I THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1972 KEN 81 CONTENTS Page Membership of the Health Committee 1 Introduction by the Acting Director of Health Services 2 Staff of the Health Department 4 Section 1 Vital Statistics 6 Section 2 Infectious Diseases 11 Section 3 Personal Health Services 15 Section 4 School Health Services 31 Section 5 Dental Services 36 Section 6 Environmental Health Services 38 Section 7 Health Education 67 Section 8 Miscellaneous Services 70 Index 73 Unless otherwise indicated, 1971 statistics included for comparative purposes appear in brackets following those for 1972. It should be noted that all the services described in this Report were under the direction of Dr. D.J. Sheerboom as Director of Health Services, who left to take up another appointment before the Report could be prepared. MEMBERSHIP OF THE HEALTH COMMITTEE as at 31st December, 1972 The Mayor (Councillor Laurence A. Kenny) The Deputy Mayor (Councillor D.H. Piper) Alderman Donald Chesworth Alderman Edward Thorn (Chairman) Councillor Geoffrey D. Baber Councillor Miss Elizabeth M. Christmas Councillor Miss Joan L. Davis Councillor Mrs. lain Hanham (Vice-Chairman) Councillor Mrs. Robin Holmes, J.P. Councillor Bryan P. Levitt, M.A., Ph.D. Councillor Henry Machol Councillor Mrs. Pat Seers Councillor Arnold H. Stevenson Councillor Mrs. Brian Sundius-Smith Co-opted members: Norman Desmond, Esq. Dr. J.F.L. King Lady Petrie Miss Doreen Weatherhead, D.S.R., S.R.R. 2 THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA Telephone: Health Department, 01-937 5464 25A Kensington Square, London W8 5HW September, 1973. To: The Mayor, Aldermen and Councillors of The Royal Borough of Kensington and Chelsea Ladies and Gentlemen, It is with mixed feelings of pleasure and regret that I submit a report on the work of the Health Department and the health of Kensington and Chelsea for 1972. This is the penultimate year of the Council's Health Department and the borough can look back with pride on achievements and triumphs. The Council have built securely in the past and their efforts will bear good fruit for many years to come. The year has seen many changes overshadowed by the uncertainties generated by the plan to reorganise the National Health Services. The entire country is expected to see a much needed rationalisation of hospital and community services which in the past has been achieved by the painstaking hard work of Borough Councillors, responsive and sensitive to the needs and aspirations of their constituents. During the year, the management structure of the Council's nursing services received continuous attention from within this department and from the Management Services Officer. At the same time, negotiations took place with the Kensington District Nursing Association for a direct service to be provided by the Council. A decision on the future of this service was crucial to any consideration of a management structure in the Council's own nursing services. The successful result of numerous meetings and discussions has been the adoption of the Mayston management structure in keeping with the hospital services as well as the careful integration of the Kensington District Nurses within the Council's Health Department and nursing services. 1972 also saw the introduction of a new system of job evaluation, and over a period of eight months, job evaluation of 149 posts throughout the Health Department was conducted. A critical assessment was made of the level of duties and responsibilities of each post in relation to salary and grade. With one exception all staff retained their grades and 33 were advanced. In the last quarter of 1972, the Kensington Students' Centre was used as a transit camp for Uganda-Asian refugees. Voluntary organisation workers, social workers, health visitors, public health inspectors and doctors co-operated magnificently to provide an efficient and humane service to these distressed people. About 2,000 refugees were cared for in the camp. Throughout the year a never-ending stream of telephone calls and letters flooded the department because of the lack of proper garbage collection and disposal due to manpower difficulties outside the responsibility of this department. Irate and frustrated residents and businessmen vehemently directed attention to these ever-present 'health hazards'. Garbage collection is an essential service which must be dealt with efficiently to prevent the deterioration of health throughout the borough. Except for the above qualifying paragraph, the health of the borough has been exceedingly satisfactory, and the study of statistics in this report shows that over the years the extent of services rendered continues to maintain the same degree of efficiency. 3 Population The population of the borough has decreased by 30,000 over the past five years. Consequently the number of births has also declined and there are now 2,162 live births this year as against 3,164 in 1967. Attendances for clinics and other services have of necessity been considerably reduced. School attendances also declined. The total September school roll for 1968 was 17,399 and in 1972 it was 15,068. Birth rate The birth rate of 11.8 per 1,000 population shows a decrease as against 13 per 1,000 population last year. The actual number of births is dropping and this is in keeping with the national trend. It could be one of the direct results of good family planning. Death rate The crude death rate per 1,000 population is 10.2 this year against 10.6 last year, but due to an increase in the Area Comparability Factor to 1.09, the adjusted death rate is 11.1. Infant death rate The rate 21.8 per 1,000 live births shows an increase over last year's figures of 14.8. The rate usually fluctuates and for Inner London, Greater London and for England and Wales respectively, it was 19.9, 17.1 and 17.0. Maternal death rate No maternal death occurred during the year. Accidents Motor vehicle accidents All other accidents Total 1971 24 44 68 1972 16 47 63 In conclusion I wish to express my appreciation to His Worship The Mayor, the Chairmen and Vice-Chairmen of Committees and all Members of the Council for their kind co-operation. The Town Clerk, Directors and Heads of Services and their staff have also been most kind and helpful. The Health Department staff have also given willingly and abundantly of their services and I am most grateful. R.A. CLAY, Acting Director of Health Services. 4 PRINCIPAL AND SENIOR OFFICERS OF THE HEALTH DEPARTMENT as at 31st December, 1972 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 Mr. J.T. Healy Nursing Staff Principal Nursing Officer Mrs. J. Harris Deputy Principal Nursing Officer Miss L.M. Baker Assistant Nursing Officers: Miss R. Alford Miss J. Gibb 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 5 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 Finance Mr. R. Smith General Administration Mr. J.A. Spencer Personal Health Mr. E.C. Caspersz Research and Information Mrs. D.M. Mandoki School Health Mr. E. Yorke Staff Mr. P. Margetts 6 1 VITAL STATISTICS AREA The area of the borough is 2,951 acres. POPULATION Census 1971 188,227 Estimate of Registrar-General at mid-year 1972 183,230 Average density of population per acre 63.7 RATEABLE VALUE Rateable value of the borough at 1st April, 1972 £26,538,306 Estimated net product of a penny rate 1972/73 £257,000 Estimated number of separately assessed dwellings at 1st April, 1972 75,796 LIVE BIRTHS Males Females Total Legitimate 891 838 1,729 Illegitimate 209 224 433 Totals 1,100 1,062 2,162 Crude birth rate per 1,000 of the estimated population 11.8 Adjusted birth rate for comparative purposes (Area comparability factor = 0.52)* 6.1 STILLBIRTHS Total (11 males and 12 females) 23 Rate per 1,000 total live and stillbirths 11 DEATHS Total (879 males and 990 females) 1,869 Crude death rate per 1,000 population 10.2 Adjusted death rate (Area comparability factor = 1.09)* 11.1 INFANT MORTALITY Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 21 15 36 Illegitimate 7 4 11 Totals 28 19 47 7 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 21.8 Death rate of legitimate infants per 1,000 legitimate live births 20.8 Death rate of illegitimate infants per 1,000 illegitimate live births 25.4 Death rate of male infants per 1,000 male live births 25.5 Death rate of female infants per 1,000 female live births 17.9 Neo-natal deaths (under 4 weeks of age) (22 males and 16 females) 38 Death Rates of:— Males per 1,000 male live births 20.0 Females per 1,000 female live births 15.0 All infants per 1,000 live births 17.6 Early neo-natal deaths (under 1 week of age) (21 males and 13 females) 34 Death Rates of:- Males per 1,000 male live births 19.1 Females per 1,000 female live births 12.2 All infants per 1,000 live births 15.8 Perinatal mortality (deaths under 1 week plus stillbirths) (32 males and 25 females) 57 Death Rates of:— Males per 1,000 male live and stillbirths 28.8 Females per 1,000 female live and stillbirths 23.2 All infants per 1,000 live and stillbirths 26.0 MATERNAL DEATHS Maternal deaths (Abortion) Nil DEATHS FROM CERTAIN CAUSES Tuberculosis of respiratory system 4 Cancer of the Lung and Bronchus 113 Congenital Anomalies 9 Cerebrovascular Disease 199 Heart and circulatory system diseases 673 Motor Vehicle and other accidents 63 Suicide 27 8 SUMMARY OF VITAL STATISTICS FOR KENSINGTON AND CHELSEA IN 1972 (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 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 1972 183,230 1,869 10.2 2,162 11.8 47 21.8 ILLEGITIMACY The rate of illegitimate births per 1,000 live births has again risen this year. The figures for this and the previous five years are:— 1967 212 1968 198 1969 194 1970 188 1971 195 1972 200 9 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN 1972 DISEASE Code No. All Ages Under 1 year 1 year and under 5 5 years and under 45 45 years and under 65 65 years and over Enteritis and other Diarrhoeal Diseases B4 1 - - - - 1 Tuberculosis of Respiratory System B5 4 - - - 4 - Other Tuberculosis B6(2) 1 - - 1 - - Meningococcal Infection B11 1 - 1 - - - Other Infective and Parasitic Diseases B18 3 1 - 1 - 1 Malignant Neoplasm, Buccal Cavity, etc. B19(1) 5 - - - 3 2 Malignant Neoplasm, Oesophagus B19(2) 9 - - - 3 6 Malignant Neoplasm, Stomach B19(3) 33 - - - 8 25 Malignant Neoplasm, Intestine B19(4) 48 - - - 12 36 Malignant Neoplasm, Larynx B19(5) 2 - - - 1 1 Malignant Neoplasm, Lung, Bronchus B19(6) 113 - - 1 48 64 Malignant Neoplasm, Breast B19(7) 33 - - 4 13 16 Malignant Neoplasm, Uterus B19(8) 12 - - 1 3 8 Malignant Neoplasm, Prostate B19(9) 13 - - - 3 10 Leukaemia B19(10) 12 - 1 2 3 6 Other Malignant Neoplasms B19(11) 112 - - 9 27 76 Benign and Unspecified Neoplasms B20 3 - - - - 3 Diabetes Mellitus B21 9 - - 2 2 5 Avitaminoses etc. B22 2 - - - 1 1 Other Endocrine etc. Diseases B46(1) 10 1 - 1 2 6 Anaemias B23 4 - - - 1 3 Mental Disorders B46I3) 10 - - 6 1 3 Multiple Sclerosis B46(4) 1 - - - - 1 Other Diseases of Nervous System B46(5) 15 - - 1 3 11 Chronic Rheumatic Heart Disease B26 28 - - 3 4 21 Hypertensive Disease B27 26 - - - 6 20 Carried forward 510 2 2 32 148 326 10 DISEASE Code No. All Ages Under 1 year 1 year and under 5 5 years and under 45 45 years and under 65 65 years and over Brought forward 510 2 2 32 148 326 Ischaemic Heart Disease 828 418 - - 5 90 323 Other Forms of Heart Disease B29 102 1 - 1 8 92 Cerebrovascular Disease B30 199 - - 4 22 173 Other Diseases of Circulatory System B46(6) 99 - - - 9 90 Influenza B31 7 1 - - 1 5 Pneumonia B32 158 6 - - 17 135 Bronchitis and Emphysema B33(1) 98 - - - 11 87 Asthma B33(2) 6 - - 2 1 3 Other Diseases of Respiratory System B46(7) 13 - - 1 2 10 Peptic Ulcer B34 21 - - - 3 18 Intestinal Obstruction and Hernia B36 7 - - - - 7 Cirrhosis of Liver B37 13 - - - 9 4 Other Diseases of Digestive System B46(8) 21 - - 2 9 10 Nephritis and Nephrosis B38 8 - - - 4 4 Hyperplasia of Prostate B39 4 - - - - 4 Other Diseases, Genitourinary System B46(9) 17 - - 2 3 12 Diseases of Skin, Subcutaneous Tissue B46( 10) 1 - - - - 1 Diseases of Musculoskeletal System B46(11) 10 - - - - 10 Congenital Anomalies B42 9 6 2 - - 1 Birth Injury, Difficult Labour, etc. B43 19 19 - - - Other Causes of Perinatal Mortality B44 9 9 - - - - Symptoms and III Defined Conditions B45 14 3 - - 1 10 Motor Vehicle Accidents BE47 16 - - 5 9 2 All other Accidents BE48 47 - 3 21 10 13 Suicide and Self-inflicted Injuries BE49 27 - - 15 6 6 All Other External Causes BE50 16 - - 8 5 3 TOTAL ALL CAUSES 1869 47 7 98 368 1349 11 2 INFECTIOUS DISEASES NOTIFICATIONS The total number of notifications received during 1972 was 400 in comparison with 424 in 1971. The following Tables show (1) the number of cases of infectious disease notified during the year 1972, 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 1972 1971 1970 1969 1968 1967 Dysentery 14 16 18 11 14 11 Encephalitis 1 1 - - 1 - Enteric Fever 5 5 - 4 1 1 Erysipelas - - - 1 1 3 Food Poisoning 18 27 48 53 18 12 Infective Jaundice 90 95 108 77 41 not notifiable Malaria 17 6 4 5 2 4 Measles 142 175 254 211 296 847 Meningococcal Infection 5 6 - 4 1 2 Ophthalmia Neonatorum 1 2 2 2 - - Poliomyelitis: Paralytic - - 1 - - - Scarlet Fever 18 14 22 7 34 15 Tuberculosis (all forms) 83 63 88 79 101 77 Whooping Cough 6 14 31 12 46 78 TOTALS 400 424 576 466 556 1050 NOTE: Cases of mistaken diagnosis are excluded from the above Table 12 TABLE 2 Notifiable disease Number of cases notified in 1972 (Age groups in years) Age unknown Under 1 1 - 2 3-4 5-9 10 14 15 - 24 25 and over Dysentery - 1 - 1 1 - 6 5 Encephalitis - - - - - - 1 - Enteric Fever - - - 1 - - 2 2 Food Poisoning - - 3 1 1 - 4 9 Infective Jaundice - - - - 4 4 45 37 Malaria - - - - - 1 6 10 Measles - 3 24 44 63 2 4 2 Meningococcal Infection - - - 2 1 - 1 1 Ophthalmia Neonatorum - 1 - - - - - - Scarlet Fever - 1 3 3 6 2 3 - Tuberculosis (All forms) - - 2 2 5 4 14 56 Whooping Cough - - 2 3 1 - - - TOTALS - 6 34 57 82 13 86 122 Diphtheria This was the eleventh year in which no case of diphtheria was notified in the borough. Food Poisoning Eighteen cases of food poisoning were notified during the year. The following table gives an analysis of the various types of salmonella isolated:— Salmonella Typhimurium 2 Salmonella Enteritides 2 Salmonella St. Paul 1 Unknown 13 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 93 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 3 year old girl who also was admitted to hospital, typhoid being confirmed by blood culture. The girl came from Gambia. 