THE HEALTH OF BARKING 1965 BARK 59 LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1965 J. ADRIAN GILLET, m.b., ch.b., d.p.h., f.r.s.h. Civic Centre, Dagenham, Essex Telephone: 01-592 4500 INDEX Page Adult Training Centre 42 Ante-natal Clinics 21 Atmospheric Pollution 68 Bentry School 56 Care of Mothers and Young Children 21 Child Development 33 Child Guidance 50 Children's Department 31 Chiropody 38 Civil Defence 44 Congenital Abnormalities, Incidence of 60 Convalescence *+5 Council, Members of 3 Cytology Clinics 27 Day Nurseries 23 Deaths, Causes of 17 Dental Services 62 Diseases of Animals Act 1950 70 Domestic Help 44 Education Committee 4 Education (Special Services) Sub-Committee 5 Enuresis Clinic 52 Factories Act 1961 70 Faircross School 55 Food and Drugs, Sampling 74 Food Hawkers, Registration 74 Food, Inspection and Supervision 72 Food Poisoning 74 Food, Unsound 73 Handicapped Children 55 Health Committee 4 Health Education 19 Health Visiting 28 Home Nursing Service 34 Housing 67 Houses in Multiple Occupation 68 Ice Cream 73 Immunisation 31 Improvement Grants 67 Infant Mortality 16 Infant Welfare Centres 22 Infectious Diseases 78 Junior Training Centre 59 Page Kingsley Hall Day Centre 25 Laundry Service for the Incontinent Aged 68 Maternity Services 21 Medical Examination of Staff 41 Mental Health 42 Midwifery Service (domiciliary) 22 Minor Ailments Clinics 46 Milk 73 National Assistance Act 1948 35 Noise Abatement Act i960 69 Offices, Shops and Railway Premises Act 1963 71 Orthopaedic Clinic 50 Over Sixties Clinic, Oxlow Lane 35 Pet Animals Act 1951 69 Play Therapy 25 Prevention of Damage by Pests Act 1949 70 Public Swimming Baths 67 Rag Flock and Other Filling Materials Act 1951 69 Rehousing on Medical Grounds 41 Rent Act 1957 67 Riding Establishments Act 1939 70 Sanitary Inspection of District 65 School Health 46 School Meals Service Staff, Medical Invigilation of 46 School Medical Inspections 47 Selective School Medical Examinations 47 Sewerage and Sewage Disposal 66 Sickroom Equipment 34 Slum Clearance 67 Smoke Control Areas 68 Speech Therapy 53 Staff 6 Tents, Vans and Sheds 68 Tuberculosis 35 Unmarried Mother, Care of 22 Vaccination 31 Vital Statistics 16 Water 65 2 MEMBERS OF THE COUNCIL (as at 31st December, 1965) MAYOR Alderman W. E. BELLAMY, J.P. DEPUTY MAYOR Alderman B. E. ROYCRAFT, G.L.C. ALDERMEN A. E. BALL, J.P. Mrs. A. M. MARTIN F. BROWN J. R. SWEETLAND Q. H. A. CROUCH Mrs. A. R. THOMAS COUNCILLORS C. H. AYRES DANIEL LINEHAN C. E. AYRTON DAVID LINEHAN Mrs. M. BALL, G.L.C., O.B.E. E. R. McKEE G. J. G. BEANE, J.P. W. MILNE R. BLACKBURN, J.P. J. P. MOORE Mrs. M. BREDO R. W. MUGE J. A. BUTLER, J.P. W. G. NOYCE, J.P. Mrs. J. CALLAN D. 0. DWYER H. J. CLEAVER H. A. POWELL S. G. COLE C. PRENDERGAST, B.E.M., G.L.C. D. A. L. G. DODD Mrs. M. S. PRESTON F. C. EDGECOMBE A. C. V. RUSHA R. C. FOSTER L. SENIOR Mrs. C. S. M. GODFREY, J.P. M. SPENCER R. H. F. GODFREY F. C. SPRAGGINS D. 0. GRANDISON S. C. SIVELL L. F. HENSTOCK, J.P. J. S. THOMAS H. J. HOWIE F. G. TIBBLE C. W. JILLINGS L. W. TODD Mrs. D. M. JONES J. B. WARD F. C. JONES S. J. WARR H. R. JONES Mrs. M. A. WARREN J. L. JONES, J.P. D. W. WEBB H. P. LARKING E. J. WOODS J. H. LAWRENCE Mrs. F. F. WOODS 3 HEALTH COMMITTEE (as at 31st December, 1965) CHAIRMAN Councillor Mrs. J. CALLAN VICE-CHAIRMAN Councillor Mrs. M. BALL MEMBERS His Worship the Mayor Councillor E. R. McKEE The Deputy Mayor Councillor R. W. MUGE Alderman J. R. SWEETLAND Councillor D. O'DWYER Alderman Mrs. A. R. THOMAS Councillor F. C. SPRAGGINS Councillor Mrs. C. S. M. GODFREY Councillor F. G. TIBBLE Councillor Mrs. D. M. JONES Councillor S. J. WARR Councillor H. R. JONES Councillor Mrs. F. F. WOODS Councillor J. H. LAWRENCE EDUCATION COMMITTEE (as at 31st December, 1965) CHAIRMAN Councillor G. J. G. BEANE VICE-CHAIRMAN Councillor A. C. V. RUSHA REPRESENTATIVE MEMBERS His Worship the Mayor Councillor C. W. JILLINGS Alderman A. E. BALL Councillor Mrs. D. M. JONES Alderman F. BROWN Councillor F. C. JONES Alderman J. R. SWEETLAND Councillor Daniel LINEHAN Councillor Mrs. M. BALL Councillor David LINEHAN Councillor R. BLACKBURN Councillor D. O'DWYER Councillor Mrs. M. BREDO Councillor C. PRENDERGAST Councillor J. A. BUTLER Councillor Mrs. M. S. PRESTON Councillor S. G. COLE Councillor L. SENIOR Councillor D. A. L. G. DODD Councillor S. C. SIVELL Councillor Mrs. C. S. M. GODFREY Councillor Mrs. M. A. WARREN Councillor R. H. F. GODFREY Councillor D. W. WEBB Councillor D. 0. GRANDISON Councillor E. J. WOODS Councillor L. F. HENSTOCK Councillor Mrs. F. F. WOODS CO-OPTED AND NOMINATED MEMBERS Mrs. I. M. BROCKELBANK The Rev. Louis HESTON Mr. J. H. COCKS Mr. F. H. KING Mr. J. M. DAVIES Mr. W. J. MANN Mr. P. GRIMES Mr. S. J. RUSSELL Miss M. C. GROBEL, M.A. The Rev. Prebendary J. D. Mr. E. E. HENNEM WAKELING, M.C., M.A. 4 \ EDUCATION SPECIAL SERVICES SUB-COMMITTEE (a6 at 31st December, 1965) (This Sub-Committee deals, inter alia, with the School Health Service) CHAIRMAN Councillor G. J. G. BEANE MEMBERS Alderman F. BROWN Councillor A. C. V. RUSHA Councillor Mrs. M. BREDO Councillor L. SENIOR Councillor Mrs. C. S. M. GODFREY Councillor Mrs. M. A. WARREN Councillor D. 0. GRANDISON Councillor Mrs. F. F. WOODS Councillor Mrs. D. M. JONES Mrs. I. M. BROCKELBANK Councillor Mrs. M. S. PRESTON 5 OFFICERS OF THE HEALTH SERVICE (as at 31st December, 1965) MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER J. Adrian Gillet, M.B., Ch.B., D.P.H., F.R.S.H. ASSOCIATE MEDICAL OFFICER OF HEALTH Margaret I. Adamson, M.B., Ch.B., D.P.H. DEPUTY MEDICAL OFFICER OF HEALTH Ji Slorae, M.R.C.S., L.R.C.P., M.B., B.S., D.Obst. R.C.O.Q., D.C.H,, D.P.H., D.I.H. SENIOR MEDICAL OFFICERS W. H. G. Batham, M.R.C.S., L.R.C.P. D.P.H. E. H. Maseey, B.Sc., M.B., Ch.B., D.P.H., D.I.H. SENIOR ASSISTANT MEDICAL OFFICERS V. Spiller, M.D., M.R.C.S., L.R.C.P., D.P.H. M. Weizmann, M.R.C.S., L.R.C.P. ASSISTANT MEDICAL OFFICERS D. Burgess, M.D. E. Klein, M.D., L.R.C.P.& S. K. Fitzpatrick, M.B., Ch.B. G. Michael, M.R.C.S., L.R.C.P., B.A. M. T. Fernandes, M.B., B.S., D.P.H., E. L. M. Wallace, L.R.C.P.& S. D.C.H., D.I.H. In addition 6 medical officers are employed on a sessional basis. PRINCIPAL DENTAL OFFICER J. K. Whitelaw, L.D.S., R.C.S. DENTAL OFFICERS P. K. Chaudhury, L.D.S., R.C.S. V. H. Foy, L.D.S., R.C.S. In addition 6 dental officers are employed on a sessional basis. DENTAL SURGERY ASSISTANTS Mrs. M. Brideson Miss M. Sealey Mrs. B. Hurford (part-time) Mrs. M. Strachan (9) Mrs. K. E. McKenzie Miss D. Troupe (23) Mrs. I. A. Rourke Miss D. R. Willing Mrs. F. B. Sadler DENTAL AUXILIARIES Miss S. D. Ware (24) Miss E. A. Wells (24) SENIOR DENTAL TECHNICIAN-IN-CHARGE Mr. J. Constable 6 SENIOR DENTAL TECHNICIANS Mr. G. F. Dickerson Mr. S. H. Whelan Mr. D. Leftwich (25) DENTAL APPRENTICE Mr. V. Marks CHIEF PUBLIC HEALTH INSPECTOR Mr. F. W. S. Fox (1), (2), (3), CO DEPUTY CHIEF PUBLIC HEALTH INSPECTOR Mr. M. R. Williams (1), (2), CO PUBLIC HEALTH INSPECTORS Mr. J. Allam (1), (2), CO Mr. S. A. Leramon (1), (2), CO Mr. N. Burton (1), (2) Mr. J. Powell (1), (2), CO Mr. J. Cook (1), (2), (3) Mr. B. Saunders (1), (2), CO Mr. E. Day (1), (2), CO Mr. F. Silverthorne (1), (2) Mr. T. W. Glew (1), (2) STUDENT PUBLIC HEALTH INSPECTORS Mr. K. Hunt Mr. B. Orme SUPERINTENDENT HEALTH VISITOR Miss B. Long (5), (6), (7), (22) DEPUTY SUPERINTENDENT HEALTH VISITOR Mrs. M. P. Hassan (5), (6), (7) SENIOR HEALTH VISITORS Mrs. P. Broad (5), (7), (8), (14) Mrs. B. Ramsey (5), (6),.(7), (20) HEALTH VISITORS Miss J. Baldwin (5), (6), (7) Mrs. M. N. Kalu (5) Mrs. M. F. Bass (5), (6), (7) Mrs. E. Lyon (5), (6), (7), (21) Miss S. M. Bergstrom (5), (6), (7) Miss 0. Ologunro (5), (6), (7) Miss A. E. Boorman (5), (6), (7) Miss E. G. Parry (5), (6), (7) Miss M. T. Dowd (5), (6), (7), (12) Mrs. R. L. Robertson (5), (6), (7), Mrs. L. Dunbar (5), (6), (7) (12) Miss E. P. Heffernan (5), (6), (7), Miss D. B. Rudd (5), (6), (?) (13) Miss M. F. Savage (5), (6), (7), Miss R. Hutchinson (5), (6), (7), (21) (14) Miss P. I. Jefford (5), (6), (7) Mrs. F. M. Stuart (5), (6), (7) Miss M. D. Wint (5), (6), (7) HEALTH VISITORS (part-time) Mrs. M. Nelson (5), (6), (7) Mrs. R. Walker (5), (6), (7), (12) 7 NON-MEDICAL SUPERVISOR OF MIDWIVES Miss M. Dobson (5), (6), (21) ASSISTANT NON-MEDICAL SUPERVISOR OF MIDWIVES Mies M. Teather (5), (6) MIDWIVES Mrs. I. M. Bronnick (5), (6) Mrs. F. Harrington (5), (6), (14) Miss A. Cunningham (6) Miss D. Hearsey (5), (6) Miss E. Deheney (5), (6) Miss P. R. Shackleton (5), (6), (9) Miss S. W. Etherton (5), (6), (14) Mrs. P. Shardlow (5), (6) Miss L. M. Grant (6), (9) Mrs. P. Vanbrook (5), (6) Miss M. Hall (5), (6) Miss M. Walker (5), (6) SUPERINTENDENT OF NURSES' HOMES Miss M. Dobson (5), (6), (21) ASSISTANT SUPERINTENDS OF NURSES' HOMES Miss E. S. Hart (5), (6), (7), (12), (21) DISTRICT NURSES Mrs. J. Charles (5), (6) Miss D. Meek (5), (6), (21) Mrs. J. M. Cotterill (5) Miss K. M. Mollerup-Peterson (5), Mrs. J. W. Cowell (5), (21) (21) Mrs. E. J. Daniels (5), (6), (21) Miss N. Norris (5), (6), (21) Miss N. Devaney (5), (6), (21) Miss T. O'Kelly (5) Mrs. J. M. Findlay (5) Miss N. Rebboah (5), (21) Mrs. D. Foulkes (5) Mls6 R. Richards (5), (6), (21) Miss J. R. Heath (5) Miss J. Smith (5), (9) Mrs. R. Hislop (5), (6), (21) Mrs. L. Thomas (5), (8), (21) Mr. R. D. Lintott (5), (16), (21) Mrs. J. E. Walsh (5) Miss P. Lowery (5) Mrs. G. White (5), (6), (21) Mrs. P. E. McGregor (5), (21) DISTRICT NURSES (part-time) Mrs. W. Bates (5) Mrs. N. Flynn (5), (8), (21) Mrs. E. Colgate (9) Mrs. M. O'Riordan (5), (8) Mrs. J. E. Fairbrass (5) STUDENT DISTRICT NURSES Miss J. Carey (5) Mr. R. Turpin (5) Miss M. Ellis (5), (20) SCHOOL NURSES Mrs. E. A. Hogg (5) Mrs. P. A. Picken (5) Mrs. J. I. Hogg (5) Mrs. M. C. Twomey (5) Mrs. E. M. McCheyne (5) Mrs. N. F. Yarnell (5), (21) CLINIC NURSES Mrs. S. M. C. Barber (5) Mrs. R. McCormack (5) 8 CLINIC NURSES (part-time) Mrs. J. Benzie (5), (8) Mrs. S. Henderson (5), (12) Mrs. N. A. Boyce (5) Mrs. D. G. L. Jarvis (5) Mrs. R. K. D. Clark (5), (8) Mrs. A. Marsh (5), (6) Mrs. I. M. Collingwood (5) • Mrs. M. McGee (5) Mrs. K. Daly (5), (6) Mrs. M. E. Montgomery (5) Mrs. Y. A. Dignum (5) Mrs. G. Pratt (5) Mrs. M. Halligan (5), (6), (12) Mrs. A. Ward (5) SPEECH 1HERAPISTS Miss C. J. Delaforce (18) Miss E. N. Symes (18) ASSISTANT SPEECH THERAPIST Miss S. Marquand (18) PHYSIOTHERAPIST (part-time) Mrs. A. J. Lawrence (30) CHIEF CHIROPODIST Mr. H. Leavesley (11) SENIOR CHIROPODISTS Mr. D. Ditsell (11) Mrs. D. Mann (11) Mr. N. Freeman (11) Mr.H. Stenson (11) DOMICILIARY CHIROPODIST Mrs. E. V. Morgan (11) In addition 2 chiropodists are employed on a sessional basis. TRAINING CENTRES Castle School and Training Centre, Supervisor: Mrs. R. Early (29) Ripple Road. Senior Assistant Dagenham, Essex. Supervisor: Mrs. R. Murray Adult Training Centre, Manager: Mr. W. Matthews (29) Osborne Square, Dagenham, Essex. Senior Instructor: Mr. C. Dodd DAY NURSERIES, etc. Goresbrook Day Nursery, Matron: Mrs. E. Maddison (5), (12) Dagenham Avenue, Dagenham, Essex. Deputy: Mrs. J. Houghton (14) 9 DAY NURSERIES, etc. (continued) Fanshawe Day Nursery, Matron: Mrs. P. A. Ardley (14) Fanshawe School Annexe, Parsloes Avenue, Deputy: Mrs. G. M. Maddison (14), (17) Dagenham, Essex. Eastbury Day Nursery, Matron: Miss F. B. Nason (5), (6), (12) Blake Avenue, Barking, Essex. Deputy: Mrs. B. A. Bell (5) Kingsley Hall Day Centre Sister-in- Mrs. V. C. Torrington (5) for Handicapped Children, Charge: Hobart Road, Dagenham, Essex. PRINCIPAL MENTAL WELFARE OFFICER Mrs. J. W. W. Dixon (27) SENIOR MENTAL WELFARE OFFICERS Mr. L. Balls (27) Mr. D. Bishop (10) MENTAL WELFARE OFFICERS Mr. G. R. Welsh (10) Miss E. J. Sleigh (28) HEALTH EDUCATION OFFICER Mr. G. S. Self (1), (2),(4) ASSISTANT HEALTH EDUCATION OFFICER Miss D. Milbank (5), (6), (7), (20), (26) LAY ADMINISTRATIVE OFFICERS Mr. F. W. Knight (1), (2) Mr. G. H. Ruff SENIOR ADMINISTRATIVE ASSISTANTS Mr. F. H. Martin (15) Mr. B. S. Weaver SECTION HEADS Mr. S. Deeks Staffing and Management Mrs. P. Floodgate Vaccination and Immunisation Miss G. K. Harris Environmental Mrs. H. Jackson Mental Health Mrs. M. Newman Care and After Care Mr. B. S. Tyrrell Finance, Supplies, etc. 10 MEDICAL OFFICER OF HEALTH'S SECRETARY Miss E. S. Bell SECTION CLERICAL STAFF Staffing and Management Mrs. P. McMillan Mrs. I. Dupree Mr. H. Pitt Miss C. Nurton Miss B. Wells Miss K. Read Vaccination and Immunisation Mrs. F. Cox Environmental Miss M. Flint Miss N. Toms Miss J. Lewis Mr. D. Ward Mrs. G. Sanger Care and After Care Miss J. Cooper Finance. Supplies, etc. Mrs. G. Anger Mrs. J. Smith Miss V. Cheal Mrs. C. Smythe Maternal and Child Health Miss E. Adams Mrs. E. Neport Mrs. D. Archer Mrs. I. Page Miss E. Brown Mrs. J. Phillips Mrs. J. Bunney Miss M. Rhodes Miss N. Cloke Miss K. Richards Mrs. P. Collins Mrs. G. Shannon Mrs. K. Conroy Miss B. Slater Mrs. D. Ellis Mrs. J. Taylor Mrs. J. Hart Miss M. Watts Mrs. M. Ireson Mrs. D. Wilkins Miss C. Lincoln Mrs. J. Wilson Mrs. J. Morgan Part-time Mrs. K. Bird Mrs. E. Harsent Miss G. Cooper Mrs. M. Lodge Mrs. M. Edwards Mrs. E. Wilford DOMESTIC HELP SERVICE Senior Organisers Mrs. L. Everitt Organiser: Mrs. E. Nottage Assistant Organiser: Mrs. D. Woods Clerical Assistants: Miss W. Shaw Miss J. Baxter 11 OFFICERS SECONDED ON PART-TIME BASIS FROM THE REGIONAL HOSPITAL BOARD ORTHOPAEDIC SURGEON A. F. Bryson, M.A., M.B., B.CHIR., F.R.C.S. OPHTHALMOLOGISTS R. F. Jamieson, M.B., Ch.B., D.O.M.S. P. Lancer, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H., D.O.M.S. OBSTETRICIANS B. G. Spiers, F.R.C.S. Miss J. Lambert, F.R.C.S. PAEDIATRICIAN S. Stephen Carter, M.D., M.R.C.P. EAR, NOSE AND THROAT SURGEON Miss M. Mason, F.R.C.S. PHYSIOTHERAPIST Mrs. E. Ottley, M.C.S.P. PUBLIC ANALYST (part-time) J. Hubert Hammence, Ph.D., M.Sc., F.R.I.C. 12 QUALIFICATIONS (1) Certificate of Royal Society of Health. (2) Meat Inspector's Certificate. (3) Sanitary Science as applied to Building and Public Works Certificate. CO Smoke Inspector's Certificate. (5) State Registered Nurse. (6) State Certified Midwife. (7) Health Visitor's Certificate. (8) State Certified Midwife, Part 1. (9) State Enrolled Nurse. (10) Registered Mental Nurse. (11) State Registered Chiropodist. (12) State Registered Fever Nurse. (13) Tuberculosis Certificate. (14) Certificate of National Nursery Examination Board. (15) Diploma in Public Administration. (16) Certificate of National Society of Children's Nurses. (17) Certificate of Child Care Reserve Course. (18) Diploma of Licentiateship of College of Speech Therapists. (19) Diploma in Social Science. (20) Registered Sick Children's Nurse. (21) Queen's Nurse. (22) Royal College of Nursing Certificate of Public Health Administration. (23) Certificate of Examining Board of Dental Surgery Assistants. (24) Certificate of Proficiency as Dental Auxiliary. (25) Final Examination in Dental Technology of the City and Guilds Institute. (26) Diploma in Contents and Methods of Health Education. (27) Certificate in Social Work. (28) Member of Association of Occupational Therapists. (29) Diploma of National Association of Mental Health. (30) Member of Chartered Society of Physiotherapy. 