THE HEALTH OF WESTMINSTER 1972 City of Westminster Report of the Medical Officer of Health WES 82 CONTENTS Introduction 3 Health Committee 5 Staff of the Health Department 7 Health Department Premises 9 Statistics and Social Conditions 10 Environmental Health Services 14 Personal Health Services 38 School Health 55 Dental Service 57 Chest Clinics 57 Statistical Tables 59 — 92 Index 93 J. H. Briscoe- Smith, M.B., Ch.B., D.P.H., Medical Officer of Health and Principal School Medical Officer (inner London Education Authority) 1972 3 CITY OF WESTMINSTER Telephone: 01-828 8070 Health Department, City Hall, Victoria Street, London, SW1E 6QJ To The Right Worshipful The Lord Mayor, Aldermen and Councillors of the City of Westminster. My Lord Mayor, Aldermen and Councillors, I have the honour to present for your information my Annual Report on matters affecting the health of the City of Westminster in the year 1972. Once again opportunity has been taken to include comparable statistics of the previous year; they appear in the text in parentheses or elsewhere in a separate column. The most noticeable feature of the vital statistics for 1972 is a fall in the adjusted birthrate of 14 per cent as compared with 1971. The proportion of live births to unmarried mothers, although still high has also declined slightly. Taken together these figures might indicate that family planning including termination of pregnancy is already having an effect. It is however too early to draw any conclusions. Details are given on page 38 of four maternal deaths which occurred during the year; the highest number since 1965. Three were Westminster residents; the fourth was a citizen of France who had come to this country for treatment. In two cases death was due to complications of late pregnancy. The other two deaths followed termination of pregnancy in its early stages and must to some extent be regarded as a reflection of the high number of such terminations carried out in hospitals and nursing homes in the City. Although this report deals with 1972 it has been written in 1973 and will be the last of its kind before the reorganisation of the National Health Service on 1st April, 1974. Toward the end of 1973 after many months of discussion and consultation the boundaries of the new health regions and areas in London were defined, and Kensington and Chelsea together with Westminster were grouped as one area. A Joint Liaison Committee on which all the many health interests serving the City and Royal Borough were represented was formed, of which I have had the honour to be chairman. This body has now largely completed its task which was to collect and collate information and to present options to the new Area Health Authority setting out possible patterns for the services and administration of the area. The Area Health Authority has been appointed and met for the first time on 9th October, 1973. The effect on the Westminster City Council's services of the reorganisation in 1974 may be summarised by saying that the personal health services described in this report will be transferred to the Area Health Authority while the environmental health services will remain with the City Council. In his introduction to the section of the report dealing with environmental health services Mr. Pike the Chief Public Health Inspector expresses the hope that after reorganisation local authorities will not fragment the organisation of the Public Health Inspectorate. Much of the routine work of the public health inspectors may appear to be related to the functions of a number of departments of a local authority and to some extent to overlap them. For this reason some authorities may be tempted to divide their public health inspectors and transfer them to the departments concerned. Whilst this may appear superficially attractive from a management standpoint it must be remembered the public health inspectors also have a function in a number of emergency situations which demand urgent action by a well trained, organised and unified force which can be called out at short notice. Fortunately in Westminster it has been decided that the public health inspectors will be transferred as a body under the Chief Public Health Inspector to a newly formed Public Protection Section of the Town Clerk's Department. Throughout the personal health services section of the report numerous references are made to the close ties which have already been established with hospitals and general practitioners in the City in medical, nursing and social work fields. This augurs well for the future integration of the services in 1974 when they become the responsibility of the new Area Health Authority. 4 In the meantime unfortunately the prospect of another reorganisation has had an unsettling effect on the staff of the department many of whom have experienced previous unheavals in 1948, 1965 and 1971. This had led to a number of resignations particularly among junior staff and difficulty in filling resulting vacancies because applicants are unwilling to enter a service where their future is uncertain. This in turn has meant that senior members of the staff have often to undertake duties normally performed by their juniors, with detriment to their own work. It is becoming increasingly difficult to maintain the services of the department at the high standard the public has come to regard as normal; and with the imminent prospect of senior officers being appointed to posts under the Area Health Authority which they will be expected to fill immediately the situation is likely to deteriorate between now and April 1974. Nevertheless I know that the remaining staff of the department will as always give of their best. In concluding this Introduction to the final Annual Report of its kind may I express to you, my Lord Mayor, and to all Members of the Council, my sincere appreciation of the support and encouragement I have received over the past fourteen years since I was appointed as Medical Officer of Health to the "old" City of Westminster. My thanks are also due to the other Chief Officers and their staffs at all levels for their continued assistance. Finally, to the staff of my own department I record my warmest thanks for their loyal and conscientious help readily given at all times. October 1973 J.H. BRISCOE-SMITH Medical Officer of Health 5 HEALTH COMMITTEE (from July 1972) THE LORD MAYOR (ex-officio): Councillor John E, Guest THE DEPUTY LORD MAYOR (ex officio): Councillor Wing Commander W.H. Kearney, OBE CHAIRMAN: Councillor Dr. Brian Warren VICE-CHAIRMAN: Councillor Mrs. Rachel Trixie Gardner, BDS, JP. MEMBERS: Councillor Diane, Countess Beatty Councillor Mrs. Barbara Bowles Councillor Mrs. June Bremner Councillor John Bull Councillor Alfred Dubs Councillor Dr. L. Jacobs Councillor Richard May Councillor Mrs. Phoebette Sitwell Councillor Miss Manuella A Sykes Councillor Miss Alison Tennant CO-OPTED MEMBERS: Mr. R.A. Balfe, GLC Mrs. R.T. Glenny Mr. E. Lindsey Hancock, DFC Miss Margaret Jonathan, SRN, RSCN Miss Wilhelmina Linford Mr. J.G. Spriggs Mr. L.F. Squires Mrs. P.L. Veendam Members of the Health Committee were appointed to:— Abbey Community Association Councillor Mrs. Phoebette Sitwell Association of Municipal Corporations (Social Services) Councillor Diane, Countess Beatty Christian Union Almshouses Councillor Mrs. Barbara Bowles City of Westminster District Nursing Association Mrs. R.T. Glenny City of Westminster Old People's Welfare Association Councillor Miss Manuela A. Sykes Mrs. R.T. Glenny City of Westminster Savings Committee Mr. E. Lindsey Hancock, DFC County Primary Schools — Managers Barrow Hill, Robinsfield and George Eliot Schools Mrs. R.T. Clenny Churchill Gardens School Councillor Miss Manuela A. Sykes Councillor Miss Alison Tennant Edward Wilson School Councillor John Bull Essendine School Councillor John Bull Hallfield and Paddington Green Schools Mrs. P.L. Veendam Millbank School Councillor Miss Alison Tennant Greater London Association for the Disabled Councillor John Bull Greater London Conference on Old People's Welfare Councillor Mrs. Barbara Bowles Mrs. P.L. Veendam Greater London Home Safety Council Councillor Mrs. Barbara Bowles Inner London Education Authority Councillor Mrs. Phoebette Sitwell Inner London Executive Council Councillor Miss Alison Tennant London Boroughs Association Councillor Mrs. R.T. Gardner London Boroughs Children's Regional Planning Committee Councillor Mrs. R.T. Gardner Councillor Dr. Brian Warren (Deputy Representative) London Boroughs Training Committee Councillor Mrs. Barbara Bowles National Association for Maternal and Child Welfare Councillor Mrs. Phoebette Sitwell Mrs. R.T. Glenny 6 North Thames Gas Consultative Council, Central and North London District Committee Councillor John Bull Primary School Managers St. Peters, Eaton Square, C.E Councillor Miss Alison Tennant St. James's and St. Michael's Schools Mr. J.G. Spriggs St. Marylebone T.B. Care Committee Mrs. R.T. Glenny St. Mary-le-Strand Charity Councillor Mrs. Barbara Bowles St. Mary's Hospital Board Councillor Dr. L. Jacobs Samaritan Hospital for Women and Western Ophthalmic Hospital (House Committee) Mrs. R.T. Glenny South East Regional Association for the Deaf (General Council) Councillor Miss Alison Tennant Southern Regional Association for the Blind (General Council) Councillor Mrs. Barbara Bowles South West Metropolitan Regional Hospital Board: London Liaison Committee Councillor Dr. Brian Warren United Westminster Almshouse sMr. L.F. Squires Westminster Amalgamated Charity Councillor Diane, Countess Beatty Westminster Community Relations Council Councillor John Bull Councillor Alfred Dubs Westminster Council of Social Service Councillor Miss Alison Tennant Councillor Alfred Dubs Mr. E. Lindsey Hancock, DFC Westminster Council of Social Service: Harrow Road Project Mrs. P.L. Veendam Westminster Disablement Association Councillor John Bull Westminster Hospital Board Councillor Dr. Brian Warren Westminster Housing Trust Miss Margaret Jonathan Councillor Richard May Westminster Moral Welfare Council Councillor Mrs. Phoebette Sitwell Westminster Youth Committee Councillor Mrs. Phoebette Sitwell 7 STAFF OF THE HEALTH DEPARTMENT (as at 31 December 1972) Medical Officer of Health and Principal School Medical Officer: J.H. Briscoe-Smith, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health: Mary T. Paterson, M.B., B.S., D.P.H. Principal Medical Officers: Marjory A. Dawson, M.B., Ch.B., D.P.H. Migrnion B. Alexander, M.R.C.S., L.R.C.P., D.P.H. (Died 4.1.1974) Ruth P. Mathers, M.B., B.S., M.R.C.S., L.R.C.P. Senior Medical Officers: Monica M.H. Cogman, M.B., B.S., M.R.C.S., L.R.C.P. Olga M. Morgan, M.R.C.S., L.R.C.P., D.P.H. Deirdre R.B. Sullivan, M.R.C.S., L.R.C.P., D.P.H. Sheila Mabel Turell, B.M., B.Ch., D.C.H., D.P.H. Departmental Medical Officers: Full-time — 3; Part-time — 2 (full-time equivalent 1.4) Sessional Medical Officers: Part-time 24 = 46 sessions per week (full-time equivalent 4.6) Chief Administrative Officer: John H. Gillett F.H.A. Principal Administrative Assistant (Management Services): H.J. Parker Senior Administrative Assistants: A.J. Anscomb (Personal Health Services) J.J. Parker (Environmental Health Services) Administrative and Clerical Staff — 78 Chief Public Health Inspector: E.W. Pike, M.R.S.H., M.A.P.H.I., A.M.B.I.M. Deputy Chief Public Health Inspector: V.A. Bignell, F.A.P.H.I., M.R.S.H. Principal Public Health Inspectors: R.F. Stubbs, F.A.P.H.I., A.R.S.H. V.A. Vickers, M.A.P.H.I., M.R.S.H. Senior Public Health Inspectors — 22 Area District Public Health Inspectors — 37 (10 vacancies) Student Public Health Inspectors — 17 (2 vacancies) Technical Assistants — 27 (1 vacancy) Chief Dental Officer: D.K. Hardy, L.D.S., R.C.S. Senior Dental Officer: Mrs. J.M. Pallot, B.D.S., L.D.S., R.C.S. Dental Officers: Full-time — 1; Part-time — 5 (full-time equivalent 1.8) Dental Auxiliary — 2 Dental Surgery Assistants — 8 (3 vacancies) 8 Director of Nursing Services Miss E.A. Evans, S.R.N., S.C.M., H.V. Area Nursing Officers — 4 Nursing Officers — 8 Health Visitors — 54 (12 vacancies) Clinic and School Nurses — 22.5 (5 vacancies) District Nurses — 54 (5 vacancies) District Midwives — 3(1 vacancy) Student Health Visitors — 9 Clinic Auxiliaries — 9 Playgroup staff — 9 Home Bathing Attendants — 8 Principal Social Worker (Health Services): Miss I.J. McFarlane, M.A. Social Workers — 13.5 Ancillary Staff: Chief Chiropodist: Mrs. M. Goldwater Chiropodists — 18 (full-time equivalent 11.3) Physiotherapist — 1 (full-time equivalent 0.3) Coroner's Court and Mortuary: Superintendent — W.H. Wilshire First Mortician — 1 Mortuary Assistants — 3 Rodent Control Service: Pest Control Officer — 1 Assistant Rodent Officers — 2 Rodent Operatives — 6(1 vacancy) Disinfection and Disinfestation Service: Supervisor, Disinfecting and Cleansing Station — 1 Disinfection and Disinfestation Staff — 11 (1 vacancy) Manual and Domestic Staff: 30 (full-time equivalent 22) staff of various categories are employed at Maternal and Child Health Centres, the Nurses' Headquarters and Home, and other establishments. 9 HEALTH DEPARTMENT PREMISES ADMINISTRATION City Hall, Victoria Street, S.W.1. Paddington Office, 313/319 Harrow Road, W.9. St. Marylebone Office, Council House, N.W.1. MATERNAL AND CHILD HEALTH CENTRES 1 Bessborough Street, S.W.1. 1 Ebury Bridge Road, S.W.1. Hallfield, Pickering House, Hallfield Estate, W.2. 283A Harrow Road, W.9. Linnet House, Charlbert Street, N.W.8. 217 Lisson Grove, N.W.8. Marshall Street, W.1. Middlesex Hospital, Cleveland Street, W.1. Queen's Park, 20B Lancefield Street, W.10. Council House Extension, Upper Montagu Street, W.1. Westminster Health Society, 121 Marsham Street, S.W.1. SCHOOL TREATMENT CENTRES 283A Harrow Road, W.9. Hallfield, Pickering House, Hallfield Estate, W.2. 217 Lisson Grove, N.W.8. Council House Extension, Upper Montagu Street, W.1. 40 Alderney Street, S.W.1. CHEST CLINICS Westminster Hospital, Page Street Wing, S.W.1. 14-18 Newton Road, W.2. Council House Extension, Upper Montagu Street, W.1. HOME NURSING Headquarters, City Hall, Victoria Street, S.W.1. Area 1: MCH Centre, Lancefield Street, W.10. Area 2: Council House, Marylebone Road, N.W.1. Area 3: 1 Bessborough Street, S.W.1. Area 4: 117 Sutherland Avenue, W.9. Nurses' Home: 117 Sutherland Avenue, W.9. ENVIRONMENTAL HEALTH Coroner's Court and Mortuary, 65 Horseferry Road, S.W.1. Rodent Control Depot, 1 Bessborough Street, S.W.1. Rodent Control, 313/319 Harrow Road, W.9. Bathing Centre, 217 Lisson Grove, N.W.8. Disinfecting Station and Medicinal Baths, Kensal Road, W.10. Disinfecting Station, Lisson Grove, N.W.8. 10 STATISTICS AND SOCIAL CONDITIONS 1972 1971 (where applicable) Area (acres) 5,334 Population (Registrar General's Estimate, mid-year 1972) 233,360 237,250 Population, Census, 1971 234,130 Domestic rateable hereditaments 89,037 87,649 Rateable Value (at 1st April, 1972) £114,571,603 £112,416,973 BIRTHS Westminster Greater London England & Wales 1972 1971 1972 1971 1972 1971 Total live births 2,286 2,621 Total live births — males 1,159 1,336 Total live births — females 1,127 1,285 Birth rate per 1,000 of the estimated population (Area Comparability Factor — Births: 0.71) 9.8 11.05 14.1 15.2 14.8 16.0 Birth rate (adjusted) 7.0 8.17 13.0 14.1 14.8 16.0 Total stillbirths (legitimate — males 11; females 8 illegitimate — males 3; females 2) 24 29 Rate of stillbirths per 1,000 (live and still) births 10.0 10.94 11.2 11.7 12.0 12.0 Total live and still births 2,310 2,650 Total illegitimate live births 396 451 Total illegitimate live births — males 207 219 Total illegitimate live births — females 189 232 Illegitimate live births per cent of total live births 17.0 17.21 11.7 11.5 9.0 8.0 Premature births notified — live 146 164 Premature births notified — still 15 19 Total premature births notified 161 183 DEATHS Total number of deaths registered 2,594 2,822 Total number of deaths registered — males 1,269 1,461 Total number of deaths registered — females 1,325 1,361 Death rate per 1,000 of the estimated population (Area Comparability Factor — Deaths: 1.02) 11.1 11.89 11.8 11.5 12.1 11.6 Death rate (adjusted) 11.3 12.36 11.7 11.6 12.1 11.6 MATERNAL MORTALITY Deaths from pregnancy, childbirth, and abortion 4 1 Rate per 1,000 total (live and still) births *(Based on less than 100 occurrences and excluding deaths due to abortion) 1.73 0.38 *0.20 0.12 *0.12 *0.17 11 INFANT MORTALITY Westminster Greater London England & Wales 1972 1971 1972 1971 1972 1971 Total deaths of infants under 1 year 30 35 legitimate 22 26 illegitimate 8 9 Death rate of all infants under 1 year per 1,000 live births 13 13.35 17.1 17.4 17.0 18.0 legitimate infants per 1,000 legitimate live births 12 11.98 Illegitimate infants per 1,000 illegitimate live births 20 19.95 Total deaths of infants under 4 weeks 22 22 legitimate 16 16 illegitimate 6 6 Neo-natal mortality rate (deaths under 4 weeks per 1,000 total live births) 10 8,39 11.7 11.6 12.0 12.0 Total deaths of infants under 1 week 20 19 legitimate 14 13 illegitimate 6 6 Early neo-natal mortality rate (deaths under one week per 1,000 total live births) 9 7.25 9.8 9.7 10.0 10.0 Perinatal mortality rate (stillbirths plus deaths under one week per 1,000 total live and stillbirths) 19 18.11 20.9 21.3 22.0 22.0 Details showing causes of infant death according to age group and sex are given in Table 2, page 61. ACCIDENTAL DEATHS Total deaths of residents from accidents of all kinds 72 91 Deaths from motor vehicle accidents 30 27 The total number of deaths shown in Table 1, page 60, includes persons who, though normally resident in Westminster, died elsewhere in England and Wales but excludes persons who, though they died in the City, were ordinarily resident in other parts of England and Wales. Deaths of persons ordinarily resident outside the borders of England and Wales are included in the figures if they occurred in the City, as also are those of members of H.M. Forces who were stationed in the area. INFECTIOUS AND OTHER NOTIFIABLE DISEASES The incidence of infectious disease in the City, in general, continues to show a downward trend. Notifications received (excluding tuberculosis) decreased from 368 in 1971 to 295 in 1972 due largely to fewer cases of measles, 143 as compared with 190 in the previous year. (126 cases against 117 in 1970). Table 3, page 62, gives details of notifications received and the age groups concerned. Acute Poliomyelitis, Diphtheria and Smallpox No cases of these diseases occurred in Westminster during 1972. Dysentery The decrease in the number of cases of dysentery observed in 1970 has been maintained. Nineteen notifications were received during 1972 compared with twenty-five in the previous year. There were no outbreaks of dysentery in any Hospital in Westminster or City Council Nurseries. Infective Jaundice Fifty-nine notifications (50) of Infective Jaundice were received during 1972, the fourth full year since the disease became notifiable. 12 Malaria There were twelve cases of malaria occurring in the City during the year. In each instance the disease had been contracted abroad. All the patients were admitted to hospital. Paratyphoid and Typhoid Fever Two notifications of typhoid fever were received during the year. One related to a person who had visited Spain, and the other to a traveller returning from India. No cases of paratyphoid fever were notified during the year. Tuberculosis Table 3, page 62, gives information regarding primary notifications of pulmonary and non-pulmonary tuberculosis received during the year. Table 4, page 63, shows the age and sex distribution of all new cases and deaths from all forms of the disease. The tuberculosis visitors working from the chest clinics visit all tuberculous households to ascertain home conditions and to advise patients on such matters as isolation, steps to be taken to avoid the spread of the disease, and diet. Home contacts are urged to attend for X-ray examination or Mantoux testing, and where necessary, B.C.G. vaccination, and to attend clinic sessions for the purpose of regular surveillance. The tuberculosis visitors also follow up patients who do not visit the chest clinic as regularly as required, and where rehousing is sought, their detailed reports on home conditions assist in the award of "points" for medical priority of the family's application. Where insanitary conditions appear to exist the matter is referred to the public health inspector for further investigation. Whooping Cough The number of cases of whooping cough was very low, only one notification being received during 1972 compared with fourteen in the previous year. MASS MINIATURE RADIOGRAPHY During 1972 the North West and the South West London Mass X-ray Services continued to provide regular public sessions at numerous points in Westminster INTERNATIONAL CERTIFICATES OF VACCINATION AND INOCULATION Arrangements continued for the authentication by the Medical Officer of Health of international certificates of vaccination and inoculation completed by medical practitioners in Westminster. These certificates are required by persons proceeding abroad from this country and the purpose of the authentication is to provide proof to those health authorities abroad who desire it that the signature of the person issuing the certificate is that of a registered medical practitioner. After normal office hours, at weekends and on public holidays, certificates can be authenticated upon application to the Duty Officer at City Hall. During the year under review 25,903 (34,230) such certificates were authenticated, the demand being largely due to people going abroad for holidays. Travellers to known or possibly infected areas were advised as a precaution to be vaccinated. Travellers to Britain from endemic areas were required to produce an international certificate of vaccination on arrival. Arrangements were continued for travellers not in possession of a certificate to be kept under surveillance. The Medical Officer of Health also issues, on request and in appropriate circumstances, certificates to the effect that no cases of smallpox have occurred in the district during the preceding month. The certificates, of which 9 (24) were issued during 1972, were sought by persons proceeding to the United States of America who did not wish to submit to vaccination. 13 AFTER HOURS EMERGENCY TELEPHONE SERVICE This service provides an out of office hours continuity for the emergency work of the Social Services and the Health Departments of the City of Westminster and the Royal Borough of Kensington and Chelsea. Through it a number of standby specialist officers can be contacted to deal with urgent problems or the duty officer can advise or deal directly with less pressing cases, passing information to the appropriate day-time sections for follow-up action when necessary. The control centre is based at Westminster City Hall and is manned by one of four duty officers working on a rota. The service is financed jointly by both boroughs. During 1972 a total of 14,649 (13,109) calls were received by the duty officers, 11,905 (10,994) relating to the City of Westminster and 2,744 (2,115) to the Royal Borough of Kensington and Chelsea. An analysis is given in Table 6, page 64. VISITORS TO THE DEPARTMENT In addition to the practical training provided for various members of the Health Department staff (to which reference is made elsewhere in the Report) nearly 400 persons were welcomed during 1972 for visits of observation. Being located close to the central Government departments and near to many Embassies or Legations of other countries, the City Council receives numerous requests to receive visitors comprising officials from central or local government of this country or from abroad; members of foreign municipalities or Commonwealth countries; doctors, students from teaching hospitals, nurses, social workers, etc. Indeed the point has now been reached when it has become necessary to "ration" the number of visitors who can be received without seriously interfering with the day-to-day work of the Department. These visits embrace all the activities of the Health Department and although they may be timeconsuming they prove interesting and stimulating to the staff concerned. It is of interest to note that although the majority of visitors to the department came from the United Kingdom, the overseas countries concerned included Australia, Canada, Holland, Italy and the United States of America. 14 ENVIRONMENTAL HEALTH SERVICES Chief Public Health Inspector: E.W. PIKE, M.R.S.H., M.A.P.H.I., A.M.B.I.M. Deputy Chief Public Health Inspector: V.A. BIGNELL, F.A.P.H.I., M.R.S.H. At 31st December 1972 Establishment In Post Public Health Inspectors 63 (59) 53 (58) Student Public Health Inspectors 17 (17) 15 (13) Technical Assistants 27 (28) 26 (27) WORK OF THE PUBLIC HEALTH INSPECTORS Last year, a reference was made in the Annual Report to the reorganisation of the National Health Service and the uncertainty prevailing concerning the future of the public health inspectors. There were few indications during 1972 from government sources to encourage forward planning, although in the absence of official instructions to the contrary, it can be assumed that such duties as the public health inspectors in London carry out at present will remain with them without fragmentation irrespective of the type of departmental staff structure and administrative affiliation that each authority will decide for itself. The Bains Report published during the year contained advice to local authorities that reflected the views of the Study Group on Local Authority Management Structures. The Group was set up by the Secretary of State for the Environment in May 1971, and suggested that for the first time in local government there should be recognised and designated a chief environmental health officer. This did much to allay the fears of public health inspectors that their duties would be redistributed and that their professional future was in jeopardy. Nevertheless, in the absence of a more positive assurance, some apprehension as to future prospects continued to influence many younger inspectors and remained a contributory factor to the staff shortages affecting in particular urban authorities, which for some time had been finding difficulty in attracting and retaining newly qualified inspectors to work in their areas. It is undeniable that Westminster has much to offer young inspectors, keen to gain experience and knowledge. It is not always realised or accepted, however, that the environmental health problems that require investigation, whether they affect the resident population, those who enter the City to work, those on holiday, or in transit, are considerable, and frequently require a great deal of time spent on them before matters are finally concluded. Two aspects of the public health inspectors' work (referred to in other parts of this report) that merit particular reference for the year under review and which almost always require numerous prolonged visits and other lengthy investigations before the issues are resolved, concern the public health inspectors' involvement with demolition of buildings, with the subsequent site redevelopment, and the various matters relating to tourism, including catering and hotel accommodation. The increase of tourism has affected the work of the public health inspectors as it has other Departments of the City Council. The opinion of Counsel that all hotels, hostels and boarding establishments whose purpose it is to provide accommodation of a limited duration, are liable to compliance with all sections of the Housing Acts relating to houses in multiple occupation, has opened a new field of responsibility and control, which although still subject to decisions by the Courts, indicates that the inspectors will have a far greater involvement in issues such as the maximum number of guests who should be in residence consistent with the size and number of the rooms and facilities available, and the management and maintenance of the entire building. During the year a senior inspector with one technical assistant endeavoured to deal with complaints and other enquiries concerning such premises. It is a reasonable assumption that these will increase considerably each year and will add to the difficulties of a depleted staff. 15 The new developments and drainage section of the inspectorate also experienced a decided increase in activity in matters for which they are responsible during the year. The very technical nature of the work of the four inspectors (2 seniors) is coupled with the necessity to be constantly informed of new materials of construction in drainage and plumbing works, in building developments and variations in technique in the installation of sanitary fittings. Additional responsibilities of the inspectors in this section, also connected with site development that continues to be of significance, include noise control and, in association with the City Engineer's Department, nuisances from dust and smoke during demolition work. In dealing with complaints that have arisen, experience has confirmed the necessity for the revised legislation proposed to control unreasonable noise. It is to be hoped a similar pattern concerning the control of dust etc. during the demolition of buildings, particularly necessary in areas such as Westminster, will not be long delayed. Public Health Inspectors — Duties outside normal office hours The need for regular inspection of itinerant food vendors and premises where visits are only possible during the late evening, particularly at weekends, referred to in previous reports, remains a necessary feature of effective food and food premises control. The number of contraventions of the Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations found by the inspectors employed on a "duty rota" basis, referred to later in this report (page 28), (see also Analysis of Legal Proceedings, Table 25, page 72) illustrates the need to continue the arrangement. Student Public Health Inspectors Since amalgamation, Westminster has proved the value of the fully comprehensive and systematic training scheme provided within the Department for its complement of students. The overall supervision of the four-year studentship of accepted pupils to ensure that experience gained is balanced in all aspects of the work, and that it is, as far as possible, co-ordinated with the programme of lectures and practical visits of instruction arranged by the Technical Colleges, remains the responsibility of a senior inspector. Three students who completed their studies during the year passed the qualifying examination. A further four students were appointed during the year, bringing the total still in training to fifteen. Technical Assistants Prior to the amalgamation of the London Boroughs in 1965, Westminster, St. Marylebone and Paddington had employed technical assistants as a supplement to their establishment of public health inspectors to assist them with their work in various ways. In general terms they were essentially enquiry officers, as in principle they still are, although naturally their usefulness and capacity is relative to the experience they acquire. It has been found that the value of the technical assistant to the particular inspector or to the section within which he works is greater if he remains more or less permanently attached to that section. Changes are therefore kept to a minimum although it has been accepted that each technical assistant may progress in salary, subject to his proven ability indicating that he can undertake work of greater responsibility. The establishment of technical assistants to the public health inspectors in Westminster is 27. The ever-increasing scope of the public health inspectors' work, which is of a highly technical nature, and its potential legal involvement make it necessary to ensure that the services of public health inspectors are utilised to the best advantage. As far as possible they concentrate on duties which require their full professional skills. The appointment of assistants, without previous training, experience or qualifications, must not be regarded as alternatives to inspectors, but nevertheless the assistants have a valuable part to play in the environmental health scene, subject to discretion being used in their deployment. It is recognised that there is no substitute for the skill and judgment of the fully qualified officer. District Inspection The district public health inspectors work in three groups under the day to day control of three Area Inspectors of senior grading. Despite the various aspects of environmental work demanding specialist staff, district duties are essentially the basis of general overall surveillance and control. District Inspectors therefore continue in their full statutory responsibility for their respective areas in all aspects of the work, liaison being maintained with their specialist colleagues as individual circumstances require. A statistical summary of visits by public health inspectors appears in Table 9, on page 65. 