ANNUAL REPORT Director of Public Health and Medical Officer of Health London Borough of Islington ISL102 CONTENTS SUBJECT PAGE Introduction 1 Health Committee 2 Principal Officers of the Department 3 Vital Statistics 5 Infectious and other Diseases 13 Environmental Health 21 Health Education Services 53 Personal Health 65 School Health 75 Staff and Premises 83 Index 91 To the Mayor, Aldermen and Councillors of the London Borough of Islington INTRODUCTION In 1973, uncertainty over the possible consquences of the impending National Health Service Reorganisation was naturally very much on the minds of staff of my department of all disciplines who, along with the Council's Personal Health Services, were to be transferred on 1 April 1974 to the newly-formed Camden and Islington Area Health Authority. The fact that Mr. E.J. Sharp (Chief Administrative Officer) and I were members of the Joint Liaison Committee, and that other senior officers were members of National Health Service Reorganisation Working Groups, meant that additional pressures were experienced by many of the staff of all sections of the department. It says much for their calibre and loyalty that the high standards reached by the Personal and Environmental Health Services after nine years of expansion and improvement under the London Borough of Islington were maintained during the year. Moreover, despite the encroachment on normal duties of National Health Service Reorganisation activities, certain developments, including the following, did take place - Health Centres: Bath Street Health Centre opened in December, replacing Leage Street Maternal and Child Health Centre and containing two surgeries for general medical practitioners. Built to the Council's specification in a Greater London Council housing development scheme, Bath Street is the Council's third completed health centre (River Place and Highbury Grange preceded it) and experience has shown that closer relationships between the various services housed in these centres has been to the benefit not only of the professional staff, but also, and what is especially important of course, the patients. Family Planning Service: The public's use of the Council's free family planning service continued to increase during the year and the facilities provided were enhanced in January by the inclusion of vasectomy, for which the Family Planning Association acted as agents. The Council also decided to pay the fees of surgeons undertaking vasectomies on Islington residents. General Practitioner Obstetricians: Liaison with the General Practitioner Obstetric Services continued during the year and a second unit was opened at the Whittington Hospital in May. Dental Services: Pre-School Children: The inclusion in the Child Health Computer System of a new print-out of letters, stressing the importance of routine dental supervision and inviting parents of children attaining the age of 2 Zi years to take advantage of the Council's dental services, resulted in a significant increase in clinic attendances. This will be the last 'Annual Report', the office of medical officer of health (or director of public health) ceasing to exist on 31 March 1974. As the department divides into staff transferring to the National Health Service and those remaining in the new Environmental Health Department, I am grateful to have this chance of stressing once again my indebtedness for their support since I joined the Council's service in 1970. My thanks are also due, of course, to the Chairman and Members of the Health Committee for their interest in and support of the work of the department and also to other individuals and organisations too numerous to mention, for their goodwill and cooperation during my time in Islington. C.BURNS Director of Public Health and Medical Officer of Health 1 HEALTH COMMITTEE (31.12.73) Chairman Councillor Mrs. P. BROWN Vice-Chairman Councillor Jack WALKER, J.P. Aldermen J.R. GOODMAN, J.P., F.I.O.B. C.R.ST. HILL, Dip., P.H.A. Councillors Mr. H.C. BEARD, B.E.M. Mrs. E.K. BROWNING Mr. J. CANNON Mrs. I. HAGLAND Mr. E M. HOLROYD-DOVETON Mr. H.E. JORDAN Miss M. McCANN Mr. P. McKENDRY Co-opted Members Mrs. J. DENNISON, B.A., 38 Douglas Road, London, N1 Dr. M. KELLMER-PRINGLE, B.A., Ph.D., D.Sc., Director, National Children's Bureau, 8 Wakley Street, EC1V 7QE. Mrs. V.R.M. ROSEN, B.A., 30 Newington Green, London, N16. 2 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 Den tal 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, ISOLDE W. FELLNER B.A., L.R.C.P., M.R.C.S., M.B., B.S., M.D., L.R.C.P. Edin., L.R.C.S. Edin., D.C.H., D.P.H. L.R.F.P.S. Glas. Chief Administrative Officer Chief Public Health Inspector E.J. SHARP, F.H.A. W.T. STEVENSON, M.A.P.H.I. Assistant Chief Administrative Officer Deputy Chief Public Health Inspector S. GODSTONE A.J. TRUSLOVE, F.A.P.H.I. Principal Administrative Officers Assistant Chief Public Health Inspector R.D. BILLINGS,F.H.A., A.C.I.S. Dip. Comp J.A. HARRIS, M.A.P.H.I. L.E. SNASHALL R.C. WHITTAKER, M.A.P.H.I. S.WRIGHT (E.F. KIRBY, M.A.P.H.I. from 7.11.73) Chief Nursing Officer Principal Nursing Officer Miss L.K.MAY Miss M. BRERETON S.R.N.,S.C.M.,H.V.,Q.N. Dip.,Soc. S.R.N.,S.C.M.,B.T.A.,H.V. Diploma Health Service Admin (Aston Univ) Senior Nursing Officers D.F.PROCTER, Mrs. P.B. STOKES, S.R.N.,Q.N. S.R.N.,S.C.M.,N.D.N. Mrs. M. TAMBLYN, Miss W.YOUNG, S.R.N.,H.V.,R.F.N. S.R.N.,S.C.M.,H.V.,Q.N. Health Education Officer Senior SocialWorker K.M.N. ROBERTSON, Mrs. A. HOSKER L.M.R.S.H.,M.I.H.E.,M.R.I.P.H.H. (transferred to Social Services) 1st April 1973 3 VITAL STATISTICS VITAL STATISTICS Area — 3,679 acres Population (Estimated Mid-Year) — 188,160 Marriages solemnised in the Borough 1,808 (provisional) BIRTHS Live Births - Total Male Female Legitimate 2,163 1,115 1,048 Illegitimate 402 192 210 2,565 1,307 1,258 Islington England and Wales Live Birth Rate Per 1,000 Population 13.6 13.7 Birth rate after applying 'Area Comparability' Factor of 0.90 12.3 Illegitimate Live Births Per Cent of Total Live Births 15.7 8.6 Total Male Female Still Births - Legitimate 20 11 9 Illegitimate 5 4 1 25 15 10 Islington England and Wales Still Birth Rate Per 1,000 Population 0.13 0.16 Still birth rate per 1,000 live and still births 9.65 11.62 Total Male Female Total Live and Still Births — Legitimate 2,183 1,126 1,057 Illegitimate 407 196 211 2,590 1,322 1,268 DEATHS Total Male Female All Causes 2,251 1,133 1,118 Islington England and Wales Death Rate (Crude) Per 1,000 Population 12.0 12.0 Death rate after applying 'Area Comparability' factor of 1.05 12.6 7 Infant Deaths Total Male Female Deaths of Infants under one year of age — Legitimate 41 24 17 Illegitimate 11 9 2 52 33 19 Islington England and I/Vales Infant Mortality Rate (per 1,000 live births) — All Infants 20.3 16.9 Legitimate 18.9 16.4 Illegitimate 21.4 22.1 Neo-Natal Mortality Total Male Female Deaths of Infants under 4 weeks of age — Legitimate 23 14 9 Illegitimate 6 4 2 29 18 11 Islington England and Wales Neo-Natal Mortality Rate (per 1,000 live births) All Infants 11.3 11.1 Legitimate 10.6 10.9 Illegitimate 14.9 13.4 Early Neo-Natal Mortality Total Male Female Deaths of Infants under 1 week of age — Legitimate 20 13 7 Illegitimate 3 1 2 23 14 9 Early Neo-Natal Mortality Rate (per 1,000 live births) Islington England and Wales All Infants 9.0 9.5 Legitimate 9.2 9.3 Illegitimate 7.5 11.8 Perinatal Mortality Total Male Female Still births and deaths under 1 week combined 48 29 19 Perinatal Mortality Rate (per 1,000 total live and still births) Islington England and Wales 18.5 21.0 Maternal Deaths (including abortion) NIL 86 Rate (per 1,000 total live and still births) NIL 0.13 8 ANALYSIS OF INFANT DEATHS - 1973 (Based on Registrar General's Returns) Primary Cause of Death Under 1 day Days Weeks Months 1 - 2 2-3 3-4 14-5 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 | 70- 11 | 11-12 s Enteritis and other diarrhoeal diseases 1 1 Meningococcal infection 1 1 Other infective and parasitic diseases. 1 1 Active rheumatic fever 1 1 Pneumonia 1 1 1 3 1 1 1 9 Diseases of genito-urinary system 1 1 Congenital anomalies 1 1 2 4 Difficult delivery and/or anoxic condition 4 1 4 1 2 1 13 Other causes of perinatal mortality 4 1 5 1 11 Symptoms and ill-defined conditions 1 2 2 1 1 1 8 Motor vehicle accidents NIL All other accidents 1 1 All other external causes 1 1 Totals 8 4 10 1 1 3 2 5 5 3 3 3 1 1 1 1 52 Estimated Child Population Under 1 year 1-4 Total under 5 5- 14 Total under 15 Islington 2,600 10,000 12,600 25,600 38,200 Greater London 96,700 398,100 494,800 1,026,400 1,521,200 Deaths of Infants under One Year The infant mortality rate shows a considerable increase since 1972 whereas the national rate has decreased slightly. The increase is due to the fact that although the number of deaths rose by two, live births in the borough fell by 525. Respiratory disease still remains the greatest risk to infants from one to twelve months; of a total of twenty three infant deaths in the age group one to twelve months, seven were due to pneumonia. Maternal mortality It is gratifying to note that there were no maternal deaths during 1973. Respiratory Tuberculosis I reported last year that the death rate for lung tuberculosis of 0.03 per 1,000 population during 1971 and 1972 was the lowest ever recorded in the borough. Unfortunately, this trend did not continue in 1973 when the rate was 0.04. 9 Pneumonia and Bronchitis In 1973 there were 245 deaths ascribed to pneumonia and 126 to bronchitis which constituted an increase of 26 pneumonia and a decrease of 32 bronchitis deaths on the previous year. Malignant Growths of Lung and Bronchus During 1973 the number of deaths ascribed to lung cancer was 166 (131 male, 35 female) as against 190 (155 male, 35 female) in 1972. It is gratifying to note that this represents a decrease in the borough of nearly 151/2% in respect of male deaths from this disease, whereas the national figures show a slight increase in both male and females in 1973. Coronary Disease with Angina There were 465 deaths (271 male, 194 female) from this cause in 1973. This shows a decrease ■ from the 1972 deaths of 487 (297 male, 190 female). ACCIDENT DEATHS - Comparative table. 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 Motor vehicle accidents 28 29 34 34 23 29 24 29 27 25 Other violent accidents 62 60 58 65 38 47 47 35 36 50 ACCIDENT DEATHS - Analysis by age groups Type under 4 iveeks 4 weeks and under 1 year 1- 5- 15- 25- 35- 45- 55- 65- 75 + M F Total Motor Vehicle accidents . - - - 2 6 2 - 4 1 8 2 12 13 25 Falls - - 1 - 1 - - - 2 1 10 8 7 15 Drowning - - - - - 1 - 1 - - - 1 1 2 Accidental Poisoning (Solid, Liquid Gases and Vapours) 1 1 1 - 4 3 2 2 - 3 3 9 10 19 Fire - - - - - - - 1 1 - - 1 1 2 Inhalation of stomach contents, ingestion of food, etc. - - -- - - - 1 1 1 - - 3 - 3 Other (Railway Accidents, etc.) - - - - 2 - 1 - - 3 3 4 5 9 Total - 1 2 2 13 6 4 9 5 15 18 38 37 75 10 1973: 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 - - - - - - - - - - - - - - - - - - - - - - - - - Bacillery dysentery and amoebiasis - - - - - - - - - - - - - - - - - - - - - - - - - Enteritis and other diarrhoeal diseases 2 - 2 - - 1 - - - - - - - - - - - - - - - - - - - Tuberculosis of respiratory system 2 2 4 - - - - - - - - - - - - - - - - - - - - - - Late effects of respiratory tuberculosis 4 - 4 - - - - - -- - - - - - - - - - - - - - - - - Other tuberculosis - - - - - - - - - - - - - - - - - - - - - - - - - Plague - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - Streptococcal sore throat and scarlet fever - - - - - - - - - - - - - - - - - - - - - - - - - Meningococcal infection 1 1 2 — — 1 - - 1 - - - - - - - - - - - - - - - - Acute poliomyelitis — — - — - - - - - - - - - - - - - - - - - - - - - Smallpox — — — - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - - Typhus and other rickettsioses - - - - - - - - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - - - - - - - - Syphilis and its sequelae — 2 2 - - - - - - - - - - - - - - - 1 - - - - - 1 All other infective and parasitic diseases 3 4 7 - - 1 - - - - 1 - - 1 - - - 1 - - - - - 1 Malignant neoplasm - buccal cavity and pharynx 6 2 8 - - - - - - - - - - - - - 1 - - - 1 2 - 3 1 Malignant neoplasm - oesophagus 7 5 12 - - - - - - - - - - - - - - - - 3 2 2 2 2 1 Malignant neoplasm - stomach 33 20 53 - - - - - - - - - - - - - - - - 10 3 11 5 10 12 Malignant neoplasm - intestine 21 35 56 - - - - - - - - - 1 - - 1 1 2 4 5 11 10 3 18 Malignant neoplasm - larynx 2 - 2 — — — — — - - - - - - - - - - - 1 - 1 - - - Malignant neoplasm - Lung, bronchus 131 35 166 - - - - - - - - - - - - - - 13 1 36 6 54 18 28 10 Malignant neoplasm - breast 1 48 49 - - - - - - - - - - - - - 1 1 9 - 8 - 13 - 17 Malignant neoplasm - uterus - 23 23 - - - - - - - - - - - - - 1 - 4 - 7 - 8 - 3 Malignant neoplasm - prostate 15 - 15 - - - - - - - - - - - - - - - - - - 3 - 12 - Leukaemia 10 7 17 - - - - - - - - 1 1 - 1 - - - 1 2 - 4 - 3 4 Other malignant neoplasms, including neoplasms of lymphatic and haematopoietic tissue 55 72 127 - - - - - - - 1 1 1 2 - 2 3 3 5 16 15 20 23 11 24 Benign neoplasms and neoplasms of unspecified nature . 6 6 12 - - - - - - - - - - - - - - - 2 2 1 3 2 - 1 Diabetes mellitus 6 11 17 - - - - - - - - - - - - - - - - 2 1 1 3 3 7 Avitaminoses and other nutritional deficiency — - — - - - - - - - - - - - - - - - - - - - - - - Other endocrine, nutritional and metabolic diseases 1 6 7 - - - - - - - - - - - - - - - - 1 1 - - - 5 Anaemias 2 6 8 - - - - - - - - - - - - - - - - - - - - 2 6 Other diseases of blood and blood-forming organs - - - - - - - - - - - - - - - - - - - - - - - - - Mental disorders 7 4 11 — — — — — — 1 - - - - - 1 - - - - - 2 4 2 Meningitis - - — - - - - - - - - - - - - - - - - - - - - - - Multiple sclerosis 1 2 3 - - - - - - - - - - - - - - - - 1 - - 2 - - Other diseases of nervous system and sense organs 8 7 15 - - - - - - - - - - - - 1 - 3 3 4 1 1 2 Active rheumatic fever 1 1 2 1 - - - - - - - - - - - - - - - - - - - - 1 Chronic rheumatic heart disease 7 20 27 --- - - - - - - - - - - - - 1 1 1 2 2 2 2 15 Hypertensive Heart Disease 21 24 45 - - - - - - - - - - - - - 1 4 - 3 1 5 4 9 18 Ischaemic heart disease 271 194 465 - - - - - - - - - - - 1 7 1 23 8 81 21 96 54 64 109 Other forms of heart disease 40 69 109 - - - - - - - - 1 1 - - - 1 1 - 6 1 11 8 21 58 Cerebrovascular disease 68 131 199 — — — — — — - - - - - - 4 - 5 6 12 12 24 27 23 86 Other diseases of the circulatory system 60 80 140 - - - - - - - - - - 1 - 1 - 2 1 6 2 21 15 29 62 Influenza — - — — — — — — — — — - - - - - - - - - - - - - - Pneumonia 104 141 245 — 2 6 1 - - - - - - - 1 2 - 6 - 8 6 29 23 53 108 Bronchitis, emphysema 94 32 126 - - - - - - - - - - - - - — 4 3 21 2 36 8 33 19 Asthma 3 1 4 — - — — — — — — — - - - - - 1 - 1 - 1 - - 1 Other diseases of the respiratory system 10 7 17 — — - - - - 1 - - - - - - - - 1 - - 1 2 7 4 Peptic ulcer 9 6 15 - - - - - - - - - - - - - - 3 - 1 1 5 1 - 4 Appendicitis - - - - - - - - - - - - - - - - - - - - - - - - Intestinal obstruction and hernia 2 4 6 — - - — — — — — — — — — 1 — — — — — — 2 1 2 Cirrhosis of liver 2 1 3 - - - - - - - - - - - 1 — — — — 1 — 1 — — — Other diseasos of the digestive system 17 16 33 - - - - - - - - - 1 1 — 1 — 3 — 5 - 3 1 4 14 Nephritis and nephrosis 11 6 17 — — — — - - - - - - 1 - 1 - 2 1 2 1 2 - 3 4 Hyperplasia of prostate 4 - 4 - - - - - - - - - - - - - - - - - - 1 - 3 - Other diseases of the genito-urinary system 6 8 14 1 — — — — — — — — - — - — - 1 1 - - 1 2 3 5 Abortion — - - - - - - - - - - - - - - - - - - - - - - - - Other complicatio's of pregnancy, childbirth and Puerperium - - - - - - - - - - - - - - - - - - - - - - - - - Diseases