I ANNUL REPORT Director of Public Health and Medical Officer of Health London Borough of Islington ISL 99 CONTENTS SUBJECT PAGE Introduction 1 Social Services and Health Committee 4 Principal Officers of the Department 5 "Absent Friends" 9 Nursing Services 15 Vital Statistics 19 Infectious and other Diseases 27 Environmental Health 39 Health Education 71 Mental Health 85 Personal Health 91 School Health 109 Staff and Premises 119 Index 127 To the Mayor, Aldermen and Councillors of the London Borough of Islington INTRODUCTION In his report for 1969 my predecessor. Dr. S. King, described 1969 as "the year of the Consultants" and referred to the changes and re-organisation which were beginning or were foreshadowed in the work of the Health Department. Change and the prospect of change were predominant throughout 1970 and indeed are likely to be so for a considerable time to come, culminating in the total re-organisation of the National Health Service which the Government has decided will take place in 1974 and which will involve the personal health functions of the department together with its medical nursing and associated administrative staff being absorbed into an area health authority outside local government. The environmental health services will remain with the Borough, and in this connection the future role of the public health inspectorate and in particular the Chief Public Health Inspector assumes great importance. It is vital that there should remain in local government a senior officer with overall responsibility for Environmental Health. Any move towards the fragmentation of the responsibilities of local authorities in this field over a number of departments would therefore be undesirable, since only by placing the responsibility for Environmental Health in all its aspects firmly on the shoulders of an officer of adequate training, experience and seniority will it be possible to ensure that adequate emphasis is given in the future to the important role which local authorities will continue to have in this field. In addition, of course, the arrangements which will have to be made for medical advice to be available when necessary from Area Health Boards will be much easier to implement in practice if the Environmental Health services of the local authority are retained in a single department with a responsible senior officer rather than broken up and divided between several departments. Fortuitously, 1970 saw, in addition to organisational change, the continuation of a series of retirements amongst the senior members of the department's staff which began late in 1969 with the departure of Miss K. B. Harvey, the former Principal Nursing Officer, and her replacement by Miss L. K. May. These retirements taken together entailed a complete change of personnel in the four senior posts of Director of Public Health, Chief Public Health Inspector, Principal Nursing Officer and Chief Administrative Officer. Tribute is paid elsewhere in this report to the services rendered to the department and the borough by the retiring officers, but I should like to take this opportunity of mentioning my personal indebtedness to Dr. King, both for leaving me a department whose efficient administration made my task in taking over responsibility so much lighter than it might otherwise have been, and for his kindness and help during the period of overlap between my commencing my services with the borough in June and his retirement in August. It is also a pleasure to pay tribute to the exemplary manner in which Messrs. Jacob and Sharp, the newly-appointed Chief Public Health Inspector and Chief Administrative Officer respectively, and Miss May, the Principal Nursing Officer, have acquitted themselves during their first year in post. To return to the subject of organisational change, 1970 saw the completion of the restructuring of the department along the lines laid down by Messrs Booz Allen and Hamilton, and it is hoped that the new structure will facilitate further and continued improvement in the quality of the services provided by the department. Under this head it is proper that tribute should be paid to the Personnel Officer and his Organisation and Methods team for the manner in which they carried through the detailed re-organisation, and for the extent to which the views of the department were taken into account in formulating proposals. The issues on which an "agreement to differ" had to be reached and which were referred for settlement to the Personnel Committee's Working Party were thus reduced to a minimum. The year was marked by the passage into law of the Local Authority Social Services Act which implemented the proposals of the Seebohm Committee and by the publication in February of the second Green Paper on the Re-organisation of the National Health Service. Development in the latter sphere was interrupted by the change of Government resulting from the General Election of June 18th, but the new Government confirmed its intention to re-organise the National Health Service concurrently with reforming 1 the structure of local government outside London and to publish a Consultative Document on the former and a White Paper on the latter, both of which were still awaited at the end of the year. The end result of this series of administrative unheavals will be the complete separation of the health from the personal social services, as a consequence of the departure of the personal health services from local government to the proposed area health boards. While recognising the political factors which have rendered this at the present time virtually inevitable, one would venture to forecast that the fundamental disadvantages of such a situation must eventually lead to a further major reform. Changes of this magnitude, however, are infrequent and it must be accepted that for probably the next two decades much effort will need to be expended by both health and social service administrators in surmounting the barriers which are currently being erected between them. Dr. Johnson once said "Depend upon it Sir. When a man knows he is to be hanged in a fortnight it concentrates his mind wonderfully." It behoves those of us who are responsible for local authority health departments during the final two or three years of their existence to concentrate our minds upon two fundamental tasks: firstly, to foster the development of a relationship between the new social services departments and the health services which will survive the re-organisation of the health service and provide a foundation on which the social services departments can relate to and co-operate with the new health service authorities; and secondly, to develop the preventive and community health services so as to prepare them for the new and broader role which will be theirs in the re-organised health service. As far as the former point is concerned, planning for the transfer of functions from the health to the social services department commenced in the autumn and, in addition to consideration being given to the need for a continued close liaison between officers of the two departments, the geographical service areas were also reviewed in order, as soon as possible, to render them co-terminous. In the latter respect, efforts continued to bring the borough's personal health services into closer relationship with both the hospital and the general practitioner services. Examples were, on the hospital side, the participation of borough nursing staff in hospital nurse study days at the Whittington Hospital and reciprocally the arrangement of day visits by hospital nursing staff to the community nursing services, the attachment of borough nurses and medical staff to paediatric and geriatric ward rounds in the local hospitals and the commencement of plans for student nurses at the Royal Northern Hospital to spend a period of their training attached to the borough nursing service. On the general practitioner side, progress was made in the attaching of local authority nursing staff to work directly with designated practices. By the end of the year there were eight members of nursing staff in full attachment, seven members of nursing staff in partial attachment/liaison — a total of fifteen nursing staff covering twenty-two general practitioners. The borough's health centre programme continued to develop; arrangements were made for two general practitioners to be provided with practice accommodation at the Finsbury Health Centre, the construction of the River Place Health Centre approached completion by the end of the year and that of Highbury Grange commenced. Despite the unsettling effects of the impending transfer of functions to the Social Services Department steady progress continued in the development of all the services for which the department was responsible. It is, of course, impossible to refer in detail here to all the department's activities. These are covered in detail in the pages which follow. Matters which do seem worthy of special mention are the extension of facilities for the day care of pre-school children by the opening in May of the Council's first purpose-built day nursery at Lough Road, the increase in the number of registered playgroups from twelve to twenty-eight, and the Council's agreement towards the end of the year to accept financial responsibility for the playgroup fees of children who were in need of such provision for social or medical reasons but whose parents were unable or unwilling to pay the fees. Further growth took place in the provision of family planning, which is jointly undertaken by the borough and the Family Planning Association, and a substantial increase was recorded in the number of attendances. The service was extended in April to entitle all residents of the borough over the age of sixteen to free advice and in medical or necessitous cases to free supplies also. In November the Council agreed to 2 amend the method of providing financial support to the Family Planning Association by participating in their National Family Planning Agency Scheme which provides for a standard per capita charge to be paid by all local authorities for specified agency work. Several alternative applications of the scheme are available according to the range of services required and the application selected for Islington retains the restrictions referred to above on the provision of free supplies. The logical next step in the development of family planning services is the removal of this restriction to provide a completely free and universally available service and the case for this is all the stronger in the light of the Abortion Act. Housing continued to be a major, if not the major issue confronting the Council and its various departments; the health department, in particular the public health inspectorate, played a full role in dealing with the various issues involved. In this the department worked closely with the development and legal departments. In the autumn the Council approved a scheme for the registration of houses in multiple occupation. Multiple occupation is a particular feature of housing in Islington and is likely to remain so for the foreseeable future. The purpose of the registration scheme is to bring multiple occupation under control and to raise the standard of amenities in multi-occupied houses to an acceptable level in relation to the number of residents. The scheme will require substantial increases in staff and the approval of the Secretary of State for the Environment and it is anticipated that it will come into operation in the second half of 1971. The record of progress was not entirely unmarred by setbacks and it is pleasant to record that what might have been a serious setback to the Council's Smoke Control policy in the event created no difficulties. During the summer the Council, in common with other local authorities, was advised by the then Ministry of Housing and Local Government that a shortage of solid smokeless fuels was likely to develop during the winter and, reluctantly, in order to avoid hardships to residents, especially the elderly. Smoke Control Orders, which had covered the entire borough since October 1969, were suspended temporarily in an area including 40% of the population. Fortunately, doubtless due to the mild winter, no shortage developed and the public, contrary to fears expressed by some, did not seize the opportunity to burn smokey fuels. I have already referred to the fact that I took up my duties in the middle of the year and this is consequently my first annual report. It is a particular pleasure therefore to pay tribute to the Chairman and Members of the then Health and Social Services Committee for their help and to the staff of the department at all levels for their unstinted loyalty and support. C. BURNS Director of Public Health and Medical Officer of Health 3 SOCIAL SERVICES AND HEALTH COMMITTEE (31-12-70) Mayor Alderman J. R. GOODMAN, J.P., F.I.O.B. Chairman Councillor R. E. CANDLIN B.Sc., M.B., Ch.B., F.R.C.S. Vice-Chairman Councillor P. D. BROMLEY, B.Sc. Councillors MRS. EDITH HILDA ARCHER MRS. JENNIFER MARGARET BAKER MRS. SANDRA RUTH BRON MISS ANNIE THERESA CALLAGHAN MRS. MAY ELSIE GARNER MRS. MARION JOAN HARVEY, B.A. DONALD BENTLEY HOODLESS, B.A., D.P.A. 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-(31.12.70) Director of Public Health and Medical Officer of Health C. BURNS, M.B., Ch.B., D.C.H., D.P.H. Deputy Medical Officer Of Health AUDREY K. ARNOLD M.B., B.Ch., B.A.O., D.Obst., R.C.O.G., D.P.H. Principal Medical Officer Chief Dental Officer and BETTY GROVES Principal School Dental Officer M.B., B.S., D.P.H. R. E. HYMAN L.D.S., R.C.S., (Eng.) Public & Agricultural Analyst R. G. MINOR, F.P.S., F.R.I.C., M.Chem.A. Senior Medical Officers JOAN M.CLARKE BERYL H. EVANS B.A., L.R.C.P., M.R.C.S., M.B., B.S., D.C.H., D.P.H. M.B., B.Ch., D.Obst., R.C.O.G., D.C.H., D.P.H Chief Administrative Officer Chief Public Health Inspector E.J.SHARP M.JACOB|, M.A.P.H.I. Assistant Chief Administrative Officer Deputy Chief Public Health Inspector S. GODSTONE A.J. TRUSLOVE. F.A.P.H.I. Principal Administrative Officers Assistant Chief Public Health Inspectors MISS D. EGGINTON W. T. STEVENSON, M.A.P.H.I. R. D. BILLINGS, A.C.I.S., Dip.Comp. R. C. WHITTAKER, M.A.P.H.I. R. C. LOCKWOOD, M.A.P.H.I., A.R.S.H. Principal Nursing Officer Deputy Principal Nursing Officer MISSL. K.MAY MISS M. BRERETON, S.R.N., S.C.M., H.V., Q.N., Dip.Soc. S.R.N., S.C.M., B.T.A., H.V., Diploma Health Service Admin (Aston Univ) Assistant Nursing Officers Supervisor of Midwives MRS. M.TAMBLYN MISS W.YOUNG MRS. V. A. AUSTIN S.R.N., H.V., R.F.N. S.R.N., S.C.M., H.V., Q.N. S.R.N., S.C.M., Q.N. Senior Social Worker Deputy Senior Social Worker MISS M. MACMORRAN MRS. A. HOSKER Principal Mental Health Social Worker Deputy Principal Mental Health Social Worker MISS N. E. BRIAN J. P. QUINN Health Education Officer K. M. N. ROBERTSON, L.M.R.S.H., M.I.H.E., M.R.I.P.H.H. 5 ABSENT FRIENDS In addition to the retirement of my eminent predecessor, Dr. Stanley King, the year witnessed the departure after long and distinguished careers in local government of two other principal officers of the department, namely Mr. F. L. Clark, Chief Administrative Officer, and Mr. W. C. Bartlett, Chief Public Health Inspector. Details of their careers as reported to the appropriate Committees of the Council on their retirement are given below. STANLEY KING, M.D., D.P.H. Dr. King qualified in 1928 with the M.R.C.S. (England) and L.R.C.P. (London), and went on to gain his M.B., B.S. (London), M.R.C.P. (London), M.D. (London) and D.P.H. (England). In 1933, after holding a number of hospital appointments, Dr. King was appointed Assistant Tuberculosis Officer to the Metropolitan Borough of Stepney. A year later he became Deputy Medical Officer of Health and Tuberculosis Officer to the Metropolitan Borough of Battersea, and in 1939 he was appointed Medical Officer of Health to the Metropolitan Borough of Stoke Newington. In 1948 Dr. King was appointed as Divisional Medical Officer for L.C.C. Division 4; this Division embraced Hackney, Shoreditch and Stoke Newington, and he was responsible for organising, for the Division, the service under the National Health Service Act 1946. In addition, as Divisional Officer, he undertook duties as Medical Officer of Health for Stoke Newington. In 1964 Dr. King was appointed as Medical Officer of Health for the London Borough of Islington to organise the service for the then new Health Department, and in 1969 he became the Borough's first Director of Public Health and Medical Officer of Health. Since 1946 he has regularly lectured on Public Health subjects to doctors taking the D.P.H. course at the Royal Institute of Public Health and Hygiene, and for nine years he was an examiner for the Royal College of Physicians and Royal College of Surgeons for the Diploma in Public Health. Dr. King, who is a past Chairman of the Metropolitan Branch of the Society of Medical Officers of Health, has served since 1948 as a member of the Management Committees of Hackney, Long Grove and New Southgate Hospitals; at the present time he is a member of the North London group of hospitals, being Vice-Chairman of the Planning and General Purposes Committee and Chairman of a Sub-Committee on Community Services. Since 1965 Dr. King has been Chairman of the Association of Inner London Borough Medical Officers of Health, and he is currently Chairman of the Inner London Local Obstetric Committee of the Inner London Executive Council. Dr. King is a Member of the Council of the Royal Institute of Public Health and Hygiene and Chairman of its Education Committee. 9 Dr. A. K. Arnold, Deputy Director of Public Health and Deputy Medical Officer of Health, writes "In the formation of the new Islington Health Department and subsequently in the planning and introduction of new services, Dr. King proved himself a medical administrator of outstanding ability. His depth of knowledge coupled with great foresight enabled him to plan new procedures well in advance of national trends. He possessed that rare combination of talent and amiability and all sections of the staff were happy to serve under him." FRANK CLARK, B.A. Joining the London County Council as a general grade officer in the Education Department Mr. Clark, on promotion to the major establishment, was transferred to the Public Health Department which had been reorganised to take over the hospital services from the Boards of Guardians and Metropolitan Asylums Board under the Local Government Act, 1929. He assisted in dealing with many aspects of the consolidation of rates of pay and conditions of service and the review of staff establishments in creating a unified hospital service. After the War, in which he served in the R.A.F. V.R. as Station Adjutant in the Middle East with the rank of Flight Lieutenant, Mr. Clark assumed administrative responsibility for the domiciliary midwifery service at a time of heavy pressure due to the rise in the post-war birth rate. This responsibility subsequently extended to include the central administrative control of the maternity and child welfare services transferred to the London County Council under the National Health Service Act, 1946. Promotion to Divisional Administrative Officer for Health Division No. 7 followed in 1955 and in August, 1964 he was appointed Chief Administrative Officer to assist the Medical Officer of Health in the planning and inauguration of the administration of the health services for the London Borough of Islington. Mr. Clark is an Honours Graduate and a Member of the Convocation of the University of London. In his service for the London Borough, Mr. Clark proved himself to be an officer of exceptional ability whose contribution to the establishment and development of the new Health Department cannot be overstressed. He never spared himself in applying his talents to the many and varied problems which have arisen. All who had the pleasure of working with Mr. Clark, I am sure, felt that they were losing a first-class colleague whose help and cheerful, patient approach to his work would be greatly missed. WILLIAM BARTLETT, F.R.S.H., M.A.P.H.I. Following appointments at Stoke-on-Trent and Brighton, Mr. Bartlett was appointed as a District Public Health Inspector by the former Islington Borough Council in August, 1930. During the following ten years, he gained a detailed knowledge of the Borough and its public health problems. During the period 1940/41 he was seconded to the Ministry of Food as an Enforcement Officer and was commended by a Food Control Committee for the extremely efficient and conscientious manner in which he performed his duties. He was also Food Salvage Officer and Food Decontamination Officer. In October, 1941, Mr. Bartlett was appointed as Senior Sanitary Inspector in charge of a specialised section of the inspectorate and in February, 1947, was promoted to the position of Senior Sanitary Inspector in charge of the whole of the Council's inspectorate; 1951 saw him redesignated as Chief Sanitary Inspector, a title to be changed by 10 statute in 1956 to that of Chief Public Health Inspector. In 1965 he became the new London Borough's first Chief Public Health Inspector. Mr. Bartlett is a fellow of the Royal Society of Health and has always been an active Member of the Association of Public Health Inspectors, serving on various Standing Committees of the London Centre of the Association. He was also the Chairman of the London No. 1 (Northern) Pest Control Committee. Mr. Bartlett gave the Council long and loyal service and always displayed a judicious approach to the many and varied public health problems which arose. He was a valuable source of advice and guidance to his colleagues. It would be difficult to highlight every aspect of the contribution made by Mr. Bartlett to the progress made in environmental health during his four decades with the Council; however, in 1969 the Borough reached a milestone of which I think it can be justly proud, it became completely smoke controlled. Throughout the programme which commenced in 1959, Mr. Bartlett carried responsibility for all technical aspects and thus played a significant part in securing cleaner air for Islington. He was the officer responsible to the Council and to the Public Health Inspectors Education Board for the training of students. The Islington training scheme is second to none and one on which training in other boroughs has been modelled. 11 NURSING SERVICES NURSING SERVICES Public health nursing has none of the drama of modern hospital procedures, but the work of the community nursing services is one of the foundations of the health of the country, for as has been said, "the health of the people lies in their homes." The nursing staff of the borough have had a busy and active year, during which all the usual fields of work continued, health visiting, school nursing, home nursing, midwifery, visiting tuberculous patients and day nursery work. There was particular involvement with those members of the public, who are especially vulnerable, the aged, the chronic sick, expectant and nursing mothers and children of all ages, extra attention being paid to those in danger of neglect or "battering" and the handicapped. The aim of the daily work was, as always, to nurse, to help, to advise and to educate, in the child health centres, in the homes of the people, in schools, colleges, clubs and in hospitals. Interest in community nursing has increased greatly, particularly since the General Nursing Council's new syllabus of 1969, which made public health nursing one of the choices open to student nurses during their training. With this in mind, the nursing section held a symposium on community nursing at the Whittington Hospital, in the course of which four members of staff spoke to 90 departmental and ward sisters about their work. Following this, arrangements were made for ward sisters to spend time in the community, a health visitor started attending a paediatric ward round and a geriatric visitor geriatric ward rounds. A further step in the field of closer linkage between hospital and community nursing was taken when the General Nursing Council approved a 12 weeks' training period for student nurses from the Royal Northern Hospital to be spent with nurses of the borough. Home nurses now attend sessions with the physiotherapist at the hospital, so that they can rehabilitate patients in their own homes more effectively, particularly in disabling diseases such as strokes. Stroke rehabilitation was the subject when the B.B.C. television unit filmed the Islington home nurses at work toward the end of the year. This film was one in a series of teaching films for student nurses in hospital. We continued — though slowly — with attachments and liaison of health visitors and home nurses to general practitioners, and altogether 22 general practitioners were involved with such schemes. A second health visitor started work with a special mothers' group at the National Children's Home. Lough Road Day Nursery was opened in April and in spite of national shortage we were able to find the necessary staff for the new nursery. The Department of Health and Social Security approved the nursery as a training nursery for nursery students as from September, 1970. A great number of students were received during the year, including a party of 15 Dutch post-graduate public health students, whom the Royal College of Nursing had asked us to give an insight into British public health nursing. The Department of Health and Social Security arranged for a three-day visit by the head of the West Berlin Child Day Care Section to see what the borough provided in that field. With the ever changing pattern of medical, paediatric, geriatric and social knowledge it is essential that nursing staff keep abreast of new developments in these various fields. A number of staff attended courses during the year, either in-service courses or those run by other agencies. With the publication of the Report of the Working Party on Management Structure in the Local Authority Nursing Services plans were made for senior nursing staff to attend courses in management. The year brought an expansion of the family planning services provided by the borough and several members of staff were trained in family planning to enable them to play an active part in this service. A number of midwives and health visitors took part in a survey carried out by the Institute for Social Studies in Medical Care on Birth Control Services. During 1970 Prince Philip, the Duke of Edinburgh, said: "The trouble with prevention is that it has none of the glamour of achievement. Achievement is measurable, something was wrong, I have put it right! If you have prevented something happening, there is nothing to say, that it would have happened." This truly applies to the work of the nursing section and we can only hope that by our daily work, our teaching and learning we may have contributed to the health and happiness of the people of Islington. 