16 Dwelling Houses General inspection of dwelling houses arising from complaints and for routine purposes, as distinct from duties under the Housing Acts and other specialised functions dealt with later in this Report, are undertaken by the district public health inspectors. An analysis of reasons for initial inspections of dwelling houses is given in Table 7, page 64, and an analysis of 2,237 (2,583) nuisances and unsatisfactory conditions found and remedied appears in Table 8, page 64. Notices Seven hundred and forty (712) informal notices and 398 (513) statutory notices were served in 1972 to secure the abatement of nuisances. An analysis of statutory notices served is given in Table 10, page 65. Legal Proceedings The summary of legal proceedings undertaken during 1972 is set out in Table 25, page 72. Noise Public reaction to excessive, unnecessary or obtrusive noise interfering with the comfort and enjoyment it is reasonable to expect and demand at work or leisure, continues to be expressed by complaint to the department. Two hundred and seven (242) complaints were received and investigated during the year, and 507 (862) visits by public health inspectors were made to secure abatement, or reduction to tolerable levels. Noise occurring by night and at week-ends necessitated investigations out of normal office hours. Demolition and construction of buildings and roadworks involving mechanical power machinery and tools, are a principle source of complaint. Contractors are made aware of their liabilities and are advised to embark upon public relations work amongst local residents who may be disturbed by their activities, and particularly in respect of the programming of their projects. Without legislative control upon permitted hours of work, such as can be imposed, for example, by a writ of injunction, noise occasioned by late and night operations will continue to present control problems, particularly where on large building sites there are working a number of specialist sub-contractors. Other sources of complaint include noise from extractor fans, from small factories, and from night entertainments and amplified music. In the majority of cases, informal action by way of reasoned advice is effective in abating and preventing nuisance, and proceedings had to be instituted in only three cases. Drainage and New Developments During the year under review 1,244 (1,201) Notices of Execution of Drainage Works were registered, and a total of 10,616 (12,631) visits to sites and to premises were made in connection with these notices. Of the proposals to do work, which required the specialist knowledge and attention of the Development Team of four public health inspectors 485 (455) related to large scale development of which 155 (223) concerned new buildings. The number of houses and flats constructed by private enterprise was 370 (292), and at the end of the year 680 (812) housing units exclusive of municipal development were in various stages of construction. Sewerage The City's sewerage system is under the control of and maintained by the City Engineer, and discharges at a number of points into the major sewerage system of the Greater London Council, who are the authority for main drainage and sewage disposal. 17 Town Planning During 1972 there was a considerable increase in the number of plans submitted to the Council under the Town and Country Planning Acts 1962/1968. Observations were made by the Health Department on 482 (153) plans so submitted. It is of interest to note that in 1970 ninety-three plans were submitted to the department for observation so that in a short period there has been a five-fold increase in the work involved. Clean Air Daily volumetric measurements of smoke and sulphur dioxide were taken at stations situated at the following premises:— Anson House, Churchill Gardens, S.W.1. Monck Street Depot, S.W.1 London College of Fashion, Holies Street, W.1. Westminster Council House Extension, Upper Montagu Street, W.1. Paddington Office, 313 Harrow Road, W.9. Arrangements for these measurements are made in conjunction with the Warren Spring Laboratory of Department of Trade and Industry as part of the National Survey of Air Pollution. Two sequential fog samplers operate at Anson House and Westminster Council House. They were installed by arrangement with the Air Pollution Division of the Medical Research Council and the results obtained are always available to them and to Warren Spring Laboratory. These instruments measure the smoke content of smog more completely than the apparatus used for the daily measurement of smoke and sulphur dioxide, and are switched on at the discretion of the City Council's Smoke Control Officer when fog is imminent or at the request of the Medical Research Council. All these measurements show a continuing decline in the concentrations of both these pollutants in the City's air. The reduction in smoke has been particularly marked and is now only one-fifth of what it was in the 1950's. Sulphur dioxide is also down but only by about 40%, due principally to the amount of high sulphur content fuels still being burnt in the City. Heavy oils also often cause the smuts referred to below and for both these reasons the Council hope that eventually legislation will be passed which will ban the use of these fuels in the City. In the meantime the department is having some success in urging fuel users to transfer to low-sulphur fuels and it is hoped this will help to accelerate the reduction in air-borne sulphur dioxide. Regular measurements of the air-borne concentration of carbon monoxide are made in all underground garages open to the general public to ensure that no danger is occasioned to users or employees. All undue emissions of smoke observed or reported to the Health Department are investigated and appropriate action taken. There are many oil-fired boilers of varying sizes in the City providing heating to offices, flats and shops and in addition to the usual smoke problems, they give rise to complaints of smuts and odours. Unlike visible smoke, the sources of smuts and odours are more difficult to trace; nevertheless, although these investigations are somewhat time-consuming, considerable success is being achieved in remedying this kind of nuisance. During the year, the senior public health inspector responsible for the control of atmospheric pollution, made 202 (204) visits in connection with complaints received, 433 (461) smoke observations and 878 (995) routine visits. New boiler installations notified to the Council under Section 3 of the Clean Air Act 1956 are investigated to ensure that (a) they are capable of operating smokelessly and (b) the flue gasses are discharged so as not to inconvenience persons working and living nearby. During 1972 a total of 75 (56) such notifications were received, of which 10 (11) included application for the Council's approval of new boilers. Section 6 of the Clean Air Act 1968 gives the Council control over the height of chimneys of larger boiler installations. All new chimneys, or existing chimneys serving boilers the combustion space of which has been enlarged, must be approved by the Council, this approval being additional to all existing planning and constructional requirements. Eighteen (13) such applications were received, of which 1 (1) was not approved. 18 North Westminster Project It was reported last year that work in the Rehabilitation Areas had been delayed as a result of the loss of staff and the inability to replace them quickly. During 1972 the staff position improved and the process of follow-up regarding individual premises commenced. The surveys were virtually completed in the redevelopment areas and as a result of some minor boundary changes the survey of additional premises was undertaken. The continuing response from owners already contacted still had to be given priority and it was encouraging to find that despite the very genuine difficulties facing the private owner there was a steady stream of schemes being submitted or discussed. Certainly the difficulties in this area of intense multi-occupation did not diminish during the year. In common with so many areas the price of property was rising as were both interest and building rates. Moreover the reluctance of some tenants to accept alternative accommodation even when offered delayed or prevented some schemes being implemented. There appeared to be a general reduction in the number of premises coming onto the market and fewer premises were actually acquired by the City Council or Housing Trusts. A small proportion of converted units of accommodation were offered for sale rather than relet and thus the proportion of owner occupation was slightly increased. During the year a further 120 units were commenced or completed in 33 houses, bringing the total number of units brought up to the desired standard by private owners to some 293 units in 119 houses. Taking the Council owned and Housing Trust premises into account it was calculated that some 30% of the accommodation in these areas has now been brought up to the full standard of self containment with exclusive facilities. Slum Clearance During the year action was taken as follows in respect of premises included in the Council's slum clearance programme for the period 1970—73:— Brewer Street, Green's Court, Peter Street Area: The compulsory purchase order under Part III, Housing Act 1957, made by the Council on 21st December, 1971 was the subject of a Public Inquiry on 18th July, 1972. The decision of the Secretary of State for the Environment is awaited. The order is in respect of Nos. 1, 2, 3, 4, 5 (also known as 22A and 23A Peter Street), 8, 9 and 10/11 (also known as 20 Brewer Street) Green's Court, W.1; Nos. 24/25 (also known as St. Peter's Buildings) and 26 Peter Street, W.1; and Nos. 14/16 Brewer Street, W.1 (also known as Pulteney Chambers), and includes as "added lands" Nos. 18 and 22 Brewer Street, W.1. Daventry Street/Lisson Street Areas: A compulsory purchase order under Part III, Housing Act 1957, was made by the Council on 29th March, 1972. The Public Inquiry into the confirmation of the order was held on 22nd November, 1972 and the decision of the Secretary of State for the Environment is awaited. The order is in respect of Nos. 75 and 76 Ashmill Street, N.W.1; Nos. 67—75 Bell Street, N.W.1; Nos. 1 — 100 Christchurch Residence, Lisson Street, N.W.1; Nos. 25—51 Daventry Street, N.W.1; Nos, 3, 4 and 20 Ranston Street, N.W.1; Nos. 23 Shroton Street and No. 6 Stalbridge Street, N.W.1. Archer Street Area: Consideration is being given to the action to be taken to deal with conditions in this area generally which includes 57 dwellings in 3 tenement blocks. Bell Street/Lisson Street Areas: A survey of the 25 premises in these two areas has been completed and a report on the conditions found is in course of preparation. Great Titchfield Street/Carburton Street Area: A survey of the 20 premises in this area was nearing completion at the end of the year. A tenement block containing 25 dwellings in the Mayfair district of the City was deleted from the slum clearance programme in June 1972. Closing orders were applied to all the dwellings and these have been vacated. The following areas were included in the slum clearance programme 1966—70:— Herries Street Areas: By the end of the year all of the houses in these areas had been demolished. A summary of visits in connection with slum clearance is included in Table 11, page 65. 19 Unfit Premises Details of action taken during the year in relation to closing order procedure as given in Table 13, page 66. Tenement Dwellings During the latter half of 1972 a senior public health inspector, with technical assistance, carried out a re-survey of tenement dwellings throughout the City. This survey was completed by the end of the year and a report indicating the situation regarding sub-standard tenement dwellings is being prepared. A summary of visits in connection with tenement dwellings is included in Table 11, page 65. Houses in Multiple Occupation (a) Management Orders, Directions and Notices The inspection of houses in multiple occupation in the Pimlico area has continued during the year. Some interruption of this work occurred however because of staff shortage and the consequent necessity for the public health inspector engaged in these specialist inspections under the Housing Acts to be transferred to other duties. A summary of the work of the inspectorate in connection with multi-occupied houses and tenement dwellings is given in Table 12, page 66. (b) Means of Escape in case of Fire The Director of Architecture and Planning served 5 (30) notices under Section 16 of the Housing Act 1961 and 12 (26) were complied with during the year. In respect of a further 109 (160) premises proper and adequate means of escape were provided as a result of informal action taken by the Director. Grants, Subsidies and Loans The following summary indicates the number of applications referred to the Health Department for inspection and comment during the year:— No. of Dwellings Discretionary Grants (a) Works of improvement 147 (222) (b) Conversions 1,272 (775) Standard Grants 39 (39) Subsidies to Housing Associations for the improvement and conversion of properties 123 (221) Loans for the acquisition and/or improvement of premises in Westminster 77 (60) A summary of visits is given in Table 11, page 65. Qualification Certificates At the end of the year 251 (628) applications for qualification certificates had been received. Details appear in Table 14 page 66. A qualification certificate certifies that a dwelling satisfies the qualifying conditions laid down in the Housing Finance Act 1972. The "qualifying conditions" are that the dwelling is provided with all the standard amenities (bath, wash-hand basin, sink, hot water supply to these, and water closet) for the exclusive use of its occupants, is in good repair, having regard to its age, character and locality and disregarding internal decorative repair, and is in all other respects fit for human habitation. If a dwelling is improved to reach these standards (or if it already satisfies such conditions) the controlled tenancy can be converted to a regulated tenancy. Overcrowding (1) Number of new cases of overcrowding reported during the year 79 (93) (2) Number of cases of overcrowding relieved during the year 26 (35) 20 Housing Priority on Medical Grounds During the year under review 2,003 (1,840) medical certificates or claims for priority in respect of applications for re-housing or transfers were considered and assessed by a Principal Medical Officer. Housing Finance Act 1972 The Housing Finance Act 1972 received the Royal Assent on 27th July and came into force during August. It introduced a new system of housing subsidies, provided for rent rebate and rent allowance schemes and made other provisions as to housing finance. The Act also significantly amends the law about rents of private dwellings. Part III supersedes Part III of the Housing Act 1969 and effects certain changes in the procedures whereby on the landlord's application, qualification certificates may be issued for the conversion into regulated tenancies of those controlled tenancies which reach the qualifying standard of amenity and repair. Section 35 of the Act provides that controlled tenancies, other than those of dwellings notified unfit, are to be brought out of rent control by a staged programme and the applicable dates in Greater London are as follows:— Rateable value of dwelling-house (as at 31st March, 1972) Applicable date £95 or not more than £400 1st January, 1973 £80 or more but less than £95 1st July, 1973 £70 or more but less than £80 1st January, 1974 £60 or more but less than £70 1st July, 1974 £50 or more but less than £60 1st January, 1975 Less than £50 1st July, 1975 Local Land Charges During the year 14,345 (12,703) formal enquiries were dealt with and reported upon. This number includes 884 personal searches, which have shown a steady increase over the past few years. "Personal searches" relates to the current practice of enquirers personally visiting each Council department concerned with property matters to obtain an immediate answer to their enquiries, rather than following the normal practice of completing a Land Charge enquiry form which is then circulated to departments and returned to the enquirer within a period of 2 — 3 weeks. It is thought that the "personal searches" practice is attributable to the increase in the number of properties now being sold by auction and to "gazumping" which was particularly prevalent during 1972. On occasions of property auctions it is not unusual for as many as twenty personal searches to be made in one day, each enquirer demanding immediate attention, causing considerable disruption to the work of the sections involved. Tourism It is estimated that Westminster's normal resident population (233,000), which increases each working day to about 600,000 rises during the tourist season to well over 1,000,000 persons. The environmental problems which may be created in the City by the successful tourist industry already receive careful study. The continued rise which has been forecast in the numbers of overseas visitors who come to London lends urgency to these studies. Reliable figures are not yet available but the recent estimate given in a Greater London Council report is that over £50 million is spent by our visitors in London's restaurants and cafes. This serves as a yardstick indicating the extent of one vast environmental health problem facing the City Council's public health inspectors in their endeavour to ensure compliance with satisfactory standards of food and catering hygiene. Westminster also contains not only a very high proportion of the restaurants in London but it provides more than half the hotel bedrooms. The majority of these bedrooms are provided in large well established hotels which rarely present problems. The report 'Hotel Prospects to 1980' published by the Hotels and Catering Economic Development Council shows that licensed hotels provide almost five times the amount of hotel accommodation provided by unlicensed premises, which are usually the smaller type of hotel. 21 Cases of overcrowding that occur are rarely the subject of direct complaint as they often involve members of groups under a leader who usually is so fully occupied that he is unlikely to take the trouble to complain unless conditions are very bad. Such complaints as are received by the department and other information from a variety of sources indicate a need for much more regular inspection of hotels which cater for groups. During the year eight statutory notices were served requiring a reduction in the excessive numbers of persons for whom accommodation was being provided. The low priced hotels now available were originally houses mostly in multi-occupation. A relatively small amount of conversion work has been done and the number of toilets and bathrooms available is minimal. Building costs render this situation inevitable and without much tighter control and the application of realistic minimum standards it is not surprising that some of these premises give cause for complaint. Although the majority of these hotels provide excellent and clean accommodation there area few that give recurrent trouble year after year. For such cases existing legislative control could well be strengthened to provide powers to enable local authorities to restrict the use of such hotels and in persistently bad cases to effect complete closure of the premises. There is evidence of a changing pattern and in future it is likely that a far greater proportion of the low priced accommodation required will be provided not in so-called hotels or guest houses, but in 'nonconventional' types of holiday accommodation such as self-catering flats, apartment-hotels and private homes. Whilst for economic reasons these developments may be inevitable this demand for a further large increase in the amount of low priced accommodation which it is reported will be required to meer the needs of visitors over the next decade must give cause for concern. The increasing difficulties now arising in popular tourist centres are recognised in 'Hotel Prospects to 1980' which states "tourism can, and does, impose social costs in the form of congestion, local inflation, pollution and so on. This makes it important that pilot studies into the concept of 'environmental capacity' be carried out in selected areas as a foundation for preliminary and specific local cost benefit studies of tourism". In centres such as Westminster where 'saturation' has already occurred the problems are more the concern of the local authority that those of the regional tourist board. If by 1980 as is anticipated there will be 50% increase in the number of beds which will be needed for visitors, particularly in low priced accommodation with "peak demand exceeding capacity in virtually all areas" i.e. "self-catering flatlets, apartment-hotels and other forms of operations offering minimal services and few communal rooms" — 'designed to accommodate the family unit' there is an obvious need for more and detailed information concerning all the available housing now at risk. Common Lodging Houses There are two common lodging houses in Westminster. One accommodating 550 men is kept by the Salvation Army at 18 Great Peter Street, S.W.1, whilst the other for 706 men at Bruce House, Kemble Street, W.C.2 is directly controlled by the Westminster City Council. Regular inspections of the premises are made by the public health inspectors, particular attention being given to fire precautions, the number of lodgers accommodated, sanitary and washing facilities, and to general compliance with bye-law requirements. Both common lodging houses were well managed and satisfactorily maintained throughout 1972. Facilities are provided at Bruce House for the disinfestation of any residents who require this service together with a doctor's room in which local general practitioners can see their patients. Arrangements also exist for regular visits to this lodging house by the Council's social workers. Radioactive Substances Act 1960 Persons who keep or use radioactive materials are, unless exempted, required to register with the Secretary of State for the Environment. Copies of certificates of registration, authorisation and supplementary provisions, the cancellation or variation of certificates issued by the Minister in respect of users in the City, are received and recorded. Appropriate action is taken in respect of any special precautions so far as they relate to the Department in connection with the conditions specified in the certificates. 22 Rodent Control The staff at present consists of two assistant rodent officers in charge of six rodent operatives under the supervision of the Pest Control Officer based at two centres, namely 313/319 Harrow Road for the northern half of the City, and at Bessborough Street Maternal and Child Health Centre for the southern half of the City. Primary and follow-up visits are made without charge in respect of complaints of rat and mouse infestation in domestic and business premises and a free disinfestation service is provided for domestic premises. Short-term treatment only is undertaken at business premises where circumstances permit and for this a charge is made. Where treatment necessitates regular attention on a long-term basis, business firms are advised to employ a commercial pest control organisation. The problems of illness and retirement amongst the staff plus the difficulties experienced in obtaining suitable recruits adversely affected the treatment service particularly to the business sector. Continued attention is given to advances in methods of treatment, with particular regard to formulation of poison baits as recommended by the Ministry of Agriculture, Fisheries and Food. The increase in mouse infestations which is a largely unexplained national phenomenon continued during 1972, but there was a considerable reduction in the rate of increase as compared with previous years. The baiting of sewers against rat infestation, in accordance with the requirements of the Ministry of Agriculture, Fisheries and Food, is undertaken by a contractor on behalf of the City Council. Every manhole and side entry to the sewers is baited with an approved rodenticide, on four occasions annually. The operation requires advance information to be given to the Metropolitan Police, the Greater London Council, the adjoining Boroughs and the City of London Corporation, the Ministry of Agriculture, Fisheries and Food and the City Engineer with regard to safety precautions which apply. Greater London Mouse Survey The survey initiated by the Pest Control Unit of the Ministry of Agriculture, Fisheries and Food was designed to obtain a cross sectional evaluation of infestation with particular regard to mice. By the employment of the department's technical assistants, participation in the survey was carried out in a four week period during the months October and November which involved doorstep enquiries at one thousand premises. From preliminary results so far as the City of Westminster is concerned the number of premises infested at any time since 1971 indicated that 32% were infested by mice and 3% by rats. Disinfection and Disinfestation The disinfection service is carried out from two centres, namely Lissonia, 217 Lisson Grove, N.W.8 and Wedlake Street Medicinal Baths, Kensal Road, W.10 by a staff of five disinfectors who also undertake disinfestation. During the year 52 (83) rooms, 3,912 (5,566) articles of bedding and clothing and 150 (208) books were disinfected. The department continued to be asked by residents to certify that clothing intended for despatch to foreign countries, mainly those in Central Eastern Europe, was free from infection. In such cases disinfection is carried out only when the articles concerned have actually been in contact with an infectious disease. Thirteen (76) certificates were issued indicating that no infectious disease had been reported for a least one month at the premises from which the clothing was purported to have come. The pest control staff continued to deal with complaints concerning insect infestations. The insecticides used are recommended by the Ministry of Agriculture, Fisheries and Food. As in the case of rodent control, a free service is provided in domestic premises but in business premises where insect control is a matter of routine maintenance it is advised that a commercial pest control organisation be employed. During the year 4,669 (4,850) rooms were disinfested, and 33 (54) wasp nests destroyed. 23 Pigeon Control Section 74 of the Public Health Act, 1961 empowers the City Council to take any steps necessary to reduce the number of pigeons for the purpose of mitigating any nuisance, annoyance or damage caused by their congregation in a built-up area. Where pigeons congregate at feeding or roosting sites much fouling of the adjacent buildings or other surfaces is caused by their droppings. At their nesting sites the fouling is more concentrated which, apart from being unsightly, encourages insect infestation. Although perhaps well-intentioned, indiscriminate and regular feeding of pigeons by members of the public results in concentrations which give rise to complaint, and is one of the most important factors which militate against effective control. There is unfortunately no legislation which can be used to prevent the indiscriminate feeding of birds. Investigation of complaints is carried out by public health inspectors and the pest control staff who, depending upon the circumstances of the complaint, either take action themselves or advise the occupier of the premises as to the remedial measures to be taken including where necessary the use of repellents and the employment of suitable commercial pest control organisations in appropriate cases. During the year 30 (43) complaints were investigated. Water The chief source of a constant water supply throughout the City is from the mains of the Metropolitan Water Board whose Director of Water Examination has kindly provided the following information which, it should be noted, relates to the Board's direct supply to the area and not to supplies from any other sources— "1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1972. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar General's estimates at 30 June, 1972, was 229,832. (ii) No houses were permanently supplied by standpipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occuring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:— River Thames — derived water from Thames Valley group stations. New River — derived water from Stoke Newington Works. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown in Tables 16 and 17, pages 67 and 68. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead." In the event of any suspicion of contaminated public mains water, the Metropolitan Water Board is informed and investigations are made; if necessary, samples are taken for examination. Complaints (which are extremely few) have usually referred to some alleged unusual taste. 