ANNUAL REPORT Director of Public Health and Medical Officer of Health London Borough of Islington ISL 101 CONTENTS SUBJECT PAGE Introduction 1 Health Committee 3 Principal Officers of the Department 4 Nursing Services 5 Vital Statistics 9 Infectious and other Diseases 17 Environmental Health 25 Health Education Services 53 Personal Health 63 School Health 79 Staff and Premises 89 Index 94 To the Mayor, Aldermen and Councillors of the London Borough of Islington INTRODUCTION In 1972, as in the immediately preceding years, the developing plans for the reorganisation of the National Health Service continued to occupy a dominant position in the minds of those engaged in every branch of that service, but perhaps more particularly so in the case of local authority health service staff who are facing changes of the most far-reaching kind. It was not until the autumn that one major source of uncertainty was removed by the publication - in October - of the Secretary of State's decision as to the regional and area structure for the new N.H.S. organisation in London. Although reservations were felt by some regarding the details of the decision and, in particular, the refusal of the Secretary of State to accept the case made by the London Boroughs Association for health areas corresponding on a one to one basis with the London Boroughs, nevertheless the decision ended uncertainty and allowed the commencement of preparation for the reorganisation in which London had been falling behind the rest of the country. In the case of Islington, the proposed combination with the neighbouring borough of Camden had been expected and was accepted by both borough councils as a logical combination in the circumstances. In December the constitution of the Joint Liaison Committee for the new Health Area was fixed,although the first meeting was not to be held until early January 1973. Concurrently with these developments the personal health services, for which the borough will continue to remain responsible until 31.3.74, continued to progress and amongst the developments worthy of particular mention the following stand out. (i) Family Planning Service The decision to remove all charges for family planning services in the borough which had been taken in the autumn of 1971 was implemented on April 1st, 1972, and was immediately successful in achieving its objective. Figures analysed after six months of the free service indicated that the rate at which the public use of the service had been growing had doubled and that a substantial proportion of the new cases had not previously been receiving any professional advice. The borough's wish to extend its family planning service by offering free vasectomy in appropriate cases was obstructed by the then state of the law but a Private Members Bill, which the borough's M.P.'s supported in the House of Commons, completed its passage through Parliament in the autumn and as a result the final legal obstacle to a totally free and comprehensive family planning service in Islington and other progressive local authorities was removed. It is regrettable to have to add that when,on April 1st, 1974, the National Health Service Reorganisation Act becomes operative and responsibility for providing family planning services will pass to the new Area Health Authorities, apart from the general exemption provisions in cases of hardship, etc., the standard prescription charges will be levied for family planning requisites as for other drugs and appliances prescribed under the health service. This clearly represents a set back for those local authorities currently providing a totally free service. The authorities concerned, now a substantial number within London and the provinces, will undoubtedly be examining methods whereby their residents can continue to enjoy the benefits of a free family planning service and it is greatly to be hoped that some means can be found of avoiding what can only be regarded as a retrograde step. (ii) Noise Control Growing concern regarding the effect of noise in the borough led the Health Committee in January 1972 to initiate a noise survey of the borough in the carrying out of which help was sought from the local secondary schools. Following a meeting with teachers attended by the Chairman of the Health Committee a number of the schools agreed to co-operate by including the survey as part of their science or environmental studies curricula. The survey involved firstly the sending out of leaflets to each dwelling in the borough, these were accompanied by an invitation to return forms indicating particular noise complaints, and secondly the 1 survey itself which involves the school children visiting selected premises with questionnaires and subsequently making noise level measurements using meters provided by the public health department. It is hoped by these means to produce a noise map of the borough which will be of considerable value for planning purposes. (iii) Toys Also in the field of environmental health a good deal of interest was aroused by the work carried out by the public health inspectorate in enforcing the Toys (Safety) Regulations 1967, which prohibit the use of celluloid in toys other than ping pong balls and impose limits on the heavy metal content of the paints used on toys. The Council's public health inspectors have been very active in enforcing the regulations,and during the first three years almost half the samples purchased (admittedly selected because they were thought likely to prove unsatisfactory) were certified by the Public Analyst as failing to comply with legal standards. The law was strengthened in 1971 following which further sampling indicated some improvement in the situation, but an unacceptably large proportion of samples continued to be found unsatisfactory. The vast bulk of unsatisfactory toys are imported, mainly from China, Japan and Eastern Europe, and in view of the continued hazard it would seem that what is required is a direct ban on the importation of toys which fail to comply with the regulations. It is a pleasure again to thank the Chairman and Members of the Health Committee 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. 2 HEALTH COMMITTEE (31.12.72 ) Mayor Councillor Mrs. P.A. BRADBURY Chairman Councillor D.B. HOODLESS, B.A., D.P.A. Vice-Chairman Councillor Mrs. P. BROWN Aldermen J.R. GOODMAN, J.P., F.I.O.B. C.R. St. HILL, Dip. P.H.A. Councillors Mrs. E.K. BROWNING Jack CANNON G.F. FLVNN Mrs. I. HAGLAND H.E.JORDAN Miss Mary C. McCANN Mrs. P.J. MILSOM Jack WALKER, J.P. Co-opted Members Mr. T. CLAY, Chief Nursing Officer, North London Group Hospital Management Committee. Mrs. J. DONNISON, B.A. Dr. M.L. KELLMER PRINGLE, B.A„Ph.D.,D.Sc. Mrs. V.R.M. ROSEN, B.A. 3 PRINCIPAL OFFICERS OF THE PUBLIC HEALTH DEPARTMENT Director of Public Health and Medical Officer of Health, and Principal School Medical Officer C. BURNS, M.B., Ch.B., D.C.H., D.P.H., M.F.C.M. Deputy Director of Public Health and Deputy Medical Officer of Health, and Deputy Principal School Medical Officer AUDREY K. ARNOLD, M.B., B.Ch., B.A.O., D.Obst., R.C.O.G., D.P.H., M.F.C.M. Principal Medical Officer Chief Dental Officer and BETTY GROVES Principal School Dental Officer M.B., B.S., D.P.H. R.E. HYMAN L.D.S., R.C.S., (Eng.) Public & Agricultural Analyst R.G. MINOR, F.P.S., F.R.I.C., M. Chem.A. Senior Medical Officers JOAN M.CLARKE, 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 (L.E. SNASHALL from 23.11.72) R.D. BILLINGS, A.C.I.S., Dip. Comp. R.C. LOCKWOOD, M.A.P.H.I., A.R.S.H. (S. WRIGHT from 18.12.72) 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. (W.T. STEVENSON, M.A.P.H.I., from 16.6.72) 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. (J.A. HARRIS, M.A.P.H.I. from 26.10.72) R.C. WHITTAKER, M.A.P.H.I. Principal Nursing Officer (Preventive) MISSM. 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 MRS. A. HOSKER 4 NURSING SERVICES 5 NURSING SERVICES. 1972 was a very busy year for the nursing section. A major casue of this was the continued development of schemes for improving co-operation with general practitioners, hospitals and the Social Services Department. The number of attachments of nurses directly to general practitioners practices was increased. The demands for the services of home nurses, both from general practitioners and hospitals, were so great that additional staff were required to ensure that a good service could continue to be given to the patients in their own homes. Links for working with hospitals were also strengthened. The chief nursing officer gave a talk to hospital nurse tutors on the work of nurses in the community and senior nursing officers took part in symposia on the same subject to ward and departmental sisters at St. Bartholomew's Hospital and at the North London Group of Hospitals. Ward sisters from the North London Group of Hospitals continued to spend occasional days with the home nurses and many of the Council's nursing staff attended a variety of hospital study days. Arrangements were also made for hospital midwives to spend a day with their domiciliary colleagues, and for the latter to do likewise in hospital. It is hoped that an increasing awareness of each other's work by hospital and community nursing staff will lead to a real continuity of care for the benefit of the patients concerned. This also is the underlying thought of the general practitioner obstetrician beds scheme with the City of London Hospital, which was planned in 1971 and came to fruition in 1972. Under this scheme the general practitioner obstetricians and domiciliary midwives co-operate in ante-natal care, delivery and postnatal care of mothers. Towards the end of 1972 plans were made for local authority midwives to participate in the ante-natal care and delivery of patients booked for hospital confinements at the Whittington Hospital and this is due to start early in 1973. The Social Services Department asked the nursing section to instruct home helps on the needs of the elderly, in first aid, posture and lifting, simple nursing procedures and emergency midwifery. Home nurses gave talks and demonstrations to assistants in the residential homes for the elderly on simple nursing, lifting and home safety. All nursing staff took part in the survey carried out by the Social Services Department for the purposes of the Chronically Sick and Disabled Persons Act, 1970. One of the senior nursing officers gave talks to staff from many of the Council's departments on the emergency treatment of casualties according to the direction of the Local Government Training Board. For the first time a nursing officer and geriatric visitor were asked to participate in a pre-retirement course run by one of the larger firms in the Borough. Staff attended refresher, management and family planning courses. In-service training included the use of visual aids, seminars in psychiatry for health visitors and school nurses, and visits to the psychiatric department at St. Bartholomew's Hospital by home nurses. It has been stated that "the objective in reorganising the National Health Service is to enable health care to be improved". This has always been the aim of the nursing services in the Borough and will continue to be our goal in the future. 7 VITAL STATISTICS 9 VITAL STATISTICS Area — 3,679 acres Population (Estimated Mid-Year) — 194,280 Marriages solemnised in the Borough 1,985 (provisional) BIRTHS Live Births — Legitimate Illegitimate Live Birth Rate Per 1,000 Population Birth rate after applying 'Area Comparability' Factor of 0.86 Illegitimate Live Births Per Cent of Total Live Births Still Births — Legitimate Illegitimate Still Birth Rate Per 1,000 Population Still birth rate per 1,000 live and still births Total Live and Still Births — Legitimate Illegitimate DEATHS All Causes Death Rate (Crude) Per 1,000 Population Death rate after applying 'Area Comparability' factor of 1.05 Total 2,583 507 3,090 Male 1,310 268 1,578 Female 1,273 239 1,512 Islington 15.9 13.7 16.4 England and Wales 14.8 8.6 Total 31 10 41 Male 15 6 21 Female 16 4 20 Islington 0.21 13.1 England and Wales 0.18 12.0 Total 2,614 517 3,131 Male 1,325 274 1,599 Female 1,289 243 1,532 Total 2,352 Male 1,232 Female 1,120 Islington 12.1 12.7 England and Wales 12.1 11 Infant Deaths Deaths of Infants under one year of age — Legitimate Illegitimate Infant Mortality Rate (per 1,000 live births) — All Infants Legitimate Illegitimate Neo-Natal Mortality Deaths of Infants under 4 weeks of age — Legitimate Illegitimate Neo-Natal Mortality Rate (per 1,000 live births) All Infants Legitimate Illegitimate Early Neo-Natal Mortality Deaths of Infants under 1 week of age — Legitimate Illegitimate Early Neo-Natal Mortality Rate (per 1,000 live births) All Infants Legitimate Illegitimate Perinatal Mortality Still births and deaths under 1 week combined Perinatal Mortality Rate (per 1,000 total live and still births) Maternal Deaths (including abortion) Rate (per 1,000 total live and still births) Total 39 11 50 Male 16 9 25 Female 23 2 25 Islington 16.2 15.1 21.7 England and Wales 17.2 16.9 21.0 Total 27 4 31 Male 9 3 12 Female 18 1 19 Islington 10.0 10.4 7.9 England and Wales 11.5 11.3 13.9 Total 24 4 28 Male 8 3 11 Female 16 1 17 Islington 9.1 9.3 7.9 England and Wales 9.8 9.6 12.4 Total 69 Male 32 Female 37 Islington 22.0 England and Wales 21.7 2 0.64 111 0.15 12 ANALYSIS OF INFANT DEATHS - 1972 (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 Benign and unspecified neoplasms 1 1 Other diseases of nervous system 1 1 1 1 Pneumonia 2 1 1 4 Other diseases of the respiratory system 1 1 1 3 Congenital anomalies 4 1 1 1 1 1 1 10 Birth injury, difficult labour, etc 7 2 1 2 1 2 15 Other causes of perinatal mortality 4 1 1 6 Symptoms and ill defined conditions 1 2 1 1 1 6 All other accidents 1 1 1 3 Totals 16 3 2 2 4 1 2 1 6 5 2 1 2 1 2 50 Estimated Child Population Under 1 year 1-4 Total under 5 5- 14 Total under 15 Islington 3,240 10,160 13,400 26,300 39,700 Greater London 104,990 399,710 504,700 1,060,900 1,565,600 Deaths of Infants Under One Year The infant mortality rate shows an increase since 1971 but is still below the national rate. The increase is due to the 1972 rates being based on 1971 census statistics as against 1961 census for previous years. Nearly one third of all infant deaths occurred within the first twenty four hours following birth. Respiratory disease remains the greatest risk to infants from one to twelve months; of a total of nineteen infant deaths in the age group one to twelve months, seven were due to pneumonia and other diseases of the respiratory system. Maternal mortality In a total of 3,131 live and still births there were two maternal deaths, one was due to abortion and the second to complications of preganancy. Respiratory Tuberculosis The death rate for lung tuberculosis of 0.03 per 1,000 population last year was the lowest ever recorded in the borough and the rate was unchanged in 1972. 13 Pneumonia and Bronchitis In 1972 there were 158 deaths ascribed to bronchitis and 219 to pneumonia, an increase on the previous year of 17 and 20 respectively. Malignant Growths of Lung and Bronchus During 1972 the number of deaths ascribed to lung cancer was 190 (155 male, 35 female) as against 220 (182 male, 38 female) in 1971. It is gratifying to note that this represents a decrease in the borough of nearly 15% in respect of male deaths from this disease, whereas the national figures show a slight increase in both males and females in 1972. Coronary Disease with Angina There were 487 deaths (297 male, 190 female) from this cause in 1972, This shows a slight decrease from the 1971 deaths of 502 (308 male, 194 female). ACCIDENT DEATHS - Comparative table. 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 Motor vehicle accidents 34 28 29 34 34 23 29 24 29 27 Other violent accidents 84 62 60 58 65 38 47 47 35 36 ACCIDENT DEATHS - Analysis by age groups Type under 4 weeks 4 weeks and under 1 year 1- 5- 75- 25- 35- 45- 55- 65- 75+ M F Total Motor Vehicle accidents - - - 1 7 2 3 3 3 4 4 22 5 27 Falls - - - 1 - - - - - 2 5 3 5 8 Drowning - 1 - - 1 - 1 - - - - 2 1 3 Accidental Poisoning (Solid, Liquid Gases and Vapours) _ 1 _ - 1 3 4 2 1 1 1 7 7 14 Fire • • - - - - 1 • - - 1 - 2 2 Inhalation of stomach contents, ingestion of food,etc. _ _ _ . 1 _ . 1 _ 1 Other (Railway Accidents, etc.) 1 1 1 . 1 2 2 _ 6 2 8 Total - 3 1 3 9 5 10 7 7 7 11 41 22 63 14 1972: CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION (REGISTRAR GENERAL'S RETURNS) CAUSE OF DEATH AGE GROUPS All Ages Under 4 weeks 4 weeks and under 1 year 1- 5- 15- 25- 35- 45- 55- 65- 75 & over M F Total M F M F M F M F M F M F M F M F M F M F M F Cholera _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Typhoid fever — — — — — — — — — — — _ — — — — — _ — _ _ _ — _ — Bacillary dysentery and amoebiasis _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Enteritis and other diarrhoeal diseases 1 _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ 1 _ Tuberculosis of respiratory system 5 1 6 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 3 _ 2 _ Late effects of respiratory tuberculosis _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Other tuberculosis 1 2 3 _ _ _ _ _ _ _ _ _ _ _ _ 1 1 _ _ _ _ _ 1 _ _ Plague — — — — — — — — — _ _ _ _ _ _ _ _ _ _ _ _ _ _ — — Diphtheria _ - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - Streptococcal sore throat and scarlet fever _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Meningococcal infection 1 - 1 _ _ _ _ _ _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ Acute poliomyelitis - - - - - - - - - - - _ - - - _ _ _ - _ _ - - - - Smallpox _ - — — — - - — — - - — - - - — — - — _ _ - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - - - Typhus and other rickettsioses — - — — — — — - — — — — — — _ _ — _ _ _ _ — _ — — Malaria _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Syphillis and its sequelae 3 1 4 - - - - - - - - - - - - - - - _ 1 - 2 - - 1 All other infective and parasitic diseases 2 1 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 - 1 _ _ _ Malignant neoplasm - buccal cavity and pharynx 4 1 5 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 1 _ 1 1 1 _ Malignant neoplasm - oesophagus 8 8 16 1 1 1 2 - 4 4 1 2 Malignant neoplasm - stomach 35 13 48 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 1 8 2 19 4 7 6 Malignant neoplasm - intestine 30 43 73 — — — — — _ 1 _ 1 _ _ _ 1 2 1 1 10 5 7 14 9 21 Malignant neoplasm - larynx 5 - 5 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 - 1 - 2 _ Malignant neoplasm - Lung, bronchus 155 35 190 _ _ _ _ _ _ _ _ _ _ _ _ 2 - 13 3 43 15 71 12 26 5 Malignant neoplasm - breast 1 59 60 — — — — — — — — — — — 2 — 4 — 6 — 15 1 17 — 15 Malignant neoplasm - uterus - 13 13 - — — - - - - - - - - - — 2 - - - 4 - 5 - 2 Malignant neoplasm - prostate 13 - 13 - - - - - - - - - - - - - - - - - - 7 - 6 - Leukaemia 4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 2 3 1 3 Other malignant neoplasms, including neoplasms of lymphatic and haematopoietic tissue 62 71 133 _ _ _ _ _ _ _ _ 1 2 1 2 2 2 6 8 16 16 23 22 13 19 Benign neoplasms and neoplasms of unspecified nature . . . 