13 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. Tuberculosis During the year 83 new cases of tuberculosis were notified of which 70 were respiratory and 13 were non-respiratory and 15 other cases of persons moving into this borough were reported, mainly by other borough councils. In addition to the 83 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 339 158 27 32 Total 556 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 and cholera. When completed by a medical practitioner, the certificate must be authenticated by the Medical Officer of Health. During the year 13,140 of these certificates were authenticated. In addition 3 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 235 persons intending to stay in the borough who could not produce valid certificates of vaccination after leaving countries which were declared local infected endemic areas. Of these 114 were kept under observation for the surveillance period and remained quite well and 10 were found to have moved to other areas of which the Medical Officers of Health were notified. The remaining 121 persons could not be traced at the addresses given by the port authorities. 14 VENEREAL DISEASES New cases reported during 1972, 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 1972 1971 1970 1972 1971 1970 1972 1971 1970 1972 1971 1970 1972 1971 1970 Central Middlesex Hospital 29 33 26 - - - - 1 * 5 9 6 24 23 20 Dreadnought Seamen's Hospital 6 6 8 -- - - - - .- - 1 — 6 5 8 The London Hospital 132 130 144 - - - 2 1 - 20 19 21 110 110 123 Middlesex Hospital 1783 2008 1234 10 10 6 6 8 9 243 261 219 1524 1729 1000 Moorfields Eye Hospital 5 10 * - - * - - * -- - * 5 10 * St. Bartholomew's Hospital 177 194 200 1 - 5 - - - 23 24 29 153 170 166 St. George's Hospital 2148† 1926t * 12† 4† * 8† 24† * 276† 243† * 1852† 1655† * St. Mary's Hospital 4389 3853 3264 23 26 39 16 25 39 856 797 808 3494 3005 2378 St. Thomas Hospital 634 746 577 5 3 1 7 3 2 83 103 100 539 637 474 University College Hospital 325 - - 2 - - 1 - -- 46 - - 276 - - West London Hospital 4022 4015 4613 35 18 27 13 14 17 684 780 1057 3290 3203 3512 Westminster Hospital 820 667 344 5 2 2 3 4 - 82 93 52 730 568 290 TOTALS 14470 13588 10410 93 63 80 56 80 67 2318 2330 2292 12003 11115 7971 † Approximate figures * Figures not available 15 3 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN There were 2220 notified births, 289 fewer than in 1971 and of these 2195 or 98.8 were institutional confinements. Maternal and Child Health (Clinic Services) Details of attendances at Health Centre clinics are as follows: Ante-natal and post-natal clinics: Total number of sessions 314 (356) Total attendances 2,032 (2,751) Number of women attending during year: Ante-natal 592 (652) Post-natal 29 (34) Child health clinics: Total number of sessions (infant welfare and toddlers) 1,289 (1,348) Total attendances 17,602 (20,254) Number of children attending during year: Born in current year 1,628 (1,744) Born in preceding five years 2,664 (2,789) Total attendances at special toddlers clinics 1,066 (1,683) During 1972, the total number of children under 5 years of age who attended clinics was 4,292 compared with 4,533 in 1971, a decrease to be expected in view of the steadily falling birthrate. The above figures refer only to children in attendance at the Council's health centres, but there are many who attend child health sessions held in surgery premises by their own general medical practitioners and the Council's health visitors. During 1972, 365 (411) such sessions were held and 3,845 (4,802) attendances were made by children under 5 years of age. 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., remained at 36. The total number of sessions held during the year was 1,699 and total attendances 19,484 compared with 1,731 and 22,333 respectively in 1971. Handicapped Children and Children "At Risk" The Council's Observation and Handicapped Register of children under 5 years of age 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 723. The following is a summary of the 103 handicapped children included in the above figure on the register classifed under major handicaps: Talipes and other orthopaedic defects 18 Congenital Heart Disease and Cardiac Murmurs 14 Mental Retardation 13 Epilepsy 8 Spina Bifida, Meningocele and Hydrocephalus 6 16 Asthma 4 Cleft Lip and/or Cleft Palate 4 Downs Syndrome (Mongolism) 4 Sickle Cell Anaemia and Thalassaemia 4 Blind or Partially Sighted 3 Cerebral Palsy 3 Cystic Fibrosis 3 Hemiplegia 3 Others including Hernias, Renal and Bowel Defects 3 Deafness or Defective Hearing 2 Hypothyroidism 2 Speech Defects 2 Adreno-Genital Syndrome 1 Coeliac Disease 1 Grecian Nose Dwarfism 1 Infantile Autism 1 Leukaemia 1 Phenylketonuria 1 Pierre Rabin Syndrome 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 years are as follows: 1972 1971 1970 1969 1968 Total Total notified live and still births (1) 2220 2509 2547 2686 2928 12890 Children with congenital defects (2) 36 49 48 59 41 233 Stillbirths with congenital defects included in (1) and (2) 1 1 3 8 2 15 Children with more than one defect 5 4 11 13 9 42 Total number of malformations reported 41 54 63 70 49 277 Children with defects per 1000 live and stillbirths 16.2 19.5 18.8 22.0 14.0 18.0 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 the prospective parents are interviewed by their own general medical practitioner and informed of any possible adverse prognosis. 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. 17 The following is a summary of the cases dealt with: Adoption Cases Children suitable for adoption 15 Children unsuitable for adoption — Couples suitable to adopt children 16 Couples unsuitable to adopt children 2 Boarding-Out Cases Children suitable for boarding-out 13 CERVICAL CYTOLOGY During the year 81 sessions were held at South Kensington, Holland Street and St. Quintin health centres with a total of 666 attendances. No positive smears were recorded. Since 1967 the Council have accepted financial responsibility for the screening service provided for residents at the Well-women Clinic of the Royal Marsden Hospital. During 1972, 130 residents attended this Clinic. No positive smears were recorded. The Annual Report for 1969 contained a comprehensive survey of the Cervical Cytology services provided by the borough since 1966 and it was stated that attendances at the cytology sessions had been disappointing in spite of the intensive publicity campaign in 1968. The figures published at the time referred only to "voluntary" attendances at the Council's Clinics and the Royal Marsden Hospital, but it was known that a considerable number of women had smears taken by their general practitioners, private consultants, or in hospital and family planning clinics. Based on very inaccurate data, it was estimated that about 4,000 residents had smears taken in these various ways every year. The National Recall Scheme introduced by the Department of Health and Social Security for the routine testing every five years of women over 35 years of age commenced on 1st January, 1972. This scheme made it possible for us to have more accurate numbers of residents tested, as the revised Cervical Cytology report form used by the majority of laboratories throughout the country provides a copy of the report for the Medical Officer of Health of the borough in which that person resides. In 1972, a total of 7,536 reports were received. The numbers are encouraging but not altogether satisfactory because 5,433 were women under 35 years of age and therefore not in the "at risk" group. Going back to the estimated figure of 8,000 "at risk" women who should be examined annually, the number of women tested in this category represents 28% of the total. I am pleased to note, however, that 4,185 were tests taken for the first time. Another advantage of the National Recall Scheme is that a woman in the "at risk" age group will receive an automatic reminder after five years that a further test is due. During the year 713 borough residents, known to have taken a previous test in 1967, received letters inviting them to take another test. Several letters were returned undelivered due to the constant movement of the population in this area. This fact alone would appear to justify the setting-up of a National Scheme. Local arrangements still continue for the recall of women under 35 years of age. The difficulty, however, still lies in persuading women in the "at risk" age group to take the initial test as a necessary precaution and there is a known reluctance among women in social classes 3, 4 and 5, who are a particularly high risk group, to come forward for examination. This is borne out by the figures for 1972 which show that although women in groups 3, 4 and 5 represent about 70% of the borough's female population, they accounted for only 29% of the total tests. FAMILY PLANNING Family planning Services continued to be provided by the West London Branch of the Family Planning Association in six Centres in the borough. Attendances again increased during the year and the Council accepted financial responsibility for 7230 borough residents as against 5305 in 1971. 18 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: New Patients Transfers Total Visits F.P.A. and Non-F.P.A. Cytology Chelsea (St. Stephen's Hospital) 1033 (1003) 137 ( 92) 5705 (5150) 929 (1027) Kensington (Holland Street) 378 ( 361) 92 ( 88) 2145 (1659) 398 ( 372) North Kensington (242 Ladbroke Grove) 1950 (2202) 170 ( 246) 10987(11704) 2217 (2715) St. Charles Hospital 218 ( 177) 8 ( 15) 886 ( 682) 220 ( 205) Violet Melchett 159 ( 218) 17 ( 23) 946 ( 920) 195 ( 152) Walmer Road 172 ( 160) 36 ( 32) 629 ( 347) 72 ( 67) TOTAL 3910 (4121) 460 ( 496) 21298 (20462) 4031 (4538) (Comparative figures for 1971 in brackets) Domiciliary Family Planning During 1971, as it was felt by both the Council's staff and members of the Family Planning Association that the services provided were in many cases not reaching those in most need of them, a domiciliary service was organised and commenced on 1st November of that year. Brief explanatory memoranda were circulated to all the Council's Medical and Social Service personnel and to hospitals, general practitioners and voluntary organisations, but by the end of 1971 only two women had been referred. Response during 1972 was equally disappointing as only 15 women were referred — all by the Council's health visitors. No requests for a home visit were received from any outside agency. A brief investigation into the reasons for the poor use of the service revealed that although many women in need were urged to accept it, some were not willing to be visited at home, or claimed that their husbands would object; others who finally agreed to accept family planning advice decided that they would, after all, prefer to attend a clinic and did so. It is probable that the ready availability of clinics (and this borough is well covered) reduces the need for women to be visited in their own homes. Nevertheless, as this is an area where there are many families with problems and a large immigrant population with language and other difficulties, it is still considered that more use should be made of this service and information about it will again be extended to all those likely to be in contact with possible recipients. COMMUNITY NURSING SERVICES All nurses working within the community either as health visitor, home nurse, school or clinic nurse or domiciliary midwife, have, as their aim, the promotion of family health within the home, and the prevention of illness. This aim includes people of all ages, from birth to old age. 19 Health teaching, including information about healthy living and the maintenance of health, is an integral part of all home, clinic and school activities. During the year all nurses moved towards closer working in teams based at health centres. This move was in preparation both for the adoption of the Mayston management structure and for the full integration of all community nursing services. In its turn the reorganisation of the National Health Service in 1974 will provide for the integration of both community and hospital nursing, thus preparing the way for continuous nursing care in the community, in the hospital and back into the home again. Health Visiting Staffing levels were maintained throughout the year, but this was difficult to extend due to the high cost of living in Central London and the difficulties of finding staff suitable accommodation at an economic rent; the turnover of staff was therefore considerable. Despite these factors the service continued effectively and efficiently with an ever increasing range of activity, due largely to the very high calibre of staff in post. The traditional concept of the health visitor who visits only the 0—5 year age group has long since gone and with a lower birth rate visits in this age group were greatly reduced. Visits to school children increased, as did visits to persons over 65 years of age. It is in the field of the care and support of the elderly within the community that there is great scope for expansion. Health visitors continued to be the major profession undertaking health teaching, and for this she is fully equipped both by education and training. During the year health visitors gave 1,262 talks to a total audience of 16,911. Discussions took place with the Borough Engineer for swimming classes to be established for mothers with young children of 6 months — 5 years. Health visitors have been increasingly concerned at the vulnerability of local families when visiting the seaside or local pools. It is hoped to start these classes with an instructor and, escorted initially by a health visitor, in early January, 1973. The following table records details of visits by health visitors during the year: First visits to: 1972 1971 Children — born in 1972 2190 2372 — others under 5 4903 6199 School children 707 385 Ante-natal cases 878 713 Other adults under 65 1739 1138 Persons aged 65 and over 1124 547 Mentally disordered persons (of all ages and included in above) 127 68 Households —Tuberculosis 159 126 — Other infectious diseases 91 71 — For any other reason 390 * Totals — First visits Effective 12181 12126 Ineffective 4026 * Revisits Effective 21506 * 1 neffective 4476 * Effective 33687 * Ineffective 8502 9316 * (NOTE: There are certain alterations to the categories of visits arising out of new requirements of the Department of Health and Social Security. As a result, some of the details recorded for 1971 are not comparable and have been omitted.) 