I. BARK 60 THE HEALTH OF BARKING 1966 BARK 60 LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1966 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 41 Ante-natal Clinics 22 "At Risk" Register 31 Atmospheric Pollution 67 Bentry School 54 Care of Mothers and Young Children 22 Child Guidance 48 Children's Department 29 Chiropody 36 Civil Defence 41 Community Survey of Aged 33 Congenital Abnormalities, Incidence of 60 Convalescence 43 Council, Members of 3 Cytology Clinics 27 Day Nurseries 24 Deaths, Causes of 17 Dental Services 61 Diseases of Animals Act 1950 69 Domestic Help 42 Education Committee 4 Education (Special Services) Sub-Committee 5 Enuresis Clinic 49 Factories Act 1961 69 Faircross School 53 Food and Drugs, Sampling 73 Food Hawkers, Registration 73 Food, Inspection and Supervision 71 Food Poisoning 73 Food, Unsound 72 Geriatric Liaison 33 Handicapped Children 53 Health Committee 4 Health Education 19 Health Visiting 28 Home Nursing Service 32 Housing 66 Houses in Multiple Occupation 66 Hypothermia 33 Ice Cream 72 Immunisation 29 Improvement Grants 66 Infant Mortality 16 Infant Welfare Centres 23 Page Infectious Diseases 77 Junior Training Centre 57 Kingsley Hall Day Centre 27 Laundry Service 67 Maternity Services 22 Medical Examination of Staff 39 Mental Health 40 Midwifery Service (domiciliary) 23 Minor Ailments Clinics 44 Milk 72 National Assistance Act 1948 33 Noise Abatement Act 1960 68 Offices, Shops and Railway Premises Act 1963 70 Orthopaedic Clinic 48 Over Sixties Clinic, Oxlow Lane 32 Pet Animals Act 1951 68 Play Therapy 26 Prevention of Damage by Pests Act 1949 68 Public Swimming Baths 65 Rag Flock and Other Filling Materials Act 1951 68 Rehousing on Medical Grounds 40 Rent Act 1957 66 Riding Establishments Act 1939 69 Sanitary Inspection of District 64 School Health 44 School Meals Service Staff, Medical Invigilation of 44 Selective School Medical Examinations 45 Sewerage and Sewage Disposal 65 Sickroom Equipment 32 Slum Clearance 66 Smoke Control Areas 67 Speech Therapy 50 Staff 6 Tents, Vans and Sheds 67 Tuberculosis 34 Unmarried Mother, Care of 23 Vaccination 29 Vital Statistics 16 Water 64 2 MEMBERS OF THE COUNCIL (aa at 31st December, 1966) MAYOR Alderman A. E. BALL, J.P. DEPUTY MAYOR Alderman W. E. BELLAMY, J.P. ALDERMEN F. BROWN G. H. A. CROUCH Mrs. A. M. MARTIN B. E. ROYCRAFT, J.P., G.L.C. J. R. SWEETLAND Mrs. A. R. THOMAS COUNCILLORS C. H. AYRES C. E. AYRTON Mrs. M. BALL, O.B.E., G.L.C. G. J. G. BEANE, J.P. R. BLACKBURN, J.P. Mrs. M. BREDO J. A. BUTLER, J.P. Mrs. J. CALLAN H. J. CLEAVER S. G. COLE D. A. L. G. DODD, J.P. F. C. EDGECOMBE Mrs. C. S. M. GODFREY, J.P. R. H. F. GODFREY D. O. GRANDISON L. F. HENSTOCK, J.P. H. J. HOWIE C. W. JILLINGS Mrs. D. M. JONES F. C. JONES H. R. JONES J. L. JONES, J.P. H. P. LARKING J. H. LAWRENCE DANIEL LINEHAN DAVID LINEHAN E. R. McKEE W. MILNE J. P. MOORE R. W. MUGE W. G. NOYCE, J.P. D. O'DWYER H. A. POWELL C. PRENDERGAST, B.E.M., G.L.C. Mrs. M. S. PRESTON A. C. V. RUSHA L. SENIOR S. C. SIVELL, J.P. M. SPENCER F. C. SPRAGGINS J. S. THOMAS F. G. TIBBLE L. W. TODD J. B. WARD, J.P. S. J. WARR Mrs. M. A. WARREN D. W. WEBB E. J. WOODS Mrs. F. F. WOODS 3 HEALTH COMMITTEE (as at 31at December, 1966) CHAIRMAN Councillor Mrs. M. BALL VICE-CHAIRMAN Councillor Mrs. D. M. JONES MEMBERS His Worship the Mayor The Deputy Mayor Alderman J. R. SWEETLAND Alderman Mrs. A. R. THOMAS Councillor Mrs. C. S. M. GODFREY Councillor H. R. JONES Councillor J. H. LAWRENCE Councillor E. R. McKEE Councillor R. W. MUGE Councillor D. O'DWYER Councillor Mrs. M. PRESTON Councillor F. C. SPRAGGINS Councillor F. G. TIBBLE Councillor S. J. WARR Councillor Mrs. F. F. WOODS CO-OPTED MEMBERS Councillor Mrs. M. BREDO Dr. M. LEWIS Mrs. D. M. GLENNY EDUCATION COMMITTEE (as at 31st December, 1966) CHAIRMAN Councillor G. J. G. BEANE VICE-CHAIRMAN Councillor A. C. V. RUSHA REPRESENTATIVE MEMBERS His Worship the Mayor Alderman W. E. BELLAMY Alderman F. BROWN Alderman J. R. SWEETLAND Councillor Mrs. M. BALL Councillor R. BLACKBURN Councillor Mrs. M. BREDO Councillor J. A. BUTLER Councillor S. G. COLE Councillor D. A. L. G. DODD Councillor Mrs. C. S. M. GODFREY Councillor R. H. F. GODFREY Councillor D. O. GRANDISON Councillor L. F. HENSTOCK Councillor C. W. JILLINGS Councillor Mrs. D. M. JONES Councillor F. C. JONES Councillor Daniel LINEHAN Councillor David LINEHAN Councillor D. O'DWYER Councillor C. PRENDERGAST Councillor Mrs. M. S. PRESTON Councillor L. SENIOR Councillor S. C. SIVELL Councillor Mrs. M. A. WARREN Councillor D. W. WEBB Councillor E. J. WOODS Councillor Mrs. F. F. WOODS CO-OPTED AND NOMINATED MEMBERS Mrs. I. M. BROCKELBANK Mr. J. H. COCKS Mr. J. M. DAVIES Mr. P. GRIMES Miss M. C. GROBEL, M.A. Mr. E. E. HENNEM The Rev. Louis HESTON Mr. F. H. KING Mr. A. RICHARDS Mr. S. J. RUSSELL The Rev. J. W. ROXBURGH 4 EDUCATION SPECIAL SERVICES SUB-COMMITTEE (as at 31st December, 1966) (This Sub-Committee deals, inter alia, with the School Health Service) CHAIRMAN Councillor G. J. G. BEANE MEMBERS Alderman F. BROWN Councillor Mrs. M. BREDO Councillor Mrs. C. S. M. GODFREY Councillor D. O. GRANDISON Councillor Mrs. M. S. PRESTON Councillor A. C. V. RUSHA Councillor L. SENIOR Councillor Mrs. M. A. WARREN Mrs. I. M. BROCKELBANK Mrs. J. M. DAVIES Rev. Louis HESTON 5 OFFICERS OF THE HEALTH SERVICE (as at 31st December, 1966) 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 J. Slome, M.R.C.S., L.R.C.P., M.B., B.S., D.Obst. R.C.O.G., 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. Massey, 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. K. Fitzpatrick, M.B., Ch.B. S. N. Jazeel, M.B., B.S., D.C.H. E. Klein, M.D., L.R.C.P. & S. G. Michael, M.R.C.S., L.R.C.P., B.A. In addition 8 medical officers are employed on a sessional basis. PRINCIPAL DENTAL OFFICER J. K. Whitelaw, L.D.S., R.C.S. SINIOR DENTAL OFFICER P. K. Chaudhury, L.D.S., R.C.S. DENTAL OFFICERS V. H. Foy, L.D.S., R.C.S. N. J. Graham, L.D.S., R.C.S. C. Sumsawaste, L.D.S., R.C.S. In addition 4 dental officers are employed on a sessional basis. DENTAL SURGERY ASSISTANTS Mrs. M. Brideson Mrs. G. Lynch Mrs. K. E. McKenzie Mrs. I. A. Rourke Mrs. F. B. Sadler Miss M. Sealey Mrs. M. Strachan (9) Miss P. Strickland Miss D. R. Willing SENIOR DENTAL TECHNICIANS Mr. G. F. Dickerson Mr. S. F. Whelan CHIEF PUBLIC HEALTH INSPECTOR Mr. F. W. S. Fox (1), (2), (3), (4) DEPUTY CHIEF PUBLIC HEALTH INSPECTOR Mr. M. R. Williams (1), (2), (4) PUBLIC HEALTH INSPECTORS Mr. J. Allam (1), (2), (4) Mr. S. A. Lemmon (1), (2), (4) Mr. N. Burton (1), (2) Mr. J. Powell (1), (2), (4) Mr. J. Cook (1), (2), (3) Mr. B. Saunders (1), (2), (4) Mr. E. Day (1), (2), (4) Mr. F. Silverthorne (1), (2) Mr. T. W. Glew (1), (2) STUDENT PUBLIC HEALTH INSPECTORS Mr. K. Hunt Mr. B. Orme SUPERINTENDENT HEALTH VISITOR Mies B. Long (5), (6), (7), (22) DEPUTY SUPERINTENDENT HEALTH VISITOR Vacant 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. F. Bass (5), (6), (7) Miss S. M. Bergstrom (5), (6), (7) Miss A. E. Boorman (5), (6), (7) Miss M. T. Dowd (5), (6), (7), (12) Mrs. L. Dunbar (5), (6), (7) Miss R. Hutchinson (5), (6), (7), (21) Miss P. I. Jefford (5), (6), (7) Mrs. E. Lyon (5), (6), (7), (21) Mrs. J. O'Brien (5), (7) Miss O. Ologunro (5), (6), (7) Miss E. G. Parry (5), (6), (7) Mrs. H. V. Reeder (5), (7) Mrs. R. L. Robertson (5), (6), (7), (12) Miss D. B. Rudd (5), (6), (7) Miss M. F. Savage (5), (6), (7), (14) Mrs. F. M. Stuart (5), (6), (7) Miss M. D. Wint (5), (6), (7) HEALTH VISITOR (part-time) Mrs. M. Nelson (5), (6), (7) NON-MEDICAL SUPERVISOR OF MIDWIVES Miss M. Dobson (5), (6), (21) ASSISTANT NON-MEDICAL SUPERVISOR OF MIDWIVES Miss M. Teather (5), (6) 7 MIDWIVES Mrs. I. M. Bronnick (5), (6) Miss A. Cunningham (6) Miso £. Daheney (5), (6) Hiss S. W. Etherton (5), (6), (1*0 Miss L. M. Grant (6), (9) Mies M. Hall (5), (6) Mlsa 0. Hearsay (5), (6) Miss C. Rafferty (5), (6) Miss H. V. Rungay (5), (6) Miss P. R. Shackleton (5), (6), (9) Mrs. P. M. Shardlow (5), (6) Mrs. P. Vanbrook (5)« (6) Miss M. Walker (5), (6) SUPERINTENDENT OF NURSES' HOMES Miss M. Dobson (5), (6), (21) ASSISTANT SUPERINTENDENT OF NURSES' HOMES Miss E. S. Hart (5), (6), (7), (12), (21) DISTRICT NURSES Miss J. Carey (5), (21) Mrs. J. M. Cotterill (5) Mrs. I. A. Dignum (5), (21) Miss M. D. Ellis (5), (20), (21) Mrs. J. M. Findlay (5) Mrs. A. Hayden (5), (21) Mrs. Q. A. Headley (5), (8), (21) Miss J. R. Heath (5) Mr. R. D. Lintott (5), 06), (21) Miss P. Lowery (5) Miss D. Meek (5), (6), (21) Miss K. M. Mollerup-Peterson (5), (21) Miss N. Norris (5), (6), (21) Mrs. M. O'Riordan (5), (8), (21) Mrs. M. Pront (5) Miss N. Rebboah (5), (21) Miss R. Richards (5), (6), (21) Miss J. Smith (5), (6), (21) Mrs. J. Smith (5), (9), (21) Mr. R. J. Turpin (5), (21) Mrs. J. E. Walsh (5) Mrs. G. White (5), (6), (21) DISTRICT NURSES (part-time) Mrs. W. Bates (5) Mrs. N. Flynn (5), (8), (21) Mrs. E. Colgate (9) Mrs. J. E. Thomas (5) STUDENT DISTRICT NURSES Mrs. P. Clancy (5) Miss T. O'Kelly (5). (8) SCHOOL NURSES Mrs. J. I. Hogg (5) Mrs. P. A. Picken (5) Mrs. E. M. McCheyne (5) Mrs. M. C. Twomey (5) CLINIC NURSES Mrs. S. M. C. Barber (5) Mrs. A. Noden (5), (14) Mrs. E. G. Frisby (5) Mrs. E. M. Robinson (5) Mrs. M. Mudd (5) Mrs. M. Warner (20) CLINIC NURSES (part-time) Mrs. J. Jenzie (5), (8) Mrs. A. M. Marsh (5), (6) Mrs. R. K. D. Clark (5), (8) Mrs. M. McGee (5) Mrs. I. M. Collingvood (5) Mrs. M. E. Montgomery (5) Mrs. M. Halligan (5), (6), (12) Mrs. G. Pratt (5) Mrs. S. Henderson (5), (12) Mrs. A. Ward (5) Mrs. D. G. L. Jarris (5) SPEECH THERAPISTS Miss C. J. Delaforce (18) Miss E. N. Symes (18) ASSISTANT SPEECH THERAPIST Miss S. Marquand (18a) 8 PHYSIOTHERAPIST Mies A. Dotzler (30) PHYSIOTHERAPIST (part-time) Mrs. J. M. Warwick (29) 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 Hrs. E. V. Morgan (11) TRAINING CENTRES Castle School and Training Centre, ) Ripple Road, ) Dagenham, Essex. ) Gale Street Annexe ) Adult Training Centre, Osborne Square, Dagenham, Essex. Supervisors Mrs. R. Early (28) Manager: Mr. W. Matthews (28) 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 (1*0 Annie Prendergast Day Nursery, Matron: Mrs. P. A. Ardley (l*f) Ashton Gardens, Chadwell Heath, Deputy Mrs. G. M. Maddison (1*f, (17) Romford, Essex. Eastbury Day Nursery, Matron: Miss F. B. Nason (5), (6), Blake Avenue, (12), (19) Barking, Essex. Deputy: Mrs. B. A. Bell (5) Kingsley Hall Day Centre Sister-in-Charge: Mrs. K. I. Daly (5), (6), (20) for Handicapped Children, Hobart Road, Dagenham, Essex. PRINCIPAL MENTAL WELFARE OFFICER Mrs. J. W. W. Dixon (26) SENIOR MENTAL WELFARE OFFICERS Mr. L. H. Balls (26) Mr. D. G. Bishop (10) MENTAL WELFARE OFFICERS Miss H. M. Hiddleston (26) Miss E. J. Sleigh (27) Mr. S. Ruchpaul (5), (10) Mr. G. R. Welsh (10) HEALTH EDUCATION OFFICER Mr. G. S. Self (1), (2), CO ASSISTANT HEALTH EDUCATION OFFICER Miss D. Milbank (5),(6),(7), (20),(21),(25) PROJECTIONIST/TECHNICIAN Mr. A. Cross 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 Mr. B. S. Tyrrell SECTION HEADS Mrs. P. H. Floodgate Vaccination and Immunisation Miss G. K. Harris Environmental Mrs. H. Jackson Mental Health Mrs. M. C. Newman Care and After Care Mr. H. Pitt Staffing and Management Mrs. J. Smith Finance, Supplies, etc. Mr. A. G. Stevenson Maternal and Child Health MEDICAL OFFICER OF HEALTH'S SECRETARY Hiss E. S. Bell SECTION CLERICAL STAFF Vaccination and Immunisation Mrs. F. A. Cox Environmental Mrs. J. W. Morgan Miss N. M. Toms Mrs. J. Phillips Miss B. Wells 10 Care and After Care Miss J. E. Cooper Staffing and Management Miss M. Middleton Mrs. I. M. H. Dupree Mrs. P. McMillan Miss K. M. Read Miss J. A. Stroud Mrs. X. E. Smith Mr. D. E. Ward Finance. Supplies, etc. Mrs. G. Anger Mr. S. A. Hubert Miss V. E. Cheal Mrs. C. E. Smyth Maternal and Child Health Miss E. A. Adams Mrs. E. J. Neport Miss E. D. Brown Mrs. I. A. Page Miss N. E. Cloke Miss M. A. Rhodes Mrs. P. M. Collins Miss K. Richards Mrs. K. M. Conroy Miss G. K. Shannon Miss A. C. Davies Miss B. M. Slater Mrs. D. Ellis Mrs. J. Taylor Mrs. M. Ireson Miss M. A. Watts Miss P. Kimberley Mrs. D. Wilkins Mrs. Y. King Mrs. J. Wilson Miss C. A. Lincoln Miss S. B. Wise Part-time Mrs. K. Bird Mrs. E. Harsent Miss G. Cooper Mrs. M. Lodge Mrs. M. Edwards Mrs. E. Wilford ADMINISTRATIVE TRAINEE Mr. A. R. Moss DOMESTIC HELP SERVICE Senior Organiser: Mrs. L. Everitt Organisers: Miss J. M. Peraberton Mrs. E. Tidbury Assistant Organisers: Mrs. P. M. Archer Mrs. G. M. Sanger Clerical Assistants: Miss W. A. Shaw Miss J. F. Baxter 11 REGIONAL HOSPITAL BOARD OFFICERS ATTENDING PART-TIME 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. CONSULTANT PSYCHIATRIST R. Rodriguez-Arganaras, M.D., M.R.C.P., D.P.M. EAR, NOSE AND THROAT SURGEON Mies 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 Sanitary Institute. (2) Meat Inspector's Certificate. (3) Sanitary Science as applied to Building and Public Works Certificate. (4)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. (18a) Temporary 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) Diploma in Contents and Methods of Health Education. (26) Certificate in Social Work. (27) Member of Association of Occupational Therapists. (28) Diploma of National Association of Mental Health. (29) Member of Chartered Society of Physiotherapy. (30) Member Oslo Orthopaedic Institute of Physiotherapy. 13 Health Department, Civic Centre, Dagenham. To: THE MAYOR, ALDERMEN AND BURGESSES OF THE LONDON BOROUGH OF BARKING. The end of 1966 saw the end of the first full year of the new London Borough of Barking. It was a year of considerable progress in the settling in of staffs, the beginning of the emergence of a new pattern of borough services very different from the pre-amalgamation days. The building up of new relationships, both inside and outside the department, continued. The need for fostering these relationships between members of the staff of the department itself and with other departments began to make itself evident towards the end of 1966. This it was felt should be a major aim during 1967. At the end of 1965 the department was leading a hand-to-mouth existence, coping with day-to-day problems as they arose but with very little time for long-term planning. During 1966 plans were made and efforts continued to develop the mental health section of the department so as to lay down a satisfactory pattern for the future. Towards the end of the year, in spite of shortages of staff, improvements in the quality of service were beginning to be achieved. It gives me particular pleasure to be able to say that looking at the main body of the report one is struck by the developments in certain sections of the department in spite of their patchiness. Progress continued in health education on which so much of our primary preventive work for the future must depend. One special aspect of health education which occupied a considerable amount of the time of the health education staff was health education in schools. It became evident that much of the health education in schools would have to be carried out by teaching staff, and it is hoped to increase the in-service training for teaching staff started in 1966. In the general field of health education it is of vital importance that all members of the staff should play their part and not assume that the health education staff alone should carry out this task. In this connection, the next step in development in health education should be the beginnings of evaluating health education in the borough. The evaluation should be first enquiry as to the need for health education and for the particular aspects required within the borough, followed by an assessment of results to find out whether what has been attempted has, in fact, been achieved. This evaluation has been held up because of staff shortages. A reduction in ante-natal attendances continues, but this must not detract us from continuing to press forward with ante-natal preparation classes until every expectant mother - whether she has her confinement in hospital or at home - who resides in the borough has attended at least for her first pregnancy at a course of ante-natal preparation and that the expectant fathers too have been given an opportunity of attending with their wives. It is with particular pleasure that we have to announce that we were at long last able to open the Annie Prendergast Clinic and Day Nursery named after Mrs. Annie Prendergast. Mrs. Prendergast has done invaluable work over many years for the health of the people of Dagenham, and it is due to her foresight that the seeds of many of the progressive measures within the borough were sown. The borough owes her a debt which perhaps cannot ever be repaid, but it was I feel a particularly happy thought on the part of the present Chairman, Alderman Mrs. Ball, to suggest that the Annie Prendergast Clinic 6hould be named after her, and it gave many people a great dead of pleasure that this plan was carried through. 