTAL 2,413 (2,439) SPECIALS - at request of:- Head Teacher - child's name entered in special book 126 ( 138) Head Teacher - others 228 ( 228) School nurse - following health survey 22 ( 49) School nurse - others 19 ( 35) Divisional Education Officer 66 ( 45) District Care Organiser or Care Committee 11 ( 25) Parent 48 ( 49) School Medical Officer 151 ( 149) SUB-TOTAL 671 ( 718) OTHERS Accident on school premises 2 ( 5) Connected with remedial exercises, foot classes or by gymnast or physiotherapist - ( 1) Referred by general practitioner - ( 2) Miscellaneous 15 ( 42) SUB-TOTAL 17 ( 50) TOTAL OF ALL NON-ROUTINE MEDICAL INSPECTIONS 9,388 (9,438) 104 RECOMMENDATIONS FOR SPECIAL SCHOOLING Recommendations were made for some children to be admitted to special schools, which after special medical examinations, the examining medical officers felt would be more suitable for them than ordinary schools. These recommendations were vetted by the Deputy Principal School Medical Officer before being passed to the Education Officers Department. Hospital reports etc, were also often taken into account. No. of recommendations sent in 1969. For day schools for the delicate 1(10) For day schools for physically handicapped children 12 (10) For boarding open air schools 11 (3) After physical medical examinations, vision and hearing tests other children were examined under Section 34 of the Education Act 1944 by specially trained medical officers and recommendations were approved by a Principal Medical Officer who specialised in this work. Arrangements were made for interpreters to attend at 44 of these examinations. No. of recommendations made in 1969. For day schools for educationally subnormal children 89 (103) For boarding schools for educationally subnormal children 1 (3) To continue at ordinary school possibly with extra help in reading, Arithmetic etc. 66 (79) Seven (3) children were recommended for home tuition. SCHOOL NURSES' INSPECTIONS During 1969 24,618 (21,195) comprehensive health surveys were held at which most pupils were examined annually by the school nurse for cleanliness of the head and other aspects, e.g. squint, ear discharge and nutritional state. Where necessary children were referred for further investigation or treatment. 0.88 (1.24%) were found verminous. 10,230 (6,292) selective health surveys were carried out when necessary and 1.92 (1.53%) were found verminous. Vision testing was carried out as part of each periodic medical inspection except for "entrants" to infant schools who were tested as soon as possible after admission. All infants were given an audiometer test as soon as possible after entry to school. REMEDIAL FOOT CLASSES Two organisers of remedial classes were employed part-time by the Inner London Education Authority to assist with the arranging and running of simple exercise classes by teachers who had attended a course organised by the Education Officer at the College of Physical Education. Unfortunately some of the teachers trained to take remedial foot classes were no longer available and the number of schools in which these were held was reduced to 9 (11). The co-operation of the head teachers Who made the necessary arrangements to enable the classes to be held in these schools and of the teachers who volunteered for and carried out this work was much appreciated. All classes were visited by a Medical Officer at the beginning and end of each term. AUDIOLOGY As soon as possible after entry to school, all infants were given a routine sweep test, 7,025 (7,647) being carried out by school nurses in 1969. Where these tests showed any doubt as to the children's hearing 105 being normal, a pure tone test was also given by a specially-trained school nurse. 83 (166) of these tests were carried out during the year and 83 (163) children were found to have defective hearing and were referred for further investigation. At the end of the year 75 children were in attendance at audiology clinics. 6 (8) were provided with hearing aids during the year making a total of 133 (114) children still attending Islington schools who had been provided with them. All of these children do not, of course, live in Islington. Many of them come from other Boroughs to attend Frank Barnes School for the Deaf. SPECIAL INVESTIGATION CLINiCS Children suffering from obesity, enuresis and early emotional problems could be referred by the school doctor to special investigation clinics, where advice was given and emotional problems and management could be discussed with parents. At the end of the year 404 (404) children were attending these investigation clinics at 6 centres in the borough. Total attendances were 1,785 (1,736) and 65 (71) children were discharged cured. B.C.G. VACCINATION Twenty-one (21) secondary schools in the Borough were visited and 1,763 (1,752) children were Mantoux tested. 