London Borough of Islington PUBLIC HEALTH DEPARTMENT With the Compliments of the Director of Public Health and Medical Officer of Health 159/167 Upper Street, Islington , N.I. Telephone 01-226 1234. Extension Please ask for AC-4361 2nd Copy ANNUAL REPORT Director of Public Health and Medical Officer of Health London Borough of Islington 1971 ISL 100 CONTENTS SUBJECT PAGE Introduction 1 Health Committee 3 Principal Officers of the Department 4 Dr. Blyth Brooke 5 River Place Health Centre 7 Nursing Services 13 Vital Statistics 19 Infectious and other Diseases 27 Environmental Health 37 Health Education 67 Personal Health 77 School Health 93 Staff and Premises 103 Index 110 1 To the Mayor, Aldermen and Councillors of the London Borough of Islington INTRODUCTION The introduction to my annual report for 1970 and to that of my predecessor for 1969 referred to the major changes impending in the organisation of the health and social services. In 1971 the first stage in this series of changes took place with the setting up of the Social Services Department and the transfer to it from the Health Department of a wide range of services for handicapped and vulnerable groups in the community, including the mental health service, the day care of pre-school children, and the meals on wheels and home help services which are of particular importance to the elderly. My predecessor's final annual report, that for 1969, included a review of progress and developments in the services for which the Borough assumed responsibility on its formation in 1965 and this amongst other things describes the substantial development which had been achieved in these services in the period between their passage to the Borough Health Department from the former London County Council and their transfer to the Social Services Department. These achievements, together with plans for development worked out during the same period will, it is hoped, provide a firm basis on which to build for the future. Reference was made in my report for 1970 to the importance of fostering a close working relationship between the health and social services departments in order to minimise the damage which may result from the separation of health from social services which will take place on the re-organisation of the National Health Services in 1974. In order to ensure the smooth transfer of services from the health to the social services a series of meetings of senior officers of the two departments was commenced and these have continued to be held at quarterly intervals. In addition a senior member of the health department's nursing staff was seconded to the social services department for a six month period in order to assist in the initial period of responsibility for the transfer of services in the field of child care. Progress towards the re-organisation of the National Health Service continued with the publication in the middle of the year of the Consultative Document in which the Secretary of State set out his proposals for the future organisation of the service. Later in the year the expert study into the detailed management structure of the new organisation, and the working party to study the vital matter of collaboration between the Area Health Authorities and the Local Authorities, both referred to in the Consultative Document, commenced their work and it is anticipated that a White Paper will be published in the summer or early autumn of 1972. During the year anxieties were expressed in some quarters that the approaching loss of their health services might lead some less enlightened local authorities to neglect them during the interim period and the Secretary of State took action to try and prevent this by issuing circulars and holding local and regional meetings with local authority representatives. It is pleasant to record that as far as Islington is concerned, the Borough remains fully committed to maintaining and extending its health services in the interests of its residents so that they can be transferred to the new health authorities in a strongly developed and vigorous state and in particular a programme of health centre provision has been worked out which will, it is hoped, provide the Borough with a total of ten health centres over the next few years. In April the River Place Health Centre, the first purpose-built health centre constructed in the Borough, was opened providing accommodation for seven general practitioners and a wide range of local authority personal and school health services. A fuller appreciation of the working of this centre appears in the body of this report at page 7 : there is no doubt that the experience of closer working relationships between the various services housed in the centre has been to the benefit not only of the professional and other staff involved but also, and more important, to the patients. Development and expansion took place in a number of other sections of the department during the year and are fully reported in the body of this report. Amongst those worthy of special mention is the Health Education unit. Always amongst the most active and successful departments of its kind in London, and indeed in the country, this unit was increased in strength during the year by two additional posts and 2 plans were made for the transfer of the entire unit to a new suite of rooms at the headquarters office at Upper Street, thus laying the foundation for further growth in activities. This transfer was made possible by the extension of the headquarters office to include accommodation at 167 Upper Street which had previously been let by the Borough Housing Department as a flat. Adaptation of this for office purposes provided much needed extra office space in addition to allowing the improvement in the health education section's accommodation to take place. As a result of a detailed examination by the Personnel Officer of the management structure of the nursing service carried out in the light of the "Mayston" Report, the Council adopted a new structure with effect from 3rd November, 1971. It is anticipated that the strengthened organisation thus created will help the nursing service to deal more effectively with the many and complex problems posed to it in an area such as Islington. In September the Council took the decision presaged in my report for 1970 to make the family planring services in the Borough free of all charges with effect from 1st April, 1972. This decision was taken in the light of the general and growing anxiety about the population problem generally, together with a number of local factors. In 1970, 594 births, i.e. one in every six births to Borough residents, were illegitimate and, it was estimated that in the same year the number of abortions on Borough residents carried out under the 1967 Abortion Act might well exceed 1,000. Islington was the first English local authority to take such a decision and not unnaturally it attracted a good deal of publicity - the bulk, although not all, of which was favourable. A number of other local authorities in London have since taken a similar decision; one borough was in fact able to implement it in advance of Islington. It seems certain that family planning will ultimately be made universally available free of charge as part of the National Health Service - perhaps as part of the major reorganisation of the National Health Service anticipated in 1974. Following the substantial changes of personnel in the senior management of the department which took place in 1969-70, 1971 was a year of relative stability in this field. It is sad, however, to have to record the death on 24th September, 1971, of Dr. Blyth Brooke who retired on 14th July, 1965, from the post of Associate Medical Officer of Health. An appreciation of Dr. Blyth Brooke appears at page 5 . In conclusion I wish to thank the chairmen and members of both the present and the former Health Committees for their unfailing interest in and support of the work of the department and its staff. I also wish to pay tribute to the staff of the department of all grades for their loyal support so freely given to me personally and for their indefatigible efforts in pursuit of the department's aims. Acknowledgement is also due to the many other individuals and organisations, both inside and outside the Council, for their goodwill and co-operation without which the smooth operation of the department would have been impossible. C.BURNS Director of Public Health and Medical Officer of Health 3 HEALTH COMMITTEE (31.12.71) Mayor Councillor E.C. GOUGH, J.P. Chairman Councillor D.B. HOODLESS, B.A., D.P.A. Vice-Chairman Councillor R.J. REDRUPP Aldermen A.H.S. HULL C.R.ST. HILL, Dip. P.H.A. Councillors Mrs. P. BROWN Mrs. E.K. BROWNING JACK CANNON V.J. CORDWELL G.F. FLYNN Mrs. P.J. MILSOM, Dip. Social Admin. Mrs. M.A. OGILVY-WEBB, B.A. (Cantab.) JACK WALKER Co-opted Members Dr. J.S. NORELL, M.R.C.S., L.R.C.P., M.B., B.S. F.A. RIDDETT, ESQ., M.B.E. Mrs. J. DONNISON, B.A. Mrs. V.R.M. ROSEN, B.A. 4 PRINCIPAL OFFICERS OF THE PUBLIC HEALTH DEPARTMENT (31.12.71) Director of Public Health and Medical Officer of Health C. BURNS, M.B., Ch. B., D.C.H., D.P.H. Deputy Director of Public Health and 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 BETTY GROVES M.B., B.S., D.P.H. Chief Dental Officer and Principal School Dental Officer R.E. HYMAN L.D.S., R.C.S., (Eng.) Public & Agricultural Analyst R.G. MINOR, F.P.S., F.R.I.C., M. Chem.A. Senior Medical Officers JOAN M. CLARKE B.A., L.R.C.P., M.R.C.S., M.B., B.S., D.C.H., D.P.H. Chief Administrative Officer E.J.SHARP Assistant Chief Administrative Officer S. GODSTONE Principal Administrative Officers MISS D. EGGINTON R.D. BILLINGS, A.C.I.S., Dip. Comp. R.C. LOCKWOOD, M.A.P.H.I., A.R.S.H. Chief Nursing Officer MISS L.K. MAY S.R.N., S.C.M., H.V., Q.N., Dip. Soc. Senior Nursing Officers MRS. M. TAMBLYN MISS W. YOUNG S.R.N.,H.V.,R.F.N. S.R.N.,S.C.M.,H.V.,Q.N. D.F.PROCTER MRS P.B. STOKES S.R.N., Q.N. S.R.N.,S.C.M., N.D.N. Health Education Officer K.M.N. ROBERTSON, L.M.R.S.H., M.I.H.E., M.R.I.P.H.H. ISOLDE W. FELLNER M.D., L.R.C.P.Edin., L.R.C.S.Edin., L.R.F.P.S.GIas. Chief Public Health Inspector M. JACOB, M.A.P.H.I. Deputy Chief Public Health Inspector A.J. TRUSLOVE, F.A.P.H.I. Assistant Chief Public Health Inspectors W.T. STEVENSON, M.A.P.H.I. R.C. WHITTAKER, M.A.P.H.I. Principal Nursing Officer (Preventive) MISS M. BRERETON S.R.N.,S.C.M., B.T.A., H.V. Diploma Health Service Admin (Aston Univ) Principal Nursing Office (Therapeutic) MRS. V.A. AUSTIN S.R.N., S.C.M., Q.N. Senior Social Worker MISS M.MACMORRAN Deputy Senior Social Worker MRS. A. HOSKER 5 DR. C.O.S. BLYTH BROOKE, O.ST.J., M.D., D.P.H. Barrister at Law From November 1939 until 1st April, 1965, Dr. Blyth Brooke was Medical Officer of Health of the Metropolitan Borough of Finsbury. A Fellow of the Royal Society of Medicine, a Fellow of the Society of Medical Officers of Health, and Chairman of the City Division of the British Medical Association, he was from 1948 a pioneer in the field of old people's services, and was responsible for establishing in 1951 "Brooke House", London's first work centre for the elderly. Dr. Blyth Brooke addressed numerous conferences, both in this country and abroad, on public health matters (particularly geriatrics), published several treatises in professional papers on medical subjects and was an examiner in public health examinations. He was for many years a Barrister of the Middle Temple and an acknowledged authority on medical ethics. From the time he joined Finsbury in 1935 as Tuberculosis Officer and Assistant Medical Officer of Health, Dr. Blyth Brooke took a very real and personal interest in every aspect of the development of public health services in that Borough. Possessed of great ability coupled with energy and enthusiasm, he applied his talents unreservedly to the duties of his office, and his diligence gave an inspiring lead to all who worked with him. He was responsible for instigating many of the schemes and improvements achieved by the former Finsbury Borough Council which have continued to the benefit of Islington's present health services. Dr. A.K. Arnold, Deputy Director of Public Health, who was Dr. Blyth Brooke's deputy in Finsbury, writes as follows:- "With Dr. Brooke's death, public health has lost an eminent and popular personality. The friendly, almost family atmosphere of Metropolitan Finsbury at both officer and councillor levels owed a great deal to his personal influence. Dr. Brooke left this Council's service in 1965 on reaching the age of 65, but he had too active and enquiring a mind ever to retire completely. The five years following his official retirement were spent in Gambia where his expert knowledge of tuberculosis was of great assistance to the health authorities in checking the spread of this disease. Reasons of health compelled him to return to this country in 1970 but he continued to take an interest in public health matters until the very end of his life. His passing is a loss to all those who had the privilege of knowing him and working with him." RIVER PLACE HEALTH CERTRE 9 RIVER PLACE HEALTH CENTRE The health centre, situated close to Essex Road Underground Station, opened on 1st April, 1972. Services provided include the following:- General Practitioners 5 surgeries (7 doctors) Borough Ante Natal Cervical Cytology I.L.E.A. Child Guidance Special Investigation Vision Child Health Chiropody Creches Family Planning Prophylaxis The initial proposal for the health centre was discussed with local General Practitioners and the Inner London Executive Council; a fairly central site was found (no mean achievement in an area like Islington) and discussion took place on the services to be included, the layout of the building, its staffing and equipment. At each stage of the process consultation took place with various personnel involved. Among the factors requiring consideration were the following. Did the doctors run appointment systems? (the waiting space can be reduced by some 40% where appointment systems are in operation). How were patients to be called to the consulting rooms from the reception area? What type of telephone system would be required? How many receptionists? What form of record cabinet? The premises designed for use as a health centre must not only meet present needs but must also have regard to the potential demands of the future, and it is probably fair to say that most buildings, looked at with the hindsight of the experience gained in running them, would have been designed differently. Within the geographical and financial limits imposed, however. River Place compares favourablv with other modern centres in terms of site area and services provided. The centre has been visited by numerous doctors, nurses, planners, administrators and architects from various parts of England and from abroad, who have discussed the problems of planning, design, systems, administration and inter-relationships of staff before embarking on their own schemes. In the modern health centre the team replaces the individual and the object is to bring together all those involved in the provision of primary medical care for the purpose of providing a service acceptable to the public and, at the same time, satisfying to the professional aspirations of all the staff. The team cannot be held together by authoritative means, the democratic group is welded as a reality by each member having respect for the other's discipline. The nurses, for example, are not mini-doctors but professionals in their own right. Although such teamwork is not easy to achieve, this does not invalidate any means which aims at its eventual achievement. To achieve the efficiency preached for health centres, while maintaining a reasonably personal atmosphere, a key factor is the attitude of every member of the centre's staff. Everyone must have a sense of direction and a good working relationship. One of the general practitioners at River Place has given the following account of his first few month's experience at the Centre. "It was with some apprehension and many mental reservations that I finally decided to enter the health centre. My mind had been eased somewhat by the kind consideration, guidance and attention to the wishes of the general practitioners that had been received from the Medical Officer of Health and the Executive Council throughout the early planning stages, but I still had certain misgivings about the possibility of a non-homogenous group of doctors and ancillaries working together in the same building. 10 River Place Health Centre Entrance River Place Health Centre - Reception Desk 11 River Place Health Centre - Treatment Room River Place Health Centre - Staff Rest Room 12 At last having dealt with the problems relative to the move from premises in which I had practised for many years (and anyone who has moved house after many years knows precisely what it involves) came the day of decision. I had met one of the staff, briefly, and was not quite sure what to think; was the smile that of some partner in a devious plan to rob me of my independence? Having settled in the Centre I was relieved to find not only a friendly atmosphere and a lot of goodwill all round, but an immediate reaction of enthusiasm for joint working. In the first place, this applied to my initial contacts, the personnel on switchboard and reception duties, whom I have since found to be the pillars responsible for the day-to-day running of the surgeries, and secondly to the health visitors, clinic nurses, social workers and representatives of the other services all helped along by the tactful management of the Administrative Officer. I hasten to add that this spirit of friendliness and co-operation has also become the keynote of the relationship between we general practitioners. The synergistic effect of health centres has entered the jargon of the medical publications and I have found in practice that the convenience of being able to discuss the social and psychiatric problems of patients with an expert ancilliary staff, without the frustrations of having to contact various departments, does indeed stimulate greater co-operation. Probably more significant is the opportunity which arises to meet members of other disciplines regularly on both the social and professional basis. This is the great advantage, for one is able to get straight to the point, knowing their problem and knowing that they "speak your language". The health centre is not, however, simply an office with services in close proximity providing regular contact. It is a seed-bed of ideas. Ways are constantly being considered for the expansion and development of our work, and the staff of the centre seem to be dedicated to this end. In the early stages, we have been able to implement procedures to add to the comfort and convenience of our patients, especially in respect of waiting time for surgeries and for prescriptions. In conjunction with the health visitors we have been able to provide extra services for some of our patients who have a weight problem and we are in the process of arranging a comprehensive pathology service for the Centre, various aspects of which will be of immense value both to the patient and to the doctors. Much of the technical and administrative work involved in these systems is being dealt with by the centre staff. I have found nothing but positive attitudes and constructive ideas from all sections of the staff, and this is only the beginning. After all this elaborate praise one asks oneself about the drawbacks. We have been working together now for just over six months and so far I can find none of this, and I am hopeful that this honeymoon of inter-relationships will continue." At the end of 1971, I think it could be fairly said that the centre continued to function very satisfactorily. The problems met are of the type that could not easily have been foreseen in the planning stages and considerable experience has been gained for the future. NURSING SERVICES 15 NURSING SERVICES In spite of the re-organisation of the work of the department resulting from the implementation of the Social Services Act and the transfer of some of the services previously carried out by the nursing section, there was in fact an increase in the activity during the year. It is obvious that although some of the services are no longer under direct administration of the section, time is still spent on these as help or advice on nursing matters is frequently required by the Social Services Department. The day-to-day work continued with the aim of all public health nurses in mind, i.e. the promotion of health, the improvement of conditions in the social and physical environment, rehabilitation and the prevention of illness and disability. Attachment and/or liaison of health visitors and home nurses to general practitioners has increased so that 38% of health visitors and 10% of home nurses now work in these schemes. A group of general practitioners, concerned about the health and welfare of their patients in the 65+ age group, requested the help of the nursing services to ascertain the needs of these people. Geriatric visitors and health visitors, including staff of the London Borough of Hackney where some of the patients lived, cooperated in this project. Many of these elderly people were found to be well and active, some still in full-time or part-time employment. The majority of those who were frailer, housebound or ill, were receiving a variety of domiciliary services from the boroughs concerned. Additionally, a geriatric visitor was involved in the planning of a pilot survey questionnaire for screening of the elderly, and later in carrying out this survey on patients in one group practice. The year has been a busy one for the home nurses; an increased number of patients entailing a larger number of visits. 