14 The year 1966 was, I feel, a year of progress, of sorting out priorities within priorities, and of looking ahead. This is not to say that practical progress has not been made, and indeed progress will be evident to anyone dipping into the main body of this report. I must thank all the staff, medical and lay, for their co-operation during the year, and the Health Committee with its Chairman and Members for the support they have given me during the year. J. ADRIAN GILLET Medical Offieer of Health 15 VITAL STATISTICS 1966 Registrar General's estimate of resident population, mid-year 1966 171,000 Live Births: Legitimate (1,194 male, 992 female) 2,186 Illegitimate ( 83 male, 79 female) 162 Total (1,277 male, 1,071 female) 2,348 Illegitimate live births per cent of total 6.89 Live birth rate per 1,000 population 13.73 Live birth rate adjusted by comparability factor of 1.04 14.29 Stillbirths: Legitimate ( 19 male, 13 female) 32 Illegitimate (- male, 2 female) 2 Total ( 19 male, 15 female) 3^ Stillbirth rate per 1,000 live and stillbirths 14.27 Total live and stillbirths 2,382 Deaths: Infant deaths (under 1 year) ( 23 male, 13 female) 36 Infant death rate per 1,000 live births 15.33 Legitimate infant death rate per 1,000 legitimate live births ( 22 male, 12 female) 15.55 Illegitimate infant death rate per 1,000 illegitimate live births ( 1 male, 1 female) 12.35 Neo-natal mortality rate (deaths under 4 weeks (26) per 1,000 live births) 11.07 Perinatal mortality rate (stillbirths (34) and deaths under one week (22) per 1,000 live and stillbirths) 23.51 Early neo-natal mortality rate (deaths under 1 week per 1,000 live births) 9.37 Maternal mortality (deaths from pregnancy, childbirth, abortion) 2 Maternal mortality rate per 1,000 total births 0.84 General mortality: Number of deaths ( 995 male, 706 female) 1,701 Death rate per 1,000 population-crude 9.95 Death rate adjusted by comparability factor of 1.33 13.23 The vital statistics for the borough remained substantially the same as in the previous year. The infant death rate was again well below the national average of 19*0 and the stillbirth rate showed a welcome fall from 18.74 in 1965 to 14.27 in 1966. I regret to report that two mothers died from causes associated with pregnancy and childbirth during the year. Everything was done to preserve life and subsequent investigations attributed both deaths to natural causes. 16 17 Causes of Death, 1966 Under 1 yr. 1 and under 5 yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 4-5 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and over Total M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory - - - - - - - - 2 - 4 - 1 - 3 1 10 1 2. Tuberculosis, other - - - - - - - 1 - - 1 - - - - - 1 1 3. Syphilitic disease - - - - - - - - - - 1 - 1 - - - 2 - 4. Diphtheria - - - - - - - - - - - - - - - - - - 5. Whooping cough - - - - - - - - - - - - - - - - - - 6. Meningococcal infections - - - 1 - - - - - - - - - - - - - 1 7. Acute poliomyelitis - - - - - - - - - - - - - - - - - - 8. Measles - - - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases - - - - - - - - - - 2 - - - - - 2 - 10. Malignant neoplasm, stomach - - - - - - - - - - 11 1C 11 7 4 5 26 22 11. Malignant neoplasm, lung, bronchus - - - - - - - - 3 - 54 9 42 8 15 5 114 22 12. Malignant neoplasm, breast - - - - - - - - - 4 - 12 1 9 - 5 1 30 13. Malignant neoplasm, uterus - - - - - - - - - - - 12 - 7 - 1 - 20 14. Other malignant and lymphatic neoplasms - - - - 1 1 - - 5 5 30 24 30 28 32 22 98 80 15. Leukaemia, aleukaemia - - - - - - 1 - 1 - 2 - 2 - 1 - 7 - 16. Diabetes - - - - - - - - - 1 2 - 1 8 - 3 3 12 17. Vascular lesions of nervous system - - - - - - - - 3 1 15 14 32 30 28 57 78 102 18. Coronary disease, angina - - - - - - 1 - 6 - 119 27 97 44 38 47 261 118 19. Hypertension with heart disease - - - - - - - - - - 9 2 2 4 - 8 11 14 20. Other heart disease - - - - - - - - 1 3 14 11 13 12 23 32 51 58 21. Other circulatory disease - - - - - - - - 2 1 7 5 7 7 6 15 22 28 22. Influenza - - - - - - - - - - 1 - - 1 1 - 2 1 23. Pneumonia 3 3 - - - - 1 - 1 2 4 6 16 11 23 31 48 53 24. Bronchitis 1 2 - - - - - - - 1 22 1 43 9 37 19 103 32 25. Other diseases of respiratory system - - - - - - - - 1 - 9 2 4 1 5 1 19 4 26. Ulcer of stomach and duodenum - - - - - - - - - 1 1 - 3 - 2 4 6 5 27. Gastritis, enteritis and diarrhoea - - - - - - - - - - 4 - - 1 1 1 5 2 28. Nephritis and nephrosis - - - - - - 1 - 3 - 2 1 1 2 1 2 8 5 29. Hyperplasia of prostate - - - - - - - - - - - - 2 - 3 - 5 - 30. Pregnancy, childbirth, abortion - - - - - - - - - 2 - - - - - - - 2 31. Congenital malformations 5 1 - 1 1 - - - - - - - - - - - 6 2 32. Other defined and ill-defined diseases 13 7 1 - - 1 - 1 5 2 16 14 10 15 15 27 60 67 33. Motor vehicle accidents - - - - - - 7 1 2 2 4 1 3 - 2 1 18 5 34. All other accidents 1 - - - 3 - 2 - 1 - 7 - 1 1 4 7 19 8 35. Suicide - - - - - - - - 1 2 3 6 4 1 - 1 8 10 36. Homicide and operations of war - - - - - - - 1 1 - - - - - - - 1 1 Total 23 13 1 2 5 2 13 4 38 27 157 327 206 244 295 995 706 CAUSES OF INFANT DEATHS Cause of Death Under 4 weeks 4 weeks to 1 year Total Pneumonia 2 4 6 Bronchitis - 3 3 Congenital malformations 6 - 6 Accidents - 1 1 Other causes (Prematurity etc.) 18 2 20 Totals 26 10 36 PRINCIPAL CAUSES OF DEATH (all ages) Diseases of heart and circulatory system 563 Cancer and other malignant diseases 420 Pneumonia, bronchitis and other respiratory diseases (excluding tuberculosis) 262 Diseases of the brain and nervous system 180 DEATHS FROM MALIGNANT DISEASES 1966 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 - - - - 3 - 54 9 42 8 15 5 114 22 Stomach - - - - - - 11 10 11 7 4 5 26 22 Breast - - - - - 4 - 12 1 9 - 5 1 30 Uterus - - - - - - - 12 - 7 - 1 - 20 Blood - - 1 - 1 - 2 - 2 - 1 - 7 - Other 1 1 - - 5 5 30 24 30 28 32 22 98 80 Totals 1 1 1 - 9 9 97 67 86 59 52 38 246 174 18 HEALTH EDUCATION The policy, initiated in 1965, of concentrating on courses and in-service training rather than on providing large numbers of sporadic talks was continued in 1966. Expansion of the service was not possible until the full establishment of staff was available in August, but by the end of the year under review considerable progress was being made, particularly with health education in schools and in-service training. It is obvious that the latter must become one of the principal duties of the section as it will never be possible for the health department in general to provide all the health teaching necessary for the borough. Advice, instruction, equipment, literature and information will be freely available if required, but a considerable amount of the actual teaching of the public will have to be carried out by teachers, health visitors, youth leaders and others in contact with them. Health Education in Schools Assistance was given to ten schools during the year, each programme being tailored to the individual requirements of the head teacher and staff. In some cases the assistance was limited to a few talks and a supply of visual aids and literature. In others, regular weekly lectures were given. Probably the most satisfying aspect of this work was the sense of complete integration of the health education programme into the general syllabus of many of the schools where health topics became part of the normal curriculum and undue emphasis on such controversial matters as sex education and the use and abuse of drugs was avoided. In one school a parent/teacher association meeting was addressed by a panel comprising some members of the teaching staff and representatives of the school health service and the health education section. In-Service Training A seminar on child development held in the Small Hall, Barking, was attended by about 80 representatives from the health and education departments of our own and adjoining boroughs. It proved very successful and may well set the pattern for future discussions on topics of mutual interest. Talks on health education and demonstrations of equipment were given to the staffs of three schools, and an exhibition was also provided at a course organised by the education department for young teachers. An excellent liaison exists between the staffs of the two departments, and as a result a series of weekly lectures in health education for Post-Graduate Certificate of Education students was run in the autumn term. Requests from teachers for a course on the use of visual aids were also received, and by the end of 1966 arrangements had been made for this to commence in the new year. So far as health department staff were concerned, in addition to the seminar, demonstrations of equipment for health visitors were arranged and five film shows provided. The latter enabled the medical, nursing and mental health staffs to see and discuss recently released films. The matron of a local hospital requested a series of talks on public health matters for her final year students, and these were provided. 19 Food Hygiene Education Following on the discussions with the Royal Institute of Public Health and Hygiene in 1965, a pilot course for the Diploma in General Food Hygiene was organised at the beginning of 1966. As the syllabus was purely experimental, many meetings were necessary both with the staff of the Institute and with the bakery staff of Rush Green College without whose willing co-operation it would have been impossible to run the course. A pass rate of 60% in the final examination was rather lower than we had hoped, but the fact that there were no precedents upon which to base the teaching was no doubt to some extent responsible. The Certificate Courses in Food Hygiene for the full-time bakery students, commenced in September 1965, were continued for the remainder of the academic year, and 100% passes were achieved in the examinations in July. At the request of the Principal the course was re-commenced in September for the new first-year students, and it is anticipated that a food hygiene course will in future be included in the syllabus for all full-time bakery students. Also, in September an evening Certificate Course was started with the intention of continuing to Diploma level in the spring and summer terms. The possibility that food hygiene courses may qualify for grant under the Industrial Training Act was discussed with the College and Institute, and if this does occur, the number of students may increase rapidly. A number of meetings with the staff of one of the bakeries where a separate food hygiene certificate course used to be run led to the firm agreeing to organise its own preliminary training for the majority of the staff and to send those who wished to take the examination to Rush Green College for tuition. Home Safety With the co-operation of the local press a quarterly home safety bulletin was commenced. In addition to those printed in the newspapers, 19,000 copies of each issue were distributed throughout the borough to schools, libraries and interested organisations. Support was also given to the No. 10 Area RoSPA Home Safety Committee and to the RoSPA National Conference. Seven talks were given to students at the Technical College, women's and old people's organisations, and in addition home safety teaching is included in every school health education programme. Training of Students In March, one South African and one Chinese student were attached to the department by the London University Institute of Education for practical health education training. In December, two others both from Nigeria spent one week doing practical work. Four overseas students from the environmental hygiene course of the Royal Institute of Public Health and Hygiene were with us for two weeks. Occasional visitors included two social workers from Finland, one from Hong Kong, four from the Barking Regional College Social Studies Course, three student health visitors and four student nurses. Youth Under the auspices of the Youth Officer in the Education Department, two meetings of youth leaders were attended and a demonstration of health education films was given to others on a third occasion. Visual aids were supplied to one youth club to assist the warden in his teaching and a talk was given by the health education officer to another at the request of the organiser. 