1,568 (1,521) of these children were given B.C.G. vaccination. 88 (100) children were found to have positive reactions and were referred to Chest Clinics. 61 (89) children were X-rayed and of these 1 (5) was found to need treatment and 15 (38) were kept under supervision by the Chest Physician. TUBERCULOSIS INCIDENTS During 1969 notifications were received that 5 (5) schoolchildren in Islington 3 (2) girls and 2 (3) boys were suffering from pulmonary tuberculosis. A sixth (6th) notification was that of a member of school staff teaching in Islington. 7 (6) different schools and one (-) pre-school playgroup were involved. Following investigation of school contacts, 12 (24) children required supervision by the Chest Physician. PROPHYLAXIS SESSIONS IN SCHOOLS 19 sessions were held in primary schools at which a total of 469 children received complete courses of diphtheria, tetanus and poliomyelitis and 1,484 received 'booster' doses. It is estimated that the average percentage of children protected in schools was raised by 9%. MEDICAL TREATMENT At minor ailments clinics, nurses treated schoolchildren for verrucae, athlete's foot, eye, ear and skin diseases as well as bruises, lacerations etc. Appointments were made for schoolchildren needing dental treatment to attend one of the four dental clinics in the Borough unless their parents expressed a wish to arrange for them to be seen by their private dentist. Schoolchildren with defective eyesight could be referred to one of the four vision clinics in the Borough where ophthalmologists employed by the Regional Hospital Board tested their eyes and opticians were available to arrange for spectacles to be provided if necessary. Parents were, however, free to take the prescription to any other optician if they wished. 106 Details of sessions and attendances at schoolchildren's clinics during 1969 were as follows:- Type of clinic. No. of sessions. New Cases. Attendances. Minor Ailments (Nurses.) 322 (326) 975 (952) 5,247 (5,872) Special Investigation. 259 (252) 232 (292) 1,785 (1,736) Dental. 2,114 (1,981) 4,286 (8,961) 13,618 (15,360) Vision. 251 (255) 739 (837) 4,803 (4,450) Audiology. 35 (38) 86 (134) 254 (511) BATHING CENTRES No. of attendance for treatment of scabies. 339 (299) No. of attendance for treatment of vermin and nits. 247 (187) HYGiENE AND SANITARY ARRANGEMENTS IN SCHOOLS Where the school medical officer at his annual inspection discovered that the hygiene and sanitary arrangements at a school did not meet the regulations laid down by the Department of Education and Science, defects were notified to the Education Officer in order that they might be rectified wherever possible. Arrangements were also made for medical rooms to be adequately equipped, i.e. fires properly guarded, examination couches provided, etc. NATIONAL CHILD DEVELOPMENT STUDY Assistance was given in the second follow-up of children born between 3rd and 9th March 1958, originally studied at birth by the National Birthday Trust Fund and then followed up in 1965 by the National Child Development Study with the collaboration of the Society of Medical Officers of Health. This follow-up was aimed at the particular problems of the 11 year old with emphasis on the major and minor variations in health and educational ability and disturbances of the special senses and co-ordination. Subject to the agreement of the parents of the 52 children involved in this Borough, schools were asked to give details of the children's progress and whether they had any particular strong or weak points. Three standard tests of reading, mathematics and general ability were given and the children were asked to complete a short questionnaire about their interests and hobbies. Health visitors interviewed the parents of each child and completed a form about the child's development and health. Pure tone audiometry was carried out and school medical officers carried out a thorough medical examination of each child and completed the necessary report forms which were returned to the National Child Development Study. STUDY OF PHYSICALLY HANDICAPPED CHILDREN IN ORDINARY SCHOOLS Miss Anderson, Research Officer of the University of London Institute of Education, was given assistance in chosing nine handicapped children who attended ordinary schools in this Borough for her study of physically handicapped