of the skin and subcutaneous tissue - 1 1 - - - - - - - - - - - - - - - - - - - - - 1 Diseases of the musculoskeletal system and connective tissue 1 6 7 - - - - - - - - - - - 1 - 1 - - - 1 - 2 1 1 Congenital anomalies 3 5 8 — 2 1 1 — 2 — — — - — - - - - - 2 - - - - - Birth injury, difficult labour, and other anoxic and hypoxic conditions 7 6 13 7 5 - 1 - - - - - - - - - - - - - - - - - - Other causes of perinatal mortality 9 2 11 9 2 - — — — - — - — — — — — — — — — — — — — Symptoms and ill-defined conditions 10 13 23 — — 5 3 — — — — — — — — — — — — 1 1 -3 — 1 9 Motor vehicle accidents 12 13 25 - - - - - - 2 — 4 2 - 2 - - 2 2 1 - 3 5 - 2 All other accidents 26 24 50 — — — 1 1 1 — - 7 - 2 2 3 1 3 2 3 1 3 4 4 12 Suicide and self-inflicted injuries 9 6 15 - - - - - - - - 1 - - 2 1 2 2 2 2 - 2 - 1 - All other external causes 2 3 5 - - - 1 — - - - - - 1 2 - - 1 - - - - - - - All Causes 1,133 1,118 2,251 18 11 15 8 1 4 5 2 15 7 10 14 26 14 87 54 241 105 366 249 349 650 Totals 2,251 29 23 5 7 22 24 40 141 346 615 999 Percentages 100 1.29 1.02 0.22 0.31 0.98 1.07 1.78 6.26 15.37 27.32 44.38 11 INFECTIOUS AND OTHER DISEASES m me mmm INFECTIOUS AND OTHER DISEASES Notifications and deaths recorded during 1973 (Infectious diseases are those statutorily notifiable as at 31st December, 1973) Disease Number of notifications Number of deaths Removed to hospital Number of Cases returned to R egistrar-G eneral after correction of diagnosis Cases "coming to knowledge" but not notified Measles 63 / (169) - 19 637 - Dysentery 60 (65) - 13 63 21 Scarlet Fever 59 (66) • 3 59 21 Whooping Cough 11 (6) - 2 11 7 Infective Jaundice 73 (64) - 33 73 7 Ac. Meningitis 12 '10) 2 11 12 6 Ac. Encephalitis - (2) - - - - Ophthalmia Neonatorum 1 (6) - 1 1 - Paratyphoid Fever - (-) - - - - Typhoid Fever 1 (3) - 1 1 1 Food Poisoning 72 (64) 1 20 59 17 Malaria 8 (9) - 8 8 - Tuberculosis Lungs (primary) 81 (73) 8 _ 81 2 Tuberculosis Other Forms (primary) 15 126) - - 15 - (Figures in brackets are notifications for 1972) 15 FOOD POISONING Notifications Received 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 1955 315 1961 148 1967 90 1973 72 There was one outbreak to be reported in accordance with Memo 188 Med. of the Ministry of Health. Date No. of Notifications No. of persons served No. of cases reported No. of deaths Foods involved and organisms responsible 12.8.73. • 104 32 *1 Pork belly Clostridium welchii *This man had been suffering from a necrotising ulcerative colitis for some time and it is not certain how far the food poisoning contributed to his death. The above outbreak of food poisoning related to an Islington 'Home for the Retired.' As a result of detailed investigation it was ascertained that boned and rolled pork belly had been delivered to the Home on 10th August and cooked at about 10.00 a.m. the same day. After cooking, the pork was cooled and stored in refrigerator over night. On the following morning, 11th August, it was taken out of refrigerator, sliced and re-heated prior to being served at 12.30 p.m. Final reports showed that 32 people were affected with an interval from ingestion to onset of 12 hours onwards. The main symptoms included diarrhoea and abdominal pains. Laboratory investigations showed that, of 25 cases examined, 11 proved positive for Clostridium welchii a common cause of food poisoning in communal feeding establishments where meat has been cooked, allowed to cool slowly and then re-heated. All 5 of the food handlers submitted specimens which were negative. In consequence of this outbreak, advice was given to the catering staffs of Council establishments drawing attention to the dangers of re-heating food as described above. SMALLPOX Most recipients of this Report will, no doubt, be aware of the four cases of smallpox in London which occurred during March/April 1973, and which, subsequently, resulted in the tragic deaths of a young married couple. In connection with this, information was received in the department on the evening of 10th April concerning an Islington male resident aged 18 years employed as a van boy, transporting hospital laundry, who had handled a bag containing soiled linen of the two deceased persons, thus becoming a close contact. He had been vaccinated on 5th April. The Deputy Medical Officer of Health visited the home of this contact the following morning, i.e. 11th April, obtained particulars of all family and other contacts and arranged for vaccination of all concerned. At the same time, a Notice was served requesting the boy involved to remain away from employment and avoid mixing with people as far as possible until the 20th April 1973, to which he acceded, and he stayed indoors at home during this period. 16 Visits were made daily by one of the senior medical staff and the boy remained well during the time of surveillance. Compensation was paid by the Council for financial loss suffered as a result of complying with the Notice. Enquiries were received in respect of 50-60 other various classes of contacts residing or working in Islington which were successfully dealt with by the medical and administrative staffs of this department, and vaccination offered where considered necessary. Medical practitioners were kept aware of the situation by periodic issue of bulletins until the London Boroughs were formally declared free from smallpox on 13th May, 1973. Of the remainder of 54 references for suspected smallpox and supervision of possible smallpox contacts, 50 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. Advice was sought from the medical staff of the department in respect of four patients suffering from a rash of a type where it was desirable to exclude smallpox as a possible cause. Three cases were subsequently diagnosed as chicken pox and the remaining case had recently received a smallpox vaccination and had caused infection to other parts of the body by touching etc., the site of the vaccination. CERTIFICATES OF VACCINATION AND INOCULATION Applications for authentication dealt with by the Medical Officer of Health numbered 6,240 as against 4,269 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. LEAD POISONING There were eight references to the department on this subject during the year. Raised blood lead level was found to exist in seven of the cases and, of this number, works were carried out to remedy the conditions of five and rehousing effected in one. The remaining case concerned Council pre-war property and, as it was impractical for remedial works to be carried out with the tenant in occupation, rehousing was, therefore, effected to a post-war flat where the paint had a low lead content. CHOLERA There were 13 sporadic references to the department during 1973 for the supervision of possible cholera contacts who had arrived in this country from declared endemic or locally infected cholera areas as against 7 in 1972. All were kept under observation for the 5-day surveillance period. TYPHOID AND PARATYPHOID FEVER There were two cases of typhoid fever during the year but none of paratyphoid. Both cases occurred in a family comprising father, mother and two daughters aged 10 and 6 years respectively. The mother and daughters had returned to this country on 22nd June 1973, after a five-months stay in Pakistan; the father did not accompany his family abroad. 17 It was reported that the 6-years old girl who had been immunised on 20th June in Pakistan, had felt unwell with a fever and intermittent headache from the time of arrival in this country. She was seen on 25th June and received treatment but, as the fever persisted, she was admitted to an isolation hospital for observation on the 4th July. No other members of the family had been ill. On examination she had a slightly raised temperature but looked well and her temperature settled rapidly within 24 hours and she remained clinically well. However, salmonella typhi was isolated from blood culture taken on the day of admission. Following this, salmonella typhi was also isolated from stool specimens. She was progressing well until on the 16th July a high fever developed which persisted the following day; a blood culture was taken which again grew salmonella typhi. Her temperature subsided after four days and following this she made a very good recovery and was eventually discharged home on the 21st August after six faecal and urine cultures had been obtained, following treatment. The 10-years old girl was reported to have had a temperature in Pakistan but on arrival in this country her health was good. However, as a result of routine specimen procedure carried out by this department, salmonella typhi was isolated from stool specimen and she was admitted to the same isolation hospital as her sister on the 23rd July. This child remained well and was discharged home on 10th August after several negative faecal and urine specimens. Further enquiries and routine bacteriological investigations of the family and other domiciliary contacts were carried out and their medical practitioners informed. All bacteriological results from these contacts proved negative. Periodical checks on the two cases after discharge from hospital all proved negative. DYSENTERY There were 81 cases notified and 'coming to knowledge'during the year. Of these, 67 proved positive whilst 14 were clinical cases with negative stools. Approximately two-thirds of these were isolated cases, the remainder comprising small outbreaks at day nurseries and play groups. TUBERCULOSIS In 1973, 96 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 3 2 1 2 2 12 3 13 7 6 4 55 F 2 - 2 - 3 6 6 5 - 1 1 26 Non-Pulmonary M - - 2 2 2 - - - - - 6 F - - - 1 2 3 2 1 - - - 9 Totals - 5 2 3 5 9 23 11 19 7 7 5 96 The notification rate of all forms of Tuberculosis was the same as 1972 for both the borough and the whole country, i.e., 0.51 and 0.23 per 1,000 population respectively. The total number of cases remaining on the register after adjustment for deaths and transfers was on the 31st December 1973; Male Female Total Pulmonary 755 554 1,309 Non-Pulmonary 111 158 269 Totals 866 712 1,578 There were 8 tuberculosis deaths (all pulmonary) during 1973. The death rate of all forms of tuberculosis in the borough, per 1,000 population was 0.04, the national rate being 0.03. 18 VISITING OF NEWLY ARRIVED IMMIGRANTS -YEAR ENDED 31st DECEMBER, 1973 COUNTRY where passport was issued as stated by Port Health Authority Number of advice* notes received during the year from ports and airports relating to arrival of immigrants Number of firstt successful visits paid during the yearΦ COMMONWEALTH COUNTRIES Caribbean 48 7 India 86 27 Pakistan 23 12 Other Asian - - African 95 31 Other 55 12 TOTAL: 307 89 NON-COMMONWEALTH COUNTRIES European 28 4 Other 69 14 TOTAL: 97 18 GRAND TOTAL: 404 107 * Advice of arrival of immigrant. † First successful visit means the first time the local health authority officer established contact with the immigrant. ΦThese successful visits do not necessarily relate to advice notes received within the same period. 107 successful visits were paid to immigrant arrivals to the Borough by an officer of the Social Services Department during 1973 and I should like to record my thanks to the Director. SCABIES AND VERMIN Scabies Vermin Children under 5 years Number treated 38 91 Number of baths given 56 - Number of treatments - 91 I.L.E.A. Children Number treated 110 418 Number of baths given 175 - Number of treatments - 433 Adults Number treated 152 171 Number of baths given 182 - Number of treatments - 175 There was a slight decrease in the numbers treated for scabies in 1973 - 300 compared with 324 in the previous year. The numbers treated for vermin infestations, however, increased by some 36%, i.e. 680 as opposed to 500 in 1972. BACTERIOLOGICAL EXAMINATIONS The number of specimens sent to the Public Health Laboratory, Dulwich Hospital, S.E.22, for bacteriological examination was 2,648. This compared with a total of 2,852 specimens submitted last year. Annual fluctuations are due mainly to the extent of dystentery outbreaks in any particular year. 19 Examinations carried out Swabs (Diphtheria) 16 Sputum (Tuberculosis) 0 Faeces, Urine & Blood (Enteric Fever) 436 Faeces (Food Poisoning) 299 Faeces (Dysentery)1,862 Swabs (Streptococci) 0 Other Specimens 35 Total 2,648 VENEREAL DISEASES There were 6774 new cases giving Islington addresses treated at hospital clinics in London during the year, including 67 cases of syphilis and 1008 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 1973 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 2 5.4 2 4.7 18 and 19 2 5.4 2 33.33 4 9.3 20 and 24 8 21.6 2 33.33 10 23.3 25 and over 25 67.6 2 33.33 27 62.7 TOTALS 37 100 6 100 43 100 GONORRHOEA Under 16 10 1.1 12 1.9 22 1.4 16 and 17 14 1.5 80 12.4 94 6.0 18 and 19 86 9.2 133 20.7 219 13.9 20 to 24 299 32.1 218 33.9 517 32.8 25 and over 523 56.1 200 31.1 723 45.9 TOTALS 932 100 643 100 1575 100 20 ENVIRONMENTAL HEALTH SUBJECT PAGE Air Pollution 25 Consumer Protection 30 Disinfection and Disinfestation 33 Factories & Outwork 34 Food and Drugs 37 Housing 45 Noise 47 Offices and Shops 48 21 ENVIRONMENTAL HEALTH At the beginning of 1973 a review of the Special Services Section of the Public Health Inspectorate was carried out by the Council's Management Services Unit. The Special Services Section covers work primarily in the areas of food, clean air, noise, factories, offices and shops as well as consumer protection and public control functions. The investigation confirmed that routine work objectives were not being maintained, particularly in connection with inspection of food premises, due to pressures and contraints in other fields. As a result, the Council agreed to increase the establishment of officers by the addition of one post of Senior Public Health Inspector, two positions of basic Public Health Inspector and one Technical Assistant, in effect creating four area teams instead of three. These revised arrangements should provide for an increased frequency of inspections and go a long way to achieving higher standards. At the same time the opportunity was taken to allow one of the Senior Public Health Inspectors to act as Noise Advisory Officer without normal district inspection duties. Unfortunately, however, due to retirement, internal promotion and extended sick leave, the staff situation has worsened. At the end of the year the effective number of Public Health Inspectors available in the four teams of the Special Services Section was 50% under established strength. In common with other London Boroughs the Council has been unable to attract applicants for the basic post of Public Health Inspector. It has had to rely on its students qualifying and remaining with the Borough, the supply of which does not meet the demand, in spite of the fact that the establishment of students (14) exceeds the number normally allowed by the Public Health Inspectors Education Board. Mr. R.S. BARBER The retirement of Mr. R. S. Barber, Barrister-at-Law, Senior Meat Inspector on 30th June was reported to the Council. Mr. Barber commenced duty as assistant to the Meat Inspector of the former Metropolitan Borough of Finsbury in August 1932. He later obtained his professional qualifications and subsequently was appointed Senior Meat Inspector to Finsbury Council, a position which he continued to hold on the amalgamation of Finsbury with Islington to form the London Borough of Islington. Mr. Barber became a Visiting Lecturer at the College of Distributive Trades, Department of Food Commodities, and was elected a Fellow of the Association of Public Health Inspectors in 1960. In 1966, a further honour was conferred on him as a result of his appointment as an Examiner in Meat Inspection for the Public Health Inspectors' Diploma. He was elected a Fellow of the Royal Society of Health in 1970. During his local government service of nearly 41 years Mr. Barber established himself as an authority in his field and was called upon many times to read papers at Conferences and Seminars. At all times Mr. Barber carried out his duties most efficiently and was a popular and loyal member of the staff. When he retired the Council lost the services of an officer of outstanding merit. 