sark u i ^y- LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and S PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1969 J. ADRIAN GILLET, m.b., ch.b., d.p.h., f.r.s.h. Civic Centre, Dagenham, Essex Telephone: 01-592 4500 f 4J LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1969 J. ADRIAN GILLET, m.b., ch.b., d.p.h., f.r.s.h. Civic Centre, Dagenham, Essex Telephone: 01-592 4500 Page Adult Training Centre 54 Ante-natal Clinics 27 Atmospheric Pollution 78 "At Risk" Register 33 Bentry School 68 Care of Mothers and Young Children 27 Causes of Deaths 18 Causes of Infant Deaths 17 Child Guidance 64 Child Health Centres 28 Children's Department 36 Chiropody 48 Congenital Abnormalities, Incidence of 71 Convalescence 47 Co-ordination of Services 26 Council, Members of Cytology Service 35 Day Nurseries Dental Services 72 Diseases of Animals Act 1950 82 Education Committee 4 Education (Special Services) Sub-Committee 5 Enuresis Clinic 63 Factories Act 1961 80 Faircross School 67 Family Planning Service 41 Food and Drugs, Sampling 84 Food Hawkers, Registration 83 Food, Inspection and Supervision 82 Food Poisoning 89 Food, Unsound 83 Geriatric Clinic 43 Geriatric Liaison Officer 43 Guthrie Test 42 Handicapped Children 70 Health Committee 4 Health Education 23 Health Visiting 35 Holiday Play Centre 57 Home Help Service 45 Home Nursing Service42 Hostel for the Mentally Subnormal 57 „ „ „ „ „ plan 58 Housing 75 Houses in Multiple Occupation 77 Ice Cream 83 Immunisation 37 Improvement Grants 76 Infant Mortality 16 Infectious Diseases 88 Junior Training Centre, Castle School 56 Page Kidney Machines 47 Kingsley Hall Assessment Centre 33 Laundry Service 78 Mass Radiography 51 Maternity Services 28 Medical Examination of Staff46 Mental Health 53 Midwifery Service (domiciliary) 28 Milk 83 National Assistance Act 1948 44 Noise Abatement Act 1960 78 Offensive Fumes 79 Officers of the Health Service 6 Offices, Shops and Railway Premises Act 1963 81 Orthopaedic Clinic 63 Osborne Workshop 53 Pet Animals Act 1951 80 Play Therapy 32 Porters Avenue Day Centre 55 Prevention of Damage by Pests Act 1949 80 qualifications 13 Rag Flock and Other Filling Materials Act 1951 79 Registration of Nurseries and Child Minders 32 Rehousing on Medical Grounds 46 Rent Act 1957 76 Residential Accommodation 55 Riding Establishments Act 1939 80 Sanitary Inspection of District 74 School Consultative Clinics 60 School Health 60 School Medical Inspections 60 Sewerage and Sewage Disposal 75 Sickroom Equipment 46 Slum Clearance 75 Speech Therapy 64 Swimming Baths 75 Tents, Vans and Sheds 77 Tuberculosis 50 Typhoid Fever 90 Unmarried Mother, Care of 28 Vaccination 37 Vital Statistics 16 Voluntary Associations 57 Water 74 Westfield Psychiatric Social Club . 59 2 MEMBERS OF THE COUNCIL (as at 31st December, 1969) MAYOR Councillor A. C. V. RUSHA, J.P. DEPUTY MAYOR Councillor H. J. HOWIE ALDERMEN A. E. BALL, O.B.E., J.P. D. O' DWYER, K.S.G. W. E. BELLAMY, J.P. B. E. ROYCRAFT, O.B.E., J.P. G. H. A. CROUCH J. R. SWEETLAND Mrs. A. M. MARTIN Mrs. A. R. TOOMAS COUNCILLORS D. W. ATTRIDGE J. L. JONES, J.P. C. H. AYRES Mrs. E. J. KITCHEN Mrs. M. BALL, O.B.E. J. H. LAWRENCE D. W. BARNETT DANIEL LINEAN G. J. G. BEANE, J.P. Mrs. P. D. MILLER L. T. BLAKE W. J. PADINGTON G. A. BROOKER C. A. POOL, J.P. J. A. BUTLER, J.P. Mrs. V. H. POOL S. G. COLE Mrs. M. S. PRESTON L. A. COLLINS L. G. RIMINGTON R. E. COSTER M. J. SPENCER J. T. DEAN F. C. SPRAGGINS D. A. L. G. DODD, J.P. J. S. THOMAS, J.P. A. E. EAST F. G. TIBBLE E. G. J. EDO) H. TINDELL Mrs. J. H. EUGWELL B. P. WALKER Miss J. FACKERELL, J.P. S. J. WARR Mrs. C. S. M. GODFREY, J.P. Mrs. M. A. WARREN D. O GRANDISON D. J. WATERS R. F. HAWKEN D. W. WEBB E. E. HENNEM J. G. F. WILLMOTT C. W. JILLINGS T. A. WOODCOCK Mrs. D. M. JONES E. J. WOODS F. C. JONES 3 HEALTH COMMITTEE (as at 31st December 1969) CHAIRMAN Councillor Mrs. M. Ball VICE-CHAIRMAN Councillor Mrs. D. M. Jones MEMBERS His Worship the Mayor The Deputy Mayor Alderman D. O'DWYER Alderman Mrs. A. R. THOMAS Councillor D. W. BARNETT Councillor R. E. COSTER Councillor Mrs. J. ENGWELL Councillor Mrs. C. S. M. GODFREY Councillor Mrs. E. J. KITCHEN Councillor Mrs. P. D. MILLER Councillor Mrs. V. H. POOL Councillor F. C. SPRAGGINS Councillor F. G. TIBBLE Councillor H. TINDELL Councillor S. J. WARR Councillor J. G. F. WILLMOTT CO-OPTED MEMBERS Mrs. D. L. BELCHAMBER Dr. A. F. MacDONALD Mrs. M. BREDO Mrs. A. E. PRENDERGAST Mr. K. H. ROSE EDUCATION COMMITTEE (as at 31st December 1969) CHAIRMAN Councillor G. J. G. BEANE VICE-CHAIRMAN THE MAYOR, Councillor A. C. V. RUSHA REPRESENTATIVE MEMBERS Alderman A. E. BALL Alderman W. E. BELLAMY Alderman Mrs. A. MARTIN Alderman D. O'DWYER Alderman J. R. SWEETLAND Councillor Mrs. M. BALL Councillor L. T. BLAKE Councillor J. A. BUTLER Councillor S. G. Cole Councillor R. E. Coster Councillor D. A. L. G. DODD Councillor A. E. EAST Councillor Miss J. FACKERELL Councillor Mrs. C. S. M. GODFREY Councillor D. 0. GRANDISON Councillor R. F. HAWKHI Councillor E. E. HENNEM Councillor C. W. JILLINGS Councillor Mrs. D. M. JONES Councillor F. C. JONES Councillor Daniel LINEHAN Councillor Mrs. M. S. PRESTON Councillor H. TINDELL Councillor D. J. WATERS Councillor D. W. WEBB Councillor J. G. F. WILLMOTT Councillor T. A. WOODCOCK Councillor E. J. WOODS CO-OPTED AND NOMINATED MEMBERS Mr. R. BLACKBURN Mr. W. E. JOUGHIN Mrs. I. M. BROCKELBANK Mr. F. H. KING Mr. P. GRIMES Mr. D. F. REED Miss M. C. GROBEL, M.A. Mr. A. RICHARDS The Rev. Louis HESTON The Rev. J. W. ROXBURGH Mr. S. J. RUSSELL 4 M.O.H I Baikmg Repuv 1969 Ms. Pwivos A110 EDUCATION SPECIAL SERVICES SUB-COMMITTEE (as at 31st December 1969) (This Sub-Committee deals inter alia, with the School Health Service) CHAIRMAN Councillor G. J. G. BEANE MEMBERS THE MAYOR Alderman Mrs. A. MARTIN Councillor R. E. COSTER Councillor A. E. EAST Councillor Miss J. FACKERELL Councillor Mrs. C. S. M. GODFREY Councillor Mrs. M. S. PRESTON Councillor H. TINDELL Councillor D. J. WATERS Councillor E. J. WOODS Mrs. I. M. BROCKELBANK Mr. W. E. JOUGHIN 5 OFFICERS OF THE HEALTH SERVICE (as at 31st December, 1969) MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER J. Adrian GILLET, M.B., Ch.B., D.P.H., F.R.S.H. DEPUTY MEDICAL OFFICER OF HEALTH R. BEAVER, M.B., B.S. (Rangoon) D.C.H., D.P.H. SENIOR MEDICAL OFFICER W. H. G. BATHAM, M.R.C.S., L.R.C.P., D.P.H. SENIOR ASSISTANT MEDICAL OFFICERS E. KLEIN, M.D. (Naples), M.D. (Budapest) L.R.C.P. & S. M. WEIZMANN, M.R.C.S., L.R.C.P. ASSISTANT MEDICAL OFFICERS D. BURGESS, M.D. (Malta). B.Pharm. K. FITZPATRICK, M.B., Ch.B. G. MICHAEL, M.R.C.S., L.R.C.P., B.A. (Cantab) In addition 11 Medical Officers are employed on a sessional basis PRINCIPAL DENTAL OFFICER J. K. WHITELAW, L.D.S., R.C.S., (Ireland) SENIOR DENTAL OFFICER P. K. CHAUDHURY, L.D.S., R.C.S.(Eng.) DENTAL OFFICERS V. H. FOY, L.D.S., R.C.S.(Eng.) N. J. GRAHAM, L.D.S., R.C.S.(Eng.) C. SUMSAWASTE, L.D.S., R.C.S.(Eng.) SENIOR DENTAL SURGERY ASSISTANT Mrs. F. B. SADLER (23) DENTAL SURGERY ASSISTANTS Miss P. BRADLEY (35) Mrs. D. MURRAY (23) Mrs. M. BRIDESON Miss M. SEALEY Mrs. J. HUNTER Mrs. M. SIPOS (part-time) Miss L. KARMIOS (23) Mrs. M. STRACHAN (9) DENTAL AUXILIARY Mrs. G. CROUCHER (24) SENIOR DENTAL TECHNICIAN-IN-CHARGE Mr. J. CONSTABLE 6 CHIEF PUBLIC HEALTH INSPECTOR Mr. M. R. WILLIAMS, (l), (2),(4) DEPUTY CHIEF PUBLIC HEALTH INSPECTOR Mr. B. SAUNDERS, (l), (2), (4) PUBLIC HEALTH INSPECTORS Mr. J. ALLAM, (1), (2), (4). Mr. T. W. GLEW, (l), (2) Mr. N. BURTON, (l), (2). Mr. S. A. LEMMON, (1), (2), (4). Mr. J. COOK, (1), (2), (3). Mr. J. POWELL, (1), (2), (4). Mr. E. DAY, (l), (2), (4). Mr. F. SILVERTHORNE, (l), (2) STUDENT PUBLIC HEALTH INSPECTORS Mr. R. KING 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 D. MEEK, (5), (6), (21). Mrs. J. M. COTTERILL, (5). Miss K. M. MOLLERUP-PETERSON, (5), (21). Mrs. Y. A. DIGNUM, (5), (21). Mrs. Y. V. NICHOLLS, (5), (6), (21). Miss M. D. ELLIS, (5), (20), (21). Miss N. NORRTS, (5), (6), (21). Mrs. A. HAYDEN, (5), (21). Mrs. M. O'RIORDAN, (5), (8), (21). Miss J. R. HEATH, (5). Mrs. M. PRONT, (5). Mrs. V. E. HENNESSEY, (5), (21). Miss R. RICHARDS, (5), (6), (21). Mrs. A. L. HILLAS, (5), (21). Mrs. A. M. ROBINS, (5). Mr. S. A. HODGES, (5), (10a), (21). Miss J. M. SMITH, (5), (6), (21). Mr. C.O. E. KING, (5), (10). Mrs. E. A. STIMSON, (9). Mrs. D. J. KITCHEN, (5), (6), (21). Mrs. J. S. STONE, (5), (21). Mr. R. D. LINTOTT, (5), (l6), (21). Mr. R. J. TURPIN, (5), (21). Mr. D. J. MARTIN, (5). Mrs. M. E. M. WHATHAM, (5), (8), (12). Mrs. s. w. Mcquillan, (9), (21). DISTRICT NURSES (part-time) Mrs. J. E. BIGGART, (5). Mrs. N. FLYNN, (5), (8), (21). Mrs. E. COLGATE, (9). Mrs. E. M. E. McCALLUM, (5), (21). NON-MEDICAL SUPERVISOR OF MIDWIVES Miss M. DOBSON, (5), (6), (21) ASSISTANT NON-MEDICAL SUPERVISOR OF MIDWIVES Miss M. TEATHER, (5), (6). MIDWIVES Mrs. N. M. ADAMS, (5), (6). Mrs. I. M. BRONNICK, (5), (6). Miss J. M. HALL, (5), (6). Miss D. HEARSEY, (5), (6). Mrs. M. E. HEW, (5), (6), (21). Miss H. V. RUNGAY, (5), (6) Miss P. R. SHACKLETON, (5), (6), (9) Miss M. WALKER, (5), (6). Mrs. C. B. WATSON, (5), (6) 7 PART-TIME MIDWIFE Mrs. M. E. R. WAINWRIGHT (5), (6). SUPERINTENDENT HEALTH VISITOR Miss B. M. LONG, (5), (6), (7), (21), (22). DEPUTY SUPERINTENDENT HEALTH VISITOR Mrs. C. C. LEDDEN, (5), (6), (7), (21). SENIOR HEALTH VISITOR Mrs. B. RAMSEY, (5), (6), (7), (20). HEALTH VISITORS Miss J. D. BALDWIN, (5), (6), (7), (21). Miss T. O'KELLY, (5), (8), (21) Miss A. E. BOORMAN, (5), (6), (7), (21). Miss O. OLOGUNRO, (5), (6), (7). Mrs. L. DUNBAR, (5), (6), (7). Miss E. G. PARRY, (5), (6), (7). Mrs. H. J. HARRIS, (5), (7), (8) Mrs. J. REEVES, (5), (7), (8). Miss R. D. HUTCHINSON, (5), (6), (7), (21). Miss D. B. RUDD, (5), (6), (7). Mrs. A. KHAN, (5), (6), (7), (21). Miss M. F. SAVAGE, (5), (6), (7), (l4) Mrs. M. M. MILLER, (5), (7), (8). Mrs. A. WARD, (5), (7), (31). Mrs. J. O'BRIEN, (5), (7). Miss M.D. WINT, (5), (6), (7). HEALTH VISITOR (part-time) Mrs. M. NELSON, (5), (6), (7). SPONSORED STUDENT HEALTH VISITORS Miss E. T. O'CONNOR, (5), (6). Miss A. E. B. TREACY, (5), (6). SCHOOL NURSES Mrs. J. I. HOGG, (5). Mrs. P. A. PICKEN, (5). Mrs. E. M. McCHEYNE, (5) Mrs. M. C. TWOMEY, (5) CLINIC NURSES Mrs. S. M. C. BARBER, (5). Mrs. A. NODEN, (5), (14). Mrs. M. A. FLEMING, (5). Mrs. M. A. PEARCE, (5), (8). CLINIC NURSES (part-time) Mrs. S. J. BROWNE, (9). Mrs. A. LYONS, (9). Mrs. R. K. D. CLARK, (5), (8). Mrs. M. E. MONTGOMERY, (5). Mrs. I. M. COLLINGWOOD, (5). Mrs. G. PRATT, (5) Mrs. B. CULLUM, (5). Mrs. A. RAVEN, (9). Mrs. N. N. FARMER, (5). Mrs. R. J. SCAMELL, (5), (21). Mrs. M. HALLIGAN, (5), (6), (12). Mrs. P. A. WHITE, (5) Mrs. R. M. LEWIN, (5), (6). GERIATRIC LIAISON OFFICER Mrs. J. HARROLD, (5), (12), (36). 