75% of the patients are over 65 and many are between 80 and 90 years. The chronic sick, handicapped and terminally ill make up the largest proportion of patients, many requiring prolonged and intensive care. Co-operation with hospitals gained momentum. A second health visitor attends paediatric ward round at Whittington Hospital, and a health visitor now goes to Elizabeth Garrett Anderson Hospital for case conferences involving Islington patients. These arrangements were made after consultation with the London Borough of Camden. Visits were made to St. Bartholomew's and University College Hospitals to facilitate entree to these hospitals for home nurses, so that patients can be seen either after admission or prior to discharge, thus ensuring continuity of care. Staff are frequently invited to nurse-study days at the hospitals with which they liaise. The importance of community medicine has also been receiving increasing recognition by medical schools; several medical students obtained experience in this field in the Borough during the year. A lecture on the work of public health nurses was given to doctors taking the Diploma of Public Health at the Royal Institute of Public Health and Hygiene by the Chief Nursing Officer. Visits were arranged for nursing officer colleagues from other London Boroughs to see the new River Place Health Centre. Others came to glean information gained from work with the Keystone Vision Screening apparatus which the school nurses have used successfully during the year. On the other hand, three of the nursing officers gave a symposium to nursery nurses at the North London College and a meeting was held with the Area Team Leaders of the Social Services Department to explain the aims, functions and duties of the nursing service. Apart from refresher courses attended by staff, in-service training included:- (i) mouth to mouth resuscitation - talks to all nursing staff; (ii) domiciliary family planning - symposium for health visitors and midwives; and (iii) training sessions concerning the computerisation of child health records - health visitors. 16 Home Nurses Domiciliary Midwife 17 With the ever increasing demand for family planning, further clinics were opened; there was an urgent need to train more nursing staff in family planning and use was made of all available courses. Domiciliary family planning was taken over by the Borough from the Family Planning Association on 1st April. The report by the nurse concerned is included in the item on this subject. The Department of Health and Social Security asked all local health authorities to implement a nurse management structure in the light of the Mayston report,which was approved by the Personnel Committee in November and is gradually being implemented. 1974 is not far distant, with all the changes it will bring to the health service of the country, including nursing services, but - to quote James Thurber - "Let us not look back in anger nor forward in fear, but around us in awareness" for the benefit of the service we are hoping to give to the community. VITAL STATISTICS VITAL STATISTICS Area — 3,678 acres Population (Estimated Mid-Year) — 200,730 Marriages solemnised in the Borough 1,978 (provisional) BIRTHS Total Male Female Live Births — Legitimate 3,030 1,535 1,495 Illegitimate 538 251 287 3,568 1,786 1,782 Islington England and Wales Live Birth Rate Per 1,000 Population 17.8 16.0 Birth rate after applying 'Area Comparability' Factor of 0.80 14.2 Illegitimate Live Births Per Cent of Total Live Births 15.1 8.4 Total Male Female Still Births — Legitimate 31 15 16 Illegitimate 3 2 1 34 17 17 Islington England and Wales Still Birth Rate Per 1,000 Population 0.17 0.20 Still birth rate per 1,000 live and still births 9.4 12.5 Total Male Female Total Live and Still Births — Legitimate 3.061 1,550 1,511 Illegitimate 541 253 288 3,602 1,803 1,799 DEATHS Total Male Female All Causes 2,392 1,226 1,166 Islington England and Wales Death Rate (Crude) Per 1,000 Population 11.9 11.6 Death rate after applying 'Area Comparability' factor of 1.09 13.0 21 Infant Deaths Total Male Female Deaths of Infants under one year of age — Legitimate 44 20 24 Illegitimate 8 6 2 52 26 26 Islington England and Wales Infant Mortality Rate (per 1,000 live births) — All Infants 14.6 17.5 Legitimate 14.5 16.9 Illegitimate 14.9 24.1 Deaths of Infants under 4 weeks of age — Total Male Female Legitimate 29 13 16 Illegitimate 6 4 2 35 17 18 Islington England and Wales Neo-Natal Mortality Rate (per 1,000 live births) All Infants 9.8 11.6 Legitimate 9.6 11.3 Illegitimate 11.1 15.1 Early Neo-Natal Mortality Total Male Female Deaths of Infants under 1 week of age — Legitimate 21 8 13 Illegitimate 5 3 2 26 11 15 Early Neo-Natal Mortality Rate (per 1,000 live births) Islington England and Wales All Infants 7.3 9.9 Legitimate 6.9 9.6 Illegitimate 9.3 12.9 Perinatal Mortality Total Male Female Still births and deaths under 1 week combined 60 28 32 Perinatal Mortality Rate Islington England and Wales (per 1,000 total live and still births) 16.7 22.2 Maternal Deaths (including abortion) Nil 133 Rate (per 1,000 total live and still births) Nil 0.17 22 ANALYSIS OF INFANT DEATHS - 1971 (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 Meningococcal infection 1 1 Meningitis 1 1 Other diseases of nervous system and sense organs 2 1 3 Pneumonia 2 2 4 Bronchitis, emphysema 1 1 Other diseases of the repiratory system 1 3 1 5 Intestinal obstruction and hernia 1 1 Congenital anomalies 4 3 1 2 1 1 12 Birth injury, difficult labour, and other anoxic and hypoxic conditions 7 3 1 1 1 2 15 Other causes of perinatal mortality 5 1 1 7 Symptoms and ill-defined conditions 1 1 Totals 16 3 4 1 1 ■ 1 3 4 2 2 6 1 2 3 1 2 ■ • - ■ 52 Estimated Child Population Under 1 year 1 - 4 Total under 5 5- 14 Total under 15 Islington 3,720 13,780 17,500 27,200 44,700 Greater London 114,720 414,280 529,000 1,041,200 1,570,200 DEATHS OF INFANTS UNDER ONE YEAR The infant mortality rate shows a substantial fall since 1970 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. Nearly 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 seventeen infant deaths in the age group one to twelve months, eight were due to pneumonia, bronchitis and other diseases of the respiratory system. MATERNAL MORTALITY It is a very considerable tribute to the hospitals, the local health authority and the family practitioners that in a total of 3,602 live and still births, there were no maternal deaths. 23 RESPIRATORY TUBERCULOSIS The death rate for lung tuberculosis (including late effects) in 1971 was 0.03 per 1,000 population, and is the lowest ever recorded in the borough. DEATHS DUE TO PNEUMONIA AND BRONCHITIS In 1971 there were 141 deaths ascribed to bronchitis and 199 to pneumonia. These figures show more bronchitis but less pneumonia deaths than those for 1970, which were 137 and 209 respectively. MALIGNANT GROWTHS OF LUNG AND BRONCHUS I reported last year that lung cancer deaths in males of 166 showed a rise over 1969 when there were 160 deaths. Unfortunately this trend continued in 1971 when 182 males died from this disease. Female deaths from this cause of 38 were the same as in 1970. CORONARY DISEASE WITH ANGINA There were 502 deaths (308 male and 194 female) from this cause in 1971. This shows an overall increase from the 1970 figure of 476 (268 male and 208 female). ACCIDENT DEATHS - Comparative table. 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 Motor vehicle accidents 22 34 28 29 34 34 23 29 24 29 Other violent accidents 69 84 62 60 58 65 38 47 47 35 ACCIDENT DEATHS - Analysis by age groups Type under 4 weeks 4 week' and under 1 year 1- 5- 75- 25- 35- 45- 55- 65- 75+ M F Total Motor Vehicle accidents - . 2 3 3 3 3 1 2 5 7 19 10 29 Falls – - - 2 2 - - 1 1 1 4 6 5 11 Accidental Poisoning (Solid, Liquid Gases and Vapours) – _ _ _ 2 3 1 3 1 1 6 5 11 Fire ■ - 1 2 - - - - 2 - 1 2 4 6 Inhalation of stomach contents, ingestion of food,etc. – – 1 – – – – – – – – 1 – 1 Other (Railway Accidents, etc.) – – – 1 1 1 – 1 1 – 1 3 3 6 Total - - 4 8 8 7 4 6 7 7 13 37 27 64 24 1971: 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 dysentary and amoebiasis — — — - — - — - - - - — — - - - - - _ - _ _ _ _ - Enteritis and other diarrhoeal diseases — 1 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Tuberculosis of respiratory system 2 1 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 2 _ Late effects of respiratory tuberculosis 3 — 3 - - - - — - - - — - - - - - - _ - _ 2 _ 1 _ Other tuberculosis - - - - - - - - - - - - - - • - - - - - - - - _ _ - Plague — — — — — — - — — — — — — - — — — — — - _ _ _ _ - Oiphtheria - — - - - - - - - - - - - - - - - - _ - _ _ _ _ _ Whooping Cough — — _ - — — - - - - - - - _ - — - — _ - _ _ _ _ _ Streptococcal sore throat and scarlet fever — _ — - - - - - - - - - - — - - - - _ - _ _ _ _ _ Meningococcal infection - 1 1 - - - 1 - - - - - - _ - - - - _ - _ _ _ _ _ Acute poliomyelitis - - - - - - - - - - - - - - - - - - - - - - _ _ - Smallpox — - — - - - - - - - - - - - - - - - - - - - _ - - Measles — — — — — — — — — — — — — _ — — — — _ - _ _ _ _ Typhus and other rickettsioses — — _ - - - - - - - - - - _ - _ - _ _ _ _ _ Malaria — - - - - - - - - - - — - _ - _ - _ _ _ _ _ _ Syphilis and its sequelae 2 - 2 - - - - - - - - - - _ - _ - _ - 1 _ _ _ 1 _ All other infective and parasitic diseases 1 — 1 — - - — — — - - — - _ - 1 _ _ - — _ _ _ _ _ Malignant neoplasm - buccal cavity and pharynx 3 1 4 - - - - - - - - - - - - 1 _ 1 - - _ _ _ 1 1 Malignant neoplasm - oesophagus 5 5 10 — — — — — — — — — — — — — — — — 1 1 1 _ 3 4 Malignant neoplasm - stomach 33 30 63 — — — — — — — — — — — — — — 5 - 11 4 14 11 3 15 Malignant neoplasm - intestine 28 27 55 — — — — — — — — — — 1 _ 1 - 3 - 4 6 9 13 10 8 Malignant neoplasm - larynx 2 1 3 - - - - - - - - - - - _ - - _ 1 1 - - _ 1 - Malignant neoplasm - lung, bronchus 182 38 220 1 1 1 16 3 53 12 75 13 37 8 Malignant neoplasm - breast — 54 54 - - - - - - - - - - - - - 1 - 9 _ 6 - 16 _ 22 Malignant neoplasm - uterus — 16 16 - - - - - - - - - - - - - 1 _ 5 _ 2 - 2 _ 6 Malignant neoplasm - prostate 18 - 18 - - - - - - - - - - - - - - _ - 1 _ 4 _ 13 - Leukaemia 11 4 16 - - - - 1 - - 2 1 1 - - - - 3 - 2 - 2 _ 2 1 Other malignant neoplasms, including neoplasms of lymphatic and haematopoietic tissue 63 80 143 - - - - - - - - 1 3 2 3 2 9 6 17 17 23 18 8 34 Benign neoplasms and neoplasms of unspecified nature 6 1 7 - - - - - - - - 1 - — - 1 - - - 2 _ 2 _ - 1 Diabetes mellitus 8 13 21 - — — - - — - - _ — 1 — — 1 — — 1 2 3 6 3 4 Avitaminoses and other nutritional deficiency - 1 1 - - - - - - - - - - - - - - - - - - - - - 1 Other endocrine, nutritional and metabolic diseases 1 2 3 - - - - - - - - - - - - - - - - - - 1 - 1 Anaemias 5 7 12 - - - - - - - - - — 2 - - - _ - _ _ - - 3 7 Other diseases of blood and blood-forming organs — - - - - - - - - - - - - - - - - - - _ _ - - - - Mental disorders - 3 3 - - - - - - - - - - - - - - - - _ - - - - 3 Meningitis 1 — 1 — — 1 — — - — — — — — _ - _ _ — _ _ - - - — Multiple sclerosis 1 1 2 - - - - - - - - — - - - - _ _ 1 1 _ - - - - Other diseases of nervous system and sense organs 11 6 17 - - 2 1 - - - - 1 - _ - 1 - _ - 2 1 4 - 1 4 Active rheumatic fever — — — — — — — — — — — — — - _ _ _ _ - _ _ - — — — Chronic rheumatic heart disease 10 30 40 1 1 1 1 1 2 2 4 2 11 3 11 Hypertensive disease 16 17 33 - - - - - - - - - - - _ - - _ 1 4 2 6 4 6 10 Ischaemic heart disease 308 194 502 - - - - - - - - — 4 _ 6 _ 33 7 82 20 110 55 73 112 Other forms of heart disease 64 108 172 - — — - — - - - - — 2 _ _ _ _ - 5 2 11 10 45 96 Cerebrovascular disease 78 150 228 - - - - - - - - - - - 1 2 2 4 5 14 28 28 30 30 84 Other diseases of the circulatory system 34 69 103 - - - - - - - - - - - 1 - 1 1 2 7 5 9 13 17 47 Influenza 1 — 1 — — — — — — — — — — — _ _ _ _ — _ _ 1 - — - Pneumonia 78 121 199 1 1 - 2 1 1 - - - - - _ 1 _ 4 2 10 1 20 14 41 100 Bronchitis, emphysema 93 48 141 - - - 1 - - - - - - - _ - _ 4 1 14 5 38 10 37 31 Asthma 2 2 4 - — — — - - - — — _ 1 _ - _ _ — 1 1 - - - 1 Other diseases of the respiratory system 25 7 32 - - 4 1 - - - - - - 1 _ - - _ - 3 2 5 2 12 2 Peptic ulcer 13 9 22 - - - - - - - - - - - - 1 - 1 1 4 - 4 4 3 4 Appendicitis — 1 1 - - - - — — - - - - — - — - — - _ - - - - 1 Intestinal obstruction and hernia 8 5 13 1 - - - — - - - _ — - _ - - _ - 1 - 3 2 3 3 Cirrhosis of liver 5 1 6 — — - - - — — — _ — 1 _ 1 - _ - 2 1 1 - - - Other diseases of the digestive system 6 20 26 1 1 - 1 2 1 - 1 - 3 3 4 - 9 Nephritis and nephrosis 7 5 12 - - - - 1 - - - — 1 1 - - - 2 - - - 2 3 1 1 Hyperplasia of prostate 1 — 1 - - - - - - - - - - - - - - - - - - - - 1 - Other diseases of the genito-urinary system 5 10 15 - - - - - - - - - - - - 1 1 1 - 1 1 - 2 2 6 Abortion - - - - - - - - - - - - - - - - - - - - - - - - - Other complications of pregnancy, childbirth and puerperium _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - Diseases of the skin and subcutaneous tissue _ 3 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Diseases of the musculo skeletal system and connective tissue 7 9 16 _ _ _ _ _ _ _ _ _ 1 1 _ 1 _ 3 _ 2 8 Congenital anomalies 12 7 19 5 5 1 1 1 1 - - 1 - 1 - 1 - 1 - 1 - - - - _ Birth injury, difficult labour, and other anoxic and hypoxic conditions 7 8 15 7 8 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - Other causes of perinatal mortality 3 4 7 3 4 — — — — — — — — — — — — — — — — — — — ~ Symptoms and ill-defined conditions 3 9 12 - - 1 - - — - — - — 1 - - - - 1 - - - - 1 _ Motor vehicle accidents 19 10 29 - - - - 2 — 3 - 2 1 3 - 3 - 1 - 1 1 2 3 2 _ All other accidents 18 17 35 - - - - 1 1 5 - 4 1 2 2 1 - 3 2 1 4 1 1 - 6 Suicide and self-inflicted injuries 7 6 13 - - - - - 1 1 - 3 1 - 1 1 1 1 2 _ All other external causes 10 3 13 _ _ _ _ _ _ _ _ 3 _ _ 1 _ _ _ _ 1 _ _ _ _ _ All Causes 1.226 1,166 2,392 17 18 9 8 7 3 8 2 16 6 27 11 35 13 96 51 252 133 391 252 368 669 Totals 2,392 35 17 10 10 22 38 48 147 385 643 1,037 Percentages 100 1.46 0.71 0.42 0.42 0.92 1.59 2.01 6.15 16.09 26.88 43.35 25 INFECTIOUS AND OTHER DISEASES Notifications and deaths recorded during 1971 (Infectious diseases are those statutorily notifiable as at 31st December, 1971) Disease Number of notifications Number of deaths Removed to hospital Number of Cases returned to Registrar-General after correction of diagnosis Cases "coming to knowledge" but not notified Measles 318 (1,081) - 10 318 - Dysentery 28 (112) - 6 28 17 Scarlet Fever 29 (63) - - 29 10 Whooping Cough 45 (75) - 9 45 16 Infective Jaundice 103 (80) - 40 101 16 Ac. Meningitis 13 (13) - 13 13 4 Ac. Encephalitis (-) - - - - Ophthalmia Neonatorum 1 (1) - 1 - Paratyphoid Fever (3) - - - - Typhoid Fever 1 (3) - 1 1 - Food Poisoning 85 (121) - 12 78 47 Malaria 2 (1) - 2 2 2 Tuberculosis Lungs (primary) 82 (81) 6* - 81 7 Tuberculosis Other Forms (primary) 25 (21) - - 25 - * Includes late effects of respiratory tuberculosis. (Figures in brackets are notifications for 1970) SMALLPOX Of the 27 references for suspected smallpox and supervision of possible smallpox contacts, 24 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 1st August 1963, all were visited and kept under surveillance for the required period. 29 Advice was sought from the medical staff of the department in respect of one patient suffering from a rash of a type where it was desirable to exclude smallpox as a possible cause. This case was subsequently diagnosed as chicken pox. The last reference concerned two technicians who arrived from Germany and who gave business addresses in Islington, they had been in contact with a child who was admitted to a smallpox hospital with suspected smallpox. As they were residing in another borough the Medical Officer of Health of that borough agreed to keep them under observation until they returned to Germany. CERTIFICATES OF VACCINATION AND INOCULATION Applications for authentication dealt with by the Medical Officer of Health numbered 4,243 as against 4,073 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 1971 85 There was only one outbreak (summarised below) to be reported in accordance with Memo. 188 Med. of the Ministry of Health. No. of No. of No. of No. of Notifica- persons cases deaths Foods involved and organisms Date tions served reported responsible 15.7.71. — 75 26 — Chicken Elizabeth Salmonella enteritidis The above related to an outbreak involving a firm of caterers who supply pre-cooked meals to various business premises. Information was received from another Borough concerning the reported outbreak of food poisoning amongst members of the staff of a firm operating in their area which occurred on 15th July, 1971. It was understood that Salmonella enteritidis had been isolated from at least one person who suffered illness, and that the Islington catering firm were responsible for the preparation and supply of the suspected meal which included Chicken Elizabeth (cold chicken and cold curry-flavoured mayonnaise). As a result of detailed investigation it was ascertained that the chickens had been delivered to the catering firm the day prior to consumption. They were boiled at about mid-day that day for one and a half hours, allowed to cool, deboned, cooked for a further 45 minutes, cooled and eventually refrigerated (it was an exceptionally hot day). The meat was removed from the refrigerator the following day, the meal prepared, plates covered with cellophane and subsequently delivered to the various firms supplied by mid-day. 30 Final reports showed that 26 people were affected; average interval from ingestion to onset was between 12 to 48 hours. The main symptoms included fever, vomiting, abdominal pain and diarrhoea. The severity of illness ranged from moderate to severe and in several cases persisted many days after onset. Laboratory investigations showed that, of 19 cases examined, 5 proved positive for Salmonella enteritidis. Of the food handlers examined, 6 ate or tasted the meal, but with no resulting symptoms, 4 of these showed Salmonella enteritidis present. One other did not consume the meal and was negative. The 2 butchers who prepared the chickens at the wholesalers proved negative, whilst the chicken farm implicated was also the subject of detailed investigation but with negative results. LEAD POISONING There was only one reference to the department on the subject of lead poisoning during 1971. This concerned a two-year-old girl who was reported by a local hospital as having a raised blood lead level. 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 the window. Consequently the Inspector ordered its removal and reported on his last visit that conditions were satisfactory. CHOLERA There were 250 references to the department for the supervision of possible cholera contacts who had arrived in this country from declared endemic or locally infected cholera areas. The large numbers reported occured mainly during the period September to November, 1971 and generally concerned holiday makers from Spain. This supervision was necessary consequent upon the discovery of a number of cases in the Barcelona and Valencia Provinces of Spain. Because cholera is a disease of sudden onset without premonitory symptoms there can be no certain way of detecting a person entering the country during the incubation period. This is short, usually two to three days. Accordingly the surveillance period is short. Indeed, in a large percentage of the arrivals it was found that by the time the notification of arrival had been received the 5 day surveillance period was up. In these instances it was decided that a letter should be sent with a proforma to be filled in by the arrival and only in those instances where a history of enteric illness was reported would they be followed up. Needless to say all those notified within the 5 day quarantine period were visited and kept under observation. TYPHOID AND PARATYPHOID FEVER There were only two cases of Typhoid Fever during the year and none of Paratyphoid. The first case of Typhoid Fever was a young man of 26 years, an in-patient at an Eye Hospital in the Borough, found to be a confirmed case of Typhoid. He had come to London from Uganda at the end of June with his parents and stayed at a hotel in another borough. On the 28th July, he flew to Bombay where he remained for one week. On 6th August he flew to Brussels and was joined there by his parents. All meals were taken at this address. On the 13th August he went by train to Paris with his parents and subsequently returned to London to a hotel in another borough. On the 15th August, the patient was admitted to the Eye Hospital where he had a corneal graft operation on the 16th August. On the 19th, he ran a temperature and began to complain of headache. Samples of blood and urine were sent for laboratory analysis, the blood culture being positive whilst the urine negative. No faeces were sent as the patient was constipated. While in hospital the patient had been visited by his parents and two friends, one who was a nurse in a hospital outside the Borough. He was of course transferred to an isolation hospital and the Medical Officers of Health of the other boroughs implicated were informed. Hospital contacts were placed under daily clinical surveillance until three weeks from the last date of contact. All tests of contacts proved negative. 31 The second Typhoid Fever case was a 17 year old male admitted to an isolation hospital on the 26th September, 1971. A clinical diagnosis of Typhoid Fever made at the hospital was subsequently confirmed. Onset of symptoms was given as the 18th September, and it was reported that the patient together with other members of the family, arrived home from a holiday in Naples, Italy on the 10th September. Repeated specimens of blood, faeces and urine were obtained from all contacts of this case and the Medical Officers of Health of Boroughs where contacts were employed were kept fully informed. Unfortunately, there were a number of food handlers amongst the contacts employed at two restaurants and also a number employed at hospitals. The Medical Practitioners of contacts were also kept fully informed. The patient continued to excrete the typhoid bacilli in his faeces and it was feared that he would become a chronic carrier. Accordingly discussions were held with the Department of Health & Social Security and the Consultant Physician of the Isolation Hospital and it was felt by all parties that it would not be practical either to insist that a boy of 17 years should permanently live apart from his family or that his father at 45 years of age should change his occupation. Therefore stringent provisions and precautions to safeguard both the family and the public were laid down; these included monthly specimens of faeces, urine and blood from the patient and his mother and father. His doctor was warned that in the event of any suspicious illness they had been asked to report to him immediately. These instructions were communicated to the family both in writing and by word of mouth in the native language of the family. Fortunately subsequent tests have proved negative and it is hoped that the carrier state in which this patient was discharged may not prove permanent. Continued stool cultures are being obtained and should these all prove negative it would be reasonable to regard the patient as no longer being a danger. The other references to the Department concerned an old Typhoid case living in another Borough attending an Islington School and there were three other contacts of Typhoid and four contacts of Paratyphoid all with satisfactory conclusions. DYSENTERY There were only forty-five cases notified and 'coming to knowledge' during the year. Of these, thirty three proved positive whilst twelve were clinical cases with negative stools. Roughly two-thirds of these were isolated cases, the remainder comprising 2 small outbreaks at a day nursery and a play group. TUBERCULOSIS In 1971, 107 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 1 3 6 16 7 5 12 8 3 63 F - - - - - - 4 8 2 1 3 1 — 19 Non-Pulmonary M - 4 1 1 — — — 6 F - - 1 1 1 3 5 1 2 2 2 1 19 Totals — 1 2 2 4 13 33 11 9 17 11 4 107 The notification rate of all forms of tuberculosis was 0.53 per 1,000 population as against 0.24 for the whole country. The total number of cases remaining on the register after adjustment for deaths and transfers was, on the 31st December, 1971: Males Females Total Pulmonary 919 675 1,594 Non-Pulmonary 114 58 172 Totals 1,033 733 1,766 There were 6 tuberculosis deaths (all pulmonary) during 1971. The death rate of all forms of tuberculosis in the borough, per 1,000 population, was the same as the national rate - i.e. 0.03. 