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. 23 24 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. 24,098 747 1,272 63 6 949 Housing - Public Health action, drainage, refuse collection, pests, domestic noise and general nuisances. 22,668 2,371 838 89 462 1,888 (b) SPECIAL SERVICES Food & Drugs - Food premises, markets, stalls and delivery vehicles, sampling, meat and poultry inspection. 9,758 — 209 27 — — Offices, Shops & Railway Premises Act 1963. 2,133 — 155 4 — — Air Pollution and Factories - smoke observations, surveys, complaints, pollution volume measurements, Factories Act 1961, industrial noise 2,007 — 65 4 — — Public Control functions - Shops Acts, licensing, consumer protection, fertilizers and feeding stuffs, sampling. 10,924 — — 19 — — TOTALS 71,588 3,118 2,539 206 468 2,837 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) 13 Clean Air Act 1956 - Section 3 (3) Applications for prior approval of installation of furnaces (all approved) 6 Clean Air Act 1968 - Section 6 Applications for approval of chimney heights (all approved) 3 CONTRAVENTION OF A SMOKE CONTROL ORDER: Reference was made in last year's report to a complaint of nuisance from smoke arising from the burning of an unauthorised fuel, viz; wood off-cuts, on a coke heating stove in a factory in Southgate Road. in spite of several warnings the nuisance continued and legal proceedings were taken against the firm resulting in a fine of £10 and £5 costs for contravening a Smoke Control Order. MEASUREMENT OF AIR POLLUTION: The measurement of smoke and sulphur dioxide proceeded at the Department's three sites with a fourth site being operated by the Medical Research Council Air Pollution Unit situated at St. Bartholomew's Hospital Medical College in Charterhouse Square, London, EC1. The combined average monthly pollution figures for the Borough's three sites are shown in the form of two block graphs, comparison being made with the figures for 1972. Surprisingly, several months of the year indicate higher pollution levels than those recorded in 1972 and the reasons for this could be complex and varied. As an example, the mean monthly temperatures for April were below normal which undoubtedly led to an increase in the use of heating appliances and in May patches of inland fog coincided with unsettled weather conditions generally. 25 26 POLLUTION FROM DIESEL FUMES Arising out of the consideration of my annual report for the year 1971, I was requested to report more fully on the question of atmospheric pollution from diesel fumes. The following is the substance of the report I submitted to the Health Committee in February 1973. The subject falls naturally into two main sub-headings, viz., Road Traffic and Railways. (a) ROAD TRAFFIC The Council has no statutory responsibilities for the control of air pollution arising from road traffic. The Ministry of Transport and the Police are responsible for the enforcement of the Road Traffic Act and the Regulations made thereunder. Amending Regulations applying to diesel vehicles came into force in June, 1972. The Motor Vehicles (Construction and Use) (Amendment) Regulations 1972 require that no avoidable smoke or visible vapour shall be emitted. In addition, a driver must not be able to operate the excess fuel device, for easier starting, whilst the vehicle is in motion, unless such device does not cause any increase in smoke or visible vapour. This should ultimately eliminate the practice of lorry drivers tampering with the excess fuel device to gain more power and thereby producing dense black smoke. After 1st April 1973, a compression - ignition engine must be so constructed that it complies with the British Standard Specification for maximum opacity of smoke. The diesel engine is far more efficient than the petrol engine in that, except when starting from cold, there is, theoretically, always more than sufficient air to ensure complete combustion of the fuel. Broadly speaking it can be said that a diesel engine tends to emit more smoke than a petrol engine and about the same amounts of oxides of nitrogen, but it emits less hydrocarbons and aldehydes and very much less carbon monoxide (between 0.1 and 1%). A properly maintained and adjusted diesel engine emits no visible smoke and virtually no carbon monoxide. The sulphur content of diesel oil is quite low, averaging 0.3%. Diesel smoke in quantity is dirty and nauseating but research has not shown that it has any direct ill-effects on health. The petrol engine, in comparison is a more prolific and insidious source of pollution, producing up to 6% of carbon monoxide which is invisible. In this country a great deal of research on the health effects of motor vehicle emissions has been carried out by the Medical Research Council and other bodies and is still continuing. The Department of the Environment has recently commissioned a study to extend up to five years in five city centres, and in London a site in Cromwell Road, Kensington, has been selected. The behaviour of various pollutants will be investigated and the extent to which motor vehicle exhaust is contributing to the general urban pollution will be assessed. The Scientific Branch of the Greater London Council has continued to make measurements of pollution by spot tests and by continuous monitoring. Recent results have confirmed that, in general, the levels of pollution in London streets fall within what are currently considered to be medically acceptable limits. One such investigation was carried out by the Greater London Council in 1970 following a complaint of increased exhaust fumes in Batchelor Street, N.1, arising from the Barnsbury Traffic Scheme. The results showed carbon monoxide concentrations to be low, usually between 0 and 5 parts per million (by volume) and the highest value recorded was 10 ppm. Daily averages of smoke varied from 40 to 270 microgrammes per cubic metre. In the opinion of the Scientific Adviser the results gave little cause for complaint. In view of the lead organo-metallic additives used in petrol, a three year exercise was conducted by my department from 1968-1970 to measure the atmospheric lead contamination in Upper Street. The average lead content varied from 0.2 to 1.5 microgrammes per cubic metre of air. Based on a suggested American standard of 6 microgrammes per cubic metre, these results did not suggest any danger from that source. 27 (b) RAILWAYS Railway engines are prohibited from emitting 'dark' smoke but are not subject to the grit and dust emission provisions of the Clean Air Acts nor to a Smoke Control Order. THe Clean Air Act 1956 requires the owner of any railway locomotive to use any practical means there may be for minimising the emission of smoke. Since the changeover from steam-powered to diesel and electric locomotives during the past two decades there has been a marked reduction in atmospheric pollution from smoke and other pollutants. The same principles and conditions apply at an enhanced rate to the use of diesel oil for railway motive power as they do for road traffic. The overhead railway lines in the Borough include a small section of London Transport (electric) and parts of three British Rail suburban lines (diesel) together with the main British Rail Eastern Region (Northern Section ) line which traverses the Borough (partly underground) from Kings Cross to Finsbury Park. The motive Power Depot for this Region is situated at Finsbury Park, in conjunction with extensive railway yards and sidings, and would be the most likely source of nuisance from diesel fumes in Islington. Locomotives refuel at this depot and the engines are parked on the sidings and ignited prior to being brought into service. The ignition period takes only a few minutes and the amount of smoke observed by the Public Health Inspectors who visited the depot when the process was in operation was very slight. Daily observations at varying times have recently been made from Isledon Road and no dark smoke has been seen. British Rail, who operate a 24 hour service, appear to take all possible steps to prevent pollution from diesel fumes. The Depot Manager stated that no complaints of fumes have been received and there is no record of any complaints having been made to my Department. Electrification of the suburban lines from Kings Cross is expected to commence within the next five years. In connection with the National Survey of Atmospheric Pollution, the Council maintains three testing sites and, bearing in mind that one of the sites is approximately only 300 feet from the Motive Power Depot, the following data is of interest. For comparison, the relative figures for 1962 are shown in brackets as an illustration of the reduction in atmospheric pollution during the last 10 years. MEAN READINGS FOR THE YEAR 1972 MICROGRAMMES PER CUBIC METRE Smoke Sulphur Dioxide Pine Street, E.C.1. 33 178 (270) Upper Street, N.1. 46(125) 166 (218) Isledon Road, N.7. 35 (107)* 150 (169)* * Seven Sisters Road. These results indicate that the air in the vicinity of Isledon Road is generally cleaner in respect of smoke and sulphur dioxide than in the other areas and that no adverse effect results from these diesel emissions compared with the Borough as a whole. From the British Railways' point of view the most important toxic constituents of diesel fuel are the oxides of nitrogen. These are easily monitored, however, and the safe level is defined as 5 ppm. This limit is only likely to be achieved if diesel engines have to be run in confined spaces for any length of time, e.g. during tunnel tests. Benzpyrene (a carcinogen) is produced in measurable quantities only by engines which are grossly over-fuelled or in a very bad state of repair producing heavy black smoke. The soot particles in the smoke absorb the benzpyrene and it is not easily desorbed by body mechanisms. In other 28 words, the conditions which tend to produce benzpyrene at the same time tend to render it harmless. H.M. Inspector of Factories is, of course, responsible for the working conditions at the British Rail Depot. I have been in contact with the Chief Medical Officer of the British Railways Board who has offered to investigate the situation at Finsbury Park Depot, including the sampling. Bearing in mind the extensive research and investigations into atmospheric pollution being conducted on a national basis and the impracticability of undertaking additional measurements locally I am of the opinion that further action by the Council is unnecessary at the present time. The results of tests subsequently carried out by the Area Scientist of British Railways produced low readings in respect of both carbon monoxide (less than 5 ppm) and total nitrogen oxides (less than 0.5 ppm) and confirmed the views I expressed in my original report. 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 brough in his area. 29 CONSUMER PROTECTION AND PUBLIC CONTROL These functions are concerned with conditions of employment, closing hours and exemption orders under the Shops Act 1950 and related legislation, licensing or registration requirements of premises and sampling of materials on sale to the public. Explosive Acts 1875 and 1923 Fireworks Act 1951 The Keeping of Fireworks Order 1959 London County Council (General Powers) Acts 1920 and 1921 Employment Agencies Massage or Special Treatment Establishments Theatrical Employers Registration Acts 1925 — 1928 Performing Animals Act 1925 Celluloid & Cinematograph Film Act 1922 Nurses Agencies Act 1957 Public Health Act 1936 Nursing Homes Act 1936 Mental Health Act 1959 Pet Animals Act 1951 Rag Flock & Other Filling Materials Act 1951 Greater London Council (General Powers) Act 1967 Hairdressers and Barbers SAMPLING FUNCTIONS Fertilizers & Feeding Stuffs Act 1926 Premises registered: 100 Premises licensed: 84 9 Registered employers: 11 Current registrations: Nil Premises used for storage: 1 Premises licensed: 5 Nursing Homes registered: 1 Premises-licensed: 17 Premises on register as upholsterers: 12 Premises registered: 209 Registrations during year: 4 Samples taken: 6 Consumer Protection Act 1961 Samples taken: Toys (Safety) Regulations 1967 108 Nightdresses (Safety) Regulations 1967 4 Heating Appliances (Fireguards) Regulations 1973 3 Cooking Utensils (Safety) Regulations 1972 10 30 ENFORCEMENT The following is a list of the prosecutions undertaken during the year in respect of the contraventions of the legislation referred to above:- Consumer Protection Acts 1961 and 1971 Toys (Safety) Regulations 1967 Selling the following toys, having a coating of paint containing lead in excess of that permitted:- Fine Costs £ £ Engines, trucks and skittles 10 10 Xylophone 25 10 Toucan (Shopkeeper) 10 10 (Wholesaler) 10 10 Duck glove puppet 15 10 Drum (Shopkeeper) 35 10 (Wholesaler) 50 12.60 Lorry 25 15 Xylophone 40 10 Lorry 25 15 Tambourine 5 10 The Nightdresses (Safety) Regulations 1971 Selling an adult's nightdress not complying with Regulations. (Shopkeeper) 10 10 (Wholesaler) 50 20 Selling an adult's nightdress not complying with Regulations. (Shopkeeper) Conditional Discharge of 6 Months. 5 (Wholesaler) 10 20 Selling an adult's nightdress not complying with Regulations. 10 15 Heating Appliances (Fire Guards) Regulations 1953 The Electrical Appliances (Colour Code) Regulations 1969 and 1970 Selling a gas fire not fitted with a guard. 12 10 Selling a number of domestic appliances with main leads with wrong colour code. 100 12 Pet Animals Act 1951 Failure to comply with a condition of the licence that the sale of birds, fish and small animals be prohibited during a period from 1st October until 31st March. 