20 In addition to the above: (a) 616 Uganda-Asians were seen whilst being accommodated at the Kensington Barracks, and (b) Health visitors attended the following sessions at G.P. surgeries: Child Health 365 Ante-natal 33 Health Visitor Students Nine students were sponsored for the one year course and again all were successful in gaining the Health Visitors' Certificate. Training was variously undertaken at the University of Surrey, Polytechnic of North London, Polytechnic of South Bank, Brighton Polytechnic and Chiswick Polytechnic. Within the borough, training facilities were again provided with field work instructors for eight students for various London colleges. Co-operation with General Practitioners All requests from general practitioners for discussions and planning of attachment of community nursing staff to practices were followed up. Existing attachment and liaison schemes continued. In some practices both health visitors and district nurses were part of the practice team, thus providing a complete service to the patient with continuity of medical care, health visiting advice and nursing treatment. Health Visiting with the Elderly The clubs for the elderly continued to expand and are now held in six of the Council's eight health centres. These clubs are part of health education activities, with the object of providing formal health teaching, regular supervision of personal health, individual advice and guidance and the general benefit of companionship and the mental stimulation that this provides. Members of the clubs are encouraged to attend the screening clinics for elderly persons already established at two centres and mentioned elsewhere in this Report. Domiciliary Midwifery A full domiciliary service continued to be provided, the midwives undertaking a varied range of duties within the nursing services. The number of home confinements again decreased from 43 in 1971 to 17 in 1972. The number of early discharges from hospital 48 hours after confinement increased from 200 in 1971 to 298 in 1972. It is regrettable that of these, 163 cases were not booked with the midwives in advance, but were only notified to the service within a few hours of discharge. It is to be hoped that, as more midwives in hospital become aware of the community services, this will be remedied. The General Practitioner maternity unit, formerly at St. Mary Abbots Hospital, opened during the year at the Princess Beatrice Hospital. Domiciliary midwives were responsible for delivery of 29 cases in the unit. 21 Cases booked Cases not booked (i) Domiciliary Deliveries with a doctor with a doctor Attended by: Council's midwives 17 ( 31) Nil ( 2) Hospital Midwives Nil (9) Nil ( 1) 17 ( 40) Nil ( 3) (ii) Early Discharges Planned Not Planned Nursed by: Council's midwives 125 ( 94) 159 (93) Hospital midwives 10 ( 11) 4(2) 135 (105) 163 (95) (iii) General Practitioner Maternity Unit Confinements attended by Council's midwives 29 (50) Number in which doctor was present 26 (46) Guthrie Tests During the year midwives obtained 345 specimens of blood from babies for the Guthrie test. These visits are made either when the baby is delivered at home, is discharged from hospital before the test is due at 6 days, or when the first test is inadequate. Four cases of raised phenylketonuria levels were found, but on re-test were deemed normal. Training of Pupil Midwives Eight pupil midwives from St. Mary's Hospital, Harrow Road, completed their domiciliary training with the Council's midwives. Twenty-eight student nurses undertaking the three month obstetric course during general training at St. Stephen's Hospital made visits with the midwives. Discussions were held to implement the new one-year combined midwifery course as recommended by the Central Midwives Board. 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 84 (88) Refresher courses attended by midwives in accordance with Section 9 of the Rules of the Central Midwives Board 5 (12) Home Nursing This service continued to be provided on an agency basis by the Kensington District Nursing Association for the whole borough. The Council reimbursed the Association to the extent of 93% of net approved expenditure. 22 Discussions were held on the feasibility of the full integration of this service with the community nursing services of the Council. State registered and state enrolled nurses 38.0 Total full-time equivalent 37.0 Students 4.0 The following is a summary of the service for the year: — 1. Number of patients attended: 0-4 18 5-64 516 65+ 1,721 Total all ages 2,255 ( 2,241) 2. Number of new cases Medical 1,253 Surgical 285 Tuberculous 13 Maternity 3 Mental ill health 24 1,578 ( 1,531) 3. Visits made for: Injections only 13,412 Injections plus other treatment 1,715 Other treatment only 78,200 93,327 (87,226) 4. Nursing Treatment Number of patients attended for at least 3 months 205 ( 108) Number of completed treatments 1,666 (1,610) Number of patients being attended at end of year 846 ( 754) Average number of visits per patient 41 ( 39) 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 After April 1st, 1974, this will no longer be listed as a separate item, but until then, as the date draws nearer, it is increasingly necessary to create and improve closer working with the hospital service. It is gratifying to report that teaching and practical training for student nurses again increased. Programmes of training for student nurses from both St. Charles and St. Stephen's Schools of Nursing were developed. These programmes are as recommended in the 1969 General Nursing Council 23 syllabus in which selected students spend six weeks with the various nursing and other professions working in the locality. From this, these future nurses will have a knowledge of the effect of the home and the environment upon the patient and thus within the hospital setting will have a greater understanding of the needs of patients. Liaison with hospital specialist departments continued in: — St. Charles Hospital (Paediatric Department) St. Mary's Hospital, Paddington (Maternity Department — Post Natal teaching) St. Mary's Hospital, Harrow Road (Maternity Department — Post Natal teaching) Maternity Liaison) St. Stephen's Hospital (Maternity Department — Post Natal teaching ) Maternity Liaison) St. Mary Abbots Hospital (Geriatric Department - Geriatric Liaison) Princess Beatrice (Maternity) Hospital — G.P. Unit) Ante-Natal teaching ) Post Natal teaching ) The liaison with the geriatric department, formerly at St. Luke's Hospital, has now transferred to St. Mary Abbots Hospital, where a nursing officer attends the regular ward rounds and is able to ensure that services within the home are mobilised before the patient is discharged. In this way regular visits for both home nurses and health visitors maintain the service and should re-admission be required this can be quickly arranged with the geriatric unit. The liaison with the psychiatrist from the Earls Court Child Guidance Unit (ILEA) increased to case discussion groups at two health centres weekly, greatly to the benefit of all concerned. In-Service Training Talks were arranged during the year for members of staff. These included "Improvement Areas" by Mr. D.C. Draper, Chief Public Health Inspector; "Drug Abuse" by Dr. R. Chappie, Medical Director, C.U.R.E; and "Fair Rent Act" by Mr. J. Crewdson, Housing Manager. An "Open Forum" was held by Mr. J. Beddoes, Manager of the local branch of the Department of Health and Social Security. A joint study-day for community nursing staff and hospital nursing staff was arranged with speakers from both services. Ten members of staff from the community services and fourteen members of hospital staff attended. Members of staff attended various courses, including: 1 Top Management Course by a senior nursing officer. 1 Middle Management Course by a senior nursing officer. 1 Preparation for Integration of the National Health Service course for a senior nursing officer. 1 Midwife successfully completed the Practical Teaching Course at the Royal College of Midwives. 24 Co-operation was given to other agencies— 1. British Broadcasting Corporation: health visitors were interviewed for programmes on health subjects— (i) Summer Holiday Accidents (ii) Care of the Elderly 2. The Council for Education and Training of Health Visiting: One health visitor acted as subject of a new recruitment pamphlet. 3. Health Visitors Association: A senior nursing officer acted as Group Leader to a two week professional refresher course. Students and Visitors We were pleased to welcome the following visitors undertaking study leave in this country:— Public Health Nurse from Malaysia — W.H.O. Fellowship Nurse Administrator from Kenya — Nursing Administration Nurse Administrator (Hospital) from Greece — R.C.N, course Medical Officer of Health from Germany — Administration Course. Dr. A. Lombard from Israel — Education Research for the disadvantaged. Programmes of visits of observation of the work of the community nursing and preventive services were made for the following persons:— Number of Sessions 8 Community Option Student Nurses from St. Charles Hospital 480 139 student nurses from St. Stephen's Hospital 139 55 Obstetric Students from Princess Beatrice Hospita 55 48 student nurses from St. Charles Hospital 48 8 student nurses from the Middlesex Hospital 44 12 Obstetric students from St. Mary Abbot's Hospital 12 6 Social Welfare Assistants from Social Services Department 12 9 student teachers from Maria Assumpta College of Education 9 1 Public Health nurse from Malaysia, World Health Fellowship 8 2 student administrators from the Royal College of Nursing Hospital Administrators' Course 6 2 Social Administrators' Course, London School of Economics 4 2 Social studies students from Polytechnic of Central London 4 1 Medical social worker from St. Charles Hospital 2 1 Geriatric ward sister from Princess Louise Hospital 2 1 Ward sister from Princess Louise Hospital 2 VACCINATION AND IMMUNISATION Records of primary courses and reinforcing doses show a drop in almost all types of immunisation administered, with the exception of measles. In February 1972, the figures for measles vaccination were perhaps boosted by a special effort covering the age two to three years. A further impetus was the offer of the Department of Health and Social Security to supply vaccine free of charge. It has been felt for some time that only a sustained effort backed up by continuous follow-up will help to maintain a reasonable level of immunisation against communicable diseases. Procedures are being devised to keep closer contact with all children under five years of age so as to ensure that they receive their injections and boosters at the proper time. It is hoped, in this way, to make parents more aware of the need for immunisation and also to encourage them to attend the clinics with their children. 25 Vaccination against smallpox was deleted from the Council's Schedule of Routine Vaccinations in 1971 as 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. This was a recommendation of the Joint Committee on Vaccination and Immunisation. The reasons for a fall are therefore obvious. Vaccination against smallpox continues to be available on request. General practitioners may also obtain tetanus vaccine on request although the Council's clinics do not provide immunisation for persons over sixteen years of age. The following is a summary of the immunisations given:- Poliomyelitis vaccination (No Salk vaccine was used) Primary courses completed Reinforcing doses 1392 (1570) 1760 (2507) Sabin at Council Clinics by general practitioners 719 ( 904) 222 ( 378) TOTAL 2111 (2474) 1982 (2885) Diphtheria Immunisation at Council Clinics 1333 (1511) 1168 (1530) by general practitioners 737 ( 819) 213 ( 445) TOTAL 2070 (2330) 1381 (1975) Whooping Cough Immunisation at Council Clinics 948 (1050) 27 ( 105) by general practitioners 599 ( 494) 36 ( 42) TOTAL 1547 (1544) 63 ( 147) Tetanus Immunisation at Council Clinics 1342 (1453) 1682 (2086) by general practitioners 739 ( 831) 269 ( 496) TOTAL 2081 (2284) 1951 (2582) Measles Vaccination Primary courses completed at Council Clinics 838 (734) by general practitioners 247 (213) TOTAL 1085 (947) 26 At Council clinics By general practitioners Total Smallpox Vaccination Primary vaccinations Under 5 years 141 (620) 55 (221) 196 (841) 5—15 years 20 ( 36) 17 ( 32) 37 ( 68) 16 years and over 6 ( 9) 2 ( 8) 8 ( 17) TOTAL 167 (665) 74 (261) 241 (926) Re-vaccinations Under 5 years 14 ( 34) 22 ( 21) 36 ( 55) 5—15 years 22 ( 58) 51 ( 71) 73 (129) 16 years and over 9 ( 3) 211 (226) 220 (229) TOTAL 45 ( 95) 284 (318) 329 (413) Rubella (German Measles) Vaccination against rubella for girls between their eleventh and fourteenth birthdays continued during the year as follows: — Vaccinations under Council arrangements 231 (992) Vaccinations by General practitioners 13 (31) I was informed in March, 1972, that the Joint Committee on Vaccination and Immunisation had advised the Secretary of State for Social Services that rubella vaccinations may be given, on request, to women of child-bearing age who are found to be seronegative. This decision placed considerable responsibility on the administering doctor. Due to the practical difficulties involved in taking