AC 43368 THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1971 D. J. SHEERBOOM M.B., B.S., D.P.H. MEDICAL OFFICER OF HEALTH CONTENTS Page Introduction by the Director of Health Services 1 Membership of the Health Committee 4 Staff of the Health Department 5 The Health Services— 1. Vital Statistics 7 2. Infectious Diseases 12 3. Services transferred to the Social Services Department 18 4. Personal Health Services 20 5. School Health Services 34 6. Dental Services 39 7. Environmental Health Services 42 8. Health Education 74 9. Miscellaneous Services 79 Index 82 Unless otherwise indicated, 1970 statistics included for comparative purposes appear in brackets following those for 1971. KEN 80 THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA Telephone: Health Department, 01-937 5464 25A Kensington Square, London W8 5HW October, 1972. To: The Mayor, Aldermen and Councillors of The Royal Borough of Kensington and Chelsea Ladies and Gentlemen, I submit with pleasure a report on the health of Kensington and Chelsea for 1971. This report includes public, environmental and personal health matters together with an account of the school health service in respect of which I act as Principal School Medical Officer for the Inner London Education Authority. The year 1971 was a milestone in local authority health and social services departments since it saw the completion of the setting-up of the social service departments as separate entities with the transfer to them of all of the children's and welfare services and a number of personal health services for which Councils are responsible. In London these services had only recently settled into an effective pattern after the setting-up of the new authorities in 1965, and, in fact, this transfer caused more difficulty to those involved than did that major rearrangement of local government services. For this reason I make no apology for dealing first with departmental matters. Meetings were held with the Director of Social Services and his senior colleagues throughout the year in order to effect the smooth transfer of the functions of which details are given in a separate section of this report. Both the Director and I were most concerned that no interruption or failure of service should occur. The good relationship between the departments begun in the previous year developed and went far towards making the task easier. At the same time a viable structure for the health department was prepared. Some development of existing services was already under consideration. This and other matters were referred to a number of working groups for study. As a result the extension of geriatric health care, the care of well women, the further development of the observation and handicap register of children at risk, the introduction of facilities for genetic advice for parents and the setting up of a research and information section in the department were decided upon and formed part of the new structure which became effective during the year. The Deputy Director and Medical Officer of Health, Dr. P.J.C. Walker, in May took up the appointment of Medical Officer of Health to the County of Hereford. He took with him the good wishes of the department and I must record my own gratitude for his help during a most difficult period. Early in the year I welcomed as Deputy Director of Health Services, Dr. R.A. Clay, and as Principal Dental Officer, Mr. A. Longden; Mrs. McNicholl, full-time dental officer, left the service in November 1971 and the vacancy so created had not been filled by the end of the year. Mr. P. Grace already a Public Health Inspector in the department was appointed Health Education Officer in the autumn, together with a 4 MEMBERSHIP OF THE HEALTH COMMITTEE as at 31st December, 1971 The Mayor (Councillor Mrs. Walter Gumbel, J.P.) The Deputy Mayor (Councillor Arnold H. Stevenson) Alderman Donald Chesworth Councillor Mrs. J.A. Albert (Vice-Chairman) Councillor Geoffrey D. Baber Councillor Miss Elizabeth M. Christmas (Chairman) Councillor Miss Joan L. Davis Councillor Mrs. lain Hanham Councillor Mrs. Robin Holmes, J.P. Councillor Laurence A. Kenny Councillor Bryan P. Levitt, M.A., Ph.D. Councillor E. Rennie Councillor Mrs. Pat Seers Councillor Mrs. Brian Sundius-Smith Non-Council Members: Norman Desmond Dr. J.F.L. King (Inner London Local Medical Committee) Lady Petrie Miss Doreen M. Weatherhead, D.S.R., S.R.R. 5 PRINCIPAL AND SENIOR OFFICERS OF THE HEALTH DEPARTMENT as at 31st December, 1971 Medical Staff Director of Health Services, Medical Officer of Health and Principal School Medical Officer Dr. D.J. Sheerboom Deputy Director of Health Services, Deputy Medical Officer of Health and Deputy Principal School Medical Officer Dr. R.A. Clay Principal Medical Officers Dr. H.E.E. Gunn Dr. W.T.D. Ray Medical Officers (Full-time) Dr. R.G. Casey Dr. F.M. Gaskell Dr. J. Martin Dr. B.D. Perrott Public Analysts Dr. H. Amphlett Williams Mr. D.G. Forbes Dental Staff Principal Dental Officer Mr. A. Longden Dental Officers (Full-time) Miss M.H. Black Mrs. J. Milne Mrs. L. Porebska Public Health Inspectorate Chief Public Health Inspector Mr. D.C. Draper Deputy Chief Public Health Inspector Mr. J.G. Tompkins Specialist Housing Inspectors Mr. A.E.F. Sills Mr. A.F. Standish Nursing Staff Principal Nursing Officer Mrs. J. Harris Deputy Principal Nursing Officer Miss L.M. Baker Assistant Nursing Officer Miss R. Alford Mrs. M.I. Martin Chiropody Staff Chief Chiropodist Miss H. Duke Disinfection Services Chief Disinfector Mr. J.W. Noble Health Education Health Education Officer Mr. P. Grace Assistant Health Education Officer Miss L.M. Hughes 6 Administrative Staff Chief Administrative Officer Mr. G.A. Pickis Deputy Chief Administrative Officer and Principal Administrative Officer, Personal and School Health Services Mr. C.G. Legge Principal Administrative Officer, Environmental Health Mr. I.M. Thomson Senior Officers — Environmental Health (Housing Acts) Mr. S. Chamberlain General Administration Mr. J.A. Spencer Finance Mr. R. Smith Staff Mr. P. Margetts Research and Information Mr. L.E. Snashall 7 1 VITAL STATISTICS AREA The area of the borough is 2,951 acres. POPULATION Census 1971 184,392 Estimate of Registrar-General at mid-year 1971 186,570 Average density of population per acre 63.4 RATEABLE VALUE Rateable value of the borough at 1st April, 1971 £26,427,037 Estimated net product of a penny rate 1971/72 £255,000 Estimated number of separately assessed dwellings at 1st April, 1971 60,385 LIVE BIRTHS Males Females Total Legitimate 997 958 1,955 Illegitimate 237 237 474 Totals 1,234 1,195 2,429 Crude birth rate per 1 000 of the estimated population 130 Adjusted birth rate for comparative purposes (Area comparability factor = 0.60)* 78 STILLBIRTHS Total (14 males and 11 females) 25 Rate per 1,000 total live and stillbirths 10.2 DEATHS Total (921 males and 1,050 females) 1,971 Crude death rate per 1,000 population 10.6 Adjusted death rate (Area comparability factor = 0.99)* 10.5 INFANT MORTALITY Infant deaths (all deaths of live born children under one year) Males Females Total Legitimate 21 12 33 Illegitimate 3 Nil 3 Totals 24 12 36 8 COMPARABILITY OF RATES ( *) The area comparability factors for use with crude birth and death rates contain adjustments for boundary changes and make allowances for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole. In addition, the death area comparability factors have been adjusted specifically to take account of the presence of any residential institutions in each area. When local crude birth and death rates are multiplied by the appropriate area comparability factor, they are comparable with the crude rate for England and Wales or with the corresponding adjusted rate for any area for that year. Death rate of all infants per 1,000 live births 14.8 Death rate of legitimate infants per 1,000 legitimate live births 16.9 Death rate of illegitimate infants per 1,000 illegitimate live births 6.3 Death rate of male infants per 1,000 male live births 19.4 Death rate of female infants per 1,000 female live births 10.0 Neo natal deaths (under 4 weeks of age) (15 males and 9 females) 24 Death Rates of:— Males per 1,000 male live births 12.2 Females per 1,000 female live births 7.5 All infants per 1,000 live births 9.9 Early neo-natal deaths (under 1 week of age) (13 males and 8 females) 21 Death Rates of:— Males per 1,000 male live births 10.5 Females per 1,000 female live births 6.7 All infants per 1,000 live births 8.6 Perinatal mortality (deaths under 1 week plus stillbirths) (27 males and 19 females) 46 Death Rates of:— Males per 1,000 male live and stillbirths 21.7 Females per 1,000 female live and stillbirths 15.8 All infants per 1,000 live and stillbirths 18.8 MATERNAL DEATHS Maternal deaths (Abortion) Nil DEATHS FROM CERTAIN CAUSES Tuberculosis of respiratory system 5 Cancer of the Lung and Bronchus 119 Congenital Anomalies 20 Cerebrovascular Disease 228 Heart and circulatory system diseases 719 Motor Vehicle and other accidents 68 Suicide 42 9 SUMMARY OF VITAL STATISTICS FOR KENSINGTON AND CHELSEA IN 1971 (Compared with previous five years) Year Total Population (mid-year ests.) Total Deaths Crude Death Rate Total Live Births Crude Birth Rate Total Infant Deaths Infant Mortality Rate 1966 215,210 2,242 10.42 3,394 15.82 75 22.09 1967 213,310 2,188 10.26 3,164 14.88 80 25.28 1968 210,720 2,234 10.6 2,925 13.9 54 18.46 1969 208,480 2,170 10.4 2,567 12.3 46 18 1970 203,730 2,155 10.6 2,513 12.3 54 21.5 1971 186,570 1,973 10.6 2,429 13.0 36 14.8 (* The mid-year estimate for 1971 is based on the 1971 Census; estimates for previous years are based in the 1961 Census.) ILLEGITIMACY The rate of illegitimate births per 1,000 live births has risen this year. The figures for this and the previous five years are:— 1966 201 1967 212 1968 198 1969 194 1970 188 1971 195 10 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN 1971 DISEASE Code No. All Ages Under 1 year 1 year and under 5 5 yean and under 45 45 years and under 65 65 years and over Enteritis and other Diarrhoeal Diseases B4 2 - - 1 - 1 Tuberculosis of Respiratory System B5 4 — — — — 4 Late effects of Respiratory T.B. B6(1) 1 — — — 1 — Other Tuberculosis B6(2) 2 — — — 2 — Other Infective and Parasitic Diseases B18 10 — 1 2 2 5 Malignant Neoplasm, Buccal Cavity, etc. B19(1) 12 — — — 5 7 Malignant Neoplasm, Oesophagus B19(2) 15 — — — 4 11 Malignant Neoplasm, Stomach B19(3) 37 — — — 10 27 Malignant Neoplasm, Intestine B19 (4) 50 — — — 15 35 Malignant Neoplasm, Larynx B19(5) 6 — — — 2 4 Malignant Neoplasm, Lung, Bronchus B19(6) 119 — — 3 59 57 Malignant Neoplasm, Breast B19(7) 34 — — 3 12 19 Malignant Neoplasm, Uterus B19(8) 16 — — 4 5 7 Malignant Neoplasm, Prostate B19(9) 14 — — — 2 12 Leukaemia B19(10) 8 — — 1 1 6 Other Malignant Neoplasms B19(11) 138 — — 8 59 71 Benign and Unspecified Neoplasms B20 4 — — 1 2 1 Diabetes Mellitus B21 8 — — 1 — 7 Other Endocrine etc. Diseases B46(1) 3 — 1 — — 2 Anaemias B23 4 — — — 1 3 Mental Disorders B46(3) 4 — — 1 2 1 Meningitis B24 2 1 1 — — — Multiple Sclerosis B46(4) 7 — — — 5 2 Other Diseases of Nervous System B46(5) 13 1 — 1 — 11 Chronic Rheumatic Heart Disease B26 42 — — 14 10 18 Hypertensive Disease B27 22 — — 1 5 16 Carried forward 577 2 3 41 204 327 11 DISEASE Code No. All Ages Under 1 year 1 year and under 5 5 yean and under 45 45 years and under 65 65 years and over Brought forward 577 2 3 41 204 327 Ischaemic Heart Disease B28 48 — — 10 93 315 Other Forms of Heart Disease B29 126 — — 6 5 115 Cerebrovascular Disease B30 228 — — 1 23 204 Other Diseases of Circulatory System B46(6) 111 — — 4 5 102 Influenza B31 4 — — 1 — 3 Pneumonia B32 139 4 — 2 12 121 Bronchitis and Emphysema B33(1) 77 — — — 16 61 Asthma B33(2) 8 — — 3 4 1 Other Diseases of Respiratory System B46(7) 13 3 — — 5 5 Peptic Ulcer B34 14 - — 1 2 11 Intestinal Obstruction and Hernia B36 11 1 1 — 1 8 Cirrhosis of Liver B37 10 — — 1 5 4 Other Diseases of Digestive System B46(8) 22 - — 1 4 17 Nephritis and Nephrosis B38 12 - — — 3 9 Hyperplasia of Prostate B39 1 — — — — 1 Other Disease, Genito-Urinary System B46(9) 18 — — 1 2 15 Diseases of Skin, Subcutaneous Tissue B46( 10) 3 — — — — 3 Diseases of Musculo-skeletal System B46(11) 7 — — — 2 5 Congenital Anomalies B42 20 8 5 5 1 1 Birth Injury, Difficult Labour, etc. B43 9 9 — — — — Other Causes of Perinatal Mortality B44 9 9 — — — — Symptoms and III Defined Conditions B45 11 — — — — 11 Motor Vehicle Accidents BE47 24 — 1 15 2 6 All other Accidents BE48 44 — 1 19 13 11 Suicide and Self-inflicted Injuries BE49 42 — — 16 15 11 All Other External Causes BE50 13 — — 5 7 1 TOTAL ALL CAUSES 1,971 36 11 132 424 1,368 12 2 INFECTIOUS DISEASES NOTIFICATIONS The total number of notifications received during 1971 was 424 in comparison with 576 in 1970. The following Tables show (1) the number of cases of infectious disease notified during the year 1971, with the comparative figures for the previous five years; and (2) the number of notifications divided into age groups. TABLE 1 Notifiable disease Number of cases notified 1971 1970 1969 1968 1967 Dysentery 16 18 11 14 11 Encephalitis 1 - - 1 - Enteric Fever 5 - 4 1 1 Erysipelas - - 1 1 3 Food Poisoning 27 48 53 18 12 Infective Jaundice 95 108 77 41 not notifiable Malaria 6 4 5 2 4 Measles 175 254 211 296 847 Meningococcal Infection 6 - 4 1 2 Ophthalmia Neonatorum 2 2 2 - - Poliomyelitis: Paralytic Nil 1 - - - Scarlet Fever 14 22 7 34 15 Tuberculosis (all forms) 63 88 79 101 77 Whooping Cough 14 31 12 46 78 TOTALS 424 576 466 556 1050 NOTE: Cases of mistaken diagnosis are excluded from the above Table 13 TABLE 2 Notifiable disease Number of cases notified in 1971 (Age groups in years) Age unknown Under 1 1-2 3-4 5-9 10-14 15-24 25 and over Dysentery - 1 3 1 1 2 2 6 Encephalitis - - - - 1 - - - Enteric Fever - - - - - - - 5 Food Poisoning - 2 1 1 3 1 5 14 Infective Jaundice 1 - 1 1 9 6 35 42 Malaria 1 - 1 - - - 2 2 Measles 2 16 29 59 57 5 3 4 Meningococcal Infection - 1 - - 1 - - 4 Ophthalmia Neonatorum - 1 1 - - - - - Scarlet Fever - - 3 6 4 1 - - Tuberculosis (All forms) 1 - - - 2 - 9 51 Whooping Cough — 2 4 2 4 2 - - TOTALS 5 23 43 70 82 17 56 128 Diphtheria Although this was the tenth year in which no cases of diphtheria were notified in the Borough, there were a number of diphtheria carriers found in a private school. A case of diphtheria occurred in Hammersmith and the patient's sister attended a school in Chelsea; a number of children from this school had attended a children's party at which the diphtheria case had been present. Because of the seriousness of this disease, the entire school was investigated and nose and throat swabs were submitted to the Laboratory from all children and staff at the school — a total of 120. At the same time a letter was handed to each parent explaining the position. Six children were found to be diphtheria carriers and were immediately removed from the school and admitted to hospital. Their contacts were investigated which resulted in the discovery and removal to hospital of a further carrier. A number of children were absent at the time of swabbing and they were swabbed in their homes by members of my nursing staff or by their own doctors. Yet another carrier was found and was admitted to hospital. In view of the number of carriers found and the questionable state of immunisation of the remaining children they were all offered immunisation which was accepted without exception. Having removed all the known cases from the school, it was not considered 14 necessary to close the school, but arrangements were made for the school to be kept under observation and further swabs were taken 8 days after the original date of swabbing when the school was free from infection. The children removed to hospital were found to be carriers of c. diphtheria mitis. The pathogenicity of the organism was very weak, and I am pleased to be able to report that no further cases occurred. However, an incident such as this is a pertinent reminder that this particular organism is still present in the community and that immunisation in early childhood should in no way be relaxed. Food Poisoning Twenty seven cases of food poisoning were notified during the year. The following table gives an analysis of the various types of salmonella isolated:— Salmonella Typhimurium 6 Salmonella St. Paul 4 Salmonella Reading 1 Salmonella Litchfield 1 Salmonella Anatum 1 Unknown 14 The majority of these notifications related to sporadic cases. The only exception involved a husband and wife who were both admitted to hospital with suspected food poisoning which was later confirmed as Salmonella St. Paul. It was ascertained that they had both attended a hospital Dinner/Dance in Surrey organised by a large London hospital, the majority of the guests being staff from that hospital. The organisers gave information as to the caterers who were traced by the Medical Officer of Health of the area concerned who carried out the necessary enquiries. In the meantime the organisers of the function found that other guests had food poisoning symptoms. At this stage from the facts at hand it was apparent that a large food poisoning outbreak was developing. Therefore the Medical Officer of Health of the area where the hospital was situated was informed of all the relevant facts, for at this time he was not aware that such an outbreak was evolving in his area. It was later established that approximately 80 people had been infected out of the 800 guests that had attended this function, of which 45 persons were living in this borough at the time, many of them hospital staff all of whom had to be fully investigated. Of these 45 persons 12 were found to be positive cases of Salmonella St. Paul. The cause of the outbreak was finally thought to have been due to the ineffective thawing, cooking and cooling of the chickens that formed the basis of the menu at this function. This outbreak is a good example of the benefit that arises from co-operation between local authorities; although this particular outbreak did not primarily involve this borough the first investigations were instituted by my Department following the admission to hospital of the husband and wife who were local residents. Smallpox No case of smallpox has been reported in the area of the present Borough since 1929. However, the Ministry of Health's memorandum on vaccination recommends that persons likely to deal with cases of smallpox at short notice should be regularly revaccinated at not more than yearly intervals. During the year 154 members of the staff of the department were vaccinated or revaccinated. Typhoid Five cases of typhoid were notified during the year. Of these, 4 were people coming into this country from abroad — all requiring hospital treatment. The remaining case was that of a 25 year old male who also was admitted to hospital, typhoid being confirmed by blood culture. 15 The patient was born in India but had lived permanently in this country since 1960, although he had been on holiday in Spain four months prior to his admission to hospital. All known contacts were traced and where necessary Medical Officers of Health of the areas concerned were informed. Those contacts in this borough were kept under observation in addition to submitting specimens, the results of which were negative. A local restaurant was also fully investigated as the patient had eaten a meal there prior to the onset of his illness, but because of the period of time that had elapsed it was not possible to submit any food from the meal for analysis. However, as shell fish were the main items on the menu and since they are a suitable vehicle for the spread of this disease samples were obtained for analysis and in addition all members of the staff submitted specimens for bacteriological examination. The results were negative. Following the patient's discharge from hospital he was kept under observation by this Department. Tuberculosis During the year 63 new cases of tuberculosis were notified of which 53 were respiratory and 10 were non-respiratory and 14 other cases of persons moving into this borough were reported, mainly by other Borough Councils. In addition to the 63 new cases on the register, there were those who were removed from the register because they had moved out of the borough, died, been cured or moved without trace, and the final figures in the register at the end of the year were as follows:— Respiratory Non-respiratory Male Female Male Female Total 378 195 24 50 647 Every effort has been made by health visitors to visit all newly notified cases (and those transferred to or changing address in the borough) with the object of tracing the source, preventing the spread and removing the conditions favourable to infection. Particular attention was given to the home conditions in addition to the dissemination of advice to prevent the transmission of infection to contacts. INTERNATIONAL CERTIFICATES In order to prevent the spread of infectious diseases, certain countries require that visitors should be vaccinated or inoculated against specific diseases. International certificates have been prescribed for smallpox, cholera and yellow fever. When completed by a medical practitioner, the certificate must be authenticated by the Medical Officer of Health. During the year 13,773 of these certificates were authenticated. In addition 9 special certificates were issued to travellers who refused vaccination on medical or religious grounds. Smallpox Information was received during the year from port authorities of 149 persons intending to stay in the borough and who could not produce valid certificates of vaccination after leaving countries which were declared local infected endemic areas. Of these 69 were kept under observation for the surveillance period and remained quite well and 6 were found to have moved to other areas of which the Medical Officers of Health were notified. 