4 5 9 - 1 - - - - - 1 _ - - - _ _ _ 1 1 _ _ 2 3 - Diabetes mellitus 7 15 22 - - - - - - - - - - 1 - - - - 1 2 5 2 5 2 4 Avitaminoses and other nutritional deficiency — 1 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 Other endocrine, nutritional and metabolic diseases 5 5 10 _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ 1 3 1 2 2 Anaemias 2 9 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ _ _ Other diseases of blood and blood-forming organs 1 1 2 _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ 1 1 Mental disorders 3 5 8 - — - - — — — — — 1 — 1 2 — — — — — — 2 1 1 Meningitis _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ Multiple sclerosis 3 1 4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ Other diseases of nervous system and sense organs 5 13 18 _ _ _ 1 _ 1 _ _ _ _ _ _ _ _ 1 3 1 3 4 4 Active rheumatic fever _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Chronic rheumatic heart disease 3 21 24 — — — — — — _ _ _ _ _ 1 _ _ _ 2 2 5 1 2 — 11 Hypertensive disease 25 22 47 1 _ 7 1 5 1 7 5 5 15 Ischaemic heart disease 297 190 487 — — — — — — — _ _ _ 1 _ 3 2 31 9 83 17 103 53 76 109 Other forms of heart disease 53 69 122 - - 1 - - . - - - - - - - 1 - 4 - 3 4 16 4 28 61 Cerebrovascular disease 94 137 231 _ _ _ _ _ _ _ _ _ _ _ _1 1 5 1 15 14 29 18 44 103 Other diseases of the circulatory system 41 69 110 _ _ _ _ _ _ _ _ _ _ _ _ _ 1 1 - 10 7 10 11 20 50 Influenza 7 4 11 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3 1 4 2 Pneumonia 91 128 219 - - 3 1 1 _ _ __ _ _ _ 3 - 2 4 5 5 18 14 59 104 Bronchitis, emphysema 123 35 158 _ _ _ _ _ _ _ _ _ _ _ _ 1 1 4 2 22 49 6 47 25 Asthma 3 3 6 _ _ _ _ _ _ _ _ _ _ _ _ 1 - 1 1 - 1 1 1 - - Other diseases of the respiratory system 8 14 22 — _ 3 — — 1 — — — — — — — 1 — 1 1 1 3 _ _ _ Peptic ulcer 6 10 16 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 - 1 1 2 9 Appendicitis 1 — 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Intestinal obstruction and hernia 1 2 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 1 2 Cirrhosis of liver 4 — 4 — — — — — — — _ _ — — — 1 _ — — 3 — — — — — Other diseases of the digestive system 4 11 15 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ 3 - 1 2 7 Nephritis and nephrosis 8 7 15 - - - - - - - - - 1 - - - - 1 - - - 4 3 Hyprerplasia of prostate 4 — 4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 — _ — 2 — Other diseases of the genito-urinary system 5 18 23 _ _ _ _ _ _ _ _ _ 1 1 - - - 1 - 1 - - 2 2 15 Abortion — 1 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ Other complication of pregnancy, childbirth and puerperium _ 1 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Diseases of the skin and subcutaneous tissue 3 2 5 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 - 2 2 Diseases of the musculoskeletal system and connective tissue 3 10 13 _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ 1 2 3 1 5 Congenital anomalies 10 8 18 3 5 1 1 2 - - - - - 1 - - - - - 2 1 - _ 1 - Birth injury, difficult labour, and other anoxic and 6 9 15 6 9 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Other causes of perinatal mortality 2 4 6 2 4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Symptoms and ill-defined conditions 6 8 14 1 - 3 2 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 6 Motor vehicle accidents 22 5 27 _ _ _ _ _ _ _ 1 6 1 2 — 3 — 3 — 1 4 — 2 2 All other accidents 19 17 36 - - 2 1 • - 1. 1 1 1 1 2 1 4 3 3 1 2 2 2 1 2 5 Suicide and self-inflicted injuries 14 4 18 - - - - - - - - - - 1 - 7 2 1 2 5 - - - - - 9 2 11 _ _ - _ 1 - - _ 1 _ 3 _ 1 _ 1 1 2 _ — 1 _ _ All Causes 1,232 1,120 2,352 12 19 13 6 5 4 2 3 11 8 13 8 36 26 92 48 255 132 405 227 388 639 Totals 2,352 31 19 9 5 19 21 62 140 387 632 1,027 Percentages 100 1.32 0.81 0.38 0.21 0.81 0.89 2.64 5.95 16.45 26.87 43.67 15 INFECTIOUS AND OTHER DISEASES 17 INFECTIOUS AND OTHER DISEASES Notifications and deaths recorded during 1972 (Infectious diseases are those statutorily notifiable as at 31st December, 1972) 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 169 (318) - 4 169 - Dysentery 65 (28) 1 17 63 59 Scarlet Fever 66 (29) - 2 66 24 Whooping Cough 6 (45) - - 6 10 Infective Jaundice 64 (103) - 27 64 22 Ac. Meningitis 10 (13) 1 9 9 6 Ac. Encephalitis 2 (-) - 2 2 1 Ophthalmia Neonatorum 6 (1) - 3 6 - Paratyphoid Fever - (-) - - - - Typhoid Fever 3 (1) - 3 3 1 Food Poisoning 64 (85) - 8 63 19 Malaria 9 (2) - 9 9 - Tuberculosis Lungs (primary) 73 (82) 6 - 73 6 Tuberculosis Other Forms (primary) 26 (25) 3 - 26 2 (Figures in brackets are notifications for 1971) SMALLPOX Of the 42 references for suspected smallpox and supervision of possible smallpox contacts, 39 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. 19 Advice was sought from the medical staff of the department in respect of two patients suffering from a rash of a type where it was desirable to exclude smallpox as a possible cause. These cases were subsequently diagnosed as chicken pox. The last reference concerned an Islington resident who was a member of the staff of the outpatients department of a hospital in another borough where a female who had arrived from Hong Kong attended with spots and sores - thought to be possible smallpox. Subsequently, the diagnosis of smallpox was • excluded. CERTIFICATES OF VACCINATION AND INOCULATION Applications for authentication dealt with by the Medical Officer of Health numbered 4,269 as against 4,243 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 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 1953 270 1959 196 1965 115 1971 85 1954 137 1960 206 1966 101 1972 64 There were no outbreaks to be reported in accordance with Memo 188 Med. of the Ministry of Health. LEAD POISONING There were two references to the department on this subject during the year. The first concerned a six-years-old girl who was diagnosed as a case of lead poisoning at a hospital in 1970 but who had failed to attend the clinic since then. The senior public health inspector visited the premises and found that the internal painting had been carried out with a lead free paint, and it was presumed that the original paintwork before re-decoration may have been responsible. The other case referred to a four-years-old boy reported by a 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 were reported as being within the normal accepted standards. No evidence of lead was found in this family's flat during a subsequent visit by the inspector, and there were no toys or other articles in the flat which could be suspected of having a lead content. CHOLERA There were only 7 sporadic references to the department during 1972 for the supervision of possible cholera contacts who had arrived in this country from declared endemic or locally infected cholera areas as against 250 in 1971 when a number of cases were discovered in the Barcelona and Valencia areas of Spain. All were kept under observation for the 5-day surveillance period. 20 TYPHOID AND PARATYPHOID FEVER There were three cases of typhoid fever during the year but none of paratyphoid. The first two cases occurred in a family comprising father, mother and three sons aged 9, 8 and 5 years respectively, who had returned to this country on 8th April, 1972, after a three months' stay in India. It was reported that the 9-years-old boy felt unwell about 29th March with mild fever, cough, cold and headache, and was treated in Bombay for these complaints. The symptoms persisted and on 6th April he was noticed to be pyrexial with chills. After his return to this country he continued to remain feverish with cough and developed diarrhoea; on 14th April he vomited and was admitted to an isolation hospital. Subsequently, salmonella typhi was isolated from blood culture taken on 18th April. The patient improved until 23rd May when he had a relapse and blood culture again grew salmonella typhi. However, by 23rd June after several further tests had been made which proved negative, he was thought fit and discharged home. The patient's brothers, although having no symptoms, were also admitted to the same isolation hospital on the 14th April, as a precaution. In the ward, the 5-years-old boy ran an intermittent pyrexia, was found to be weak and lethargic and had several loose stools. Subsequently, salmonella typhi was isolated from a blood culture taken on 24th April and also from a repeat blood specimen on 27th April. Six faecal and urine specimens were all negative for salmonella typhi and other pathogens. This child was discharged from hospital on 30th May. All tests for the 8-years-old boy were negative and he was discharged home on 28th April. Enquiries and routine bacteriological investigations of the family and other domiciliary contacts were carried out and their medical practitioners informed, as were the medical officers of health of the areas concerned in respect of non-residential contacts. All bacteriological results from these contacts proved negative. Periodical checks made on two positive cases after discharge from hospital were negative until November 1972 when the family moved to another borough, and the medical officer of health of that area was acquainted with the history of the cases. The third case of typhoid fever concerned a 3½-years-old male who was admitted to a general hospital on 27th October, 1972 with a history of cough and fever, with onset date reported as 20th/21st October. From blood culture taken at the hospital salmonella typhi was isolated and the child transferred to an isolation hospital on 30th October. The patient had arrived in this country from India on 15th September with his mother and 5-yearsold brother, the father having been in this country for some seven months. The mother, who was pregnant and reported to have contracted typhoid in 1971, was also admitted to the isolation hospital on 1st November to be with the child as he was rather fretful. Subsequently, her stools also grew salmonella typhi which proved to be of untypable strain. She remained persistently positive. As the child progressed satisfactorily, he was thought to be fit and finally discharged on 1st December. However, the mother, who was delivered of a daughter on 15th December, was not discharged until 31st December, still in a carrier state. Due to this carrier state, the father who worked in a supermarket, was excluded from his employment and, in accordance with Section 41 of the Public Health Act, 1961, was compensated in full for loss of earnings for the period from 31st October, 1972, until he was found employment by this department which was not connected with food handling. In addition, as the family occupied rooms in multiple occupied premises and there was a risk of the other tenants contracting typhoid due to the mother's carrier state, the medical officer of health recommended priority rehousing on medical grounds and the family was rehoused on 4th December. 21 Specimens of blood, faeces and urine taken from all other contacts were negative and their medical practitioners informed. A family comprising six persons who were residential contacts moved to another borough on 31st October before specimens could be obtained, and the medical officer of health of the borough concerned was informed. There were five other references to the department concerning typhoid or query typhoid cases from other boroughs, etc., of contacts who resided or worked in Islington, all with satisfactory conclusions. SUSPECTED DIPHTHERIA Information was received regarding a 5-years-old school girl who was admitted to an isolation hospital on 1st June, 1972, with a three day history of cold, sore throat and listlessness. It was reported that the child had been immunised against diphtheria in 1971. On examination at the hospital a brownish exudate on both tonsils was observed which was difficult to scrape off and at this stage it was thought she could be an atypical diphtheria. Enquiries were made and particulars of contacts, including class contacts, obtained. However, as all further tests for diphtheria were negative and a final diagnosis of infectious mononucleosis was made, it became unnecessary to proceed any further. After two days the child's health improved, she remained apyrexial and was discharged on 9th June. DYSENTERY There were 123 cases notified and 'coming to knowledge' during the year. Of these, 104 proved positive whilst nineteen were clinical cases with negative stools. Roughly two-thirds of these were isolated cases, the remainder comprising outbreaks at two day nurseries and a homeless families unit. TUBERCULOSIS In 1972, 99 primary notifications were received, with age and sex distribution as follow: 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total Pulmonary M - — 1 — 1 1 5 13 5 6 9 6 6 53 F - — — — — 1 1 7 3 2 5 1 — 20 Non-Pulmonary M — — — — — 3 5 4 3 2 — — 17 F - — — — — 1 — 3 1 1 2 1 — 9 Totals — — 1 — 1 3 9 28 13 12 18 8 6 99 The notification rate of all forms of tuberculosis was 0.51 per 1,000 population as against 0.23 for the whole country. The total number of cases remaining on the register after adjustment for deaths and transfers was on the 31st December 1972; Males Females Total Pulmonary 868 633 1501 Non-Pulmonary 122 159 281 Totals 990 792 1782 There were 9 tuberculosis deaths (6 pulmonary, 3 other forms) during 1972. The death rate of all forms of tuberculosis in the borough, per 1,000 population was 0.05, the national rate being 0.03. 22 VISITING OF NEWLY ARRIVED IMMIGRANTS - YEAR ENDED 31st DECEMBER, 1972 COUNTRY where passport was issued as stated by Port Health Authority Number of advice' notes received during the year from ports and airports relating to arrival of immigrants Number of first successful visits paid during the yearø COMMONWEALTH COUNTRIES Caribbean 83 72 India 86 49 Pakistan 30 21 Other Asian 5 4 African 216 113 Other 33 18 TOTAL: 453 277 NON-COMMONWEALTH COUNTRIES European 73 50 Other 78 42 TOTAL: 151 92 GRAND TOTAL: 604 369 *Advice of arrival of immigrant. t First successful visit means the first time the local health authority officer established contact with the immigrant. øThese successful visits do not necessarily relate to advice notes received within the same period. It will be seen from the chart that 369 successful visits were paid to immigrant arrivals to the Borough by an officer of the Social Services Department during 1972 and I should like to record my thanks to the Director. SCABIES AND VERMIN Scabies Vermin Children under 5 years Number treated 53 70 Number of baths given 86 — Number of treatments — 73 I.L.E.A. Children Number treated 126 307 Number of baths given 235 — Number of treatments — 433 Adults Number treated 145 123 Number of baths given 254 — Number of treatments — 139 There was a slight increase in the numbers treated for scabies in 1972 - 324 compared with 301 in the previous year. The numbers treated for vermin infestations, however, increased by some 26%, i.e. 500 as opposed to 396 in 1971. BACTERIOLOGICAL EXAMINATIONS The number of specimens sent to the Public Health Laboratory, County Hall, S.E.1, for bacteriological examination was 2,852. This compared with a total of 2,145 specimens submitted last year. Annual fluctuations are due mainly to the extent of dysentery outbreaks in any particular year. 23 Examinations carried out Swabs (Diphtheria) 39 Sputum (Tuberculosis) 1 Faeces, Urine & Blood (Enteric Fever) 415 Faeces (Food Poisoning) 473 Faeces (Dysentery) 1,786 Swabs (Streptococci) 0 Other Specimens 138 Total 2,852 VENEREAL DISEASES There were 6,925 new cases giving Islington addresses treated at hospital clinics in London during the year, including 56 cases of syphilis and 1,085 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 1972 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 16 and 17 1 4.17 1 4.0 18 and 19 1 4.17 1 4.0 20 and 24 7 29.16 7 28.0 25 and over 15 62.50 1 100 16 64.0 TOTALS 24 100 1 100 25 100 GONORRHOEA Under 16 20 2.0 3 0.55 23 1.50 16 and 17 21 2.1 80 14.55 101 6.46 18 and 19 81 7.9 117 21.27 198 12.66 20 to 24 337 33.3 192 34.91 529 33.81 25 and over 555 54.7 158 28.72 713 45.57 TOTALS 1014 100 550 100 1564 100 24 ENVIRONMENTAL HEALTH Air Pollution 29 Consumer Protection 32 Disinfection and Disinfestation 35 Factories & Outwork 36 Food and Drugs 38 Housing 46 Noise 48 Offices and Shops 51 25 ENVIRONMENTAL HEALTH During 1972, despite increased work loads combined with staff shortages, the Environmental Health Section maintained, and in some instances increased, its work output. Assistance to the Forward Planning Team with property surveys, increased activity connected with tenement blocks and the transfer of responsibility for the supervision of certain drainage works from the Borough Engineer's department were among the increased duties. The Registration Scheme for Houses in Multiple Occupation was eventually confirmed and came into operation in December. Progress continued on the inspection of areas of multiple occupation throughout the year. Over half the property in the Council's part of the Slum Clearance Programme 1971/75 had been dealt with by the end of 1972. The year showed a significant increase in the number of prosecutions to remedy deficiencies in residential accommodation; from 70 cases in 1971 to 255 in 1972. The general shortage of building resources has caused delays and it is hoped that the proposed extension of the Council's labour force may enable default works to be carried out more expeditiously. GOLD MEDAL AWARD I am pleased to report that Mrs. Sheila Maxwell, B.Sc., public health inspector, won the Gold Medal of the Ronald Williams Awards made annually by the Association of Public Health Inspectors to the most outstanding student of the Year. WATER SUPPLY Water supplies within the area are provided by the Metropolitan Water Board. No artificial fluoride is added to supplies which were otherwise satisfactory both as regards quality and quantity during the year. SEWERAGE & SEWAGE DISPOSAL No major defects or difficulties were encountered during the year arising from the Borough's sewer system. INSPECTION OF SCHOOL PREMISES By arrangement with the Inner London Education Authority, the Council has agreed to carry out an annual inspection of school premises. This is complementary to any inspections carried out by the staff of the Medical Adviser to the Greater London Council and Inner London Education Authority. During 1971 it was decided to transfer the responsibility for this function from the medical staff to the public health inspectorate in the special services section and since then 96 schools have been inspected up to the end of 1972. There are 109 schools in the Borough, including voluntary aided schools, and two private schools. Inspections are carried out with particular regard to the application of the Food Hygiene Regulations to school kitchens or meals centres and to the adequacy of sanitary accommodation, including washing facilities, cloakroom accommodation, changing rooms, showers, etc. The Inner London Education Authority standards are based on the Standards for School Premises Regulations 1959. In addition, inspectors report on the accommodation and facilities available for the medical inspection of children with reference to the requirements for such rooms laid down by the Medical Adviser. Deficiencies which came to light as a result of the inspections were reported to the Inner London Education Authority for attention. 