blood tests before the injection, arrangements were made to offer it only to nursing and other staff of this department, and the Social Services Department, who were constantly in contact with children. The response was very encouraging. It is, however, not intended to offer this injection at our health centres. Tuberculosis (B.C.G. Vaccination) School Children (13 year olds) Schools visited 10 (9) Number of eligible children 1259 (1807) Number of acceptances 955 (1344) Acceptance rate 75.8% (74%) Number skin-tested and read 691 (899) Number given B.C.G. vaccination 663* (853) Number of positive reactors 24 (46) Positivity rate 3.6% (5.1%) The skin-test is Mantoux (IOTU). *Four children already had other vaccinations less than one month previously. Contacts Number skin-tested and read 61 (102) Number found negative 46 (63) Number given B.C.G. vaccination 48 (64) Number found positive 15 (39) 27 Influenza In past years, vaccination against influenza was made available to staff in the Health Department. As a preventive measure, it was decided that this facility should be extended to all staff and residents in establishments maintained by the Department of Social Services. I am pleased to note that large numbers of staff dealing with children and the elderly, as well as the residents themselves, made good use of this opportunity to be protected against influenza before the winter. I feel sure that such precautions will enable particularly persons in the old people's homes to withstand the severe effects of influenza which can cause serious complications. HOME DIALYSIS During the course of the year arrangements for home dialysis had to be made for three patients who were being trained at the Home Dialysis Unit, Charing Cross Hospital. In all three cases the living accommodation in the patients' homes was found to be either unsuitable or inadequate and applications were made for rehousing these patients in Council property. In view of the demand for Council housing no firm guarantees can be given for priority housing in these cases but the Council have always considered such applications with sympathy and understanding. It was a coincidence that a flat, previously adapted for another patient, fell vacant due to the death of the patient. One of the patients was therefore accommodated in this flat already adapted for home dialysis, with minimum inconvenience and expense. CHIROPODY Clinic Services There has been a drop in the number of persons attending Council clinics which can be explained by the extension of the domiciliary service. It is significant, however, that the number of total attendances has increased appreciably which would suggest that patients are receiving treatment more frequently. This is indeed a welcome trend and one that should be encouraged. Unfortunately, like the other boroughs in London, we have to contend with the acute shortage of trained staff and it is to the credit of our chiropodists that I can present these figures. The wide disparity in the treatment afforded to males and females over pensionable age (a proportion of 1:5) appears to merit comment. I should like to stress, once again, that there is great need for children and young women to be given timely advice on the care of the feet and the use of correct footwear. Details of attendances etc. are as follows: — Total number of Chiropodist sessions held at Council clinics 2774.5 (2,795) Number of persons attending Council clinics 2,115 (2,690) Analysis by age-groups of attendances at Council clinics: Children — under 5 years Nil (3) 5—14 years 142 (150) Expectant mothers 25 (2) Males— 15—64 years 950 (1,086) 65 years and over 2,378 (2,117) Females— 15—59 years 3,081 (3,479) 60 years and over 11,574 (10,401) Total attendance at Council clinics 18,150 (17,233) 28 Included in these figures are 42 handicapped persons who made 155 attendances. Ancilliary Service by Private Chiropodist Number of patients treated 123 (23) Number of treatments given 1,019 (986) Domiciliary Service The Domiciliary Service operated by the former Old People's Welfare Committee was taken over as a Council service by this department on 1st January 1972. Changes had to be made as the day to day work was shared by the staff of the Welfare Department and the British Red Cross Society (Kensington and Chelsea Branch) whereas the Old People's Welfare Committee exercised overall supervision and financial responsibility. I am pleased to report that the variations in procedures and other changes were effected with the utmost goodwill and without any inconvenience whatever to the patients concerned. All administrative and clerical work is centred in Head Office and the chiropodists are glad that they are now free to concentrate on treating the patients. The first year of administering this service has proved, without doubt, that there are large numbers of residents who can be reached only by taking these services to their homes - I refer particularly to the elderly, the infirm and the disabled. The following figures show the progress made during the year- Number of patients treated 621 (492) Number of treatments given 3,147 (2,552) Included in Domiciliary Treatments are 12 handicapped persons who received 27 treatments as follows: — Males under 65 years of age 8 Females under 60 years of age 4 We started off with five chiropodists working eleven sessions per week. It was soon apparent that expansion was inevitable and desirable. The retirement of Miss Scott during the year gave us the opportunity of taking stock and, with the employment of another chiropodist on domiciliary work, the number of sessions was increased to thirteen a week. The number of treatments given show an increase of 23 per cent over those for 1971. It is extremely difficult to maintain this rate of expansion of the service with existing staff resources. The service has reached saturation point when the chiropodists cannot take on more patients and maintain an adequate level of service. I would urge that more resources in money be made available for this worthwhile task of providing a service to a section of the community who have very few opportunities of using the other services made available to the public. WELL-WOMEN CLINIC In January of 1972, a Well-women clinic was opened at the Raymede Health Centre in North Kensington and sessions were held weekly on Tuesday afternoons, staffed by a medical officer and health visitors. This clinic was intended not for the treatment of women with symptoms of illness but for symptom-free women, apparently in good health and over the age of 35 years. The aim of the clinic was to detect disease in its early or symptom-free stage and to refer the woman for treatment or further investigation in order to prevent the development of chronic ill-health, morbidity or incurable disease. The Well-women clinic was publicised in the press and by posters issued to health centres, public libraries, general practitioners and social service offices and it was stated that attendance would be by appointment only in order to allow adequate time for full medical examination and discussion of problems. During the year, a total of 145 women attended and the examinations carried out VIEW OF A ROOM IN A COUNCIL FLAT ADAPTED FOR HOME DIALYSIS EQUIPMENT 29 included examinations of the heart, lungs, urine, blood pressure and blood. Hearing and vision were tested, a cervical smear was taken and arrangements were made for chest X-ray. Breast examination was carried out and, by special arrangement with the Royal Marsden Hospital, any woman suspected of having an abnormal breast condition could be referred directly to the hospital for further examination and consultant opinion. No treatment was given or advised at the Well-women clinic but, where abnormalities were found, women were asked to consult their own doctors to whom full reports were sent. A survey of the 145 women who attended the clinic in the first year has been carried out and the findings are summarised below. Average age of attenders — was 44 years with an age range of 24 to 75 years. Marital State Married — 92 (63% of total) Widowed, divorced or separated - 25 (17% of total) Single — 28 (20% of total) Average number of children — was 1.7 Source of Information about the Well-women clinic All attenders were asked how they had heard about the clinic or by whom they had been referred and the answers were as follows: — Informed by Health Visitor 41 (28%) Informed by friends 41 (28%) Advertisements seen at Health Centres 30 (20%) Advertisements seen in libraries 13 ( 8%) Information in the press 2 Information on Television (Presumably publicising a similar clinic in some other borough) 1 Referred by general practitioners 7 ( 5%) Referred by Citizens Advice Bureau 2 Referred by Family Planning Association 2 Referred by Chiropodists 5 Referred by Social Services Department 1 Country of Origin The country of birth of all women was recorded and it was found that 83% of those attending were born in the United Kingdom or Ireland while the remaining 17% were immigrants or visitors from 14 different countries. United Kingdom 96 Ireland 25 West Indies 6 Spain 3 Pakistan 2 Germany 2 Guyana 2 Singapore 1 Yugoslavia 1 Switzerland 1 St Helena 1 Iceland 1 Canada 1 Poland 1 Austria 1 Mauritius 1 30 Abnormalities detected at Well-women clinic The following conditions which had not been diagnosed or treated when the woman first attended the clinic were notified to the patient's general practitioner. Anaemia 18 Anxiety .10 Dental Caries 10 Obesity 9 Varicose Veins 7 Arthritis 4 Depression 3 Muscular cramps 3 Gynaecological abnormalities 3 Other women were found to be suffering from anaemia, varicose veins and hypertension but were already being treated by their own doctors. One woman was referred to the breast clinic at the Royal Marsden Hospital, but no abnormality was diagnosed. CLINICS FOR ELDERLY PEOPLE Clinics for elderly people began in February of 1972, one clinic a week being held at both Lancaster Road Health Centre and Violet Melchett Health Centre, and staffed by a medical officer and a health visitor. At first the sessions were slow and poorly attended, especially at Lancaster Road. However, after advertising notices were displayed in the local libraries, attendances improved and from 4 to 6 people were seen at each session. In May, Radio London visited one of the Centres, but the broadcast then did not affect attendance. Although the clinics are open to everyone over the age of fifty the vast majority of patients are in their sixties. Conditions encountered were varied but the most common was osteo-arthritis, followed by hypertension, and emotional disorders coming third. 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 increased as indicated by the 656 issues made by the Council and 1,442 by the British Red Cross Society, as compared with 556 and 1,283 respectively during 1971. The demand for incontinence pads again increased, as did the number of patients (265 compared with 210 in 1971). 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. The total number of fireguards issued during 1972 was 39 compared with 47 in 1971. 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. 31 4 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 responsible 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 1972. Where relevant, comparable figures relating to the previous year are shown in brackets. At May 1972 there were 15,247 children on the School Roll in the borough. Situated within the borough were 30 primary schools, 8 secondary schools, 2 nursery schools and 1 special school. SCHOOL MEDICAL INSPECTION Conditions governing the medical examination of all schoolchildren remain the same as in previous years. Children are examined on entry to infant school at about 5 years of age, on entry to primary school at about 8, on entry to secondary school at 11-plus, and finally during the term immediately preceding the end of their school life. Routine Medical Inspections Number inspected 5,974 Percentage of number inspected with parent present 52.7 Care Committee present 67.9 Reported Immunised against: Diphtheria 91.5 Whooping-cough 80.9 Reported Vaccinated against: Smallpox 69.1 Poliomyelitis 92.0 Inspected with: Unsatisfactory physical condition 0.9 Referred for treatment of: Defects 16.5 Defects other than vision 8.5 Non-Routine Inspections Re-inspections 3,752 Specials 1,550 32 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 48 (47) statutory examinations were carried out. Referrals included 24 (32) for the statutory E.S.N, examination which resulted in 14 (19) recommendations for education at schools for the educationally subnormal. The remainder included 12 (15) recommendations for open air schools. Special examinations included, among others, 112 (147) secondary school pupils seeking employment and 826 (758) wishing to go on school journeys. HANDICAPPED PUPILS A total of 203 (206) children requiring special educational treatment attended day schools in other boroughs and 105 (89) were placed in boarding schools. Included in these numbers were:— Physically handicapped children— In attendance at day schools 25 (26) In attendance at boarding schools 3 (5) Children attending ordinary schools and suffering from— Epilepsy 73 (72) Orthopaedic and postural defects 39 (42) Rheumatism 15 (17) Asthma 218 (228) Eye diseases other than refractions and squints 17 (14) Cerebral and Spastic cases 18 (16) The number of maladjusted children referred to the Problem Case Conference was 108 (112). Of this number, 60 (80) were referred to Child Guidance Clinics. There were 2 tutorial classes for maladjusted children and 5 (11) children were recommended for them from Case Conferences. CLINICS Vision The total attendances numbered 1,741 (1,880) at 162 (149) sessions held during the year. New cases attending during the year numbered 702 (790). Partially sighted children educated in special schools numbered 7 (8). Hearing Audiometry During the year 3,305 (3,656) children in ordinary schools were given the "Sweep" test by the nursing sisters. 