13 Health Department, Civic Centre, Dagenham. To; THE MAYOR, ALDERMEN AND BURGESSES OF THE LONDON BOROUGH OF BARKING. On the 1st April 1965 the new London Borough of Barking came into being under the London Government Act 1963. The department was formed out of the former Boroughs of Dagenham and Barking, although a portion of each was not included in the new Borough. The total population of the new London Borough at its inception was 172,970. I find it difficult to comment on the services of the new London Borough during this first nine months in the way one usually comments upon the services of a borough which has been established for some years. Prior to 1st April 1965 a good deal of preliminary discussion had, of course, taken place, and the new Council had adopted a policy which was opposed to any member of the staff being declared redundant. It was decided that Dr. Adamson, the Medical Officer of Health of the old Borough of Barking should be made Associate Medical Officer of Health of the new London Borough, and that Dr. Slome and Dr. Packer would both be Deputies in the new Borough. On 1st April 1965 there were then a Medical Officer of Health and an Associate, two Deputy Medical Officers of Health, two Lay Administrative Officers, two Home Help Organisers, and a number of other dual appointments. This could have created extremely difficult problems of personal relationships if the staffs of the two departments concerned had not been so helpful and extremely co-operative. There was much discussion as to whether the headquarters of the new health department should be in the Barking Town Hall or at the Civic Centre, Dagenham. It was finally decided that a small portion of the department, namely the home help service of the old Borough of Barking, with its Organiser, should stay in the Town Hall at Barking, while the rest of the department would be housed in the Civic Centre, Dagenham. Fortunately, a new extension at the Civic Centre, a proportion of which housed the health department staff, had been planned and built when it was already known that the new London Borough would be coming into existence in 1965. This enabled me to make certain provision for extra services such as the mental health service, an expanded school health service, and a separate health education section, which would be necessary for the functioning of the new borough. Shortly after amalgamation the Dagenham Home Help Organiser retired, and the opportunity was taken to rehouse the whole of the home help service in the Dagenham Civic Centre. In spite of the smooth way in which the department continued to function after the new London Borough was set up, there were many problems, not least of all those created by differing practices in the two boroughs. It was decided to extend decentralisation of the clinic services to the whole of the new borough, and the administrative staff set about the task of carrying this through. Throughout the period of the changeover from old to new borough, emphasis was laid on the service in the field continuing to function as before. Any necessary administrative changes were made in such a way as to alter the service to the public as little as possible. There was much to learn about services for which the boroughs had not been responsible before April 1965; for example, the mental health service, the home nursing service and a proportion of the domiciliary midwifery service. This created a considerable amount of extra work for the staff, as did also the fact that the new authority is a local health authority (that is a first tier authority) 14 whereas most of the previous health services were second tier under the Essex County Council. As well as this, a new executive council dealing with the family doctor services was created covering Metropolitan Essex with which new relationships had to be made so that the domiciliary services in the borough could be adjusted as far ae possible to local needs as expressed by the local medical committee. Because the new borough is situated in the Greater London Area, a multiplicity of committees had to be set up under various names to co-ordinate inter-borough services and to look at ways of overcoming difficulties created by new boundaries and by differing practices in different areas. By the end of the year, one felt that the department was still leading a hand to mouth existence because of the enormous amount of extra work undertaken by staffs who in many cases were still learning their way about unfamiliar services. Initially it was agreed that the committee structure would consist of a Health Committee dealing with main policy matters to be referred on to the Council. It was also agreed that environmental health, domiciliary services and mental health sub-committees would deal with the detail of these three aspects of the service. Later it was felt that the environmental health service could operate within the main Health Committee. During the year, the new Borough Council informed the Metropolitan Water Board and the South Essex Waterworks Company that they favour the addition of fluoride salts to their water supplies. In December a communication was received from the London Boroughs Committee to the effect that the British Waterworks Association had recommended the Water Associations that they should only take action in connection with the fluoridation of water on the request of all the health authorities within the area of their supplies. The London Boroughs Committee proposed to take a consensus of opinion of their delegate authorities. The Barking Borough Council informed the London Boroughs Committee that they favour the fluoridation of water and indicated that legislation was desirable to achieve this. There the matter rested at the end of the year. Staff shortages, particularly of trained field workers, were a major problem during the year, and the Council had already begun to discuss the need for provision for training staff. It was agreed, for instance, that the Council would sponsor up to six health visitor students a year and up to six district nurses and midwives a year for training, and no doubt this policy will extend during 1966 to other sections of the health department. The period of the changeover did not, I feel, adversely affect the ordinary citizens or their use of the services to any great extent. Progress towards an improved service should follow as improvements in staffing and organisation occur. I must thank the staff of the department for having worked so hard and so loyally during the first nine months, as well as the new Chairman and Members of the new Health Committee for the support they have given me. J. ADRIAN GILLET Medical Officer of Health 15 VITAL STATISTICS 1965 Registrar General's estimate of resident population, raid-year 1965 172,970 Live Births: Legitimate (1,106 male, 1,13^ female) 2,240 Illegitimate ( 70 male, 98 female) 168 Total (1,176 male, 1,232 female) 2,408 Illegitimate live births per cent of total 6.98 Live birth rate per 1,000 population 13.92 Live birth rate adjusted by comparability factor of 1.04 14.48 Stillbirths: Legitimate ( 23 male, 20 female) 43 Illegitimate ( 2 male, 1 female) 3 Total ( 25 male, 21 female) 46 Stillbirth rate per 1,000 live and stillbirths 18.74 Total live and stillbirths 2,454 Deaths: Infant deaths (under 1 year) ( 22 male, 18 female) 40 Infant death rate per 1,000 live births 16.61 Legitimate infant death rate per 1,000 legitimate live births ( 21 male, 15 female) 16.07 Illegitimate infant death rate per 1,000 illegitimate live births ( 1 male, 3 female) 23.81 Neo-natal mortality rate (deaths under 4 weeks (30) per 1,000 live births) 12.46 Perinatal mortality rate (stillbirths (46) and deaths under one week (27) per 1,000 live and stillbirths) 29.75 Early neo-natal mortality rate (deaths under 1 week per 1,000 live births) 11.21 Maternal mortality (deaths from pregnancy, childbirth, abortion) 1 Maternal mortality rate per 1,000 total births 0.41 General mortality: Number of deaths ( 980 male, 768 female) 1,748 Death rate per 1,000 population - crude 10.11 Death rate adjusted by comparability factor of 1.32 13.34 CAUSES OF INFANT DEATHS Cause of Death Under 4 weeks 4 weeks to 1 year Total Pneumonia 4 3 7 Bronchitis - 1 1 Congenital malformations 5 1 6 Accidents - 1 1 Other causes (Prematurity etc.) 21 4 25 Totals 30 10 40 16 17 Causes of Death, 1965 Under 1 yr. 1 and under 5 yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and over Total M j" M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory - - - - - - - - - 5 - 3 - - - 8 - 2. Tuberculosis, other - - - - - - 1 - - - - - - - - - 1 - 3. Syphilitic disease - - - - - - - - - - 1 - - - 1 1 2 1 4. Diphtheria - - - - - - - - - - - - - - - - - - 5. Whooping cough - - - - - - - - - - - - - - - - - - 6. Meningococcal infections - - - - - - - - - - - - - - - - - - 7. Acute poliomyelitis - - - - - - - - - - - - - - - - - 8. Measles - - - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases - - - - - - - - 2 - 2 - - - - - 4 - 10. Malignant neoplasm, stomach - - - - - - - - 1 1 14 6 12 8 8 3 35 18 11. Malignant neoplasm, lung, bronchus - - - - - - - - 1 2 56 5 50 8 14 3 121 18 12. Malignant neoplasm, breast - - - - - - - - - 4 - 17 - 8 - 7 - 36 13. Malignant neoplasm, uterus - - - - - - - - - 1 - 5 - 1 - 1 - 8 14. Other malignant and lymphatic neoplasms 1 - 7 2 39 24 34 28 15 19 96 73 15. Leukaemia, aleukaemia - - - - 2 - 1 1 - - 2 1 2 1 2 - 9 3 16. Diabetes - - - - - - - - - - 3 1 2 5 - 4 5 10 17. Vascular lesions of nervous system - - - - - - - - - - 19 22 24 36 27 53 70 111 18. Coronary disease, angina - - - - - - - - 9 - 107 30 81 54 48 53 245 137 19. Hypertension with heart disease - - - - - - - - - - 3 1 1 7 3 5 7 13 20. Other heart disease - - - - - - - - 4 2 15 16 8 23 21 49 48 90 21. Other circulatory disease - - - - - - - - - 2 14 8 3 14 13 21 30 45 22. Influenza - - - - - - - - - - - 1 - - - 1 - 2 23. Pneumonia 6 1 - 1 1 - - - 1 - 7 1 18 7 18 18 51 28 24. Bronchitis 1 - - - - - - - - - 26 5 33 11 38 14 98 30 25. Other diseases of respiratory system - - - - - - - - - - 6 3 6 5 2 2 14 10 26. Ulcer of stomach and duodenum - - - - - - - - - - 5 3 5 2 4 1 14 6 27. Gastritis, enteritis and diarrhoea - - - - - - - - - - 1 - - - - 1 1 1 28. Nephritis and nephrosis - - - - - - - - - - 4 - 5 3 2 4 11 7 29. Hyperplasia of prostate - - - - - - - - - - - - 1 - 2 - 3 - 30. Pregnancy, childbirth, abortion - - - - - - - - - 1 - - - - - - - 1 31. Congenital malformations 4 2 1 1 - - - - - - - 1 - 1 - - 5 5 32. Other defined and ill-defined diseases 11 14 1 - 1 1 1 - 4 4 14 14 11 19 17 40 60 92 33. Motor vehicle accidents - - 1 1 - - 7 2 1 - 8 3 - 1 1 - 18 7 34. All other accidents - 1 2 1 1 - - - 2 - 4 3 4 2 3 5 16 12 35. Suicide - - - - - - 1 - 1 2 3 1 2 - - - 7 3 36. Homicide and operations of war - - - - - 1 - - 1 - - - - - - - 1 1 Total 22 18 5 4 5 2 12 3 34 21 358 171 305 244 239 305 980 768 PRINCIPAL CAUSES OF DEATH (all ages) Diseases of heart and circulatory system 615 Cancer and other malignant diseases 417 Pneumonia, bronchitis and other respiratory diseases (excluding tuberculosis) 233 Diseases of the brain and nervous system 181 DEATHS FROM MALIGNANT DISEASES, 1965 Site of Disease Age at Death Under 15 years 15-24 years 25-44 years 45-64 years 65-74 years 75 years+ Total M F M F M F M F M F M F M F Lung/Bronchus - - - - 1 2 56 5 50 8 14 3 121 18 Stomach - - - - 1 1 14 6 12 8 8 3 35 18 Breast - - - - - 4 - 17 - 8 - 7 - 36 Uterus - - - - - 1 - 5 - 1 - 1 - 8 Blood 2 - 1 1 - - 2 1 2 1 2 - 9 3 Other - - 1 - 7 2 39 24 34 28 15 19 96 73 Totals 2 - 2 1 9 10 111 58 98 54 39 33 261 156 18 HEALTH EDUCATION The reorganisation of London government provided an opportunity for the recognition of health education as a separate section. Although, in common with other sections, staffing problems were experienced, much useful work was done in this field during 1965. It was decided that sporadic talks on individual health topics would continue to be given to various organisations at their request. In order, however, to provide more effective health education throughout the new borough, it was also decided that the main effort would be directed towards:- (1) fuller co-operation with schools in assisting them to provide broadly based health education courses at various levels. (2) the expansion of training facilities for workers in the food industry. (3) the provision of in-service training for health department staff. (4) an increase in the provision of literature and visual aids for clinics and schools undertaking their own health teaching. Health Education in Schools Full courses, each comprising a complete series of lectures, were provided for six schools. In most instances these involved regular weekly attendances, sometimes only for a few weeks, in other cases for one or two terms. Occasional, talks on specific subjects were given to another five schools. The subjects discussed ranged from the history of public health to personal hygiene and included dental hygiene, home safety, clean food, child care, the duties of the various public health officers and the dangers of smoking. In many instances the talks given by health department staff were attended by the appropriate teachers who developed the subject in other lessons. This co-operation is proving very rewarding to both teaching and health department staffs. Food Hygiene Education A complete course for full-time bakery students in their first and second years at Rush Green College was arranged and commenced in September 1965. This was in addition to part-time evening courses leading to the Certificate and Diploma of the Royal Institute of Public Health and Hygiene. As it was felt that the Diploma in Bakery Hygiene was too specific for the needs of the general food trader, an approach was made to the Royal Institute of Public Health and Hygiene for the provision of a more broadly based Diploma in General Food Hygiene. A number of meetings were held with the Examination Committee of the Institute and by the end of 1965 a syllabus and programme had been agreed for implementation during 1966. Apart from these examination courses, a one-day seminar was arranged in the Small Hall, Barking Town Hall, for the shop managers of a chain of supermarkets. A lecture was given to the canteen supervisors of a large industrial firm and talks were provided for three separate groups of trainee manageresses of a bakery group. In-Service Training Two seminars were provided during the year. One was with assistance from the Central Council for Health Education on "Health Education in Schools." The other on "Congenital Dislocation of the Hip" was given by a local orthopaedic consultant. The one on health education was attended by school nurses, health visitors, teachers and medical officers and was considered to be very successful. The other, which was well attended, was limited to health visitors and midwives and was illustrated by a film. 19 Other Activities Catalogues of equipment, literature and films available were prepared and circulated to members of the health department and to all schools. As a result requests for visual aids increased considerably particularly since it was necessary to restrict the number of actual lectures given by the health education staff because of the secondment of the Assistant Health Education Officer to a London University Course for the Diploma in Health Education. At the request of the Old People's Welfare Committee, short courses on diet and exercises for the over 60's were provided. The demand far exceeded the amount of professional time available for this purpose and as a result many courses had to be held over until 1966. Talks on various health topics were given on request to various organisations, and 27 film shows were also provided. Three students from the health education course of the London University Institute of Education attended the department for two weeks in March to receive practical training in health education. Six students from the London School of Hygiene and Tropical Medicine also paid a series of visits and in addition the work of the department was shown to four other overseas visitors. The film on child development commenced some time ago at Becontree Clinic was completed and edited. It is now in use. A colour film on the work of the Kingsley Hall Assessment Centre for the Under-Fives was also commenced but was not completed by the end of the year. The Council agreed that home safety was an integral part of health education and that the health education officer should be responsible for organising home safety teaching within the borough. No exhibitions were held this year, but the fire prevention campaign organised by the Home Office and RoSPA was supported by posters and leaflets. Representatives were sent to the newly-formed No. 10 Area, RoSPA Home Safety Committee and to the Annual Conference. The whole of a 40 ft. tent was utilised for the health department display in the Town Show. The theme was the work of the various sections within the department, and the exhibition was of help not only to the visitors but also to the members of staff on duty who were able to meet new colleagues from other sections with which they had recently amalgamated. 20 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN Ante-natal and post-natal care is offered at the centres shown below. During the year 1,239 mothers attended for ante-natal examination and 321 for post-natal care. In addition 2,748 attendances were made at mothercraft and relaxation classes. Ante-natal and Post-natal Clinics Center Frequency of Session When Held The Clinic, 1st and 3rd in month. Wednesday p.m. Ashton Gardens, Chadwell Heath. The Clinic, Weekly. Tuesday and Becontree Avenue, Wednesday p.m. Dagenham. Central Clinic, Weekly. Tuesday a.m. Vicarage Drive, Barking. The Clinic, Weekly. Monday a.m. Ford Road, Dagenham. Greatfields Clinic, Weekly. Monday a.m. Movers Lane, Barking. Leys Clinic, Weekly. Wednesday p.m. Ballards Road, Dagenham. Marks Gate Clinic, 2nd and 4th in month. Wednesday p.m. Lawn Farm Grove, Marks Gate. The Clinic, Weekly. Tuesday and Oxlow Lane, Thursday a.m. Dagenham. The Clinic, Weekly. Wednesday a.m. Porters Avenue, Dagenham. Julia Engwell Clinic, Weekly. Wednesday a.m. Woodward Road, Dagenham. Rush Green Clinic, 1st and 3rd in month. Friday a.m. 179 Dagenham Road, Dagenham. Thames View Clinic, Weekly. Monday a.m. Bastable Avenue, Barking. Upney Clinic, Weekly. Thursday a.m. Upney Lane, Barking. 21 Midwifery Service This year saw many changes in the health department. Not least in importance were the changes in the midwifery service. Midwives' ante-natal clinics have been held for some years in Central, Julia Engwell, Porters Avenue and Thames View Clinics, and the introduction of a midwives' ante-natal clinic at Marks Gate Clinic has aided in giving better antenatal care. It is hoped to establish more of these ante-natal clinics in the future. With the creation of the new London Borough of Barking came the Part II Midwifery Training School. This was already long established under Essex County Council administration, at York House and 144 Longbridge Road Nurses' Homes. This School is still being used by pupil midwives of the Waltham Forest School. During this year twenty pupils completed their Part II training successfully. Nine of our midwives are approved as teachers by the Central Midwives Board. It is hoped in the near future to introduce the alternate week-end system of off-duty for all midwives serving the borough. During the year, midwives attended 658 domiciliary confinements of which 591 had also booked their family doctor or G.P. obstetrician. In addition, 948 cases of early discharge from hospital received nursing care from the domiciliary midwives. Care of the Unmarried Mother The Chelmsford Diocesan Moral Welfare Association, acting on behalf of the Council, arranged for the comprehensive care and confinement of 55 cases. Infant Welfare Centres During the year, 7,078 children attended the following centres:- Center Frequency of Sessions When Held The Clinic, Weekly. Thursday a.m. Ashton Gardens, and p.m. Chadwell Heath. The Clinic, Weekly. Monday p.m. Becontree Avenue, Wednesday a.m. Dagenham. Central Clinic, Weekly. Tuesday p.m. Vicarage Drive, Thursday p.m. Barking. The Clinic, Weekly. Tuesday a.m. Ford Road, Thursday p.m. Dagenham. Greatfields Clinic, Weekly. Tuesday p.m. Movers Lane, Barking. Julia Engwell Clinic, Weekly. Tuesday and Woodward Road, Friday p.m. Dagenham. Leys Clinic, Weekly. Tuesday p.m. Ballards Road, Thursday a.m. Dagenham. 