24 In common with many of the London Borough Councils, the City Council is in favour of the Metropolitan Water Board being asked to adjust the fluoride content of the public water supplies to the optimum amount necessary to prevent dental caries. Private Water Supplies — Deep Wells The water from 77 boreholes is used for drinking and domestic purposes in 58 premises. Of these, 10 bores supply water to 5 premises occupied by Government departments or Crown Agents, and examination and maintenance of these are in the hands of the Government Chemist and the Department of the Environment. In relation to the 67 boreholes in private ownership 157 (107) samples of water were submitted for bacteriological examination and 49 (41) for chemical analysis. The results of all these tests were satisfactory. Swimming Bath Water Examination Monthly examinations were carried out at each of the 11 public swimming baths in Westminster. One hundren and twenty (113) samples were submitted to the Public Health Laboratory Service for bacteriological examination, and 119 samples were also examined at the baths for residual chlorine and pH value. The results of 119 of these examinations were satisfactory. One had a high coliform count and four others though satisfactory had higher plate counts than usual. These results may have been due to faulty handling or sampling as in all cases there was an adequate content of free residual chlorine. Satisfactory results were subsequently obtained from these pools. River Thames Flood Precautions The Health Department, in co-operation with other departments of the City Council concerned in precautions in the event of flooding, has prepared plans to be brought into operation immediately on receipt of warning by the Police, in accordance with the London Tidal Flood Warning System. Offices, Shops and Railway Premises Act 1963 New registrations received in 1972 totalled 925 (783), showing an upward trend attributable to the occupation of newly-built office blocks. At the end of the year the total number of premises registered was 18,350 (18,230), in which the number of employees is recorded as 377,532 (374,195). When considering these figures it should be borne in mind that there are deletions and newly registrable premises which may not become evident until routine inspections have been made. Deletions and new registrations cancel out to some extent, and the annual total, which is accepted as being slightly less than the real total of registrable premises, remains fairly stable. The total number of employees is arrived at from original registration figures and from information arising from inspections. Because of seasonal variations, and changes in the success or otherwise of business ventures, this figure must be regarded as an approximation only. Notifiable accidents, most of them of a minor nature, but causing absence from work of three days or more, totalled 540 (467). This increase is probably an indication of an increasing awareness of the need to notify such accidents. Investigations revealed minor contraventions in all cases, and in 3 of these the contravention may have been contributory to the accident. A considerable amount of work was carried out in connection with the Hoists and Lifts Regulations, made under the Act. Reported defects were followed up by informal notices in 337 cases. With the exception of one, these notices were complied with, or were in the process of being complied with at the end of the year. The outstanding case was put forward for enforcement action. Statistics which are set out in Table 18, page 68, include some of those contained in the Annual Report to the Department of Employment. 25 Factories There were 4,194 (4,287) factories on the register at the end of the year. Statistics relating to matters which are the concern of the Health Department under Parts I and VIII of the Factories Act, 1961, are given in Tables 19 and 20 page 69. Outworkers Returns made by 118 (140) employers, together with 97 (126) notifications from other local authorities, accounted for a total of 1,350 (1,387) outworkers. Of these 558 (630) were residing in the City of Westminster. Nearly all were engaged in the tailoring and gown trades. (Table 21, page 70). Basement Bakehouses The Factories Act, 1961, which re-enacted with amendments the Act of 1937, requires that a 'basement bakehouse' shall not be used unless a Certificate of Suitability has been issued by the Council and that the premises were so used in 1937. There are three such basement bakehouses in Westminster. This number does not, of course, include those basement bakehouses which are incorporated in hotels and form part of the general catering. The Act is a continuation of 'social' legislation enacted at the beginning of the century and forbids setting up anew a basement bakehouse — a fact which is difficult to explain logically to would-be bakers in a City where basement kitchens are a widespread feature. Food and Catering Premises — Inspection The estimated number of food and catering premises in Westminster on 31st December 1972, totalling 6,771 is categorised as shown in Table 22, page 70. During the year 9,205 (13,201) visits were made by the public health inspectors and 656 (1,002) informal notices were served in respect of matters requiring attention. During the year 1,136 (896) complaints were received concerning general matters affecting foodstuffs, food premises, food handlers etc. Appropriate action was taken in each instance. Catering Establishments This year has again seen an intensive effort on the part of the public health inspectors engaged in the supervision of catering premises. During the year several inspectors successfully sought higher graded positions with other local authorities and their valuable experience in this type of enforcement work was lost to the City Council and replacement has not been possible. It is a matter for regret that the large measure of co-operation received from many catering organisations is minimised by the seeming indifference of others. Though every effort is made to overcome those misunderstandings which arise from difference in language, temperament or custom, and the loss of contact due to the constant changing of managements and staff, it has to be reported that there is no ground for complacency in the prevailing standards of hygiene. Routine maintenance and cleaning of premises should be top priority for any food business. The employment of a sufficient number of conscientious staff who are amenable and responsive to supervision is necessary to prevent a deterioration in standards to a point where the public health inspector has to forsake his preferred role of adviser and become a law enforcement officer. 26 There is ample evidence that the general public are becoming increasingly concerned at the lack of food hygiene practised in food premises. This is not peculiar to Westminster — it is a national trend and rightly so. People are entitled to be able to eat and purchase food at premises where conditions of hygiene are of an acceptable standard. Too often the dining area and ancillary rooms display a magnificence which belies the conditions present in the kitchen. The Inspector has only the power to enforce the regulations which are available to him and which individually attract a maximum fine of £100. Many caterers realize that the Courts have no power to close food premises and any penalty imposed can be shrugged off unless the proceedings have been the subject of wide adverse publicity. It is a fact that the majority of the catering inspectors' time is taken up in preparing lists of adverse hygiene conditions noted when inspections are made. Many caterers appear to rely entirely on these periodical visits to indicate to them matters requiring attention and thereafter await the service of a notice before executing the necessary works. With the decreasing number of inspectors available for the inspection of premises the presence of adverse conditions in many such establishments will inevitably go unchecked. There have again during the year been references to the need for registration to enable effective control to be exercised where premises are to be used for the preparation and consumption of food. Proposals to promote a Greater London Council (General Powers) Bill were under consideration at the end of the year, the purpose of which is to give power to local authorities to seek the sanction of the Court to disqualify food premises where conditions are a danger to health. Similar power to this is already available to the Manchester Corporation. The proposal has the advantage, over previously proposed legislation, that disqualification of the premises is recommended rather than the person carrying on the business as now provided under the Food and Drugs Act 1955. The year has seen a marked increase in the incidence of mouse infestation at catering premises. This is a serious matter although in many instances it is tolerated by the caterers who accept the marginal economic damage caused, and have little regard for the food poisoning potential which could arise from this source. Most caterers employ contractors for vermin control, but unless this is accompanied by a high degree of cleansing, proper storage conditions, and effective proofing of the premises the control exercised is largely abortive. Complaints have been received during the year in respect of noise emanating from premises where food or drink are sold in association with amplified or recorded music. Unless premises providing this amenity are efficiently proofed the loud playing of music and the indiscriminate use of amplifying equipment will undoubtedly cause annoyance to the surrounding neighbourhood where this is of a domestic nature. Caterers should have careful regard to this factor when introducing this amenity into their premises. Customers may welcome the innovation but considerable bad feeling can be engendered in the locality where its use is not tempered with commonsense. A number of complaints received during the year have referred to the unsatisfactory state or closure of public sanitary accommodation in eating places. Often when a complaint is made direct to the management by a customer the amenity is closed and remains so until the appropriate staff is available to cleanse the accommodation and this is sometimes not until the following day. Complaints received tend to centre around certain areas and the subsequent investigation usually reveals that vandalism and careless hygiene practised by the general public have been the cause. Difficulty is experienced by caterers in finding persons who are willing to undertake the cleansing of toilet accommodation and it has been suggested that permanent attendants may be the only solution. If conveniences were permanently supervised much of the abuse which now occurs could be prevented or certainly lessened. The City Council during 1972 took legal proceedings in respect of dirty and verminous conditions found at a number of catering premises. A summary is shown elsewhere in this Report (Table 25, page 72). It is perhaps pertinent to relate that the total fines of £6,400 in respect of twenty premises is a very modest sum in comparison with the financial investment involved in an industry which ranks first in Westminster. A programme on television shown early in the year included visits to several restaurants in the Westminster area. The manner in which entrance was gained to these premises is not a matter for this report; the least that can be said is that it was not with the assistance, approval or knowledge of the City Council's health officers. Adverse conditions were disclosed at four premises. These were already known to the City Council. It is perhaps a remarkable coincidence that three of the premises were already the subject of impending legal proceedings; at the fourth premises a notice had already been served and works were in progress to remedy shortcomings. 27 Licensing Act 1964 Throughout the year inspections have been made of all premises where notification has been received in the department of impending alterations at licensed premises or where applications for new licences had been made for the sale of alcoholic beverages. The Licensing Justices have continued to co-operate fully with public health inspectors engaged on these duties, and this has been very much appreciated. In appropriate cases the Justices have deferred the grant of a licence until adverse conditions have been rectified. The financial loss associated with the delay in the grant of a licence to sell intoxicating liquor can be considerable, and it is noticeable that previously apathetic proprietors have been galvanized into action in carrying out essential works when the issue of a licence is in suspension. The report of the Departmental Committee on Liquor Licensing (known as the Erroll Report) was published towards the end of the year. The intention of the proposals envisages greater participation by a local authority in the granting of licences for the sale of intoxicating liquor. If the local authority felt unable on grounds of planning, public safety, sanitation, food hygiene or compliance with building regulations requirements, to concur in the application it would be empowered to withhold the necessary certificate of suitability, in which case the Justices would be unable to grant a liquor licence. At present the grounds for objection by the Health Department are confined to lack of suitable sanitary accommodation, or in the terms of Part IV of the 1964 Act, that the premises are not "structurally adapted" for the preparation of the "customary main meals". Should the Erroll Report receive statutory approval in essentially its present form additional work will inevitably result from its operation. Inspections were also made throughout the year at those premises where application had been made to the Magistrates' Court for a Club Registration Certificate or the renewal of an existing Certificate for a further period. No objections were raised to the applications received. Licensed Street Traders At the commencement of the year it was hoped with reasonable optimism that the difficulties experienced in association with the provision of a suitable stall for use by street traders to comply with the requirements of the Food Hygiene (Markets, Stalls & Delivery Vehicles) Regulations, 1966, had at last been resolved. The prototype was examined by the Public Health Inspector (Food Control) and some minor alterations were suggested to the manufacturer who agreed to put them in hand. Regrettably it has to be reported that the firm concerned suddenly ceased business. Another firm took over the fibre glass moulds and a further two stalls were supplied to fruit and vegetable traders in the City. However, the response has been generally disappointing. Efforts by their own Association to encourage certain traders to purchase stalls were equally unsuccessful, it being the general opinion that unless suitable storage accommodation can be provided, traders are not prepared to expend capital on new stalls. Labour costs and materials have increased since the beginning of the year and itsis a matter of concern that the situation may soon be reached where the cost of the provision of a suitable stall will not only be an uneconomical proposition for the manufacturer, but may also be beyond the financial capability of the trader himself. The question of storage space for stalls is a vexing one. High land values often make the incorporation of storage facilities for stalls in new developments an uneconomic factor, and the City Council has no legal obligation to make such a provision. However, it is virtually impossible for an individual street trader to find even minimal storage accommodation for his stall and food stocks in the City. Even if he is fortunate enough to do so, it is unlikely that the statutory facilities would be available or could even be installed. A number of traders therefore have to share already inadequate accommodation or even leave their stalls in the street overnight where they can be subjected to abuse. Until such times as suitable stalls — and associated facilities — are acquired by traders to replace the present outmoded vehicles used, it is impracticable for them to comply with the requirements of the abvoementioned Regulations. However, routine examination of stalls selling foodstuffs has been undertaken during the year to ensure that the standards of hygiene being maintained were commensurate with the limited facilities available. 28 Unauthorised Street Traders Enforcement action under the Food Hygiene (Markets, Stalls & Delivery Vehicles) Regulations 1966 against unauthorised street traders is a time-consuming operation if the necessary evidence to mount a successful prosecution is to be obtained. The inspectorate of the Food Control Section have been unable during the past year to devote the time to these enforcement duties which is needed and this has resulted in a deterioration in the already questionable standards of hygiene practised by most unauthorised stall holders. Requests from the Police for the inspection to be undertaken of stalls detained at Police Stations and where hygiene offences have been thought to exist have on occasions had to be resisted due to the pressure of other duties on the inspector's time and the shortage of staff. There is no reason for optimism in suggesting that the position will improve in the immediate future. During the year six stall holders were successfully prosecuted for offences under the Regulations. Two of these resulted from Police observations. In a further three cases summonses could not be served and in another case the defendant did not appear in the Court in answer to the summons. Fines totalling £137 were imposed in the cases heard. One further trader was granted an absolute discharge in respect of hygiene offences. Food Hygiene Etc. Lectures Where possible requests to the inspectorate for assistance in giving lectures on food hygiene and food control matters to managements of catering organisations, those engaged in food handling duties, student nurses and others undertaking courses associated with food hygiene, have been fulfilled. It is a matter for regret that more time cannot be given to this project for experience has shown that there is a great potential for educational enlightenment in this particular field. The greatest stumbling block to progress is the problem of language. Many who should attend are excluded on account of their inability to understand the subject of the lecture. As many of these are concerned with the very basic elements of hygiene — cleansing of utensils, apparatus and structures — their exclusion is a serious matter. If managements could be relied on to convey to these employees the principles preached by the inspectors much good would result. Regrettably, however, managements often display a reluctance to exert their authority where matters of adequate maintenance and hygienic conditions are concerned. This in turn is reflected in the indifference and casualness too often met amongst staff engaged in this work. Food Sampling and Analysis Consumer complaints investigated by the Food Control Section of the Health Department during the past year have increased by 20%, while at the same time, due to internal movement, resignations and sickness, the section throughout the year has been considerably under-strength. Wide publicity lately given through the mass media has resulted in more and more people being conscious of their right to expect that food sold to them shall be in a sound condition and in all respects fit for human consumption. Unfortunately this is not always the case — careless storage, retention of goods for too long a period, contamination by rodents, unhygienic conditions, improper temperature control — these all result in complaints being received in the Food Control Section. Many could be avoided with the normal application of commonsense and a regard to elementary principles of hygiene — it does not need much ability to realise that if you exhibit foods at an ambient temperature in a shop during the day, return it to the refrigerator during the night, and again the following day display it for sale, the growth of mould is hastened. If perishable foods are received on a regular delivery basis, sale in strict order of receipt, coupled with an expiry date on the wrapper would obviate most of the complaints of stale goods. Mouse contaminated food is in most cases due to apathy on the part of the retailer. The evidence of rodent infestation is not difficult to see, but is is often ignored by management and employees alike. During the year a total of 1,347 (1,269) samples of foodstuffs obtained during routine inspection or as a result of complaint were submitted to the Council's Public Analyst. Of this number 166 (12.3%) (178 13.2%) were reported upon adversely and appropriate action was taken. 29 Legal Proceedings — Food and Food Premises During the year legal proceedings were taken in respect of unhygienic conditions in 20 food and catering premises. Two of these further included contraventions of the Offices, Shops & Railway Premises Act 1963. Fines totalling £6,400 with £652 costs were imposed. In one other case proceedings could not be taken as it was impossible to discover the full name of the Company carrying on the food business and the difficulty of proceedings being sustained against a person associated with the business. In another case the defendant left the country before the hearing took place. The following matters arising from complaints also resulted in legal proceedings: Sale of bread pudding and a cake each containing a cigarette end. Also dirty condition of a food mixer. Two defendants each fined £21 with £10 costs. Ham roll containing a quantity of live larvae. Fined £50 with £26.25 costs. Selling food unfit for human consumption — the food had been gnawed by mice. Fined £30 with £25 costs. Sale of sausage rolls affected by mould growth and having in possession for sale food unfit for human consumption. Fined a total of £30 with £3 costs. Selling a loaf of bread containing a cigarette end. Fined £75 with £15 costs. Selling a chocolate Swiss roll affected by mouse contamination. Fined £25 with £5 costs. Exposing for sale mouse contaminated foodstuffs. Fined £65 with £15 costs. Serving marmalade at hotel premises which contained a piece of glass and failing to place food so as to avoid risk of contamination. Fined £75 with £20 costs. Sale of two cartons of soup containing cockroaches and failing to protect other food from risk of contamination. Fined £75 with £25 costs. Sale of a 'take-away' meal which contained mouse droppings. Fined £40 with £5 costs. Sale of a cake containing a piece of glass. Fined £75 with £25 costs. Sale of a bacon roll in which an insect was embedded in the bread. Fined £5 with £15 costs. Milk and Dairies (General) Regulations 1959 Under these Regulations a local authority is required to keep a register of persons carrying on the trade of distributor of milk at or from premises within their district whether or not such premises are occupied by the distributor. As at the 31st December, 1972, 287 distributors of milk were registered. Milk (Special Designation) Regulations, 1963 (as amended) The City Council is responsible for the granting on application of Dealers' Licences in relation to prepacked milks sold under the special designations "Untreated", "Ultra Heat Treated", "Pasteurised" and/or "Sterilised". A Dealer's Licence permits the sale of milk both outside as well as inside the area of the licensing authority. The numbers of such licences current in the City at the end of 1972 were:— Untreated 49 (49) Ultra Heat Treated 122 (119) Pasteurised 276 (270) Sterilised 191 (186) 30 Milk Supplies — Brucella Abortus Brucella abortus is the organism associated with contagious abortion in cattle and its transmission to man occurs through drinking raw milk. As almost the entire supply of milk sold and consumed in Westminster is heat-treated, no tests to determine the presence of this organism were carried out during the year. Food and Drugs Act 1955 — Section 16 The number of premises registered with the City Council at 31st December, 1972 is shown in Table 23 page 71. Food Poisoning During the year information was received of 169 persons stated to be suffering from food poisoning and a summary of the individual outbreaks affecting more than one person is as follows:— A dinner at a London hotel was attended by 173 persons. The menu at the dinner included roast duck with liver stuffing. Between 18 and 72 hours after the dinner at least 108 guests and one member of the hotel kitchen staff became ill. Their symptoms were headache, fever, abdominal pain, backache and diarrhoea. In many cases the illness was severe and prolonged. Its mean duration was 5 days with limits of 3 and 9 days. Eleven guests required hospital attention after dehydration. There were 50 recorded isolates of salmonella typhimurium from those with symptoms. All these isolates were phage typed and found to be phage type 4. Among those affected 85 people ate duck and stuffing, 20 ate duck only and 4 ate liver stuffing only. At least 23 guests complained that their portions of duck were undercooked. Due to late notification of the incident, no duck remained for bacteriological examination. During the investigation one duck was purchased via each of the large wholesale traders from the duck farms whence the hotel supply had originated. Salmonella typhimurium, phage type 4 was isolated from heart, liver, gizzard and intestines of one of these. Apart from the member of the hotel kitchen staff who ate the duck the other food handlers provided negative faecal specimens. Salmonella typhimurium, phage type 4 is historically associated with ducks which are the commonest source of infection by this phage type. The investigation disclosed that some or all of the ducks and/or stuffing forming the main dish were at the time of service heavily infected with salmonella typhimurium, phage type 4 and were unfit for human consumption. The cold storage facilities available were totally inadequate for the scale of catering carried on. This has now been rectified. The failure to exercise the temperature control requirements of the Food Hygiene (General) Regulations 1970 allowed food poisoning organisms present in the poultry to multiply sufficiently to produce an infective dose beyond the resistance of those who later consumed the meal. An outbreak involving two persons was not notified to this department until almost a month after the occurrence. The incident came to the notice due to the continued illness of one of the two persons affected who suffered recurrent diarrhoea. The onset of the infection due to salmonella organisms occurred following a meal at a restaurant which included poultry. The subsequent investigation at the catering premises concerned disclosed that a large number of birds were cooked at one time and that these were stored in the warm atmosphere of the wash-up area in the kitchen during the day. The most seriously affected patient continued excreting salmonella typhimurium organisms for some two months after the occurrence but was eventually cleared of the infection. This appeared to be yet another instance where the requirements of the Food Hygiene (General) Regulations 1970 in relation to temperature control had been ignored which resulted in the growth of harmfull organisms. Information was received concerning an outbreak of salmonella infection at a local hospital. A joint investigation was undertaken with the hospital medical staff and stool specimens from a number of cases were examined in the hospital laboratory. Positive specimens were obtained from both staff and patients for salmonella enteritidis, but the investigation failed to disclose the vehicle of infection. The onset in most of the cases was over a 48 hours period and this suggested the consumption of food to be the cause. In a further outbreak two people notified as suffering from food poisoning left the country before an investigation could be carried out and in another involving a family of four the symptoms were similar to those associated with food poisoning but were in fact found to be the result of the inhalation of fumes from a defective heating appliance. 31 Other individual cases of salmonella infection and suspected food poisoning which came to the attention of this department during the year were all investigated but no positive association with the consumption of a particular food could be established at the time of investigation. Abrus Seeds Following the nationwide publicity given in the Press and other media after the disclosure by Bristol Health Department of the potential danger associated with a certain type of seed used in the making of necklaces, rosaries, curios etc., likely sources where these might be on sale in Westminster were immediately visited. None was found. The general public having been made aware of the matter brought suspected articles to the City Hall or took them to their local Police Station and these were later delivered to the Health Department for identification. The seeds are known by several names, e.g. jumble beads, love beans and are from the woody, climbing plant known as Abrus Precatorius which is widespread in the tropics. The seed itself is hard with a smooth glossy surface and of a bright scarlet colour with a black patch at the end which joins the stalk. The danger associated with the seed is that it contains a poisonous substance known as Abrin. If the seed is swallowed whole no harm is likely to result because the skin or outer covering is so hard that toxin would not be freed. Even if well chewed it has been suggested that three whole seeds would be required to produce a lethal dose. It is, however, highly toxic when absorbed through a wound, the minutest quantity being sufficient to produce fatal results. Enquiries disclosed that the last fatal case in this country from this form of poisoning occurred some two hundred years ago; the seeds have been known in the United Kingdom since the 1500's. A total of 52 articles were received in the Health Department of which 23 were identified as containing the Abrus seed. These latter articles were destroyed and those not containing the seed returned to the owner, where requested. The Health Department is indebted to Dr. R.M. Polehill of the Royal Botanical Gardens, Kew for the considerable assistance and valuable information he gave the public health inspectors of the Food Control section during their investigation. Unsound and Unsaleable Food — Examination and Disposal Under Section 72 (1) of the Public Health Act 1936 a local authority may undertake the removal of trade refuse from premises within their district and having so undertaken shall, at the request of the occupier, remove such trade refuse. Westminster has entered into such an undertaking. Schedule II Part II (7) of the Local Government Act 1963, stated that any person who has in his possession or under his control any article of food which is unsound, unwholesome or unfit for human consumption, may, by notice to the local authority, specifying and identifying the article, request its removal as if it were trade refuse. During the year some 202 tons of unsaleable foodstuffs were voluntarily surrendered for disposal. This figure includes four large consignments — 12¼ tons of grapes, 7¼ tons of melons, 22% tons and 23½ tons of pears all of which had been rendered unmarketable. Four hundred and ninety seven requests were received in the department during the year for inspections to be made of out-of-condition foods. The Liquid Egg (Pasteurisation) Regulations, 1973 There are no egg pasteurisation plants in Westminster, and any liquid egg used at premises in the City would be subject to supervision by the local authority at the source of manufacture or examined on importation. 