15 !M Blii VITAL STATISTICS Area — 3,678 acres Population (Estimated Mid-Year) — 227,340 Marriages solemnised in the Borough 2,055 (provisional) 19 BIRTHS Live Births — Legitimate Total 3,273 Male 1,676 Female 1,597 Illegitimate 594 302 292 3,867 1,978 1,889 Islington England and Wales Live Birth Rate Per 1,000 Population 17.0 16.0 Birth rate after applying 'Area Comparability' Factor of 0.80 13.6 Illegitimate Live Births Per Cent of Total Live Births 15.4 8.3 Still Births — Total Male Female Legitimate 34 22 12 Illegitimate 7 5 2 41 27 14 Islington England and Wales Still Birth Rate Per 1,000 Population 0.18 0.21 Still birth rate per 1,000 live and still births 10.5 13.0 Total Male Female Total Live and Still Births — Legitimate 3,307 1,698 1,609 Illegitimate 601 307 294 3,908 2,005 1,903 DEATHS Total Male Female All Causes 2,503 1,227 1,276 Islington England and Wales Death Rate (Crude) Per 1,000 Population 11.0 11.7 Death rate after applying 'Area Comparability' factor of 1.09 12.0 Infant Deaths Total Male Female Deaths of Infants under one year of age — Legitimate 46 21 25 Illegitimate 14 9 5 60 30 30 Islington England and Wales Infant Mortality Rate (per 1,000 live births) — All Infants 15.5 18.2 Legitimate 14.1 17.5 Illegitimate 23.6 25.9 Neo-Natal Mortality Total Male Female Deaths of Infants under 4 weeks of age — Legitimate 28 11 17 Illegitimate 8 6 2 36 17 19 Islington England and I/Vales Neo-Natal Mortality Rate (per 1,000 live births) All Infants 9.3 12.3 Legitimate 8.6 11.9 Illegitimate 13.5 17.2 Early Neo-Mortality Total Male Female Deaths of Infants under 1 week of age — Legitimate 26 10 16 Illegitimate 7 5 2 33 15 18 Early Neo-Natal Mortality Rate (per 1,000 live births) Islington England and Wales All Infants 8.5 10.6 Legitimate 7.9 10.2 Illegitimate 11.8 15.2 Perinatal Mortality Total Male Female Still births and deaths under 1 week combined 74 42 32 Perinatal Mortality Rate Islington England and Wales (per 1,000 total live and still births) 18.9 23.5 Maternal Deaths (including abortion) Rate (per 1,000 total live and still births) 1 0.26 147 0.18 20 ANALYSIS OF INFANT DEATHS - 1970 (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 Meningococcal infection 1 1 All other infective and parasitic diseases 1 1 Other diseases of nervous system and sense organs 1 1 Pneumonia 2 1 1 2 6 Bronchitis, emphysema 1 1 Other diseases of the respiratory system 3 1 1 1 6 Intestinal obstruction and hernia . 1 1 Other diseases of the genitourinary system 1 1 Congenital anomalies 8 1 2 1 1 1 14 Birth injury, difficult labour, and other anoxic and hypoxic conditions 7 1 4 1 13 Other causes of perinatal mortality 4 4 1 9 Accidents: Motor vehicle — Nil - All other 1 2 1 4 Totals 20 6 4 1 - 1 1 1 2 - 7 4 1 4 3 - 1 2 2 - - 60 Estimated Child Population Under 1 year 1-4 Total under 5 5- 14 Total under 15 Islington 3,920 16,380 20,300 27,900 48,200 Greater London 113,450 468,350 581,800 1,020,600 1,602,400 COMMENTS ON VITAL STATISTICS DEATHS OF INFANTS UNDER ONE YEAR The infant mortality rate shows a substantial fall since 1969 and is below that for England and Wales. While this is gratifying, too much should not be read into it as the absolute figures are low enough to allow chance variations to play a significant role. One third 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 twenty-four infant deaths in the age group one to twelve months, thirteen were due to pneumonia, bronchitis and other diseases of the respiratory system. 21 MATERNAL MORTALITY In a total of 3,908 live and still births, there was one maternal death; this was due to cerebral embolisms following termination of pregnancy. RESPIRATORY TUBERCULOSIS The death rate for lung tuberculosis (including late effects) in 1970 was 0.05 per 1,000 population, and compares favourably with previous years. DEATHS DUE TO PNEUMONIA AND BRONCHITIS In 1970 there were 137 deaths ascribed to bronchitis and 209 to pneumonia. These figures show less bronchitis but more pneumonia deaths than those for 1969, which were 195 and 199 respectively. MALIGNANT GROWTHS OF LUNG AND BRONCHUS I reported last year that lung cancer deaths in males of 160 showed a rise over 1968 when there were 145 deaths. Unfortunately this trend continued in 1970 when 166 males died from this disease. Female deaths from this cause which showed a rise from 28 in 1968 to 40 in 1969 fell to 38 in 1970. CORONARY DISEASE WITH ANGINA There were 476 deaths (268 male and 208 female) from this cause in 1970. This shows an appreciable fall from the 1969 figure of 548 (332 male and 216 female). ACCIDENT DEATHS — Comparative table. 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 Motor vehicle accidents 37 32 22 34 28 29 34 34 23 29 24 Other violent accidents 69 65 69 84 62 60 58 65 38 47 47 ACCIDENT DEATHS — Analysis by age groups Type under 4 weeks 4 weeks and under 1 year 7- 5- 15- 25- 35- 45- 55- 65- 75+ M F Total Motor Vehicle accidents . 1 2 4 2 1 1 4 4 5 16 8 24 Falls - - - - - 1 - 3 2 4 8 6 12 18 Accidental Poisoning (Solid, Liquid Gases and Vapours) - - - - - - 2 1 1 1 - 3 2 5 Fire - 1 5 1 - - 1 1 1 2 1 3 10 13 Drowning - - - 1 - 1 - - - - - 1 1 2 Other (Railway Accidents, etc.) 1 2 - - - 2 1 1 1 - 1 6 3 g Total 1 3 6 4 4 6 5 7 9 11 15 35 36 71 22 1970: CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION (REGISTRAR GENERAL'S RETURNS) CAUSE OF DEATH AGE GROUPS 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 - 2 2 - - - 2 - - - - - - - - - - - - - - - - - - Tuberculosis of respiratory system 6 2 8 - - - - - - - - - - - - - 1 - - 4 - 1 - 1 1 Late effects of respiratory tuberculosis 2 2 4 - - - - - - - - - - - - - - - 1 1 1 - - 1 - Other tuberculosis - 1 1 - - - - - - - - - - - - - - - - - - - 1 - - Plague - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - Streptococcal sore throat and scarlet fever - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal infection - 1 1 - - - 1 - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - - - - - - - - - - - - - Measles - 1 1 - - - - - 1 - - - - - - - - - - - - - - - - Typhus and other rickettsioses - - - - - - - - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - - - - - - - - Syphilis and its sequelae - - - - - - - - - - - - - - - - - - - - - - - - - All other unfective and parasitic diseases 2 2 4 - - 1 - - 1 - - - - - - - 1 - - - - 1 - - - Malignant neoplasm - buccal cavity and pharynx 4 2 6 - - - - - - - - - - - - - - 1 - 1 - 1 1 1 1 Malignant neoplasm - oesophagus 3 8 11 - - - - - - - - - - - - - - - - 1 1 1 2 1 5 Malignant neoplasm - stomach 37 28 65 - - - - - - - - - - 1 - - - 3 - 13 6 13 9 7 13 Malignant neoplasm - intestine 33 31 64 - - - - - - - - - - - - 1 - 3 2 10 - 12 12 7 17 Malignant neoplasm - larynx 6 1 7 - - - - - - - - - - - - - - 1 1 - - 1 - 4 - Malignant neoplasm - lung, bronchus 166 38 204 - - - - - - - - - - - - 2 2 12 2 50 11 75 13 27 10 Malignant neoplasm - breast - 47 47 - - - - - - - - - - - 1 - 1 - 13 - 15 - 11 - 6 Malignant neoplasm - uterus - 9 9 - - - - - - - - - 1 - 1 - 1 - 3 - 1 - - - 2 Malignant neoplasm - prostate 11 - 11 - - - - - - - - - - - - - - - - - - 5 - 6 - Leukaemia 2 9 11 - - - - - - - - 1 - - - - 1 - 2 - 1 1 2 - 3 Other malignant neoplasms, including neoplasms of lymphatic and haematopoietic tissue 80 73 153 - - - - - - - - 2 - 1 2 - 2 8 9 25 12 34 23 10 25 Benign neoplasms and neoplasms of unspecified nature 3 4 7 - - - - - 1 - - - - - - 1 - - 2 - - - - 2 1 Diabetes mellitus 9 10 19 - - - - - - - - - - - - - 1 1 - 1 1 5 2 2 6 Avitaminoses and other nutritional deficiency 1 1 Other endocrine, nutritional and metabolic diseases 2 10 12 - - - - - - - 1 - - - 1 - - 1 - - - - 3 1 5 Anaemias 1 4 5 - - - - - - - - - 1 - - - - - - - - 1 1 - 2 Other diseases of blood forming organs - - - - - - - - - - - - - - - - - - - - - - - - - Mental disorders 1 2 3 - - - - - - - - - - - - - - - - - - 1 1 - 1 Meningitis 2 - 2 - - - - - - - - - - - - 1 - - - - - - - 1 - Multiple sclerosis 3 1 4 - - - - - - - - 1 - - - - - 1 1 - - 1 - - - Other diseases of nervous system and sense organs 13 10 23 - - 1 - - - 1 - - - - - - - 1 - 2 2 3 2 5 6 Active rheumatic fever - - - - - - - - - - - - - - - - - - - - - - - - - Chronic rheumatic heart disease 22 27 49 - - - - - - - - - - 1 - - - 1 2 4 4 9 6 7 15 Hypertensive disease 18 26 44 - - - - - - - - - - - - - - 2 - 5 3 4 6 7 17 Ischaemic heart disease 267 208 476 - - - - - - - - - - 2 - 7 - 19 6 75 32 99 55 65 115 Other forms of heart disease 80 187 267 - - - - - - - - - - 1 - - - - 1 7 1 16 12 56 173 Cerebrovascular disease 85 148 233 - - - - - - - 1 - 1 - 3 1 5 3 8 13 7 29 43 39 80 Other diseases of the circulatory system 32 57 89 - - - - 1 - - - - - - - - - 3 2 1 8 10 12 17 35 Influenza 3 9 12 - - - - - - - - - - 1 - - - - 1 - 1 1 1 1 6 Pneumonia 96 113 209 - - 3 3 1 1 - - - - 1 - - - 2 - 8 2 23 11 58 96 Bronchitis, emphysema 94 43 137 - - 1 - - - - - - - - - - - 3 1 32 6 24 8 34 28 Asthma 2 5 7 - - - - - - - - 1 1 1 - - - - 1 - - - 3 - - Other diseases of the respiratory system 18 15 33 - - 4 2 - - - - - - - - - - 1 1 2 2 7 3 4 7 Peptic ulcer 14 7 21 - - - - - - - - - - - - - - 2 1 1 - 6 1 5 5 Appendicitis - 3 3 - - - - - - - - - - - 1 - - - - - 1 - - - 1 Intestinal obstruction and hernia 4 9 13 1 - - - - - - - - - - - - - - - - 1 3 1 - 7 Cirrhosis of liver 6 2 8 - - - - - - - - - - - - 1 - 1 - 3 1 1 1 - - Other diseases of the digestive system 11 13 24 - - - - - - 1 - - - - - 1 1 - - 3 1 2 2 4 9 Nephritis and nephrosis 6 3 9 - - - - - - - - - - - - - - 1 1 3 2 2 - - - Hyperplasia of prostate 4 - 4 - - - - - - - - - - - - - - - - - - 1 - 3 - Other diseases of the genito-urinary system 7 14 21 1 - - - - - - - - - - - 1 - - - 3 3 - 4 2 7 Abortion - 1 1 - - - - - - - - - 1 - - - - - - - - - - - - Other complications of pregnancy, childbirth and puerperium - - - - - - - - - - - - - - - - - - - - - - - - - Diseases of the skin and subcutaneous tissue 2 2 4 - - - - - - - - - - - - - - 1 - - - 1 1 - 1 Diseases of the musculoskeletal system and connective tissue 2 7 9 - - - - - - - - - - - - - - - 1 1 - 1 - - 6 Congenital anomalies 10 12 22 5 6 2 1 1 - 1 - - - 1 1 - - - 1 - 3 - - - - Birth injury, difficult labour, and other anoxic and hypoxic conditions 5 8 13 5 8 - - - - - - - - - - - - - - - - - - - - Other causes of perinatal mortality 5 4 9 5 4 - - - - - - - - - - - - - - - - - - - - Symptoms and ill-defined conditions 3 6 9 - - - - - - - - - - - - - - - - - - - - 3 6 Motor vehicle accidents 16 8 24 - - - - - 1 2 - 4 - 2 - 1 - 1 - 2 2 1 3 3 2 All other accidents 19 28 47 - 1 1 2 1 4 - 2 - - 3 1 2 2 4 2 5 - 2 5 1 9 Suicide and self-inflicted injuries 8 11 19 - - - - - - - - - 2 2 2 3 2 - 2 2 1 - 1 1 1 All other external causes 2 1 3 - - - - - - - - - - 1 - - - - 1 - - - - 1 - All Causes 1,227 1,276 2,503 17 19 13 11 4 9 5 4 9 7 18 13 22 20 76 68 278 132 398 262 387 731 Totals 2,503 36 24 13 9 16 31 42 144 410 660 1,118 Percentages 100 1.44 0.96 0.52 0.36 0.64 1.24 1.68 5.75 16.38 26.36 44.67 23 INFECTIOUS AND OTHER DISEASES INFECTIOUS AND OTHER DISEASES Notifications and deaths recorded during 1970 (Infectious diseases are those that were statutorily notifiable as at 31st December, 1970) Disease Number of notifications Number of deaths Removed to hospital Number of Cases returned to Registrar-G eneral after correction of diagnosis Cases "coming to knowledge" but not notified Measles 1,081 (1,023) 1 14 1,081 - Dysentery 112 (246) - 17 113 70 Scarlet Fever 63 (63) - 3 63 16 Whooping Cough 75 (28) - 7 75 29 Infective Jaundice 80 (133) 1 23 79 24 Ac. Meningitis 13 (10) 2 13 12 7 Ac. Encephalitis (4) 2 - - 2 Ophthalmia Neonatorum 1 (1) - - 1 - Paratyphoid Fever 3 (1) - 3 3 - Typhoid Fever 3 (4) - 3 3 - Food Poisoning 121 (157) 1 29 81 3 Malaria 1 (2) - - 1 1 Tuberculosis Lungs (primary) 81 (103) 12* - 80 6 Tuberculosis Other Forms (primary) 21 (18) 1 - 20 1 * Includes late effects of respiratory tuberculosis. (Figures in brackets are notifications for 1969) SMALLPOX Of the 42 references for suspected smallpox and supervision of possible smallpox contacts, 40 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. 27 Advice was sought from the medical staff of the department in respect of two patients suffering from rashes of a type where it was desirable to exclude smallpox as a possible cause. These were subsequently diagnosed as chicken pox. CERTIFICATES OF VACCINATION AND INOCULATION - AUTHENTICATION - MINISTRY OF HEALTH CIRCULAR 60/48 Applications for authentication dealt with by the Medical Officer of Health numbered 4,073 as against 4,045 for the previous year. The applications comprised requests for authentication of International Certificates of Vaccination and Inoculation against smallpox, yellow fever, cholera, etc., and constituted a substantial item of work. 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 1970 121 There was only one outbreak (summarised below) to be reported in accordance with Memo. 188 Med. of the Ministry of Health. Date No. of Notifications No. of persons served No. of cases reported No. of deaths Foods involved and organisms responsible 3/4.11.70 - 208 56 - Minced beef CI. Welchii The above related to an outbreak involving elderly people receiving "meals on wheels." Information was received on the afternoon of the 4th November that a number of Meals on Wheels recipients had reported symptoms of vomiting, diarrhoea and abdominal pain following the meal consumed the previous day. Investigations were immediately instituted and pointed to the main dish of minced meat being implicated. The full meal consisted of minced meat, cabbage and mashed "real potatoes," sponge pudding and custard. The meat was delivered on the 2nd November in a ready-minced "chilled condition" and stored overnight in the kitchen refrigerator. It was cooked on 3rd November for approximately two hours and served immediately after cooking into individual containers between 10 a.m. and 10.30 a.m. The prepared meals were then delivered to the elderly people during the remainder of the morning in charcoal-heated hotlocks. Subsequent questioning of all those at risk (208) revealed that 56 persons reported symptoms, most of these having recovered by the following day. One person who had suffered a stroke previously was removed to hospital on the instructions of the general practitioner. The average interval between ingestion and onset of symptoms (8-16 hours) pointed to the source of infection as being due to the heat resistant organism, Clostridium welchii. This was subsequently confirmed when, as a result of laboratory investigation, four faecal specimens submitted showed cl. welchii present, a common cause of food poisoning in communal feeding establishments. The vehicle of infection is almost invariably meat which has been cooked and allowed to cool slowly and then eaten either cold or re-heated. 28 The most probable cause of this outbreak was inadequate cooking of the meat, presumably due to (a) insufficient cooking time, (b) inadequate cooking temperature and/or (c) cooking in such large quantities that the meat remained only partially cooked Whilst the instruction to save a meal from the previous day was adhered to, unfortunately the specimen was disposed of shortly before the first reports of illness were received by the department. Arrangements were subsequently made for these meals to be retained for a longer period. SUSPECTED DIPHTHERIA Information was received from a Medical Officer of Health of another London Borough regarding a woman aged 29 years who had recently been investigated for a sore throat and found to be a carrier of a diphtheria mitis toxin producing organism. Investigations showed that seven other persons, all connected in some way, were also carriers of the bacillus in their noses or throats. All were well, but two persistent carriers were admitted to infectious diseases units. Some tenuous contacts were reported in other Boroughs and, in this connection, investigation of an adult male Islington resident who was a suspected carrier was carried out. Examination of two nose and throats swabs, however, proved negative. Medical practitioners were alerted to the possibility that this diphtheria bacillus was more prevalent in London than was at that time recognised and they were advised to consider investigating cases of sore throats before giving treatment. LEAD POISONING There were two references to the department on the subject of lead poisoning during 1970. The first concerned a three-year-old boy admitted to hospital with a history of convulsion and abdominal pain. Subsequent investigations revealed a high serum-lead and x-rays of long bones compatible with lead-poisoning. As a result, domiciliary enquiries were carried out and a series of samples submitted to the Public Analyst for examination. From these investigations it appeared likely that the offending lead was that contained in paint on a lead pipe and window sill. Consequently the Inspector ordered its removal and reported on his last visit that conditions were satisfactory. The other case concerned a three-and-a-half-year old boy admitted to hospital with a raised blood lead level. Apparently the child had a history of Pica, when it was noted that he ate a wide range of substances ranging from paper to caterpillars. As a result of domiciliary enquiries carried out, a series of samples were submitted to the Public Analyst but with indeterminate results. Further samples were taken in an endeavour to trace the source of this lead poisoning but without effect. Arrangements were made for this child to be seen at regular intervals. SUSPECTED RABIES A telephone call was received on the evening of the 14th May, from the Ministry of Agriculture and Fisheries (Animal Health Division) to report details of a sea captain's pet monkey which had died that morning. The Forestry Department of the London Zoo performed a post-mortem at which they suspected death was due to rabies and sent the brain of the monkey for further analysis; the Captain had tried to revive the monkey with the kiss of life. Meanwhile the Captain had returned to his ship which was due to sail that evening. It was further reported that the Captain's wife and other householders had kissed and cuddled the monkey, and two dogs at this house had also played with the animal. On the advice of the Department of Health and Social Security the ship was delayed at Gravesend and rabies vaccine given to the Captain and other persons at risk. Use of anti-serum was not advocated at this time. Subsequently it was ascertained that the Captain had possessed the monkey for some eight months; prior 29 to that it was in Holland, although it was thought to have originated from India. The monkey had been ill for five or six days before its demise; symptoms were "being off its food" with slight vomiting. It was found on the morning in question prostrate and looking very ill. Its vomit was very frothy and slightly blood stained. Finally, the histological test proved negative and the diagnosis was not confirmed. TYPHOID AND PARATYPHOID FEVER There were three confirmed cases of typhoid fever and three confirmed paratyphoid cases during the year as follows: Of the three typhoid cases referred to above, the first concerned an adult Moroccan male who arrived in this country by air on 1st August and had resided at an address in Islington since that time. On 19th August he became ill, and was admitted to a general hospital on the 23rd; subsequently being transferred to an isolation hospital on the 28th August on confirmation of diagnosis of typhoid fever. On domiciliary enquiry, it was ascertained that he worked at a Steak House in another borough where he was employed in the kitchen helping the cook. Source of infection at this time was indeterminate although the incubation period suggested that he caught the infection abroad. Nevertheless, as he had all his meals at the restaurant, the possibility of the infection being contracted there had to be considered. Accordingly, detailed investigation including examination of contacts was undertaken. In the house 13 contacts were discovered; of these many were food handlers and had to be excluded from work. In an adjacent household where there had also been close contact, a further 11 contacts were investigated. The patient was discharged on 14th October and although the last 6 faecal specimens and the last 7 urine specimens were negative, it was felt that the patient could not be permitted to return to work in the food trade owing to the continued possibility of his urine reverting to the positive state. In addition, he would be residing in a multi-occupied house where he was in close contact with 24 other people, mostly Arab or Pakistani immigrants, resident in this and in an adjacent house, nearly all of whom were also engaged in the food trade; this was clearly undesirable from a public health point of view and constituted a grave risk. Consequently, discussions took place with the Home Office and it was finally arranged for the patient to return to his home in Tangier. In accordance with Section 41 of the Public Health Act, 1961, he was compensated in full for loss of earnings for the period of his discharge from hospital to the time he returned to Tangier and, in addition, the Council paid for his passage home. Compensation was also paid as appropriate to those excluded food handler contacts employed in Islington. The second case concerned a 15-year-old male who arrived in the borough from Pakistan on the 10th September reporting to his doctor as having been ill one month previously. As a result of a precautionary faecal specimen submitted at the request of the medical practitioner, Salmonella Typhi was isolated and the patient removed to an Isolation Hospital. Domiciliary enquiries were carried out and bacteriological examination of the 11 residents in the house proved negative. Their medical practitioners were informed. The other typhoid case concerned an adult Nigerian woman resident in Islington, who was admitted to an isolation hospital with pyrexia of unknown origin on the 3rd November, 1970. Subsequent blood cultures proved positive for Salmonella Typhi, Phage type C.I, which is a European organism. The date of onset was stated to be the 27th October. Specimens of blood, faeces and urine were taken of Islington contacts including the employees in shops where the patient normally purchased her groceries, etc. Sewer swabs were also inserted into the drain from the house at the patient's residence. All bacteriological results from the above proved negative. Neither the patient nor her husband had been out of the country during the previous month. 30 * As no source of infection was apparent, the investigations were further extended and specimens of blood, faeces and urine were obtained from the management and staff of the firm where the patient worked. Results were negative and the source of infection was never determined. Of the paratyphoid cases, the first concerned a theatre nurse in a general hospital in the borough who was admitted to an isolation hospital suffering from paratyphoid infection which was subsequently confirmed. The date of onset of symptoms was given as 23rd August, although she was reported to have been on duty on the 26th. Medical practitioners of Islington patients and medical officers of health of patients residing in other boroughs were informed where it was reported that their patients had passed through the theatre during the period. The source of infection was not finally determined, bacteriological examination of family and other close contacts gave indeterminate results. The next case referred to an adult female Islington resident who returned from a holiday in Turkey on 1st September 1970, became ill on the 8th September, and was admitted to an isolation hospital on the same date. Paratyphoid "B" infection was subsequently confirmed. Bacteriological results of domiciliary contacts all proved negative. Their medical practitioners were kept informed. The third case referred to an adult female residing in Islington who returned from a holiday in North Africa and Turkey on the 29th August, 1970. She was confirmed as suffering from paratyphoid "B" Phage type "Taunton" and removed to an isolation hospital on 25th September. The date of onset was reported as being 2nd September. It was ascertained that the patient was a school teacher at an Islington school and that she was on duty until 23rd September. This was brought to the notice of all medical practitioners, so that they could bear this in mind should any schoolchildren, etc., report significant symptoms within the following three weeks. Finally, it was confirmed that her brother, resident in Ireland, who had accompanied her on the holiday was also admitted to hospital suffering from paratyphoid. The other references were for 48 contacts of typhoid and two contacts of paratyphoid all with satisfactory conclusions. DYSENTERY There were one hundred and eighty-three cases notified and 'coming to knowledge' during the year. Of these, one hundred and fifty-two proved positive whilst thirty-one were clinical cases with negative stools. Roughly one-half of the positive cases occurred in June and July, with three day nurseries mainly affected. TUBERCULOSIS In 1970, 102 primary 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 — 1 2 4 12 16 8 8 4 4 60 F - — — 1 — 2 5 3 3 2 3 1 1 21 Non-Pulmonary M — — — — — — 1 5 2 — 1 — 9 F - — — — — 1 2 1 2 4 — 2 — 12 Totals — — 1 1 1 5 11 17 26 16 11 8 5 102 The notification rate of all forms of tuberculosis was 0.45 per 1,000 population as against 0.25 for the whole country. 