20 Certain organisations for young people take part in the Duke of Edinburgh Award Scheme and the health education section undertook examinations in the home safety aspects of this scheme. The Adolescent Clinic at Becontree Avenue continued during the early part of the year, but it was not found possible to re-commence it after the summer holidays. The staff of Porters Avenue Clinic decided to inaugurate a clinic for adolescents on a Thursday evening, and this began in the late autumn. In both cases visual aids and general assistance were provided by the health education section. Old People's Clubs The short courses on diet and exercises for the over sixties which had proved so popular in 1965 were continued in four old people's clubs in 1966. The colour film "Exercises for the Over Sixties" which had been made locally was widely used and proved of great interest. Discussions were held on the possibility of organising a course for voluntary workers with old people, but it was not found practicable to complete the arrangements in 1966. Displays and Exhibitions An exhibition for Mental Health Week was held in the Small Hall, Barking, in June, 1966. A great deal of work was put in by the staffs of the mental health section, the adult and junior training centres and the Goodmayes Hospital, and it is unfortunate that more members of the public did not attend. For the first time at the Dagenham Town Show a municipal tent was provided to display some of the services provided by the local authority. The health department stand depicted the work of the domestic help service, the school health service and the public health inspectors. A large crowd attended the Show which was well worth-while. Just before Christmas the film "Batman" was shown at the local cinema, whose owners kindly agreed to allow us to place a suitable home safety display in the foyer. Other Activities Seven talks were given to various groups on subjects ranging from Weil's disease to oral contraception. Owing to pressure of other duties, it was not possible to do much in the way of film making apart from the production of an 8 mm loop film on the activities of the Westfield Club for the Mentally Handicapped, and the completion of the colour film on the work of the Kingsley Hall Assessment Centre. In all, 86 film shows on various topics were arranged during the year. 21 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, 449 mothers attended for ante-natal examination and 60 for postnatal care, compared with 1,239 and 321 respectively during the previous year. In addition, 2,057 attendances were made at mothercraft and relaxation classes compared with 2,748 in 1965. The fall in attendances at these clinics reflects the tendency for ante-natal care to be centred on the hospital and general practitioner services, and a review of the need for some ante-natal sessions is being undertaken. Ante-natal and Post-natal Clinics Centre Frequency of Sessions When Held Annie Prendergast Clinic, Ashton Gardens, Chadwell Heath. 1st and 3rd in month. Wednesday a.m The Clinic, Becontree Avenue, Dagenham. Weekly. Tuesday and Wednesday p.m. Central Clinic, Vicarage Drive, Barking. Weekly. Tuesday a.m. The Clinic, Ford Road, Dagenham. Weekly. Wednesday p.m. Greatfields Clinic, Movers Lane, Barking. Weekly. Monday a.m. Leys Clinic, Ballards Road, Dagenham. Weekly. Wednesday p.m. Marks Gate Clinic, Lawn Farm Grove, Marks Gate. 2nd and 4th in month. Wednesday a.m. The Clinic, Oxlow Lane, Dagenham. Weekly. Tuesday and Thursday a.m. The Clinic, Porters Avenue, Dagenham. Weekly. Wednesday a.m. Julia Engwell Clinic, Woodward Road, Dagenham. Weekly. Wednesday a.m. Rush Green Clinic, 179 Dagenham Road, Dagenham. 1st and 3rd in month. Friday a.m. Thames View Clinic, Bastable Avenue, Barking. Weekly. Monday a.m. Upney Clinic, Upney Lane, Barking. Weekly. Thursday a.m. 22 Midwifery Service There were no notable changes in the midwifery service in 1966, and the service continued to settle down after the upheaval of the year previously. It was very pleasing to note that during the year all our pupil midwives were successful in their examinations, which speaks well of the training they receive. In 1966 the trend for responsibility for patients' ante-natal care to be centred on the general practitioner/domiciliary midwife team in home confinement cases continued, and midwives increasingly held their own ante-natal sessions thus relieving hard-pressed medical officers. During the year, midwives attended 644 domiciliary confinements of which 581 had also booked their family doctor or G.P. obstetrician. In addition, 1,220 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 36 cases. Infant Welfare Centres During the year, 7,088 children attended the following centres:- Centre Frequency of Sessions When Held Annie Prendergast Clinic, Ashton Gardens, Chadwell Heath. Weekly. Wednesday and Thursday p.m. The Clinic, Becontree Avenue, Dagenham. Weekly. Monday p.m. Wednesday a.m. Central Clinic, Vicarage Drive, Barking. Weekly. Tuesday and Thursday p.m. The Clinic, Ford Road, Dagenham. Weekly. Tuesday a.m. Thursday p.m. Greatfields Clinic, Movers Lane, Barking. Weekly. Tuesday p.m. Julia Engwell Clinic, Woodward Road, Dagenham. Weekly. Tuesday and Friday p.m. Leys Clinic, Ballards Road, Dagenham. Weekly. Tuesday p.m. Thursday a.m. Marks Gate Clinic, Lawn Farm Grove, Marks Gate. Weekly. Monday p.m. The Clinic, Oxlow Lane, Dagenham. Weekly. Wednesday and Friday p.m. The Clinic, Porters Avenue, Dagenham. Weekly. Monday and Friday p.m. 23 Infant Welfare Centres (continued) Centre Frequency of Sessions When Held Rush Green Clinic, 179 Dagenham Road, Dagenham. 2nd, 4th and 5th in month. Weekly Friday a.m. Friday p.m. Thames View Clinic, Bastable Avenue, Barking. Weekly. Wednesday and Friday p.m. The Clinic, Thompson Road, Dagenham. Weekly. Tuesday p.m. Friday a.m. Upney Clinic, Upney Lane, Barking. Weekly. Wednesday and Friday p.m. Welfare foods and nutrients are sold at these centres during infant welfare sessions and also at Central Clinic, Barking, on Wednesday afternoons and Thursday mornings, and at the Thompson Road Clinic on Monday mornings and Thursday afternoons. During the year, the following amounts of welfare foods were issued:- National Dried Milk 36,876 tins Cod Liver Oil 3246 bottles Vitamin A and D Tablets 2894 packets of 20 Orange Juice 40,961 bottles DAY NURSERY SERVICE The average daily attendances and numbers on registers are shown below for each month of 1966:- Month Goresbrook Fanshawe/ Ashton Gardens Eastbury Average Daily Attendance No. on Register Average Daily Attendance No. on Register Average Daily Attendance No. on Register January 29.7 38 24.5 42 39.2 50 February 29.9 38 30.5 40 36.0 49 March 31.9 41 37.9 41 36.6 48 April 29.1 38 26.4 41 38.5 48 May 30.7 41 33.9 39 42.6 50 June 33.5 46 28.2 33 38.2 49 July 32.6 41 25.3 33 36.7 50 August 22.1 39 21.7 35 29.9 50 September 28.08 42 29.7 37 37.3 51 October 32.7 49 25.7 31 43.5 52 November 38.5 44 13.9 31 41.5 50 December 33.01 43 23.9 32 36.4 48 24 Eastbury Day Nursery - Matron reports as follows:- The year 1966 has been the first complete year since we came to our new Nursery. The children have enjoyed the extra space and facilities that are available. Staffing problems have been very difficult, mainly due to trained staff shortages. Three nursery students entered for the N.N.E.B. examination in July, and I am pleased to report they were all successful. I feel that it has been a happy and successful year. Fanshawe/Annie Prendergast Day Nursery - Matron reports as follows:- We spent most of 1966 at Fanshawe Nursery, only moving to our new nursery on 24th October of that year. It was indeed a busy, and in a way a rather unsettling period, the enquiries regarding our move, equipment, etc., etc., were constant, the delay seemed endless, the setbacks many, we were at one and the same time excited, disappointed at the delay, and always longing to get in. The staff and I made frequent visits to prepare what we could, and when we were finally told the day of departure a cheer could be heard around the building. This didn't mean, of course, that we hadn't enjoyed our stay at Fanshawe; it was gratifying to see how well all the nursery staff, parents, staff in the school nearby, including the caretaker, not to mention all the people "on our own side" had co-operated to make our stay there as settled as possible. The children, too, were happy and confident in their temporary home. They used to enjoy the coach ride which was (according to them) always taking us off to some seaside resort or another, but I must admit the staff heaved a sigh of relief when we made the last coach journey. Anyway, I think we shall always have a soft spot for Fanshawe Nursery, or as it is called now "Elmshaw Youth Centre"; the young people had many plans for it, and we can only wish them every success. It seemed strange when we did finally move to our modern, centrally heated, nursery. The routine ran more smoothly, it was easier to keep clean, and after we found our way around, we began to feel quite at home, and to enjoy it all, especially being surrounded by lovely new equipment and toys. Also, as we had been rather isolated at Fanshawe, it was good to feel back in the centre of things again. The official opening of the nursery and clinic on the 14th November was a pleasant and, I think, a successful occasion. We had many, many visitors prior to that, and afterwards, men walking around with tape measures, and officiallooking papers, examining this, that and the other. We took it all in our stride, and cooed over all the admiring remarks made about the nursery by these and other visitors. We have continued the open evenings we started at Fanshawe (usually two or three a year) and find this a good opportunity not only of getting health education over to parents and staff alike, but also of meeting the parents socially, in a relaxed and informal mood. In conclusion, I would mention the progress that is being made through the Nursery Nursing Advisory Committee in our relationship with Hornchurch College of Further Education. It has gone from strength to strength. New developments have been made which appear to be advantageous to both nursery and college staff, not 25 the least of which is the forthcoming course to be held there for senior nursery staff. Perhaps this is one way in which we can look forward to an even greater understanding and closer liaison between health and education authorities, which in turn will enable us to give an even better and wider service, both to parents, children, and the students who are appointed to train in our nurseries. Goresbrook Day Nursery - Matron reports as follows:- An uneventful year. Our biggest problem has been shortage of trained staff. Owing to this, the intake of children has now to be reduced. This is a very unhappy situation. Apart from liking the nursery working to full capacity, a certain amount of hardship must be caused to the parents who have children on the waiting list, especially the unmarried mother who is keen and willing to support her child. PLAY THERAPY During 1966 our play therapy sessions continued to give excellent service. During these sessions the child (2-5 years of age) has a wonderful opportunity of 'letting off steam', and this' evidence may be illustrative of an underlying emotional upset. This group of children, deliberately restricted in number to about 8 to 10, all have come emotional problem but are of infinite variety and type. Included among these children may be the child who is 'withdrawn', a possible psychotic, the child who is being 'killed by kindness' by one or both parents - usually an only child, the child who is 'difficult' or even one who is getting on mother's nerves with disastrous effects on both mother and child. Ac an observer, it is fascinating to watch the child who on his first visit remains aloof and an outsider, gradually at each succeeding session make tentative approaches to the other children and the staff. The latter welcome this approach, respond immediately, and eventually a most satisfactory rapport is established between them. The development of the child's own individual personality is encouraged and guided by the staff in charge (who hold the National Nursery Examination Board certificate). Each child is admitted on a doctor's recommendation and the doctor may be a general practitioner, clinic doctor, or in some cases a consultant from Great Ormond Street or similar children's hospital. In the first instance, the child is introduced into the group for a period of approximately three months but this may be extended if it is considered to be advantageous, due consideration being given to the 'waiting list'. At present the play therapy sessions operate twice a week at Northbury School (as accommodation at Central Clinic is so limited), Thames View Clinic and Julia Engwell Clinic. Each session functions only for two hours, and again the short duration is deliberate to avoid the child getting the impression that his mother is trying to 'get rid of him' I think it is true to say that the parents of these children are most grateful for the help they are being given and are receptive of ideas given by the staff, as we are all beginning to realise how much a child's emotional development can be encouraged by the stimulus and understanding he receives from his parents and the other adults around him. In all groups 91 children have been helped. We had waiting lists for all groups. It is hoped in the very near future to establish another unit, but this has not yet been realised. 26 Northbury - 29 children have been helped including two mentally handicapped children, seven children having difficulty with speech, four disturbed children, three from unhappy homes and one partially deaf child, one physically handicapped child. Julia Engwell - 38 children have been helped including two completely deaf children, one autistic child, two mentally backward children, five with speech difficulty and two very timid children who would not mix. Thames View - 24 children have been helped including two mentally backward children, one spastic little girl, and six having speech difficulty. KINGSLEY HALL DAY CENTRE We were very sorry indeed to lose Sister Torrington this year, and wish her every happiness in her new home in America. We welcome Sister Daly in her place, and hope she will enjoy the work at Kingsley Hall. We also wish Miss Howe a happy retirement - she left us this year after 26 years' work in the nurseries. The day centre has continued to function very well. The average daily attendance was 15.5 The number of new admissions was 11, and the number of discharges 8. All those discharged were sent to school or training centre suitable for their requirements. We continue to have most helpful weekly visits from Miss Hodges(the teacher of the deaf) and also two sessions a week from Mrs. Warwick our physiotherapist who is a most valuable member of the staff. We have been most fortunate to have the services of a very devoted volunteer worker, Miss May Smith, who comes every Friday for the whole day. The children and staff look forward to her weekly visits, and she has never failed us. We have had our usual amount of interested visitors from various parts of the country, and we also had a visit from Dr. Rioux from Washington, U.S.A., who was very interested in our work. Altogether it was a successful and progressive year. CYTOLOGY CLINICS During 1966 we continued to hold a weekly session for cervical cytology at Oxlow Lane Clinic. The public response was very good and we have been able to send 20 appointments per week. The session proved very useful, as apart from detecting two carcinomas-in-situ, many other gynaecological conditions have been referred for specialist advice. I't has also been possible to give instruction in the self-detection of breast cancer. With the growth of laboratory facilities we were in the happy position of being able to increase our service to the public by starting a cytology clinic at Porters Avenue Clinic in November and by seeing a greater number of patients at Upney Clinic. Of 675 patients examined in these two clinics, 4 cases of carcinoma-in-situ were detected and a number of cases were referred for other gynaecological conditions. The total number of patients seen was 1,186 of which 104 were referred to hospital for further investigation and treatment. I am most grateful to the consultant gynaecologists who very kindly 27 accepted, investigated and treated all the patients we referred to them, and also to the