32 VISITING OF NEWLY ARRIVED IMMIGRANTS - YEAR ENDED 31st DECEMBER, 1971 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 firstt successful visits paid during the year COMMONWEALTH COUNTRIES Caribean 95 80 India 95 59 Pakistan 59 29 Other Asian 37 26 African 237 166 Other 37 15 TOTAL: 560 375 NON-COMMONWEALTH COUNTRIES European 171 111 Other 44 24 TOTAL: 215 135 GRAND TOTAL: 775 510 * Advice of arrival of immigrant. t First successful visit means the first time the local health authority officer established contact with the immigrant. 0 These successful visits do not necessarily relate to advice notes received within the same period. It will be seen from the chart that 510 successful visits were paid to immigrant arrivals to the Borough during 1971. 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. SCABIES AND VERMIN Scabies Vermin Children under 5 years Number treated 44 38 Number of baths given 88 — Number of treatments — 48 I.L.E.A. Children Number treated 107 270 Number of baths given 210 — Number of treatments — 271 Adults Number treated 150 88 Number of baths given 321 — Number of treatments — 94 There was a considerable decrease in the numbers treated for scabies by some 28% in 1971 - 301 compared with 419 in the previous year. The numbers treated for vermin infestations, were virtually the same i.e. 396 as opposed to 397 in 1970. BACTERIOLOGICAL EXAMINATIONS The number of specimens sent to the Public Health Laboratory, County Hall, S.E.1, for bacteriological examination was 2,145. This compared with a total of 4,152 specimens submitted last year. Annual fluctuations are due mainly to the extent of dysentery outbreaks in any particular year. 33 Examinations carried out Swabs (Diphtheria) Sputum (Tuberculosis) 3 Faeces,Urine & Blood (Enteric Fever) 497 Faeces (Food Poisoning) 390 Faeces (Dysentery) 974 Swabs (Streptococci) 0 Other Specimens 213 Total 2,145 VENEREAL DISEASES There were 6983 new cases giving Islington addresses treated at hospital clinics in London during the year, including 56 cases of syphilis (26 primary and 30 secondary) and 1250 cases of gonorrhoea. I am not able to break down these cases into sexes and age groups, but the following statistics relating to persons attending the clinic at the Royal Northern Hospital in 1971 are a useful indication of the likely age and sex distribution in Islington residents. Age Group Males Females Total % of total % Cases of total % Cases of total SYPHILIS Under 16 2 8.0 2 6.9 16 and 17 18 and 19 1 4.0 1 25.0 2 6.9 20 and 24 7 28.0 2 50.0 9 31.0 25 and over 15 60.0 1 25.0 16 55.2 TOTALS 25 100 4 100 29 100 GONORRHOEA Under 16 11 1.1 3 0.5 14 0.9 16 and 17 14 1.3 71 12.7 85 5.3 18 and 19 79 7.5 106 19.0 185 11.5 20 to 24 281 26.8 201 35.9 482 30.0 25 and over 663 63.3 178 31.9 841 52.3 TOTALS 1048 100 559 100 1607 100 34 Contact Tracing Social workers employed by the Council are attached to special clinics at Holloway Prison and the Royal Northern Hospital. As a result of visits made by the social workers attached to the Royal Norther Hospital, the following contacts were traced and received treatment: Syphilis Gonorrhoea Non-venereal diseases Royal Northern Hospital 5 391 111 Other Hospitals 1 55 20 General Practitioners 4 1 H.M. Prisons 3 1 Total 6 453 133 These are minimal figures as, although some contacts state that they are receiving treatment (and from the information given authenticity of their statements is not doubted), for personal reasons they do not wish to divulge the names under which they have attended clinics. Consequently, as it is not possible to verify their attendances they cannot be included in the statistics. The number of new patients attending the clinics at the Royal Northern Hospital has increased during the year as is shown by the following comparative figures Female Male Total 1970 2,880 4,201 7,081 1971 3,799 5,079 8,878 Apart from the primary task of tracing contacts and visiting defaulters, help is increasingly being given to patients on such matters as health education and family planning, and also in making referrals on their behalf to other agencies. 35 Air Pollution Consumer Protection Disinfection and Disinfestation Factories & Outwork Food and Diseases of Animals Housing Noise Offices and Shops 37 ENVIRONMENTAL HEALTH The year 1971 was one of substantial progress as far as work in the Environmental Health field was concerned. The reorganisation of the Public Health Inspectorate carried out in late 1970 allowed for greater flexibility in the use of staff and improved work output. A comprehensive examination of all food establishments was commenced within the Borough including those under the control of the Council with a view to raising food hygiene standards generally. As the year ended arrangements were in hand to supplement these inspections with a Health Education Programme for Food Staffs to be commenced early in 1972. A Clean Food Booklet was published by the Council as a means to assist in raising standards, but with the large number of small retail food establishments and many foreign and immigrant food traders the onus in any clean food programme within the Borough must rest on the repeated visits to premises by Public Health Inspectors. In the housing sector the first year of the Council's slum clearance programme 1971/75 saw all first year scheduled properties represented before the end of the year. A new departure was for 17 properties in Keystone Crescent to be excluded from the programme during the year following detailed discussions with owners and tenants and two reports to the Town Planning and Development Committee. This scheme reflects the present trend of property improvement and influence of increased property values and in the future there will no doubt be further examples of pressure on the Council not to demolish unfit houses in prospective Clearance Areas where the owners can make a substantial and viable case at a sufficiently early date to rehabilitate them. The confirmation of the Registration Scheme by the Secretary of State for the Environment in respect of houses in multi-occupation within the Borough was still awaited at the end of the year, but work proceeded on the 7 areas of multi-occupation chosen as a pilot study in advance of such confirmation. The programme of dealing with tenement blocks also made considerable progress and the establishment of the permanent working party of officers on tenements has been to date a successful measure in dealing with this housing problem which is in the main confined to dense population areas such as Islington. INSPECTION AND ENFORCEMENT DUTIES 75,122 inspections were made by the Staff of the Public Health Inspectorate Division, and the functions and work output during the year are summarised in the table which follows. Attention is drawn to the statistics relating to housing, particularly in the first line of the table. The amount of work carried out has been substantially increased in 1971, by reason of the advance duties on the Council's Registration Scheme for multi-occupation. WATER SUPPLY Water supplies within the area are provided by the Metropolitan Water Board. No artificial flouride is added to supplies which were otherwise satisfactory both as regards quality and quantity during the year. MEAT INSPECTION Following the closure of Messrs. Harrison Barber & Co. Ltd's slaughterhouse in 1970, there is now no slaughterhouse operating within the Borough. Meat Inspection is still carried out at the various wholesale and retail establishments in and around Smithfield, however, and details are given in the section concerned with Food & Drugs. SEWERAGE & SEWAGE DISPOSAL No major defects or difficulties were encountered during the year arising from the Borough's sewer system. 39 40 Inspection and Enforcement Action Inspections and Visits NOTICEi 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. 22,638 829 2,178 25 4 962 Housing - Public Health action, drainage, refuse collection, pests, domestic noise and general nuisances. 20,314 2,129 1,602 45 331 1,911 (b) SPECIAL SERVICES Food & Drugs - Food premises, markets, stalls and delivery vehicles, sampling, meat and poultry inspection. 14,469 - 228 54 — — Offices, Shops & Railway Premises Act 1963. 3,147 - - - — — Air Pollution and Factories - smoke observations, surveys, complaints, pollution volume measurements, Factories Act 1961, industrial noise 2,893 - 190 1 — — Public Control functions - Shops Acts, licensing, consumer protection, fertilizers and feeding stuffs, sampling. 11,661 - — 4 — — TOTALS 75,122 2,958 4,198 129 335 2,873 AIR POLLUTION DOMESTIC SMOKE CONTROL It is gratifying to report that it did not prove necessary in 1971 to repeat the procedure adopted in the previous year to suspend a proportion of the Smoke Control Orders owing to the shortage of solid smokeless fuels. The graphs illustrate the effect of the suspension with the average smoke concentrations for the Borough higher for the months of January, February and April,the tail end of the period affected by the suspension than they were for 1970. Smoke Control Orders are again in full operation for the whole Borough and no difficulties have been reported recently regarding supplies of fuel. 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): 14 Clean Air Act 1956 - Section 3 (3) Applications for prior approval of installation of furnaces (all approved): 12 Clean Air Act 1968 - Section 6 Application for approval of chimney heights (all approved): 10 CLEAN AIR ACTS - CONTRAVENTIONS On the 13th April, 1971, at the East Central Magistrates' Court, a tailoring firm in Stanmore Street, N.1. was fined £20 with£7costs for causing a heavy smoke emission by permitting cloth off-cuts to be burnt on a disused basement bakery furnace in contravention of the Kings Cross (No. 1) Smoke Control Order. A number of complaints of heavy smoke nuisances from a hospital incinerator was confirmed by observations carried out by officers of the Department. On investigation it was found that the existing small gas fired incinerator had been replaced by a much larger type to cope with the large quantities of medical waste from the wards. This waste was placed in plastic bags and the contents included plastic petri-dish, tubes and syringes, etc., which were the cause of the smoke nuisance. A meeting was arranged with the Hospital Group Secretary and Chief Engineer and, whilst it was agreed that it was essential for the hospital to have plant to burn its own waste material, other arrangements were made for its disposal until the makers had carried out modifications to the appliance to comply with the Clean Air Act. A bank of after-burners was fitted and a further trial operation of this incinerator was carried out, starting from cold, by the firm's own engineer and stoker. Whilst some improvement was effected, the Group Secretary was advised that the emission of smoke did not meet the requirements of the Smoke Control Order. At the end of the year discussions were continuing with a view to further improvements. DANGEROUS CHEMICALS In August a telephone complaint was received that drums of dangerous chemicals had been dumped in the entrance of the disused Frederica Street, British Rail, Eastern Region Goods Yard. The site was visited and it was found that seven blue coloured drums containing a waste substance were marked*Sodium Cyanide 98% - 99% N.A.C.N.'There were two further drums partly full and marked Chromic Acid flakel'lt was imperative that the drums be removed immediately as it was a period of school holidays and children played in this area. The Railway Police from the King's Cross Transport Terminal were contacted and the drums were removed in a matter of hours for disposal. Enquiries failed to determine the identity of the dumpers. 41 ASBESTOS DUST A complaint was received from the Archway and Tufnell Park Transport Action Committee, who were disturbed by accumulations of dust and smell at these stations which might be caused by the asbestos brake blocks of the trains on the route. The Public Relations Officer of London Transport was contacted and it was ascertained that the asbestos content of the brake blocks was only about 1%, but it was admitted that the smell at times was unpleasant. The brake blocks in use on the Northern Line did in fact create rather more dust than on the modern equipment fitted to new rolling stock on other lines. Research was being undertaken in conjunction with the manufacturers to reduce the amount of dust through the use of a better type of brake block. In addition, a tunnel cleaning machine was being designed which, when available, would extensively reduce the amount of dust in the railway tunnels. New rolling stock was on order for the Northern Line which will have electrical braking and any dust therefrom would be absolutely minimal and created only on the final braking operation. A sample of dust taken from the vicinity of the Archway Station and submitted to the Public Analyst did not reveal the presence of asbestos fibres. MEASUREMENT OF AIR POLLUTION The measurement of smoke and sulphur dioxide proceeded at the department's three sites, with a fourth being maintained by the Greater London Council at Hillside, St. Johns Way, N.19. A fifth site is operated by St. Bartholomew's Hospital Medical School in Charterhouse Square, E.C.1. The average monthly pollution figures forthe whole Borough at the Council's three sites are shown in the form of two blockgraphs, comparison being made with figures for 1970. The unit employed for expressing both smoke and sulphur dioxide concentrations >s microgrammes per cubic metre being the unit also adopted for international use by the Organisation for Economic Cooperation and Development. 42 43 44 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 : 125 London County Council (General Powers) Acts 1920 and 1921 Employment Agencies Massage or Special Treatment Establishments Premises licensed : 70 12 Theatrical Employers Registration Acts 1925 — 1928 Registered employers 12 Performing Animals Act 1925 Current registrations Nil Celluloid & Cinematograph Film Act 1922 Premises used for storage : 1 Nurses Agencies Act 1957 Premises licensed : 3 Public Health Act 1936 Nursing Homes Act 1936 Mental Health Act 1959 Pharmacy & Poisons Act 1933 Listed sellers of Part II Poisons other than pharmacists : 100 Additions to the list during the year: 9 Pet Animals Act 1951 Rag Flock & Other Filling Materials Act 1951 Premises licensed : 13 Premises on register as upholsterers : 31 Greater London Council (General Powers) Act 1967 Hairdressers and Barbers SAMPLING FUNCTIONS Fertilizers & Feeding Stuffs Act 1926 Samples taken : 8 Consumer Protection Act 1961 Toys (Safety) Regulations 1967 Nightdresses (Safety) Regulations 1967 ENFORCEMENT Samples taken : 36 6 Total 42 One successful prosecution was taken for the sale of an adult nightdress not bearing a warning label to keep it away from fire in accordance with the Nightdresses (Safety) Regulations, 1967. 45 Nursing Homes registered 1 Premises registered : 220 Registrations during year 42 CHILDREN'S TOYS The Toys (Safety) Regulations 1967 prohibit the use of celluloid in toys other than ping pong balls and impose restrictions in relation to the paint which may be used on toys in that such paint may not contain more than 5,000 parts per million of lead or 250 parts per million of arsenic, soluble antimony, barium, cadmium or chromium. Celluloid is highly inflammable and a potential fire risk and the ingestion of paint containing lead, etc. by children, who naturally suck or chew toys, could lead to serious ill-health and possible mental retardation. Since the Regulations came in to force, 125 samples (purchased from 86 shops, 15 stalls, 1 wholesaler and 3 importers in the Borough) have been submitted to the Public Analyst for examination. No less than 43 toys (34.4% of the toys sampled) imported mainly from China, Japan and Eastern Europe did not comply with the Regulations. Celluloid was used in the manufacture of 13 of these toys and the remaining 30 were coated with paint containing excess lead or chromium. In this latter group, amounts of lead up to 110,000 parts per million have been certified by the Public Analyst. It was a defence under the Consumer Protection Act, 1961 for a seller to prove that he had reasonable cause to believe that goods in question complied with the requirements of the Regulations. In some cases, importers or wholesalers gave a form of warranty to protect retailers. Where contravention of the Regulations occurred, and the retailer possessed such a warranty, the Council was unable to institute legal proceedings for the contravention against an importer or wholesaler if the business premises of such a person were outside the Borough boundary. The Consumer Protection Act, 1971 removed this restriction and the Council is now able to proceed legally against an importer or wholesaler of toys but it was felt by the Council that this additional power was inadequate to prevent the sale of dangerous toys within the Borough. Following a report to the Health Committee, the Association of Municipal Corporations was asked to make urgent representations to the appropriate Government Departments with the object of preventing the importation of toys which did not meet the requirements of the Toys (Safety) Regulations, 1967. The Association of Municipal Corporations replied that they wish to see if the Consumer Protection Act 1971 reduces the number of dangerous toys on sale in the country before making-fecommendations to the Government Departments on restriction of foreign toys at the ports of entry. The Association will review the situation again in the Spring of 1972. My view is that the task of ensuring that only harmless imported toys are offered for sale throughout the country is quite beyond the resources of local authorities and a ban on the importation of harmful toys is necessary. RAG FLOCK AND OTHER FILLING MATERIALS The Rag Flock and Other Filling Materials Regulations, 1971 came into force on the 3rd November, 1971. These new Regulations revoked the 1961 and 1965 Regulations and brought the following additional materials, increasingly used as fillings, within the scope of the Act: (1) Rubberised hair and fibre. (2) Rubberised or resin bonded felt. (3) Cellular rubber and cellular plastic crumb. (4) All kinds of wood fillings, including wood shavings, sawdust and wood wool (new or used). Seven samples of various filling materials were taken during the period November/December and these were all certified as satisfactory by the Prescribed Analyst. HAIRDRESSERS & BARBERS An increase in the registration of hairdressers and barbers over last year's figure is due to the re-registration of occupiers. Changes in the occupation of registered premises are likely to have occurred over an accumulated period. 46 ELECTRICAL GOODS The Electrical Appliances (Colour Code) Regulations 1969 require that in any domestic electrical appliance, the coating of wires within a three core mains lead must be coloured in accordance with the Code. The appliance must also bear a label indicating the meaning of the Colour Code. During the year visits were made to sellers of second hand electrical goods and, where appliances contravened the Regulations, a recommendation was made that the appliances be withdrawn from sale until a mains lead which accorded with the colour code had been fitted and an explanatory label affixed. ELECTRIC BLANKETS The Electric Blankets (Safety) Regulations 1971 came into force during the year. Premises supplying electric blankets were visited and, as a result, blankets which did not accord with the Regulations were withdrawn from sale. MASSAGE AND SPECIAL TREATMENT ESTABLISHMENTS A Sauna Bath - the second in the Borough - was opened during the year. In granting the licence, the Council specified that only clients of one sex may be on the premises at any one time. Some local authorities permit both sexes to be present at the same time but 'mixed saunas' have not been accepted by this Council. EMPLOYMENT AGENCIES An increase in the number of employment agencies licensed for the year was noticeable - 25% increase on the figure for 1970. THEATRICAL EMPLOYERS The 72.7% decrease in the number of employers registered over the 1970 figure is because of reappraisal of the register. DISINFECTION AND DISINFESTATION DISINFECTION Infectious Disease Rooms treated 180 Clothing for export Certificates issued 38 DISINFESTATION Rats and Mice Complaints of mice infestations increased again this year but rat complaints were reduced by more than 50%. (Figures in brackets refer to the year 1970). Premises Domestic Business Local Authority Rats 276 (783) 76(153) 58 (90) Mice 2856(2094) 484(425) 112 (31) Total 3132(2877) 560(578) 170(121) 35 Smoke tests of suspected defective drains were carried out and there were two treatments of sewers. 47 Vermin Rodents treated 2652. In January the rodent control staff commenced working under incentive bonus scheme conditions resulting in a greatly improved service being provided. Pigeons Treatments by an authorised catcher are carried out on the Council's behalf. During the year a total of 20 treatments were made. FACTORIES AND OUTWORK FACTORIES ACT 1961 Routine inspections were carried out during the year and several joint visits were carried out with the H.M. Factory Inspectorate of the Department of Employment and Productivity to resolve problems of mutual concern. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by local authorities. 21 12 - (ii) Factories not included in (i) in which section 7 is enforced by the local authority. 2,120 728 190 - (iii) Other premises in which Section 7 is enforced by the local authority (excluding out-workers' premises). 