31 The total number of cases remaining on the register after adjustment for deaths and transfers was, on the 31st December, 1970: Males Females Total Pulmonary 1,018 745 1,763 Non-Pulmonary 118 157 275 Totals 1,136 902 2,038 There were 13 tuberculosis deaths (12 pulmonary and 1 non-pulmonary) during 1970. The death rate of all forms of tuberculosis was 0.06 per 1,000 of the population, as against the national rate of 0.03. Hostel for homeless tuberculous men During the year eight men were discharged from Cromwell Lodge, some to ordinary hostels and some to hospital and, unfortunately, two others died in hospital. Twelve men were admitted and the number in residence at the end of the year was 27 (25). 21 (20) of these were from other London Boroughs. 1(1) Islington man was in residence at Hurlingham Lodge Hostel in the London Borough of Hammersmith. A quarterly case conference (comprising, inter alia, my deputy, Dr. A. K. Arnold and the assistant chest physician, Whittington Hospital) was established to review the continued need for residence in each case with the aim of reducing the waiting list of referrals for admission to the hostel by encouraging a turnover of residents. Over the years the hostel has suffered severely from staff recruitment difficulties, particularly in regard to the assistant warden's post and, to a lesser extent, that of the cook. In fact, in the past four years the post of assistant warden has been occupied for only seven months, despite intensive advertising covering many publications. So it may be said that one of the outstanding events of 1970, in connection with the hostel, was the appointment of an assistant warden in August. However, a few months later he succeeded the warden, who retired after ten years unstinting and invaluable service and, at the end of the year, we were once again faced with the problem of recruiting an assistant warden. Home Visiting — by health visitors Total visits (including contacts, but excluding unsuccessful visits). 2,913 (2,951). Diversional Therapy Total sessions held at Cromwell Lodge Hostel 93½ (125). Total number of visits made to patients in their own homes 1,420 (1,495). 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 The Committee again concentrated on the provision of food and fuel vouchers. 170 patients were given gifts at Christmas and letters of appreciation were received showing how much these were welcomed. Other grants were made during the year to help to cover the urgent needs caused by sudden illness. A telephone was installed on the recommendation of the medical staff for one patient who lived alone. Help was received from the Friends of the Royal Northern and Associated Hospitals, the Friends of Whittington Hospital, the Cloudesley Trust, Benevolent Society of Saint Patrick, Marks and Spencers, other firms in the Borough and many generous folk. The Starliners gave a most enjoyable concert to nearly 700 people at the Town Hall which raised enough money to pay for an outing to Eastbourne for 50 patients. 32 The officers of the Committee were: Mrs. B. Stradling Mrs. M. Ward Dr. H. O. Williams Miss A. Phelps Chairman Vice-Chairman Honorary Treasurer Welfare Officer and Secretary CASES ON ISLINGTON CHEST CLINIC REGISTER No. of definite cases of Tuberculosis on Chest Clinic Register as at 31st December, 1970 Pulmonary Non-Pulmonary Total Adults Children Adults Children Adults Children M F M F M F M F M F M F 709 (795) 421 (475) 49 (48) 50 (55) 71 (65) 87 (88) 4 (5) 3 (4) 780 (860) 508 (563) 53 (53) 53 (59) GRAND TOTAL 1,394 (1,535) VISITING OF NEWLY ARRIVED IMMIGRANTS - YEAR ENDED 31st DECEMBER, 1970 COUNTRY where passport was issued as stated by Port Health Authority Number of advice* notes received during the year from ports and airports relating to arrival of immigrants Number of first† successful visits paid during the yearø [COMMONWEALTH COUNTRIES Caribean 113 119 India 93 82 Pakistan 55 51 Other Asian 51 43 African 183 154 Other 27 25 TOTAL: 522 474 NON-COMMONWEALTH COUNTRIES European 31 31 Other 72 62 TOTAL: 103 93 GRAND TOTAL: 625 567 * Advice of arrival of immigrant. † First successful visit means the first time the local health authority officer established contact with the immigrant. ø These successful visits do not necessarily relate to advice notes received within the same period. It will be seen from the chart that 567 successful visits were paid to immigrant arrivals to the Borough during 1970. These visits were paid by an officer of the former Welfare Department, and I should like to record my thanks to the Director of Social Services. 33 SCABIES AND VERMIN Scabies Vermin Children under 5 years Number treated 64 59 Number of baths given 121 — Number of treatments — 60 I.L.E.A. Children Number treated 125 239 Number of baths given 252 — Number of treatments — 240 Adults Number treated 230 99 Number of baths given 470 — Number of treatments — 101 There was a considerable decrease in the numbers treated for scabies by some 32% in 1970 — 419 compared with 664 in the previous year. The numbers treated for vermin infestations, also showed a decrease from 452 to 397 (12%). • BACTERIOLOGICAL EXAMINATIONS The number of specimens sent to the Public Health Laboratory, County Hall, S.E.1, for bacteriological examination was 4,152. This compared with a total of 5,843 specimens submitted last year. Annual fluctuations are due mainly to the extent of dysentery outbreaks in any particular year. Examinations carried out Total Swabs (Diphtheria) 67 Sputum (Tuberculosis) 5 Faeces & Urine (Enteric Fever) 772 Faeces (Food Poisoning) 592 Faeces (Dysentery) 2,390 Swabs (Streptococci) 8 Other Specimens 318 Total 4,152 VENEREAL DISEASE Social workers employed by the Council are attached to the special clinics at Holloway Prison and the Royal Northern Hospital. The officers attached to the former clinic resigned in September and it was not possible to find a replacement until the end of the year. During the past five years there has been a large increase in the number of new patients seen in the venereal diseases clinic at the Royal Northern Hospital. In 1965 there were 3,375 and this rose to 6,610 in 1970. This rise reflects the national and international pattern of a higher incidence of venereal disease. One of the ways of preventing the spread of venereal disease is by tracing contacts quickly and persuading them to attend for treatment. It is also important to ensure that patients do not cease attending before their treatment is completed. Since March, 1966, a social worker has been attached to the clinic with the responsibility of tracing contacts and getting them to attend for treatment and for following up patients who fail to complete treatment. Because of the increase in the number of patients attending the clinic a second social worker was appointed at the end of November, 1970. 34 Contact tracing is difficult and time consuming because the "clues" given by patients are often very vague. When contacts are local or within the London area they can usually be traced by patience and persistence and the help of colleagues in other Boroughs. Tracing is very difficult when the contact has been a casual "pick-up" in another part of the country, and these persons if infected but untraced and untreated will be responsible for much of the increase in the incidence of venereal disease, though some of them may present as new patients at clinics in their own areas. The efforts being made to increase public awareness of the dangers of sexual promiscuity, of the signs and symptoms of venereal disease and of the necessity of seeking treatment if infected are referred to in the Health Education section of this report. 35 ENVIRONMENTAL HEALTH Air Pollution 43 Consumer Protection 49 Disinfection and Disinfestation 50 Factories & Outwork 51 Food and Diseases of Animals 54 Housing 60 Noise 63 Offices and Shops 63 ENVIRONMENTAL HEALTH On the recommendation of the Council's Organisation and Methods team and following a full review of the decision, the responsibilities of the Public Health Inspectorate and associated administrative section were divided into two major sections; (i) Housing and District, dealing with domestic accommodation — complaints, repairs, improvements, slum clearance and redevelopment; and (ii) Special Services, dealing with commercial and industrial premises — complaints, food and food premises inspection, Offices, Shops and Railway Premises Act inspection, clean air requirements, noise in relation to machinery and public control functions of the department in respect of licensing. Shops Acts and consumer protection. The new organisation presents a far more logical disposition of staff, cuts down on duplication of functions and promotes increased efficiency. This latter factor is one which can be measured by the increased work output from the division since the change took place. In all areas of work the reorganisation has proved beneficial in this respect. The various functions and statistics are listed in this section of the Report and reference is made to Council decisions of major policy and new aspects of work which arose during the year. The registration scheme in respect of multi-occupation, the suspension of 40% of the Borough's Smoke Control Orders and the adoption of a new programme to deal with the Borough's tenement buildings were major decisions taken. The completion of the Borough Survey in the early part of the year allowed its findings to play a major part in redevelopment and future improvement policy, though in a borough like Islington, where the housing scene is one of constant change, any survey has to be subject to constant review to make it valid. The Housing Act, 1969, has now paved the way for the staff of the Housing and District Section to work towards definite goals in respect of the Borough's private housing accommodation. The activities of the Special Services Section will in the future be concentrated on food premises and safeguarding food and drink sold in the Borough. All statutory functions of the division will be maintained and improved upon wherever possible with action in respect of private housing accommodation and food inspection functions being the basis of routine work. INSPECTION AND ENFORCEMENT DUTIES The total of 79,673 inspections made in 1970 by the staff of the division shows an increase of 6,271 on the previous year or 8%. The following tables 1 and 2 summarise the functions and work output of the division during the year. Once again a considerable amount of court work in respect of public health nuisance action and multi-occupation was necessary. It is regrettable that so much of the work of maintaining minimum housing standards has to be enforced in this manner by legal proceedings, rather than by agreement. MANUAL WORKERS STRIKE The six weeks' strike of a large number of the Council's manual workers in the autumn of 1970 placed a considerable strain on other Council resources. The absence of a refuse collection service was particularly difficult as it resulted in many extra complaints being made to the department, particularly where smell and fly nuisance was being suffered. By use of the Public Health Notice procedure, in liaison with the Strike Committee, accumulations of refuse causing serious nuisance were removed, but not without some delays. Extra attention to accumulations were given, particularly over the Guy Fawkes night period when patrols of staff co-operated with Police and Fire Brigade to ensure that no serious fire situations occured. WATER SUPPLY The Metropolitan Water Board are the responsible authority for water supplies in this area. The supply for the Borough of Islington was satisfactory both as regards quality and quantity in 1970. No artificial fluoride is being added to supplies. 39 40 41 TABLE 1 Inspection and Enforcement Action Inspections and Visits NOTICES Formal SERVED Informal Prosecutions Work in Default Properties and Premises Repaired or Improved (a) HOUSING AND DISTRICT Housing - Slum Clearance, repairs, improvements, redevelopment. Means of escape in case of fire. 21,691 1,153 941 82 11 921 Housing - Public Health action, drainage, refuse collection, pests, domestic noise and general nuisances. 27,277 1,609 2,032 46 284 2,192 (b) SPECIAL SERVICES Food & Drugs - Food premises, markets, stalls and delivery vehicles, sampling, meat and poultry inspection. 10,117 — 277 25 — — Offices, Shops & Railway Premises Act 1963. 4,066 — 352 - — — Air Pollution and Factories - smoke observations, surveys, complaints, pollution volume measurements. Factories Act 1961, industrial noise 5,907 — 285 — — — Public Control functions - Shops Acts, licensing, consumer protection, fertilizers and feeding stuffs, sampling. 10,615 — — 9 — — TOTALS 79,673 2762 3,887 162 295 3,113 42 TABLE 2 MEAT INSPECTION REGULATIONS 1963/1966 CARCASES AND OFFAL INSPECTED AND CONDEMNED IN WHOLE OR IN PART PERIOD AT PREMISES OF MESSRS. HARRISON, BARBER & CO. LTD., 180 YORK WAY, N.I. 1st January-30th June 1970 Cattle excluding cows Cows Calves Sheep and Lambs Pigs Horses Number killed — — — 15 — 143 Number inspected — — — 15 — 143 All diseases except Tuberculosis and Cysticercus Bovis Whole carcases condemned — — — — — — Carcases of which some part or organ was condemned — — - 9 — 66 Percentage of the number inspected affected with disease other than tuberculosis and cysticercus bovis — — — 60% — 46% Tuberculosis only: Whole carcases condemned — — — — — — Carcases of which some part or organ was condemned — — — — — — Percentage of the number inspected affected with tuberculosis — — — — — — Cysticercus Bovis Carcases of which some part or organ was condemned — — — — — — Carcases submitted to treatment by refrigeration — — — — — — Generalised and totally condemned — — — — — — SEWERAGE AND SEWAGE DISPOSAL No difficulties were encountered during the year arising from major defects in the Borough's sewer system. AIR POLLUTION DOMESTIC SMOKE CONTROL It is regrettable to have to report that, one year after the Borough became completely smoke controlled, the availability of solid smokeless fuels situation deteriorated to such an extent that Islington, like the majority of other London Boroughs, found it necessary to suspend orders relating to approximately 40% of its property. It was estimated that the solid smokeless fuel appliances in use within the Borough amounted to only about 4% of appliances used. However, in view of the advice received from the Society of Coal Merchants, the Ministry of Housing and Local Government and the London Boroughs Association, the Council decided that it could not sustain the risk of even a very small number of residents being without fuel supplies that might otherwise be available if smoke control was relaxed to some extent. It is hoped that the present situation will be short-lived as it has taken a great deal of effort since the Clean Air Act 1956 to achieve complete smoke control. In the short term there is no likelihood of the return of the notorious London Smogs, but any lengthy suspension of smoke control must mean that the resolve of all concerned to achieve cleaner and healthier surroundings by the absence of air pollution is weakened and thereby the whole clean air programme is prejudiced. CHROMIUM CONTAMINATION As a result of complaints received from residents living in an area in which their houses back on to a metal plating works, samples of foliage and leaves from vegetables growing in the gardens were sent to the public analyst. The examination of the leaves indicated the presence of some chromium contamination. A public health inspector met the alkali inspector at the factory and on his advice the firm were asked to carry out works which included the addition of water sprays to the three existing scrubbing plants. To control the process, it is intended to take further samples from time to time. DEMOLITION SITES With the vast amount of demolition work being carried on in this Borough, the burning of old timber and other waste material can become a serious smoke nuisance if not frequently checked. Public health inspectors now make themselves aware of all demolition work due to start, to meet the demolition contractors, and visit the sites often to ensure that the work is being carried out reasonably. INDUSTRIAL AND COMMERCIAL CONTROL The following are the number of notifications and applications received during the year in respect of new furnace installations and chimneys: — Clean Air Act, 1956. Section 3 (1) Notifications of installation of furnaces (over 55,000 BTU's) = 15 Clean Air Act, 1956. Section 3 (3) Applications for prior approval of installation of furnaces (all approved) = 8 Clean Air Act, 1968. Section 6 Application for approval of chimney heights (all approved) = 8 43 44 SMOKE NUISANCES A number of smoke nuisances arose from metal dealers coming into the Borough and burning off quantities of copper covered cable, etc., on waste and cleared sites and disused railway yards. Action was taken where offenders could be traced and constant vigilance is necessary on these sites to prevent such occurrences happening. MEASUREMENT OF AIR POLLUTION The measurement of smoke and sulphur dioxide proceeded at three sites, with a fourth being operated by the Greater London Council at Hillside, St. John's Way, N.19. A fifth site is also maintained by St. Bartholomew's Hospital Medical School in Charterhouse Square, E.C.1. The average monthly pollution figures for the whole Borough are shown in the form of two block graphs, comparison being made with figures for 1969. 45 46 47 AVERAGE MONTHLY SMOKE CONCENTRATIONS 48 ATMOSPHERIC LEAD CONTAMINATION - UPPER STREET All grades of petrol as sold today at garages contain additive materials such as tetra-ethyl or tetra-methyl, lead organo-metallic agents which are successful in preventing "knock" in high compression engines. In order to ascertain whether there was any danger to residents or persons continually working in the Upper Street area, by inhaling lead or absorbing lead by ingestion an investigation was started in 1968. An 8 port valve smoke recording instrument was set up on the second floor of the departments offices facing Upper Street — a busy main road — and the daily filter paper stains were sent each month to the public analyst. The table below shows the result of this three-year exercise. It indicates that there does not appear to be any danger to inhabitants of this borough from atmospheric lead contamination bearing in mind the Technical Report of California Standards for Ambient Air Quality (State of California 1960) which suggested an estimated standard of six microgrammes per cubic metre as a permissible maximum: — AVERAGE LEAD CONTENT IN MICROGRAMMES PER CUBIC METRE OF AIR 1968 1969 1970 January 1.3 1.18 0.71 February 0.9 0.89 0.57 March 0.85 0.48 0.64 April 0.85 0.54 0.83 May 0.74 0.47 0.65 June 0.49 0.36 0.50 July 0.52 0.46 0.95 August 0.20 0.41 0.84 September 0.21 0.70 0.75 October 1.04 1.58 1.10 November 1.14 0.77 0.97 December 1.05 0.58 1.50 FUMES FROM BARNSBURY TRAFFIC SCHEME When the Barnsbury Traffic Scheme came into operation, Batchelor Street became a one-way Street and a complaint was received from a resident that the increased exhaust fumes given off from the motor vehicles could be harmful to health. The scientific branch of the Greater London Council was approached and agreed to measure the concentration of the two major pollutants, smoke and carbon monoxide, for a week from a sampling point eight feet above pavement level at the face of 32 Batchelor Street. The results showed carbon monoxide concentrations to be low, usually between 0 and 5 p.p.m. (parts per million by volume), and the highest value recorded was 10 p.p.m.,on the evening of Friday, 16th October. Daily averages of smoke varied from 40 microgrammes of equivalent standard urban smoke per cubic metre on Monday 19th October, to 270 microgrammes per cubic metre on Saturday 17th October. Both the pollutants measured are emitted in greater quantities from chimneys and are present in the atmosphere as a general background concentration. In the opinion of the Scientific Advisor, the fumes from traffic at 32 Batchelor Street gave little cause for complaint. 49 CONSUMER PROTECTION AND PUBLIC CONTROL These functions are concerned with conditions of employment, closing hours and exemption orders under the Shops Act 1950 and related legislation, licensing or registration requirements of premises and sampling of materials on sale to the public. Explosive Acts 1875 and 1923 Fireworks Act 1951 The Keeping of Fireworks Order 1959 Premises registered: 152 London County Council (General Powers) Acts 1920 and 1921 Employment Agencies Massage or Special Treatment Establishments Premises licensed: 56 13 Theatrical Employers Registration Acts 1925 - 1928 Performing Animals Act 1925 Registered employers: 44 Current registrations: Nil Celluloid & Cinematograph Film Act 1922 Premises used for storage: 1 Nurses Agencies Act 1957 Premises licensed: 2 Public Health Act 1936 Nursing Homes Act 1936 Mental Health Act 1959 Pharmacy 8t Poisons Act 1933 Nursing Homes registered: 1 Listed sellers of Hart II Poisons other than pharmacists: 112 Registrations during the year: 1 Premises licensed: 14 Pet Animals Act 1951 Rag Flock & Other Filling Materials Act 1951 Premises on register as upholsterers: 32 Greater London Council (General Powers) Act 1967. Hairdressers and Barbers Premises registered: 233 Registrations during year: 6 Sampling Functions Fertilizers & Feeding Stuffs Act 1926 Samples taken: 8 Consumer Protection Act 1961 Toys (Safety) Regulations 1967 Nightdresses (Safety) Regulations 1967 Samples taken: 23 1 Total 24 Rag Flock and other Filling Materials No samples taken due to the Prescribed Analysts not accepting samples because of low fees. ENFORCEMENT Five successful prosecutions were instituted against shopkeepers during the year for contraventions of the Explosives Act 1875. Three of these were for selling fireworks to children under thirteen years of age and two for the improper storage of fireworks. 50 One shopkeeper was successfully prosecuted for selling an adults nightdress which did not comply with the Nightdresses (Safety) Regulations 1967, because there was no label, warning that it should be kept away from fire. There were a number of minor infringements of statutory provisions during the year and these were dealt with successfully by informal action. Some difficulty has been experienced during the year due to the high lead contents in paint on toys and toys containing cellulose nitrate (celluloid) imported from China and Japan. The lead contents were above the maximum limits set by the Toy (Safety) Regulations 1967 and cellulose nitrate is not permitted in toys (with the exception of "ping pong" balls). This matter is still actively being pursued. The current trend towards the enactment of further safety provisions in Consumer Protection legislation will mean an increased interest in this field of work by the Council. DISINFECTION AND DISINFESTATION DISINFECTION Infectious Disease Rooms treated 247 Clothing for export Staff of the department supervised the disinfection by formaldehyde gas of clothing for export. Visits Clothing treated on factory site at disinfecting station 4 2.2 tons 8.5 tons DISINFESTATION Rats and Mice Although the total number of complaints of rodent infestations during the year rose from 3,095 in 1969 to 3,576, there has been a reduction in complaints of rats. The continued upward trend in complaints of mice infestations once again illustrates the lack of a suitable alternative all purpose rodenticide to replace Warfarin, to which the mice have unfortunately, become largely resistant. Rodent Complaints Domestic Business Local Authority Rats 748 (35) 153 (-) 88 (2) Mice 1969 (125) 408 (17) 27 (4) Total 2717(160) 561(17) 115(6) Figures in brackets are repeat complaints. There were 19,526 visits made by rodent operatives dealing with infestations. 30 smoke tests of suspected defective drains were carried out and there were two treatments of sewers. Vermin Pigeons Treatments by authorised catcher 11 Rooms treated 1870 51 Pigeons Treatments by authorised catcher 11 FACTORIES AND OUTWORK Industrial activities in the Borough include the following: — Clothing Cigarettes Optical lenses and spectacles Thermometers Book binding Handbags General leather goods Footwear Furniture and Upholstery Joinery and Wood Turning Iron Foundry Light Engineering Clock Making Watch Repairs Television and Radio Engraving Silversmiths Metal Plating, Polishing and Spinning Sheet Metal Works Wire Works Breweries and Distilleries Food Druggists and Chemists Furriers Soft Furnishings Electrical Appliances Cellulose Spraying Plastic Injection Moulding General Printing Lithographic and Silk Screen Printing Printing Ink Rubber Stamps Brushes Artificial Flowers Jewel Cases Motor Vehicle Repairs Pottery Laundries and Dry Cleaning Tents FACTORIES ACT 1961 Routine inspections and revisits were carried out under the Factories Act and the Sanitary Accommodation Regulations during the year. In appropriate cases technical advice was given to manufacturers concerning fumes arising from various processes, including paint spraying, with a view to the prevention of nuisances. 52 1 — INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises (1) Number on Register (2) Number of Inspections (3) Written notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by Local Authorities. 