general practitioners who were most co-operative and helped our work tremendously. HEALTH VISITING The service has been carried on with certain limitations due to unfilled staff vacancies. While visits have been made to all mothers and newborn infants, with phenylketonuria tests made at 3 And 6 weeks, further follow-up work has not been maintained at the level we would wish. Most mothers attend their nearest Infant Welfare centre until the baby is a year old, and have the opportunity to discuss developmental problems with the medical officer and the health visitor, but follow-up work amongst toddlers has tended to lag. It is during the middle pre-school years that behaviour patterns begin to emerge, and close observation is needed in order to recognise deviations from normal. As progress is made towards a full child development assessment programme, problems in behaviour become more clearly recognised, and health visitors are seeking to assist mothers in day-to-day management through both personal and group discussions. Several regular sessions are under way wherein emotional as well as physical development are considered, and whilst the undoubted need for more home visits exists, profitable time must also be spent in health education. An Open Evening for fathers is usually very well attended. With the decline in demand for local health ante-natal services, some sessions are being taken over by the midwifery section, and others used for cytology. This service has opened up the health and social needs of a section of the community not hitherto dealt with, and clinic premises are more and more visited by adults other than expectant or nursing mothers. Health visitors are tending to have a closer relationship with the school population, and are available to both staff and children. They have been frequently involved in the health education programmes. An Adolescent Clinic is held at one centre following school hours. Visits to the elderly to assess needs, capacity, and those concerning conditions likely to cause physical and mental deterioration, have been Bade initially by health visitors with clinic nurses taking the weight of follow-up visiting. To keep abreast with trends and developments, the staff have had opportunities to attend refresher courses and conferences, including an evening at York House when a Consultant discussed the need for early diagnosis of congenital dislocation of hip in the newborn, and demonstrated both with film and with a baby borrowed for the occasion, techniques of examination to midwives and health visitors. All health visitors in the area attended courses on screening tests for early detection of hearing loss. Health Visiting Statistics Cases visited by Health Visitors Number of Cases Children born in 1966 2,963 Children born in 1965 2,034 " " 1961-64 6,086 Total 11,083 28 Cases visited by Health Visitors (continued) Number of Cases Personal aged 65 or over 469 Mentally disordered persons 14 Persons discharged from hospitals (excluding maternity patients) 33 Number of tuberculous households visited 22 Number of households visited on account of other infectious diseases 4 Homes visited by tuberculosis visitors 729 CHILDREN'S DEPARTMENT During the year, 105 medical examination forms completed by local general practitioners have been perused by the Deputy Medical Officer of Health. In this way, important medical aspects are brought to the notice of the Children's Officer. These children were boarded out into foster homes. Each of the Children's Homes have been visited by my Deputy, and were found to be in good order. Liaison with the Children's Department is ensured by the attendance of my Deputy at Children's Committee meetings. However, 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 The number of vaccinations against smallpox performed during 1966 shows a marked increase over the previous year. 2,196 persons were vaccinated or re-vaccinated compared to 1,100 in 1965. This increase is due mainly to cases of smallpox occurring elsewhere in the country, and to the requirements of other countries abroad for travellers from the U.k. to be vaccinated. Vaccination against Smallpox Age at date of vaccination or re-vaccination Vaccinated Re-vaccinated Under 1 year 85 - 1 year 1,074 1 2 - 4 year 385 14 5 - 15 years 257 380 Total all ages 1,801 395 29 Whooping Cough Immunisation Year of Birth Primary Immunisation Children who received a booster dose 1966 742 3 1965 1,231 333 1964 169 1,149 1963 54 260 1959 - 62 46 270 Others under age 16 9 29 Total all ages 2,251 2,044 Diphtheria Immunisation Year of Birth Primary Immunisation Children who received a booster dose 1966 743 3 1965 1,235 338 1964 175 1,174 1963 68 281 1959 - 62 245 1,441 Others under age 16 65 676 Total all ages 2,531 3,913 Tetanus Immunisation Year of Birth Primary Immunisation Children who received a booster dose 1966 743 3 1965 1,235 340 1964 176 1,174 1963 69 278 1959 - 62 667 1,341 Others tinder age 16 447 862 Total all ages 3,337 3,998 30 Poliomyelitis Vaccination Year of Birth Primary Immunisation Children who received a booster dose 1966 713 - 1965 1,225 7 1964 182 43 1963 79 40 1959 - 62 310 1,696 Others under age 16 156 322 Total all ages 2,665 2,108 "AT RISK" REGISTER OR "OBSERVATION REGISTER" The "At Risk" Register was commenced in May 1966. This scheme is an attempt to give special care and attention by doctors, health visitors and all those concerned, to any children who have been born with a possible hazard to normal development. It is our intention to review these children frequently during their first year of life. As they adjust to their environment, it will probably be found that by the end of their first year, a large proportion will no longer be "at risk" from the medical point of view. As the scheme has been functioning for only a few months, it is much too soon to give an assessment of its value. 31 PREVENTION OF ILLNESS, CARE AND AFTER-CARE HOKE NURSING SERVICE This service continued to develop during the year, and met the steadily increasing demands made upon it. These demands include a great deal of bed-bathing which we feel might be done by less highly skilled staff such as bathing attendants. Perhaps in the future it may be possible to supplement the service in this way. The persistent shortage of hospital beds for the elderly chronic sick laid a heavy burden on nursing staff in endeavouring to maintain at home, patients who would otherwise have been in hospital. It is pleasing to report that all the pupil nurses in training for the Queen's Certificate passed their examinations, thus achieving a 100% pass for the second consecutive year. Statistics Total number of persons nursed during the year 1758 Number of persons who were aged under 5 at first visit 16 Number of persons who were aged 65 or over at first visit 682 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, bed-pans, back-rests, walking aids, waterproof sheets, disposable pads, etc. 2,166 articles were loaned during the year and 3,591 items were out on loan at the end of the year. In addition, 26,500 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 heated blocks of flats. Where patients have not been able to dispose of the pads, this has been arranged at the destructor plant. 0XL0W LANE GERIATRIC CLINIC (for the Over Sixties) The clinic continued to "tick over" despite staffing and transport problems which considerably limit a more ambitious programme (in spite of any demand). Outside interest continues to be shown in the activities of the clinic, and we have had the privilege of demonstrating some of these to various visitors. Although under constant pressure arising from acute staff shortage, the prospect of opening a clinic in another part of the borough to cater for the 32 needs of a wider public has not been forgotten. We were fortunate in securing the services of an experienced geriatric liaison officer, Mrs. J. Harrold. She is proving a very welcome addition to the staff. COMMUNITY SURVEY OF AGED There are some 2,000 cases served by the domestic help service which contain a high proportion of older people. A survey of these cases was started to assess any need of ophthalmic or dental treatment, district nurse, etc. Visits have been made by the Senior Domestic Help Organiser and a Senior Medical Officer. Talks have been given on health topics to groups of older people. These have been designed with a view to helping both pre-retirement groups and those people already retired. GERIATRIC LIAISON OFFICER This post was instituted on the 20th October, 1966, and during the period to 31st December, 1966 (ten weeks) the initial work was obviously of a preparatory nature, with the emphasis on the co-ordination of domiciliary services - the main hospital discharges. Time has also been taken on making contacts and having good relations with the various agencies and departments. 75 cases were reported in this period; of these, 48 were hospital discharges. HYPOTHERMIA Arising from findings in other parts of the country that old persons may be suffering from the effects of accidental hypothermia, i.e. excessively low temperature, without this being realised, home nurses were equipped with special low-reading thermometers, and a small pool of equipment for emergency heating was set up at the Nurses' Training Home at York House. However, the winter of 1966 remained comparatively mild, and only two cases of hypothermia, both of a temporary nature, came to light. In both cases the sub-normal temperatures lasted for one day only and were attributed to age and inactivity. NATIONAL ASSISTANCE ACT. 1948 Section 47 It unfortunately became necessary to remove two persons (one aged 91 years and the other 73 years) from their homes as being unable to care for themselves and not receiving adequate care find attention from others. The action taken was a last resort, and both the patients died in hospital, one two days and the other six days after arrival there. 33 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 3 2 - - - - 5 - - - - 15 9 7 - 1 2 - 19 2 1 - - 45 11 4 - - - - 15 7 - - - 65 and upwards 13 2 - - - 1 16 8 6 - 2 Totals 37 16 - 1 2 1 57 17 7 - 2 Transferred Cases Clinic Into Borough Out of Borough Net gain or loss Upney 8 9 -1 Five Elms 26 22 + 4 Totals 34 31 + 3 Chest Clinics Clinic No. cases on register No. households involved No. home visits made Upney 411 372 889 Five Elms 574 516 748 Totals 985 888 1,637 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 853 - 617 5 248 2 Five Elms 90 - 537 7 81 8 Totals 943 - 1,154 12 329 10 The statistics presented here are a combination of the morbidity and mortality figures for tuberculosis throughout the year of 1966 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:- 34 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 1966 57 26 Free Milk On the recommendation of a Chest Physician additional supplies of milk are made available to patients suffering from tuberculosis, and 157 patients were so assisted during the year. Mass Radiography Mass Radiography Unit 6A visited the western area of the borough in March 1966, and I am indebted to the Medical Director for the following details:- Location Male Female Total South East Essex College of Technology 519 135 654 Impalco Foils Ltd. 272 134 4o6 The Volunteer 699 261 960 Forecourt, Magistrates' Court, East Street 1,256 1,820 3,076 Thames Plywood Ltd. 211 117 328 British Eastlight Ltd. 48 204 252 Fanshawe Tavern 274 381 655 Sherwood Parsons Ltd. 107 88 195 Magnavox Co. Ltd. 253 428 681 Thames View Estate (Bastable Avenue) 152 225 377 Barking Generating station 726 32 758 Jeyes Compounds Co. Ltd. 83 153 236 Remploy Ltd. 102 30 132 Total number X-rayed 4,702 4,008 8,710 Requiring further investigation 90 68 158 Groups Attending Male Female Total General Public 1,681 2,389 4,070 Organised Groups 3,016 1,614 4,630 Referred by General Practitioner 5 5 10 35 Pulmonary Tuberculosis Male Female Total Requiring immediate treatment 2 1 3 Requiring close clinic supervision 1 - 1 Requiring occasional clinic supervision 9 (3 pk) 3 (1 pk) 12 Suspect tuberculosis - not confirmed - 1 1 Presumed healed, no further action required 10 (1 pk) 13 (1 pk) 23 pk = previously known Groups in which significant Tuberculosis was discovered Male Female Total Requiring immediate treatment: General Public 2 - 2 Organised Groups - 1 1 Requiring close clinic supervision: General Public 1 - 1 CHIROPODY SERVICES The Chief Chiropodist reports as follows:- The grand total of treatments given in all branches of the chiropody services throughout the borough in 1966 was 18,367, which is made up as follows:- By attendances at foot clinics: Adults 14,934 Children 831 By treatments at patients' own homes (domiciliary service) 1,894 By treatments at established old people's homes 708 Total 18,367 Foot Clinics and Operators in use during the year Central Mr. H. Leavesley, Chief Chiropodist. Clinic open on Monday, Tuesday, Wednesday and Friday, Thursday being devoted to clinic visiting and clerical duties, etc., of Chief Chiropodist. Julia Engwell Mrs. D. Mann. Clinic open Monday to Friday. Porters Avenue Mr. D. Ditsell. Clinic open Monday to Friday. 36 Kingsley Hall (Temporary premises used while our Ford Road building was being re-modelled.) Chiropodist Mr. N. Freeman. Clinic open on Monday, Wednesday and Thursday. Clinic ceased 27th October. Ford Road Clinic re-started 31st October after alterations to building, and working days continued as for Kingsley Hall. St. Chad's Church Hall (Temporary premises used while our new clinic was being built at Ashton Gardens.) Chiropodist Mr. N. Freeman. Clinic open on Tuesday and Friday until 21st October when we moved into our new building at Ashton Gardens. Annie Prendergast Started the Foot Clinic 24th October. All new equipment was installed at the start. Chiropodist Mr. N. Freeman as at St. Chad's Hall. Open Tuesday and Friday. Greatfields Mr. H. Stenson. Clinic open Monday, Tuesday, Wednesday and Thursday. Thames View Mr. H. Stenson. Clinic open for one day each week - Friday. Domiciliary Service Operated in the old Barking area by Mrs. Morgam on a full-time basis, except for a weekly two session attendance at the Mayesbrook Old People's Home. In the Dagenham and Chadwell Heath area a part-time Chiropodist (Mr. P. Freel) operates two sessions each week. Old People's Homes Mayesbrook: Mrs. Morgan 2 sessions weekly. Mr. Fenton 1 session monthly. The Lawns: Mr. Fenton 1 session fortnightly. Saywood Lodge: Mr. Fenton 1 session fortnightly. (Mr. Fenton is a part-time Chiropodist.) General We are continuing to accept patients on the priority ruling, i.e. 65 years, physically handicapped, ante-natal and children. Patients are referred to us via doctors, clinics, health visitors, local welfare officers, and other branches of the local services. A voluntary car service is in operation based on our Annie Prendergast Clinic which is quite useful, and foreshadows the time when our own motor transport will be in action. All clinics carry heavy case loads, and the interval between appointments is generally from eight to ten weeks. This position is greatly aggravated at times of holidays or sickness among the staff when the respective clinics have to be closed. 