68 56 - Total 2,209 796 190 - 48 Defects were found in the following cases. No prosecutions were instituted. Defects Cases Prosecutions instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness (S.1) 7 2 — — — Overcrowding (S.2) 2 2 — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 19 13 — 2 — (b) Unsuitable or defective 337 290 — 6 — (c) Not separate for sexes 7 4 — — — Other offences against the Act (not including offences relating to Outwork). 21 28 — — — Total 393 339 — 8 — Basement Bakehouses (Section 70) There are nine basement bakehouses (listed below) in the Borough and routine inspections under the Food Hygiene (General) Regulations, 1970, were carried out during the year. The bakehouses were inspected under Section 70 of the Factories Act 1961 in 1970 (it is the duty of the Council to examine every fifth year under the act) and certificates of suitability were issued during 1970. 146 Blackstock Road, N.4. G.C. Mull & Company Limited. 3 Cardwell Terrace, N.7. E.Oliver. 123 Newington Green Road, N.I. F. Hahn. 76 Caledonian Road, N.1. W.J. Baker. 59 Junction Road, N.19. W.J. McCandless, 7 Junction Road, N.19. M.A. Ranee & Company. 2 Tysoe Street, E.C.1. D.L. Crisp. 88 Farringdon Road, E.C.1. D.L. Crisp. 44 Amwell Street, E.C.1. 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 49 Making cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel 1015 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) 52 Making, ornamenting, mending and finishing of lace and of lace curtains and nets 1 Cabinet and furniture making and upholstery work 2 Making or repairing of umbrellas, sunshades, parasols, or parts thereof 13 Making of artifical flowers 8 Making of tents 2 Making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip or similar material 95 Making of brushes 7 Carding, boxing or packeting of buttons, hooks and eyes, pins and hair pins 16 Making of stuffed toys 1 Christmas stockings, or similar articles or parts of articles 20 Unspecified TOTAL 12 1244 Offensive Trades There are four offensive trades operating in the Borough as follows:Tripe Boiler J.L. Henson Ltd. 26/40 Vale Royal, N.7. Fat Melter -do- Fur Skin Dresser J.A. Fischer Limited, 440A, Hornsey Road, N.19. Gut Scraper Tracey and Company Limited, 5 Tileyard Road, N.7. Routine inspections were carried out during the year and the premises were found to be free from nuisance. FOOD AND DISEASES OF ANIMALS FOOD AND DRUGS PREMISES The scope of the Special Services Section was extended during the year as a result of additional responsibility following a decision that Council establishments involved in food handling should be inspected by Public Health Inspectors; this included not only the major canteens but also the various childrens' and welfare homes, day nurseries and day centres. In addition, the annual sanitary inspection of school premises on behalf of the Inner London Education Authority was transferred from the Council's Medical Staff to the Public Health Inspectorate. Several premises closed during the year particularly in areas pending demolition but with other areas being redeveloped the total remained fairly static. The up-to-date list of all known food premises is as follows:- Bakehouses 34 Bakers 36 Butchers 134 Confectioners 224 Fried Fish Shops 55 Fish Curers 11 50 Fishmongers 11 Green Grocers & Fruiterers 107 Grocery & Provision Shops 341 Wholesale Stores 69 Food Factories 36 Public Houses 301 Off Licences 51 Catering Establishments (Cafes and Restaurants) 389 Canteens 75 Schools etc. 85 Local Authority Establishments 27 Total 1,986 A total of 225 informal intimations under the Food Hygiene (General) Regulations 1960/1970 was served and the following prosecutions instituted:- (1) Food equipment dirty, preparation table dirty and contaminated by mouse and bird excreta; food exposed to risk of contamination: no 'wash your hands'notices displayed. £40total fine. (2) Absence of sink in a food room: £5 fine £2 costs. (3) Food business being carried on in an insanitary premises: £50 fine £3 costs. (4) Condition of premises exposing food to risk of contamination: no'wash your hands' notice; dirty refrigerator; dirty pastry cutters; dirty walls, ceiling and window; failure by employer to stop employee smoking. £80 total fine £5 costs. (5) Food exposed to risk of contamination; basement food rooms not kept clean; basement store not kept clean; drainage interceptor not kept in working order-; absence of first aid kit; absence of soap, towel and nail brush. £70 total fine. (6) Walls, floor and ceiling in a dirty condition. (4 summonses). £40 total fine £10 costs. (7) Floors not kept in good order; insufficient ventilation. £20 total fine £10 costs. (8) Dirty equipment; dirty walls, dirty floors. (5 summonses). £50 total fine £10 costs. (9) Food exposed to risk of contamination; dirty food rooms. £20 total fine £2 costs. 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 the Borough and these receive constant supervision; during the year 103 inspections were made. The total numberof premises registered for the manufacture and/or the sale and storage of ice cream was 678. 51 Preserved Food Premises Premises registered for the preparation or preservation of food 207 Premises registered as fish friers/fish curers 73 Milk (Special Designation) Regulations 1963 (As amended) Number of licences in force 339 Milk and Dairies (General) Regulations 1959 Number of dairies registered in the Borough 10 Number of distributors registered in the Borough 334 LEGAL PROCEEDINGS Food and Drugs Act 1955 The following are details of prosecutions during the year under Food & Drugs Act 1955 or Regulations made under the Act. In 2 instances during 1971 food was seized by Public Health Inspectors and taken before a Magistrate for condemnation. In both cases legal proceedings were taken. In the first case a complainant brought a packet of butter to the office which had been gnawed by mice and a subsequent inspection of the premises concerned revealed other packets in the same state. The total fine imposed was £10. Proceedings were also taken in this case under the Food Hygiene (General) Regulations and the Prevention of Damage by Pests Act (see below). In the other case a Public Health Inspector, while inspecting a cafe observed food in a refrigerator which he considered to be unfit for human consumption. In this case the Magistrates imposed a total fine of £70 with costs of £2. Following a formal sample, the packers of a product described as Ground Cinnamon were prosecuted for selling a product not of the quality demanded. The product consisted of Ground Cassia Buds when it should have consisted solely of ground bark of Ceylon Cinnamon. The Magistrates imposed a fine of £10 and an award of £5 costs to the Council. Following this adverse report a total of 9 other brands of cinnamon were submitted for analysis. In three cases minor adulteration was discovered and appropriate action taken. Prevention of Damage by Pests Act 1949 An occupier of a food business was fined the maximum penalty (£5) on two summonses for failing to notify the Council that his premises were infested by mice and rats. Preservatives of Food Regulations 1962 At the beginning of the year three butchers were fined for illegally adding preservatives to minced meat. A subsequent survey of all the butchers'shops was carried out and appropriate action taken where necessary. In the three cases that were taken to Court the Magistrates imposed two fines of £20 and one of£10 with costs of £6 in each case being awarded to the Council. COMPLAINTS Complaints relating either to the condition of food or to the fact that the food contained some foreign matter were received in 100 instances during 1971. All the complaints were investigated and the following prosecutions were instituted:- 52 Mouldy sausages £20 fine £5 costs Wood Bristle in Steak and Kidney Pie £15 fine £7 costs Iron rust in loaf of Bread £10 fine £5 costs Mouldy sausage rolls £10 fine £2 costs Mosquito in iced bun £25 fine £5 costs Human hairs in jam doughnut £20 fine £7 costs Matchstick in bottle of beer £10 fine £5 costs Mouldy orange drink £8 fine £5 costs Piece of glass in loaf of bread £10 fine £10 costs Maggot in beef filling of French bread £25 fine £10 costs Stale cabbage Dismissed Mould on yoghurt £15 fine £10 costs 1%" piece of grey plastic in loaf £15 fine £10 costs Piece of chewing gum in milk £20 fine £2 costs Mouse droppings in potato crisps £10 fine £8 costs Mould in bottle of milk £20 fine £10 costs In some cases it was not possible to take legal proceedings following a food complaint and during the year these included an acetone smell in a can of coca cola due to a fault in the manufacture of the can, glass on a bottle of vinegar, a large stone in a bag of potatoes, various insects in differing foods.ablackcurrant health drink which had become discoloured due to over exposure to light and a piece of metal in a packet of crisps. Complaints were also received about alleged unhygienic practices and special attention was given to one particular aspect during 1971. Complaint was received that early morning deliveries of food stuffs to shops were not being properly protected from contamination in that products like bread were being left on open forecourts of shops adjacent to footways. Early morning visits were carried out and the offending companies were notified. Subsequent visits revealed a considerable improvement. SAMPLING Bacteriological checks are made on the cleanliness of the food to establish if it is either free from or infected with pathogens and chemical examination is made with a view to establishing that the contents of the food are as the purchaser considers them to be at the time of buying. This analysis therefore compares the constituents found in foods with those known to be in similar food types, the description of the food on a container and the advertisement that may accompany it to ensure that the purchaser is getting exactly what he or she wants. (a) Bacteriological 1. Ice-cream 9 samples of ice-cream were sent for bacteriological examination and all fell within either grade 1 or 2 and were therefore regarded as satisfactory. 2. Imported Egg Pasta During the year, under the provisions of the Imported Food Regulations 1968, a large pasta importing company, who now use containers for their shipments from Israel, had the inspection of such products transferred to this authority. Routine samples were taken of products containing egg for the possible isolation of salmonella. In all cases, however, salmonella was absent from the specimens after incubation. 53 3. Other Foods Of the other samples taken, in no case did the laboratory report evidence of food poisoning organisms. (b) Chemical In order that an overall check can be kept on foods sold within the Borough, food is purchased as the housewife would buy it and it is then submitted for analysis to the Public Analyst. Informal Purchases 760 Adverse 69 Formal Samples 27 Adverse 10 Of the adverse reports, 51 related to labelling deficiencies. This emphasises the continuing need for constant attention to be given to this aspect of food and drugs work. The contraventions of the Labelling of Food Order 1953 may be very minor but in some cases totally misleading labels were dealt with as were products labelled completely in a foreign language. As a general rule, the importers take immediate steps to amend the labelling and only in cases where co-operation is not forthcoming does the Council become involved in legal proceedings. The use of non-premitted colours in food continues to cause concern, particularly in sweets from Cyprus and Italy. In a number of cases excess tin was found in some informal purchases but on investigation the can was found to be very old stock which indicated poor stock rotation on the part of the retailer. In these cases the appropriate advice was given and steps taken to ensure better retail sale management. Of the routine spirit samples taken from public houses within the Borough one was found to contain added water and legal proceedings were instituted. The hearing was due in early 1972. The results of other formal samples have been recorded earlier under the heading Legal Proceedings. Within the overall sampling programme there has been a continued check on residual insecticide levels in foods. This year the samples taken have been more ambitious than previously and advantage has been taken of the proximity of Smithfield Market and the shell fish stalls within the Borough. The samples taken specifically for pesticide residues were tomatoes, apples, Dutch tomatoes, New Zealand apples, pigs' liver, 'cod' fat from an Irish beef carcase, a pair of grouse, Portugese oysters, live eels, native oysters, Worcester apples and a Grey Lag wild goose. In all cases, with one minor exception, the levels found were well within the limits recognised as being safe. The one exception was that in the liver of one grouse the gamma BHC was .03 above the reporting limits for the National Survey of Pesticide Residues. This is barely significant as there is a tendency for pesticide to accumulate in the liver. UNFIT FOOD During the year the total amount of unfit food voluntarily surrendered was as follows from premises other than in the Smithfield Market areas:- Description Tons Cwt. Qtr. Lbs. Canned Goods 8 8 3 0 Confectionery 0 1 1 25 Cheese 0 4 0 2 Fruit & Vegetables 1 5 1 2 Meat 3 0 1 25 Meat Products 2 17 2 0 Fish 0 16 0 24 Cereals 0 0 2 25 Frozen Food 2 10 0 0 Miscellaneous 0 2 0 4 Total 19 6 1 23 In addition Soft Drinks - 1100 fl. ozs. 54 656 voluntary surrender certificates were issued and 219 inspections or visits were necessary in connection with this work. Surrendered food was removed, in general, by the Council and disposed of at a local tip. A firm specialising in the collection of waste meat for manufacturing purposes was also employed. STREET MARKETS The regular inspection of market stalls has brought about a more consistent standard in the markets although the accumulation of refuse still remains a major problem. Routine inspection of the stalls continued on Saturdays and Sundays throughout the year. A total of 15 summonses were issued under the Regulations for various offences and fines totalled £57 and costs £10. Following complaints from members of the public and in conjunction with the police, inspections were made of the hot dog stalls trading in the vicinity of the Arsenal Stadium. These itinerant traders need constant attention and the difficulties of inspection are considerable. However, this concerted action improved the general standard of hygiene although further inspections will be required at intervals. 7 traders were taken to Court following these inspections and fines totalling £290 were imposed. In all cases the trolleys were without personal washing facilities and each was in need of general overall cleaning. GREATER LONDON COUNCIL (GENERAL POWERS) ACT, 1968 PART VIII - NIGHT CAFES In this Borough all premises which are open to serve food and drink after 11 p.m. have to be registered, subject to certain exceptions, as Night Cafes. A re-registration of each premises has to be made each year and this gives the local authority opportunity to review all registrations in force. The inspection of night cafes has continued, both during normal hours and during the night and as a result three prosecutions were instituted during 1971; fines totalled £210 and costs £10. In one case a defendant was fined £150 for being open after hours without proper registration. Application made but not finalised at the end of 1970 8 Applications received 1971 60 68 Applications granted or renewed 1971 51 Applications refused 1971 5 Applications withdrawn 1971 7 Applications pending, carried forward to 1972 5 68 Premises registered at 31st December 1971 50 One applicant who had been refused a night cafe registration certificate appealed to a Court of Summary Jurisdiction in accordance with the Act but, after hearing evidence from the appellant, near-by residents and the local authority, the Magistrates dismissed the appeal and awarded £25 costs to the Council. LATE NIGHT REFRESHMENT HOUSES ACT 1969 Because of the higher standard of the Greater London Council (General Powers) Act, 1968 some traders are content to remain open only until 11 p.m. and thus do not require registration as a night cafe. However, it is necessary that they hold a late night refreshment house licence if they remain open between 10 p.m. and 11 p.m. In spite of the increase in the annual licence fee, 36 premises were licensed at the end of the year. 55 MEAT INSPECTION In the area of the Borough adjoining the Smithfield Meat Market, there are 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, 1832 certificates were issued in respect of unsound meat and other foods and 347 health certificates were issued for the export of meat, etc. to overseas countries. In each case this was an increase compared with the previous year. The full effect of the Imported Food Regulations 1968 was felt during 1971. The Regulations allow the importation of meat and other food direct to an inland authority without an inspection being carried out at the port of entry. The responsibility for the inspection of the food subsequently rests with the inland authority. The extent of the increase in this containerisation method of transport as it affects Islington is reflected in the considerably larger number of notifications received from ports of consignments directed to establishments in the Borough. 272 such notifications were received in 1971, compared with 156 in 1970, mainly comprising meat and offal from the continent and Eire. Additional notifications were received in respect of other foods. 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 1971, the Senior Meat Inspector condemned or had surrendered to him the undermentioned. The quantity of unsound meat condemned during 1971 was double the amount condemned during the previous year. This is largely due to the increase in containerised imports. Tons Cwts Qrts. Lbs. Meat (diseased) 5 11 0 6 Meat (unsound) 45 3 2 9 Bacon 5 5 3 21 Offals (diseased,and unsound) 6 6 3 14 Poultry - 15 0 24 Game - 16 0 4 Rabbits - - 9 Canned Foods 8 2 1 21 Butter - 15 2 24 Cheese 11 17 0 3 Miscellaneous - - 2 10 Total 84 14 2 5 56 Poultry Inspection by Senior Meat Inspector at Smithfield Market. Meat preparation room at a modern super-market showing washing-up and hand washing facilities, together with first aid equipment required by food hygiene (general) regulations. 57 DISEASES OF ANIMALS ACT 1950 AND ALLIED LEGISLATION The arrangements made by the Council with the Corporation of the City of London were varied during the year to include inspections by the Veterinary Officer of premises and persons licensed under the Pet Animals Act and the Performing Animals (Regulation) Act 1925, in addition to the functions already performed in connection with the Diseases of Animals Act. Veterinary Officers paid regular visits to the 13 pet shops regarding the health of animals. Evisceration of poultry is carried out at two kosher poulterers shops in the Borough to which quarterly visits of inspection were made. Conditions were found to be satisfactory. Visits were also commenced to butchers'shops concerning the storage and disposal of viscera. This information is required in case there should be an outbreak of fowl pest. During the year 87 such premises were visited. Under the terms of the Animal (Miscellaneous Provisions) Order 1927, the following Orders were advertised in the national press:- Live Poultry (Restrictions) Order 1971. Live Poultry (Restrictions) Amendment Order 1971. In December 1971, Chipperfield's Circus appeared at the Rainbow Theatre for two weeks. Three visits of inspection were carried out, two of them jointly with a Public Health Inspector. Instruction and advice was given on animals' accommodation. On the 28th December the circus was again visited, animals performances witnessed and licences checked. It was discovered that one man, presenting 6 tigers in the circus, was not licensed under the Performing Animals (Regulation) Act 1925, and he was informed that he must apply for a certificate of registration. This was being followed up at the end of the year. HOUSING REGISTRATION OF HOUSES IN MULTIPLE OCCUPATION The scheme approved by the Council in 1970 had not yet been approved by the Department of the Environment at the end of the year due mainly to certain modifications requested by the Council to make it more applicable to circumstances in Islington. Progress was being made in discussions however with Ministry representatives and it is hoped that the scheme will be confirmed and operative early in 1972. Meanwhile work on the 7 pilot areas of registration proceeded using the various Housing and Public Health Act powers, 672 houses being involved. In these areas Public Health Inspectors press owners, informally, to carry out improvements with the aid of grants available before resorting to statutory enforcement powers. In an 8th area, Milner Square, the Council made a Compulsory Purchase Order Resolution under Part V of the Housing Act 1957 following initial public health investigation into conditions of disrepair and heavy multi-occupation in the 46 houses. It is proposed to rehabilitate and convert these houses into self-contained flats with full amenities. SLUM CLEARANCE PROGRAMME 1971-75 During the year the programme of 812 houses (213 to be dealt with by the Greater London Council) was reviewed and in the autumn a report was submitted to the Council through the Town Planning and Development Committee, deleting 70 houses which had been demolished without Council intervention, made fit, or were better dealt with by individual action. Inspection of the Borough had revealed a further six areas totalling 77 properties which should be dealt with by clearance and these were added to the programme. It is proposed to review the programme annually. During 1971, 12 areas totalling 140 houses occupied by 268 families comprising 659 persons were represented as clearance areas, and Compulsory Purchase Orders were made in all cases except for 2 very small areas where Clearance Orders were made. 58 The areas represented were:- Beaumont Rise 13 houses 38 families Fairbridge Road/Sussex Way 20 houses 22 families Ashmount Road/Elthorne Road 25 houses 30 families Eddington Street 11 houses 11 families Wyatt Road 5 houses 10 families Calshot Street / Killick Street 14 houses 8 families Baron Street 6 dwellings 5 families Central Street 3 houses 1 family Bride Street/Ellington Street/Liverpool Road 20 houses 52 families Dagmar House T7 dwellings 26 families Parkfield Street/Layton Road/Liverpool Road 27 houses 65 families There has been a marked increase in the interest shown by owners in the possibility of rehabilitation of houses included in clearance areas, and in one particular area (Keystone Crescent) undertakings were given by the owners of all the properties that the houses would be brought up to a satisfactory standard; the area was removed from the slum clearance programme and improvement grants have been applied for. Care has been taken to ensure that the security of the tenants will not be prejudiced. It is anticipated that further areas may be dealt with in this manner. INDIVIDUAL UNFIT DWELLINGS In 1971, 24 whole houses were represented as unfit for habitation and not repairable at reasonable cost, and 92 basements or other parts of buildings were similarly dealt with. Closing Orders were determined after dwellings had been made fit in 16 cases. Towards the latter end of the year, rising values of houses resulted in a Council reappraisal of the situation relating to "reasonable cost". As a result the need for action changed generally from dealing with unfit houses not repairable at reasonable cost to houses repairable at reasonable cost under Section 9 of the Housing Act 1957, Informal notices were served in respect of 83 houses either unfit or in need of substantial repair, and 6 formal notices were served, mainly in the pilot registration areas. TENEMENT DWELLINGS Responsibility for dealing with sub-standard tenement blocks is shared with the Greater London Council. Tenement blocks which are classified as unfit are dealt with under the provisions of Part III of the Housing Act 1957. i.e. they are represented as unfit and eventually demolished. To deal with those tenement blocks considered suitable for improvement a working party of officers are set up in October 1970. In each case the owner's views and co-operation are sought and in appropriate cases the owner is advised that the Council will consider purchase. If these approaches are unsuccessful then, subject to adequate planning life, the practicability of the works necessary and financial viability, the service of improvement notices is recommended. TENEMENTS DEALT WITH BY THE BOROUGH 24 blocks of tenements were classified as being fit only for demolition. At the conclusion of 1971 the following tenement blocks were still standing. 