25 134 280 - (ii) Factories not included in (i) in which section 7 is enforced by the Local Authority. 2152 1015 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises). 61 132 - Total 2238 1281 280 - Defects were found in the following cases. No prosecutions were instituted. Particulars (1) Number of cases in which defects were found Number of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Referred To HM Inspector (4) By HM Inspector (5) Want of cleanliness (S.1) — — — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 109 80 1 (b) Unsuitable or defective 675 527 — 11 — (c) Not separate for sexes 17 13 — 1 — Other offences against the Act (not including offences relating to Outwork). 2 2 2 — — Total 803 622 2 13 — 53 Basement Bakehouses (Section 70) There are nine basement bakehouses remaining in the Borough, and apart from the routine inspections under Food (General) Regulations 1960, it is the duty of the Council to examine these bakehouses every fifth year in accordance with Section 70 of the Factories Act, 1961. Certificates of suitability were issued during the year. Basement Bakehouses in the Borough: 146 Blackstock Road, N.4 3 Cardwell Terrace, N.7 123 Newington Green Road, N.5 76 Caledonian Road, N.1 59 Junction Road, N.19 7 Junction Road, N.19 2 Tysoe Street, E.C.1 88 Farringdon Road, E.C.1 44 Amwell Street, E.C.1 G. C. Mull & Company, Limited E. Oliver F. Hahn W. J. Baker W. J. McCandless M. A. Ranee & Company D. L. Crisp D. L. Crisp D. L. Crisp Outwork (Sections 133 and 134) Visits were made to the homes of persons notified as outworkers. In no case was it found that work was being undertaken in unwholesome premises. The types of outwork and number of workers were as follows:— Wearing Apparel-Making etc.. Cleaning and Washing: 869 Making up, ornamenting, finishing and repairing of table linen, bed linen or other household linen (including in the term linen, articles of cotton, or cotton and linen mixtures): 31 Cabinet and furniture making and upholstery work: 2 Manufacture of brass and of any articles or parts of articles of brass (including in the term brass any alloy or compound of copper with zinc or tin): 12 Making or repairing of umbrellas, sunshades, parasols, or parts thereof: 28 Making of artificial flowers: 43 Making of tents: 1 Making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material: 86 Making of brushes: 1 Carding, boxing or packeting of buttons, hooks and eyes, pins and hair pins: 19 Making of stuffed toys: 4 The making or filling of cosaques, Christmas crackers, Christmas stockings or similar articles or parts of articles: 9 Not specified: 30 Total 1,135 54 Offensive Trades There are still four offensive trades operating in the Borough, vizi- Tripe Boiler Fat Melter Fur Skin Dresser Gut Scraper J. L. Henson Limited, 26/40 Vale Royal, N.7 J. L. Henson Limited, 26/40 Vale Royal, N.7 J. A. Fischer Limited, 440A Hornsey Road, N.19 Tracey & Company Limited, 5 Tileyard Road, N.7 Routine inspections were carried out during the year. RADIOACTIVE SUBSTANCES ACT 1960 This Act came into operation on the 1st December, 1963, to regulate the keeping and use of radioactive material. Persons who keep or use radioactive material are required to register with the Department of the Environment and to obtain authorisation from the Secretary of State for the keeping of radioactive material and the disposal of radioactive waste; certificates of registration are issued. Subject to national security considerations, the Secretary of State is required to send copies of the certificates to local authorities of the area concerned. A general register is kept in the Department, 23 premises being listed. FOOD AND DISEASES OF ANIMALS FOOD AND DRUGS PREMISES Following the reorganisation of the Public Health Inspectorate and the creation of the new Special Services Section in September, a close examination of statistics was made in relation to the new working areas set up. As a result, the following is now the up-to-date list of all known food premises within the Borough. Bakehouses 34 Bakers 36 Butchers 134 Confectioners 221 Fried Fish Shops 54 Fish Curers 11 Fishmongers 11 Greengrocers & Fruiterers 106 Grocery & Provision Shops 352 Wholesale Stores 68 Food Factories 30 Public Houses 296 Off Licences 47 Catering Establishments 402 Canteens 67 Schools, etc. 85 Local Authority Establishments 27 Total 1981 Routine inspections continued during the year and, in respect of premises needing special attention, either because of the type of food handling carried out or because of the low standard found in operation previously, increased supervision by way of extra visits was made. 55 A total of 214 Notices under the Food Hygiene (General) Regulations 1960 was served and the following prosecutions instituted:— (1) Food premises insanitary; food not protected from contamination; food premises infested with mice. £25 Fine on each Summons and £5 Costs Total £80. (2) Absence of a sink for washing food or equipment £10 Fine, £2 Costs. At the end of the year a number of Food Hygiene offences were in the hands of the Director of Legal and Administrative Services, most of which were awaiting dates for hearing at the Magistrates' Court. REGISTRATION AND LICENSING The following premises were subject to inspection during the year in connection with legislation relating to Registration and Licensing. Ice Cream Premises There are a number of premises in which ice cream is manufactured in this Borough and these received constant supervision during the year. During 1970, 51 inspections were made. The total number of premises registered for the manufacture and/or the sale and storage of ice cream is 679. Preserved Food Premises Premises registered for preparation or preservation of food 208 Premises registered as Fish Fryers/Fish Curers 68 Milk (Special Designation) Regulations 1963, (as amended) Number of licences in force 378 Milk and Dairies (General) Regulations 1959 Number of dairies registered in the Borough 10 Number of distributors registered in the Borough 373 383 Slaughterhouses Act 1958 and Slaughter of Animals Act 1958 The small private slaughterhouse situated within the Borough closed during the year and the relevant licence was not renewed. Similarly, slaughtermen's licences which expired were not renewed. LEGAL PROCEEDINGS The following are details of prosecutions during the year under the Food and Drugs Act 1955 or Regulations made under the Act. Food and Drugs Act 1955, Section 6 — False Labelling of Food A description "cochineal flavour" falsely described the product. Fine £10 — Costs £5. Soft Drinks Regulations 1964 A soft drink described as "grape soda" did not contain any derivative of grapes. Fine £25 — Costs £10 56 Preservative in Food Regulations 1962 A hot sauce contained a non-permitted preservative. Fine £10 — Costs £5.25 Complaints Complaints relating either to the unfitness of food or the fact that the food contained some foreign matter were received in 83 instances during 1970. All the complaints were investigated and the following prosecutions were instituted. Offence Iron bolt in a bun loaf Bacon infested with live fly maggots Mouldy steak and kidney pie Mouldy pork pie Dirty milk bottle Mouldy steak and kidney pie Rust on inside of cans containing chicken curry ditto Chips with a cigarette end Mouse gnawed loaf Match-stick in sausages Costs £30 Fine — £10 Costs £20 Fine — £2 Costs £10 Fine— £2 Costs £10 Fine— £5 Costs £10 Fine— £5 Costs £10 Fine— £7 Costs £8 Fine — £5 Costs £7 Fine — No Costs £7 Fine — £5 Costs £20 Fine — £6 Costs £25 Fine — £10.50 Costs SAMPLING This is sub-divided into two categories, viz., bacteriological and chemical. In the first case, checks are being made on the cleanliness of the food to establish if it is either free from or infected with pathogens. In the second category the examination is with a view to establishing that the contents of the food are as the purchaser considers it to be at the time of buying. The analysis therefore compares the constituents found in this food with those known to be in a similar food type, the description of the food on the container and the advertisement that may accompany it to ensure that the purchaser is getting exactly what he or she wants. (a) Bacteriological i. Ice Cream Thirty samples of ice cream were sent for bacteriological examination during the year, of which one was a water ice which was satisfactory. Of the remaining 29 samples, eight were taken as 'follow-up' samples after unsatisfactory results. The classification from the laboratory gives an indication of the ice cream's quality, ice cream falling within Grade I and II, being regarded as satisfactory. The samples taken were graded as follows: — Grade I 12 Grade II 5 Grade III 2 Grade IV 10 In most cases samples taken are from manufacturers within the Borough and if unsatisfactory results occur re-visits are made and advice given. The products are re-sampled at a later date and the results re-assessed. ii. Cream Two samples of cream which were known not to be heat treated were taken during the year. In both cases the Brucella organism was not isolated. 57 iii. Other Foods Other foods were sampled bacteriologically, generally in connection with a complaint or as part of a food poisoning investigation. The results of these samples were as follows:— Product Result Can of salmon at 37°C. for three to four days remained sterile. Portion of cooked chicken no staphylococcus aureus isolated. Complete meal (boiled bacon, no staphylococcus aureus isolated, no carrots, dumplings and salmonella, no Clostridium welchii. mashed potatoes) Fresh cream bun staphylococcus aureus present in 1 gram. Pork sausage meat no salmonella isolated. Pork sausages no salmonella isolated. Investigations were carried out to ascertain the origin of the contamination of the fresh cream bun and representations were made to both manufacturer and retailer. (b) Chemical In order that an overall check can be kept on food sold within the Borough, food is purchased as the housewife would buy it. These informal purchases, which numbered 738 in 1970, are submitted for analysis by the Public Analyst. Products which receive adverse reports are then formally sampled under the provisions of the Food and Drugs Act 1955. Formal samples totalled 15. As in previous years, many adverse reports referred to labelling. This aspect must continue to be given constant attention. Details of the samples are given below: — Informal purchases 738 Adverse 53 Formal samples 15 Adverse 1 Of the adverse reports, 29 related to labelling deficiencies, the others related to excess preservatives, excess metals, excess water in milk, insufficient fat in cheese and excess water in butter. One product, in particular, proved most interesting. It involved a ton of black-eye beans which were found to contain 300 parts per million of DDT. The entire consignment was voluntarily surrendered and the matter taken up with the Department of Health and Social Security and the Cyprus High Commission. As a check on residual insecticide levels, seven samples were taken during the year. These were a pheasant, strawberries, cherries, Worcester apples, grapes, tangerines, and tomatoes. In all cases the levels found were within the limit recognised as being safe. UNFIT FOOD During the year the total amount of unfit food voluntarily surrendered was: — Description Tons Cwts. Qtrs. Lbs. Canned goods 13 5 0 23 Fruit and vegetables 1 9 1 10 Meat 5 3 2 24 Meat Products 1 3 0 8 Fish 6 6 3 16 Cereals 3 9 3 10 Frozen Food 4 8 2 23 Others 9 10 1 18 Total 44 17 0 20 58 886 voluntary surrender certificates were issued and 296 inspections or visits were necessary in connection with this work. Surrendered food was removed, in general, by the Council and disposed of at the Ashburton Grove Depot. From here it was conveyed under supervision to the refuse tip. A firm specialising in animal feeding stuffs was also employed when the surrendered product could be used in this way. GREATER LONDON COUNCIL (GENERAL POWERS) ACT, 1968 - PART VIII - NIGHT CAFES During 1970 the first year of Registration of Night Cafes was completed. All premises which serve food or drink after 11 p.m. subject to certain exceptions, have to be registered as Night Cafes. This means of control has reduced the number of premises of this description in the Borough. The Public Health Inspectors have continued to inspect registered premises both during normal hours and at night. As a result, legal proceedings were instituted in three instances, the premises being open after 11 p.m. without a valid Certificate of Registration being in force. This resulted in Fines totalling £25 and Costs of £6. The following is a list of applications etc. received during 1970. Applications made, but not finalised at the end of 1969 28 Applications received, 1970 57 85 Applications granted or renewed,1970 59 Applications refused, 1970 14 Applications withdrawn,1970 4 Applications pending, carried forward to 1971 8 85~ Premises registered at the 31st December, 1970 43 LATE NIGHT REFRESHMENT HOUSES ACT 1969 In some cases proprietors selling food and drink for consumption on the premises wished to remain open after 10 p.m. but desired to restrict their hours so as not to become Night Cafes. Such premises must hold a Late Night Refreshment House Licence. At the 31st December, 1970, 49 premises were licenced. One prosecution was taken during 1970 under the parent Act, Refreshment Houses Act, 1860 (as amended), resulting in a fine of £10 and Costs of £2. STREET MARKETS The inspection of the stalls selling food throughout the Borough has continued during the year, the Inspectors making regular visits to the main street market areas. This included routine inspections on Saturdays and Sundays. 63 Notices were served under the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 and revisits were made to ensure compliance. 15 Summonses were issued under the Regulations for various offences and these resulted in Fines totalling £65 and Costs of £19. Tribute must be paid to the stall holders in the main markets for their work during the Refuse Strike. Clearance of refuse was organised by the traders themselves and the markets were kept in extremely good condition despite all the difficulties encountered. 59 MEAT INSPECTION In the area of the Borough adjoining the Smithfield Meat Market, there is a large number of wholesale butchers and associated trades, as follows: — Wholesale butchers, including offal and poultry dealers 27 Wholesale bacon factories 7 Sausage casing factories 8 Wholesale provision warehouses 6 Public cold air stores 3 The Senior Meat Inspector is engaged full-time in seeing that no diseased or unsound meat is passed on to the public. During the year, 1568 certificates were issued in respect of unsound meat and other foods and 328 health certificates were issued for the export of meat etc., to overseas countries. The Imported Food Regulations 1968 permit the officer at the port of entry to allow any imported meat etc., to be removed, unexamined, to an inland authority who is then responsible for carrying out this examination under the Regulations. During 1970, 156 such notifications were received, mostly in respect of large containers of meat and offals, consigned from the Continent and Eire. The collection of unsound meat and other foodstuffs continues to be carried out by a Council contractor who renders down this unsound food for non-edible purposes. During 1970, the Senior Meat Inspector condemned or had surrendered to him the following:— Tons Cwts. Qtrs. Lbs. Meat (diseased) 3 1 0 5 Meat (unsound) 22 5 0 27 Bacon 5 17 0 18 Offals (diseased and unsound) 13 1 1 4 Poultry 2 5 3 9 Game 0 10 0 26 Rabbits 0 8 1 9 Canned Foodstuffs 7 15 2 20 Miscellaneous 4 6 1 11 Total 59 11 0 17 DISEASES OF ANIMALS ACT, 1950 AND ALLIED LEGISLATION The Veterinary Officer of the Corporation of the City of London continued to implement this legislation by arrangement with the Council and liaison was maintained with the Health Department. Visits were made to Chapel Market in connection with the possible sale of live poultry. In addition, inspections were carried out at the two Kosher poulterers and the slaughterhouse up to the time of its closure. In May it was reported that a monkey belonging to a resident had died and was suspected of having rabies. Action was taken under the Rabies Order 1938, and other animals in the same house and two other houses were restricted by notice. This was later withdrawn as a post mortem carried out at the London Zoo was negative for rabies. Under the terms of the Animals (Miscellaneous Provisions) Order, 1927, the following Orders were advertised in the national press:— Export of Horses (Excepted Cases) Order, 1969. Export of Horses (Protection) Order, 1969. 60 HOUSING HOUSING ACT 1969 This Act, which became operative on 25th August 1969, is a major piece of legislation which may eventually have more impact on the private housing scene than any previously passed. The increase in ceiling for Improvement Grants from £400 to £1,000, the introduction of special grants in respect of shared facilities and the prospect of increased rents has considerably changed the thinking in the private housing field from, in many cases, a resigned attitude to property deterioration to a determined effort to preserve. The introduction of Conservation Areas by the Civic Amenities Act 1967, has given further stimulus to the desire to preserve property but unfortunately it is not yet clear as to the viability of the principle of the General Improvement Area under the Housing Act, 1969, in areas of Inner London, where so much property is in multi occupation and so many problems have to be resolved in converting shared accommodation into self-contained units. It is hoped that General Improvement Areas can prove a practical answer to the amenity aspects of both the environment and the accommodation in twilight areas, but at this early stage it would appear that the lack of compulsory power to effect improvements and the amount of officer time required to get schemes off the ground provide substantial disadvantages. The regulatory powers of control of multi-occupation contained in the new Act, combined with the approach that in respect of multi-occupied houses the Council can enforce its statutory powers to effect improvements, stand a far greater chance of success in this type of property, especially now that the availability of a variety of grants provides owners with alternative solutions. This method of approach has been adopted by the Council to be used in the application of its registration scheme. The basic purposes of the scheme adopted are that registration should control the present number of multi-occupied properties, estimated at 20,000, and that over a period of fifteen years the scheme should substantially raise in standard the properties that will remain in multi-occupation at the end of that time — estimated at 9,000. Before the end of the year, work was commenced on a pilot scheme in an area of approximately 100 houses in Highbury. This was with a view to seeing what degree of success would be forthcoming to the informal approach to house owners on improvement, using our statutory powers if necessary if this should prove unsuccessful. It is hoped that Registration may act as an inducement to owners to improve. Early indications are promising so that later in 1971, after Ministry approval of the full Registration Scheme, extensions of this type of approach will be possible. SLUM CLEARANCE PROGRAMME 1966-1970 The above five year programme has been undertaken jointly by the London Borough of Islington and the Greater London Council. During 1970, that part of the programme which fell to be dealt with by the Borough, was completed insofar as representation and making orders was concerned. During the year representation and compulsory purchase orders were made in respect of six Areas, comprising 212 houses and flats involving 320 families. These areas were: — Carlton & Pembroke Houses 30 dwellings 30 families Eden Grove 3 houses 12 families Burder Road 70 houses 108 families Hornsey Road (1) 30 dwellings 32 families Coombes Street 8 houses 11 families Hemingford Road 71 houses 127 families Two of these areas, Carlton and Pembroke Houses and Hornsey Road (No. 1), had previously been allocated to the Greater London Council but it subsequently was agreed that this authority should deal 61 with these. In one other case, Hemingford Road, an area already represented by the Greater London Council, was enlarged by the addition of an area in the 1971 — 1975 programme, and a fresh representation was made of the whole area. There was one further area, Coombes Street, from the 1971 — 1975, programme which was represented in order to permit early redevelopment. PROPOSED SLUM CLEARANCE PROGRAMME 1971 - 1975 As the 1966-1970 Programme neared completion, the proposed programme for the period 1971-1975 was prepared. This provisional programme which was based on the information obtained in the Borough Survey carried out in 1969, was submitted to the Town Planning and Development Committee, in July 1970. The programme is comprised of 812 dwellings and at the end of the year the statutory consultation required with the Greater London Council was still continuing as to the division of responsibilities for the representation concerned. The properties will be dealt with over the years 1971-1974 inclusive, leaving 1975 as a year for amendment and completion. The provisional programming will be based on known priorities and those which arise later. Each area will receive a detailed inspection and will be the subject of individual reports of the Committee at the representation stage. As in previous years, it is anticipated that some properties will be acquired by agreement when the Council is interested in the site for housing development purposes and where the number of unfit houses is small in relation to the number of houses in the development area. Property not dealt with by purchase by agreement will be subject to Compulsory Purchase Orders, or in the case of particularly small sites by Clearance Order proceedings where the Council has no use for the land. 62 INDIVIDUAL UNFIT DWELLINGS During 1970, 19 houses were represented as unfit for habitation and not repairable at reasonable expense. Similarly, 106 basements and parts of buildings were represented with a view to Closing Orders being applied. The number of Closing Orders determined during the year, after dwellings had been made fit, was 18. TENEMENT DWELLINGS The Housing Act 1969, increased considerably the grants available for improvement and as a result the general policy for dealing with Tenement Blocks was reviewed. A list of all the known tenements in the Borough was prepared and the tenements classified according to their existing condition. These classifications are:— (A) To be dealt with by the Borough Council. (B) To be dealt with by the Greater London Council. (1) At a reasonable modern standard. (2a) Should be improved. (2b) Because of layout, high decant and economic objections, should not be improved but could provide reasonable accommodation for the time being. (3) Should be demolished by Greater London Council or Islington Borough Council action. Categories 2a and 2b are the critical ones as depending on action taken the property can either provide suitable accommodation or deteriorate until Slum Clearance procedure is inevitable. To consider these blocks in detail and to instigate action, a Working Party of Officers from the various interested departments has been set up to consider the blocks on a priority basis. Each property is being appraised and the owner's views obtained. Schemes are being prepared and reports submitted to the Committee, together with a recommended course of action. The first meeting of the Working Party of Officers was held on the 20th October, 1970. Preliminary discussions have taken place with the Greater London Council on their part of the tenement programme to ensure that all substandard tenements are expeditiously dealt with. 1975 is the target date which has been set for the completion of the tenement programme. IMPROVEMENT AREAS - HOUSING ACT, 1964 No improvement areas under the above Act were declared in the year. The Housing Act 1969, which came into force in the middle of the year repealed the provisions for the declaration of such areas, but introduced procedures for General Improvement Areas. The high degree of multi-occupation in the Borough does not lend itself easily to large scale use of these provisions, but modified use of the procedures is now being considered in co-operation with the Director of Development. The use of statutory powers to deal with the houses in multiple-occupation is being vigorously pursued and it is hoped that this action can be related to substantial improvement work so that such houses will not only conform to the legal requirements, but provide fully satisfactory units of accommodation in future. MEANS OF ESCAPE IN CASE OF FIRE Systematic inspection within selected areas of houses in multiple-occupation was continued by Fire Inspectors working under the Housing Act, 1961 (Section 16), to obtain satisfactory means of escape from fire. This action was concentrated in the northern part of the Borough. Other areas within the Borough are also being inspected in conjunction with the Public Health Inspectors with a view to joint action under Housing Act, 1961 (Sections 15 & 16), to obtain increased facilities and means of escape from fire. 63 One fatality by fire was reported, in a property which had previously been dealt with under Section 16 of the Act. In this case, the door of a basement separation, previously rendered self-closing, was left in the open position and allowed fire to spread from the basement into the staircase enclosure, trapping persons on the top floor. Unfortunately, there is no provision in the Housing Act 1961, whereby failure to maintain means of escape constitutes an offence. Premises occupied by persons applying to be registered as Child Minders and Play Groups were inspected, and in most cases the Inspector was able to recommend registration subject to providing safeguards. Properties for which application for mortgage or grants are made are also inspected and recommendations made for means of escape to the Borough Valuer. Prior to 1961, Means of Escape from Fire in residential premises was dealt with by the London County Council, under the provisions of Section 35 of the London Building Acts (Amendment) Act 1939. Although this section remains in force it has been largely superseded by the Housing Acts 1961 to 1969, which give greater control over this type of premises. In 1965, the Greater London Council delegated certain of its powers to the Boroughs to enable them to deal with conversions of residential buildings into flats, subject to compliance with the Greater London Council Code, or after consultation with that Council. This work has been carried out by the Borough Planning Officer, and during the past year assistance has been given by this Department's Fire Inspectors in many cases. On the 15th December, 1970 the Council approved the transfer of the work under Section 35 of the London Building Acts (Amendment) Act, 1939 in respect of residential premises to this Department. Between that date and the end of the year, six cases have been dealt with. NOISE NOISE ABATEMENT ACT 1960 93 complaints concerning noise were received during the year. All were investigated and action taken to abate the nuisances which related to 36 industrial premises, 33 domestic and 24 commercial premises. The complaints in question included noise from pneumatic road drills, extract fans, compressors, industrial works, garages, laundrettes and amplified music from clubs. A typical complaint was that of noise from the exhaust fans of a metal plating works operating at night in respect of which a formal notice was served in accordance with the Noise Abatement Act. Extensive investigations were carried out by Public Health Inspectors and several noise level measurements were taken of individual fans and combinations of fans in operation as well as the ambient noise. This involved a number of visits by day and night. As a result of the conclusions arrived at, the firm undertook to operate not more than two of the fans at night thus mitigating the nuisance. Another case investigated by the Department, was a complaint of loud noise emanating from premises being used without planning permission by an organisation as a "commune" which included a cultural centre. The cultural activities were varied and included musical sessions which ranged from a single instrument, followed by an instructional discussion to "pop sessions" which extended late into the night and early hours of the morning. The occurrence of noise was not consistent in its frequency as the Centre was used for practice sessions any evening or occasionally during the day. This entailed many late evening visits by the Inspectors to build up a case relating to frequency, volume and times. Eventually, a Notice was served under the Noise Abatement Act and the Public Health (Recurring Nuisances) Act, 1969, and subsequent to meetings with leaders of the commune, activities ceased pending the decision on a planning application. OFFICES AND SHOPS The Offices, Shops and Railway Premises Act, 1963 and the associated Regulations protect the safety. 