I. BARK 61 LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1967 J. ADRIAN GILLET, m.b., ch.b., d.p.h., f.r.s.h. Civic Centre, Dagenham, Essex Telephone: 01-592 4500 BARK 61 LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1967 J. ADRIAN GILLET, m.b., Ch.b., d.p.h., f.r.s.h. Civic Centre, Dagenham, Essex Telephone: 01-592 4500 INDEX Page Adolescent Clinic 53 Adult Training Centre 45 Ante-natal Clinics 22 "At Risk" Register 31 Atmospheric Pollution 68 Barking Hospital 65 Bentry School 58 Care of Mothers and Young Children 22 Child Guidance 52 Children's Department 29 Chiropody 36 Civil Defence 46 Congenital Abnormalities, Incidence of 6l Convalescence 47 Council, Members of 3 Cytology Service 27 Day Centre for the Mentally ill 80 Day Nurseries 24 Deaths, Causes of 17 Dental Services 62 Diseases of Animals Act 1950 70 Domestic Help 46 Education Committee 4 Education (Special Services) Sub-Committee 5 Enuresis Clinic 54 Factories Act 1961 70 Faircross School 58 Food and Drugs, Sampling 75 Food Hawkers, Registration 74 Food, Inspection and Supervision 72 Food Poisoning 74 Food, Unsound 73 Geriatric Liaison Officer 33 Handicapped Children 58 Health Committee 4 Health Education 19 Health Visiting 8 Home Nursing Service 2 Housing 67 Houses in Multiple Occupation 68 Hypothermia, Accidental 34 Ice Cream 73 Immigrants 8 Immunisation 29 Improvement Grants 68 Infant Mortality 16 Infant Welfare Centres 23 Infectious Diseases 79 Page Junior Training Centre, Castle School 40 Kingsley Hall Day Centre 27 Laundry Service 68 Maternity Services 22 Medical Examination of Staff 39 Mental Health 40 Midwifery Service (domiciliary) 22 Minor Ailments Clinics 48 Milk 73 National Assistance Act 1948 35 Noise Abatement Act 1960 69 Offices, Shops and Railway Premises Act 1963 71 Orthopaedic Clinic 52 Over Sixties Clinic, Oxlow Lane 33 Pesticides in Food Survey 74 Pet Animals Act 1951 69 Play Therapy 26 Prevention of Damage by Pests Act 1949 69 Public Swimming Baths 67 Rag Flock and Other Filling Materials Act 1951 69 Rehousing on Medical Grounds 39 Rent Act 1957 68 Riding Establishments Act 1939 70 Sanitary Inspection of District 66 School Health 48 School Meals Service Staff, Medical Invigilation of 48 Selective School Medical Examinations 48 Sewerage and Sewage Disposal 67 Sickroom Equipment 33 Slum Clearance 67 Smoke Control Areas 68 Speech Therapy 55 Staff 6 Tents, Vans and Sheds 68 Tuberculosis 35 Unmarried Mother, Care of 23 Vaccination 29 Vital Statistics 16 Water 66 2 MEMBERS OF THE COUNCIL (as at 31st December, 1967) MAYOR Councillor W. G. NOYCE, J.P. DEPUTY MAYOR Alderman A. E. BALL, O.B.E., J.P. ALDERMEN W. E. BELLAMY, J.P. B. E. ROYCRAFT, J.P., G.L.C. G. H. A. CROUCH J. R. SWEETLAND Mrs. A. M. MARTIN Mrs. A. R. THOMAS D. O'DWYER, K.S.G. COUNCILLORS C. H. AYRES J. H. LAWRENCA C. E. AYRTON DANIEL LINEHAN Mrs. M. BALL, O.B.E., G.L.C. DAVID LINEHAN G. J. G. BEANE, J.P. E. R. McKEE R. BLACKBURN, J.P. W. MILNE Mrs. M. BREDO J. P. MOORE J. A. BUTLER, J.P. R. W. MUGE H. J. CLEAVER H. A. POWELL S. G. COLE Mrs. M. S. PRESTON L. A. COLLINS A. C. V. RUSHA D. A. L. G. DODD, J.P. L. SENIOR F. C. EDGECOMBE S. C. SIVELL, J.P. Mrs. C. S. M. GODFREY, J.P. M. J. SPENCER R. H. F. GODFREY F. C. SPRAGGINS D. 0. GRANDISON J. S. THOMAS, J.P. L. F. HENSTOCK, J.P. F. G. TIBBLE H. J. HOWIE L. W. TODD C. W. JILLINGS J. B. WARD, J.P. Mrs. D. M. JONES S. J. WARR F. C. JONES Mrs. M. A. WARREN H. R. JONES D. J. WATERS J. L. JONES, J.P. D. W. WEBB H. P. LARKING E. J. WOODS 3 HEALTH COMMITTEE (as at 31st December 1967) CHAIRMAN Councillor Mrs. M. Ball VICE-CHAIRMAN Councillor Mrs. D. M. Jones MEMBERS His Worship the Mayor Councillor E. R. McKEE The Deputy Mayor Councillor R. W. HUGE Alderman D. O'DWYER Councillor Mrs. M. PRESTON Alderman J. R. SWEETLAND Councillor F. C. SPRAGGINS Alderman Mrs. A. R. THOMAS Councillor F. G. TIBBLE Councillor Mrs. C. S. M. GODFREY Councillor S. J. WARR Councillor H. R. JONES Councillor D. J. WATERS CO-OPTED MEMBERS Councillor Mrs. M. BREDO Dr. M. LEWIS Mrs. D. M. GLENNY EDUCATION COMMITTEE (as at 31st December 1967) CHAIRMAN Councillor G. J. G. BEANE VICE-CHAIRMAN Councillor A. C. V. RUSHA REPRESENTATIVE MEMBERS His Worship the Mayor Councillor D. 0. GRANDISON Alderman A. E. BALL Councillor L. F. HENSTOCK Alderman W. E. BELLAMY Councillor C. W. JILLINGS Alderman Mrs. A. MARTIN Councillor Mrs. D. M. JONES Alderman D. O'DWYER Councillor F. C. JONES Alderman J. R. SWEETLAND Councillor Daniel LINEHAN Councillor Mrs. M. BALL Councillor David LINEHAN Councillor R. BLACKBURN Councillor Mrs. M. S. PRESTON Councillor Mrs. M. BREDO Councillor L. SENIOR Councillor J. A. BUTLER Councillor S. C. SIVELL Councillor S. G. COLE Councillor Mrs. M. A. WARREN Councillor L. A. COLLINS Councillor D. J. WATERS Councillor D. A. L. G. DODD Councillor D. W. WEBB Councillor Mrs. C. S. M. GODFREY Councillor E. J. WOODS Councillor R. H. F. GODFREY CO-OPTED AND NOMINATED MEMBERS Mrs. I. M. BROCKELBANK The Rev. Louis HESTON Mr. J. H. COCKS Mr. F. H. KING Mr. J. M. DAVIES Mr. A. RICHARDS Mr. P. GRIMES Mr. S. J. RUSSELL Miss M. C. GROBEL, M.A. The Rev. J. W. ROXBURGH Mr. E. E. HENNEM 4 EDUCATION SPECIAL SERVICES SUB-COMMITTEE (as at 31st December 1967) (This Sub-Committee deals, inter alia, with the School Health Service) CHAIRMAN Councillor G. J. G. BEANE MEMBERS Alderman Mrs. A. MARTIN Councillor A. C. V. RUSHA Councillor Mrs. M. BREDO Councillor L. SENIOR Councillor L. A. COLLINS Councillor Mrs. M. A. WARREN Councillor Mrs. C. S. M. GODFREY Councillor D. J. WATERS Councillor D. 0. GRANDISON Mrs. I. M. BROCKELBANK Councillor Mrs. M. S. PRESTON Rev. Louis HESTON 5 OFFICERS OF THE HEALTH SERVICE (as at 31st December 1967) 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. R. Beaver, M.B., B.S., D.C.H., D.P.H. SENIOR ASSISTANT MEDICAL OFFICERS E. Klein, M.D., L.R.C.P. & S. M. Weizmann, M.R.C.S., L.R.C.P. ASSISTANT MEDICAL OFFICERS D. Burgess, M.D. S. N. Jazeel, M.B., B.S., D.C.H. K. Fitzpatrick, M.B., Ch.B. G. Michael, M. R.C.S., L.R.C.P., B.J In addition 9 medical officers are employed on a sessional basis. PRINCIPAL DENTAL OFFICER J. K. Whitelaw, L.D.S., R.C.S. SENIOR DENTAL OFFICER P. K. Chaudhury, L.D.S., R.C.S. DENTAL OFFICERS V. H. Foy, L.D.S., R.C.S. C. Sumsawaste, L.D.S., R.C.S. N. J. Graham, L.D.S., R.C.S. In addition 2 dental officers are employed on a sessional basis. SENIOR DENTAL SURGERY ASSISTANT Mrs. F. B. Sadler (23) DENTAL SURGERY ASSISTANTS Mr8. M. Brideson Mrs. I. A. Rourke Mrs. G. Lynch Miss M. Sealey Mrs. K. E. McKenzie Mrs. M. Strachan (9) Mrs. D. Murray (23) Mrs. P. Strickland (part-time) DENTAL AUXILIARIES Mrs. J. Nagel (24) Miss S. D. Ware (24) SENIOR DENTAL TECHNICIAN-IN-CHARGE Mr. J. Constable 6 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 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 Mrs. S. L. Bradley (5), (6), (21), (32) Miss P. Lowery (5) Mrs. P. M. Clancy (5), (21) Miss D. Meek (5), (6), (21) Mrs. J. M. Cotterill (5) Miss K. M. MoLL erup-Peterson (5), (21) Mrs. Y. A. Dignura (5), (21) Miss N. Norris (5), (6), (21) Miss M. D. Ellis (5), (20), (21) Miss T. O'Kelly (5) Mrs. J. M. Findlay (5) Mrs. M. O'Riordan (5), (8), (21) Mr. D. V. Goodman (5), (21) Mrs. M. Pront (5) Mrs. A. Hayden (5), (21) Miss R. Richards (5), (6), (21) Mrs. G. A. Headley (5), (8), (21) Miss J. Smith (5), (6), (21) Miss J. R. Heath (5) Miss J. Smith (5), (9), (21) Mrs. A. L. Hillas (5), (21) Mr. R. J. Turpin (5), (21) Mrs. D. J. Kitchen (5), (6), (21) Mrs. J. E. Walsh (5) Mr. R. D. Lintott (5), (16), (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 NURSE Mrs. E. McCallum (5) 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 C. Rafferty (5), (6) Mies A. Cunningham (6) Miss H. V. Rungay (5), (6) Miss S. W. Etherton (5), (6), (14) Miss P. R. Shackleton (5), (6), (9) Miss M. Hall (5), (6) Mrs. P. M. Shardlow (5), (6) Miss D. Hearsey (5), (6) Mrs. P. Vanbrook (5), (6) Mrs. N. Lewis (5), (6), (10) Miss M. Walker (5), (6) SUPERINTENDENT HEALTH VISITOR Miss B. Long (5), (6), (7), (22) DEPUTY SUPERINTENDS HEALTH VISITOR Mrs. C. C. Ledden (5), (6), (7), (21) 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. J. O'Brien (5), (7) Mrs. M. F. Bass (5), (6), (7) Miss O. Ologunro (5), (6), (7) Miss A. E. Boorman (5), (6). (7), (21) Miss E. G. Parry (5), (6), (7) Miss J. M. Cottle (5), (7), (8) Mrs. H. V. Reeder (5), (7) Mrs. L. Dunbar (5), (6), (7) Mrs. R. L. Robertson (5), (6), (7), (12) Miss R. Hutchinson (5), (6), (7), (21) Miss D. B. Rudd (5), (6), (7) Miss J. D. Jarvis (5), (6), (7) Miss M. F. Savage (5), (6), (7), (TO Miss P. I. Jefford (5), (6), (7) Mrs. F. M. Stuart (5), (6), (7) Mrs. E. P. Kenny (5), (6), (7), (13) Mrs. A. Ward (5), (7), (31) Mrs. E. Lyon (5), (6), (7), (21) Miss M. D. Wint (5), (6), (7) HEALTH VISITOR (part-time) Mrs. M. Nelson (5), (6), (7) SPONSORED STUDENT HEALTH VISITORS Mrs. H. J. Harris (5), (8) Mrs. M. M. Miller (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. M. A. Pearce (5), (8) Mrs. E. G. Frisby (5) Mrs. E. M. Robinson (5) Miss P. A. Hayes (5), (31) Mrs. M. Warner (20) Mrs. A. Noden (5), (14) CLINIC NURSES (part-time) Mrs. S. J. Browne (9) Mrs. S. Henderson (5), (12) Mrs. R. K. D. Clark (5), (8) Mrs. D. G. L. Jarvis (5) Mrs. I. M. Collingwood (5) Mrs. A. M. Marsh (5), (6) Mrs. B. Cullum (5) Mrs. M. E. Montgomery (5) Mrs. M. Halligan (5), (6), (12) Mrs. G. Pratt (5) 8 SPEECH THERAPISTS Miss C. J. Delaforce (18) Miss E. N. Symes (18), (19) ASSISTANT SPEECH THERAPIST (part-time) Miss S. Marquand (18a) PHYSIOTHERAPIST Mrs. A. Walker (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. E. Dransfield (11) Mr. H. Stenson (11) Mr. N. Freeman (11) DOMICILIARY CHIROPODIST Mrs. E. V. Morgan (11) CHIROPODISTS (part-time) Mrs. E. A. Barber (11) Mr. P. Freel (11) Mr. R. H. Fenton (11) TRAINING CENTRES Castle School and Training Centre, Supervisor: Mrs. M. A. Washer (28), (33), Ripple Road, (34) Dagenham, Essex. Adult Training Centre, ) Manager: Mr. W. Matthews (28) Osborne Square, ) Dagenham, Essex. ) Senior Gale Street Annexe ) Instructor: Mr. C. Dodd DAY NURSERIES, etc. Goresbrook Day Nursery, Matron: Mrs. E. Maddison (5), (12) Dagenham Avenue, Dagenham, Essex. Deputy: Miss A. B. Cunningham (14) Annie Prendergast Day Nursery, Matron: Mrs. P. A. Ardley (14) Ashton Gardens, Chadwell Heath, Deputy: Mrs. G. M. Maddison (14), (17) Romford, Essex. Eastbury Day Nursery, Matron: Miss F. B. Nason (5), (6), Blake Avenue, (12), (19), (35) Barking, Essex. Deputy: Mrs. B. A. Bell (5) Kingsley Hall Day Centre for Sister-in-Charge: Mrs. K.I.Daly (5), (6), (20) Handicapped Children, Hobart Road, Dagenham, Essex. 9 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 Mr. J. Byrne (5), (10) Miss E. J. Sleigh (27) Mr. S. Ruchpaul (5), (10) Mr. G. R. Welsh (10) HEALTH EDUCATION OFFICER Mr. G. S. Self (1), (2),(4) ASSISTANT HEALTH EDUCATION OFFICER Miss n. Milbank (5), (6), (7), (20), (21), (25) PROJECTIONIST/TECHNICIAN Mr. A. Phillips 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. J. Pitt Staffing and Management Mrs. J. B. Smith Finance, Supplies, etc. Mr. A. G. Stevenson Maternal and Child Health MEDICAL OFFICER OF HEALTH'S SECRETARY Miss E. S. Bell SECTION CLERICAL STAFF Vaccination and Immunisation Mrs. M. King Miss B. M. Slater Environmental Miss L. J. Ellis Miss N. M. Toms Mrs. J. W. Morgan Miss B. Wells Mrs. J. Phillips Care and After Care Mrs. J. E. Barnes 10 Staffing and Management Miss M. Middleton Mrs. I. M. h. Dupree Mrs. P. McMillan Miss K. M. Read Mr. A. R. Moss Mrs. I. E. Smith Miss J. A. Stroud Finance. Supplies, etc. Mrs. G. Anger Mrs. C. E. Smythe Miss V. E. Cheal Mr. D. E. Ward Maternal and Child Health Miss E. A. Adams Mrs. E. J. Neport Miss E. D. Brown Mrs. E. Nottage Miss N. E. Cloke Mrs.S. B. Orme Mrs. P. M. Collins Mrs. I. A. Page Mrs. K. M. Conroy Miss M. A. Rhodes Miss V. N. Davies Miss K. Richards Miss A. C. Davies Mrs. G. K. Shannon Miss R. Drake Miss D. Tilson Mrs. D. Ellis Miss M. A. Watts Mrs. D. G. Green Mrs. D. Wilkins Miss C. A. Lincoln Part-time Mrs. K. Bird Mrs. S. Hopson Mrs. M. Edwards Mrs. M. Lodge Mrs. E. Harsent Mrs. J. E. Schofield ADMINISTRATIVE TRAINEE Mr. R. G. James DOMESTIC HELP SERVICE Senior Organiser: Mrs. L. Everitt Organisers: Miss J. M. Pemberton Mrs. G. Sanger Assistant Organisers: Mrs. p. M. Archer Mrs. P. M. Sinclair Clerical Assistant: Miss J. F. Baxter geriatric liaison officer Mrs. J. M. Harrold (5), (12). 11 REGIONAL HOSPITAL BOARD OFFICERS 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 PSYCHIATRISTS E. Danos, M.R.C.S., L.R.C.P., D.P.M., D.C.H. K. R. Masani, M.R.C.S., L.R.C.P., D.P.M. J. D. Waldman, M.B., B.Ch. EAR, NOSE AND THROAT SURGEON Miss M. Mason, F.R.C.S. PHYSIOTHERAPIST Mrs. E. Ottley, M.C.S.P. PUBLIC ANALYST J. Hubert Hammence, Ph.D., M.Sc., F.R.I. C. 12 QUALIFICATIONS (1) Certificate of Royal Sanitary Institute (2) Heat 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 (31) Obstetric Nurse Training Course (32) State Enrolled Assistant Nurse Certificate (Tropical Nursing), Malaysia (33) Margaret Morris Movement Diploma (33) Montessori Method of Education Diploma (35) Housekeeping Certificate 13 Health Department, Civic Centre, Dagenham. To: THE MAYOR, ALDERMEN AND BURGESSES OF THE LONDON BOROUGH OF BARKING. This report covers the second full year of the new London Borough of Barking. So many changes took place during the year and so much progress was made that I can only draw attention to some of the main features in this short introduction. Those interested in more detail will find it in the main body of the report. It is never very difficult to put forward innumerable projects which would make for progress in a service-especially if the service includes Preventive Medicine. Unfortunately, there must always be the limiting factors of finance and of manpower which must of necessity slow down progress in many directions desirable as it might appear to be. This means selecting priorities, never an easy matter. In 1965, the London Borough of Barking selected as one of its major priorities the development of its mental health services. During 1967, progress was made in planning and putting into operation some of the projects in mental health which the Health Committee felt were of major importance. During the year the Porters Avenue Day Centre was opened. This centre was acquired during 1966 and the end of 1967 seems an appropriate time to review the activities carried on there. This will be found in the mental health section of the report, but I would particularly like to draw attention to the transfer of the Westfield Psychiatric Social Club to the Porters Avenue Centre. This club provides a free and easy source of social contact and a link with voluntary activities in the field of mental illness. The maisonette reported on in 1966 proved its value during 1967 in helping towards the rehabilitation of patients. It is hoped to extend and develop this idea. It is particularly pleasing to record the acceptance of the patients by other tenants living in neighbouring flats. Developments in the field of subnormality also took place during the year. Unfortunately, Mrs. Early, Supervisor in charge of the Castle School and the Gale Street annexe for older girls, resigned to take up a teaching appointment at the Chiswick Polytechnic. We wish her well in her new appointment. Following Mrs. Early's resignation, it was decided to place the Gale Street annexe for older girls under the control of Mr. Matthews, Manager of the Adult Training Centre. The new centre scheduled for opening in 1968 was well under way at the end of 1967. Meanwhile, planning for further developments continues and will no doubt form part of the annual report in future years. Health Education must also be one of our major priorities, and here too progress was made during the year; progress, for instance, towards the giving of courses in health instead of sporadic talks on various subjects. Although the Health Education Officer and his assistant are beginning to give their attention more to organisation than to conducting courses themselves, I look forward to the time when their function will be to use their expertise to organise courses carried out by others, to give in-service training to teachers, health visitors and others (teaching the teachers), to assess what needs to be taught to specific groups (by planned surveys into what people really need to learn) and to investigate the results of health education as they relate to both the acquisition of knowledge and to any change in attitude or behaviour resulting from what has been learnt. 14 The appointment of a Geriatric Liaison Officer, mentioned in 1966 as an innovation, has I think proved of value and has improved the already existing good relationship with geriatricians and family doctors. During the year the department took part in a pilot scheme of investigation into the incidence of accidental hypothermia in the elderly and its real significance. The results showed the need for further research. Shortages of staff, e.g. home helps and chiropodists, have unfortunately created problems, and the medico-social assessment centre for the over sixties at Oxlow Lane Clinic was unable to function satisfactorily because of shortage of appropriate medical staff. The school health service received attention during the year. One change was made to bring the service more into line with current practice. Selective medical examination of school leavers was further extended to replace the old routine school examination of every child, which is so uneconomical in terms of medical manpower. In this method of working, only those children are examined who as a result of a questionnaire to parents, or on request by teachers, are found by the school medical officer to need an examination. Linked with periodic screening for defects of hearing and vision, this can be relied on to uncover any important defects in these days when most children are seen much more frequently by their own doctor than used to be the case. Though this new method has not been found to produce a saving in medical manpower, it is hoped to extend it to other age groups because of its effectiveness. The school dental service merits special mention. It too has made steady progress during 1967, and though I must refer to the main body of the report anyone interested in the detail, the use of dental auxiliaries merits special mention. I must finally draw attention to the shortage of health visitors as a serious long-term difficulty which merits a stepping-up of our efforts to recruit students for training and the use of ancilliaries to assist the health visitor in carrying out her functions. Many more developments were in process of planning or were beginning to take place than I have mentioned in this short introduction to the annual report for 1967, most of which will be contained in the main body of the report. I must in conclusion thank all the staff of the department - medical and lay - for their help during 1967, and the Health Committee its Chairman, Vice-Chairman and Members for their support and co-operation during the year. J. ADRIAN GILLET Medical Officer of Health 15 VITAL STATISTICS 1967 Registrar General's estimate of resident population, mid-year 1967 170,100 Live Births: Legitimate (1,114 male, 1,022 female) 2,136 Illegitimate (91 male, 69 female) 160 Total (1,205 male, 1,091 female) 2,296 Illegitimate live births per cent of total 6.97 Live birth rate per 1,000 population 13.50 Live birth rate adjusted by comparability factor of 1.04 14.04 Stillbirths: Legitimate ( 17 male, 14 female) 31 Illegitimate (-male, 1 female) 1 Total (17 male, 15 female) 32 Stillbirth rate per 1,000 live and stillbirths 13.69 Total live and stillbirths 2,328 Deaths: Infant deaths (under 1 year) (22 male, 23 female) 45 Infant death rate per 1,000 live births 19.6 Legitimate infant death rate per 1,000 legitimate live births (21 male, 20 female) 19.19 Illegitimate infant death rate per 1,000 illegitimate live births (1 male, 3 female) 25.00 Neo-natal mortality rate (deaths under 4 weeks (26) per 1,000 live births) 11.32 Perinatal mortality rate (stillbirths (32) and deaths under one week (25) per 1,000 live and stillbirths) 24.48 Early neo-natal mortality rate (deaths under 1 week per 1,000 live births) 10.89 Maternal mortality (deaths from pregnancy, childbirth, abortion) 1 Maternal mortality rate per 1,000 total births 0.43 General mortality: Number of deaths (985 male, 730 female) 1,715 Death rate per 1,000 population-crude 10.08 Death rate adjusted by comparability factor of 1.33 13.31 The vital statistics for the borough remained substantially the same as in the previous year. The infant death rate was slightly above the national average of 18.3 which is the lowest national rate ever recorded, and the stillbirth rate again showed a welcome fall from 14.27 in 1966 to 13*69 in 1967. I regret to report that one, mother died from causes associated with pregnancy and childbirth during the year. Everything was done to preserve life, and subsequent investigations attributed this death to natural causes. 