16 The remaining 74 persons could not be traced at the addresses given by the port authorities. Cholera Because of the presence of cholera in Mediterranean countries, the United Kingdom required travellers to this country to be in possession of a valid international certificate of vaccination against cholera if they had been in any country, any part of which had been infected with cholera. Information was received during the year from port authorities of 308 persons intending to stay in this borough who were not in possession of valid vaccination certificates. Of these 136 were kept under observation whilst 172 had either moved to other areas or were unable to be traced. 17 VENEREAL DISEASES - New cases reported during 1971, summarised from the returns made by the physicians in charge of treatment centres at which residents of the borough were treated Situation of Clinic Total of all venereal conditions SYPHILIS GONORRHOEA Other venereal conditions Primary and Secondary Other 1971 1970 1969 1971 1970 1969 1971 1970 1969 1971 1970 1969 1971 1970 1969 Central Middlesex Hospital 33 26 . — — . 1 * * 9 6 * 23 20 * Dreadnought Seamen's Hospital 6 8 6 — — — — — 1 1 1 5 8 4 The London Hospital 130 144 156 — — — 1 - 2 19 21 35 110 123 119 Middlesex Hospital 2008 1234 1328 10 6 15 8 9 19 261 219 282 1729 1000 1012 Moorfield Eye Hospital 10 . 9 - * - - * - - * — 10 - 9 St. Bartholomew's Hospital 194 200 143 - 5 - - - .0 24 29 29 170 166 114 St. George's Hospital 1926 † . . 4 † * * 24† . * 243† * * 1655 † * . St. Mary's Hospital 3853 3264 2454 26 39 39 25 39 28 797 808 735 3005 2378 1652 St. Thomas Hospital 746 577 586 3 1 7 3 2 1 103 100 112 637 474 466 West London Hospital 4015 4613 3475 18 27 16 14 17 23 780 1057 922 3203 3512 2514 Westminster Hospital 667 344 351 2 2 1 4 - 2 93 52 73 568 290 275 TOTALS 13588 10410 8508 63 80 78 80 67 76 2330 2292 2189 11115 7971 6165 † Approximate figures * Figures not available 18 3 SERVICES TRANSFERRED TO THE SOCIAL SERVICES DEPARTMENT The Local Authority Social Services Act, 1970, drew a dividing line distinguishing between medical or social need through the personal health services formerly administered as a cohesive group under the National Health Service Acts, 1946/68. Staff responsible for the administration of the transferable services, and their associated staffing and financial aspects were all affected to some extent and there were very few whose duties were wholly on one side or the other of the statutory division. It was accordingly necessary before the appointed day, 1st April, 1971, to retrain staff and agree a phased programme for transferring administrative functions and the release of officers being transferred to the Social Services Department whilst continuing to administer services on a caretaker basis, in one case until 1st September, 1971. PRIVATE DAY CARE OF CHILDREN The registration and supervision of Private Day Nurseries and Child-Minders under the Nurseries and Child-Minders Regulation Act, 1948 (as amended) was transferred on 19th April, 1971. This included the comparatively new scheme for subsidising the payment of fees in respect of selected children placed in private care. At the time of transfer 54 premises were registered as private day nurseries with a total of 1,087 approved places and 115 persons as child-minders authorised to care for 268 children; subsidised placements consisted of eight children with child-minders and one in a private day nursery. Legal proceedings to close an unsatisfactory day nursery continued; an Appeal Court decision on 10th February, 1971, upheld an Order made by the Council cancelling registration and rendered the cancellation effective from that date but further proceedings were necessary to effect closure in June, 1971. A Principal Medical Officer and a Senior Administrative Officer of the Health Department, who had been witnesses for the prosecution throughout the proceedings, continued to be concerned until later in the year, when the likelihood of their being called upon to give further evidence ceased. MENTAL HEALTH SERVICES These services administered by the Health Department prior to 1st April, 1971, were subject to the transfer to the Inner London Education Authority on that date of the Kensington Junior Training Centre, Wallingford Avenue, W.10., which included the Special Care Unit for severely sub-normal children with multiple handicaps opened at the end of the previous year. The transfer effected under the Education (Handicapped Children) Act, 1970, resulted in junior training centres for the severely sub-normal children becoming an education authority responsibility and being designated as special schools. This Centre became the Dame Evelyn Fox School and the Health Department's only remaining responsibility was in respect of school health services. The Adult Training and Day Centre, 1-9 St. Mark's Road, W.11., was transferred to the Social Services Department on 17th May, 1971, as were functions relating to emergency admissions to hospital, residential and community care with the associated general administrative functions on 1st June, 1971. The number of patients affected by this transfer of responsibilities was in the region of 1,300. The Health Authority continues to be responsible for the approval of Medical Practitioners who may be required to give medical certificates of mental illness. HOME HELP SERVICE This service was transferred on 7th June, 1971. The number of staff involved was the largest of any of the services affected and consisted of approximately 140 persons actively engaged in giving service to over 1,100 households. 19 RECUPERATIVE HOLIDAYS The arrangements for placement of all adults and children under five years of age in private homes, together with the associated financial arrangements were transferred on 1st July, 1971. Holidays for school children, the responsibility of the Inner London Education Authority, were unaffected and remained a school health function for which the Health Department continues to be responsible. CHEST CLINIC SERVICES The Welfare Officer (Chest Clinic) was also transferred on 1st July, 1971, and, with her, her duties which included the Secretaryship of the Care Committee, the provision of extra nourishment, bedding and clothing to needy tuberculous patients, and the associated financial procedures. Other services transferred at the same time were the care of patients in residential hostels for the tuberculous, rehabilitation of ex-tuberculous patients, and the boarding-out of child contacts. At the time of transfer there was only one active case, a resident in Hurlingham Lodge Hostel for Tuberculous Men. DAY NURSERY SERVICE The Day Nurseries were transferred to the Social Services Department on 1st September, 1971. The need for this service arises from a very varied and sometimes complex number of circumstances. The day to day administration consequently involved many lay and professional staff. Arrangements were made for continued co-ordination between health visiting staff and the Social Services Department for the referral of children for attendance, and as a result health visitors in fact still take initial steps in a large number of cases and continue to be responsible for reviewing the need for further attendance. The five Council day nurseries transferred had a total of 312 places at which were employed 58 nursing staff (in the main nursery nurses) 20 student nursery nurses and 34 other grades such as kitchen staff and domestics. Progress was made during the year in the building of an additional 50-place day nursery in North Kensington and financial provision was made for a special unit (6 places) to be added to the Violet Melchett Day Nursery in Chelsea. FAMILY CASEWORK The staff engaged on intensive casework including the Principal Social Worker (Health Services) and the Assistant Principal Social Worker (Health Services) were transferred to the Social Services Department on 1st April, 1971. Their case load became the responsibility of social workers in the Social Services Department, who also undertook the liaison arrangements with the West London Family Service Unit and the Family Welfare Association. THE BOROUGH CO-ORDINATING COMMITTEE The Borough Co-ordinating Committee of which the meetings were intermitted during the setting up of the Health and Social Services Department resumed during the year and met on two occasions. It was decided that the Committee had a valuable place in continuing liaison arrangements between authorities and Departments of the Council and provided a forum for the discussion of Health and Social Service matters of general concern. It was agreed that the Chair should be taken in turn for six month periods by the Director of Health and Director of Social Services respectively and arrangements for the holding of intermediate case conferences were approved. 20 4 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN There were 2509 notified births, 73 fewer than in 1970 and of these 2,455 or 97.8 were institutional confinements. Maternal and Child Health (Clinic Services) Details of attendance at Health Centre clinics are as follows: Ante-natal and post-natal clinics: Total number of sessions 356 (368) Total attendances 2,751 (2,885) Number of women attending during year: Ante-natal 652 (741) Post-natal 34 (21) Child health clinics: Total number of sessions (infant welfare and toddlers) 1,348 (1,267) Total attendances 20,254 (19,633) Number of children attending during year Born in current year 1,744 (1,748) Born in preceding five years 2,789 (3,056) Total attendances at special toddlers clinics 1,683 (1,759) During 1971, the total number of children under 5 years who attended clinics was 4,533 compared with 4,804 in 1970 a decrease to be expected in view of the steadily falling birthrate. Total clinic attendances however increased by 621, so that the average number of visits made by each child during the year rose from 4.0 in 1970 to 4.4 in 1971, indicating that some, at least, of the children who attend clinics do so more frequently. The above figures refer only to children in attendance at the Council's Health Centres, but there are now many who attend Child Health sessions held in surgery premises by their own general medical practitioners and the Council's health visitors. During 1972, 411 such sessions were held and 4,802 attendances were made by children under 5 years. Occasional Creches The number of weekly occasional creche sessions provided at health centres and at which children can be cared for while their mothers attend hospitals or clinics or do their shopping, etc. was increased by two during the year to a total of 36. The total number of sessions held during the year was 1,731 and total attendances 22,333 compared with 1,440 and 17,880 respectively in 1970. Handicapped Children and Children 'At Risk' The Council's Observation and Handicap Register of children with known handicaps or 'at risk' of developing a handicapping condition is compiled from several sources, and all cases are reviewed at regular intervals. The total number of children on the register was 621. 21 The following is a summary of the 125 handicapped children on the register classified under major handicaps. Talipes and other Orthopaedic defects 23 Congenital Heart Disease and Cardiac murmurs 20 Mental Retardation 16 Others including Hernias, renal and bowel defects 12 Epilepsy 6 Cleft lip and/or cleft palate 5 Spina Bifida, Meningocele and Hydrocephalus 5 Deafness or defective hearing 4 Hemiplegia 4 Speech defects 4 Blind or partially sighted 3 Cerebral palsy 3 Coeliac disease 3 Downs Syndrome (Mongolism) 3 Achondroplasia 2 Cystic Fibrosis 2 Hypothyroidism 2 Infantile Autism 2 Sickle cell anaemia and Thalassaemia 2 Grecian nose dwarfism 1 Phenylketonuria 1 Pierre Rabin syndrome 1 Ricketts 1 Notification of Congenital Malformations All congenital malformations noted at birth in both live and stillborn children are notified to the Medical Officer of Health for onward transmission to the Office of Population Censuses and Surveys. The numbers of children so notified over the past five vears are as follows:— 1967 1968 1969 1970 1971 Total Total notified live and still births (1) 3188 2928 2686 2547 2509 13858 Children with congenital defects (2) 56 41 59 48 49 253 Stillbirths with congenital defects included in (1) and (2) 4 2 8 3 1 18 Children with more than one defect 8 9 13 11 4 45 Total number of malformations reported 66 49 70 63 54 302 Children with defects per 1000 live and stillbirths 17.6 14.0 22.0 18.8 19.5 18.3 CERVICAL CYTOLOGY Regular fortnightly sessions were held during the year at the South Kensington, Holland Street and St. Quintin Health Centres. There were 786 attendances at 81 sessions; only 1 doubtful positive smear was recorded. Since 1967 the Council has accepted financial responsibility for the screening service provided at a well woman clinic at the Royal Marsden Hospital. During 1970, 155 residents attended this clinic; no positive smears resulted. FAMILY PLANNING Family Planning services have continued to be provided by the West London Branch of the Family Planning Association who hold clinics in their own premises at Telford Road, 22 in St. Stephen's and St. Charles Hospitals and at some of the Council's Centres. During 1971, a weekly afternoon clinic was opened at Walmer Road Health Centre and an additional evening session started at Holland Street Centre. Attendances increased during the year and the Council met the cost of Family Planning for 5,305 borough residents as against 3,765 in 1970 and 3,197 in 1969. The total number of patients (including non-borough residents) dealt with at the Family Planning Association's clinics in Kensington and Chelsea during the year is summarised as follows:— Number of new patients during year Total number of patients (old and new) Total clinic sessions Total doctor's sessions North Kensington Marriage Welfare Centre, Telford Road 2,202 11,704 619 872 Kensington Clinic, 9 Holland Street 361 1,659 75 75 Chelsea Clinic, Violet Melchett Health Centre 218 920 52 52 Chelsea Clinic, St. Stephen's Hospital 1,003 5,150 146 322 St. Charles Hospital 177 682 51 51 Walmer Road, F.P.A. Clinic 160 347 34 34 TOTAL 4,121 20,462 977 1,406 Domiciliary Family Planning It has always been recognised that the family planning services in this borough do not reach many of the women who would most benefit from them — mothers of problem families, of large families living in overcrowded and often sub-standard housing and others who, because of some physical or psychiatric disability either could not easily attend a clinic or lack the necessary initiative to do so. A 'ferry-service' providing transport and an escort for such women has been available for some years but has not been used to any great extent and when the problem was discussed early in the year by Health Department staff and a representative of the Family Planning Association, it was agreed that the most effective way of extending family planning advice to the areas of greatest need would be to take the service to women in their own homes. A scheme for a domiciliary family planning service was then worked out and was successfully submitted to the Home Office for grant aid under Phase IV of the Urban Programme. The new service which commenced on 1st November was made known to all organisations and individuals likely to be in touch with women in need of it. A brief explanatory leaflet was sent to the Council's medical, nursing, midwifery and social service personnel and to general practitioners, hospitals, probation services and voluntary welfare organisations. 23 The leaflet states that the service is available in all cases where a need for family planning advice is unlikely to be met in any other way and requests for it can be made simply by telephoning one of the Council's Health Centres. Response to this publicity was disappointing, as during November and December only 2 referrals were made, both by members of the Council's staff. It is anticipated that further publicity will be given to this new service during the coming year and it is hoped that the response will be more in line with the need which is known to exist. ADOPTION AND BOARDING-OUT OF CHILDREN Adoption Persons proposing to adopt children are required to submit medical certificates as to their health before a child is placed with them. These certificates are verified by the Council's medical officers before consent is given. Similarly, the medical records of the children to be adopted are scrutinised and the Director of Social Services advised on the child's suitability for adoption. Should the reports reveal any medical defects, inheritable disease or handicap in the child, further enquiries are made and, in the case of inheritable disease in the natural parents, the prospective parents are interviewed by their own general medical practitioner. Boarding-Out The medical examination is given in accordance with the Boarding-Out of Children Regulations, 1955, and includes the Wasserman and/or Kahn tests except where the child is over school leaving age or is boarded out in an emergency or in accordance with Part III of the Regulations. Again, the results of these medical examinations are scrutinised in my department and the Director of Social Services informed as to their suitability. The following is a summary of the cases dealt with:— Adoption Cases Children suitable for adoption 10 Children unsuitable for adoption - Couples suitable to adopt children 12 Couples unsuitable to adopt children - Boarding-Out Cases Children suitable for boarding-out 7 COMMUNITY NURSING SERVICES Advising, supporting and caring for the family, the young, the handicapped, the aged, the lonely and the sick in their health needs within their own homes has none of the excitement of the hospital, with the drama of major surgery or modern medical miracles. Yet at any time only quite a small proportion of the population is receiving care within the hospital service. The Community Nursing Services include all those nurses working within the community setting. The district nurses provide for bedside nursing within the home. Health visitors provide skilled advice and guidance within the home, the clinic or the surgery. Domiciliary midwives care for the mother within the home or within the general practitioner maternity unit attached to the hospital. State registered nurses work within the clinics or within the schools as school nurses carrying out the variety of screening, treatment and teaching activities required within the school health service. All nurses working within the community undertake health education activities and have continued to provide care, advice, guidance and education for the community, within their own homes, in clinics, in schools, in clubs, with voluntary organisations and foundations, and in centres of advanced education, at polytechnics, colleges and universities. 