8 SPEECH THERAPISTS Hiss C. J. DELAFORCE, (l8). Hiss E. N. SYMES, (18), (19). PHYSIOTHERAPIST Mrs. A. WALKER, (30). PHYSIOTHERAPISTS (Part-time) Mrs. A. LAWRENCE, (29). Mrs. J. M. WARWICK, (29). TRAINING CENTRES AND DAY CENTRE CASTLE SCHOOL & TRAINING CENTRE, Ripple Road, Supervisor: Mrs. M. A. WASHER, (28), (33), (34). Dagenham, Essex. ADULT TRAINING CENTRE, Manager: Hr. W. J. MATTHEWS, (28) Gascoigne Road, Barking, Essex. Deputy Manager: Mr. C. E. DODD OSBORNE WORKSHOP, Manager: Mr. C. W. HARE Osborne Square, Senior Dagenham, Essex. Instructor: Mr. J. W. BASS PORTERS AVENUE Senior DAY CENTRE, Occupational Mrs. E. A. HARDMAN, (27). Porters Avenue, Therapist: Dagenham, Essex. Instructor: Mr. L. G. McCAUL HOSTEL FOR THE MENTALLY HANDICAPPED LOUISE GRAHAM HOUSE, Resident Warden: Mr. G. BARTRIP Ripple Road, Resident Assistant Barking Essex. Warden: Mrs. J. BARTRIP CHIEF CHIROPODIST Mr. H. LEAVESLEY, (ll). SENIOR CHIROPODISTS Mr. D. DITSELL, (ll) Mrs. H. G. LEAGE, (11). Hrs. M. GOSS, (11). Mrs. D. MANN, (ll). Mr. N. FREEMAN, (11). Mr. H. STENSON, (11). CHIROPODISTS (Part-time) Mr. J. BUNDER, (11). Mr. R. H. FENTON, (ll). Mr. P. FREEL, (11). 9 DAY NURSERIES, etc. Goresbrook Day Nursery, Matron: Mrs. H. M. SHEPHERD, (14) Dagenham Avenue, Dagenham. Deputy: Miss I. M. BRIGHTWELL, (l4). Annie Prendergast Day Nursery Ashton Gardens, Matron: Mrs. P. A. ARDLEY, (14). Chadwell Heath, Romford. Deputy: Mrs. G. E. ELLIS, (l4). Eastbury Day Nursery, Blake Avenue, Matron: Mrs. B. A. BELL, (5) Barking. Deputy: Mrs. J. M. HOWELL, (37) Kingsley Hall Assessment Centre Hobart Road, Dagenham. Sister -inCharge: Mrs. K. I. DALY, (5), (6), (20). PRINCIPAL MENTAL WELFARE OFFICER Mrs. J. W. W. DIXON, (26). SENIOR MENTAL WELFARE OFFICER Mr. D. G. BISHOP, (10). MENTAL WELFARE OFFICERS Miss O. B. CLAYBUHN, (38). Mrs. V. WESTRUPP, (10). Mrs. M. V. HARRISON, (39). Mr. M. R. WYLDE, (10). Mr. G. R. WELSH, (10). Mr. S. L. WU, (40). HEALTH EDUCATION OFFICER Vacant ASSISTANT HEALTH EDUCATION OFFICER Miss D. MILBANK, (5), (6), (?), (20), (21), (25). PROJECTIONIST/TECHNICIAN Mr. A. PHILLIPS LAY ADMINISTRATIVE OFFICERS Mr. F. W. K. KNIGHT, (l), (2). Mr. G. H. RUFF SENIOR ADMINISTRATIVE ASSISTANTS Mr. F. H. MARTIN, (15). Mr. B. S. TYRRELL Mr. B. S. WEAVER 10 SECTION HEADS Mrs. P. H. FLOODGATE, Miss G. K. HARRIS, Mrs. H. JACKSON, Mrs. M. C. NEWMAN, Mr. H. J. PITT, Mrs. J. B. SMITH, Vacant Vaccination and Immunisation. Environmental. Mental Health. Care and After Care. Staffing and Management. Finance, Supplies, etc. Maternal and Child Health. Miss E. A. ADAMS Miss E. D. BROWN Miss N. E. CLOKE Mrs. P. M. COLLINS Mrs. K. M. CONROY Miss A. C. DAVIES Mrs. D. M. ELLIS Mrs. D. G. GREEN Miss C. A. LINCOLN Mrs. E. J. NEPORT Mrs. K. BIRD Mrs. B. K. COPELANI Mrs. M. EDWARDS Miss B. M. SLATER Mrs. J. phillips Miss N. M. toms MEDICAL OFFICER OF HEALTH'S SECRETARY Mrs. J. M. de BRUIN SECTION CLERICAL STAFF Vaccination and Immunisation Mrs. M. KING Environmental Miss J. HAMILTON Mrs. J. W. MORGAN Rodent Operative/Driver Mr. H. J. DUFF Care and After Care Mrs. J. E. BARNES Staffing and Management Miss V. e. cheal Miss J. A. gardiner Miss m. middleton Mrs. p. McMillan Finance. Supplies, etc. Mrs. G. ANGER Mrs. C. E. SMYTH Maternal and Child Health Mrs. I. M. H. DUPREE Mrs. I. E. SMITH Miss L. WHITE Mr. D. E. WARD Part-time Mrs. E. M. NOTTAGE Mrs. S. B. ORME Mrs. I. A. PAGE Mrs. V. N. F. PATIENCE Mrs. J. R. REDMAN Miss M. A. RHODES Miss K. RICHARDS Mrs. G. K. SHANNON Miss D. TILSON Miss M. A. WATTS Mrs. D. WILKINS Mrs. E. harseut Mrs. s. hopson Mrs. a. McCarthy 11 HOME HELP SERVICE Senior Organiser: Mrs. L. EVERITT Organisers: Mrs. P. ARCHER Mrs. G. SANGER Assistant Organiser: Mrs. J. M. JOHNSON Clerical Assistants: Mrs. D. NEWMAN Mrs. M. G. WILLIAMSON REGIONAL HOSPITAL BOARD OFFICERS ATTENDING PART-TIME ORTHOPAEDIC SURGEON A. F. BRYSON, M.A., M.B., B.CHIR., F.R.C.S. OPHTHALMOLOGISTS Dr. R. F. JAMIESON, M.B., Ch.B., D.O.M.S. Mr. P. LANCER, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H., D.O.M.S. PART-TIME CONSULTANT PSYCHIATRIST Dr. S. I. FAHMY, M.B., Ch.B. EAR NOSE AND THROAT SURGEON Miss M. MASON, F.R.C.S. PHYSIOTHERAPIST Mrs. E. OTTLEY, M.C.S.P. PUBLIC ANALYST (part-time) J. HUBERT HAMMENCE, Ph.D., M.Sc., F.R.I.C. 12 QUALIFICATIONS (1) Certificate of Royal Sanitary Institute. (2) Meat Inspector's Certificate. (3) Sanitary Science as applied to Building & 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. (10a) Registered Mental Nurse, Part 1. (11) State Registered Chiropodist. (12) State Registered Fever Nurse. (13) Tuberculosis Certificate. (14) Certificate of National Nursery Examination Board. (15) Diploma in Public Administration. (16) Certificate of National Society of Children's Nurses. (17) Certificate of Child Care Reserve Course. (18) Diploma of Licentiateship of College of Speech Therapists. (19) Diploma in Social Science. (20) Registered Sick Children's Nurse. (21) District Nursing Certificate. (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), (33) Margaret Morris Movement Diploma Malaysia. (34) Montessori Method of Education Diploma. (35) Certificate of Royal Dental Hospital. (36) Institute of Home Help Organisers. (37) Royal Sanitary Institute Examination for Nursery Nurses. (38) B.A. (Social Administration), University of Manchester. (39) Social Work Assistants Course, Havering Technical College. (40) B.Sc.(Sociology), London University. 13 Health Department, Civic Centre, Dagenham. To: THE MAYOR, ALDERMEN AND BURGESSES OF THE LONDON BOROUGH OF BARKING. Once again as in the Report for 1968 I must point out that the lateness of the publication of this Report for the year 1969 is due to the pressure of work brought about by staff shortages and by constantly changing emphases resulting in new demands being made on the Department. The consequent difficulties militate against the careful thought needed to plan logical progress of work. This introduction is written at a time when changes brought about by the Social Services Act of 1970, and the threats of pending new legislation in 1974 overshadow so many other considerations. Late though it is, it is still worth considering the progress made during 1969 and some of the incidents which occurred. The retirement of Dr. Adamson, and the resignation of Dr. Slome and Mr. Self during the year created gaps in the Department; the shortage of senior medical staff still persists and still creates difficulties. The production of the Seebohm Report which foreshadowed the setting up of Social Service Departments produced an unsettling influence on the staff when they were just beginning to settle down from the upheaval of 1965 caused by the reorganisation of London Government. During the year the establishment of the Health Education Section which was under heavy pressure was increased by one, although economies did not allow us to recruit an additional Assistant Health Education Officer. It was, however, possible during the year to secure the Gale Street Centre as the first Health Education Centre to be established in the Borough. During the year a film was proposed by the Barking College Photographic Department which was to depict the work of the Dental Auxiliary and to which the Health Department contributed. The commencement of a film strip depicting the Osborne Workshop was also a step forward in health education. The Department was invited to contribute to a Refresher Course held by the Maternity and Child Health Group of the Society of Medical Officers of Health and Miss Milbank and I contributed a talk on the Role of Health Education in the Personal Relations of the Adolescent. The closure of York House and the further reduction in domiciliary confinements enabled the orientation of the midwifery services towards the hospital and family doctor to continue. Child Health Centres made progress in altering their function and reshaping the service. Health education and parent counselling, together with screening of babies and children for handicaps brought the service nearer to the Sheldon concept. The Child Minders Regulations introduced during the year imposed numerous extra burdens on an already depleted health visiting staff and 14 the functions of the new legislation had to be carried out without any increase of staff. This meant a reduction of service in other directions notably in home visiting. The Kingsley Hall Assessment Centre continued to make its contribution to a vital need in the sphere of handicapped children and both family planning and cervical cytology while making a little progress were affected by limitations of resources. The Guthrie Test for the detection of phenylketonuria was introduced during the year and should provide for the beginnings, of what may prove in future years, a comprehensive scheme for the detection of diseases caused by bio-chemical abnormalities, small in number though important in their effects. The medical examination of staff continued to take up medical resources and to reveal that there is a need to consider at some future date the possibility of setting up a staff health service. The loan of sick room equipment continued to be an important function of the Department. Almost 2,500 articles were lent during the year and over 3,000 were still out on loan at the end of the year. The use of incontinence pads continued to meet a need and almost 39,000 of these were supplied. Various aspects of the mental health service continued to develop the Osborne Workshop, the Adult Training Centre, the Porters Avenue Day Centre and 4 more places were secured in maisonettes where patients could be resident under the supervision of the Mental Welfare Officers. Louise Graham House was completed and opened. The School Health Service continued to provide for the examination of children who were in need of it and the counselling of parents where necessary and the special schools provided a valuable service. The dental service made a worth while contribution to services in the Borough for the children under 5, school children and expectant and nursing mothers. I would like to draw attention to the Report of the Chief Public Health Inspector which shows considerable progress. One incident which merits particular mention is an account of a case of typhoid fever in a man whom it is believed contracted it on a holiday in Tangier. A more detailed account of the services is to be found in the main body of the Report than can be given in this short introduction. Although as will be seen from the main body of the Report, 1969 was a year in which we fell far short of what we had hoped to achieve it will be seen that considerable progress was made during that year in spite of many difficulties. J. ADRIAN GILLET Medical Officer of Health. 