16 17 Causes of Death, 1967 Under 1 yr. 1 and under 5 yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45 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 - - - - - - - - - - 1 - 4 - 1 - 6 - 2. Tuberculosis, other - - - 1 - - - - - - - - - - - 1 - 2 3. Syphilitic disease - - - - - - - - - - 1 - - - 2 - 3 - 4. Diphtheria - - - - - - - - - - - - - - - - - - 5. Whooping cough - - - - - - - - - - - - - - - - - - 6. Meningococcal infections - - - - - - - - - - - - - - - - - - 7. Acute poliomyelitis - - - - - - - - - - - - - - - - - - 8. Measles - - - 1 - - - - - - - - - - - - - 1 9. Other infective and parasitic diseases - - - - 1 - - - - - 2 - - 1 - - 3 1 10. Malignant neoplasm, stomach - - - - - - - - 1 - 7 10 18 7 6 7 32 24 11. Malignant neoplasm, lung, bronchus - - - - - - - - - - 62 10 38 9 17 3 117 22 12. Malignant neoplasm, breast - - - - - - - - - - - 10 1 9 - 8 1 27 13. Malignant neoplasm, uterus - - - - - - - - - 2 - 6 - 3 - 4 - 15 14. Other malignant and lymphatic neoplasms - 1 1 1 - 1 - - 5 5 53 30 31 29 24 19 114 86 15. Leukaemia, aleukaemia - 1 - - - 1 - - 1 - 2 1 1 2 1 - 5 5 16. Diabetes - - - - - - - - - 1 - 5 2 6 5 6 7 18 17. Vascular lesions of nervous system - - - - - - - - 3 3 21 17 30 27 23 61 77 108 18. Coronary disease, angina - - - - - - - - 5 1 93 16 86 47 53 66 237 130 19. Hypertension with heart disease - - - - - - - - - - 2 1 3 2 2 8 7 11 20. Other heart disease - 1 - - - - 1 - - 1 15 10 19 12 15 31 50 55 21. Other circulatory disease - - - - - - 2 - 1 2 4 4 12 8 13 26 32 40 22. Influenza - - - - - - - - - - - - 1 - - 1 1 1 23. Pneumonia 2 1 - - - - - - 1 1 5 2 10 7 26 18 44 29 24. Bronchitis 3 1 - - - - - - - 2 25 4 46 13 30 12 104 32 25. Other diseases of respiratory system 1 - - - - - - - - - 4 2 9 1 5 3 19 6 26. Ulcer of stomach and duodenum - - - - - - - - 1 - 3 - 4 1 2 3 10 4 27. Gastritis, enteritis and diarrhoea - - - - - - - 1 - - 1 1 1 1 - 3 2 6 28. Nephritis and nephrosis - - - - 1 - - - - - - 2 1 - 1 2 3 4 29. Hyperplasia of prostate - - - - - - - - - - - - 3 - 4 - 7 - 30. Pregnancy, childbirth, abortion - - - - - - - - - 1 - - - - - - - 1 31. Congenital malformations 5 4 - - - - 1 - 2 - - 4 - - - - 8 8 32. Other defined and ill-defined diseases 11 14 - 1 1 - 1 - - 2 15 17 17 23 18 25 63 82 33. Motor vehicle accidents - - 1 - - - 6 - 4 - 1 - 2 - - - 14 - 34. All other accidents - - - - 1 - 3 - 1 - 5 1 - 2 3 5 13 8 35. Suicide - - - - - - 1 - - 1 3 1 1 2 1 - 6 4 36. Homicide and operations of war - - - - - - - - - - - - - - - - - - Total 22 23 2 4 4 2 15 1 25 22 325 154 340 212 252 312 985 730 CAUSES OF INFANT DEATHS Cause of Death Under 4 weeks 4 weeks to 1 year Total Pneumonia 1 2 3 Bronchitis - 4 4 Other Respiratory Disease - 1 1 Malignant Neoplasm - 1 1 Leukaemia - 1 1 Heart Disease - 1 1 Congenital Malformations 5 4 9 Other causes (Prematurity etc.) 20 5 25 Totals 26 19 45 PRINCIPAL CAUSES OF DEATH (all ages) Diseases of heart and circulatory system 562 Cancer and other malignant diseases 448 Pneumonia, bronchitis and other respiratory diseases (excluding tuberculosis) 236 Diseases of the brain and nervous system 185 DEATHS FROM MALIGNANT DISEASES 1967 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 - - - - - - 62 10 38 9 17 3 117 22 Stomach - - - - 1 - 7 10 18 7 6 7 32 24 Breast - - - - - - - 10 1 9 - 8 1 27 Uterus - - - - - 2 - 6 - 3 - 4 - 15 Blood - 2 - - 1 - 2 1 1 2 1 - 5 5 Other 1 3 - - 5 5 53 30 31 29 24 19 114 86 Totals 1 5 - - 7 7 124 67 89 59 48 41 269 179 18 HEALTH EDUCATION The two notable features of 1967 from a health education point of view were an increase in the number of visitors and students, especially from overseas, and a closer liaison with the Education Department in general and the teaching staffs in particular. Although a full establishment of staff was maintained for the whole year (apart from a very short period between the departure of Mr. Cross the Technician/Driver and the arrival of his replacement Mr. Phillips) it was not possible to meet all requests for assistance. As a result, some schools had to be cut down from a weekly programme to a fortnightly one and some cut out altogether. The one item which expanded was in-service training and this was done in the hope that in future years teachers would be able to undertake some of the talks at present dealt with by health staffs. Health Education in Schools Full programmes were provided in ten schools, and short programmes of three or four talks in a further six. In almost every case the talks given by our staff were part of a complete health education programme agreed with the head teacher and integrated into the general curriculum. By this means the teaching staff were able to "follow-up" the health talks and to bring to our notice points which required further elaboration. In many schools considerable flexibility was achieved in health education programmes, topics which the pupils themselves felt to be important being discussed when appropriate. A new child care course for senior girls of lesser academic ability, leading to a basic examination arranged by the National Association for Maternal & Child Welfare was carried out in one school. This was so successful that it is now included in their regular health education programme. Arrangements were made with the head teachers of two other schools for the television programme "Understanding" to be used as the basis of a series of discussions on human relationships. This was a very interesting experiment from the point of view of both pupils and staff. A meeting between head teachers of secondary schools and representatives of the Health and Education Departments was held in October and proved to be very useful. The desire of teachers for more information on the content of modern health education was apparent, and it is hoped in the future to produce some literature on the subject as well as to provide further in-service training. At the request of a school Parent Teacher Association a talk and film show were given on drug dependence. In-Service Training Four courses were arranged during the year, two being on psychology and health education for teachers taking the Post-Graduate Certificate of Education. Another was designed for domestic science and other teachers training students for the G.C.E. '0' level examination in human biology which includes a certain number of health topics. A seminar on drug addiction was held in the Assembly Hall, Barking, where some 200 people including members of the Council, magistrates, probation officers, doctors, teachers, mental welfare officers, health visitors, public health inspectors and some visiting students, listened to a talk by a consultant psychiatrist. 19 Food Hygiene Education Rush Green College was again the main centre of activity in this field, courses for both the Certificate and the Diploma in General Food Hygiene being organised in conjunction with the College staff. These were quite well attended and very satisfactory results were obtained in the examinations. At the request of the Medical Department of Messrs. Fords, three short courses on food handling were given to the canteen staffs in the Engines Division. This was the first occasion on which we have been able to co-operate in this field, and we hope that it will be the fore-runner of other courses in the future. One talk for trainee manageresses in a large multiple bakers and another for school meals supervisors were also arranged. Home Safety The quarterly home safety bulletins inaugurated in 1966 were continued and some requests were received for additional copies. We were representated at the regular meetings of the London Home Safety Council, but pressure of other duties precluded attendance at the annual RoSPA National Home Safety Conference. The majority of the home safety training is done in schools where every programme contains this topic, but a considerable amount of home safety teaching is carried out in the clinics by health visitors in the course of their day-to-day work. Training of Students In January a chief public health inspector from the Sudan was attached to the section for two months' continuous practical training. He was followed in March by two Nigerian students attending the Health Education Diploma Course at London University. Another chief public health inspector from Barbados arrived in September for three weeks. It is always interesting to meet overseas students and to learn of their problems which, in spite of so many differences of climate and environment, are very often closely related to ours. In addition to the visitors from overseas, talks were given to student nurses from Rush Green Hospital and student health visitors from the Barking Regional College. Visitors The health education section also attracts its share of visitors, 2k of whom called during the year. Their places of origin varied from Turkey to Kingston-on-Thames and included a group of six Rotarians from Le Havre who were attending a meeting of the Dagenham Rotary Club. Youth The adolescent clinic at Porters Avenue continued during 1967, the main health education activity being the production of a filmstrip and 16 mm film on teenage behaviour. Apart from this, films and other visual aids were provided for the clinic staff in their talks. Examinations in home safety for young people undertaking the Duke of Edinburgh Award Scheme were continued, a high standard of work generally being produced. 20 Only one talk was given to Youth Clubs during the year, but some help with films and other visual aids was offered to leaders who wished to carry out their own health education projects. There is no doubt that this is an age group to which much health education effort should be directed, but it will be much more effective when the demand comes from the young people themselves rather than from their leaders. Displays and Exhibitions The twin themes for the Health Department stand in the Town Show were mental health and health education the world over. The stand was located in the Municipal Tent where the display shells were professionally constructed. Like last year, this arrangement was much more successful than the system of small individual tents which had been used prior to 1966. The weather was in our favour and a record crowd attended the show. The Municipal Tent with its cool floral display and many other attractions received a fair share of the visitors. At the request of the headmistress, a dental health exhibition was organised in an infants' school to coincide with an open day. Some of the children's work was included, and this added to the popularity of the display. Other Activities In accordance with the previously declared policy of concentrating on courses, only nine individual talks were given to various groups in 1967. These included one on health education to the local branch of the Royal College of Nursing and two on home safety to old people's clubs. During the year, 88 film shows were arranged and presented. 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, 606 mothers attended for ante-natal examination and 76 for post-natal care, compared with 449 and 60 respectively during the previous year. In addition, 1,682 attendances were made at mothercraft and relaxation classes compared with 2,057 in 1966. As foreshadowed in the 1966 report, a review of attendances at ante-natal sessions was undertaken during the year, and some clinic sessions were deleted from the programme. This enabled medical officers to devote more time to the screening of women for cancer (cervical cytology) and to the early detection of deviations from the normal in infants and young children at child development sessions. Ante-natal and Post-natal Clinics Centre Frequency of Sessions When Held Annie Prendergast Clinic, 1st and 3rd in month Wednesday a.m. Ashton Gardens, Chadwell Heath. The Clinic, Weekly Tuesday and Becontree Avenue, Wednesday p.m. Dagenham. Central Clinic, Weekly Wednesday p.m. Vicarage Drive, Barking. The Clinic, Weekly Wednesday p.m. Ford Road, Dagenham. Marks Gate Clinic, 2nd' and 4th in month Wednesday a.m. Lawn Farm Grove, Marks Gate. The Clinic, Weekly Tuesday and Oxlow Lane, Thursday a.m. Dagenham. The Clinic, Weekly Wednesday a.m. Porters Avenue, Dagenham. Julia Engwell Clinic, Weekly Wednesday a.m. Woodward Road, Dagenham. Midwifery Service Unfortunately, three midwives left the Borough during the year. One obtained a post elsewhere in this country, one went to Canada and one left to have her second child. Only one of these midwives was replaced, so leaving the service very depleted. It is hoped to replace the other two midwives in the future, but the main difficulty seems to lie in the fact that living accommodation for midwives is not always readily available. The number of midwives employed at the end of 1967 was 13 including one Non-Medical Supervisor of Midwives and one Assistant Non-Medical Supervisor. 22 Pupil midwives trained during the year numbered 19. Nine trained in the Barking area and were from Barking Hospital. Ten trained at York House and were from Waltham Forest. There was, again unfortunately, very little done by midwives in the way of health talks and ante-natal preparation classes as such. Each midwife talks about health to each individual patient under her care, but it is difficult to establish classes when midwives are in short supply. Only at one midwives clinic were such classes run with the co-operation of the health visitor. Other patients were directed to the ante-natal preparation classes held by health visitors at the various clinics. During the year, midwives attended 532 domiciliary confinements of which 500 had booked their family doctor or G.P. obstetrician. In addition, 841 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 32 cases. Infant Welfare Centres During the year, 6,1^9 children attended the following centres:- Centre Frequency of Sessions When Held Annie Prendergast Clinic, Weekly Wednesday and Ashton Gardens, Thursday p.m. Chadwell Heath. The Clinic, Weekly Monday p.m. Becontree Avenue, Wednesday a.m. Dagenham. Central Clinic, Weekly Tuesday and Vicarage Drive, Thursday p.m. Barking. The Clinic, Weekly Tuesday a.m. Ford Road, Thursday p.m. Dagenham. Greatfields Clinic, Weekly Tuesday p.m. Movers Lane, Barking. Julia Engwell Clinic, Weekly Tuesday and Woodward Road, Friday p.m. Dagenham. Leys Clinic, Weekly Tuesday p.m. Ballards Road, Thursday a.m. Dagenham. Marks Gate Clinic, Weekly Monday p.m. Lawn Farm Grove, Marks Gate. The Clinic, Weekly Wednesday and Oxlow Lane, Friday p.m. Dagenham. The Clinic, Weekly Monday and Porters Avenue, Friday p.m. Dagenham. 23 Infant Welfare Centres (continued) Centre Frequency of Sessions When Held Rush Green Clinic, Weekly Friday p.m. 179 Dagenham Road, Dagenham. Thames View Clinic, Weekly Wednesday and Bastable Avenue, Friday p.m. Barking. The Clinic, Weekly Tuesday p.m. Thompson Road, Friday a.m. Dagenham. Upney Clinic, Weekly Wednesday and Upney Lane, Friday p.m. Barking. Welfare foods and nutrients are sold at these centres during infant welfare sessions and also at Central Clinic 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 24,883 tins Cod Liver Oil 3,169 bottles Vitamin A and D Tablets 2,070 packets of 20 Orange Juice 38,696 bottles DAY NURSERY SERVICE The average daily attendances and numbers on registers are shown below for each month of 1967:- Month Goresbrook Annie Prendergast Eastbury Average Daily Attendance No. on Register Average Daily Attendance No. on Register Average Daily Attendance No. on Register January 27.5 42 24.9 34 20.2 45 February 26.6 36 25.1 31 34.1 45 March 30.7 33 27.7 31 32.2 39 April 29.05 33 28.1 33 32.9 38 May 28.7 32 26.6 34 31.6 36 June 26.8 33 29.9 33 26.1 36 July 25.5 36 25.5 36 29.9 36 August 22.0 35 22.3 32 20.1 34 September 29.1 34 26.2 33 30.9 38 October 32.2 38 31.9 39 34.7 44 November 28.7 39 33.7 38 34.3 45 December 26.0 36 29.2 34 36.3 43 24 All three nurseries had waiting lists throughout the year, but admissions were limited by reason of staff shortages. To ease staffing problems a shorter working day was instituted for a trial period of three months-the nurseries opening 45 minutes later in the morning at 8 a.m. and closing at 5.15 p.m. instead of at 6 to 6.30 p.m. Mothers and employers co-operated in the revised arrangements, and the shorter hours were subsequently adopted as a permanent arrangement. Goresbrook Day Nursery Matron reports as follows:- "It is now a year since the new nursery hours were introduced-8 a.m. instead of 7.15 a.m. and closing at 5.15 p.m. instead of 6.30 p.m. I thought this would cause a lot of trouble and complaints, but it is amazing how the mothers have co-operated and adjusted themselves to the new hours. The shorter nursery day means the children have more time in the evening at home with their own family before bed-time. "As usual we have been busy with lots of very young babies which we are delighted to have for the students' training. "All the students were successful in passing the N.N.E.B. examination. Two are continuing in nursery work, and another has gone for teacher training." Annie Prendergast Day Nursery Matron reports as follows:- "The year of 1967 was the first complete one in our new nursery, so in the summer months we were able to enjoy the freedom our larger garden gave us. "The number of visitors we received when the nursery first opened gradually dwindled and the staff and children were able to settle down to an established routine. The visitors who did come, however, were very welcome; they seemed to enjoy their visit and, I hope, felt at home with us. "Our intake of students increased, bringing the total number to seven. The two students who took their examination were successful, and now hold the National Nursery Examination Board Certificate. Havering Technical College held its first refresher course for senior nursery staff in the autumn, which lasted for seven days. The course came about as a result of