25 10 31 CHILDREN'S TOYS In the two previous annual reports detailed references were made to the extensive sampling and investigation of toys sold in the Borough to ascertain whether the Toys (Safety) Regulations 1967 made under the Consumer Protection Act 1961 were being complied with. During the year 1973 a total of 111 toys were purchased from shops, warehouses and stalls in Islington and submitted to the Public Analyst for examination. Of these, 12 exceeded the maximum permissable amounts of lead or chromium in the paint, viz. 5,000 ppm and 250 ppm respectively of the dry paint film. In most cases the toys concerned were coated with more than one coloured paint which exceeded the legal limit. Amounts of lead varied considerably but in one instance no less than 320,000 ppm of lead was found in the paint on a toy xylophone - 64 times the permissible amount. The same toy contained 3,000 ppm of soluble chromium - 12 times the permissible amount. One of the 12 toys, a metal coach, in addition to having excess lead and chromium, also contained 53 pieces of cellulose nitrate comprising windows in its construction. Celluloid is entirely prohibited in toys except for table tennis balls. The 12 toys which failed the legal standards represent 10.8% of the total sampled in 1973 compared with 13% the previous year and 34% reported in 1971. Four of the toys were known to have been manufactured in Great Britain of which one was old stock. It is the Council's policy to institute legal proceedings against the manufacturer or importer and details are included in this report of proceedings which took place during the year. Four cases were still being processed by the Borough Solicitor at the end of the year. It was decided not to take legal action against one firm whose premises consisted only of showrooms. It does appear that some importers are still not showing due diligence in respect of toys being imported into this country. To quote an example, a prosecution is being considered by the Borough Solicitor in respect of a toy importer who has already one conviction within this Borough in respect of a contravention of the Toys Regulations, 1967. It is doubtful, when toys are tested prior to being imported, that they are tested as specifically laid down in the Schedule to the Toys (Safety) Regulations, 1967. Inspectors should as a routine precaution have a proper analysis of all the toys that they inspect. Adverse publicity is a greater deterrent to traders than the fines imposed for contraventions, but no deterrent should be necessary to protect the health of children. RAG FLOCK AND OTHER FILLING MATERIALS ACT 1951 Inspections of the thirteen registered premises were carried out during the year. One sample of feathers and one sample of coir fibre were taken during November and submitted to the prescribed Analyst. Both were found to comply with the standards laid down in the Regulations. EMPLOYMENT AGENCIES The Employment Agencies Act 1973 received the Royal Assent on the 18th July, 1973 but does not come into force until the Secretary of State by Order appoints. The Act considerably strengthens the law relating to employment agencies but in the meantime the London County Council (General Powers) Act 1921 continues to operate. 32 DISINFECTION & DISINFESTATION DISINFECTION Infectious Disease Rooms Treated 78 Secondhand clothing, horsehair, bristles etc., for export Certificates Issued 22 DISINFESTATION Rats and Mice (figures in brackets refer to the year 1972) Prime Complaints. Premises Domestic Business Local Authority Totals Rats 302 ( 495) 117 (171) 118 (173) 537(839) Mice 2154 (2491) 412 (414) 112 ( 99) 2678(3004) Totals 2456 (2986) 529 (585) 230 (272) 3215(3843) 56 smoke tests of defective drains were carried out, and there were 3 treatments of sewers. During the latter part of the year, following a short trial period, a new rodenticide (based on Calciferol and Warfarin) was introduced as a first choice poison in the treatment of mice infestations. This, combined with a splendid team effort on the part of the rodent operators, proved very effective and whilst it is too early to claim outstanding successes it is hoped that there will be substantial progressive reductions in mice complaints. Vermin (other than rodents) Rooms treated 2236 Wasp nests treated 2 N.B. Contractual arrangements were made late in the year for a private pest control firm to undertake the treatment of wasp nests on behalf of the Council commencing 1974. PIGEONS: Thirteen treatments were carried out on the Council's behalf by an authorised catcher during the year. 33 FACTORIES AND OUTWORK FACTORIES ACT 1961 Routine inspections were carried out during the year as indicated in the following schedule. The number of non-power factories in the Borough has declined even further. PART 1 OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises (1) Number on Register (2) Number of Inspections 13) Written noticps (4) Occupiers prosecuted (5) (i) Factories in which Sections 1,2,3,4,6 and 7 are enforced by local authorities. 14 15 65 — (ii) Factories not included in (i) in which Section 7 is enforced by the local authority. 2,044 481 3 (iii) Other premises in which Section 7 is enforced by the local authority 71 14 — Total 2,129 510 65 3 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) — — — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 55 17 — — — (b) Unsuitable or defective 217 166 — 1 2 (c) Not separate for sexes 8 8 — 1 1 Other offences against the Act (not including offences relating to Outwork). 3 — 3 1 — Total 283 191 3 3 3 FACTORIES - LEGAL PROCEEDINGS During 1973, legal proceedings were successfully instituted against the occupiers of factories in respect of the undermentioned contraventions of the Sanitary Accommodation Regulations, 1938:- 34 Failure to make effective provision for lighting and maintaining the sanitary £20 fine conveniences in a clean condition. £10 costs Failure to provide separate sanitary accommodation for the sexes. £20 fine £15 costs Failure to maintain the sanitary convenience in a clean condition. £10 fine £10 costs FACTORIES ACT - CONDITIONS IN THE CLOTHING INDUSTRY In May the Parliamentary Secretary of State met a deputation from the Association of Clothing Contractors and the National Union of Tailors and Garment Workers to discuss the deteriorating conditions in the clothing industry in London. As a result a meeting was called by Her Majesty's Acting Superintendent Inspector of Factories of the authorities concerned. The Deputy Chief Public Health Inspector and a representative of the Borough Planning Officer's Department attended on behalf of the Council. The delegation expressed concern about unfair competition from some firms within the clothing industry arising from the owners' failure to comply with Factories, Public Health & Planning Legislation. It was agreed to refer the matter to the London Boroughs Association and at the same time to examine and improve where possible the means of liaison between Her Majesty's Factory Inspectorate and the local authorities so that both were aware of new premises requiring inspection. Existing arrangements provide for the Public Health Department to be notified by the Factory Inspectorate of all new factories registered under the Factories Act and it was agreed that notification be extended to include the Planning Department. In addition arrangements were put in hand for the Chief Public Health Inspector to send to the Factory Inspectorate a monthly list of factories which had been brought to the Department's attention for the first time and in particular to draw attention to any in bad condition. At the same time it was arranged that the lists of planning applications be forwarded to the Factory Inspectorate for their information. These arrangements operated from the beginning of August and have greatly improved the liaison between the Factory Inspectorate and the Council's officers. By the end of 1973, 55 new clothing factories had been notified to the Factory Inspectorate by this Department. BASEMENT BAKEHOUSES (SECTION 70 - FACTORIES ACT 1961) The following nine basement bakehouses remain in the Borough. Routine inspections under the Food Hygiene (General) Regulations, 1970, were carried out during the year. Only minor items required to be attended to. 146, Blackstock Road, N.4. 3, Cardwell Terrace, N.7. 123, Newington Green Road, N.5. 76, Caledonian Road, N.1. 59, Junction Road, N.1. 7, Junction Road, N.19. 2, Tysoe Street, E.C.1. 88, Farringdon Road, E.C.1. 44, Amwell Street, E.C.1. 35 OFFENSIVE TRADES (PUBLIC HEALTH ACT 1936 - SECTIONS 107 & 108) There are four offensive trades operating in the Borough as follows:- Tripe Boiler J.L. Henson Limited, 26/40 Vale Royal, N7. Fat Melter J.L. Henson Limited, 26/40 Vale Royal, N7. Fur Skin Dresser J.A. Fischer Limited, 440A Hornsey Road, N19. Gut Scraper Geo. Tracey & Co. Ltd., 5 Tileyard Road, N7. Routine inspections were carried out during the year, but no action was required to be taken by the Council. 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 BOROUGH LIVING IN OTHER BOROUGHS Employed by firms in borough Employed by firms out of borough Employed by firms in borough Making, cleaning, washing, altering, ornamenting, finishing and repairing of wearing apparel 134 61 661 Making up, ornamenting, finishing and repairing of table linen, bed linen or other household linen 27 — 30 Making ornamenting, mending and finishing of lace and of lace curtains and nets — — 1 Making of curtains and furniture hangings — — 4 Cabinet and furniture making and upholstery work — — — Making or repairing of umbrellas, sunshades, parasols, or parts thereof — — 13 Making of artificial flowers 1 — 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 33 1 33 Making of brushes — 1 — Carding, boxing or packeting of buttons, hooks and eyes, pins and hair pins 5 1 4 Making of stuffed toys 1 — — Christmas stockings, or similar articles or parts of articles 14 — 4 Unspecified — — 5 TOTALS 216 64 759 One company was successfully prosecuted for persistently failing to make a bi-annual return of outworkers employed by them, as required under Section 133 of the Act. A fine of £20 was imposed, together with £20 costs. 36 FOODS AND DRUGS The up-to-date list of all known food premises is as follows:- Bakehouses 33 Bakers 35 Butchers 123 Confectioners 213 Fish fryers 54 Fish curers 10 Fishmongers 11 Greengrocers and fruiterers 101 Grocery and provision shops 325 Wholesale stores 70 Food factories 37 Public houses 295 Off licences 48 Cafes and restaurants 382 Canteens 75 Schools 85 Local authority establishments 25 Total 1922 209 informal intimations under the Food Hygiene (General) Regulations 1970 were served during the year, five legal proceedings under these Regulations were heard during the year, and 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 18 premises in the borough in which ice cream is manufactured and these received particular atttention; during the year 42 inspections were made. Premises registered for the manufacture and/or sale and storage of ice cream totalled 681. Preserved Food Premises Premises registered for the preparation or preservation of food 208 Premises registered as fish fryers/fish curers 67 Milk (Special Designation) Regulations 1963 (as amended) Number of licences in force 342 Milk and Dairies (General) Regulations 1959 Number dairies registered in the borough 10 Number of distributors registered in the borough 336 37 LEGAL PROCEEDINGS Food and Drugs Act, 1955 In last year's Annual Report mention was made of an article of food being seized by a Public Health Inspector and taken before a Magistrate for condemnation. The case was heard early in 1973 and the defendant was found guilty of selling half a cooked chicken in an unfit condition in that it contained insect larvae. The Magistrates imposed a fine of £25 and awarded costs to the Council of £10. It was possible to take this food to the Magistrate for condemnation because the complaint was made immediately after purchase. Such action by a consumer greatly assists the local enforcement officers. Seventeen other prosecutions were taken during the year, following formal food complaints and details of these are given below. Milk and Dairies (General) Regulations, 1959 It is the obligation of companies bottling milk to ensure that the bottles are clean immediately before they are used. One complaint of a dirty milk bottle during the year was particularly bad and this was taken before the court having jurisdiction in the area in which the bottle was used. The bottle contained some paperlike foreign matter and a dense mass of dead mould growth. The company concerned was fined £50 with an award of £10 costs to the Council. Preservatives in Food Regulations, 1962 Last year it was reported by the Public Analyst that two formal samples of minced meat contained non-permitted preservative. These cases were heard early in 1973 and both offences were found proved by the Magistrates. In one case the fine imposed was £25 and in the other £50 as this was a second offence. In each case costs of £10 were awarded to the Council. Food Hygiene (General) Regulations, 1970 Details of legal proceedings taken during the year are given below:- Fine Costs Insufficient ventilation. Cooked meat not being kept at a temperature above 145°F or below 50°F £50 £10 Floors of food rooms not kept clean. Premises insanitary. (on each of two partners) £60 £5 Cooking range in kitchen not kept clean. Premises insanitary. Walls of food rooms not kept clean. No notice requesting users to wash their hands after using conveniences. First aid equipment not provided. £85 £25 Food room communicating directly with the room containing a sanitary convenience. Sanitary convenience not kept clean. Supply of hot and cold water not provided for every wash hand basin. Hand-powered service lift with which food was liable to come into contact was not kept clean. Insanitary premises. Cooking range not kept clean. £70 £15 Insanitary premises. £40 £10 38 COMPLAINTS During 1973 the number of complaints about food containing foreign matter or being out of condition was 129. This was slightly less than last year's total and amounts to a very small percentage of food that must be bought and consumed in the Borough during a full year. Each complaint made was thoroughly investigated but legal proceedings were only possible in those cases where the complainant was willing to give evidence of purchase on the Council's behalf. However, the more informal investigations proved rewarding in that the manufacturer or the producer was made aware of a deficiency or oversight on the part of his company which had led to a customer being dissatisfied and was able to take remedial action. The involvement of the local authority, even in an informal investigation following a food complaint means, that manufacturers and producers are more likely to take necessary action. The following prosecutions were instituted under Section 2 of The Food and Drugs Act 1955:- FOOD AND DRUGS ACT 1955 - SECTION 2 Fines £ Costs £ Live larvae in packet of mixed cereal 60 15 Mould Growth in portion of cooked chicken 50 10 Mould Growth in crumpets 25 10 Mouse in packet of rice Absolute discharge 10 Loaf containing a portion of a cutting blade 20 10 Mould Growth and white coating on coffee creams 100 20 Mould Growth in can of beans with tomato sauce 35 10 Piece of metal in part sliced large white loaf 75 25 Stale sausage and one affected with mould growth in packet of sausage rolls 15 10 Packet of walnut pieces infested with insects 75 10 Packet of prunes containing two parts of a mouse 25 10 Two foreign bodies in small white loaf 25 10 Spider in meat pie 20 10 Eccles cake containing human hair 30 10 Cockroach in cooked Madras Curry 25 10 Loaf of bread containing mould growth 15 10 Mouldy beefsteak and kidney puddings 50 10 SAMPLING Bacteriological checks are made regarding the cleanliness of food to establish whether it is free from or infected with pathogens. Chemical examination of food is made to establish that the contents are to the standard the purchaser is entitled to demand. Labels are examined to ensure compliance with the Labelling of Food Regulations. 