33 Details of the results are shown in the following table- Boys Girls Total Sweep test Number tested 1,718 1,587 3,305 Number passed 1,582 1,480 3,062 Number failed 136 107 243 Pure Tone Test of Sweep Test Failures Number tested 75 67 142 Number passed 39 40 79 Number failed and referred to otologist 36 27 63 Other Pure Tone Tests (including hospital care) Number tested 69 46 115 Number passed 50 32 82 Number failed and referred to otologist 19 14 33 In addition to 7 (8) children attending schools for the deaf, 11 (8) attended partially hearing units. Of the 19 (23) wearing hearing aids who attended other schools 17 (15) were in ordinary schools, 1 (3) was in a school for the physically handicapped and 1 (5) was in a school for the educationally subnormal. Audiology The total attendances at the 38 (37) sessions held numbered 215 (210). New cases attending during the year totalled 85 (75). 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 was 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 overweight are dealt with. Cases of debility and poor general physique account for most other referrals. At the 104 (115) sessions held, 109 (123) new cases were seen, while the total attendances amounted to 774 (784). Minor Ailments Medical officers conducted 77 (83) sessions and examined 152 (395) new cases. Nursing sisters held 791 (685) sessions and saw 615 (602) new cases. Altogether the total attendances at the clinics numbered 4,667 (5,943). Speech Therapy There were 3 (3) clinics staffed by 3 (3) speech therapists with 10 (11) sessions a week. 34 PERSONAL HYGIENE Of 14,123 (14,616) children seen during comprehensive surveys 226 (178) were found to be verminous. Inspections during selective surveys numbered 8,114 (7,862) wh«n 486 (293) children were found to be verminous. BATHING CENTRE Children attended the bathing centre on 537 (680) occasions, when 91 (212) cases of scabies and 445 (468) verminous cases were treated. One case of impetigo was also 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 8 primary schools and 173 (225) 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. IMMUNISATION Details of immunisation in schools are given below— Completed primary courses Reinforcing injections (re-vaccinations) Smallpox 3 ( 68) 1 ( 129) Diphtheria/Tetanus/Whooping Cough: Triple Diphtheria/Tetanus 193 ( 232) 807 (1,661) Diphtheria 1 ( 58) 6 ( 31) Tetanus 8 ( 20) 526 ( 515) Poliomyelitis: (No Salk vaccine was used) Sabin 236 ( 238) 1,377 (2,402) Measles 23 ( 51) - Rubella 225 (1,022) - INFECTIOUS ILLNESS The following table shows the number of cases of infectious illness reported from schools by head teachers during 1972- Disease Total Chickenpox 112 Dysentery ) Diarrhoea ) 23 Enteritis ) German Measles 31 Influenza 12 35 Impetigo 17 Jaundice & Hepatitis 2 Measles 83 Mumps 192 Ophthalmia & Conjunctivitis 3 Ringworm (scalp) 1 Ringworm (body) 2 Scabies 4 Scarlet Fever 6 Tonsillitis 34 Whooping Cough 5 RECUPERATIVE HOLIDAYS FOR SCHOOL CHILDREN During the year, the School Health Service received 65 applications for school children to have recuperative holidays unaccompanied by their parents and 5 applications made in the previous year were still awaiting placement. Arrangements were made for 58,5 applications were withdrawn or cancelled and 7 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 THIRTEEN-YEAR OLD CHILDREN A medical officer, together with two clerical assistants, visited 10 (9) schools. There were 1,259 (1,807) children eligible for B.C.G. vaccination. The parents of 955 (1,344) children gave their consent and out of this number 691 (899) were skin-tested and read. Of these, 663 (853) children were vaccinated. A total of 24 (46) were found to be positive reactors, and 4 children who were found to be negative were not vaccinated because they had already received other vaccinations less than one month previously. 36 5 THE DENTAL SERVICES STAFF On 31st December, 1972, the staff consisted of the Principal Dental Officer, three whole-time and one part-time dental officers, supported by four whole-time dental surgery assistants and one part-time anaesthetist. Miss M.H. Black commenced duties as dental officer in February, 1972 and no further changes in staff occurred during the year. PREMISES AND EQUIPMENT Four dental centres were in use during the year. The Chelsea Clinic has vacated the old premises at Bramerton Street and has removed to the newly-equipped clinic at the Violet Melchett Health Centre. A second clinic for the use of an orthodontist and a dental auxilliary is nearing completion at the Violet Melchett Centre and should be ready for occupation in the early spring of 1973. Building work commenced on the new Raymede Centre during the year and is expected to be completed by the summer of 1973. This Centre will also contain two surgeries and will re-house the old Tavistock Road Clinic. INSPECTIONS AND TREATMENT OF SCHOOL CHILDREN During the year twenty infants schools, twenty-one junior schools, six senior schools, four nursery schools and one school for the physically handicapped received routine dental inspections. A total of 8,533 children were inspected during 933 inspection sessions. In addition, 2,303 children were inspected at clinic treatment sessions giving a total annual inspection of 10,836; of these, 5,393 were offered treatment. Details of treatment provided are given in the tables at the end of the report. A total of 2,632 courses of treatment were completed during 1445.9 treatment sessions. The ratio of teeth filled to teeth extracted was 17.6:1 in the permanent and 2.2:1 in the temporary teeth, excluding orthodontic extractions. The following summary of the School Dental Services shows comparative details for 1971: Number of Sessions 1972 1971 Inspection 93.3 95.6 Ordinary treatment 1,409.3 1,482.2 General Anaesthetic 18.8 19.7 Orthodontic 17.8 3.1 Health Education 4.0 2.0 Total 1,543.2 1,602.6 Inspections Number of children given: First inspection at school 8,533 9,158 First inspection at clinic 2,326 2,111 Proportion found to require treatment 51.3% 49% Reinspection at school or clinic in 1972 1,599 1,948 Proportion found to require treatment 67.7% 54% Total number of appointments made 13,566 14,104 Total number of attendances by appointment 9,816 10,204 Response rate 72.4% 72% Average attendances per session 6.4 6.9 Visits for treatment Number of first visits 3,218 2,806 Number of subsequent visits 6,225 6,195 Total visits 9,443 9,001 Emergencies 273 124 37 Additional courses commenced 812 677 Treatment given Number of fillings in permanent teeth 4,096 4,378 in temporary teeth 2,929 3,372 Number of extractions of permanent teeth 205 250 of temporary teeth 1,234 1,215 Number of other operations (Prophylaxis, X-rays, inlays, crowns, etc.) 5,786 3,020 Courses of treatment completed 2,632 2,656 Orthodontics Number of new cases 11 4 Number of removable appliances fitted 10 5 Number of fixed appliances fitted 2 nil Number of cases referred to hospital consultant 47 45 MATERNAL AND CHILD HEALTH DENTAL SERVICE Dental inspections during the year were carried out on 468 children under five years of age and 49 expectant or nursing mothers. Treatment was offered to 286 (61%) of the children and 45 (92%) of the mothers. The dental inspection invitation scheme for three year olds was introduced in 1972. A total of 294 invitations were sent to the parents of three year olds inviting the children to receive a dental inspection. Sixty-four responded and were seen at the school clinics and, in the majority of cases, this was the child's first introduction to the dentist. The results are encouraging and the scheme will be repeated annually. Details of work done are given below with comparative details for 1971 in brackets. Expectant or Nursing Mothers Children under five Number of appointments given 208 (259) 1,514 (1,220) Number of attendances— by appointment 156 (186) 927 (887) other 5 ( - ) 25 ( 5) Number of patients given first inspection during the year 49 (61) 468 (426) Number of patients above found to require treatment 47 (57) 296 (201) Number of patients above offered treatment 45 (57) 286 (200) V isits for treatm ent: F i rst 51 (56) 275 (201) Subsequent 103 (108) 422 (471) Number of treatments given: Fillings 87 (122) 416 (532) Teeth extracted 12 (23) 76 (36) Patients X-rayed 24 (40) 16 (2) Prophylaxis 48 (44) 144 (35) Number of courses of treatment completed 25 (38) 188 (126) Number of patients supplied with other dentures 3 (1) 38 6 ENVIRONMENTAL HEALTH SERVICES Mr. D.C. Draper Chief Public Health Inspector At the end of 1972, the Public Health Inspectorate consisted of 29 Public Health Inspectors and 17 Technical Assistants. For the purpose of routine inspection of premises and the investigation of complaints the borough is divided into four areas; the overall supervision of each area being the responsibility of a Senior Public Health Inspector. The four areas are sub-divided into twelve districts which are delineated on a ward basis. In addition, Public Health Inspectors are engaged in various specialised capacities including Housing, Food Inspection, Clean Air, Offices and Shops Inspections and Improvement Grants. Public Control functions including the licensing and supervision of employment agencies and nursing agencies, the control of some amusements with prizes and the licensing and supervision of massage establishments have continued to be undertaken. Inspections are carried out by a Senior Inspector and two Assistants. The work of Rodent Control is undertaken by a Rodent Officer and six assistants. The Disinfection and Disinfestation work and the other services which are provided at the Medicinal Baths in North Kensington are undertaken by the Chief Disinfector and five assistants. In April 1972, the Council made a new Byelaw controlling the operation of wireless sets, gramophones, amplifiers, etc. The Secretary of State confirmed the Byelaws and they became operative in September, 1972. The main purpose of the Byelaw is to prohibit the operation so as to cause annoyance to other persons of amplifiers in any business premises, public place or other place open to the public. The Byelaw was drawn to the attention of all shopkeepers using amplified sound apparatus and although no proceedings were instituted during the year a considerable improvement was effected. In view of the large increase in the number of hotels in the borough a specialist section was set up during the year to deal with the many pubic health problems which arose. The main purpose was the inspection of food preparation areas and restaurants in hotels, boarding-houses and hostels, but also included, where necessary, the inspection of offices and the implementation of the Council's standards in relation to overcrowding and the provision of sanitary facilities. Considerable importance is attached to the training of student public health inspectors which is undertaken in conjunction with two Technical Colleges in London. The present establishment of students is nine and as they qualify they are taken on to the staff filling vacancies created by retirement and officers leaving to take up positions with other authorities. 39 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 4,363 3,550 Infectious disease enquiries 769 NIL Drainage work inspected 5,717 1,444 Drains tested 548 NIL Clean Air Act, 1956 Area Survey 70 NIL Adaptations 172 1 Smoke emissions 61 3 Smoke observations 107 NIL Air Pollution Recording Stations 11 NIL New furnaces and chimney heights 71 NIL Housing Acts, 1957 to 1969 Routine inspections (not included below) 929 512 Houses in multiple occupation 3,077 4,993 Overcrowding 147 43 Underground rooms 915 210 Improvement grants 2,863 1,815 General improvement areas 39 687 Factories Act, 1961 Factories (mechanical) 418 NIL Factories (non-mechanical) 15 NIL 47 NIL Offices, Shops and Railway Premises Act, 1963 Offices 702 1 Retail Shops 962 35 Wholesale shops and warehouses 35 NIL Fuel storage depots NIL NIL Catering establishments and canteens 391 77 Other visits (not general inspections) 1,709 16 Food and Drugs Act, 1955 Butchers . . 40 12 Bread and cake shops 28 3 Fishmongers and friers 3 1 General provision shops 252 18 Greengrocers 19 2 Milk vendors 27 NIL Ice Cream vendors 97 NIL Ice Cream manufacturers 6 NIL Bakehouses 4 2 Chocolate and confectionery 22 1 40 Inspections Made Initial visits Re-visits Food and Drugs Act, 1955 — continued: Street traders' stalls, etc 374 NIL Street traders' stores 2 NIL Wholesale warehouses 2 NIL Catering establishments 913 168 Clubs 15 2 Hotels 481 68 Hostels 122 47 Inspection of Food 146 NIL Sampling 311 NIL Other visits 143 22 Pharmacy & Poisons Act, 1933 9 NIL Consumer Protection Act, 1961 NIL NIL Rag Flock Act (Sampling) 1951 3 NIL Various Noise complaints 131 114 Pet Animals Act 7 2 No-access visits 2,897 101 All other visits 2,362 29 Work Completed New items provided Drains 265 Inspection chambers 107 Intercepting chambers 12 Soil pipes 158 Waste pipes 381 Rainwater pipes47 Water closets 662 Bidets 55 Wash-hand basins 588 Sinks 262 Baths/showers 474 Urinals 54 Hot water supplies NIL Separate cooking facilities NIL Means for space heating 1 Dustbins 14 Items repaired or renewed Drains 8 Inspection chambers 3 Intercepting chambers 2 Soil pipes 28 Waste pipes 25 Rainwater pipes 36 Water closets 49 Wash-hand basins 12 Sinks 9 Urinals 1 Roofs 116 Gutters 1 Walls 106 Ceilings 97 Floors 30 Windows 78 Doors and frames 22 Fireplaces 1 Staircases 16 Yards and areas NIL Water waste preventers 1 Baths/Showers 1 Items cleansed or cleared Drains 49 Soil pipes NIL Waste pipes 6 Rainwater pipes 2 Cisterns 8 Noxious matter 7 Other rubbish 76 Number of houses where dampness eradicated 232 Number of houses where artificial lighting to staircase provided 11 41 Notices Served Public Health Acts 1936 and 1961 Intimation notices 542 Statutory notices 497 Final notices 80 Housing Acts 1957 to 1972 Section 9 (repair) 30 Section 14 (deficiencies of management) 4 Section 14 (additional amenities) 87 Section 16 (means of escape from fire) 115 Section 90 (overcrowding) 1 Various Food Hygiene (General) Regulations, 1960 98 Offices, Shops & Railway Premises Act, 1963 75 Other notices 55 42 DISINFECTING STATION AND MEDICINAL BATHS Medicinal Baths The following table shows the work carried out during 1972: DESCRIPTION SCABIES VERMIN IMPETIGO Persons Cleansings Persons Cleansings Persons Cleansings Adults Kensington & Chelsea 85 138 184 186 - - Other boroughs - — — — — — Schoolchildren Kensington & Chelsea 79 79 309 309 1 1 Other boroughs 12 12 136 136 — — Children under five Kensington & Chelsea 11 19 30 30 - - Other boroughs - - - - - - TOTALS 187 248 659 661 1 1 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 1972 by the disinfecting staff is shown in the following table: Houses disinfected after infectious disease 36 (83 rooms) Houses disinfected after vermin 352 (1173 rooms) Total weight of bedding, etc., dealt with 1¾ 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 twenty-five parcels of clothing were disinfected and the income amounted to £12.50. The following table indicates the destinations of these parcels: Destination No. of parcels Argentina 8 East Germany 11 Spain 6 TOTAL 25 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. 