27 28 Inspection and Enforcement Action Inspections and Visits NOTICES SERVED Prosecutions Work in Default Properties and Premises Repaired or Improved Formal Informal (a) HOUSING AND DISTRICT Housing - Slum Clearance, repairs, improvements, redevelopment. Means of escape in case of fire. 24,121 1,301 1,693 145 6 1,181 Housing - Public Health action, drainage, refuse collection, pests, domestic noise and general nuisances. 21,233 1,792 1,448 110 295 2,089 (b) SPECIAL SERVICES Food & Drugs - Food premises, markets, stalls and delivery vehicles, sampling, meat and poultry inspection. 9,239 - 232 17 — - Offices, Shops & Railway Premises Act 1963. 2,171 - 117 - — - Air Pollution and Factories - smoke observations, surveys, complaints, pollution volume measurements. Factories Act 1961, industrial noise 2,340 - 73 — — — Public Control functions - Shops Acts, licensing, consumer protection, fertilizers and feeding stuffs, sampling. 9,797 - — 18 — — TOTALS 68,901 3,093 3,563 290 301 3,270 AIR POLLUTION 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) 10 Clean Air Act 1968 - Section 6 Applications for approval of chimney heights (alI approved) 10 CONTRAVENTIONS OF SMOKE CONTROL ORDERS A complaint of a nuisance from smoke being caused by the burning of unauthorised fuel (wood off-cuts) on a heating stove was received and investigated. In spite of several warnings to the firm concerned the nuisance continued. Towards the end of the year, therefore, the case was reported to the Council's Chief Solicitor for the institution of legal proceedings in accordance with Section 11 of the Clean Air Act 1956. In my last report I referred to nuisances arising from the burning of waste on the incinerator of a hospital in the Borough. During 1972, arrangements were made for the waste to be disposed of elsewhere whilst modifications were carried out to the incinerator. In spite of the alterations, when the apparatus was brought back into service complaints of smoke were again received and substantiated, as a result of which, it subsequently became necessary to report the matter to the Department of Health and Social Security in accordance with Section 22 of the Clean Air Act 1956. MEASUREMENT OF AIR POLLUTION The Department continued to monitor the levels of smoke and sulphur dioxide in the borough for the purposes of the National Survey being conducted by the Department of Trade and Industry through Warren Springs Laboratory. The three testing sites are situated at the Health Department, Upper Street, N.1.; Finsbury Health Centre, Pine Street, E.C.1.; and the Training Centre, Isledon Road, N.7. A fourth site is maintained by the Medical School of St. Bartholomew's Hospital in Charterhouse Square, E.C.1. The testing apparatus formerly maintained by the Greater London Council at 'Hillside', St. John's Way, N.19 has ceased to function following the closure of the premises. The accompanying graphs illustrate the average monthly figures obtained from the three sites in the Borough. Unfortunately, the disruption of the electrical power supplies affected the running of two of the automatically operated measuring instruments in February and to a lesser degree in March. The figures for February are those recorded only in respect of Upper Street, the station normally showing the highest levels of pollution. The results for March are also shown to be above average due to the Pine Street and Isledon Road stations being out of action for part of the period. It is encouraging to note that, in general, the levels of pollution from smoke and sulphur dioxide are lower than those recorded for 1971. 29 30 WORKING PARTY ON THE SUPPRESSION OF ODOURS The Department of the Environment set up a Working Party on the Suppression of Odours from Offensive and Selected Other Trades under the Chairmanship of Dr. F.H.H. Valentin, Deputy Director of Warren Spring laboratory. The Council was requested to supply details of establishments in the Borough that created, or could create, a smell nuisance, together with an indication of any measures taken to deal with such smells and the degree of success obtained. Details of 22 premises were submitted, as a result of which the Working Party expressed a wish to visit Islington. Arrangements were therefore made for representatives to inspect a cross section of the premises concerned. These included three of the offensive trades, viz. a tripe dresser, fat melter and fur skin dresser together with a ham boiler, a coffee manufacturer, a sausage casings factory and an industrial chemist and assayer. The members of the Working Party found the visits informative and useful. ALKALI, ETC. WORKS REGULATION ACT 1906 There are no registrable premises in Islington to which this Act applies, but co-operation was maintained during the year on a two-way basis with the Alkali Inspector who includes the borough in his area. CONSUMER PROTECTION AMD 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 Premises registered : Fireworks Act 1951 ( 109 The Keeping of Fireworks Order 1959 London County Council (General Powers) Acts 1920 and 1921 Premises licensed : Employment Agencies 76 Massage or Special Treatment Establishments 8 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 : 5 Public Health Act 1936 ( Nursing Homes registered : Nursing Homes Act 1936 1 Mental Health Act 1959 Pet Animals Act 1951 Premises-licensed : 15 Rag Flock & Other Filling Materials Act 1951 Premises on register as upholsterers : 13 Greater London Council (General Powers) Act 1967 { Premises registered : [ 223 Hairdressers and Barbers { Registrations during year : 6 SAMPLING FUNCTIONS Fertilizers & Feeding Stuffs Act 1926 Samples taken : 3 Consumer Protection Act 1961 Samples taken : Toys (Safety) Regulations 1967 61 Nightdresses (Safety) Regulations 1967 5 Oil Heaters Regulations 1962 - 1966 4 ENFORCEMENT The following is a list of the prosecutions undertaken during the year in respect of contraventions of the legislation referred to above:- 32 Shops Act 1950 - Sections 61 and 64 Retail trading in butcher's meat on Sunday £5 fine £3 costs " " £5 fine £3 costs " " £5 fine " " £5 fine £15 costs " " £5 fine " " £5 fine Shops Act 1950 - Sections 47 and 59 Clothing shop trading on Sunday £3 fine £5 costs Consumer Protection Acts 1961 and 1971 The Nightdresses (Safety) Regulations 1971 Selling an adult's nightdress not complying with Regulations - Conditional discharge for twelve months £20 costs. Selling an adult's nightdress not complying with Regulations - Adjourned sine die. Consumer Protection Acts 1961 and 1971 Toys (Safety) Regulations 1967 Selling a toy xylophone having a coating of paint containing lead in excess of that permitted. - Six months conditional discharge Consumer Protection Acts 1961 and 71 Heating Appliances (Fireguards) Regulations 1953 The Electrical Appliances (Colour Code) Regulations 1969 and 70 Electric fire not fitted with a guard £20 fine £10 costs Conductors in the main lead with wrong colour code £2 fine Consumer Protection Acts 1961 and 1971 The Oil Heaters Regulations 1962 and 1966 Selling an oil heater not complying with regulations: Flame regulator £10 fine ) Spilling of fuel £5 fine) £21.50 costs Warning Notice £5 fine) Selling an oil heater not complying with regulations: Draught resistance £10 fine Spilling of fuel £5 fine costs CHILDREN'S TOYS Last year it was reported that since The Toys (Safety) Regulations, 1967 became operative, 125 toys had been purchased by the end of 1971 of which 43 (34%) failed to comply with the regulations. Following the coming into force of the Consumer Protection Act 1971 on 30th April of that year, local authorities were empowered to institute legal proceedings against a wholesaler or importer whose premises were outside its area. Since that date 86 samples have been purchased by the general purposes inspectors. Of these, 49 toys were imported and 29 manufactured in the United Kingdom. In 8 cases the origin of the toy was not established. 11 toys, 8 of which were imported, were certified by the Public Analyst to be coated with paint containing lead in excess of that permitted viz. 5,000 p.p.m. The countries concerned were Japan, Hong Kong, Poland, Spain and West Germany. Types of illegal toys found in 33 Islington covered a very wide range and included toy pianos, xylophones, building bricks, trucks, trains, cars, roundabouts, animals and many others. Quantities of lead discovered in these toys varied from 5,100 to 110,000 p.p.m. In the latter case, legal proceedings were instituted, but owing to the failure or refusal of the retailer to provide sufficient evidence by way of invoices, it was not possible to proceed against the importers, thus illustrating a defect in the legislation. The percentage of all toys sampled in Islington failing to meet the legal standards has dropped from 44% to 13%. Of the imported toys, 16% of those sampled between 30th April 1971 and 31st December, 1972 were found to be unsatisfactory. It would be safe to assume, therefore, that the Consumer Protection Act 1971 has had some effect in reducing the volume of dangerous toys. Nevertheless, assuming Islington's figures to be representative, the number of unsatisfactory toys imported into the country must still be considerable and continue to present a serious hazard to children's health. The 1971 Act may have resulted in some importers going to great lengths to ensure that toys made abroad comply with British Standards but, in spite of guarantees given by foreign manufacturers, unsatisfactory toys are still being sold in this country. Thus the validity of "Warranties" given by foreign firms to importers as a means of defence under the Act must be seriously open to question. The Act does not prevent the importation, distribution or sale to the public of toys before it can be ascertained whether or not they have complied with the relevant regulations. A report was prepared and subsequently submitted to the Health Committee recommending that the Association of Municipal Corporations again be asked to make urgent and strong representations to the appropriate Government Department with the object of preventing the importation of toys which do not meet the requirements of the Toys (Safety) Regulations 1967. TOXIC BEADS (SEED NECKLACES) The Police from Upper Street and Caledonian Road Stations submitted necklaces suspected of having toxic properties which had been handed in by residents following press publicity. The necklaces were submitted to the Public Analyst for examination and report and one of the necklaces, 48" long, was composed entirely of threaded red seeds of Abrus Precatorius (the Jequirity Seed). These seeds are known to have toxic properties on ingestion or absorption. The Police reported back to the owners and later requested this department to have the necklaces destroyed. RAG FLOCK AND OTHER FILLING MATERIALS ACT 1951 There are no premises in the borough licensed for the manufacture of storage of rag flock. During the year a reappraisal was carried out and firms no longer trading were removed from the register, as a result of which there are now only 13 premises registered as upholsterers under the Act. Three formal samples of various filling materials were taken towards the end of the year, all of which were certified by the Public Analyst as complying with the standards laid down in the regulations. EMPLOYMENT AGENCIES A private Member's Bill has been presented to Parliament with the object of strengthening the law relating to the control of employment agencies and new legislation is expected during 1973. 34 DISINFECTION AND DISINFESTATION DISINFECTION Infectious Disease Rooms treated 53 Secondhand clothing, horsehair, bristles etc. for export Certificates issued 35 DISINFESTATION Rats and Mice (figures in brackets refer to the year 1971) . Prime Complaints. Premises Domestic Business Local Authority Totals Rats 495 (276) 171 (76) 173 (58) 839 (410) Mice 2491 (2856) 414 (484) 99 (112) 3004 (3452) Totals 2986 (3132) 585 (560) 272 (170) 3843 (3862) 35 smoke tests of defective drains were carried out, and there were two treatments of sewers. Vermin (other than rodents) Rooms treated 2291. Wasps nests treated 60. Pigeons 13 treatments were carried out on the Council's behalf by an authorised catcher during the year. 35 FACTORIES AND OUTWORK FACTORIES ACT 3961 Routine inspections were carried out during the year including some joint visits with H.M. Factory Inspectorate of the Department of Employment and Productivity to resolve problems of mutual concern. The number of non-power factories in the Borough continues to decline. PART 1 OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises Number on Register Inspections Number o f Occupiers prosecuted Written notices (1) (2) (3) (4) 15) (i) Factories in which Sections 1,2,3,4, and 6 are to be enforced by local authorities. 19 5 (ii) Factories not included in (i) in which Section 7 is enforced by the local authority. 2,090 768 73 (iii) Other premises in which Section 7 is enforced by the local authority (excluding out-workers' premises). 61 34 - Total 2,170 807 73 - 2. Cases in which DEFECTS were found. Particulars Number of cases in which defects were found Prosecutions instituted Found Remedied Referred To HM Inspector By HM Inspector Want of cleanliness (S.1) - - - 2 - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - - - 1 - Ineffective drainage of floors (S.6) 1 1 - - - Sanitary Conveniences (S.7) (a) Insufficient (b) Unsuitable or defective (c) Not separate for sexes 5 245 3 8 214 - 29 1 4 - Other offences against the Act (not including offences relating to Outwork). — — 1 4 — Total 254 223 1 41 - 36 BASEMENT BAKEHOUSES (FACTORIES ACT 1961 - SECTION 70) Routine inspections were made during the year of the nine basement bakehouses in the borough in accordance with the Food Hygiene (General) Regulations 1970 and only minor infringements were observed and rectified. Certificates of suitability, which are required every fifth year, were last issued by the Council in 1970. OFFENSIVE TRADES (PUBLIC HEALTH ACT 1936 - SECTION 107 & 108) 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 J.L. Henson Ltd., 26/40, Vale Royal, N.7. Fur Skin Dresser J.A. Fischer Ltd., 440A Hornsey Road, N.19. Gut Scraper Tracey & Co. Ltd., 5, Tileyard Road, N.7. Routine inspections were carried out during the year and these trades were carried on without nuisance. OUTWORK (FACTORIES ACT 1961 - SECTIONS 133 and 134) Visits were made to the homes of persons, in the borough, notified as outworkers. In no case was it found that work was being undertaken in unwholesome premises. Types of outwork and numbers of workers were as follows:- TYPE OF OUTWORK LIVING IN Employed by firms in borough BOROUGH Employed by firms out of borough LIVING IN OTHER BOROUGHS Employed by firms in borough Making, cleaning, washing, altering, ornamenting, finishing and repairing of wearing apparel 117 121 664 Making up, ornamenting, finishing and repairing of table linen, bed linen or other household linen 23 — 51 Making ornamenting, mending and finishing of lace and of lace curtains and nets — — 1 Making of curtains and furniture hangings - 1 - Cabinet and furniture making and upholstery work - - 1 Making or repairing of umbrellas, sunshades, parasols, or parts thereof — — 11 Making of artificial flowers 3 - 4 Making of tents 1 - - Making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip or similar material 41 5 33 Making of brushes - 1 - Carding, boxing or packeting of buttons, hooks and eyes, pins and hair pins 8 3 1 Making of stuffed toys 1 - - Christmas stockings, or similar articles or parts of articles 20 — 3 Unspecified — 4 6 TOTALS 214 135 775 37 FOOD AND DRUGS PREMISES The routine work of the public health inspectors in the Special Services Section continued to be largely concerned with the inspection of food premises, although other work did, on occasions, interfere with the routine work objectives. Once again, the total number of food premises shows a slight decrease on last year's figures. The upto-date list of all known food premises is as follows:- Bakehouses 34 Bakers 36 Butchers 128 Confectioners 217 Fried fish shops 61 Fish curers 10 Fishmongers 11 Greengrocers and fruiterers 106 Grocery and provision shops 338 Wholesale stores 55 Food factories 37 Public Houses 297 Off-licences 49 Catering establishments (cafes and restaurants) 379 Canteens 78 Schools, etc. 85 Local Authority establishments 25 TOT AL 1946 232 informal intimations under the Food Hygiene (General) Regulations 1970 were served during the year. No legal proceedings under these Regulations were heard during the year, but some cases were reported for legal proceedings on a date to be fixed. 