39 Bacteriological Sampling Ice Cream Twenty-two samples of ice cream were sent for bacteriological examination and, of these, twelve were returned as being unsatisfactory. These were immediately followed up by the Public Health Inspectors who checked on the cleaning procedures in the premises of manufacture and also considered the general hygiene of the premises and the personnel handling the ice cream. Where the ice cream was manufactured outside this Borough, the appropriate authority was notified for their follow-up procedure. Premises from which unsatisfactory ice cream was obtained in this Borough have their products resampled and this continues until better results are obtained. Other Foods Five samples of various other foods were taken. These were frozen chicken parts, drinking choclate from a vending machine, Chinese food and two samples of uncooked prawns. Only the sample of Chinese food produced any oganisms which were likely to cause food poisoning. In this case, the organism Bacillus Cereus was isolated from the cooked rice. This organism has produced food poisoning in several reported cases and Public Health Inspectors now check on the handling of cooked rice when inspecting Chinese restaurants, etc., in an attempt to prevent food poisoning from this source. Chemical Sampling Throughout the year the Public Helath Inspectors have again informally purchased a wide range of foods for informal analysis by the Public Analyst. The food is purchased over the counter in the same way as a housewife would buy it and in most cases the vendor will not know that it is being purchased for analysis. The figures for 1973 are as follows; Informal purchases 665 Adverse 45 Formal Samples 7 Adverse 1 The samples purchased to monitor the residual insecticide levels in foods were Golden Delicious apples, Satsumas, 2 separate pounds of new potatoes from different sources, black and white grapes and Irish Back Bacon. In the back bacon, there was a very slight trace of DDT but in the others the Public Analyst could detect no traces of pesticidal residues. A routine check is kept on milk supplies available in the Borough and twenty samples were informally submitted for analysis. All these samples showed milk fat and milk-solids-not-fat to be well above the permitted percentage or legal standard depending upon the type of milk purchased. LABELLING 1973 was the first full year after the coming into force of the Labelling Of Food Regulations 1970. These Regulations lay down specific and very detailed requirements for the labelling of food to ensure that the purchaser is able to ascertain exactly what she is buying. Where sampling indicated that the food product was incorrectly labelled an informal approach was made to the manufacturer and the label appropriately amended. The Regulations are new and complicated and most infringements have been of a minor nature. Any serious infringements would result in legal proceedings. 40 UNFIT FOOD During the year the following unfit food was surrendered voluntarily:- Tons Cwts Quarters Pounds Canned Goods 10 7 2 13 Meat Products 2 4 — 2 Meat 2 16 1 4 Frozen Foods 3 13 — — Currants 1 14 — 21 Vegetables — 14 1 24 Others — 7 — 10 21 16 2 18 Pints Quarts Gallons Milk 67 — — I Beer 24 — — I Ice Cream — — 14 574 voluntary surrender certificates were issued and 194 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 lcoal 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. There were 84 listed sellers of Part II poisons other than pharmacists, including 1 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. Applications made but not finalised at the end of 1972 7 Applications received 1973 58 TOTAL 65 Applications granted or renewed 1973 48 Applications refused 1973 5 Applications withdrawn 1973 5 Applications pending, carried forward to 1974 7 TOTAL 65 Premises registered at 31st December 1973 48 41 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. 31 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 29 Wholesale bacon factories 7 Sausage casing factories 7 Wholesale provision warehouses 5 Public cold air stores 3 The Senior Pub|c Health Inspector (Meat) is responsible for ensuring that no diseased or unsound meat or other food stuff is passed on to the public. During the year, 1367 certificates were issued for unsound meat and other foods and 243 health certificates were issued for the export of meat, etc., to overseas countries. Since joining the European Economic Community there has been a steady increase in the number of containers transporting meat into the Borough from the continent of Europe. In the foreseeable future this trade will continue to expand. It is now estimated that annually, well in excess of 1,000 vehicles are bringing meat into the wholesale premises and cold stores in the Islington/Smithfield area. In all cases where notification is received from the ports of an un-examined container, the vehicle is seen on arrival at its place of destination and its contents examined. In addition, as a result of daily visits to wholesale premises within the district, the contents of a vast majority of the remaining containers are examined as a matter of routine, thus ensuring adequate supervision of the increased meat trade involved. 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. During 1973, the Senior Public Health Inspector (Meat) condemned or had surrendered to him the undermentioned food stuffs:- Tons Cwt Qtrs lbs Meat (diseased) 2 18 3 1 Meat (unsound) 12 7 3 0 Bacon 9 8 0 0 Offals 1 8 2 8 Poultry 0 13 3 19 Game 0 5 2 22 Rabbit 0 0 0 11 Canned Foods 2 18 1 10 Cheese 5 4 1 15 Miscellaneous 3 17 1 16 Total 39 2 3 18 42 FOOD HYGIENE EDUCATION As in previous years the Public Health Inspectors in the Special Services Section were called upon to give talks to interested organisations and groups on their work. In addition, towards the end of the year a four-session series of talks was given to girls in one of the secondary schools in the Borough as part of their Community Education course. In April the Department launched its Food Hygiene Courses for Food Handlers. A preview was held for management and those who employ large numbers of staff in the food industry. About 40 attended. All the material that would be used in the Courses was shown and those attending were invited to make comments and criticisms. The Course itself was split into two afternoon sessions and each attender was given a Certificate of Attendance on completion of the Course. Special sessions were also arranged for the Heads of school kitchens. In all 106 people attended. The main part of the first session was a sound/colour-slide presentation entitled "Mind Your Own Business". These slides attempted to show that the majority of food hygiene is common sense and that poor premises can lead to a poor business. This was followed by some criticisms of premises that Inspectors have found during routine visits and attempts were made to highlight dangerous practices which have been seen to occur. The second week put the emphasis on food poisoning and how lax staff practices can put a large number of people at risk. A new colour film was shown during this session. There followed a sound/colour slide presentation of an Officer of the Local Authority obtaining a formal sample and attenders were reminded of certain other aspects of the running of their food business which could be of advantage to them. The lectures were given in the Health Education Centre Conference Room in the Department in which special wall display units were constructed on related topics. DISEASES OF ANIMALS ACTS, 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:- Swine Vesicular Disease (Amendment) Order 1973 Movement of Pigs (Waste Food Precautions) Order 1973 Diseases of Animals (Waste Food) Order 1973 Tuberculosis (Amendment) Order 1973 Quarterly inspections were made of the two kosher poulterers shops in the Borough at which evisceration of poultry is carried out. Two new premises were licensed under the Pet Animals Act, 1951 during the year, making a total of 17 premises. All were subject to routine inspections during the year in connection with the health of animals kept for sale on the premises. At one of the pet shops an animal boarding establishment was opened after being licensed by the Council following satisfactory reports from the Council's General Purposes Inspector and the Veterinary Officer. The advice given by the two officers resulted in a high standard in the premises and equipment. 43 Performing Animals (Regulation) Act 1925 In June, Sir Robert Fossett's Circus appeared in Highbury Fields. During the time it was performing there several visits were made and inspections carried out. All animals quarters were inspected and were found to be clean and well kept. There was ample supply of water and food and refuse was properly removed. All performing animals certificates were checked and were in order. 44 HOUSING REGISTRATION OF HOUSES IN MULTIPLE OCCUPATION: A) Registration Scheme This scheme came into force on the 18th December, 1972 and although maximum publicity was given at the time for the need for owners to register houses having three or more households in occupation the response to the publicity was very poor. At the end of the year 605 properties had been registered and it will be appreciated that these houses are only a small proportion of those to which the scheme applies. 225 of the registered properties were the subject of detailed inspections by the Public Health Inspectorate and the appropriate notices were served to secure improvement and repairs. B) The Area Approach In addition to the Registration Scheme areas of the Borough have been designated for detailed inspections on a house-to-house basis. Following inspection action is instituted to remedy disrepairs and bring the house up to the standards prescribed for houses in multiple occupation. At the end of the year 1,344 houses had been inspected. Both approaches are securing improvements to the living conditions of people sharing accommodation but the procedures make great demands on staff resources which are critically short. The rate of progress will continue to be unsatisfactory until sufficient staff is available. CLEARANCE PROGRAMME 1971/1975 The programme is reviewed annually and at the end of 1973 there were 1022 houses in the programme. Responsibility is divided between the Greater London Council and the London Borough of Islington and of the 273 houses remaining to be inspected 122 are to be dealt with by the Greater London Council and 151 by the London Borough of Islington. 7 clearance areas were represented during 1973 as indicated below and comprised 53 houses occupied by 118 families containing 288 persons. Address: Houses: Persons: Families: Balmoral Grove No. 1 Clearance Area 14 84 32 Balmoral Grove No. 2 Clearance Area 3 11 4 Balmoral Grove No. 3 Clearance Area 2 11 6 Eden Grove No. 1 Clearance Area 12 46 20 Eden Grove No. 2 Clearance Area 4 20 7 PentonvilleRoad Clearance Area 5 31 12 Brookside Place Clearance Area 13 85 37 53 288 118 INDIVIDUAL UNFIT DWELLINGS: In 1973, 8 whole houses were represented as unfit for habitation and not repairable at reasonable cost, and 26 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 25 cases. 12 Notices were served under the provisions of Section 9 of the Housing Act 1957 requiring the repair of unfit houses and 39 notices were served under the provisions of Section 9 (1A) of the Housing Act, 1957 for houses which although not unfit, required substantial repairs. 45 TENEMENT DWELLINGS: Tenement blocks which should be improved are considered by a working party of officers who seek the views and cooperation of the owners and in appropriate cases recommend the service of improvement notices. During 1973 improvement notices under Section 20 of the Housing Act 1964 were served upon the owners of 7 tenement blocks. Following discussions, the owners of 6 of these blocks agreed to sell to the Council. The owner of the other block agreed to carry out improvements. In 1973, the Council agreed to purchase the following tenement blocks: Albert Mansions, Liverpool Road. Anson House, Essex Road. Arundel House, Halton Road. Brookfield House, Halton Road. Dagmar House, Dagmar Passage. Devonshire House, Cross Street. Essex House, Essex Road. Fowler House, Halton Road. Salisbury Buildings, Clerkenwell Close. St. Johns Mansions, St. John Street. Tufnell House, Pleasant Place. VACANT & PART VACANT PROPERTY PROGRAMME Concerned at the number of vacant and part vacant properties in a Borough having a severe housing shortage, the Council, at their July meeting, adopted procedures to try and bring such property back into use. Briefly the procedure is for the Public Health Inspector to contact the owner to discuss the situation. Where the owner expressed a wish to sell to the Council details were passed to the Borough Valuer. Some of the properties referred for investigation were found to be in the process of conversion or awaiting grant or planning approvals. During the latter part of the year 114 properties were referred to the Health Department for investigation. 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. 1324 houses were inspected under these provisions during the year. 26 cases of fire in multiple-occupied properties were reported by the London Fire Brigade and 3 fatalities occurred. Each case reported is investigated and notices served, where appropriate. 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 third 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. 324 applications were dealt with in the year. Inspections are now made, and advice given to the Housing and the Social Services Departments on all matters relating to fire precautions in sheltered housing, day and residential care establishments, in addition to the inspections carried out in connection with the registration of child minders and play groups. Buildings under the control of this Department are also inspected, and advice given to other departments on request. 46 NOISE NOISE SURVEY IN CONJUNCTION WITH SCHOOL CHILDREN The noise survey described in the last annual report has continued this year. It is being undertaken by Secondary Schools and residents'organisations. The project has run into difficulties mainly because of the staffing problems in Islington Schools. The exercise would be pointless unless a worthwhile final result was obtained. Indeed, schools would not participate in the project unless worthwhile results for their labours could be seen. In order to obtain the results which could be used, a great amount of detailed work is required and this necessitates a great deal of time devoted to the survey by the children. This time has to be found during school hours. The survey work is undertaken in the Borough away from the school premises and to safeguard the interests of the children they must be supervised in this exercise by a member of the school staff. Staffing of the project by the schools has in many cases proved an insurmountable problem. Islington schools generally have been very short staffed and those staff who are available are needed to teach and not to supervise community projects. Each year sees a large turn-over of teaching staff and whilst a teacher initially taking on the noise survey would have an interest in the survey he/she might be replaced by someone who does not have similar interests. However, the survey continues. TRAFFIC NOISE The biggest noise problem in Islington is traffic noise. A Department of the Environment Circular (10/73) encouraged liaison between Environmental Health Departments and Planning Departments. As a response to this my department arranged with the Planning Department for measurement and analysis of traffic noise in projects associated with environmental schemes and with the Borough Transportation Study. Traffic noise is assessed by measuring it over an 18 hour period (6 a.m. - 12 midnight) and this is analysed to show the level of noise which is present for 10% of the measured period of time. Equipment purchased for this purpose included a Sound Level Meter, a Tape recorder, a Sound Level Recorder and a Statistical Distribution Analyser. 