24 This diverse range of activities calls for the use of all the skills and knowledge of the nursing staff, whether they be health visitors, district nurses, midwives, school nurses, or clinic nurses. Health Visiting Throughout the year a high level of staffing has been maintained and it is gratifying to note that the number of visits made has increased by over 20% compared with 1970. The work of the health visiting staff has continued to develop and as the following figures show the general increase in visiting has been spread throughout all age groups. The wide range of health education activities has continued under the guidance of an assistant nursing officer and the programmes planned and teaching undertaken has shown even further expansion. The syllabus of training for health visitors contains detailed instruction in teaching methods and practice and all staff are prepared to meet the demands of any teaching situation. Details of these activities appear later in this report (Section 7). The following table records details of visits by Health Visitors during the year:— First visits to: 1971 1970 Children born 1971 2,372 2,397 Children born 1970 2,304 1,900 Children born 1966/69 3,895 3,181 Persons aged 65 or over 547 353 Mentally disordered persons 68 84 Persons discharged from hospitals (excluding mental) 64 88 Tuberculous households 126 177 Infectious households 71 56 Ante-natal cases 713 ) 1,146 School-children 385 ) Other adults under 65 1,138 ) All other cases 444 ) Total cases visited 12,126 9,382 Total effective visits and revisits 33,142 25,935 Unsuccessful visits 9,316 8,188 Survey into the Work of Health Visitors in London During 1969 the Intelligence Unit of the Greater London Council analysed a million minutes of health visitors' working time. A one in five sample of staff in this borough took part. This survey demonstrated conclusively many of the problems of which the senior nursing staff have been aware in providing a continuing health visiting service. The percentage of staff selected for the survey in Greater London with less than 6 years experience was 51% but the comparable figure for those selected for this borough was 87%. The Intelligence Unit provided a breakdown of the figures for this borough and a reflection on the concentration of young people was shown by 4.3% of time spent on unsupported mothers in comparison with 2.4% in Greater London, and with young adults this was 3.5% as against 1.9%. Topics covered during visits showed, as would be expected, a high proportion of time spent on advice on child management (33.9%) though other health topics (15.7%) and social services (20.5%) took a high proportion of the working day. Health Visitor Students Eight students were sponsored at four different colleges for training by this authority, and all were successful in their final examinations. Training facilities for practical work with a fieldwork instructor were provided for seven students from the Polytechnic of North London, and Chiswick Polytechnic. 25 Co-operation with General Practitioners Schemes for closer working between general medical practitioners and community nursing staff continued to develop. Attachment and liaison schemes now involve 11 practices with a total of 19 doctors and a total of 17 community nursing staff. Health visitors have provided hospitality and have invited general medical practitioners to the health centres, to learn more of the facilities and services provided. Health Visiting with the Elderly As the numbers of elderly people within the community increase so it becomes more necessary to ensure that they receive help and guidance in the maintenance of good health. Home visiting continues to increase and the clubs for the elderly organised by health visitors at the health centres have continued to provide health teaching and a valuable opportunity for health care and supervision. Domiciliary Midwifery The Council's domiciliary midwives continued to play their part within the community nursing service and be closely involved in both health education and student training. The fall in the number of domiciliary confinements continued and there were 43 in 1971 as compared with 52 in 1970. The midwives have accepted 200 early discharge cases, compared with 214 in 1970. Within the general practitioner unit at St. Mary Abbots Hospital there have been 50 deliveries of mothers who for a variety of social reasons could not be delivered at home. Details of the midwives' activities are as follows:— (i) Domiciliary Deliveries Cases booked with a doctor Cases not booked with a doctor Attended by: Council's midwives 31 (38) 2 (3) Hospital midwives 9 (10) 1 (1) 40 (48) 3 (4) (ii) Early Discharges Planned Not Planned Nursed by: Council's midwives 94 (107) 93 (92) Hospital midwives 11 ( 12) 2 ( 3) 105 (119) 95 (95) (iii) General Practitioner Maternity Unit Confinements attended by Council's midwives 50 (44) Number in which doctor was present 46 (42) During the year the domiciliary midwives have obtained 447 specimens of blood from babies for the Guthrie test. These visits are made when either the baby is discharged before the test is due at 6 days or when the first test has proved inadequate. 26 The educational supervisor of the Central Midwives Board visited the borough to see the facilities provided for domiciliary training; a satisfactory report was received. Training of Pupil Midwives Six pupil midwives from the St. Mary's Hospital, Harrow Road completed their domiciliary midwifery training with the Council's midwives with whom eight obstetric nurse students from the St. Stephen's and St. Mary Abbots Hospitals made visits as part of their obstetric course. Midwives Act, 1951 The Council are the local supervisory authority for the purposes of the Midwives Act, 1951 and have a duty to inspect and supervise all midwives practising in the area. Notifications received from midwives of intention to practise 88 (90) Refresher courses attended by midwives in accordance with Section 9 of the Rules of the Central Midwives Board 12 (11) Home Nursing District Nurses This service is provided by the Kensington District Nursing Association for the whole of the borough area, and the Council reimburse the Association to the extent of 93% of net approved expenditure incurred in providing the service. The supervising staff consists of the Superintendent (Miss E.M. Evans, S.R.N., S.C.M., M.T.D.) and one Assistant Superintendent. Other home nursing staff employed at 31st December, 1971 were as follows:— State registered and state enrolled nurses 40.0 Total full-time equivalent 38.5 Students 7.0 The following is a summary of the service for the year:— 1. Number of patients attended: 0-4/37 5-64/575 65 +/1629 Total all ages 2,241 (2,393) 2. Number of new cases: Medical 1,247 Surgical 258 Tuberculous 7 Maternity 2 Mental ill health 17 3. Visits made for: 1,531 (1,688) Injections only 15,854 Injections plus other treatment 1,853 Other treatment only 69,519 4. Nursing treatments: 87,226 (89,730) Number of patients attended for at least 3 months 108 ( 174) Number of completed treatments 1,610(1,808) Number of patients being attended at end of year 754 ( 719) Average number of visits per patient 39 ( 37) 27 Since 1965, whilst the overall tendency has been a steady decrease in the numbers of patients nursed this has resulted from a decrease only in certain groups. The numbers of new surgical cases and those suffering from mental ill health undertaken each year have remained at about the same level, while all other types have decreased. With regard to age distribution, the trend appears only for patients under 65; the numbers of those over 65 varied from year to year, but never more than 10% either up or down. The numbers of long-term patients, i.e., those attended for at least three months, have fallen and, this year, are the lowest since 1965. On the other hand the average number of visits per patient is the highest over the same period. Included in the visits made are a number in which patients attend evening clinic sessions held in the Association's premises; these sessions are almost entirely devoted to injection treatments. Little Sisters of the Assumption A grant of £100 was made to the Little Sisters of the Assumption in respect of the domiciliary nursing service provided by the Order. Co-operation with Hospitals This co-operation takes three forms:— (i) Participation in training in the Schools of Nursing. (ii) Liaison with hospital departments, and (iii) Study days. (i) Within the Schools of Nursing health visitors continued to teach at both St. Charles and St. Stephen's hospitals. Following the amalgamation of the training schools of St. Mary Abbots and St. Stephen's Hospitals, all nurses in training in this borough received talks from the community nursing staff and made visits of observation to the local authority services. The 1969 General Nursing Council syllabus extends the type and range of experience in general nurse training; as a result students may choose to undertake periods of study and observation in psychiatric, geriatric, community or obstetric care. Programmes for the first students undertaking a period of six weeks within the community nursing services are being planned to take place early in 1972. (ii) Closer liaison has continued to develop with the hospital services, and community nursing staff are working with the following hospital departments: St. Charles Hospital — Paediatric Department St. Mary's, Paddington — Maternity Department (a) Post natal teaching St. Mary's, Harrow Road — Maternity Department (a) Post natal teaching (b) Maternity liaison St. Stephen's Hospital — Maternity Department (a) Post natal teaching (b) Maternity liaison St. Lukes Hospital — Geriatric Services Preparations were made for increased liaison with the re-opened Princess Beatrice Hospital and for liaison with the Princess Louise Hospital upon its redesignation as a geriatric hospital. The liaison between health visitors and the psychiatrist from the Earls Court child guidance unit (I.L.E.A.) continued to be generally beneficial. (iii) A further study day was held during the year for staff of the Chelsea and Kensington group of hospitals and the community nursing staff. 28 Schemes for closer working become more vital and important as we progress towards the re-organisation of the National Health Service and the establishment of integrated patterns of health care. In-Service Training Talks were arranged during the year for members of the nursing staff. These included "Geriatric Care" by Dr. N.K.P. Singh, Consultant Geriatrician, Westminster and St. Lukes Hospitals and "Future Development within the Health Department" by myself. Dr. Fluker, Consultant Venereologist, West London Hospital held a study day, to which both nursing and social work staff were invited, on "Venereal Disease". Senior nursing staff acted as lecturers at courses which included the following: (i) London Boroughs Training Committee (a) Study Day "Prevention of Mental Illness" (b) Training Course for School Nurses (c) Re-entry Course for Health Visitors (ii) St. Mary's Hospital — School of Midwifery (a) "Domiciliary Midwifery" (iii) Induction course for interviewers for the Colville Study (iv) Greater London Conference on Old People's Welfare Course on "Help for the Elderly" (v) I.L.E.A. Teachers Centre — Study Day for Domestic Science Teachers "Family Life in an Underprivileged Area". Students and Visitors We were pleased to welcome the following visitors undertaking study leave in this country:— Research Professor, WHO Fellowship from the U.S.A. Research Fellow, WHO Scholarship from India Child Educationalist from Institute of Child Health — U.S.A. Social Administration — Degree Course Student Diploma Child Health — Doctor from Australia General Practitioner — Student trainee Programmes of visits of observation of the work of the community nursing and preventive services were made for the following persons:— 209 student nurses from St. Stephens & St. Charles Hospitals 34 student nurses taking the obstetric course 5 student nurses from the Middlesex Hospital 4 student dieticians from the Queen Elizabeth College 1 Community Tutor student 40 student teachers from the Froebel Institute 6 student teachers from Maria Assumpta Training College 1 Sister Tutor Diploma student 6 Nursery Nurse students 1 Child Care student 1 student probation officer 1 teacher of handicapped children 24 new entrants to the Council's service 32 schoolgirls 29 VACCINATION AND IMMUNISATION In spite of the decrease in the number of births in the borough there is a tendency for a larger number of people to use the facilities provided for immunisation against communicable diseases. There have been marked increases in both primary courses and reinforcing doses against poliomyelitis, diphtheria and tetanus, and a smaller increase in primary courses against whooping-cough, but primary courses against measles have decreased. These movements followed slight increases in primary courses against all these diseases in the previous year. Although, following a recommendation of the Joint Committee on Vaccination and Immunisation, local health authorities were advised by the Department of Health and Social Security that vaccination against smallpox need not be a routine procedure in early childhood and it was deleted from the Council's schedule of routine vaccination during the year, the number of revaccinations of children, particularly around school-leaving age, increased slightly. This presumably arises out of the requirements of travel abroad which now becomes an important inducement in this connection. Vaccination against smallpox continues to be available on request. The following is a summary of immunisations given:— Primary courses completed Reinforcing doses Poliomyelitis vaccination (No Salk vaccine was used) at Council clinics: Sabin 1570 (1593) 2507 (1613) by general practitioners: Sabin 904 ( 319) 378 ( 243) TOTAL 2474 (1912) 2885 (1856) Diphtheria Immunisation at Council clinics 1511 (1350) 1530 (1301) by general practitioners 819 ( 334) 445 ( 254) TOTAL 2330 (1684) 1975 (1555) Whooping Cough Immunisation at Council clinics 1050 (1046) 105 ( 174) by general practitioners 494 ( 270) 42 ( 73) TOTAL 1544 (1316) 147 ( 247) Tetanus Immunisation at Council clinics 1453 (1358) 2086 (1443) by general practitioners 836 ( 351) 496 ( 264) TOTAL 2284 (1709) 2582 (1707) 30  Primary courses completed Measles Vaccination at Council clinics 734 ( 952) by general practitioners 213 ( 207) TOTAL 947 (1159) Smallpox Vaccination At Council clinics By general practitioners Total Primary vaccinations Under 1 year 11 ( 26) 5 ( 7) 16 ( 33) 1 year 360 (473) 59 (132) 419 (605) 2-4 years 249 (286) 157 (149) 406 (435) 5 — 14 years 36 ( 35) 32 (41) 68 ( 76) 15 years and over 9 ( 2) 8 ( 9) 17 ( 11) TOTAL 665 (822) 261 (338) 926 (1160) Revaccinations Under 1 year Nil ( 2) 1 (Nil) 1 ( 2) 1 year 8 ( 5) 7 (Nil) 15 ( 5) 2 — 4 years 26 ( 14) 13 ( 16) 39 ( 30) 5-14 years 58 ( 42) 71 (118) 129 (160) 15 years and over 3 (16) 226 (180) 229 (196) TOTAL 95 ( 79) 318 (314) 413 (393) Tetanus The Council clinics do not provide immunisation for persons over 16 years, but vaccine is supplied to general medical practitioners on request. At the request of the Medical Adviser of the Inner London Education Authority a letter was sent to the Heads of colleges of further education in the borough drawing attention to the importance of tetanus immunisation, and the availability of medical staff and vaccine for special sessions if they so desired. Rubella (German Measles) Vaccination against Rubella for girls between their 11th and 14th birthdays commenced in the borough during the Spring term 1971. The immunisations given for the first year are as follows:— Vaccination under Council arrangements 992 Vaccinated by General Practitioners 31 Surveys have shown an association between abnormalities found in children and rubella infection of their mothers in early pregnancy. Vaccination against rubella is intended to give long-term benefits rather than conventional immunity which is the object of other prophlylactic measures. In order to ascertain the effect of rubella vaccine and the incidence 31 of congenital defects in children which may be attributable to rubella, a National Surveillance Programme over a period of ten years is being carried out under the direction of Dr. J.A. Dudgeon of the Hospital for Sick Children, Great Ormond Street, London. This department has agreed to participate fully in the study so as to provide information which may help to answer the queries regarding multiple defects in children covering a wider and more varied spectrum. Tuberculosis (B.C.G. Vaccination) School Children (13 year olds) Schools visited 9 (9) Number of eligible children 1807 (2876) Number of acceptances 1344 (2043) Acceptance rate 74% (71.0%) Number skin-tested and read 899 (1322) Number given BCG vaccination 853 (1209) Number of positive reactors 46 (113) Positivity rate 5.1% (8.6%) The figures for the two years stated above are not strictly comparable as those for 1970 included children who should really have been attended to in 1969. However, the acceptance rate on the numbers eligible shows an upward trend and may be regarded as a satisfactory level. The skin test used is Mantoux (IOTU). Contacts The decrease in the numbers of contacts of cases of tuberculosis dealt with at chest clinics has continued, but not to the same degree as noted in previous years. The positivity rate, which is usually high in this group, has risen to 38.2% compared with 17.3% in 1970; this rate shows considerable variation and the increase is not significant. Number skin tested and read 102 (104) Number found negative 63 (86) Number prior B.C.G. vaccination 64 (86) Number found positive 39 (18) HOME DIALYSIS Four applications were received during 1971 for adaptations to be carried out to provide for the installation of artificial kidney machines in the homes of patients who had been trained in hospital for haemodialysis at home. In all four cases the premises occupied by the patients and their families were found to be unsuitable for various reasons and, after consultation with all interested parties, decisions were taken which had the following effect- Two patients were rehoused in Council property, and in each case a suitable room was specially adapted to enable installation of the home dialysis equipment. One patient was provided with a Portakabin Unit, which was suitably adapted and erected in the garden at the rear of the house. The total cost of the works involved and provision of the Portakabin Unit was £3,241.50. I regret to record that one of the rehoused patients died during the year, and it was decided to make his Council flat with the dialysis equipment available for the fourth patient. In addition, an application received in the previous year was still outstanding because the applicant had purchased a house which required extensive alteration. The adaptation for the installation of an artificial kidney machine, which proved to be only a small part of the total work involved, was only completed by the end of 1971. 32 The cost of adaptation works continues to increase and averaged £758 for the work on the four applications made. The estimated cost of work in connection with the application in 1970 was £520 but the actual cost proved to be £635. This Council has been quite willing to arrange for rehousing, to carry out adaptations and pay for them in respect of those patients who cannot afford to do so. CHIROPODY There has again been a substantial increase in the number of treatments given, although the number of persons treated at Council clinics has dropped. This indicates that patients have been given treatment more frequently thus enhancing the quality of service. It is hoped that this trend will be maintained. The large number of women who need chiropody treatment as compared to men seems to suggest that some form of advice on the care of the feet and correct footwear should be given to young women and girls, preferably at school. As a long-term measure the referral of more children of the age group 5-14 years to Council clinics whenever foot abnormalities are detected at school medical examinations would be welcomed. Details of attendances, etc., are as follows:— Total number of Chiropodist sessions held at Council clinics 2,795 (2,380) Number of persons attending Council clinics 2,690 (2,864) Analysis by age-groups of attendances at Council clinics: Children — Under 5 3 (1) 5—14 years 150 (153) Expectant mothers 2 (1) Males - 15 to 64 years 1,086 (1,168) 65 years and over 2,117 (1,684) Females — 15 to 59 years 3,479 (3,537) 60 years and over 10,401 (7,996) Total attendance at Council clinics 17,233 (14,540) Number of patients referred to private Chiropodist 23 (48) Number of treatments given by private Chiropodist 986 (1,018) (Note — Included in above are 19 handicapped persons under 65 who made 78 attendances.) LOAN OF HOME NURSING EQUIPMENT Under Section 12 of the Health Services and Public Health Act, 1968, the Council provide on loan articles necessary for the efficient nursing of patients in their own homes. Such equipment is normally lent only in instances where the patient is under active medical treatment; the equipment remains with the patient as long as the medical need exists and no charge is made for this service. A supplementary service is provided by the British Red Cross Society. During the year, the Council gave this Society a grant of £125 towards this work. The demand for all types of equipment has increased as indicated by the 556 issues made by the Council, and 1,283 by the British Red Cross Society, as compared with 633 and 826 respectively during 1970. The demand for incontinence pads has again increased although the number of patients has decreased to 210 (232 in 1970). 