1 Baron Street Represented 15.6.71. Carlton House, Stanmore St. Acquired and part vacant Compton Flats, Goswell Road. Acquired. Part demolished and part used as temporary modation. Dagmar House, Dagmar Passage. Represented 14.9.71. 59 Keystone Crescent - removed from slum clearance programme for rehabilitation 60 Drayton House, Hornsey Road ) Hatton House, " ) Highbury House, " ) Represented 7.9.70. Order confirmed by Minister 31.12.71. Holloway House, " ) Ingram House, " ) Javens' Chambers, Clerkenwell Road Dealt with by Closing Orders. Tenants rehoused. Planning permission given for conversion to office use. Palmerston Buildings, City Garden Row. Acquired for demolition. Part of H.D.A. 60 Pembroke House, Stanmore Street. Acquired and now part vacant Salisbury Buildings, Clerkenwell Close. Acquired for demolition. Now vacant. The Purchase of tenement blocks Colne House, Offord Road. Terms agreed for purchase. Thatched House Buildings, Essex Road. Purchased W.S. Horner Estate, Canonbury Avenue Terms agreed for purchase. The Improvement of tenement blocks During 1971 improvements were carried out in 8 tenement blocks and there were 9 applications made for improvement grants affecting tenements. In one case. Guinness Buildings, Lever Street, the owners have decided to demolish the tenements and replace them with flats of a modern standard. GENERAL IMPROVEMENT AREAS The high degree of multi-occupation in the Borough makes the large scale use of these powers impractical but there are some small areas where at least a modified use of the procedures can be considered. The initial inspection of houses is carried out by the Public Health Inspectorate and recommendations for suitable areas are made to the Director of Development. The problems of multi-occupation are now being vigorously combated. In the Registration pilot areas inspections are made house by house, and all available statutory powers are being used to improve the conditions. The main objective is to control the occupancy in such houses and to ensure that the basic amenities are provided. MEANS OF ESCAPE FROM FIRE Systematic inspection within selected areas of houses in multi-occupation was continued by Fire Inspectors working under the provisions of 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. The Registration areas are also being inspected in conjunction with the Public Health Inspectors to secure joint action under the Housing Act 1961 (Sections 15,16 and 19) to provide sufficient amenities, means of escape and to control the occupancy. 34 cases of fires in multi-occupied properties were reported by the London Fire Brigade and five fatalities occurred. Each case reported is investigated and notices served where appropriate. 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 the provision of adequate safeguards. Properties for which applications for mortgages or grants are made are also inspected and the Borough Valuer is notified of the requirements necessary for proper means of escape. 61 This is the first full year in which the Department has been responsible for approval of applications under Section 35 of the London Building Acts (Amendments) Act 1939. This section deals mainly with the provision of proper means of escape in larger properties which are converted into smaller units such as flats or maisonettes. Over 200 applications were dealt with and it is likely that this number will increase with the current improvement and conversion impetus. UNLAWFUL OCCUPATION - SQUATTERS Two instances arose during the year, the first in Victoria Dwellings, E.C.1. an extensive and derelict block of tenements. Following a G.L.C. Clearance Order in 1968, the tenants were rehoused and the vacant buildings boarded up. The presence of a small group of young people was noted by the Inspector in August; describing themselves as the London Street Commune, they numbered about 8 permanently residing individuals, aged between 18 and 30. At that time, the Inspector's principal concerns were with basic sanitation and fire hazard, warnings and advice being given. The dwellings had no main services and sanitary fitments were mainly broken or unuseable. The group had an elected "leader", appeared cohesive, enthusiastic and determined. Two useable closets were cleansed and whitewashed, being flushed by slopwater. By early September, the situation had deteriorated considerably, occupation spread to all other blocks (5 in all), number accommodated at night and week-ends was in excess of 80 persons, any semblance of control or organisation had disappeared and "hooligan" activities gave rise to public complaint and police enquiry. To minimise a considerable risk to health, substantial quantities of waste matter were cleared, and disinfection and disinfestation carried out by arrangement with the owners. Regular visits continued, and pressure previously broughtto bear on the owner's Agents and the GLC to implement clearance was increased. Fires occurred in October, and a cleansing process again became necessary. One contractor refused absolutely to clear excrement and other waste. A young man interviewed by the Inspector stated he had lived permanently in the premises for over a year, cutting out flooring for firewood, cooking on the open grate and periodically cleaning the flue from the roof by hoisting and lowering a brick tied to a length of rope! Following the fires a small group of young people took up occupation in Bartholomew Buildings, E.C.1. A demolition contract was in progress here, but occupation was confined to vacant flats above occupied shop premises fronting Central Street and the vandalistic activities of this teen-age group caused serious complaints. Several of the occupants approached the Finsbury Health Centre seeking personal cleansing, a service provided under Section 85 of the Public Health Act 1936. Both persons and premises were accordingly treated; demolition workers subsequently made the vacated flats uninhabitable and occupation ceased. From these events, we have been made acutely aware that, short of eviction or demolition, no immediate action is available to gain possession of property occupied in this way; that to prevent such circumstances and hazards arising it is essential for vacant and derelict property destined for clearance to be made uninhabitable, and that there is a pressing need for cheap, clean and organised hostel accommodation for the seasonal influx of young people to London. NOISE NOISE ABATEMENT ACT, 1960 The number of complaints of noise recorded during the year dropped by a third to sixty-four. Each complaint was investigated and it was considered that twelve which concerned nuisance from noisy animals or wireless sets, amplifiers, etc., came within the scope of the relevant bye-laws and complainants were advised to take the prescribed action requiring the service of a notice by three householders. 62 Of the remainder, five complaints related to chimes of ice cream vans (Section 2), four related to statutory undertakers, thereby exempt from the Noise Abatement Act, leaving forty-three to be dealt with under Section 1 of the Act of which two were repeat complaints. The following table indicates the action taken:- Industrial Premises Commercial Premises Construction Demolition Domestic Others Total Cases complained of 11 8 6 15 1 41 Nuisances confirmed 5 6 5 1 1 18 Remedied informally 4 5 3 1 1 14 Abatement Notices Served 1 1 2 — — 4 The most common activities complained of concerned noisy machinery, demolition or construction sites, ventilation or refrigeration plants and domestic sewing machines. In many cases Inspectors were able to give technical advice which resulted in investigating nuisances informally. One complaint which occupied a considerable amount of Inspector's time was in respect of nuisance of noise from the construction of a hotel immediately abutting on to existing occupied dwellings. Because of the tight schedule, work was carried on until a late hour at night as well as on Saturdays and Sundays. An abatement notice was served and discussions subsequently held with the management of the building firm which finally resulted in agreement as to working times and the elimination of construction work on Sundays. This example emphasises the need for continual liaison between Health and Planning Departments. OFFICES AND SHOPS The Offices, Shops and Railway Premises Act 1963 and associated Regulations, protect the safety, health and welfare of employees in certain classified premises. The number of persons employed in premises within the Borough to which the Act applies is approximately 59,000, about the same as last year. The number of wholesale shops, warehouses and catering establishments is similar to that recorded for 1970. This is the first year the number has remained static since 1967, when all classified premises in the Borough became registered under the Act; previous years have shown a decrease in these types of premises. The number of retail shops, however, decreased as it has done each year since 1967. ACCIDENTS AT WORK Comment was made in my previous report on the intention to foster 'accident prevention at work'. 158 accidents were notified as compared with 116 in 1970 - an increase of 26.5%. This, no doubt, was largely due to the publicity given to the requirements of the Act that employers should notify accidents to the Council and in that respect is gratifying. 100 of the notified accidents were investigated - this involved a visit to the premises on which the accident occurred and where necessary suitable advice was given to the employer to prevent a recurrence in similar circumstances. A follow-up visit was made where this was thought necessary. Whilst the Act makes provision for the prosecution of an employer who fails to take reasonable steps to safeguard his employees against accidents, in no case was it found necessary to prosecute. 63 TRENDS An analysis of accidents notified showed lifting of goods to be a major cause; in fact 25% were for back and shoulder injuries caused through lifting. This must give cause for concern as such injuries can bring about a number of chronic conditions. Hernia in males can be caused through lifting heavy weights and one such accident was notified. Lifting, though a necessity in many jobs, is a hazard but, where it is unavoidable, correct methods should be shown to the employees involved. It is possible that complete mechanisation of work will eliminate injuries caused by lifting, but that Utopian situation has yet to be reached. Consideration is being given to the preparation of information on the hazards and correct methods of lifting for circulation to all employers in the Borough. PUBLICATIONS The Department of Employment and Productivity is responsible for co-ordinating and guiding those responsible for the implementation of the Act. To this end, they publish booklets on various aspects of the work. One such booklet gives guidance on the safe use of food slicing machines, including advice on safety devices available and methods of safe working which should be followed by all persons operating or cleaning these machines. The booklet has been circulated to owners of such machines, but it is difficult to evaluate the effects of the publicity in providing greater awareness of the need for care in their use. Perhaps one criterion of measurement is the number of accidents caused by such machines - no accidents were reported in 1971, one in 1970, and two in 1969. Officers, in promoting safety in the use of machines, have found this type of booklet of great value when discussing safety with an owner or operator of a machine. AUTHORISED OFFICER Appreciation must be expressed for the guidance and advice given through the year by the appointed Authorised Officer of the Department of Employment and Productivity. STATISTICS 1970 figures in brackets REPORTED ACCIDENTS Fatal Non-Fatal Investigated Action Inf. Warning Formal Warning Prosecution (i) Offices — 110 (68) 67 (16) 7 (16) 6(4) — (ii) Retail Shops — 34 (19) 21 (12) -(8) 2 (2) — (iii) Wholesale Shops & Warehouses —(1) 11 (21) 10(7) -(4) 1 (1) — (iv) Catering Establishments & Canteens — 3(8) 2(3) -(1) — — » (v) Fuel Storage Premises — — — — — — Totals -(1) 158 (116) 100 (38) 7 (29) 9(7) — 64 (1) REGISTRATION AND GENERAL INSPECTIONS Class of Premises (1) Number of premises newly registered during the year (2) Total number of registered premises at end of year (3) Number of registered premises receiving one or more general inspections during the year 14) Offices 97 (87) 1,567 (1,564) 332 (222) Retail shops 57 (40) 1,214 (1,267) 583 (355) Wholesale shops, warehouses 20 (14) 251 (247) 190 (76) Catering establishments open to the public. Canteens 26 (25) 355 (343) 325 (215) Fuel Storage Depots — — — Totals 200 (166) 3,387 (3,421) 1,430 (868) (2) Total number of visits of all kinds to premises Registered under the Act = 3,147 (4.066) (3) ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED IN REGISTERED PREMISES Class of workplace (1) Number of persons employed (2) Offices 45,982 (45,645) Retail shops 5,556 . (6,107) Wholesale departments, warehouses 4,658 (4,658) Catering establishments open to the public 1,713 (1,578) Canteens 924 (925) Fuel Storage Depots 2 (2) Total 58,835 (58,915) Total Males 36,948 (37,040) Total Females 21,887 (21,875) 65 HEALTH EDUCATION HEALTH EDUCATION SERVICE "Our remedies oft in ourselves do lie which we ascribe to Heaven." ALL'S WELL THAT ENDS WELL. Act I.Sc.1. William Shakespeare The title of the delightful Shakespeare play holds within it all the things that the individual hopes for. The remedies to so many ills do lie within ourselves, but to apply them we need information and the motivation to use it. The task of the Health Educator is to attempt to provide both. In a previous report I suggested thought might be given to the appointment of extra staff to meet the ever-increasing demand for health education. It is gratifying that this year there have been two additions to the health education team. One of these, an Assistant Health Education Officer, has a specific responsibility for health education in girls' schools and deals with Human Relationships, Menstruation, Venereal Disease, Family Planning and related subjects, in addition to general health topics usually discussed in schools and youth clubs. In addition a Health Education Assistant has been recruited whose main duties are concerned with the promotion of Home Safety. Also he assists the other Assistant Health Education Officer in the presentation of displays, etc. The team (comprising the Health Education Officer, 2 Assistant Health Education Officers, a Technical Assistant and a Clerical Assistant) is now big enough to examine and tackle most of the problems in the health education field and to offer to other colleagues the facilities available at the Health Education Centre. ADVISORY PANEL The panel continued to meet on a regular basis to preview new material and discuss projects and campaigns to be promoted throughout the year. These included Once again the perennial topics were presented at the appropriate times during the year. It is good to note that the number of injuries arising from Fireworks has fallen substantially and the number of Oil Heater fires has dropped and it is hoped that this is partly due to the intensive publicity programmes mounted. Indeed the London Fire Brigade praised the efforts of Islington Council in urging the public to dispose of their old and obsolete oil heaters commenting "We hope that all local authorities will pursue this campaign with the same vigour". STAFFING January — Infectious Disease and Prophylaxis February — Smoking March — Dental Health April — Prophylaxis May — Food Hygiene June — Venereal Disease and Drugs July — Summer Safety August — Preparation for School and Aspects of Child Development September — Nutrition October — Fireworks and Fire Hazards November — Winter Hazards, Hypothermia and Winter I lis December — A Safe and Happy Christmas - Toys, Flameproof Materials/ Decorations 69 Simple silk screen displays designed and made by the health education technical staff which can be used in any odd corner. 70 some of the happy members of the Drayton Park Geriatric Health Circle at the home of a member of the Health Department staff. A simple silk screen display designed and made by the health education technical staff which can be used in any odd corner. 71 EDUCATIONAL ESTABLISHMENTS The Health Education staff visited all grades of schools and educational establishments in the Borough, ranging from Nursery Schools to Further Education establishments, to give talks on specific topics including Dental Health, Smoking, Drugs, Human Relationships, Venereal Disease, Home Safety, Personal Hygiene, Emergency First Aid and Resuscitation and, for the first time, Family Planning and Contraception. Many talks on this delicate but vital subject have been given in Secondary Schools by the Health Education Officer to fourth year students. The talks have been received with enthusiasm and frankness, which is not surprising as so many parents are unable to communicate with their children when it comes to discussing sexual matters. Children are maturing physically at a much earlier age, many girls are beginning to menstruate whilst at primary school and are not given sufficient warning by parents about what may happen to them because the parents themselves are not aware of the changes taking place and are apt to base their attitudes on their own experience. Many parents have adopted a complacent attitude towards immunisation and vaccination. "These things don't happen any more so we needn't bother" is an attitude too often adopted today. It is only by constant vigilance that many infectious diseases can be kept at bay. The Health Education Officer went to many Primary Schools to speak to the mothers of entrants about the wisdom of maintaining the immunisation levels of their children. He also visited many Secondary Schools to talk about vaccination against Tuberculosis and German Measles and it is pleasing to note that as a result the acceptance rate for Rubella immunisation increased by nearly 100% at a number of schools. The Health Education Assistant lectured on Emergency First Aid and Oral Resuscitation at a number of Secondary and Primary Schools in the Borough and the interest shown indicates that there is a definite need and demand for this form of health education. The Health Education Officer was invited to give lectures on smoking at the City Day College for Further Education. He spent an entire week addressing groups of 400 or more students each day and the Principal later reported that the effect was remarkable, many students and members of staff having given up smoking. One only hopes that the effect will be sustained! The Health Education Officer was invited to talk to a number of Liberal Studies groups for the over 50's at Further Education Institutes in the Borough. The talks covered many topics including "Keeping Well in Retirement". Many more teachers are taking advantage of the Health Education facilities available to them through the Health Education Service; thus we see a greater interest being fostered in health education. It is anticipated that an even greater interest will be shown when the school leaving age is raised next year as much health education can be slotted into the "Liberal Studies" and "Humanities" groups of subjects. PARENT TEACHER ASSOCIATIONS Many schools in Islington,but not all,have Parent/Teacher Associations. It is possible, through these associations, for the Health Education team to demonstrate to parents the topics discussed with their children and to show visual aids and films used during the lessons. In addition, many parents are themselves seeking help and advice on a number of topics and through the medium of the Parent/Teacher Association are able to discuss problems and obtain information about subjects which might not usually be available to them in other areas. CENTRAL Y.M.C.A. The Health Education Officer continued to take part in courses on Human Relationships presented by the Association for Islington school leavers. YOUTH SERVICE AND CLUBS The demand for talks on various health topics continues and is increasing. The subjects most frequently under discussion are V.D., Drugs and Alcohol. 