37 The public in general are becoming still more "foot conscious", and it is quite obvious that we contribute substantially to the effective mobility and welfare of our elderly people. I have now a more general knowledge of the large new area covered by our health service and the patients drawn into our chiropody services from the various districts, which makes me convinced that our clinic coverage is far from adequate. To provide a first-class service, further clinics are required in the Upney Lane, Becontree, Oxlow Lane and Kingsley Hall areas. Patients in each of these districts have to travel rather a long way for their treatments. Old People's Homes This service is, without doubt, the most stable of our activities. The number of patients remain constant and the easy regulation of treatments makes the outcome very satisfactory. Domiciliary The demands made on the domiciliary service increase because of our ageing housebound population. Circulatory and rheumatic conditions present an evergrowing problem. More chiropodists are needed to cope with the demand in this field. We are receiving daily requests for our attention from doctors, health visitors and welfare officials. Footwear Education Much good work has been done in this direction by our individual contacts with both young and old people, using literature and personal demonstrations. There is very much more that could be done along these lines for it is unfortunately true that our young people - in particular girls - are creating very serious conditions which will cause them to have a lot of trouble as they get older. It is not possible, due to our staff shortage, to direct chiropodists to this educational side owing to the requirements of the number of patients needing treatment. Conclusion My concluding remarks for the year would be that more staff cure needed to provide an adequate service - with this should go the establishment of more foot clinics. Treatments for the year Clinics Children Adults Total Sessions -4 5-16 O.A.P. Others A/N P/H Central 2 158 2,230 112 1 5 2,508 411 Julia Engwell 5 97 2,723 - - 82 2,907 509 Porters Avenue 1 51 2,766 22 5 30 2,875 511 Greatfields - 25 2,672 25 - - 2,722 494 Thames View 2 115 619 3 - - 739 111 Ford Road - 226 1,753 34 - 472 2,485 317 Annie Prendergast 3 146 1,172 10 - 198 1,529 213 Total 13 818 13,935 206 6 787 15,765 2,566 38 Old People's Homes Adults Total Sessions   O.A.P. P/H Mayesbrook 271 - 271 42 Kingsley Hall - - - - The Lawns 217 - 217 24 Saywood Lodge 220 - 220 25 Total 708 - 708 91 Domiciliary Adults Total Sessions O.A.P. P/H Central Area 1,421 153 1,574 401 Eastern Area 320 - 320 88 Total 1,741 153 1,894 489 Grand Totals for the Year Section Number of Treatments Sessions Worked Clinics 15,765 2,566 Old People's Homes 708 91 Domiciliary 1,894 489 18,367 3,146 MEDICAL EXAMINATION OF STAFF The aim of these examinations is to determine whether the candidate is physically 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. Number of persons examined and passed as fit 979 Number of persons examined and not accepted 15 Number of special examinations in connection with sickness payments 12 Number of medical examinations carried out for other authorities 3 Number of medical examinations carried out by other authorities 25 Number of chest x-rays arranged in connection with medical examinations 489 39 REHOUSING ON MEDICAL GROUNDS As in previous years, all applications for rehousing on medical grounds are dealt with by one of my staff (the Deputy Medical Officer of Health), and thereby uniformity of "urgency" and recommendation is maintained. The work that this has involved during the year is as follows:- Total number of applications 317 Number of families visited 78 Number recommended for rehousing 17 Applicants with medical grounds can be divided into two categories:- (1) Younger married couples with more children than can be reasonably accommodated in present circumstances. (2) Elderly persons who cannot negotiate stairs. Many of the difficulties of the latter group could have been prevented, if middle-aged persons were housed as near the ground floor as possible, or where there is a lift. To house an older person alone on the second floor upwards where there is no lift will inevitably cause difficulty in the future. MENTAL HEALTH Work of the Mental Welfare Officers During the year, 473 new patients were referred for investigation and/or action. Referred by general practitioners 109 Referred by hospitals on discharge 115 Referred by hospitals after or during out-patient or day treatment 72 Referred by local education authorities 22 Referred by police and courts 20 Referred by other sources, e.g. neighbours, relatives, Ministry of Social Security and other social and welfare agencies 135 473 Number of mentally ill patients receiving care 211 Number of subnormal patients receiving care 345 Number of admissions for temporary residential care to relieve the family 8 Number of admissions to mental hospitals during the year: Informal 62 Compulsory 105 Via Court 3 170 Number of emergency calls dealt with outside office hours 108 40 The furnished maisonette was opened and took its first patients in September. They have settled down and have quickly become part of the community. The weekly psychiatric social club continues to flourish and has doubled its membership. Activities during the year have included theatre trips, film shows, play reading, make-up demonstrations, talks and demonstrations from the Milk Marketing Board, and a visit by the Morris Dancers. Talks were given by mental welfare officers to groups of student nurses, to pre-retirement courses, to schools, and to women's groups, etc. During the year, medical students from Barts,who are on a residential placement at Warley Hospital,have spent some time in the mental health section. Adult Training Centre The programme at the centre consisted of woodwork, leatherwork, basketry, needlework, housewifery, i.e. cooking, laundry, shopping, tea-making, etc. Contract work included stripping small H.P. motors to be returned for reassembly, and the closing of plastic caps and assembling of Mum tubes. The money earned on contracts is distributed amongst all the trainees at the centre, and payments vary from 2s.6d. for the lower-grade trainee to 10/- and £1 for the higher-grade trainee. The amount earned for 1966 was between £900 and £1,000. Certain trainees were taken from time to time to visit the factories from where we get the contracts, so they might see the machinery that is used. On two mornings each week the trainees visit the local sports centre where they are supervised by qualified staff. A visit was paid to a theatre in London to see Cinerama. The trainees and staff had a day at Minnis Bay in June, but unfortunately the weather was not as good as we had hoped. At the end of April the trainees and staff spent a very enjoyable week at St. Mary's Bay, Dymchurch. A Christinas party was held at the centre for trainees and their parents, and another for the trainees only. All the trainees were invited to a further Christmas party at the Assembly Hall, Barking. A social club is held every Monday evening for both trainees and their parents, and the trainees are picked up at home and taken back home after the club by a mini-bus,which was bought from money given for the benefit of the boys and girls. CIVIL DEFENCE Close liaison has been maintained between the health department and the Civil Defence Corps of this borough. The following are details of First Aid and Home Nursing Courses, etc., run by the Civil Defence Corps and the health department:- 41 Date Place Course Nos. Attending 4.1.66 15.3.66 Eastbury Good Neighbours Club, Barking Emergency Home Care 36 15.2.66 Eastbury School Duke of Edinburgh Examination 22 17.3.66 12. 5.66 Axe Street Centre (Parks and Baths employees) Borough Engineer's Full First-Aid Course 9 17.5.66 & 18.5.66 Axe Street Centre Borough Engineer's "Safety in Sewers" 15 26.7.66 Axe Street Centre Junior Red Cross Society First-Aid Examination 16 31.8.66 Axe Street Centre British Red Cross Society Presentation of First-Aid Awards 30 4.10.66 29.11.66 Civic Centre (Council Staff) Emergency Home Care 21 5.12.66 British Red Cross Society Home Nursing Examination 22 DOMESTIC HELP SERVICE (1) General (Administration and Organisation) (a) Many of the teething troubles which followed the amalgamation of the two previous administrative areas in October 1965 gradually dispersed, and a unified pattern of administration and organisation is now being followed throughout the borough. (b) The revision of establishment, which provided for an additional Organiser i.e. 1 Senior Organiser. 2 Organisers and 2 Assistant Organisers, contributed towards a more efficient and smoother running organisation. (2) Case Loads (a) The overall case load showed a steady increase throughout the year, and cases served during the year were as follows: Aged (over 65 years) 1,647 Chronic Sick 237 Mentally Disordered 5 Maternity 48 Others 53 Total 1,990 An increase of 240 on the previous year. 42 (b) Cases in need of night attendance were referred from time to time, and service was provided to cover four such cases. (3) Recruitment of Labour To meet the increase in demand it was necessary to engage additional labour and, although throughout the year there was considerable fluctuation, at the close of the year the number of domestic helps employed was as follows:- Whole-time 1 Part-time 233 * An increase of 22 in the year. (4) Training It has not been possible to launch a training scheme for domestic helps, but the foundation has been laid for courses during the next year to be held at Hornchurch College of Further Education. (5) Social Activities Functions of this nature continued to be held from time to time, but were not so well patronised as heretofore, and there is little or no enthusiasm for such activities on the east side of the borough. The annual dinner and dance was attended by the Chairman and Vice-Chairman of the Health Committee. 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) 1 4 Section 28 (Prevention of illness, care and after-care) 27 - SCHOOL HEALTH SERVICE There are 66 primary and 23 secondary schools in the borough. We also have two special schools. The Bentry Special School caters for educationally sub-normal pupils, and Faircross Special School for delicate and physically handicapped pupils. At the end of the year, numbers on roll were as follows:- Primary schools 16,635 Secondary schools 11,609 Special schools 314 Total 28,558 MINOR AILMENTS CLINICS Minor ailments sessions at which a doctor was present were held at the following clinics:- Annie Prendergast 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, Wednesday and Friday 9*10 a.m. Upney Monday, Wednesday and Friday 9-10 a.m. A total of 1,385 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 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 310 candidates were reviewed. Further investigations were made in 65 cases, three persons were found to require treatment and were subsequently accepted, and one case only was rejected. 44 SELECTIVE SCHOOL MEDICAL EXAMINATIONS Following a successful pilot scheme for the selective medical examination of school leavers at two senior schools, the Education Committee agreed the scheme be extended to all senior schools and a start was made during the year. Completed medical questionnaires were scrutinised by school medical officers and 165 pupils were found not to warrant a medical examination. 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 No. of Pupils (by year of birth) Inspected 1962 and later 134 1961 1,384 1960 1,180 1959 267 1958 136 1957 91 1956 264 1955 1,359 1954 782 1953 137 1952 180 1951 and earlier 1.387 7,301 Other Inspections Number of special inspections 2,735 Number of re-inspections 1.628 4,363 45 46 DEFECTS FOUND BY MEDICAL INSPECTION Defect or Disease Periodic Inspections Special Inspections Treatment Observation Treatment Observation Skin 308 91 1,768 193 Eyes: (a) vision 417 299 261 71 (b) squint 25 28 16 7 (c) other 18 17 174 5 Ears: (a) hearing 37 71 73 76 (b) otitis media 10 28 47 3 (c) other 12 26 34 1 Nose and throat 107 297 144 37 Speech: 49 66 51 20 Lymphatic glands 35 134 11 3 Heart: 41 83 11 9 Lungs: 63 143 29 16 Developmental: (a) hernia 4 9 3 1 (b) other 42 129 36 52 Orthopaedic: (a) posture 16 27 10 4 (b) feet 69 99 118 24 (c) other 61 64 272 39 Nervous system: (a) epilepsy 25 12 1 2 (b) other 59 72 23 11 Psychological: (a) development 62 62 29 15 (b) stability 21 93 43 17 Abdomen 21 27 22 - Other 127 93 666 128 General Condition of Children Out of 7,301 pupils examined, only 5 were considered to be of unsatisfactory general condition. INFESTATION WITH VERMIN During the year 20,153 pupils were examined, and 241 found to require treatment. CONVALESCENT TREATMEUT Pupils who are recommended convalescent treatment on medical advice are sent away for periods of up to four weeks. 117 cases received treatment during the year. EMPLOYMENT OF CHILDREN 130 pupils were examined for fitness for employment out of school hours and certificates were granted. 47 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 1962 and later 1 11 11 1961 30 145 159 1960 48 158 159 1959 15 58 61 1958 14 18 29 1957 4 23 22 1956 24 26 36 1955 87 207 221 1954 61 114 144 1953 4 27 28 1952 13 23 25 1951 and earlier 116 153 250 Total 417 963 1,145 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 tonsillitis 67 Received other forms of treatment 278 Total number of pupils in schools who are known to have been provided with hearing aids:- (a) In 1966 10 (b) In previous years 73 ORTHOPAEDIC AND POSTURAL DEFECTS An Orthopaedic Consultant attends monthly at Leys Clinic where a whole-tine physiotherapist is also in attendance. Pupils known to have been treated (a) At clinics or out-patient departments 388 (b) At school for postural defects - CHILD GUIDANCE TREATMENT At the 31st December 1966 there were 73 cases awaiting first appointment at the clinic, and 87 cases under treatment. 103 new cases were seen during the year and 555 interviews undertaken by the psychiatrist. The newly established clinic in temporary premises at the Southwood Centre rapidly got into its stride, and after a few months with Dr. J. Swift as a locum psychiatrist, the North East Metropolitan Regional Hospital Board appointed Dr. Rodriguez Arganaras as part-time Consultant Psychiatrist for four sessions per week with effect from 1st August 1966. The need for a purpose-built child guidance clinic was already realised, and following Joint visits by officers of the education, borough architect's and health departments to newly built child guidance premises elsewhere, a visit was made to the Department of Education and Science when sketch plans were discussed and the Department's views obtained. This should result in an ideally designed building, a site for which after some initial difficulty was found on land at Shipton Close, Dagenham, and it is hoped building will start in 1967. A report has been received from the Educational Psychologist of the Ilford Child Guidance Clinic as follows "I find that there were Barking children seen at this clinic during 1966. The majority of these are children we have known for some long time as we are not taking new referrals as a rule from the Barking area; but there were one or two 48 The large number of patients who do not attend for their appointmenta - 58 (and who do not inform us accordingly) give an unnecessary large amount of extra work to all concerned. The results of treatment (using the buzzer) are satisfactory, and very similar to results in previous years %of total Number cured 104 80% Number failed or poor result 26 20% This cure rate of 80%is reduced by about 10% in fact, as several cases relapse within a few months. The causes of failure are virtually all due to one of two causes - the buzzer fails to awake the child, or the child awakes but is too frightened and unable to co-operate. Invariably these failures occur in the 6 year old group (the minimum age seen), and therefore there is sufficient reason to raise the minimum age to receive buzzer treatment to 7 years old. 49 cases where a brother or sister of a child already attending this clinic was referred here as we felt it better to keep the dealings with one family in one clinic rather than for different members of the family to be seen at different clinics." 