33 PROVISION OF FIREGUARDS Fireguards continue to be available on loan without charge to necessitous households where there are children under twelve years of age, or elderly, handicapped or blind people. Forty-seven were issued during 1971, compared with 35 in 1970. Some of these were of a type specially designed for use with oil heaters and others of nursery pattern suited to meet circumstances in particular homes. 34 5 SCHOOL HEALTH SERVICES (Annual Report by Dr. D.J. Sheerboom Borough Medical Officer of Health and Principal School Medical Officer) The Inner London Education Authority is responsible for the school health service but by virtue of an agreement required by Section 32 of the London Government Act, 1963, there is joint use by the Authority and the Council of professional staff, premises and equipment. The Medical Officer of Health is the principal school medical officer of the Inner London Education Authority for the area of the borough and is responsibile to that Authority for the day-to-day running of the service. The following is a summary of the work of the school health service during the year ended 31st December, 1971. Where relevant, comparable figures relating to the previous year are shown in brackets. At September, 1971, there were 9,826 (9,441) pupils attending 31 (30) primary schools and 6,266 (6,155) pupils attending 8 (8) secondary schools. In addition, 148 (164) children attended nursery schools. As a result of the Education (Handicapped Pupils) Act, 1970, as from the 1st April, 1971, the Junior Training Centre at Wallingford Avenue became part of the education system and is known as Dame Evelyn Fox School. The number of children attending is 72. ROUTINE MEDICAL INSPECTIONS Conditions governing the medical examination of all school-children remain the same as in previous years. Children are examined on entry to infant school at about five years of age, on entry to primary school at about eight, on entry to secondary school at eleven-plus, and finally during the term immediately preceding the end of their school life. During the year 6,803 (7,046) children were examined in 683 (708) sessions. The total number of defects found was 2,277, representing an incidence of 33% of the number of inspections. Of these defects 1,113 (16%) were noted for treatment. Vision defects comprised 1,141 of the total of which 558 were noted for treatment. SPECIAL MEDICAL INSPECTIONS A child exhibiting hitherto unnoticed physical or mental abnormalities may be specially examined at the request of teachers, parents or other interested parties at any time during school life. Defects discovered at routine medical inspection may also result in special medical examinations. During the year children thought to be in need of education in special schools were referred from various sources and a total of 47 (49) statutory examinations were carried out. Referrals included 32 (40) for the statutory E.S.N, examination which resulted in 19 (14) recommendations for education at schools for the educationally sub-normal. The remainder included 15 (9) recommendations for open air schools. Other examinations included 147 (190) secondary school pupils seeking employment and 795 (1,005) wishing to go on school journeys. HANDICAPPED PUPILS Apart from the Dame Evelyn Fox School mentioned above there are no special schools for the education of handicapped pupils in the area, but a total of 206 (208) 35 children requiring special educational treatment attended schools in other boroughs and 89 (86) were placed in boarding schools. Included in these numbers were 26 (26) physically handicapped children in attendance at day schools and 5 (6) at boarding schools. Attending ordinary schools were 72 (70) epileptic children, 42 (45) with orthopaedic and postural defects, 6 (7) suffering from diabetes, 17 (15) from rheumatism, 228 (213) from asthma, 16 (17) cerebral and spastic cases, and 14 (14) with eye diseases other than refractions and squints. The number of maladjusted children referred to the Problem Case Conference was 112 (153). Of this number, 80 (103) were referred to Child Guidance Clinics. There were two tutorial classes for maladjusted children and 11 (15) children were recommended for them from Case Conferences. CLINICS Vision The total attendances numbered 1,880 (2,028) at 149 (162) sessions held during the year. New cases attending during the year numbered 790 (838). Partially sighted children educated in special schools numbered 8 (8). Hearing Audiometry During the year 3,656 (4,177) children in ordinary schools were given the "Sweep" test by the nursing sisters. Details of the results are shown in the following table:— Boys Girls Total Sweep Test Number tested 1,862 1,794 3,656 Number passed 1,632 1,604 3,236 Number failed 230 190 420 Pure Tone Test of Sweep Test Failures Number tested 93 88 181 Number passed 56 58 114 Number failed and referred to otologist 37 30 67 Other Pure Tone Tests (including hospital care) Number tested 79 62 141 Number passed 52 36 88 Number failed and referred to otologist 27 26 53 In addition to 8 (8) children attending schools for the deaf, 8 (6) attended partially hearing units. Of the 23 (16) children wearing hearing aids who attended other schools, 15 (11) were in ordinary schools, 3 (1) were in schools for the physically handicapped and 5 (4) were in schools for the educationally sub-normal. 36 Audiology The total attendances at the 37 (40) sessions held number 210 (277). New cases attending during the year totalled 75 (84). In addition, a "deaf" register, reviewed at regular intervals by a designated medical officer, was kept in the principal social worker (Health Services) section, where a social worker is responsible for maintaining liaison with the special services provided for deaf children, some of whom may be attending audiology clinics other than those referred to above, and of whom a number are in boarding schools. Special Investigation Children with a wide variety of problems attend the special investigation clinics, where in the main problems of enuresis and over-weight are dealt with. Cases of debility and poor general physique account for most other referrals. At the 115 (111) sessions held, 123 (93) new cases were seen, while the total attendances amounted to 784 (782). Minor Ailments Medical officers conducted 83 (92) sessions and examined 395 (361) new cases. Nursing sisters held 685 (746) sessions and saw 602 (955) new cases. Altogether the total attendances at the clinics numbered 5,943 (6,693). Speech Therapy There were 3 (3) clinics staffed by 3 (3) speech therapists with 11 (10) sessions a week. PERSONAL HYGIENE Of 14,616 (15,459) children seen during comprehensive surveys 178 (192) were found to be verminous. Inspections during selective surveys numbered 7,862 (5,717) and on 293 (274) occasions children were found to be verminous. The number of individual children found to be verminous was 296 (244). BATHING CENTRE Children attended the bathing centre on 680 (428) occasions, when 131 (78) cases of scabies and 448 (272) verminous cases were treated. As in the previous year no cases of impetigo were treated. There is still clearly a need for vigilance on the part of all concerned. REMEDIAL FOOT CLASSES With the continued co-operation of the head teachers, remedial classes were held in eight primary schools and 225 (190) children were treated by teachers who have attended special classes at the College of Physical Education. Overall supervision was given by a medical officer who visited each class at regular intervals. 37 IMMUNISATION Details of immunisation in schools are given below: — Completed primary courses Reinforcing injections (re-vaccinations) Smallpox 68 ( 76) 129 (160) Diphtheria/Tetanus/Whooping Cough: Triple 8 ( 17) 75 ( 54) Diphtheria/Tetanus 232 (192) 1,661 (1,170) Diphtheria 58 { 2) 31 ( 51) Tetanus 20 ( 22) 515 (199) Poliomyelitis: Salk Nil (nil) Nil (nil) Sabin 238 (244) 2,402 (1,547) Measles 51 ( 72) - - Rubella 1,022 - - INFECTIOUS ILLNESS The following table shows the number of cases of infectious illness reported from the schools by head teachers during 1971 Disease Total Disease Total Chicken Pox 128 Ringworm (scalp) 1 Dysentery ) Ringworm (body) 3 Diarrhoea ) 16 Scabies 5 Enteritis ) Scarlet Fever 11 German Measles 34 Tonsilitis 33 Influenza 10 Whooping Cough 2 Impetigo 7 Meningitis 2 Jaundice 23 Abdominal pains & vomiting 55 Measles 68 Glandular Fever 3 Mumps 8 Conjunctivitis, 1 Pneumonia 1 38 RECUPERATIVE HOLIDAYS FOR SCHOOL CHILDREN During the year, the School Health Service received 50 applications for school-children to have recuperative holidays unaccompanied by their parents and two applications made in the previous year were still awaiting placement. Arrangements were made for 29, 18 applications were withdrawn or cancelled and 5 were still awaiting placement at the end of the year. Arrangements for the placement of school-children to have recuperative holidays with their parents are made by the Social Services Department. B.C.G. VACCINATION FOR 13-YEAR OLD CHILDREN A medical officer, together with a clerical assistant, visited 9 (9) schools. There were 1,807 (2,876) children eligible for B.C.G. vaccination. The parents of 1,344 (2,043) children gave their consent and out of this number 899 (1,322) were skin-tested and read. Of these 853 (1,209) children were vaccinated. The remaining 46 (113) were found to be positive reactors. In 1969 the programme was not completed due to staff shortage, and the figures for 1970 therefore include the backlog so arising. 39 6 THE DENTAL SERVICES STAFF Mr. A. Longden, the Principal Dental Officer commenced duties on 1st February, 1971. One full-time Dental Officer, Mrs. M. McNicholl left the Council's service in November, 1971. Her successor was appointed in December, 1971, and will commence duties on 1st February, 1972. On 31st December, 1971 the Staff consisted of the Principal Dental Officer, two whole-time and one part-time Dental Officers, supported by four whole-time Dental Surgery Assistants, and one part-time anaesthetist. PREMISES AND EQUIPMENT Four dental centres were in use during the year. Motor chairs and X-Ray equipment have now been installed at the North Kensington and Westbourne Grove centres. All four centres are now equipped with X-Ray apparatus, and patients are no longer referred to other clinics for X-Ray examination. INSPECTION AND TREATMENT OF SCHOOL CHILDREN During the year 22 infants schools, 20 junior schools, 5 senior schools and 5 nursery schools received routine dental inspections. A total of 9,158 children were inspected during 95.6 inspection sessions. In addition 2,111 children were inspected at clinic treatment sessions, giving a total annual inspection of 11,269; of these 5,433 were offered treatment. Details of treatment provided are given in the tables at the end of the report. A total of 2,656 courses of treatment were completed during 1,505 treatment sessions. The ratio of teeth filled to teeth extracted was 18.6: 1 in the permanent and 2.7: 1 in the temporary teeth, excluding orthodontic extractions. The following summary of the School Dental Services shows comparative details for 1970. Number of sessions 1971 1970 Inspection 95.6 95 Ordinary treatment 1,482.2 1,252 General anaesthetic 19.7 17 Orthodontic 3.1 Nil Health Education 2 3 Total sessions 1,602.6 1,367 Inspections Number of children given First inspection at school 9,158 6,994 First inspection at clinic 2,111 2,187 Proportion found to require treatment 49% 57% Reinspection at school or clinic in 1971 1,948 1,949 Proportion found to require treatment 54% 48% Total of appointments made 14,104 12,667 Total of attendances by appointment 10,204 9,057 Response rate 72% 71% Average attendances per session 6.9 7.3 40 Visits for treatment 1971 1970 Number of first visits 2,806 2,401 Number of subsequent visits 6,195 5,360 Total visits 9,001 7,761 Emergencies 124 128 Additional courses commenced 677 499 Treatment given Number of fillings In permanent teeth 4,378 3,741 In temporary teeth 3,372 3,028 Number of extractions Of permanent teeth 250 195 Of temporary teeth 1,215 799 Number of other operations (Prophylaxis, X-Rays, Inlays, Crowns, etc.) 3,020 1,866 Courses of treatment completed 2,656 1,416 Orthodontics Number of new cases 4 9 Number of removable appliances fitted 5 11 Number of cases referred to Hospital Consultant 45 9 MATERNAL AND CHILD HEALTH DENTAL SERVICE Dental inspections during the year were carried out on 426 children under five years of age, and 61 expectant or nursing mothers. Treatment was offered to 200 (47%) of the children, and 57 (93%) of the mothers. A 3-year-old birthday scheme was introduced in December, 1971. The card invites children to a first dental inspection during their third year, the aim being to encourage the habit of regular dental inspection at as early an age as possible. Details of work done are given below with comparative details for 1970 in brackets. Expectant or Nursing Mothers Children under five Number of appointments given 259 (169) 1,220 (1.206) Number of attendances by appointment 186 (125) 887 (900) other - ( 1) 5 ( 18) Number of patients given first inspection during year 61 ( 45) 426 ( 440) Number of patients above found to require treatment 57 ( 41) 201 ( 206) Number of patients above offered treatment 57 ( 41) 200 ( 201) Visits for treatment: First 56 ( 37) 201 ( 195) Subsequent 108 ( 67) 471 ( 391) Number of treatments given: Fillings 122 (100) 532 ( 471) 41  Expectant or Nursing Mothers Children under five Teeth extracted 23 (14) 36 ( 61) Patients X Rayed 40 ( 15) 2 ( 4) Prophylaxis 44 ( 19) 35 ( 21) Number of courses of treatment completed 38 ( 25) 126 ( 42) Number of patients supplied with dentures (F.U. or F.L.) first time 0 ( 1) Number of patients supplied with other dentures 1 ( 1) 42 7 ENVIRONMENTAL HEALTH SERVICES Mr. D.C. Draper Chief Public Health Inspector At the end of 1971 the Public Health Inspectorate consisted of twenty-eight public health inspectors and fifteen assistants. In addition, a senior officer and two assistants were engaged in public control functions, a rodent officer with a deputy and six assistants on rodent control duties and a chief disinfector with a deputy and four assistants on disinfection and disinfestation work. During the course of the year, the number of applications for improvement grants increased and for the first time grants approved exceeded one million pounds. With the support of the Management Services Officer, the staff of this section was increased by three assistants to the public health inspectors and there is every indication of further expansion during the forthcoming year. A milestone was reached in connection with the Council's Smoke Control duties when in June, 1971, the Secretary of State of the Department of the Environment confirmed the Order for the last smoke control area in the borough. This Order will not become operative until July 1972. The work of the section dealing with atmospheric pollution will, of course, lessen but some duties will be retained such as routine measurement of atmospheric pollution, installation of new furnaces, determination of chimney heights, etc. In common with the majority of other boroughs there has been a considerable increase in mouse infestation. A report was submitted to the Council and authority was obtained for the employment of an additional assistant rodent officer and the purchase of a specially adapted vehicle. It is hoped that when this vehicle is in service, in addition to dealing with the large number of complaints, the section will also be able to undertake some routine block treatment in the worst affected areas. There is a continued shortage of qualified public health inspectors and great reliance is therefore placed upon the students who are trained in the Department and when qualified are taken on to the staff, thus filling vacancies created by retirement and officers taking up positions with other authorities. Nine students are employed and are required to undertake a sandwich course over three years in conjunction with one of the two Technical Colleges providing training in London. At the end of the course the students sit a comprehensive examination extending over several days in order to obtain the Diploma of the Public Health Inspectors' Education Board. 43 WORK OF THE PUBLIC HEALTH INSPECTORS AND THEIR ASSISTANTS The following is a summary of the work carried out during the year by, or under the supervision of, the public health inspectors and their assistants:- Inspections Made Initial visits Re-visits Public Health Acts 1936 and 1961 Complaints 4,003 4,240 Infectious disease enquiries 1,095 NIL Drainage work inspected 6,693 2,483 Drains tested 696 NIL Clean Air Act, 1956 Area survey 29 NIL Adaptations 532 NIL Smoke emissions 82 2 Smoke observations 133 NIL Air Pollution Recording Stations 27 NIL New furnaces and chimney heights 118 NIL Housing Acts 1957 to 1969 Routine inspections (not included below) 762 561 Houses in multiple occupation 2,869 4,355 Overcrowding 252 389 Underground rooms 506 133 Improvement grants 1,455 1,605 General improvement areas 325 318 Factories Act, 1961 Factories (mechanical) 310 NIL Factories (non-mechanical) 23 NIL Outworkers 45 NIL Offices, Shops and Railway Premises Act, 1963 Offices 585 NIL Retail Shops 675 30 Wholesale shops and warehouses 18 NIL Fuel storage depots NIL NIL Catering establishments and canteens 309 76 Other visits (not general inspections) 1,921 52 Food and Drugs Act, 1955 Butchers 49 2 Bread and cake shops 36 1 Fishmongers and friers 14 5 General provision shops 421 44 Greengrocers 31 NIL Milk vendors 46 NIL Ice Cream vendors 101 NIL Ice Cream manufacturers 5 NIL Bakehouses 19 3 Chocolate and confectionery 6 NIL 44 Inspections Made Initial visits Re-visits Food and Drugs Act, 1955 — continued: Street traders' stalls, etc. 302 8 Street traders' stores 1 NIL Wholesale warehouses 1 1 Catering establishments 990 352 Clubs 14 NIL Inspection of Food 167 NIL Sampling 474 NIL Other visits 350 15 Pharmacy & Poisons Act, 1933 12 NIL Consumer Protection Act, 1961 5 NIL Rag Flock Act (Sampling) 1951 4 NIL Various Noise complaints 269 137 Pet Animals Act 8 1 No-access visits 2,469 104 All other visits 3,193 237 Work Completed New items provided Drains 237 I nspection chambers 118 Intercepting chambers 22 Soil pipes 146 Waste pipes 153 Rainwater pipes 50 Water closets 592 Bidets 35 Wash-hand basins 718 Sinks 208 Baths/showers 467 Urinals 42 Hot water supplies 20 Separate cooking facilities 16 Means for space heating 14 Dustbins 20 Items cleansed or cleared Drains 55 Soil pipes 3 Waste pipes 4 Rainwater pipes 3 Cisterns 9 Noxious matter 23 Other rubbish 78 Items repaired or renewed Drains 23 Inspection Chambers 7 Intercepting chambers 5 Soil pipes 19 Waste pipes 51 Rainwater pipes 49 Water closets 76 Wash-hand basins 16 Sinks 16 Urinals 3 Roofs 172 Gutters 25 Walls 278 Ceilings 205 Floors 84 Windows 147 Doors and frames 29 Fireplaces 2 Staircases 36 Yards and areas 6 Water waste preventers 14 Number of houses where dampness eradicated 384 Number of houses where artificial lighting to staircase provided 10 45 Notices Served Public Health Acts 1936 and 1961 Intimation notices 618 Statutory notices 569 Final notices 110 Housing Acts 1957 to 1969 Section 9 (repair) 46 Section 14 (deficiencies of management) NIL Section 15 (additional amenities) 45 Section 16 (means of escape from fire) 48 Section 90 (overcrowding) 5 Various Food Hygiene (General) Regulations, 1960 77 Offices, Shops & Railway Premises Act, 1963 74 Other notices 37 46 DISINFECTING STATION AND MEDICINAL BATHS Medicinal Baths The following table shows the work carried out during 1971 Description Scabies Vermin Persons Cleansings Persons Cleansings Adults Kensington & Chelsea 101 160 203 213 Other boroughs - - - - Schoolchildren Kensington & Chelsea 110 172 281 304 Other boroughs 21 40 167 171 Children under five Kensington & Chelsea 22 38 42 42 Other boroughs - - - - TOTALS 254 410 693 730 In addition to the cleansing of persons referred to above, the number of articles disinfested at the medicinal baths during the year numbered 131. Disinfection and Disinfestation A summary of the routine work carried out in 1971 by the disinfecting staff is shown in the following table:— Houses disinfected after infectious disease 42 ( 90 rooms) Houses disinfected after vermin 548 (1778 rooms) Total weight of bedding, etc., dealt with 2% tons Certain foreign countries