43 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, 2,356 separate collections of laundry were made and the number of articles cleansed totalled 28,695. 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 3,714 visits to deliver or collect loan equipment (wheelchairs, hoists, commodes, etc.) and to distribute incontinence 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 2,628 cases in 1972. 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; (d) increasing demands on the time of the rodent control staff as complaints increase mean 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; 44 (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 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. The Minister of Agriculture, Fisheries and Food reuqested a report for the twelve months ended 31st December, as follows: Treatment of premises (rats and mice) Number of properties in the borough 76,805 Total number of properties inspected following notification 3,655 Number infested by rats 99 Number infested by mice 2,628 Total number of properties inspected for rats and/or mice for reasons other than notification 1,882 Number infested by rats 1 Number infested by mice 146 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 5,779 Premises where rats were found 100 Premises where mice were found 2,774 Premises where other vermin were found 243 Number of visits made 17,574 Number of successful treatments 2,385 Cases in which advice only was given 595 Borough Council properties dealt with (excluding dwelling houses) 241 45 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, twenty samples of fertilisers were obtained and submitted for analysis in accordance with the provisions of the Act. The composition of one sample was found to vary beyond the prescribed limits, and 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 87. There were six 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 two samples of Algerian Fibre, two samples of Cellular Plastics Crumb, one sample of Rag Flock and one sample of Cotton Felt were taken for analysis. They were all reported to be satisfactory. 46 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, six 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 On 1st July this year, the North and South Stanley Wards became a Smoke Control Area, thus completing the Council's programme to bring the whole borough within the scope of the Act, with the exception of certain properties in the Norland, St. Charles, Golborne and South Stanley Wards which have been exempted from the appropriate Smoke Control Orders due to the proposed clearance of these areas for the construction of new housing estates and road development, etc., and these will be kept continually under review for any change of circumstances. Smoke Control Area Map Ref. Boundaries Order operative Holland Ward (No. 1) Holland Ward (No.3) Church Ward Holland Ward (No.2) 1 3 C1 2 N. Holland Park Avenue E. Campden Hill Road S. Kensington High Street W. Abbotsbury Road N. Notting Hill Gate E. Borough boundary S. Kensington High Street W. Campden Hill Road Church Ward boundaries N. Holland Park Avenue E. Abbotsbury Road S. Kensington High Street W. Borough boundary 1.10.1959 1.10.1960 1.11.1960 1.10.1961 47 Smoke Control Area Pembridge Ward (No. 1) Pembridge Ward (No.2) Hans Town Ward Norland Ward (No. 1) Norland Ward (No.2) Cheyne and Royal Hospital Wards Earls Court and Queen's Gate Wards Earls Court Redcliffe and Brompton Wards Redcliffe and Brompton Wards Brompton and Queen's Gate Wards St. Charles Ward (No. 1) St. Charles and Golborne Wards Map Ref 4 5 C2 6 7 C3 8 9 10 11 12 13 Boundaries N Westbourne Grove E. Borough boundary S. Notting Hill Gate W. Ladbroke Grove N. Lancaster Road E. Borough boundary S. Westbourne Grove W. Ladbroke Grove Hans Town Ward boundaries N. Lancaster Road E. Ladbroke Grove S. Holland Park Avenue W. Walmer Road and Princedale Road N. Lancaster Road E. Walmer Road and Princedale Road S. Holland Park Avenue W. Borough boundary Cheyne Ward and Royal Hospital Ward boundaries N. Kensington High Street E. Palace Gate and Gloucester Road S. West Cromwell Road W. Borough boundary N. Cromwell Road and West Cromwell Road E. Queen's Gate S. Old Brompton Road W. Borough boundary N. Old Brompton Road E. Onslow Gardens and Neville Terrace S. Fulham Road W. Borough boundary N. Borough boundary 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 N. Centres of North Pole Road St. Quintin Avenue and Chesterton Road E. Centre of Portobello Road S. Centre of Lancaster Road W. Borough boundary N. Borough boundary E. Borough boundary S. Centres of North Pole Road, St. Quintin Avenue, Chesterton Road, Portobello Road and Lancaster Road W. Borough boundary Order operative 1.10.1961 1.10.1962 1.11.1962 1.10.1963 1.10.1964 1.7.1965 1.10.1965 1.10.1966 1.10.1967 1.10.1968 1.10.1969 1.10.1970 48 Smoke Control Area North end South Stanley Wards Map Ref. C4 Boundaries N. Fulham Road E. Old Church Street S. High water mark of medium tides W. Borough boundary Order operative 1.7.72 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 places. During the year, 26 notifications were received without objection to the proposals submitted. Smoke Nuisances During the year 79 complaints of smoke nuisance were received and 107 formal smoke observations were carried out. An abatement notice was served in respect of one case and the remainder were 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 (Microgrammet per Cubic Metre) Sulphur Dioxide Microgrammet per Cubic Metre) Monthly Average Highest Daily Reading Monthly Average Highest Daily Reading ABC DABCDABAB 1971 July 27 22 59 36 69 57 118 65 164 152 367 435 Aug. 25 21 53 31 63 43 118 57 131 104 288 258 Sept. 49 45 98 58 118 81 165 95 221 203 561 524 Oct. 43 45 87 54 124 130 214 96 192 204 689 500 Nov. 54 52 84 53 110 117 145 88 257 267 561 649 Dec. 52 51 102 65 158 148 122 136 279 282 463 569 1972 Jan. 36 52 95 57 80 120 176 115 253 299 582 668 Feb. 35 83 43 84 - 141 83 293 - 536 Mar. 56 - 122 58 162 - 255 176 373 - 857 Apr. N 22 N N 88 81 151 92 N 166 352 297 May 279 154 95 N 686 461 460 1122* 232 270 484 575 June 599* 414* 104 145 2095* 956* 180 291 214 247 400 381 "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. 49 Site address: A - Chenil Galleries, King's Road, S.W.3. B - ( The Red House, Hornton Street, W.8. (July 1971 to Jan. 1972 inclusive) - ( 25A Kensington Square, W.8. (Apr. 1972 to June 1972 inclusive) 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.) NOISE ABATEMENT ACT, 1960 One hundred and seventy-four complaints of alleged noise nuisances were received during the year, compared with one hundred and forty-six for 1971. 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 48 33 15 Roadworks, construction and demolition 84 52 32 Domestic 24 10 14 Boutiques and Pop Groups 8 6 2 Exhibitions, Studios, Clubs 5 2 3 Animals 5 5 — 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 1972, formal notices were served in thirteen 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. 1/73. Part I of the Act 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. 19 15 - - (ii) Factories not included in (i) in which Section 7 is enforced by the local authority. 552 418 2 (iii) Other premises in which Section 7 is enforced by the local authority (excluding out-workers' premises) 2 TOTALS: 573 433 2 - 50 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 (1) Number of cases in which defects were found No. of cases in which prosecutions were instituted (6) Found (2) Remedied (3) Referred To H.M. Inspector (4) By H.M. Inspector (5) Want of Cleanliness (S.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 40 18 - 1 - (c) Not separate for sexes 1 — — — — Other offences against Act (not including offences relating to Outwork) 2 - - - - TOTALS 44 18 - 1 - Part VIII of the Act Outwork (Sections 133 and 134) Nature of Work <»> Section 133 Section 134 No. of outworkers in August lists required by Section 1 33(1)(c) (2) No. of cases of default in sending lists to the Council (3) No. of prosecutions for failure to supply lists (4) No. of instances of work in unwholesome premises (5) Notices served (6) Prosecutions (7) Wearing apparel 22 _ _ _ _ Curtains and furniture hangings 1 _ _ — — — Artificial flowers - - - — — — Boxmaking - - - - — — Feather sorting - - — — — — Packing of glass fibre rods in cellophane — _ — — — Lampshades 1 — — — — — TOTALS 24 - - - - - During the year, 47 inspections were made of outworkers' premises, and no infectious disease was reported from any premises where home work was carried on. 51 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 51 7 King's Road 232 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 Cass 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 125 1,102 702 Retail shops 92 1,202 866 Wholesale shops, warehouses 6 46 35 Catering establishments open to the public, canteens 57 526 236 Fuel storage depots - - - TOTALS 280 2,876 1,839 Number of visits of all kinds (including general inspections to registered premises) 3,928 52 Analysis by workplace of persons employed in registered premises at end of year Class of Workplace Number of persons employed Offices 16,065 Retail shops 11,496 Wholesale departments, warehouses 976 Catering establishments open to the public 5,712 Canteens 306 Fuel storage depots — TOTAL 34,555 TOTAL MALES 17,202 TOTAL FEMALES 17,353 Summary of Contraventions Section of Act Contraventions found during general inspections and routine visits Section 4 Cleanliness 8 Section 5 Overcrowding - Section 6 Temperature 322 Section 7 Ventilation 17 Section 8 Lighting 6 Section 9 Sanitary conveniences 70 Section 10 Washing facilities 37 Section 12 Accommodation for clothing 2 Section 13 Sitting facilities 1 Section 15 Eating facilities - Section 16 Floors, passages and stairs 47 Section 17 Fencing of exposed parts of machinery 3 Section 24 First Aid 175 Section 49 Notification of fact persons are employed 189 Section 50 Information for employees 353 Hoists and Lifts Regulations, 1968 125 TOTAL 1,355 53 The Offices, Shops and Railway Premises (Hoists and 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. During the year 113 reports were received. 54 Workplace Number reported Total number investigated Action recommended Accidents The following tables show the total number of accidents reported during the year and their primary causes: Fatal Non Fatal Prosecution Formal warning Informal advice Offices 22 Retail shops - 76 2 - - 2 Wholesale shops and warehouses - 9 1 - - 1 Catering establishments open to the public, canteens - 25 1 - - 1 TOTALS NIL 132 4 - - 4 Causes of accidents Offices Retail shops Wholesale shops Warehouses Catering establishments open to the public, canteens Machinery - 6 1 1 Transport 2 8 2 - Falls of persons 9 22 1 10 Stepping on or striking against object or person 1 10 2 Handling goods 5 22 5 8 Struck by falling object 2 - - 2 Electrical - - — 1 Use of hand tools — 4 — - Not otherwise specified 3 4 - 1 55 LAND CHARGES The number of land charge enquiries dealt with during the year was 9,788 compared with 8,794 in 1971. These concerned outstanding statutory or informal notices, closing orders, smoke control orders, certificates of disrepair, slum clearance, etc. TOWN PLANNING APPLICATIONS During the year 2,218 applications were referred to the Health Department for observations, compared with 1,839 in 1971. 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 seventy-six copies of applications to the Licensing Justices (191 restaurant and/or residential, 26 clubs, 50 publicans and 9 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, 32 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, five 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. 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-eight applications for registration were received, but five of these were from premises not eligible for registration. Twenty-nine premises were registered during the year. 56 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. Twenty-nine late night refreshment house licences were issued by this department during the year. 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 245 For the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 100 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 IInspections Bakehouses 23 6 Butchers 135 52 Bread and Cake Shops 142 31 Greengrocers 96 21 Confectioners 176 23 Cafes, restaurants, canteens and public houses 898 1,081 Licensed Clubs 107 43 Wine Bars 10 16 Off-Licences 140 55 Hotels, hostels and guest houses 352 718 Frozen Food Centres 1 1 Take-away food shops 22 67 Fishmongers and fried fish shops 30 4 General provision shops 210 270 Street Markets — Stalls 94 374 Storage premises 51 2 Wholesale warehouses and Factories 17 2 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. 