47 NOISE IMOISE AT NIGHT FROM INDUSTRIAL PREMISES An effort has been made in tackling noise nuisance to residents who occupy premises adjacent to industrial concerns which work at night. Owners of Industrial premises often say 'we have been working at night for years and nobody has complained before'. The answer to this statement appears to be that because of the change in public opinions helped by public education on the subject, noise is now considered an environmental pollutant. Therefore, levels of noise which people would accept several years ago are not acceptable at the present time. This change in the public attitude is being reflected in proposed legislation governing noise control. NOISE ABATEMENT ACT, 1960 - COMPLAINTS 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 33 7 1 21 — 30 92 Nuisances confirmed 16 3 1 8 — 9 37 Remedied informally 14 2 - 7 — 9 32 Abatement Notices served 2 1 — 1 — — 4 OTHER NOISE COMPLAINTS Four complaints were received relating to statutory undertakers whose activities are exempted under the Act; nevertheless informal action was taken in each case. Four 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. Fourteen complaints were received regarding traffic noise. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 In submitting the annual report on the administration of the Offices, Shops and Railway Premises Act, 1963, the Department of Employment requested that the Council review the ten year operation of the Act bearing in mind the possible repeal of the Act by impending legislation. The following comments formed the basis of the review. Over the years a system has been evolved to monitor proposals and applications made to various Departments of the Council for the construction or alteration of buildings in order to ensure full compliance with the Offices, Shops and Railway Premises Act. Liaison with the Planning Department has been particularly close. The resulting consultation between the Public Health Inspectors, Architects and Builders at an early stage of proposals has resulted in premises complying with the legislation prior to occupation. 48 The Council's major effort on the enforcement of the Act was accomplished in 1966 with the completion of the first inspections of all registered premises. A full survey of the Borough, to disclose the unregistered premises, was carried out in that year. Certain of the specific provisions of the Act have never provided more than minor individual problems. These are the provisions relating to the supply of drinking water, clothing accommodation and seating and eating facilities. The requirement regarding cleanliness of premises can be seen, over the nine years of operation of the Act, to be largely a problem concerned with the common parts of multi-occupied premises, i.e. water closet accommodation and stairways and passages. Overcrowding, in its broadest sense, has not proved to be a problem. However, it is still common to find an overcrowded and probably ill-ventilated telephonist/receptionist cubicle, formed by partitioning off a part of an office. Ventilation in office accommodation is generally satisfactory. Many of the recent office developments in the Borough are provided with full or partial air conditioning. No problems have so far come to notice from the use of these plants. From time to time, the Department receives complaints about inadequate heating. These are generally found to be a result of a breakdown or malfunction of heating plant and the complaints arise most frequently from multi-occupied premises. One of the most common breaches of the requirements of the Act is failure to provide a thermometer. In 1965 a special report was made on the lighting in various premises. Certain parts of the premises, notably staircases in multi-occupied blocks, warehouses, and the stockrooms of shops and sanitary accommodation, were found to be poorly lighted. This is still the position and requirements are made when poorly lighted parts of premises come to notice. In the first Annual Report on this Act, for 1965, the comment was made that the condition of floors, passages and staircasing constituted the greatest threat to the employees' welfare. Despite the inspectors' efforts over the years, this statement is still partly true. Constantly attention has to be drawn to defects of structure and obstructions. In many cases it appears that wear and tear and continuing poor practice pass unnoticed by the occupiers, who come to accept conditions as normal. Some use has been made of letters quoting Section 22 of the Act in cases where danger exists. A firmly worded letter pointing out that an application could be made to a Magistrates' Court for an Order to prohibit a particular practice has been found to be effective. The Act has been effective in reducing the hazard at one time posed by dangerous machinery, hoists and lifts. Initial difficulties with the guarding of food slicing machines have now been overcome. Occasionally unguarded prescribed dangerous machines are found and guards still have to be required. The system whereby hoists and lifts in premises subject to the Act are inspected by a competent person and reports on certain defects are sent to the Council has been in operation since 1969. It is normal for this Council to require the responsible person to remedy the defects set out in the inspecting engineer's report. In 1973 it was found necessary to take what must be an unusual course in the enforcement of this particular Section of the legislation. This Council successfully prosecuted a firm of engineering surveyors for failure to correctly notify the Department of the result of their inspection. Three summonses were issued for failure to submit the necessary reports in respect of two hand operated lifts and a hoist at a Public House. The summonses were not contested and the defendants were fined £10 on each summons with £3 costs. 49 The requirement to notify accidents is considered to be an essential piece of legislation. Any deficiences of working conditions or methods brought to light can be firmly dealt with. Employers appear to have become progressively more aware of the requirements of legislation in respect of notification. This Council has for several years distributed leaflets giving advice on the notification of accidents. This Department has experienced some minor difficulties in identifying owners in multi-occupied office blocks where there has been some degree of subleasing. This could be overcome if some power, such as that provided by Section 277 of the Public Health Act 1936, were incorporated in any future legislation requiring the occupier and the principal lessor to give sufficient information on the ownership of the property to allow legal proceedings to be undertaken. The assistance of the Department of Employment and Productivity, both in contact with their officers at local and regional level and by reference to the many circulars and booklets produced by them, has been invaluable. 50 STATISTICS 1972 figures in brackets REPORTED ACCIDENTS Fatal Non-Fatal Investigated ACTION Informal Warning Formal Warning Prosecution (i) Offices - (1) 103(115) 92 (76) 5(6) 3(13) -(-) (ii) Retail Shops 1 (-) 23 (36) 12 (17) 1 (-) - (3) -(-) (iii) Wholesale Shops & Warehouses - (-) 11 (12) 10 (6) 2 (-) - (1) -(-) (iv) Catering Establishments & Canteens - (-) 13 (13) 9 (11) - (1) 1 (2) -(-) (v) Fuel Storage Premises - (-) - (-) (-) - (-) • (-) -(-) Totals 1 (1) 150(176) 123(110) 8(7) 4(19) -(-) REGISTRATION AND GENERAL INSPECTIONS Class of Premises Number of premisec 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) (14) Offices 165 (74) 1633 (1590) 442 (213) Retail Shops 54 (40) 1136 (1191) 313 (301) Wholesale shops & Warehouses 14 (15) 259 (260) 72 (82) Catering Establishments open to the Public, Canteens 9 (16) 348 (360) 111 (213) Fuel Storage Depots (-) (-) (-0 Totals 242 (145) 3376 (3401) 938 (809) Total number of visits of all kinds to premises Registered under the Act = 2119 (2191) ANALYSIS BY WORKPLACE OF PERSONS EMPLOYED IN REGISTERED PREMISES Class of workplace Number of persons employed (1) (2) Offices 47460 (46719) Retail Shops 5593 (5575) Wholesale departments, warehouses 4765 (4548) Catering establishments open to the pu6lic 1802 (1721) Canteens 926 (954) Fuel Storage Depots 2 (2) Total 60548 (59519) Total Males 37607 (37410) Total Females 22941 (22109) 51 HEALTH EDUCATION HEALTH EDUCATION SERVICE "For the merchandise of it is better than the merchandise of silver, and the gain thereof than fine gold." "She is more precious than rubies; and all the things thou canst desire are not to be compared unto her." "Length of days is in her right hand; and in her left hand riches and honour." "She is the tree of life to them that lay hold upon her; and happy is every one that retaineth her." Book of Proverbs These verses referred to "understanding", but they could be applied equally well to that which it is the main function of Health Education to provide - Good Health. It cannot be purchased at any price and to maintain it is to preserve a personal fortune. With good health we should be able to lengthen our days and of course improve the quality of life. As forecast in last year's report the activities of the service have again expanded, the new centre and conference room is in constant use, and more professional workers from all disciplines in the health, education and social welfare fields are coming for advice, information and practical instruction in the presentation of health education, its method and content. TRAINING Many colleagues from other authorities have enquired about our health education service and the way in which it was created and is now administered. It is a great compliment to our service that visits have been made to the health education centre by members of these authorities in order to see exactly how we run. Student health visitors from the Northern Polytechnic receive instruction in the method and content of health education and are assisted in their practical field work by using materials, visual aids and advice freely supplied by the service. Medical students receiving training in Community Medicine are given a tutorial on health education practice and practical instruction is also given to student public health inspectors. School teachers from local schools attend the centre for practical instruction and the previewing of audio visual material which is so useful to them when preparing lessons. Additionally, groups of children from various schools in the Borough attend for lectures on a number of health topics and some are attending a condensed course in health education. Day nursery matrons have attended a course on topics which are particularly relevant to the children and their parents, and are now asking to be included within the area of our operations. Matrons of residential homes from the Social Services Department attended a course of lectures dealing with topics particularly suitable for young people who are in residential care. These included human relationships, contraception, sexually transmitted infections, smoking and drug abuse. Home helps from the Social Services Department have attended courses on hypothermia recognition in the elderly and the emergency action to be taken in such cases; they have also been given practical instruction in oral resuscitation. Health visitors and school nurses have received "In Service" training in the presentation of talks to secondary school children on B.C.G. and rubella immunisation. The presentation of these talks enables children to fully understand the implications attached to prophylaxis and the reasons why they should be protected. The value of talks by health education staff in the past has been shown by 55 the increased acceptance figures for these protections and it is hoped that with continual reinforcement by the nursing staff the take-up rate will be maintained. Post graduate medical students who are reading for the diploma in public health at the Royal Institute of Public Health and Hygiene received practical instruction in method and content and visited the health education centre. Groups of nursing students from the Hackney area also visited the centre to receive instruction. It is gratifying that the health education centre is being used to the full, not only by members of my own staff but by colleagues from other departments in the Borough, medical students, nursing schools, universities and polytechnics who give professional training and other interested persons from all over the country. SMOKING ADVISORY CLINIC The clinic celebrated its tenth anniversary of its first day of operation, since when many hundreds of people have managed to "kick the habit" through the advice and help received. Nearly two hundred people attended the celebration party, held in the Council Chamber, for those who have managed to give up smoking through the clinic. There were also many letters of regret from former patients who were unable to attend but were still maintaining their non-smoking habit. The occasion was marked by the cutting of a giant cake in the form of a lighted cigarette which was featured on the B.B.C. Television programme "Nationwide" and the clinic received much favourable publicity and response as a result. The health education officer appeared on the Thames Television programme "Good Afternoon" and was featured in a special programme dealing with smoking. Both Dr. Howard Williams and the health education officer have broadcast on Radio London and London Radio "chat" programmes presented to assist people in giving up smoking. There has been liaison with my colleagues in the London Boroughs of Lambeth and Enfield who have also established smoking advisory clinics. The health education officer has been invited by "Action on Smoking and Health" to serve on a sub-committee dealing with the creation and running of smoking advisory clinics on a national basis. A unit from the American Broadcasting Corporation again visited the clinic in order to film it in operation so that it could be televised on the American network. Mr. Fife Robertson the well known Television personality made a feature of the clinic in his television series "Robbie". Another well known theatrical personality the famous comedy actor Mr. Brian Rix, very kindly tape-recorded a personal message about smoking and the advantages of attending the smoking advisory clinic. The tape can be heard by anyone ringing a special telephone number which is widely advertised throughout the Borough. A copy of the poster advertising the number is included in this report. It is hoped that the success of the smoking advisory clinic will continue and that other local authorities and perhaps in the future area health authorities of the new Health Service will also commence activities in this very important sphere of health education; if we bear in mind that more than 100,000 premature deaths per year in this country are attributable to the smoking habit then the value of smoking advisory clinics will be fully appreciated. 