the meetings between the Nursery Nursing Advisory Committee and the College, who felt that such a course was needed. Authorities from Southend and the neighbouring London Boroughs and Dr. Barnardos sent members of their staff, who enjoyed the course tremendously. It was, in fact, so successful that the College envisages this becoming an annual event. "The mixed age range grouping of the children which was started two years ago is still "workable". There are a few difficulties, but being aware of them is, it seems, half the battle. For instance, with a group of 2-5 year olds there is a tendency to "play down" story telling to capture the interest of the younger listeners, which we found was not really fair to the older children whose vocabulary and intellectual powers were greater. So there are times when the age groups are separated to enable the children to follow pursuits most fitted to their age and capabilities. We even have a sewing circle with some pretty good wielders of real neediest "The two open evenings held during the year were again pleasant and, thanks to the health education section, instructive. Attendance was not 100% but the 25 parents who did support us were extremely helpful and enthusiastic. "The children's Christmas party, as always, was a noisy but very happy occasion. "1967 ended for the staff on a sociable note with our first "Dinner and Dance" which sounds a little pretentious, but which in fact was delightful. A three-course meal prepared and served by "shifts" of staff and the dancing that followed was acclaimed by staff and their escorts as a great success. "For my part it was gratifying to know that staff who work and co-operate so well in the running of the nursery, can also when the occasion demands make such an evening so pleasant. In all I think we feel that this year of 1967 has laid down a pattern for us which we would do well not only to follow, but I hope improve upon in the future." Eastbury Day Nursery Matron reports as follows:- "The year 1967 was one of routine work with our children and nursery students. "Trained nursing staff shortages were our greatest difficulty, but we managed to care for our children and continue with the training of our students. Three nursery students gained the Certificate of the National Nursery Examination Board in July 1967. "It appears that the alteration in the nursery hours has not created any great inconvenience to our mothers. I would say that this plan of a shorter nursery day has worked very well." PLAY THERAPY In February this year we opened our fourth child development group at Oxlow Lane Clinic. On the first day we had six children and very quickly our numbers increased and now, like all the other groups, we have a waiting list. Oxlow Lane-25 children have been helped, including one physically handicapped child, two very aggressive children, four from unhappy homes, and seven with speech difficulty. Thames View-24 children have been helped, including three mentally backward children, one partially deaf child, two from unhappy homes, one very timid and lonely child and nine having difficulty with speech. Julia Engwell-23 children have been helped, including one deaf child, two partially deaf, three mentally backward children, one spastic child, two who would not mix and eight who have speech difficulty. Northbury-22 children have been helped, including two mentally backward, one autistic child, one partially deaf, three very aggressive children, two very timid children who would not mix, and six with speech difficulty. In all groups, 94 children have been helped this year. 26 KINGSLEY HALL DAY CENTRS The Centre continued running smoothly throughout 1967. The average daily attendance was 13.5 and there were 11 new admissions and 11 discharges. There was one death and two removals from the district, and the rest were suitably placed either in special school or the Castle School when they reached the age of five years. The Centre staff were greatly helped this year by frequent visits from Dr. Kenneth Holt and some of his assistants from the Institute of Child Health, Great Ormond Street. He is extremely interested in the progress of handicapped children in a nursery situation, and he discusses with the staff many details of their management. The interest he showed and the trouble he took was very much appreciated. During the year, many former children were seen by the staff either by visiting them at their various schools or having them visit the Centre. This is important as it gives a clearer idea of the value of the early work done for these children. Their introduction to school life is certainly effected with much less trauma than the children who were not fortunate enough to have this nursery experience. CYTOLOGY SERVICE The estimated female population between 35/54 years of age at present resident in the London Borough of Barking is 22,500. The number of women screened in our local authority clinics was 1,186 in 1966 and 1,346 in 1967. The number of women screened by general practitioners from 1.4.67 to 31.3.68 was 202. Altogether 12% of the female population in question have been screened. This is a very rough estimate as we have no knowledge, of course, of the women who have been screened in various hospitals. Our present policy is to accept anyone who wishes to have a test regardless of age or parity, but we give priority to the 35/50 age group. The screening of cervical smears began in Dagenham in 1964/65. A more intensive programme started in 1966 after the creation of the new London Borough. The screening programme throughout the country is still in rather a fluid state, there being no firm policy as yet. The Ministry of Health published a circular in 1966 giving the outlines of the service when the age limit was given as 35 and upwards. Another circular in 1967 dealt with the record forms to be used by all taking part in cytology services: one copy of the uniform record was to be sent to the General Register Office. The main purpose of this was to set up a national recall system for women who had negative smears and also to provide information for statistical analysis in the study of the natural history of the disease. There has been much controversy about the appropriate priorities and the value of cervical cytology. The Ministry of Health has a number of pilot schemes and it is hoped that as a result of these some guidance will be given about the priority groups and the system of recall. We have been running five clinics in the area. Of the 1,346 patients seen in 1967, 17 were found to require recall for further investigation. 27 HEALTH VISITING In view of the increasing overlap of counselling services it seems necessary to define the function of the health visitor. The following definition is that given by the National Body in agreement with the World Health Organisation. "Health Visiting is a specialised field of nursing and exists for the promotion of health, the improvement of conditions in the social and physical environment, rehabilitation, and the prevention of illness and disability." The health visitor provides a continuing service, having the following aspects: - 1. The prevention of mental, physical and emotional ill health and its consequences. 2. Early detection of ill health and the surveillance of high risk groups. 3. Recognition and identification of need and mobilisation of appropriate resources to meet it where necessary. 4. Health teaching. 5. Provision of care; this includes support during periods of stress, advice and guidance in cases of illness, and in the care and management of children. The health visitor should not, however, be actively engaged in technical nursing procedures. To prepare for this work the state registered nurse must have completed a recognised course in obstetric nursing or midwifery, followed by a course in health visiting which now lasts one calendar year. Practical tuition, interposed during academic training, is given by a trained fieldwork instructor. The health visitor student then undergoes a three-month period of supervised practice before qualification. Unfortunately, there is a shortage of trained nursing staff with the appropriate academic standard who offer themselves for this field of service. Due to several staff leaving the Borough on retirement or for pastures new, it has been necessary to take the regrettable step of changing the existing visiting areas in order to provide as comprehensive a service as possible during the period of shortage and when recruitment is difficult. Ancillary staff have been appointed, but there is further scope for the use of less qualified staff in supportive roles. There has been some improvement in liaison with the general practitioners in the Borough chiefly through health visitors' referrals to the family doctor and discussions with other medico-social workers in the hospital field. There is still too little co-ordination with regard to the social problems of school children, but it is hoped that as the health visitor becomes better known in the school health service, discussions with head teachers will help to close this gap. 28 Health Visiting Statistics Cases visited by Health Visitors Number of Cases Children born in 1967 2,891 " " " 1966 2,323 " " " 1962-65 7.007 12,221 Persons aged 65 or over 507 Mentally disordered persons 56 Persons discharged from hospitals (excluding maternity patients) 27 Number of tuberculous households visited 19 Number of households visited on account of other infectious diseases 9 Homes visited by tuberculosis visitors 309 CHILDREN'S DEPARTMENT During the year, 103 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. Only if there is close liaison between departments at the field worker level will we work satisfactorily together, 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 1967 were slightly lees than during the previous year. 2,046 persons were vaccinated or re-vaccinated compared to 2,196 in 1966 Vaccination against Smallpox Age at date of vaccination or re-vaccination Vaccinated Re-vaccinated Under 1 year 40 - 1 year 1,389 - 2-4 year 405 4 5-15 years 106 102 Total all ages 1,940 106 29 Whooping Cough Immunisation Year of Birth Primary Immunisation Children who received a booster dose 1967 807 - 1966 1,211 482 1965 100 1,032 1964 38 178 1960-63 57 357 Others under age 16 5 60 Total all ages 2,218 2,109 Diphtheria Immunisation Year of Birth Primary Immunisation Children who received a booster dose 1967 809 - 1966 1,214 483 1965 104 1,052 1964 51 205 1960-63 254 2,115 Others under age 16 76 783 Total all ages 2,508 4,638 Tetanus Immunisation Year of Birth Primary Immunisation Children who received a booster dose 1967 816 - 1966 1,215 484 1965 111 1,056 1964 57 208 1960-63 448 2,182 Others under age 16 526 1,058 Total all ages 3,173 4,988 30 Poliomyelitis Vaccination Year of Birth Primary Immunisation Children who received a booster dose 1967 769 - 1966 1,187 438 1965 121 624 1964 70 111 1960-63 270 1,835 Others under age 16 132 356 Total all ages 2,549 3,364 "AT RISK" RE3ISTER The "At Risk" Register, or as it is now known "Observation Register", was commenced in May, 1966. A selection was made, compiled from hospital maternity reports and other sources such as reports from domiciliary midwives, of those children who may require a little more detailed supervision and care than the average child during their first year of life. During this, the most important phase of their physical, emotional and mental development, an assessment of progress is made at periodic intervals while the health visitor on her home visits supports the mother in every possible way. The list of "at risk" children may be augmented by health visitors, clinic doctors or general practitioners in appropriate cases. Children are fairly tough, and though perhaps environmental and obstetrical factors may be against them at birth, at the end of the first year we find that approximately 75% of this selected group will no longer be considered "at risk" but will have adapted themselves to a normal, steady and stable developments The 25% remaining in this group at the end of the first year now remain on the "Observation Register" for a more continuous period of special care and observation. Those children with a definite handicap such as deafness, blindness or other measurable defect, have now been transferred to our "Handicapped Register." Many authorities who have been carrying out this procedure for a much longer period than ourselves have become rather critical of the system and its value. Perhaps in two or three years' time we will be able to give a more accurate assessment of its value. We are now becoming more and more interested in the mental deviations which may be present, but it is extremely difficult to detect these. In this work of observation regarding the "At Risk" Register, the health visitor and the clinic doctor form a team, and with the help of the central office staff who send out the reminder letters, we hope to ensure that each child with a potential handicap within the Borough will be discovered as early as possible so that it gets every opportunity of having the effect of its handicap minimised. 31 PREVENTION OF ILLNESS. CARE AND AFTER-CARE HOME NURSING SERVICE There was no marked increase in the proportion of elderly sick, 65 years and over, nursed during the year. The total of 713 new patients for the year is not in excess of other years. Similarly, there was no increase in the young chronic sick, 5-65 years. There were six new patients with disseminated sclerosis. The number of patients discharged from hospital for further care at home was 306. The actual figures of patients discharged from hospital are probably higher than shown, because requests for treatment are sent by hospitals to the doctor and passed on by him to the district nursing service. A total of 11,850 blanket baths were given during the year. This is approximately 20% of the total number of visits paid to all patients (61,171). The number of patients requiring blanket baths varies from month to month, but on average there are 270 patients having weekly baths, plus a few daily according to their,condition; e.g. incontinent patients. An analysis of the time spent by the home nurse shows the following:- Injections, all types, quarter-hour each patient, new patients half-hour. Dressings, all types, half-hour, new patients one hour. General care or blanket bath half-hour, new patients one hour. Bowel washouts, enemas, bladder washouts, and attention to colostomies, half-hour each patient. More time is allowed if needed, according to each individual patient's requirements. The extra time allowed where new patients are concerned, is taken in giving advice and instruction to relatives or friends who may be caring for the patient, or to the patient him/herself. It also falls to the nurse on occasions, particularly in winter months, to light fires, make tea, and obtain prescriptions from doctors' surgeries and take them to the chemist, in order to carry out necessary treatment. This happens in many cases where a patient lives alone and has no home help or relatives visiting. Time is also spent in rehabilitation of patients, teaching diabetics to give their own injections where possible, and teaching patients who have had strokes exercises in walking and in the use of their hands again where possible. There are six hydraulic hoists in use in the Borough, and one electric hoist which is on loan from Barking Hospital. Other nursing aids in use are four "Easinurse" mattresses, four "Easinurse" cushions, one "Easinurse" bedstead, eight "Northbed" pads (artificial sheep-skin pads). Of great help in nursing are incontinence pads which are issued in a similar manner as other sick-room equipment; i.e. bed-pans, urinals, back-rests, draw sheets, air rings and foam rubber rings, waterproof sheeting, bed-cradles and feeding cups. Students taking their district training numbered four, and these were all successful in their examinations. They also obtained posts in the Borough on qualification. There were 29 State Registered Nurses (26 full-time and three part-time) and one part-time State Enrolled Nurse employed against the authorised 32 establishment of 36 nurses. The establishment also provides for a Superintendent and two Assistant Superintendents, but one of the latter poets has not been occupied. Footnote-From the above report it will be seen that a great deal of time is spent by professional staff doing work, e.g. bed baths, which could quite adequately be done by less highly qualified staff. Statistics Total number of persons nursed during the year 1,868 Number of persons who were aged under 5 at first visit 28 Number of persons who were aged 65 or over at first visit 713 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 by relatives. 2,024 articles were loaned during the year and 3,858 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 major difficulty up to the present, although their increasing use may call for epecial 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. Following advice from the Ministry of Health in August 1966, the sick-room equipment loan scheme was extended to include the provision of waterproof pants and knickers with disposable linings for incontinent people. During the year, 19 patients were issued with these garments. OVER SIXTIES CLINIC, OXLOW LANE The medico-social assessment of the elderly continued through the year, although there was a period when its activities were suspended due to a severe shortage of doctors. The centre has proved over the past nine years that it has a useful contribution to make towards the preventive care of the elderly. Active preparation is taking place for the provision of an additional centre at the Porters Avenue Clinic in 1968. Further expansion of this service is hampered by chronic shortage of medical staff which exists not only in this Borough but throughout the nation. GERIATRIC LIAISON OFFICER An important function of the Geriatric Liaison Officer is to provide a link between the geriatrician, the family doctor, and those departments of the Borough Council and voluntary organisations concerned with the support of the elderly. She also contributes to the task of promoting greater understanding of the problems and needs of the elderly amongst their relatives and the public at large. During the year, close liaison with family doctors and geriatricians was maintained. In addition, a good working relationship with other departments has been strengthened and contacts formed with voluntary agencies concerned with the care of the elderly. 