22 Infant Welfare Centrea (continued) Center Frequency of Sessions When Held Marks Gate Clinic, Weekly. Monday p.m. Lawn Farm Grove, Marks Gate. The Clinic, Weekly. Wednesday and Oxlow Lane, Friday p.m. Dagenham. The Clinic, Weekly. Monday and Porters Avenue, Friday p.m. Dagenham. Rush Green Clinic, 2nd, 4th and 5th in month. Friday a.m. 179 Dagenham Road, Dagenham. Weekly. Friday p.m. Thames View Clinic, Weekly. Wednesday and Bastable Avenue, Friday p.m. Barking. The Clinic, Weekly. Tuesday p.m. Thompson Road, Friday a.m. Dagenham. Upney Clinic, Weekly. Wednesday and Upney Lane, Friday p.m. Barking. Welfare foods and nutrients are sold at these centres during infant welfare sessions and also at Central Hall, Heathway, on Tuesday and Friday, at the Methodist Church Hall, Rainham Road South, on Wednesday afternoons, and at Central Clinic, Barking, on Wednesday afternoons and Thursday mornings. During the year, the following amounts of welfare foods were issued:- National Dried Milk 32,4-00 tins Cod Liver Oil 3,068 bottles Vitamin A and D Tablets 2,710 packets of 20 Orange Juice 34,874 bottles DAY NURSERY SERVICE Early in March 1965 Ashton Gardens Nursery was closed and transferred to Fanshawe Junior School while the old building and clinic were demolished in preparation for rebuilding. The nursery was comfortably accommodated in a building within the school grounds. The Headmaster and Staff of the school were most welcoming and helpful, for which we are very grateful. The School Meals Service provided us with meals, making special arrangements for the babies, and we would like to thank them for taking such a lot of trouble. On the whole, it has been a very happy arrangement, the children particularly appreciating the 'bus ride to and from St. Chad's Church Hall which was the picking-up and returning point each day. We look forward to returning soon to Ashton Gardens, and hope to report next year that we have returned there. Another important event during the year was the completion of the new Eastbury Day Nursery in Blake Avenue, Barking. The children were transferred 23 from the Gale Street premises on 6th August 1965 and the amenities of the new building are much appreciated by staff and children alike. As the nursery is situated in a central position in the western half of the borough, it was found possible to discontinue the coach service that previously had conveyed children to the Gale Street premises. The increasing recognition of the benefit of group life for the 3-5 yearolds is manifest in the opening of numerous play-groups and child-minder groups throughout the borough. These do not always answer the problems of the working mother or the socially distressed family. At least half the parents of our nursery children are receiving assistance with the fees. There are many children placed in day nurseries because of minor handicaps and behaviour problems. This fact is recognised by the training colleges who have increased the amount of time devoted to the care and observation of handicapped children in their student training syllabus. These children are not sufficiently handicapped to consider them for the Day Centre at Kingsley Hall, but nevertheless they would greatly benefit to be in the care of trained staffeven for a few weeks. I am thinking particularly of children with little or no speech by the age of 3-4 years, or children with extremely poor social development. These children are lost in their first years at school and rarely catch up with their age groups. The nurseries continue to be recognised as training centres by the Ministry of Health. I would like to mention here the formation of an Advisory Committee for Nursery Nursing at the Hornchurch College of Further Education, Ardleigh Green. I believe the College intend to run advanced training courses for qualified nursery nurses, and I hope some of our staff will be able to attend them. The average daily attendances and numbers on registers are shown below for each month of 1965:- Month Goresbrook Ashton Gardens/ Fanshawe Gale Street/Eastbury Average Daily Attendance No. on Register Average Daily Attendance No. on Register Average Daily Attendance No. on Register January 35.5 46 41.5 43 36-0 45 February 37.9 48 40.1 48 34.3 48 March 37.6 45 33.3 43 36.9 48 April 33.2 43 30.8 41 27.3 48 May 24.5 39 33.3 40 40.7 50 June 29.7 43 4o.o 44 36.6 48 July 35.7 49 34.5 47 39.1 49 August 31.0 45 34.9 46 34.0 48 September 32.4 42 38.1 49 37.0 50 October 38.0 45 35.9 42 38.9 48 November 31.1 43 33.0 41 41.9 49 December 30.0 43 31.2 37 40.3 51 24 PLAY THERAPY Play therapy sessions for children under five years continued twice weekly at Thames View Clinic and Northbury Infants School during the year, and were extended by the addition of two sessions per week at Julia Engwell Clinic with effect from 9th February 1965. At Julia Engwell Play Therapy, 2 children attended for the first two weeks, but very quickly the numbers went up to 12, with a waiting list of 15 children. All children with a special need are admitted immediately. Twenty-four children have been helped in this play group this year, including one little deaf girl who is making great progress with her speech, three backward children, and four who were having difficulty with their speech, and one very difficult boy who was sent to us by Ilford Child Guidance Clinic. At Thames View, 22 children have been helped in this play group including two mentally backward children, three children who were having difficulty with speech, and two Indian children who would not speak at all. Horthbury Play Therapy has helped 19 children, including two mentally backward children, three very timid children who would not mix with other children, and five who were having speech difficulty. In all the groups, 65 children have been helped during 1965. KINGSLEY HALL DAY CENTRE We were very sorry indeed to lose Dr. Hodgson this year, but we wish her the very best of luck in her new and most exalted appointment in the Ministry of Health. She has been most helpful in any difficulty we have encountered, and still maintains a great interest in Kingsley Hall. To add to our deprivation, Sister Torrington also left us - but only for a few months while she had her baby. Despite our difficulties, the nursery continued to function. The devotion and skill of the staff was a great source of help and encouragement to the new recruits who took over the running of the nursery. Attendance has continued to be excellent. Despite a rather lengthy period of infection with measles, mumps and chicken pox, the average attendance was 15.5 per day. The number of admissions was 16 and the number of discharges 15. There were an increasing number of hospital and dental appointments arranged by the nursery to which our Staff Nurse accompanied the child. These visits are most successful, as the specialist is able to get a more accurate account of the child's behaviour in the nursery. The following is a summary oc accompanied visits:- London Hospital Dental School 36 Great Ormond Street Paediatrician 9 I.V.P. 1 Barium Meal 1 Ophthalmic 8 Grays Inn Road Audiology Unit 5 Oldchurch Orthopaedic 4 Maudsley Hospital 2 Child Guidance Training Centre, Hampstead 2 25 We would like to thank Miss Norah Gibbs of the Hampstead Child Guidance Training Centre for taking so much trouble with the assessment of two of our children, one deaf and one partially-sighted. We would also like to thank the staff of the Romford Child Guidance Clinic for their help in the early part of 1965. Now, since the formation of the new London Borough of Barking, we have the services of Mr. Sheridan the educational psychologist, who comes very quickly to our aid and is most interested and helpful. We have weekly visits from Miss Hodges the peripatetic teacher of the deaf, and Mrs. Lawrence the physiotherapist who joined the staff this year - their work is of great value to us. An interesting film is being made at Kingsley Hall by Mr. Self our Health Education Officer, with help from Mr. Williams, the Essex County Health Education Officer. We had very little new equipment this year, but there was one piece which has proved to be a very great boon - a Baby Relax chair. The first one of these was lent to us by the Baby Relax Company and we have subsequently acquired one of our own. We have had several interested visitors during the year, including Dr. Hinden and his medical staff from Whipps Cross Hospital, and Dr. Yarrow, the Area Medical Officer of S.E. Essex, with his Deputy and Mrs. Cottee, the Chairman of the S.E. Essex Health Area Sub-Committee. The latter are intending to set up a similar centre in S.E. Essex. We also received a deputation of nursery school teachers from the County of Northampton, who were very interested in our work and spent a morning with us. Discharges Age Handicap Remarks Years Months 4 3 Spina bifida. Moved out of area. Much improved. 4 8 Hemiplegia. To residential school. Improved. 3 9 Socially retarded. Home. ) Both much improved and 3 9 " " " ) adjusted. 11 11 Mongol. To Castle School. 5 2 Congenital heart. To normal school. Compensating well. 4 11 Mentally retarded. Awaiting place at E.S.N, school. 5 7 Microcephalic. Much improved. 5 7 Microcephalic, spastic. To Castle School. Very much improved. 4 9 Spina bifida, hydrocephalic. Home. Awaiting residential placement. 5 3 Thalidomide. To normal school. 5 6 Maladjusted. To Park Hospital, Oxford. 2 Socially maladjusted. Home. Well adjusted and happy little boy. 3 5 Socially maladjusted. Home. Improved. 3 2 Retarded. Home. 26 Admissions Age Handicap Progress Years Months 3 8 Mentally retarded.? Autistic. Fair. 4 6 Thalidomide. To normal school. 1 6 Spina bifida. Fair. 3 9 ? Retarded. ? Deaf (bilateral). Very good. 3 1 Mongol. Fair. 2 1 Deaf (bilateral). Not walking. Good. Walking. 5 4 Maladjusted. To Park Hospital. 2 - Socially maladjusted. Very good. Home. 2 - Spina bifida. Good. 3 2 Maladjusted. Fair. 2 - Hydrocephalic. Very good. 1 6 Spina bifida. Good. 3 - Retarded. No speech. 4 7 Retarded. No speech. Fair. 1 6 Spina bifida. Fair. 4 1 Retarded. No speech. CYTOLOGY CLINICS The first Cytology Clinic was opened in Dagenham in 1964. This was a small pilot scheme and was started in conjunction with Dr. Atkinson, the pathologist at Oldchurch Hospital. The scheme proved to be very successful and consequently it was decided to enlarge the scope of our efforts, establishing a regular session in Dagenham and one in Barking. We have had a very good response from the public and have made every effort to contact those women who are specially considered to be at risk. Unfortunately the number of smears taken is still limited by the lack of laboratory facilities. 115 smears were taken during the year, but it is hoped that it will prove possible to take an increased number of smears next year. Records of each patient are kept, and their local doctor is fully informed. Prom the outset we decided that we would use specially trained nurses to do the actual smear-taking but have so arranged the session that it runs concurrently with the ante-natal clinic; this means that there is always a doctor present to supervise the running of the session and to give help or advice if needed. I would like to thank Dr. Atkinson for his help and advice, and particularly for allowing his technician to come and demonstrate the technique of smeartaking and slide-making. Our Cytology Clinic in the western area of Barking was commenced towards the end of October on a very modest scale - six patients a week on account of staff difficulties. We deliberately did not advertise the clinic because of our limited capacity. During the period from the 23rd October to the end of December 27 we saw 44 patients. Naturally such a short period and small number does not allow us to draw any conclusions yet. We feel, nevertheless, that the clinic plays an important part in prevention and also gives a good opportunity for staff to meet the patients and to discuss some of their problems in an informal way. HEALTH VISITING Present Staff:- Superintendent Health Visitor Deputy Superintendent Health Visitor Fieldwork Instructors 2 Health Visitors 19 full-time (establishment - 48) 2 part-time Nurses 12 full-time 10 part-time The outstanding feature in this field is the shortage of qualified health visitors. Clinic nurses who meet the requirements are encouraged to train. Of those at present employed, three have made application for health visitor training. Fieldwork Instructors Two appointments have been made from among existing staff. The recommendations of the Council for the Training of Health Visitors include the reduction of their present case load, in order to concentrate on the training of students. Instructors will attend a two-week course arranged by the Royal College of Nursing. Health Visiting Health visitors have been seeking to keep up their commitment of home visits, on a more selective basis than previously. Certain cases take priority, which often means that toddlers are not followed up as adequately as they should be. It is in this age group that the less obvious deviations from normal development may be revealed. The health visitor is primarily a nurse, engaged in preventive medicine. Over the past years, having regard to the family environment in which the child is reared, she has of necessity accumulated more social work than is envisaged for the future; and that it is right for her to shed in some measure is obvious by the amount of untouched work in her own sphere. Whereas previously the health visitor was concerned with the advice to parents on the adequate care of their children, to-day more emphasis is put on the whole potential of the child, and the possibility of promoting normal development. Since the introduction of "at risk" registers, in which is noted any condition of family health which might affect the development of a child before or soon after birth, the health visitor needs to direct her powers of observation based on sound knowledge in order to detect any early signs of defect, and to encourage further investigation and treatment. Post-graduate instruction of health visitors has become much more detailed in the assessment of child development in relation to minimal brain damage, and vision and hearing defects. All the present health visitors have attended courses on the testing of hearing in the young child, chiefly at Gray's Inn Hospital. 28 Infant Welfare Sessions This trend towards assessment of child development is already having an effect on infant welfare sessions. Mothers are making more specific enquiries concerning their children's capacities and testing of the vision and hearing of toddlers is more in demand. This often poses problems for the staff in making the necessary time available for this work. A suitable quiet room is a must, as background noise distracts a small child from the tests. It would seem that time spent on full child capacity tests will obviate the need of weekly visits for weighing and maternal assurance. Ante-natal Work Health visitors continue to attend ante-natal clinics, together with a midwife when possible. The health visitor's role is to give social advice and health education. Contacts with expectant mothers also establishes a relationship of value later on. There is a continued demand for pre-natal instruction, and again several classes are shared together with the midwives. The difficulties encountered by unmarried mothers are often first revealed to the health visitor who advises and, where necessary, refers them to the Diocesan Moral Welfare Worker. Other Visits Statistical information is not available to date on the variety of "other" visits which are increasingly undertaken, but more detailed return forms are being drafted to give a clearer picture. The Elderly Since the Health Service Act, the health visitor has been brought more into contact with the elderly. Her function is still concerned with the prevention of ill-health, while arranging for the alleviation of immediate need. Early action can frequently avert or deter the onset of depression or neurosis. Much work has still to be done among adults "at risk" due to fears, and the loneliness following bereavement. Mental Welfare It is good to have a specialised section to deal with the more severe needs, but there is still great pressure from the insidious increase of mild neuroses in the community. Most health visitors in this area have had opportunity to attend courses at either Goodmayes or Severalls Hospitals, which has alerted them to the early signs of pending breakdown, and the need to help support the families of the mentally sick. Tuberculosis It has been common practice for specialist visitors to work in this field, but the trend is towards area health visitors undertaking the supervision of families in their areas, with a liaison health visitor in close contact with the consultant chest physician. As things are developing, this work will cover all chest diseases, including cancer of the lung, and tuberculosis will be a less isolated disease. At present, both Barking and Five Elms Clinics are each staffed by a health visitor and a clinic nurse. 