57 Informal samples totalling 1,104 were submitted for analysis, of which 80 were either adulterated or otherwise unsatisfactory. Sixteen formal samples were also submitted for analysis, of which eight were either adulterated or otherwise unsatisfactory. Legal proceedings were authorised in respect of six of the formal samples. The remaining two 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, 208 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, beer, vegetables, yoghurt, soft drinks, poultry, eggs, coffee, potato crisps, butter, cream, biscuits, rice, sandwiches, etc. Of these complaints, legal proceedings were authorised in respect of seventeen cases and warning letters were sent in twelve instances. The remaining 179 cases were dealt with informally, either owing to lack of sufficient evidence, or to the complaint not being substantiated. Surrender During the year, the following amounts of food were surrendered and condemned as unfit for human consumption: Commodity Weight (in lbs.) Offal 560 Meat (raw) 1,120 Cooked meat and meat products 8,248 Canned meats 531 Other canned foods 2,388 Frozen foods 2,939 Other foods 628 TOTAL 16,414 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: 58 Designation Licences issued 1972 Total number in force at end of year Pasteurised milk 25 188 Sterilised milk 25 188 Ultra-heat Treated milk 25 188 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 *31 22 8 31 Sterilised — — — — — — — Ultra-heat Treated 3 - - — — 3 - Raw 1 — — — — 1 — P = Passed F = Failed * Of these 31 samples of pasteurised milk, 1 was rendered void because the atmospheric shade temperature exceeded 70 degrees Fahrenheit and the Methylene blue test 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 189. 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. Nine complaints were investigated during the year. In one case legal proceedings were authorised; a warning letter was sent in another case and the remaining cases were dealt with by informal approach to the producers at the request of the complainants. 59 Composition of Milk During the year, 116 samples of milk (all grades) were submitted to the Public Analyst for examination.One sample was found to be below the legal standards laid down, and a warning letter was sent to the vendor. 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. The following table shows the average percentages of milk fat and non-fat solids of the genuine samples taken during each month: Month Numer of samples taken Average Percentages Milk Fats Non-fat Solids January 2 4.62 8.80 February 1 4.80 8.85 March 2 4.38 8.85 April 3 4.22 8.63 May 2 4.45 8.87 June 2 4.47 9.17 July - - - August - - - September 2 4.65 8.95 October 2 4.67 9.02 November 3 4.45 8.98 December — — - Average for the whole year 4.49 8.89 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 9 3.64 8.58 February 10 3.66 8.47 March 8 3.64 8.49 April 11 3.55 8.67 May 7 3.53 8.77 June 11 3.56 8.82 July 4 3.62 8.84 August 7 3.87 9.15 September 5 3.83 8.68 October 5 3.80 8.81 November 19 3.77 8.83 December - - - Average for the whole year 3.68 8.73 Legal minimum standard 3.00 8.50 J 60 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 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 1972 for chemical analysis compared with those taken in the previous year: 1972 1971 Number of samples 7 20 Percentage range of fat content 5.8 to 8.9 4.9 to 13.3 Percentage range of non-fat content 17.3 to 27.2 20.2 to 38.4 Average fat content per cent 7.52 8.27 Average non-fat content per cent 23.72 25.72 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, twenty-two samples of ice-cream were taken and submitted to the methylene blue test. The results were as follows: Grade Number of samples 1 8 2 3 3 7 4 4 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. 61 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. PUBLIC CONTROL DUTIES Once again, the greater part of this work has been in connection with the licensing and inspection of employment agencies, nurses agencies and massage establishments. In the former two cases, although 51 new licences were issued during the year, 65 ceased to operate and the overall number of such premises licensed at the end of the year decreased by 14 — equivalent to 7½%. The number of massage establishments licensed, however, increased by approximately 6%. The two Working Parties of officers under the auspices of the London Boroughs Association mentioned in my last Annual Report met on several occasions during the year and duly reported their recommendations in respect of the licensing of Employment Agencies and Massage Establishments. At the end of the year it became known that a Private Member's Bill, entitled The Employment Agencies Bill, which had the support of the Government, was to be introduced in the House of Commons. At the request of the Department of Employment, the members of the Working Party, which included the Senior Public Control Inspector of this Council, outlined their views with the result that a number of their recommendations were included in the Bill. The report relating to the licensing of massage establishments was circularised to the London Boroughs and the Working Party are to be re-convened during 1973 for further consideration on certain aspects of the report. During the year an illegal Sunday market opened in King's Road, Chelsea, but immediate action by the Council's officers taken under the Shops Act, 1950, resulted in its closure after a period of four weeks. The practice of opening the major exhibitions at Earls Court to the public on certain Sundays during the year resulted in an increase in the volume of duties carried out under the Shops Acts. The number of premises registered during the year for the storage and sale of fireworks revealed a small increase. Statistics The following is a summary of the number of licences, permits, etc., issued during the year ended 31st December, 1972: Licences, Permits, Etc. Discontinued New Licences etc. granted during year Total in force at 31.12.72 Employment Agencies 59 47 193 Nurses Agencies 6 4 8 Massage Establishments 13 19 110 Theatrical Employers - 6 220 Permits for the provision of amusements with prizes - 3 40 Sale and Storage of fireworks - 3 57 Storage of celluloid and cinematograph film - - 1 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 of flats owned by the Council containing 20 dwellings. 62 The systematic house-to-house inspection of the area continued during the year and every endeavour was made to encourage owners to improve their properties by converting them into self-contained dwellings with the aid of improvement grants. Since the area was declared, the Council approved grants in respect of 56 properties for the provision of 227 dwellings. Of these, work was completed in respect of 16 houses for the provision of 33 dwellings. In addition, the Council was currently dealing with applications in respect of a further 9 houses at the end of the year. As a result of the further house-to-house inspections which were carried out, notices under the relevant sections of the Housing Acts were served upon the owners of those houses where no steps were taken to bring them up to a reasonable standard for habitation. The following is a summary of the total number of notices which were served in respect of the properties in the area: Housing Act, 1957 Section 9 127 Housing Act, 1961 Section 14 12 Section 15 121 Section 16 130 Management Orders made 10 During the year, it will be seen that works of improvement and conversion gathered momentum in the area. In addition, further properties were acquired by Housing Trusts so that the total owned by them is 57. Fourteen houses in the area are owned by the Council and are already arranged as self-contained dwellings. Although progress in the General Improvement Area was initially very slow, the situation at the end of the year was more satisfactory. Persistent pressure is still necessary on those owners who are reluctant to carry out more than the minimum works on their properties. Qualification Certificates The procedure for dealing with applications for qualification certificates under Part III of the Housing Act, 1969, as described in my earlier reports, was repealed during the year and replaced by a revised procedure under Part III of the Housing Finance Act, 1972. Although basically similar to the original procedure, the new one takes account of all those cases where applicants fell into the pitfall of commencing the work before they obtained their certificates of provisional approval and the certificates of fair rent and thus prevented the Council from issuing the full qualification certificate. The applicant can now carry out the work to make the dwelling qualify and then apply to the Council for the qualification certificate. The following shows the number of applications for qualification certificates dealt with during the year: Where amenities already provided Applications received 44 Qualification Certificates issued 54 Qualification Certificates refused 27 Where amenities to be provided Applications received 36 Provisional Certificates issued 34 Provisional Certificates refused 2 Qualification Certificates issued 21 General Conversion from Controlled to Regulated Tenancies Under the provisions of Section 35 of the Housing Finance Act, 1972, a general programme was introduced for the conversion of all Controlled tenancies to Regulated tenancies over a period of 2Vi years, based on the rateable value of the dwelling on 31st March, 1972. The first group of dwellings, with rateable values of £95 or more, become regulated on 1st January, 1973, and this is followed at six-monthly intervals by dwellings with gradually decreasing rateable values. THE ROYAL BOROUGH OF KENSINGTON & CHELSEA MAP AND STREET PLANS OF (1) General Improvement Area (see page 62) (2) Earls Court Area (see page 64) 63 The majority of the controlled dwellings in the borough will fall into the first of these categories and very few applications for qualification certificates are, therefore, likely to be received after 1st January, 1973. Grants for the Improvement or Conversion of Private Dwellings Standard Grants Eighteen applications for standard grants were approved by the Council during 1972, compared with nineteen applications for the previous year. Improvement (Discretionary) Grants The number of applications for improvement (discretionary) grants dealt with showed a further increase over the year, although not so dramatic a rise as occurred in 1970 and 1971. The following is a summary of the number of discretionary grants dealt with during 1972, shown diagramatically with comparative figures for the last eight years: Applications approved (dwellings) 1,235 Total amount of grants approved £1,360,248 64 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 total Of 746 houses were inspected and 736 Directions were recommended. Directions were given in respect of 535 houses. The systematic re-inspection of all the houses subject to Directions continued, 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-nine variations were approved during the year, and one contravention of a Direction was 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 is shown on the map included in this report. The houses in this area are large and well built. They are predominantly either in multiple occupation or in use as hostels or hotels. The area was selected for inspection as it was known that many of the houses were deficient in sanitary facilities and amenities. It was also probable that, in many cases, the provisions for means of escape from fire were not of the standard required by the Greater London Council's Code of Practice for houses in multiple occupation. The detailed house-to-house survey of this area continued throughout the year and the following is a summary of the action so far taken: Premises inspected ......205 Notices served Housing Act, 1957: Section 9 (Repair) 23 Section 90 (Overcrowding in houses let in lodgings) 3 Housing Act, 1961 Section 12 (Informal undertakings to remedy management defects) 40 Section 14 (Management defects — formal notices) 3 Section 15 (Sanitary facilities and amenities) 76 Section 16 (Means of escape from fire) 104 Management Orders made 2 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 1972 was 57 (9 penal and 48 non-penal), giving an equivalent number of persons of 226½. The total number of recorded cases where overcrowding was abated during the year was 25, comprising a total of 96 units. Since October, 1945, 2,975 cases have been reported, and the number of cases remaining on the register at the end of the year was 73. 65 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 338 Houses repaired after service of formal notices under the Public Health Acts 175 Houses made fit after service of formal notices under Section 9 of the Housing Act, 1957 (a) by owners 8 (b) by local authority in default 1 Action under Section 18 of the Housing Act, 1957 (a) closing orders made 19 (47 rooms) (b) closing orders determined 12(22 rooms) (c) closing orders cancelled (premises demolished) 7 (d) consents given to use of closed rooms for non-sleeping purposes 3 (6 rooms) (e) undertakings accepted from owners to render part of building fit for habitation NIL (f) part of building rendered fit and undertaking cancelled 1 Assessment of Housing Priorities on Medical Grounds During the year, 297 applications for rehousing on medical grounds were examined, and recommendations for the award of additional points were made to the Borough Housing Manager. 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 prejudicial to the patient. On this information, and that supplied by the Borough Housing Manager, an assessment of points to be awarded on medical grounds was made in 282 cases. LEGAL PROCEEDINGS Public Health Acts, 1936 and 1961 Forty-seven summonses were authorised during the year but only 41 were subsequently issued as the nuisances were abated in six cases. In eighteen cases, Abatement Orders were secured, fines totalling £125, and costs amounting to £100, were obtained. In thirteen cases the summonses were withdrawn and in one case the summons dismissed, the nuisance having been abated prior to the Court hearing. In four cases the summonses were adjourned sine die, as the necessary works were being carried out by the defendant. In two cases, Orders were made for the nuisances to be remedied within 7 days and 21 days respectively and in three cases within 2 months. Housing Acts, 1957 to 1969 Overcrowding Twelve summonses were issued for permitting dwellings to be overcrowded but these were subsequently withdrawn as the owners had contracted to sell the properties. 