72 Girl Guides, Scout Groups, Cub Scouts, Campaigners, etc., are asking for talks and assistance when presenting First Aid and Home Safety Courses. One group of Girl Guides also asked for a talk and discussion about drugs. This was presented to a large group which included parents who had come from a wide area of North London. We are also receiving requests from Church Youth Groups who wish to know more about human relationships, and talks are now provided to these groups covering areas never explored in the past, such as V.D., Sex Education and the birth of a baby. Opinions are changing and it is good to see enlightenment. A group of I.L.E.A. Youth Officers and Youth Leaders attended a seminar presented by the Health Education Officer and were able to preview films which dealt with some of the many health topics provided by the Health Education Service and from this a number of youth groups asked for integrated courses of Health Education on Human Relationships. TRAINING Student Public Health Inspectors received tutorials from the Health Education Officer on the content and method of Health Education. Nearly 300 members of Council staff attended In Service Training Courses on Emergency First Aid and Oral Resuscitation given by the Health Education Assistant, who has a special responsibility for the promotion of Home Safety. In addition many Home Helps received a talk on the detection and emergency action to be taken in cases of Hypothermia. Many groups of students from various disciplines have visited the Health Education Centre and the Health Department for practical instruction and tutorials on the method and content of Health Education and received advice on how to create and administer a Health Education Service. These students included groups from The Centre for Educational Development Overseas , Student Nurses, Medical Students and Student Teachers. It is pleasing to note the following comment in a report by the Student Teachers Tutor. "The teaching aids available to Islington must be one of the finest collections extant". The Health Education Officer was invited to give papers and lectures at a number of conferences and seminars organised by national bodies. He lectured at Cambridge University to the Students' Union on "Giving up Smoking". At a conference presented by A.S.H. (Action on Smoking and Health) at the King Edwards' Fund Hospital Centre, he gave a paper on Smoking Advisory Clinics. He was again invited to lecture at the Speakers Conference of the Women's National Cancer Control Campaign on the presentation of Cancer Education and at Phillipa Fawcett Teachers' Training College on the dangers of smoking. In addition he gave papers on Smoking and Drug Addiction to D.P.H. Students at the Royal Institute of Public Health and Hygiene. Talks on V.D., Drugs and Smoking were also given to staff at the Whittington Hospital in a series of seminars. GERIATRIC CLINICS Advisory Health Circles for Elderly People continue to flourish and go from strength to strength each year. They maintain a happy atmosphere and enable the members of the groups to see each other on a regular basis. Friendships are struck up at the Circles, which provide a meeting to look forward to every week, and a place where nutriments can be bought cheaply and a little health education received at the same time. A group of 60 old folk from the Drayton Park Circle organised a coach trip to Hampton Court last summer where they thoroughly enjoyed themselves. Afterwards they were entertained to tea at the country home of a member of the Health Department Staff and were each given a small parcel of food samples provided by various companies. At Christmas time each Geriatric Circle has a Party and a Carol gathering, these are enjoyed immensely, and the centre staff spend a tremendous amount of time in organising and raising funds for these functions and at the same time the ladies of the Circles have contributed by knitting squares which are made into patchwork blankets and presented to needy elderly folk. 73 SMOKING ADVISORY CLINIC The Clinic continues to function with the same excellent degree of success and many other local authorities send members of their staffs to see how our clinic is run and model similar clinics within their own areas on our lines. The second World Conference on Smoking and Health was held in London in September at Imperial College under the auspices of the Health Education Council. The Islington Smoking Advisory Clinic was featured in the International Exhibition which ran concurrently as part of the Conference. The Health Education Council invited the Health Education Officer to man the Smoking Clinic stand and give delegates information about the Islington Smoking Advisory Clinic. The Central Office of Information featured the Islington Clinic in a film shown at the Conference about the smoking habit. The Clinic was again featured on Radio London, and Dr. H.O. Williams and the Health Education Officer answered questions telephoned by listeners about smoking; also it was again highlighted in the television programme "Horizon". A well-known pharmaceutical company made a video tape recording of a clinic session for their medical library and the tape is available to any interested local authority. DENTAL HEALTH CAMPAIGN Dental Caries is the most easily preventable disease and although Dental Health Education is continually pressed at schools we do endeavour to have a major campaign at least once a year. Once more the television and circus personality "Pierre the Clown" visited primary schools in the Borough and gave an hilarious demonstration about tooth care. In addition every child received an apple and literature about the care of teeth. More than 40 schools were visited and 12,000 apples distributed. His Worship the Mayor, Alderman Robin Goodman, took a great interest in the campaign and visited a number of schools whilst it was on. In conjunction with the General Dental Council an evening seminar on dental health education for teachers was held at the Teachers' Centre, William Tyndale School. The Health Education Officer contributed to a Dental Health Education programme presented by the Health Education Council on Radio London. This featured an Islington Infant School, and the tape recording of this broadcast was used at a national seminar on mass communication for Health Education Officers at Selwyn College, Cambridge, to illustrate how dental health education can be presented to large groups. EXHIBITS AND PUBLICITY MATERIAL The Health Education Service is particularly fortunate in having good facilities for the production of exhibits, audio visual teaching aids and publicity material and highly skilled staff to devise and produce them. The exhibits and publicity materials are tailored to meet the needs of specific local campaigns and require much thought before the manufacturing process takes place; this often includes silk screen printing, plastics cutting, woodwork and electronics. We are fortunate in having a master craftsmam in the Health Education Team who knows how to create the right sort of exhibit at the right time; his ingenuity with mechanical displays makes them amusing, entertaining and instructive, thereby delivering the message which will attract attention and stick. Many new items of publicity material have been produced during the year including V.D. publicity material. For the first time a fully comprehensive list of Special Clinics for men and women in the Greater London area was produced which gives not only the address but also the telephone and extension numbers, the days and times open and specifies when doctors are in attendance for consultation and treatment. Further V.D. publicity material has been produced for display in urinals and water closets giving full details of the local Special Clinics and a telephone number to call for detailed information about V.D. 75 Special leaflets have been produced publicising immunisation and vaccination. Our "Ostrich" leaflet on immunisation has been most effective in reminding mothers of pre-school children that primary immunisation and boosters are required before "Johny" and "Jane" commence school. A leaflet publicising BCG vaccination has been printed in seven languages, English, Cypriot Turkish, Cypriot Greek, Urdu, Hindi, Bengali and Punjabi. Another leaflet published by the Health Education Service reminded the public that "Cold can Kill the Elderly" and contained concise information on action to be taken if a person was suspected of suffering from Hypothermia. Family Planning leaflets giving information about the various methods employed were produced and distributed widely, and a special leaflet inviting people to take advantage of the Domiciliary Family Planning Service was also produced. The Health Education van, by using a slogan banner board on its roof, served, in addition to its normal function, as a mobile advertising unit throughout the Borough and around London. The boards, produced by the staff, are changed at monthly intervals to accord with the theme or campaign being presented. The Health Education activities of this department are constantly publicised by the mass media which includes newspapers and magazines, both local and national, the active participation in television and radio broadcasts and documentary film making. It will thus be seen that this important aspect of public health work is penetrating into many homes and that vital information concerning the health of the community is reaching the masses as well as the individual. Banner boards carried by th* health education section vehicles publicising various monthly campaigns. 76 Personal health Care of Mothers and Young Children 79 Health Visiting 79 Domiciliary Midwifery 80 Home Nursing 80 Prophylaxis 82 Chiropody 83 Family Planning 84 Cervical Cytology 86 Recuperative Holidays 86 Services for the Elderly 87 Other Items 89 77 PERSONAL HEALTH SERVICE CARE OF MOTHERS AND YOUNG CHILDREN MATERNAL AND CHILD HEALTH CENTRES The local clinic has continued to be a focal point for the mothers and babies of Islington during the past year. All the usual clinic functions including ante and post-natal, family planning, child health and toddlers sessions have continued. Creche facilities continue to be in demand and all sessions are well attended. A total of thirteen sessions was held each week, compared with nine in 1970. Educational sessions have been held in the centres for a variety of groups of all ages and there has been an increased attendance particularly where Mothers' Clubs are available. Undoubtedly 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 attendances totalled 6,031 (4,639). STATISTICS Attendances (1970) Borough Clinics Child Health 40,652 (45,063) Toddlers' 2,630 (3,239) Ante and Post Natal 2,436 (3,023) (excluding G.P.O. sessions) Total 45,718 (51,325) General Practitioners'Surgeries 6,031 4,639 Occasional Creche : sessions per week 13 (9) attendances 4,366 (4,258) HEALTH VISITING Health visitors are well accepted by all strata of society and have become adept at coping with different languages and cultures. Fewer home visits have been made during the past year due to a changing work pattern. Where parents are unable or unwilling to bring their children to a child health centre for hearing tests, health visitors now carry these out in the home. Due to the ever increasing case-loads of geriatric visitors, geographically based health visitors are now visiting more of the elderly in the population; this is in line with the work pattern of health visitors attached to group practices, who are already involved in working with all age groups. Health education is also a vital part of a health visitor's job and health education sessions are held in the centres and schools. A slimming clinic commenced in River Place Health Centre in September at the request of the general practitioners based there, patients being referred directly to the clinic, held fortnightly. Cases visited by Health Visitors flQ7n) Children born between 1966 and 1971 15,839 (16,278) Persons over 65 687 (220) Mentally disordered persons 95 (150) 79 (1970) Persons (excluding maternity cases) discharged 117 (229) from hospitals (other than mental hospitals) T.B. Households 6 (37) Households visited on account of other infectious illnesses 294 (659) Other cases 3,688 (3,313) Effective visits 49,349 (51,344) Ineffective visits 15,420 (14,614) STUDENT TRAINING Seven 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 to fire cases continued, involving a great deal of home visiting of the families concerned for advice and health education. Fires notified 30 Fatalities 3 (10%) Fires involving fatalities 3 Children involved 1 Injuries 6 (20%) Fires involving injuries 5 Fires involving oil heaters 10 (33%) DOMICILIARY MIDWIFERY The number of domiciliary deliveries continued to decline, falling to a total of 142, compared with 155 in 1970. In addition to the 142 home confinements, 46 other patients were booked for domiciliary confinement but subsequently transferred to hospital for the following reasons:- Complication of pregnancy 27 Premature labour 1 In labour at term 10 Moved out of area 8 The planned early discharge scheme resulted in 325 assessments of home conditions being made; 98 homes were found to be unsuitable. 475 patients (including unplanned early discharges) were nursed at home following hospital delivery. 35 patients originally booked for home confinements but who were delivered in hospital were subsequently discharged for home nursing (giving a total of 510 hospital discharges). The Emergency Obstetric Unit from University College Hospital was called to 3 patients by midwives on account of retained placentas and in one case post-partum haemorrhage. All were admitted to hospital. HOME NURSING Early in May, the home nursing office moved from the quiet Alwyne Road premises overlooking the New River to the departmental offices in Upper Street. The transfer went smoothly and the administration 80 of the service is now integrated within the personal health section to the benefit of all concerned. The home nurses are based at main maternal and child health centres, in six separate groups, each group with a senior nurse as team leader. All messages and requests for nursing services are received centrally and transferred at least three times daily to the team leaders concerned. Two new group attachment schemes were initiated during the year, making a total of five such attachments, all of which are working successfully. Four pupil nurses from St. Matthew's Hospital completed successfully the course of training for district nursing, and there was an intake of three district nurses taking the district nursing training, all of whom gained the National Certificate. Three of the district nurses attended a practical work instructors course, and others attended study days on various aspects of nursing care, including cancer and its treatment, multiple sclerosis and community coronary care. A sisters' study day at University College Hospital was attended by two members of the nursing staff and was much appreciated. Ten patients with terminal carcinoma received extra nourishment from the Marie Curie Memorial Foundation and eight received night nursing care, in addition to the home nursing care provided by the Council. Thus, these patients were able to spend their last days at home with their families. The service lost a valuable member of staff during the year when one of the nurses died after a short illness. Her funeral was attended by most of her colleagues and some of the patients she had nursed. STATISTICS (1970) Patients being nursed at (a) 1.1.71 819 (709) (b) 31.12.71 899 (819) Total nursed 2,526 (2,363) Total visits 111,693 (101,714) Visits to persons over 65 95,487 (82,468) Proportion of visits to persons aged over 65 85.4% (83.8%) Nursing treatments completed 1,627 (1,610) Nursing treatments commenced 1,707 (1,724) 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 fojlowing: Equipment (1970) No. on loan (31.12.71) Air and sorbo rings 97 (110) 156 Bed cradles 79 (86) 106 Bed and back rests 105 (116) 140 Bed pans 80 (72) 122 Commodes 286 (323) 461 Hoists 13 (6) 18 Dunlopillo 8 (10) 23 Fracture boards 29 (27) 78 Hospital beds 10 (12) 13 Walking aids 114 (99) 130 Wheel chairs and other special chairs 92 (108) 169 81 PROPHYLAXIS VACCINATION AND IMMUNISATION All infants attending child health sessions are offered the basic course of immunisation unless they are already being given this protection by their own doctors. In addition, ad hoc vaccination and immunisation sessions (7 weekly) continued to be held at most of the main maternal and child health centres. The revised schedule introduced in October 1970, and referred to in my previous report, has inevitably resulted in fewer babies completing courses of immunisation during 1971, but this will be self-adjusting during 1972. A computerised child health record system was introduced during the year to which reference is made elsewhere in this report. One of the purposes of this computer scheme is to provide an automatic reminder to health visitors for each child failing to complete the primary course of protection by the due date, thus enabling the child to be followed up. In this way, it is hoped to achieve a higher rate of acceptance of protection by parents for their pre-school children. The parents of children commencing school are handed a leaflet reminding them of the need for protection against disease. Unfortunately, some children still commence school unprotected and these are immunised at school medical inspections provided parental consent can be obtained. Alternatively, parents of these children are encouraged to bring them to child health centres during the school holidays. STATISTICS The Health Education section has been active in promoting the department's immunisation campaign with lively and eye-catching material in the form of leaflets, posters, displays, etc. Primary courses completed 1970 Diphtheria 1,588 (3,692) Whooping Cough 1,386 (3,267) Tetanus 1,632 (3,800) Polio 1,654 (3,754) Measles 1,980 (3,092) Booster doses 1970 Diphtheria 4,689 (5,706) Whooping Cough 2,456 (2,457) Tetanus 5,220 (5,799) Polio 5,276 (5,767) Percentages of children born in 1969 and vaccinated by 31.12.71 Islington National Average Diphtheria 78% 80% Whooping Cough 78% 78% Tetanus 78% 80% Polio 78% 80% SMALLPOX VACCINATION Arising from recommendations made by the Joint Committee on Vaccination and Immunisation (Department of Health Circular CMO. 12/70), vaccination against smallpox is no longer recommended as a routine in early infancy. It is still required for travellers to and from areas of the world where smallpox is endemic, and is strongly advised for health service staff at risk of coming into contact with a case of smallpox. Annual statistics are no longer required by the Department of Health. 82 It was decided therefore, not to provide vaccination against smallpox from August 1971 at Council clinics for members of the public and the procedure has been deleted from the basic schedule of protection offered to young children. Arrangements are made for all medical, nursing and public health inspectorate staff to be offered vaccination against smallpox on appointment and re-vaccination at 3-yearly intervals while remaining in the Council's service. The distribution of smallpox vaccine to general practitioners continues to be the responsibility of local health authorities. RUBELLA VACCINATION During the year a vigorous attempt was made to vaccinate against rubella all girls between the ages of eleven and fourteen years. Eleven schools were each visited three times and 2,617 girls vaccinated. New entrants to girls'secondary schools will now be offered protection as a routine. This is a long term policy which, it is hoped, will reduce the number of retarded children born to mothers who contract rubella during the early months of their pregnancy. B.C.G. VACCINATION 21 schools were visited, 14 of them twice. 3,317 children were Heaf tested and of these, 3,011 were given B.C.G. vaccinations. 45 children were found to have positive reactions and were referred to the chest clinic. 40 children were x-rayed, 10 were found to need treatment and 21 were kept under supervision by the Chest Physician. It was decided to lower the age at which B.C.G. was given in order to try to avoid absenteeism when the B.C.G. team visited the school. It was felt that younger children would be less likely to absent themselves and B.C.G. is now offered to entrants to secondary schools at age eleven. HEAF TESTING It had been decided in 1970 to offer new entrants to Borough primary schools a tuberculin test at age 5 years in an effort to detect unknown cases of tuberculosis in the community, the family contacts of children producing strongly positive reactions to be followed up at the chest clinic. Various factors prevented the introduction of this pilot scheme during 1971, but plans were completed for it to commence at the beginning of 1972. CHIROPODY This service is provided for priority categories at seven centres throughout the Borough, i.e. for women over 60, men over 65, expectant mothers, physically handicapped persons and children under school-leaving age. Treatment is by appointment, and is free for persons receiving old age and normal retirement pensions, those on Social Security and children. The charge in other cases is 25p per treatment, but this may be reduced in necessitous cases. A total of 12 chiropody chairs are currently staffed at the various centres, and provision is made for a maximum of 95 sessions to be held each week. During 1971 the average number of sessions held was 82 per week. In addition, domiciliary treatment is provided for the housebound, and there is a regular weekly flow of new patients referred for domiciliary visiting. Considering the national shortage of Chiropodists, the staff situation remained reasonably steady. Every effort is made to recruit and indications are that the outlook here is improving. 