29 School Health Visiting It is not expected that health visitors will continue the full range of practical duties in this field, but make more use of ancillary staff. A closer relationship with teaching staff will help with the prompt investigation of the children's problems. Here again, there is a heightened response to possible causes of the lack of well-being or of educational progress. Where health visitors have become better known to the children, this has been followed by a demand to question and confide in them. It becomes evident that the health visitor must be made available to these young people outside of clinic sessions. The staff have learned much from assisting with the Adolescent Clinic, and two health visitors hope to recommence in the autumn term. It is hoped that another centre will develop. Health Education A member of the health visiting staff has been appointed as Assistant Health Education Officer. This is a most welcome move, as health education is part of the substance of health visiting. However, class or formal group teaching is not everyone's medium, but for those who will undertake this work there is a great opportunity and a great demand. In schools, the wide variety of subject matter already requested is an answer as to the need for teaching healthy living. At present the staff are handicapped by lack of clerical assistance in the clinics. It is more necessary than ever for detailed reports to be submitted. Thoughts have been expressed in regard to small tape recorders, but much practice in their use is needed. Recruitment Vacancies in both previous areas have been advertised in the nursing and local press many times, with little success. As there is an increasing number of married health visitors, or single persons with family responsibilities, some consideration to provide temporary accommodation in certain circumstances would be helpful. The sponsoring of students will, it is hoped, increase the ratio of qualified staff over the next five years. Health Visiting Statistics Cases visited by Health Visitors Number of Cases Children born in 1965 2,458 " " " 1964 1,793 " " " 1960-63 4.079 Total 8,330 Persons aged 65 or over 734 Mentally disordered persons 28 Persons discharged from hospitals (excluding maternity patients) 59 Number of tuberculous households visited 10 Number of households visited on account of other infectious diseases 146 Homes visited by tuberculosis visitors 839 30 CHILDREN'S DEPARTMENT Since 1st April 1965 (the inception of the Children's Department in the London Borough of Barking) 86 medical examination forms completed by local general practitioners have been perused by the Deputy Medical Officer of Health. These children were boarded out into foster homes. Each of the four Children's Homes have been visited by my Deputy, and were found to be in good order. Close liaison with the Children's Department is ensured by the attendance of one of my staff at Children's Committee meetings. Only if there is close liaison between departments at the field worker level will we work in harmony, and thus give children in need the benefit of our combined knowledge and experience. VACCINATION AND IMMUNISATION In September 1965, a meeting was held to discuss a new programme for immunisation, which would be uniform throughout the six new London Boroughs from Essex. A representative medical officer from each area attended, and after various deliberations and correspondence with the Ministry, a letter went out in November 1965 to all Barking medical practitioners as well as to the clinics, submitting a suggested scheme of immunisation. This scheme has been used in the clinics ever since, the main innovation being the simultaneous administration of oral polio and triple vaccine from age 3 months. This curtails the number of attendances necessary, and the protection acquired is in no way reduced. In September 1965, a letter was received from the Ministry of Health suggesting that now that anthrax vaccine had been made efficacious and safe, it should be offered to workers in those factories where there was a risk of acquiring the disease. In December 1965, a draft circular was received from the Ministry concerning recent research into measles vaccination, stating that they were prepared to consider proposals from local authorities for arrangements to offer measles vaccination. However, they thought it premature to embark on any general programme of immunisation. The following statistics relate to persons protected either by general practitioners or local health authority medical officers. Vaccination against Smallpox During 1965, 1,100 persons were vaccinated or re-vaccinated. Age at date of vaccination or re-vaccination Vaccinated Re-vaccinated Under 1 year 195 - 1 year 655 - 2-4 years 171 4 5-15 years 44 31 Total all ages 1,065 35 31 Whooping Cough 4,040 children received immunising doses against whooping cough, including booster doses. Primary 2,309 Boosters 1,731 Diphtheria Immunisation Year of Birth Primary Immunisation Children who received a booster dose 1965 537 1 1964 1,360 332 1963 270 1,001 1962 62 161 1958-61 218 1,459 Others under age 16 45 505 Total all ages 2,492 3,459 Tetanus Immunisation Year of Birth Primary Immunisation Children who received a booster dose 1965 533 1 1964 1,364 332 1963 262 1,004 1962 65 161 1958-61 627 1,204 Others under age 16 396 599 Total all ages 3,247 3,301 Poliomyelitis Vaccination Year of Birth Primary Immunisation Children who received a booster dose 1965 369 - 1964 1,425 2 1963 175 9 1962 108 13 1958-61 275 1,890 Others under age 16 188 370 Total all ages 2,540 2,284 32 DEVELOPMENTAL CLINIC Dr. Hodgson, who was responsible for this clinic, left us on 20th April 1965 and a period elapsed before the clinic was resumed. We saw 28 new cases under one year of age, 12 new cases between one and two years, and 10 new cases between two and five years. These were screened for hearing and vision, and 20 of them had come form of intelligence assessment done. There were 5 hospital referrals, and 12 came back for observation in the clinic. We hope in future that every infant welfare centre will have its own developmental clinic, seeing "at risk" children by appointment only. 33 PREVENTION OF ILLNESS, CARE AND AFTER-CARE HOME NURSING SERVICE The year 1965 dawned, and with it a feeling of sadness and certainly some doubts, at the coming departure from Essex County Council administration and the inevitable merger into the new London Borough of Barking in the coming April. April came, plus the new borough, and with it a dispelling of doubts. An increase in the number of home nursing staff helped greatly in coping with the increasing demand on the service. During the year, the training of Queen's Student District Nurses continued, in conjunction with the London Borough of Waltham Forest School at the Lady Rayleigh Training Home. Six students, including one male nurse, completed their training and were successful in passing their examinations. This was, in fact, a 100% pass. With the shortage of hospital beds, the need for more elderly and chronic sick people to be nursed at home became very evident. However, many of the older folk being cared for by home nurses did not, in fact, require skilled attention, and it was strongly felt that the introduction of a bath attendant service would be of great value, but, of course, the patients would still be visited by the nurses. This service is, however, very much in the future. A very valuable addition to the home nursing service was the commencement in November of the Marie Curie Day and Night Nursing Service for patients with terminal cancer. There are eight nurses in this service, and in the short time that they have been employed have already brought great comfort and relief not only to the patients but also to relatives of patients they have nursed. Ten such cases were assisted during the year. Statistics Total number of persons nursed during the year 1,791 Number of persons who were aged under 5 at first visit 23 Number of persons who were aged 65 or over at first visit 683 LOAN OF SICK-ROOM EQUIPMENT Patients being nursed at home may, on medical recommendation, be loaned a wide variety of equipment to assist in their care. Bulky items are delivered to patients' homes, smaller articles are collected from the health department. The types of equipment available include hydraulic hoists for lifting certain helpless patients from their beds to chairs, their bath, toilet, etc., commodes, ped-pans, back-rests, walking aids, waterproof sheets, disposable pads, etc. 2,138 articles were loaned during the year and 3,193 items were out on loan at the end of the year. In addition, 16,900 disposable pads for incontinent patients were issued. The disposal of these pads has not given rise to any difficulty up to the present, although their increasing use may call for special arrangements in the future, particularly in smokeless zones and in centrally 34 heated blocks of flats. Where patients have not been able to dispose of the pads, this has been arranged at the destructor plant. OXLOW LANE GERIATRIC CLINIC (FOR THE OVER SIXTIES) The year has proved a difficult one, not only arising from integration of services, but also in view of staff changes. Dr. Packer, who had been responsible for day-to-day running of the clinic left for another appointment, as did Dr. Wallace, and Mrs. Walker continued her post in the face of increasing ill-health. These rendered valued service, and their efforts to achieve a relaxed, happy atmosphere are much appreciated by members and staff. A series of talks were given on subjects of general health interest, and suitable exercises were carried out under the supervision of a health visitor until May, after which we were fortunate to obtain the services of a physiotherapist until the end of the year. We have also been privileged to show interested visitors some of the activities of the clinic. The Chiropodist, Mr. Kelly, who attended at the clinical sessions, treated 28 female and 3 male patients over a total of 123 individual visits. Unfortunately, Mr. Kelly left the Council's service in November 1965, and it has not been possible to replace him. For the time being, patients for chiropody are being referred to the clinic at Chadwell Heath. Thirty medical examinations were made by the medical staff (Dr. Wallace, Dr. Packer and Dr. Massey). There were 175 attendances at the exercise class. NATIONAL ASSISTANCE ACT. 1948 Section 47 It unfortunately became necessary to remove three persons from their homes as being unable to care for themselves and not receiving adequate care and attention from others. In all three cases, the action taken was a last resort and the patients died in hospital shortly after arrival there. TUBERCULOSIS Notifications and Deaths New Cases Deaths Pulmonary Meninges and CNS Other Total Pulmonary NonPulmonary M F M F M F M F M F Under 5 years _ _ _ 1 1 _ 2 _ _ _ _ 5- 1 1 _ _ _ 1 3 _ _ _ _ 15- 18 12 _ _ 3 3 36 1 _ _ _ 45- 12 2 _ _ _ _ 14 11 _ _ _ 65 and upwards 3 _ _ _ 1 1 5 5 1 - - Totals 34 15 - 1 5 5 60 17 1 - - 35 Transferred Cases Clinic Into Borough Out of Borough Nett gain or loss Upney 17 10 + 7 Five Elms 32 37 - 5 Totals 49 k7 + 2 Chest Clinics Clinic No. cases on register No. households involved No. home visits made Upney 470 371 724 Five Elms 554 499 778 Totals 1,024 870 1,502 Clinic Ante-natal Child Contacts No. B.C.G. given No. chest X-rays No. T.B. No. of Attendances No. T.B. Children Other Upney 1,155 1 2,579 1 230 - Five Elms 163 - 660 1 108 10* Totals 1,318 1 3,239 2 338 10 *Staff at Dagenham Hospital. The statistics presented here are a combination of the morbidity and mortality figures for tuberculosis throughout the year of 1965 in the whole of this new London Borough. So that a comparison can be made with the situation previous to 1965, the following table is given:- Year New Cases Notified (all forms of T.B.) Number of Deaths Barking Dagenham Total Barking Dagenham Total 1963 31 48 79 7 22 29 1964 24 28 52 7 19 26 1965 60 18 Mass Radiography Mass Radiography Unit 6A visited the Dagenham area of the borough in November 1965, and I am indebted to the Medical Director for the following details:- 36 Location Male Female Total Stafford's Bakeries 154 387 541 May & Baker Ltd. 1,563 1,305 2,868 Sterling Engineering Co. 155 116 271 Kingsley Hall 137 207 344 Royal Oak 136 160 296 The Bull, Rainham Road 146 160 306 Chequers Parade 355 350 705 White Horse, Chadwell Heath 82 101 183 The Heathway 209 355 564 Rose Lane, Chadwell Heath 51 122 173 Merry Fiddlers 261 277 538 Firestone Co. 148 149 297 Lewis Berger Ltd. 558 326 884 Telephone Cables Ltd. 748 304 1,052 Hector Powe Ltd. 313 412 725 Ever Ready Co. 210 407 617 Total number X-rayed 5,226 5,138 10,364 Requiring further investigation 88 74 162 Groups attending Male Female Total General Public 1,386 1,718 3,104 Organised Groups 3,840 3,420 7,260 Pulmonary Tuberculosis Male Female Total Requiring immediate treatment 1 - 1 Requiring close clinic supervision 1 - 1 Requiring occasional clinic supervision 7 2 9 Presumed healed no further action necessary 17*(4pk) 24*(2pk) 41 *pk = previously known Groups in which significant Tuberculosis was discovered Male Female Total Requiring immediate treatment: Organised Groups 1 - 1 Requiring occasional clinic supervision: Organised Groups 1 - 1 37 A.nong other abnormalities discovered were:- Male Female Total Carcinoma of the lung 3 1 4 Primary carcinoma of the colon 1 - 1 Abnormalities of the heart and vessels (congenital) 1 2 3 Abnormalities of the heart and vessels (acquired) 7 13 20 Sarcoidosis 1 1 2 Benign tumours of the lung and mediastinum 1 2 3 Bronchiectasis 2 - 2 Emphysema 3 - 3 Pulmonary fibrosis (non-t.b.) 9 9 18 Pneumoconiosis 1 - 1 Pleural thickening and calcification 5 2 7 Abnormalities of the diaphragm - 1 1 Hamartoma - 1 1 Abnormalities of the bony thorax (acquired) 4 1 5 Abnormalities of the bony thorax (congenital) 2 1 3 Did not attend for further investigation 1 3 4 Did not attend for repeat miniature film - 1 1 CHIROPODY SERVICES The Chief Chiropodist reports as follows:Clinics Central Foot Clinic - Clinic operated by the Chief Chiropodist singlehanded. Appointments range from 8 to 10 weeks, and there are facilities at this clinic for at least three chiropodists. Car parking facilities are needed, as this is important in the future recruitment of staff, and for access to the clinic as parking problems increase. Total treatments - 2,123. Sessions worked - 396. Julia Engwell Clinic - Clinic operated by Mrs. D. Mann. There are two surgeries equipped. The clinic has a heavy case load, but help could be given when staff is available. Total treatments - 2,476. Sessions worked - 479. Porters Avenue Clinic - Clinic operated by Mr. D. Ditsell; a single surgery with a heavy case load. This could be eased by sending some cases to the nearby Julia Engwell Clinic when staff conditions make this possible. Appointments 8 to 10 weeks. Total treatments - 2,759. Sessions worked - 497. 38 Greatfields Clinic - Operated by Mr. H. Stenson from Monday to Thursday. This single surgery clinic fringes Central Clinic area and is able to take some of the Central patients when necessary. Appointments range 9 to 10 weeks. Total treatments - 2,835. Sessions worked -517. Thames View Clinic - This is a single surgery clinic operated by Mr. H. Stenson on one day - Friday - each week. It is very likely that more sessional time will be required here quite soon as there is a rapid increase in the demand for treatment. Total treatments - 710. Sessions worked - 114. Ford Road Clinic - Operated by Mr. N. Freeman and Mr. Kelly (resigned 19th November 1965) in conjunction with Ashton Gardens Clinic, assisted by Clerk/Receptionist, Miss Richards. Clinic open on Monday, Wednesday and Thursday. The staff go over to Chadwell Heath on Tuesday and Friday. This clinic has a heavy case-load, and more staff is urgently required to cope with the demand. The building is earmarked for extensive alteration in 1966. Total treatments - 4,594. Sessions worked - 704. Ashton Gardens Clinic - Operated by Mr. N. Freeman and Mr. Kelly (resigned 19th November 1965) assisted by Clerk/Receptionist, Miss Richards. Clinic open on Tuesday and Friday. Since March 1965 treatments have been carried out at St. Chad's Church Hall nearby, while the clinic is being rebuilt. Total treatments - 2,204. Sessions worked - 367. General Remarks - All clinics, due to staff shortages, have heavy caseloads, in spite of the fact that we are accepting only old age pensioners, expectant mothers, the physically handicapped and children. Owing to the resignation of Mr. Kelly, the remaining chiropodist in the Dagenham area, Mr. Freeman, has now to cover Ford Road and Chadwell Heath areas single-handed. These districts are very densely populated and 1could provide work for at least four chiropodists. At the end of the year, six chiropodists were employed, and there were five vacancies. Domiciliary This service is being operated by Mrs. Morgan, who receives a car allowance. Almost 700 patients are now on our list, and this number is being added to daily and covers mainly only the western half of the borough. It is impossible for Mrs. Morgan to do any more, and we are greatly in need of at least one other domiciliary chiropodist to cover the eastern area of the borough. Mrs. Morgan also visits the Mayesbrook Old People's Home on one day every two weeks. Total domiciliary treatments - 1,668. Sessions - 433. Old People's Homes Mayesbrook Home - Attendance by Mrs. Morgan one day every two weeks. Total treatments - 312. Sessions - 52. Saywood Lodge - Visited fortnightly by Mr. Fenton (part-time, sessionally appointed chiropodist). This Home, together with The Lawns, appears to be very well served by Mr. Fenton. Total treatments - 170. Sessions - 20. 