32 Imported Food Regulations 1968 During the year 62 notifications were received of imported foodstuffs coming into Westminster which had not been examined at the port of entry. Immediately notification was received a visit was made to the premises and an examination made of the consignment. A firm in Westminster was informed that imported canned beans they had obtained through London Agents and supplied to a customer outside Westminster had been the subject of adverse reports as to the tin content. There is no statutory standard limiting the presence of tin in food products. However, a limit of 250 parts per million has been recommended by the Ministry of Agriculture, Fisheries & Food following an investigation by the appropriate Government Committee into the toxic effect to the consumer of tin content in food products. It is the limit on which any formal action would be based. Three tins of beans of different codings were submitted to the Public Analyst for analyses. He reported that they contained 170, 280 and 335 parts per million of tin respectively. He was of opinion that the one with the lowest tin content would soon have reached the maximum limit and the whole consignment was not suitable for sale. Following discussions with the company concerned, arrangements were made for the whole consignment consisting of some 1,500 tins each weighing 6 lb. 13 ozs. to be returned to the country of origin, and this was later effected. In a further case drums of imported grape juice were found on analysis to contain 363 parts per million of sulphur dioxide. The Preservatives in Food Regulations 1962 permits the presence of 350 parts per million of this preservative. An undertaking was obtained from the importers that the juice would be diluted by four times its volume before being made available for use. On this understanding there was no objection to distribution taking place. The company concerned was requested to inform their principals abroad as to the statutory requirements in relation to the preservative content allowed for grape juice. Dessert mix examined at the port of entry was later reported by the Public Analyst to contain a blue colouring matter which was not permitted by the Colouring in Food Regulations 1966. The retail premises in Westminster were visited and the total consignment consisting of 34 packets was voluntarily surrendered for destruction. Export Certificates Applications for Certificates of Export received in the Health Department during the year in respect of foodstuffs to be despatched abroad numbers 10 (7). Trade Descriptions Act, 1968/72 During the year 15 complaints were received alleging contraventions of these Acts. None of the matters reached the stage of legal proceedings but where necessary informal action was taken under the appropriate food legislation. One complaint concerned a restaurant where it was stated that cooking was carried out in the French style — 'Cuisine Francaise'. The complainant alleged that the staff and method of cooking were alien to this declaration. A test meal of French dishes from the menu disclosed them to be cooked in 'French style' and the cheeseboard consisted of a selection of French cheese. It was the opinion of the Health Department Officers that the statement 'Cuisine Francaise' exhibited outside an establishment did not necessarily infer that all food served there was prepared in the French manner. The description would apply if a particular dish was described on the menu or had otherwise been represented as being French cuisine. A false trade description under the above-mentioned Act is defined as being 'false to a material degree', and no contravention of the Act or the Food & Drugs Act, 1955 was adjudged to have occurred in the circumstances related. Under Section 2 of the now revoked Merchandise Marks Act, 1926, certain imported goods bearing a name or trade mark of British manufacturer or trader were required to bear an indication of origin. This was not re-enacted in the Trade Descriptions Act 1968. The Health Department took the view that compliance could still be secured in that the absence of a suitable declaration constituted a false trade description under the 1968 Act. Under powers conferred by the Trade Descriptions Act 1972, pre-packed imported foods, other than canned or bottled foods, which bear a trade mark or name which might be taken to mean that they originated in the United Kingdom, will be required as from 29th June, 1973 to carry a statement of their country of origin in a conspicuous position; this requirement will extend to canned or bottled food as from 29th June, 1974. 33 Advice on Labelling of Pre-Packed Foods Ninety-three requests were received during the year from manufacturers, packers and advertising agencies for assistance and advice on matters relating to the requirements of the labelling of pre-packed food products in order that these should conform to the requirements of the Labelling of Food Regulations, 1970, which came into effect on 1st January, 1973. Section 6 of the Food & Drugs Act, 1955, prohibits false or misleading claims. This general provision will now be reinforced by specific requirements when new labelling regulations come into effect which concern the composition of food for which certain claims are made, and the labelling and advertising of such foods. The requirements apply whether the claims are made on labels or in advertisements. Several of the matters on which advice has been given during the year concerned low calorie foods and those which claim to aid slimming. Before such claims are made certain criteria must be observed. For example for a claim that food is a source of protein, at least 12 per cent of the calories must be provided by protein; for claims that vitamins and minerals are present the food must contain one or more of the vitamins or minerals specified in the Regulations with a statement of the minimum quantity. Claims that food can aid slimming may only be made if the food 'can make a definite and positive contribution to weight control or to weight reduction'. It must be made clear that the food cannot aid slimming except as part of a calorie controlled diet and the calorie content must be given. Undoubtedly cases will come to the attention of the Health Department where pre-packed foods for retail sale do not comply with the Regulations. This is particularly applicable to imported foods, although importers are now becoming increasingly aware of their responsibility in this matter. Experience has shown that the need for enforcement action is usually confined to technical offences in association with the common or usual name, or the appropriate designation. Branded or coined names which are already widely used may still be used in conjunction with the appropriate designation, or if they have been used for 30 years before 4th January, 1971, such names may be used alone provided this could not mislead the consumer. In addition all pre-packed foods will have to show on the label the name and address of a responsible person such as the packer, labeller or the person on whose behalf the food is labelled or packed. A registered trade mark can no longer be given as an alternative. The statutory provisions contained in the Regulations are a welcome addition to those already in force. Date Marking of Foods Much of the doubt regarding the freshness of food will be eliminated if statutory support is given to the growing demand by consumers that date marking be introduced for perishable and other foods. During the year the Ministry of Agriculture, Fisheries & Food — Food Standards Committee — issued a 'Report on the Date Marking of Food'. The Committee indicated that some element of priority had been accorded to the review, despite the importance of other reviews before it, in view of the widespread public concern about the reports of the sale of stale and deteriorating food. The Committee commented that the present systems of conveying information from manufacturer to retailer to aid rotation and to prevent the sale of outdated and stale food, were for many foods, and for most retail outlets, inadequate. A multiplicity of codes giving different dates, codes kept secret from the retailer, codes hidden in positions not seen by the retailer, together with a reluctance of retailers to organise their stock rotation themselves have all contributed to the situation. At the close of the year there seems every likelihood that the general proposals in the Report will be adopted although legislation is not expected to be effective until 1975. Nonetheless manufacturers will need to make provision for this in their advance packaging proposals, and it is hoped that many will adopt the open dating of food voluntarily without delay. A few retailers have already introduced a comprehensive system of 'sell by' notations on their products and there has been no evidence to suggest that abnormal wastage has resulted. There is already provision for some form of open dating in EEC marketing regulations for eggs. Proposals are understood to be under consideration for a similar provision in respect of poultry, milk, butter (other than farm butter), frozen fish, fresh fish and dietetic foods. 34 At the commencement of the year a survey was conducted of some 100 grocers' shops in Westminster by Mr. E.W. Kingcott, a Senior Public Health Inspector employed in the Food Control Section, in association with his submission of a paper to the Royal Society of Health on the value of open date marking as an aid to achieving efficient stock control. His paper which received wide publicity in the national press and on television disclosed that in almost every shop surveyed one item of food was being offered for sale beyond the manufacturers' recommended shelf life and that this practice was much more widespread with small shops than with supermarkets. As an example 3,234 meat pies were examined in retail shops. Of these 386 were more than five days old and of these 84 were more than 12 days old. (The Practice Notes agreed between the Meat Pie Manufacturers Association and the Association of Public Health Inspectors states that meat pies should never be sold after 48 hours from the day of delivery.) Mr. Kingcott is to be commended for his excellent paper which the Food Standards Committee acknowledged as a document of reference in its Report. [Note — Although the above gives the situation at the close of the year, the Parliamentary Secretary to the Ministry of Agriculture, Fisheries & Food in a reply to a Question in the House of Commons in February 1973, stated that the Government had accepted the recommendations of the Food Standards Committee that there should be regulations on open date marking to come into effect in 1975 but that in the meantime date marking should be developed as fully as possible. It was mentioned that the coming year (1973) would see the start of, or experiments in, 'sell by' date marking of almost all products where freshness was of most concern to the housewife.] Poultry Processing Premises There are no poultry processing premises in Westminster. Slaughter of Animals There are no slaughter houses in Westminster, but in the grounds of the Zoological Society of London for many years there has been a knacker's yard, licensed by the Council. The necessary licence for this was renewed during the year. Applications are also received from time to time from the Royal Society for the Prevention of Cruelty to Animals for Slaughterman's Licences to be issued to probationary inspectors. Thirty-six such licences were issued during the year; they are necessary in order that the inspectors concerned can commence training as slaughtermen and receive from the Society practical training and instruction in modern methods of humane slaughter. Two annual licences were renewed for members of the Society's Headquarters staff. Diseases of Animals Act 1950 and Other Acts Relating to Animals Under an arrangement entered into in 1965 the Corporation of the City of London acts on an agency basis on behalf of the Westminster City Council in connection with duties under the Diseases of Animals, Riding Establishments, Performing Animals, Pet Animals, and Animal Boarding Establishments Acts where veterinary services are involved. Veterinary officers of the Corporation of London undertake routine inspection of animals in transit and inspections for licensing purposes under the Riding Establishments Act, together with inspections specially requested by the Medical Officer of Health of Westminster. All other necessary inspections are made by the public health inspectors. The Corporation issues any notices and advertisements which may be required under these Acts but licensing and registration of the persons concerned and any premises used which are in Westminster is undertaken by the City Council. Pharmacy and Poisons Acts 1933 and 1941 At the end of the year the names of 126 (109) traders were on the Council's list of persons entitled to sell poisons included in Part II of the poisons list, the number of premises concerned being 154 (146). 35 Rag Flock and Other Filling Materials Act, 1951 Under the provisions of this Act various types of premises concerned with the upholstery trade or with the provision of materials for the trade must be registered or licensed with the local authority. At the end of the year 15 premises were on the register and one was licensed for storage purposes. Verminous Persons The cleansing of persons' baths at Lissonia and Wedlake Street dealt with 901 (721) verminous persons: adults 605 (507) - men 512 (405), women 93 (102); children 296 (214) - boys 104 (60), girls 192 (154). Table 26, page 72). Scabies The two establishments mentioned in the foregoing paragraph treated 105 (235) scabies patients; adults 64 (151) — men 60 (114), women 4 (37); children 41 (84) — boys 13 (36), girls 28 (48). The number of persons treated for verminous conditions (referred to in the preceding section) and the number treated for scabies at the Health Department centres showed a steady increase during the year 1966—1969. In 1970 there was a sudden decrease in numbers attending and the decrease continued into 1971, so far as adults were concerned, although there was a slight increase in attendances by children. In 1972 the decrease in the number of persons treated for scabies showed a dramatic fall of 58% in the case of adults and 50% in respect of children. The number of persons cleansed for verminous conditions however, increased by some 22%. It is possible that the decrease in scabious conditions arises from improved environmental circumstances, a greater awareness of the need for personal hygiene and perhaps advice and treatment being given by other agencies (e.g. the patient's own doctor). The number of verminous persons treated is the second highest since 1965 and it is of interest to note that the higher numbers occur in children rather than in adults treated. (See Table 27, page 73). Old People's Bathing Under the provisions of Section 43 of the London County Council (General Powers) Act, 1953 sanitary authorities are empowered to make arrangements for bathing old people at their request or with their consent. During the year 356 (394) baths were given, 306 (322) to women and 50 (72) to men, under a scheme for bathing old persons at the Lisson Grove Centre. The old people are conveyed between their homes and the Centre by a Health Department vehicle. The bathing of persons in their own homes is also undertaken by Bathing Attendants employed by the Health Department as part of the home nursing service (see page 39). Special Laundry Service The Department continues to operate a service for laundering bed linen and clothing of the acutely ill, incontinent or very dirty and verminous old people. In certain cases a certificate is given by the Medical Officer of Health under the provisions of Section 84 of the Public Health Act 1936. The work has been carried out by the staff of the Department's Laundries at 217 Lisson Grove and to a limited extent, at Wedlake Street Baths. During the year 12,131 (11,325) bags each containing about 10 lbs. of soiled linen were collected, laundered and returned to the owners. This essential service is much appreciated by the recipients; and a special word of praise is again due to the staff at the centre for the excellent way in which they carry out this work which is not only hard but also unpleasant. Disposable Incontinence Pads Under Ministry of Health Circular 14/66 a service is provided for patients residing in Westminster (on written application by a general practitioner or district nurse) whereby the patient is supplied free of charge with disposable incontinence pads and, where required, protective rubber pants. These are either collected by the patient or his representative from a convenient centre, or, where necessary, delivered to the patient's home by a Health Department van. If difficulty is experienced at the home in disposing of the soiled pads, these are placed in disposable waterproof bags, collected by the van delivering new supplies and, through the kind co-operation of St. Mary's Hospital, Harrow Road, incinerated there. During the year under review 165 (156) new cases arose, making a total of 280 (274) persons who received deliveries of supplies in their homes, and 7 (14) who arranged for them to be collected from centres. It is of interest to note that in 1972, 162,648 (145,100) disposable incontinence pads and 141 (152) pairs of protective pants were issued. Establishments for Massage or Special Treatment The City Council is responsible for the licensing and regulation of establishments for massage or special treatment in the City. This matter is dealt with by the Public Control Section of the Town Clerk's Department, but enquiries with regard to apparatus, technique, qualifications and suitability of the persons employed at the premises are referred to the Medical Officer of Health for his observations. The number of such enquiries referred to the Health Department during the year was 28 (34). The establishments about which enquiries were made ranged from those premises giving facial beauty treatment, general massage, and certain forms of electrical treatment, to those which provide Turkish and sauna baths and chiropody. The basic objects of the legislation are to prevent immorality and to ensure that persons employed to give other than non-remedial treatment can produce evidence that by examination or experience they are suited to give such treatments. At the end of the year 253 (261) establishments were in operation. Betting Shops These establishments are required to be licensed by the Betting Licensing Justices and applicants for such licences must, by law, submit copies of their application to the police and to the City Council in order that, if necessary, these authorities may raise objection to the licence being granted. During the year under review two (8) applications for betting shops were referred to the Health Department for reports as to suitability. CORONER'S COURT AND MORTUARY The Coroner's Court and Mortuary is situated in Horseferry Road, S.W.1. The arrangements made by H.M. Coroner (Inner West London) for the reception at the mortuary of bodies under his jurisdiction in the City of Westminster and from the Royal Borough of Kensington and Chelsea continue to operate satisfactorily. The Greater London Council (which is responsible for the provision of Coroners' Courts) contributes to the City Council's costs in regard to the Coroner's accommodation, and the City Council has a financial arrangement with the Royal Borough of Kensington and Chelsea in respect of bodies from that borough accommodated in the mortuary. The staff comprises the Superintendent, a First Mortician, 3 Mortuary Assistants and 2 cleaners. Details of the work carried out at the Mortuary during the year are set out in Table 28, page 73. 37 BURIALS AND CREMATIONS ARRANGED BY THE CITY COUNCIL Under the provisions of Section 50 of the National Assistance Act 1948 it is the duty of the City Council to cause to be buried or cremated the body of any person who has died or is found dead in its area if no other arrangements have been made for the disposal of the body. Where persons without known relatives die in the City it is not only necessary to arrange their funeral but in certain cases to dispose of the contents of their homes. This is done in consultation with the Treasury Solicitor. Such action is necessary to avoid rent accruing, to release accommodation for housing purposes as early as possible and occasionally to enable the proceeds to be applied towards the cost of the funeral. During 1972 a total of 125 (117) burials or cremations were arranged by the Health Department as follows:— Burials at City of Westminster Cemetery, Hanwell 15 (14) Paddington Cemetery, Mill Hill, N.W.7. 10 (14) St. Marylebone Cemetery, East Finchley, N.2 1 (3) St. Mary's Cemetery, N.W.10 1 (-) Morden Cemetery - (1) Islington Cemetery - (1) Cremations at City Council's Crematorium, East Finchley, N.2 98 (84) The burial which took place at St. Mary's Cemetery was so arranged to enable the body to be interred in a family grave. In addition to the cases summarised above a further 12 (17) were referred to the Health Department; however, action by my officers resulted in private funerals being carried out either by relatives or other responsible persons. Requests for burials or cremations were received from the following sources:— H.M. Coroner 57 (56) Relatives or friends of the deceased 48 (51) Hospitals in the City 20 (10) CREMATION - WORK OF THE MEDICAL REFEREE The Medical Officer of Health is Medical Referee for the Council's Crematorium, which is situated at the St. Marylebone Cemetery, East Finchley. During the year 1,875 (2,013) certificates authorising cremation were issued. Since December, 1937 when the crematorium was opened 43,628 cremations have taken place. 38 PERSONAL HEALTH SERVICES MARJORY A. DAWSON, M.B., Ch.B., D.P.H., Acting Deputy Medical Officer of Health The decline in the City of Westminster's birth rate, perhaps related in some degree to the extension of the City Council's free family planning service, is resulting in a smaller child population. The health visitors, therefore, have less work to do in connection with ante-natal and infant welfare services and can devote more time to the elderly. With the advance of medical science the number of elderly within the community is increasing; and this results in larger numbers requiring surveillance and assistance both from health visitors and district nurses. The increased availability of professional help and advice, not only to residents but also to voluntary associations dealing with the elderly, is a very real advantage. In addition, the Health Department provides health visitor and district nurse attachments to seven general practitioner group practices whose case loads naturally include many in the older age groups. These attachments give considerable assistance to the family doctors and help to promote a valuable screening service to the elderly cared for by the various practices. Not only does this save the doctor's time but especially does it facilitate early warning of a resident's particular medical or physical needs. It will be seen therefore that the role of the district nurse and the health visitor in particular is becoming more orientated towards our older residents. This extension of the sphere of health care is a vital factor in the concept of an overall community health service. INFANT AND CHILDHOOD DEATHS Coupled with a further decline in the number of births, there was a consequential fall in the number of infant deaths, which totalled 30 in 1972 (35 in 1971). Deaths occurring in the first week of life amounted to 19 (19) and of these 11 were due to prematurity and allied causes. The causes of death are set out in detail in Table 2, page 61. It is of interest to record that 27 out of the 30 deaths occurred in local hospitals, with 2 deaths at home; the other death related to a newly-born female child who was found dead at Victoria Coach Station. The cause of death in this case was inhalation of mucus. At an inquest HM Coroner recorded an open verdict, there being insufficient evidence as to the circumstances. In one case, a girl of some 3 months, death in a local hospital resulted from asphyxia. In this case also HM Coroner at an inquest recorded an open verdict. There were 2 unexpected sudden deaths in infancy; boys of 1 month and 2 months respectively. Both deaths occurred in hospital. In the age group 1 — 5 years there were 4 deaths during 1972. Three of these children were normally resident abroad and had been brought to this country from Greece (2) and Libya (1) for treatment. There was also one tragic accidental death — a boy almost 5 years of age who died in the Mount Vernon Hospital from shock due to burns. (Table 2, page 61). MATERNAL MORTALITY Unfortunately there were four maternal deaths reported in Westminster during 1972, there having been one in 1971. The first maternal death was due to intestinal obstruction due to volvulus following a routine termination of pregnancy at 14 weeks of the fourth pregnancy of a 22 year old woman. 39 The second death reported was due to massive haemorrhage from placenta praevia in an eleventh pregnancy presenting as a breech. The woman, aged 43, had had no ante-natal care until a month previously. She was admitted in a state of extreme shock and did not respond to resuscitation. The third death was that of a French woman of 42 who had undergone termination of a third pregnancy at nine weeks, in a private nursing home, who suffered cardiac arrest and failed to respond to all attempts at resuscitation. The fourth death was associated with termination by Caesarian section of an eighth pregnancy of a 33 year old woman because of fulminating pre-eclamptic toxaemia at 35 weeks. She was delivered of a live child but died seven hours later of subarachnoid haemorrhage. HANDICAPPED CHILDREN A register is kept of all children who are handicapped by a developmental defect, by illness or by adverse environmental conditions. Children are entered on this register as a result of hospital reports, including those notified at birth as having congenital malformations, those admitted or investigated because of acute illness, trauma or failure to thrive, or as a result of serial screening when the medical officer finds some deviation from the normal. Westminster is fortunate in having 68 special nursery places available for handicapped children and in addition many of the less severely handicapped are admitted to ordinary day nursery places. As the value of early assessment of handicap has been so clearly demonstrated in previous years there are now 4 full-time medical officers specially trained for this work and 3 more are in training at present. Assessment of Handicapped Children Assessment is undertaken at two levels. First, special clinics for handicapped children staffed by specialist medical officers trained in developmental assessment are run by the City of Westminster. Parents attend by appointment and time is allowed for complete examination with psychometric testing and for parent counselling. Secondly, at two of the teaching hospitals in the area, assessment clinics are held in the paediatric departments. At both, a principal medical officer from the Health Department attends to undertake psychometric testing and co-ordinate further training and parent guidance. Westminster therefore provides a complete and comprehensive service for handicapped children. LOCAL AUTHORITY NURSING SERVICES At the request of the Department of Health and Social Security, the City Council reviewed the Health Department's nursing services and late in 1971 approved the Medical Officer of Health's recommendations for a three tier management structure for the City of Westminster's nursing service. The revised management structure was brought into operation early in 1972 and the necessary nursing appointments were completed by the Summer. At top management level the Director of Nursing Services is responsible for policy and co-ordination of all the nursing services. In the City of Westminster these services are divided into four geographical areas which correspond as far as possible, taking into account the siting of the maternal and child health and district nursing centres, with the four geographical areas of the Social Services Department. An upper middle management nursing officer is in charge of each area, with overall responsibility for all the nursing services in her area. Two lower middle management nursing officers in each area deal with the day-to-day management of the field personnel in health visiting and district nursing respectively. The upper middle management nursing officers also specialize in certain aspects of the nursing services according to their special qualifications and experience. Reports from the individual Area Nursing Officers follow; from these reports it is amply evident that integration of the community services and hospital services is already well under way in Westminster in advance of the forthcoming reorganisation of the national health service. 40 AREA 1 Area Nursing Officer: Miss B. Pearson with special responsibility as adviser to district nurses and for their training. Area 1 includes Queen's Park and Bayswater. Health Visiting Services Queens Park Clinic. The clinic is situated in an area where there are many problems related to poor housing, low income, a high proportion of immigrants, and population changes caused by demolition of old houses and building of new flats. Because of the pressures involved in working in such an area, young staff have tended to leave when their contract with the Council has expired. An area nursing officer has made a study of working conditions in the clinic and her recommendations are under consideration. Twelve sessions a week are held at the Clinic including child welfare, family planning, ante natal, immunisation, special investigation and chiropody services. Hallfield Clinic, Bayswater is situated in a pleasanter area though here too there are families with problems. Twelve sessions a week are held at this clinic including child welfare, immunisation, cytology, special investigation, dental and youth advisory. There is also a highly-attended weekly Mother's Club and three playgroup sessions. In the evening the clinic is used by other agencies including the Social Services Department and the Tenants Association. The nursing staff of both clinics are also concerned with the health of 2,250 school children in the areas. Both clinics have reported a closer working relationship with the Social Services Department since the latter's area office moved to new accommodation in Kensal House Annexe, Harrow Road, W.10. District Nursing Services Since October 1972 the nursing staff have all been based at the Queen's Park clinic. Formerly part of the staff were based at 117 Sutherland Avenue, but the new arrangement enables better management and co-operation with the health visitors who are also centred at the clinic. District nursing staff of Area 1 and Area 4 have continued to train staff for district nursing courses and instruct medical and nursing staff from hospitals in the neighbourhood on the work of the district nurse. At Christmas a group of nurses visited patients' homes singing carols which were much appreciated by their audiences. Arrangements for Area 1 and Area 4 to liaise with St. Mary's Group of Hospitals are under way and the first meeting of senior nursing staff is planned for January 1973. Student nurses from St. Mary's Hospital, Praed Street started their six-week Community Care Course in the summer. Arrangements are also being made for a health visitor to visit the maternity wards in the hospital and advise in the family planning clinics. AREA 2 Area Nursing Officer: Miss P.A. Slack with special responsibilities for health education. Area 2 includes 5 Child Health Clinics from which 12 health visitors, 6 clinic and school nurses, 11 district nurses, 2 bath attendants and 1 clinic auxiliary work. Marshall Street Clinic serves the Mayfair and Charing Cross area and the Middlesex Hospital Child Health Clinic covers Soho. The Westminster Council House Clinic caters for the Marylebone area and also houses the chest clinic for the whole area as well as providing the base for the district nurses and the two nursing officers. 217 Lisson Grove is now the clinic for the new Lisson Green Development and the Linnet Housing clinic serves the St. John's Wood area. Since the implementation of the new structure co-ordination between the clinics has improved and regular area-based meetings between staff from a series of disciplines has fostered good working liaison at local level. 