33 Home assessment visits to advise on the social care of the elderly and visits to patients discharged from hospital continued to form a major part of the work of the Geriatric Liaison Officer. At the request of the geriatrician assessment visits were made to the homes of old people prior to admission to hospital, and in many cases patients were admitted without a further visit by him. A welcomed development during the year was home visiting by the occupational therapist when it was felt that the patient required further help following discharge from hospital. Much time is also taken up in finding suitable placement for the elderly who require more care than can be provided in the home. Source of Referral No. of Cases Consultant Geriatricians 220 Consultant Physicians 92 General Practitoners 20 Health Visitors 9 Mental Welfare Officers 5 Home Help Organisers 16 District Nurses 9 Old People's Welfare 5 Miscellaneous 111 Total 487 ACCIDENTAL HYPOTHERMIA In December 1965, following research reports indicating that elderly people may suffer from hypothermia without this being realised, health visitors and district nurses were issued with low reading thermometers in an endeavour to detect the condition in its early stages. The winder of 1965/6 was comparatively mild, however, and two cases only came to notice, in each of which the low temperature was transitory, and was attributed to age and inactivity. Preparations were made for a more detailed study of the problem during the following winter in conjunction with the London Borough of Redbridge, each authority to carry out a pilot survey during January, February and March, 1967, of 20 old people each month. In Barking, a pool of equipment, available night and day, was set up in the Nurses' Training Home, consisting of blankets, safety oil stoves, one gallon oil cans, hot water bottles and sleeping bags-which could be used also as quilts - so that any serious case discovered could be rapidly assisted even if gas and/or electricity or solid fuel were not available. The cases were selected on a different basis in each Borough because available sources of information differed. The cases in Barking were chosen at random from elderly persons in receipt of home nursing services, and in Redbridge they were selected from a source provided by the Local Executive Council. The survey was carried out by home nurses who were equipped with Max/Minimum Thermometers and who visited each patient daily to record body temperature with a low reading thermometer, minimum temperature of the bedroom 34 and the living room, and current air temperature. A social questionnaire was also completed by the home nurse. Each patient's general practitioner was advised of the survey and of any hypothermia revealed. Of the 60 patients selected in Barking, two were admitted to hospital and two died before completing the survey period, but in none of these instances was illness attributed to hypothermia. It has not been possible to recover the survey form appertaining to one of the cases who died, so this case has been ignored for statistical purposes. A total of 1,633 body temperatures were recorded, 61 of which were 95°F. or below and 85-98.1 °F. or over. The 61 low temperatures related to 21 patients, six of whom showed a low temperature on one occasion only. Temperatures of 98-1 F. or over related to 22 patients. No excessively low room temperatures were recorded for any continuous period, and the weather throughout the survey was comparatively mild. The survey has provided valuable experience in the problems to be met in mounting a full-scale enquiry and in respect of the type of information likely to prove most useful. The number of cases chosen, though small, involved a large number of observations and a mass of statistics for further study. It is too early to comment on the actual results, as their numbers were not very great, and the mildness of the winter also made it difficult to draw conclusions, but the overall impression would seem to support the observation that environment has an effect on body temperature, and that hypothermia as such may exist without any obvious ill effect, unless there exists some definite cause. The difference between the two groups under survey may provide some interesting comparisons in that while one group is selected from patients receiving home nursing services, the other group is to some extent selfselected. NATIONAL ASSISTANCE ACT. 1948 Section 47 During the year, it was not found necessary to remove any person from their home as being unable to care for themselves and not receiving adequate care and attention from others. This may be due in some measure to improved co-ordination in the care of the elderly resulting from the appointment of the Geriatric Liaison Officer. TUBERCULOSIS Arising out of the opening of the new Barking Hospital in 1967 the Chest Clinic Services based on the hospital were reorganised to concentrate the home visiting and follow-up of chest cases at the Chest Clinic at Five Elms, Dagenham, which now caters for the whole of the Borough. We were again indebted to Dr. J. T. Paterson and his staff for their help and co-operation during the year. 35 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 2 1 - - - - 3 - - - - 5 - 1 - - - - - 1 - - - - 15 - 11 11 - - 1 4 27 - - - - 45 - 7 4 - - 1 - 12 2 3 - - 65 and upwards 4 1 - - - - 5 12 2 - - Totals 25 17 - - 2 4 48 14 5 - - Transferred Cases Into Borough Out of Borough Nett increase 31 29 2 Tuberculosis Visiting No. of Cases on Register No. of Households N Involved No. of Home Visits Made 800 667 666 Chest Clinic Child Contacts No. given B.C.G. No. of Attendances No. T.B. Children Other 675 8 143 15 Free Milk On the recommendation of a Chest Physician additional supplies of milk are made available to patients suffering from tuberculosis, and 149 patients were so assisted during the year. CHIROPODY SERVICE The Chief Chiropodist reports as follows:Clinics Central Foot Clinic-Operated single-handed by the Chief Chiropodist on Monday, Tuesday, Wednesday and Friday. Julia Engwell Clinic-Operated single-handed by Mrs. D. Mann, who also attends the Senior Girls' Training Centre one session fortnightly. Porters Avenue Clinic-Operated single-handed by Mr. D. Ditsell. 36 Ford Road Clinic- Operated single-handed by Mr. E. Dransfield who joined our staff on the 2nd January of this year. Annie Prendergast Foot Clinic- This clinic has now passed through the initial "teething" stages, and is operated by Mr. N. Freeman (full-time) and Mrs. E. Barber (part-time, operating two sessions weekly). Miss Richards continues with her Clerk/Receptionist duties. The car transport service is still being run from this clinic and is invaluable for the elderly infirm patients who are thus able to be moved to and from the clinic. Greatfields Clinic- Operated by Mr. H. Stenson from Monday to Thursday. Due to the absence of Mr. Stenson through illness from the 14th October, the clinic was reduced to four sessions (two days) per week. These sessions were operated by Mrs. Mann and Mr. Ditsell. Mr. Stenson was still off duty at the close of the year. Thames View Clinic- Operated by Mr. Stenson on Fridays, but the clinic was closed down from the 18th October due to Mr. Stenson's illness. Domiciliary Service Western Area- Operated by Mrs. E. Morgan who also attends Mayesbrook Old People's Home for one day fortnightly. Eastern Area- Operated by Mr. P. Freel (part-time Chiropodist) for three sessions weekly. This is helpful, but does not touch the fringe of the demand for domiciliary treatment in this large area. Old People's Homes Mayesbrook- Attended by Mrs. Morgan for two sessions fortnightly, also by Mr. R. Fenton (part-time Chiropodist) for one session monthly. Saywood Lodge- Attended by Mr. Fenton one session fortnightly. The Lawns- Attended by Mr. Fenton one session fortnightly. Senior Girls' Training Centre Chiropody equipment was supplied and a surgery set up at this centre. As from the 1st July Mrs. Mann visited for one session every fortnight. This arrangement was made so that necessary treatments could be given to these patients in their own familiar surroundings. The results have been very satisfactory. General Remarks All clinics and the domiciliary service are very heavily case-loaded, and there is an urgent need for more staff. The time between appointments ranges from ten to twelve weeks, and longer at holiday periods when the clinic has to close while a chiropodist is on leave. This also applies in cases of staff sick leave. I would like to make a special note of appreciation for the help given by Mrs. Mann and Mr. Ditsell during the absence of Mr. Stenson owing to severe illness. A skeleton service was maintained at Greatfields Clinic which helped the service considerably. My appreciation is also extended to Miss Long and her staff for their co-operation. The Old People's Homes service continues to be very satisfactory, as the constancy of numbers and the co-operation of the respective Matrons enables good work to be done in this important field. 37 Treatments for the year Children Adults Total Sessions -5 5-16 O.A.P. Others A/N P/H Central - 168 1,940 84 1 7 2,200 387 Julia Engwell 2 33 2,149 4 1 48 2,237 395 Porters Avenue - 30 2,655 6 - 12 2,703 473 Greatfields 2 18 1,982 5 1 2 2,010 342 Thames View 1 64 455 3 - 2 525 72 Ford Road 6 349 3,405 6 - 19 3,785 525 Annie Prendergast 1 336 2,455 32 12 590 3,426 543 Total 12 998 15,041 140 15 680 16,886 2,737 Old People's Homes Adults Total Sessions O.A.P. P/H Mayesbrook 264 - 264 41 Saywood Lodge 233 - 233 24 The Lawns 207 - 207 25 Total 704 - 704 90 Adults Total Sessions O.A.P. P/H Domiciliary 2,116 161 2,277 577 No. of Treatments No. of Sessions Senior Girls' Training Centre 58 9 Grand Totals for the Year Section Number of Treatments Sessions Worked Clinics 16,886 2,737 Old People's Homes 704 90 Domiciliary 2,277 577 Senior Girls' Training Centre 58 9 Total 19,925 3,413 38 MEDICAL EXAMINATION OF STAFF The Council's practice to arrange for the medical examination of all entrants to its service came under review during the year, and in view of the large number of medical examinations involved, which cause heavy demands on medical staff time, it was decided after consultation with Joint Committees, to dispense with medical examinations except in the case of:- (1) Employees transferring from another authority or with a short break in service. (2) Teaching staff. (3) Where the Medical Officer of Health decides that an examination is necessary in the light of replies to a medical questionnaire. (4) Where a Chief Officer, in agreement with the Medical Officer of Health, considers a medical examination is advisable. These arrangements were put into effect on 1st August 1967 for a trial period of one year. During the year the following examinations were carried out:- Number of persons examined and passed as fit 693 Number of persons examined and not accepted 35 Number of special examinations in connection with sickness payments 28 Number of medical examinations carried out for other authorities 10 Number of medical examinations carried out by other authorities 16 Number of chest X-rays arranged in connection with medical examinations 307 Number of health history questionnaires scrutinised 301 Number of candidates approved without further inquiry 227 REHOUSING ON MEDICAL GROUNDS In order that every person who considers himself eligible for rehousing on medical grounds is treated with equal fairness, one of my medical officers (the Deputy Medical Officer of Health) is responsible for investigating the medical histories of all applicants. This is a breakaway from the usual pattern, whereby the doctor receives housing reports and medical/social reports from the public health inspector and health visitor respectively. All information (i.e. housing details from the Housing Department and medical recommendation from a doctor) is submitted to my Deputy, and where it is not possible to make a decision from this information, he will visit the person in his home. Statistics Total number of applications 335 Number of families visited 102 Number recommended for rehousing 21 39 All the applicants with young families were already on the Council's list for rehousing either by virtue of overcrowding - the majority - or because of clearance areas, and therefore overcrowding of itself cannot be considered as a medical reason. The other main group of applicants were retired pensioners who found their present accommodation physically unsuitable because of increasing infirmities. The most frequent problem was the difficulty in climbing stairs. Often it is necessary to climb four flights of 12 - 14 stairs to reach their accommodation. MENTAL HEALTH Work of the Mental Welfare Officers During the year, 497 patients were referred to the mental health service. Mentally Ill Mentally Sub-Normal Referred by general practioners 120 3 Referred by hospitals on discharge 119 - Referred by hospitals after or during out-patient or day treatment 90 - Referred by Local Education Authority - 27 Referred by police and courts 16 2 Referred by other sources: e.g. neighbours, relatives, Ministry of Social Security and other social and welfare agencies, inward transfers from other areas 106 14 451 46 Number of persons receiving community care at the end of the year 269 370 Number of persons attending day centres 22 174 Number receiving residential care 6 17 Number of admissions for temporary residential care to relieve the family 2 28 During the year the following admissions to mental hospital were dealt with by the department: Informal 85 Compulsory 87 Via Court 1 173 Castle School During the autumn term, the London Borough of Havering were able to accommodate 24 of their children who had been attending Castle School, and this allowed 13 Barking children who had been attending centres in Redbridge and Havering to be accepted at the school, thus enabling all Barking trainees to attend a school within the Borough. 40 Social training included trips to the Tower of London, Mayesbrook Park, and many shopping excursions which involved travelling by train and bus. Many children continue to receive swimming instruction, and most of the school attend the physical education class. Both the swimming and P.E. classes are held at the Barking Regional College of Technology. Our association with the R.M.S. Arlanza flourishes. Captain Gibbons attended the children's Christmas party, and other members of the crew have made social calls. Captain Gibbons presented the children with a huge Christmas cake made by the cook of the Arlanza. In turn, the children collect reading books to replenish the ship's library. The visit by the children to Wembley to see "Cinderella on Ice" was also made possible by the goodwill of the Arlanza crew. Local old age pensioners were invited to the Harvest Festival and the produce was given to them and others who were unable to attend this service. During September we were happy to welcome Mrs. Mitson as a new member of staff in a temporary capacity replacing Mrs. McKenzie, who had gained a place on a teacher training course. Miss V. Green also joined the staff, filling the vacancy created by Mrs. Mathews. Visitors to the school have included:- Dr. Balbal - Philippines Miss Willis - Tutor, N.A.M.H. Course Students - Guy's Hospital Students - Chiswick Polytechnic Health Visitors Pupils from Fairlop Secondary School. The Speech Therapist pays a weekly visit to the school, and routine medical inspections are undertaken by Dr. Burgess, School Medical Officer. During the early part of the year, structural alterations were made at Castle School to provide a small special care unit for physically handicapped sub-normal children. This unit was opened on the 24th April when four children were admitted; two cot cases, a girl aged six and a boy aged fifteen, and two chair cases, boys aged twelve and fourteen. At the end of the year, there were four cases on the waiting list for admission, but arrangements were in hand to admit a further two cases to the unit at the beginning of 1968. Westfield Psychiatric Social Club Aims of the Club: 1. To provide a stepping-stone between illness and isolation on the one hand and good mental health, re-socialisation and integration into the community, on the other. 2. To widen the interests of the members and thus stimulate them into outside activities on their own initiative. 3. To provide a regular meeting point for staff and members in a social setting. 4. To follow up with introduction to outside clubs. During 1967 the average attendance increased by 80%. In January we were able to move to new and larger premises, the Day Centre 41 at Porters Avenue, thus making contact with Day Centre members as well as direct Club referrals. Proximity of the Club to the Day Centre has enabled us to integrate Day Centre/Club members into preparation of refreshments, etc., for social evenings previously organised by staff because of lack of contact with Club members during the week. The move to new premises gave a natural break which was used by the members of the mental health staff to delegate more responsibility to Club members, e.g. (a) transport was no longer provided as the new premises were on an adequate bus route. (b) two members gradually took over responsibility for preparing refreshments. Previous rotas had fallen through because of inconsistency of attendance. The influx of a younger element from the Day Centre stimulated wider interests. Activities included: 1. Visits from and to other similar clubs. 2. Parties for all past and present members. 3. Demonstrations from outside bodies, e.g. North Thames Gas Board Cookery, Milk Marketing Board, Yardley - Make-up, Flower Arranging, Morris Dancing. 4. Trips to local theatres. 5. Group activities within the Club - Community Singing, Beetle Drives, Play Reading, Bingo. It is often not necessary to organise anything in an evening when one is certain that everyone is making contact with another person through the playing of a game, through conversation or through dancing to the latest 'pops'. On the other hand, to use the second half of the Club evening for an organised group activity is sometimes very necessary in order to (a) stimulate the group as a whole, or (b) include the isolated person who very often lives alone and for whom the Club is the only contact with others. Beetle Drives and Morris Dancing have claimed notable success here. Residential Accommodation - Maisonette In May 1965, the Health Committee decided to allocate a maisonette for the use of patients no longer in need of hospital care, but with no home to go to, so that they could be discharged to live in the community. The maisonette, which is on the first floor of a large new block, has two single bedrooms and one double bedroom. Each bedroom was furnished with a single bed, wardrobe, dressing table, bedside cabinet and chair for each person, making four places in all. The lounge/dining room and kitchen are communal and furnishings included cooker, refrigerator, drying cabinet and all other household necessities. There is a plentiful supply of linen. Prior to the maisonette being ready for use, we approached both Warley and Severalls Hospitals to find out what female patients they had who could readily be discharged, but the immediate response was very disheartening and the place was standing ready for occupation for nearly six months before the first patients were admitted. 