64 health and welfare of employees in certain classified premises. There are approximately 59,000 persons employed within the Borough in premises to which the Act applies. This is an increase of approximately 6,500 persons on last year's figure, due mainly to the establishment of the Post Office as a public authority, bringing staff the the Mount Pleasant Post Office, within the scope of the Act. The majority of premises to which the Act applies were registered by 1967 and, since then, there has been a continued decrease in the number of persons employed in retail shops, wholesale departments and warehouses and catering establishments open to the public. ACCIDENTS An accident occurring on premises subject to the Act must be notified to the enforcing authority where such accident results in death of a person or in his absence from employment for three or more days. Where the Council receives such a notification, and if an investigation is warranted, the site of the accident is visited and an enquiry made. The purpose is not to apportion blame but to try and prevent accidents occurring again in similar circumstances. Fatal Accident One fatality occurred during the year in a food wholesaler's premises. A verdict of accidental death was returned at a subsequent inquest held at St. Pancras Coroner's Court. The premises, although used for trading, were in the course of re-construction and this was a contributory factor to the cause of the accident. After an investigation, the owners were required to carry out an amount of repair to the premises in addition to the reconstruction work. Non-Fatal Accidents One hundred and sixteen non-fatal accidents were notified to the Council during the year but possibly many accidents occurred which were not notified. This may be because employers are unaware of their obligations to notify. Publicity To publicise the need to notify accidents, a separate pamphlet on the subject has been printed by the Council and is being issued to employers giving details of their obligations, how accidents are to be notified, penalties for not doing so and the purpose of notifications. On initial and subsequent visits to premises, officers are making a point of emphasising to employers their obligations to notify accidents and the pamphlet is left with the employers or the responsible person on completion of the officer's visit. Prevention The possible remedy of conditions which have resulted in an accident is necessary and worthwhile but, this is perhaps 'locking the stable door after the horse has bolted'. An attempt is being made, therefore, to make employers 'accident prevention conscious' and an officer on an initial and on subsequent visits to premises is constantly on the look out for conditions which could give rise to accidents and such conditions are brought immediately to the employer's attention. Where someone on the premises has special responsibility for safety, contact between him and the Council's officer on accident prevention work in the premises can be worthwhile. It is hoped in the future to foster 'accident prevention at work'. HOISTS AND LIFTS The use of hoists and lifts in premises to which the Act applies can be a source of accidents and the Hoists and Lifts Regulations were enacted in 1968 to ensure that they could be operated with safety. The Regulations require that a hoist or lift be examined by a competent person once every six months if operated mechanically and once every twelve months if operated non-mechanically. When as a result of this examination it is found that work is necessary to enable the lift to be used with safety, a report specifying these works is forwarded by the competent person to the Council. A notice is then served upon the responsible person specifying any deficiencies, followed up by a visit to ensure the work is carried out. When an officer makes a routine visit under the Act to premises containing a lift or a hoist, he asks to see a copy of the competent person's last report. Where a lift has not been examined by a competent person, or if the last report is out of date, the responsible person is requested to have the lift examined immediately. Should the competent person's report not be available on the premises e.g. in some cases such reports are kept in a company's head office, a request is made to the company for a sight of the report. Notices in respect of lifts and hoists are served only after receipt of a competent person's report. A number of premises, particularly catering and licensed premises, contain hand power lifts and hoists which have not been examined by a competent person. An effort is being made to make owners aware of this requirement. Many of these premises are visited under the Food Hygiene (General) Regulations, 1960 and the opportunity is used to deal at the same time with the Offices, Shops and Railway Premises Act in general and Hoists and Lifts in particular. Sometimes it has been found that a competent person's report on a hand power lift or hoist does not contain sufficient detail in the adequate protection of a 'liftway' and a suitable item is being included to cover this in the notice served by the Council. The interest shown and the willing assistance given by the Authorised Officer of the Department of Employment and Productivity is greatly appreciated. REPORTED ACCIDENTS Fatal Non-Fatal Investigated Action Inf. Warning Formal Warning Prosecution (i) Offices — 68 16 16 4 — (ii) Retail Shops — 19 12 8 2 — (iii) Wholesale Shops & Warehouses 1 21 7 4 1 — (iv) Catering Establishments & Canteens — 8 3 1 — — (v) Fuel Storage Premises — — — — — — Totals 1 116 38 29 7 — 65 (1) REGISTRATION AND GENERAL INSPECTIONS Class of Premises Number of premises newly registered during the year Total number of registered premises at end of year Number of registered premises receiving one or more general inspections during the year (1) (2) (3) (4) Offices 87 1,564 222 Retail shops 40 1,267 355 Wholesale shops, warehouses 14 247 76 Catering establishments open to the public, Canteens 25 343 215 Fuel Storage Depots — — — Totals 166 3,421 868 (2) Total number of visits of all kinds to premises Registered under the Act = 4,066 (3) ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED IN REGISTERED PREMISES Class of workplace Number of persons employed (1) (2) Offices 45,645 Retail shops 6,107 Wholesale departments, warehouses 4,658 Catering establishments open to the public 1,578 Canteens 925 Fuel Storage Depots 2 Total 58,915 Total Males 37,040 Total Females 21,875 66 YEAR—1970 DEFICIENCES FOUND AND REMEDIED OFFICES SHOPS W'SALE W/HOUSES CATERING PREMISES CANTEENS FUEL STORAGE TOTAL Fnd Rem Fnd Rem Fnd Rem Fnd Rem Fnd Rem Fnd Rem Fnd Rem Cleanliness 30 74 64 85 16 17 35 16 7 2 - - 152 194 Overcrowding - 1 - - - - 2 - - - - - 2 1 Heating - 1 4 3 - - 1 - - - - - 5 4 Provision of Thermometer 43 53 36 35 12 11 17 15 - - - - 108 114 Ventilation 14 14 22 41 4 3 10 7 - 1 - - 50 66 Lighting 14 11 19 22 1 6 6 1 - - - - 40 40 Insufficient Sanitary Accommodation 7 - - - - - 1 - - - - - 8 - Deficient Sanitary Accommodation 20 25 36 23 3 12 10 13 1 - - - 70 73 Insufficient Washing Facilities 4 - 4 1 1 1 5 1 1 - - - 15 3 Hot Water/Warm Water Required 12 7 8 3 4 3 8 - 1 - - - 33 13 Other Deficient Washing Accommodation 11 17 12 19 3 3 2 5 - - - - 28 44 Drinking Water - - 1 2 - - - 1 - - - - 1 3 Clothing Accommodation 4 7 6 3 - 1 4 - - - - - 14 11 Seating Facilities - - 2 - - - - - - - - - 2 - Eating Facilities - - - - - - - - - - - - - - Dangerous Machinery 13 24 12 12 1 3 8 21 - - - - 34 60 Floors & Staircases 56 74 67 78 24 21 31 34 - - - - 178 207 Noise & Vibration - - - - 1 - - - - - - - 1 - First Aid 57 66 69 68 11 18 25 14 - - - - 162 166 Abstract 68 152 67 135 21 27 21 27 - - - - 177 341 Hoists and Lifts 3 1 3 - 3 - 16 - - - - - 25 1 TOTALS 356 527 432 530 105 126 202 155 10 3 - - 105 1341 Intimations Served 137 150 35 30 - - 352 NOTE: Deficiencies remedied relate to those found during the previous and current years. 67 HEALTH EDUCATION HEALTH EDUCATION "We have left undone those things which we ought to have done, and we have done those things which we ought not to have done, and there is no health in us." THE BOOK OF COMMON PRAYER. The first part of the prayer which is so well known to us is as valid to-day as it was when it was written so long ago. However, the second part of the prayer is not so accurate as we know that to-day the general health of the nation has probably never been better. This should not lead us to complacency as we know that man could improve his health much more if only he were to heed a little the first part of the prayer; we know that if we were to be more stringent with our attitudes to diet, smoking, exercise, alcohol, leisure pursuits etc., we would indeed be able to improve not only the length of life but also its quality; this is where health education takes an active part in showing the citizen how to improve his life as a whole. The earlier concept of public health practice, whereby the prevention of infectious disease was achieved, is an accepted part of day-to-day living, and the measures taken to prevent outbreaks of infection are now the norm. Health education can, if we wish it, assist us to achieve our aim of good health within the entire community. The implementation of health education facilities by a local authority is not the simple addition of an "optional extra" to public health work, but the major keystone on which all future public health activities will rest. We are all conversant with the old adage "Prevention is better than cure" and to-day, with sophisticated management techniques, we are beginning to understand that good health is a valuable, indeed vital, community asset. The question is how do we begin to sell good health to the community without being thought of as those peculiar people who have a "thing" about being healthy? Unfortunately, the public has an inbuilt distrust of the person who tries to promote health, and often regards him as a crank. It has been said that the health educator tries to frighten people to death. I would prefer Lord Cohen of Birkenhead's definition — "He frightens people to life!!" The ultimate object of all health education is to persuade the individual to select for himself the correct way of living so that eventually he has health. GENERAL ACTIVITIES Since the staff of the health education service was increased, many further tasks in the preventive field have been tackled, and we endeavoured to keep up with the increasing demand for health education facilities. With the inclusion of a technical expert in the team we have been able to present displays of high professional standard using sophisticated techniques. In addition, other Council departments continue to take advantage of the technical expertise available to them when mounting their own displays, thus obliquely presenting health education through their own outlets. ADVISORY PANEL The Panel which is comprised of representatives of all professional, field and administrative staff, continued to meet regularly under the Chairmanship of the Deputy Director of Public Health, to learn about the new materials, methods and communication tools which are constantly being produced for the furtherance of health education and communication. The following topics were chosen for presentation as monthly themes during the year. February 1970 Dental Health. March 1970 Prophylaxis. April 1970 Aspects of Child Development. 71 May 1970 Food Hygiene. June 1970 Venereal Disease. July 1970 Summer Safety. August 1970 Preparation for School. September 1970 Smoking. October 1970 Fireworks — Fire Hazards. November 1970 Winter Hazards. December 1970 A Safe and Happy Christmas — Toys, Flameproof Materials and Decorations. January 1971 Hypothermia — Winter Ills. EDUCATIONAL ESTABLISHMENTS The activities in schools continue and further contacts with teaching staffs are being made all the time. The perennial topics — smoking, drugs, human relationships, home safety, personal hygiene and life in general are under constant discussion; a new venture as far as boys are concerned is the inclusion in health education courses of films showing the birth of a baby. These films have, of course, been used for many years at girls' schools, but teachers now feel that boys should be fully involved in understanding about ante-natal care and the fact that they, too, should be included in a family experience. After all, boys are the fathers of tomorrow and parenthood is a shared experience. More teachers continue to make use of the health education facilities offered by the department, and are borrowing films, slides and visual aids, increasingly, as well as making greater use of the stock of disposable materials, i.e. posters and leaflets which are available freely on demand. Another contact made this year was at the North London College of Further Education. The Health Education Officer presented a course of general health education topics to students who were doing liberal studies. Some of the sessions dealing with drug abuse and dependence culminated in lively discussion, between the pro-legalising "pot" faction and those who wished the law to stay as it is. Talks on general health topics were given at Pentonville Prison to those prisoners who were taking liberal studies as part of a general education programme. Venereal disease and the birth of a baby were of particular interest to the course students who for the first time were receiving factual information on health matters in a way which could be understood by them. The Health Education Officer also gave talks on a number of health subjects to telephone engineer apprentices at the Northern District Office of the G.P.O.; he also lectured to all new students at the Northern Polytechnic, outlining health service facilities offered to the community by the borough and the National Health Service. PARENT TEACHER ASSOCIATIONS The Health Education Officer continued to make contact with parent-teacher associations and gave a number of talks dealing with subjects in which parents had shown interest. He was able to show associations at primary schools the new Radio Vision programmes "Where do babies come from" and "Growing up", thus enabling the parents to discuss the content of the programmes with the teachers and other interested parties. It is interesting to note that after the showing of the programmes and the discussions, the attitude of parents changed and their fears were allayed. DENTAL HEALTH The dental health of children in the borough is under constant surveillance, and, in order to press home its importance, campaigns are mounted in schools throughout the year. A unique form of presentation to primary school children was devised this year. All new entrants to schools in the borough received a talk from the Health Education Officer and the I.L.E.A. dental health educator, and they were intrigued to see a giant set of teeth and a huge toothbrush being used to demonstrate the correct way to brush one's teeth. 72 His Worship the Mayor and the Mayoress, Councillor and Mrs. D. Bromfield, attended most of the demonstrations at the primary schools and enjoyed meeting the children who were able to show how quickly they had learned to clean their teeth in the proper manner. At the end of the demonstration each child was presented with a dental hygiene kit, comprising a mug, a toothbrush and a tube of toothpaste, together with a letter to parents from the Medical Officer of Health and the Chief Dental Officer. 54 infant and nursery schools were visited during the year, and more than 2,000 kits were distributed. HYPOTHERMIA Many elderly people, particularly those living alone, find themselves in danger when the temperature drops during the winter months. Hypothermia can set in, thus causing distress, illness, and sometimes death. Many old people are unable to maintain an adequate body temperature particularly if their clothing, bed clothing, nutrition or room temperature are inadequate, often due to financial circumstances. The old saying heard amongst elderly people "I would rather have a fire on a cold day than a meal" is a truism which reflects the dire circumstances under which some of them exist. The department has produced emergency kits containing blankets, sleeping bags, thermometers, an approved oil heater and oil heater guard, coins for prepayment meters, a small stove and tins of soup. These kits are available for immediate use on a 24-hour basis; in addition, publicity material, leaflets and posters designed by the health education service were displayed and distributed throughout the borough. Much press, radio and television publicity was given to the emergency scheme to bring the attention of all elderly people and those responsible for caring for and helping them to the hypothermia problem. VENEREAL DISEASE Gonorrhoea is now second only to measles as the most widespread infectious disease, and it used to be said that "everyone gets measles". Fortunately measles is now being controlled by immunisation, but this cannot be said of gonorrhoea. The best way to fight this menace to health is by education. Until this year it was very difficult to promote V.D. campaigns publicly owing to the risk of prosecution under Section 5 of the Indecent Advertisements Act 1889. Baroness Alma Birk, Chairman of the Health Education Council, was successful in the promotion of "The Indecent Advertisement (Amendment) Bill" which became law on 29th May of this year. The Act enables publicity dealing with V.D. to be used on a wide scale without fear of prosecution and Islington was amongst the first local authorities to use V.D. publicity freely after its enactment. V.D. had been chosen as the borough health education theme for June and so our publicity reinforced the intensive press, radio and television publicity given to the Bill. YOUTH CLUBS AND GROUPS Many youth clubs continued to ask for talks and films on health matters. Drugs and venereal disease were the subjects most often discussed but one club asked for a course on general topics; this included a film showing the birth of a baby and proved to be the most popular session of this series. YOUNG MEN'S CHRISTIAN ASSOCIATION The Health Education Officer continues with his participation in courses arranged at the Central Young Men's Christian Association for school leavers from Islington. SMOKING ADVISORY CLINIC This is now in its ninth year of operation. The degree of success achieved by those patients who completed the six weeks' course is most encouraging, and even more so to know that more than 60% of those who had stopped smoking as a result of the course were still not smoking after one year. It does seem a pity, however, that so few people wish to take advantage of this unique facility which is offered to them. 73 Could it be that the public do not want to stop smoking? One thing is perfectly clear — the Government is ambivalent about the matter. The man in the street says "If there were anything in this smoking business which is really harmful, then the Government would do something about it", and thus he goes blissfully on his way. The Government, of course, collects £1,100 million per year in tax from the smoker and, it would appear, has a double standard when discussing smoking — from the Treasury on the one hand and the Department of Health on the other. The work of the Islington Smoking Advisory Clinic has been acknowledged internationally and Dr. H. O. Williams (Consultant Chest Physician) and the Health Education Officer have broadcast on radio and television frequently during the year, on national programmes, such as "Nationwide" and "Television Doctor", "World at One", "Radio 4 Reports" and on overseas broadcasts. They also wrote a booklet, published by the Chest and Heart Association, "How to stop smoking" which received much publicity and was written up by most national newspapers. Mention was also given in Australian, South African and European newspapers and journals. The booklet was also featured in a "World at One" radio broadcast. TRAINING It is customary for Student Public Health Inspectors to receive practical training in health education as part of their examination course. Students from the department were given tutorials on the method and content of health education and practical instruction. Student State enrolled nurses were given assistance on their courses by members of the health education service staff. A number of student health visitors from the North Western Polytechnic visited the health education centre and were given practical instruction and advice in the use of audio-visual aids, promotion and design of display, and talks on the content and method of health education. Islington is recognised as having one of the most forward health education services in the country and groups of overseas students visit us in order to develop their own services and model them on our lines. Students from "The Centre for Educational Development Overseas" and nurses from Holland on special courses were among our visitors this year. The Women's National Cancer Control Campaign invited the Health Education Officer to lecture its National Conference on the techniques of Cancer Education. A Geriatric Visitor and the Health Education Officer gave talks on "Keeping well in old age" and "Health Education Advisory Circles for the over 60's" at a geriatric training course organised by the London Boroughs Training Committee. The Phillipa Fawcett Teacher Training College also invited the Health Education Officer to speak to student teachers on "The dangers of smoking" this being part of their practical health education training. HOME SAFETY There's no place like home — to have an accident. We are appalled at the number of deaths on the roads, but we appear to accept with complacency the devastating toll of life and injury to persons which occurs in the confines of their homes, possibly because the accident occurs behind closed doors and drawn curtains. Nevertheless, more people are killed through home accidents than on the roads and, with this in view, much time is spent in endeavouring to persuade the public to take more care at home. Talks are given at schools and youth groups; Girl Guide, Cub Scout and similar youth groups are regularly visited by the health education team. The Health Education Officer acts as an examiner of Duke of Edinburgh's Award candidates taking home safety as one of their subjects for the bronze and silver award. He was also asked to act as a judge for the London Borough of Barnet's Inter-Schools Home Safety competition. The Community Relations Officer is very much aware of the dangers which exist in houses in multi-occupation where oil heaters are the standard form of heating, and with this in mind he invited the Health Education Officer to address a meeting of leaders of the immigrant sections of the community in order to press home the necessity of understanding the inherent dangers which surround one in the home. 74 An exhibit which was staged at the National Home Safety Conference held in October concentrated on oil heater safety and the safe-guarding of young children. It received much favourable comment, and a leaflet "Free Oil Heater information" about oil heater safety produced by the health education section proved a success judged by the quantities taken by delegates attending the conference, and their consequent take up in the borough. EXHIBITIONS Health education topics must be presented in a highly professional manner. When one considers the first-class presentation and packaging of household goods, which capture the eye and the imagination, then the task facing the service is one of competition with everyday things. Good health is never noticed until it is absent. To this end much time, effort and ingenuity in devising, building and presenting exhibits, which are not only eye-catching but which sell a health topic without appearing to inhibit the people receiving the message, is necessary. Exhibitions and displays were presented at The City Livery Hall, The Guildhall, during an educational conference "Your Chest, your Heart, your Health"sponsored by the Chest and Heart Association; open days at the Whittington Hospital; the annual Islington Civic Conference; the civic exhibition held at the Upper Holloway Baptist Church following the Church Service for his Worship the Mayor, Alderman Robin Goodman; the Mayor's Reception at the Town Hall and an exhibition demonstrating the Community Nursing Services in conjunction with "Contact", a symposium presented by the department's nursing service. The themes of these displays dealt with Home Safety, Smoking and Health, Dental Hygiene, Water Safety, the School Health Services, Immunisation, Hypothermia, Fireworks and many other topics. In addition to these major exhibitions, the display windows of the Health Department were fully utilised every month with displays relevant to the monthly theme. They were invariably animated and were thus more interesting to the passer-by who stopped to take in the message. Individual triptych displays, made for showing in health centres, also followed the monthly theme and were, therefore, never on display long enough to become "part of the furniture". Indeed some mothers said that they looked forward to seeing the next "instalment" of the triptych story, which indicated that health education was being stimulated and the themes were reaching their targets. The Health Education Officer distributed the prizes at Pakeman Primary School and incorporated a number of topical health education anecdotes. He is to be congratulated on being elected President of the Guild of Health Education Officers for the year 1970/71. It is encouraging to know that within the department there are many enthusiasts for health education who see it as being the ultimate public health weapon. Every member of the Health Department should act as a health educator even if he is not a member of the professional or field staff, as attitudes and demeanour can create an impression, good or bad, on the public. The fact that we work in the Health Department should, in itself, indicate our aim — "The promotion of Health for the Community". 