prohibit the import of parcels of clothing, unless accompanied by a certificate that the articles have been disinfected. The Council afford facilities to persons desirous of sending clothing abroad and, for this service, a standard charge is made of 50p per parcel. During the year thirty-seven parcels of clothing were disinfected and the income amounted to £18.50. The following table indicates the destination of these parcels:— Destination No. of parcels Argentina 16 East Germany 14 Spain 7 TOTAL 37 47 Laundry Service for the Aged Incontinent The Council have no direct authority to provide a laundry service but under Section 84 of the Public Health Act, 1936, they are empowered to cause any article in a house to be cleansed, disinfected or destroyed if it is in such a condition as to be a danger to health. Fouled bed linen in cases of incontinence may be cleansed under this section. In order to comply with legal requirements, the Medical Officer of Health has been given a general authority by the Council to take whatever action appears to him to be necessary under the terms of the Act in order to fulfil the great need for such a service in the borough. During the year, 2,013 separate collections of laundry were made and the number of articles cleansed totalled 24,934. The articles were marked, collected and laundered at the Council's disinfecting station, and returned to the persons' homes. Issue of Medical Aids and Loan Equipment During the year, the disinfecting staff also made 3,069 visits to deliver or collect loan equipment (wheelchairs, hoists, commodes, etc.) and to distribute incontinent pads, interliners and pants at the request of the Council's officers and others who deal with the problems of the handicapped and elderly. PREVENTION OF DAMAGE BY PESTS The Prevention of Damage by Pests Act, 1949, imposes a duty on occupiers of premises to notify the Council of rodent infestation and the Council are required to ensure that the borough is, as far as practicable, kept free from rats and mice. The Council deal with rat and mouse infestation in dwelling houses without cost to the occupiers, but expenditure incurred in treating infestations on commercial and industrial premises is recovered from the owners. The Council are required to submit reports on:— (i) the extent of infestation; (ii) special circumstances to which any undue presence of rats and mice might be attributed; and (iii) the nature and extent of co-operative working with contiguous local authorities. It has been confirmed with the Ministry of Agriculture, Fisheries and Food that over the past few years local authorities throughout the country have been receiving increasing numbers of complaints of mice. The increase in the numbers of such complaints received by local authorities in urban areas has risen quite markedly, particularly in London where most of the Inner London Boroughs are finding great difficulty in dealing with the current mouse problem. So far as Kensington and Chelsea is concerned, the increase has been dramatic, rising from 551 confirmed cases of mouse infestation in 1965, to 2,632 cases in 1971. The reasons for the rapidly increasing number of complaints are not clear, but factors influencing the position are:— (a) an increase in public awareness of the service offered by the Council; (b) the increase in the number of houses in multiple occupation, particularly single-room lettings, with the consequent storage of waste foodstuffs throughout the entire premises and with no one person responsible for good hygiene standards; (c) the general increase in the amount of food available and the carelessness in the disposal of waste food; 48 (d) increasing demands on the time of the rodent control staff as complaints increase means that less attention can be paid to each individual job, with less chance of complete success; (e) redevelopment work in certain areas had dispersed mice from the demolished properties; (f) fewer cats appear to be kept as pets; (g) the reduction of the rat population has left the mice with less competition; and (h) the standard poison in use over the past five years has been Warfarin, a blood anti-coagulant, and there is evidence to suggest that a strain of mice is developing which is resistant to Warfarin. Extensive research has been undertaken concerning the source of the mice complaints over the past few years and whilst it is found that each ward is affected to some extent, it is also clear that certain streets in each ward are principal reservoirs of mouse infestation. It is possible by plotting the complaints received on a map to find those areas in the borough where the majority of complaints originate. If comprehensive treatments could be undertaken in these worst affected areas the officers are of the opinion that the pressure on the staff visiting the premises on complaints would be substantially reduced. The problem has been discussed with officers of the Ministry of Agriculture, Fisheries and Food and they share the view that the most satisfactory method of dealing with this matter is to retain the existing staff on visiting complaints and form, in addition, a special squad of men to carry out area treatments where infestations are at their heaviest. The Council have authorised the employment of one extra rodent control officer and also the purchase of a new van, properly fitted out, so that it may be used as a mobile supply base for the treatment of some of the worst areas in the borough. Delivery of the van is expected in the first half of 1972. The Minister of Agriculture, Fisheries and Food requested a report for the twelve months ended 31st December, 1971, as follows: — Treatment of premises (rats and mice) Number of properties in the borough 75,310 Total number of properties inspected following notification 4,063 Number infested by rats 63 Number infested by mice 2,632 Total number of properties inspected for rats and/or mice for reasons other than notification 1,325 Number infested by rats 3 Number infested by mice 163 Generally The rodent staff, in addition, deal with infestations from pests other than rats and mice, and the following is a summary of action taken during the year in respect of all forms of infestation:— Premises inspected following complaints 4,593 Premises where rats were found 66 Premises where mice were found 2,795 Premises where other vermin were found 425 Number of visits made 22,591 Number of successful treatments 2,533 Cases in which advice only was given 499 Borough Council properties dealt with (excluding dwelling houses) 202 49 FERTILISERS AND FEEDING STUFFS ACT, 1926 On 1st April, 1965, the duties under the above Act were transferred to the London Boroughs from the London County Council under the provisions of the London Government Act, 1963. During the year, fifteen samples of fertilisers and five samples of feeding stuffs were obtained and submitted for analysis in accordance with the provisions of the Act. The composition of two samples of fertilisers and one sample of feeding stuffs was found to vary beyond the prescribed limits, and in each case the matter was taken up with the supplier concerned. DISEASES OF ANIMALS ACT, 1950, AND OTHER ASSOCIATED ACTS Generally As from 1st April, 1965, the Council assumed responsibility for administering the above Acts and, in July, 1965, authorised and appointed the Veterinary Officer and Inspectors of the City of London to act on their behalf. By agreement with the Council, the City Corporation have undertaken to provide administrative, clerical, professional, scientific and technical services in connection with certain functions under the Acts, and have further agreed that they should report offences occurring in the borough and thereafter their officers should take such action as may be necessary, subject to prior consultation with the appropriate officers of the Council. Riding Establishments Act, 1964 This Act provides for the licensing and inspection of any establishment where the business of keeping horses for hire, for riding or for providing riding instruction is carried on. Two riding establishments in the borough are licensed and, in each case, satisfactory reports on their suitability were received from the Veterinary Officer during the year. PHARMACY AND POISONS ACT, 1933 At the end of the year, the number of sellers of Part II poisons (other than registered pharmacists) on the list maintained by the Council was 93. There were five new registrations during the year. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 This Act regulates the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. Subject to certain exceptions, the Act makes it unlawful to use prescribed filling materials except on premises registered by a local authority. The local authority are required, on the application of the occupier of premises, to register the premises on payment of a registration fee of Two Pounds. At the end of the year, there were twenty-one registered premises in the borough. If, on registered premises, there are unclean filling materials, the occupier shall be guilty of an offence. It is also an offence to sell or offer for sale any article which is upholstered with unclean filling materials (second-hand articles are excepted). Inspections of the registered premises were made during the year and four samples of Algerian Fibre, three samples of Cotton Felt and one sample of Cellular Plastics Crumb were taken for analysis. They were all reported to be satisfactory. 50 PET ANIMALS ACT, 1951 This Act requires that no person shall keep a pet shop except under the authority of a licence issued by the Council and in compliance with any conditions specified in the licence. During the year, eight premises were licensed under the Act. No contraventions of the Act were found during regular inspections of the premises, and at all times the stock was well cared for and maintained in accordance with the conditions specified in the licence. CONSUMER PROTECTION ACT, 1961 This Act empowers the Secretary of State to make regulations imposing, in respect of any prescribed class of goods, requirements which are expedient to prevent or reduce risk of death or personal injury. THE OIL HEATERS REGULATIONS, 1962 AND 1966 These Regulations prescribe certain standards of construction, design and performance with which both new and second-hand unflued domestic oil heaters must comply, and make it an offence for any person to sell, or let on hire, or hire purchase, or have in his possession for sale, any such heater or component part thereof not complying with the Regulations. During the year, visits were made to all shops and stalls displaying second-hand oil heaters for sale to the public. No contraventions of the Regulations were found. In addition, investigations were made into all cases of fires involving oil heaters which were notified to the department by the fire authority. ATMOSPHERIC POLLUTION Clean Air Act, 1956 Smoke Control Areas During 1970, the Council decided to make a Smoke Control Order in respect of the North and South Stanley Wards, bounded on the north by the centre of Fulham Road, on the east by the centre of Old Church Street, on the south by the high water mark of medium tides and on the west by the borough boundary. It has an area of approximately 192 acres (map reference No.C4) and was the only part of the borough not covered by an Order. In making this Order, the Council exempted properties in an area bounded on the north by King's Road, on the east by Ashburnham and Cremorne Roads, on the south by Lots Road and on the west by the borough boundary. A number of these properties are to be cleared for the construction of the West Cross Route scheme and the remainder are expected to be included in projected schemes by the Greater London Council at a future date. In estimating the cost of adaptations for the whole area, no account has been taken of these latter premises. The detailed survey showed that the total cost of adaptation will be approximately £40,850 of which, after deducting Exchequer Grant and the cost for which private owners will be responsible, the Council will be responsible for payments amounting to £16,145. The Order was made on 28th October, 1970. There was one objection to the Order and after a hearing held on 6th April, 1971, by an inspector of the Department of the Environment, the Secretary of State confirmed the Order on 15th June, 1971, giving the operative date as 1st July, 1972. Details follow of the Orders already effective:— 51 Smoke Control Area Map Ref. Boundaries Order operative Holland Ward 1 N. Holland Park Avenue 1.10.1959 (No.1) E. Campden Hill Road S. Kensington High Street W. Abbotsbury Road Holland Ward 3 N. Notting Hill Gate 1.10.1960 (No.3) E. Borough boundary S. Kensington High Street W. Campden Hill Road Church Ward C1 Church Ward boundaries 1.11.1960 Holland Ward 2 N. Holland Park Avenue 1.10.1961 (No.2) E. Abbotsbury Road S. Kensington High Street W. Borough boundary Pembridge Ward 4 N. Westbourne Grove 1.10.1961 (No.1) E. Borough boundary S. Notting Hill Gate W. Ladbroke Grove Pembridge Ward 5 N. Lancaster Road 1.10.1962 (No.2) E. Borough boundary S. Westbourne Grove W. Ladbroke Grove Hans Town Ward C2 Hans Town Ward boundaries 1.11.1962 Norland Ward 6 N. Lancaster Road 1.10.1963 (No.1) E. Ladbroke Grove S. Holland Park Avenue W. Walmer Road and Princedale Road Norland Ward 7 N. Lancaster Road 1.10.1964 (No.2) E. Walmer Road and Princedale Road S. Holland Park Avenue W. Borough boundary Cheyne and Royal C3 Cheyne Ward and Royal 1.7.1965 Hospital Wards Hospital Ward boundaries Earls Court and 8 N. Kensington High Street 1.10.1965 Queen's Gate Wards E. Palace Gate and Gloucester Road S. West Cromwell Road W. Borough boundary Earls Court 9 N. Cromwell Road and 1.10.1966 Redcliffe and West Cromwell Road Brompton Wards E. Queen's Gate S. Old Brompton Road W. Borough boundary 52 Smoke Control Area Map Ref. Boundaries Order Operative Redcliffe and 10 N. Old Brompton Road 1.10.1967 Brompton Wards E. Onslow Gardens and Neville Terrace S. Fulham Road W. Borough boundary Brompton and 11 N. Borough boundary 1.10.1968 Queen's Gate Wards E. Hoopers Court S. Fulham Road, Draycott Avenue, Walton Street, Walton Place, and Basil Street W. Palace Gate, Gloucester Road, Queen's Gate, Onslow Gardens, Neville Terrace and Cromwell Road St. Charles Ward 12 N. Centres of North Pole Road, 1.10.1969 (No.1) St. Quintin Avenue and Chesterton Road E. Centre of Portobello Road S. Centre of Lancaster Road W. Borough boundary St. Charles and 13 N. Borough boundary 1.10.1970 Golborne Wards E. Borough boundary S. Centres of North Pole Road, St. Quintin Avenue, Chesterton Road, Portobello Road and Lancaster Road W. Borough boundary Suspension Orders During 1970 it became obvious that the supply of solid smokeless fuel would be inadequate to meet the consumer demand during the winter of 1970/71. Accordingly, the London Boroughs Association set up a working party to examine the situation and it was finally recommended that each London borough should ask the Minister to make Suspension Orders in respect of 40 per cent of its Smoke Control Orders, to cover the period 1st November, 1970, to 31st March, 1971. In Kensington and Chelsea this was achieved by asking the Minister to make Suspension Orders for that period in respect of the following Smoke Control Orders:— Kensington No.1 (Holland Ward No.1) Kensington No.2 (Holland Ward No.2) Kensington No.3 (Holland Ward No.3) Kensington No.4 (Pembridge Ward No.1) Kensington No.5 (Pembridge Ward No.2) Kensington No.6 (Norland Ward No.1) Kensington No.7 (Norland Ward No.2) Chelsea No.1 (Church Ward) Chelsea No.2 (Hans Town Ward) These Orders affected 22,462 dwellings in 1,121 acres. The Orders were successful in conserving fuel supplies. The supply of solid smokeless fuels later improved substantially and it was not necessary to request the Minister to make Suspension Orders for the winter of 1971/72. 53 New Furnaces Section 3 requires that new furnaces, not used mainly for domestic purposes and exceeding a specified capacity, shall be, so far as is practicable, smokeless. Any person installing such a furnace must give prior notice to the Council and may submit detailed plans and specifications for approval before the work of installation takes place. During the year, 32 notifications were received without objection to the proposals submitted. Smoke Nuisances During the year, 61 complaints of smoke nuisance were received and 133 formal smoke observations were carried out. Each case was dealt with informally. Routine Measurement of Atmospheric Pollution There are four premises in the borough where apparatus has been installed for measuring atmospheric pollution. The readings obtained by the Council are forwarded to the Warren Spring Laboratory, where they are converted by computer into the figures shown in the following table. The table covers the twelve-month period up to and including the latest figures obtained from the laboratory when this report was prepared:— Sites Smoke (Microgrammes per Cubic Metre) Sulphur Dioxide (Microgrammes per Cubic Metre) Monthly Average Highest Daily Reading Monthly Average Highest Daily Reeding ABCDABCDABAB 1970 July 24 21 38 27 53 58 86 50 104 84 253 183 Aug. 27 28 64 30 50 65 127 64 157 131 484 465 Sept. 23 34 72* 32 49 89 182* 52 136 124 464 390 Oct. 34 42 107 62 86 158 268 107 199 206 594 649 Nov. 34 41 103 58 147 134 237 140 229 239 803 924 Dec. 67 73 131 94 151 252 296 325 310 306 762 936 1971 Jan. 62 59 105 66 198 169 220 184 350 338 796 880 Feb. 52 54 119 75 115 105 179 138 255 333 481 567 Mar. 24 32 90 45 67 52 121 58 185 218 286 325 Apr. 22 33 103 N 68 85 163 81 185 268 425 548 May 26 29 87 34 81 103 172 77 189 214 476 540 June 19 20 69 N 48 49 106 70 130 114 255 227 "N" — level of readings insufficient to obtain accurate measurements. An asterisk* appearing against any average smoke concentration or highest daily figure indicates that at least one daily figure covered by the average, or the highest daily figure itself, has been estimated from a reflectometer reading of less than 40. Site address: A — Chenil Galleries, King's Road, S.W.3. B — The Red House, Hornton Street, W.8. C — Public Library, Lancaster Road, W.10. D — Child Health Centre, Redcliffe Street, S.W.10. (Sites C and D have smoke measuring apparatus only.) 54 NOISE ABATEMENT ACT, 1960 One hundred and forty six complaints of alleged noise nuisances were received during the year, compared with one hundred and six for 1970. From the following summary of the sources of the complaints, it will be seen that in all cases where the complaints were justified it was possible to secure remedies without recourse to legal action:— Source of Noise Number of complaints Remedied Informally No nuisance No action Commercial 46 36 10 Roadworks, construction and demolition 64 49 15 Domestic 22 17 5 Boutiques and Pop Groups 10 7 3 Exhibitions, Studios, Clubs 2 2 — Animals 2 2 — BYELAWS AS TO THE ARTIFICIAL LIGHTING OF COMMON STAIRCASES IN TENEMENT HOUSES AND FLATS The Council's Byelaws relating to artificial lighting of common staircases in tenement houses and flats were made on 3rd May, 1967, under the provisions of Section 63 of the London County Council (General Powers) Act, 1956, as amended by Article 3 and the 1st Schedule to the Local Law (Greater London Council and Inner London Boroughs) Order, 1965, and came into operation on 1st August, 1967. During 1971, formal notices were served in ten instances, requiring compliance with these Byelaws. FACTORIES ACT, 1961 Section 153(1) of the Factories Act, 1961, requires the Medical Officer of Health to make an annual report in regard to the Council's functions under the Act. The following tables give the prescribed particulars in the form requested by the Secretary of State for Health and Social Security in Circular No.1/72. Part I of the Act 1. INSPECTIONS for the purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises (1) No. on Register (2) Number of Inspections (3) Written Notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 23 23 - - (ii) Factories not included in (i) in which Section 7 is enforced by the local authority 589 280 2 - (Hi) Other premises in which Section 7 is enforced by the local authority (excluding out-workers' premises) 32 30 1 - TOTALS 644 333 3 - 55 2. Cases in which DEFECTS were found: (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases"). Particulars Number of cases in which defects were found No. of cases In which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of Cleanliness (S.1) 1 1 Overcrowding (S.2) - - - - — Unreasonable temperature (S.3) - - - — — Inadequate ventilation (S.4) - - - — — Ineffective drainage of floors (S.6) - - - - - Sanitary conveniences (S.7) (a) Insufficient - - - - - (b) Unsuitable or defective 14 13 - 4 - (c) Not separate for sexes - - - - - Other offences against Act (not including offences relating to Outwork) - - - - - TOTALS 15 13 - 5 - Part VIII of the Act Outwork (Sections 133 and 134) Nature of Work Section 133 Section 134 No. of outworker in August lists required by Section 133(11(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing apparel 33 - - - Curtains and furniture hangings 3 - - - - Artificial flowers 1 — — — — Boxmaking _ — — — Feather sorting — — — - Packing of glass fibre rods in cellophane - - - - - Lampshades 1 - — — — TOTALS 38 - - - - During the year, 45 inspections were made of outworkers' premises, and no infectious disease was reported from any premises where home work was carried on. 56 Basement Bakehouses The Factories Act, 1961 (Section 70), requires the Council to inspect in every fifth year all basement bakehouses in the borough for which certificates of suitability have been issued. The certificates continue to operate if the Council are satisfied that the bakehouses are still suitable. The latest quinquennial review was carried out in 1968, and there are nine basement bakehouses in use in the borough, as follows:— 151 Earls Court Road 134 King's Road 178 Fulham Road 517 King's Road 323 Fulham Road 139 Portland Road 65 Golborne Road 46 Walton Street 79 Golborne Road OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The Offices, Shops and Railway Premises Act, 1963, makes provision for the safety, health and welfare of persons employed in such premises. The requirements of the Act follow closely those of the Factories Act and include provisions relating to cleanliness, overcrowding, temperature, ventilation, lighting, sanitary conveniences, washing facilities, drinking water, seats, safety of machinery, first-aid and fire precautions. Enforcement of the provisions of the Act is, in most premises, the Council's responsibility, but H.M. Inspectors of Factories are responsible for the enforcement in premises which are associated with, or broadly similar in their conditions to, factories, i.e., railway premises, fuel storage depots on railway premises, and offices in factories. They are also responsible for inspecting premises owned or occupied by the Crown and those occupied by local authorities. Provisions relating to fire precautions are the responsibility of the Fire Authority. Registrations and General Inspections Class of premises Number of premises registered during year Total number of registered premises at end of year Number of registered premises receiving general inspections during the year Offices 113 1,079 626 Retail shops 84 1,244 611 Wholesale shops, warehouses 2 45 14 Catering establishments open to the public, canteens 25 489 109 Fuel storage depots - - - 224 2,857 1,360 TOTALS Number of visits of all kinds (including general inspections to registered premises 3,666 57 Analysis by workplace of persons employed in registered premises at the end of year Class of Workplace Number of persons employed Offices 16,103 Retail shops 11,823 Wholesale departments, warehouses 943 Catering establishments open to the public 5,478 Canteens 309 Fuel storage depots - TOTAL 34,656 TOTAL MALES 16,928 TOTAL FEMALES 17,728 Summary of Contraventions Section of Act Contraventions found during general inspections and routine visits Section 4 Cleanliness 15 Section 5 Overcrowding 1 Section 6 Temperature 162 Section 7 Ventilation 19 Section 8 Lighting 8 Section 9 Sanitary conveniences 47 Section 10 Washing facilities 30 Section 12 Accommodation for clothing 8 Section 13 Sitting facilities 1 Section 15 Eating facilities 1 Section 16 Floors, passages and stairs 40 Section 17 Fencing of exposed parts of machinery 5 Section 24 First Aid 91 Section 49 Notification of fact persons are employed 51 Section 50 Information for employees 192 Hoists and Lifts Regulations, 1968 136 TOTAL 807 58 Accidents A fatal accident occurred in a steel warehouse during the unloading of a lorry carrying bundles of ¾" steel reinforcing bars 40' 0" long. Each bundle was lifted from the lorry by an overhead travelling crane and taken to a stack of bundles in the steel warehouse. The bundles were guided into place on the stack by an experienced warehouseman. In one bundle one bar was bent upwards, and the warehouseman moved the bundle to try to place it in a position where it would not be affected by the bent bar. The chain carrying one end of this bundle slipped and the bundle fell on the warehouseman, and his spine was crushed. At the inquest it was not established how the chain had slipped. A verdict of accidental death was recorded. Since the first annual report of the Ministry of Labour under the Act there has been little variation in the proportions of the primary causes of accidents in registered premises throughout England, despite the changes in the numbers of registered premises and the numbers of employed persons. The reduction, nationally, in the numbers of accidents notified under the Act and industrial accidents during 1970 indicates that there are causes of accidents which are not apparent during the investigation of a single accident. Each year since 1965, this Department has made tentative examinations of different aspects of accident occurrence in registered premises, and in 1971 it was possible to take a longer look at the causes of accidents, and come to some conclusions. The number of notified accidents in the borough has been compared each year with national accident statistics published in the Annual Report of the Department of Employment. Not only has there been no consistency in the proportions of the primary causes of accidents in the borough, but the borough's annual statistics of accidents have not resembled those of England as a whole. The numbers and proportions of notifiable accidents classified as to primary cause in the borough are therefore not a representative sample of the national accident statistics. The tables (page 59) show the total number of accidents reported, and their primary causes. The Offices, Shops and Railway Premises (Hoists & Lifts) Regulations, 1968 The work of the department under these Regulations can be summarised as follows:— (1) The listing of all registerable premises in which lifts are installed, and the recording of the details of manufacture, type and construction. (2) Communication with occupiers who have not made arrangements for lifts to be inspected in accordance with the Regulations. (3) The receipt of a report on a lift by a competent person is followed by a standard letter to the occupier or owner of the premises. This letter draws attention to the time limits recommended by the inspecting engineer for the completion of the necessary works, and it requests that the department be notified when the works have been completed. (4) The failure of the occupier or owner to give this notification after the expiry of the time limit is followed by another letter asking whether the necessary works have been carried out. (5) In the event of a second unsatisfactory report an inspection is made of the premises, and if the work has not been completed, the owner or occupier is then informed that the Council will be recommended to take proceedings. (6) Requests are received from architects and surveyors to discuss the installation of lifts, and these often mean that several visits have to be made. Officers of health departments have no formal training in mechanical engineering, and therefore find it difficult to distinguish the mechanical problem requiring a mechanical remedy from a safety problem requiring a non-mechanical or legal remedy. Notwithstanding this difficulty, owners and occupiers have been co-operative. 59 Accidents — Places and Causes Workplace Number reported Total number investigated Action recommended Fatal Non Fatal Prosecution Formal warning Informal advice Offices - 23 - - - - Retail shops - 82 - - - - Wholesale shops and warehouses 1 9 2 - - 2 Catering establishments open to the public, canteens - 13 1 - - 1 TOTALS 1 127 3 - - 3 Causes of accidents Offices Retail shops Wholesale shops Warehouses Catering establishments open to the public, canteens Machinery - 4 1 1 Transport - 7 3 - Falls of persons 11 24 1 6 Stepping on or striking against object or person 4 13 — 1 Handling goods 5 22 3 2 Struck by falling object 2 3 1 1 Electrical - 1 - - Use of hand tools - 6 - - Not otherwise specified 1 2 1 2 60 Up to the end of 1970 a total of 99 reports on lifts had been received, but in 1971 the number of reports received was 132. A difference of practice between London and the rest of England was noted in the implementation of the Building Regulations in respect of lifts in basements. A platform lift in a car-showroom was to be altered, and in accordance with Part B of the Building Regulations, 1965, the installation engineer had specified that the lift in the basement was to be enclosed in a fire-resistant brick wall. The London Building Act does not require such an enclosure, and the District Surveyor and the Fire Authority were of the opinion that an enclosure to a lift in a large London basement might be disadvantageous. LAND CHARGES The number of land charge enquiries dealt with during the year was 8,794 compared with 7,152 in 1970. These concerned outstanding statutory or informal notices, closing orders, smoke control orders, certificates of disrepair, slum clearance, etc. TOWN PLANNING APPLICATIONS During the year, 1,839 applications were referred to the Health Department for observations, compared with 1,688 in 1970. The persons responsible for carrying out any accepted schemes were informed of the various requirements of the Health Department before any work was commenced. Close liaison between the officers of the Health, Town Clerk's and Borough Engineer and Surveyor's Departments and the public health inspectors ensured that any development which took place was in accordance with the relevant Acts and Byelaws relating to health. LICENSING ACT, 1964 Two hundred and fifty copies of applications to the Licensing Justices (146 restaurant and/or residential, 30 clubs, 72 publicans, 1 beerhouse keeper, and 1 wine only) for licences were received during the year. Inspections were made in each case to ensure that there were no breaches of the Food Hygiene (General) Regulations, 1970, and that there was sufficient and properly sited sanitary accommodation for the use of patrons. In addition, 30 copies of applications in respect of Off-Licences were received and the premises inspected to ensure that they complied with the Food Hygiene (General) Regulations, 1970, and the Offices, Shops and Railway Premises Act, 1963. LICENCES FOR PUBLIC ENTERTAINMENT During the year, two copies of applications for music and dancing licences from the Greater London Council were referred to this department for reports of any actual complaints on the grounds of noise nuisance received from local residents. No complaints were made to this department in respect of the premises concerned. GREATER LONDON COUNCIL (GENERAL POWERS) ACT, 1968 The Borough Council adopted the provisions of Part VIII of the above Act and fixed the appointed day as 2nd June, 1969, and from that date no premises in the borough may be used as a night cafe without being registered with the Council under the Act. The registration must be renewed every year. The term "night cafe" means any premises kept open for refreshment at any time between the hours of 11.00 p.m. and 5.00 a.m. whether for use by the public or by a club, organisation or body, except that public houses, theatres, cinemas, hotels, guest houses, specified licensed premises or premises used for charitable purposes or as a sports club or staff canteen are excluded from this definition. 61 Any person whose night cafe operates without being registered is liable to a fine of up to £200 or three months' imprisonment or both. Any person applying for registration of premises or for renewal of registration as a night cafe must pay to the Council a fee of £1 and give public notice in the prescribed manner drawing attention to the right of members of the public to object to the registration. Thirty-three applications for registration were received, but one of these was from premises not eligible for registration. Twenty-eight premises were registered during the year and two applications were refused. One refusal was on the grounds that the premises were not provided with satisfactory means of sanitation and the other one on the grounds that there was a likelihood of nuisance being caused by reason of the situation of the premises and the character of adjacent premises. No appeals were made against the Council's decisions Kensington Police reported three unregistered restaurants being used as night cafes after 11.00 p.m., and the Notting Hill Police reported one. The Council prosecuted the persons concerned and each case was proven and fines amounting to £165 were imposed. One appeal was made against conviction and this was dismissed, £50 costs being awarded to the Council. LATE NIGHT REFRESHMENT HOUSES ACT, 1969 A refreshment house licence is required for any shop or other premises not licensed for the sale of intoxicating liquor, but which is kept open for public refreshment or resort at any time between 10.00 p.m. and 5.00 a.m. except premises where the provisions of the Greater London Council (General Powers) Act, 1968 — Part VIII apply. A licence is needed in respect of refreshment rooms which form part of the premises used for public entertainment and resort, for example, Cinemas, Skating Rinks, etc. (if kept open for public refreshment during the hours mentioned). Licences commence on 1st April and expire one year later. Thirty-five late night refreshment house licences were issued by this department during the year. Two premises not licensed under the Act were reported open for public refreshment after 10 p.m. by the Kensington Police. The persons concerned were prosecuted by the Council and found guilty. Fines amounted to £30. FOOD AND DRUGS ACT, 1955 - INSPECTION AND SUPERVISION OF FOOD This is the principal Act for controlling the composition, labelling, fitness and hygienic handling of food. The Food Hygiene (General) Regulations, 1960, and the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations, 1966, are the principal instruments for enforcing good food hygiene practice. Premises Registered under Section 16, Food and Drugs Act, 1955 For the sale, or the manufacture for the purpose of sale, of ice-cream or the storage of ice-cream intended for sale 279 For the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 99 62 The following table shows the number of inspections made of the various types of food premises in the borough during the year:— Food Premises Number of Premises Number of Inspections Bakehouses 23 22 Butchers 104 51 Bread and Cake shops 150 37 Greengrocers 120 31 Confectioners 203 6 Cafes, restaurants, Public Houses, Hotels, etc. 1,114 1,642 Clubs 150 14 Fishmongers and fried fish shops 35 19 General provision shops 321 465 Street marketsStalls 110 310 Storage premises 47 1 Wholesale warehouses and Factories 15 7 Off-Licences 155 65 Unsound Food Food Sampling The practice continued during the year of taking formal samples only in those cases - where there was reason to believe a product was well below the required standards, usually following an adverse report on an informal sample. Informal samples totalling 1,101 were submitted for analysis, of which 136 were either adulterated or otherwise unsatisfactory. Nineteen formal samples were also submitted for analysis, of which fifteen were either adulterated or otherwise unsatisfactory. In the case of one of the formal samples, legal proceedings were authorised, details of which are given at the end of this section of the report. The remaining five formal samples were dealt with satisfactorily on an informal basis. The results of all unsatisfactory samples were brought to the notice of the producers, manufacturers or vendors as appropriate. Complaints During the year, 204 complaints were received from members of the public alleging the unsatisfactory condition of food purchased by them in the borough. The complaints generally related to the presence of foreign matter in foods, and the unsatisfactory condition of meat, fish, sausage, pies, fruit, bread, sweets, cakes, milk, cheese, wine, spirits, vegetables, yoghurt, soft drinks, poultry, eggs, jam, soup, tea, flour, cream, biscuits, ice-cream, margarine, sugar, sandwiches, etc. Of these complaints, legal proceedings were authorised in respect of nineteen cases and warning letters were sent in two instances. The remaining 183 cases were dealt with informally, either owing to lack of sufficient evidence, or to the complaint not being substantiated. 63 Surrender During the year, the following amounts of food were surrendered and condemned as unfit for human consumption: — Commodity Weight (in lbs.) Offal 152 Meat (raw) 773 Cooked meat and meat products 863 Canned meats 217 Other canned foods 937 Frozen foods 11,970 Other foods 6,894 TOTAL 21,806 All food condemned as unfit for human consumption is collected by the Council, taken to the refuse destructor in Fulham, and destroyed. Milk (Special Designation) Regulations, 1963 Milk Licences These Regulations, as amended by the Milk (Special Designation) (Amendment) Regulations, 1965, require that all milk sold by retail in England and Wales shall be specially designated, and that retailers must be licensed by the local authority to sell such milk. Licences are issued by the Council for a five-year period and all current licences are valid until the end of 1975. The number of licences granted by the Council during the year in respect of each designation, together with the total number in force at the end of the year, are shown in the following table:— Designation Licences issued in 1971 Total number in force at end of year Pasteurised milk 190 184 Sterilised milk 190 184 Ultra-heat Treated milk 190 184 64 Milk Examinations The following table shows the number of samples of untreated milk and processed milks taken during the year for examination in accordance with the Regulations, together with the results obtained: — Designation No. of Samples Methylene blue test Phosphatase Test Colony Count Test P F P F P F Pasteurised *36 29 4 36 - - - Sterilised — — — — — — — Ultra-heat Treated 5 - - - - 5 - P = Passed F = Failed * Of these 36 samples of pasteurised milk, 3 were rendered void because the atmospheric shade temperature exceeded 70 degrees Fahrenheit and the Methylene blue tests could not be carried out. Milk & Dairies (General) Regulations, 1959 Registrations The number of persons registered under these Regulations at the end of the year to sell milk from premises in the borough (including the sale of cream in sealed containers) was 186. Unclean milk containers It is an offence under these Regulations for any dairy farmer or distributor to use for holding milk any vessel that is not in a state of thorough cleanliness immediately before use. In the case of bottled milk, the term "immediately before use" is considered to mean at the time the bottle is first filled and, therefore, any offence would be committed at the time and place of bottling. Six complaints were investigated during the year. In one case legal proceedings were authorised and the remaining cases were dealt with by informal approach to the producers at the request of the complainants. Composition of Milk During the year, 119 samples of milk (all grades) were submitted to the Public Analyst for examination. Two samples were found to be below the legal standards laid down. The packers in respect of one sample were informed accordingly and in the other case the owner of a restaurant was given a warning by letter. Channel Islands and South Devon Milk The Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956, require that all milk for human consumption sold under the specific description of "Channel Islands Milk", "Jersey Milk", "Guernsey Milk" or "South Devon Milk" must contain not less than four per cent by weight of milk fat. This compares with the presumptive milk fat standard of three per cent specified for ordinary milk by the Sale of Milk Regulations, 1939. 