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 85 inspections were made. Premises registered for the manufacturer and/or sale and storage of ice cream totalled 682. Preserved food premises Premises registered for the preparation or preservation of food 207 Premises registered as fish fryers/fish curers 71 Milk (Special Designation) Regulations 1963 (as amended) Number of licences in force 340 Milk and Dairies (General) Regulations 1959 Number of dairies registered in the borough 10 Number of distributors registered in the borough. 335 38 LEGAL PROCEEDINGS Food and Drugs Act 1955 In last year's Annual Report, mention was made of a formal sample of vodka which was found to contain added water. This case was heard in the early part of 1972, and the offences were found proved by the magistrates who imposed the following fines:- Vodka sold to the prejudice of the purchaser being not of the substance demanded - £25 fine. Vodka sold from a container bearing a label calculated to mislead as to substance - £25 fine, and costs were awarded to the Council of £45. Fourteen prosecutions were taken during the year following formal food complaints and details of these are given below. One complaint resulted in the article of food being seized by the public health inspector and taken before a magistrate for condemnation. At the end of year, this matter was still in the hands of the Chief Solicitor for legal proceedings to be taken. Colouring Matter in Food Regulations 1966 One case relating to a formal sample of coloured sweets taken at the end of 1971 was heard early in 1972. The case concerned jars of coloured sweets used to decorate cakes; the red sweets were found to contain a non-permitted colour, Rhodomine B, which is thought to be carcinogenic. The magistrates found the case proved and imposed a fine of £75 on the importer and awarded costs of £15.50 to the Council. Preservatives in Food Regulations 1962 Informal samples of minced meat were purchased from butchers' shops during the year and where they were found to contain preservatives the butchers were warned and resampling was done at a later date. Two formal samples taken after the warnings were found to contain non-permitted preservative. Legal proceedings were recommended and the cases were due for hearing early in 1973. COMPLAINTS During 1972, the number of complaints (138) about food containing foreign matter or being out of condition was 38% higher than in 1971. The large increase was no doubt due in part to a greater public concern that food should be free from foreign matter as well as to radio, television and press publicity about the importance of food hygiene. Each complaint made was thoroughly investigated. In some cases complainants did not wish to give evidence on the Council's behalf and in others investigation revealed shortcomings which were undoubted accidents, but in every case the manufacturer or producer was made aware of the complaint. Manufacturers and producers are most concerned when complaints are made to the local authority and their investigations often result in improved techniques to the ultimate advantage of the consumer. The recent alteration in the manner in which evidence may be put before the Court has meant that most complainants have not been required to attend Court. A signed written statement has been sufficient. From 1st January, 1973, under the Criminal Justice Act, 1972, the power of the Magistrates will be extended so that compensation of up to £400 may be awarded for any personal injury or loss, if a manufacturer, retailer or producer is convicted under the provisions of the Food and Drugs Act 1955. The following prosecutions were instituted under Section 2 of the Food and Drugs Act 1955:- Maggots in a chicken £10 fine £10 costs Rock cake containing a cigarette end £15 fine £10 costs 39 Fruit loaf containing a wad of paper £ 15 fine £ 1 costs Metal shaving in a meat pie £25 fine £5 costs Metallic iron in bar of chocolate £25 fine £5 costs Dirty milk bottle £20 fine £5 costs Mouldy fruit tart £30 fine £5 costs Loaf containing mouse's head £60 fine £10 costs Fermenting yoghurt £10 fine £ 10 costs Skinless sausage encased in a plastic sheath Absolute discharge £ 10 costs Fruit cake containing stones Case dismissed Fish in process of decomposition £10 fine £5 costs Mouldy sliced loaf of bread £7G fine £ 15 costs Mould growth in pork pie £10 fine £5 costs SAMPLING Bacteriological checks are made on the cleanliness of food to establish whether it is free from or infected with pathogens. On the other hand, chemical examination of food is made to establish that the contents are to the standard the purchaser is entitled to demand. In addition, a label is considered as a check on the advertisement and description of the product. Bacteriological Ice Cream 65 samples of ice cream were sent for bacteriological examination and of these 24 were returned as being unsatisfactory. In all cases where unsatisfactory samples were obtained, the public health inspectors checked the cleaning procedures of manufacturing premises in the borough and in all cases the food hygiene standards of personnel handling ice cream. In addition, the Council where appropriate notified the local authorities in which manufacture took place. Ice creams were then re-sampled until satisfactory results were obtained. Other Foods 21 samples of various other foods were taken, including egg pasta, egg powder, meat pies, ham, sausages and salami. In no case did the laboratory return results showing organisms that might cause food poisoning. Milk Supplies - Brucella Abortus No samples of raw milk were examined. 40 Chemical In order that an overall check could be kept on foods sold within the Borough, food was purchased as the housewife would buy it and submitted to the Public Analyst. Figures for 1972 are as follows:- Informal Purchases - 720 Adverse - 38 Formal Samples - 6 Adverse - 2 Of the adverse reports, 25 related to labelling deficiencies. As there is an ever-increasing demand that the purchaser should know exactly what he is buying, the following-up of labelling deficiencies is an important although time-consuming part of the work. In some cases, the deficiencies are of a relatively minor nature, but in most cases the company concerned makes provision to amend the label. This cooperation avoids the necessity of legal proceedings. It is anticipated that the new Labelling of Food Regulations 1970, which come into operation on 1st January, 1973, will occupy considerably more time as the labelling laws become more comprehensive. Throughout the year, the public health inspectors have continued to monitor the residual insecticide levels in foods. Twelve samples were taken during the year specifically for this purpose and inspectors endeavoured to sample those foods which were in season at the time of sampling. The samples taken were tomatoes (2), leeks, bananas, ortaniques, spring greens, dutch butter, apples, peaches, pears, brazil nuts and chestnuts. In some cases, no pesticide residue at all was discernible, in others it was barely detectable, but in no case was the level approaching the reporting limit for the National Survey for Pesticide Residues. STREET MARKETS Routine inspections of the three main street markets in the borough continued throughout the year, and although no particular progress can be reported, the standard appeared to be constant. The general look of the market areas, however, continues to be poor as a result of the considerable accumulation of refuse. These routine inspections continued on Saturdays and Sundays throughout the year. The 'hot dog' stalls which trade in the vicinity of the Arsenal Stadium were inspected and, on one occasion, with the co-operation of the police, offending street traders were arrested and appeared before a stipendiary magistrate. As far as food hygiene requirements were concerned, the standard of the stalls was better than when similar action took place last year. Of the 18 stalls inspected, only four were found to contravene the regulations to any marked degree and, of these, one was found to be operated by a juvenile. In this case, it was not possible to proceed with the offences immediately, but the Police Juvenile Branch took the matter over. The food trader concerned was eventually cautioned in the presence of his parents at the police station near his home. The three other traders were charged with a total of eight offences and fines totalling £24 were imposed on six of these charges. One of the remaining two was dismissed and in the other case the food handler was conditionally discharged for one year. In addition to inspections of the stalls outside the ground, those inside the Arsenal Stadium were also inspected as were the bars, snack bars and restaurants. PUBLIC RELATIONS Public health inspectors in the special services section are always available to give talks to interested organisations and groups on their work. During 1972 talks were given to groups of butchery managers and trainees, students of dietetics and home economics, food handlers and housewives. In some cases the lectures have been of a very specialised nature but considerable interest has been shown in the routine duties of a public health inspector engaged in food inspection. 41 MEALS ON WHEELS SERVICE The closing of 'Hillside' necessitated the Director of Social Services making alternative arrangements for the "Meals on Wheels" that were prepared there. The senior public health inspector (food) acted in close consultation with the Director and the Catering Manager to establish a system which provides for the meals to be produced, transported and delivered at a sufficiently high temperature. The liaison between departments on this issue has been good and the advice given by the public health inspectorate has been acted upon. UNFIT FOOD During the year the following unfit food was surrendered voluntarily:- Tons Cwts Qtrs Lbs Canned Goods 10 6 2 11 Meat Products 4 4 2 12 Meat 1 13 2 22 Confectionary - 2 1 4 Frozen Food 1 3 1 6 Cooked Meats - 2 1 18 Biscuits - 2 1 27 Cereals - 2 - 9 Fish - 1 - - Others - - 1 5 Total 17 18 3 2 Ice Cream Beer 2% Gals. 70 Pts. 621 voluntary surrender certificates were issued and 157 inspections or visits were necessary in connection with this work. Surrendered food was removed, in general, by the Council and disposed of, under supervision, at a refuse tip operated by the Greater London Council. PHARMACY AND POISONS ACT 1933 With the exception of dispensing chemists, shopkeepers who sell certain poisons can only do so if they are on the local authority's list of authorised sellers. This is designed to ensure that poisons are labelled, stored and handled correctly and that they are kept away from foodstuffs. Most products which contain poisons that are listed within Part II of the Poisons Lists are correctly labelled and properly stored. However, there are a number of products on sale which are not labelled and which may be Part II poisons. During 1972, six such products were sampled but these were all found to be correctly labelled or found to contain no poisons given in the list. There were 88 listed sellers of Part II poisons other than pharmacists, including 2 added during the year. 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 the night. 42 Applications made but not finalised at the end of 1971 5 Applications received 1972 57 TOTAL 62 Applications granted or renewed 1972 46 Applications refused 1972 2 Applications withdrawn 1972 7 Applications pending, carried forward to 1973 7 TOTAL 62 Premises registered at 31st December 1972 46 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 (from £1-05 to £6) as many as 36 premises were licensed at the end of the year. MEAT INSPECTION In the area of Islington adjoining Smithfield Meat Market there are the following wholesale butchers shops and associated trades: Wholesale butchers, including offal and poultry dealers 26 Wholesale bacon factories 7 Sausage casing factories 9 Wholesale provision warehouses 6 Public cold air stores 3 The senior meat inspector is engaged full time in ensuring that no diseased or unsound meat or other foodstuff is passed on to the public. During the year, 1389 certificates were issued for unsound meat and other foods and 339 health certificates were issued for the export of meat, etc. to overseas countries. The Imported Food Regulations allow the port health inspector at the port of entry to release any imported meat or other foodstuffs to go direct to an inland authority without any inspection at the port of entry taking place. The inland authority then becomes responsible for the inspection of this meat, etc. and takes over the duties of the port health inspector. The extent of the increase inthecontainerisation method of transport as it effects Islington is reflected in the considerable number of notifications received from ports of consignments directed to wholesale premises in the borough. 339 such notifications were received in 1972 relating to meat and allied products alone compared with 272 in 1971 and 156 in 1970. Additional notifications were also received in respect of other types of food. It is anticipated that with the entry of the United Kingdom into the Common Market there will be a further increase in the number of notifications during 1973. The collection of unsound meat and other foods continues to be carried out by a Council contractor who renders down this unsound food for technical purposes. 43 During 1972, the senior meat inspector condemned or had surrendered to him the undermentioned foodstuffs. Tons Cwt Qtrs Lbs Meat (diseased) 1 19 1 14 Meat (unsound) 29 7 1 26 Bacon 16 17 0 20 Offals (diseased and unsound) 3 6 3 27 Poultry 13 1 2 Game 4 1 18 Rabbit 6 Canned Foods 3 17 2 5 Cheese 4 18 1 7 Miscellaneous 1 5 1 0 Total 02 9 3 13 DISEASES OF ANIMALS ACT, 1950 AND ASSOCIATED LEGISLATION The Council continued the arrangements made with the Corporation of the City of London for that authority to undertake, through its Veterinary Staff, any action necessary under the Diseases of Animals Act. In accordance with the Animals (Miscellaneous Provisions) Order 1927, the following Orders made by the Ministry of Agriculture, Fisheries and Food were advertised in the national press:- Newcastle Disease (England & Wales) Order 1971 Brucellosis (Eradication Areas) Orders Brucellosis (Area Eradication) Orders Diseases of Animals (Approved Disinfestants) (Amendment) Order 1972 Tuberculosis (Compensation) Amendment Order 1972 Diseases of Animals (Miscellaneous Fees) Order 1972 Live Poultry (Restrictions) Amendment Order 1972 Foot & Mouth Diseases (Infected Areas) (Vaccination) Order 1972 Quarterly inspections were made of the two kosher poulterers shops in the borough at which evisceration of poultry is carried out. The 15 premises licensed under the Pet Animals Act, 1951 were all subject to routine inspections during the year in connection with the health of animals kept for sale on the premises. A total of 84 such visits was carried out. Following a press report of warnings relating to the possibility of budgerigars suffering from psittacosis transmitting the disease to humans, two separate incidents were drawn to the attention of the Islington Health Department. The first concerned the death of a parrot purchased from a pet shop in the borough. This parrot was replaced by another which also died. The complainant also bought a budgerigar from the same source which died and the purchaser took two of the carcases to the local R.S.P.C.A. clinic who contacted this department. The dead birds did not exhibit any abnormal symptoms but as a precaution, the carcases were taken to the Public Health Laboratory, Colindale, tor examination. In the meantime, a joint visit was immediately paid to the pet shop by the veterinary officer and the Council's general purposes inspector and daily observations carried out until it was learned that the pathological examination had revealed no evidence of psittacosis. 44 The second incident concerned a macaw kept by a publican which evidenced symptoms similar to psittacosis. A private veterinary surgeon was called in to treat the bird. Members of the publican's family became unwell with symptoms of influenza, throat infection and diarrhoea. The veterinary officer was asked to examine the macaw but, again, psittacosis was not diagnosed. 'PERFORMING ANIMALS (REGULATION) ACT 1925 In June, Cottle and Austen's Circus appeared at Miranda Road Site, N.19. Several visits of inspection were made and performances witnessed. All animals and living quarters were checked and found to be in good condition. There was ample supply of food and water. Litter was disposed of on a portable tip supplied by the Council. All performing animals certificates were in order. 45 HOUSING REGISTRATION OF HOUSES IN MULTIPLE OCCUPATION The scheme approved by the Council in 1970 was eventually approved by the Department of the Environment and came into force in December 1972. Meanwhile during the year detailed inspections continued to be carried out on a house to house basis in selected areas of the borough. The original seven areas have now been further extended and three additional areas commenced, a total of 1613 houses being involved. In these areas the owners' co-operation is sought in securing improvements with the aid of grants. If no progress is made as a result of the informal approach, the various Public Health and Housing Act powers are invoked. SLUM CLEARANCE PROGRAMME 1971 -1975 This is reviewed each year and at the close of 1972 there were 871 houses in the programme. 