56 57 58 USE OF THE MEDIA The mass media is one of the most potent health education tools available to my department and the presentation of health facts in an easily understood manner is invaluable to the health educator. The service has been asked by many leading journalists to provide material for articles in the national and local press dealing with health topics. The B.B.C. sought information concerning the Council's free family planning service and broadcast a feature about it. A similar feature was broadcast on the Italian wave length of the European Service. The B.B.C. television programme "The Burke Special" featured sexually-transmitted infections and the health education service was pleased to supply the producer with information and material for the programme. Much new printed material in the form of posters and leaflets has been produced for general distribution in the campaigns on various topics which are presented at two-monthly intervals throughout the year. These have included posters and triptych displays on Nits, Weaning, Family Planning, Smoking, Immunisation, Home Safety and Vision. A series of slides with a tape-recorded commentary entitled "The Slimming Game" was produced by members of the health education team and this is now widely used by the department's slimming clinics which have been commenced at various centres throughout the Borough, including one for Council staff. The health education officer acts as an adviser on health education matters to the Women's National Cancer Control Campaign. The Campaign recently made a new 16 mm sound film on cervical cytology on the production of which he gave his advice. A very effective flannelgraph dealing with routine immunisation schedules, based on an idea submitted by a member of the health visiting staff, was devised and produced. Some of the material produced, e.g. posters, displays and flannelgraphs, has been purchased by other local authorities who are impressed with the quality and originality of the material. Photographs of some of these items are included in my report. ACTIVITIES IN THE SCHOOLS General activities in the schools continue and the demand for advice and audio visual material is constantly increasing together with the requests for lectures and discussions on many health subjects. "In Service Training" sessions are held on a regular basis to enable teachers to be brought up-to-date with trends and to be made aware of the content of the material which is readily available to them free of charge through the service. Media resource kits have been devised and assembled which enable a teacher to present a particular topic to any group of varied age and ability. The topics covered by these kits include menstruation, smoking, personal hygiene, contraception, foot health, dental hygiene and home safety. Additionally kits covering other topics are also in the process of being assembled. The kits contain sound film, slides or film strips, models and other visual aids; samples of some items used, e.g. contraceptives, toiletries, menstruation aids, etc., leaflets, fact sheets and lesson outlines are also included so that the teachers should have no difficulty in presenting the topic effectively once they have become familiar with the contents. The primary schools in the Borough once again received a visit from the dental health puppet show and each child received a dental hygiene kit. The show is always enthusiastically received and the children love to take home to mummy their very own tooth-cleaning outfit. 59 60 Parent teacher associations at many schools were addressed on a number of occasions by members of the health education team, and much of the material used in lectures given at the schools to the pupils was seen by the parents and approved by them, thus endorsing the action of the head teacher in presenting the talks, some of which in certain areas are thought to be controversial, e.g. contraception, drugs and sexually-transmitted infections. However, once the material had been viewed by the parents they accepted it quite readily. The service is in constant touch with the health education advisers and the health educators of the I.L.E.A. and they work very effectively in co-operation with each other. The health education officer has been asked on a number of occasions to give special talks at conferences presented by the I.L.E.A. OTHER AGENCIES A wide use of the service has been made by many agencies other than those previously mentioned in my report. Voluntary bodies such as "Grapevine", the Y.M.C.A., the British Red Cross, Youth and Church groups are requesting talks and the loan of audio visual material and equipment and seeking advice. Commercial undertakings are also asking for talks to staff on health problems of today. The Post Office telecommunication branch continues to ask for lectures to its apprentices on their induction course. These young men come from all over the country and mary have never had the opportunity of receiving the information given to them at their previous schools. Pre-retirement courses which will help people during their retirement are presented at some further education establishments in the Borough, and the health education staff have been asked to address them on relevant topics. The Salvation Army has shown an interest in our service and made particular enquiries about hypothermia and its detection and prevention. A number of our colleagues from other London Boroughs are also making use of our service by borrowing audio visual material and aids from time to time. Arrangements were made to give talks at Holloway prison to some of the prisoners. The topics included babycare, sexually-transmitted infections, drug abuse and smoking and contraception. Students from an American university came for field work instruction as part of their training for a B.Sc. course in health education. The health education officer was invited to speak at the National Conference of "Casualties Union" at Nottingham University where he gave a paper on "Drug abuse". He was also asked by the Salop County Council to present a paper on "Communication and the media" at a health education conference presented at the Shire Hall. FURTHER EXPECTATIONS The health education service was recently investigated by the Management Services Team who concluded that additional staff will be necessary in order to continue with the expanding demands made upon it, and it is hoped that this increase in staff will ultimately contribute to the reduction of morbidity and mortality in the community and add to the body of knowledge about the maintenance of good health as a valuable community asset. The tree of life can be maintained by health education and this is possibly the root of all happiness. 61 62 63 PERSONAL HEALTH SUBJECT PAGE Maternal and Child Health Clinics 67 Health Visiting 67 Domiciliary Midwifery 68 Home Nursing 68 Prophylaxis 69 Chiropody 70 Family Planning 70 Cervical Cytology 71 Recuperative Holidays 71 Handicap Register 71 Services for the Elderly 72 Dental Service 72 Other Items 74 65 PERSONAL HEALTH The clinic and other services for the care of mothers and young children and elderly persons have continued on the same lines as previously reported for 1972. While there has been some expansion of these services there is a fairly clear statistical pattern showing a reduction in the numbers of young children and mothers receiving service and an increase in those relating to elderly persons. The first of these trends is a continuing one, matching that of the falling birth rate, and the second is a feature which has arisen in recent years from a growing awareness of the needs of the elderly. Notable exceptions from these trends are firstly, the continuing increase in family planning services and, secondly, the increase in attendances of young children at the Council's dental clinics; more detail concerning the latter is given later in this report. Also the continuing demand for creche facilities has led to an increase in sessions and attendances. Statistical details of the various activities are given in the following paragraphs, those for 1972 being included for purposes of comparison. MATERNAL & CHILD HEALTH CLINICS - ATTENDANCES Borough Clinics 1973 1972 Child Health 32,304 33,768 Toddlers 2,114 2,340 Ante & Post Natal 653 1,935 Totals 35,071 36,953 General Practitioner Surgeries 4,697 5,507 Occasional Creches Weekly Sessions 21 17 Total Attendances 5,284 4,669 HEALTH VISITING Cases visited - 1973 1972 Children under 5 12,695 15,573 Persons aged 5 to 16 917 2,144 Persons aged 17 to 64 4,688 5,296 Persons aged 65 and over 5,933 1,938 Mentally disordered persons (included above) 332 205 Tuberculous households 421 12 Infectious households (other than TB) 188 256 Other categories 1,143 1,193 Totals of all effective visits including revisits 71,516 62,044 Totals of all ineffective visits 16,048 16,060 67 DOMICILIARY MIDWIFERY Home confinements attended 58 95 Other bookings - 16 40 Moved out of area 5 6 Cancelled 4 15 Transferred to hospital service 7 19 Reasons for transfer to hospital service - Complications of pregnancy 1 14 Complications at term 4 3 Premature labour 2 2 Maternal deaths Nil Nil Stillbirths 1 Nil Calls for Emergency Obstetric Unit Nil 3 Planned early discharges from hospital - Assessment of home conditions 367 351 Found unsuitable 116 119 Patients nursed at home following early discharge - 394 448 Patients originally booked for home ment but delivered in hospital and nursed at home following early discharge (included above) 5 8 Guthrie tests carried out by Domiciliary Midwives - First Tests 529 668 Repeat T ests 104 311 GENERAL PRACTITIONER OBSTETRICIAN UNITS City of London Maternity Hospital 1973 1972 (opened Nov. 1972) Booked for delivery 62 10 Delivered in Unit 41 2 Delivered at home 8 5 Transferred to hospital service 4 2 Whittington Hospital (opened May 1973) Booked for delivery 14 Delivered in Unit 7 Delivered at home 3 HOME NURSING P.Tients being nursed at 1.1.73 1,043 899 Patients being nursed at 31.12.73 1,077 1,043 Total patients nursed 3,188 2,771 Total visits 124,361 113,906 Visits to persons over 65 107,388 96,588 Percnetages of visits to persons over 65 86.35 84.80 Nursing treatments completed 2,028 1,728 Nursing treatments commenced 2,062 1,872 68 LOAN OF EQUIPMENT Items Total loans during year Total items on loan at end of year 1973 1972 1973 1972 Air & Sorbo rings 85 201 203 177 Bedcradles 99 132 233 119 Bed & back rests 95 175 156 153 Bed pans 56 167 140 122 Commodes 326 510 543 504 Dunlopillo mattresses 7 32 28 24 Fracture boards 28 90 92 80 Hoists 14 29 22 24 Hospital beds 12 21 14 19 Walking aids 109 287 160 235 Wheelchairs & other special chairs 149 220 207 199 PROPHYLAXIS Primary courses completed 1973 1972 Diphtheria 2,137 2,270 Whooping Cough 1,937 2,052 Tetanus 2,201 2,316 Polio 2,208 2,299 Booster doses Diphtheria 1,739 2,377 Whooping Cough 110 680 Tetanus 2,715 2,956 Polio 2,633 2,873 Percentages of children born in 1971 & vaccinated by 31 December 1973 Islington England St Wales Diphtheria 62% 81% Whooping Cough 60% 79% Polio 62% 80% 1973 1972 Measles vaccination - children vaccinated 1,691 1,693 Rubella Vaccination - Schools visited 12 12 Children vaccinated 858 859 B.C.G. Vaccination - Schools visited 20 15 Heaf tests & readings 1,753 1,472 Children vaccinated 1,651 1,339 Positive reactions referred to Chest Clinic 113 151 No. of above x-rayed 97 91 Found to need treatment 14 13 Kept under observation 22 24 69 CHIROPODY Clinic Activities 1973 1972 Sessions 5,153 4,453 Appointments booked 32,231 30,213 Attendances - Children 0-4 6 6 Children 5-14 114 350 Adults Male 5,496 4,931 Adults Female 23,501 21,547 Physically handicapped 329 411 Total 29,446 27,245 Domiciliary Treatments given 7,873 7,261 FAMILY PLANNING Early in 1973, a reciprocal agreement was made with the borough of Camden similar to that made in 1972 with the Borough of Hackney. A third voluntary organisation was included in the agency arrangements. Also arrangements were made for the Family Planning Association to act as the Council's agents for the provision of a free vasectomy service. Clinic Activities 1973 1972 New cases attending 2,103 1,565 Total attendances 10,303 7,176 Referred from hospitals for follow up 366 427 I U Ds fitted 162 99 Payments to Voluntary Organisations for 1973/74 1972/73 agency services £ £ Family Planning Association 22,873 24,153 Brook Advisory Centre 3,602 3,046 Vasectomy Service Operations 105 Counselling only 121 Domiciliary Service 1973 1972 Patients referred 55 81 Sources of referral - Family doctor 1 13 Health Visitor 29 47 Domiciliary Midwife 11 15 Social Worker Nil 2 FPA 1 1 Hospital 6 3 Other 7 Nil 70 CERVICAL CYTOLOGY Results of examinations of smears Five Year Recall Others Totals 1973 1972 1973 1972 1973 1972 Negative 274 238 2525 1965 2799 2203 Negative with gynaecological disorders (excluding cancer) which required treatment 13 15 110 92 123 107 Doubtful smears referred for repeat examination 4 2 33 21 37 23 Positive Nil Nil Nil Nil Nil Nil Totals 291 255 2668 2078 2959 2333 Age-Groups of Total Smears taken 1973 1972 Under 25 961 681 25-34 1046 868 35-44 491 450 45-54 343 221 Over 55 118 113 Percentage response to Five-Year recall invitations 1973 1972 Replied and re-tested 12% 18% No replies 47% 47% Moved out of borough 17% 16% RECUPERATIVE HOLIDAYS 1973 1972 Persons recommended 652 404 Not approved 41 37 Holidays arranged - Expectant & Nursing Mothers 12 Nil Tuberculous adults 1 4 Other adults 131 115 Psychiatric patients 10 17 Accompanied children 64 42 Unaccompanied children 109 102 HANDICAP REGISTER 1973 1972 Children on register at end of year 2090 1631 Special Advisory Clinic sessions 29 21 Children seen at Special Advisory Clinics 169 161 Home visits 142 137 Other visits (to Day Centres, Playgroups, etc.) 136 118 Children on SAC at end of year 155 108 71 72 SERVICES FOR THE ELDERLY Visits by Medical Officers to elderly persons paid with a view to compulsory removal to hospital (Section 47 National Assistance Act 1948) 21 34 Persons compulsorily removed to hospital 10 15 Persons voluntarily removed 3 6 Persons visited by Health Visitors 5933 4738 Visits paid by Health Visitors 15808 11624 Special cleansing of properties occupied by elderly or infirm persons 18 17 DENTAL SERVICES FOR CHILDREN UNDER 5 AND NURSING & EXPECTANT MOTHERS Towards the end of 1973, a facility was added to the Child Health Computer System which provided for monthly batches of letters to be sent to the parents of children attaining the age of 2½ years; the letters pointed out the importance of regular visits to a dentist and their initiation in early childhood, and included an invitation to apply for an appointment to one of the Council's clinics. The first batch of letters went out at the beginning of November and the response rate has averaged approximately 20%; in addition, a number of parents wrote to express their thanks and intention of taking their children to private dentists. An immediate increase in clinic attendances was apparent; the monthly average for first inspections for January to October 1973 was 26, while that for November and December was 66, the corresponding figures for first attendances for treatment were 16 and 28 respectively, and those for total attendances were 48 and 59. Details of activities for the year as compared with 1972, were as follows - 1973 1972 First inspections 506 440 Found to require treatment 263 205 Offered treatment 261 205 Re-inspections 58 100 First visits for treatment 199 160 Subsequent visits 365 547 Total visits 564 707 Additional courses commenced 1 9 Treatments provided Fillings 641 533 Teeth filled 583 507 Teeth extracted 4 2 Prophylaxis 44 98 Teeth otherwise conserved 295 372 Courses of treatment completed 153 214 Nursing and expectant mothers also attended the dental clinics in small numbers. Details are as follows - First inspections 26 35 Found to require treatment 24 28 Offered treatment 24 28 73 First visits for treatment 12 13 Subsequent visits 49 62 Total visits 61 75 Treatments provided - Fillings 53 36 Teeth filled 52 35 Prophylaxis 13 41 Courses of treatment completed 10 14 TRAINING SCHEMES 1973 1972 Student Health Visitors Sponsored for training by the Borough 9 9 Others given practical training 5 5 Pupil Midwives Trained in district experience by Council's domiciliary Midwives 20 22 In training at end of year 7 7 District Nursing SRN: completing course for District Nursing Certificate 12 13 SEN: completing in-service course 12 16 Arrangements with Hospitals Community Care nurses placed at Royal Northern, and Whittington Hospitals (13 weeks) 30 25 Pupil midwives placed at City of London Maternity Hospital 20 23 Visits to Department by other students Medical students 19 12 Pre-clinical medical students Nil 8 Diploma of Public Health Students Nil 21 Medical students attached to GP 5 3 Pre-entry nurses 20 24 Student nurses 22 64 Post Graduate nurses Nil 7 Dietetic students 8 13 Ward sisters 9 6 NNEB students 2 2 Others from various colleges 21 25 Total 106 185 74 OTHER ITEMS Emergency Telephone Arrangements Calls dealt with by the Admissions & Doctors' Enquiry Service, Whittington Hospital 1973 1972 Domiciliary Midwifery 217 224 Home Nursing 399 543 Other, including Infectious Diseases 190 . 