75 76 Drawings from the How To Stop Smoking booklet by Dr. H.O.Williams and K.M.N. Robertson. Reproduced by permission of the Chest and Heart Association. Graphs by E. V. Thompson. Cartoons by A. S. Graham. 77 The Mayor and Mayoress "Councillor and Mrs. D. Bromfield showing the children of Highbury Quadrant Infant School how important it is to look after their teeth. Photo by Hamilton Studios. Dental Health Kit presented to all new statutory entrants to Primary schools in Islington Photo by K. Robertson. One of the Smoking Clinic Displays designed and produced by the Health Education Service Photo by K. Robertson. The Health Education Officer displaying one of the first V.D. notices to be placed on public display after the passing of the "Indecent Advertisement (Amendment) Act" Photograph by the Health Education Council Ltd. Fireworks triptych display designed and produced in quantity by the Health Education Service. Every Child Health Centre and many other venues used this display to promote firework safety Photo by K. Robertson. Dr. Carl Burns the Director of Public Health examining a hypothermia kit Photograph by permission of the Hacknev Gazette 80 Community Nursing Services Display. Devised and constructed by the Islington Health Education Service Photo by K. Robertson. 81 MENTAL HEALTH MENTAL HEALTH Since mental health services in Islington became the responsibility of the new London Borough in April 1965, successive annual reports have recorded new developments in the field of mental health, and by the end of 1969 we had the beginnings of a comprehensive mental health service. The outstanding gap was in residential provision, but plans for two purpose-built hostels had been accepted with completion due in 1972. In the meantime, former Islington residents were being given financial support by the Borough in hostels and homes run by various voluntary bodies. With a fairly wide variety of services becoming available, the impetus to provide additional services slowed down a little and the main aim for 1970 was consolidation, and improvement in the quality of the service. Extra social worker posts had been added to the establishment, together with two senior posts in the social work field, so that advice could be readily available to less experienced staff and attention could be given to co-ordination and general development. We were fortunate in filling all additional social work posts before the end of 1969 and in remaining fully staffed. With the additional social work establishment we were able to reduce the social workers' case loads and to improve the quality of our service. While consolidation was the main aim for 1970, there were a number of new developments during the year. HARPERBURY OUT-PATIENT CLINIC Work with the mentally handicapped has been greatly helped by the setting-up of a weekly out-patient clinic for parents and children at Finsbury Health Centre. This clinic is run by a consultant psychiatrist from Harperbury Hospital who is also available to our social workers for consultation and discussion, thus enabling the catchment hospital and the local authority to work more closely together. LINKS WITH HOSPITALS The co-operation between hospital and local authority has been further developed in the area of mental illness. During 1970, meetings of various types have been held by the mental health section and by Friern, Halliwick and St. Bartholomew's Hospitals where each others' social workers have been welcomed; combined meetings for psychiatrists and social workers have also taken place. Islington now has two joint appointment social workers, one with Barts and one with Friern, and it seems worthy of mention that one of our senior mental health social workers has just been appointed as principal psychiatric social worker at Barts. PSYCHIATRIC ASSESSMENT By kind permission of the Professor of Psychological Medicine, a senior psychiatric registrar from Barts was made available to the mental health section at the Finsbury Health Centre on three days a week in order to see and assess semi-acute emergencies and, where possible, refer patients for day care at the Pine Street Day Centre rather than arranging hospital admission. Following on from this, a staff nurse from Friern has been seconded to work full time at the Pine Street Day Centre to help the supervisor and her assistant in the management of these more severely disturbed patients. Through having a staff nurse from Friern at the health centre we have, in response to local need, been able to open a Modecate out-patient clinic there (a branch of the Friern Hospital clinic). This enables patients in the community, who would otherwise travel to and from Friern Hospital for their fortnightly injections, to be treated in their home area. WORK WITH GENERAL PRACTITIONERS 1970 has seen further development of work with general medical practitioners and by the end of the year six general practices had mental health social worker attachments, with the social workers attending the 85 surgeries weekly in order to help with short term preventive case work. Also general practitioners have attended monthly case discussions in the mental health section run by the department's consultant psychiatrist. This drawing together of the local authority, the catchment and teaching hospitals and the family doctors has been taking place very gradually in Islington since 1965. This is an essential development if we are to care for more and more of the mentally ill and the severely mentally handicapped in the community. DAY CENTRES AND TRAINING CENTRES With the increasing emphasis on community care rather than hospitalization, considerable responsibility is carried both by the mental health social workers and by the staff of day centres and training centres. Purpose-built premises have been available for only one of the seven centres opened since 1965. Many of the buildings are far from ideal but the important thing seemed to be to get these centres going in whatever premises were available, and each centre is designed to meet an entirely different type of need. Of the three day centres for the mentally ill, one is run on group lines providing short-term rehabilitation for younger clients, one is for longer term treatment in an industrial setting and the third provides for psychogeriatric clients. For the mentally handicapped, we now have two mixed adult centres so that some grading can be arranged according to age and ability, one purpose-built training school (including special care unit) and one separate special care unit to provide the extra places needed for the children with dual handicap. In addition we have the use of a 24 place day nursery run for the Borough by the Islington Society for Mentally Handicapped Children. The training school and separate special care unit will be transferred to the Inner London Education Authority on 1st April, 1971. All the centres are now well established and are running at maximum capacity to meet a wide variety of needs. ADMISSION TO HOSPITAL The fact that community care has developed considerably in scope and quality since 1965 does not obviate the necessity for hospital admission in some cases and mental health social workers have continued with their "rota" work for emergency day calls and also during the night and at week-ends. This work can be very stressful and sometimes dangerous, as those will realize who heard of the experience of one of our social workers recounted by the B.B.C. on the early morning news bulletin some months ago. PROVISION FOR THE MENTALLY HANDICAPPED A feature of mental health in Islington is that the Borough has a tradition of caring for the mentally handicapped which dates from the time when Elfrida Rathbone set up the first "Occupation Centre" in the Borough in the 1920's and, to augment the work carried out by our social workers, much help is now given with the after-care of former E.S.N, school children and their families by the Islington Elfrida Rathbone Committee. It should also be mentioned that the Islington Society for Mentally Handicapped Children has been working constructively with the local authority for more than twenty years, perhaps its most notable achievement being its excellent day nursery, already mentioned, where young children with varying degrees of mental handicap are accepted and given a high standard of care and training. Both these voluntary organisations continue to be grant-aided by the Borough. PLANNING FOR THE FUTURE This is the last report on the service as a responsibility of my department. In conformity with national policy mental health social workers will, by this time next year, have joined with their colleagues in the Welfare and Children's Departments to form the Borough's new Social Services Department. Therefore, in the latter part of 1970 welfare officers and child care officers were invited to spend days in our mental health section in order to see something of social work from the mental health angle and our social workers have participated in combined working parties, meetings and discussions in preparation for the future. 86 Many appointments for the new department have already been made and two of our mental health social workers have been appointed as team leaders, one as a training officer, two as senior management advisers and two others have been appointed to senior positions in the area teams, so our social workers can anticipate having every opportunity to play a full part in the building up of the Social Services Department. As the transfer date draws nearer there are naturally feelings of hope and expectancy amongst the staff concerned combined with a sense of regret at severing ties with the Health Department after six years of development and progress. SUMMARY OF PROGRESS Much has happened since the 1st April, 1965. A consultant psychiatrist has been attached to the mental health section for nearly five years and has weekly sessions with our social work team and our day centre staff. We now have eight centres (including the Islington Society of Mentally Handicapped Children's nursery) for day care. We are working increasingly closely with hospitals and with family doctors. There are two hostels in process of erection. Our social work team has doubled in size and is more highly qualified than in 1965 so that we are now able to offer social work of a high standard. Two of our senior social workers* have had papers published in medical journals. Student training has become a regular feature of the work. This is a record which does give us some feeling of achievement and yet we realize that in this six years we have only witnessed a beginning of the Borough's mental health programme. Cross fertilization of ideas in the future Social Services Department will reveal further needs. New ways will be found to meet these needs so that in a few years' time the achievements in the first six years may be overshadowed by future and more spectacular mental health projects. Nevertheless we prepare to hand over the service to the new department with the conviction that a firm foundation has been laid and a standard set for future development. There has been close team work, centre staff and social workers pulling together, with the help and encouragement of our Principal Medical Officer and our consultant psychiatrist to build up this specialist service. The eleven social workers who formed the nucleus of the team have remained with us, apart from training periods, throughout the six years, and in spite of increasing numbers a family spirit has prevailed. Although they look forward to working in a wider setting, mental health social workers and centre supervisors naturally feel much sorrow at the breaking up of their united team. We look back on six years of exacting work but work which has been both stimulating and rewarding. C. M. B. Pane & * Hermione Raven "Follow-up of patients referred for termination of pregnancy." The Lancet 28.3.1970 * Dorothy Crofts "Psychiatric Social Work in a Group Practice." State of Mind: Vol. 2 No. 10 March 1969 STATISTICS The total number of persons referred to the mental health section by general practitioners, local education authorities, police, etc., was as follows (1969 figures in brackets): Mentally ill Subnormal and severely subnormal Total 982 (1,038) 83 (70) 1,065 (1,108) The total number in community care at the end of the year was 852 (775). 36 (45) mentally subnormal patients and one mentally ill patient were provided with short-term residential care during the year. Of these 20 (22) were at the Council's expense and 17 (23) 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 67 (62), 32 (35) mentally ill and 35 (27) mentally subnormal or severely subnormal. 87 Training Centres Junior Senior Centres *2 2 Places *114 100 Attendances 16,524 (13,054) 13,915 (12,920) * These figures include two special care units, one in the main centre and a newly opened one in separate premises. Day Centres for the Mentally III Centres 2 Places 60 Attendances 9,650 (8,452) The Archway Citadel day centre, held in Salvation Army premises, has 16 places and the total attendances during the year was 2,168 (799). PERSONAL HEALTH Page Care of Mothers and Young Children 91 Day Care of Children 91 Health Visiting 92 Domiciliary Midwifery 93 Home Nursing 94 Prophylaxis 96 Chiropody 98 Family Planning 99 Cervical Cytology 99 Recuperative Holidays 100 Home Help 100 Services for the Elderly 101 Grants to Voluntary Organisations 104 Other Items 105 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. The demand for creche facilities continues and all sessions are well attended. A total of nine sessions are held each week. Many educational sessions have been held in the centres for a variety of groups of all ages and some increase in these has taken place. 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, and where 1,566 children were seen during 1970, and attendances totalled 4,639. A ttendances 1969 Child Health 45,063 (50,557) Toddlers' 3,239 (3,079) Ante & Post Natal 3,023 (4,864) (excluding G.P.O. sessions) Total 51,325 (58,500) Occasional Creche: sessions per week attendances 9 (9) 4,258 (5,293) DAY CARE OF CHILDREN DAY NURSERIES - COUNCIL A new nursery to accommodate 56 children was opened officially by the Mayor in May, thus bringing the number of Council Day Nurseries to six, providing 355 places for children under five years. Another nursery is under construction and is due to open early in 1971, providing an additional 56 places. Twenty-four students were in training during the year. Eight students sat the N.N.E.B. examination and all were successful. Careers Officers extended invitations to one of the Nursing Officers to give talks to school leavers on nursery training. Other invitations were extended by head teachers for the same purpose. These visits to schools continue to be of great value in recruiting students. A research project on the effects of day care on young children and their parents was started in one nursery by the Tavistcok Centre. Social workers visited the nursery to observe the children at play and to talk to parents who were asked to participate in the project. Anonymity was preserved. Day nursery waiting lists remained consistently long and only children in the highest priority groups were admitted. STATISTICS Average daily attendance during the year 298 Average rate of occupation 89% Waiting list at the end of the year: Priority 145 Others 391 Total 536 91 DAY NURSERIES - PRIVATE Four full-time day nurseries in the Borough registered under the Nurseries and Child-Minders Regulation Act continue to provide 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. CHILD MINDERS A large number of cases of illegal daily minding came to light during the year. Sources of information varied widely, but the public have been most helpful in bringing to our attention unsatisfactory conditions of daily care. A steady flow of people applied to be registered and at the end of the year there was a total of 178 Registered Child-Minders permitted to take a total of 400 children. Mr. Wehr, Welfare Officer from West Berlin, spent two days in the Borough visiting daily minders and playgroups in the area. PLAYGROUPS A number of new playgroups began during the year and at the end of the year there were 28 groups in the Borough registered for a total of 680 children. The Mayor and Mayoress visited them all during the year — the children patently enjoyed the visit — the Mayoral chains being much fingered and admired. An Assistant Nursing Officer was invited to speak to a parent-teachers association and groups of church members on the need for new pre-school playgroups. The playgroup movement in the Borough appears enthusiastic and willing to expand but is hampered by the lack of suitable buildings and unwillingness in some quarters to allow premises to be used for this purpose. STATISTICS (as at 31.12.70) Full-time nurseries registered 4 Children permitted 73 Part-time playgroups registered 28 Children permitted 680 Child-minders registered 178 Children permitted 400 In November, 1970, the Council approved a scheme to subsidise: (a) the attendance of individual children at selected nurseries and/or part-time play-groups run by private or voluntary bodies and (b) individual children with selected child-minders. The playgroup sponsorship scheme is intended for children in recognised priority categories known to health visitors as likely to benefit from attendance at a play-group, but whose parents are unable or unwilling to pay the fee. In such instances, recommended by health visitors, the Council undertakes to pay the play-group or nursery fee, and the health visitor keeps the case under regular review. This scheme came into operation in January, 1971. HEALTH VISITING As can be seen from the statistics overleaf, the total number of home visits by health visitors has increased. The health visitors are well accepted by all strata of society and have become adept at coping with differing languages and cultures. 92 Cases visited by Health Visitors 1969 Children born between 1965 and 1970 16,278 (18,048) Persons over 65 220 (265) Mentally disordered persons 150 (106) Persons (excluding maternity cases) discharged from Hospitals (other than mental hospitals) 229 (236) T.B. Households 37 (58) Households visited on account of other infectious illnesses 659 (800) Other cases 3,313 (2,697) Effective visits 51,344 (47,775) Ineffective visits 14,614 (12,989) The health visitors are constantly on the alert to ensure new needs of families are met. STUDENT TRAINING Eight health visitor students were sponsored for training by the Borough and all were successful in their examinations. Five health visitor students from other boroughs were given practical training in Islington. FIRE CASES The follow-up by health visitors of fire cases continued. This involved a great deal of home visiting of the families concerned for advice and health education. Fires notified 71 Fatalities 4 (5%) Fires involving fatalities 2 Children involved 4 (in 2 fires) Injuries 24 (34%) Fires involving injuries 16 Fires involving oil heaters 21 (30%) DOMICILIARY MIDWIFERY The number of domiciliary births continued to decline, falling to a total of 155 in 1970, compared with 254 in 1969. In addition to the 155 home confinements, 100 other patients were booked for domiciliary confinement but subsequently transferred to hospital for the following reasons: Complications of pregnancy 53 Premature labour 4 In labour at term 21 Moved out of area 22 The planned early discharge scheme resulted in 435 assessments of home conditions being made; 113 homes were found to be unsuitable. 435 patients (including unplanned early discharges) were nursed at home following hospital delivery. 68 patients originally booked for home confinement but who were delivered in hospital were subsequently discharged for home nursing (giving a total of 503 hospital discharges). 93 MATERNAL DEATHS Confidential enquiries in accordance with Department of Health instructions were initiated into the deaths of four women who had been Islington residents. In no case was the Council's staff involved. TRAINING The Council's eight domiciliary midwives trained pupils from the City of London Maternity Hospital. During 1970, 23 pupils completed their district experience and a further six were in training at the end of the year. GUTHRIE TESTING Domiciliary midwives continued to undertake screening tests for phenylketonuria resulting in a total of 1,047 tests. Of these, 683 were first tests, and 364 were repeats. HOME NURSING Islington is changing; drab tenement houses with no conveniences are being replaced by light airy centrally-heated flats, in pleasant surroundings, making easier the nursing of people in their homes. The new Islington does, however, bring problems for the nursing staff; road closures, one-way traffic systems and new parking restrictions, mean extra time being spent in getting from one patient to another. Many elderly patients moved into these new flats take time to settle, especially if they have to get to know a whole new set of neighbours. For the housebound the new move can be traumatic unless they can be moved with neighbours they know. Throughout the year there has been slight but steady increases in the number of patients taken on the books. There has been a sharp increase in supervisory visits, the majority of these by nursing staff attached to group practices; others are to patients referred to the bathing service but kept on the books for supervisory visits by trained nursing staff. A further attachment of a home nurse to a group practice commenced at the beginning of the year. The demands on the service are becoming increasingly heavy. Many more patients with terminal illnesses are staying at home and the rehabilitation of patients recovering from strokes takes more nursing time. Many heavy patients need two nurses where it is impracticable to get mechanical equipment in the home. Fifteen patients with terminal carcinoma received Marie Curie night nursing during the year, and four patients received extra nourishment. Queen Mary's Needlework Guild sent us warm clothing and bed linen for needy patients. Several of the nursing staff have been on study days this year on: Care of the Feet Diabetes in the Community Epilepsy Care of the Stoma Care of the Elderly One senior nurse was sent on a Practical Work Instructors course at Chiswick Polytechnic. All the nursing staff derive benefit from these study days; it widens their knowledge and thus enables them to give improved care. During the year the Whittington Hospital started sending at regular intervals, two ward sisters for a day's observation of nursing in the community. This continues and is proving very successful, home nurses and ward sisters learning one from the other. 