39 The Lawns - Visited fortnightly by Mr. Fenton. Total treatments - 132. Sessions - 16. Kingsle.y Hall - Visited by Mr. Freel (part-time sessionally appointed chiropodist) from 28th January to 11th November, 1965. Total treatments - 287. Sessions - 59. General Remarks Domiciliary and old people's home work is very rapidly becoming a major problem, and we urgently need a much larger staff to cope with the demands being made. We are constantly having notifications of need from many outside sources, Welfare Department, medical practitioners, and our own health visitors Many of these cases referred to us are in some degree of urgency and warrant immediate attention. Treatments for the Year Clinics Children Adults Total Sessions -4 5-16 O.A.P. Others A/N P/H Central 2 142 1,921 52 - 6 2,123 396 Julia Engwell 1 44 2,425 1 1 4 2,476 479 Porters Avenue - 66 2,628 22 2 41 2,759 497 Greatfields 1 42 2,705 87 - - 2,835 517 Thames View 2 76 625 4 - 3 710 114 Ford Road 8 513 1,723 1,807 3 540 4,594 704 Ashton Gardens 4 177 1,018 832 1 172 2,204 367 Total 18 1,060 13,045 2,805 7 766 17,701 3,07^ Old People's Homes Mayesbrook 312 - 312 52 Kingsley Hall 287 - 287 59 The Lawns 132 - 132 16 Saywood Lodge 170 - 170 20 Total 901 - 901 147 Domiciliary Central Area 1,537 131 1,668 433 Grand Totals for the Year Section Number of Treatments Sessions Worked Clinics 17,701 3,074 Old People's Homes 901 147 Domiciliary 1,668 433 Grand Total .. .. 20,270 3,654 40 MEDICAL EXAMINATION OF STAFF The aim of these examinations is to determine whether the candidate is suitable for the particular job for which he has applied, and whether he is considered fit enough to give a reasonable period of service in his employment. When staff who are to work among children are concerned, one additional aim is to prevent the spread of infection. The figures given below reflect a satisfactory level of fitness for employment in relation to the number of examinations carried out and we look forward to maintaining them in an integrated service. Number of persons examined and passed as fit 737 Number of persons examined and not accepted 8 Number of special examinations in connection with sickness payments 24 Number of medical examinations carried out for other authorities 10 Number of chest x-rays arranged in connection with medical examinations 187 REHOUSING ON MEDICAL GROUNDS In order that every person who considers himself eligible for rehousing on medical grounds is treated with equal fairness, one of my medical officers (the Deputy Medical Officer of Health) is responsible for investigating the medical histories of all applicants. This is a breakaway from the usual pattern, whereby the doctor receives housing reports and medical/social reports from the public health inspector and health visitor respectively. All information (i.e. housing details from Housing Department and medical recommendation from a doctor) is placed in front of my Deputy, and where it is not possible to make a decision from this information, he will visit the person in his home. Statistics Total number of applications 208 Number of families visited 55 Number recommended for rehousing 15 All the applicants with young families were already on the Council's list for rehousing either by virtue of overcrowding - the majority - or because of clearance areas, and therefore overcrowding of itself cannot be considered as a medical reason. The other main group of applicants were retired pensioners, who found their present accommodation physically unsuitable because of increasing infirmities. The most frequent problem was the difficulty in climbing stairs. Often it is necessary to climb four flights of 12-14 stairs to reach their accommodation. 41 MENTAL HEALTH As a result of the amalgamation of the London Boroughs, 1965 the first year that the mental health services for this borough were administered and organised locally, and not dependent upon "long distance" administration. Owing to the close co-operation of all staff concerned, the "changeover" was made with a minimum of disturbance to those in need. For the first time, the needs of the community can be looked at locally. Efforts will be made to meet those needs. The persons most concerned with the dispensing of the local authority mental health services to the mentally ill and the mentally subnormal, are the mental welfare officers. We were fortunate that three of these officers were previously employed by the Essex County Council, and so continuity of service was possible. Two further officers were appointed during the year. The following table gives an idea of the work they cover Mentally Subnormal Number in community 319 Number in residential care 9 Number of cases given temporary care 10 Number of E.S.N, school leavers referred 16 Mentally 111 Number in community (i.e. living at home) 96 Number in residential care 6 Number referred from mental hospitals for community care 66 Admissions to Warley Hospital: Informal 40 Compulsory: Section 25 15 Section 29 45 Section 26 1 Via Courts 3 =104 Total number of visits to patients outside office hours 130 The function of the mental welfare officers is to see that all mentally* handicapped persons and their families receive the care and attention that the local authority, as well as the hospitals, are able to provide. As the mental hospital for the London Borough of Barking is situated so far away (at Warley), the mental welfare officers are a very important link with the hospital serving our community. Since October 1965 a Social Club for the Mentally 111 has been held once weekly at the Adult Training Centre during the evening. Forty-nine patients are on the register, and a variety of social activities take place, including film shows, play reading, table tennis, billiards, visits to theatre, etc. We look forward to developing two important projects within the borough during 1966 - a full-time Day Centre for the Mentally 111, and a furnished Council flat which will be used for mentally ill ladies. These it is hoped will be patients needing hospital care only because of the absence of a suitable home to which they can be discharged. Adult Training Centre On 8th March during this year the new Centre for Adult Subnormals was opened, and 24 persons were put on the register. During the year, the numbers steadily increased to 30-35 persons. 42 Every effort is made to introduce into the lives of the trainees all those activities that the non-handicapped person enjoys - or perhaps takes for granted. The activities of the Centre are as follows:- Industrial Work (a) One firm supplied the Centre with small electrical motors which the trainees dis-assembled into constituent parts. Eightpence was received for each motor. (b) Another firm supplied the Centre with thousands of plastic caps. All it was necessary for the trainees to do was to close the caps - apparently no machine can do this. For every 1,000 caps closed, 2s.6d. was received. The total amount of money received during the year for these contracts was approximately £166, and this sum was divided equally amongst all the trainees. We are very grateful to the two firms who co-operated with us in this way, and who also allowed our trainees to visit the factories concerned. Handicrafts Handicrafts are an important activity in the Centre because they utilise so many of the normal physiological activities of the body (limb manipulation, eye - limb co-ordination, etc.). The handicrafts consisted of leather work (wallets, purses, etc.), woodwork (stools, ottomans, etc.), basketry (baskets, trays, etc.), needlework (cushions, etc.). Domestic Science In rotation, each boy and girl is taught laundry work and cooking utilising the needs of the Centre itself as work material. The usefulness of this training in the homes of the trainees is obvious and goes some of the way to making their home a normal one. Other teaching activities which can well be included under this heading are how to use a telephone, the Highway Code, and regular shopping expeditions. Social Activities The most important item under this heading is the evening social club started in September. Parents are encouraged to come whenever possible. The attendance was very good, and so we hope to hold this social evening every week, instead of fortnightly as at present. Dancing lessons are given regularly, and the period after lunch is frequently occupied by the boys and girls dancing together to music from a gramophone. In June, all the trainees and staff spent an enjoyable day at the seaside - Minnis Bay, Kent. In December, all the trainees and staff attended a variety show in London's West End - it was enjoyed by all. There were two Christmas parties - one for the trainees during the day, and another for trainees and their parents, relations and friends in the evening. 43 Physical Activities Every Tuesday morning, all the trainees who are physically fit enough to do so visit Halbutt. Street Sports Centre, where they can participate in various sports activities under the supervision of a qualified instructor. Some of the trainees who showed fear of heights are taught to overcome this fear by climbing up and down small steps and eventually ladders. Eventually they are able to climb alone without help from the instructors. CIVIL DEFENCE A new function that the amalgamation of the two boroughs has placed upon th Health Department is the medical aspect of civil defence. Close liaison has bee maintained with the Civil Defence Corps of this borough, and all health matters are discussed with them. During the year, the Deputy Medical Officer of Health attended a week's course on the subject of the Medical Aspects of Nuclear War Survival which had been organised by the Ministry of Housing and Local Government Headquarters at Sunningdale. The Emergency Home Care Course (Ministry of Health) consisting of nine one-hour lectures and demonstrations, was given to 40 members of the Eastbury Good Neighbours Club, Barking. A health visitor gave the lectures; the demonstrations were given jointly by the health visitor and the Civil Defence Officer. DOMESTIC HELP SERVICE Cases served during the year 1965 Aged (over 65 years) 1,4-05 Chronic sick 218 Mentally disordered 4 Maternity 68 Others 55 Total 1,750 Number of Domestic Helps employed at close of year Whole-time 1 Part-time 211 The appointment of an Assistant Organiser on the 1st April, who then became primarily engaged on routine visiting, brought this aspect of the work up to a more desirable standard and each case was being visited at.least once in three months. A training course was held at Hornchurch College of Further Education 12th January - 30th March at which 12 domestic helps attended. The departmental mini-bus was used for transporting personnel. 44 CONVALESCENCE Arrangements were made for persons recommended a recuperative holiday by general practitioners or medical officers to go away for a period, usually of two weeks, as summarised below:- Adults Children National Health Service Act: Section 22 (Mothers and Young Children) 2 6 Section 28 (Prevention of illness, care and after-care) 59 - 45 The social activities continued to flourish, and included:- Evening Theatre Outing - February Day's River Trip (Sunday) - August Evening Social - October Dinner and Dance - December Six cases received the services of a Night Attendant, and at the close of the year, one was employed. SCHOOL HEALTH SERVICE There are 68 primary and 23 secondary schools in the borough. We also have two special schools, Bentry and Faircross, each of which has a physically handicapped and an educationally sub-normal section. It is planned, however, to amalgamate the sections when the new Faircross School is completed, and to concentrate the physically handicapped and delicate children at Faircross and the educationally sub-normal at the Bentry School. At the end of the year, numbers on roll were as follows:- Primary schools 15,720 Secondary schools 12,055 Special schools 318 Total 28,093 MINOR AILMENTS CLINICS Minor ailments sessions at which a doctor was present were held at the following clinics:- Ashton Gardens Friday p.m. Becontree Avenue Monday and Thursday a.m. Central Monday to Friday 9-10 a.m. Five Elms Monday p.m., Friday a.m. Ford Road Monday a.m., Friday p.m. Julia Engwell Monday to Friday 9-10 a.m. Leys Monday p.m. Marks Gate Friday p.m. Oxlow Lane Wednesday a.m. Porters Avenue Monday to Friday 9-10 a.m. Upney Monday., Tuesday, Wednesday, Friday 9-10 a.m. A total of 2,228 pupils were seen during the year. MEDICAL INVIGILATION OF SCHOOL MEALS SERVICE STAFF In order to minimise the risk of spread of infection, the health history of all part-time staff employed in the school meals service is obtained and reviewed by a member of the medical staff. Medical examinations are then arranged for appropriate cases, together with laboratory investigation where necessary. During the year, the medical histories of 214 candidates were reviewed. 46 SELECTIVE SCHOOL MEDICAL EXAMINATIONS With the approval of the Education Committee, a pilot scheme for selective school medical examinations was commenced in respect of children in their final year at two secondary schools. Under these arrangements, the parents of children due to leave school are sent a detailed questionnaire concerning their child's health. The completed questionnairs are studied by the school medical officer, and children thought to require examination are invited to attend. Any parent is able, however, to request an examination and the views of head teachers and teaching staff are taken into account. During the year, questionnaires were sent in respect of 56 children, 7 of whom were examined. In addition, a further three children were examined at the request of the head teacher. When further experience of the selective method of medical examinations has been gained, a report will be made with a view to extending this system if it proves successful. SCHOOL MEDICAL INSPECTIONS Routine school medical inspections are carried out on:- (a) pupils entering primary school, (b) pupils in their last year at primary school, and (c) pupils in their last year at secondary school. In addition, pupils entering the borough from other areas and children found to require observation or treatment are followed up as necessary. Particular attention is paid to pupils at the special schools. Periodic Inspections Age Groups Inspected (by year of birth) No. of Pupils Inspected 1961 and later 90 1960 1,366 1959 731 1958 99 1957 90 1956 46 1955 178 1954 1,206 1953 595 1952 75 1951 661 1950 and earlier 2,032 7,169 47 Other Inspections Number of special inspections 4,733 Number of re-inspections 2,336 Total 7,069 DEFECTS FOUND BY MEDICAL INSPECTION Defect or Disease Periodic Inspections Special Inspections Treatment Observation Treatment Observation Skin 336 81 2,616 56 Eyes: (a) vision 711 261 172 62 (b) squint 36 16 5 25 (c) other 18 10 166 9 Ears: (a) hearing 55 51 95 89 (b) otitis media 16 28 26 4 (c) other 24 12 72 - Nose and throat 140 119 163 18 Speech 51 45 68 33 Lymphatic glands 21 59 4 - Heart 47 42 13 2 Lungs 45 80 15 4 Developmental: (a) hernia 7 10 - - (b) other 39 58 30 8 Orthopaedic: (a) posture 15 7 4 2 (b) feet 148 83 37 6 (c) other 57 33 227 8 Nervous system: (a) epilepsy 13 6 2 1 (b) other 21 38 12 5 (a) development 65 48 43 9 (b) stability 53 67 29 9 Abdomen 8 15 30 - Other 131 27 791 286 48 PUPILS FOUND TO REQUIRE TREATMENT Age Groups Inspected (by year of birth) Individual Pupils found to require treatment For Defective Vision (excluding squint) For any other condition Total Individual Pupils 1961 and later 8 38 40 1960 95 249 314 1959 100 244 294 1958 7 46 52 1957 5 48 50 1956 1 33 34 1955 15 47 51 1954 137 154 281 1953 62 75 128 1952 5 34 38 1951 51 82 104 1950 and earlier 225 213 410 Total 711 1,263 1,796 General Condition of Children Out of 7,169 pupils examined, only 9 were considered to be of unsatisfactory general condition. INFESTATION WITH VERMIN With higher social standards existing today, the incidence of infestation with vermin is generally much lower than it was a few years ago, and it was decided to reduce the number of hygiene inspections by school nurses unless otherwise requested by head teachers, thus making a great saving of nurses' time. During the year 28,280 pupils were examined, and 188 found to require treatment. CONVALESCENT TREATMENT Pupils who are recommended convalescent treatment on medical advice are sent away for periods of up to four weeks. 