15 VITAL STATISTICS 1969 Registrar General's estimate of residential population, mid-year 1969 167,960 Live Births: Legitimate (1,082 male, 988 female) 2,070 Illegitimate ( 83 male, 8l female) 164 Total (1,165 male, 1,069 female) 2,234 Illegitimate live births per cent of total 7.34 Live birth rate per 1,000 population 13.30 Live birth rate adjusted by comparability factor of 1.04 13.83 Stillbirths: Legitimate (16 male, 16 female) 32 Illegitimate (1 male, 1 female) 2 Total (17 male, 17 female) 34 Stillbirth rate per 1,000 live and still births 14.99 Total live and still births 2,268 Deaths: Infant deaths (lander 1 year) (25 male, 14 female) 39 Infant death rate per 1,000 live births 17.46 Legitimate infant death rate per 1,000 legitimate live births (22 male, 11 female) 15.94 Illegitimate infant death rate per 1,000 illegitimate live births ( 3 male, 3 female) 36.59 Neo-natal mortality rate (deaths under 4 weeks (22) per 1,000 live births 9.85 Peri-natal mortality rate (stillbirths (34) and deaths under one week (15) per 1,000 live and still births) 21.60 Early neo-natal mortality rate (deaths under 1 week per 1,000 live births) 6.71 Maternal mortality (deaths from pregnancy, childbirth, abortion) Nil General Mortality: Number of deaths (1,027 male, 875 female) 1,902 Death rate per 1,000 population - crude 11.32 Death rate adjusted by comparability factor of 1.30 14.72 Continuing the trend of recent years the Registrar General's estimate of population shows a slight fall from 170,100 in 1968 to 167,960 in 1969. Infant death, and associated mortality rates remained below the national average with the exception of the illegitimate infant death rate of 36.59 which was well above the rate of 25 per thousand illegitimate live births for England and Wales as a whole. The local statistics however are based on too few occurrences and tend to fluctuate too widely for this rise to be regarded as significant. This rate in previous years has varied as follows: 1965 - 23.8, 1966 - 12.35, 1967 25.0; 1968 - 6.29. I am happy to report that there were no deaths associated with childbirth, pregnancy or abortion during the year. 16 CAUSES OF INFANT DEATHS Cause of Death Age at Death Total under 4 wks. 4 wks. - 1 year Congenital Anomalies 7 7 14 Birth Injury, Difficult Labour etc. 10 – 10 Meningococcal Infection – 2 2 Pneumonia 1 4 5 Other respiratory diseases – 2 2 Diabetes Mellitus – 1 1 Intestinal Obstruction and hernia 1 – 1 Other Disease, Genito-urinary system 1 – 1 Other causes - Perinatal Mortality 1 – 1 Other External Causes 1 1 2 22 17 39 I give below for purpose of comparison the birth and death rates of Barking, Greater London and England and Wales for 1969* Barking Greater London England and Wales Live births (per 1,000 population) 13.30 15.7 16.3 Stillbirths (per 1,000 live and still births) 14.99 12.7 13.0 Infant mortality (per 1,000 live births) 17.46 17.9 18.0 Deaths (per 1,000 population) 11.32 11.5 11.9 CAUSES OF DEATH In 1968 the World Health Organisation introduced the Eighth Revision of the International Classification of Diseases and consequently the Registrar General's short list of 36 causes of death used for analysis of mortality by Medical Officers of Health was revised to accord with the new classifications. The Registrar General's revised list contains 50 main causes of death with some further sub-divisions to improve comparability with the previous list. 17 18 CAUSES OF DEATH 1969 Cause of Death AGE AT DEATH Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25years 25 and under 45years 45 and under 65years 65 and under 75years 75 and over Total M F H F M F M F M F M F M F M F M F 1. Cholera – – _ _ _ _ _ – – – – – – – – – 2. Typhoid Fever – – – – –– – – – – – – – – – – – – – 3. Bacillary dysentery and Amoebiasis – – – – – – – – – – – – – – – 4. Enteritis and other diarrhoeal diseases – – – – – – – – – – – 1 – – – 1 5. Tuberculosis of Respiratory System – – – – – – – – 2 – 2 1 – – 4 1 6. Other Tuberculosis, incl. late effects – – – – – – – – 1 1 – – – – 1 1 7. Plague – – –– – – – – – – – – – – – – – 8. Diphtheria – – – – – – – – – – – – – – – 9. Whooping Cough – – – – – – – – – – – – – – 10. Streptococcal sore throat and scarlet fever – – – – – – – – – – – – – 11. Meningococcal infection 2 – – – – – – – – – – – – 2 _ 12. Acute poliomyelitis – – – – – – – – – – – – – – 13. Smallpox – – – – – – – – – – – – – – – 14. Measles – – – – – – – – – – – – – – – 15. Typhus and other Rickettsioses – – – – – – – – – – – – – 16. Malaria – – – – – – – – – – – – – – 17. Syphilis and its sequelae – – – – – – – – – – – – – – – 18. All other infective and parasitic diseases – – – – – – – – 1 1 – 1 – – 1 2 19. Malignant Neoplasm - Stomach " " - lung, – – – – – – – – 13 5 12 6 9 6 34 17 bronchus – – – –– – – – 2 - 56 12 46 6 25 11 129 29 " " - Breast – – – – – – – 1 3 21 1 7 11 2 42 " " - Uterus – – – – – – – – – 2 – 12 – 2 _ 1 – 17 Leukaemia – – – – – – – – 1 – 2 – – – 2 4 5 4 Other Malignant Neoplasms, incl. Neoplasms of lymphatic and – – 1 – 2 1 – 1 3 3 37 42 28 23 24 3^ 95 104 Haematopoietic tissue. carried forward 2 – 1 – 2 1 – 1 7 8 112 94 89 47 60 67 273 218 19 CAUSES OF DEATH 1969 (contd.) Cause of Death AGE AT DEATH Inder 1 yr 1 and under 5 years 5 and under 15 years 15 and under 25yrs 25 and under 45yrs 45 and under 65yrs 65 and under 75yrs 75 and over Total M F M F M F M F M F M F M F M F M F brought forward 2 – 1 – 2 1 – 1 7 8 112 94 89 47 60 67 273 218 20. Benign Neoplasms and Neoplasms of unspecified nature – – – – – – 1 – – – 4 1 1 1 – 2 6 21. Diabetes Mellitus 1 – – – – – – – – – 2 3 2 6 – – 5 13 22. Avitarainoses and Other Nutritional deficiency _ _ _ _ _ – _ _ – – – – – – – – – 23a.Other endocrine, nutritional and metabolic diseases – – – – – – – – – – – – – 1 – 6 – 7 24. Anaemias – – – – – – – – – – – 1 3 1 1 4 4 6 23b.Other diseases of blood and blood forming organs _ _ _ _ _ _ _ – – 1 _ _ – – _ 1 – 2 23c.Mental disorders – – – – – – 1 – – – – – – 1 3 4 4 5 25. Meningitis – – – – – – – 1 – – – – 1 – – – 1 1 23d.Other diseases of nervous system and sense organs – – – – – – – – 1 2 3 6 1 _ 4 9 8 26. Active rheumatic fever – – – – – – – – – – – – – – – – – – 27. Chronic rheumatic heart disease – – – – – – – 1 i 8 9 3 9 1 6 13 25 28. Hypertensive disease – – – – – – – – – i 8 1 4 7 3 8 15 17 29. Ischaemic heart disease – – – – – – – – 5 i 95 27 109 49 58 84 267 161 30. Other forms of heart disease – – – – 1 – – – – 1 – 7 5 13 26 22 31 31. Cerebrovascular disease – – – – - – – – 1 i 9 13 32 35 44 77 86 126 23e.Other diseases of the circulatory system – – _ _ _ _ _ 1 1 3 6 10 13 11 20 25 40 32. Influenza – – – – – 1 1 – – 1 2 4 7 4 5 4 15 14 33. Pneumonia 1 4 – – 1 – – – 2 - 10 4 18 13 26 36 58 57 carried forward 4 4 1 – 4 2 2 3 18 15 252 169 292 193 226 351 799 737 20 CAUSES OF DEATH 1969 (contd.) Cause of Death AGE AT DEATH Under 1 yr 1 and under 5 years 5 and under 15 years 15 and under 25yrs 25 and under 45yrs 45 and under 65yrs 65 and under 75yrs 75 and over Total M F M F M F M F M F M F M F M F M F brought forward 4 4 1 - 4 2 2 3 18 15 252 169 292 193 226 351 799 737 34a. Bronchitis emphysema - - - - - - - - 2 - 25 2 51 10 37 24 115 36 34b. Asthma - - - - - - - - - - 1 - - - - 1 1 3 25f. Other diseases of the respiratory system 1 1 - - - - - - - - 2 3 5 5 6 3 14 12 35. Peptic Ulcer - - - - - - - - 1 - 4 - 3 1 7 2 15 3 36. Appendicitis - - - - - - - - - - - - - 37. Intestinal obstruction and hernia - 1 - - - - - - 1 - 1 2 1 - 1 2 4 5 38. Cirrhosis of liver - - - - - - - - - - - - - 2 - 1 - 3 23g. Other diseases of the digestive system - - - - - - 1 - 1 - 2 3 3 5 - 3 7 11 39. Nephritis and nephrosis - - - - 1 - - 1 - - 2 1 1 1 1 3 1. 6 40. Hyperplasia of prostate - - - - - " ~ - ~ ~ 1 - c. 23h. Other diseases of the genitourinary system 1 _ 1 2 3 3 11 6 15 41. Abortion - - - - - - - - - - - - - - - - - - 42. Other complications of pregnancy, childbirth and puerperium - - - - - - - - - - - - - - - - - - 231. Diseases of the skin and subcutaneous tissue - - - - - - - - - - - - - - - 1 - 1 23 j. Diseases of the musculoskeletal system and connective tissue - - -- - - - - - 2 - 1 2 1 2 1 4 5 43. Congenital anomalies 12 2 - 1 - - - - - - 1 " - - - - 13 3 44. Birth injury, difficult labour and other anoxic and hypoxic conditions 6 4 - - - - - - - - - - - - - - 6 4 carried forward 24 12 1 1 5 2 3 4 23 17 291 182 360 223 285 403 992 544 CAUSES OF DEATH 1969 (Contd.) Cause of death AGE AT DEATH Under 1 yr 1 and under 5 years 5 and under 15 years 15 and under 25yrs 25 and under 45yrs 45 and under 65yrs 65 and under 75yrs 75 and over Total M F M F M F M F M F M F M F M F M F brought forward 24 12 1 1 5 2 3 4 23 17 291 182 360 223 285 403 992 844 45. Other causes of perinatal mortality 1 – – – – – – – – – – – – – – 1 _ 46. Symptoms and ill-defined conditions _ _ _ _ _ _ _ _ _ _ _ _ 1 _ 2 8 3 8 47. Motor vehicle accidents - - - 1 2 1 - 1 1 - 2 - 1 - 2 2 8 5 48. All other accidents - - 2 1 - - 2 - 3 1 5 1 - 2 1 8 13 13 49. Suicide and self-inflicted injuries _ _ _ - _ 1 _ 1 _ 3 2 - - - 8 3 50. All other external causes - 2 - - - - - - - - 2 – – – – – 2 2 TOTAL 25 14 3 3 7 3 6 5 28 13 304 186 364 225 290 421 1027 875 PRINCIPAL CAUSES OF PEATS (all ages) Diseases of Heart and Circulatory system 6l6 Cancer and Other Malignant Diseases 486 Pneumonia and other Respiratory Diseases (excluding tuberculosis) 325 Cerebrovascular Disease and other diseases of the Brain and Nervous System 210 22 HEALTH EDUCATION At the beginning of 