41 Links have been made with the Middlesex Hospital where a liaison scheme to provide continuity of care for Westminster patients was planned to start in 1973. It is envisaged that the two community nursing officers from the area will visit the hospital wards on Wednesday afternoons when follow-up care of Westminster patients due for discharge will be discussed. Health visitors and district nurses participated in 2 Sisters Study Days when both hospital and community staff were briefed: all staff will have an opportunity to participate in the scheme. The work of the health visitor attached to the Geriatric Unit has increased considerably and informal links between health visitors and the Maternity and Paediatric Units continued. Two health visitors are already attached to general practitioner group practices in the area and discussions are taking place as to the possibilities of attaching further staff next year when these practices, together with one other, take up residence in temporary accommodation on the Lisson Green Development in preparation for a final move to the planned Health Centre close by. The work in all clinics including the chest clinic continues as before with increases in family planning and chiropody sessions. Somerset House have expressed interest in cytology and it is planned to start regular sessions there in the Spring of 1973. In common with other areas there was considerable stress from lack of supportive staff at the beginning of the year; however the later months presented a more stable picture. District Nursing Services By the end of the year this, too, was more stable having suffered earlier from considerable movement of staff. The number of patients and visits increased and it is anticipated that there will be a continual rise in view of the Hospital Liaison Scheme which has been warmly welcomed by the Middlesex Hospital consultants planning earlier discharges for their patients. Accordingly we have recruited one extra S.R.N, and a bathing attendant. Since the group has moved to the Council House it has been easier to establish and foster good working relationships with other health department staff in the area and with Social Services, the Old Peoples' Welfare Association and other agencies closely linked with district nursing. The office accommodation at the Council House was moved from the basement to the second floor and it is planned to start a morning clinic in the vacated room in 1973 for injections and dressings. This is for the convenience of patients going to work or those sufficiently ambulant to benefit from the journey to the clinic. AREA 3 Area Nursing Officer: Mrs. E.M. Fisher with special responsibilities for midwifery. Area 3 covers the south of the City embracing the 'Old' Westminster area including Knightsbridge, Pimlico and Millbank. There are three Child Health clinics, at Ebury Bridge, Bessborough Street and Marsham Street, the latter being run on an agency basis by the City of Westminster Health Society. Two senior health visitors were appointed to Nursing Officer posts — one remaining in Area 3 and the other moving to Area 4. Two health visitors resigned, and three newly qualified health visitors were appointed and one experienced health visitor transferred from area 4. Two clinic nurses resigned and were replaced and a third clinic nurse was appointed to help with schools and extra clinics started and act as relief for annual leave and sickness. Seven Child Health Clinic sessions are held per week between the three Clinics. The number of mothers and children attending remain much the same as last year. Children attend for regular developmental checks and immunisations are also given at these sessions. Health visitors are available at all sessions to give mothers any advice needed. 42 Ante Natal Clinics continue to be well attended in all three Clinics by patients booked for their confinements at Westminster. Mothercraft classes are also held. At Marsham Street this is held at six weekly intervals; an Expectant Parent evening is well attended. There is also a thriving Mothers Club held weekly with a good cross section of ages from 20 — 60 year olds. Filmshows are organised, talks are given by outside speakers, demonstrations and outings are arranged. A Keep Fit Class was started in February at Marsham Street Clinic. This has enjoyed considerable success and has 20 — 25 people attending. Mrs. Male from the Kensington and Chelsea Institute is "in charge" of these sessions. The Cytology Clinic at Ebury Bridge continues to be fully booked. Sewing classes are held at each Centre with an ILEA teacher in attendance. These are well supported and children are minded at the creche in each clinic while their mothers are sewing. English classes for immigrant mothers and discussion groups are held weekly at Ebury Bridge Clinic and are popular. Family planning clinics are held at all three Health Clinics: the one at Bessborough Street Clinic is run for the City Council by the Family Planning Association. That at Ebury Bridge was started in April 1972, is now fully booked and there may be a need for a further session in 1973. The Marsham Street Clinic was started in June 1972 and is held in the evening. Doctors devote considerable time to each person and counselling sessions have proved to be of great value. Men are also using this service. Total attendance up to December 31st was 110. The health visitors and one clinic nurse completed their Family Planning Training this year. One health visitor is attached to a group practice in the area and has her baby clinic and a family planning clinic held in the general practitioners' surgery. Chiropody Sessions are held daily in Bessborough Street Clinic and at Marsham Street three times weekly, and are greatly appreciated by the elderly. Three private chiropodists have discontinued their practice in the area. At Marsham Street Clinic the old folk attending are also encouraged to come to a coffee morning held weekly. Here they can make new friends and a health visitor is available for advice and health education. We are hoping this session may in the future develop into a geriatric screening clinic and further promote the welfare of old people in the area. Hospital Liaison — during the past year we have continued to liaise with Westminster Hospital. This includes the health visitors giving a talk to an Ante Natal Class every fifth week and also attending the Outpatient and Consultant Clinics at Westminster Children's Hospital. Both Nursing Officers do a weekly ward round and are able to discuss Westminster Patients with the hospital staff prior to their discharge home. Close contact has continued with other services in the area, in particular with the Social Services Department and the Old People's Welfare Association, also with the Toddlers Club, Task Force and the Pimlico Neighbourhood Centre. School Health Service — Health visitors and school nurses have continued to go into all the schools in the area for statutory medical examinations and comprehensive health surveys. There are 4 Nursery, 10 Primary, 3 Secondary Modern Schools and one Grammar School in the area. One nurse is responsible for the audiology testing of all school children in this area. She also has responsibility for Ebury Bridge Special School and this has necessitated the purchase of more specialised equipment for testing these children. Students — At six weekly intervals for one week throughout the year student nurses from Westminster Hospital have participated in a Community Health Care training programme, and have been based at each clinic to observe the work of the health visitors and all the community Health and Social Services available in the area. Four health visitor students were trained in the area and three health visitor students did their three months supervised practice and were subsequently, after being awarded the Health Visitor Certificate, taken on to the permanent health visitor staff. 43 Home Nursing Service At 31st December, 1972, 280 patients were being nursed. During the year 31,555 visits were made; of these 2,651 were for injections only, 202 were for injections and other treatments, and 28,702 were for all other treatments. During the year 13 members of staff left the service for a variety of reasons and 10 new members were recruited. It was necessary to employ 8 SRN's from private nursing agencies to cover staff shortages. The three group practice attachments are working well with an SRN and SEN attached to two and an SRN attached to the third. Liaison with another group practice has started. In April 1972 a Liaison Scheme was started with Westminster Hospital and has gradually developed. The Nursing Officer goes weekly into the wards to discuss the hospital discharges to the community nursing service with the hospital staff. The existing geriatric liaison with St. Mary Abbots hospital has continued, thus enabling a better continuity of care to be given to patients in the area. During the past year 2 SRN's and 2 SEN's qualified for National Certificates in District Nursing; 1 SEN was from the Middlesex Hospital Integrated Nurse Training Scheme. Twenty community care students from Westminster Hospital each spent 1 week with the district nurses as part of their six weeks' Observation of Community Services. Twelve pupil nurses from Westminster Hospital each spent two weeks working with the district nurses during their SEN training. Two SRN students from St. Mary's Hospital Praed Street each spent one day observing the work of the District Nursing Service. The nursing officer attended a first line Manager's course at Chiswick Technical College, two senior district nurses undertook the Practical Work Instructors Course, and another attended a Refresher Course. Two district nurses attended study days. Miss Jones, District Nursing Sister, resident in the Royal Mews, provides nursing care for members of the Royal Household staff. She is relieved for annual leave and days off by a part-time SRN also living in the Mews and when necessary by the nurses from the Great Smith Street base. The cost is reimbursed to the City Council. AREA 4 Area Nursing Officer: Miss A.H. Kane with special responsibilities for health visitor students and as health adviser to the Social Services Department's day nurseries. Health Visiting Services The staff for this area of Paddington are based at the Maternal and Child Health Clinic situated at 283A Harrow Road together with three part-time nurses at the Paddington and Kensington Chest Clinic. When fully staffed the nursing staff at the Harrow Road Clinic is comprised of the lower middle nursing officer, fifteen health visitors, one school nursing sister, four school/clinic nurses, four auxiliaries and four part-time nursing assistants; these latter work in the play group sessions. Two of the health visitors are attached to general practitioner group practices in the area, and one health visitor is a field work instructor. Two health visitors hold child welfare clinics in St. David's Hall, and since 2nd October, 1972, in the mobile Health Clinic situated in Lanark Road, W.9. The latter clinic was formerly held in Dibdin House, Maida Vale, W.9. Sessions are held in the unit weekly, the health visitor being in attendance at each session, and a doctor attending every other week for advisory and immunisation sessions, and alternate weeks holding child development clinics in the Harrow Road Centre to which the mothers are invited to attend as the Mobile Unit is not suitable for the necessary examinations. For the first three months attendances were similar to those in Dibdin House compared with the figures in the October to December months in the previous year, but since Christmas they have been dropping slightly. There are several reasons for the decline including the fact that the birth rate for the area has been lower over the past three months, and also as there is no room in the Mobile Unit for the toddlers to play, the mothers have been less inclined to bring this age group and younger members of the family into the clinic as frequently as when the clinic was held in Dibdin House. Total clinics held weekly in the Harrow Road Health Clinic are 47, including child health, family planning, cytology, special investigation, ante-natal, dental and chiropody sessions. There are also mothers' clubs, and six playgroup sessions per week. The staff are also concerned with the health of 7,000 school children in the area. 44 Liaison with St. Mary's Hospital, Harrow Road, continues as before with health visitors visiting the patients in the Maternity Wards to advise on family planning and make appointments for the clinic held at 283A Harrow Road which the Gynaecological Registrar from the hospital attends. Since May 1972 when family planning supplies became free, the numbers attending the family planning clinics have risen and it may be necessary to increase the number of sessions. At the end of 1972 the Area Nursing Officer visited the Samaritan Hospital to interview the nursing staff of the Wednesday evening Family Planning clinic who were to be transferred to the City Council when the Health Department became responsible for the clinic in January 1973. The Harrow Road Clinic suffered during the year from shortage of nursing staff, particularly of school/ clinic nurses. Two health visitors left in September, one to take the Health Visitor Tutor's course, the other to study for a degree, neither of whom it has been as yet possible to replace. The extra work taken on by the two health visitors who are attached to the general practitioner group practices means that they are not able to relieve the health visitors in the Centre when required in such instances as annual leave; at times therefore some of the staff are considerably overworked. The group practices where the health visitors are attached have also asked for more health visitor assistance which of course is not possible at present with an overall shortage of staff. District Nursing Services The Centre for the District Nursing Services for Area 4 is situated at 117 Sutherland Avenue, W.9. Here again there have been some changes and shortages of staff which have added to the work of the staff on duty but as many letters from patients and patients' relatives have been received expressing gratitude for nursing care given, the nurses are to be congratulated on their standard of work. One of the new members of Staff, Miss de Monti, SEN who completed her district nurse training on the area, recently won the Most Outstanding Pupil of the Year award from her training school, the Middlesex Hospital. The staff have also given their time to other tasks in addition to their routine nursing duties. A six half-day training course for Bathing Attendants in the City of Westminster was organised by Miss Ball, the nursing officer in charge of the centre and staff from the Centre and Area 1 district nurses participated in training courses for Home Helps and Care Assistants, organised by the Social Services Department. In July 1972 at the instigation of the Queen's Institute, the Nursing Officer was honoured with an invitation to a garden party at Buckingham Palace. At Christmas the nursing staff distributed food and gifts to needy patients provided by the District Nursing Association and the children of St. Saviour's School. On Christmas Eve staff helped to deliver to patients frozen meals provided by the City of Westminster Old People's Welfare Association and to transport patients to and from Leonora House, Lanark Road, W.9 on Christmas Day for the lunch, entertainment and tea provided by the Association. NURSE TRAINING During the year Health Department nursing staff attended In-service Training, Refresher and Management Courses and Conferences as indicated:— Courses/Conferences No. of staff attended Middle Management Courses 2 First Line Management Courses 3 Health Visitor Refresher Courses 6 District Nurse Refresher Courses 2 Study Days and Conferences 93 In addition, the City Council sponsored and assisted in the training of 8 health visitor students and 6 district nurse students. 45 Further, 223 student nurses from local hospitals received community experience and an additional 62 attended a six week community care course. It is proposed to extend the community care course to 96 places in 1973. Thirteen SEN pupils and 2 SRN students received community experience leading to their integrated certificate. DOMICILIARY MIDWIFERY SERVICE During 1972 the City Council continued to provide a domiciliary midwifery service to meet the needs of mothers wishing to be confined at home and for those who were confined in hospital and whose social conditions permitted early discharge. In the S.W.I.area Westminster Hospital provided the service on an agency basis for the City Coulcil. During the year discussions continued with St. Mary's Hospital, W.2 to negotiate an integration of the domiciliary and hospital midwifery services to cover the remainder of the City. The approval of the Secretary of State for Health and Social Security was given in December 1972 and arrangements were concluded with the Board of Governors of St. Mary's Hospital. The Inner London Executive Council and the Inner London Local Medical Committee were consulted and they welcomed and supported the proposals. This joint venture between the City Council and the hospital is another step towards the forthcoming reorganisation of the National Health Service in 1974. The revised arrangement came into operation on Monday 1st January, 1973, and the Council's midwives are based at St. Mary's Hospital, Harrow Road, W.9. They continue to conduct home confinements when required and do ante-natal visits and post natal nursings for early discharge patients. They are employed in the hospital in the labour wards and lying-in wards and the Ante-Natal and Post Natal Clinics, enabling them to maintain their efficiency and gain additional experience. Nurses from the Middlesex Hospital again spent a day with the City Council's Midwives as part of their obstetric training. Three midwives were in post at the beginning of the year. Two resigned early in the year and were replaced by 1 permanent member. Agency nurses were engaged for relief during periods of annual leave and sickness. The City Council's midwives attended 6 home confinements during 1972 in addition to ante- and postnatal nursing, and took 159 blood samples from babies for Guthrie Tests to detect Phenylketonuria besides those taken as a routine on babies discharged from hospital before their seventh day of life. Details relating to the number of domiciliary confinements and early discharges nursed in 1972 are set out in Table 38, page 81. LOAN OF HOME NURSING EQUIPMENT The service provided by the City Council under the scheme for the free loan of home nursing equipment continues to fulfil the needs of Westminster residents and to ease the burden of those who have the problem of nursing sick relatives at home. The provision of this equipment often enables the ailing to be nursed at home and thereby postpone or obviate hospital admission; also by the provision of essential nursing aids many patients are able to be discharged home from hospital earlier than would be possible otherwise. Items requested tend to follow the pattern of previous years. My gratitude is extended once more to the British Red Cross Society (Westminster Division) for their continued help in the distribution of smaller items of equipment. 46 The following items were issued during the year in addition to equipment already on loan:— Air rings 33 Back rests 53 Bed cradles 48 Bed pans. 29 Bed tables 2 Carri chairs 1 Commodes 246 Cot sided beds 4 Dunlopillow mattresses 17 Easi carri hoists 6 Fracture boards 49 Hospital beds 18 Penryn hoists 11 Quadrupeds 7 Ripple mattresses 14 Tripods 15 Urine bottles 17 Walking frames 112 Wheelchairs 98 VACCINATION AND IMMUNISATION Vaccination and Immunisation against diphtheria, tetanus, whooping cough, poliomyelitis, measles and smallpox are available to all children under school-leaving age, either at the child health clinics, in schools or at the surgeries of their family doctors. Smallpox vaccination is also available in the medical suite at City Hall for adults residing or working in Westminster; 95 adults were vaccinated in 1972 in addition to 72 at maternal and child health clinics. Immunisation against poliomyelitis and tetanus is also provided for adults on request. In mid-1971 the Joint Committee on Vaccination and Immunisation recommended that routine vaccination against smallpox should be discontinued. Accordingly smallpox vaccination has been deleted from the children's vaccination and immunisation programme and such vaccination is now only provided on request for children who are going abroad and require an international certificate. Rubella vaccination, started in 1970, is available to all girls aged 11 — 13 and special sessions for this purpose are arranged in senior schools. CRECHES In addition to the occasional creches which are available at the larger Maternal and Child Health Clinics for the minding of children whilst their mothers attend clinic activities, hospital or dental appointments, the Health Department provides therapeutic playgroups for children under 5 years of age at four of these clinics. These latter accept children who are understimulated at home, or are failing to thrive due to adverse housing conditions or for other reasons. Such children are recommended for entry by doctors or health visitors. Whilst at the playgroups they have the chance to mix with others and their progress can be observed by the professional staff. During 1972 the total number of child attendances at the occasional creches and the therapeutic playgroups was 12,120. NURSING HOMES Eleven nursing homes are registered with the City of Westminster, all of which take medical patients; 6 also take surgical patients; 3 take maternity patients and one is registered under Part 3 of the Mental Health Act 1959 to take patients suffering from mental illness. Three of the homes are non-profit making organisations. Under Section 1 of the Abortion Act 1967, six of the eleven registered nursing homes applied to and were approved by the Department of Health and Social Security to take patients for treatment for the termination of pregnancy. During 1972 one additional nursing home was opened providing 29 beds for geriatric patients. One established nursing home changed ownership and after structural alteration, redecoration and refurbishing reopened to continue similar services as offered by the former proprietors. The construction of a further purpose-built nursing home is expected to be completed in 1973. 47 A Principal Medical Officer and a Public Health Inspector regularly visit the nursing homes to inspect the premises, check the service provided, and give advice on alterations and improvements. By this means all the nursing homes are maintained to the required standards. Guidance is also given to enquirers seeking advice on general requirements prior to considering a nursing home project in detail. HEALTH EDUCATION During 1972 a number of first-class professional films were shown to members of the Health Department staff and invitations were issued to Social Services, Hospital staff and many voluntary organisations when the subjects were appropriate. The response was excellent and lively discussions were followed by individual action. These meetings also provided an opportunity to strengthen links between the various Health, Social work and hospital disciplines. The Health Department's Assistant for Health Education left the City Council's service in the autumn and it was not found possible to appoint a successor. In the meanwhile the City Council approved an additional post of Health Education Officer as from 1st April, 1973 and in the intervening period the duties of the Assistant for Health Education were taken over by an Area Nursing Officer and a Senior Administrative Assistant. In September, under the chairmanship of the Area Nursing Officer, a small working party composed of Nursing Officers from the Health Visiting and District Nursing disciplines was formed with the aim of planning a comprehensive programme of Health Education for 1973. Monthly topics corresponding with national and local projects were arranged and staff briefing notes for the year were circulated to all staff concerned. Topics arranged for 1973 are as follows:— Mental Health to include stimulation of the pre-school child; Nutrition; Family Planning; Dental Health; Resuscitation; Smoking, Health and Beauty; Servicing of Oil Heaters; Feet; Back to School; What to do in case of illness; Fireworks; Reminder on servicing of oil heaters; Hypothermia, and choosing toys for Christmas; Christmas safety. Plans for the January and February topics were laid before Christmas and it was agreed that the former should concentrate on stimulation of the pre-school child. The Children's Librarian of the Libraries Department agreed to participate and used the Maternal and Child Health Clinics during January to exhibit children's books and encourage and advise mothers on suitable reading material for young children. Several playgroups agreed to participate in having open days when parents could visit and be given practical instruction and teaching in play materials and methods. Health Visitors issued invitations and encouraged families most in need of this kind of information to attend the open days. The health visitors were also available to participate and help with instruction. It was hoped that the scheme once launched would be a continuing process. 48 It was decided that the February topic on Nutrition should concentrate on the elderly and for this a separate working party was set up including Miss MacLaughlin, Chief Dietician from the Middlesex Hospital, and representatives from the City of Westminster Old People's Welfare Association. The working party planned to conduct a small survey on the buying and eating habits of the elderly in the area, and on the results to base a mobile exhibition to be used in chiropody clinics and luncheon clubs throughout the City. It would be manned by student dieticians and health visitors. By the end of 1972 plans for Health Education in 1973 were well established and these should provide a firm foundation on which the Health Education Officer can base future campaigns. FAMILY PLANNING On 1st February, 1968, the City Council approved arrangements for the implementation in the City of Westminster of the National Health Service (Family Planning) Act 1967. All forms of contraception were provided to all residents of Westminster irrespective of marital status or sex. Those persons recommended on medical grounds received advice, appliances and other supplies free of charge, whilst those seeking guidance on non-medical grounds received free advice but a charge was made for appliances and supplies. The service was provided and continues to be so, in part directly by the City Council and in part on an agency basis by the Family Planning Association, the latter in company with the Catholic Marriage Advisory Service being granted the use of accommodation free of charge in Health Department establishments. Persons living outside the City of Westminster may attend the Family Planning Association's clinics run by the Council's establishments in which case the Association applies to the appropriate local authority for reimbursement of their expenses. This arrangement is especially valuable to the public. It is a common practice of patients to choose a clinic not necessarily in their home area and this especially affects the City of Westminster since large numbers of young girls and women travel from the suburbs into the City to work and seek the anonymity of clinics in the area. Early in 1972, the Medical Officer of Health reviewed the availability and sufficiency of free birth control services in the City. Since the introduction by the City Council of a free service accompanied by the supply of free contraceptives could possibly have an adverse effect financially on general medical practitioners and chemists, the Medical Officer of Health drew this aspect of such a scheme to the attention of the Inner London Executive Council, the Inner London Local Medical Committee and the Inner London Local Pharmaceutical Committee. No objections were received. The Medical Officer of Health presented his report to the Health Committee and subsequently the City Council approved the provision, as from 1st May, 1972 of an entirely free family planning service, including free contraceptives, to all Westminster residents whether attending on medical or non-medical grounds. The City Council considered the decision to be amply justified if it served to encourage wise family planning, bearing in mind that unwanted pregnancies often led to child neglect and could generate a demand for children to be taken into care. In addition the City Council authorised the issue of free contraceptives to patients attending their own medical practitioners for family planning advice, on presentation of an appropriate prescription. General medical practitioners in the City of Westminster were informed of the City Council's free family planning service and to assist them a special prescription form was devised; pads of prescription forms together with a list of contraceptive supplies available under the scheme were sent to medical practitioners on application. After completion by the doctor, patients are at liberty to present the prescriptions at any of the family planning clinics run directly by the City Council or by the Family Planning Association for free issue of the prescribed items. Considerable publicity was given to the introduction of the free service. This took the form of posters and leaflets displayed at the Health Department's three administrative centres, the maternal and child health clinics and the district nursing centres. By arrangement with the Chief Officers of the departments concerned some 150 posters and 4,000 leaflets were distributed for display at the City Council's Public Libraries, Day Nurseries and Social Services Department's area offices, the Finance Department's cash receiving points, the Baths and Halls establishments, Housing Estate Offices and public conveniences. In addition, supplies of leaflets and posters were sent to the Citizens Advice Bureaux. General practitioners in the City were sent a poster and leaflets for display, if they so wished, in their surgeries. In total over 500 posters and 7,000 leaflets were distributed for display throughout the City. 49 The Chief Information Officer arranged for advertisements containing the particulars given on the leaflet (i.e. general information about the City Council's free family planning service together with details of available family planning clinics in the City) to be prominently displayed in the local press for two consecutive weeks. Concurrently with the advertisements an article by a member of the Chief Information Officer's staff appeared in the local newspapers outlining the development of the family planning service in Westminster. Further, the advertisement, reproduced in full, appeared in the September issue of "Information Westminster" — the City Council's quarterly publication issued free to the public giving advice on civic matters of interest and importance to residents. The advent of the free service and the publicity given to it resulted, as had been predicted, in an acceleration of demand. To meet this and to reduce the waiting time for appointments for new patients three additional family planning sessions a week were started in the latter half of 1972. The trend continues and extra sessions will be opened as and when these prove necessary. At the end of the year 16 family planning sessions were being held weekly. In addition, a youth advisory service with counselling as the main object is available at two centres; details of this service are set out in the next section. The estimates for the financial year 1972/73 were prepared well prior to the conception and subsequent approval by the City Council of a free family planning service to all Westminster residents. Calculations indicated that a very substantial additional sum would be required to meet the extra cost of the free service. The City Council approved this estimated expenditure giving a total provision for family planning of approximately £62,000 for that financial year. A sum of £75,000 has been estimated for 1973/74. For some years the City Council has given financial assistance towards family planning clinics run at the Westminster, Middlesex and St. Mary's Hospitals and the Samaritan Hospital for Women. Payment by the Council is made in respect of services provided to Westminster residents who attend the hospital clinics and is in the form of a yearly grant or of sessional fees of the medical officer or nursing staff as appropriate. A post-natal family planning service staffed jointly by the City Council and St. Mary's Hospital, Harrow Road, W.9 for mothers confined in that hospital is run at the Maternal and Child Health Clinic, 283A Harrow Road, W.9 with both authorities sharing the expenses. With the proposed reorganisation of the National Health Service in April 1974 in mind. Professor Beard of the Department of Obstetrics and Gynaecology, St. Mary's Hospital Medical School approached the City Council for co-operation in a venture to develop a comprehensive family planning service for hospital patients at St. Mary's Hospital Praed Street, W.2 and at the Samaritan Hospital for Women, Marylebone Road, W.1. It was proposed that a combined post-natal and family planning clinic should be run at the Praed Street Hospital on the same lines as that currently operating at Harrow Road. The hospital would provide a registrar and the accommodation, and the City Council would provide a medical officer, a clerk/receptionist and a nurse as well as the free supply of the appropriate contraceptives. The International Planned Parenthood Federation, who were running a weekly evening family planning clinic at the Samaritan Hospital for Women, indicated their wish to withdraw their services at the end of 1972. It was proposed that this clinic should be taken over by the City Council and free supplies provided. The Medical Officer of Health strongly recommended co-operation with the hospital authorities on these projects and the City Council approved. The arrangements at St. Mary's Hospital, Praed Street have proved highly successful and the response from the patients so encouraging that a second weekly session has been opened. Grants continue to be made to the Middlesex and Westminster Hospitals. A domiciliary family planning service has been in existence in the Paddington area of the City for many years. Experience showed however that it was difficult in practice for doctors and nurses adequately to carry out the necessary physical examination, fitting and instruction in the use of contraceptive appliances in the homes of the patients concerned, particularly as these were often members of problem families. Moreover, it was largely because of problems arising from their families and home conditions that they had difficulty in attending the clinic. As an alternative, therefore, arrangements were made for health visitors to visit these mothers to persuade them of the need for family planning and then to make such arrangements as might be necessary — for example, by the provision of baby sitters and transport to take them to the appropriate clinic for family planning advice and service, and return them home afterwards. This arrangement has worked extremely well and this modified service has been extended over the rest of Westminster. 