94 At the moment this is a one-way exchange, but it is intended in due course that the home nursing staff will spend a day in the hospital. Five pupil nurses from St. Matthews and one S.E.N. on our staff completed successfully the course for District Nursing. We had an intake of seven District Nurses who took the District Nurse Training, and gained the National Certificate. Miss Payne retired this year after 30 years as a District Nurse, having started as the nurse for the Marquess of Northampton's Estate, in the old Borough of Finsbury. She was very conscientious and willing, and will be greatly missed by old and young alike who loved and had great respect for her, both as a nurse and a person. She still resides in the district however, so contact with her is not lost altogether. We employed another part-time evening nurse, and now have three nurses working from 6.30 p.m. - 11 p.m., increasing the service we can give to ill patients. The nursing staff have worked well, taking in their stride the extra burden of sick colleagues' work during the second half of the year. There are many new projects being discussed for 1971 in which the District Nursing staff will be involved. The changes which the projects will bring about are designed to improve further the service to the patient. 1969 Patients being nursed at (a) 1.1.70 709 (649) (b) 31.12.70 819 (709) Total nursed 3,041 (2,380) Total visits 98,544 (93,870) Visits to persons over 65 82,468 (74,310) Proportion of visits to persons aged over 65 83.8% (79.2%) Nursing treatments completed 1,610 (1,671) Nursing treatments commenced 1,724 (1,731) 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 1969 No. on loan (31.12.70) Air and sorbo rings 110 (48) 122 Bed cradles 86 (53) 78 Bed and back rests 116 (74) 110 Bed pans 72 (37) 105 Commodes 323 (214) 426 Hoists 6 (2) 13 Dunlopillo mattresses 10 (6) 21 Fracture boards 27 (14) 60 Mackintosh sheets 0 (0) 0 Hospital beds 12 (15) 16 Urinals 0 (0) 0 Walking aids 99 (44) 109 Wheel chairs and other special chairs 108 (80) 142 95 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 It is generally accepted that a better immunological response is obtained if the commencement of the basic schedule of protection is delayed until the child is nearing six months of age, and the intervals between doses extended. This also has the advantage that only one "booster" is necessary just before, or as soon as possible after, school entry. For these reasons it was decided towards the end of 1970 to introduce in this borough the revised schedule recommended by the Joint Committee on Vaccination and Immunisation. All children born on and after 1st October, 1970, are now offered the revised schedule commencing at age five months (instead of at three months) with an interval of 6-8 weeks between the first and second doses of Triple Antigen and Oral Polio vaccine, and an interval of approximately six months between the second and third doses. The revised recommended schedule is as follows: Diph/Tet/Pert/Polio 5 months Diph/Tet/Pert/Polio 7 months Diph/Tet/Pert/Polio 13 months Measles Vaccination 14-15 months Smallpox Vaccination 15-16 months Diph/Tet Oral Polio — Booster doses approx. 4½-5 years Re vaccination against smallpox approx. 4½-5 years Rubella Vaccination between 11-14 years — girls only B.C.G. Vaccination 13 years Oral Polio Tetanus — Booster doses School leavers or at age 15-19 Smallpox Revaccination only 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 (7% weekly) continued to be held at most of the main maternal and child health centres. STATISTICS Primary courses completed 1969 Diphtheria 3,692 (4,102) Whooping Cough 3,267 (3,738) Tetanus 3,800 (4,160) Poliomyelitis 3,754 (4,173) Measles 3,092 (1,739) 96 Booster doses Diphtheria 5,706 (5,961) Whooping Cough 2,457 (2,699) Tetanus 5,799 (5,691) Poliomyelitis 5,767 (5,727) Smallpox vaccination Primary courses 2,464 (2,759) Re-vaccinations 530 (191) Percentages of children Islington National average (a) born in 1968 and vaccinated by 31.12.70 Whooping Cough 78% 79% Diphtheria 79% 81% Poliomyelitis 79% 79% (b) under two years old and vaccinated in 1970 Smallpox 41% 35% 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. Seventeen sessions were held in primary schools, and the co-operation of school staff in making this possible much appreciated. 499 children completed basic courses of immunisation and 1,031 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 10%. MEASLES VACCINATION The Department of Health in a letter dated 29th July, 1970, drew attention to a rise in the number of notified cases of measles and the need to pursue a vigorous campaign to protect young children at risk. Protection against measles is now accepted as an integral part of the basic schedule, as the figures quoted above confirm. In addition, sessions were arranged in thirty-six (36) schools for school children at risk, and 473 children were vaccinated at these sessions. RUBELLA VACCINATION As a result of the trials of this new vaccine which were carried out in 1969 and in which two Islington schools took part, the Minister of Health recommended the vaccination of girls in the 11-13 age group, because of the known association of certain foetal abnormalities with rubella infection in pregnancy. Plans were put in hand for a vigorous campaign of immunisation to commence in 1971, for girls in this age group. B.C.G. VACCINATION Nineteen secondary schools were visited in the Borough. 1,594 children were Mantoux tested, 1,415 of these were given B.C.G. vaccinations; 79 children were found to have positive reactions and were referred to the Chest Clinics. 63 children were X-rayed, eleven were found to need treatment and 34 were kept under supervision by the Chest Physician. In view of the fact that the level of new notifications of tuberculosis in this Borough, although falling, remained between two and three times the National average, new plans were put in hand to reduce the incidence of this disease. 97 It was decided to offer new entrants to Borough primary schools a tuberculin test at age five years in an effort to detect unknown cases in the community, the family contacts of children producing strongly positive reactions to be followed up at the Chest Clinic. Plans were put in hand to introduce this test in 1971. A pilot scheme of tuberculin testing all new immigrant children was introduced at one school in the Borough, with the same object of tracing family contacts. New techniques of immunisation against tuberculosis were introduced during the year. The Heaf test, which was substituted for the Mantoux test, is an almost painless multi puncture method. The subsequent vaccination was carried out by the Pan-Jet method. This forces the vaccine into the skin by air pressure and as no needle is involved, it is absolutely painless. It is hoped that these new methods will make skin-testing and vaccination more acceptable to children and thus help to reduce the incidence of tuberculosis by early detection. T.B. INCIDENTS During 1970 a member of staff at a school in the Borough was notified as suffering from tuberculosis. Following investigation of school contacts 40 children required supervision by the Chest Physician. CHIROPODY In my last report I stated that the new Chief Chiropodist commenced duty on 1st July, 1969. Unfortunately, he resigned during 1970 and his last day of service was 31st August, 1970. Difficulty was again experienced in recruiting a replacement and the new Chief Chiropodist commenced duty on 23rd November, 1970. CLINICS The number of failures to attend clinics continued to decrease. 1969 Sessions 5,400 (4,792) Appointments booked 34,123 (31,191) Attendances Children 0-4 years 4 (6) 5-14 years 149 (109) Adults Male 5,692 (4,990) Female 24,895 (22,691) Physically Handicapped 115 (31) 30,855 (27,827) DOMICILIARY In 1970 transport was not provided for folk needing chiropody who were unable to make their own way to the clinic and these people were, therefore, treated in their own homes. This increased the number of domiciliary chiropody treatments carried out in the year, but even taking this into consideration the number of such treatments increased by 1,182. The number of appointments not kept increased from 125 in 1969 to 399 in 1970. 1969 Appointments booked 7,211 (5,467) Treatments given 6,812 (5,342) 98 OLD PEOPLE'S HOMES Sessions 15 (14) Appointments booked 100 (94) Attendances 99 (94) TRANSPORT Appointments booked (330) Attendances (288) FAMILY PLANNING In April, 1970, the Council extended its family planning service to include all Islington persons wishing to make use of it, irrespective of medical or special social needs. All such persons are eligible to attend Council clinics or clinics run by the Family Planning Association, which is grant-aided by the Council for this purpose, the grant having been increased from £2,000 in 1969/70 to £8,000 in 1970/71. There is no charge for advice and examination, and supplies are also provided free to those women needing this service on health grounds. In other cases a charge is ordinarily made for supplies but this is reduced, or the supplies provided free, in cases of hardship. General Practitioners providing this service to their own Islington patients on social grounds may refer necessitous persons to a Council clinic to obtain supplies at reduced charges or free. 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 continued to hold a weekly "Advice for Young Persons" clinic, and unmarried persons under 18 years of age, resident in Islington, referred to this special clinic, were seen and advised free of charge, the Council accepting financial responsibility. During 1970, the Council's clinics increased in number from seven (7) to eleven (11) per week. This included one evening session and three combined with existing ante-natal clinics. There was a marked increase in attendances at Council clinics which totalled 3,102 during 1970 compared with 1881 in 1969. 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 1970, referrals being made by the Council's health visitors. By the end of 1970 a total of 41 referrals had been made to the Association for this service. CERVICAL CYTOLOGY Cervical Cytology sessions 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 1,153, a slight increase compared with 931 in 1969. The results were as given below: Normal 1,084 Other gynaecological disorders (excluding cancer) which required treatment. These women were referred either to their general practitioner or directly for gynaecological advice and treatment 51 99 Doubtful cases referred for repeat examination 17 Positive 1* Under 25 225 35-44 280 25-34 446 45-54 153 Over 55 49 * Referred to hospital. Result not known. Patient moved away. RECUPERATIVE HOLIDAYS 293 persons were recommended by their doctors, hospital consultants, etc., for recuperative holidays during 1970. 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. 46 recommendations were not approved, some on the grounds that medical and nursing care were required, and these applications were referred to the appropriate hospital boards. Others related to elderly persons who had not recently been ill and these were referred to the Welfare Department, etc. Recommendations on behalf of school children were mostly referred to the Inner London Education Authority which maintains two holiday homes. 84 persons cancelled their holidays at some stage after approval in spite of the fact that the maximum charge is £5 a week plus fares and this charge is frequently reduced for persons unable to pay this amount. As shown below, the number of recuperative holidays decreased again this year, although those for psychiatric patients increased. Holidays arranged 1969 Expectant and Nursing Mothers 2 (2) Tuberculous adults 11 (10) Other adults 70 (124) Psychiatric patients 15 (8) Accompanied children 23 (22) Unaccompanied children (placed by I.L.E.A.) 38 (60) Total 159 (226) HOME HELP This service continued to operate from three area offices, each staffed by a home help organiser, an assistant and a clerk. The demand for the service is constant, and it is without doubt amongst the most important and practical of social services. For the elderly housebound, the home help often becomes a valued friend, and is always a vital link with the outside world for the lonely elderly. One organiser reports that in her area voluntary contributions were made by clinic and home help office staff and by home helps to collect together items for parcels to the value of 75p each. 82 such parcels were delivered to aged patients by home helps, etc., as Christmas gifts and were much appreciated. By arrangement with Health Visitors and/or Social Workers, the provision of this service is used in suitable instances to provide early morning and evening "mothering" for deprived children who might otherwise need residential care. In many of these and other cases, individual home helps give much kindly help beyond the service for which they are paid. 100 Recruitment of suitable women for this work is not easy, and there is considerable fluctuation in numbers employed during the year in each of the areas. STATISTICS 65 or over on first visit in 1970 Under 65 on first visit in 1970 Chronic sick & Tuberculous Mentally Disordered Maternity Other Total Cases 1970 (1969) 2,236 (2,252) 133 (130) 8 (5) 24 (34) 185 (196) 2.586 (2,617) Home Helps employed at end of 1970 (whole-time equivalent): 151.5 (135.5). 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. Two cases were dealt with under Section 47, and three persons subsequently agreed to be admitted to hospital or a welfare home to receive care and attention. HOME VISITING As trained nurses the home visitors for the aged are able to work as a team with the health visitors. Health visitors visit some of the old people in the Borough, but the home visitors carry out the bulk of the home visiting to the aged. During their visits the visitors attempt to prevent infirmities and deterioration in physical health and to give encouragement and advice on diet, hygiene and general care. They may provide help in the home and also meals on wheels. The visitors are vigilant with regard to the prevention of home accidents, many of the aged live in conditions of high risk; most fatal accidents in the home occur in people 65 years old and over. The elderly living alone particularly appreciate the visits by the home visitors for the aged, who frequently are their only link with the outside world. As we live in a time of ageing population the case loads of the home visitors are very high and visits cannot be paid at the frequency we would like to achieve. Statistics of geriatric visiting for the year are as follows: New cases Re-visits Unsuccessful visits Total 1,256 10,882 2,580 14,718 SPECIAL CLEANSING From time to time it was found that property occupied by elderly or infirm persons was in such an unclean, verminous or insanitary condition as to warrant special cleansing by the department prior to the introduction of home help and other services. Nineteen such cases, reported by the public health inspectors, home visitors, hospital authorities, etc., were dealt with during the year. MEALS During 1970 the meals services continued in accordance with the re-organisation, i.e. ten vans were operating Meals on Wheels, and four vans Invalid Meals. 101 Comparison of the total meals served for the last four years: Invalid Meals Meals on Wheeis Delivery Restaurant 1967 96,379 50,490 4,405 1968 103,463 47,739 4,195 1969 118,233 46,224 5,147 1970 127,200 45,251 7,992 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 18,268 weekend and bank holiday meals were provided during the year. GERIATRIC PREVENTIVE CLINICS The following table analyses the work of the medical sessions during the first four years of their Operation ATTENDANCES December Quarter 1966 1967 1968 1969 First Half 1970 Total Source of Referral: Geriatric Visitors 35 32 27 16 3 113 Personal Applications 55 143 84 45 23 350 Others 2 33 33 2 2 72 Totals 92 208 144 63 28 535 Subsequent cancellations 14 48 36 17 8 123 Clinics held 22 104 83 53 23 285 First attendances 43 177 113 53 21 407 Age Group M F T M F T M F T M F T M F T 60-64 1 1 2 7 20 27 3 17 20 ? 5 7 1 1 57 65-69 1 4 5 25 31 56 12 24 36 11 11 22 4 3 7 126 70-74 1 10 11 18 22 40 10 22 32 7 5 12 3 1 4 99 75-79 8 3 11 6 24 30 6 11 17 1 4 5 3 3 6 69 80-84 3 5 8 9 9 18 2 5 7 2 2 4 - 37 85-89 3 3 1 4 5 1 - 1 1 2 3 2 1 3 15 90-94 1 1 2 1 - 1 - . . . . . . . _ 3 95+ 1 - 1 . . . . . . . . . . . - 1 16 27 43 67 110 177 34 79 113 24 29 53 12 9 21 407 Re-examinations 16 121 112 137 60 446 Average attendance per session 2.7 2.9 2.7 3.2 3.5 3 102 Since 1966 a clinic based geriatric advisory service has been operating in Islington. At these clinics, a medical examination is offered to elderly persons, either at their own request or on referral by family doctors, geriatric/health visitors, social workers, etc. Following examinations, arrangements are made through the family doctor for the follow-up of any abnormalities found. Associated with these clinics, health education sessions have been held regularly with the assistance of the department's Health Education Officer. These have been and continue to be very successful and reasonably well attended. It is clear that the numbers seen in relation to the total elderly population of the Borough have been small (407 persons examined in the four year period out of a population aged 65 years or over in excess of 28,000), and furthermore it is the impression that the clinics have been failing to reach those most in need of the service since, by the very nature of their problems, the medically unfit and potentially neglected are the least likely to attend a clinic. In addition, the fact must be faced that to provide a full routine medical examination service, with adequate arrangements for follow-up and repeat examinations for the whole of the age group, would require a very large amount of medical time and it is doubtful whether such a scheme would be feasible. An alternative approach is therefore under consideration and this would involve the use of non-medical staff, e.g. health/geriatric visitors to visit persons in their own homes in order to carry out a preliminary screening investigation, referring for medical examination only those whom the results of the screening tests indicate to require this. There is evidence that the incidence of medical problems begins to rise rapidly once the age of 70 years has been reached and it is therefore proposed, in order to obtain the greatest return for work carried out, to apply the screening procedure to those aged 70 years and over. It is hoped to carry out a pilot study of such a service in 1971. LAUNDRY SERVICES The laundry service for incontinent persons (most of them elderly) is provided from the Finsbury Health Centre. During the year 2,827 collections of laundry were made (involving 27,351 articles). The service was being provided to about 115 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 15 at the commencement of the year, to 10 at the end of the year, 135 parcels of laundry were collected during the twelve months under review. BATHING FACILITIES The services provided from the Finsbury Health Centre continued throughout the year. 6,089 baths were carried out in the homes of elderly persons under the Domiciliary Service. 1,932 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 Task Force in Islington, which was set up in October, 1965 to encourage and foster voluntary effort amongst young citizens, continued to operate during 1970 from the Welfare Centre, Corsica Street, N.I. Their valuable service was again used extensively by officers of my department, in particular, in those instances where statutory authorities were unable to help. ISLINGTON CREMATORIUM The Medical Referees during the year certified 564 applications for cremation at the Council's Crematorium, East Finchley. 103 GRANTS TO VOLUNTARY ORGANISATIONS During 1970 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 personal health services. SERVICE VOLUNTARY ORGANISATION Grant 1970/71 £ Maternal and Crusade of Rescue 85 Child Health London Diocesan Council for Wei-Care 2,490 North Islington Infant Welfare Centre 19,817* Day Nursery and West London Mission (Hopedene Nursery) 3,500* Playgroups Archway Playgroup 50* Caxton House Settlement — (Martin Luther King Playgroup) 150 Claremont Central Mission Playgroup 90* Islington Pre-School Playgroup Association 560* Junction Road Congregational Church Playgroup 85* Mixifren Playgroup Ashley Road 135* Playgroup 31 110* 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, York Way and Golden Lane Playgroups) 1,918* St. Andrew's Mission (Goodinge Rd., Playgroup) 100* St. Giles Playgroup 95* Stoke Newington Council of Churches Playgroup Highbury Quadrant 20* Stroud Green (Holly Park Church Hall Playgroup) 90* Upper Holloway Baptist Church Playgroup 105* Prevention of Illness Chest & Heart Association 10.50 Care and After-Care (Tuberculosis) (General) Islington Chest & Tuberculosis Care Committee 250 Catholic Marriage Advisory Council 375 Family Welfare Association 5,790 Family Planning Association (Central London Branch) 8,000* Health Education Council 374.95 London Borough of Islington (Health Amenities Fund) 100 London Marriage Guidance Council 670 National Association of Voluntary Hostels 150 Mental Health (Day Centres) (General) Salvation Army (Archway Citadel Day Centre) 1,220* Elfrida Rathbone Committee (Islington and Camden) — General 3,000 104 — Playgroups 500* Islington Society for Mentally Handicapped Children 6,458* National Association for Mental Health 100 *Estimated grant, subject to adjustment OTHER ITEMS HANDICAP REGISTER A central index of handicapped children 0-21 years continued to be maintained centrally under the general supervision of the principal medical officer. The Kalamazoo Fact-finder system installed in 1969 has greatly facilitated the extraction of information. It was thus possible to improve the review of the development and welfare of those on the register. Schoolchildren on the handicap register are reviewed annually, or more frequently if necessary. School Care Committees and the Invalid Children's Aid Association combine to provide useful links with this department on social problems. Social workers and peripatetic teachers are attached to Frank Barnes (Deaf) and Hargrave Park (Partially Hearing Unit) Schools. Social workers are also attached to Cloudesley (Physically Handicapped) School and a Social Worker employed by the Inner London Education Authority, and based on this Department, is attached to the Autistic Unit at Horizon (Educationally Sub-normal) school. Children attending the three Islington Educationally Sub-IMormal Schools and their families are visited periodically by case workers from the Elfrida Rathbone Committee. Handicapped School leavers are found employment through the established arrangements between the Borough Services and the Handicapped Young Persons Section of the Youth Employment Services. The Principal Mental Health Social Worker (or her representative) attends the meeting of the Youth Employment Bureaux sub-committee for handicapped children. Deaf children of all ages are registered with the Senior Social Worker (Health Services) who in liaison with the Principal Medical Officer reviews their cases constantly. A Senior Medical Officer who visits residential establishments regularly follows-up children in care who suffer from a mental or physical handicap. Hospital reports are requested for individual children when required and close contact is kept with the Children's Officer and his Child Care Officers on individual cases. At the end of 1970 the number of children on the Central Handicap Register was: 1970 1969 Handicap Register 0-21 years 2,103 2,084 BATTERED BABIES Six conferences were held during the year on young children suspected of being "Battered babies." Medical and nursing staff of the hospital concerned, officers of the Health and Children's Departments and of the N.S.P.C.C. were present and general practitioners were invited and attended when possible. In each case plans were made for the continued supervision of the child and family and assistance and support for the parents. PREVENTION OF BREAK-UP OF FAMILIES The Co-ordinating Committee met five times during the year. The manager of one of the local offices of the Department of Health and Social Security joined the Committee as a permanent member. 105 Case Conferences have continued to be held at fortnightly intervals to consider families with housing problems likely to place them in danger of eviction. Twenty-five meetings were held and 152 families were discussed. Almost all these were families living in local authority property (either Islington Borough or Greater London Council) who were in arrears with their rent payments. STUDENT VISITS The number of students, medical, nursing, social worker and others, for whom arrangements are made to visit various branches of the department, continues to increase. During 1970 these totalled 606 compared with 471 in the previous year. It is considered worthwhile to continue to arrange for these visits as a means of providing a knowledge of the work of a Public Health Department to students from a variety of disciplines and in the hope of 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 in the Council's day nurseries where they gave voluntary help. 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. 