696 Totals 806 1463 Co-operation with Social Services Department Visits to Residential establishments for children 79 90 Visits to Residential establishments for the elderly 9 8 Laundry Service for the Incontinent Collections made 3599 3812 Persons serviced 148 182 Bathing Facilities Baths given in patients' homes 6609 4455 Baths given at Finsbury Health Centre 2671 2470 Islington Crematorium Applications for cremation certificates 1057 1022 SCHOOL HEALTH 77 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. The greater part of the service has continued on the same lines as reported for 1972, the only substantial change being the withdrawal of medical officers from regular attendance at Minor Ailment Clinics. These clinics were then run solely for the treatment of verrucae under the title of Wart Clinics. THE HEALTH OF SCHOOL CHILDREN The school roll for the Borough continued to decrease, the May 1973 figure being 31, 857, the corresponding 1972 figure being 32,902. Routine medical inspections were carried out on 36.7% of the children, and of those inspected 0.07% were thought to be in an unsatisfactory physical condition; the comparable figures for 1972 were 38.9% and 0.1% respectively. ROUTINE & NON ROUTINE MEDICAL INSPECTIONS Details of routine and non-routine medical inspections are given in the following tables. Variations between the figures for 1973 and those for 1972 are, in the main of little or no significance, but it is worthy of note that the numbers of children requiring treatment for vision defects have increased fairly regularly over the last five years; this could well be due to the introduction of the Keystone vision Screening system in 1971. 78 ROUTINE MEDICAL INSPECTIONS - defects Numbers of cases noted for treatment or observation expressed as a rate per 1,000 inspected (1972 figures in brackets). SKIN Treatment Observation 7.97 (6.41) 7.97 (6.65) EYES (a) Vision 87.07 (71.65) 53.22 (43.41) (b) Squint 11.40 (7.67) 5.91 (3.99) (c) Other 1.11 (1.64) 2.49 (1.17) EARS (a) Hearing 6.68 (6.88) 5.06 (4.62) (b) Otitis Media 1.71 (1.80) 2.49 (3.36) (c) Other 1.71 (1.17) 1.46 (1.17) NOSE AND THROAT 3.77 (2.58) 10.63 (12.59) SPEECH 5.40 (4.07) 6.86 (5.40) LYMPHATIC GLANDS 0.43 (0.63) 7.20 (9.62) HEART (a) Acquired 1.20 (0.63) 2.49 (2.19) (b) Congenital 1.71 (1.10) 3.00 (3.29) LUNGS (a) Bronchitis 0.60 (0.86) 1.37 (1.56) (b) Asthma 3.77 (4.15) 3.94 (3.99) (c) Other 0.43 (0.39) 1.63 (2.03) DEVELOPMENT (a) Hernia 0.94 (1.17) 1.80 (1.96) (b) Other 3.00 (2.97) 4.03 (3.05) ORTHOPAEDIC (a) Posture 1.37 (0.70) 3.86 (3.05) (b) Feet 2.66 (2.58) 11.91 (8.21) (c) Other 3.09 (2.11) 6.68 (5.55) NERVOUS SYSTEM (a) Epilepsy 1.54 (1.49) 2.83 (2.11) (b) Other 0.69 (0.78) 2.74 (1.41) PSYCHOLOGICAL (a) Development 1.63 (3.60) 11.40 (6.26) (b) Stability 1.89 (4.30) 16.63 (9.86) ABDOMEN 0.51 (0.47) 2.91 (1.49) DEBILITY 0.60 (0.55) 1.46 (1.33) ENURESIS 10.71 (10.25) 14.65 (16.97) OBESITY 3.86 (3.99) 10.46 (6.65) OTHER 2.83 (3.21) 1.54 (1.49) 79 NON-ROUTINE MEDICAL INSPECTIONS Bathing Centre inspections - scabies 1 (NIL) - others 10 (NIL) Employment certificates 411 (135) Theatre children 32 (40) School journeys 2,583 (1,938) Recuperative holidays - pre-departure 210 (126) Candidates for higher awards 1 (3) Outward Bound courses 5 (4) Infectious disease investigation NIL (3) T.B. contacts NIL (NIL) Boarding school for the delicate - pre-departure 50 (56) - on return 8 (NIL) Handicapped pupils - statutory examinations 99 (170) - periodic special defect examination 121 (71) Research investigations and enquiries 29 (35) Secondary school annual surveys 18 (NIL) TOTAL 3,578 (2,581) Special examinations following referrals by:- Head Teacher - child's name entered in special book 84 (59) Head Teacher - others 254 (302) School nurse - following health survey 14 (8) School nurse - others 27 (12) Divisional Education Officer 11 (32) Divisional Education Welfare Officer 12 (23) Parent 42 (45) School Medical Officer 166 (204) TOTAL 610 (685) Others For free travel 1 (NIL) Accident on school premises NIL (NIL) Miscellaneous (including inspections specifically for provision of free milk) 48 (242) Reference connected with remedial exercises 69 (NIL) TOTAL 118 (242) Totals - Special Medical Examinations 4,306 (3,508) Re-inspections 5,671 (5,393) All non-routine medical inspections 9,977 (8,901) 80 Minor Ailments (later Wart) Clinics Sessions held - Nurses 866 (357) Medical officers 197 (68) New cases - Nurses 457 (608) Medical officers 143 (36) Total attendances 4,678 (5,085) Dental Clinics Sessions held 2,768 (2,655) New cases 5,243 (5,076) Total attendances 13,920 (13,646) Bathing Centre Attendances for cleansing Vermin 444 (437) Scabies 191 (228) Miscellaneous Items Schools holding remedial foot classes 6 (6) Children recommended for special transport necessitated by temporary disability 7 (21) 81 RECOMMENDATIONS FOR SPECIAL SCHOOLING The following recommendations were made as a result of special medical examinations and consideration of other relevant information:- Day schools for the delicate 15 (16) Day schools for physically handicapped children 12 (13) Boarding open air schools NIL (10) Day schools for educationally subnorrrBl children 31 (32) Boarding schools for educationally subnormal children NIL (NIL) Continue at ordinary school possibly with extra help in reading, arithmetic, etc. 9 (20) Home tuition 7 (11) Transfers to ordinary school from ESN school 11 (22) Health Surveys in Schools Inspections carried out by school nurses resulted in findings as follows:- Annual comprehensive inspections 26,133 (30,394) Occasions on which vermin were found 567 (541) Percentage found verminous 2.17 (1.78) Selective inspections 9,091 (8,547) Occasions on which vermin were found 305 (238) Percentage of selective inspections in which vermin were found 3.35 (2.78) Individual pupils found verminous 862 (756) Percentage of school rolls found verminous 2.71 (2.30) Percentage of school rolls found verminous for whole of ILEA area 1.75 (1.82) SPECIALIST ACTIVITIES AND CLINICS Audiology Children sweep tested by school nurses in schools 5,716 (7,191) Children found to have defective hearing and referred to otologists 132 (115) Children in attendance at audiology clinics at end of year 165 (114) Audiology clinic sessions held 30 (28) Total attendances at audiology clinics 10 (9) Total of children with hearing aids attending Islington schools 90 (78) Special Investigation CIinics (for obesity, enuresis and early emotional problems) Children attending clinics at end of year 386 (388) Total clinic attendances 1,549 (1,756) Children discharged cured 78 (63) Vision Clinics Sessions held 245 (260) New cases 1,341 (1,269) Total attendances 5,784 (5,427) Errors of refraction and squint 1,410 (1,433) 82 REPORT OF THE PRINCIPAL SCHOOL DENTAL OFFICER AND CHIEF DENTAL OFFICER The School Dental Service, which is run on behalf of the Inner London Education Authority in conjunction with the Borough service, continued at a fairly even pace during 1973. There was a slight increase in sessions compared with 1972 and an increase in the whole-time equivalent of dental officers from 4.8 to 6.3, this being due in part to the opening of the new dental clinic at Highbury Grange. The number of sessions devoted to Dental Health Education rose substantially from 13 in 1972 to 90.8 in 1973, and in the same connection puppet shows were held in schools in the Borough. The orthodontic service expanded to six sessions and registered considerable progress. New cases numbered 87 against 45 in 1972, removable appliances fitted, 66 against 46 and fixed appliances 55 against 4. As far as fillings in both permanent and temporary teeth were concerned, the figures were 5.8 against 6 for 1972 - still above the national average. Thus it would be fair to say that the service on the whole maintained the levels of the preceding year. STAFF AND PREMISES 85 STAFF AND PREMISES (31.12.73) 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 Assistant Senior Medical Officer 1 Medical Officers 10 Medical Officers (Part-time) 2 18 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 7 Administrative Night Security Officer 1 Administrative Assistants 19 Secretary/Personal Assistant 1 Secretary 1 Senior Clerical Assistants 9 Clerical Assistants 41 Attendant Telephonists 2 Typing Supervisor 1 Audio Secretaries 7 Clerk/Typist 1 Copy Typist 1 Receptionist/Record Clerks 7 Clerk/Telephonist 2 Telephonist 1 Office Attendants 2 Attendant Handymen 3 Technical Assistant (Health Education) 1 124 INSPECTORATE AND TECHNICAL Chief Public Health Inspector 1 Deputy Chief Public Health Inspector 1 Assistant Chief Public Health Inspectors 2 Senior Public Health Inspectors 15 Public Health Inspectors 22 Fire Inspectors 6 Inspectors (General Purposes) 3 Technical Assistants 10 86 Student Public Health Inspectors 14 Rodent Officer 1 Rodent Investigator 1 Superintendent of Laundry & Disinfecting Services 1 77 NURSING AND MIDWIFERY Chief Nursing Officer 1 Principal Nursing Officer 1 Senior Nursing Officers 2 Nursing Officers 10 Health Visitors 54 Student Health Visitors 9 Tuberculosis Visitors 2 Clinic Nurses (full-time equivalent 19.9) 20 School Nurses 20 Creche Assistant 3 additionally one supernumary Tuberculosis Visitor held temporarily against vacancy in Health Visitors' establishment. 122 GERIATRIC SERVICES Home Visitors 1 Assistant Home Visitor 1 2 DOMICILIARY MIDWIFERY Senior Nursing Officer 1 Domiciliary Midwives 9 Domiciliary Home Nurse Midwife 1 Physiotherapist (part-time) 1 12 HOME NURSING Senior Nursing Officer 1 Senior Home Nurse 6 Home Nurses 50 Nursing Auxiliaries 2 59 CHIROPODY Chief Chiropodist/Administrative Officer 1 Senior Chiropodists 13 Chiropodists (Sessional) (Full-time equivalent - 5.1) 12 26 TUBERCULOSIS Welfare Officer (Chest Clinic) 1 Senior Occupational Therapists 1 Warden (T.B. Hostel) 1 Assistant Warden (T.B. Hostel) 1 4 87 SOCIAL CASEWORK Welfare Officers (V.D.) 3 Senior Clinical Psychologist 1 4 DENTAL Chief Dental Officer and Principal School Dental Officer 1 Senior Dental Officer 1 Dental Officers (Full-time and sessional) (Full-time equivalent 7.9) 6 Dental Officer (Orthodontics) (Full-time equivalent 0.4) 1 Dental Auxiliary 1 Dental Surgery Assistants 10 Dental Surgery Assistant/Clerical Assistant 1 21 (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 Handyman/Cleaner 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 475 Cooks 40 Kitchen Helpers 40 Needlewoman 40 Stoker/Handyman 40 Handyman/Driver 40 88 PREMISES Administrative Offices Central Office Meat Inspector's Office Rodent Control Service Disinfection and Cleansing Station Finsbury Hostel for Tuberculous Men Cromwell Lodge School Treatment Centres Islington Manor Gardens 159/167 Upper Street, N.1. 28 Cowcross Street, E.C.1. Finsbury Health Centre, Pine Street, E.C.1. Health Centre, Pine Street, E.C.1. 55 Cholmeley Park, N.6. 37 Thornhill Road, N.1. 6 Manor Gardens, N.7. Health Centres Bath Street (from 3.12.73) Finsbury River Place 60 Bath Street, EC1. Pine Street, E.C.1. River Place, Essex Road, N.1. Maternal & Child Health; Chiropody Chiropody; Dental and Physiotherapy Clinics; Disinfection and Cleansing Station. Maternal and Child Health; Chiropody; Family Planning; Cervical Cytology; School Health - Dental; Special Investigation; Vision and Speech Therapy; Minor Ailments; Midwifery; District Nursing; Staff Medicals; Health Education; I.L.E.A. Child Guidance Unit. Creche Highbury Grange 1-5 Highbury Grange, N.5. Maternal and Child Health; Chiropody; Family Planning; Cervical Cytology; School Health - Dental; Special Investigation; Special Advisory; Minor Ailments; Midwifery; 89 District Nursing; Staff Medicals; Health Education; Marriage Guidance; Mothers' Club; Creche; Ante Natal; Elderly Persons' Clinic. Centres Archway Barnsbury Congregational Church Hall, Junction Road, N.19 Carnegie Street, N.1. Child Health 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) Hilldrop 76/80 Isledon Road, N.7. Tenants' Clubroom, Hilldrop Estate, N.7. Child Health. Maternal and Child Health; Family Planning; Elderly Persons' Clinic. Maternal and Child Health; Chiropody; School Health (Special Investigations) Leage Street (closed 1.12.73) 24 Leage Street, E.C.1. 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 Islington Medical Centre Gifford Street, N.1. 303 Upper Street, N.1. Voluntary Centre North Islington 6 Manor Gardens, N.7. Maternal and Child Health. 90 INDEX Air Pollution 25 Births 7 Bacteriological Examinations 19 Basement Bakehouses 35 B.C.G. Vaccination 69 Bathing Centres 74,80 Cervical Cytology 71 Children's Toys 32 Chiropody 70 Cholera 17 Consumer Protection and Public Control 30 Co-operation with Social Services Department 74 Cremations 74 Deaths 7 Dental Services 72,82 Diseases of Animals 43 Disinfection and Disinfestation 33 Domiciliary Midwifery 68 Dysentery 18 Elderly Services for the 72 Electrical Goods 31 Emergency Telephone Service 74 Employment Agencies 32 Environmental Health Services 23 Factories and Outwork 34 Fertilisers and Feeding Stuffs 30 Family Planning 70 91 Fire Risks Means of Escape 46 Fireworks 30 Food Poisoning 16 Food and Drugs 37 Food Hygeine 38, 43 Food Premises 37 General and Vital Statistics 5-11 Geriatric Preventive Clinics 72 Handicapped Register 71 Hairdressers and Barbers 30 Health Education Service 55, 63 Health Visiting 67 Home Nursing 68 Housing 45 Ice Cream 37 Immigrants 19 Infectious Diseases 15 Inspection and Enforcement Duties 24 International Certificates of Vaccination and Innoculation 17 Laundry 74 Lead Poisoning 17 Legal Proceedings 38 Loan of Equipment 69 Lung Cancer Deaths 10 Massage or Special Treatment Establishments 30 Maternal and Child Health Centres 57 Meat Inspection 42 Medical Treatment of School Children 78 Midwifery, Domiciliary 58 Milk 37 Night Cafes 41 Noise 47 92 Nurses Agencies 30 Nursing Homes 68 Nursing Services 68 Observation and Handicapped Register 71 Offensive Trades 36 Offices and Shops 48-51 Oil Heaters 63 Outwork 34 Performing Animals (Regulations) Act 1925 44 Personal Health Services 67 Pharmacy and Poisons 41 Pigeons 33 Premises 85 Principal Officers 3 Prophylaxis 69 Public Control 30 Rag Flock 32 Rats and Mice 33 Recuperative Holidays 71 Registration and Licensing 37 Remedial Foot Classes 80 Rubella Vaccination 69 Sampling 39 Scabies and Vermin 19 School Health Service 23 Sewage and Sewage Disposal 77 Shops Acts 48 Slum Clearance 24 Smallpox 16 Smallpox - International Certificates 17 Smoking Advisory Clinic 56 Special Investigation Clinics 81 Staff 85 Statistics 5-11 93 Stillbirths 7 Street Markets 24 Training Schemes 73 Tuberculosis 18 Typhoid and Paratyphoid Fever 17 Vaccination & Immunisation 69 Venereal Disease 20 Vermin 33 Vital Statistics 5-11 Water Supply 23 Works in default 24