50 Youth Advisory Service The City Council's overall family planning service inaugurated in 1968 under the provisions of the National Health Service (Family Planning) Act 1967 included the setting up of a counselling service for Young persons seeking advice on family planning matters and adolescent problems. The service, currently 2 sessions a week, is run by a general practitioner, a specialist in this field. One session is held in the doctor's consulting room in St. Marylebone, a grant being made by the City Council towards the running costs, and the second at the Hallfield Maternal and Child Health Clinic. On this work the doctor is assisted by two social workers deployed by the Director of Social Services, who not only are in attendance at the sessions but provide a very necessary link with youth clubs, discotheques and the like as well as an extremely valuable follow-up service. A Health Department secretary acts as a receptionist at the Hallfield Clinic sessions. The number of young persons seen at each session is deliberately kept low, about 10, to enable the counselling by the doctor and the social workers to proceed in a leisurely and unhurried manner. This has produced highly satisfactory results to all concerned. Vasectomy The National Health Service (Family Planning) Amendment Act 1972 received Royal Assent on 26th October, 1972, the main purpose of the Act being to place vasectomy on the same basis as other contraceptive services which local health authorities may provide with the approval of the Secretary of State for Social Services. The Secretary of State commended the provision of such a service to local authorities and gave general approval for the making of arrangements under the Act. Both he and the Chief Medical Officer to the Department of Health and Social Security issued circulars giving advice and guidance especially on the need for a very comprehensive counselling service to the prospective patient and his partner, facilities for the operation and subsequent pathology and the qualifications required by the operating doctor. No accommodation in the City Council's Maternal and Child Health Clinics being suitable for the performance of this operation, the Medical Officer of Health approached four principal hospitals in Westminster and the Family Planning Association seeking information as to what facilities could be offered in accepting residents for counselling and the operation, including pathology and follow-up. Reports were subsequently placed before the Health Committee and the City Council formally approved a free vasectomy service for Westminster residents as from 1st May, 1973, using initially the services offered by the Family Planning Association, the Marie Stopes Memorial Centre and Westminster Hospital. VENEREAL DISEASES At the special clinics for the treatment of sexually transmitted diseases based in four teaching hospitals in Westminster, the total number of cases treated has steadily increased over the years reaching 48,893 for 1972 (45,652 in 1971). Details are given in Table 40 page 82. Since 1965 the City Council has maintained a 24 hour 7 days a week Public Enquiry Telephone Service (928 3401). This telephone is manned by lay staff who naturally do not give medical or nursing advice but impart information to enquirers regarding the whereabouts of suitable clinics and the days and times when these are held. Appropriate literature is sent to those who request it. Operative as from 1st December, 1972 the Department of Health and Social Security made arrangements with the Post Office for the introduction in the Greater London area of a telephone recorded information service giving information about venereal diseases which advised the public, inter alia: "If you are in Greater London and do not know where your nearest clinic is, ring 01-928 3401 (the City Council number); or if you have the 1972 London Postal Area S—Z telephone directory, look under "Venereal Diseases" where you will find a list of the clinics in the London Area". During the first few weeks of the introduction of this service there was extensive misuse of the City Council's line (928 3401) and the Health Department was inundated with bogus calls, some being suggestive and unpleasant. It was necessary to place a clerk on full time duty to answer that telephone. By the end of December however the novelty had expended itself and the City Council's personal telephone service reverted to the usual 20 to 30 calls a week, bona fide requests for advice and assistance. 51 It is of interest to note that the number of calls received on the Health Department Special Enquiry telephone materially increases following any nation-wide publicity given to venereal disease by such means as television or radio programmes or a leading article in a national newspaper; and after pop music festivals in the Home Counties. RECUPERATIVE HOLIDAYS On a doctor's recommendation the Health Department arranges for adults who have been suffering from a recent illness, expectant and nursing mothers with babies or children under 5 years who cannot be left at home, to receive a recuperative holiday. School children similarly recommended are the responsibility of the Inner London Education Authority which bears the cost and arranges suitable placement. The holidays are usually of two weeks duration and the recipients are accommodated in voluntary or private homes and in ordinary boarding houses. Difficulty is experienced, because of limited suitable accommodation, in placing some of the more elderly, psychiatric patients and mothers with babies and very young children. Medical or nursing care is not provided but some of the proprietresses are trained nurses and medical attention can always be obtained should this prove to be necessary. The City Council would wish once again to express its appreciation of the help and care given by the proprietors of the various establishments who accept Westminster residents. These holidays are of immense value to the recipients giving them relaxation, fresh air, good food and a happy atmosphere. It is of considerable satisfaction to the Health Department's staff to receive many letters of thanks from the patients after they have returned home and in some cases a card sent from the holiday resort. The total number of applications received during 1972 was 276 (278 in 1971) of which 179 (175) received holidays. The remaining 97 were abortive due largely to the patients not taking up offers made to them, to appropriate accommodation not being available or to the persons recommended not being considered suitable or not coming within the scheme. The 179 holidays were arranged for:— 1972 1971 Nursing mothers 1 3 Tuberculous adults Nil Nil Other adults 76 76 Accompanied children 10 12 Unaccompanied children under 5 years 1 1 School Children 91 83 179 175 Of the "other adults" 12 were psychiatric cases, as was the nursing mother. BLIND OR PARTIALLY SIGHTED PERSONS Under the provisions of the National Assistance Act 1948 the City Council's Social Services Department provides services for registered blind and partially sighted persons. On behalf of that department the Health Department arranges medical examinations as required of such persons in respect of certification under the Act. During 1972 121 (125) examinations were undertaken of which 31 (37) were in respect of new cases and 90 (88) were re-examinations of existing patients. In addition, 56 (44) certificates were received from hospitals and other local authorities. 52 CHIROPODY SERVICES Chiropody treatment is made available under Section 28 of the National Health Service Act 1946 for the elderly, handicapped, expectant mothers and children, at various centres in Westminster. These include maternal and child health clinics, the City of Westminster Old People's Welfare Association centres and the Centre for the Handicapped, 10 Warwick Row, S.W.1. This last, run by the Social Services Department, is particularly suitable as many handicapped persons already attend the Centre to participate in other activities. Chiropodists also visit residential homes for the elderly some of which are situated in the City Council's area and others as far afield as Pinner, Ealing and Virginia Water. Arrangements continue whereby patients are referred to two private chiropodists for treatment in their own surgeries on a fee per treatment basis. A domiciliary service is provided for housebound patients both by the full-time and the sessional chiropodists. The City Council is fortunate in having the Chelsea School of Chiropody situated in the St. Marylebone area. A close liaison exists between the Council's Chief Chiropodist and the Principal; the Medical Officer of Health would once again wish to express his thanks for the assistance given by the School in providing treatment to some 25 — 30 Westminster patients a week. Two minibuses are operated by the Health Department, and amongst other duties, are used to transport suitable semi-ambulant patients between their homes and the various centres for chiropody treatment. This is very popular with this type of patient since it gives them the chance to leave their homes for a short while and to meet other residents. This aspect of the service is being expanded wherever possible. Consideration was given to the provision of a workshop for the making of foot appliances. However, in view of the impending reorganisation of the National Health Service it was decided to continue the present adequate and satisfactory arrangement with the London Borough of Camden who make any required appliances to the City Council chiropodists' specifications. The Chief Chiropodist supervises the re-equipping of clinics with modern equipment within the budget provided and has the working of the service under continuous review. The demand for chiropody continues to increase and the City Council's revenue budget forecast for 1973/74 includes an additional 3 positions of senior chiropodist. At the end of the year a total of 64 sessions per week were being worked at centres, approximately 30 treatments were provided in chiropodists' own surgeries each week, and approximately 195 treatments were provided in the homes of patients each week. (Table 39, page 81). CERVICAL CYTOLOGY Cervical cytology clinics continued at four of the Council's centres and attendances remained fairly steady. In all 1,659 patients were examined of which 969 were paying their first visit and 690 repeat visits. During 1972 the normal five year follow-up examinations of those women first attending in 1967 began. Positive smears were found in four women aged between 31 and 61 years. In addition 346 women attending for the first time were suffering from various gynaecological conditions detected at clinical examination and were referred to their own general practitioners for treatment and/or further investigation. The service is available to all women living or working within the City of Westminster and publicity material is constantly displayed in various centres and public places. Our thanks are once again due to the staff of the Samaritan Hospital undertaking the laboratory examinations. Dr. Bate retired at the latter part of the year and his successor. Dr. Coleman, continues to give valuable assistance in providing this service. 53 STAFF MEDICAL SERVICE The Staff Medical Service continues to expand. The attendance of 1,710 members of the Council's staff at the medical suite in the City Hall during 1972 showed an increase of some 50% on the previous year's attendance of 1,185 persons. Of the 1,710 persons attending for medical attention or advice, 115 were referred to their own general medical practitioners or to hospital. The number of new entrants to the Council's service remained fairly steady, as did the number of physical examinations necessary in respect of applicants joining the staff. One hundren and ninety-one disabled persons were medically examined in regard to their applications for exemption from parking meter charges. One hundred and forty members of the staff on extended sick leave were interviewed, compared with 95 in 1971. It is also of interest to note that 42 members of the Council's staff were retired on grounds of permanent ill health (27 in 1971). These aspects of the staff medical service frequently involve visiting members of the staff in their homes, which can be very time consuming when long distances are involved. As part of the staff medical service, medical examinations of drivers are carried out for suitability for heavy goods vehicles driving licences. Once again, immunisation and vaccination of staff and of members of the public, remained at a fairly steady level. Statistics relating to the Staff Medical Service in 1972 are set out in Table 41, page 83). SOCIAL WORK (PERSONAL HEALTH) Miss I.J. McFarlane, M.A., Principal Social Worker There have been many new developments in the social services during the last year and rapid social changes have taken place. Part of the job of a social worker is to make an increasingly complex variety of welfare services comprehensible to the individual client, and relevant to his or her particular needs. It is vital, therefore, that one's knowledge is kept up to date and that where appropriate new skills and techniques are acquired. Throughout the year the social workers in the Health Department have been taking part in a number of seminars, courses and conferences. There are fifteen social workers, including the Principal Social Worker, in the Health Department, who undertake the following duties: Three are concerned with elderly people in need of intensive care; five are involved in social work within the School Health Service; six work as special clinics for the treatment of venereal diseases. Old People's Welfare Three social workers are concerned with the social and personal needs of the elderly, particularly those who are frail and who require intensive supervision. Many of them are housebound and suffer from adverse social conditions and they require a great deal of personal support. The social workers arrange visits from home helps, district nurses and ask for the assistance of public health inspectors in relation to tenants in unsatisfactory housing accommodation. A considerable number of home visits are carried out by a medical officer accompanied by a social worker. It is generally agreed that many old people have great difficulty in meeting their basic needs for warmth and food. Improved community resources for domiciliary care are in many cases urgently required and it is part of the social worker's job to make known the instances where the community services are inadequate. On the other hand a wide range of supportive services is available to many old people and every encouragement is given to them to make full use of these facilities. Westminster has a high proportion of elderly residents and much thought is being given as to how their needs may be identified and met. 54 The social workers co-operate closely with colleagues in statutory and voluntary agencies and in particular with the Westminster Old People's Welfare Association. In 1972 there were 256 (315) new referrals; the case-load at the end of the year was 376 (697). There were 5,347 (5,776) home visits and 74 (100) interviews in the office. The decline in case-load arose from the fact that intensive care was given to fewer old people rather than superficial care to a larger number. School Health Service Five social workers specialise in work connected with the School Health Service and they ensure that the school children referred to them have access to the many facilities which exist for their medical supervision and treatment. Social work help is provided as and when required. Owing to the number of children awaiting appointments at special investigation clinics it is hoped to arrange for an additional clinic to be started early in 1973. Children receive help at these clinics in connection with enuresis and obesity, minor behaviour problems and with failure to make satisfactory physical and educational progress. Many children who attend show early emotional problems and this aspect of the work is being developed. The service offered to them and their parents is one of preventive casework. The importance of this preventive side of the work cannot be over-emphasised as the treatment of minor behaviour problems often prevents more serious difficulties from developing. The behaviour problems dealt with are those not suitable for a child guidance clinic or where the family cannot accept the idea of child guidance at the time although referral there may later be necessary. Valuable links with the child guidance service for consultation and assessment have developed particularly at Paddington Day Hospital and the Middlesex Hospital (Department of Child Psychiatry). During the year it was arranged that a Psychiatric Registrar from the Middlesex Hospital would undertake work at one of the special investigation clinics and early in 1973 it is hoped to arrange for a second registrar to be appointed at another clinic. The hospital staff welcome this arrangement as it helps to make them more community orientated. The weekly seminars led by the Council's Consultant Psychiatrist continued throughout the year. The interchange of ideas and opinions between medical staff and social workers has proved, and is proving, most useful. Invaluable team work is being carried out and there can be no doubt of the value of such discussions. In connection with the special investigation clinics in 1972 there were 107 new referrals and 768 attendances were made at 227 sessions. There were 628 home visits and 43 interviews with clients at City Hall. The number of families with whom social workers were in contact at the end of the year was 217. In some cases the presenting problem at the time of referral to a special investigation clinic may clear up after a comparatively short time but the social worker continues to be involved with the family as there may be other difficulties. Frequent home visits and liaison with other social workers is necessary and intensive support and a comprehensive service is given to such families. The number of these cases at the end of the year was 49 and 583 home visits were made. There were 39 interviews with clients at City Hall. (These numbers include certain cases referred for specialised help which are not connected with special investigation clinics). In connection with our case work service for the families of children attending special schools the following point should perhaps first be made. Social work is basically the same in all work with handicapped children although some specialisation and knowledge of the individual handicap is required. One of the social workers has a responsibility for children who attend special schools and another for children who are deaf or partially hearing. It is important that a supportive service is offered to parents with the aim of enabling their children to live as full a life as possible within the limitations imposed by their handicap and also to help their families operate more effectively. It is very apparent that difficulties within the family may well be mitigated if guidance and support are available to parents in the early days when they first realise that their child is in need of special education. It is at this stage that much can be done to ensure that maximum benefit is derived from the educational services available. The social worker responsible for children attending special schools was in touch with 32 families at the end of the year and made 90 home visits. There were 15 interviews at City Hall. 55 Much attention is also given to the child who is deaf or partially hearing. In some cases the social worker responsible for these children maintains personal contact with the family for a considerable time and gives social work support in whatever way she considers necessary. It is important for her to know what services are available to help a particular child and she acts as a link between the home, the school and other agencies. She has a first hand knowledge of the child's background and can often play a useful role in interpreting family relationships. During the year this social worker made 19 home visits. In addition she attended the Audiology clinic where the total number of attendances was 359. Venereal Diseases Six social workers are employed at three hospitals which have special clinics for the treatment of venereal diseases. Their duties include tracing contacts and following up defaulters and arranging for them to attend for diagnosis and treatment. A considerable amount of their time is spent in dealing with a variety of social problems encountered in their work. Many of the patients who attend the clinic require a great deal of moral support as well as practical assistance. The educational aspects of this work are becoming increasingly important and the social workers are in a favourable position to educate their clients with regard to their responsibility to others without moralising or being judgmental. During the year the social workers interviewed 5,123 patients in the clinics and made 2,043 home visits. Owing to the increased attendances at these special clinics it has been found necessary to increase the establishment by the appointment of another full-time social worker who commenced duties in April, 1973. Co-ordination As from the beginning of October 1972 it was agreed that co-ordinating case conferences would in future be held in the Area Social Services offices and that the Health Department Principal Social Worker would no longer act as Secretary of the conferences. She would, however, remain as Secretary of the main Co-ordinating Committee. From January to October 1972, 22 case conferences were held and 55 families were discussed. Families were referred for discussion at the request of any social worker or agency interested in the family. The importance of referral at an early stage has always been stressed, particularly when financial pressures were building up or when some strain in the family relationships appeared to be becoming so intolerable that the unity of the family was in danger. An essential part of the Principal Social Worker's job is to maintain contact with other statutory and voluntary organisations throughout the City of Westminster and this she continued to do throughout the year. Another very important link is that between the school medical service and the education welfare service and here again every effort has been made to maintain and strengthen the liaison which has already been successfully established between these two services. SCHOOL HEALTH SERVICE Section 30 of the London Government Act 1963 places the responsibility of providing a school health service upon the Inner London Education Authority; the day-to-day operation of the service in Westminster is my concern as Principal School Medical Officer. Arrangements were made under provisions in the Act for the joint use by the City Council and the Authority of professional and clerical staff and of premises. The following report to the Inner London Education Authority was submitted in respect of the school health service for the year 1972. The usual arrangements have been made for sessions in schools to cover health surveys by school nurses and audiological sweep testing, school medical inspections, re-inspections and special medical examinations. Extra sessions have been arranged for examinations prior to school journeys by school nurses and for immunisation as and when required. At most of the schools the accommodation for medical examinations is inadequate. 56 School Medical Officers Out of the total of 56 schools in Westminster, one is attended by a local general practitioner, twenty by sessional medical officers and thirty five by whole-time medical officers. Some difficulty is experienced in recruiting medical officers for school work. Only one general practitioner is now helping in this way. Most of them are too busy in their practices to undertake regular sessions. However there are now 7 sessional medical officers doing school work. Two of these are men and between them they undertake the senior boys' schools of the area. Handicapped Children Eight full time medical officers are approved to undertake the statutory examination of children thought to be educationally subnormal. During the year 41 examinations were arranged as a result of which 25 children are recommended for ESN schools. This represents a reduction compared with previous years and is due to the more flexible arrangements that can now be made for handicapped children to be admitted to special schools informally or to receive educational help in ordinary schools. A register is maintained for handicapped children of all ages. Of the 68 born in 1967, 7 were recommended for ESN schools (1 severe), 1 for hospital care and 12 for other types of special schools. Five were accommodated in residential establishments and 6 were attending day nurseries pending special placements. The remaining 37 were all able to enter ordinary schools. A special follow-up is arranged for all handicapped children in ordinary schools. Visual Defects Special ophthalmic sessions are held in the north and south of the City. At the Western Ophthalmic Hospital a weekly session is held, staffed by four ophthalmologists from St. Mary's Hospital with clerical assistance from the Health Department. At a treatment centre in Pimlico, where a session is also held once a week, it has proved to be extremely difficult to find a permanent ophthalmologist. The present consultant is employed by the South West Metropolitan Regional Hospital Board. Immunisation Parents are encouraged to have their children fully immunised before entering school but for a variety of reasons a number of school entrants have not been protected. Arrangements therefore have sometimes to be made to hold special sessions in the schools in order to get immunisation against diphtheria, tetanus, poliomyelitis and measles completed. In secondary schools rubella vaccination is offered to girls in their first or second year and BCG vaccination is offered to all children in their second or third year. Diathermy Diathermy clinics for the treatment of plantar warts are held twice a week and continue to be well attended. Special Investigation Clinics Children who require a longer time and more privacy than is available at school medical examinations are referred to Special Investigation Clinics. During 1972 there were 107 new referrals and 768 attendances were made at 227 sessions. In addition there were 628 home visits and 43 interviews with clients at City Hall. (See also section "Social Work (Personal Health)", page 53). Colleges of Further Education At the London College of Fashion a medical officer attended once a week, and weekly sessions are held at City Hall for students from Pulteney College. For other Colleges for Further Education arrangements are made for social workers to refer students about whom they are worried to a Principal Medical Officer at City Hall for examination and investigation. 