42 Before this, however, there had been murmurs of disquiet amongst the other tenants of the block of flats when they heard that discharged mentally ill patients were to be accommodated. In order to gain the co-operation of the nearest neighbours, they were visited by the Principal Mental Welfare Officer who was able to discuss with them their fears and suspicions, and to reassure them on many of their worries. This proved very helpful as the neighbours assumed at first a protective attitude towards the patients, which has now been replaced by an acceptance on equal terms. In September 1966 the first two patients were admitted; one was a 70 year old woman who had been in a mental hospital for nine years, and the other a 45 year old woman who had been ill for four years - they had not known each other before. Every co-operation was given by the Ministry of Social Security to ensure that the women had enough money to cover their needs. During the initial settling in period, a mental welfare officer visited daily to smooth out any difficulties and to advise on diet, shopping and budgeting. Soon the two women settled down, becoming part of the community, and taking their turn at washing down the communal stairs, etc. Later they were joined by a younger woman who eventually moved to residential employment, but who was greatly helped by the temporary accommodation afforded here, being able to take stock of her personal situation. In May 1967 a male patient of 45 was suggested as suitable - he was homeless after the death of his mother. As he was known to the two ladies already resident, whom he had met at the weekly psychiatric social club, we discussed with them the possibility of his moving in. This was readily agreed to. In October 1967 they were joined by another female patient. The two younger women go to work, the man works when he is well and the 70 year old woman, who is at home all day, finds plenty to occupy her with the housework. The residents pay £2. 12. 0. a week which covers the cost of rent, heat, lighting and gas, and they buy their own food and share the cost. One mental welfare officer is responsible for visiting the unit once a week, to collect rents, give support and undertake casework. Voluntary Associations Annually the Borough Council makes a contribution to the local voluntary associations, viz. the Dagenham Association and the Barking Association for Mental Health. The Dagenham Association holds monthly meetings with speakers to stimulate a public interest in mental health and gives financial aid to the mentally ill within the Borough. The Barking Association holds a weekly club for the mentally sub-normal and their relatives, arranges a Christmas party to which our trainees are invited, and has a holiday bungalow at Clacton for self-catering holidays for the families of the sub-normal. Holiday Play Centre To provide some relief to parents during the long summer holiday, a Day Holiday Play Centre was held at Castle School from Monday to Friday for the two weeks, 14th - 25th August, 1967. The supervision of the Centre was undertaken jointly by two ladies resident in the Borough, both of whom are experienced in the work of a Training 43 Centre, and additional staff was recruited, including students of Teacher Training Colleges and mothers of the trainees. This Centre was attended by 34 trainees - junior and adult. Holiday Camp Scheme Holidays for trainees were arranged again this year at St. Mary's Bay Holiday Centre, St. Mary's Bay, Kent. A party of 36 trainees and staff from the Dagenham Adult Centre spent a week at the Camp from the 28th April to the 5th May, and a further party of 22 children from Castle School and 35 senior girls from the Gale Street Centre spent a week at the Camp from the 8th to 15th September. Each party was accompanied by members of the staff of the Training Centre concerned, and despite somewhat mixed weather, visits were made to places of interest in the locality and the holidays were reported to be a success. Mental Health Week During Mental Health Week, the theme of which was "Work to be Done", several projects were undertaken in conjunction with the local voluntary associations. A panel consisting of a mental welfare officer, a psychiatric social worker, an occupational therapist, a psychiatric nurse, and a teacher of the mentally handicapped, together with a voluntary worker, visited the two grammar schools in the area to talk to senior pupils about their individual jobs and to answer questions. An exhibition was also mounted at the grammar schools and in the libraries with appropriate literature for the various professions within the field of mental health. A wine and cheese party where Dr. Jones from Warley Hospital spoke about schizophrenia was arranged at the Day Centre. This was well attended by councillors, professional workers and members of the public. Residential Care Difficulties During the year much difficulty was still being encountered in obtaining temporary and permanent care for sub-normal patients, especially in cases of emergency. One young child had to be sent away as far as Derbyshire when his mother was admitted to hospital. Despite their inability to provide permanent care, South Ockendon Hospital nevertheless helped by providing out-patient facilities where difficult cases were seen for consultation, diagnosis and treatment. Student Placements Each month, two medical students from St. Bartholomew's Hospital who were doing a practical placement at Warley Hospital spent some time in the mental health section to gain an insight into the problems of community care. A post-graduate student undertaking a social studies course at Bedford College spent a month in the mental health section on a practical placement. A request for similar placement next year has been received and agreed to. 44 Mental welfare officers continued to give talks to schools, church groups and various organisations, and also to pre-retirement groups. Adult Training Centres Upon the resignation of Mrs. R. Early, in August, 1967, for many years the devoted supervisor of Castle School, the opportunity was taken to amalgamate the Gale Street Annexe with the Adult Training Centre in Osborne Square, so that all adult trainees would be under the supervision of Mr. Matthews. This foreshadowed the transfer of all trainees to the new Adult Training Centre due for completion in 1968. Also during the year, following the closure by the Health Committee of the dental workshop, the staff at Osborne Square was strengthened by the addition of Mr. G. Dickerson, Senior Dental Technician, who was transferred there as an Instructor. Handicrafts such as leather work, woodwork, basketry and needlework, are taught at the centres, and simple industrial processes performed for local firms. These activities resulted in an income of nearly £500 at Gale Street and £1,000 at Osborne Square, which is distributed amongst trainees. Outings were arranged to Minnis Bay, regular visits on two mornings each week were made to the sports centre in Halbutt Street, and two parties had a week's holiday at St. Mary's Bay, Dymchurch, one in May and the other in September. Grateful thanks are due to the staff and volunteers who give up their time to make these holidays possible. During the year, 9,226 attendances were made at Osborne Square and 8,933 at Gale Street Annexe. Capital Building Programme The position regarding the capital building programme for mental health projects during 1967 was as follows:- Adult Training Centre. Gascoigne Road - Work on this 120 place centre for mentally sub-normal trainees was started at the end of the summer and it is expected to be completed by the middle of 1968. Because this is the only adult training centre projected for the Borough, and by reason of the acute shortage of suitable sites, this building will be of bungalow construction initially, but will be capable of taking a further storey at a later stage if need be. Hostel for the Mentally Sub-Normal - There not being a hostel within the Borough, a review of known and potential hostel cases showed that upwards of 50 places could be filled if accommodation were available in the town. Owing to the lack of building land, the Council allocated a site in the Gascoigne Redevelopment Area as in the case of the Adult Training Centre. At the end of the year, approval had been given for building to commence, and it is anticipated that the finished building will be handed over at the end of 1968 or early in 1969. Hostel for the Mentally Ill - Again a site was allocated within the Gascoigne Redevelopment Area for a 25 place hostel, and the Ministry of Health hoped to recommend loan sanction for the year 1969/70. Replacement of Castle School (Junior Training Centre) - This, the only junior training centre in the Borough, is conducted in a former school built in 1896 and it was agreed that a replacement building should be built as soon 45 as possible on a site in Goresbrook Road, next to the Ambulance Station of the Greater London Council and on the edge of the Southern Open Belt. During the year, the Ministry of Health stated they hoped to recommend loan sanction for the replacement building in 1968/69. CIVIL DEFENCE - FIRST AID, etc., LECTURES Close liaison has been maintained between the health department and the Civil Defence Corp6 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:- Date Place Course Nos. Attending 12.1.67 16.3.67 Civic Centre (Council's Staff) Emergency Home Care 11 4.5.67 29.6.67 Axe Street Centre (Council's Staff) Emergency Home Care 9 14.6.67 Eastbury School Duke of Edinburgh Award 25 27.6.67 Beverley School Duke of Edinburgh Award 17 3.7.67 Axe Street Centre British Red Cross Society 17 10.7.67 Axe Street Centre Junior Red Cross Home Nursing 16 5.12.67 Axe Street Centre (Borough Engineer's Staff) British Red Cross Society 16 DOMESTIC HELP SERVICE General (a) In view of the national economic position, the Council placed a limit on financial expenditure and in April 1967 it became necessary to review all the current cases with a view to only the most necessitous cases being granted help within the money available. As a result of this, service was: (i) Withdrawn from 60 cases. (ii) Reduced in 427 cases. and a "cut back" in service of approximately 500 hours per week was effected. This not only gave rise to criticism and dissatisfaction among recipients but was also a subject of news for the local press. (b) With a view to meeting cases of an emergency nature at weekends, an "on call" duty rota has been established which results in:- (i) One member of the organising staff being on duty at the health department each Saturday morning and remaining accessible by telephone for the remainder of the weekend. (ii) Four domestic helps being "on call" having regard to their hours of availability over the weekend. 46 (iii) Each domestic help "on call" is afforded a retaining fee of £1 per weekend whether called upon for duty or not. Organising staff qualify for time off in lieu of Saturday morning duty. Case Loads (a) The number of cases served fluctuates from month to month and throughout the year the following cases were helped:- Aged (over 65 years) 1,645 Chronic sick 239 Mentally disordered 10 Maternity 40 Others 22 Total 1,956 A reduction of 34 on the previous year. (b) Cases in need of night attendance were referred from time to time, and throughout the year service was provided in four such cases. Recruitment of Labour Due to financial restriction wastage in labour was not replaced during the six months April - September, and the labour force fell from 250 to 215. During the three months September - December wastage was replaced and at the close of the year the labour force remained at 215. Training (a) A training course was held at Hornchurch College of Further Education on a sessional basis over a period of six weeks, and was attended by 15 domestic helps. These courses are considered valuable and are appreciated by those concerned. Due to financial restriction it was not possible to further this type of instruction but it is hoped that similar arrangements will be possible during next year. (b) Organisers were called upon to instruct student health visitors, nurses, etc., from time to time, and the Senior Organiser also gave several talks/ lectures on the domestic help service as part of school health education programmes. 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) - 9 Section 28 (Prevention of illness, care and after-care) 40 - 47 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 subnormal 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 16,009 Secondary schools 11,432 Special schools 314 Total 27,755 MINOR AILMENTS CLINICS Minor ailments sessions at which a doctor was present were held at the following clinics:- Annie Prendergast Friday a.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 a.m. Julia Engwell Monday to Friday 9-10 a.m. Leys Monday p.m. Marks Gate Friday a.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 1,825 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 390 candidates were reviewed. Further investigations were made in 138 cases, and only two cases were rejected. 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 and it was extended to all senior schools during the year. 48 Completed medical questionnaires were scrutinised by school medical officers and 760 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) where considered necessary on pupils in their last year at secondary school. In addition, pupils entering the Borough from other areas and children found to require observation or treatment are followed up as necessary. Particular attention is paid to pupils at the special schools. Periodic Inspections Age Groups Inspected (by year of birth) No. of Pupils Inspected 1963 and later 129 1962 1,591 1961 1,062 1960 229 1959 88 1958 43 1957 366 1956 1,656 1955 704 1954 52 1953 89 1952 and earliar 624 6,633 Other Inspections Number of special inspection 3,475 Number of re-inspection 1,171 4,646 49 DEFECTS FOUND BY MEDICAL INSPECTION Defect or Disease Periodic Inspections Special Inspections Treatment Observation Treatment Observation Skin 146 182 137 54 Eyes: (a) vision 355 434 125 142 (b) squint 60 47 33 18 (c) other 17 46 5 35 Ears: (a) hearing 16 122 48 116 (b) otitis media 12 47 7 1 (c) other 23 35 1 - Nose and throat 86 439 55 67 Speech 50 81 79 33 Lymphatic glands 10 137 3 7 Heart 13 178 28 32 Lungs 26 170 32 33 Developmental: (a) hernia 11 25 3 15 (b) other 30 161 25 46 Orthopaedic: (a) posture 17 36 8 15 (b) feet 102 156 18 26 (c) other 18 88 75 46 Nervous system: (a) epilepsy 4 16 4 7 (b) other 14 64 53 40 Psychological: (a) development 18 106 46 57 (b) stability 20 184 77 48 Abdomen 3 30 5 6 Other 96 142 162 160 50 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 1963 and later 5 15 20 1962 30 163 188 1961 52 135 176 1960 8 28 33 1959 2 14 14 1958 5 4 8 1957 17 12 28 1956 113 225 308 1955 51 78 119 1954 6 2 8 1953 11 9 19 1952 and earlier 55 63 108 Total 355 748 1,029 General Condition of Children Out of 6,633 pupils examined, only five were considered to be of unsatisfactory general condition. INFESTATION WITH VERMIN During the year, 18,431 pupils were examined, and 258 found to require treatment. CONVALESCENT TREATMENT Pupils who are recommended convalescent treatment on medical advice are sent away for periods of up to four weeks. 145 cases received treatment during the year. EMPLOYMENT OF CHILDREN 115 pupils were examined for fitness for employment out of school hours and certificates were granted. 51 DISEASES AND DEFECTS OF EAR, NOSE AND THROAT A Specialist Ear, Nose and Throat Consultant attends weekly at Central Clinic. Pupils known to have been treated Received operative treatment:- (a) for diseases of the ear 4 (b) for adenoids and chronic tonsillitis 131 (c) for other nose and throat conditions 3 Received other forms of treatment 198 Total number of pupils in schools who are known to have been provided with hearing aids:- (a) in 1967 10 (b) in previous years 75 ORTHOPAEDIC AND POSTURAL DEFECTS An Orthopaedic Consultant attends monthly at Leys Clinic where a wholetime physiotherapist is also in attendance. Pupils known to have been treated (a) at clinics or out-patient departments 363 (b) at school for postural defects – CHILD GUIDANCE CLINIC Dr. E. Danos, Locum Consultant Psychiatrist, reports as follows:- "I have worked in the Barking Child Guidance Clinic since the end of September 1967. The majority of cases seen in my four-weekly sessions have been behaviour problems - as it is the case in the majority of child guidance clinics. An organic cause underlying the symptoms was relatively infrequent. A few of the children were referred for a second opinion to consultants in other hospitals. When cerebral dysrhythmia was suspected the children were referred to the E.E.G. Department of Goodmayes Hospital and we received great help from them. Not having an in-patient unit of our own, we referred children to Dr. Little at Whipps Cross Hospital who always came to our rescue. "Much of the behavious disturbance of children seems to be inherent in the social structure of the family. Frequently father is away from home owing to his work, for shorter or longer hours, or on account of illness, or else because he has abandoned the family; occasionally only is his absence due to a prison sentence. When father can give no moral or financial support, mother often works and is unable to see the children off to school or wait for their return from school - this seems to trigger off a great deal of delinquency. When father is hard and unloving but mother is able to give some support to the children, the children frequently produce anxiety symptoms, such as bedwetting or nightmares or present with obsessional behaviour. "Since the weather improved about mid-April, aggressive acting out of doors, such as breaking into houses in twos or threes has been very frequent. There 52 is hardly a week without cases being referred for reports to the Courts. "Owing to the large number of deprived or rejected children referred to the Clinic, we often have to resort to such means as changing schools, transferring to boarding schools or children's homes, requesting holidays or asking for escorts to hospitals. "In order to deal with the children's problems more effectively we have multi-disciplinarian case conferences once a month; also recently we have started group therapy for adolescents. "We would not have been able to cope with these problems without the excellent co-operation of the School Health Service, the Special Services in the Education Department and the Children's Department, and the great help from the educational psychologists, remedial teacher and secretarial staff in the Clinic." ADOLESCENT CLINIC We started an Adolescent Clinic at Porters Avenue Clinic towards the end of 1966, with a group of fourteen-year-olds from a secondary modern school. The attendance has been very encouraging though fluctuating as might be expected. Mostly girls, but also quite a number of boys have been taking part in the sessions. Films, such as "From Girl to Woman" and "Learning to Live", which dealt with the growing-up period quite well, and also a film on V.D. with some explanatory talks, were welcomed seriously and with great interest. The discussions and comments which followed these films were quite revealing. Talks and slides about the care of skin, relating to the "spots" of adolescence, and also nutrition, were well accepted. In the summer term we ventured to make a film of our own. We had a rather old-fashioned, but basically sound, film on the ever-recurring theme, entitled "Mother, can I go out tonight?" Our youngsters wrote a new script with a very lively and impressive dialogue. With the very kind and expert co-operation of the Health Education Officer and his assistant, who acted as producer, director and camera-men and with the youngsters as actors, we produced a film which actually needs only the adding of the sound track. In the autumn term of 1967 we started with a new group from the same school and the attendance was also about 25 to 30. We are still very much in the experimental stage and we wish to encourage more group discussion among the young people themselves, as this has not always been achieved. We are grateful for the encouragement, enthusiasm and helpfulness of the Headmaster and Headmistress of the school. All this has been very useful experience, and we hope to learn a lot more in the future. 