83 STATISTICS Provision has been made in the 1972/73 estimates for an expansion of the service, at clinics and domiciliary, by providing 6 additional senior chiropodists together with additional supplies and equipment. Chiropody service will also be provided in a mobile clinic for which provision has also been made in the estimate. Clinics (1970 ) Sessions 4,299 (5,400) Appointments booked 34,461 (34,123) Attendances Children 0-4 years 6 (4) 5-14 years 386 (149) Adults Male 4,401 (4,414) Female 19,655 (19,274) Physically Handicapped 162 (103) Total 24,610 (23,944) Domiciliary Treatments given 6,390 (6,812) Homes for the Elderly Treatments given 1,425 (1,830) FAMILY PLANNING Family Planning services for Islington residents are provided under the Family Planning Act, 1967, at Council clinics, through a Council domiciliary service, and at clinics run by the Family Planning Association and the Brook Advisory Centres. The first Council clinics were opened in 1966, and the number of weekly sessions increased from two per week in 1966 to thirteen per week by the end of 1971, two additional clinics having been started in 1971. One of these is in a community centre on a housing estate and the other in hospital premises. Attendances continued to increase and in 1971 these totalled 4,438 compared with 3,102 in 1970. Initially, the service was restricted to those residents requiring advice and treatment on medical and on special social grounds. From April 1970, however, the service was expanded to include all Islington residents over the age of 16 years wishing to make use of it; advice and examination is provided without charge but for non-medical cases there is a small charge for supplies, abated or waived altogether in necessitous cases. Medical cases have always received supplies free of charge. GENERAL PRACTITIONERS AND HOSPITALS General practitioners are always consulted initially about their patients attending family planning clinics before oral contraceptives are prescribed. In addition an Islington resident who receives family planning advice on social grounds from her own doctor, but cannot afford to pay for the requisites, may be supplied with these at a Council family planning clinic at normal clinic cost (or less according to assessment). At the end of 1970 family planning sessions were initiated by the Royal Free Hospital in their obstetric and gynaecological departments and by arrangement with the consultant obstetrician, Islington patients were referred from these sessions to Council clinics for follow-up. In July 1971 the Council opened a family planning clinic in the Chest Clinic premises at the Whittington Hospital (St. Mary's Wing) by arrangement with the North London Group Hospital Management Committee.. 84 VOLUNTARY ORGANISATIONS The Family Planning Association is grant-aided by the Council, the grant having been increased from £2,000 in 1969/70 to £8,000 in 1970/71. In January 1971 the Council agreed to pay the Family Planning Association in accordance with their National Family Planning Agency Scheme No. 5. Under this scheme the charge made by the Association for medical cases is at the rate of £4,85p per head for those receiving advice and supplies free and £2.10p per head for those paying for their own supplies. From October 1970 the Council agreed to pay a per capita consultation fee of £3 in respect of Islington residents attending Brook Advisory Centres for family planning. There were 200 such cases during the year. DOMICILIARY Towards the end of 1968 the Family Planning Association, in conjunction with the Council, initiated a pilot scheme to provide a domiciliary birth control service for the benefit of Islington women where family restriction is deemed advisable, but the mother is not willing or not able to attend a clinic. In April 1971, it was decided to provide this service directly by the Council, and during 1971 46 patients were referred compared with 11 during 1970. The follow-up visiting was done by a nurse. Every effort was made to encourage patients to attend clinics but where this was not achieved the domiciliary service continued. During the early summer two successful staff seminars on the domiciliary service were held the Medical Officer responsible for domiciliary visiting addressing health visitors, midwives and social workers of the Council's staff. The following is contributed by the nurse who undertakes the domiciliary visiting:- "My first visit to the patient after the doctor has called is to teach the method chosen. Gaining access to the home often necessitates several visits, day or evening, Language difficulties do arise, but there is usually someone in the house to interpret, quite often a teenager. The service is warmly received by some but in other cases persuasion and education is required, and often because of religion and culture the husband has to be present. The number of visits made depends on how well patients carry out the advice given, this also applies when transferring cases to clinic. Frequently patients have to be taken by car to clinic for Inter-uterine device fitting and on several occasions as many as 5 children had to come along as well! My feeling after one year is that we are gradually reaching that part of the community who would not otherwise avail themselves of this service." FREE SERVICE During the year there was a growing pressure in many quarters for the provision of a totally free service in order to remove any financial deterrent tending to restrict use of the service. The Department of Health, in Circular 36/71, encouraged the growth of local authority family planning services and stated: " Family planning can often improve the quality of domestic life; it can prevent the unhappiness that unwanted pregnancies can cause and reduce the need for abortion." It was considered that the additional expense of a totally free service in Islington would be offset by savings which are inherent in the provision of an adequate family planning service such as preventing medicosocial problems arising from the birth of unwanted children and all the expenditure incurred for them in the social services. In addition the growth in the number of abortions since the Abortion Act 1967 became law seemed to imply the need for contraceptive facilities to be available. Accordingly, in October, 1971, theCouncil approved in principle, that with effect from 1st April, 1972, no charge be made for family planning advice or supplies to Islington residents attending Council, Family Planning Association or Brook Centre Clinics. It was also decided to approach the Association of Municipal Corporations with regard to the question of local health authorities' powers in relation to financial assistance to those undergoing vasectomy operations. In December 1971, a meeting was held with representatives of professional and voluntary agencies, to discuss the implications of the Council's scheme to provide a free family planning service, and possible future expansions. This was attended by medical colleagues from local hospitals, a representative of the Inner London Local Medical Committee, representatives of the Family Planning Association and the Brook 85 Advisory Centres, and representatives of the Council's medical, nursing and social worker staff. The implications of the decision to establish a free service were discussed and plans for the co-ordination of the services improved. CERVICAL CYTOLOGY Cervical cytology sessions (six per week) continued to be held in conjunction with family planning sessions. Attendances were by appointment and the total number of smears sent for examination was 1,293, a slight increase compared with 1,153 in 1970. The results were:- Normal 1,188 Other gynaecological disorders (excluding cancer) which required treatment. These women were referred to their general practitioner or directly for gynaecological advice and treatment. 87 Doubtful cases referred for repeat examination 17 Positive: referred to hospital 1 Age Group Under 25 381 25 - 34 476 35 - 44 236 45-54 140 Over 55 60 FIVE YEAR RECALLS The national cervical cytology screening service for women aged 35 years and over started in January, 1967 and in October 1971 the Department announced that a national recall scheme would begin in January, 1972 whereby women aged 35 and over, whose previous test result was negative, would be invited to have a further test, five years after their last examination. A revised version of the national request/report form HMR.101/5, introduced in 1967, will be introduced in 1972. This will then be a national request/report/ recall form. The local health authority will receive copies of the form for all women tested in its area, irrespective of where the test originated. In Islington, a cervical cytology service was started in April 1966, prior to the national scheme, and the women then examined were thus due for a repeat smear in 1971. A local recall scheme was, therefore, started in the spring of 1971. This will be merged with the national recall scheme to start in 1972. RECUPERATIVE HOLIDAYS It was decided by the appropriate Committee that this service although a social services function should continue for the time being to be administered by the Public Health department for the Social Services Committee. 355 persons were recommended by their doctors, hospital consultants, etc., for recuperative holidays during 1971. 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. 43 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 Social Services Department, etc. Recommendations on behalf of school children were mostly referred to the Inner London Education Authority which maintains two holiday homes. 86 The following statistics show an overall increase in the number of recommendations dealt with during 1971:- Holidays arranged 1970 Expectant and Nursing Mothers 2 2 Tuberculosis adults 2 11 Other adults 85 70 Psychiatric patients 15 15 Accompanied children 33 23 Unaccompanied children (placed by I.L.E.A.) 80 38 Total 217 159 SERVICES FOR THE ELDERLY VISITS BY MEDICAL OFFICERS Sixteen 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. Three cases were dealt with under Section 47, and two persons subsequently agreed to be admitted to hospital or a welfare home to receive care and attention. HOME VISITING During the year, the number of the aged visited by health visitors has increased by over 400. The Geriatric Visitors' work has continued unabated. The Home Help and Meals-on-Wheels services are now administered by the Social Services Department, therefore the visitors' contact with that department has been frequent, as has their liaison with General Practitioners and with the Home Nurses. Statistics of geriatric visiting for the year are as follows:- New cases Re-visits Unsuccessful visits Total 1,276 11,230 2,383 14,889 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. Seventeen such cases, reported by the public health inspectors, home visitors, hospital authorities, etc., were dealt with during the year. 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. 87 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. GERIATRIC SCREENING A pilot study for a geriatric screening service to commence in 1972 started in October 1971. Health/geriatric visitors visited persons in their own homes 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 was therefore decided, in order to obtain the greatest return for work carried out, to apply the screening procedure to those aged 70 years and over. The pilot study was nearing completion at the end of the year. LAUNDRY SERVICES The laundry service for incontinent persons (most of them elderly) is provided from Finsbury Health Centre. During the year 3,219 collections of laundry were made. The service was being provided to about 128 persons at the end of the year. The Finsbury Laundry Service for the elderly chronic sick was discontinued at the end of the year. Recipients remaining on the service were asked if they wished to transfer to the incontinent laundry service and four expressed their willingness to transfer. BATHING FACILITIES The services provided from the Finsbury Health Centre continued throughout the year. 5,410 baths were carried out in the homes of elderly persons under the Domiciliary Service. 2,266 baths were given to persons attending the centre, 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 1971 from the Welfare Centre, Corsica Street, N.1. 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 810 applications for cremation at the Council's Crematorium, East Finchley. GERIATRIC PREVENTIVE CLINICS The following table analyses the work of the medical sessions during the first four years of their operation. 88 ATTENDANCES December Quarter 1966 1967 1968 1969 1970 1971 TOTAL Source of Referral: Geriatric Visitors 35 32 27 16 5 – 115 Personal Applications 55 143 84 45 42 6 375 Others 2 33 33 2 2 – 72 Totals 92 208 144 63 49 6 567 Subsequent cancellations 14 48 36 17 10 2 127 Clinics held 22 104 83 53 41 24 327 First attendances 43 177 113 53 37 6 429 Age Group M F T 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 2 5 7 3 4 7 – 1 1 64 65-69 1 4 5 25 31 56 12 24 36 11 11 22 3 4 7 3 – 3 129 70-74 1 10 11 18 22 40 10 22 32 7 5 12 3 3 6 1 – 1 102 75-79 8 3 11 6 24 30 6 11 17 1 4 5 5 6 11 – 1 1 75 80-84 3 5 8 9 9 18 2 5 7 2 2 4 – 2 2 – – 39 85-89 – 3 3 1 4 5 1 – 1 1 2 3 2 – 2 – – 14 90-94 1 1 2 1 – 1 – – – – – – – 1 1 – – 4 95+ 1 – 1 – – – – – – – – – 1 – 1 – – 2 16 27 43 67 110 177 34 79 113 24 29 53 17 20 37 4 2 6 429 Re-examinations 16 121 112 137 120 106 612 Average attendance per session 2.7 2.9 2.7 3.2 3.8 4.7 3.2 OTHER ITEMS HANDICAP REGISTER A central index of known handicapped children and young persons up to 21 years of age continues to be maintained under the supervision of the principal medical officer. The development and welfare of those on the register is kept under constant review by means of the Kalamazoo Factfinder system. Children under 5 are reviewed six monthly until they reach school age when recommendations are made if they are in need of special schooling. Once at school they are reviewed annually, or more frequently if necessary. 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 an I.L.E.A. social worker, based in the Islington Public Health Department is,attached to the Autistic Unit at Horizon (Educationally Sub-Normal) School. Handicapped school leavers are helped to find employment through the established arrangements between the Borough Services and the Handicapped Young Persons Section of the Youth Employment Services. 89 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 Social Services Department on individual cases. Details of handicapped children born in 1971 were fed into the computer, which sends out requests for reports to Health Visitors every six months. This is the beginning of the computerisation of the handicap register. Eventually detailed statistics of each type of handicap will be rapidly available from the computer as required. At the end of 1971 the number of children and young persons on the Central Handicap Register was 2,141 (2,103). Because of the ever-growing volume of work involved in the follow-up and assessment of children with handicaps, a clinical psychologist was appointed to the staff in May 1971. Special Advisory Clinics are held to assess pre school age children with known handicaps or who have been referred because of mild retardation, slowness in speech, non-communication, disturbed behaviour, etc. Referrals come from general practitioners, health visitors, day nursery matrons and clinic doctors, and the children are seen at child health clinics, day nurseries or in their own homes. The Special Advisory clinics are held in one of three centres serving the southern, central and northern parts of the Borough. Dr. Groves, principal medical officer, sees each mother and child to obtain a full history and preliminary assessment of the child. She is assisted by the clinical psychologist, Mrs. Pahad. Subsequent assessments are made periodically by Dr. Groves, Mrs. Pahad, or Dr. Clarke, senior medical officer. If a full hospital investigation is needed, it is arranged after consultation with the general practitioner. Often the children are already under a paediatrician's care and what is needed is the mobilisation of local resources to help the mother and child. Placing in playgroups, day nurseries or a voluntary grant-aided day nursery for mentally handicapped children,or an assessment unit in a day physically handicapped school or other specialised centres, may be considered. Speech therapy, child guidance etc. may be recommended. Social support for the family may be sought. Each child's progress is watched and, if it is apparent that special education will be necessary, efforts are made with the help of the divisional education officer to see that the child enters the most appropriate school at a suitable age. Once at school, he will be followed up by the school medical officer. During 1971, the Special Advisory Clinic was concerned with a total of 158 children, 25 clinic sessions were held; 109 home visits and 91 Day Nursery visits were made. At the end of the year 136 children remained on the Special Advisory Clinic current list. COMPUTERISATION OF CHILD HEALTH RECORDS During the year notifications of birth were fed into the computer and by 31st December all children born during the year, whether they were actually born in Islington or moved into the Borough during the year, had computerised records. This basic record comprises the child's surname, date of birth, sex, place of birth and birth weight; the parity, age and marital status of the mother; and the name of the family doctor. The birth is recorded as either live or still born, legitimate or illegitimate, single or multiple. The place of birth is coded as either hospital or home and as to whether or not it is a transferable birth. Any congenital abnormalities observed at birth are also recorded. To this record significant information is added as it becomes known; for example factors which may mean that a child is handicapped or potentially so, his medical condition, admissions to hospital, vaccination and immunisation - as prophylaxis is completed. The record is instantly available for perusal by those authorised and cannot be lost or mislaid. It provides a memory aid to the health visitor and draws attention to the prophylaxis when it is overdue. 90 From the basic records the following scheduled information is produced by the computer:Weekly (a) A print giving details of child and mother, including handicap factors and congenital malformations. (b) Up-dated print-outs of records amended during the previous week. (c) Lists for Registrars of births notified for their areas. (d) Details of children born with congenital malformations observed at birth ready for typing on the montly return forms to the Registrar General. Monthly (a) Memoranda to health visitors calling for reports on children on the Handicap Register at intervals of six months from the date of birth. (b) Memoranda to health visitors to follow-up children who are not vaccinated or immunised commensurate with age. Quarterly (a) Statement of adjusted births fully analysed in child health centre districts. (b) Memoranda to general practitioners giving details of vaccination and immunisation carried out at local authority clinics on their child patients. Annually (a) Statement of adjusted births fully analysed as above. (b) Statement of births according to the Department of Health Form LHS27, Part A, but showing actual births transferred in and transferred out. (c) Analysis of premature births according to Form LHS27, Part B. (d) Table for form LHS27, Part D, but excluding number of cases delivered in hospitals and other institutions, but discharged and attended by domiciliary midwives before the tenth day. STUDENT VISITS Arrangements continue to be made for students, medical, nursing, social workers and others to visit various branches of the department. It is considered worthwhile to continue to arrange these visits as a means of providing a knowledge of the work of a local authority health department to students from a variety of disciplines, in the hope of laying a foundation for co-operation with workers in other fields in the future. There is a tendency for medical students and student nurses who see the work of the department to spend a longer time in the public health field. This is particularly true of student nurses from the Royal Northern Hospital who take the three month community nursing option of the recently revised syllabus of the General Nursing Council and spend this period of their general nursing training in Isington. A new venture was that, in conjunction with the Royal Free Hospital, their student nurses now spend a day with a community nurse during the first few days of their training. So far, 40 student nurses have spent a day in Islington. This is another method of initiating the new syllabus which encourages student nurses to consider the patient in his total environment. Initially a talk is given by members of the nursing staff, explaining the work of the community nurse, and after the day spent in Islington, a return visit is made when the student nurses discuss what they have seen and any further information is given as needed. 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 on the following page. 91 1970 Domiciliary Midwifery 254 (239) Mental Health 482 (569) Home Nursing 435 (244) Infectious diseases ) (2) Other ) 292 (79) TOTAL 1,463 (1,133) EMERGENCY TRANSPORT Midwives were able to make use of special care hire facilities. CO-OPERATION WITH SOCIAL SERVICES DEPARTMENT Interdepartmental meetings of senior staff of the two departments are held at approximately threemonthly intervals to discuss matters of common concern and have proved to be most useful to all concerned. 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 Director of Social Services for his consideration. 68 visits were made during 1971. Residential establishments for the elderly are also visited by a senior medical officer accompanied by a senior public health inspector. Ten such visits were made in 1971. The assistance of this department is sought in 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. GRANTS TO VOLUNTARY ORGANISATIONS During 1971 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 1971/72 £ Maternal and North Islington Infant Welfare Centre 23,500 Child Health Prevention of Illness Chest & Heart Association _ 10-50 Care and After-Care Islington Chest & Tuberculosis Care Committee 250 Action on Smoking and Health Ltd. 10 Health Education Council 375 PREVENTION OF BREAK-UP OF FAMILIES During the year the Co-ordinating Committee met once only, in June. 28 Case Conferences (Housing Problems) were convened by the Public Health Department at which 199 cases of families with rent arrear problems were discussed. In agreement with the Social Services Department, social workers in the Public Health Department have continued long-term, intensive casework with three families with whom they were involved before April 1971. 