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. Efforts to obtain further specialist sessions for this clinic have not been successful. Pupils known to have been treated (a) External eye diseases and other (excluding errors of refraction and squint) 23 (b) Errors of refraction (including squint) 1,978 (c) Number of pupils for whom spectacles were prescribed 1,152 EHURESIS CLINIC The statistics relating to the work of this clinic are as follows:- Appointments made dances New patients 83 62 Old patients 105 68 Total 188 130 DISEASES OF THE SKIN (excluding uncleanllness) 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 1 Scabies 2 Impetigo 40 Other (plantar warts, etc.) 1.010 Total 1,053 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, 1,121 children were skin tested. 948 were found to be suitable and were vaccinated with B.C.G. 173 pupils were found to have a positive reaction to the skin test and were referred to the chest clinic for a routine x-ray. The number of acceptances for this protection is disappointingly low, and the co-operation of parents, teachers and health staff is needed to improve natters. SPEECH THERAPY Barking Area - Miss Delaforce reports as follows:- Speech therapy was carried out at the Julia Engwell Clinic with children fron a wide area, as Central Clinic had no full-time speech therapist for most of 1966. Miss Marquand, an assistant speech therapist from New Zealand, worked at Central Clinic on a part-time basis and she treated the cases most urgently requiring speech therapy. The children attending for speech therapy at Julia Engwell Clinic came from sixteen schools in the borough. These schools were visited and it was useful to be able to discuss with the teachers the progress made with speech in the classroom. Many of the new patients referred for speech therapy during 1966 were picked out in these school visits. An attempt was made to test the hearing of all children attending for speech therapy. If there was any doubt over a result or a child proved difficult to test, the case was referred to the clinic doctor. A large number of the pre-school children needing speech therapy were also recommended for play therapy. It seemed important that this age group should be 50 Total attendances 541 Non-attendances 198 Number on register in December 1966 33 New patients during 1966 23 Patients discharged during 1966 22 Dagenham Area - Miss Symes reports as follows:- During 1966, I have continued to hold speech therapy clinics at the following centres - Oxlow Lane Clinic on Mondays, Marks Gate Clinic on Tuesday mornings, Annie Prendergast Clinic on Tuesday afternoons, Five Elms Clinic on Wednesdays and Thursdays, and at Leys Clinic on Fridays. Attendances are good at most clinics, except for Leys where, because of the distance from public transport, the percentage of irregular attendance is higher than I would wish. The Bentry School was without a speech therapist for the major part of the year, except for a short time when an assistant speech therapist was employed. There is still a vacancy there. 51 able to mix with other children before going to school, and the opportunity they were given to use speech freely was extremely valuable. A session was started in the new Faircross Physically Handicapped School and by working with a student it was possible to assess most of the children needing speech therapy. Speech therapy was continued at the Training Centre and group activities were carried out in the sessions. Individual help was given to a number of the children who, it was felt, could benefit from this type of therapy. The figures below show the number of appointments sent at Julia Engwell Clinic and Central Clinic during 1966. Julia Engwell Clinic Pre-school Infant Junior Secondary Special Attendances 118 290 364 138 394 Non-attendances 87 215 342 93 100 Total attendances 1,304 Non-attendances 837 Number on register in December 1966 98 New patients during 1966 36 Patients discharged during 1966 30 Central Clinic Pre-school Infant Junior Secondary Special Attendances 83 258 84 14 102 Non-attendances 34 125 39 - - The number of patients under treatment in my clinics at the end of 1966 was 97, and the number of treatments given during the year was 1,632. 176 patients had been treated of whom 127 were boys and 49 were girls. During the year, 79 patients were discharged, these figures being made up as follows:- Speech normal 59 Non-attendance 6 No further progress likely 7 Transferred to other areas 2 Left school 2 Discharged at parents' request 3 Total 79 I was very pleased to be able to have my own treatment room at the new Annie Prendergast Clinic, after being very kindly accommodated at Furze Infants' School from January to October 1966. 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 the treatment of speech disorders. 52 HANDICAPPED CHILDREN FAIRCROSS SCHOOL Mr. Holdsworth, the Headmaster, reports as follows:- The School opened on 10th January 1966 with 117 pupils from Old Faircross, and Bentry Schools P.H. departments. All settled in well, and although faced with a new and entirely different organisation they were working to a timetable by Wednesday, 12th January'. My grateful thanks to the Staff for a very successful and happy beginning. A very profitable and active first term followed, the highlights of which were:- (1) The Easter Service attended by the Chief Education Officer, J. L. Haselden, Esq., Mr. Newall, Miss Storm, visitors from Dr. Barnardo's, Staffs and children from neighbouring schools, old age pensioners, Friends from the Old People's Home, Parents and Old Scholars. The Service was conducted by the children. (2) Visits to the Royal Festival Hall. (3) Visits to the Earnest Read Music Association Concert at the Royal Albert Hall. (4) Visits to the British Museum, the Maritime Museum, Commonwealth Exhibition. (5) School Outing to Margate, Kent. I was delighted to see the whole school turn out for the day. Arrangements for wheelchairs made by the Beachmaster were first-class. (6) A Bring and Buy Sale in which £108 was collected. This was divided 76to the Pool Fund and £32 to the School Fund. Staff changes were few. Mrs. S. Weir left us at the end of the Easter Term to commence her family and was replaced by Miss R. Morris from the Inner London Education Authority. Mrs. Carney, Peripatetic Teacher of the Deaf visits the School each Thursday, and Miss C. Delaforce visits Thursday mornings. We are fortunate in obtaining the services of Miss A. Dotzler as Physiotherapist. She is, I fear, much overworked and I would welcome the services of a part-time Physiotherapist to ease her burden. Mr. A. Burke has left us to take up a Headship of a Special School in Middlesborough. He will be replaced by Mrs. E. Purkiss from Inner London. Mr. R. Norman was appointed Deputy Head. Since Easter this year, the main item of moment was the Official Opening of the School performed by Qroup Captain Douglas Bader. He was an immediate success with the children. The School has been host to three important in-service courses to teachers:- (1) The Difficult Child in the Classroom Situation. (2) The Institute of Education Course on the Slow Learning Child. (3) I.L.E.A. Course for Students taking the Diploma in Teaching of Handicapped Children. 53 In addition to the distinguished visitors to the Official Opening, our visitors throughout the year have been many, and include members of the East African Education Service of Tanzania, Her Majesty's Inspectors, Ministry of Health Officials, and Advisers from other authorities. I had intended to promote a school journey to Cannes in the summer holiday, but unfortunately the general public needs educating a lot more in accepting oar handicapped young people; because of the general lack of understanding it was not possible to book suitable accommodation. However, arrangements are well in hand to take the children to Leysin, Switzerland, at Whitsun 1968. For the second season the School Orchestra and Choir have received high praise at the Barking Music Festival. Many of the children, 60 to be exact, arc now playing at least two instruments. We are grateful to Mr. R. Norman, Deputy Head, for this wonderful feat. We now look forward to another year. We have the additional facility of the hydrotherapy pool and the swimming bath, for which we thank everyone who had a hand in its provision. BENTRY SCHOOL Mr. Hurton, the Headmaster, reports as follows:- In January 1966, the physically handicapped children of Bentry School were transferred to the new Faircross School, Barking, and the educationally subnormal children of Faircross School were transferred to Bentry School. This change, which was long overdue, meant that Bentry School now catered exclusively for educationally subnormal 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 twenty. 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 subnormal 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 if work is geared to real life situations of the children. Projects, centres of interest, school journeys and educational visits help to stimulate the children and provide material for interesting and useful work. 54 On Wednesday, 15th June 1966, the whole school were taken to Shoeburynesa for the day. 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. 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. 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 appointments. 55 56 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS Blind Part Sighted Deaf Part Hearing Fhysically Handicapped Delicate Maladjusted Educationally Sub-normal Epileptic Speech Defect Total Number of children newly assessed In year - 1 - 5 12 12 13 25 1 - 67 Number of children placed in Special Schools in year - 2 - 3 18 17 9 35 1 - 85 Number of children requiring places in Special Schools - - - - - 1 7 10 1 - 19 Number of children included above whose parents had refused consent to their admission - - - - - - 1 4 - - 5 Number of children on Registers of Special Schools at 19th January 1967 4 18 1 27 57 60 25 219 10 - 421 Number of children receiving tuition at home or in hospital, etc. - - - - - 3 1 - - - 4 CASTLE SCHOOL AND TRAINING CENTRE The year started with 108 on roll and ended with 111 children and trainees. Open Daya 8th and 9th June the school was opened during Mental Health Week. Some 30 members of the public attended in the overall time. 29th and 30th June - "Open Afternoons" for parents and friends. 22nd September - an "Open Evening" for the parents. 8th December - Carol Service at St. Margaret's Church Hall. Nearly 175 parents and friends attended. Outings and Visits of Interest March - Junior I visited the Zoo in connection with a completed project. 7th February - the Seniors had their Christmas outing to the Victoria Palace to see the "Black and White Minstrels". 8th February - Juniors had their Christmas pantomime outing to the London Palladium to see "Cinderella". 21st March - the Seniors visited Valence House in connection with a finished project. 31st March - Easter Service at the Parish Church. 16th May - Senior outing to Bodiam Castle and Rye. May - Junior III visited the main Ilford Post Office and Sorting Office in connection with a completed project. From May - October the Juniors had 12 one-day visits to Minnie Bay. A chalet was rented to house equipment, etc. One of these visits was paid for by the Council. 15th July - the Junior party went to the Dymchurch Holiday Camp for one week. 9th September - the Senior party went to the Dymchurch Holiday Camp for one week. 21st September - Harvest Festival Service. The fruit and vegetables, etc. brought in by the children and trainees was given to the physically handicapped at Eastbury House. Members from Eastbury House also joined us at our service; they numbered about 20, and the staff from their centre joined them. 15th December - Senior Girls Christmas Evening Social. 20th December - Junior Christmas Party. Four Social Evenings were held for the older girls during the year. 57 Visits from Students, etc. 23rd February - all the students on the N.A.M.H. course attended a lesson in the gymnasium at the Barking College of Technology. They afterwards returned with the children to the centre where they observed in the nursery for a short time. There was a short seminar before they left, to allow for questions and discussion. 23rd February - a student was received from the Middlesex Course for five weeks' practical placement. 23rd February - N.A.M.H. House Mothers Course visited en bloc. 14 th February - two social workers from the borough welfare department visited. 10th March - Mr. Fink, a student in research on mental subnormality from Los Angeles, visited and spent the day. 1966-67 - two students for six weeks each practical placement periods were received from the N.A.M.H. 1966-67 - two students for six weeks each practical placement periods were received from the Chiswick Polytechnic Course. From March - July, a trainee from Redbridge was placed at the school in order to receive training. From September - December, another trainee from Redbridge was placed at the school to receive training. June/July - three separate parties of 5th form girls, accompanied by staff, were received from Park Modern, Dane and Fairlop Secondary Modern Schools. 8th November - three N.A.M.H. students visited to study nursery techniques. 10th November - Mr. Humphrey and two friends from the Electric Power Storage Company, Dagenham Dock, called to discuss donating £100 to the School Amenity Fund. Events to Note 18th May - Mr. Souster and members of the Ilford Rotary Club officially opened the Play Room the Club had presented to the school. 10th October - Gale Street was opened as an annexe for the older girls. 