212 houses are to be dealt with by the Greater London Council, leaving 659 houses to be dealt with by this Council. At the end of the year 344 houses had been represented under Part III of the Housing Act 1957, 49 dealt with by compulsory purchase orders made under Part V of the Housing Act 1957, and 266 had still to be programmed. In 1972, the following 20 areas totalling 145 houses occupied by 265 families comprising 696 persons were represented as clearance areas, and compulsory purchase orders were made in all cases. Address Areas Houses Families Sussex Way 2 7 18 Fairbridge Road 2 15 54 Monsell Road 1 3 4 Rhodes Street/Mackenzie Road 3 20 31 Liverpool Road 1 5 17 Liverpool Road (St. Mary's) 3 13 12 Blundell Street 2 39 68 Shepperton Road 1 11 8 Barnsbury Road 4 21 40 Baring Street 1 11 15 The increase in market value of residential accommodation in the borough has meant that the comparative benefits of rehabilitation or demolition have to be carefully weighed. During the year one area was improved and repaired to such an extent that the majority of the houses were made fit even though the area had been represented and a compulsory purchase order submitted to the Department of the Environment. In consequence the Council rescinded their resolution made under Part III of the Housing Act 1957. INDIVIDUAL UNFIT DWELLINGS In 1972, 7 whole houses were represented as unfit for habitation and not repairable at reasonable cost, and 56 basements or other parts of houses were similarly dealt with. Closing orders were determined after houses or parts of houses had been made fit in 21 cases. 6 notices were served under the provisions of Section 9 of the Housing Act, 1957 requiring the repair of unfit houses, and 36 notices were served under the provisions of Section 9 (1A) of the Housing Act, 1957 for houses which, although not unfit, required substantial repairs. 46 TENEMENT DWELLINGS Responsibility for dealing with sub-standard tenement blocks is shared with the Greater London Council. Unfit tenements are represented or acquired for eventual demolition. Improvable tenements are considered by a working party of officers who seek the views and co-operation of the owners and in appropriate cases the service of improvement notices is recommended. TENEMENTS DEALT WITH BY THE BOROUGH There were originally 24 tenement blocks classified as unfit for habitation. At the end of 1972 all had been demolished, represented or acquired for eventual demolition. PURCHASE In appropriate cases the Council considers the purchase of tenement blocks. In 1972, negotiations were completed for the purchase of the following: Colne House, Offord Road W.S. Horner Estate, Canonbury Avenue Liverpool Buildings, Liverpool Road IMPROVEMENT During 1972 improvements were carried out to 8 tenement blocks and there were 12 tenement blocks for which the owners had applied for grants or submitted plans. The service of improvement notices was authorised for 7 tenement blocks. MEANS OF ESCAPE FROM FIRE Systematic inspection of houses in multiple occupation was continued by the fire inspectors working under the provisions of the Housing Act 1961 (Section 16) to obtain satisfactory means of escape from fire. 52 cases of fires in multiple-occupied properties were reported by the London Fire Brigade and 4 fatalities occurred. Each case reported is investigated and notices served, where appropriate. Premises occupied by persons applying to be registered as child minders and playgroups were inspected and, subject to the provision of adequate safeguards, the inspectors were able to recommend registration. 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 from fire. This is the second year in which the department has been responsible for approval of applications under Section 35 of the London Building Acts (Amendment) Act 1939. This section deals mainly with the provision of proper means of escape in larger properties converted into smaller units such as flats or maisonettes. Nearly 300 applications were dealt with, a 50% increase over the previous year. 47 NOISE Noise is a community problem from two environmental aspects. There is the town planning problem of designing roads, houses and leisure facilities to secure minimum damage to amenities and there is the public health problem of securing minimum noise levels because of their effects on general nuisance and prejudice to health. One aspect cannot be entirely divorced from the other as bad original planning can create many subsequent problems of enforcement to abate nuisance. In a borough like Islington, where open space and indeed living space is at a premium, the optimum standards of planning which are locally possible may not always be adequate to ensure the elimination of complaints of noise and it remains to consider what other noise reduction measures are possible. SURVEY Following the publication by the Noise Advisory Council of the document, 'Neighbourhood Noise' the Council's Health Committee in January 1972 decided to carry out a noise survey of the borough to establish particularly the ways people are troubled by noise arising from traffic and general neighbourhood noise, i.e. industrial processes, building sites, noisy machinery and noise from domestic living. It was decided to make the survey as comprehensive as possible and to invite the assistance of senior pupils from local schools and voluntary organisations in the borough to act on the Council's behalf in gathering information. Following the Health Committee meeting, teachers and pupils and the voluntary organisations were invited to the Town Hall for a discussion on the subject, and the aims of the proposed survey were explained by the chairman of the Health Committee, the chief public health inspector and myself. The press also attended this meeting. Subsequently staff and pupils from 11 secondary schools and 1 special school and 3 amenity groups agreed to participate in the survey which is being organised on a ward basis. The survey has been divided into two parts. The first consists of a 'social survey' whereby visits are made to 10% of all premises within the area covered by the school or group and questionnaires designed to highlight points of complaint are completed. This was proceeding at the end of the year. The second part will be the measurement of noise levels using sound level meters at the points of complaint. The noise levels obtained from meter readings will be transposed on to various noise maps for the whole of the borough, and contour lines of noise levels will be drawn indicating the levels of noise which apply in both the specific complaint areas and other areas deemed to be at 'noise risk' within the borough. When a comprehensive picture of the noise levels has been built up, a transparency of the noise contours will be superimposed over the future town planning zoning map, the projected housing needs future development map and the future road traffic pattern map, all of which are used for the advanced planning of road and housing development in the borough. As an additional means of assessing the overall noise problem, leaflets were circulated to the 46,500 households in the borough inviting comments as to how, in their opinion, residents were unreasonably affected by noise. Some 1,025 replies were received (2.2%) and processed. The noise sources mainly complained of related to road traffic, including overnight parking of vehicles; noise from children and teenagers, particularly around blocks of flats; domestic noise; rail transport; industrial and other workplaces; ice cream vendor chimes; sirens and alarm bells and general neighbourhood noise. It was considered that 323 of these complaints warranted investigation and this was in hand at the end of the year. It is hoped that the investigations will show where a statute falls short of providing a remedy for certain types of complaint. 48 Pupils from Dame Alice Owen School and Holloway Schools taking a sound level meter reading on a building site in Finsbury. Pupils from Mount Carmel School measuring traffic noise with a sound level meter in Holloway Road. Pupils from Dame Alice Owens School interviewing an Islington resident for completion of a noise survey questionnaire. A teacher at Barnsbury School explaining how to use a sound level meter to pupils from Barnsbury and Holloway Schools. In a borough such as Islington, it will not be easy to arrive at quick decisions as to positive forms of action that can be taken to secure reductions in the present levels of noise or to ensure minimisation of future complaints following new developments or traffic routing. Nevertheless, an endeavour must be made to control noise and reduce it wherever possible so that the people who have to live and work in the borough do not have to face conditions which are gradually becoming more and more intolerable. It is hoped that the survey will increase the greater public awareness of noise generally and the need for everyone's participation in creating a quieter environment. The reduction of noise is something in which everyone, in whatever situation he may be, has a part to play. NOISE ABATEMENT ACT, 1960 In addition to the complaints specifically received as a result of the noise survey, the following table gives details of other recorded complaints and action taken during the year under the Noise Abatement Act. Industrial Premises Commercial Premises Construction /Demolition Domestic Ice Cream Vans Others Total Cases complained of 13 11 5 15 6 1 51 Nuisances confirmed 9 6 5 7 6 1 34 Remedied informally 7 5 3 7 6 1 29 Abatement Notices served 2 1 2 - - - 5 Four other complaints were received relating to statutory undertakers whose activities are exempted under the Act; nevertheless informal action was taken in each case. Eleven additional complaints were made in respect of noisy animals or wireless sets etc., and the complainants were advised to take the prescribed action in accordance with the relevant byelaws. 50 OFFICES AND SHOPS The Offices, Shops and Railway Premises Act 1963 and associated Iregulations protect the safety, health and welfare of employees in certain classified premises. There are 59,519 persons employed in the borough in premises registered under the Act. This compares with 58,835 persons employed in registered premises in 1971. The increase is due mainly to an increase in office employees. In 1971, the number of persons working in registered offices was 45,982 whilst the figure for 1972 is 46,719 - an increase of 1.5%. The number of retail shops registered continues to decrease. ACCIDENTS AT WORK The Act requires that where any person employed in premises to which the Act applies suffers an accident which proves either fatal or keeps that person away from work for three or more days, the details of the accident must be reported to the Council. This is where the Council has a duty to enforce the provisions of the Act. As in 1971, the majority of accidents notified (26.7%) were for back and shoulder injuries caused through lifting. A booklet setting out the correct way of lifting and carrying published by the Department of Employment is being issued by inspectors of my departmentto appropriate employers. One fatal accident was notified during the year. This was caused by a person falling about 45 feet from a rooftop parapet wall to the ground below. An inquest returned a verdict of accidental death and an investigation into the accident revealed no defect at the property in respect of safety precautions for employees. GENERAL STANDARDS In view of the frequency of inspection carried out by the Council officers there are no known premises to which the Act applies where conditions are particularly bad. The types of premises most likely to fall within thiscategory are those in which the owner was formerly self-employed and has subsequently engaged staff. In such cases the owner may not be aware of the legal requirements. It did not become necessary during the year to take any action regarding dangerous conditions and practices, as provided for under Section 22 of the Act. SPECIAL CASES Concerning the particular request of the Department of Employment for information regarding specific instances of exceptionally good or bad standards in the observance by employers of their responsibilities under the Act, there are very many large modern office blocks in the commercial areas of the borougi. where standards are outstandingly high. Similarly, shops owned by many multiple firms where standards are also high are to be found throughout the borough. It would therefore be invidious to quote specific examples of the maintenance of good standards. AUTHORISED OFFICER Appreciation is again expressed for the guidance and advice given through the year by the appointed authorised officer of the Department of Employment. 51 STATISTICS 1971 figures in brackets REPORTED ACCIDENTS Fatal Non-Fatal Investigated ACTION Informal Warning Formal Warning Prosecution (i) Offices 1 (-) 115(110) 76(67) 6(7) 13(6) -(-) (iij Retail Shops - (-) 36(34) 17(21) - (-) 3(2) -(-) (ii) Wholesale Shops & Warehouses - (-) 12(11) 6(10) - (-) 1(1) -(-) (iv) Catering Establishments & Canteens - (-) 13(3) 11(2) 1 (-) 2() -(-) (v) Fuel Storage Premises -(-) -(-) - (-) -(-) -(-) -(-) Totals 1 (-) 176(158) 110(100) 7 (7) 19(9) -(-) REGISTRATION AND GENERAL INSPECTIONS Class of Premises Number of premises newly registered during the year Total number of registered premises at end of year Number of registered premises receiving one or more general inspections during the year (1) (2) (3) (4) Offices 74 (97) 1590 (1567) 213 (332) Retail Shops 40 (57) 1191 (1214) 301 (583) Wholesale shops & Warehouses 15 (20) 260 (251) 82 (1.90) Catering Establishments open to the Public, Canteens 16 (26) 360 (355) 213 (325) Fuel Storage Depots - (-) (-) -(-) Totals 145 (200) 3401(3387) 809 (1430) Total number of visits of all kinds to premises Registered under the Act = 2191 (3147) ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED IN REGISTERED PREMISES Class of workplace (11) Number of persons employed (12) Offices 46719 (45982) Retail Shops 5575 (5556) Wholesale departments, warehouses 4548 (4658) Catering establishments open to the public 1721 (1713) Canteens 954 (924) Fuel Storage Depots 2 (2) Total 59519 (58835) Total Males , 37410 (36948) Total Females 22109 (21887) 52 HEALTH EDUCATION 53 HEALTH EDUCATION SERVICE "Nemo Mortalium Omnibus Horis Sapit" (No man is at ail times wise.) This very old proverb with a world of meaning could very well describe the reason for health education in all its forms. If man were wise enough to understand the implications of those of his actions which result in harm to himself, he would perhaps not need help through health education. Man, however, is frequently wise only after the event and it is in this context that health education can perhaps prevent the increases in lung cancer, venereal disease, abortion, obesity to name but a few of the modern hazards to health which he should be able to avoid if his capabilities are used wisely. The activities of the health education section are outlined below but it is important to remember that health education involves the staff of the entire department including medical officers, nursing staff and public health inspectors. ACCOMMODATION It was felt that centralisation of the various sections would help to improve the smooth running of the service and increase the facilities available. Adaptations to accommodation at 159/167 Upper Street have enabled the service to be accommodated in self-contained premises which now comprise:- Health Education Centre and Conference Room In-service training of professional field staff in the method and content of health education is carried out here and displays of new health education visual aids are presented on a regular basis. The centre, which provides for a permanent exhibition, cinema and lecture/conference room, has become the focus of health education activity in the department and many members of the professional field staff are making use of the new centralised facilities available to them for the purpose of seminars, meetings and previewing of new aids and materials relevant to their work. Visitors from other countries and local authorities and others wishing to learn more about health education practice can now, upon request, receive formal tuition in suitable surroundings. Drawing Office, Workshops and Storage A drawing office has been provided where art work is done for the many designs required in the creation of original exhibits. There are also two workshops where silk screen printing, plastic cutting, woodworking, display construction, painting and electrical work are carried out. A high standard of workmanship and technical expertise is maintained in this work. Offices Two offices have been allocated for general administration. STAFFING The staff of the health education service now comprises the health education officer, 2 assistant health education officers, 1 health education assistant, 1 technical assistant and 1 clerical assistant. Assistant Health Education Officer The department was fortunate to be able to appoint to this additional post a qualified health visitor who has the further education teacher's certificate. She immediately paid attention to those subjects for which health education is vitally necessary in girls' schools - sex education, menstruation, venereal disease 55 and human relationships and has been received enthusiastically by head teachers who welcome this very important extension to girls' education. All girls' schools in the borough have been visited and without exception have taken advantage of the facilities offered. Health