92 SCHOOL HEALTH SERVICE The Inner London Education Authority is responsible for this 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 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 continued 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. A meeting was held in April 1971 with representatives of the Head Teachers Consultative Committee initially to discuss the best way of achieving a high rate of immunisation amongst young children. This proved useful and it was decided to hold bi-annual meetings so that various matters relating to the school health service could be discussed. At a second meeting in November it was agreed that a joint Working Party be set up to produce a comprehensive syllabus on health education covering the entire school life of a child. It is envisaged that teachers could make use of the syllabus either in whole or in part, and that it would include appropriate reference to visual aids, tapes and other material which would be made available, together with lists of expert speakers on specialised subjects. HEALTH OF SCHOOL CHILDREN In May 1971 the school roll for the Borough decreased from 34,196 to 33,449. 41.8% of these children were examined at routine medical inspections during the year and only 0.4% 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. 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 eight 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. Medical reports for the Careers Service were completed at this examination for pupils leaving school at 15 years of age. Pupils still in attendance after reaching 15 were inspected as early as possible in the term prior to that in which they would be leaving school, when a medical report for 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 Pre-entry medical examinations continued to be held at two primary schools in the Borough. These have proved successful, but have not yet been extended to any other schools in the Borough. This pre school medical examination is not, of course, regarded as a condition of entry to the schools concerned, but a higher than average percentage of mothers attend, and thus better histories and other necessary details about the children to be admitted are more easily obtained. 95 ROUTINE MEDICAL INSPECTIONS - DEFECTS Numbers of cases noted for treatment or observation expressed as a rate of per 1,000 inspect. (1970 figures in brackets) Treatment Observation SKIN 7.75 (5.31) 7.97(11.86) EYES (a) Vision 63.90 (69.05) 53.83 (60.63) (b) Squint 7.90 (7.79) 5.51 (5.52) (c) Other 1.88 (1.03) 1.81 (2.21) EARS (a)Hearing 4.93 (4.41) 4.56 (5.73) (b) Otitis Media 2.61 (1.79) 2.68 (5.59) (c) Other 1.45 (0.69) 0.65 (2.28) NOSE AND THROAT 3.84 (3.31) 16.81 (25.59) SPEECH 3.69 (3.59) 5.65 (6.76) LYMPHATIC GLANDS 0.65 (0.41) 11.66 (14.42) HEART (a) Congenital 1.52 (2.76) 2.61 (8.35) (b) Acquired 0.80 (-) 2.75(–) LUNGS (a) Bronchitis 1.23 1.88 (b) Asthma 5.14 4.49 (c) Other 0.58 2.03 DEVELOPMENT (a) Hernia 1.38 (0.83) 3,33(2.76) (b) Other 2.17 (2.21) 4.49 (5.10) ORTHOPAEDIC (a) Posture 0.80(0.62) 3.55(4.35) (b) Feet 2.54 (2.90) 9.78(11.45) (c) Other 3.12 (2.14) 4.85 (8.76) NERVOUS SYSTEM (a) Epilepsy 1.45 (1.03) 1.38 (1.79) (b) Other 0.65(0.62) 1.23 (2.28) PSYCHOLOGICAL (a) Development 1.96(2.21) 7.97 (6.76) (b) Stability 1.45 (2.07) 12.03(11.24) ABDOMEN 0.65 (0.90) 1.52 (2.69) DEBILITY 2.10 (0.48) 3.19 (0.41) ENURESIS 7.61(8.28) 18.91 (22.28) OBESITY 4.93 (3.72) 11.45 (12.69) OTHER 2.97 (2.21) 2.17 (2.41) 96 SPECIAL MEDICAL EXAMINATIONS 3,483 (2,621) special medical examinations were carried out in 1971, either at schools (where the pupils' parents were invited to attend) or in the pupils' own homes. RE-INSPECTIONS School doctors re-inspected 5,778 (6,359) children who had been referred for treatment or observation. EMPLOYMENT OF SCHOOL CHILDREN During 1971 85 (167) 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 carried out comprehensive inspections and arranged for any treatments to be given which might be needed to make them fit to go. 2,203 (1,381) 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;2,078 (1,242) children were examined in this way during 1971. HOLIDAY FOR OBESE GIRLS - STANSTEAD 1971 20 Overweight girls, aged between 11 and 13, from various London Boroughs and recommended by their school medical officers, social workers and general practitioners, were invited to take part in a group experiment for losing weight. This particular age group was chosen because it was thought that the girls were at the beginning of their clothes and figure conscious stage. In charge of the party was a senior mistress who also did a lot of evening work with teenagers, a young teacher also much involved with play groups, a dietician and a school nurse from this Borough. The holiday was for 3 weeks in the countryside in Essex. After settling in the girls - many of whom had not been away from home before - were asked to hand in any sweets, crisps, etc., they might have brought with them. The idea was to give them a 1,200 calorie diet, and at the same time to see that they had plenty of exercise. The girls were weighed and measured on arrival and thereafter weighed twice a week and measured on their last weighing day. The diet was varied and kept within normal limits as far as cost and choice of food was concerned. Sweeteners were used entirely in cooking and in drinks; ½ pint milk, ½ oz. of butter and 2 rounds of cut bread or crispbread were allowed daily per person. The butter ration often proved to be too much and the bulk of the milk was drunk on going to bed, with which they were allowed one plain biscuit. Fresh fruit was frequently taken as dessert and the girls were allowed to drink as much water or low calorie squash as they liked. After ten days it was found that the number of calories could easily be reduced to 1,000 daily without effecting much change in the diet. There was meat or fish every day, eggs, salads, 2 small potatoes or the equivalent in rice, and, of course, no thickened gravy, sauce or flour were ever used. The girls had to do exercises every day, go for long walks or swim. The results were startling as the most weight lost was 16 lbs. and the least 10 lbs. The total weight loss of the 19 girls who stayed the course was over 17 stone, so the experiment is to be repeated. 97 NON-ROUTINE MEDICAL INSPECTIONS RE-INSPECTIONS 5,778 (6,359) Bathing centre inspections - scabies 1 ( 10) Bathing centre inspections - others 1 ( 2) Employment certificates 85 ( 167) Theatre children 41 ( 35) School Journeys 2,078 (1,381) Recuperative holidays - pre-departure 130 ( 63) Candidates for higher awards 4 ( -) Outward Bound Courses 3 ( -) Infectious disease investigation 3 ( -) T.B. Contacts 1 ( 4) Boarding School for the delicate - pre-departure 37 ( 25) Boarding School for the delicate - on return - ( 2) Handicapped pupils - statutory examinations 194 ( 250) Handicapped pupils - periodic special defect examination 82 ( 72) Research investigations and enquiries 17 ( 4) SUB-TOTAL 2,677 (2,015) SPECIALS - at request of:- Head Teacher - child's name entered in special book 96( 125) Head Teacher - others 203 ( 190) School nurse - following health survey 17 ( 6) School nurse - others 13 ( 22) Divisional Education Officer 19 ( 36) Divisional Care Organiser or Care Committee 12 ( 15) Parent 43 ( 25) School Medical Officer 226 ( 178) SUB-TOTAL 629 ( 597) OTHERS For free travel - ( 1) Accident on school premises - ( -) Miscellaneous (including inspections specifically for provision of free milk) 177 ( 8) SUB-TOTAL 177 ( 9) TOTAL OF ALL NON-ROUTINE MEDICAL INSPECTIONS 9,261 (8,980) 98 River Place Health Centre Dental Surgery River Place Health Centre - School Dental Service. 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. Recommendations:- , Day schools for the delicate 23(11) Day schools for physically handicapped children 8(10) Boarding open air schools 6 (2) 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 39 (35) of these examinations. Recommendations:- Day schools for educationally subnormal children 51 (88) Boarding schools for educationally subnormal children 3 (-) Continue at ordinary school possibly with extra help in reading, arithmetic, etc. 39 (64) Home tuition. 10 (5) Transfers to ordinary school from E.S.N school 32 Leavers' Examination at E.S.N, schools 47 SPECIAL SCHOOLS - SOCIAL WORK In addition to the casework arising from referrals to Special Investigation Clinics, each full-time school health social worker is responsible for the social work in a special school or Partially Hearing Unit. Working in close association with the Education Welfare Department, she is responsible for school attendance and all aspects of general welfare of the children and their families, also undertaking casework with pupils and their families as the need arises. During the past year this has involved on-going casework with some 35 families. SCHOOL NURSES' INSPECTIONS Pupils have a comprehensive inspection annually by the school nurse, and where necessary are referred for further investigation or treatment. 28,168 (24,675) of these comprehensive health surveys were held during the year. 1.47% (1.27%) were found verminous. 6,336 (10,052) selective health surveys were carried out when necessary and 2.7% (2.0%) were found verminous. All infants were given an audiometer test as soon as possible after entry to school. HEALTH EDUCATION School nurses carried out health education, usually on an informal basis, during their normal nursing duties in school. The activities of the Health Education Service in schools is described in the section of this report on Health Education (Pages 67 to 76.) 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 six 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. Classes were visited by a medical officer at the beginning and end of each term. 100 AUDIOLOGY Infants were given a routine sweep test as soon as possible after entry to school. 5,941 (6,222) children were tested in this way by school nurses. If the test showed any doubt as to the normality of a child's hearing, a pure tone test was also given by a specially trained school nurse. 99 (72) of the tests were carried out during the year and 99 (72) children were found to have defective hearing and referred for further investigation. 38 (35) audiology sessions were held, at which the total of attendances was 215 (171). At the end of the year 84 (69) children were in attendance at audiology clinics. 1 (4) was provided with a hearing aid during the year making a total of 111 (109) children still attending Islington schools who have been provided with them. Many of these children come from other Boroughs to attend Frank Barnes School for the Deaf. 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 337 (321) children were attending these clinics at six centres in the Borough. Total attendances were 1,694 (1,741) and 67 (76) 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 1971 295.5 (309.5) sessions were held at which 526 (563) new cases attended. Total attendances during the year were 4,752 (4,834). 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. 2,655 (2,043) dental treatment sessions were held at which 4,589 (4,211) new cases attended and total attendances were 13,798 (13,110). VISION TESTING A pilot scheme was carried out early in the year, using the Keystone apparatus. 3,603 school children of varying ages were tested during a period of nine weeks and, of this number, 202 were referred for more detailed investigation. The Keystone apparatus tests for squint and colour vision as well as near and distant vision, the results being more accurate than with other methods previously used in schools. Following the successful results of the pilot scheme, it was decided to adopt Keystone vision testing in all schools, to test childrens'eyes at ages 5, 7, 9, 11, 13 and 15 years. VISION FOLLOW-UP During the latter part of the year, school nurses took over from the Education Welfare Service the function of visiting the parents of school children who failed Vision Clinic appointments. The result is an increase in attendances, so that more children with vision defects are receiving treatment. 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 252 (224) attendances for this purpose during 1971. Children found to be suffering from scabies were also sent to the bathing centre for cleansing during 1971 and total attendances for this purpose were 218 (250). 101 WOLFSON CENTRE A senior medical officer of the Department continued to attend the Wolfson Centre on Thursday afternoons when Islington children were being assessed and when some specific language assessments were carried out. 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. HOME TUITION 10 (5) 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. SCHOOL MILK Prior to the discontinuation of free milk to junior schools, school nurses spent a considerable amount of time compiling lists for medical examinations of children who it was considered would still need extra milk on medical grounds. All children so recommended were, in fact, deemed to be eligible. REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER AND CHIEF DENTAL OFFICER In writing this report on the School Dental Service, run on behalf of the Inner London Education Authority in conjunction with the Borough, it is pleasing to be able to say once again that the high degree of co-operation with ancillary staff and the Education Service has continued. It is a statutory requirement that the school population should be dentally inspected and a great deal of effort is needed to this end. During 1971, we were able to examine over 90% of the school population which, bearing in mind the restrictions of school holidays and the variety of school activities, is a high proportion. On the treatment side a varying picture is presented. No two years are exactly alike because illness and absence of children takes its toll of those invited to attend for treatment and the needs of the patients vary considerably. The number of fillings in permanent teeth declined during the year but the number in temporary teeth rose. Extractions of permanent and temporary teeth under general anaesthetic declined, possibly due to the introduction of blood testing for evidence of sickle cell anaemia. This would have resulted in some patients not co-operating in the blood testing with a resultant decline in the number presenting themselves for extraction under general anaesthetic. The orthodontic service continued to produce work of a high standard, but the volume of work has been affected by the failure of many children to complete the course. Steps will be taken during 1972 to ensure that only those really serious about having orthodontic treatment are considered. Of course, the highlight of 1971 was the opening of the new Health Centre at River Place, and it is hoped that this will have a considerable impact on the dental service; the indications are that this will be so. Some photographs of one of the surgeries are to be seen on page 99. Dental health education, covered in detail in the section of the Director of Public Health's report dealing with health education generally, continued to be a feature of the service during the year. The Maternal and Child Health Dental Service has proceeded along similar lines to the previous year. A session which has been allocated to this at River Place is proving to be quite successful. 102 STAFF AND PREMISES STAFF AND PREMISES (31.12.71) Director of Public Health and Medical Officer of Health 1 Deputy Director of Public Health and Deputy Medical Officer of Health 1 Principal Medical Officer 1 Senior Medical Officers 2 Medical Officers 10 15 ADMINISTRATION Chief Administrative Officer 1 Assistant Chief Administrative Officer 1 Principal Administrative Officers 3 Health Education Officer 1 Assistant Health Education Officers 2 Health Education Assistant 1 Senior Administrative Officers 8 Administrative Officers 6 Administrative Assistant and Night Security Officer 1 Administrative Assistants 14 Secretary 1 Senior Clerical Assistants 10 Clerical Assistants 37 Attendant Telephonists 2 Typing Supervisor 1 Audio/Copy Typists 8 Clerk/Typist 1 Copy Typist 1 Receptionist/Record Clerks 4 Telephonist 1 Office Attendants 2 Attendant Handymen 2 Technical Assistant (Health Education) 1 109 INSPECTORATE AND TECHNICAL Chief Public Health Inspector 1 Deputy Chief Public Health Inspector 1 Assistant Chief Public Health Inspectors 2 Senior Public Health Inspectors 14 Public Health Inspectors 20 Fire Inspectors 6 Inspectors (General Purposes) 3 Technical Assistants 9 Student Public Health Inspectors 12 Rodent Officer 1 Rodent Investigator 1 Superintendent of Laundry & Disinfecting Services 1 71 105 NURSING AND MIDWIFERY Chief Nursing Officer 1 Principal Nursing Officer 1 Senior Nursing Officers 2 Nursing Officers 8 Health Visitors 39 Student Health Visitors 9 *Tuberculosis Visitors 2 Clinic Nurses (full-time equivalent 16.1) 17 School Nurses 20 Creche Assistant 2 *additionally one supernumary Tuberculosis Visitor held temporarily against vacancy in Health Visitors' establishment. 101 GERIATRIC SERVICES Home Visitors 9 Assistant Home Visitor 1 Ward Sisters at Hillside Home for the Retired 10 20 DOMICILIARY MIDWIFERY Principal Nursing Officer 1 Senior Nursing Officer 1 Domiciliary Midwives 8 Domiciliary Home Nurse Midwife 1 Physiotherapist (part-time) 1 12 HOME NURSING Senior Nursing Officer 1 Senior Home Nurse 6 Home Nurses 38 45 CHIROPODY Chief Chiropodist/Administrative Officer 1 Senior Chiropodists 7 Chiropodists (Sessional) (Full-time equivalent - 5.1) 12 20 106 TUBERCULOSIS Welfare Officer (Chest Clinic) 1 Senior Occupational Therapists 1 Warden (T.B. Hostel) 1 Assistant Warden (T.B. Hostel) 1 4 SOCIAL CASEWORK Deputy Senior Social Worker 1 Social Workers (School Health Services) (Full-time equivalent 4.6) 5 Welfare Officers (V.D.) 3 Clinical Psychologist 1 10 DENTAL Chief Dental Officer and Principal School Dental Officer 1 Dental Officers (Full-time and sessional) (Full-time equivalent 6.9) 8 Dental Officer (Orthodontics) (Full-time equivalent 0.4) 1 Dental Auxiliary 1 Dental Surgery Assistants 8 Dental Surgery Assistant/Clerical Assistant 1 20 (In addition lists are maintained of doctors, who are prepared to work on a sessional basis.) ENVIRONMENTAL HEALTH - FINSBURY HEALTH CENTRE 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 32 HEADQUARTERS AND PERSONAL HEALTH CENTRES Hours per week Cleaners 435 Cooks 40 Kitchen Helpers 40 Needlewoman 40 Stoker/Handyman 40 Handyman/Driver 40 107 PREMISES Administrative Offices Central Office 159/167 Upper Street, N. 1. Meat Inspector's Office 28 Cowcross Street, E.C.1. Rodent Control Service Finsbury Health Centre, Pine Street, E.C.1. Disinfection and Cleansing Station Finsbury Health Centre, Pine Street, E.C.1. Hostel for Tuberculous Men Cromwell Lodge 55 Cholmeley Park, N.6. School Treatment Centres Islington 37 Thornhill Road, N.1. Manor Gardens 6 Manor Gardens, N.7. Health Centres Finsbury Pine Street, E.C.1. Chiropody; Dental and Physiotherapy Clinics; Disinfection and Cleansing Station. River Place River Place, Essex Road, N.1. Maternal and Child Health; Chiropody; Family Planning; Cervical Cytology; School Health - Dental; Special Investigation; Vision and Speech Therapy; Minor Ailments; Midwifery; District Nursing; Staff Medicals; Health Education; I..L.E.A. Child Guidance Unit. Centres Archway Congregational Church Hall, Junction Road, N.19 Child Health Barnsbury Carnegie Street, N.1. Maternal and Child Health; Chiropody; School Health (Special Investigations); Family Planning; Cervical Cytology. 108 Blythe Mansions Highcroft Road, N.19. Maternal and Child Health; Chiropody; Elderly Persons' Clinic; Family Planning; Cervical Cytology. Drayton Park 32 Drayton Park, N.5. Maternal and Child Health; Chiropody; Elderly Persons' Clinic; Smoking Advisory Clinic; Family Planning; Cervical Cytology; School Health (Special Investigations) Drayton Park (Branch) Aubert Court, N.5. Child Health; Family Planning. Drayton Park (Branch) 76/80 Isledon Road, N.7. Child Health. Hilldrop Tenants' Clubroom, Hilldrop Estate, N.7. Maternal and Child Health; Family Planning; Elderly Persons' Clinic. Leage Street 24 Leage Street, E.C.1. Maternal and Child Health; Chiropody; School Health (Special Investigations) Pi ne Street 13 Pine Street, E .C. 1. Maternal 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. Voluntary Centres Claremont Central Mission White Lion Street, N.1. Child Health. North Islington 6 Manor Gardens, N.7. Maternal and Child Health. 109 INDEX Air Pollution 41 Asbestos Dust 42 Audiology 101 Births 21 Bacteriological Examinations 33 Basement Bakehouses 49 B.C.G.Vaccination 83 Bathing Centres 88 Care of Mothers and Young Children 79 Cervical Cytology 86 Children's Toys 46 Chiropody 83 Cholera 31 Clean Air 41 Computerisation of Child Health Records 90 Consumer Protection and Public Control 45 Co-operation with Social Services Department 92 Cremations 88 Dangerous Chemicals 41 Deaths 21 Dental Services 102 Diseases of Animals 58 Disinfection and Disinfestation 47 District Inspection 40 Domiciliary Midwifery 80 Dysentery 32 Elderly,Services for the 87 Electrical Goods 47 Emergency Telephone Service 91 Employment Agencies 47 Environmental Health Services 37 111 Factories and Outwork 48 Fertilisers and Feeding Stuffs 45 Family Planning 84 Fire Risks 80 Fireworks 45 Food and Diseases of Animals 50 Food Poisoning 30 General and Vital Statistics 19,64 Geriatric Preventive Clinics 73,88 Grants to Voluntary Organisations 85,92 Handicapped Register 89 Hairdressers and Barbers 46 Health Education Service 67 Health Visiting 79 Home Nursing 80 Housing 58 IceCream 51,53 Immigrants 33 Infectious Diseases 27 Inspection and Enforcement Duties 39 International Certificates of Vaccination and Inoculation 29,82 Laundry 88 Lead Poisoning 31 Legal Proceedings 52 Loan of Equipment 81 Lung Cancer Deaths 24 Massage or Special Treatment Establishments 47 Maternal and Child Health Centres 79 Meat Inspection 39,56 Medical Treatment of School Children 101 Midwifery, Domiciliary 80 Milk 52 Night Cafes 55 Noise 62 112 Nurses Agencies 45 Nursing Homes 45 Nursing Services 13 Observation and Handicapped Register 89 Offensive Trades 50 Offices and Shops 63 Oil Heaters 70 Outwork 49 Personal Health Services 77 Pharmacy and Poisons 45 Pigeons 48 Premises 108 Prevention of Break-up Families 92 Principal Officers 4 Prophylaxis 82 Public Control 45 Rag Flock 46 Rats and Mice 47 Recuperative Holidays 86 Registration and Licensing 51 Remedial Foot Classes 100 Rubella Vaccination 83 Sampling 53 Scabies and Vermin 33 Sewage and Sewage Disposal 39 School Health Service 93 Shops Acts 45 Slum Clearance 58 Smallpox - International Certificates 30,29,82 Smoke Control 41 Smoking Advisory Clinic 75 Special Investigation Clinics 101 Staff 105 Statistics 19 Stillbirths 21 113 Street Markets 55 Students' Visits 91 Task Force 88 Theatrical Employers 47 Tuberculosis 32 Typhoid and Paratyphoid Fever 31 Vaccination & Immunisation 82 Venereal Disease 34 Vermin 48 Vital Statistics 19 Water Supply 39 Wolfson Centre 192 Works in default 40 114 Printed by the London Borough of Islington