children in ordinary schools. She intended to contact the parents of the children to obtain their agreement to their children being included and to meet the head teachers of the schools concerned. It was hoped that the study might be of practical use in adding to the knowledge of which handicapped children were most likely to do well in an ordinary junior school. Also that it might make it possible to give advice on the placement of physically handicapped children of junior age and on the management of the children who are placed in ordinary schools HEALTH EDUCATION The Health Education Officer continued the expansion of the service to schools in the Borough. Many schools received talks and lectures on such vital subjects as human relationships, venereal disease, drugs, menstruation, and home safety. 107 A series of lunchtime health education talks was given by the Health Education Officer to the sixth form of Dame Alice Owens' Boy's School. Initially presented as an experiment, it is hoped that these will now be maintained. More teachers are making use of the services' facilities when preparing their own health education programmes, by seeking advice and the loan of audio-visual aids, sound films, slides, flannelgraphs, etc. A dental health puppet show, devised and produced by the Health Education Officer in conjunction with the I nner London Education Authority Dental Health Education, was presented at 34 primary and inifant schools in Islington to about 8,000 children. Enthusiastically received by the children this proved to be a positive way of presenting dental health education to the very young. Parent/Teacher Associations also sought the services of the Health Education Officer, who explained at meetings what is being done in the health education field in schools, acquainted the parents with the subjects which are discussed, and the audio-visual aids which are used. This allays any fears inthe minds of some parents and enables them to have a better comprehension of some of the more intimate subjects which are raised during health education sessions. It also allows a two-way flow of communication which may have been hindered in the past by embarrassment and the inability of parents to communicate with their children. Requests were received from several Schools for talks by Nursing Officers, Health Visitors and School Nurses to children of Secondary School age. The topics covered were parent-craft, citizenship, human relations, puberty etc. Arrangements were made for small groups of school girls to visit Child Health Centres and Day Nurseries. REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER AND CHIEF DENTAL OFFICER In this report on the dental service, which is run on behalf of the Inner London Education Authority and in concert with the Borough, it is important to stress that what we aim for is to provide as full a service as staff conditions will permit. Therefore we strive for continuety and it is gratifying that, in spite of the difficulties in maintaining staff, we do succeed in this. However, unless something is done about improving the salaries paid to the dental surgery assistants, it will prove very difficult to fill any vacancies which might occur. During this year much effort has gone into planning for fresh surgeries and, with River Place Health Centre scheduled for early 1971, we do have a prospect of expanding and improving the service. In this connection a word of tribute must be paid to those working at Popham Road, one of the centres to be replaced by the new health centre, who have carried on despite broken windows and a bombardment of bricks and stones, which have resulted from the surrounding demolitions. "We never closed" would be a fitting epitaph for this old clinic. During the spring of this year a part-time orthodontist was engaged and there has been a slow but steady growth of this new service. If the progress achieved during 1969 is any indication, it can reasonably be assumed that another year could see the orthodontic service operating on a full-time basis. Dental health education has proceeded most satisfactorily and is in effect a growing service. We had a puppet show, originally sponsored by I.L.E.A., on two sets of occasions-in February and in May-and it made a very direct impact. This aspect of the service is covered in detail in that section of the Medical Officer of Health's report which deals with Health Education. 