53 EYE DISEASES, DEFECTIVE VISION AND SQUINT Ophthalmic Specialists of the Regional Hospital Board attended weekly at Central, Porters Avenue and Becontree Avenue Clinics. 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) 25 (b) Errors of refraction (including squint) 910 (c) Number of pupils for whom spectacles were prescribed 913 ENURESIS CLINIC The statistics relating to the work of this clinic are as follows:- Appointments made Attendances New patients 123 73 Old patients 111 75 Total 234 148 The large number of patients who do not attend for their appointments 86 - (and who do not inform us accordingly) give an unnecessary large amount of extra work to all concerned. Ten parents defaulted on two appointments, and were sent a "warning" letter of the costs incurred if they did not return the equipment loaned to them for treatment. The response was satisfactory. The results of treatment (using the buzzer) are satisfactory, and very similar to results in previous years:- % of total Number cured 108 86 Number failed or poor result 15 14 This cure rate of 86% is reduced by about 10% in fact, as several cases relapse within a few months. The failures are virtually all due to one of two causes - the buzzer fails to awaken the child, or the child awakes but is too frightened and unable to co-operate. Invariably these failures occur in the six year old group (the minimum age seen), and therefore there is sufficient reason to raise the minimum age to receive buzzer treatment to seven years old. 54 DISEASES OF THE SKIN (excluding uncleanliness) A Consultant Dermatologist attends twice monthly at the Upney Clinic and an assistant medical officer, acting as his clinical assistant, treats minor skin conditions at a special session. Pupils known to have been treated Ringworm: (a) scalp – (b) body – Scabies 5 Impetigo 47 Other (plantar warts, etc.) 1,241 Total 1,293 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, 1,238 children were skin tested. 1,058 were found to be suitable and were vaccinated with B.C.G. 180 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 matters. SPEECH THERAPY Dagenham Area - Miss Symes reports as follows:- During 1967, there was little to note of change in the workings of the five speech clinics. Numbers of attendances for treatment in all clinics were greater than in 1966, and the busiest speech clinic still continues to be Five Elms, Wood Lane. As usual, boys exceed girls in their need for speech therapy. Dyslalia (functional malformation of articulation) continues to be the main speech problem in this area. Unfortunately, due to pressure of work, I was unable to make an annual visit to each school, as has been my custom for many years, but I hope soon to be able to recontinue this. I have been able to take in a few selected children from the Bentry School to Five Elms Clinic for speech therapy. 55 Statistical Return for 1967 Numbers of attendances at Five Elms 681 „ „ non-attendances at Five Elms 232 „ „ attendances at Leys 458 „ „ non-attendances at Leys 156 „ „ attendances at Oxlow Lane 300 „ „ non-attendances at Oxlow Lane 71 „ „ attendances at Marks Gate 190 „ „ non-attendances at Marks Gate 37 „ „ attendances at Annie Prendergast 137 „ „ non-attendances at Annie Prendergast 47 Total attendances = 1,766 „ non-attendances = 543 The number of patients under treatment at the end of 1967 was ninety. 160 patients had been treated during 1967, of whom 115 were boys, and 45 were girls. Conditions requiring therapy were as follows:- Dyslalia 114 Delayed Language 11 Cleft Palate 3 Dysphasia 1 Dysarthria 4 Sigmatism 9 Stammering 18 During the year, 70 patients were discharged as follows:- Speech Normal 51 No further progress likely 3 Left school – Non-attendance 8 Transferred to other areas 7 Discharged at parents request 1 Total 70 Barking Area - Miss Delaforce reports as follows:- The number of cases referred for speech therapy continued to rise during 1967 with the majority of patients coming from the infant school age group. The main speech problems amongst these children were defects of articulation. The schools in the area were contacted regularly and it was valuable to be able to discuss with the head teachers any problems concerning the children attending for speech therapy. A number of new referrals for speech therapy were found on school visits. The majority of pre-school children referred were recommended for play therapy. In addition to the opportunities play therapy offered to the speech defective child, it was also useful to be able to observe the child as a member of a group. Speech therapy was continued at Faircross School and by working with a student it was possible to see most of the children requiring speech therapy. A number of the children attending for speech therapy at the Castle School were moved to another area. Consequently it was necessary to assess the new entrants and the cases most likely to benefit were selected. 56 The figures below show the number of appointments sent at Julia Engwell Clinic and Central Clinic during 1967. Julia Engwell Pre-school Infant Junior Secondary Special Attendances 56 425 200 119 404 Non-attendances 34 189 96 49 134 Number of appointments sent during 1967 1,676 Total attendances 1,204 Non-attendances 472 Number on register in December 1967 104 New patients during 1967 71 Patients discharged during 1967 45 Central Pre-school Infant Junior Secondary Special Attendances 74 152 49 – – Non-attendances 35 71 21 - - Number of appointments sent during 1967 402 Total attendances 275 Non-attendances 127 Number on register in December 1967 107 New patients during 1967 14 Patients discharged during 1967 17 57 HANDICAPPED CHILDREN FAIRCROSS SCHOOL Mr. Holdsworth, the Headmaster, reports as follows:- "There are 116 children on the roll of the school, which celebrated its opening on the 11th January. Staffing has been very stable with resultant benefit to the children. The seniors have entered for external examinations of the Royal Society of Arts in English and Commercial Subjects. Pitman's Shorthand and Typewriting examinations and the Incorporated Phonographic Society Examinations Grade 1 and Grade 2 in Typewriting. I am pleased to state that in addition to the Commercial Course we have developed Typing as a means of communication for our cerebral palsied children. The school orchestra and choir grow in number and proficiency. At the Barking Schools Festival both gained high honours. Individual tuition in piano, strings, brass, and voice is given to children of promise. In swimming we have gained many Local and National awards; included in these is the Amateur Swimming Association bronze, and silver, award for Personal Survival, and Life Saving is being developed. A prominent feature this year has been the growth of Art and Craft in the school and the gaining of National Awards in this field. As a consequence, there has developed a keen interest in visiting other schools to see the work done, and in visiting art galleries and exhibitions. Other out of school activities include visits to the London museums, Brentwood Farm, Greenwich Nautical Museum and concerts at the Royal Festival Hall and Albert Hall. A very happy day was spent at Margate when the whole school, and parents, repaired there in June. Community service spirit is fostered by inviting the general public, other schools, and the senior citizens to the school functions, which included a performance of "Aladdin" at Christmas, and a Harvest Festival Service from which the produce was taken by the children to the needy. In addition Mr. R. D. Norman, Deputy Head, and myself have given talks to many organisations on the work of the school, and as a result a better understanding of our children and their needs is developed, and a better acceptance by the public is fostered. A very happy "family" spirit prevails in the school. For this, all praise is due to the entire staff - teaching, medical and ancillary. My grateful thanks to all." BENTRY SCHOOL I have received the following report from Mr. Hurton, the Headmaster:- "This school can cater for a maximum of 240 children in twelve classes. However, in 1967 the number of children on roll varied between 191 and 197 and there was no waiting list. The school is functioning well, and standards continue to improve. Great attention is paid to developing social maturity and a programme of factory visits has been carried out by the Senior Pupils to help fit them for 'After 58 School Life'. Six pupils left at Easter 1967. Five entered open employment and one went to Training Centre. We had fourteen summer leavers and one boy returned to secondary modern school. Thirteen leavers entered open employment and one boy went to Training Centre. Numerous educational visits and school journeys were made including a visit to Colchester Zoo by Classes 5, 6 and 7. Visits were made to the local G.P.O. Sorting Office by Class 8, Farm at Havering by Class 7 and RoSPA House by Class 2. Class 5 visited the Ceylon Tea Centre in connection with their class project and Classes 3 and 4 visited Southend Airport. As part of the social training programme journeys are made by public transport, bus or tube train, as well as by private coach. As a result of these educational visits, some pupils are journeying to London, etc., on their own initiative. Our school participated in the "Learning for Earning" experiment organised by Reverend Westall. This proved extremely successful. Arrangements have now been made for some of our children in need of speech therapy to attend Five Elms Clinic. This arrangement is proving satisfactory. 59 60 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS Blind Part Sighted Deaf Part Hearing Physically Handicapped Delicate Maladjusted Educationally Sub-normal Epileptic Speech Defect Total Number of children newly assessed in year — 2 — 7 7 12 12 19 1 — 60 Number of children placed in Special Schools in year — — — 6 7 10 13 29 1 — 66 Number of children requiring places in Special Schools – 2 — 2 4 2 5 7 1 — 23 Number of children included above whose parents had refused consent to their admission – — — — — — — 3 — — 3 Number of children on Registers of Special Schools at 18th January 1968 3 14 2 31 65 61 28 207 6 — 417 Number of children receiving tuition at home or in hospital, etc. - - - - - - 4 — - - 4 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 46 babies:- Central Nervous System: Anencephalus 4 Hydrocephalus 2 Spina bifida 4 Eye, ear: Defects of ear 1 Defects of eye 2 Alimentary system: Cleft lip 3 Cleft palate 1 Rectal and anal atresia 1 Heart and great vessels: Congenital heart disease 1 Uro-genital system: Hypospadias, epispadias 4 Other defects of male genitalia 2 Limbs: Defects of lower limb 4 Reduction deformities 2 Polydactyly 4 Syndactyly 2 Talipes 7 Other defects of hand 1 Other defects of pelvic girdle and lower limbs 1 Other skeletal: Osteogenesis Imperfecta 1 Other systems: Vascular defects of skin, subcutaneous tissues, and mucous membranes (including lymphatic defects) 6 Exomphalos, omphalocele 1 Other malformations: Multiple malformations 1 Mongolism 2 Other 1 61 DENTAL SERVICES I am indebted to the Principal Dental Officer for the following report:- SCHOOL DENTAL SERVICE The school dental service was able during 1967 to provide full dental treatment for any school child receiving education under the local authority. The percentage of the school roll inspected in 1967 was 47% - this is good when compared with 1965 when it was 28%. CONSERVATIVE AND ORTHODONTIC TREATMENT I am happy to report that in both these important fields of dental work, the trend is increasing to save teeth and also to help the unfortunate child with irregular teeth; in the case of the latter I would again like to thank the Consultant Orthodontist at Whipps Cross Hospital for advice and treatment in the more difficult cases. DENTAL HEALTH EDUCATION The dental staff, as individuals, did an excellent job of work in this very important field of dental everyday routine. Dental health talks to nursery schools, infant and junior schools, supported with films were a prominent feature of dental health education in 1967, but I feel sure that in the years to come a more organised effort in conjunction with the individual effort is essential. STAFFING Four part-time dental officers left the Borough for various reasons. However, I am happy to be able to report the appointment (part-time) of a consultant anaesthetist. His work in dealing with difficult cases requiring extractions and cases requiring surgical dental treatment is excellent. The appointment of a senior dental surgery assistant has also proved a major asset to the Dental Section. I was sorry to see the dental laboratory, established in 1945, close, but happy that the chief dental technician is still working for the Borough. MATERNITY AND CHILD WELFARE DENTAL SERVICES Dental treatment was available at dental clinics in the Borough for expectant and nursing mothers and children under five years old. It gives me satisfaction to report that in this very important part of the dental services, the percentage inspected, and treated, and the number of deciduous and permanent teeth filled to each extracted, compares very well with national figures and in some cases we are in this Borough well above. Our dental auxiliaries have played a big part in this important and valuable work. The need, however, is still great and, in my opinion, it is priority number one, as it is only by starting at an early age, before bad habits are formed, that good teeth and good oral hygiene can be achieved. GENERAL COMMENTS I tried in 1967 to establish a third surgery at Oxlow Lane, but the economic situation would not allow this; however, I hope that we can soon do this. There would be two great advantages:- 62 1. Two dental auxiliaries could be employed and supervised by one dental officer. 2. The output of maternity and child welfare work could be doubled. Annie Prendergast Clinic opened for dental work in 1967; there has been a very good response for treatment especially for the under fives. I would like to conclude my report by repeating what I said in 1965. Fluoridation of water supplies appears to be the best major step to be taken in the field of preventive dentistry and I hope it will not be too many years before this is taken. DENTAL SERVICE STATISTICS Sessions (½ days) worked 1. Sessions devoted to inspection 99 2. Sessions devoted to dental health education 150 3. Sessions devoted to treatment 2,609 4. Sessions devoted to treatment of mothers and young children 281 3,139 School Dental Inspection 5. Number of pupils first inspected at school 11,755 Number of pupils first inspected at clinic 2,288 Number of pupils found to require treatment 9,277 Number of pupils offered treatment 8,897 Number of pupils re-inspected at school or clinic 749 Number of pupils found to require treatment 579 Treatment 6. Number of pupils actually treated 4,192 7. Number of attendances made 13,951 8. Number of fillings in permanent teeth 7,969 9. Number of fillings in deciduous teeth 5,473 10. Permanent teeth extracted 708 11. Deciduous teeth extracted 2,592 12. General anaesthetics given 1,303 13. Number of pupils x-rayed 349 14. Number of pupils supplied with dentures 12 Orthodontics 15. New cases commenced 83 16. Cases remaining from previous year 110 17. Cases completed 48 18. Cases discontinued 6 19. Number of appliances fitted 100 20. Pupils referred to hospital consultant 16 63 MATERNITY AND CHILD WELFARE DENTAL TREATMENT Expectant and Nursing Mothers Children under 5 years Numbers of Cases 1. Number of persons examined 72 473 2. Number of persons treated 69 416 Treatment Provided 3. Scalings and other prophylaxis 27 184 4. Filling 127 1,107 5. Teeth otherwise conserved - 149 6. Crowns and inlays 5 - 7. Extractions 74 215 8. General anaesthetics 13 122 9. Dentures provided 15 - 10. Patients x-rayed 28 5 64 BARKING HOSPITAL Following a long campaign by members of the Borough Council and other interested persons for an increase in local hospital facilities, the Regional Hospital Board in 1957 decided that the Barking Hospital should be developed to provide a full range of acute in-patient and out-patient services. Work started on the site in November 1963, the buildings were completed by the end of 1966, and the hospital was formally opened by H.R.H. Princess Alexandra on 20th April, 1967. The hospital now provides 276 beds of which 84 are for obstetrics and 54 for geriatrics. The new buildings include a twin operating theatre suite, X-ray department, pathology department, and a comprehensive physical medicine department with excellent hydro-therapy and occupational therapy sections. The final cost of the development is estimated to be approximately two and a half million pounds. 65 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRICT (a) Nature and number of visits:- Rent Act 152 Housing and Public Health Acts:- Dwelling houses 7,069 Other premises 2,474 Overcrowding and housing applications 57 Improvement grants 48l Multiple occupation 266 Bakehouses 58 Milkshops and dairies 119 Foodshops, markets, stalls and delivery vehicles 2,660 Cafes and canteens 706 School kitchens and feeding centres l8l Infectious disease enquiries 726 Foster mothers' premises 39 Number of complaints investigated 2,700 Noise nuisance 94 Clean Air Act:- Survey – Other inspections 3,124 Factories 882 Offices, Shops and Railway Premises Act 1,846 Rag Flock and Other Filling Materials Act 8 Tents, vans and sheds 152 Pet shops 34 Hairdressers 121 Ice cream premises and vehicles 594 Houses disinfested 32 Rodent control 2,413 Other visits 2,106 (b) Notices served:- Statutory 91 Informal 1,679 Complied with:- 102 1,666 WATER The water supply continues to be satisfactory both in quality and quantity. During the year 14 bacteriological samples were taken from the Company's mains in the Borough; all were satisfactory. The water does not have any plumbo-solvent properties and no action was called for in respect of any form of contamination. There is now a piped supply inside all houses. 66 During the year the following mains were laid:Length of Mains Size 42 yards 3 ins. 1,083 „ 4 ins. 10 „ 6 ins. 75 „ 9 ins. 872 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 water, of the water in its various stages of treatment, and of the water going into supply. More than 10,000 examinations have been made and all the 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 extension 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, six indoor and one hydrotherapy swimming pools in the Borough. The water from the swimming baths is taken from the mains of the South Essex Waterworks Company. During the year 62 samples of the water were taken and submitted for chemical and bacteriological examination. All results were satisfactory with the exception of one sample taken from a small indoor pool, but advice was given and there has been no further trouble. HOUSING Slum Clearance During the year two Clearance Areas were represented to the Council. On the 3rd March, 83 dwellings were declared to be unfit, and on the 13th September 165 houses were made subject to a second Order. In April the Council made Closing Orders on two unfit properties suffering from serious disrepair and instability. No representations were received from the owners. No Public Enquiries were held during the year but notice was received from the Ministry of Housing and Local Government of two enquiries to be held in January 1968. 