Education Assistant A new health education assistant was appointed in July, 1972, when the previous post holder, who had commenced in-service training of home helps in primary first aid and oral resuscitation, resigned to take up an appointment with another authority. Many schools in the borough were given lectures on these vital subjects and took an active interest in their promotion. The present health education assistant is a highly-skilled design artist and silk screen printer and devotes his time to the artistic presentation of ideas and the silk screen printing of a large number of exhibits, etc. presented by the health education service. Much favourable comment has been made on many of these items, quantities of which have been purchased by other local authorities. GENERAL ACTIVITIES These include the promotion of the various health education themes promoted on a monthly or two-monthly basis, dependent on their topicality for a specific time of the year; displays are mounted at permanent sites throughout the borough. Five windows in the Health Department building have animated or static displays which are changed at approximately six-weekly intervals. Additionally, triptych and other three-dimensional displays are set up at the maternity and child health centres in the borough and exhibits are mounted in the foyers of the Town Hall and Finsbury Health Centre. It will be appreciated that much time and effort go into the devising of new material. A poster and leaflet campaign is promoted in conjunction with the themes presented. Commercial poster sites are situated throughout the borough and tube station sites have also been acquired to promote the free family planning scheme. Libraries, Baths, Housing Department offices, Registrars' offices and many other outlets, including personal postcard advertising frames in sweetshops, etc., are utilised to promote themes and are regularly serviced with posters and leaflets. Two health education service vans carry publicity banner boards, and the postal franking machine used by the department has a different health education message every month. USE OF THE MASS MEDIA The press is continually being used for advertising, feature articles and news items: the smoking advisory clinic was featured in a half-page article in the Evening Standard, and the free family planning service received much good publicity in many national newspapers in addition to being publicised on radio and television. A number of professional journals included feature articles on services provided by the department. The health education staff have also contributed to Radio London programmes, one subject being "Drugs and their Abuse". SPECIFIC ACTIVITIES Schools The work in schools continues and it is pleasing to note that with the recruitment of the new assistant health education officer, many new topics are being examined and more work in this vital area, as already described, is being undertaken. Teachers from many schools are being encouraged to take part in in-service training sessions which will familiarise them with the media resources, i.e. films, slides, film strips, leaflets, posters, freely available from the service. 56 57 A syllabus, assisted by a variety of audio visual aids for primary schools has been devised by the section. Topics include personal hygiene, dental care, home safety and smoking. Health visitors were given the opportunity of having the syllabus demonstrated to them with a view to further developing their health education activities by running courses at schools. The health education officer continues his teaching in schools; the headmaster of Holloway Boys' School invited him to spend a term at his school advising the pupils about the dangers of V.D. and two whole weeks were spent at the City Day College lecturing to the students on the misuse of drugs and alcohol. G.P.O. apprentices also received talks on V.D., Drugs, Smoking and Alcohol during liberal study periods at the Post Office headquarters. Talks were given to entrants at primary schools in the borough on dental hygiene and the care of teeth. At the end of the demonstration each child was given a toothbrush, a tube of toothpaste and a mug, together with a letter from the Chief Dental Officer advising the parents about the wisdom of preseiving the first teeth. Many Parent-Teacher Associations in the borough were addressed by the health education team in order to acquaint them with the activities of the service. Several parents expressed their appreciation of the work being done in schools and were gratified to learn that topics which they were unable to discuss with their children, either through lack of knowledge or inability to communicate, were being freely discussed at school. Youth Clubs The contacts with youth clubs and youth leaders are maintained and calls for talks to clubs and their members are increasing, and the regular involvement with courses presented at the Central Y.M.C.A. continues. Smoking Advisory Clinic This clinic is still working with a rewarding degree of success and again has been featured by the mass media on many occasions including B.B.C. Television "Health Hazards" series. Radio, etc. The American Broadcasting Service filmed the clinic in action for a special programme for screening throughout America. In-Service Training This is now a feature of the health education service. Professional field staff who attend the health education centre for training in activities connected with the promotion of health include teachers, public health inspectors, health visiting and nursing staff, medical and nursing students and staff from the Social Services Department. In addition, home helps have received training in primary first aid and oral resuscitation, as already mentioned, as well as hypothermia recognition. Whittington Hospital A series of talks on Smoking, Venereal Disease, Drugs and Alcoholism, etc. presented to hospital staffs during lunch times was well received. Many educational agencies continue to make use of the facilities available to postgraduate and other students on health education theory and practice. The health education officer was again invited to give papers to D.P.H. students at the Royal Institute of Public Health and Hygiene. He also lectured to health visitors of the City of Westminster on anti-smoking education and its presentation, and gave a paper on "Drug Abuse and Dependence" at a training conference presented by the British Red Cross Society. The Inner London Education Authority has always taken an active interest in health education and our health education service presented displays of material at a number of conferences dealing with health education arranged for I.L.E.A. teaching staff. The health education officer was also invited to give papers on the method and content of health education at seminars presented by the Authority. 60 Our contacts with overseas agencies are still maintained and this year students from Malaysia received advice on how to create and maintain a health education service. Students from the Centre for Educational Development Overseas and student nurses and health visitors from other authorities also received practical instruction in the method and content of health education; the Women's National Cancer Control Campaign again invited the health education officer to speak at their national conference. LIAISON WITH COMMERCIAL AND INDUSTRIAL AGENCIES Jones Brothers The medical and nursing staff of Messrs. Jones Brothers, anxious that members of the staff be made aware of some of the health problems which abound today, have welcomed talks on smoking, family planning, alcoholism, V.D. etc. British Petroleum Negotiations are proceeding for health education staff to give talks and demonstrations at the offices of this large company to its staff of many hundreds, on subjects such as cervical cytology. The introduction of a smoking advisory clinic is also under consideration. Sovereign Pencil and Stationery Company The medical adviser and nursing staff of this company which has a large factory are keen for the many staff to receive information on health topics; talks have been given on venereal disease, family planning and smoking. FURTHER EXPANSION The staff of the section have been fully employed throughout the year and, as the call for health education continues to increase, the Council has included in the budget for the department a sum to provide for the appointment of additional staff to help meet the demand. PERSONAL HEALTH Maternal and Child Health Clinics 64 Health Visiting 65 Domiciliary Midwifery 66 Home Nursing 67 Prophylaxis 68 Chiropody 70 Family Planning 71 Cervical Cytology 72 Recuperative Holidays 72 Handicap Register 73 Services for the Elderly 74 Dental Service 75 Other Items 75 63 PERSONAL HEALTH SERVICE MATERNAL AND CHILD HEALTH CENTRES The clinic functions for health care of mothers and children have continued, including family planning; there were also educational sessions for a variety of groups of all ages. During the year, arrangements were made for some ante-natal clinic sessions to be combined with those already held in the Council's centres by general practitioner obstetricians. Creche facilities continued to be in demand, and the number of weekly sessions was increased from the 1971 level of 13 to 17. A number of child health clinics with health visitors in attendance continued to be held at general practitioners' surgeries. While these have affected attendances at the Council clinics, both appear to have been affected by the falling birth rate. Details of attendances at various clinics during the year were as follows:- Borough Clinics 1972 1971 Child Health 33,768 40,652 Toddlers 2,340 2,630 Ante & Post Natal 1,935 2,436 Totals 36,953 45,718 General Practitioners' Surgeries 5,507 6,031 Occasional Creches 4,669 4,366 HEALTH VISITING The health visitor's pattern of work is altering with the changes occurring in the age structure and needs of the community. This, of course, leads to changes in statistical information requirements, and in the following tables the details given for 1972 have in some instances no corresponding figures for 1971. Cases visited by Health Visitors 1972 1971 Children under 5 15,573 15,839 Persons aged between 5 & 16 2,144 - (1) Persons aged between 17 & 64 5,296 - (1) Persons aged over 65 1,938 687 Mentally disordered persons (2) 205 95 Tuberculous households 12 6 Infectious households (other than T.B.) 256 294 Other categories (1) 1,193 3,688 Notes:- (1) Other categories in 1971 included persons aged between 5 & 64. (2) In 1972, mentally disordered persons are also included in the appropriate age group; for 1971, these are a separate category. Visits made by Health Visitors Totals of all effective visits including revisits 62,044 49,349 Totals of all ineffective visits 16,060 15,420 The new work pattern is clearly shown, visits having been made to all age groups, and there has been a considerable increase in the total number of visits. 65 It is during home visiting that the needs of families and individuals are detected early and necessary support and advice can be given, or referral to the appropriate specialist agency can be effected. The present-day training of the Health Visitor prepares her fully for this role of family visitor. Health Education advice is given in the homes, but also to groups at child health centres and in schools. Frequently these sessions take the form of discussion groups so that participants can pool their knowledge and learn from each other. During the year Health Visitors participated in the investigation of the Foundation for the Study of Infant Deaths, the Health Visitor giving support and comfort to the bereaved families. STUDENT TRAINING Nine 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 The follow-up by health visitors of fires in domestic premises continued, involving a great deal of home visiting of the families concerned to give advice and health education. Fires notified 44 Fatalities 5 (11.4%) Fires involving fatalities 4 Children involved 1 Injuries 9 (20.5%) Fires involving injuries 5 Fires involving oil heaters 11 (25%) DOMICILIARY MIDWIFERY There has been a further decline in the numbers of domiciliary confinements, mainly due to the continuing fall in the birth rate, but there has also been a tendency for domiciliary births to decrease very slightly in proportion to the totals of all births. In addition to 95 home confinements attended by domiciliary midwives, there were 40 other patients booked for domiciliary confinements; of these 6 moved out of the area, 15 bookings were cancelled, and 19 were subsequently transferred for delivery to the hospital service for the following reasons:- Complications of pregnancy - 14 Complications at term - 3 Premature labour - 2 There were three calls for the services of the Emergency Obstetric Unit. The scheme for planned early discharge from hospital resulted in 351 assessments of home conditions; 119 were found to be unsuitable. A total of 448 patients, including unplanned early discharges, were nursed at home following early discharge after hospital delivery; 8 of these had originally been booked for home confinement but were delivered in hospital. The General Practitioner Obstetrician Unit at the City of London Maternity Hospital commenced to operate with 10 patients booked for delivery, of whom 9 were subsequently delivered during the year, 2 in the unit, 5 others at home, and 2 transferred to the hospital service. Domiciliary midwives were not involved with any maternal deaths or stillbirths. 66 GUTHRIE TESTING Guthrie tests for phenylketonuria were carried out by domiciliary midwiveson 979 babies, 668 were first tests and 311 repeat tests. TRAINING The Council's domiciliary midwives continue to train pupil midwives from the City of London Maternity Hospital. During 1972, 22 pupils completed their district experience and a further 7 were in training at the end of the year. HOME NURSING The work of the District Nurses continued to increase mainly in caring for the aged. Of the patients attended 88.2% were over 60, and a large proportion of these were between 80 and 96; it is with this latter group that the need for constant nursing support is growing, and where intensive care is needed. Patients who live alone often require two nurses to care for them, two or three times a day. The programme of training nurses for the District Nursing Certificate continued. Thirteen State Registered Nurses completed the course and all were successful in gaining their certificates. Sixteen State Enrolled Nurses completed their ten-week in-service course during the year; five of these were working in the Borough and eleven were nurses from St. Matthews Hospital, Shepherdess Walk, who completed their two-year integrated nurse training for State Enrollment. All sixteen were successful in gaining their District Nursing Certificates. The Medical Loan Service continued to be used extensively. Among the many items provided are Ripple Beds for the prevention of pressure sores. Also included are mechanical Hoists which have been very beneficial to patients' relatives and nursing staff. Night nursing care was provided during the year by Marie Curie Memorial Foundation for fifteen patients suffering from terminal cancer, who were thereby enabled to remain with their families to the end of their lives. An Evening Nursing Service from Mondays to Fridays was provided by four part-time District Nurses, who each work varying times to cover the hours between 7 and 11 p.m.; when extra staff is available, this service will be extended to include the weekend. A new project under discussion in 1972 was an Ambulant Clinic for patients with varicose ulcers. As an initial step, arrangements were made for two senior District Nurses to study more closely the care and treatment of varicose ulcers, with the intention of starting the clinic in 1973. Many letters of appreciation of the kindness and care given to patients by the District Nursing Sisters were received; the following extracts are typical. may ' offer my grateful thanks to every member of the Nursing Service, who helped for all those years She so much appreciated all your help, having nursed herself and loved every one of you. God Bless you all and thank you so much for the work you do". " I just cannot find the right words to do justice to you and your staff.We have never had or seen such kindness. would never have lived so long had it not been for the care and tenderness of your staff. I could never have managed on my own. Nothing was too much or too hard for them. We could never have had better service. You gave months of life". Hospitals have also made complimentary remarks on the care given to patients by District Nursing and the co-operation received from the local Authority; this is particularly gratifying as it has always been in mind that the need for greater continuity of care for the patient going from community to hospital and returning from there to the community, makes for increased co-operation and contact between these two services. 67 Statistical details of the activities of home nurses are as follows. 1972 1971 Patients being nursed (a) 1.1.72 899 819 (b) 31.12.72. 1,043 899 Total nursed 2,771 2,526 Total visits 113,906 111,693 Visits to persons over 65 96,588 95,487 Proportion of visits to persons aged over 65 84.8 85.4 Nursing treatments completed 1,728 1,627 Nursing treatments commenced 1,872 1,707 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 homes continued during the year. The items loaned included the following: Tota/s Qn loan at Equipment 1972 1971 31.12.72. Air and sorbo rings 201 97 177 Bed cradles 132 79 119 Bed and back rests 175 105 153 Bed pans 167 80 122 Commodes 510 286 504 Hoists 29 13 24 Dunlopillo mattresses 32 8 24 Fracture boards 90 29 80 Hospital beds 21 10 19 Walking aids 287 114 235 Wheel chairs and other special chairs 220 92 199 PROPHYLAXIS VACCINATION AND IMMUNISATION All infants attending child health clinic sessions are offered the basic course of immunisation unless they are already being given this protection by their own doctors. 