65 The following table shows the average percentages of milk fat and non-fat solids of the genuine samples taken during each month:— Month Number of samples taken Average Percentages Milk Fats Non-fat Solids January 2 4.75 8.70 February 1 4.30 8.70 March - - — April 1 4.20 8.85 May 1 4.50 9.15 June 2 4.47 8.70 July - - - August - - - September 2 4.55 9.05 October - - — November 3 4.43 9.05 December 2 4.37 8.80 Average for the whole year 4.47 8.88 Legal minimum standard 4.00 8.50 Other Milk The following table shows the percentage of milk fat and non-fatty solids of the genuine samples of milk, other than Channel Islands and South Devon milks, taken during each month:— Month Number of samples taken Average Percentages Milk Fats Non-fat Solids January 8 3.79 8.68 February 15 3.65 8.47 March 7 3.58 8.55 April 4 3.57 8.52 May 7 3.43 8.71 June 7 3.50 8.77 July - - - August 2 3.57 8.67 September 7 3.77 8.66 October 4 3.77 8.76 November 17 3.70 8.67 December 25 3.68 8.58 Average for the whole year 3.65 8.62 Legal minimum standard 3.00 8.50 The Food Standards (Ice-cream) Regulations, 1959 These Regulations prescribe standards for ice-cream and introduce separate standards for "dairy ice-cream" (or "dairy cream ice" or "cream ice"). The Labelling of Food (Amendment) Regulations, 1959, prohibit the labelling, marking or advertising of ice-cream in a manner suggestive of butter, cream, milk or anything connected with the dairy interest unless the ice-cream contains no fat other than milk (except such as may be introduced by the use as an ingredient of any egg, flavouring 66 substance or emulsifying or stabilising agent), but permit the presence of skimmed milk solids to be declared. These Regulations also provide that it is an offence to sell under the description "ice-cream" any pre-packed ice-cream which contains fat other than milk fat, unless it bears on the wrapper or container a declaration "Contains non-milk fat" or, if appropriate, "Contains vegetable fat" in type of a prescribed minimum size. The following table shows the number of samples of ice-cream taken during 1971 for chemical analysis compared with those taken in the previous year:— Number of samples 1971 1970 20 17 Percentage range of fat content 4.9 to 13.3 3.3 to 12.6 Percentage range of non-fat content 20.2 to 38.4 4.8 to 29.5 Average fat content per cent 8.27 7.61 Average non-fat content per cent 25.72 23.83 The Ice-Cream (Heat Treatment, etc.) Regulations, 1959, require that ingredients used in the manufacture of ice-cream be pasteurised or sterilised. There is still no legal bacteriological standard for ice-cream. As in previous years, samples were taken and submitted for examination under the provisional methylene blue reduction test, which is a simple and practical means for the routine examination of ice-cream. The test is not of sufficient precision to justify its use as a statutory test. The grading is determined by the length of time taken to decolourise the methylene blue, and it is suggested that if samples consistently fail to reach grades 1 and 2, it would be reasonable to regard this as an indication of defects in manufacture or handling which warrant further investigation. During the year, thirty-two samples of ice-cream were taken and submitted to the methylene blue test. The results were as follows: — Grade Number of samples 1 12 2 5 3 4 4 11 Premises in the borough where ice-cream is manufactured, stored or sold were frequently inspected during the year, and generally were found to be in a satisfactory condition. The Liquid Egg (Pasteurisation) Regulations, 1963 These Regulations require the pasteurisation of liquid egg to be used in food intended for sale for human consumption, other than egg broken out on the food manufacturers' premises and used within twenty-four hours. The Regulations prescribe the method of pasteurisation and the test to be satisfied. There are no egg pasteurisation plants in the borough and it was not found necessary during the year to take any samples of liquid egg in accordance with these Regulations. Generally There are no abattoirs or slaughterhouses in the borough, and no killing of animals for human consumption is carried out. There are no premises within the borough where poultry is processed. 67 METALLIC POISONING In the latter part of the year, details of a case of metallic food poisoning in the City of Westminster came to the attention of the department. Two children were violently sick about five minutes after drinking diluted orange squash at licensed premises in Westminster. On investigation, it was found that the concentrated fruit drink had been obtained from a bottle which was provided with a metal pourer. Corrosion had been caused by the chemical action of the acid content of the drink on the unplated parts of the pourer. The illness of the children was apparently caused by copper poisoning. On receiving details of this case from the City of Westminster, immediate arrangements were made for letters to be sent to all known premises within the Borough of Kensington and Chelsea, numbering about 800, drawing attention to the possibl , danger of using metal pourers when dispensing drinks which have an acid content and asking, as a precautionary measure, for the use of metal pourers in bottles containing concentrated fruit drinks to be discontinued and for them to be replaced, if necessary, with pourers made of plastic material. Queries arising as a result of these letters were dealt with by the staff, as necessary, and the traders concerned were most co-operative. PUBLIC CONTROL DUTIES As in previous years, the greater part of this work has been in connection with the licensing of employment agencies and massage establishments. The number of employment agencies licensed by the Council increased by a further 14% during the year, making a total of 205 compared with 93 licences in force in April, 1965, when this work was transferred from the former London County Council. During the year, two working parties under the auspices of the London Boroughs Association met to consider recommendations for amendments to the existing Regulations and Byelaws in respect of these functions, the main object being to achieve uniformity of administration by the licensing authorities. The working party, in both cases, included the Chief Inspector of the City of London, the Public Control Officer of the City of Westminster and the Senior Inspector, General Purposes, of this Council. The number of premises registered for the sale of fireworks was again lower than in the previous year. Statistics The following is a summary of the number of licences, permits, etc., issued during the year ended 31st December, 1971 Licences, Permits, Etc. New Licences etc. granted during year Total in force at 31.12.71 Employment Agencies 58 205 Nurses Agencies 1 10 Massage Establishments 11 104 Theatrical Employers 8 214 Permits for the provision of amusements with prizes 6 37 Storage and sale of fireworks 3 54 Storage of celluloid and cinematograph film - 1 68 HOUSING General Improvement Area This area was declared by the Council under Section 28 of the Housing Act, 1969, and is shown on the map included in this report. The area contains 302 properties of which 265 are used for habitation. There is, in addition, a school building and two modern blocks owned by the Council containing 20 self-contained flats. All the properties in the area have been surveyed and every endeavour is being made to persuade owners to improve their properties where possible by converting them into self-contained dwellings with the aid of improvement grants. Since the area became operative, grant aided works have been completed in respect of 8 properties for the provision of 11 dwellings; work is in progress in respect of 21 properties for the provision of 135 dwellings; and applications in respect of a further nine properties for the provision of 40 dwellings were being dealt with at the end of the year. Initially, progress was not as rapid as was originally hoped and where no action had been taken by owners to bring their properties up to a satisfactory standard, the Council decided to implement their statutory powers under the Housing Acts to secure the minimum repairs and improvements to those houses in multiple occupation. Many of these properties had been inspected prior to the declaration of the area and notices had been served under the Housing Acts. These inspections continued during the year, and the following is a summary of the total number of notices which have been served in respect of properties in the area:— Housing Act, 1957 Section 9 120 Housing Act, 1961 Section 16 119 Section 15 110 Section 14 11 Management Orders made 9 Qualification Certificates The following shows the number of applications for qualification certificates (Housing Act, 1969) dealt with during the year- Applications under Section 44(1) — to provide amenities Applications received 163 Qualification Certificates issued 265 Qualification Certificates refused 50 Applications under Section 44(2) — amenities provided Applications received 96 Provisional Certificates issued 37 Provisional Certificates refused Nil Qualification Certificates issued 19 Grants for the Improvement or Conversion of Private Dwellings Standard Grants Nineteen applications for standard grants were approved by the Council during 1971, compared with twenty-two applications for the previous year. Improvement (Discretionary) Grants The number of applications for improvement (discretionary) grants dealt with continued to increase during the year and by the end of July the average number received THE ROYAL BOROUGH OF KENSINGTON & CHELSEA MAP AND STREET PLANS OF (1) General Improvement Area (see page 68) (2) Earls Court Area (see page 70) 69 each month had risen to 30% above the average for the same period of 1970. By the end of the year the figures had risen again to more than 50% above those for the previous year. To take account of this additional work, and to maintain a reasonable time limit in dealing with applications, the establishment of two public health inspectors and two technical assistants was increased in July, 1971, by three additional technical assistants. The establishment was again under review at the end of the year. The following is a summary of the number of discretionary grants dealt with during 1971, shown diagramatically with comparative figures for the last seven years:— Applications approved (dwellings) 1,057 Total amount of grants approved £1,102,262 Houses in Multiple Occupation Directions to Prevent or Reduce Overcrowding The policy adopted by the Council in 1970, of issuing Directions under Section 19 of the Housing Act, 1961, as amended by the Housing Act, 1969, was continued throughout the year. A report on the favourable progress of the scheme was made to the Council in October, 1971, when it was agreed that the scheme should be extended to those parts of the St. Charles Ward which are not covered by schemes of redevelopment. 70 During the year 366 houses were inspected and 357 Directions were recommended. Directions were given in respect of 341 houses. The systematic re-inspection of all the houses subject to Directions continued throughout the year, most of the houses being re-visited at three-monthly intervals. The response of the majority of landlords was favourable and few objections were made to the limits of occupation set down in the Directions. Many landlords installed additional facilities following the initial survey visit and as a result of advice given by the inspection team. Others have carried out works subsequent to the giving of the Directions and have then applied for variations. Twenty-four variations were approved during the year, and nine contraventions of Directions were referred to the Borough Solicitor for legal proceedings to be instituted. Earls Court Area In September, 1971, the Council decided to implement the provisions of the Housing Acts relating to houses in multiple occupation in part of the Earls Court Ward. The area chosen is bounded in the north by West Cromwell Road, in the east by Earls Court Road, in the south by Old Brompton Road and in the west by the borough boundary. The properties in this area are large and well built, but there is evidence that many are in multiple occupation and are used as hostels and hotels. Individual houses have been found where the sanitary facilities are inadequate and it is probable that in many cases where there is multiple occupation, the means of escape in case of fire will not comply with the Greater London Council's Code of Practice relating to such occupation. By the end of the year preliminary house-to-house inspections had commenced in the area. Overcrowding All cases of overcrowding are dealt with on the strict interpretation of the standard laid down in the Housing Act, 1957, distinguishing between "penal" and "non-penal". The number of new cases of overcrowding reported to the Housing Committee during 1971 was 29 (20 penal and 9 non-penal), giving an equivalent number of persons of 1201/2. The total number of recorded cases where overcrowding was abated during the year was 105, comprising a total of 4251/a units. Since October, 1945, 2,918 cases have been reported, and the number of cases remaining on the register at the end of the year was 102. NOTE: Units mean the number of equivalent persons in the families, obtained by regarding children between one and ten years of age as "half persons" and disregarding infants under the age of twelve months. Individual Unfit Houses and Parts of Houses Houses made fit after informal action under the Housing or Public Health Acts 239 Houses repaired after service of formal notices under the Public Health Acts 229 Houses made fit after service of formal notices under Section 9 of the Housing Act, 1957 (a) by owners 2 (b) by local authority in default 2 Action under Section 18 of the Housing Act, 1957 (a) closing orders made 14 (27 rooms) (b) closing orders determined 7(14 rooms) 71 (c) closing orders cancelled (premises demolished) Nil (d) consents given to use of closed rooms for non-sleeping purposes 6 ( 7 rooms) (e) undertakings accepted from owners to render part of building fit for habitation 1 ( 2 rooms) (f) part of building rendered fit and undertaking cancelled Nil Assessment of Housing Priorities on Medical Grounds During the year, 236 applications for rehousing on medical grounds were examined, and recommendations for the award of additional points were made to the Chief Housing Officer. In each case, the precise medical conditions and resultant disability were determined (frequently necessitating communication with the family doctor or with the hospital attended). The premises were inspected in detail to ascertain the extent and nature of the existing accommodation; the adequacy of day and sleeping space, sanitary and structural defects; and the existence of inconveniences, such as stairs, which might be prejudical to the patient. On this information, and that supplied by the Chief Housing Officer, an assessment of points to be awarded on medical grounds was made in 224 cases. FLOODING FROM THE RIVER THAMES During the year, notice was drawn to the risk of flooding from the River Thames under certain weather conditions. The Borough Engineer and Surveyor has been appointed Flood Controller for the borough and, working under his general control, schemes have been drawn up whereby Public Health Inspectors will assist in suitable instances should flooding occur in the future. An offer to assist with temporary surgery facilities was made to a number of general medical practitioners whose premises appeared to be at risk. LEGAL PROCEEDINGS Public Health Acts, 1936 and 1961 Seventy-five summonses were authorised during the year but only sixty-nine were subsequently issued as the nuisances were abated in six cases. In twenty cases, Abatement Orders were secured, fines totalling £190 and costs amounting to £106 were obtained. In twenty-nine cases the summonses were withdrawn and in one case the summons was dismissed, the nuisances having been abated prior to the Court hearings. In sixteen cases the summonses were adjourned sine die, as the necessary works were being carried out by the defendants. In two cases Orders were made for the nuisances to be remedied within 21 days and 2 months respectively, and in the final case the Court made an Order for the Council to execute the necessary work. Housing Acts, 1957 to 1969 Overcrowding One summons was issued for permitting a dwelling to be overcrowded, but this was subsequently withdrawn as the owner had taken all necessary steps to abate the overcrowding. Directions to Prevent or Reduce Overcrowding Eight summonses were issued for permitting the number of households occupying premises to increase above the limits of Directions given by the Council. In one case a conviction was obtained, a fine of £50 was imposed and costs amounting to £5 were 72 awarded to the Council. In six cases the summonses were adjourned sine die, in three instances because it was not possible to serve witness summonses and in the other three instances because the owners agreed to liaise with the Council over the provision of extra facilities and subsequent variation of the Direction limits. The remaining case was withdrawn as the tenant left the premises and could not be traced. One summons was issued for knowingly making a false statement regarding the names of individuals living on premises. The case was adjourned sine die as it proved impossible to serve witness summonses. Food and Drugs Act, 1955 Arsenic in Food Regulations, 1959 One summons was issued in respect of the sale of a tin of Red Bean Curd which contained arsenic in excess of the amount permitted by the Regulations. A conviction was obtained and the defendants were fined £25 with £10 costs being awarded to the Council. Colouring Matter in Food Regulations, 1966 One summons was issued in respect of the sale of packets of instant Japanese Soup which contained colouring not permitted by the Regulations. The vendors in this case obtained their supplies of this soup from two separate importers and, as it was not possible to ascertain which importer supplied the soup in question, the case was withdrawn. The Preservatives in Food Regulations, 1962 Two summonses were issued in respect of the sale of Soy Sauce and Raspberry Yoghurt which contained added preservative (Benzoic Acid) in excess of, or not permitted by, the Regulations. Convictions were obtained in both cases and fines amounting to £60 were imposed, the Council being awarded £20 costs. Food Hygiene (General) Regulations, 1960 Eleven summonses were issued in respect of 165 contraventions of these Regulations, as follows:— Case No.1 (5 contraventions) A conviction was obtained in each instance. Fines amounting to £20 were imposed in respect of 3 of the contraventions, and the owner was given an absolute discharge in respect of the other two. Case No.2 (16 contraventions) A conviction was obtained in each instance. Fines amounting to £45 were imposed in respect of 7 of the contraventions and the owner was given an absolute discharge in respect of the other nine. Costs amounting to £10 were awarded to the Council. Case No.3 (9 contraventions) A conviction was obtained in each instance. Fines amounting to £225 were imposed and costs amounting to £10 were awarded to the Council. Case No.4 (41 contraventions) A conviction was obtained in each instance. Fines amounting to £500 were imposed in respect of 28 of the contraventions and the owner was given an absolute discharge in respect of the other 13. Costs amounting to £30 were awarded to the Council. An appeal was made against the conviction, when the fine was reduced to £400 and a further £10 costs were awarded to the Council. 73 Case No.5 (10 contraventions) A conviction was obtained in each instance. Fines amounting to £50 were imposed in respect of 7 of the contraventions and the owner was given an absolute discharge in respect of the other 3. Costs amounting to £10 were awarded to the Council. Case No.6 (19 contraventions) A conviction was obtained in each instance and fines amounting to £310 were imposed in respect of the 19 contraventions. Case No.7 (2 contraventions) A conviction was obtained in each instance and fines amounting to £20 were imposed. Costs of £5 were awarded to the Council. Case No.8 (19 contraventions) A conviction was obtained in respect of 17 of the contraventions, one being dismissed and one being withdrawn by the Council. Fines amounting to £210 were imposed. Case No.9 (12 contraventions) A conviction was obtained in each instance and fines amounting to £315 were imposed. Costs amounting to £5 were awarded to the Council. Case No.10 (12 contraventions) A conviction was obtained in each instance and fines amounting to £200 were imposed. Costs amounting to £30 were awarded to the Council. Case No.11 (20 contraventions) A conviction was obtained in each instance. Fines amounting to £145 were imposed in respect of 9 of the contraventions and the owner was given an absolute discharge in respect of the other 11. Costs amounting to £20 were awarded to the Council. Shops Act, 1950 One summons was issued in respect of food premises which were kept open after the general closing time, for serving customers with non-exempted articles. A conviction was obtained and a fine of £20 was imposed. Costs amounting to £10 were awarded to the Council. 