57 Arrangements are made each year for a medical examination of the students completing their training at Sidney Webb College. In the summer of 1972 8 sessions were arranged at which 53 students were seen. All Colleges for Further Education were offered sessions for BCG vaccination and most accepted. Statistics relating to the School Health Service are set out in Tables 43 and 44, page 84. DENTAL SERVICE D.K. Hardy, L.D.S., R.C.S. (Eng) Chief Dental Officer and Principal School Dental Officer It is probably as well at times to look back and see if any progress has been made. Unfortunately when I do this I cannot really say that progress or achievement can be drawn from the figures. There has been an increase of 12% in the period 1968—72 in the total number of sessions recorded. In 1972 nearly 2,400 sessions were undertaken, an increase of just over 260 sessions on 1968. If the number of school children inspected at school is compared there is no difference; in 1968 50% of the total roll was inspected and in 1972 it was the same. There has been an improvement in the dentist-to-school roll ratio; in 1968 it was one dentist to 5,520 school children, whereas in 1972 it was one dentist to 5,090. This seeming improvement of dental officer staff is reflected in the increased number of sessions spent on treatment; the increase over 1968 was 290 sessions. The sessions spent on school health treatment in 1972 amounted to 94% of the school health sessions. It is possible that a stage is being reached when it can be said that something has been achieved. Of the number of school children inspected at school in 1968 64% required treatment but in 1972 this figure was reduced to 54%. It is to be hoped that the extra effort of dental health education undertaken in schools by dental health educators is now beginning to have an effect. In 1972 another Dental Health Campaign was organised during the month of May when teams went into 37 infant schools to talk in the classrooms to new entrants, i.e. those around 5 years old. Nearly 2,000 dental hygiene kits were distributed at the same time to the new entrants only. Films were also shown and were much appreciated by the children. It is our earnest hope that these health education activities will have beneficial results in the years to come. The dental clinics continue to be improved by replacement of units with new split units, to enable seated dentistry to be performed as is now taught in most dental schools. The continuing problem which is always with us is the shortage of dental surgery assistants. At no time during 1972 did the permanent dental surgery assistant staff exceed 40% of the establishment. It is fortunate that a certain agency can produce staff to fill this void albeit erratically with visitors to this country from the Antipodes. Stabilisation of a permanent staff would undoubtedly bring with it an improvement in the services offered to mothers and children. I wish to thank the Dental Officers and Dental Surgery Assistants for their efforts in maintaining a first class dental service and to all who have assisted in any way. Statistics relating to the school dental service and the dental service for expectant and nursing mothers, and children under 5 years of age, are set out in Tables 50 and 51 pages 90 and 91. CHEST CLINICS There are three Chest Clinics in Westminster situated at the following addresses:— Paddington Chest Clinic, 14—18 Newton Road, W.2. (229 8821). St. Marylebone Chest Clinic, Council House, Marylebone Road, N.W.1. (828 8070). Westminster Hospital Chest Clinic, Page Street Wing, S.W.1. (828 9811). 58 I am indebted to the Consultant Physician at each of these Clinics for the following reports of their activities during 1972. Paddington Chest Clinic — Dr. P.A. Zorab, Consultant Physician The tuberculosis problem in this area has special features in that so many of the immigrant population live in overcrowded conditions and, in consequence, any new case may spread infection rapidly unless detected in good time, thus holding regular contact clinics has proved most helpful in our aim to eradicate the disease. Referrals from general practitioners of patients suffering from asthma, bronchitis, lung cancer as well as many less common chest diseases have increased. Liaison with local practitioners continues to be the most useful way of providing a chest service for the area. A research project on "Effects of Drugs on Sputum Viscosity" has been completed and a new project relating changes in small vessels in the lung to right heart hypertrophy in patients with chronic hypoxic lung disease, will shortly be commenced. Several fund raising functions were held by the Paddington Care Committee who arranged a very successful summer coach outing for our old-age pensioner patients and a most enjoyable Christmas Party was held at Church House, Newton Road, W.2. In addition the Committee helped many patients during 1972. St. Marylebone Chest Clinic — Dr. G. Shneerson, Consultant Physician Contrary to recent trends in 1972 there has been a slight increase in the number of newly notified cases of tuberculosis: the number of deaths reported during this past year from lung cancer has appreciably diminished. The diagnostic facilities offered by this chest clinic remain unchanged. Westminster Hospital Chest Clinic — Dr. P.A. Emerson, Consultant Physician The total number of patients attending the Clinic in 1972 remained the same as the previous year, but the number of newly diagnosed cases of tuberculosis increased considerably compared with 1971. Thirtyone new cases were notified as opposed to sixteen the previous year. Of these thirty-one, twenty-two were males and nine females. Of the tuberculous patients referred to the Clinic, one was sent by his general practitioner, three were discovered by the South West London Mass X-ray Service and the remainder were notified by various hospitals and mass X-ray units. Statistics relating to notifications of tuberculosis in Westminster, and deaths, during 1972 are set out in Table 4, page 63, whilst further statistics dealing with care and after-care of tuberculous patients, and work undertaken at the three Chest Clinics, are set out in Table 52, page 92. 59 LIST OF STATISTICAL TABLES Table Title 1 Deaths — according to age-group and sex. 2 Infant Mortality — according to cause, age group and sex. 3 Notifications of infectious and other notifiable diseases. 4 Tuberculosis — new cases and deaths. 5 Specimens submitted to the Public Health Laboratory. 6 Night and out of office hours Emergency Service. 7 Dwelling houses — reason for initial inspection. 8 Dwelling houses — nuisances and unsatisfactory conditions found and remedied. 9 Summary of visits by Public Health Inspectors. 10 Statutory notices served. 11 Summary of visits by Housing Act Inspectors. 12 Summary of work carried out by Public Health Inspectors under the Housing Act 1961 (as amended) in connection with Houses in Multiple Occupation. 13 Unfit premises. 14 Qualification Certificates. 15 Rodent Control. 16 Chemical examination of water supplied to City of Westminster — average results. 17 Bacteriological examination of water supplied to City of Westminster — average results after treatment. 18 Offices, Shops and Railway Premises Act, 1963. 19 Factories — inspections for purposes of provisions as to health. 20 Factories — defects. 21 Outwork. 22 Estimated number of premises in Westminster subject to Food Hygiene (General) Regulations 1970. 23 Premises registered for preserving food, or manufacture, storage or sale of ice-cream. 24 Food poisoning investigations. 25 Analysis of Legal Proceedings. 26 Verminous persons cleansed. 27 Scabies — persons treated. 28 Coroner's Court and Mortuary. 29 Sessions at Maternal and Child Health Centres. 30 Clinic services — ante-natal and post-natal clinics. 31 Mothercraft and ante-natal exercises. 32 Family Planning. 33 Child Health Centres. 34 Handicap Register. 35 Health Visiting. 36 Vaccination of persons under age 16 completed during 1972 at Maternal and Child Health Centres and by general practitioners. 37 Home Nursing. 38 Domiciliary Midwifery. 39 Chiropody Service. 40 Venereal diseases — cases treated in Westminster during 1972. 41 Medical suite at City Hall — work undertaken, 1972. 42 Tuberculin test and BCG vaccination of school-children and students. 43 School Health service — full-time equivalent employees. 44 School medical inspections, 1972. 45 Routine medical inspections in schools, 1972 — defects found. 46 School health service — findings at health surveys, 1972. 47 School health service — non-routine medical inspections, 1972. 48 School health service — routine medical inspections, vision — 1972. 49 School health service — comparison of defects noted at 7-plus routine and 7-plus special medical inspections, 1972. 50 School dental service statistics, 1972. 51 Dental services for expectant and nursing mothers and children under 5. 52 Tuberculosis — care and after-care — work at Chest Clinics in Westminster. 60 Table 1. — DEATHS — According to Age-Group and Sex CAUSE OF DEATH 1971 1972 Net Deaths at the sub-joined ages of residents (male and female) whether occurring within or without the City Totals All Ages All Ages Under 1 year 1 and under 5 5 and under 15 15 and jnder 25 25 and jnder 45 45 and under 65 65 and upwards M F M F M F M F M F M F M F M F Enteritis and other diarrhoeal diseases 2 1 — 1 — — — — — — — — — — — — — Tuberculosis of respiratory system 14 10 2 — — — — — — — — 1 1 6 1 3 — Other tuberculosis, including late effects — — 2 — — — — — — — — — — — — — 1 Malaria 2 — — — — — — — — — — — — — — — — Syphilis and its sequelae 3 — 2 — — — — — — — — — — — — — 2 Other infective and parasitic diseases 5 4 6 — — — — — 1 1 — 1 1 — — 2 4 Malignant neoplasm, buccal cavity etc 13 6 3 — — — — — — — — — — 3 1 3 2 Malignant neoplasm, oesophagus 17 6 9 — — — — — — — — — — — 2 6 7 Malignant neoplasm, stomach 51 33 28 — — — — — — — — — — 9 2 24 26 Malignant neoplasm, intestine 69 33 57 — — — — — — — — — — 8 12 25 45 Malignant neoplasm, larynx 2 3 — _ _ _ _ _ _ _ _ _ — — 3 — Malignant neoplasm, lung, bronchus 195 140 55 — — — — — — — — 3 1 46 17 91 37 Malignant neoplasm, breast 69 1 57 — — — — — — — — — 1 1 24 — 37 Malignant neoplasm, uterus 36 — 11 — — — — — — — — — — — 5 — 6 Malignant neoplasm, prostate 15 16 — — — — — — — — — — — 1 — 15 — Leukaemia 22 7 5 _ _ 1 1 _ _ — 2 — 2 1 2 3 Other malignant neoplasms 196 84 81 1 — — — — — 3 1 6 3 30 20 44 57 Benign and unspecified neoplasms 3 5 4 — — — — — — — — — 1 1 — 4 3 Diabetes mellitus 11 11 17 — — — — — — — — 1 — 3 3 7 14 Avitaminoses, etc. 4 1 — — — — — — — — — — — — — 1 — Other endocrine etc. diseases 10 1 2 — — — — — — 1 — — — — — — 2 Anaemias 2 — 6 — — — — — — — — — — — 1 — 5 Other diseases of blood, etc. 4 1 1 1 — — — — — — — — 1 — — — Mental disorders 16 10 10 — — — — — — 4 1 2 4 2 — 2 5 Meningitis 4 - 1 — — — — — — — — — — — — — 1 Multiple sclerosis 5 1 2 — — — — — — — — 1 — — 1 — 1 Other diseases of nervous system 25 6 8 — — — — — — — — — 1 2 3 4 4 Chronic rheumatic heart disease 41 16 19 _ _ _ _ 2 _ 1 _ 7 4 6 15 Hypertensive disease 37 19 26 — — — — — — — — 1 _ 8 8 10 18 Ischaemic heart disease 671 355 267 — — — — — — — — 8 — 134 36 213 231 Other forms of heart disease 123 37 60 — — — — — — 1 — 1 — 9 3 26 57 Cerebrovascular disease 275 83 173 — — — — — — — — 2 1 14 20 67 152 Other diseases of circulatory system 130 38 75 — — — — — — — — 2 1 9 4 27 70 Influenza 3 2 2 _ _ _ _ _ _ _ _ 1 1 2 Pneumonia 209 100 103 _ 1 _ _ _ 1 1 _ 3 _ 9 5 87 96 Bronchitis and emphysema 126 81 36 — — — — — — — — — — 15 6 66 30 Asthma 10 3 6 _ — _ _ 1 _ — — 1 2 1 4 Other diseases of respiratory system 28 20 9 2 — — — — — 1 — — — 5 1 12 8 Peptic ulcer 29 11 6 — — — — — — — — — — 4 — 7 6 Appendicitis 1 — — — — — — — — — — — — — — — — Intestinal obstruction and hernia 17 4 9 1 — — — — — — 1 — — — — 3 8 Cirrhosis of liver 27 10 6 _ _ _ _ _ — 1 1 6 4 3 1 Other diseases of digestive system 29 16 23 — — — — — — — — — 1 7 1 9 21 Nephritis and nephrosis 17 6 8 — — — — _ 1 1 _ _ 2 2 3 5 Hyperplasia of prostate 4 3 — — — — — — — — — — — — — 3 — Other diseases, genito-urinary system 20 7 17 1 — — — — — 1 — — — 3 1 2 16 Abortion 1 — — — — — — — — — — — — — — — — Other complications of pregnancy, etc — — 2 — — — — — — — — — — — — — — Diseases of skin, subcutaneous tissue 3 — 3 — — — — — — — — — — — — — 3 Diseases of musculoskeletal system 13 3 7 — — — — — — — — — — 1 2 2 5 Congenital anomalies 26 2 5 1 2 — 1 _ 1 _ _ _ 1 — — 1 — Birth injury, difficult labour, etc. 9 4 5 4 5 — — — — — — — — — — — — Other causes of perinatal mortality 6 2 6 2 6 — — — — — — — — — — — — Symptoms and ill defined conditions 9 4 6 1 — — — — — — — — 1 — 2 2 4 Motor vehicle accidents 27 13 17 _ _ _ _ _ 3 1 3 ? 3 4 4 10 All other accidents 64 16 26 _ _ 1 _ _ _ 2 1 3 5 7 5 3 15 Suicide and self-inflicted injuries 45 25 26 — — — — — — 4 3 11 7 10 7 — 9 All other external causes 27 9 8 — 1 — — — — 2 1 2 — 4 5 1 1 Totals 1,269 1,325 14 16 2 2 2 4 27 9 54 36 374 215 795 1044 2,594 30 4 6 36 90 589 1,839 1971 2,822 - 35 7 12 51 141 760 1,816 61 Table 2 — Infant Mortality — Cause, Age-group and Sex CAUSE OF DEATH Under 1 week 1 -4 weeks 1 -3 months 3-6 months 6-9 months 9-12 months Total M F M F M F M F M F M F M F Prematurity and allied causes 3 8 _ _ _ _ _ _ _ _ _ _ 3 8 Haemorrhage pulmonary _ 2 _ _ _ _ _ _ _ _ _ _ _ 2 Subarachnoid _ 1 _ _ _ _ _ _ _ _ _ _ _ 1 Foetal anoxia 1 _ _ _ _ _ _ _ _ _ _ _ 1 _ Hyperkaliaemia 1 _ _ _ _ _ _ _ _ _ _ _ 1 _ Pleural effusion 1 _ _ _ _ _ _ _ _ _ _ _ 1 _ Inhalation of mucus _ 1 _ _ _ _ _ _ _ _ _ _ _ 1 Pulmonary oedema _ _ 1 _ 1 _ _ _ _ _ _ _ 2 _ Cardiac arrest (hypoplasia) _ _ 1 _ _ _ _ _ _ _ _ _ 1 _ Intestinal obstruction _ _ _ 1 _ 1 Infancy syndrome _ _ 1 1 Asphyxia _ 1 _ _ _ _ _ 1 _ 2 Bilateral lobar pneumonia _ _ _ _ _ 1 1 Liver and renal failure _ _ _ _ _ _ 1 _ _ _ _ _ 1 _ Neuro blastoma _ _ _ _ _ _ 1 _ _ _ _ _ 1 _ Myelomeningocele _ _ _ _ _ _ _ _ _ 1 _ _ _ 1 Acute gastro enteritis _ _ _ _ _ _ _ _ 1 _ _ _ 1 _ 6 13 2 - 2 - 3 2 1 1 - - 14 16 Totals - (1971 in brackets) 19 (19) 2 (3) 2 (6) 5 (6) 2 (-) (1) 30 (35) Number of deaths of illegitimate infants included in above 7 (6) (-) (2) 1 (1) (-) (-) 8 (9) 62 Table 3 — Notification of Infectious and other Notifiable Diseases Numbers originally notified Total (All ages) Measles (excluding rubella) Dysentery Scarlet Fever Diphtheria Acute meningitis due to infection with Acute poliomyelitis Meningococcus Other specified organisms Unspecified org anisms Paralytic Non paralytic M F M F M F M F M F M F M F M F M F 72 71 10 9 5 3 — — 3 2 — — — 1 — — — — Final numbers after correction Under 1 year 2 2 — — — — — — — — — — — — — — — — 1 year 6 5 3 2 — — — — — — — — — — — — — — 2 years 5 7 1 — — — — — 1 — — — — — — — — — 3 years 10 13 1 1 1 2 — — — — — — — — — — — — 4 years 11 6 — 1 2 — — — — — — — — — — — — — 5—9 years 32 28 1 — 1 1 — — — — — — — — — — — — 10—14 years — 3 — — 1 — — — — — — — — — — — — — 1 5—24 years 2 2 1 1 — — — — 2 1 — — — 1 — — — — 25 and over 4 5 3 4 — — — — — 1 — — — — — — — — Age unknown — — — — — — — — — — — — — — — — — — Total (all Ages) 72 71 10 9 5 3 — — 3 2 — — — 1 — — — — Numbers originally notified Total (All Ages) Acute encephalitis Leptospirosis Para typhoic fever Typhoid fever Food poison ing Malaria The total number of notifications of infectious and other notifiable diseases received during the year was: — 1972 414 1971 485 Infective Post infectious M F M F M F M F M F M F M F — — — — — — — — 1 1 20 28 6 6 Final numbers after correction Under 5 years — — — — — — — — — — 3 2 1 5—14 years — — — — — — — — — — 2 — — 1 15—44 years — — — — — — — — 1 1 9 15 5 4 45—64 years — — — — — — — — — — 2 3 — 1 65 and over — — — — — — — — — — — 5 — — Age unknown — — — — — — — — — — 1 — — — Total (all Ages) — — — — — — — — 1 1 17 25 6 6 Cases of Smallpox, Anthrax, Ophthalmia neonatorum. Yellow fever. Plague, Cholera, Typhus fever. Relapsing fever and any other disease notifiable. Original Final Original F inal Original Final Original F inal M F M F M F M F M F M F M F M F Smallpox Anthrax Opthalmia neonatorum Yellow fever — — — — — — — — — — — — — — — — Numbers originally notified Total (All Ages) Tetanus Infective Jaundice Tuberculosis Whooping Cough Respiratory Meninges & C.N.S. Other Cases of fatal tuberculosis not notified before death Numbers originally notified Total (All Ages) M F M F M F M F M F M F — — 42 17 74 25 1 1 7 8 — 1 Final numbers after correction — — — — — — — — — — Males Females Final numbers after correction Under 3 month; — — 10 — 1 year — — — — — — — — — — 3 months — — 2—4 years — — — — — — — — — — 6 months — — 5—9 years — — 3 3 3 1 — — — — 9 months — — 10—14 years — — 3 1 1 — — — — — 1 year — — 15—19 years — — 2 1 2 2 — — — 1 2—4 years — — 20—24 years — — 7 4 6 5 — — — — 5—9 years — 1 25—34 years — — 16 6 12 4 — — 1 3 10—14 years — — 35—44 years — — 7 1 10 4 1 1 2 3 15—19 years — — 45—54 years — — — 1 16 4 — — 2 — 20—24 years — — 55—64 years — — 2 — 14 2 — — 1 — 25—34 years — — 65—74 years — — 1 — 8 2 — — — — 35—44 years — — — — — — 2 _ _ _ _ 1 45—54 years — — Age unknown — — 1 — 1 — — 1 — 55—64 years — — 65—74 years — — Total (All Ages) — — 42 17 74 25 1 1 7 8 75 and over — — Age unknown — — Total (All Ages) - 1 63 Table 4 — Tuberculosis: New Cases and Deaths At ages- +NEW CASES DEATHS Pulmonary NonPulmonary Pulmonary NonPulmonary Years M F M F M F M F 0-1 1 - 5 — _ _ _ _ 5-15 4 1 _ _ _ _ _ 15-25 8 7 _ 1 _ _ 25 - 35 12 4 1 3 — _ _ - 35 - 45 14 4 3 4 1 1 _ 1 45 - 55 16 4 2 _ 3 _ 55 - 65 16 2 1 _ 3 1 _ 65 and upwards 14 2 — 1 3 - - 1 Age unknown — 1 1 — — — — — Totals 1972 84 25 8 9 10 2 2 1971 81 27 8 9 12 2 — - + including all primary notifications and also any other new cases of tuberculosis which came to the knowledge of the Medical Officer of Health during the year. Table 5 — Specimens Submitted to the Public Health Laboratory Nature of Specimen Number Examined Positive Findings Nasal, throat and hand swabs 96 Haemolytic Streptococci 22 Staphylococcus Aureus 2 Faeces 374 Shigella Flexneri 1 Shigella Sonnei 28 Salmonella Typhimurium 25 Salmonella Indiana 1 Salmonella s.p 22 Salmonella Irimu 1 Salmonella Oranienburg 9 Trichuris Trichuria 5 Hookworm 2 Urine 23 T otal 493 (The total number of specimens examined during 1971 was 687) 64 Table 6 — Night and out of office hours emergency service — Analysis of calls made to Duty Officers Month 1972 Social Services Departments Health Departments Miscellan Total Mental Health Child Care Welfare Public Health Inspectors Midwives District Nurses *W K W K W K W K W K W K W K W K January 185 146 103 40 47 8 28 30 13 393 1 190 21 976 229 February 220 114 129 57 59 12 39 — 17 11 363 1 97 24 924 219 March 248 129 123 35 38 22 24 — 22 13 373 1 108 32 936 232 April 238 156 129 40 43 13 51 2 22 21 365 — 117 26 965 258 May 226 129 117 19 76 16 56 1 16 12 389 — 135 27 1,015 204 June 246 117 142 41 37 23 45 2 17 7 366 — 138 38 991 228 July 213 124 174 61 56 15 66 1 37 18 384 1 146 40 1,076 260 August 184 112 159 31 41 14 48 5 59 25 324 2 168 48 983 237 September 191 120 178 34 50 17 26 2 26 12 329 1 141 18 941 204 October 224 113 132 32 59 11 46 6 21 20 392 — 141 37 1,015 219 November 234 112 102 48 73 5 34 — 24 17 297 1 168 21 932 204 December 219 110 89 64 59 21 24 3 34 21 376 — 350 31 1,151 250 Total - 1972 2,628 1,482 1,577 502 638 177 487 22 325 190 4,351 8 1,899 363 11,905 2,744 Total - 1971 2,830 1,232 1,384 409 414 58 517 27 254 232 3,813 15 1,782 142 10,994 2,115 * "W" refers to calls relating to the City of Westminster "K" refers to calls relating to the Royal Borough of Kensington and Chelsea Table 7 — Dwelling House — Reason for Initial Inspection 1972 1971 Complaints 1,942 2,784 Routine 47 737 Smoke Control 137 200 Infectious Disease 175 499 Underground Rooms 100 127 Application for Grants and Loans 151 303 Housing Circumstances 183 938 Drainage 1,155 2,797 Rodent Control 116 216 Miscellaneous 144 658 Table 8 — Dwelling Houses — Nuisances and unsatisfactory conditions found and remedied 1972 1971 Houses, damp, dirty or dilapidated 203 215 Doors, windows, floors, ceilings, firegrates defective 852 1,051 Insufficient or unsuitable W.C. accommodation 32 36 Drains, W.C.s and waste pipe stoppages 138 117 Drains, W.C.s and waste pipes defective 205 225 Yard, area and washhouse defects 13 12 Roofs, gutters and rainwater pipes defective 206 291 Water supplies absent or insufficient 15 6 Water cisterns dirty or defective 34 19 Ashpits, dustbins, etc., insufficient or defective 43 47 Rubbish accumulations 170 169 Animal nuisances 11 16 Miscellaneous 315 379 65 Table 9 — Summary of visits by public health inspectors 1972 1971 Clean Air Act 1,586 1,805 Drainage and new developments 10,616 12,631 Dwelling houses (general matters) 9,742 13,421 Factories (other than building sites) 228 139 Food and catering premises 9,205 13,201 Hairdressers' establishments 70 62 Infectious diseases 470 1,164 Noise 507 862 Offices 770 1,153 Pigeons 29 37 Rodent control 547 770 Shops 238 663 Smoke observations 433 461 Town planning 18 11 Vermin investigations 100 331 Other purposes 723 1,604 Table 10 — Statutory Notices Served 1972 1971 Public Health Acts, 1936 and 1961 367 476 Public Health (Recurring Nuisances) Act 1969 3 2 Clean Air Act, 1956 — 7 Greater London Council Drainage Bylaws — 2 Greater London Council Water Closet Bylaws — 2 Greater London Council (General Powers) Act 1967 3 2 Factories Act, 1961 — — Noise Abatement Act, 1960 3 3 Prevention of Damage by Pests Act, 1949 22 13 Local Bylaws: Artificial Lighting of Common Staircases 11 11 Cleansing of Cisterns 3 1 Bylaw No. 11 of the Westminster City Council with respect to Good Rule and Government 1 1 Table 11 — Summary of visits by Housing Act Inspectors 1972 1971 Work in connection with the House Acts 1961 — 1969 750* 495* Clearance and development area surveys 2,421* 1,965* Tenement dwellings survey 919 97 Grant, subsidy and loan applications 789* 663* Hotel inspections 269 314 * Includes action taken in connection with North Westminster Project 66 Table 12 — Summary of work carried out by Public Health Inspectors under the Housing Act 1961 (as amended) in connection with Houses in Multiple Occupation 1972 1971 Management Orders made (Section 12) 6 2 Management Orders revoked 2 3 Notices served for contraventions of Management Regulations (Section 14) 2 2 Notices under Section 14 complied with 1 1 Informal notices served (Section 14) 10 6 Informal notices under Section 14 complied with — 2 Notices served for the provision of amenities (Section 15) 7 4 Notices under Section 15 complied with 2 1 Informal notices served (Section 15) 56 30 Informal notices under Section 15 complied with 8 4 Directions given (Section 19) 9 10 Directions varied 5 8 Directions revoked 11 12 Table 13 — Unfit Premises 1972 1971 Closing orders made on underground rooms 36 (99 rooms) 33 (84 rooms) Closing orders made on upper parts of buildings and Mews premises 28 (54 rooms) 20 (63 rooms) Closing orders made on houses in lieu of demolition orders 1 (12 rooms) Closing orders on underground rooms determined when work carried out 20 (56 rooms) 29 (88 rooms) Closing orders on upper parts and mews premises determined when work carried out 6 (18 rooms) 1 (5 rooms) Table 14 — Housing Finance Act 1972: Qualification Certificates 1972 1971 Improvement cases: Applications for qualification certificates under Section 29(1) under consideration at end of period 19 59 Certificates of provisional approval issued 42 90 Qualification certificates issued under Section 28(5) 14 14 Standard amenities already provided: Applications for qualification certificates under Section 28(1) under consideration at end of period 64 226 Qualification certificates issued under Section 28(5) 112 253 67 Table 15 — Rodent Control 1972 1971 Complaints: Complaints of rats received 436 449 Complaints of mice received 2,859 2,815 Total premises involved 3,295 3,264 Infestations treated by Council's staff: (including properties inspected for reasons other than notification) Premises rid of rats 439 451 Premises rid of mice 2,871 2,802 Total premises disinfested 3,310 3,253 Inspections by Public Health Inspectors and visits by Rodent Officers to such places 3,866 3,782 Notices: Intimation notices served 6 - Statutory notices served 22 13 Table 16 — Chemical Examination of Water Supplied to City of Westminster — Average Results Milligramms per litre (unless otherwise stated) Analysis Data Source of Supply Stoke Newington R. Thames -Derived Ammoniacal Nitrogen 0.02 0.031 Albuminoid Nitrogen 0.055 0.069 Nitrate Nitrogen 7.8 6.9 Oxygen abs. from KMn02 4 hrs. at 27°C 0.70 1.06 Hardness (total) CaC03 308 274 Hardness (non-carbonate) CaC03 78 82 Magnesium as Mg 5.5 5 Sodium as Na 28.8 24.5 Potassium as K 5.1 5.5 Chloride as CI 41 35 Phosphate as PO4 2.2 2.8 Silicate as Si02 10 10 Sulphate as SO4 52 58 Natural Fluoride as F 0.15 0.15 Surface-active material as Manoxal OT 0.02 0.02 Turbidty units 0.1 0.1 Colour (Burgess units) 9 13 pH value 7.9 7.9 Electrical Conductivity (microhms) 650 570 68 Table 17 — Bacteriological Examination of Water Supplied to City of Westminster — Average Results after Treatment Source of supply Number of Samples Agar plate count per ml. Coliform count E. coli count 20-24 hours 370C 3 days at 220C Per cent. samples negative in 100 ml. Per cent samples negative in 100 ml. Stoke Newington 753 28.1 — 100.0 100.0 R. Thames-derived 8,087 10.0 — 99.85 99.97 Table 18 — Offices, Shops and Railway Premises Act, 1963 Number Registered in 1972 Total number Registered at 31st December 1972 Number of Registered Premises receiving a General Inspection during the year Offices 748 12,357 2,406 Retail Shops 72 3,727 436 Wholesale Shops, Warehouses 36 767 49 Catering Establishments open to the Public (Canteens) 69 1,499 1,017 Fuel Storage Depots — — — Totals 925 18,350 3,908 Analysis of persons employed in Registered Premises by workplace Offices 291,568 Retail Shops 39,933 Wholesale Departments, Warehouses 18,222 Catering Establishments open to the Public 21,977 Canteens 5,832 Fuel Storeage Depots — Total 377,532 Total Males 208,936 Total Females 168,596 Inspection and Contraventions Inspections of all kinds 8,638 Premises at which contraventions were found 1,515 Accidents Notifiable accidents 540 Accidents investigated 242 Accidents investigated which revealed contraventions 11 Accidents where a contravention may have been a contributory cause 3 Fatalities — 69 Table 19 — Factories: Inspection for purposes of provisions as to health Number on Register Number of Inspections Written notices Occupiers prosecuted 1972 1971 1972 1971 1972 1971 1972 1971 Factories Act, 1961 (i) Factories in which Sections 1, 2, 3, 4 and 6, are enforced by the Local Authority 728 725 13 89 — 1 — — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 2,493 2,591 215 132 1 9 — — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 973 971 1,133 1,101 — — — 4,194 4,287 1,361 1,322 1 10 — — Table 20 — Factories: Defects Found Number of cases in which defects were found Number of cases in which prosecutions were instituted Remedied Referred to H.M. Inspector By H.M. Inspector Factories Act 1961 1972 1971 1972 1971 1972 1971 1972 1971 1972 1971 Want of cleanliness (S.1.) 8 8 7 5 — — 3 3 — — Overcrowding (S.2) — — — — — — — — — — Unreasonable temperature (S.3.) — 3 — 2 — — — — — — Inadequate ventilation (S.4.) — 2 — 2 — — 1 — — — Ineffective drainage of floors (S.6.) — — — — — — — — — — Sanitary Conveniences (S.7.) (a) Insufficient 10 5 8 3 — — — 2 — — (b) Unsuitable or defective 65 22 45 19 — — 2 — — — (c) Not separate for sexes 12 5 10 5 — — 1 1 — — Other offences against the Act (not including offences relating to Out-work) — 10 — 9 — — — — — — Total 95 55 70 45 — — 7 6 — — 70 Table 21 — Outwork Nature of work Number of out-workers in August list required by Section 133 (1) (c) Number of cases of default in sending lists to the Council Number of prosecutions for failure to supply lists Number of instances of work in unwholesome premises Notices served Prosecutions 1972 1971 1972 1971 1972 1971 1972 1971 1972 1971 1972 1971 Wearing apparel — making etc. 1,323 1,306 Household linen 18 40 — — — — — — — — — — Curtains and furniture hangings 7 15 — — — — — — — — — — Furniture and upholstery 2 1 — — — — — — — — — — 1,350 1,362 — — — — — — — — — — Table 22 — Estimated Number of Premises Subject to the Food Hygiene (General) Regulations, 1970 Grouped in Categories of Trade carried on in them. Type of premises r Hotels and boarding houses (Estimated) 700 Restaurants, cafes and snack bars 1,782 Grocers and provision merchants 473 Canteens and clubs 1,448 Public houses 549 Confectioners 536 Greengrocers and fruiterers 178 Schools, nurseries and hostels 89 Butchers 121 Off licences 259 Bakers, cake and pastry premises 119 Chemists 180 Fishmongers and poulterers 46 Food factories 23 Wholesale premises, stores and depots 268 71 Table 23 — Premises Registered for Preserving Food, or Manufacture, Storage or Sale of Ice Cream 1972 1971 Preserved food etc. 190 188 Ice Cream, Manufacture, and/or storage and/or sale 733 721 Table 24 — Food Poisoning 1972 — Investigation of Incidents and Cases Causative agent General Outbreaks Family outbreaks Sporadic Cases Total Number of outbreaks and sporadic cases Columns (1+3+5) Total Number of cases Columns (2+4+5) Number of separate outbreaks Number of cases notified or ascertained Number of separate outbreaks Number of cases notified or ascertained Notified or ascertained 1 2 3 4 5 6 7 S. typhimurium 1 109 1 2 - 2 111 Other Salmonellae 1 34 - - - 1 34 CI. welchii - - - - - - - Staph. aureus - - - - - - - Other causes - - - - - - - Cause Unknown - - 2 6 18 20 24 Total 2 143 3 8 18 23 169 72 Table 25 — Analysis of Legal Proceedings Fines Costs £ £ Public Health Act 1936 (Sec. 92) Premises in such a state as to be prejudicial to health or a nuisance 7 cases 65.00 55.00 Public Health Act 1936 (Sec. 94) Non-compliance with Magistrate's Order to abate a nuisance 5 cases 180.00 45.00 Offices, Shops and Railway Premises Act 1963 10 cases 61.00 10.00 Food & Drugs Act 1955 (Sec. 2) Selling food not of substance or quality demanded 8 cases 203.00 75.00 Food & Drugs Act 1955 (Sec. 8) Selling or exposing for sale food unfit for human consumption 27 cases 305.00 110.00 Food Hygiene (General) Regulations 1970 400 cases 6,442.00 663.00 1972 £7,256.00 £958.00 1971 £2,460.90 £261.00 Table 26 — Verminous Persons — Number of persons cleansed at Lissonia and Wedlake Street Baths Adults Children Total Men Women Total Boys Girls Total 1965 883 124 1,007 96 229 325 1,332 1966 520 111 631 45 185 230 861 1967 428 141 569 43 198 241 810 1968 507 122 629 61 136 197 826 1969 564 154 718 64 193 257 975 1970 418 153 571 51 106 157 728 1971 405 102 507 60 154 214 721 1972 512 93 605 104 192 296 901 73 Table 27 — Scabies — Number of Persons treated at Lissonia and Wedlake Street Baths Adults Children Total Men Women Total Boys Girls Total 1965 96 74 170 27 50 77 247 1966 115 93 208 25 62 87 295 1967 138 174 312 32 108 140 452 1968 129 114 243 40 139 179 422 1969 137 183 320 63 191 254 574 1970 123 55 178 35 38 73 251 1971 114 37 151 36 48 84 235 1972 60 4 64 13 28 41 105 Table 28 — Coroner's Court and Mortuary 1972 1971 Bodies received in the Mortuary on Coroner's Warrants etc. 1,313 1,192 Bodies deposited to await burial 14 5 Inquest cases 313 289 Non-inquest cases 1,014 908 Post-mortem examinations held 1,305 1,184 The verdicts returned by H.M. Coroner in the foregoing cases were as follows: — * Accidental drowning 3 3 Found drowned 4 5 Suicide by drowning 8 5 Suicide by other means 86 101 Accidents: Street 44 22 Domestic 26 20 Others 45 49 Natural causes 1,007 906 Misadventure 3 3 Murder 7 20 Miscellaneous causes 65 52 Awaiting proceedings at Central Criminal Court 15 6 * Excluding bodies brought in to await burial 74 Table 29 — Maternal and Child Health Clinics — Activities held as at December, 1972 Note: The following Table sets out the sessions held at the various Clinics in December, 1972 Changes occur from time to time to meet the need CENTRE MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. 