1969 the establishment of the health education section was increased by one assistant health education officer and it was hoped that this would enable the section to cope with the growing demands of schools, hospitals, colleges and other bodies. Unfortunately financial restrictions prevented this post from being filled so once more it was necessary to curtail the service. The effect of this on schools was offset to some extent by the fact that the section was able to obtain the old Gale Street Day Nursery for use as a Health Education Centre to which classes could be sent instead of members of the health education staff attending schools. This Centre is proving extremely useful in many other waysas an equipment store, a workshop in which equipment maintenance can be carried out, a drawing office for the production of visual aids and as a lecture hall and cinema for in¬service training. The first of the in-service courses, for health visitors and school nurses,was opened by the Chairman of the Health Committee on l^th April, 1969* Health Education in Schools During the year eighteen schools asked for assistance with their health education programmes and another required help with the Duke of Edinburgh Award Scheme. The amount of assistance given varied considerably, some schools having only one or two specialist lectures, others a weekly programme, and certain selective schools two or three day 'crash' courses in the period immediately following G.C.E. examinations. In most instances the school staffs were able to take over large parts of the programme using visual aids supplied by the Department to support their lectures. This is one of the benefits we have obtained from our previous in-service training courses for teachers and it is hoped that the current series will ultimately relieve the Department of the more routine teaching. On the other hand the introduction of comprehensive education in 1970 may well increase the demand for health topics to a level considerably higher than the current one and this is a situation which will have to be faced probably in 1971/72 The experiment commenced in the Summer Term of sending a group of children from a neighbouring school to the Centre for discussion sessions conducted mainly by the teachers who accompanied them, was felt by the headmaster concerned to be particularly valuable. In the Autumn term the same school sent three groups each week and other schools are showing interest in the idea. The child care courses for the National Association for Maternal and Child Welfare examinations again proved popular, no less than five separate examinations being held in the Borough. In-Service Training Three in¬service courses have been held since the Gale Street Centre was opened in April 1969. The first of six weeks duration was for health visitors and school nurses and was quite well attended. A series of seven talks for daily minders was not quite so well received but the last course, aimed at teachers training students for the child care certificate was a great success. 23 In addition to these full courses a half¬day seminar on dampness in buildings was held in July and although many staff were on leave forty representatives of the public health inspectors, engineers and housing departments were present. Food Hygiene Education The routine Certificate and Diploma Courses run in conjunction with Rush Green College were quite successful and an additional Certificate course was run at the College specifically for the canteen staffs of Messrs. Fords. In the Autumn term a course for the first and second year full time bakery students was inaugurated. Home Safety Continued support was given to the work of the Greater London Home Safety Council, a representative being present at each meeting and also at the National Home Safety Conference of the Royal Society for the Prevention of Accidents. Home safety talks were given to the first aid students at the Regional College and to the Area Conference of the St. John Ambulance Brigade held at Oldchurch Hospital. The topic is of course included in school health education programmes and in child care talks by health visitors. Youth A number of youth organisations operate the Duke of Edinburgh Award Scheme and the Health Education Section was involved in seven examinations at various levels. An examination in Child Care for the St. John Ambulance Brigade was also conducted. The General Studies Department of Rush Green College asked for help with their health education programme and a series of talks and film shows was arranged for two groups of engineering students and one group of electricians. Visitors Visitors to the section included a public health inspector from St. Vincent, a doctor from Lagos and a number of health education officers from other authorities. We were also pleased to welcome a representative of the National Association for Maternal and Child Welfare who visited our in-service training course. Geriatric Groups Three geriatric courses were organised by the staff of Porters Avenue Clinic and talks on heating and health were given on each. Displays, Exhibitions and Campaigns At the Town Show the Health Department display was devoted to two aspects of the work of the public health inspector - the prevention of condensation in buildings and the abatement of noise nuisances. Once again the weather was good and the exhibition was well attended. The staff of Rush Green Hospital invited the Department to provide a display in the foyer of the new Maternity Wing. The topic chosen was vaccination and immunisation and it was decided to attempt to assess the value of such a display by the use of questionnaires before and during the campaign. The hospital staff were most co¬operative in securing the completion of these forms but unfortunately an analysis of the results did not show any significant increase in knowledge attributable to the display. Preliminary arrangements were also commenced for a cervical cytology campaign, scheduled to begin in January, 1970. This is a major campaign which will take some years to complete. Films and Film Making Work on the production of the film on the dental auxiliary continued spasmodically throughout the year, the actual photography being carried out by the Photographic Department of the Regional College. Within the Health Department itself a filmstrip on the work of the Osborne Workshop was scripted and photographed. It is hoped that this will be of use to those who wish to talk on the subject of the training of handicapped people. The demand for films for use in schools, clinics, etc., remained at approximately the same level as in 1968 but the purchase of a number of new films at the end of 1969 well lead to an increased demand in future years. Talks to outside organisations Talks on a wide variety of subjects were given to equally diverse types of group. Speakers were provided for various women's organisations, for hospital staff, nursery trained staff and on two separate occasions talks on Weil's disease were provided for the staff of the Engineer's Department. Another interesting special talk was a joint paper given by the Medical Officer of Health and the Assistant Health Education Officer to a meeting of the Society of Medical Officers of Health held in London in November. The subject chosen was "The Role of Health Education in Personal Relationships of the Young Adolescent." 25 CO¬ORDINATION OF SERVICES. Co¬ordination and co¬operation of the Health Department services with family doctor and hospital services occurs at a number of levels. At Committee level there is cross-representation of members and officers. For example the Chairman of the Health Committee serves on the Regional Hospital Board. The Vice Chairman among others serves on the Executive Council and the Medical Officer of Health and members of the Health Committee serve on Hospital Management Committees. Hospital Management Committee members from two Management Committees are co-opted on to the Health Committee. The Medical Officer of Health attends the meetings of the Local Medical Committee and a family doctor is co¬opted on to the Health Committee. At officer level there are links through the Medical Officer of Health with the Hospital Medical Advisory and Staff Committees and the Medical Officer of Health serves on the area Committee of the Association of Hospital Management Committees. One Consultant from the hospital for mentally Subnormal, visits the Borough and sees subnormals at the request of the Health Department. One specialist visitor (Geriatric Liaison Officer) on the staff of the Medical Officer of Health is responsible for acting as liaison between the geriatric units - the family doctors and the Local Authority services. Health Visitors work in a health centre where a group of family doctors attend and carry on Infant Welfare Clinics there. The services of Health Visitors, District Nurses and Midwives are placed at the disposal of the family doctors as requested, the contact being made either through the Senior Nursing Staff or directly with the nursing staff concerned. Meetings between Local Health Authority Medical Officers of Health and family doctors who carry out clinics in the area are held at which common problems and new projects are discussed. 