108 Statistics Totals Fillings in permanent teeth 5,867 " "temporary" 3,386 Permanent teeth filled 5,409 Temporary " " 3,040 Permanent teeth extracted 228 Temporary " " 1,701 Number of root treatments 31 " " teeth dressed 1,487 Orthodontic permanent teeth extractions 5 " temporary " " 7 In spite of difficulties experienced from nursing shortages and changes of staff due to resignations, the numbers of fillings in both permanent and temporary teeth showed a considerable increase over the previous year. MATERNAL ANDCHILD HEALTH This service proceeded with again a similar pattern to the preceeding year. Lectures at Barnsbury were initiated and were a great success - but with the resignation of the dental officer concerned and subsequent changes of staff, this programme suffered a temporary setback; it is hoped soon to reinstitute the lectures as they do stimulate interest in dental care. 109 SERVICES FOR THE ELDERLY SERVICES FOR THE ELDERLY VISITS BY MEDICAL OFFICERS Seventeen 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 compulsory removal to hospital might be necessary under Section 47 of the National Assistance Act, 1948. One case was dealt with under Section 47, and four persons subsequently agreed to be admitted to hospital or a welfare home to receive care and attention. HOME VISITING Consequent upon the transfer of the Council's treatment centre at Seven Sister's Road to Finsbury Health Centre, the areas for the visiting of elderly people were adjusted slightly and the home visitor from the health centre was transferred to Clephane Road welfare centre to undertake visiting on a full-time basis. The Council's policy of appointing only State Registered Nurses to vacant positions of Home Visitor was followed, and at the end of the year, out of a total of 8 full-time staff five were State Registered Nurses. All visitors continued to work from welfare centres. 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 department prior to the introduction of home help and other services. Eighteen such cases, reported by the public health inspectors, home visitors, hospital authorities, etc. were dealt with during the year. MEALS During most of 1969, the meals services continued in accordance with the re-organisation undertaken in September, 1968, i.e. nine vans were operating Meals on Wheels, and four vans Invalid Meals. In December 1969, it was agreed that the spare van should be taken into use to provide a tenth van for Meals on Wheels. Comparison of the total meals served for the last three years:- Meals on Wheels Invalid Meals Delivery Restaurant 1967 96,379 50,490 4,405 1968 103,463 47,739 4,195 1969 118,233 46,224 5,147 The weekend meals on wheels service, inaugurated in April, 1968, continued to operate on Saturdays, Sundays and Bank Holidays throughout the year. The service for cases in urgent need recommended by the Council's home visitors, is limited to a maximum of 200 meals a day. The meals are supplied from the kitchen at Hillside Home for the Retired. A total of 19,120 weekend and bank holiday meals were provided during the year. GERIATRIC PREVENTIVE CLINICS The Clinics (known for publicity purposes as "Health Advisory Circles 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 the second and fourth Tuesdays of each month only. 113 Dr. D.E. Sharland, Consultant Geriatrician at Whittington Hospital, who kindly volunteered his services for this work at the inauguration of the clinics, 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 clinics at Drayton Park and Blythe Mansions 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 63 applications was received during the year, 17 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 invited to submit details of any relevant medical history which may be of interest to the examining medical officer. At the examination the patient is interviewed and medical and social history forms are completed. A medical examination is then carried out and tests for audiometry, chest x-ray, and haemoglobin, are arranged, 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, until October, and then from the Finsbury Health Centre. During the year 4,380 collections of laundry were made (involving 43,766 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 19 at the commencement of the year, to 15 at the end of the year, 392 parcels of laundry were collected during the twelve months under review. BATHING FACILITIES The services provided from the treatment centre, Seven Sisters Road, and from the Finsbury Health Centre continued throughout the year. 5,675 baths were carried out in the homes of elderly persons under the Domiciliary Service. 