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. 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 and displays. DIPHTHERIA, WHOOPING COUGH, TETANUS AND POLIO The falling birth rate, the new schedule introduced in October, 1970 and the high rate of net emigration have together contributed to a reduction in the overall numbers of completed primary courses of protection against these diseases but there are indications that the computer scheme for providing automatic reminders in respect of children failing to complete courses by the due dates is having a compensatory effect. In my previous report I referred to the inevitable result of the new schedule being a reduction in the number of babies completing courses during 1971 and which would be self-adjusting in 1972; this is evidenced in the tables below as is also the effect of the elimination from the new schedule of the booster doses at eighteen months of age. 68 Primary Courses Completed 1972 1971 Diphtheria 2,270 1,588 Whooping Cough 2,052 1,386 Tetanus 2,316 1,632 Polio 2,299 1,654 Booster Doses Diphtheria 2,377 4,689 Whooping Cough 680 2,456 Tetanus 2,956 5,220 Polio 2,873 5,276 Percentages of children born in 1970 and vaccinated by 31.12.72. Islington National Average Diphtheria 73% 81% Whooping Cough 71% 79% Polio 71% 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. 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. MEASLES Protection against this disease is offered to children at 14 months of age but those found to have had a previous infection are not vaccinated. During the year 1,693 children were vaccinated compared with 1,980 during 1971. RUBELLA VACCINATION Rubella vaccination is now offered as a routine to all first-year girls in secondary schools. During 1972, 12 schools were visited and 859 girls were vaccinated against the disease. It is hoped by this routine vaccination to reduce the number of children born with congenital malformations as a result of rubella infection of the mother during pregnancy. B.C.G. VACCINATION During the year 15 schools were visited. Heaf tests and readings were carried out on 1,472 children and of these 1,339 were given B.C.G. vaccinations. Children with positive reactions (Grade 2 or over) totalling 113 were referred to the chest clinic; 91 of these were X-rayed, 13 were found to need treatment and 24 were kept under supervision by the Chest Physician. B.C.G. vaccination is now offered to entrants of secondary schools at age 11. 69 HEAF TESTING Heaf testing has been offered to new entrants of primary schools at the age of 5 years in an effort to detect unknown cases of tuberculosis in the community. The family contacts of children producing strongly positive reactions are followed up at the chest clinic. During the year 52 primary schools were visited and 1,406 children were tested. Of these 38 were found positive and referred to the chest clinic, where 13 were found to have no abnormality, 13 were given treatment and 12 kept under observation. INFLUENZA VACCINATION Influenza vaccination was offered to staff and residents of residential homes, home helps and other staff at special risk. 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 supplementary benefits and children. The charge in other cases is 25p per treatment but this may be reduced in necessitous cases. There is a total of 12 chiropody chairs at the various centres and during the year the weekly average number of clinic sessions held was 85. The mobile clinic services commenced in October and a total of 24 clinic sessions was held. Domiciliary treatment continued to be provided for the house bound; there is a continual demand for this service. Provision was made for extension of the service by the addition to the establishment of six posts of senior chiropodist but despite all efforts to recruit the additional staff the best that could be acheived was the filling of casual vacancies which arose during the year. The net result was a slight increase in the overall number of sessions held as compared with 1971. Details of the various activities are as follows:Clinics 1972 1971 Sessions 4,453 4,299 Appointments booked 30,213 34,461 Attendances Children 0-4 years 6 6 5-14 years 350 386 Adults Male 4,931 4,401 Female 21,547 19,355 Physically handicapped 411 162 Total 27,245 24,610 Domiciliary Treatments given 7,261 6,390 Homes for the Elderly Treatments given 74 1,425 70 FAMILY PLANNING As envisaged in my previous report, the Council's decision of October, 1971 to provide a Family Planning Service to all borough residents without charge, became effective from 1st April, 1972. From that date, therefore, residents over the age of 16 could obtain free advice on family planning and family planning requisites without charge at the Council's clinics. Additionally provision was made for residents attending their own doctors for family planning purposes to obtain requisites without charge by presenting their practitioners' prescriptions for dispensing at the Council's clinics. Further developments to these arrangements included a reciprocal agreement with the neighbouring borough of Hackney, whose service is comparable to Islington's; this agreement was on a "knock for knock" basis and while conserving the principle that patients should be encouraged to attend clinics of their own borough of residence, enables residents of both boroughs to obtain similar free facilities including dispensing of general practitioners prescriptions at the clinics of either. As a result of the above arrangements attendances at the Council's family planning clinics have shown a marked increase and the number of weekly sessions was increased from 13 to 18 including the mobile clinic which was brought into use in 1972. Details of attendances are as follows:- 1972 1971 Percentage increase New Cases 1,565 989 58 Total Attendances 7,176 4,438 62 The introduction of the new arrangements had an almost immediate effect as shown by the following details for the two years over the periods 1st April to 30th September. 1972 1971 Percentage increase New Cases 847 494 71 Total Attendances 3,781 2,143 76 The obstetric and gynaecological departments of various hospitals continued to refer patients to the Council's clinics for follow-up; the total during the year was 427. One of the Council's clinics was held in the Chest Clinic premises of the St. Mary's Wing of the Whittington Hospital; early in the year special arrangements were made whereby patients recommended at other clinics for I.U.D. were referred there for fitting the device. The number fitted during the year was 99. Arrangements with voluntary organisations for agreed rates of reimbursement in respect of attendances at their clinics by Islington residents were continued but extended to include provision for a free service in accordance with the National Family Planning Agency Scheme No. 4. Payments to the Family Planning Association for the financial year 1972/73 totalled £24,153 compared with £9,632 for 1971/72 and those to the Brook Advisory Centre were £3,046 and £500 respectively for the same periods. Towards the end of the year proposals were under consideration for the inclusion of vasectomy as part of the Council's Family Planning Service in implementation of the National Health Service (Family Planning) Amendment Act, 1972. DOMICILIARY FAMILY PLANNING The domiciliary family planning service continued to provide a valuable service for Islington women who are unable or unwilling to attend a clinic owing to family restrictions. The doctor visits all new patients and the follow-up visits are carried out by a nurse. During 1972, 81 patients were referred, compared with 46 in 1971. The sources of referral were as follows:- 71 Family Doctor 13 Health Visitor 47 Domiciliary Midwife 15 Social Worker 2 F.P. Association 1 Hospital 3 Some patients, after a few visits by the doctor and nurse, responded well to encouragement and were successfully "weaned" to attend a local family planning clinic. In this respect, the service has undoubtedly proved necessary and worthwhile. CERVICAL CYTOLOGY This service continued to be provided mainly by means of sessions held in conjunction with Family Planning Clinics; there was only one fortnightly session held for the sole purpose of taking smears. The national five-year recall scheme came into operation on 1st January, 1972 and this provides for all women who had smear tests from 1st January, 1967, onwards to be invited to have repeat tests at fiveyearly intervals. In Islington the Cervical Cytology Service commenced in April, 1966, and the local scheme for five-year recall was gradually merged with the national scheme. During the year the total number of smears sent for examination was 2,333 compared with 1,293 in 1971, an increase of 80%; the findings were as follows:- Five- year Recall Others Total Negative results: 238 1,965 2,203 Negative smears with gynaecological disorders (excluding cancer) which required treatment: 15 92 107 Doubtful smears referred for repeat examination: 2 21 23 Positive Smears: - - - Totals 255 2,078 2,333 Age Groups Under 25 - 681 681 25-34 34 834 868 35-44 85 365 450 45-54 82 139 221 Over 55 54 59 113 The details given above for the five-year recalls represent a response of approximately 18% of the total number of invitations sent. There were no replies to 47%, and a further 16% had moved out of the borough. It might have been thought that the final response would have been higher but it is likely that with the extended use of cervical cytology as a routine screening procedure in the fields of family planning, gynaecology and obstetrics, many women had smears taken under these other arrangements and which could account for many of those who did not reply at all; about 10% had replied saying they had been retested. RECUPERATIVE HOLIDAYS This service continued to be administered by the Public Health Department on behalf of the Social Services Committee. 72 During the year 404 persons were recommended by their doctors, hospital consultants, etc., for recuperative holidays. 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. 37 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. The following statistics show an overall increase in the number of recommendations dealt with during 1972:- Holidays arranged 1972 1971 Expectant and Nursing mothers — 2 Tuberculous adults 4 2 Other adults 115 85 Psychiatric patients 17 15 Accompanied children 42 33 Unaccompanied children (placed by I.L.E.A.) 102 80 Total 280 217 HANDICAP REGISTER The Handicap Register is basically a central index of known handicapped children and young persons up to the age of 21 and enables their development and welfare to be kept under constant review by means of a Kalamazoo Factfinder System. In addition, details of handicapped children born from 1971 onwards are added to the Child Health Computer File from which an output is obtained requesting reports from Health Visitors every six months. The system is maintained under the supervision of the Principal Medical Officer, Dr. Groves, and provides for children under 5 to be reviewed at six monthly intervals until they attain school age, at which stage recommendations are made if they are considered to be in need of special schooling; once at school they are reviewed annually, or more frequently if necessary. The process of reviewing these children is necessarily associated with assessment of their special needs and these procedures involve a considerable variety of specialised facilities and workers. Special Advisory Clinics are held for the assessment of 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. These clinics are held in one of three centres serving the southern, central and northern parts of the Borough. Some children are seen at Child Health Clinics, Day Nurseries, Play Groups or in their own homes. The Principal Medical Officer sees each mother and child to obtain a full history and make a preliminary assessment of the child and is assisted by the Clinical Psychologist, Mrs. Pahad. Subsequent assessments are made periodically by Dr. Groves, Mrs. Pahad or Dr. Clarke. If a full hospital investigation is needed, it is arranged after consultation with the child's General practitioner; often children are already under a Paediatrician's care and the mobilisation of local resources is often needed to help the mother and child. Placement in Play Groups, Day Nurseries or Voluntary Grant-Aided Day Nurseries for Mentally Handicapped Children or in an Assessment Unit in a Day Physically Handicapped School or other specialised centre may be considered. Speech thereapy, 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 each child will be followed up by the school doctor. 73 When children are in care in residential establishments the Senior Medical Officer who carries out regular routine visits follows up those who suffer from physical or mental handicap. Hospital reports are requested as necessary and close contact is maintained with the Social Services Department in individual cases as necessary. Social workers and Peripatetic Teachers are attached to Frank Barnes (Deaf) & 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 Islington Public Health Department is also attached to the Autistic Unit at Horizon (Educationally Sub-Normal) School. Deaf children of all ages are the special responsibility of a Senior Social Worker (Health Services), who liaises with the Principal Medical Officer for constant review of the children. 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. Throughout 1972 all these services continued at an intensive level. The number of children and young persons remaining on the Handicap Register at the and of the year was 1631 compared with 2141 for 1971. A total of 21 special Advisory Clinic Sessions were held at which 161 children were seen; there were also 137 home visits and 118 other visits made to Day Nurseries and Play Groups; the Clinical Psychologist held 40 1-hour sessions of individual thereapy. There were 108 children remaining on the Special Advisory Clinic list at the end of the year. SERVICES FOR THE ELDERLY VISITS BY MEDICAL OFFICERS Thirty-four 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. Fifteen cases were dealt with under Section 47, plus an application to the Magistrates Court for an extension order on a previous case, for a further period of three months, which was granted. In addition, six persons subsequently agreed to be admitted to hospital or a welfare home to receive care and attention. HOME VISITING The work of home visiting of elderly persons has continued at an intensive level, the number of persons visited having increased considerably. Visitors' contacts with the Social Services Department, particularly in respect of Home Help and Meals-on-Wheels services, were frequent, as was their liaison with general practitioners and Home Nurses; occasions also arose when the help of the Housing Department was sought in tracing the movements of elderly persons. Details of visists for the year are as follows:- Persons visited 4,738 Visits paid 11,624 Households visited 42 Visits paid 55 Unsuccessful visits 1,690 Total of all visists 13,369 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. 74 GERIATRIC SCREENING The pilot study mentioned in my previous report was followed by a second in the middle of the year. The results were processed in the Borough's computer and an analysis carried out to determine the requirements of a computer-assisted geriatric screening service. By the end of the year, consideration was proceeding on the basis of building up a computer file of selected information obtained during the course of health/geriatric visiting with facilities for identification of individual or group health and environmental factors. LAUNDRY SERVICES AND BATHING FACILITIES Services provided from facilities based at Finsbury Health Centre include the laundry service for incontinent persons, baths on the centre premises and the domiciliary bathing service. All are used extensively but not exclusively by elderly persons and fuller details are given later in this report. DENTAL SERVICE During 1972, the numbers of children under 5 and nursing and expectant mothers attending for dental treatment under Borough arrangements were fewer than in 1971, but the average number of attendances and teeth filled for individual patients showed substantial increases. An encouraging factor was the decrease in percentages of patients found to require treatment; of children inspected this fell from 69% in 1971 to 46.5% in 1972, and the corresponding figures for mothers were 86% and 80% respectively. OTHER ITEMS STUDENT VISITS Arrangements continued to be made for various types of students to visit this Department for observation purposes at the request of their employing or sponsoring authorities. The aim of these visits is to provide the students with a background knowledge of local health authority activities, with particular emphasis on the importance of inter-departmental liaison and co-operation. These arrangements make a valuable contribution to training, and the number of students has increased during 1972. 1 Type of Students Number Period of Placement Medical students 12 2 weeks Pre-clinical medical students 8 ) Diploma of Public Health students 21 ) Medical students attached to G.P. 3 ) These varied Pre-entry nurses 24 ) between one Student Nurses 64 ) day and one Post Graduate Nurses 7 I weeK Dietetic Students 13 ) Ward Sisters 6 ) N.N.E.B. Students 2 ) Students from various colleges 25 ) 185 In addition the Council has a regular arrangement with the North London Group of Hospitals and the City of London Maternity Hospital. The period of placement is 13 weeks. Whittington Hospital > 25 Community Care nurses in groups of 4 Royal Northern Hospital ) City of London Maternity Hospital 23 pupil midwives in groups of 4 75 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 as follows: 1972 1971 Domiciliary Midwifery 224 254 Home Nursing 543 435 Infectious diseases Other 696 292 Totals 1.463 981 EMERGENCY TRANSPORT Midwives were able to make use of special car hire facilities. CO-OPERATION WITH SOCIAL SERVICES DEPARTMENT Inter-departmental meetings of senior staff of the two departments are held at approximately threes monthly intervals to discuss matters of common concern and have proved to be most useful to all concerned. Residential establishments for children 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 houseparents 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. Ninety such visits were made during 1972. Residential establishments for the elderly are also visited by a senior medical officer accompanied by a senior public health inspector. Eight such visits were made in 1972. 