26 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN Ante¬Natal Care - During the year 634 mothers attended our clinics for ante¬natal care compared with 512 in the previous year. The majority of these patients were cared for by domiciliary midwives in co¬operation with general practitioner obstetricians. The local authority medical staff generally have withdrawn from this work and are now able to devote more time to screening infants and young children for the early detection of deviations from normal development and to the screening of women for cancer (cervical cytology). In addition 1,437 attendances were made at Mothercraft and Relaxation Classes compared with 99$ attendances in 1968. Centres offering ante-natal care are as follows:- Centre Frequency of Sessions When held Annie Prendergast Clinic Ashton Gardens, Chadwell Heath. Weekly Tuesday, p.m. The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. Central Clinic, Vicarage Drive, Barking. Weekly Wednesday, p.m. The Clinic, Ford Road, Dagenham. Weekly Wednesday, p.m. Marks Gate Clinic, Lawn Farm Grove, Marks Gate. Weekly Thursday, p.m. The Clinic, Oxlow Lane, Dagenham. Weekly Tuesday, p.m. The Clinic, Porters Avenue, Dagenham. Fortnightly Wednesday, a.m. Julia Engwell Clinic, Woodward Road, Dagenham. Weekly Wednesday, p.m. Thames View Clinic, Bastable Avenue, Barking. Fortnightly Monday, p.m. 27 Domiciliary Midwifery Service- The Midwifery Service has this year improved slightly with the appointment of a Maternity Nurse to care for early Hospital discharges in particular. Two vacancies on the Midwifery Staff were also filled. The number of patients being delivered in hospitals and being discharged before their tenth day continues to increase. The training of Pupil Midwives continues in conjunction with Barking Hospital. With the closure of York House as a Nurses Residence it was no longer possible to train Pupils from Waltham Forest Borough as accommodation could no longer be provided. Deliveries attended by Domiciliary Midwives - 1969 Doctor present at delivery Doctor not present at delivery Cases delivered in hospital and attended by Domiciliary Midwives on discharge before 10th day. 31 325 1,334 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 22 cases. In addition 42 cases who made their own arrangements for confinement were advised and assisted by the Association. Child Health Centres- The review of infant welfare services foreshadowed by the 'Sheldon Report' was undertaken during the year and a beginning was made in the re¬shaping of services to accord with changed needs and conditions. Emphasis was placed on the need for adequate facilities for undertaking a more detailed and intense supervision of children's development and for health education activities and parent counselling. Certain premises were considered to be sub¬standard for use as child health centres and sessions were discontinued at Rush Green and Thompson Road Clinics, and at Upney Clinic, where the Council's agreement with the Regional Hospital Board for the joint use of the premises was about to expire. Patients attending these clinics were re-allocated to the purpose built centres at Oxlow Lane, Becontree Avenue and Central Barking. 28 At the end of the year, the following centres were operating:- Centre Frequency of Sessions When Held Annie Prendergast Clinic Ashton Gardens, Chadwell Heath. Weekly Wednesday and Thursday p.m. The Clinic, Becontree Avenue, Dagenham. Weekly Monday p.m. Wednesday a.m. Central Clinic, Vicarage Drive, Barking. Weekly Tuesday and Thursday p.m. Wednesday a.m. The Clinic, Ford Road, Dagenham. Weekly Tuesday a.m. Thursday p.m. Greatfields Clinic, Movers Lane, Barking. Weekly Tuesday p.m. Julia Engwell Clinic, Woodward Road, Dagenham. Weekly Tuesday and Friday p.m. Leys Clinic, Ballards Road, Dagenham. Weekly Tuesday p.m. Thursday a.m. Marks Gate Clinic, Lawn Farm Grove, Marks Gate. Weekly Monday p.m. The Clinic, Oxlow Lane, Dagenham. Weekly Wednesday and Friday p.m. The Clinic, Porters Avenue, Dagenham. Weekly Monday and Friday p.m. Thames View Clinic, Bastable Avenue, Barking. Weekly Wednesday and Friday p.m. During the year 6,307 children under 5 years of age attended the above Centres. Welfare foods and nutrients are sold at these centres during infant welfare sessions and also at Central Clinic on Wednesday afternoons and Thursday mornings. 29 During the year, the following amounts of welfare foods were issued:- National Dried Milk 8,550 tins Cod Liver Oil 2,557 bottles Vitamin A and D Tablets 1,850 packets of 20 Orange Juice 38,571 bottles DAY NURSERY SERVICE The average daily attendances and numbers on registers are shown below for each month of 1969. Attendances have again improved in comparison with the previous year. Goresbrook Annie Prendergast Eastbury Month Average Daily Attendance No. on Register Average Daily Attendance No. on Register Average Daily Attendance No. on Register January 31.8 40 36.7 52 32.3 45 February 30.3 41 40.1 46 35.6 47 March 34.9 44 40.2 49 34.6 46 April 29.8 43 40.0 48 38.9 49 May 26.7 42 42.7 49 44.7 48 June 38.5 48 40.6 52 37.9 47 July 35.4 39 41.0 47 39.3 46 August 26.3 44 33.7 45 33.1 48 September 34.6 49 28.5 42 38.9 48 October 39.6 48 43.3 49 40.7 48 November 39.0 49 40.7 50 39.1 49 December 35.4 39 36.6 49 41.1 48 Annie Prendergast Day Nursery Matron reports as follows:- Things went smoothly and happily in 1969. Although we never really seem to have enough room to do all we want to the staff improved still further the standard of play for the children. 30 The holding of a "mini¬fete" with side shows etc., (which helped to swell the toy fund), the kind gift of a very large portable paddling pool from the parents of one of our children, enjoyed by children and staff alike, a sponsored trip to the London Zoo by a small group of children and staff, these are some of the things we particularly remember about 1969. The end of 1969 marked the closing of a pretty memorable decade for those of us who were here when the old nursery closed down, and we were temporarily re-housed until our re-opening in 1966. All our four students were successful in the N.N.E.B. examination. Desirable qualities of candidates for training are that they should be well balanced, forward thinking, imaginative, good humoured, with a pleasing personality. A good standard of speech, and vocabulary is also desirable. It would be a tremendous step forward if nursery education were provided not only for the under¬privileged child, but for all pre¬school children, from the age of three. They would benefit in 60 many ways, by contact with adults apart from their own family, by pleasing associations with other children, and by the variety of play that can only be offered in places larger than the average home. We know that "education" begins at the mother's knee and in a homely environment but with the pace of life to¬day many mothers have not the time to spend on their energetic and enquiring 3-5 year olds. If, as is suggested, at no other time in his life does a child reach this peak of desire to learn, than during the two years preceding entry into school, not to satisfy this need could delay educational progress. Eastbury Day Nursery Matron reports as follows:- Nursing staff shortages were our greatest difficulty, but we managed to care for our children and continue with the training of our students. Our five nursery students were successful in passing the N.N.E.B. examination. In April, together with three second year students and four children, I spent a most enjoyable day at Colchester Zoo. We were accompanied by Mrs. Isaacs and Mrs. Herd, Course Tutors from Havering College, and a party of students and children from Dr. Barnardo's Home. Close liaison with Havering College has been ensured by frequent visits of the Course Tutors to the Nursery and my attendance at the Matrons' Advisory Committee Meetings at the College. The children's Christmas Party was the usual noisy but happy event, very much enjoyed by children, staff and parents. Goresbrook Day Nursery Matron reports as follows:- During 1969 there were many changes of staff. All four students were successful in passing the N.N.E.B. examination, and moved on to work in other 31 Day Nurseries and one to work as a private Nanny. In September Mrs, Cunningham left and her place as Deputy Matron was taken by Mrs. Shepherd. Mrs. Maddison retired in December 1969, after 24 years as Matron of Goresbrook Nursery. A farewell party was held for her in the Nursery at which many friends and colleagues attended. Mrs. Shepherd was subsequently appointed Matron. The year ended with the usual Christmas festivities - a Sale of Work, Nativity Play and Party for the children and parents. PLAY THERAPY Play therapy groups continued during the year at Julia Engwell, Oxlow Lane and Thames View Clinics, and at Northbury Infants' School. A total of 90 children attended the groups and benefited from playing and forming relationships with each other under the guidance of the play therapy staff. Attendance at the individual groups was as follows:- Julia Engwell Clinic - 26 children including 2 mentally backward, 2 with hearing difficulties and one child who would not mix with others. Oxlow Lane Clinic - 21 children, including 2 with speech defects and 3 mentally backward. Thames View Clinic - 20 children including 3 with speech defects, one very nervous child and one with a behaviour problem. Northbury School - 23 children including one from a poor home environment, 3 with speech defects and one with a hearing defect. REGISTRATION OF NURSERIES AND CHILD-MINDERS The Health Services and Public Health Act, 1968 came into effect on 1st November, 1968. This Act strengthened the powers of local health authorities under the Nurseries and Child-Minders Regulation Act, 1948 to lay down conditions of registration and supervision of private nurseries and child-minders and substantially increased penalties for failure to comply with the Act. As the Council already had a well established "Daily Guardian" Scheme whereby child-minders caring for children of working mothers were encouraged to register with the local authority voluntarily for a small daily payment, there was no rush of applications for registration from "unknown" child-minders in order to comply with the Act. At the end of the year there were 12 premises registered for the sessional care of 376 children and 48 persons registered in their own homes for the day care of 96 children. 32 THE AT RISK REGISTER The "At Risk" Register continues to remain an item of work under constant scrutiny. It was found that where a large number of categories of "At Risk" factors are in use the number of children who are included in the "At Risk" Register becomes excessive and the object of the Register in focusing attention on children most likely to be suffering from an abnormality is lost. In an attempt to reduce it to manageable proportions an abbreviated list of categories has been brought into use and these are given below:- 1, Genetic (family history of deafness, blindness, etc.) 2, Virus infection of the mother before the sixteenth week of pregnancy. 