1,778 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 continued during 1969 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 I am also speaking for the elderly people of the Borough when I say that it is very much appreciated. ISLINGTON CREMATORIUM The Medical Referees during the year certified 784 applications for cremation at the Council's Crematorium, East Finchley. 114 STAFF AND PREMISES STAFF AND PREMISES STAFF (Establishment of Officers (as at 31. 12. 1969) Director of Public Health and Medical Officer of Health 1 Deputy Medical Officer of Health 1 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 Assistant Health Education Officer 1 Senior Administrative Officers 8 Administrative Officers 4 Administrative Assistant and Night Security Officer 1 Administrative Assistants 13 Secretary 1 Senior Clerks 31 Clerks 37 Telephonists (one supervisor) 2 Attendant Telephonists 2 Senior Typist 1 Shorthand Typists 4 Clerk/Shorthand Typist 1 Clerk typists 2 Supervisor (Invalid Meals Service) 1 Office Attendants 2 117 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 10 Rodent Officer 1 Rodent Investigator Superintendent of Laundry & Disinfecting Services 1 71 117 NURSING AND MIDWIFERY Principal Nursing Officer 1 Deputy Principal Nursing Officer 1 Assistant Nursing Officers 2 Centre Superintendents 9 Health Visitors 38 Student Health Visitors 9 *Tuberculosis Visitors 2 Clinic Nurses (full-time equivalent 15.3) 16 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 6 Nursery Assistants 19 Nursery Students 22 Creche Assistant 1 79 GERIATRIC SERVICES Home Visitors 9 Assistant Home Visitor 1 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 HOME HELP Home Help Organisers 3 Assistant Home Help Organisers 3 6 118 MENTAL HEALTH Principal Mental Health Social Worker 1 Deputy Principal Mental Health Social Worker 1 Senior Mental Health Social Workers 2 Mental Health Social Workers 15 Senior Occupational Therapist 1 Supervisor (Junior Training Centre) 1 Deputy Supervisor (Junior Training Centre) 1 Supervisor (Training Centre) 1 Assistant Supervisor/Teachers (Training Centre) 7 Assistant Supervisors (Training Centre) 4 Supervisors (Day Centre) 2 Assistant Supervisors (Day Centre) 4 Trainees — Mental Health Social Workers 2 Trainee—Assistant Supervisor 1 Supervisor (Special Care Unit) 1 Assistant Supervisor (Special Care Unit) 1 Manager/Supervisor (Industrial Centre) 1 Senior Assistant Supervisor (Industrial Centre) 1 Assistant Supervisors (Industrial Centre) 2 49 CHIROPODY Chief Chiropodist/Administrative Officer 1 Senior Chiropodists 6 Chiropodists (Sessional) (Full-time equivalent — 5.1) 18 25 TUBERCULOSIS Welfare Officer (Chest Clinic) 1 Senior Occupational Therapists 2 Warden (T.B. Hostel) 1 Assistant Warden (T.B. Hostel) 1 5 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) 8 Dental Surgery Assistants 7 16 TOTAL NUMBER OF OFFICERS 569 (in addition lists are maintained of doctors, who are prepared to work on a sessional basis.) 119 PREMISES Establishment Address Administrative Offices Central Office 159/167 Upper Street, N.1. Home Help Service — Central Area Drayton Park Centre, 32 Drayton Park, N.5. North Area North Islington Centre, 6 Manor Gardens, N.7. South Area Barnsbury Centre, Carnegie Street, N.1. Meat Inspector's Office 28 Cowcross Street, E.C.1. Mental Health Service Finsbury Health Centre, Pine Street, E.C.1. Rodent Control Service do. Day Nurseries Canonbury Place 8 Canonbury Place, N.1. Lloyd Square 14 Lloyd Square, W.C.1. Mitford Road 1 Mitford Road, N.19. Scholefield Road Scholefield Road, N.19 Springdale 15A Springdale Road, N.16. Disinfection and Cleansing Station Finsbury Health Centre, Pine Street, E.C.1. 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) 30, Junction Road, N.19 Finsbury Health Centre, Pine Street, E.C.1. Richmond Avenue 42/44 Richmond Avenue, N.1. Mental Health Adult Training Centres Camden Road (Female) Camden Road Congregational Church Hall, 577 Caledonian Road, N.7. Bennett Court (Mixed) Bennett Court Community Centre, 25A Axminster Road, N.7. Mental Health Junior Training School Rosemary (Mixed) 75 Prebend Street, N.1. (includes special unit for children with dual defects.) 