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 1972, 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 1972/73 Maternity and Child Health North Islington Infant Welfare Centre 27,188 Prevention of Illness Chest and Heart Association 10.50 Care and After-Care Islington Chest and Tuberculosis Care Committee 350 Action on Smoking and Health Limited 10 Health Education Council 443 LAUNDRY SERVICES The laundry service for incontinent persons is provided from Finsbury Health Centre and during the year 3,812 collections of laundry were made. The service was being provided to approximately 182 persons sjt the end of the year, and as indicated earlier in my report, most of them are elderly. 76 BATHING FACILITIES The services provided from the Finsbury Health Centres continued throughout the year, and again were used mostly by elderly persons. Elderly persons were given a total of 4,455 baths in their own homes under the domiciliary service. Persons attending the centre were given a total of 2470 baths, 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 1972 from the Welfare Centre, Corsica Street, N.I. Their valuable service was again used extensively by officers of my department, in particular in those instances where statutory authorities were unable to help. ISLINGTON CREMATORIUM The Medical Referees during the year certified 1,022 applications for cremation at the Council's Crematorium, East Finchley. 77 SCHOOL HEALTH SCHOOL HEALTH SERVICE The Inner London Education Authority is responsible for this service, but by virtue of an agreement made under 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. Owing to the increasing amount of work in schools, two additional school nurses were appointed. More nurses took part in health education to small groups of school children at the request of Head Teachers. During the year a pilot scheme was carried out to test for tuberculosis in all children aged 5 years in their second term at school. Only 50% of the children eligible were actually tested owing to absence or lack of parental consent. Very few children were found to have positive results, and these were referred to the chest clinic for screening. No new cases of tuberculosis were discovered from this exercise and in view of the small result in relation to the substantial allocation of staff time which the study required it was decided not to introduce the procedure as a routine. HEALTH OF SCHOOL CHILDREN In May 1972 the school roll for the Borough was 32,902 having decreased from 33,449 for the previous year. Routine medical inspections were carried out during the year on 38.9% (41.8%) of the children, and of those inspected 0.1% (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 seven 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, and medical reports for the Careers Service completed. Pupils continuing schooling after reaching the statutory school leaving age were inspected as early as possible in the term prior to that in which they would be leaving school and their medical reports for the Careers Service completed. Special school pupils were also seen at least once a year by the school doctor, specialist or consultant, as appropriate. 81 ROUTINE MEDICAL INSPECTIONS - DEFECTS Numbers of cases noted for treatment or observation expressed as a rate per 1,000 inspect. (1971 figures in brackets) Treatment Observation SKIN 6.41 (7.75) 6.65 (7.97) EYES (a) Vision 71.65 (63.90) 43.41 (53.83) (b) Squint 7.67 (7.90) 3.99 (5.51) (c) Other 1.64 (1.88) 1.17 (1.81) EARS (a) Hearing 6.88 (4.93) 4.62 (4.56) (b) Otitis Media 1.80 (2.61) 3.36 (2.68) (c) Other 1.17 (1.45) 1.17 (0.65) NOSE AND THROAT 2.58 (3.84) 12.59 (16.81) SPEECH 4.07 (3.69) 5.40 (5.65) LYMPHATIC GLANDS 0.63 (0.65) 9.62 (11.66) HEART (a) Congenital 1.10 (1.52) 3.29 (2.61) (b) Acquired 0.63 (0.80) 2.19 (2.75) LUNGS (a) Bronchitis 0.86 (1.23) 1.56 (1.88) (b) Asthma 4.15 (5.14) 3.99 (4.49) (c) Other 0.39 (0.58) 2.03 (2.03) DEVELOPMENT (a) Hernia 1.17 (1.38) 1.96 (3.33) (b) Other 2.97 (2.17) 3.05 (4.49) ORTHOPAEDIC (a) Posture 0.70 (0.80) 3.05 (3.55) (b) Feet 2.58 (2.54) 8.21 (9 78) (c) Other 2.11 (3.12) 5.55 (4.85) NERVOUS SYSTEM (a) Epilepsy 1.49 (1.45) 2.11 (1.38) (b) Other 0.78 (0.65) 1.41 (1.23) PSYCHOLOGICAL (a) Development 3.60 (1:96) 6.26 (7.97) (b) Stability 4.30 (1.45) 9.86 (12.03) ABDOMEN 0.47 (0.65) 1.49 (1.52) DEBILITY 0.55 (2.10) 1.33 (3.19) ENURESIS 10.25 (7.61) 16.97 (18.91) OBESITY 3.99 (4.93) 6.65 (11.45) OTHER 3.21 (2.97) 1.49 (2.17) 82 SPECIAL MEDICAL EXAMINATIONS 3,508 (3,483) special medical examinations were carried out in 1972, either at schools (where the pupils' parents were invited to attend) or in the pupils' own homes. RE INSPECTIONS School doctors re-inspected 5,393 (5,778) children who had been referred for treatment or observations. EMPLOYMENT OF SCHOOL CHILDREN During 1972, 135 (85) 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. 1,938 (2,203) children were examined by a school doctor within 96 hours of departure to make sure that they Children going to Inner London Education Authority camps, where a school nurse was in attendance, were seen by the school nurses only; 1,351 (2,078) children were examined in this way during 1972. NON-ROUTINE MEDICAL INSPECTIONS RE-INSPECTIONS 5,393 (5,778) Bathing centre inspections - scabies NIL (1) Bathing centre inspections - others NIL (1) Employment certificates 135 (85) Theatre children 40 (41) School Journeys 1,938 (2,078) Recuperative holidays - pre-departure 126 (130) Candidates for higher awards 3 (4) Outward Bound Courses 4 (3) Infectious disease investigation 3 (3) T.B. Contacts NIL (1) Boarding School for the delicate - pre-departure 56 (37) Boarding School for the delicate - on return NIL NIL Handicapped pupils - statutory examinations 170 (194) Handicapped pupils - periodic special defect examination 71 (82) Research investigations and enquiries 35 (17) SUB-TOTAL 2,581 (2,677) 83 SPECIALS - at request of:- Head Teacher - child's name entered in special book 59 (96) Head Teacher - others 302 (203) School nurse - following health survey 8 (17) School nurse - others 12 (13) Divisional Education Officer 32 (19) Divisional Education Welfare Officer 23 (12) Parent 45 (43) School Medical Officer 204 (226) SUB-TOTAL 685 (629) OTHERS For free travel NIL NIL Accident on school premises NIL NIL Miscellaneous (including inspections specifically for provision of free milk) 242 .{177) SUB-TOTAL 242 (177) TOTAL OF ALL NON-ROUTINE MEDICAL INSPECTIONS 8.901 (9,261) 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 16 (23) Day schools for physically handicapped children 13 (8) Boarding open air schools 10(6) 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 22 (39) of these examinations. Recommendations Day schools for educationally subnormal children 32 (51) Boarding schools for educationally subnormal children Nil (3) Continue at ordinary school possibly with extra help in reading arithmetic, etc. 20 (39) Home Tuition 11 (10) Transfers to ordinary school from E.S.N, school 22 (32) Leavers' Examination at E.S.N, schools 64 (47) 84 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 58 families. SCHOOL NURSES' INSPECTIONS Pupils have a comprehensive inspection annually, carried out by the school nurse, and where necessary are referred for further investigation or treatment. 30,394 (28,168) pupils were so inspected during the year and 1.78% (1.47%) were found verminous. A further 8,547 (6,336) inspections were carried out at selected health surveys and vermin was found in 2.78% (2.70%) of those inspections. The number of individual pupils found verminous was 756 (506) or 2.30% (1.51%) of the school rolls. 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 that subject. REMEDIAL FOOT CLASSES 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. AUDIOLOGY Infants were given a routine sweep test by school nurses as soon as possible after entry to school, and any children in whom the test showed doubt as to normality of hearing were referred for a pure tone test carried out by a specially trained school nurse. Sweep tests were carried out on 7,191 (5,941) children and 115 (99) had pure tone tests. All the latter were found to have defective hearing and were referred for further investigation. At the end of the year 114 (84) children were in attendance at audiology clinics. There were 28 (38) clinic sessions held, at which the total of attendances was 269 (215). Hearing aids were provided to 9 (1) children, and the total of children so provided and still attending Islington schools was 78 (111). Many of these children come from other boroughs to attend the 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 388 (337) children were attending these clinics at six centres in the Borough. Total attendances were 4,756 (1,694) and 63 (67) children were discharged cured. 85 MEDICAL AND DENTAL 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 1972 there were 357 nursing services at which 608 new cases were seen; medical officers attended 68 sessions and saw 36 new cases. Total attendances during the year were 5,085 (4,752). School children found at dental or medical inspections to need dental treatment were given appointments to attend one of four dental clinics in the Borough unless their parents expressed a wish for them to be seen by their private dentists. 2,668.4 (2,655) dental treatment sessions were held at which 5,076 (4,589) new cases attended and total attendances were 13,646 (13,798). 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 437 (252) attendances for this purpose during 1972. Children found to be suffering from scabies were also sent to the bathing centre for cleansing during 1972 and total attendances for this purpose were 228 (218). WCLFSON CENT RE A senior medical officer of the department continued to attend the Wolfson Centre on Friday mornings 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 21 such children. HOME TUITION Home tuition was recommended for 11 (10) children who were unable to get to school even if transport were provided and would be absent for a considerable time. 86 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER AND CHIEF DENTAL OFFICER The School Dental Service, carried out on behalf of the Inner London Education Authority and in conjunction with the Borough service, has run smoothly during 1972. It has not been beset with the staff shortages which often hits a service of this character. Possibly due to this and the lack of dislocation which is inevitable when dental officers or dental surgery assistants leave and cannot quickly be replaced, considerable progress in all branches of the service was made. It is pleasing to note that the sessional average for fillings, both in temporary and permanent teeth, rose from 4.4 in 1971 to 6.0 in 1972, slightly above the national average. The ratio of permanent teeth filled to those extracted was 46.5, compared with 29.6 for 1971, and that of temporary teeth 4.3 compared with 3.1 for 1971, an encouraging improvement. The orthodontic service progressed in ail directions since its inception. There were 45 new cases against 28 for 1971; 46 removable appliances were fitted against 34 for 1971 and 4 fixed appliances against nil for 1971. Thus the general pattern for the year was one of improvement, although the number of school inspection sessions did not reach the high level of 1971. One important feature of the service was the addition of a dental auxiliary whose function was to promote dental health education among other duties. Dental health education was continued through the usual channels of talks at schools and by the displays of posters wherever possible. One of the windows of the departmental offices has invariably on show either a page turning machine or some similar means of communicating the ill-effects of dental disease. 87 STAFF AND PREIMISES 89 STAFF AND PREMISES (31.12.72) 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 Medical Officers (Part-time) 2 17 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 18 Secretary 1 Senior Clerical Assistants 9 Clerical Assistants 40 Attendant Telephonists 2 Typing Supervisor 1 Audio/Copy Typists 8 Clerk/Typist 1 Copy Typist 1 Receptionist/Record Clerks 7 Clerk/Telephonist 1 Telephonist 1 Office Attendants 2 Attendant Handymen 3 Technical Assistant (Health Education) 1 120 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 90 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 17.9) 18 School Nurses 20 Creche Assistant 2 *additionally one supernumary Tuberculosis Visitor held temporarily against vacancy in Health Visitors' establishment 102 GERIATRIC SERVICES Home Visitors 9 Assistant Home Visitor 1 10 t DOMICILIARY MIDWIFERY Senior Nursing Officer 1 Domiciliary Midwives 8 Domiciliary Home Nurse Midwife 1 Physiotherapist (part-time) 1 11 HOME NURSING Senior Nursing Officer 1 Senior Home Nurse 6 Home Nurses 44 51 CHIROPODY Chief Chiropodist/Administrative Officer 1 Senior Chiropodists 13 Chiropodists (Sessional) (Full-time equivalent — 5.1) 12 26 91 TUBERCULOSIS Welfare Officer (Chest Clinic) 1 Senior Occupational Therapists 1 Warden (T.B. Hostel) 1 Assistant Warden (T.B. Hostel) 1 4 SOCIAL CASEWORK 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 8.9) 6 Dental Officer (Orthodontics) (Full-time equivalent 0.4) 1 Dental Auxiliary 1 Dental Surgery Assistants 10 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 Driver/Handyman 1 Porter Cleaner 1 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 447½ Cooks 40 Kitchen Helpers 40 Needlewoman 40 Stoker/Handyman 40 Handyman/Driver 40 92 PREMISES Administrative Offices Central Office 159/167 Upper Street, N.I. 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.I. Hostel for Tuberculous Men Cromwell Lodge 55 Cholmeley Park, N.6. School Treatment Centres Islington 37 Thornhill Road, N.I. 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 lnvestigation; Vision and Speech Therapy; Minor Ailments; Midwifery; District Nursing; Staff Medicals; Health Education; I.L.E.A. Child Guidance Unit. Creche Highbury Grange 1-5 Highbury Grange, N.5. Maternal and Child Health; (20.11.72.) Chiropody; Family Planning; Cervical Cytology; School Health • Dental; Special Investigation; Special Advisory; Minor Ailments; Midwifery; District Nursing; Staff Medicals; Health Education; 93 Marriage Guidance; Mothers' Club; Creche; Ante Natal; Elderly Persons' Clinic. Centres Archway Congregational Church Hall, Child Health Junction Road, N.19 Barnsbury Carnegie Street, N.1. Maternal and Child Health; Chiropody; School Health (Special Investigations); Family Planning; Cervical Cytology. 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; Smoking Advisory Clinic; Family Planning; Cervical Cytology; Staff Medicals. 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, Maternal and Child Health; Hilldrop Estate, N.7. Family Planning; Elderly Persons' Clinic. Leage Street 24 Leage Street, E.C.1. Maternal and Child Health; Chiropody; School Health (Special Investigations) Pine 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. 94 INDEX Air Pollution 29 Births 11 Bacteriological 23 Basement Bakehouses 37 B.C.G. Vaccination 69 Bathing Centres .77,86 Cervical Cytology 72 Children's Toys 33 Chiropody 70 Cholera 15 Consumer Protection and Public Control 32 Co-operation with Social Services Department 76 Cremations 77 Deaths 11 Dental Services 75,87 Diseases of Animals 44 Disinfection and Disinfestation 35 Domiciliary Midwifery 66 Dysentery 22 Elderly Services for the 74 Electrical Goods 33 Emergency Telephone Service 76 Employment Agencies 34 Environmental Health Services 27 Factories and Outwork 36 Fertilisers and Feeding Stuffs 32 Family Planning 71 95 Fire Risks 66 Fireworks 32 Food Poisoning 20 Food and Drugs 38 General and Vital Statistics 11,52 Geriatric Preventive Clinics 75 Grants to Voluntary Organisations 76 Handicapped Register 73 Hairdressers and Barbers 32 Health Education Service 55 Health Visiting 65 Home Nursing 67 Housing 46 Ice Cream 40 Immigrants 23 Infectious Diseases 19 Inspection and Enforcement Duties 28 International Certificates of Vaccination and Innoculation 20 Laundry 75 Lead Poisoning 20 Legal Proceedings 39 Loan of Equipment 68 Lung Cancer Deaths 15 Massage or Special Treatment Establishments 32 Maternal and Child Health Centres 65 Meat Inspection 43 Medical Treatment of School Children 86 Midwifery, Domiciliary 66 Milk 38 Night Cafes 42 Noise 48 96 Nurses Agencies 32 Nursing Homes 32 Nursing Services 7 Observation and Handicapped Register 73 Offensive Trades 37 Offices and Shops 51 Oil Heaters 59 Outwork 36 . Performing Animals (Regulations) Act 1925 45 Personal Health Services 65 Pharmacy and Poisons 42 Pigeons 35 Premises 93 Principal Officers 4 Prophylaxis 68 Public Control 32 Rag Flock 34 Rats and Mice 35 Recuperative Holidays 72 Registration and Licensing 38 Remedial Foot Classes 85 Rubella Vaccination 69 Sampling 40 Scabies and Vermin 23 Sewage and Sewage Disposal 27 School Health Service 81 Shops Acts 33 Slum Clearance .46 Smallpox - International Certificates 20 Smoking Advisory Clinic 60 Special Investigation Clinics 85 Staff 89 Statistics 11 97 Stillbirths 11 Street Markets 41 Students' Visits 66 Task Force 77 Tuberculosis 22 Typhoid and Paratyphoid Fever 21 Vaccination & Immunisation 68 Venereal Disease 24 Vermin 35 Vital Statistics 11 Water Supply 27 Wolfson Centre 86 Works in default 28 98