67 Rent Act 1957 14 applications were received from tenants during the year. In one case the Council refused to issue a Certificate of Disrepair. Undertakings to do the work were given by the landlords in respect of five properties. Seven Certificates of Disrepair were issued and two objections by tenants to the Cancellation of Certificates were received. As in previous years advice was given to all who sought it and forms were obtainable from the Civic Centre. Improvement and Conversion Grants During the year 10 discretionary grants and 69 standard grants were approved. The co-operation which exists between the Town Clerk's and Architect's Departments and ourselves in administering grants continues to result in a satisfactory service. Interest in grants generally is still very active and I feel it is only the shortage of builders willing to do this work which is really the governing factor to even greater expansion. Houses in Multiple Occupation 266 visits were paid to these properties during the year but in this area it is not a major problem. It has been found that some houses are overcrowded for a short period where immigrant families have stayed with 'relatives' before going to a more permanent address. These houses are kept under observation. There are no common lodging houses in the Borough. Tents. Vans and Sheds As stated in my report last year, vacant sites in the Borough are decreasing but to the few remaining unfenced sites 152 visits were made. LAUNDRY SERVICE It was only possible again this year to operate a once-weekly collection. At the end of the year the laundry was being dealt with at the Chadwell Heath Hospital. When conditions have improved at the hospital laundry it is hoped that the service may be increased to a twice-weekly collection. As in the past the staff have been most helpful in making the running of this service successful. An average of 36 cases used the service at any one time. ATMOSPHERIC POLLUTION Due to the financial crisis the Council again agreed that the remaining smoke control areas to be dealt with must be deferred. The position is as last year, which means that 42,594 houses out of a total of 55,013 in the Borough are now within smoke control areas and the industries have continued to play their part in the general improvement. 68 The Council continues to take part in the National Survey on Air Pollution and takes readings at the eight stations in the Borough. The readings are transmitted to the Ministry for their use. One hopes the ultimate result will show the definite improvement one so often fails to see when comparing readings over short periods. The position is always changing, solid fuel gives way to other forms of heating, this and the natural expansion can all too easily give misleading results. NOISE ABATEMENT ACT, 1960 This continues to be a most difficult problem, possibly arising from the rush and bustle of present day life which causes some people to react to noise in a manner that bears no real relationship to the measurable volume. It is, at present, impossible to translate noise in terms of nuisance as the problem is complicated by the pitch of the noise which can cause a source of low volume to be a real nuisance. A small whine can often cause more trouble than a passing train. Elaborate and expensive equipment, at the present stage of development, serves little purpose. Personal reactions to a noise nuisance and action based on it seem to be the most effective means of dealing with the problem. RAG FLOCK AND OTHER FILLING MATERIALS ACT. 1951 There is only one premises in the Borough registered under Section 2 of the Act. Eight informal samples were taken from premises during the year, all of which were satisfactory. The details are as follows:- Material Number of Samples Submitted for Analysis Cotton Felt 4 Kapok 2 Sisal 2 PET ANIMALS ACT, 1951 11 licences to keep pet shops were issued during the year. The amount of livestock generally kept is very small. No breaches of the licensing conditions occurred during the year. PREVENTION OF DAMAGE BY PESTS ACT, 1949 The service given under this Act continued throughout the year. There is nothing of any moment to report. The sewers remain rat-free and the surface infestations appear to be kept well under control. Happily, Warfarin resistance has not yet spread to this Borough so we still have the use of the best practical method of keeping this problem under control until, perhaps, who knows, rats and mice may yet be exterminated completely. 69 RIDING ESTABLISHMENTS ACT, 1964 There are two riding establishments in the Borough, one at the east end and one at the west end. The staff of the Corporation of London administer this Act on our behalf and are still satisfied with the manner in which they are run. DISEASES OF ANIMALS ACT. 1950 As reported last year the Corporation of London are responsible for the administration of this Act. 45 visits were made to premises in this area by the staff of the Veterinary Department. During the Foot and Mouth Disease outbreak, concern was expressed about the manner in which cattle grazing on land adjoining Renwick Road tip gained access to the tip itself. The cattle trap on the entrance road was reconstructed and a regular patrol was kept on boundary fences. These measures resulted in the cattle being denied access to the tip. FACTORIES ACT, 1961 Inspections Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 46 75 – – Factories with mechanical power 428 807 85 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 6 56 – – Total 480 938 85 - 70 Defects Found Number of defects Number of Prosecutions Instituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness 10 9 - - - Overcrowding - - - - - Unreasonable temperature 3 3 - - - Inadequate ventilation 1 - - - - Ineffective drainage of floors 4 3 - - - Sanitary conveniences: Insufficient 15 25 - - - Unsuitable or defective 133 117 - 1 - Not separate for sexes 6 3 - 2 - Other offences 20 13 - – - Total 192 173 - 3 - Outwork Number of outworkers in August list 202 Nature of work - Making, etc. wearing apparel and Christmas crackers. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 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 27 221 65 Retail shops 30 899 439 Wholesale shops, warehouses 3 40 13 Catering establishments open to the public, canteens 3 93 58 Fuel storage depots - 3 1 71 Class of workplace Number of persons employed Offices 2,686 Retail shops 4,579 Wholesale departments, warehouses 399 Catering establishments open to the public, canteens 890 Fuel storage depots 10 Total 8,564 Total Males 4,046 Total Females 4,518 During the period, 51 notifications of accidents were received in respect of employees. INSPECTION AND SUPERVISION OF FOOD The number and types of food premises in the Borough are as follows:- 3 Bakehouses 46 Bakers and confectioners 90 Butchers 254 Cafes and canteens 45 Fishmongers 80 Fruiterers and greengrocers 156 Grocers 88 Licensed and off-licensed premises 9 Public houses with restaurants 148 Sweets, etc. All these premises are regularly inspected, and during the year 4,035 visits were made. In addition to verbal warnings and suggestions to managements and staff during routine visits, 282 informal notices were served upon owners and occupiers under the Food Hygiene (General) Regulations, 1960. 399 inspections were carried out in connection with delivery vehicles and stalls, and 72 informal notices were served. The position under the Food and Drugs Act, 1955, Section 16, apart from registrations in respect of ice cream, is as follows:- 31 butchers' premises and 16 other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 762 visits were paid. 10 fish shops are registered for frying and five are registered for the curing of fish. To these 334 visits were paid. 72 Milk All milk which is distributed in the area is produced and bottled outside the Borough. The number of registered dairies is three and the number of distributors is 83 operating from 140 premises. There are also four vending machines. 119 visits were paid to dairies and distributors' premises. The following samples were submitted for bacteriological examination during the year:- Designation of Milk Total Samples Submitted Methylene Blue Test Phosphatase Test Turbidity Test Satisfactory Unsatisfactory Satisfactory Unsatisfactory Satisfactory Unsatisfactory Pasteurised 39 39 – 39 – - - Sterilised 15 - - - - 15 - Three samples of pasteurised milk included above were taken from milk vending machines. Ice Cream The total number of registered premises selling ice cream is 147. Of this number two are registered for the manufacture of ice cream. 437 visits were paid to these premises. During the year, 68 applications for the storage and sale of ice cream were granted. 57 inspections in connection with delivery vehicles were carried out. During the year 102 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 33 6 1 - 40 Loose Ice Cream 27 9 4 3 43 Soft Ice Cream 6 6 4 3 19 In addition to ice cream, 23 lollies were submitted for examination. All were satisfactory. The fact that ice cream is occasionally graded IV does not mean it is unfit; this result i6 a guide that the method of handling and manufacture may be suspect. On the other hand, these poor gradings are often the result of the colouring matter or chocolate in or around the ice cream. It is accepted that the method used to arrive at these gradings is suspect and misleading, but it is the best we know of at the present time. Unsound Food The year has passed without any major change. The days when food was diseased or knowingly adulterated have, for all practical purposes, passed and progress has brought us to this machine-age. In addition to products being untouched by hand, they are often unseen by eye until they appear on your plate, cooked and ready to eat, the meal having been safeguarded and conditioned both naturally and artificially. No wonder we sometimes feel that food has lost its flavour; this, however, is part of the price we have to pay. During the year, the Committee considered 34 complaints concerning food. 73 Twelve warning letters were sent and twenty-one prosecutions taken; of these, two defendants were given an absolute discharge. In one case it was agreed that legal proceeding should be instituted, but the witness was unwilling to give evidence so a warning letter was sent to the manufacturers. Registration of Food Hawkers Under the provisions of the Essex County Council Act, 1952, Section 103, 10 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 S. typhimurium - - - - 6 Other Salmonellae - - - - 1 Cl. welchii - - - - - Staph, aureus - - - - - Other causes - - - - - Cause unknown - - - - - Total - - - - 7 Details of Food Poisoning due to Salmonellae other than S. Typhimurium Type of Salmonellae "Kentucky" 1 Pesticides in Food Survey - First Year 1966/67 During this period 21 samples of various foodstuffs were submitted by this authority; two of these were above the 'reporting' limit set by the Ministry of Agriculture, Fisheries and Food for organo-chlorine pesticides, and another sample, whilst above the 'reporting' limit for lead, was well below the statutory limit. There is no statutory limit for organo-chlorine pesticide contamination nor have the authorities suggested one, as they did for aldrin/dieldrin, so we can only hope that the survey will have furnished the authorities with the necessary information to enable them to set acceptable standards for these other chemicals. 74 Food and Drugs - Sampling Articles Number Examined Number Adulterated Formal Informal Formal Informal Baby Food - 3 - - Bacon - 1 - - Baking Powder - 1 - - Beans in Tomato - 1 - - Beer, Wines and Spirits - 3 - 1 Beverages 2 6 - - Biscuits - 8 - - Blackcurrane Dumpling - 1 - - Bread - 7 - 5 Bread and Butter 5 - 1 - Cakes - 5 - 1 Cereals 3 12 - 1 Cheese - 5 - - Chicken Croquettes - 1 - - Condiments - 5 - - Cooking Oil 1 3 - - Cream - 3 - - Desiccated Coconut - 1 - - Dried Yeast - 1 - - Fats - 6 - - Fish Frozen - 2 - - Fish - Tinned - 2 - - Flavouring - 2 - - Flour 1 3 - - Frankfurters - 1 - - Fruit - dried - 6 - - Fruit - fresh - 2 - - Fruit - tinned - 6 - - Fruit Drinks and Cordials etc. 4 7 - - Gravy - 1 - - Haricot Beans - 1 - 1 Herbs - 3 - - Ice cream - 4 - - Ice Cream Powder - 1 - - Ice Lollies - 1 - - Jellied Eels - 1 - - Jelly 1 3 - - Meat 3 3 - - Meat - Frozen - 3 - - Meat Pies - 6 - 3 Meat - Tinned 1 11 - 4 Medicinal Samples 1 9 - - Milk 6 15 - 3 Milk Shake - 1 - - Milk - Tinned - 2 - - Miracle Whip - 1 - - Nuts - 4 - - Pastes - 10 - - Pickles - 1 - - Pie Filling - 2 - - Potato Sticks - 1 - - Preserves - 6 - - Puddings - 5 - 1 Sauces - 4 - - Sausages 4 8 - 2 75 Food and Drugs - Sampling (continued) Article Number examined Number Adulterated Formal Informal Formal Informal Sausage Rolls — 3 — 2 Saveloys - 1 - - Scotch Pancakes - 1 — 1 Soups - 3 - - Spaghetti in Tomato and Cheese Sauce — 1 — — Starch Reduced Rolls - 2 - - Sugar - 1 - - Sweets 1 6 - - Uncooked prepared Foods — 2 - - Vegetables - Dried — 2 - — Vegetables - Fresh — 4 — — Vegetables - Tinned – 2 - - Yoghurt – 3 — — Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 22A French Loaf Informal Contained rodent excreta Warning letter to manufacturers. Witness unwilling to go to Court. 23A Sausage Rolls Informal Patches of greenish mould growth on filling of one sausage roll. Warning letter to distributor 39A Milk Bottle Informal Bottle of milk found to contain sand. Legal proceedings Fined £10 and 5 gns. costs. 40A Continental Cut Loaf Informal Contained remains of a house fly. Legal proceedings Fined £10 and 3 gns costs. 41A ) 42A ) 43A ) Pressed Ham (Tinned) Informal Contents showed presence of brownish discoloration where it had been in contact with the seams of the can. Withdrawn from stock and destroyed. 64a Bread Informal Metal screw in loaf. Legal proceedings Fined £10 and 3 gns costs. 70A Cola and Rum Informal Proof Spirit 1 per cent Content of alcohol low. Letter to Manufacturer. Label to be amended 76 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 92A Milk Informal Black specks in milk No action. 93A Sausages Informal In a mouldy condition Legal proceedings. Fined £10 and 3 gns. costs. 94A Milk Informal Contained minute specks of iron rust adhering to bottle. Warning letter to distributor. 97A Pea Flour Informal Insect infestation. Formal sample taken; this was satisfactory 115A Bread Informal String in loaf. Legal proceedings. Fined £10 and £5 costs. 117A Raisin Bran. Informal Contained a single raisin amounting to only 0.6 per cent of the total contents. Formal sample taken this was satisfactory. 145A Ham and Pork Informal Showed discoloured patches due to iron contamination which was associated with a fragment of reddish plastic-like material. Warning letter to manufacturers. 146A Scotch Pancakes Informal In a mouldy condition Legal proceedings Fined £20 and £5 costs. 147A Pork and Egg Pie Informal In a mouldy condition Legal proceedings Fined £5 and 5 gns. costs. 157A Bread Pudding Informal Contained a 4" length of thin wire. Warning letter to caterers. 158A Sliced White Loaf Informal Contained discoloured dough and insect fragments. Legal proceedings. Fined £15 and 5 gns. costs. 159A Skinless Pork Sausages Informal In a mouldy condition Warning letter to distributor 77 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 161A Steak and Kidney Pie Informal Contained an almost complete dead fly. Legal proceedings. Fined £5 and 5 gns costs 162A Sausage Rolls Informal In a mouldy condition Legal proceedings. Fined £15 and 5 gns costs 187A Haricot Beans Informal Contained three dead weevils. No action. Unable to obtain further sample. 203A Pork Pie Informal In a mouldy condition Legal Proceedings. Fined £10 and 3 gns costs. 208A Sponge Cake Informal Contained foreign matter in the form of a bristle. No action 116 Bread and Butter Formal Fat consisted of a mixture of butter and margarine. Legal proceedings. Fined £10 and 3 gns costs. IMMIGRANTS During the year 95 visits were made to long-stay immigrants. The medical officers at ports obtain the destination addresses of immigrants and these are forwarded to the district concerned. The immigrants are visited and they and their dependants are advised to register with a general practitioner with a view to chest X-rays. Printed cards in six different languages are handed out in order to assist in the interview. Whilst the figures have somewhat increased during this year there is still not a major problem in this area. 78 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 – 1 8 7 7 56 13 6 1 99 Whooping Cough 9 8 16 11 13 33 4 – – 94 Measles 68 221 230 236 209 362 274 25 5 1630 Diphtheria – – – – – – – – – – Dysentery – – – – – – – – – – Acute Poliomyelitis: Paralytic – – – – – – – – – – Non-paralytic – – – – – – – – – Meningococcal infection Under 5 yrs. 5-14 15-44 45-64 65 and over Total Pneumonia: Acute Primary 4 5 1 2 1 13 Acute Influenzal 3 1 10 8 22 Encephalitis, Acute Infective – – – – – – Post Infectious – – – – – – Erysipelas – – 1 2 – 3 Food Poisoning 2 – 2 3 – 7 Puerperal Pyrexia – – 2 – – 2 Ophthalmia Neonatorum – – – – – – Paratyphoid B – – – – – – Typhoid – – – – – – Smallpox – – – – – – Anthrax – – – 1 – 1 Notified Admitted to Rush Green Hospital Admitted to other Isolation Hospitals. Admitted to other Hospitals Dysentery – – – – Encephalitis, Acute Infective – – – – Post Infectious – – – – Erysipelas 3 – – – Food Poisoning 7 3 – 1 Measles 1,630 7 – 2 Meningococcal Infection – – – – Paratyphoid Fever – – – – Puerperal Pyrexia 2 – – 1 Pneumonia: Acute Primary 13 – – 1 Acute Influenzal 22 1 – – Acute Poliomyelitis: Paralytic – – – – Non-paralytic – – – – Scarlet Fever 99 – – – Typhoid - - – – Whooping Cough 94 3 – – Anthrax 1 – – – 29 A DAY CENTRE FOR THE MENTALLY ILL At the formation of the London Borough of Barking in April, 1965, the newly formed Health Committee of the Council was presented with a suggested programme of development of services for the mentally ill and the mentally sub-normal. The general acceptance of this programme meant that whereas the desirability of a day centre for the mentally ill was realised, other projects had priority over it by reason of the already established urgency for them. However, as the team of mental welfare officers was built up with increasing links with family doctors and the local mental hospital, etc., the need for strengthening the community care service with a day centre became more apparent. By a quirk of the hospital catchment area allocation Barking people were constrained to look to Warley Hospital (some 8 to 12 miles distant according to where they lived in the Borough) for the main centre for both in-patient and out-patient attendance for psychiatric treatment. The need for providing a local focal point for community care services became increasingly obvious and fortunately a former Methodist Church in the geographical centre of the town was offered for sale to the Council in the Spring of 1966 and it was agreed that the Health Committee had an overriding priority for acquiring it as a Day Centre for the Mentally Ill. In late 1966 the building, about 40 years old, was acquired for £23,000 and it was decided that alterations and repairs would be kept to a minimum so that when more experience of the Centre was known a firmer and more practical development programme could be arranged. Initially, therefore, some £3,000 was spent on adapting and putting the building in good order, including the installation of a new gas central heating system to replace a coke-fired installation which had seen better days and which did little or nothing to dispel the arctic conditions of a winter's day. By the Spring of 1967 the adapted building was ready for occupation. Accommodation Fortunately the building, which has a substantial piece of land attached to it, had been designed to include secular activities sponsored by the church and minimal alterations gave the following accommodation:- Main Hall - 28' 56' Work Room - 40' * 20' Dining Room - 36' * 16' Quiet Room - 20' * 30' Office Medical Room and Sick Bay Store Room Kitchen Main Hall - It was decided that this should be left as uncluttered as possible and therefore only contains a plentiful supply of stackable chairs and a half size billiard table presented by the local voluntary Mental Health Association. It is used for evening social activities and during the daytime for occupational therapy and contract work not requiring mechanical aids. It also proves most useful when sales of work, bazaars, etc., are held to raise money for the Centre's Amenity Fund. It is also used on a Wednesday afternoon by an Old People's Club which was established sometime ago and which on the take-over of the building was given grace to continue pending alternative accommodation being found. Work Room - This has been fitted with work benches and some machinery for metal and woodwork. Dining Room - This is kept exclusively for protracted "elevenses", lunches and the afternoon break. 