120 PREMISES Mental Health Industrial Unit Isledon Road 76/80 Isledon Road, N.7. School Treatment Centres Islington 37 Thornhill Road, N.1. Manor Gardens 6 Manor Gardens, N.7. Popham Road 26 Popham Road, N.1. Health Centre Finsbury Pine Street, E.C.1. Chiropody; Dental and Physiotherapy Clinics; Mental Health Day Centre; Disinfection and Cleansing Station Centres Archway Congregational Church Hall, Child Health Junction Road, N.19 Barnsbury Carnegie Street, N.1. Maternity & Child Health; Chiropody; School Health; (Special Investigation); Family Planning; Cervical Cytology Blythe Mansions Highcroft Road, N.19 Maternity and Child Health; Chiropody; Elderly Persons'Clinic. Family Planning; Cervical Cytology Clephane Road 6 Clephane Road, N.1. Maternity and Child Health; Chiropody; Family Planning; Cervical Cytology Clephane Road (Branch) The Baptist Church Hall, Child Health Cross Street, N.1. (Entrance in Fowler Road) Drayton Park 32 Drayton Park, N.5. Maternity and Child Health; Chiropody; Elderly Persons Clinic; Smoking Advisory Clinic; Family Planning; Cervical Cytology; School Health (Special Investigations) Drayton Park (Branch) 6 Hurlock Street, N.5. Child Health Drayton Park (Branch) 76/80 Isledon Road, N.7 Child Health Hilldrop Tenants' Clubroom Maternity and Child Health; Family Hilldrop Estate, N.7. Planning; Elderly Persons*Clinic Leage Street 24 Leage Street, E.C.1. Maternity and Child Health; Chipody; School Health (Special Investigations) 121 PREMISES Pine Street 13 Pine Street, E.C.1. Maternity and Child Health; Elderly Persons Clinic; School Health (minor ailments); Family Planning; Cervical Cytology; Vision; Audiology Other Chiropody Clinics Gifford Hall Mission Gifford Street, N.1. Islington Medical Centre 303 Upper Street, N.1. (temporarily at 28 Cross Street, N.1.) Voluntary Centres Claremont Central Mission White Lion Street, N.1. Child Health North Islington 6 Manor Gardens, N.7. Maternity and Child Health North Islington (Branch) Holloway Hall, Child Health 129 Seven Sisters Road, N.7. 122 INDEX Air Pollution 32 Audiology 105 Births 15 Bacteriological Examinations 29 Basement Bakehouses 43 Battered Babies 95 B.C.G. Vaccination 90, 106 Bathing Centres 107, 114 Care of Mothers and Young Children 83 Celluloid and Cenimatograph Film 38 Cervical Cytology 92 Chest Clinics 27 Child-Minding 68,84 Children's Department - Co-Operation with 96 Chiropody 90 Clean Air 32 Consumer Protection 36 Cremations 114 Cromwell Lodge Hostel for Homeless T.B. Men 26 Day Care of Children 83 Day Centres 78 Day Nurseries 83 Deaths 15 Dental Services 108 Diseases of Animals 49 Disinfection and Disinfestation 38 District Inspection 40 Domiciliary Midwifery 87 Dysentery 26 Elderly, Services for the 113 Emergency Telephone Service 96 Employment Agencies 37 123 Environmental Health Services 31 Export Certificates - Food 47 Factories and Outwork 42 Fertilisers and Feeding Stuffs 38 Family Planning 63,91 First Five Years 9 Fire Risks 51, 86 Fireworks 37 Five Year Capital Programme 2 Food and Diseases of Animals 44 Food Poisoning 24 General and Vital Statistics 15 Geriatric Preventive Clinics 68,113 Grants to Voluntary Organisations 94 Handicapped Register 95 Health Education Service 61 Health Centre, The Planning of a 73 Health Visiting 85 Home Help 93 Home Nursing 88 Housing 49 Ice Cream 47 Immigrants 28 Incontinence Pads 89 Infectious Diseases 23 International Certificates of Vaccination and Inoculation 24 Islington Chest and Tuberculosis Care Committee 27 Laundry 114 Lead Poisoning 25 Legal Proceedings 40,46, 55 Legard Road Family Centre 86 Liaison with General Practitioners and Hospitals 87 Loan of Equipment 88 Lung Cancer Deaths 19 124 Massage or Special Treatment Establishments 37 Maternal and Child Health Centres 83 Meals 113 Measles Vaccination 89 Meat Inspection 48 Medical Treatment of School Children 106 Mental Health Service 77 Midwifery, Domiciliary 87 Milk 47 Night Cafes 38 Noise 40, 55 Nurses Agencies 38 Nurseries and Child-Minders 84 Nursing Homes 38 Observation and Handicapped Register 95 Offensive Trades 44 Offices and Shops 56 Oil Heaters 68 Old Houses Into New Homes 52 Outwork 43 Personal Health Services 83 Pharmacy and Poisons 48 Pigeons 39 Planning of a Health Centre 73 Playgroups 85 Premises 120 Prevention of Break-up Families 96 Principal Officers 5 Prophylaxis 89, 106 Public Control 36 Published Papers 87 Quadruplets 86 Rag Flock 41 Rats and Mice 39 125 Recuperative Holidays 92 Remedial Foot Classes 105 Renal Dialysis 92 Rubella Vaccination 90 Scabies and Vermin 28 School Health Service 101 Shops Acts 36 Slaughter of Animals 48 Smallpox - International Certificates 24 Smoke Control 32 Smoking Advisory Clinic 68 Special Investigation Clinics 106 Staff 117 Statistics 15 Stillbirths 87 Students' Visits 96 Task Force 114 Theatrical Employers 38 Training Centres 78 Tuberculosis 26, 90, 106 Typhoid and Paratyphoid Fever 25 Vaccination & Immunisation 89, 106 Venereal Disease 96 Vital Statistics 15 Water Supply 41 Welfare Department - Co-Operation with 96 Works in default 41 126 Printed by the London Borough of Islington.