38 girls were involved in this transfer. Mrs. Murray, Mrs. Davidson and Miss Palmer transferred with the girls. Special News Through a personal friend, contact was made with the British Ship Adoption Society. Through the kindly concern of Miss Friend, the Society's Secretary, sin approach was quickly made to H.M.S. "Arlanza". Her Captain and crew readily accepted our particular school and have shown real devotion, interest and concern for our children. Members of the crew visited almost immediately, and a Mr. Stewart was actively concerned with the School Committee formed by Captain Gibbons. As the liaison officer he visited several times. These visits culminated in a visit from Captain Gibbons, on which occasion he presented all the children, trainees and staff with presents from the crew, together with a 58 cheque for £85. This latter was used to buy three dozen garden chaira for the older girls, and the rest supplemented the Minnis Bay project for the juniors. A party on board the "Arlanza" was planned, but owing to the seamen's strike it had to be postponed. Mr. Stewart left the ship, and his place as liaison officer was taken by Mr. Billings. Mr. Billings and the crew made a film of the ship's activities which was later shown to the whole school and presented to us as another gift. Later in the year, Mr. Billings joined the older girls on one of their social evenings and showed another film taken during a recent voyage, of excursions made at porta of call en route. This was not offered as a preaent as it waa the private property of a member of the crew. It ahould be recorded that when Captain Qibbons visited the school he was presented with a rug for his cabin, made by the older girls, and a model of the "Arlanza" in a South American port, made by the juniors. This measured 3 ft. by 2 ft. 6 ins. and was complete with harbour, small craft, as well as the "Arlanza", customs sheds and even background mountains and foliage. Throughout the year, the girls and children kept in touch with their ship with letters and drawings which portrayed their many activitiea in colourful language. Each child receives a birthday card from the ship. Captain Gibbons ordered a magnificent Christmas cake to be made, in the shape of the "Arlanza", for the school party. It measured 4 ft. x 2½ ft!! Further, Mr. Billings, who was chef of the "Arlanza", waa given a day's leave to come to the school and cut this outsize cake into portions. Needless to say, there was more than enough for everybody. School and Centre Programmes A full educational and social programme waa followed in the school department. An experiment waa started with a small group of emotionally disturbed children. This proved to be most successful but had to be discontinued due to lack of staff. The Seniors had a comprehensive Industried programme which included work from Spongs of Basildon, Magnavox and, later in the year, Univeraal Crackers Ltd. Theae offered variety and interest and all proved auccessful. At the same time, a full remediad, educational training was offered with full domestic training, cookery, dress-making, simple cleaning and laundry. The link with the Red Cross was continued and, in connection with this, three dozen "Disaster Kits" were made by the girls and presented to Mrs. Stewart, Officer at the Chelmsford Branch. We understand that they were later very useful at a disaster in the Middle East. The girla also enjoyed recreational activities of net-ball, singing, country and modern dances. Successes While at the Dymchurch Holiday Camp, one team was successful in defeating all opponents and was finally presented, at an evening social, with the Net Ball Certificate for the week. 59 Visitors Extraordinary May - Two students from the University of California, studying economics were sent to visit the school by the N.A.M.H. July - A doctor from Greece was also sent to Castle School. She wished to keep in touch re the methods that were being developed in number and reading. Autumn - Miss Willis, a tutor from the N.A.M.H., and Mr. Brown, both students at the London University taking the first course offered by the University for lecturers on the courses running for teachers of the mentally handicapped, visited as an official placement for the day from London. It is possible that more students from the University may be referred to Barking depending on how successful and useful the University felt this first course was. May - Visit from the I.T.V. Company televising the girla taking part in an experimental music and movement session with the Religious Drama Society. INCIDENCE OF CONGENITAL ABNORMALITIES The notification and classification of congenital abnormalities apparent in children at birth continued during the year, the following defects being noted in 36 babies:- Central Nervoua System: Anencephalus 3 Spina bifida 1 Other defect8 of spinal cord 3 Eye, ear: Defects of ear 2 Accessory auricle 2 Alimentary system: Cleft lip 7 Cleft palate 3 Rectal and anal atresia 1 Heart and great vessels: Congenital heart diaeaae 1 Uro-genital system: Hypospadias, epispadias 1 Other defects of male genitalia 2 Limbs: Defects of lower limb 2 Polydactyly 1 Talipes 9 Other defects of hand 4 Other defects of pelvic girdle and lower limbs 1 Other skeletal: Defects of ribs and aternum 1 Other ay8tems: Vascular defects of akin, subcutaneous tissues, and mucous membranes (including lymphatic defects) 3 Other defects of skin (including ichthyosis congenita) 1 60 DENTAL SERVICES SCHOOL DENTAL SERVICES The school dental service in Barking was able during 1966 to provide full dental treatment to any schoolchild receiving education under the local authority. The number of children first inspected at school in 1966 was double that of 1965. The staffing position in 1966 showed an improvement over 1965. The position of a Senior Dental Officer was established, and the first Senior Dental Officer in the borough was appointed on 1st April 1966. An establishment was created to include a third Dental Auxiliary. I am pleased also to say that two of our part-time sessional Dental Officers applied for full-time appointments in the borough and were appointed. CONSERVATIVE TREATMENT AND ORTHODONTIC TREATMENT More teeth are being saved from the need for extraction today than ever before, and I am happy to report that our work in this very important field of dentistry increased during 1966. The rather specialised field of orthodontic treatment showed an increase over 1965, and I am pleased to say that many parents and children were made a lot happier as the result of successful orthodontic treatment. I would like also to mention the excellent service given during the year by the Consultant Orthodontist at Whipps Cross Hospital, on the more difficult cases requiring treatment. DENTAL HEALTH EDUCATION The dental staff of the borough, dental officers, dental auxiliaries and dental Burgery assistants, did a very excellent job in this field. Dental health talks were given at all school inspections, and instruction was given at the chairside to all patients. The Principal Dental Officer gave two talks with demonstrations on orthodontic work to Parent Associations and Young Wives Associations in the evening. The Senior Dental Officer attended a Dental Health Conference at the General Dental Council during July, and much was learnt about the technique required to get dented health education across to the public. GENERAL COMMENTS The first major inspection by a dental officer from the Department of Education and Science of the dental services in the borough was made in February 1966. His report was sent to the appropriate committees. The post-graduate courses granted to dental officers by the Health Committee were all attended; these courses are very valuable to all dental officers. Ford Road Clinic was closed for nine months during 1966. Two new dental surgeries were equipped at Annie Prendergast Clinic. MATERNITY AND CHILD WELFARE DENTAL SERVICES Dental treatment was available during 1966 at all clinics in the London Borough of Barking for expectant and nursing mothers and for children under five years old. It is interesting to note that the number of fillings done in children (age 0-4 inclusive) was 1,154, compared with 345 in the year 1965. This achievement is due to the magnificent work done by our dental auxiliaries. 61 The dental auxiliaries have also in 1966 expanded their dental health education talks to nursery schools; this seems to be showing a healthy response. The need to get many more of the under-five children to receive regular dental treatment and care must be one of our main objectives. It is only by starting at an early age that the importance of good teeth and oral hygiene will be realised. DENTAL SERVICE STATISTICS Sessions (½days) worked 1. Sessions devoted to inspection 83 2. Sessions devoted to dental health education 183 3. Sessions devoted to treatment 2,865 4. Sessions devoted to treatment of mothers and young children 287 Total 3,418 School Dental Inspection 5. Number of pupils first inspected at school 10,070 Number of pupils first inspected at clinic 3,091 Number of pupils found to require treatment 8,749 Number of pupils offered treatment 8,678 Number of pupils re-inspected at school or clinic 693 Number of pupils found to require treatment 413 Treatment 6. Number of pupils actually treated 4,503 7. Number of attendances made 14,370 8. Number of fillings in permanent teeth 8,672 9. Number of fillings in deciduous teeth 4,578 10. Permanent teeth extracted 739 11. Deciduous teeth extracted 2,265 12. General anaesthetics given 1,161 13. Number of pupils x-rayed 246 14. Number of pupils supplied with dentures 10 Orthodontics 15. New cases commenced 100 16. Cases remaining from previous year 63 17. Cases completed 41 18. Cases discontinued 12 19. Number of appliances fitted 128 20. Pupils referred to hospital consultant 28 62 63 MATERNITY AND CHILD WELFARE DENTAL TREATMENT Expectant and Nursing Mothers Children under 5 years Numbers of Cases 1. Number of persons examined 46 461 2. Number of persons treated 35 351 Treatment Provided 3. Scalinge and other prophylaxis 18 164 4. Fillings 131 1,154 5. Teeth otherwise conserved - 178 6. Crowns and inlays 1 - 7. Extractions 105 123 8. General anaesthetice 19 64 9. Dentures provided 22 - 10. Patients X-rayed 10 6 REPORT OF THE CHIEF POBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRICT (a) Nature and number of visits:- Rent Act 172 Housing and Public Health Acts: Dwelling houses 6,668 Other premises 1,290 Overcrowding and housing applications 66 Improvement grants 568 Multiple occupation 95 Bakehouses and bakers shops 77 Milkshops and dairies 146 Foodshops, stalls and itinerant vendors 1,742 Cafes and canteens 515 School kitchens and feeding centres 168 Infectious disease enquiries 1,464 Foster mothers' premises 11 Number of complaints investigated 2,571 Noise nuisance 124 Clean Air Acts Survey 141 Other inspections 2,929 Factories 660 Offices, Shops and Railway Premises Act 1,788 Rag Flock and Other Filling Materials Act 7 Tents, vans and sheds 333 Pet shops 33 Hairdressers 97 Ice cream premises and vehicles 269 Houses disinfested 43 Rodent control 1,997 Other visits 3,182 (b) Notices served: Complied with: Statutory 153 147 Informal 1,232 998 WATER The water supply 6till continues to be satisfactory both in quality and quantity. During the year, 6 chemical and 27 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 once again 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:- 64 Length of Mains Diameter Yards 114 3" 452 4" 297 6" 168 12" 497 supplies were afforded to houses. 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 8,152 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 drainage systems of the borough are functioning reasonably well, although the capacity at times of peak flow is somewhat inadequate. The proposals for major improvements to the Dagenham trunk foul sewers are at present awaiting approval from the Ministry of Housing and Local Government. Investigation and design of improvements to the Barking central area drainage are in hand. (b) Sewage Disposal The extensions to the Council's Riverside Sewage Works are proceeding within the programme and it is anticipated that the standard of effluent will improve as new sections are commissioned. The programmed completion of the works is 1968. PUBLIC SWIMMING BATHS There are three open air and one indoor public swimming pools in the borough. In addition there is a pool at the Regional College of Technology and four of the schools have their own small pools. All swimming pools take their water from the mains of the South Essex Waterworks Company. 65 Regular samples have been taken during the year and apart from some slight occasional trouble at the small school pools, which has soon been corrected, all results were satisfactory. HOUSING Slum Clearance During the year the major work was again carried out in the Gascoigne Area and it is interesting to watch the face of the district gradually changing. A Public Inquiry concerning a further section comprising 71 properties in the Gascoigne scheme was held. Eight of the ten objections received related to shop-dwellings. Although these premises had been used for business purposes for many years the Minister considered they had retained their identity as dwelling houses, and whilst he agreed they were unfit for human habitation, in view of the substantial businesses that had been established he would not agree to their demolition and suggested that Closing Orders be made on the living accommodations which could ultimately be used for storage purposes. This action was carried out. Rent Act. 1957 25 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 13 properties. Six Certificates of Disrepair were issued and four 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 During the year, 9 discretionary grants and 78 standard grants were approved. The co-operation which we have always enjoyed with the other members of the Council's staff in the discharge of the provisions relating to grants has continued, and now that there are numerous actual examples of what can be done and the help that can be obtained, the whole scheme is rapidly expanding; in fact, the difficulty is to find firms who are willing and able to undertake the work and so, of course, the general trend is for prices to rise. The whole question of cost is often the deciding factor, both for tenants and owners, and the higher the cost the less likelihood of improvements being carried out. My doubts regarding the value of improvement areas have, apparently, been well founded. These no longer appear to be held in the high regard they were. There is no doubt in my mind that our own "postal survey" method has all the advantages without any of the disadvantages of an ordinary improvement area. Houses in Multiple Occupation 95 visits were paid to these properties during the year. It is at tines such as these that one is glad there are very few properties in this borough that lend themselves to this form of occupation, hence the comparative smallnesa of our problem. 