3, Exchange transfusion or a serum bilirubin over 20 mg, per cent, 4, Hydramnios, 5, Evidence of foetal distress, post-partum distress or anoxia, including delay in the establishment of respiration of over three minutes from whatever cause, 6, Prematurity, if the birth weight is less than 31b,12oz. 7, Baby who is "small for dates". 8, Any congenital malformation. 9, Cyanotic attacks, 10, Any other cogent reason. It is obvious that the "At Risk" register is a poor substitute for the real task of providing for a comprehensive assessment system for all children at certain points in development which forms the basic recommendation of the Sheldon report. The provision of such a comprehensive system is something for which we must constantly strive, KINGSLEY HALL ASSESSMENT CENTRE 1969 I think it might be appropriate to preface this report by stating briefly the purposes for which the Kingsley Hall Assessment Centre is used. Owing to various improvements in ante-natal and post¬natal care, there is an increasing number of children with serious handicaps who survive the perinatal period and these children require every possible care and help in order that they should develop to their full potential. We know that the earlier this problem is tackled, the better the results and the main purpose of Kingsley Hall is to take these children under the care and observation of trained staff for varying periods of time as soon as is practicable. Some very important objects can then be achieved. First and foremost is the assessment of the condition, and this is not a thing which can be done quickly or with any degree of certainty until the child has spent some time with us. Often the first time he is seen is the first time he has been out of his family circle, and his behaviour and reactions to testing are 33 completely different after spending some time with us. His integration into a group and the stimulation he gets from this and the staff, often increases considerably his innate abilities. A further very important part of our work is in parent counselling. The parents can visit us at any time and see our methods. If the children require physiotherapy, we insist that the parents visit us at least once a week when the physiotherapist is present, and they learn how to help their brain-damaged children for whom physiotherapy is part of daily life. We are very fortunate to have for this work a physiotherapist as interested and skilled as Mrs. Warwick. She takes endless trouble with the children and with training the staff and the parents. Many of the children spend a few months with us for their first assessment and for help with their socialisation, and then leave the centre and visit us from time to time so that their progress can be reviewed. Then they come back for a few months before their final placement, so that they can be accustomed again to group activities. The children with gross brain damage who require constant physiotherapy stay the longest time with us, as we really cannot estimate their capabilities when they have had intensive treatment. In 1969 we admitted 16 new children and discharged 15 and we had an average daily attendance of 15. Apart from the children who spend some time in the centre we are often asked by the Medical Officers or Health Visitors to see handicapped children whose parents are prepared to look after them at home, but want help and advice and finally assessment for placement when they are old enough. In 1969 we dealt with 10 such cases at the centre. During the year we have been able to continue our close association with the Wolfson Centre in Great Ormond Street, and all our staff have spent at least one day there, watching their methods of management and assessment. This is a most advantageous association for us. We were visited during the year by Dr. Pamela Zinkin and Dr. Reynell from the Wolfson Centre, and they were as usual very helpful. Another stimulating visit we had was from Dr. Mary Sheridan and Dr. Hodgson. They came down to photograph their methods of testing vision in mentally handicapped children. This was a most instructive and enjoyable occasion for all of us. Dr. Berman, the Reader in Child Dental Health at the London Hospital continued to treat our children. He is, as usual, most helpful and shows great interest in us, and sees that we have no difficulty in getting appointments, and we are most grateful to him for this. We also thank Mr. Lancer for dealing with our ophthalmological problems. He is a great help, particularly with our little mongol children. Finally I would like to thank the Heads of the Special Schools and Centre where our children have been placed, for allowing, and indeed welcoming, a visit from Sister Daly and myself at least once during the year to see all the children. We have learnt a tremendous amount by seeing their progress when they grow up placed into the correct environment. Only by watching them do we know that our assessment and placing has been correct! 34 CYTOLOGY SERVICE 1969 The total number of patients seen was 944. The number of abnormal smears was 8. It is interesting to consider these in some detail. Only one proved to be negative after the repeat of three months and one was considered innocuous enough by the Pathologist to be left for repeat smear in one year. Three more smears graded Pap II were followed by cone biopsy one of which was proved to be positive and underwent surgery later on. One Pap III after repeat smear three months later was regraded as Pap IV and referred to the Gynaecologist. Two patients showed frank carcinoma and they were treated in Hospital: one underwent hysterectomy and the other had cone biopsy which showed invasive carcinoma and was referred for irradiation to London Hospital. Other abnormalities which were referred to the Hospital were: Fibroids or myomata 4 Ovarian Cysts 2 Polypus 17 Erosions 14 Abnormalities which were referred to the General Practioners were: Trichomonas vaginalis infection 21 Monilia infection 12 Breast examinations were also carried out at the Cytology Clinic. Referred to surgeon 4 HEALTH VISITING The serious shortage of health visiting staff continued during the year, the recruitment of two student health visitors being more than offset by the resignation of two experienced members of staff, Mrs. Broad and Mrs. Lyon, the former gaining preferment in a neighbouring Borough and the latter moving house to another district. In September 1969 we were pleased to welcome Mrs. C.C. Ledden back to the post of Deputy Superintendent Health Visitor which she vacated for personal reasons in 1968. Amendments to the Nurseries and Child-Minders Regulation Act, 1948, made by the Health Services and Public Health Act, 1968, came into effect in February, 1969* and enabled greater supervision and control to be exercised over child¬minders and play groups than had been possible previously Although the shortage of health visitors made it difficult to step¬up the amount of visiting done in this respect, the Deputy Superintendent Health Visitor commenced a survey of all registered premises and child¬minders which was continuing at the end of the year. 35 A course of instruction of 6 lectures was made available to daily minders and playgroup organisers during September/October, 1969. The Syllabus included talks on child development, story telling, nutrition and health, home safety and first aid and play¬group organisation. Arising out of the closure in May, of Rush Green, Thompson Road and Upney Clinics, patients' records were re¬allocated to their nearest Clinic and health visiting areas were amended accordingly. An additional infant welfare session was instituted at Central Clinic, Barking on Wednesday mornings to cope with the patients transferring from the Upney area. Ante¬natal and Mothercraft talks by health visiting staff were undertaken at local clinics and after a break occasioned by lack of staff, close liaison resumed with the Maternity Department Barking Hospital in this connection. Health Visiting Statistics Cases Visited by Health Visitors Number of Cases Children born in 1969 2,357 „ „ „1968 2,314 „ „ „1964-67 5,824 10.495 Persons aged 65 or over 210 Mentally disordered persons 104 Persons discharged from hospitals (excluding maternity patients) 11 Number of tuberculous households visited 30 Number of households visited on account of other infectious diseases 39 Homes visited by tuberculosis visitors 218 Total Home visits made: (a) to pre¬school children 22,886 (b) to school children 3,310 (c) to adults 6,440 CHILDREN'S DEPARTMENT During the year 117 medical examination forms completed by local general practitioners were perused by the Deputy Medical Officer of Health. In this way, important medical aspects are brought to the notice of the 36 Children's Officer. These children were boarded out into foster homes. Close liaison continued to be maintained between the departments at all levels and every effort was made to give these children the benefit of our combined knowledge and experience. VACCINATION AND IMMUNISATION Since the formation of the London Borough of Barking in 1965 it has been possible to compare the performance of our immunisation programmes with the national averages contained in the annual reports of the Chief Medical Officer of the Ministry of Health. The table below gives the percentage of children vaccinated with comparative figures for England and Wales. It is clear that our immunisation rates compare favourably with the national averages. Year of vaccination 1966 1967 1968 1969 Year of Birth 1965 1966 1967 1968 Whooping Cough % % % % England & Wales 72 74 76 66 Barking 72 83 87 64 Diphtheria England & Wales 73 75 78 68 Barking 73 83 87 64 Poliomyelitis England & Wales 68 71 74 65 Barking 65 81 86 64 Smallpox England & Wales 58 39 38 31 Barking 48 61 60 24 The immunisation figures against infectious disease contained in this Annual Report should be viewed against the background of the new Schedule of Vaccination and Immunisation which was introduced on the recommendation of the Standing Medical Advisory Committee for the Central Health Services Council in 1968. This has resulted in a dislocation in the continuity of the immunisation statistics and it will be noted that there is an apparent decrease in the number of children born in 1968 and 1969 who received their primary immunisation and their booster doses. This fall is in fact more apparent than real in that at the end of the year there were a large number of children who had completed a part of their schedule of immunisation and were awaiting further doses of vaccine at the time these figures were obtained and it will be at least a further year before any real evaluation can be made of the effect of the new Schedule on the total number of children who are brought forward for immunisation against infectious diseases. A factor of some concern to my Department is the difficulty in obtaining adequate acceptance of the final dose of tetanus and poliomyelitis vaccine which children should receive prior to leaving school. 