126 cases received treatment during the year. EMPLOYMENT OF CHILDREN 65 pupils were examined for fitness for employment out of school hours and certificates were granted. 49 DISEASES AND DEFECTS OF EAR, NOSE AND THROAT A Specialist Ear, Nose and Throat Consultant attends weekly at Central Clinic, Barking. Pupils known to have been treated Received operative treatment:- (a) for diseases of the ear (b) for adenoids and chronic tonsilitis 177 (c) for other nose and throat conditions 258 Total number of pupils in schools who are known to have been provided with hearing aids:- (a) In 1965 5 (b) In previous years 24 ORTHOPAEDIC AND POSTURAL DEFECTS An Orthopaedic Consultant attends monthly at Leys Clinic where a whole-time physiotherapist is also in attendance. Pupils known to have been treated (a) At clinics or out-patient departments 429 (b) At school for postural defects 9 CHILD GUIDANCE TREATMENT For many years, pupils living in Barking and Dagenham were referred to Ilford and Romford respectively for child guidance treatment. A Child Guidance Clinic for the borough was eventually agreed and a Consultant Psychiatrist commenced sessions in temporary accommodation at Southwood School in August, 1965, with a staff of one whole-time and one part-time Educational Psychologist and a Clinic Clerk. Cases awaiting treatment at Ilford and Romford Child Guidance Clinics were transferred to the new clinic, although cases already receiving treatment were retained; thus continuity of treatment was maintained and the new clinic was no over-loaded. There is, however, a great need for a purpose-built child guidance clinic. At the 31st December 1965 there were 38 cases awaiting first appointment at the clinic, and 37 cases under treatment. A report has been received from the Medical Director of the Romford Child Guidance Clinic as follows "The situation at present is that there are no children on the waiting list as at 31st December 1965, and there are 30 cases under treatment. "Since your own Clinic opened we have not taken any fresh cases, but have continued with those under treatment or observation." 50 A report has been received from the Educational Psychologist of the Ilford Child Guidance Clinic as follows:- "The relevant figures concerning children seen at this Child Guidance Clinic during 1965 are as follows:- New cases referred in 1965 31 Cases referred but not seen: (a) Improved or moved from area 2 (b) Transferred to Barking Child Guidance Clinic 10 (c) Awaiting first interview at end of 1965 1 13 New cases seen during 1965 18 Cases carried over from 1964 33 Total number of Barking children seen during 1965 51 "As you know, no new cases from Barking were accepted at this clinic after July, 1965 (except where another child in the same family was already attending this clinic), and all new referrals after that date were to your own new Child Guidance Clinic in Barking. There were also (as quoted above) 10 children from our waiting list who were transferred to Barking Child Guidance Clinic when psychiatric sessions became available there. This is why we only had one Barking child left on our waiting list at the end of 1965, and presumably you will also have the figures from your own Child Guidance Clinic for the latter part of the year. "Where children were currently attending this Clinic at the time Barking Child Guidance Clinic was started, we continued with the cases, as this continuity of service was felt to be in the best interests of the children and parents. As our new referrals from Barking stopped during the year, the number of Barking children attending this clinic will gradually diminish as the children we are dealing with finish their attendance and, at the same time, the number of children attending Barking Child Guidance Clinic will increase as they build up a case load from their new referrals." EYE DISEASES, DEFECTIVE VISION AND SQUINT Ophthalmic Specialists of the Regional Hospital Board attended weekly at Central Clinic, Barking, and at Porters Avenue and Becontree Avenue Clinics, Dagenham. There is some delay in providing treatment at Becontree Avenue Clinic owing to the large number of patients in the catchment area of this Clinic. Additional specialist sessions have been authorised by the Regional Hospital Board, but unfortunately as yet they have been unable to find an ophthalmic specialist to do them. Pupils known to have been treated (a) External eye diseases and other (excluding errors of refraction and squint) 212 (b) Errors of refraction (including squint) 1,941 (c) Number of pupils for whom spectacles were prescribed 1,352 An orthoptic clinic is held at Upney Clinic, and 106 school children were treated during 1965. 51 Dr. P. Lancer, Ophthalmic Specialist, Becontree Avenue Clinic, reports as follows "The work of the clinic continues to be satisfactory, the attendance being as in previous years. The rate of non-attendance remains fairly high, and it is suggested that further sessions at other clinics in the area might help reduce this somewhat. "Once more I would ask for the early referral of eye defects since amblyopia in the older child is an unnecessary evil in many children. "In conclusion, I wish to thank the clinic nurses for their co-operation and help in the smooth running of the clinics." DISEASES OF THE SKIN (excluding uncleanliness) A Consultant Dermatologist attends twice monthly at the Upney Clinic and an Assistant Medical Officer, acting as his clinical assistant, treats minor skin conditions at a special session. Pupils known to have been treated Ringworm: (a) scalp (b) body Scabies 2 Impetigo 35 Other (plantar warts, etc.) 1,946 Total 1,983 B.C.G. VACCINATION All school children from the age of 13 years are offered the opportunity to have B.C.G. vaccination against tuberculosis, should this be indicated following a simple skin test. During the year, 1,457 children were skin tested. 1,268 were found to be suitable and were vaccinated with B.C.G. 189 pupils were found to have a positive reaction to the skin test and were referred to the chest clinic for a routine x-ray. ENURESIS CLINIC Appointments Made Attendances Alarms Issued New patients 73 41 39 Old patients 80 33 4 Totals 153 74 43 52 Analysis of 74 patients seen Cured (i.e. no enuresis during previous 6 weeks) 56 Much improved (i.e. reduced from every night to 2 - 3 times a week 12 No improvement 6 Total 74 The enuresis clinic, held fortnightly, continued to show very encouraging results during this third year of its operation. The older type of alarms with the plastic exterior buzzer, are slowly being replaced by a more robust machine. This will contribute to better results, because a frequent cause of failure is the inability of the older machine to awaken a deeply sleeping child. Seventy of the children seen were referred to this clinic by other Assistant Medical Officers, and only four from local general practitioners. All patients listed as "cured" are told to return at any time should enuresis occur again. In fact, in only four cases did this occur. As any benefit derived from use of the alarm has been found to manifest itself during the first few weeks of its use, patients are now allowed to keep it for 10 weeks and not 12 weeks as was the previous practice. This, plus the fact that we now have more alarms, has removed a long waiting list of patients requiring the alarm. SPEECH THERAPY Dagenham Area For many years past, there have been very few changes to report in the organisation and running of the speech therapy clinics within the area. However, with the amalgamation in April 1965 of Dagenham and Barking into the one London Borough of Barking, alteration in the existing services has come about, although naturally the work itself has not been affected and the needs of our patients have still been met. We were exceedingly sorry to lose Miss Eileen Shipley in August 1965, when she transferred to Enfield. Miss Shipley had worked here for eight years, and was much respected by staff and public alike, and her work had been of a very high standard. Miss Shipley has not yet been replaced and so Miss Symes has been carrying on the work of all speech therapy clinics in the Dagenham area, except for the Bentry School Clinic, which until the end of 1965 has been without a therapist. The number of patients under treatment at the end of the year was 101, and the number of treatments given was 2,142. 211 patients had been treated, of whom 138 were boys and 73 were girls. During 1965, 110 patients were discharged, these figures being made up as follows:- Speech normal 74 Non-attendance 18 No further progress likely 8 Transferred to other areas 6 Left school 3 Discharged at parents' request 1 53 The most common defect continues to be dyslalia (faulty reproduction of speech, with no apparent organic cause). Children within the infant school age-group continue to form the highest percentage of patients. This is consistent with the fact that this age-group is usually the optimum age for treatment of speech disorders. Barking Area Speech therapy was re-started at the new Julia Engwell Clinic when it opened in January 1965. The room is ideally suited for the purposes of speech therapy and the new tape recorder was immediately put to use. It was necessary, at first, to re-awaken interest in speech therapy, as the previous therapist had left the area eighteen months ago. The medical and dental staff in the various clinics were extremely helpful and cases were quickly referred for speech therapy. All the schools were visited, and this was useful both for making contact with the head teachers and their staff and in selecting cases for treatment. It was suggested that a speech therapist visited the Junior Training Centre each week, and group therapy was started with some of the children. Miss Symes and Miss Shipley had been coping admirably at Central Clinic, and it was possible to relieve them by taking on the most vital cases. We were pleased to welcome Miss Marquand from New Zealand in October. She was able to carry on at Central Clinic and start up speech therapy sessions in the Barking schools and at Faircross Special School. The number of cases seen at Julia Engwell Clinic during 1965 was 1,308. This can be divided up into:- Pre-school 122 Infant school 381 Junior school 344 Secondary school 97 Special school 364 However, 551 cases were sent appointments and failed to attend for speech therapy. The number of children on the register in December 1965 was 100. At Central Clinic, 554 cases were seen during the year and these can be divided up into:- Pre-school 85 Infant school 263 Junior school 103 Secondary school 14 Special school 89 146 cases were sent appointments and failed to attend for speech therapy. The number of children on the register in December 1965 was 39. 54 HANDICAPPED CHILDREN FAIRCROSS SCHOOL This has been rather a disturbed year for Faircross School, partly because of the pending redistribution of pupils, and partly because Miss Storm, the Headmistress, retired in September. The E.S.N, group of children were due to be transferred to Bentry after the end of the year, and the P.H. and O.A. children were to be moved into the new Faircross School, which was completed towards the end of 1965- Thus, the total number of children on the register is lower than usual because no E.S.N, children were accepted after the summer holidays, the purpose being to avoid a second change of school so soon after admission. Miss Storm, who retired in September, had taught in the school for 29 years, and had been Headmistress for 15 years. Our relationship with her had always been of the most cordial, and we were very sorry to see her leave. She invariably attended the weekly S.M.I.'s and supported us loyally in every possible way. Every medical officer who worked with her had the greatest admiration and respect for her. Nothing was too much trouble, and we particularly appreciated her wonderful understanding of the children and their problems. In spite of all our efforts we had only the intermittent use of a speech therapist, and we were still without a physiotherapist. Children who required this latter facility had to attend their own hospitals, except in the case of one or two where Mr. Hynd was able to help on Ross Ward, Barking Hospital. I am indebted to Mr. A. Burke, Deputy Headmaster, for the following comments on the work of the school "1965 saw the closure of the old Faircross School. As might be expected the uncertainty about the future made recruitment of staff difficult, and the replacement of teachers who left through illness or for family reasons was considerably hindered. Nevertheless, there was still a great deal of activity. As well as the classroom work, there were visits to museums, factories and theatres. The trip to Boulogne, the third of its kind, proved to be the most interesting. The coach driver who took us round had been brought up in England and was able to tell us a great deal about life in France. Mr. Burkhill, from the County Advisory Staff, used some of our pupils as a demonstration class for the teaching of music. Under Mr. R. Norman, both the Choir and Orchestra performed well at the Dagenham Festival. At a reception - attended by over 240 persons - held when Miss Storm was presented with a testimonial from the authority by Mrs. Engwell, we met again many former pupils. This sort of meeting indicates a measure of our success in our work which is both social and educational. Although severely understaffed in the Autumn term, we still sent children to see plays and ballets, and one teacher attended a short course on hygiene. Almost the last activity of the old school was the Carol Service and Nativity Play." 55 BENTRY SCHOOL This year marked the end of an era for the Bentry School, as it was its last year as a combined school for physically handicapped and educationally sub-normal children. During the year we were informed that the physically handicapped children would in future attend the new school at Faircross. Consequently, much of the time was spent making preparations for the change-over. The children were all reassessed with a view to selecting the most suitable type of schooling for them. It was possible to return two physically handicapped children to normal school and two others to special residential school. Next year we are expecting to admit approximately 50 educationally subnormal children from Faircross School and we are hoping to start a special nursery class for the youngest group. We wish to thank Mr. Hurton and his staff for their co-operation during the year; also our thanks to Mr. Sheridan, Educational Psychologist, for his help. The following report has been received from Mr. T. G. Hurton, Headmaster of the Bentry School:- "In January 1966, the physically handicapped children of Bentry School were transferred to the new Faircross School, Barking, and the educationally sub-normal children of Faircross School were transferred to Bentry School. This change, which was long overdue, meant that Bentry School now catered exclusively for educationally sub-normal children. However, the school is now larger, catering for 210 children, and when teaching staff becomes available will accommodate 230 children. The age range is from 6 years to 16 years. The maximum size of a class under the Handicapped Pupils and Special Schools Regulations is 20. The youngest and least able children are in somewhat smaller classes. The classes for the youngest children are run on nursery class lines, the teacher having the help of a nursery assistant. A nursery playground with swings and facilities for sand and water play has been established. Children are encouraged to play freely and purposefully, to mix in a friendly fashion with other children and to speak intelligibly. A few children are of doubtful educability, but are given an adequate trial period before a final decision is made. Intelligence well below normal determines that the education and training in this school catering for educationally sub-normal children shall be significantly different from that in an ordinary school. Educational progress is often slow, although social behaviour may improve much more rapidly. It is therefore an advantage to have both primary and secondary departments in one school so that children can be transferred to work at secondary level when they are ready and not at any particular age. Although in special schools there is some place for class teaching, individual and group work takes up most of the school day. Progress in learning must be measured against the individual's own performance and not against that of others in the class. Literacy and numeracy are of great importance and can ultimately be achieved in realistic work-a-day terms by many of the children. 