74 8 HEALTH EDUCATION In the autumn a health education officer was appointed as the head of a health education section consisting of an administrative officer and a technical assistant. The object was to enable the department's health education programme to be expanded as it was considered that the health education officer with no other commitments would be better able to organise widely based activities and particularly those dealing with broad sectors of the public. It was not considered that his efforts would replace the activities of those members of the staff who already were conducting health education as a part of their normal duties, notably the nursing staff (and particularly the health visitors) and the public health inspectors. Indeed the intention was that he would support and augment these activities and that they in their turn would play their part with his section in all projects of wider scope. It was decided that his first projects would be limited to conducting on the Council's behalf the campaign for housing improvement sponsored by the Department of the Environment and to mount a campaign against venereal disease. Preliminary work was being undertaken on both projects and was well advanced at the end of the year. Otherwise he was concerned for the time being only in a supportive role in connection with existing activities. A grant was made to the Health Education Council of £356 for the year 1971/72 in respect of that organisation's support and help and of £45 to the Royal Society for the Prevention of Accidents (Home Safety Division). From the beginning of the year an extensive health education programme had been maintained based on the Health Centres and the School Health Service, the largest percentage still being provided by the health visiting staff. A programme of key subjects was again followed. This included the following:— January — Hypothermia. February — Immunisation — Especial emphasis on Rubella and Measles vaccinations. March — Personal Hygiene. April — Nutrition; Obesity in the Elderly. May — Cervical Cytology; Cancer Education. June — Day Care of Children — Travelling with children. Holidays. Water safety. July — Dental Health. August — Drug addiction. Safe storage of drugs. September — Day Care of Children. October — Care of the Handicapped and Aged (Mental Health Week — 17th October). Hypothermia. November — Child safety. Safe toys. Prevention of firework accidents. December — Home safety The public health inspectors have taken their part in health education in the course of their duties which bring them into contact with shopkeepers and foodhandlers and every opportunity is taken of advising the management and staffs of the establishments they visit. They also visit private dwellings and have widespread dealings with families and individual 75 residents in the course of which they exploit the health education opportunities presented. The concern with offices, shops and railway premises also gives an approach to a wide field. They also receive requests for talks from a variety of organisations on health subjects and they are particularly pleased to give talks to the staffs of businesses. They are always willing to give such talks to any organisations and particularly to such specialist groups as food handlers and catering staff. HEALTH CENTRE CLUBS Health visitors have continued to organise clubs for both the "over 50's" and for mothers, and these, covering a varied programme of activities related to health, have been increased, a club for "Over 50's" having been started in the Spring at the Violet Melchett Centre. (1) The "Over 50's" Clubs Mothers' Clubs St. Quintin Raymede Raymede Lancaster Kensal Kensal Lancaster South Kensington Violet Melchett Walmer (2) Activities (a) Speakers In addition to talks given by the health visiting staff, club meetings have been addressed by speakers from a variety of outside agencies including the British Red Cross Society, the Crime Prevention Officer of the Notting Hill Police and the Fire Brigade. (b) Practical activities Health visitors included the following practical subjects in club programmes:— Cookery classes Sewing classes Keep-fit classes Exercises for the elderly (c) Visual Suitable films were included, often as an introduction to a discussion session. HEALTH EDUCATION IN SCHOOLS Teaching as part of the school curriculum, and also for special subjects has continued in eight schools in the borough. Ladbroke Secondary Girls (Upper) 3 Health Visitors 4th and 6th year girls St. Thomas More Secondary Mixed 2 Health Visitors 4th and 6th year girls St. Francis Junior Girls 1 Health Visitor 10 and 11 year old girls Holland Park Secondary Mixed 1 Health Visitor 2 school nurses Mixed groups Christ Church Junior Mixed 1 Health Visitor 10 year olds 76 Colville Infants 1 school nurse Selected mixed Isaac Newton Secondary Boys 1 school nurse Selected senior boys Bevington Junior Mixed & Infants 1 Health Visitor Selected groups The St. Nicholas Montessori Training School 1 Health Visitor 3 series of Mothercraft and child development OTHER HEALTH EDUCATION ACTIVITIES Hospitals Health visitors gave talks to mothers awaiting discharge from St. Mary's Hospital, Praed Street, and St. Stephen's Hospital on the care of their babies and the health visiting and other services available. Psych oprophylaxis Classes have been held at Holland Street, Walmer Road, Kensal New Town, Raymede, South Kensington, Violet Melchett and Lancaster Road. In addition to day time classes, sessions have been held during the evenings to which expectant fathers have been invited. SUMMARY The following details give an indication of the subjects undertaken within the Health Education programme:— To Adults No. of Groups Speaker Attendance Health Visitor Other SUBJECTS: Psych oprophylaxis 324 322 2 1607 Mothercraft 269 262 7 2357 Nutrition 79 69 10 946 Recreational Activities 80 75 5 960 Keep Fit Classes 45 44 1 563 Cancer 8 8 - 123 Importance of Play 20 18 2 215 Accident Prevention 32 26 6 359 Community Services 39 32 7 636 Immunisation 5 5 - 100 77 To Adults No. of Groups Speaker Attendance Health Visitor Other Personal Relationships 7 6 1 58 General Health & Hygiene 29 24 5 450 Family Planning 7 4 3 78 Mental Health 2 1 1 32 Discussion groups 27 25 2 281 Other 137 107 30 137 Social Activities 18 18 - 456 To School Children No. of classes Speaker Attendance SUBJECTS: General Health & Hygiene 56 Health Visitor or School Nurse 1634 Mothercraft 37 II 555 Community Services 24 II 205 Reproduction and Development 99 II 1813 Smoking 6 II 86 Drugs 14 II 339 Nutrition 18 II 389 Prevention of Accidents 15 II 1319 Venereal Disease 11 II 175 Importance of Play 2 II 29 General Discussion 11 II 129 Personal Relationships 5 II 88 Use of Leisure 7 " 615 Importance of Rubella Vaccination 1 II 500 78 Totals To Adults: There were 9358 attendances at 1128 groups given on 1046 occasions by health visitors and 82 occasions by other speakers To Schoolchildren: There were 7876 attendances at 306 classes given on 306 occasions by health visitors or school nurses i.e. 17234 attendances at 1432 teaching sessions Audiences: These have included: — School children Parents Expectant parents Over 50's Student Teachers Student Nurses Youth Groups Young Wives Club (Army) Social Workers Creche Attendants REPRESENTATION ON OTHER ORGANISATIONS A member of the Health Committee and a nursing officer represented the Council on the Greater London Home Safety Committee of the Royal Society for the Prevention of Accidents. A principal medical officer represented the Department on the Inner London Education Authority's Health Education Panel. 79 9 MISCELLANEOUS SERVICES EMERGENCY CALL SERVICE This service, which is operated from Westminster City Hall and shared between this Council and the City of Westminster, provides cover for emergency calls on local authority health and social services arising outside normal office hours. The cost is shared between the two authorities, and between the Health and Social Services Departments of this Council. During 1971, 2,115 calls were received in respect of this Council's services. NURSING HOMES Registration and Inspection (Public Health Act, 1936 — Part VI) During 1971, one nursing home providing accommodation for 12 medical and geriatric patients closed early in the year and no new homes were registered. Seven routine visits of inspection were made by a principal medical officer and the Chief Public Health Inspector and all the homes were found to be generally very satisfactory. At one home, where various works were in progress in connection with means of escape in case of fire, further visits were made by an officer of the Department of the Director of Technical Services and a public health inspector and the Council's requirements were met. In May, notification was received that it was proposed to re-open the nursing home closed earlier in the year and the usual preliminary inspections were carried out by officers of the Council and of the London Fire Service. As the new owners wished to accommodate more patients than permitted by the previous registration, various requirements were made with regard to structural alterations, sanitary accommodation, fire precautions and means of escape in case of fire. Formal application for registration was made in November, but had not been implemented by the end of the year as the owners had failed to meet some of the Council's requirements. Number of homes registered at 1st January 7 Number of registrations cancelled during the year 1 Number of homes registered at 31st December 6 Total number of beds at 31st December 175 Registered for medical patients only 130 Registered for medical and surgical patients 38 Registered for medical and maternity patients 7 Inspections by Principal Medical Officer and Chief Public Health Inspector 7 Other inspections by Council's staff 4 Visits made by Principal Medical Officer and Chief Public Health Inspector to proposed nursing home 4 Scheme to Provide Residential Care for Elderly Ladies The Sisters of Charity of St. Vincent de Paul, who are responsible for the management of St. Vincent's Nursing Clinic, 11/13 Ladbroke Terrace, W.11., have generously offered facilities for elderly dependent relatives of single persons or young families to stay at this clinic for periods of 1—2 weeks whilst their relatives take a holiday. This service is available for those families where the elderly dependent, due to failing health, is unable to remain alone or to accompany the family on holiday. The Council's role in this scheme is limited to liaison with the Order to assist them and applicants. 80 WATER SUPPLY The water supply in Kensington and Chelsea is almost entirely provided by the Metropolitan Water Board, but there are two premises which obtain water, used for domestic purposes, from artesian wells. Samples of water were taken both by the Council and the owners for bacteriological and chemical examinations, and the results were in all cases satisfactory. Swimming Baths There are five swimming pools in the borough which are regularly examined, two at the Public Baths in Silchester Road, two at the Public Baths in Chelsea Manor Street, and one private pool, used by school children, situated in the Kensington Close Hotel. The water used in the pools at Silchester Road and the Kensington Close Hotel is taken from the main supply of the Metropolitan Water Board, and the pools at Chelsea Manor Street are supplied from a deep well situated beneath the baths. In all establishments the water is treated by chlorination and continuous filtration. During the year, samples of water were taken from the pools and from their sources of supply for bacteriological examination, and all were satisfactory. Regular examinations of the bath waters were carried out by the department, and full chemical analyses were carried out periodically by the Public Analyst. Fluoridation Fluoridation of water supplies to a level of 1.0 part per million has been shown to be both harmless to health and most suited for the purpose of dental protection. This concentration of fluoride occurs naturally in many parts of the country, and artifical fluoridation in London is intended to make generally available the protection which is enjoyed by these other areas. The Council have agreed to support the general policy regarding fluoridation of water supplies, but no action has yet been taken by the Metropolitan Water Board to introduce the fluoridation of water in the London area. BACTERIOLOGICAL AND ANALYTICAL WORK During the year, arrangements were continued whereby specimens for bacteriological examination were dealt with by the laboratories at County Hall or St. Stephen's Hospital. The following table shows the total number of specimens examined by the two laboratories:— Nature of Sample Number Examined Nose and throat swabs 547 Faeces and rectal swabs 538 Urine 103 Milk (bacteriological) 41 Water (drinking) 26 Water (swimming) 55 Ice cream 32 Miscellaneous 33 81 PUBLIC MORTUARY FACILITIES Since 1st April, 1965, the Council have had an arrangement with the City of Westminster whereby all Kensington and Chelsea bodies are accommodated in the Westminster Mortuary at Horseferry Road, S.W.1., which had been enlarged in order to deal with the extra requirements. The total number of Kensington and Chelsea cases admitted during the year was 608. PARKING CONTROL Application for free parking facilities on grounds of physical disability are referred to the Medical Officer of Health for consideration and advice. If necessary, applicants are medically examined. During the year, 70 applications were received, 57 were granted and 13 refused. STAFF MEDICAL EXAMINATIONS For some years candidates have not been required to undergo a full medical examination before engagement, but to complete a comprehensive health questionnaire. Only where there is an element of doubt is the applicant medically examined. Number of questionnaires received 693 Number referred for medical examination 25 Number failing to pass 6 Number referred for further opinion 25 Number required to be re-examined within 12 months 21 In addition, 7 members of the staff who had been on prolonged sick leave were referred for my opinion as to their suitability to continue to be employed on their existing duties. Eight medical examinations were carried out at the request of other local authorities. 82 INDEX (Functions which became the responsibility of the Social Services Department are shown in italics) Page Abbattoirs 66 Accidents 2—3, 58,59 Adoptions (Medical Assessment) 23 Amusements with Prizes - Permits 67 Area of Borough 7 Area Comparability Factors 7-8 Artificial Kidney Machines 31 Artificial Lighting of Common Staircases 54 Atmospheric Pollution 50—53 "At Risk" Register 20-21 Bacteriological and Analytical Work 80 Basement Bakehouses 56 Bathing Centre 36 B.C.G. Vaccinations 31, 38 Births 2, 7 Boarding-Out of Children (Medical Assessment) 23 Borough Co-ordinating Committee 19 Care of Mothers and Young Children 20 Causes of Deaths 8, 10—11 Celluloid and Cinematographic Film — Registration for Storage 67 Cervical Cytology 21 Chest Clinic Services: B.C.G. Vaccination (Contacts) 31, 38 Social Work 19 Child Minders 18 Children "At Risk" 20-21 Chiropody 32 Cholera 16 Clean Air Act, 1956 50—53 Clinic Services: Ante-Natal 20 Child Health 20 Dental 39—41 Hearing 35—36 Minor Ailments 36 Special Investigation 36 Speech Therapy 36 Vision 35 Closing Orders 70—71 Community Nursing Services 23—33 Congenital Malformations 21 Consumer Protection Act, 1961 50 Co-operation with: General Practitioners 25 Hospitals 27 Creches 20 83 Page Day Care of Children 18 Day Nursery Service 19 Deaths: Vital Statistics 2, 7-8, 9 Causes 8, 10, 11 Dental Services: School Health 39-40 Maternal and Child Health 40—41 Diphtheria 13—14 Diphtheria Immunisation 29, 37 Discretionary Grants 68—69 Diseases (notification) 12-15 Diseases of Animals Ac t, 1950 49 Disinfection and Disinfestation 46 District Nurses 26 Domiciliary Deliveries 25 Domiciliary Family Planning 22—23 Domiciliary Midwifery 25—26 Early Discharges 25 Emergency Call Service 79 Employment Agencies and Nurses Agency Licences 67 Environmental Health Services 42—73 Factories Act, 1961 54—56 Family Casework 19 Family Planning 21—23 Family Planning (Domiciliary) 22—23 Fertilizers and Feeding Stuffs Act, 1926 49 Fireguards - Provision of 33 Fireworks — Registration for Storage and Sale 67 Flooding 71 Fluoridation 80 Food and Drugs Act, 1955: Food Standards (Ice Cream) Regulations 1959 65—66 Inspection and Registration 61-62 Liquid Egg (Pasteurisation) Regulations, 1963 66 Milk (Special Designations) Regulations, 1963 63-64 Milk and Dairies (General) Regulations, 1959 64—65 Legal Proceedings 72—73 Food Poisoning 14 Food Premises - Inspection and Registration 61-62 Food Sampling 62 Food Surrendered 63 Gaming Act, 1968 67 General Practitioners — Co-operation 25 General Practitioner Maternity Unit 25 Grants and Loans 27, 74 Greater London Council (General Powers) Act, 1968 60 Handicapped Children 20—21, 34—36 Health Centres: Clinic Services 20 Clubs 75 Health Committee 4 84 Page Health Education 74—78 Health Visiting 24—25 Home Dialysis 31—32 Home Help Service 18 Home Nursing 26—27 Home Nursing — Loan of Equipment 32 Hospitals — Co-operation 27 Housing 68-71 Housing Priority on Medical Grounds 71 Ice Cream 65—66 Illegitimate Births 9 Immunisation and Vaccination 29—31, 37 Improvement Areas 68 Improvement Grants 68—69 Infant Mortality 2, 7-8 Infectious Diseases 12—17 Infectious Illness in Schools 37 In-Service Training 28 Inspections and Supervision of Food Premises 61—62 International Certificates 15 Introduction 1—3 Issue of Medical Aids and Loan Equipment 47 Land Charges 60 Late Night Refreshment Houses 61 Laundry Service for the Aged Incontinent 47 Legal Proceedings 71—72 Licensing Act, 1964 60 Licences for Public Entertainment 60 Licensing and Registrations (Public Control) 67 Liquid Egg (Pasteurisation) Regulations, 1963 66 Loan of Home Nursing Equipment 32 Loans and Grants 27, 74 Massage Establishments 67 Maternal Deaths 2, 8 Maternal and Child Health 20 Maternal and Child Health Dental Service 40—41 Maternity Unit 25 Measles Vaccination 30, 37 Medical Examination of Staff 81 Medical Inspections at Schools 34 Medicinal Baths 46 Membership of the Health Committee 4 Mental Health Services 18 Midwifery 25—26 Milk 63-65 Miscellaneous Services 79—81 Metallic Poisoning 67 Mortuary Facilities 81 Night Cafes 60—61 Noise Abatement Act, 1960 54 Notification of Congenital Malformations 21 Notification of Infectious Diseases 12—15 85 Page Nursing Homes 79 Nursing Homes — Residential Care for Elderly Ladies 79 Occasional Creches 20 Officers of the Health Department 5—6 Offices, Shops and Railway Premises Act, 1963 56—60 Oil Heaters Regulations, 1962 and 1966 50 Outwork 55 Overcrowding 69—70, 71—72 Parking Control 81 Personal Cleansing 46 Personal Health Services 20—33 Personal Hygiene in Schools 36 Pet Animals Act, 1951 50 Pharmacy and Poisons Act, 1933 49 Poliomyelitis Vaccination 29, 37 Population 2, 7 Prevention of Damage by Pests Act, 1949 47 Psychoprophylaxis (Health Education) 76 Public Control 67 Public Health Inspectorate 43—45 Pupil Midwives 26 Qualification Certificates 68 Rag Flock and Other Filling Materials Act, 1951 49—50 Rateable Value 7 Rats and Mice 48 Recuperative Holidays 19 Recuperative Holidays for School Children 38 Registration of Food Premises 61—62 Remedial Foot Classes 36 Riding Establishments Act, 1964 49 Rodent Control 47—48 Rubella Vaccination 30—31, 37 Scabies 46 School Dental Services 39—40 School Health Services 34—38 School Treatment Centres 35—36 Services Transferred to Social Services Department 18—19 Shops Act, 1950 73 Slaughterhouses 66 Smallpox 14—16 Smallpox Vaccination 30, 37 Smoke Control Areas 50—53 Staff: Health Department 5—6 Medical Examinations 81 Standard Grants 68 Statistics: Dental Health 39—40 Environmental Health 42—73 Health Education 74—78 Infectious Diseases 12—17 86 Page Statistics — continued Personal Health 20—33 School Health 34-38 Vital 2,7-11 Stillbirths 7 Students and Visitors 28 Surrender of Unfit Food 63 Swimming Baths 80 Tetanus Immunisation 29-30, 37 Theatrical Employers — Registration 67 Town Planning Applications 60 Training of Pupil Midwives 26 Tuberculosis: Care and After-care 15 Contacts 31 Notifications, deaths, etc 15 Vaccination 31 Visiting 15 Typhoid 14-15 Unclean Milk Containers 64 Unfit Houses and Parts of Houses 70—71 Unsound Food 62 Vaccination and Immunisation 29—31, 37 Venereal Disease 17 Vermin 46 Vital Statistics 2, 7—11 Water Supply 80 Whooping Cough Immunisation 29,37