283A Harrow Road, W.9. Dental (School) Special Investigation Chiropody Child Health Occ. creche Dental (School) Chiropody Family Planning 2nd Child Health (alt. weeks: appts only) English classes Evening:— Child Health (alt.weeks) Dental (School) Mothercraft Ante-natal relaxation classes Chiropody Child Health Home Advice Dental (School) Chiropody Occ. creche Evening:— Catholic Marriage Guidance & Family Planning (once monthly) Dental (School) Special Investivation Chiropody Ante-Natal (alt. weeks) Cytology (alt. weeks) Child Health Chiropody Dental (M.C.W.) Occ. creche Chiropody Dental (M.C.W. & School) Gas Sess. (1 st Thurs. in month) Mentally Handicapped children Post-natal Family Planning Child Health Occ. creche Chiropody Dental (M.C.W.) Evening:— Family Planning (2 sessions) Chiropody Dental (School) Cytology (alt. weeks) Discussion Group (psychiatric) Chiropody Child Health Dental (School) Family Planning Hallf ield, Pickering House, W.2. Cytology (alt weeks) Dental (School) Child Health Dental (School) Playgroup Child Health Dental (School) Evening:— Youth Advisory Clinic Special Investigation Ante-Natal (1 st and 3rd weeks) Dental (School) Gas Sess. 2nd and 4th weeks) Playgroup Child Health Dental (School) Evening:— Old People's Club Dental (M.C.W.) Playgroup Dental (School) Child Health Social Services Mental Health Immunisation and Vacc. (1 st and 3rd weeks) Dental (School) Occ. creche Mothers' Club Dental (School) 75 Table 29 — Maternal and Child Health Centres — Activities held as at December, 1972 — (continued) MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. Queens Park, 20B Lancefield St., W.10. Special Investigation Playgroup Home Advice Group Playgroup Evening:— Child Health Child Health Playgroup Ante-natal Playgroup Immunisation and Vacc. 2nd and 4th weeks) Chiropody (1st and 3rd weeks) Playgroup Child Health Playgroup Evening:— Family Planning Chiropody Playgroup Child Health Playgroup Family Planning Playgroup Child Health Special Assessment (1 st and 3rd weeks) Chiropody (alt. weeks) Playgroup Mobile Clinic Child Health in Maida Vale area W.9. St. David's St. Mary's Terrace W.2. Child Health Child Health (1st and 3rd weeks) Linnet House Charlbert Street N.W.8. Child Health Child Health 217 Lisson Grove n:w;8: Dental (M.C.W. and School) Playgroup Special Investigation as required Toddlers (3rd week only) Sewing Occ. creche Physiotherapy Special Investigation as required Dental (M.C.W.) Evening:— Family Planning Speech Therapy Chiropody Dental (School) Special Investigation as required Playgroup Speech Therapy Child Health Chiropody (also Evening) Dental (School) Relaxation and Mothercraft Chiropody Dental (School) Playgroup Discussion Group Chiropody Dental (School) Occ. creche Chiropody Speech Therapy Dental (M.C.W. and School) Playgroup Child Health Dental (School) Speech Therapy Evening:— Chiropody Chiropody Playgroup Ante-natal (alt. weeks) Dental (School) Gas. sess. 3rd Friday in month Evening:— Chiropody 76 Table 29 — Maternal and Child Health Centres — Activities held as at December, 1972 — (continued) MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. Westminster Council House Extension, W.1. Dental (School Playgroup Dental (School Diathermy Child Health Dental (School Cervical Cytology Playgroup Dental (School) Mothers' Club and Creche Dental (School) Playgroup Child Health Dental (School) Special Investigation Dental (M.C.W.) Playgroup Sewing Dental (School) Diathermy Creche Evening:— Family Planning Dental (School (Gas sess. 2nd Fri in month) Playgroup Child Health Dental (School) Middlesex Hospital Playgroup Playgroup Child Health Playgroup Mothercraft Playgroup Playgroup Child Health Bessborough Street S.W.1. Chiropody Ante-natal Chiropody Mothercraft Chiropody Child Health Chiropody Occ. creche Sewing class Evening:— Family Planning Family Planning Chiropody Family Planning Chiropody Evening — Family Planning Mentally & Physically handicapped children (1st Friday in month Chiropody Child Health Chiropody Ebury Bridge Road S.W.1. Ante-natal Mothercraft Child Health Child Health Sewing Occ. creche Family Planning English language class for foreign mothers Occ. creche Cytology Mothers' Club Occ. creche Child Health Marshall Street W.I. Toddlers' Club Chiropody Child Health Vaccination and Immunisation Toddlers' Club Family Planning (11.30 to 3.30) Toddlers' Club Family Planning (11.30 to 3.30) Toddlers' Club Chiropody Child Health Toddlers' Club Chiropody Sewing Occ. creche 77 Table 29 — Maternal and Child Health Centres — Activities held as at December, 1972 — (continued) MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. A.M. P.M. 121 Marsham Street S.W.1. Chiropody Sewing Occ. creche Play Room Evening:— Family Planning Old People's Coffee morning Child Health Play Room Evening: — Keep F it Child Health Immunisation and Vaccination Chiropody Ante-natal Relaxation and Mothercraft Chiropody Play Room Ante-natal Sewing Play Room Evening:— Mothers' Club Chiropody Play Room Chiropody 40 Alderney St., S.W.1. (I LEA School Health premises) Dental (School) Speech Therapy Dental (School) Speech Therapy Dental (School) Dental (School) Dental (School) Vision Dental (School) Special Investigation (alt. weeks) Dental (School) Dental (School) Vision Dental (School) Dental (School) Immunisation and Poliomyelitis vaccination is available at all child health sessions. Minor ailments sessions are held Monday to Friday from 8.45 a.m. to 10.00 a.m. at: Alderney Street Harrow Road and by arrangement at: Lisson Grove Westminster Council House Extension 78 Table 30 — Clinic Services, Ante-Natal and Post-Natal Clinics Number of women Attended Number of sessions held by Total Attendances For Ante-natal Examination For Post-natal Examination Medical Officers Midwives Medical Officer Sessions Midwives Sessions 1972 489 858 363 10 2,273 18 1971 583 897 353 43 2,634 100 Table 31 — Mothercraft and Ante-Natal Exercises 1972 1971 Total number of women who attended during the year 508 582 Total number of attendances during the year 3,139 2,433 Total number of sessions during the year 386 353 Table 32 — Family Planning City Council Clinics: 1972 1971 Number of patients seen 1438 female 80 male 1175 female 68 male Total number of attendances 5,714 5,107 Total number of sessions 434 357 Family Planning Association Clinics: Number of Westminster residents seen 5,160 3,078 Table 33 — Child Health Clinics Number of children who attended during the year Total number of sessions Total number of attendances Total medical examinations Number of children on handicapped register at end of year Born in 1972 Born in 1971 Born in 1967-70 Total 1,967 1,845 2,329 6,141 1,856 29,787 10,471 537 1971 6,684 1,948 35,677 12,910 484 79 Table 34 — Handicap Register (0—5 year age range) Year Total live births On Register Number of children on Handicap Register as % of live births 1968 3,180 92 2.89 1969 2,899 88 3.03 1970 2,765 118 4.26 1971 2,621 102 3.89 1972 2,286 137 5.99 537 Table 35 — Health Visiting Cases seen by Health and Tuberculosis visitors during year Total number of cases seen Number of casesincluded in previous column seen at special request of: — Hospital GP 1 Children born in 1972 2,046 149 27 2 Other children aged under 5 5,317 41 53 3 Persons aged between 5 and 16 seen as part of health visiting, (i.e. excluding those seen as part of school health service) 514 11 20 4 Persons aged between 17 and 64 1,946 182 131 5 Persons aged 65 and over 1,453 161 232 6 Households visited on account of tuberculosis 438 9 - 7 Households visited on account of other infectious diseases 26 2 2 8 Households visited for any other reason 410 4 15 9 Total 12,150 559 480 Number of persons included in lines 1—5 above who are:— Mentally handicapped 23 1 5 Mentally ill 26 6 3 80 Table 36 — Vaccination of Persons under age 16 completed during 1972 at Maternal and Child Health Centres and by General Practitioners TABLE A — Completed Primary Courses — Number of persons under age 16 Type of Vaccine or Dose Year of Birth Others under age 16 Total Total Completed 1972 1971 1970 1969 1965-68 At Clinics By G.P.s 1. Quadruple D.T.P.Po. — — — — — — — — — 2. Triple D.T.P. 446 1,028 113 23 26 1 1,637 1,454 183 3. Diphtheria/Pertussis. - - - - — - - — — 4. Diphtheria/Tetanus. 17 25 6 15 114 29 206 182 24 5. Diphtheria - - — — — — — — — 6. Pertussis — — — — — — — — — 7. Tetanus — — — — 1 19 20 2 18 8. Salk — — — — — — — — — 9. Sabin 481 1,081 137 32 154 39 1,924 1,679 245 10. Measles — 466 334 50 40 2 892 798 94 Lines 1+2+3+4+5 (Diphtheria) 463 1,053 119 38 140 30 1,843 1,636 207 Lines 1+2+3+6 (Whooping cough) 446 1,028 113 23 26 1 1,637 1,454 183 Lines 1+2+4+7 (Tetanus) 463 1,053 119 38 141 49 1,863 1,638 225 Lines 1+8+9 (Polio) 481 1,081 137 32 154 39 1,924 1,679 245 TABLE B — Reinforcing Doses — Number of Persons under age 16 Type of Vaccine or Dose Year of Birth Others under age 16 Total Total Completed 1972 1971 1970 1969 1965-68 At Clinics By G.P.s 1. Quadruple D.T.P.Po. — — — — — — — — — 2. Triple D.T.P. 23 841 363 43 107 2 1,379 1,212 167 3. Diphtheria/Pertussis. — — — — — — — — — 4. Diphtheria/Tetanus . — 36 42 22 915 177 1,192 1,097 95 5. Diphtheria - - — — — — - — - 6. Pertussis — — — — — — — — — 7. Tetanus — — — — 20 13 33 13 20 8. Salk — — — — — — — — — 9. Sabin 17 864 399 66 1,012 194 2,552 2,352 200 Lines 1+2+3+4+5 (Diphtheria) 23 877 405 65 1,022 179 2,571 2,309 262 Lines 1+2+4+6 (Whooping Cough) 23 841 363 43 107 2 1,379 1,212 167 Lines 1+2+4+7 (Tetanus) 23 877 405 65 1,042 192 2,604 2,322 282 Lines 1+8+9 (Polio) 17 864 399 66 1,012 194 2,552 2,352 200 D = Diptheria T = Tetanus P = Pertussis (Whooping cough) Po = Poliomyletis Salk = Poliomyletis vaccine Sabin = Poliomyletis vaccine (oral) 81 Table 37 — Home Nursing 1972 1971 Total number of persons nursed during the year 3,472 3,495 Number of persons who were aged under 5 at first visit in year 239 207 Number of persons who were aged 65 and over at first visit in year 2,434 2,459 Table 38 — Domiciliary Midwifery Number of cases delivered in hospitals and other institutions but discharged and attended by domiciliary midwives Discharged within 2 days 60 3—7 days 288 8 or more days 470 Total 818 Number of domiciliary confinements attended by midwives under NHS arrangements 11 (Revised format as required by D.H.S.S. Earlier figures not comparable) Table 39 — Chiropody Service A. Number of persons treated By City Council By City of Westminster Old People's Welfare Association Total 1972 1971 1972 1971 1972 1971 Persons aged 65 and over 2,124 1,761 2,237 2,349 4,361 4,110 Expectant mothers 2 - - - 2 - Others 76 145 12 26 88 171 Total 2,202 1,906 2,249 2,375 4,451 4,281 B. Number of treatments given In clinics 10,354 10,988 4,871 3,094 15,225 14,082 In patients' homes 982 493 5,615 5,506 6,597 5,999 In old peoples' homes 715 852 828 701 1,543 1,553 In chiropodists' surgeries - - 1,679 3,182 1,679 3,182 Total 12,051 12,333 12,993 12,483 25,044 24,816 82 Table 40 — Venereal Diseases Hospital M F Total 1972 Total 1971 Middlesex Hospital, W. 1. Syphilis 142 16 158 181 Gonorrhoea 1,255 477 1,732 1,900 Other Genital Infections 4,401 4,286 8,687 9,212 Other conditions 3,306 2,094 5,400 5,151 Total 9,104 6,873 15,977 16,444 St. George's Hospital, S.W.1. Syphilis 24 3 27 41 Gonorrhoea 315 73 388 352 Other Genital Infections 940 392 1,332 1,180 Other conditions 976 595 1,471 1,319 Total 2,155 1,063 3,218 2,892 St. Mary's Hospital, W.2. Syphilis 196 19 215 223 Gonorrhoea 2,936 947 3,883 4,047 Other Genital Infections 6,856 4,914 11,770 9,916 Other Conditions 5,796 2,773 9,569 7,698 Total 15,784 8,653 24,437 21,884 Westminster Hospital, S.W. 1. Syphilis 46 4 50 51 Gonorrhoea 397 194 591 537 Other Genital Infections 1,314 1,809 3,123 2,714 Other conditions 965 532 1,497 1,130 Total 2,722 2,539 5,261 4,432 Grand Totals 29,765 19,128 48,893 45,652 VENEREAL DISEASES - Contact Notifications Number of notifications received from American Forces, from abroad (through the Department of Health and Social Security— and from other local Authorities 93 (122) Number traced and brought to treatment 32 34.4% (78) (63.9%) 83 Table 41 — Medical suite at City Hall — Work undertaken in 1972 1972 1971 Medical Questionnaires scrutinised in respect of persons entering the Council's service 1,295 1,410 Persons leaving the Council's service — withdrawal of records 1,179 1,019 Medical Examinations (special categories of staff) 181 162 Interviews — Medical Questionnaire 149 135 Examinations — extended sick leave 140 95 Examinations — Parking Meter exemptions 191 150 Retired on health grounds 42 27 ILEA Medicals 47 - Advice and First Aid 1,710 1,185 Referred to general practitioners or hospitals 115 86 FFI examinations 5 18 Vaccinations: Smallpox 90 93 Anti-tetanus 72 19 Influenza 110 52 Poliomyelitis 12 4 TAB, Cholera 15 8 Cholera 11 17 TAB 6 19 Anti-histamine injections 20 20 84 Table 42 — Tuberculin Test and B.C.G. Vaccination Number of persons vaccinated through the Authority's approved arrangements under Section 28 of the National Health Service Act A. Contacts 1972 1971 (i) Number of skin tested 210 411 (ii) Number found positive 143 251 (iii) Number found negative 67 160 (iv) Number vaccinated 66 121 B. School Children and Students (i) Number of skin tested 3,169 1,661 (ii) Number found positive 501 459 (iii) Number found negative 2,505 1,137 (iv) Number vaccinated 2,505 969 Table 43 — School Health Service The table below shows the grades and numbers (full-time equivalents as at 31st December, 1972) of staff employed on school health work in the City of Westminster together with the totals for the Inner London Education Authority as a whole. Grade FULL-TIME EQUIVALENT EMPLOYEES AS AT 31st DECEMBER, 1972 IN: City of Westminster Inner London Education Authority 1972 Inner London Education Authority 1971 Medical — M.O.'s & G.P.'s (excluding for the boroughs, centrally-directed Consultants and Specialists) 3.63 91.74 94.39 Nursing (all categories of staff) 10.38 281.34 265.16 Speech Therapists (centrally-directed) 0.90 40.00 37.50 Social Workers 5.90 57.30 54.68 Dental Officers 4.72 79.50 85.68 Dental Auxiliaries 2.00 15.43 17.81 Dental Surgery Assistants 4.25 109.33 105.45 Dental Technicians — 7.50 7.50 Dental Health Education Officers — 2.00 2.00 Table 44 — School Medical Inspections (excluding Dental and Health Surveys) 1972 City of Westminster Inner London Education Authority 1972 1971 SCHOOL ROLL 21,377 423,992 424,890 ROUTINE INSPECTIONS Number inspected 7,045 151,788 157,966 PERCENTAGE OF No. INSPECTED OF:- Parent present 47.8 54.3 52.4 Care Committee present 81.9 50.6 61.7 No. vaccinated against smallpox 69.5 66.0 69.1 No. Immunised against diphtheria 90.8 89.8 88.9 No. Immunised against whooping cough 84.7 84.9 82.1 No. Vaccinated against poliomyelitis 90.9 89.9 88.5 Physical condition unsatisfactory 1.0 0.4 0.7 Referred for treatment of defects 16.3 16.6 16.5 Referred for treatment of defects other than vision 7.8 8.6 8.9 NON-ROUTINE INSPECTIONS (i) Specials 1,899 50,272 51,467 (ii) Re-inspections 4,687 68,681 69.718 Totals (i) and (ii) 6,586 118,953 121,185 No. of routine inspections as percentage of school roll 33.0 35.8 37.6 No. of non-routine inspections as percentage of school roll 30.8 28.1 28.5 85 Table 45 — Routine Medical Inspections 1972 — Defects NUMBER OF CHILDREN NOTED FOR TREATMENT OR OBSERVATION EXPRESSED AS A RATE PER 1,000 INSPECTED Number Inspected City of Westminster Inner London Education Authority 7,045 1972 151,788 1971 157,966 DEFECTS † SKIN T 6.25 10.36 10.57 O 11.78 9.70 10.25 EYES (a) Vision T 93.26 89.95 86.95 O 51.24 47.36 46.03 (b) Squint T 6.96 10.76 9.86 O 5.82 4.44 4.47 (c) Other T 1.70 2.13 1.56 O 2.84 1.69 1.69 EARS (a) Hearing T 6.81 9.10 7.71 O 9.08 6.44 6.51 (b) Otitis Media T 1.70 2.69 2.27 O 3.69 2.97 3.15 (c) Other T 1.14 1.02 1.18 O 0.57 0.84 0.86 NOSE AND THROAT T 3.83 5.36 5.36 O 16.04 18.72 20.40 SPEECH T 3.42 5.76 5.25 O 9.08 7.43 7.14 LYMPHATIC GLANDS T 0.43 0.77 0.72 O 4.40 5.16 6.19 HEART *Congenital T •2.84 + 0.43 *2.80 + 0.55 *2.53 + 0.84 + Acquired O *2.84 + 2.27 *4.84 + 2.10 *4.62 + 2.23 LUNGS T 7.24 8.60 7.92 O 7.38 7.99 8.66 DEVELOPMENT (a) Hernia T 0.85 1.40 1.33 O 2.13 2.31 2.69 (b) Other T 3.41 2.60 2.85 O 4.97 4.51 4.95 ORTHOPAEDIC (a) Posture T 0.57 1.15 1.19 O 1.99 2.67 3.28 (b) Feet T 2.70 4.06 4.13 O 5.54 9.40 10.72 (c) Other T 1.85 2.57 2.98 O 4.40 3.24 3.30 NERVOUS SYSTEM (a) Epilepsy T 1.85 2.50 2.06 O 1.28 1.14 1.23 (b) Other T 0.85 1.24 1.48 O 1.85 1.07 1.35 PSYCHOLOGICAL (a) Development T 1.99 2.78 2.09 O 7.81 6.11 6.36 (b) Stability T 5.39 3.72 3.32 O 16.89 11.19 11.62 ABDOMEN T 0.57 0.88 0.86 O 2.27 1.29 1.54 DEBILITY T 0.71 0.75 0.91 O 1.28 1.22 1.37 †T = Treatment O = Observation 86 Table 46 — School Health Service — Findings at Health Surveys 1972 City of Westminster Inner London Education Authority 1972 1971 SCHOOL ROLL - May 21,377 423,992 424,890 1. Comprehensive Surveys (a) Number examined 14,558 321,727 304,431 (b) Number (occasions) found verminous 268 5,847 4,994 (c) Percentage found verminous 1.84 1.82 1.64 2. Selective Surveys (a) Number examined 5,420 162,175 145,573 (b) Number (occasions) found verminous 238 6,317 5,771 (c) Percentage found verminous 4.39 3.90 3.96 3 (a) Total times vermin found (1 (b) + 2 (b)) 506 12,164 10,765 (b) Total percentage found verminous (3 (a) as percentage of 1 (a) + 2 (a)) 2.53 2.51 2.39 (c) Number of individual pupils found verminous 337 7,733 7,053 (d) Percentage of individual pupils found verminous (of school roll) 1.58 1.82 1.66 4. Action taken with verminous cases (a) Advice and/or Lorexane 467 9,755 8,844 (b) Further action 39 2,409 1,924 (c) 4 (b) expressed as a percentage of 4 (a) 8.35 24.70 21.72 Analysis of 4 lb) cases — referrals of hardcore cases to bathing centres Voluntary attendance at bathing centres Number of pupils 355 2,609 1,737 Number of Statutory notices issued — — — Number cleansed at centres following statutory notices Voluntarily - — - Compulsorily — — — 5. Communicable disease surveys Number examined for: Athlete's foot — 18,352 21.807 Plantar Warts — Dysentery — 36 90 Other communicable diseases 68 19,575 17,239 Totals of (5) 68 37,963 39,136 87 Table 47 — School Health Service — Non-Routine Medical Inspections 1972 Type of Inspection City of Westminster Inner London Education Authority 1972 1971 Re-inspections 4,687 68,681 69,718 Bathing Centre Inspections — Scabies 1 29 33 Bathing Centre Inspections — Other 1 81 90 Employment certificates 147 2,544 2,851 Theatre children 7 788 572 School Journeys 800 26,499 26,325 Recuperative holidays — pre-departure 58 975 934 Recuperative holidays — on return — 2 5 Secondary school annual surveys 175 415 136 Candidates for higher awards — 113 100 Nautical school entrants — — 1 Outward bound courses 2 177 108 Infectious disease investigation 25 281 50 T.B. contacts — 2 4 Boarding Schools for the delicate pre-departure 1 131 125 Boarding Schools for the delicate on return — 9 13 Handicapped Pupils — Statutory examination 27 1,196 1,842 Handicapped Pupils — Periodic special defect examination 40 4,577 5,063 Research investigations and enquiries 2 178 268 Sub-Total 1,286 37,997 38,520 SPECIALS — At request of: Head Teacher — Child's name entered in special book 46 905 1,352 Head Teacher — Others 170 3,251 3,195 School Nurse following halth survey 21 547 529 School Nurse — Others 39 706 699 Division Education Officer 29 437 479 District Care Organiser or Care Committee 21 297 289 Parent 76 1,020 1,038 School Medical Officer 99 1,623 1,715 Sub-Total 501 8,786 9,296 Other — Accident on School premises — 6 _ Boxing — Reference from schools A.B.A. or similar Association. — 11 114 For free travel — 1 2 Reference: (i) connected with remedial exercises foot classes — (ii) by gymnast or physiotherapist — 11 30 Referred by Hospital — 3 4 Referred by Speech Therapist — 3 1 Referred by general practitioner — 2 — Miscellaneous 112 3,452 3,500 Sub-Total 112 3,489 3,651 Total of all Non-Routine Medical Inspections 6,586 118,953 121,185 88 Table 48 — School Health Service — Routine Medical Inspections 1972 — Vision PERCENTAGE OF NUMBER TESTED Percentage of total number tested and noted for treatment A — Not Wearing Glasses B — Wearing Glasses Number Tested 6/6 6/9 6/12 or worse Noted for Treatment 6/6 6/9 6/12 or worse Noted for Treatment Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys and Girls City of Westminster 3,364 3,095 78.1 76.8 8.1 7.9 6.1 7.1 4.8 6.6 3.6 3.3 2.1 1.9 2.0 2.1 4.2 4.6 10.0 I.L.E.A. 1972 72,740 68,073 83.0 81.3 6.2 6.6 5.1 5.4 5.2 5.9 2.7 3.2 1.5 1.7 1.5 1.7 3.6 4.6 9.6 I.L.E.A. 1971 73,418 71,489 82.7 80.9 6.1 6.6 5.1 5.3 5.1 5.6 3.0 3.3 1.5 1.8 1.5 1.9 3.6 4.6 9.5 89 Table 49 — School Health Service Comparison of Defects noted at 7-Plus Routine and 7-Plus "Special" Medical Inspections 1972 Number of Children Noted for Treatment and Observation expressed as a rate of 1,000 inspected City of Westminster Inner London Education Authority 1972 1971 Number inspected at 7-plus routine inspections 320 37,546 Number inspected at 7-plus experimental scheme inspections 707 1,746 Defects * A † B * A † B * A † B Skin 6.3 18.4 21.7 18.3 24.8 18.1 Eyes — Vision 137.5 135.8 148.7 146.6 146.6 122.7 Squint 18.8 19.8 16.9 23.7 16.6 19.8 Other 0.0 4.2 3.3 2.9 2.6 1.1 Ears— Hearing 25.0 19.8 20.5 18.3 18.3 17.5 Otitis media 0.0 7.1 6.0 6.3 5.4 6.2 Other 3.1 0.0 2.4 1.1 2.7 4.0 Nose and Throat 15.6 32.5 29.4 24.6 31.1 37.3 Speech 18.8 11.3 12.6 9.7 12.6 11.9 Lymphatic Glands 6.3 1.4 6.6 8.6 7.6 13.0 Heart 12.5 7.1 10.6 8.0 10.7 14.6 Lungs 12.5 18.4 18.3 21.2 18.9 23.2 Developmental — Hernia 0.0 2.8 3.9 5.2 4.8 5.1 Other 6.3 5.7 8.2 9.2 9.8 13.6 Orthopaedic — Posture 3.1 0.0 3.8 2.3 5.1 5.7 Feet 3.1 15.6 14.9 9.2 16.2 5.1 Other 12.5 7.1 5.9 6.9 5.8 6.2 Nervous System — Epilepsy 3.1 0.0 3.2 3.4 3.7 2.8 Other 3.1 0.0 2.9 1.7 3.3 3.4 Psychological — Development 15.6 18.4 12.2 18.9 11.1 21.5 Stability 37.5 46.7 19.3 29.8 19.3 29.4 Abdomen 3.1 2.8 2.2 3.4 2.0 5.1 Other 140.7 86.3 72.0 89.4 63.8 79.2 * Column 'A' refers to 7-plus routine medical inspections, † Column 'B' refers to 7-plus experimental scheme inspections. 90 Table 50 — School Dental Service Statistics 1972 (Statistics, 1971 shown in brackets) NUMBER OF SESSIONS Inspection Ordinary treatment Health Education Anaesthetic Total 78.4 (76.6) 2227.8 (1819.3) 40.8 (114.1) 9.6 (6.8) 2356.6 (2016.8) INSPECTIONS First inspection at school First inspection at clinic Percentage found to require treatment 9,909 (8,703) 2,076 (3,392) 54.0 (64.5) Re-inspection at school or clinic 101 (1,008) 89.1 (86.3) NUMBER OF VISITS FOR TREATMENT Number of 1st visits 3,786 (3,992) Number of subsequent visits 8,432 (7,258) Emergencies 552 (429) Total (including emergencies) 12,770 (11,679) FILLINGS' EXTRACTIONS AND OTHER OPERATIONS Permanent teeth Temporary teeth Fillings: 9,003 (7,225) 7,534 (6,269) Extractions 127 (134) 676 (712) Other operations (prophylaxis. X-rays, crowns, etc.) 6,492 (4,256) Number of dentists and auxiliaries employed (effective whole time equivalent) at 31st December, 1972 6.2 (4.4) 91 Table 51 — Dental Services for Expectant and Nursing Mothers and Children under 5 Part A — Attendances and Treatment Number of Visits for Treatment during year Children 0—4 (incl.) Expectant and Nursing Mothers 1972 1971 1972 1971 First Visit 312 386 44 53 Subsequent Visits 244 421 70 63 Total Visits 556 807 114 116 Number of Additional Courses of Treatment other than the First Course commenced during year 16 82 1 6 Treatment provided during the year- Number of Fillings 465 658 144 125 Teeth Filled 328 517 90 78 Teeth Extracted 8 25 5 4 General Anaesthetics given 4 2 — — Emergency visits by patients 51 32 4 12 Patients X-rayed 1 35 12 12 Patients Treated by Scaling and/or Removal of Stains from the Teeth (Prophylaxis) 173 165 26 35 Teeth Otherwise Conserved 87 114 — — Teeth Root Filled - - - 1 Inlays — — — — Crowns — — — - Number of Courses of Treatment completed during the year 229 246 17 25 Part B — Prosthetics Patients supplied with F.U. or F.L. (first time) 1 Patients supplied with other Dentures 1 — 2 - Number of Dentures supplied 1 — 3 — Part C — Anaesthetics General Anaesthetics administered by Dental Officers - - - - Part D — Inspections Number of Patients given First Inspections during year (a) 194 (a) 557 (d) 6 (d) 36 Number of Patients in (a) and (d) above who required Treatment (b) 66 (b) 366 (e) 6 (e) 35 Number of Patients in (b) and (e) above who were offered Treatment (c) 66 (c) 354 (f) 6 (f) 34 Part E — Sessions 1972 1971 Number of Dental Officer Sessions (i.e. Equivalent complete half-days) devoted to Maternity and Child Welfare Patients— For Treatment 103 151 For Health Education 5 — 92 Table 52 — Tuberculosis — Care and After Care Paddington Chest Clinic Marylebone Chest Clinic Westminster Hospital Chest Clinic 1972 1971 1972 1971 1972 1971 T.B. Patients on Register of Chest Clinics at 31st December 357 429 428 438 1,018 987 T.B. Visitors — Visits to homes 1,291 1,721 931 1,026 — — After-Care Work (Social Worker): Number of patients in receipt of extra nourishment at end of year 5 5 13 11 4 8 Patients assisted for the first time with bed or bedding 1 2 - - - — Patients assisted for the first time with clothing or footwear 10 22 — — — — B.C.G. Vaccinations during the year in accordance with City Council scheme 40 80 16 11 38 30 Rehabilitation Hostels: Patients in residence at end of year _ - - — 1 - Hostels for Homeless tuberculous men: Patients in residence at end of year — — — — 14 7 Child contacts boarded out during the year — — — — — — 93 INDEX Page Abrus Seeds 31 Acute Poliomyelitis 11 Advice on Labelling 33 After Hours Emergency Telephone Service 13 Analysis of Calls made to Duty Officer 64 Animals, Slaughter of 34 Ante-natal Exercises, Mothercraft and 78 Ante-natal and Post-natal Clinics 9, 78 Area of City 10 Assessment of Children 39 Attachment of Health Visitors to Medical Practitioners 43 Attendances at M. and C.H. Clinics 78 Basement Bakehouses 25 Bathing Service for Old People 35 BCG Vaccination 12, 84 Betting Shops 36 Births 10 Blind and Partially Sighted Persons 51 Brucella Abortus, Milk Supplies 30 Burial/Cremation of the Dead 37 Catering Establishments 25 Catering Premises and Food, Inspection 25 Cervical Cytology 52 Chest Clinics 57, 58, 92 Childhood, Infant and. Deaths 38 Child Health Clinics 9, 74, 78 Chiropody Service 52, 81 Clean Air 17 Colleges of Further Education 56 Committees, Appointment of Members of Health Committee to 5 Common Lodging Houses 21 Community Training Programme for Student Nurses 44 Control Orders, Houses let in Multiple Occupation 19 Co-ordination 55 Coroner's Court and Mortuary 36, 73 Creches 46 Cremation, Work of Medical Referee 37 Deaths 10, 11, 60 Deaths, Causes of. According to Age Group and Sex 60 Deaths, Infant Mortality 11 Deep Wells 24 Dental Services 57, 90, 91 Diathermy 56 Diseases of Animals Act 1950, and other Acts relating to Animals 34 Disinfection 22 Disinfestation, Insect Pest Control 22 Disposable Incontinence Pads 36 Disposal of Unsound or Unsaleable Food 31 District Inspection, Public Health Inspectors 15 Domestic Rateable Hereditaments 10 Domiciliary Midwifery 45, 81 Drainage and New Developments 16 Duty Officer, Calls made to 13, 64 Dwelling Houses, Inspections 16, 64 Dwelling Houses, Nuisances and Unsatisfactory Conditions 64 Dysentry 11 Emergency Telephone Service 13, 64 Environmental Health Services 14 Establishments for Massage or Special Treatment 36 Export Certificates 32 Page Factories 25 Factories, Inspections 69 Factories, Defects 69 Family Planning 48, 78 Food and Drugs Act 1955 — Section 16 30 Food, Date Marking 33 Food Hygiene, etc., Lectures 28 Food Hygiene (General) Regulations 1970 70 Food, Legal Proceedings 29 Food Poisoning 30, 71 Food Premises, Legal Proceedings 29 Food Premises, Number of 68 Food Premises, Registration of 68 Food Sampling and Analysis 28 Food and Catering Premises, Inspection 25 Food, Unsound or Unsaleable, Disposal of 31 Grants, Subsidies and Loans 19 Handicap Register 39, 79 Handicapped Children 39, 56 Health Committee 5 Health Department, Premises 9 Health Education 47 Health Visitors, Attachment to Medical Practitioners 43 Health Visiting Service 43, 79 Home Nursing 81 Home Nursing Equipment, Loan of 45 Houses in Multiple Occupation, Management Orders and Directions 19 Houses in Multiple Occupation, Control Orders 19 Houses in Multiple Occupation, Summary 66 Housing Acts, Visits by Public Health Inspectors 65 Housing Acts 1961 — 1969, Work Carried out by Inspectors 66 Housing Finance Act 1972 20, 66 Housing Priority on Medical Grounds 20 Ice Cream, Premises Registered 71 Imported Food Regulations 1968 32 Immunisation and Vaccination 46, 56 Incontinence Pads 36 Infant and Childhood Deaths 38 Infant Mortality 11, 61 Infectious and Other Notifiable Diseases 11, 62 Infective Jaundice 11 Insect Pest Control, Disinfestation 22 Inspection of Dwelling Houses 16, 64 international Certificates of Vaccination and Inoculation 12 Introduction 3 Labelling, Advice on 33 Laundry Service, Special 35 Legal Proceedings 16, 72 Legal Proceedings, Food and Premises 29 Licensing Act 1964 27 Liquid Egg (Pasteurisation) Regulations 1963 31 Loan of Home Nursing Equipment 45 Loans, Grants and Subsidies 19 Local Land Charges 20 Lodging Houses, Common 21 Malaria 12 Management Orders and Directions — Houses in Multiple Occupation 19 94 Page Management Structure of Local Authority Nursing Service 39 Mass X-ray 12 Massage and Special Treatment Centres 36 Maternal and Child Health Centres 9, 74 Maternal Mortality 10, 38 Medical Referee, Work of 37 Medical Suite, City Hall 83 Midwifery 45, 81 Milk and Dairies (General) Regulations 1959 29 Milk Dealers' Licences 29 Milk (Special Designation) Regulations 1963 29 Milk Supplies, Brucella Abortus 30 Mobile Health Clinic 43 Mothercraft and Ante-natal Exercises 78 Mouse Survey, Greater London 22 National Assistance Act 1948, Section 50 36 New Developments, Drainage 16 Noise 16 North Westminster Project 18 Notices 16, 65 Notification of Infectious Diseases 11, 62 Nursing Homes 46 Nurse Training 44 Nursing Services 39 Offices, Shops and Railway Premises Act 1963 24, 68 Old Peoples Welfare 53 Old Persons' Bathing Service 35 Outworkers 25, 70 Overcrowding 19 Paratyphoid Fever 12 Partially Sighted and Blind Persons 51 Personal Health Services 38 Pharmacy and Poisons Acts 1933 and 1941 34 Pigeon Control 23 Poliomyelitis Acute 11 Population 10 Poultry Processing Premises 34 Premises Registered, Preserved Food or Manufactured 71 Premises Registered, Ice Cream 71 Preserved Food or Manufactured, Premises Registered 71 Priority on Medical Grounds, Housing 20 Private Water Supplies, Deep Wells 24 Public Health Inspectors, District Inspection 15 Public Health Inspectors, Night and Weekend Duties 15 Public Health Inspectors, Summary of Visits 65 Public Health Laboratory, Specimens submitted to 63 Qualification Certificates 19, 66 Radioactive Substances Act 1960 21 Rag Flock and Other Filling Materials Act 1951 35 Rateable Value 9 Recuperative Holidays 51 River Thames Flood Precautions 24 Rodent Control 22, 67 Sampling and Analysis, Food 28 Scabies 35, 73 School Dental Service 57, 90 Page School Health Service 54, 55, 84, 86 School Health Service, Number employed in 84 School Medical Officers 56 School Medical Inspections, Defects Found 84 School Medical Inspections, excluding Surveys 84 School Medical Inspections, Health Surveys 86 School Medical Inspections, Non-routine Inspections 87 School Medical Inspections, Routine Inspections 85, 88 School Medical Inspections, Comparison of Defects found 89 Sewerage 16 Slaughter of Animals 34 Slaughterman's Licences 34 Slum Clearance 18 Social Work (Personal Health Service) 53 Special Investigation Clinics 56 Special Laundry Service 35 Special Counselling Service, Family Planning 48 Specimens to Public Laboratory 63 Staff of Health Department 7 Staff Medical Service 53, 83 Statistical Tables, List of 59 Statistics and Social Conditions 10 Statutory Notices served 16, 65 Street Traders, Licensed 27 Street Traders, Unauthorised 27 Student Public Health Inspectors 15 Subsidies, Loans and Grants 19 Swimming Bath Water, Examination 24 Technical Assistants 15 Tenement Dwellings 19 Tourism 20 Town Planning 17 Trade Descriptions Act 1968 32 Tuberculin Test and BCG Vaccination 12, 84 Tuberculosis, Care and After Care 92 Tuberculosis, New Cases and Deaths 12, 63 Typhoid Fever 12 Unauthorised Street Traders 27 Unfit Premises 19, 60 Unsound or Unsaleable Food, Disposal of 31 Vaccination against Smallpox 46 Vaccination and Immunisation 46, 80 Vaccination and Inoculation, International Certificates of 12 Vaccinations performed 84 Vasectomy 50 Venereal Diseases 50, 55, 82 Verminous Persons 35, 72 Visitors to Health Department 13 Visual Defects 56 Water 63 Water, Bacteriological Examinations 68 Water, Chemical Examination 67 Water Supplies, Private Deep Wells 24 Whooping Cough 12 X-ray, Mass Miniature Radiography 12 Youth Advisory Service 50 Printed by Vail & Co. 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