56 Projects, centres of interest, school journeys and educational visits help to stimulate the children and provide material for interesting and useful work. Swimming, games and athletics are popular, as with other children, and good use is made of inter-house contests and athletic events. A school swimming pool would be a great advantage to the children and I trust that in the not too distant future a pool will be provided. Standards of achievement in music, dancing, drama and craft are good, and the school participated in the Barking School Festivals in the Music, Dancing and Choral Speech Sections with excellent results. Efforts are made to prepare pupils for entering employment. School work is made relevant to employment with practice in filling in forms and answering questions. The School Club is to be re-started in September 1966. Suitable employment is found for school leavers by the combined efforts of the Handicapped Children's Employment Officer, the School Medical Officer and the Headmaster. All attend the school leaver's interview when problems are discussed with the leaver and the parent. The School Medical Officer, Dr. Fitzpatrick, attends the school weekly and her interest and co-operation over and above her line of duty is much appreciated. The School Dental Officer also attends weekly, and facilities exist for him to carry out his duties on the premises. However, there is an urgent need for a Speech Therapist for the school, as we have many children who require speech therapy. I feel that the appointment of a School Welfare Officer would be of great advantage to the school. Many local education authorities have already made such an appointment." 57 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS Blind Part Sighted Deaf Part Hearing Physically Handicapped Delicate Maladjusted Educationally Sub-normal Epileptic Speech Defect Total Number of children newly assessed in year - 4 - 1 9 15 10 30 2 - 71 Number of children placed in Special Schools in year - 4 - 4 8 12 6 32 2 - 68 Number of children requiring places in Special Schools - 1 - - - 3 4 16 - - 24 Number of children included above whose parents had refused consent to their admission - - - - - - - 3 - - 3 Number of children on Registers of Special Schools at 20th January 1966 5 17 1 42 48 54 25 215 10 - 399 Number of children receiving tuition at home or in hospital, etc. - - - 1 3 1 - 1 - 6 58 JUNIOR TRAINING CENTRE When the London Borough of Barking took over the Junior Training Centre in Ripple Road from the Essex County Council in April 1965, no less than 103 trainees were accommodated in premises built as a school in the 1890's. These 103 trainees consisted of 65 juniors (16 years old and less) and 38 girls and adults over this age. The average daily attendance during the year was 91. Curriculum The principle of teaching trainees, especially the junior group, the fundamentals of reading, writing and numbers, has been continued and developed by the Supervisor in charge, Mrs. Early. This practice has attracted the attention of several teaching bodies who have consequently sent their students to the Training Centre for instruction in teaching methods for the mentally subnormal, viz:- National Association for Mental Several foreign visitors. Health Students taking teacher training courses. Six weeks' full-time placement for training in respect of two students. Chiswick Polytechnic: 16 students taking teacher training courses. Senior girls from Park Modern Secondary School, Dane Secondary School, Ilford, and Fairlop Secondary Modern School. During this year, 8 of the adult girls took the first part of the Red Cross Examination in First Aid - all were successful (the examiner was a member of the Red Cross). Also 7 of the juniors were awarded certificates for 15 yards free style swimming. Industrial Work The adult girls are given light industrial work for regular periods each day. This included the assembly of pot scourers and the assembly of certain record player parts. We are grateful to the firms concerned for providing this work. As a result of these contracts, approximately £400 was earned, and distributed to the girls concerned. Social Activities In order to encourage the trainees to take part in and enjoy the innumerable activities that are available, the following social visits were made:- The B.B.C. "Joe Loss Lunch Time Music" Programme (older girls) St. George's Hospital, Hornchurch (older girls - Red Cross group) Bertram Mills' Circus (older girls) Pantomime - Robin Hood (juniors) Transport Museum, London (Junior Class II) Film - "Mary Poppins" (juniors and adult girls) P.D.S.A. Hospital (Junior Class III) Barking Red Cross Society (adult girls) Canterbury Cathedral and Heme Bay (adult girls) Annual outing, Chalkwell (juniors) 59 Visitors Parents of the trainees, members of the public and other interested persons are given every opportunity to see for themselves the work that takes place in the Centre. This includes:- Mrs. Halsall, Ministry of Health Ilford Rotarians Romford Inner Wheel Manor Townswomen's Guild Parents are encouraged to see the school in progress, especially during the two Open Days held during the year, and one evening Parent/Teacher meeting. This also gives an opportunity to show the coloured film made at the school, and the handiwork made by the trainees. The Christmas parties are another occasion when parents and teachers can meet. Staffing, etc. During the year we lost one Assistant Supervisor, Miss Miller, but she was replaced by Mrs. McKenzie. Sufficient Coach Guides were engaged so that each of the four coaches has its own Coach Guide. INCIDENCE OF CONGENITAL ABNORMALITIES In order to obtain nationally some information on the incidence of congenital abnormalities, with effect from 1st January 1964 any congenital defect apparent in a child at birth is notified by the midwife in attendance to the Medical Officer of Health, who classifies the abnormality in accordance with a code based provisionally on the International Classification of Disease, and forwards the information to the Registrar General. Hospital and domiciliary midwives have co-operated well in this scheme and during 1965 the following defects were detected in 54 babies at birth:- Central Nervous System: Anencephalus 7 Hydrocephalus 5 Spina bifida 4 Other defects of spinal cord 1 Eye, ear: Defects of eye 1 Other defects of ear 1 Alimentary system: Cleft lip 6 Cleft palate 3 Tracheo-oesophageal fistula, oesophageal atresia stenosis 1 Other defects of alimentary system 1 Heart and great vessels: Other defects of heart and great vessels 1 Respiratory system: Other defects of respiratory system 1 60 Uro-genital system: Obstructive defects of urinary tract (hydronephrosis, hydro-ureter) 1 Other defects of kidney and ureter 1 Hypospadias, epispadias 2 Limbs: Defects of upper limb 1 Defects of lower limb 1 Polydactyly 1 Syndactyly 1 Dislocation of hip 1 Talipes 15 Other skeletal nil Other systems: Vascular defects of skin, subcutaneous tissues, and mucous membranes (including lymphatic defects) 1 Other defects of skin (including ichthyosis congenita) 1 Other malformations: Mongolism 3 Other 1 61 DENTAL SERVICES SCHOOL DENTAL SERVICE The school dental service in Barking was able during 1965 to provide full dental treatment to any school child receiving education under the local authority. The aim of the service has been not only to treat but also to try and make more children more dentally conscious. The staffing position was fairly good, the eleven surgeries in the borough were staffed by three full-time dental officers and six part-time officers employed on a sessional basis, also in March and September of the year we employed two full-time dental auxiliaries. The clinic in Becontree Avenue was re-opened in May 1965. CONSERVATIVE TREATMENT The saving of teeth has always been the aim of the School Dental Service; now with more staff it has been possible to enlarge the scope of conservative treatment. More teeth are being saved today than ever before. The most marked improvement in dental health has been in the young school child 5 to 9 years of age. Treatment was comprehensive with a large amount of advanced conservation by crowns and inlays and the ratio of teeth filled to teeth extracted was good. DENTAL HEALTH EDUCATION The appointment of the two Dental Auxiliaries has helped in the year 1965 to bring the Cinderella of our dental services into the limelight. Dental health talks have been given to 4,169 children in the schools, and chairside instruction is given to every patient including demonstration with models. A dental health exhibition was arranged at the local town show and if the disappearance of dental health education literature was anything to go by it was an enormous success. MATERNITY AND CHILD WELFARE Dental treatment was available during 1965 at all clinics in the London Borough of Barking for any expectant or nursing mother and for children under five years of age. (1) The number of expectant and nursing mothers examined during the year was 112 and the number who commenced treatment was 81. (2) The number of children aged under 5 examined during the year was 362 and the number who commenced treatment was 243. GENERAL ANAESTHETICS These have been administered by borough medical officers. It is important in my opinion that the same anaesthetist and dental surgeon should work together as far as possible. This results in easier sessions and, more important, adds to the safety of the patient. In an emergency, each member - and this includes the nurse - should know his or her duties and these can only be fully co-ordinated after working together for some time. During the year, 1,179 general anaesthetics were administered in the borough. 62 EQUIPMENT High speed aerotors for cavity preparation are being used in six of our surgeries (dental auxiliaries do not use this equipment), and they are an essential item of surgery equipment. Dental radiographic facilities were available in five surgeries. GENERAL COMMENTS The need to get many more of the under-five children to receive regular dental care must be one of our main aims in the future. It is by teaching dental health from a very early age that the importance of good teeth and oral hygiene may be realised; also a lot must be done to attract many more expectant and nursing mothers to our dental clinics. Fluoridation of water supplies appears to be the next major step to be taken in the field of preventive dentistry. I hope it will not be too many years before this is possible. DENTAL SERVICE STATISTICS Sessions(½ days) worked 1. Sessions devoted to inspection 63 2. Sessions devoted to dental health education 89 3. Sessions devoted to treatment 3,293 4. Sessions devoted to mothers and young children 234 Total 3,679 School Dental Inspection 5. Number of pupils inspected at school 5,084 Number of pupils inspected at clinic 3,781 Number of pupils found to require treatment 5,713 Number of pupils offered treatment 5,438 Treatment 6. Number of pupils actually treated 4,960 7. Number of attendances made 13,978 8. Number of fillings in permanent teeth 7,200 9. Number of fillings in deciduous teeth 4,420 10. Permanent teeth extracted 666 11. Deciduous teeth extracted 2,514 12. General anaesthetics given1,179 13. Number of pupils x-rayed 210 14. Number of pupils supplied with dentures 11 Orthodontics 15. New cases commenced 78 16. Cases remaining from previous year 58 17. Cases completed 27 18. Cases discontinued 46 19. Number of appliances fitted 75 20. Pupils referred to hospital consultant 5 63 MOTHER AND CHILD WELFARE DENTAL TREATMENT Expectant and Nursing Mothers Children under 5 years Numbers of Cases 1. Number of persons examined 112 362 2. Number of persons treated 81 243 Treatment Provided 3. Scalings and gum treatment 23 2 4. Fillings 105 345 5. Silver nitrate treatment 1 114 6. Crowns and inlays 1 - 7. Extractions 52 129 8. General anaesthetics 6 129 9. Dentures provide 24 - 10. Radiographs 6 2 64 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRICT (a) Nature and number of visits:- Rent Act 162 Housing and Public Health Acts:- Dwelling houses 6,585 Other premises 1,510 Overcrowding and housing applications 398 Improvement grants 419 Multiple occupation 97 Bakehouses 96 Milkshops and dairies 147 Foodshops, stalls and itinerant vendors 2,667 Cafes and canteens 638 School kitchens and feeding centres 259 Infectious disease enquiries 3,007 Foster mothers' premises 19 Number of complaints investigated 2,168 Noise nuisance 162 Clean Air Act:- Survey 3,152 Other inspections 4,768 Factories 687 Offices, Shops and Railway Premises Act 1,942 Rag Flock and Other Filling Materials Act 16 Tents, vans and sheds 160 Pet Shops 46 Hairdressers 74 Ice cream premises and vehicles 337 Houses disinfested 15 Rodent control 2,088 Other visits 2,271 (b) Notices served:- Complied with:- Statutory 125 169 Informal 1,355 1,015 WATER The water supply continues to be satisfactory both in quality and quantity. During the year, ten chemical and ten bacteriological samples were taken from the Company's mains in the borough; all were satisfactory. The water does not have any plumbo-solvent properties and no action was called for in respect of any form of contamination. There is now a piped supply inside all houses. During the year the following mains were laid:- 65 Length of Mains Yards Diameter 172 12" 324 6" 1,059 4" 78 3" 533 supplies were afforded to houses (331 to Dagenham and 202 to Barking). The General Manager and Chief Engineer of the South Essex Waterworks Company has furnished the following report:- "Bacteriological and chemical examinations are made of the raw river water, of the water in its various stages of treatment and of the water going into supply and of both raw and chlorinated water from the Company's wells. Analyses are also made of samples obtained from consumers' taps in the various parts of the Company's district and all proved to be satisfactory. Over 7.867 chemical, bacteriological and biological examinations have been made during the year. In addition samples were examined for radioactivity. All water going into supply was wholesome." SEWERAGE AND SEWAGE DISPOSAL The Borough Engineer and Surveyor has supplied the following information:- (a) Sewerage The separate drainage systems of the borough are functioning reasonably well although the capacity of each at times of peak flow is somewhat inadequate. Further works of culverting the Wantz Stream through built-up areas will commence in the near future. Proposals by the Council's Consulting Engineers for improvements to the Foul Trunk Sewerage System are anticipated to commence during the current year. (b) Sewage Disposal The Council's Riverside Sewage Works continues to operate under considerable pressure due to the high overload with which it is expected to deal, and the final effluent is often far from satisfactory. The first contracts for the works extensions are considerably well advanced and it is hoped to commission the first part of the main pumping station within the next few months. 66 PUBLIC SWIMMING BATHS There are three open air and three indoor swimming pools in the borough. The water from the swimming baths is taken from the mains of the South Essex Waterworks Company. During the year, regular samples of the water have been taken and submitted for bacteriological and chemical examination with satisfactory results. An open-air Purley Pool at one of the schools has continued to give satisfactory service. HOUSING Slum Clearance The clearance and redevelopment of the Gascoigne Area continues. A Public Inquiry relating to 99 properties was held on 16th November 1965. The Compulsory Purchase Order was confirmed by the Minister. Orders relating to 19 houses were represented to the Council, who declared the properties unfit for human habitation. Rent Act. 1957 14 applications were received from tenants during the year. In no case did the Council refuse to issue a Certificate of Disrepair. Undertakings to do the work were given by the landlords in respect of eight properties. Six Certificates of Disrepair were issued and three cancelled on the completion of the repairs. As in past years, advice was given to tenants and they were able to obtain the necessary forms at the Civic Centre. Improvement and Conversion Grants In connection with the administration of the improvement grant provisions, I am pleased to say that during the year the close co-operation between other sections of the Council's staff and ourselves continued, and the whole scheme has gradually expanded, 11 discretionary grants and 33 standard grants being approved during the year. We have found that no amount of propaganda and advertising can compare with actually seeing a completed scheme in operation. I still have grave doubts of the wisdom of improvement areas as set out in the Housing Act, 1964, and in an endeavour to achieve the desired results - the improving within the improvement grant provisions of tenanted houses without the disadvantages (which will not be apparent for five years) - postal surveys are carried out in suitable areas, and the subsequent response and co-operation from owners and tenants have been most encouraging. As far as I know, we are the only authority who have carried out such surveys. The biggest problems are to get builders to carry out this type of work, and to persuade tenants to pay the increased rent, which is roughly £1 a week extra for a back addition bathroom or 10/- a week where a bedroom is converted. Two types of grant are available; the "discretionary" grant for the more extensive forms of improvement or conversion, and the "standard" grant where little or no structural alterations are necessary. Applicants are always encouraged to make preliminary enquiries before any expense is incurred. Every effort is made to deal with the application as speedily as possible. During the 67 year many enquiries were received; in some cases the improvements desired were not eligible for grant. Houses in Multiple Occupation This problem, while fortunately not as large as some authorities have to contend with, is nevertheless always with us and requires constant vigilance if it is to be kept under control. 