1970 1969 Domiciliary Midwifery 239 318 Mental Health 569 596 Home Nursing 244 263 Infectious diseases 2 2 Other 79 42 Total 1,133 1,221 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 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. 68 visits were made during 1970. Residential establishments for the elderly are also visited by a senior medical officer accompanied by a senior public health inspector. Nine such visits were made in 1970. 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. 106 SCHOOL HEATH SCHOOL HEALTH 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 the Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area and is responsible to that Authority for the day to day running of the service. The co-operation of the Medical Adviser's department of the Inner London Education Authority, the local Divisional Education Officer and Head Teachers of the schools in the Borough has been much appreciated throughout the year. HEALTH OF SCHOOL CHILDREN In May 1970 the school roll for the Borough was 34,196. 42.4% of these children were examined at routine medical inspections during the year and only 0.5% were thought to be in an unsatisfactory physical condition. ROUTINE MEDICAL INSPECTIONS As a routine, all pupils in nursery schools and nursery classes were medically inspected on admission and annually thereafter. Each pupil was also 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. Other children were medically examined as soon as possible after admission to infants' schools (except at two schools where pre-entry medical examinations were held). They were next seen after their transfer to junior school except at nine schools in the Borough where only selected pupils were seen. The next routine medical examination took place after the pupils were transferred to secondary school when boys were also tested for colour vision. Pupils were again seen as early as possible in the term before the one by the end of which they would reach Statutory school leaving age. A medical report to the Careers Service was completed at this examination for pupils who intended to leave school at 15 years of age. Pupils who were still in attendance after attaining 15 years of age were inspected as early as possible in the term prior to that in which they would be leaving school, when a medical report to the Careers Service was completed. Special school pupils were also seen at least once a year by the school doctor, specialist or consultant, as appropriate. PRE-ENTRY MEDICAL EXAMINATIONS At two schools in the Borough medical examinations were arranged, as an experiment, to take place before actual admission to school, instead of the normal examination as soon as possible after their admission to school. The pre-school medical examination could not, of course, 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. However, a higher than average percentage of mothers attended these pre-entry medical examinations with their children and, as a result of this, better histories and other necessary details were 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-entry medical examinations until further notice. 109 ROUTINE MEDICAL INSPECTIONS - DEFECTS Numbers of cases noted for treatment or observation expressed as a rate per 1,000 inspected. (1969 figures in brackets.) Treatment Observation SKIN 5.31 ( 6.30) 11.86 (13.38) EYES (a) Vision 69.05 (55.40) 60.63 (75.37) (b) Squint 7.79 ( 4.72) 5.52 ( 8.59) (c) Other 1.03 ( 1.57) 2.21 ( 2.51) EARS (a) Hearing 4.41 ( 4.37) 5.73 ( 9.45) (b) Otitis Media 1.79 ( 1.57) 5.59 ( 6.37) (c) Other 0.69 ( 0.64) 2.28 ( 1.15) NOSE AND THROAT 3.31 ( 4.08) 25.59 (29.63) SPEECH 3.59 ( 3.01) 6.76 ( 7.01) LYMPHATIC GLANDS 0.41 ( 0.36) 14.42 (13.31) HEART 2.76 ( 1.36) 8.35 ( 9.59) LUNGS 5.03 ( 3.22) 10.90 (16.61) DEVELOPMENT (a) Hernia 0.83 ( 0.79) 2.76 ( 4.80) (b) Other 2.21 ( 1.29) 5.10 ( 7.44) ORTHOPAEDIC (a) Posture 0.62 ( 0.79) 4.35 ( 9.59) (b) Feet 2.90 ( 1.72) 11.45 (16.32) (c) Other 2.14 ( 1.50) 8.76 ( 9.66) NERVOUS SYSTEM (a) Epilepsy 1.03 ( 0.64) 1.79 ( 1.86) (b) Other 0.62 ( 0.07) 2.28 ( 2.08) PSYCHOLOGICAL (a) Development 2.21 ( 0.93) 6.76 ( 7.16) (b) Stability 2.07 ( 0.93) 11.24 (11.95) ABDOMEN 0.90 ( 0.64) 2.69 ( 2.51) DEBILITY 0.48 ( 0.07) 0.41 ( 1.50) ENURESIS 8.28 ( 8.59) 22.28 (30.13) OBESITY 3.72 ( 3.58) 12.69 (18.97) OTHER 2.21 ( 1.22) 2.41 ( 2.86) 110 SPECIAL MEDICAL EXAMINATIONS 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 educational treatment might be necessary were brought before the school doctor by head teachers. The Education Officer, etc. also requested that certain children be examined at times other than the normal routine examinations. 2,621 (3,101) of these examinations were carried out in 1970, either at schools (where the pupils' parents were invited to attend) or in the pupil's own homes. RE INSPECTIONS School doctors re-inspected 6,359 (6,287) children who had been referred for treatment or observation. SPECIAL RECOMMENDATIONS BY SCHOOL DOCTORS School doctors sometimes made special recommendations (e.g. position in class because of hearing and vision limitations, restrictions of physical training activities) and head teachers or other responsible teachers saw that they were carried out. They were also asked to ensure that children with defective vision wore spectacles prescribed for them and children with hearing aids used them. EMPLOYMENT OF SCHOOL CHILDREN During 1970 167 (181) examinations were carried out on school children of 13 years of age and over who were employed part-time delivering milk, newspapers, in shops, etc. These examinations were carried out within 14 days of the commencement of their employment and every 12 months thereafter. 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. SCHOOL JOURNEY MEDICAL EXAMINATIONS Before children went away for a school journey, the school nurses checked their medical records and arranged for any treatments to be given which might be needed to make them fit to go, referring them to the school doctor if necessary. Any information regarding the child's physical condition mentioned on the parental consent form and about medicine or tablets being taken was also passed on to the medical officer. The type of journey was, of course, taken into consideration. Strenuous expeditions might be too much for delicate children, children with plantar warts might not be able to walk far and other children might present special problems. 1,381 (1,660) children were examined by a school doctor within 96 hours of departure to make sure that they had not been in contact with infectious disease and to determine whether they were fit to go. One of the accompanying teachers was available for the school doctor to discuss any restriction which should be placed on the activities of any of the children. This reduced risks not only to individual children but to the party as a whole. Children going to Inner London Education Authority camps, where a school nurse was in attendance, were seen by the school nurses only. 1,242 (852) children were examined in this way during 1970. One school nurse accompanied a party of physically handicapped school children on a school journey to Devon. 111 NON-ROUTINE MEDICAL INSPECTIONS TYPE OF INSPECTION No. SEEN RE-INSPECTIONS 6,359 (6,287) Bathing centre inspections — scabies 10 ( 1) Bathing centre inspections — others 2 ( 11) Employment certificates 167 ( 181) Theatre children 35 ( 45) School Journeys 1,381 (1,660) Recuperative holidays — pre-departure 63 ( 103) Outward Bound Courses - ( 14) Infectious disease investigation - ( 1) T.B. Contacts 4 ( - ) Boarding Schools for the delicate — pre-departure 25 ( 45) Boarding Schools for the delicate — on return 2 ( - ) Handicapped pupils — statutory examinations 250 ( 228) Handicapped pupils — periodic special defect examination 72 ( 124) Research investigations and enquiries 4 ( - ) SUB-TOTAL 2,015 (2,413) SPECIALS — at request of:— Head Teacher — child's name entered in special book 125 ( 126) Head Teacher — others 190 ( 228) School nurse — following health survey 6 ( 22) School nurse — others 22 ( 19) Divisional Education Officer 36 ( 66) Divisional Care Organiser or Care Committee 15 ( 11) Parent 25 ( 48) School Medical Officer 178 ( 151) SUB-TOTAL 597 ( 671) OTHERS For free travel 1 ( - ) Accident on school premises - ( 2) Miscellaneous 8 ( 15) SUB-TOTAL 9 ( 17) TOTAL OF ALL NON-ROUTINE MEDICAL INSPECTIONS 8,980 (9,388) RECOMMENDATIONS FOR SPECIAL SCHOOLING After special medical examinations, the examining medical officers recommended that some children be admitted to special schools which it was felt would be more suitable for them than ordinary schools Hospital reports, etc. were often taken into account and recommendations were vetted by the Deputy Principal School Medical Officer before being passed to the Education Officer's Department. 112 Recommendations:— Day schools for the delicate 11(1) Day schools for physically handicapped children 10 (12) Boarding open air schools 2(11) 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 35 (44) of these examinations. Recommendations:— Day schools for educationally subnormal children 88 (89) Boarding schools for educationally subnormal children - (1) Continue at ordinary school possibly with extra help in reading, arithmetic, etc. 64 (66). 5 (7) children were recommended for home tuition. SCHOOL NURSES' INSPECTIONS Most pupils are examined annually by the school nurse for cleanliness of the head and other aspects, e.g. squint, ear discharge and nutritional state. They referred children where necessary for further investigation or treatment. During 1970 24,675 (24,618) of these comprehensive health surveys were held. 1.27% (0.88%) were found verminous. 10,052 (10,230) selective health surveys were carried out when necessary and 2.0% (1.92%) were found verminous. All infants were given an audiometer test as soon as possible after entry to school. HEALTH EDUCATION All school nurses carried out health education, usually on an informal basis, during their usual nursing duties in school. REMEDIAL FOOT CLASSES The Inner London Education Authority continued to employ two part-time organisers of remedial classes 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. The head teachers of seven schools in the Borough kindly continued to make the necessary arrangements to enable classes to be held in their schools and teachers there co-operated by volunteering for and carrying out this work. It was unfortunate that the number of schools in which these classes were held was reduced during the year due to teachers trained becoming no longer available. All classes were visited by a medical officer at the beginning and end of each term. AUDIOLOGY All infants were given a routine sweep test as soon as possible after entry to school. 6,222 (7,025) children were tested in this way by school nurses in 1970. If these tests showed any doubt as to the normality of the child's hearing, a pure tone test was also given by a specially-trained school nurse. 72 (83) of these tests were carried out during the year and 72 (83) children were found to have defective hearing and were referred for further investigation. 35 (35) audiology sessions were held at which the total attendances were 171 (254). At the end of the year 69 (75) children were in attendance at audiology clinics. 4 (6) were provided with hearing aids during the year making a total of 109 (135) children still attending Islington schools who have been provided with them. 113 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. Published papers — "Talk" (published by the National Deaf Children's Society) — "The Link between Home and School" by Frieda Sanderson, M.A., Dip.Soc., Sc. (Mrs. Sanderson is the Social Worker attached to the Partially-Hearing Unit at Hargrave Park School). SPECIAL INVESTIGATION CLINICS Special investigation clinics were held for children suffering from obesity, enuresis and early emotional problems. The school doctor could refer children to these clinics where advice was given and emotional problems and management discussed with parents. At the end of the year 321 (404) children were attending these clinics at six centres in the Borough. Total attendances were 1,741 (1,785) and 76 (65) children were discharged cured. MEDICAL TREATMENT Nurses treated school children for verrucae, athlete's foot, eye, ear and skin diseases as well as bruises, lacerations etc. at minor ailments clinics. During 1970 309.5 (322) sessions were held at which 563 (975) new cases attended. Total attendances during the year were 4,834 (5,247). School children found at dental or medical inspections to need dental treatment were given appointments to attend one of the four dental clinics in the Borough unless their parents expressed a wish for them to be seen by their private dentist. During 1970 2,043 (1,978) dental treatment sessions were held at which 4,211 (4,286) new cases attended and total attendances were 13,110 (12,629). School children found by school nurses who carried out vision testing in schools to have 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. 247 (247) vision sessions were held during the year at which 617 (739) new cases attended and total attendances were 4,692 (4,803). A total of 876 (956) pairs of spectacles were prescribed, 803 (930) of which were dispensed by the optician who attended the clinics. BATHING CENTRES Parents of children found by school nurses at comprehensive or selective medical examinations to have vermin and nits were given a special shampoo and instructions as to how to cleanse their child's head at home. If, however, this was not successful the children were referred to the Council's bathing centre for cleansing as were any children found verminous at recuperative holiday or school journey pre-departure examinations. There was a total of 224 (247) attendances for this purpose during 1970. Children found to be suffering from scabies were also sent to the bathing centre for cleansing during 1970 and total attendances for this purpose were 250 (339). ATTACHMENT TO THE WOLFSON CENTRE Arrangements were made for one of the Senior Medical Officers to attend the Wolfson Centre on Thursday afternoons when Islington children were being assessed and when some specific language assessments were carried out. SURVEY OF PHYSICALLY HANDICAPPED CHILDREN IN ORDINARY SCHOOLS During 1970, 107 forms in respect of physically handicapped children in ordinary schools and 60 in respect of schools they attended were completed for the Department of Education and Science. This was in 114 connection with their survey of physically handicapped children in special schools, to discover the number of such children and the degree and severity of their handicap. PROVISION OF SECOND PAIRS OF SPECTACLES As children at special schools are especially dependent on their spectacles (i.e. some deaf children being unable to lipread or read from the blackboard without them) arrangements were made for them to be issued with a second pair. These spectacles were to be kept at the school as a reserve so that they could be used if the pupils arrived at school without the other pair or if the other pair was broken. TRANSPORT OF CHILDREN TO ORDINARY SCHOOLS If a child suffered an accident or illness which resulted in a temporary disability which prevented him or her travelling to school in the normal way, the school medical officer was sometimes asked to decide whether special transport should be provided. Careful enquiries were made to ensure that the transport was justified and that the child would be able to work satisfactorily when he eventually reached school. A child with a leg plaster, for example, might have great difficulty in negotiating several flights of stairs in order to attend various classes during the course of the day. School medical officers recommended that special transport should be provided for a number of such children during the year. HOME TUITION 5 (7) children who were unable to get to school even if transport were provided and would be absent for a considerable time were recommended for home tuition during 1970. REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER AND CHIEF DENTAL OFFICER The School dental service, which is run on behalf of the Inner London Education Authority and in conjunction with the Borough, is a service possibly more than any other where everything is interdependent. Without adequate ancillary staff and the co-operation of the Education Service in permitting dental inspections it would cease to exist. Happily our efforts to see that things do not go wrong in these respects are on the whole successful. The full-time equivalent of dental officers employed increased from 4.3 to 4.6, which resulted in an increase in sessions from 2,257 in 1969 to 2,406 in 1970. The total visits for treatment increased from 12,629 to 13,110. It is gratifying that the total number of fillings in both permanent and temporary teeth increased from 9,253 to 11,068. During 1970 we introduced blood testing to guard against the possibility that someone with sickle cell anaemia might have a general anaesthetic without knowledge and its introduction would account, possibly as a result of the incidental extra trouble involved, for the number of anaesthetic sessions decreasing from 34 to 26; the total number of extractions also decreased, from 1,929 to 1,623, although this latter decrease is not necessarily entirely related. The number of emergencies attending for treatment fell from 667 in 1969 to 453 in 1970. The ratio of permanent teeth filled to permanent teeth extracted was 24.6 compared with 23.7 in 1969, and that of temporary teeth filled with those extracted 2.4 compared with 1.8 in 1969. This registers an improvement but again must be set against the fewer general anaesthetic sessions. The new orthodontic service did not expand quite as much as had been hoped for, but did nevertheless register a considerable advance over 1969. The number of new orthodontic cases increased from 23 to 36, and 44 removable and 10 fixed appliances were fitted compared with 31 removable appliances in 1969. Altogether, this service is attracting much more attention and I am confident that it will continue to grow. 115 Dental health education in 1970 continued to be a feature of the service as in preceding years, projects taking place in February and September. This aspect of the service is covered in considerable detail in that section of the Director's Report which deals with Health Education. It was not possible to complete inspection of all the schools in 1970 but there is good reason to believe that very nearly 100% will be achieved in 1971. All in all, 1970 was quite a good year, and bearing in mind the difficulties of Popham Road as it nears its closure, there is considerable cause for satisfaction in the maintenance of our continuity of service, which is after all what we strive for. The Maternity and Child Health Service continued in much the same manner as in 1969. It is hoped that with the opening of the new clinic in River Place in 1971 that it will be possible to expand this service. 116 STAFF AND PREMISES STAFF AND PREMISES Establishment of Officers—31.12.1970 Director of Public Health and Medical Officer of Health 1 Deputy Medical Officer of Health 1 Principal Medical Officers 1 Senior Medical Officers 2 Medical Officers 9 14 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 9 Administrative Officers 6 Administrative Assistant and Night Security Officer 1 Administrative Assistants 13 Secretary 1 Senior Clerical Assistants 19 Clerical Assistants 35 Attendant Telephonists 2 Typing Supervisor 1 Senior Typist 1 Audio/Copy Typists 5 Clerk/Typist 1 Copy Typist 1 Supervisor (Invalid Meals Service) 1 Office Attendants 2 Attendant Handyman 1 Technical Assistant (H.E.) 1 107 INSPECTORATE AND TECHNICAL Chief Public Health Inspector 1 Deputy Chief Public Health Inspector 1 Assistant Chief Public Heath Inspectors 2 Senior Public Health Inspectors 12 Public Health Inspectors 20 Fire Inspectors 6 Inspectors (General Purposes) 3 Technical Assistants 4 Student Public Health Inspectors 10 Rodent Officer 1 Rodent Investigator 1 Superintendent of Laundry & Disinfecting Services 1 119 62 NURSING AND MIDWIFERY Principal Nursing Officer 1 Deputy Principal Nursing Officer 1 Assistant Nursing Officers 2 Centre Superindentents 9 Health Visitors 38 Student Health Visitors 9 'Tuberculosis Visitors 2 Clinic Nurses (full-time equivalent 15.6) 16 School Nurses 18 'additionally one supernumary Tuberculosis Visitor held temporarily against vacancy in Health Visitors' establishment. 96 DAY NURSERIES Matrons 6 Deputy Matrons 6 Staff Nursery Nurses 24 Nursery Wardens 6 Nursery Assistants 25 Nursery Students 13 Creche Assistant 1 81 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 8 Domiciliary District Nurse Midwife 1 Physiotherapist (part-time) 1 12 HOME NURSING Superintendent 1 Assistant Superintendent 1 District Nurses 43 45 HOME HELP Home Help Organisers 3 Assistant Home Help Organisers 3 6 120 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 18 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 Centree) 6 Supervisors (Day Centre) 2 Assistant Supervisors (Day Centre) 4 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 52 CHIROPODY Chief Chiropodist/Administrative Officer 1 Senior Chiropodists 6 Chiropodists (Sessional) (Full-time equivalent — 5.1) 15 22 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) 10 Dental Surgery Assistants 6 Dental Surgery Assistant/Clerical Assistant 1 18 Total Number of Officers 550 (In addition lists are maintained of doctors, who are prepared to work on a sessional basis.) 121 Establishment of Manual Workers—31.12.70. ENVIRONMENTAL HEALTH Bathing Attendants 8 Drivers 6 Porter Cleaner 2 Female Cleaner, Supervisor 1 Female Cleaners 4 Washing machine attendants 2 Rodent Operative Chargehand 1 Rodent Operatives 8 MEALS SERVICE Cook (32% hours) 1 Assistant Cook (2 x 32½ hours) 2 Kitchen Helpers (3 x 32½ hours; 1 x 20 hours) 4 Drivers (20 hours each) 14 Helpers (20 hours each) 14 HOME HELP SERVICE Total Home Helps (hours) 6400 HEADQUARTERS AND PERSONAL HEALTH Hours per week Attendants 155 Cleaners 1159 Cooks 344 Guides 303 Kitchen Helpers 211 Laundresses 182 Needlewoman 40 Porter/Cleaner 24 Stoker/Handyman 120 Handyman/Driver 40 Handyman 15 122 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.I. Lough Road Lough Road, N.7. 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 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.) 123 PREMISES Mental Health Industrial Unit Isledon Road 76/80 Isledon Road, N.7. Mental Health Special Care Unit Holloway 577, Caledonian 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.I. Health Centre Finsbury Pine Street, E.C.I. 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; Chiropody; School Health (Special Investigations) 124 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. 125 INDEX Absent Friends 9 Air Pollution 43 Attachment to The Wolfson Centre 114 Audiology 113 Births 19 Bacteriological Examinations 34 Basement Bakehouses 53 Battered Babies 105 B.C.G. Vaccination 97 Bathing Centres 103,114 Care of Mothers and Young Children 91 Celluliod and Cenimatograph Film 49 Cervical Cytology 99 Chest Clinics 32 Child-Minding 92 Children's Department - Co-Operation with 106 Chiropody 98 Clean Air 43 Consumer Protection 49 Cremations 103 Cromwell Lodge Hostel for Homeless T.B. Men 32 Day Care of Children 91 Day Centres 86 Day Nurseries 91 Deaths 19, 94 Dental Services 115 Diphtheria, Suspected 29 Diseases of Animals 59 Disinfection and Disinfestation 50 District Inspection 41, 52 Domitiliary Midwifery 93 Dysentery 31 127 Elderly, Services for the 101 Emergency Telephone Service 106 Employment Agencies 49 Environmental Health Services 37 Export Certificates - Food 59 Factories and Outwork 51 Fertilisers and Feeding Stuffs 49 Family Planning 99 Fire Risks 93 Fireworks 49 Food and Diseases of Animals 54 Food Poisoning 28 General and Vital Statistics 17 Geriatric Preventive Clinics 102 Grants to Voluntary Organisations 104 Handicapped Register 105,114 Health Education Service 69,113 Health Visiting 92 Home Help 100 Home Nursing 94 Home Safety 74 Housing 60 Ice Cream 55, 56 Immigrants 33 Incontinence Pads 96 Infectious Diseases 25, 27 Inspection and Enforcement Duties 39, 41 International Certificates of Vaccination and Inoculation 28 Islington Chest and Tuberculosis Care Committee 32 Laundry 103 Lead Poisoning 29 Legal Proceedings 55 Loan of Equipment 95 Lung Cancer Deaths 22 128 Massage or Special Treatment Establishments 49 Maternal and Child Health Centres 91 Meals 101 Measles Vaccination 97 Meat Inpsection 42, 59 Medical Treatment of School Children 109,114 Mental Health Service 83 Midwifery, Domiciliary 93 Milk 55 Night Cafes 58 Noise 41, 63 Nurses Agencies 49 Nurseries and Child-Minders 91 Nursing Homes 49 Nursing Services 13 Observation and Handicapped Register 105,114 Offensive Trades 54 Offices and Shops 63 Oil Heaters 74 Outwork 53 Personal Health Services 89 Pharmacy and Poisons 49 Pigeons 50 Playgroups 92 Premises 119,123 Prevention of Break-up Families 105 Principal Officers 5 Prophylaxis 96 Public Control 49 Rabies, Suspected 29 Rag Flock 49 Radioactive Substances Act 1960 54 Rats and Mice 50 Recuperative Holidays 100 Refuse 39 Remedial Foot Classes 113 129 Rubella Vaccination 97 Sampling 56 Scabies and Vermin 34 Sewage and Sewage Disposal 43 School Health Service 107 Shops Acts 49 Slaughter of Animals 55 Slum Clearance 60 Smallpox- International Certificates 27 Smoke Control 42 Smoking Advisory Clinic 73 Special Investigation Clinics 114 Staff 119 Statistics 17 Stillbirths 19 Street Markets 58 Students' Visits 106 Task Force 103 Theatrical Employers 49 Training Centres 86 Tuberculosis 31, 98 Typhoid and Paratyphoid Fever 30 Vaccination & Immunisation 96 Venereal Disease 34, 73 Vital Statistics 17 Water Supply 39 Welfare Department - Co-Operation with 106 Works in default 41 130 Printed by the London Borough of Islington