37 VACCINATION AGAINST MEASLES The campaign to vaccinate the maximum number of children eligible for protection continued through the year 1969. Here again the withdrawal of a measles vaccine as a result of unacceptable reactions and the following adverse publicity did for some months have an effect on the number of children accepting vaccination against measles. However, this adverse publicity now appears to have receded and the up¬take of measles vaccination is gradually returning to its former level. During the year a total of 2,594 children were vaccinated against measles and further details are given in the following table. The effect on the incidence of measles continues to be satisfactory although there was an increase in the number of children notified. MEASLES NOTIFICATIONS-1959-1969 Dagenham Borough Council Barking Borough Council 1959 2,038 896 1960 23 36 1961 1,965 1,112 1962 214 135 1963 1,045 861 1964 701 131 London Borough of Barking 1965 2,158 1966 1,039 1967 1,630 1968 175 1969 207 VACCINATION AGAINST MEASLES 1969 Year of birth Primary Vaccination 1969 _ 1968 502 1967 811 1966 401 1962-1965 472 others under age 16 408 Total all ages 2,594 VACCINATION AGAINST SMALLPOX Statistics relating to the number of persons vaccinated against smallpox are given on the next page. It will be noted that here again the new Schedule has brought about some changes in these statistics. The number of children between the age of 5 and 15 years who have been vaccinated or re-vaccinated against smallpox has risen from 307 to 775. There has been an overall decline in the number of persons of all ages who were vaccinated against smallpox from 2,088 vaccinated in 1968 to 1,647 persons in 1969. This decline can be accounted for by the rigorous 38 enforcement of the recommendation that all children and their families who suffer from eczema or are likely to be contacts of an eczematous individual are excluded from the programme. All parents are notified of the contraindications in writing when an appointment is made for vaccination against smallpox. During the year there have been no complications attributable to smallpox vaccination in the Borough. While the decline in the total number of persons vaccinated may be undesirable, the continuing toll of complications attributed to the vaccination of individuals where a contra¬indication exists or where a vaccinated individual has through contact infected such an individual, continue to appear with monotonous regularity in the Annual Reports of the Chief Medical Officer of the Department of Health and Social Security, there can be no doubt that this policy of rigorous exclusion is undeniably necessary. The following statistics relate to persons protected at council clinics or by general practitioners during 1969: VACCINATION AGAINST SMALLPOX Age at date of vaccination or re-vaccination Vaccinated Re-vaccinated under 1 year 18 _ 1 year 543 5 2-4 years 250 56 5-15 years 120 655 Total all ages 931 716 WHOOPING COUGH IMMUNISATION Year of Birth Primary Immunisation Children who received a booster dose 1969 40 _ 1968 704 410 1967 55 923 1966 28 142 1962-65 20 270 Others under age 16 3 38 Total all ages 850 1.783 DIPHTHERIA IMMUNISATION Year of Birth Primary Immunisation Children who received a booster dose 1969 40 _ 1968 710 4l8 1967 55 944 1966 31 152 1962-65 109 2,107 Others under age 16 49 319 Total all ages 994 3,940 39 TETANUS IMMUNISATION Year of Birth Primary Immunisation Children who received a booster dose 1969 40 _ 1968 709 419 1967 58 948 1966 31 160 1962-65 141 2,143 Others under age 16 374 873 Total all ages 1,353 4,543 POLIOMYELITIS VACCINATION Year of Birth Primary Immunisation Children who received a booster dose 1969 42 _ 1968 711 424 1967 80 871 1966 35 139 1962-65 119 2,067 Others under age 16 48 563 Total all ages 1,035 4,064 B.C.G. VACCINATION B.C.G. vaccination is a safe and very effective method of protecting the individual against tuberculosis. Extensive trials in England and Wales have shown that it provides 80% protection against subsequent tuberculous infection. The protection is long lasting and remains substantial for 10 or more years after vaccination. During 1969 the use of an intradermal jet injector was evaluated in a survey of 500 children injected by this relatively new technique. It was found that over 99% showed a conversion in tuberculin sensitivity as demonstrated by the appearance of a local reaction or by further Heaf testing. It is intended to use thi6 as the sole method of B.C.G. vaccination next year. If it is permitted to lift the veil of statistics we will be reporting a 29/<> increase in the total number of children accepting B.C.G. vaccination. During this year 1,261 children were given B.C.G. vaccine, an increase of 17 over 1968. 8l pupils had a grade 2 or more reaction to Heaf testing and were referred to the Consultant Chest Physician for further investigation. It is now our policy to vaccinate children showing Grade 1 response to Heaf testing as it is more than probable that their response to the Heaf test is due to mycobacteria other than tuberculosis. In addition 256 contacts of tuberculosis were vaccinated by the Chest Physician. 40 FAMILY PLANNING SERVICE The Family Planning Association has continued to provide clinics at the following centres:- Annie Prendergast Clinic - Wednesday, 6.30 p.m. - 8.00 p.m. Central Clinic - Friday, 7.00 p.m. - 8.30 p.m. Five Elms Clinic, Five Elms Road. Tuesday, & Thursday, 7.00 p.m. 8.30 p.m. 6.30 p.m. - 8.00 p.m. Thames View Clinic - Tuesday fortnightly 2.30 p.m. - 4.00 p.m. Owing to financial restriction it was not possible to expand the service to any degree, but progress was made by the commencement of a domiciliary family planning service, through the Association, for those special cases where attendance at a Clinic was not recommended or could not be achieved. 41 PREVENTION OF ILLNESS, CARE AND AFTER-CARE HOME NURSING This year has brought some changes in the Home Nursing field which should prove to be for the good of the service and patients. One big improvement occurred in March with the commencing of a bath attendant service. This has been a big boon to both the nursing staff and patients. Although there are four nursing attendants employed on a parttime basis it is hoped to increase the number next year. In September the closure of York House as a nurses' residence for which it was built and opened in 1932 by the Duchess of York, now the tiueen Mother, was a sad event. Five resident staff were accommodated in flats and an office was provided at the Civic Centre for administrative purposes. The number of nurses providing the service has remained the same as only a small number of vacancies occurred during the year. These were quickly filled. The training of nursing staff for district work has continued, though on a smaller scale. Three nurses took this course but all were successful and were placed on the establishment. The Marie Curie Day/Night Nursing Service has continued its invaluable work, but it is still regrettable that so few people are available to do this The need for Marie Curie nurses is irregular and because there is no retainin) fee, most people leave to find more regular employment. Statistics Total number of persons nursed during the year 1,949 Number of persons who were aged under 5 at first visit 12 Number of persons who were aged 65 or over at first visit 830 THE GUTHRIE TEST Phenylketonuria is a genetic disease which affects 1 in every 10,000 children born in England and Wales. The early diagnosis of this disorder is now a matter of urgency since it is now known that early dietary control will mean a child of normal or near normal intelligence and ability. Failure to diagnose this condition leads to a severely mentally handicapped child requiring a life¬time of special education and community care. The introduction of the "Phenistix" test for phenylketonuria was an important step forward in the field of preventative mental health. There are, however, two disadvantages associated with this test, (i) It lacks sufficient sensitivity; (ii) a positive test might not be obtained until the 6th week of life. The Guthrie test requires a drop of blood taken on the 6th - 7th day of life. It is a very sensitive test for phenylketonuria and so far the rate of detection of cases approaches the known incidence of the disease. 42 Its chief disadvantage is that at present it detects only one of a number of metabolic disorders which lead to mental or physical handicap if not detected and suitably treated. The screening of babies by the Guthrie method commenced for all babies born at home in the Borough or at Rush Green Hospital on 1st May 1969. Babies born at Barking Hospital continued to be tested by the "Phenistix" method. REPORT OF THE GERIATRIC LIAISON OFFICER A greater understanding of Local Authority services for the elderly has I feel been of great help to the General Practitioners and hospital staff, thus enabling a continued and co-ordinated service on patients leaving hospital. Home assessment visits continued to advise on the care of the elderly and the follow¬up observation of patients discharged from hospital, these forming a major part of my work. Cases Visited 1969 f Cases Referred by Geriatric Consultants on discharge from hospital 213 Referred by General Practitioners 23 Referred by Consultant Physicians on discharge from hospital 102 Miscellaneous Referrals 201 Revisits to cases 672 Total visits made 1.211 GERIATRIC CLINIC - Porters Avenue Clinic Our Geriatric Clinic maintained its popularity but for various technical reasons and staff difficulties, we were unable to run as many courses as we would have liked. Thirty one persons asked for a medical examination, but as two had been under investigation and/or had check¬ups at the same time in hospital, only twenty nine were examined. Some comparison with social and medical data of the previous year produced the following information. Ages ranged from 60 years to 78 years. The majority were between 66 and 70 years of age. The only 60 year old was a male, grossly over¬weight (40fc) edentulous, wearing no dentures, suffering from incipient Parkinsonism. 