97 visits were paid during the year. There are no common lodging houses in the borough. Tents, Vans and Sheds Although there are only a few remaining vacant sites in the borough for gypsies to pull their vans on to, during the year 160 visits have been paid to the sites, these being mainly unfenced sites of former buildings. LAUNDRY SERVICE FOR THE INCONTINENT AGED This service operates twice weekly, and helps meet a need in many homes. The staff's helpful and co-operative attitude in discharging what is sometimes not.a pleasant duty has done much to ensure the satisfactory running of the service. An average of 51 cases use the service at any one time. ATMOSPHERIC POLLUTION The general improvement in this field continues, with the Council playing no small part in their action of continuing to declare Smoke Control Areas. The present position is as follows:- Dagenham Order No. No. of Houses Date of Operation 1 1,000 (Marks Gate) 1st September, 1959 2 3,722 (L.C.C. Estate) 1st November, 1961 3 3,230 (" ") 1st November, 1962 4 4,562 (" ") 1st November, 1963 5 1,542 (Chadwell Heath) 1st August, 1964 6 3,046 (L.C.C. Estate) 1st November, 1964 7 2,690 (" ") 1st November, 1965 Barking 1 4,558 (1,756 L.C.C.) 1st January, 1962 2 1,864 (L.C.C. Estate) 1st November, 1962 3 2,365 1st November, 1962 4 1,728 (L.C.C. Estate) 1st November, 1963 5 2,949 (Private) 1st November, 1963 6 1,421 (L.C.C. Estate) 1st November, 1964 7 1,569 1st November, 1964 8 2,446 1st November, 1964 9 589 1st July, 1966 10 1,337 (L.C.C. Estate) 1st July, 1966 11 1,976 1st November, 1966 68 This means that 42,594 houses out of a total of 55,013 houses in the borough are now within smoke control areas. Industry has also played its part in this general improvement. The Council take part in the National Survey on Air Pollution. We now have eight units operating in various parts of the borough. These record the smoke and sulphur dioxide pollution present in the air. With the continued diminution of smoke emission from chimneys, the emphasis regarding atmospheric pollution may soon be switched to motor vehicle exhausts. NOISE ABATEMENT ACT, 1960 This is fast becoming a problem to the department. Whilst noise can be measured, it cannot be directly related to nuisance; so much hinges on personal reaction to each individual noise. A number of complaints were received during the year, and 162 visits were paid, sometimes during the night, in an endeavour to assess the problem and if possible achieve improvement. Complaints have been received from tenants residing above two launderettes which are open to the public day and night. Investigations have been carried out late at night, and the tenants have cause for complaint. Every effort is being made to minimise the noise, and alterations are being made by the owners of the premises to endeavour to improve conditions. RAG FLOCK AND OTHER FILLING MATERIALS ACT. 1951 One premises which has been registered under Section 2 of the Act continues to operate. Samples are regularly taken at the factories in the borough where filling materials are manufactured. Twelve informal samples were taken from premises during the year, all of which were satisfactory. The details are as follows Material Number of Samples Submitted for Analysis Rag Flock 1 Cotton Felt 5 Coir Fibre 1 Kapok 1 Sisal 3 Layered Flock 1 PET ANIMALS ACT. 1951 14 licences to keep pet shops were issued during the year. The amount of livestock generally kept is quite small. No serious breach of the conditions occurred during the year. 69 PREVENTION OF DAMAGE BY PESTS ACT. 1949 The service under this Act continued, rats and mice being destroyed by the two Rodent Operatives acting under the direction of the Public Health Inspectors, While householders receive a free service, a charge is still made to occupiers of business premises. RIDING ESTABLISHMENTS ACT. 1939 The two riding schools in the borough operate under the supervision of the Corporation of London, who act under delegated powers. Both schools are satisfactorily conducted, and the animals are well cared for. DISEASES OF ANIMALS ACT. 1950 I was very glad when the Council decided to delegate the administration of this Act to the Corporation of the City of London. I consider that one authority should have been responsible for this work throughout Greater London. I appreciate that the "animal" population is not high, but if an outbreak should occur, several authorities would automatically be involved. Happily, the year passed without incident, and it has been a pleasure to deal with the Corporation of London officials. FACTORIES ACT. 1961 Inspections Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical 53 67 2 - Factories with mechanical 450 620 53 - Other premises under the Act (including works of building and engineering construction but not including outworkers' 23 119 3 - Total 526 806 58 - 70 Defects Found Number of defects Number of Prosecutions Instituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness 10 10 - - - Overcrowding - - - - - Unreasonable temperature 2 2 - - - Inadequate ventilation 2 1 - 1 - Ineffective drainage of floors 5 5 - - - Sanitary conveniences: Insufficient 14 14 - 1 - Unsuitable or defective 112 105 2 1 - Not separate for sexes - - - - - Other offences 8 3 5 - - Total 153 140 7 3 - Outwork Number of outworkers in August list - 229 Nature of work - Making, etc., wearing apparel. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 This Act continued to occupy a lot of the Inspectors' time, and our normal duties under this Act were delayed by the necessity to inspect and advise on all the Council's premises. The following statistics indicate the work done by the Public Health Inspectors during the year:- No. of Premises Registered during the year Total No. of Registered Premises at end of year No. of registered premises receiving a general inspection during the year Offices - 180 51 Retail shops 24 892 329 Wholesale shops, warehouses - 28 14 Catering establishments open to the public, 5 87 27 Fuel storage depots - 3 - 71 72 Class of workplace Number of persons employed Offices 2,335 Retail shops 4,478 Wholesale departments, warehouses 297 Catering establishments open to the public, canteens 846 Fuel storage depots 10 Total 7,966 Total Males 3,713 Total Females 4,253 During the period 13 notifications of minor accidents were received in respect of employees. INSPECTION AND SUPERVISION OF POOD The numbers and types of food premises in the borough are as follows 7 Bakehouses 49 Bakers and Confectioners 87 Butchers 227 Cafes and Canteens 44 Fishmongers 84 Fruiterers and Greengrocers 152 Grocers 62 Licensed and off-licensed premises 18 Public Houses with Restaurants 141 Sweets, etc. All food premises are regularly inspected and during the year 3,450 visits were paid. In addition to numerous verbal warnings and suggestions to management and staff during these routine visits, 216 informal notices were served upon owners or occupiers. 238 inspections were carried out in connection with itinerant vendors and stalls, and 25 informal notices were served. The position under the Food and Drugs Act, apart from registrations in respect of ice cream, is as follows:- 73 butchers' premises and 11 other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 634 visits were paid. 37 fish shops are registered for frying. To these 254 visits were paid. Milk All milk distributed in this area is produced and bottled outside the borough. The number of registered distributors is 71 operating from 100 premises. 147 visits were paid to dairies and distributors' premises. The following samples were submitted for bacteriological examination during the year:- Designation of Milk Total Samples Submitted Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 74 72 2*- void 74 - - - Sterilised 17 - - - - 17 - Channel Island Pasteurised 21 20 * 1 - void 21 - - - •These three samples were rendered 'void' because the shade temperature at the time exceeded the permissible maximum of 65°F. Four samples of pasteurised milk included above were taken from milk vending machines. Ice Cream The total number of registered premises selling ice cream is 222. Of this number, two are registered for the manufacture of ice cream. 274 visits were paid to these premises. During the year, four applications for the storage and sale of ice cream were granted. 39 inspections in connection with itinerant vendors were carried out. During the year, 122 samples of ice cream were submitted for bacteriological examination; they were graded as follows:- Grade I Grade II Grade III Grade IV Total Wrapped Ice Cream 38 12 2 4 56 Loose Ice Cream 26 5 4 4 39 Soft Ice Cream 13 6 4 27 In addition to ice cream, 37 lollies were submitted for examination. All were satisfactory. When Grade IV samples appear, this does not necessarily mean a "dirty" product. Some harmless but heat resistant bacteria are not destroyed by pasteurisation but have an adverse effect on the methylene blue test which is the test used to grade ice cream - a test which is admitted to have shortcomings. Unsound Food The general increase in mechanisation of the preparation, packaging and distribution of food brings in its trail its own problems. Years ago the shopkeeper and customer actually saw what was being sold. Now, very properly in the interests of hygiene and convenience, many commodities are rarely, if ever, touched by hand, and one is faced with an entirely different set of problems; e.g. mould in wrapped products and oil contamination from machinery, while foreign objects often only come to light when containers are opened, and identical "deliveries" make stock rotation a must. 73 During the year the Committee considered 25 complaints concerning food. Sixteen were sent warning letters, and three were prosecuted. In one case it was agreed that legal proceedings should be taken, but the main witness was unwilling to give evidence; consequently, a warning letter was sent to the manufacturers. Registration of Food Hawkers Under the provisions of the Essex County Council Act, 1952, Section 103, two persons were registered as food hawkers during the year. Food Poisoning The following is a copy of the annual return submitted to the Ministry of Health:- Incidents and Cases Causative Agent General Outbreaks Family Outbreaks Sporadic Cases No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained Notified or ascertained 1 2 3 4 5 S. typhimurium - 5 - - 2 Other Salmonellae - - - - - C1. welchii - - - - - Staph, aureus - - - - - Other causes - - - - - Cause unknown - - - - - Total - 5 - - 2 The five cases shown in column 2 were part of an apparent outbreak which took place at Oldchurch Hospital, Romford, whilst these people were receiving in-patient treatment. Food and Drugs - Sampling Perhaps the most noticeable change recently is in the articles sampled - by their names alone I am often quite unable to even hazard a guess as to the contents. With holidays abroad and the influx of immigrants, I suppose these changes are inevitable. Article Number Examined Number Adulterated Formal Informal Formal Informal Almonds,Ground - 1 - - Beetroot - 1 - - Biscuits - 4 - - Black Pudding - 2 - - Brawn - 3 - - 74 Food and Drugs - Sampling (continued) Article Number Examined Number Adulterated Formal Informal Formal Informal Bread _ 5 - 4 Butter 5 2 - - Cakes - 7 - - Cereals 3 3 - - Cheese 1 1 - - Chicken - 4 - 2 Chips - 1 - 1 Cockles and Mussels - 2 - - Coffee 2 - - Colouring - 1 - - Condiments 5 if - - Confectionery 1 8 - - Cordials if 10 1 2 Cream - 2 - - Desiccated Coconut 2 1 - - Essences - 7 - - Fish - tinned - 5 * - Flour 2 1 - - Fruit-tinned - 4 - - Fruit - dried - 5 - - Gelatine - 1 - - Hamburger - 7 - - Ice Cream - 13 - - Ice Lolly - 2 - 1 jams 5 5 - 2 Jellies - 7 - - Lard 6 1 - - Margarine 5 3 - - Meat,minced 1 7 - - Meat, tinned - 5 - 2 Medical sample 2 8 2 1 Milk 8 7 - - Milk bottle - 1 - 1 Oil 5 2 - - Paste - 4 - - Peanuts, salted - 1 - - Pie Filling - 7 - 1 Peas - 2 - - Rice 1 3 - - Sauces - 3 - — Sausages 51 8 2 - Scotch Eggs - 1 - - Smoked Frogs Legs - 1 - - Spices - 4 - - Tea 9 2 - - Vegetables, dried 1 1 - - Wines and Spirits 10 3 - 1 75 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 5894 Orange Marmalade flavoured with Cointreau Liqueur Informal Poor in respect of its content of Cointreau only 0.33%. Importers warned. 1440A Milk Bottle Informal Contained foreign matter in the form of a film of dry milk containing iron oxide. Warning letter to distributor. 1442A Cherry Brandy Informal Proof spirit 40.0%. 2% less than stated amount. Referred to Importers. 1447A Bread Informal Showed presence of blackish streaks due to presence of minute fragments of burnt bread and traces of iron. Warning letter to manufacturers. 1455A Bread Informal Contained foreign matter in the form of charred dough containing traces of iron. Warning letter to manufacturers. 5964 Boned Chicken in Chicken Jelly Informal Proportion of chicken jelly excessive. Warning letter to Importers. 5985 Scotch Whisky Flavoured Marmalade Informal Contained no significant amount of Scotch Whisky Labelling amended. 5987 Boned Chicken in Chicken Jelly (two tins) Informal Proportion of chicken jelly in both cases excessive. Total meat content in one can was low, being 73%- Warning letter to Importers. 1468A Casserole Steak Informal Meat - 66%. Meat content low for an article described as "Casserole Steak". Warning letter to Importers. 1472A Cough Mixture Informal Glycerine - 0-54%. Contained approximately 11% of the stated amount of glycerine. Formal sample taken. No. 6028. 1481A Pieces of Steak and Kidney Pie Informal Contained part of a cigarette filter tip. Warning letter to manufacturers. 76 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 1486A Calcium Drink Informal Sodium cyclamate - 0.72%. Sodium cyclamate not allowed by Artificial Sweetener in Food Order 1953. Later approved by Additive Committee of the Ministry. 1488A Cereal Informal Infested with spider beetles and larvae. Legal action. Fined £10 and 5 gns. costs. 1507 A Slices of Bread Informal Contained insect webbing and insect fragments mixed with dough. Warning letter to manufacturers. 1508A Belgium Bun Informal Had nine rodent pellets adhering to bun. Warning letter to manufacturers. 1531A Dry Ginger Ale Informal Benzoic acid - 200 parts per million. Exceeded permitted maximum by 40 parts per million. Formal sample taken - No. 6054. 1546A Luncheon Meat Informal Greyish discoloration patches on meat due to presence of iron. Warning letter to distributor. 3587 Chips Informal Contained a cigarette filter tip. Warning letter to retailer. 2760 Pork Sausages Formal No declaration of preservatives. Verbal warning to retailer. 6028 Cough Mixture Formal Contained only approximately 10% of stated amount of glycerine. Further sample taken - No. 6053. 2767 Pork Sausages Formal Meat - 58%. 10% deficient in respect of meat content. Further sample to be taken. 6053 Cough Mixture Formal Glycerine - 0'43%. Tinct. Ipecac - Nil. 91% deficient in glycerine and completely deficient in respect of Tinct. Ipecac. Warning letter to distributor. 6054 Dry Ginger Ale Formal Benzoic Acid - 200 parts per million. Exceeded permitted maximum by 40 parts per million. Warning letter to manufacturers. 77 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES Notifiable Diseases (other than Tuberculosis) Under 1 yr. 1 - 2 - 3 - 4- 5 - 10 - 15 - Over 25 yrs Total Scarlet Fever - 4 9 14 5 82 11 2 - 127 Whooping Cough 4 7 2 9 6 16 2 - 1 47 Measles 91 267 283 301 289 895 25 6 1 2158 Diphtheria - - - - - - - - - Dysentery - - 1 1 1 6 1 - 4 14 Acute Poliomyelitis: Paralytic - - - - - - - - - - Non-paralytic - - - - - - - - - - Meningococcal infection - - - - - - - - - -  Under 5 yrs 5-14 15 - kk 45-64 65 and over Total Pneumonia: Acute Primary 1 - 2 6 - 9 Acute Influenzal 1 1 - 2 1 5 Encephalitis, Acute: Infective - - - - - - Post Infectious - - - - - - Erysipelas - - 4 1 - 5 Food Poisoning 5 1 2 - - 8 Puerperal Pyrexia - - - - - - Ophthalmia Neonatorum 3 - - - - 3 Paratyphoid B - - - - - - Typhoid - - - - - - Smallpox - - - - - -  Notified Admitted to Rush Green Hospital Admitted to other Isolation Hospitals Admitted to other Hospitals Dysentery 14 - - - Encephalitis, Acute: Infective - - - - Post Infectious - - - - Erysipelas 5 2 - 1 Food Poisoning 8 - 1 5 Measles 2158 2 - Meningococcal Infection - - - - Paratyphoid Fever - - - - Puerperal Pyrexia - - - - Pneumonia: Acute Primary 9 - - - Acute Influenzal 5 - - - Acute Poliomyelitis: Paralytic - - - - Non-paralytic - - - - Scarlet Fever 127 - - - Typhoid - - - - Whooping Cough 47 2 - - 78 1 * «c'-