30 Kitchen - The original kitchen was enlarged so that it can be used for training and demonstration purposes. e.g. for a housewives group, as well as being able to provide light refreshments for large social gatherings, to dish up the mid-day meals provided through the school meals service, etc. Quiet Room - This has been furnished as a lounge and is available for use throughout the day for any individual wishing to get away from the main stress of the centre. Apart from the lunch break this room is not sought after and plans are in hand to use it for group therapy sessions. Medical Room and Sick Bay - This is used by the consultant psychiatrist once a week for his conference with centre staff and mental welfare officers and for anyone who feels "seedy" but for much of the time this room provides a retreat for staff wishing to catch up with "paper work". Store Room - In the original lay-out of the building it was proposed that a créche should be included so as to make it easier for the married woman with a young child to accept a centre placement. This facility is still something for the future because from the moment the centre was opened storage space became a major problem and so temporarily the créhe has become a storeroom. However, within the next two years the Centre is due to inherit a large transportable pre-cast concrete annexe which at present is part of the junior training centre for the mentally sub-normal soon due for replacement. General - It was agreed that apart from initial colour washes the decor of the building should be left so that the talents of the centre-goers could be exploited. Lampshades, pictures and a large mural have already been added to give the premises 'character'. Aims and functions of the Day Centre These were defined briefly as follows:- 1. To enable in-patients at Warley Hospital, etc., to be discharged earlier than they would otherwise. 2. To prevent the mentally ill from becoming mental hospital in-patients. Admissions to the Day Centre It was decided that all requests for admission whether from a family doctor or hospital should be made in writing so that all admissions could be agreed upon by the Centre staff, the Principal Mental Welfare Officer and the Senior Medical Officer in charge of the Mental Health Service, who would also have access to the Borough's Consultant Psychiatrist, if need be. It was further decided that initially all centre-goers would be expected to make their own way to and from the centre but that bus and train fares would be paid in needy cases. In practice it has been found that in special cases such as patients suffering from agoraphobia (fear of open spaces) it would be a distinct advantage to give door to door transport but this facility can only be arranged when more transport is available to the Department because existing minibuses are already fully committed. The Centre is at present open for full-time attendance by all cases from Monday to Friday from 9.30 a.m. to 4.30 p.m. throughout the year. Staff In view of the need to build up the Centre gradually it was decided that 31 32 an occupational therapist and an instructor should be appointed initially, and also for clerical help to be provided. This was achieved and, together with domestic staff, viz. a handyman,a cleaner, and a mid-day assistant for mealtimes, the Centre was ready to function in May, 1967. It was, of course, understood that mental welfare officers should have an interest in the Centre and should be available to assist when applicable in crises affecting centre-goers, etc. The First Year of the Centre Statistics etc. - Although the following statistics summarise the work of the Centre, they do not give any measure of the great success of the Centre in terms of human happiness and dignity - it is hoped to convey this in subsequent paragraphs:- Total number of referrals 59 Total number of individual cases who attended the Centre (either during part of whole of period) 54 No. of cases who failed to keep up attendances 12 No. of cases who gained employment 12 No. of cases re-admitted to hospital 8 Total attendances 5096 (half-day sessions) No. of cases attending regularly at end of period under review 27 (11 making good progress ) (12 making slow progress ) ( 4 no apparent improve- ) ( ment at present. ) Most of the referrals were made by the medical staff of Warley Hospital, with whom there is close contact, i.e. regular visits are paid to the hospital by both the senior medical officer responsible for the Mental Health Service and the mental welfare officers, who also maintain contact and liaise between patient and agencies concerned with health and welfare. It soon became obvious that the flow of referrals, if all were approved, would soon absorb the resources of the Centre and promptly the Health Committee agreed that a further instructor should be appointed so that in its second year the Centre would be able to increase its number of places from 20 to 30. As each new case was accepted the variety of differences between cases e.g. temperament, social background, educational attainment, degree and type of illness, made it obvious that within the centre streaming would have to be introduced for groups of people who would be compatible with each other so that their rehabilitation could have due regard to one or more of the following objectives:- 1. To restore or promote self confidence. 2. To promote and stabilize better social relationships. 3. To encourage work habit with a view to return to open employment. It has been found in practice that some people work better on their own, e.g. typewriting, painting, and other quiet pursuits (including a wide range of activities initiated by the Occupational Therapist); others work better in small groups; whilst others enjoy the more robust atmosphere of a large workroom, where a number of rewarding contracts have already been fulfilled. Staff always have to be ready to cope with behaviour problems e.g. impulsive or aggressive behaviour, fits of weeping. Overall it has become obvious that ultimately the Centre will require greater flexibility in its layout in order to give sufficient diversity of accommodation. It is anticipated that when the annexe is transferred from the Junior Training Centre (as mentioned in a previous paragraph) much more division will be possible. Training of Staff - The staff so far appointed have worked exceedingly well as a team and in the future it is proposed that they should be supported in their work by arranging suitable training facilities for them. Transport - Regular transport is not necessary for most centre members, but from time to time a need for this arises. One of our members had been housebound for fifteen years, and needed help in this respect until she became confident enough to travel by bus. We also have agoraphobic patients, who at certain times are unable to travel, and who would benefit from attendance at the Centre during these difficult periods. Sometimes it is necessary too, to convey a person home if she or he becomes unwell while at the Centre. Social Activities - The West field Psychiatric Social- Club meets every Thursday evening at the Day Centre. Recreational facilities include a billiards/snooker table (given by the Dagenham Mental Health Association), darts, chess, table tennis, etc., and a record player for members' records. Periodically demonstrations of special and practical interest are given. The Gas Board sent a representative who introduced recipes and showed how to cook them on the latest type gas cooker. Techniques in flower arranging have also taken place, given by a specialist. A whole evening was given over to a visit by the Morris Dancers and the Club members joined in the programme. At any time during the Thursday evening club there are Mental Welfare Officers available for any counselling required, and a member of the Day Centre Staff is usually in attendance also. Members attending the Day Centre are offered the opportunity to go to a West End theatre about once or twice a month. The tickets are generously given by the Old Age Pensioners Club who meet every Wednesday afternoon at the Day Centre. These outings provide new experiences for many Centre members. Confidence is gained by travelling in a group and this in turn encourages good behaviour. Afternoon tea is usually taken in a tea shop adjacent to the particular theatre. All incidental expenses are met from the Centre's Amenity Fund. The Amenity Fund commenced with a Jumble Sale organised by the Dagenham Mental Health Association which then donated a further sum to give a total of £100. The Centre has since organised functions on its own account, the proceeds going to the Fund. The Fund is used generally for educational, social and recreational pursuits, e.g. it is used for theatre outings (including fares and admission charges), for chartering a sailing barge and supplying food for the day on board, and tea breaks, etc., on such journeys. At Christmas time the Amenity Fund meets the cost of much of the Centre's Christmas Party and for the provision of gifts to members. Individual Cases Synopses of a few selected cases are now given to show in some measure the true worth of the Centre A. A young man, 25 years of age with a good work record as a labourer. He had deteriorated mentally over a period of one year and had been admitted to hospital. On referral to the Day Centre he was found to be uncommunicative but interested in work. He soon settled down to a regular work habit and in the months that followed began to overcome his fear of persons working around him. Eventually he began to socialise in the Centre and found a girl 33 friend. The girl's father arranged an interview at his firm and this resulted in a member of the staff discussing suitable employment with the Personnel Officer of the organisation. The young man was selectively placed in the Stores Department and has maintained his position there. His length of stay at the Centre was one year. B. An elderly widow who lives alone in a poorly furnished Council house. During the last few years (since the death of her husband) she has had several hospital admissions for depression and drug addiction - and has on occasion taken overdoses of drugs. She is an extremely lonely and nervous person, who spent most of her evenings in bed, and most of the daytime wandering around the parks and streets. She has now been attending the Centre regularly for a year. This has been helpful in providing her with simple occupation, a daily hot meal, and most important, companionship - and she has made friends whom she visits from time to time in their own homes. It also enables Centre staff to keep an eye on her general mental and physical condition and to encourage her to keep hospital and family doctor appointments. C. A man of 40 years of age who had spent his working life, from the age of 16, in various mental hospitals. On arrival at the Day Centre he was free from obvious symptoms but was very slow, somewhat apathetic and aimless. He soon settled down after stating that he did not want a woman for his •"boss". It was not long, however, before he fully accepted female members of the staff, and made friends within the Centre. He now works well at his individual craft work and it may well be within the bounds of possibility that he will eventually obtain employment, but this is a long term view that will entail a problem regarding age. •Referring to the Occupational Therapist. D. Is a young schizophrenic girl who has been ill since the age of 14. She was extremely withdrawn, refused to leave the house, take her medication, or even to change her clothing when necessary. She was treated in Warley Hospital for five months and referred to the Day Centre in December, 1967. At first she was almost mute and had a fixed smile on her face. However, she gradually became more responsive and confident, until she was able to talk to the other Centre members, as well as to the staff. She eventually made a "special" friend of a young man, who has helped her a great deal she now takes an active interest in her appearance, work and social activities. Because she missed several years of school, she is educationally backward, and she has been coached in a few practical aspects, such as telling the time - but it was felt that it was more important to concentrate at first on social rather than educational improvement. E. A young postman of 34, unmarried, who was referred to the Centre in January, 1968, after two months in Warley Hospital where his father had been for over 30 years. When this man came to the Centre most of his psychotic symptoms had disappeared, but he was withdrawn socially and lacking in confidence. He worked well and consistently, began to show overall improvement, and took an active interest in the tidiness and cleanliness of the Centre. He experienced a tragic set-back when he returned home one evening to find his mother dead on the kitchen floor. During this difficult period he had a great deal of help from his mental welfare officer, and support from the Centre, but the staff were impressed by his efficient handling of the situation, and his ability to come to terms with the problem of living alone. (He took some cookery classes - and made friends in the Centre who were helpful to him). He obtained a job as porter/cleaner, and has held this now for several months. G. A woman of 54 years of age, widowed two years previously, with two grown up daughters in employment and living at home. She had suffered a stroke one year previously, had become depressed and disheartened, with a positive degree of fear to go about on her own and was referred to the Day Centre for support. For the first three months, during part time attendance, both resentment and aggression were shown to staff and members. This was followed by a response to occupational therapy with use of handicraft, and an interest in selling 34 the completed articles. At the same time she became able to walk to the pillar-box, accompanied at first, finally on her own. Next a successful attempt was made to reach the centre by public transport instead of the hospital car service. She now attends daily on her own, can do craft and industrial contract work, and takes part in group activities such as cookery. The day centre has played a supportive role in this member's group therapy sessions at Ardleigh Green and Collier Lodge. Length of stay, so far, 9 months. H. A man aged 30 years with numerous hospital admissions during the last decade. He was one of the first referrals to the Day Centre. During the first few weeks he made a good effort to lead the social relationships between the various newcomers, and at the same time made spasmodic attempts to carry out different kinds of work. He succeeded in making simple frames for pictures, and painted a large wall mural but his work tolerance proved to be very low, and before long he was evading work as much as possible. This situation has continued. He still endeavours to make friends with new arrivals but fails to maintain any such relationship. He is always going to find employment "in a month from now". Will sometimes work in the centre for short periods but soon becomes anxious and agitated if encouraged to keep at it. His attendance is very regular and he states that coming to the Centre gives him a sense of security. I. Married with two school age children, was referred to the Centre because of her depressive episodes and her fear of travelling. She is a pleasant, extremely capable person, who was able to cope efficiently with any task given, and at times fulfilled the role of "relief member of staff" during staff absence. Was passionately fond of babies. She suffered bouts of extreme depression and anxiety, which often led to an inability to travel, and physical symptoms such as fainting attacks. She soon found that she was able to confide in, and talk freely to one of the Centre staff hitherto she had complained that she was unable to discuss her problems with anyone, including her psychiatrist. However, her neurosis was so severe and complex that the staff felt she needed much more specialised help, and so contact was made with her hospital doctor who arranged to see her fortnightly and subsequently admitted her to hospital. She has been in hospital for three months and will probably be returning to the Centre shortly. Two problems are emphasised by this case. One is transport - in that on occasions she was not able to reach the Centre because of her travelling phobia - although time permitting she was collected by staff - and secondly, that of the care of her children, particularly during school holidays, if these occurred at a period when she was not well enough to cope with them at home and needed Day Centre support. The Future It is evident even at this early stage that the Day Centre is successfully fulfilling a very real need. A pressure for admission to the Centre is already building up and the need for the extension of the service calls for careful thought and preparation. The Centre caters for many patients whose illnesses are chronic and recurring so that some will require to attend the Centre at times of mental crises which may arise periodically over the years. Experience in the past has always shown that the extent of need for a service only becomes known when such a service comes into being. An extension of the service to the resocialisation and rehabilitation of the isolated and withdrawn elderly person would create a further challenge to the skill of all those concerned with the patients who attend the Day Centre. 35 Printed by the Town Clerk's Department London Borough of Barking