66 Directions to Prevent or Reduce Overcrowding One summons was issued for permitting the number of households occupying premises to increase above the limits of Directions given by the Council. A fine of £10 was imposed and costs amounting to £5 were awarded. Food and Drugs Act, 1955 Colouring Matter in Food Regulations, 1966 Thirteen summonses were issued, seven cases were adjourned, four dismissed and two were fined. Fines totalled £60 and costs amounting to £15 were imposed. Food Hygiene (General) Regulations, 1960 One summons was issued in respect of 14 contraventions of these regulations. Total fines amounted to £800 and total costs were £35. Section 2 — Offences Twenty summonses were issued in respect of the sale of food not of the nature, substance or quality demanded. In sixteen cases convictions were obtained and fines totalling £480 were imposed, and the Council were awarded £120 costs. Three cases were adjourned, and one summons was not served. Clean Air Act, 1956 Section 2 - Holland Ward (No. 1) Smoke Control Order, 1958 One summons was issued in respect of a smoke nuisance. A fine of £5 was imposed and costs amounting to £5 were awarded. 67 7 HEALTH EDUCATION The extensive programme of Health Education activities involving health visitors continued. A key to subjects regarding programmes was followed and included: January Hypothermia February/March Prophylaxis April Family Planning May Nutrition and Obesity June/July Play, Day care of children and Holiday Safety August Food Hygiene September Dangers of Smoking October Prevention of Fireworks Accidents November Prevention of Infectious Diseases December Mental Health HEALTH CENTRE CLUBS The clubs within health centres continued to be organised by health visitors. These clubs are for the "over fifties" and for mothers, and covered a varied programme of activities relating to health. Location "Over 50's" Clubs Mothers' Clubs St. Quintin Raymede Raymede Lancaster Kensal Kensal Lancaster South Kensington Violet Melchett Walmer Road Activities (a) Speakers In addition to the talks given by the health visiting staff, both types of clubs were addressed by speakers from varied outside agencies, including the British Red Cross Society, the Crime Prevention Officer of the Notting Hill Police, and local shop owners relating to budget buying. (b) Practical Activities Health visitors included practical subjects in club programmes, such as cookery classes, sewing classes, keep-fit classes, exercises for the elderly. (c) Visual Suitable films were included as an introduction and visual aid to discussion sessions. HEALTH EDUCATION IN SCHOOLS The school curriculum continued to include health subjects, with speakers provided from the community nursing section as follows: 68 Ladbroke Lower School 2 health visitors 5th year Girls St. Thomas More 1 health visitor 6th year Girls St. Francis Junior 1 health visitor 10 and 11 year old girls Christchurch Junior 1 health visitor 10 year olds Isaac Newton 1 school nurse Selected senior boys The St. Nicholas Montessori 1 health visitor 3 series of Training School mothercraft and child development OTHER HEALTH EDUCATION ACTIVITIES Hospitals Talks in hospitals by health visitors continued. These were given to mothers awaiting discharge following delivery in St. Mary's Hospital, Praed Street, and Princess Beatrice Hospital, Chelsea. Subjects included were "Care of Infants", "Health Visiting", and "Other Services Available". Psychoprophylaxis The psychoprophylaxis classes continued at Holland Street, Walmer Road, Kensal New Town, South Kensington, Violet Melchett and Lancaster Road health centres. In addition to the day time classes, sessions were held during the evenings to which expectant fathers were invited. With the evening sessions, where appropriate, this included a visit to the maternity unit in Princess Beatrice Hospital. SUMMARY OF HEALTH EDUCATION INVOLVEMENT BY COMMUNITY NURSING STAFF Range of Audience Type of Audience Number of Attendances Number of Talks Schoolchildren 4,542 258 Mothers 3,672 373 Ante-natal Mothers 2,182 289 Over 50's 3,660 203 Student Teachers 614 19 Pensioners 449 35 Girls' Clubs 141 25 Mixed Parent Groups 157 10 Other Outside Agencies 123 4 Pupil Midwives and Midwives 4 1 District Nurses 11 1 Range of Subject Matter Subject Number of A t tendances Number of Talks "Psychoprophylaxis" 1,360 220 "Ante-natal Care" 460 48 "Mothercraft" 2,364 248 "General Health and Hygiene" 1,983 119 "Keep Fit" 936 47 "Diet/Nutrition and Cookery" 897 60 "Venereal Disease" 78 8 "Drugs" 144 12 "Reproduction and Child Development" 696 48 69 Subject Number of Attendances Number of Talks "Personal Relationships" 177 12 "Recreation and Leisure" 1,442 85 "Social Activities" 470 29 "Family Planning" 111 13 "Dangers of Smoking" 201 12 "Community Services" 2,038 122 "Accident Prevention and Home Safety" 1,290 44 "The Importance of Play with Children" 363 27 "Dental Care" 108 5 "Marriage Guidance" 18 2 "Hypothermia" 41 3 "First Aid" 397 18 "Mental Health" 126 8 "Care of the Elderly" 120 8 "Prophylaxis" 49 4 "Cancer Education" 15 1 "General Health Subjects including Discussion Groups" 1,035 77 70 8 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 1972, 2,744 calls were received in respect of this Council's services. NURSING HOMES Registration and Inspection (Public Health Act, 1936 — Part VI) During 1972, no registrations were cancelled and 1 new Home was registered. This had previously been a Home for 12 medical patients until it closed early in 1971. Under a new owner, considerable reorganisation and reconstruction was carried out to provide accommodation for 18 medical patients and the Home was registered again in March 1972. During the year, 10 routine visits of inspection were made by a Principal Medical Officer and the Chief Public Health Inspector and there were also 3 follow-up visits. All the Homes were found to be generally satisfactory and only minor requirements were made in 3 of them. Number of Homes registered on 1st January, 1972 6 Number of registrations cancelled during the year Nil Number of Homes registered during the year 1 Number of Homes registered at 31st December, 1972 7 Total number of beds at 31st December, 1972 193 Medical Beds 148 Medical and Surgical Beds 38 Medical and Maternity Beds 7 Inspections by Principal Medical Officer and Chief Public Health Inspector 13 Other inspections by Council's staff 2 Visits to proposed Nursing Home premises by Principal Medical Officer and Chief Public Health Inspector 3 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. 71 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 purposes of dental protection. This concentration of fluoride occurs naturally in many parts of the country, and artificial 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 311 Faeces and rectal swabs 311 Urine 41 Milk (bacteriological) 35 Water (drinking) 30 Water (swimrhing) 36 Ice cream 22 Miscellaneous 15 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 630. 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 1972, 78 applications were received; 69 were granted, 7 were refused, and 2 decisions were awaited at the end of the year. In addition, 19 disabled drivers were medically examined. 72 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 578 Number referred for medical examination 64 Number failing to pass 10 Number referred for further opinion 23 Number required to be re-examined within 12 months 10 In addition, five 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. Ten medical examinations were carried out at the request of other local authorities. INDEX 73 Page Abbattoirs 61 Accidents 3,54 Adoptions (Medical Assessment) 16 Amusements with Prizes - Permits 61 Area of Borough 6 Area Comparability Factors 6-7 Artificial Kidney Machines (Home Dialysis) 27 Artificial Lighting of Common Staircases 49 Atmospheric Pollution 46-49 "At Risk" Register 15-16 Bacteriological and Analytical Work 71 Basement Bakehouses 51 Bathing Centre 34 B.C.G. Vaccinations 26,35 Births 3,6 Boarding-out of Children (Medical Assessment) 16-17 Care of Mothers and Young Children 15 Causes of Deaths 7,9-10 Celluloid and Cinematographic Film - Registration for Storage 61 Cervical Cytology 17 Chest Clinic Services — B.C.G. Vaccination (Contacts) 26,35 Children "At Risk" 15-16 Chiropody 27-28 Clean Air Act, 1956 46-49,66 Clinic Services: Ante Natal 15 Child Health 15 Dental 36-37 Elderly People 30 Hearing 32-33 Minor Ailments 33 Special Investigation 33 Speech Therapy 33 Vision 32 Well-women 28-30 Closing Orders 65 Community Nursing Services 18-30 Congenital Malformations 16 Consumer Protection Act, 1961 46 Controlled Tenancies 63 Co-operation with: General Practitioners 20 Hospitals 22-23 Creches 15 Deaths: Vital Statistics 3,6-8 Causes 7,9-10 Dental Services: School Health 36-37 Maternal and Child Health 37 Diphtheria 15 74 Page Diphtheria Immunisation 25,34 Discretionary Grants 63 Diseases (notification) 11-17 Diseases of Animals Act, 1950 45 Disinfection and Disinfestation 42 District Nurses 21-22 Domiciliary Chiropody 28 Domiciliary Deliveries 21 Domiciliary Family Planning 18 Domiciliary Midwifery 20-21 Early Discharges 21 Elderly People's Clinic 30 Emergency Call Service 70 Employment Agencies and Nurses Agency Licences 61 Environmental Health Services 38-66 Factories Act, 1961 49-51 Family Planning 17-18 Family Planning (Domiciliary) 18 Fertilizers and Feeding Stuffs Act, 1926 45 Fireguards — Provision of 30 Fireworks — Registration for Storage and Sale 61 Fluoridation 71 Food and Drugs Act, 1955: Colouring Matter in Food Regulations, 1966 66 Food Standards (Ice Cream) Regulations, 1959 60 Inspection and Registration 56-57 Legal Proceedings 66 Liquid Egg (Pasteurisation) Regulations, 1963 60 Milk (Special Designations) Regulations, 1963 57-58 Milk and Dairies (General) Regulations, 1959 58-59 Food Hygiene (General) Regulations, 1960 66 Food Poisoning 12 Food Premises — Inspection and Registration 56-57 Food Sampling 56-57 Food Surrendered 57 Gaming Act, 1968 61 General Conversion from Controlled to Regulated Tenancies 63 General Practitioners — Co-operation 20 General Practitioner Maternity Unit 21 Grants and Loans 22 Greater London Council (General Powers) Act, 1968 55 Handicapped Children 15-16,32 Health Centres: Clinic Services 15-37 Clubs 67 Health Committee 1 Health Education 67-69 Health Visiting 19-20 Home Dialysis 27 Home Nursing 21-22 Home Nursing — Loan of Equipment 30,43 Hospitals — Co-operation 22-23 Housing 62-65 Housing Priority on Medical Grounds 65 75 Page Ice Cream 60 Illegitimate Births 8 Immunisation and Vaccination 24-27,34 Improvement Area 62 Improvement Grants 63 Infant Mortality 3,6-7 Infectious Diseases 11-14 Infectious Illness in Schools 34-35 Influenza Vaccination 27 In-Service Training 23-24 Inspections and Supervision of Food Premises 56 International Certificates 13 Introduction 2-3 Issue of Medical Aids and Loan Equipment 43 Land Charges 55 Late Night Refreshment Houses Act, 1969 56 Laundry Service for the Aged Incontinent 42-43 Legal Proceedings 65-66 Licensing Art, 1964 55 Licences for Public Entertainment 55 Licensing and Registration (Public Control) 61 Liquid Egg (Pasteurisation) Regulations, 1963 60 Loan of Home Nursing Equipment 30,43 Loans and Grants 22 Massage Establishments 61 Maternal Deaths 3,7 Maternal and Child Health 15 Maternal and Child Health Dental Service 37 Maternity Unit 21 Measles Vaccination 25,34 Medical Examination of Staff 72 Medical Inspections at Schools 31 Medicinal Baths 42 Membership of the Health Committee 1 Midwifery 20-21 Milk 57-59 Miscellaneous Services 70-72 Mortuary Facilities 71 Night Cafes 55-56 Noise Abatement Act, 1960 49 Notification of Congenital Malformations 16 Notification of Infectious Diseases 11-13 Nursing Homes 70 Occasional Creches 15 Officers of the Health Department 4-5 Offices, Shops and Railway Premises Act, 1963 51-53 Oil Heaters Regulations, 1962 and 1966 46 Outwork 50 Overcrowding 64-65 65-66 76 Page Parking Control on grounds of Physical Disability 71 Personal Cleansing 42 Personal Health Services 15-30 Personal Hygiene in Schools 34 Pet Animals Act, 1951 46 Pharmacy and Poisons Act, 1933 45 Poliomyelitis Vaccination 25,34 Population 3,6 Prevention of Damage by Pests Act,1949 43-44 Psychoprophylaxis (Health Education) 68 Public Control 61 Public Health Inspectorate 39-41 Pupil Midwives 21 Qualification Certificates 62 Rag Flock and Other Filling Materials Act, 1951 45 Rateable Value 6 Rats and Mice 44 Recuperative Holidays for School Children 35 Registration of Food Premises 56 Remedial Foot Classes 34 Riding Establishments Act, 1964 45 Rodent Control 43-44 Rubelia Vaccination 26,34 Scabies 42 School Dental Services 36-37 School Health Services 31-35 School Treatment Sessions 32-34 Slaughterhouses 61 Smallpox 12,13 Smallpox Vaccination 26,34 Smoke Control Areas 46-49,66 Staff: Health Department 4-5 Medical Examinations 72 Standard Grants 63 Statistics: Dental Health 36-37 Environmental Health 38-66 Health Education 67-69 Infectious Diseases 11-14 Personal Health 15-30 School Health 31-35 Vital 3,6-10 Stillbirths 6 Students and Visitors 24 Surrender of Unfit Food 57 Swimming Baths 70-71 Tetanus Immunisation 25,34 Theatrical Employers — Registration 61 Town Planning Applications 55 Training of Pupil Midwives 21 77 Page Tuberculosis: Care and After-Care 13 Contacts 26 Notifications, deaths, etc 13 Vaccination 26 Visiting 13 Typhoid 12-13 Unclean Milk Containers 58 Unfit Houses and Parts of Houses 65 Unsound Food 56-57 Vaccination and Immunisation 24-27 Venereal Disease 14 Vermin 42 Vital Statistics 3,6-10 Water Supply 70 Well-women Clinic 28-30 Whooping Cough Immunisation 25,34