66 There are no common lodging houses in the borough. Tents, Vans and Sheds While I appreciate the Central Government'e efforts to solve the question of "travellers", I do not think this will overcome the problem, although I hope it does. Genuine gipsies welcome a place to winter-in after the seasonal fruit picking, etc., but 1 have grave doubts about the rest. Sites are becoming increasingly hard to find and the borough has kept reasonably clear of vans, but this condition has only been achieved as a result of 333 visits made by my staff. This is time that, with a depleted staff, we can ill-afford to spend on duties of this nature. LAUNDRY SERVICE This service has now been reduced to a once weekly collection. The hospital and laundry were rebuilt, and due to pressure of work this necessitated a reduction in the service allowed to this department. The staff have continued to be most helpful and co-operative in making this service satisfactory. An average of 51 cases use the service at any one time. ATMOSPHERIC POLLUTION The position as to smoke control areas has not changed from last year. Due to the financial crisis the Council felt that the extension of smoke control areas in the borough must be deferred. It is to be hoped that by next year the economic situation will have improved and the extension of this most important work may proceed. The present position is as follows:- 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 67 Barking (continued) Order No. No. of Houses Date of Operation 9 589 1st July, 1966 10 1,337 (L.C.C. Estate) 1st July, 1966 11 1,976 1st November, 1966 This means that 42,594 houses out of a total of 55,013 houses In the boroug are now within smoke control areas. Industry, however, has continued to play its part in the general improvement. The Council take part in the National Survey on Air Pollution and continue to take readings at the eight stations in the borough. The readings aire transmitted to the Ministry for their use. These readings, particularly over short periods, cause some confusion; however, we are assured by the Ministry that to appreciate the trends in level of pollution, periods of even up to 20 years must be considered. NOISE ABATEMENT ACT. I960 In spite of all the technological advances that have been made, the positioi regarding noise has not changed as far as nuisance is concerned; we are no closer now to relating noise to nuisance than ever we were. One's interest in the source of the noise has a tremendous influence on personal reactions and no two people'8 reactions are the same. However, we continue to endeavour to make conditions more acceptable when people feel the noise is excessive. RAG FLOCK AND OTHER FILLING MATERIALS ACT. 1951 There is still only one premises in the borough registered under Section 2 of the Act. Samples, however, continue to be taken from the premises where fillings cure made and used. The details are as follows:- Material Number of Samples Submitted for Analysis Cotton Felt 2 Kapok 1 Sisal 1 PET ANIMALS ACT. 1951 12 licences were issued to chese premises during the year; the extent of their livestock is very small. No breaches of the licensing conditions occurred during the year. PREVENTION OF DAMAGE BY PESTS ACT. 1949 The situation during this year is comparable with last year from an infestation point of view. A test baiting of sewers in the west end of the borough revealed no infestation. Consequently it was decided not to have the sewers 68 baited by contractors as in previous years. RIDING ESTABLISHMENTS ACT. 1939 The two riding establishments, one at the east and the other at the weBt end of the borough, continue to operate and the staff of the Corporation of London who administer this Act on our behalf are satisfied with the manner in which they are run. DISEASES OF ANIMALS ACT. 1950 Again we have had a trouble-free year, and the activities of the Corporation of London officials to whom these duties are delegated, have happily been confined to matters of routine prevention. It has been a pleasure to co-operate with the Corporation officials as occasions arise, and I feel the Council are well served by delegating these duties to such a helpful and capable authority. FACTORIES ACT. 1961 Inspections Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical Power 40 24 2 - Factories with mechanical power 410 638 73 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 40 38 1 - Total 490 700 76 - 69 Defects Found Number of defects Number of Prosecutions Instituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness 5 15 1 - - Overcrowding - - - - - Unreasonable temperature 1 - 1 - - Inadequate ventilation 6 5 - 1 - Ineffective drainage of floor 4 5 _ - _ Sanitary conveniences: Insufficient 5 3 - 1 - Unsuitable or defective 115 84 - 1 - Not separate for sexes - - - - - Other offences 9 4 1 - - 145 116 3 3 - Outwork Number of outworkers in August list 76 Nature of work - Making, etc., wearing apparel. OFFICES. SHOPS AND RAILWAY PREMISES ACT. 1963 During the year, a considerable amount of time was again spent by the Inspectors carrying out the normal duties under this Act. The following statistics indicate the work done by the Public Health Inspectors:- 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 26 197 122 Retail shops 21 890 541 Wholesale shops, warehouses 13 38 23 Catering establishments open to the public, 6 90 87 Fuel storage depots - 3 2 70 Class of workplace Number of persons employed Offices 2,513 Retail shops 4,449 Wholesale departments, warehouses 364 Catering establishments open to the public, canteen 865 Fuel storage depots 10 Total 8,201 Total Males 3,849 Total Females 4,352 During this period, 24 notifications of minor accidents were received in respect of employees. One of these notifications was in respect of a 15 year oli youth who was employed in a local butcher's shop; he cut the fingers of his lef hand whilst cleaning the blade of a slicing machine. Under the provisions of this Act it is an offence to allow a person under 18 years of age to clean machinery if there is danger of injury from moving parts. A successful prosecution was taken in respect of this case. INSPECTION AND SUPERVISION OF FOOD The number and types of food premises in the borough are as follows 4 Bakehouses 43 Bakers and Confectioners 87 Butchers 130 Cafes and Canteens 42 Fishmongers 76 Fruiterers and Greengrocers 148 Grocers 73 Licensed and off-licensed premises 9 Public Houses with Restaurants 138 Sweets, etc. All these premises are regularly inspected and during the year 3,441 visits were made. In addition to verbal warnings and suggestions to managements and staff during the routine visits, 150 informal notices were served upon the owners and occupiers. 152 inspections were carried out in connection with itinerant vendors and stalls, and 23 informal notices vere served. The position under the Foo'i and Drugs Act, 1955, apart from registrations in respect of ice cream, is as follows 70 butchers' premises and 18 other food premises aire registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 462 visits were paid. 34 fish shops are registered for frying. To these 261 visits were paid. 71 Milk All milk which is distributed in the area is produced and bottled outside the borough. The number of registered distributors is 79 operating from 116 premises. 147 visits were paid to dairies and distributors' premises. The following samples were submitted for bacteriological examination during the ye&r:- Designation of Milk Total Samples Submitted Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 76 74 2* - void 74 - - - Sterilised 26 - - - - 26 - Channel Island Pasteurised 11 11 - 11 - - - •These two samples were rendered 'void' because the shade temperature at the time exceeded the permissible maximum of 65°F. Three samples of pasteurised milk included above were taken from milk vendin, machines. Ice Cream The total number of registered premises selling ice cream is 237• Of this two are registered for the manufacture of ice cream. 213 visits were paid to these premises. During the year, two applications for the storage and sale of ice cream were granted. 56 inspections in connection with itinerant vendors were carried out. During the year 137 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 37 2 8 1 48 Loose Ice Cream 39 6 5 2 52 Soft Ice Cream 19 13 2 3 37 In addition to ice cream, 25 lollies were submitted for examination. All were satisfactory. We still get some Qrade IV results but as has been previously explained the tests used are admitted to have many shortcomings, and results, in addition to naturally being influenced by the presence of bacteria, are also affected by sonw ingredients, flavourings, etc., so an overall assessment has to be made which is not always a very easy task, particularly as the majority are obtained from itinerant vendors operating from outside the borough. Pnsound Food The odd cases of food not of the "nature, substance and quality" demanded are still being received, but when one realises the tremendous increase in food packaging that has taken place these last few years and that food is now bought virtually "on trust", I feel the overall standard is a satisfactory reflection on the efforts of the manufacturers to provide foodstuffs in the manner required by the present-day populace. 72 During the year, the Committee considered 29 complaints concerning unsound food bought by residents. 14 warning letters were sent and 12 prosecutions taken. In three cases no action was possible. Registration of Food Hawkers Under the provisions of the Essex County Council Act, 1932, 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. typhlmurium - - - - Other Salmonellae - - - 3 - Cl. welchii - - - - - Staph. aureus - - - - - Other causes - - - - Cause unknown - - - - - Total - - - 3 - Details of Food Poisoning due to Salmonellae other than S. Typhlmurium Type of Salmonellae "Chester" 3 The first of these three cases was a 14 month old baby who was ill on the boat from Australia, the other cases being her mother, and grandmother with whom they were staying. Food and Drugs - Sampling Article Number Examined Number Adulterated Formal Informal Formal -Informal Baby Foods _ 5 - 1 Beef Dinner - Frozen - 1 - - Beef and Ham Burgers - Frozen 1 5 - - Beverages - 7 - - Biscuits - 9 • - Bread - 8 - 7 Cake Decorations - 2 - 73 Food and Drugs - Sampling (continued) Article Number Examined Number Adulterated Formal Informal Formal Informal Cereals 4 5 _ _ Cheese - 5 - - Cockles - cooked - 1 - - Confectionery - 13 - 1 Condiments - 6 • • Cream - 7 - - Cream-synthetic - 1 - - custard Powder - 4 _ - Desiccated coconut - 2 - - Fats 3 7 _ - Fish - tinned - 7 - _ Flavourings - 5 - - Flour 2 1 _ - Fruit - dried - 4 - - Fruit - fresh - 1 - - Fruit - tinned - 6 - 2 Fruit Drinks, Cordials, etc. 3 19 1 1 Fruit Pies, etc - 3 - - Gravy - 3 - - Herbs - 1 _ _ Jelly - 3 - - Ice Cream - 7 - _ Ice cream powder _ 1 _ — Ice Lollies _ 1 — _ Macaroni in cheese sauce - 4 - _ Meat - tinned 1 11 - 2 Meat - 10 - 2 Medicinal Samples - 11 • _ Milk 3 4 - 1 Milk - condensed - 1 - _ Milk - Powder 1 - - _ Milk Pudding - tinned - 1 - - Nuts 1 3 1 _ Pastes _ 7 _ _ Preserves 1 6 _ 1 Puddings - 6 - _ Sausages 8 3 2 - Sauces _ 4 _ _ Soups - 3 - - Steak and Kidney Pies and 1 4 - - Sweets _ 17 _ _ Sugar _ 1 _ _ Tomato puree _ 1 _ 1 Uncooked Prepared Foods _ 3 _ _ Vegetables 1 5 — 1 Wines and Spirits 5 - - - 74 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 1562A Lamb Chop Informal Contained foreign matter in the form of fine sawdust. Warning letter to Retailer. 1565A Tomato Puree Informal Copper (expressed on dried solids) 165 p.p.m. 65% above recommended limit. Warning letter to Importers. 1585A Slice of Bread Informal Contained a pellet of rodent excreta. Legal proceedings. Fined £10 and 5 gns. costs. 1586A Large White Loaf Informal Contained a used cigarette filter tip cut in two. Legal proceedings. £15 and 5 gns. costs. 1589A Lean Mince Informal Fat ... 20-5&. Proportion of fat high for Lean Mince. No action possible. 1621A Devon Round Informal Contained a piece of white translucent plastic material weighing 224 milligrams. Legal proceedings. £10 and 5 gns. costs. 1636A Cherry and Brandy Preserve Informal Alcohol (Proof Spirit) 1.8% The presence of Brandy was apparent in the smell and the taste of the preserve. Manufacturer altering labels to "Cherry with Brandy Preserve." 1658A Grapefruit Segments Informal Label stated "Grapefruit Segments" whereas they were "Grapefruit Segments in Syrup." Importers warned. 1704A Steak Informal Contaminated with traces of copper. No action. 1729A Roll Informal Egg filling in state of decomposition. Legal proceedings. £10 and 5 gns. costs. 1731A Baby Food Informal The can had a slit in the side which allowed the access of air which caused mould growth. Warning letter to distributor. 1737A Dried Peas Informal Label incorrect; should indicate that packet consisted of dried peas or dehydrated peas. Future labels to be amended. 75 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 1740A Empty Milk Bottle Informal Contained a film of mould growth. Warning Letter. 1741A Six Bread Rolls Informal In a mouldy condition. Legal proceedings. Manufacturer and retailer fined £5 and 17/6d. costs each. 1744A Brown Loaf Informal Contained a small quantity of discoloured dough. Warning letter to Manufacturers. 1742A Brown Loaf Informal Small area of mould growth on two slices. No action. 1771A Lemonade Informal Contained mould growth. Warning letter to Manufacturers. 1772A Cherries Informal Can had a hole approx. 2mm x 3 mm which had caused deterioration of the contents. Warning letter to Manufacturers. 1791A Salad Roll Informal Contained a dead earthworm. Legal proceedings. 1815A Corned Beef Informal Contained iron and calcium salts together with waxy matter. Referred to Wholesalers. 102 Pork Sausages Formal Meat 62$, therefore slightly deficient in respect of meat content. No action. 103 NRG Blackcurrant Health Drink Formal Misdescribed as "Pure Blackcurrant." Contained only 15$ of fruit juice, therefore claim that it contained more fruit juice than Ribena not justified. Warning letter to Retailer. 20 New Season's Walnuts Formal Some of the nuts in a mouldy condition. Referred to Importers and Country of origin. 105 Pork Sausages Formal Meat 57%. 12% deficient in meat. Legal proceedings. Defendant given an absolute discharge. Costs refused. 76 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 _ 3 1 4 18 38 11 4 - 79 Whooping Cough 8 13 19 12 11 31 4 - 1 99 Measles 33 102 137 131 143 417 61 11 4 1,039 Diphtheria - - - - - - - - - - Dysentery - 1 1 - - 5 - - 3 10 Acute Poliomyelitis: Paralytic - - - - - - - - - - Non-paralytic - - - - - - - - - - Meningococcal infection 1 - 1 - - - - - - 2 Under 5 yrs 5-14 15 - 44 45 - 64 65 and over Total Pneumonia: Acute Primary - 1 1 - - 2 Acute Influenzal - - - 1 3 4 Encephalitis, Acute: Infective - - - - - - Post Infectious - 1 - - - 1 Erysipelas - - - 5 1 6 Food Poisoning 1 - 1 1 - 3 Puerperal Pyrexia - - - - - - Ophthalmia Neonatorum - 2 - - - 2 Paratyphoid B - - 1 - - 1 Typhoid - - - - - - Smallpox - - - - - - Notified Admitted to Rush Green Hospital Admitted to other Isolation Hospitals Admitted to other Hospitals Dysentery 10 _ - - Encephalitis, Acute: Infective - - — _ Post Infectious 1 1 - - Erysipelas 6 - - — Food Poisoning 3 - - - Measles 1,039 4 - 2 Meningococcal Infection 2 1 - - Paratyphoid Fever 1 - - 1 Puerperal Pyrexia - - - - Pneumonia: Acute Primary 2 - - - Acute Influenzal 4 - - - Acute Poliomyelitis: Paralytic - - - - Non-paralytic - - - - Scarlet Fever 71 - - - Typhoid - - _ _ Whooping Cough 99 2 - - 77 iw5-