1968 1969 Total number examined 43 29 Hales 15 8 Females 28 21 Married and living together 28 15 Living alone. Females 11 10 „ „ Males 1 0 Living with relations. Females 3 3 „ „ „ Males 0 1 43 22 had consulted their General Practitioners recently and fairly regularly, and 9 more than six months before. 1968 1969 Obesity - Female 12-8 significantly 18-of whom 14 were more than 15% Male - 4-3 only 10% and 1 40% Underweight 7 3 - not significantly Hypertension - - 11 - 3 of whom were well controlled by treatment. Out of these eleven, one was underweight, one was normal. All the others were grossly overweight. 5 were suffering from hypertensive heart disease. Conditions affecting the Locomotive System - 9 - but only 2 were affected severely. (1968 - 18) Only 3 have a mild form of recurrent Bronchitis. (1968 - 12) Mental illness - in 1968 there were 7 and in 1969 there were 5 with mild anxiety and/or depression and getting treatment from general practitioner. Deafness - in 1968 - 8 so severe that it interfered with normal living in 1969 - 1 just in the process of getting a hearing aid, 3 were moderately deaf but coping quite well and not requiring hearing aids. Vision - There was no one without impaired vision. They have all attended opticians every two years. 3 have been suffering from Glaucoma. 1 had an operation the previous year on both eyes. The other two have continuous treatment. Two had cataracts. We made a routine blood check for anaemia but not one case was found. Other Miscellaneous conditions: Varicose veins 7 - one had an operation 20 years ago 1 Post Herpetic Ophthalmic Neuralgia. 1 Parkinsonism 1 Giant Cell Arteritis. 1 Diabetes (mild) grossly obese and Hypertensive. 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 arising from the work of the Geriatric Liaison Officer. 44 HOME HELP SERVICE (1) GENERAL (a) There has been no change in the general pattern of organisation or administration. It has been necessary, of course, for financial reasons to keep the provision of service at a restricted level. (b) The week¬end emergency service arrangements continued to operate but the demand for service has been negligible. Due to a vacancy in establishment for almost 9 months of the year, organising staff have been "on call" 1 week¬end in 4, instead of as previously, 1 in 5 The question of compensatory leave for stand¬by duty remains unsettled. (c) Routine visiting has not been carried out at the desired level due to:- (l) the almost continual vacancy for an Assistant Organiser. (11) the termination of duty of 2 clerks, July/August which necessitated the remaining Assistant Organiser becoming all but fully engaged on clerical duties. (d) With a view to overcoming this particular difficulty, coupled with the overall increase in case loads and deployment of labour, consideration is being given to some amendment of the staffing of the section. (2) CASE LOADS (a) Fluctuation from month to month continued, and throughout the year the following cases were served:- Aged (over 65 years) = 1731 Chronic Sick = 207 Mentally Disordered = 4 Maternity =16 Others 29 Total 1987 Requests received during the year = 997 Requests not acceded to during the year (for varying reasons) = 191 (b) Night Attendance provided for 2 cases only. (3) RECRUITMENT OF LABOUR Recruitment of labour was restricted due to the overall need for economy. Wastage and replacement was as follows:- Terminations of employment = 105 (for varying reasons) Commencement of employment = 107 At the close of the year the labour force stood at 232 (4) TRAINING (a) Due to (i) overall economy, (ii) inadequacy of staff, no training for manual workers was carried out. (b) One Organiser and one Assistant Organiser attended London Boroughs Training Committee Seminars, one day per week for six consecutive weeks as follows:- 19th February - 26th March 1969 8th October - 26th November 1969 45 (5) SOCIAL ACTIVITIES Monthly meetings of the Social Club continue to be held at the Porters Avenue Day Centre on the first Wednesday of the month. The attendance at these meetings is not as good as was originally hoped for, and the value thereof is questionable. Various activities have taken place, and in particular a very successful party on the 7th May to commemorate 21 years of Home Help Service under the National Health Service Act of 1946. The response on this occasion was excellent, and the function was attended by several members of the Domiciliary and Nursing Sub¬Committee. REHOUSING ON MEDICAL GROUNDS As in previous years my Department has continued to act as advisor to the Housing Department where applicants have put forward medical grounds in their claims for rehousing. As almost half the cases require a visit from at least one and sometimes two or more members of staff as well as enquiries to hospital or family doctor, it will be seen from the statistics given below that this often difficult task continues to require a considerable amount of time from the staff of the Health Department. Statistics Total number of applications 290 Number of families visited 104 Number recommended for rehousing 53 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. 2,444 articles were loaned during the year and 3,031 items were out on loan at the end of the year. In addition, 38,800 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 special arrangements in the future, particularly in smokeless zcnes 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, 48 pairs of these garments were issued. MEDICAL EXAMINATION OF STAFF The medical invigilation of new entrants to the Council's service, and the review of cases absent from duty owing to illness continued during the year. Generally the physical condition of candidates for 46 appointment is satisfactory but it is noted that for certain occupations mainly of a seasonal nature, the majority of applicants are persons of pensionable age or those with permanent disabilities. This poses some difficulty in assessing their suitability for entry to the Council's sick pay scheme. During the year 993 health questionnaires were submitted for scrutiny. 629 candidates were approved without further enquiry and 47 were accepted after satisfactory reports had been received from general practitioners or hospital consultants. The following examinations were carried out:- No. of persons medically examined 540 No. of persons found to be unfit 36 No. of persons accepted conditionally 35 No. of persons examined in connection with sickness payments 36 No. of persons examined for other authorities 4 No. of persons examined by other authorities 18 No. of Chest x-rays arranged in connection with medical examinations 343 In addition 72 students were medically examined in connection with entry to teacher training colleges. 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:- National Health Service Act: Adults. Children Section 22 (Mothers and Young Children) 2 3 Section 28 (Prevention of illness, care and after care) 31 ADAPTATIONS OF HOMES TO INSTALL ARTIFICIAL KIDNEY MACHINES Patients suffering from chronic renal failure who are suitable for treatment at home may have their homes adapted by the local health authority to enable the necessary equipment to be installed and operated in hygienic conditions. During the year a further home was adapted - a Barking Corporation house - making a total of three patients having treatment in their own homes at the end of the year. 47 CHIROPODY SERVICE The Chief Chiropodist reports as follows:- Old Peoples Homes. This section continues to be a most satisfactory service, nicely managed by our part-time Chiropodist Mr. Fenton. Car Transport Service. Based at Annie Prendergast Clinic, this service continues to provide great help to many handicapped old people, who would otherwise - due to our shortage of Domiciliary Chiropodists - not be able to receive treatment. With the assistance of Hiss K. Richards many handicapped old people are assisted to and from the Clinic. Louise Graham House. This Centre is one of our recent undertakings. Mrs. D. Mann is delegated to make regular visits, and to attend to any foot troubles reported. Domiciliary Service. Demands for this Service are extremely heavy, and our difficulties, due to the resignation of Mrs. Morgan, have greatly increased. However, we have been able to obtain the part-time services of Mr. Bunder and Mr. Lewis, which - plus our full-time staff Chiropodists doing a few extra sessions weekly - has enabled us to give attention to our most urgent cases. There is an urgent need for more staff in this rapidly growing section. Mrs. Morgan left us to go into training for the Teaching Profession, and we wish her the very best in her new career. She has kindly offered to come and help out when she is on vacation, for which we are very grateful. General Remarks. A new clinic was started at Oxlow Lane Clinic on the 29th September, and is being operated by Mrs. M. Goss, who joined our staff at this time on a full-time basis. This clinic was badly needed to provide chiropody service for the large number of people resident in the area between Ford Road Clinic and Annie Prendergast Clinic. Since opening this new clinic I find that many old people had not been having the necessary treatment due to the distance to their nearest clinic. A similar set of conditions exists in the Becontree Clinic area, and I hope that we may be able to consider the setting up of a foot clinic in this area quite soon. Finally. From reports and figures from the various sections of this service I am convinced that 1969 was one of the most outstanding years in our history, and I would short-list the following items in attempting to keep up - and even better this record. (1) Recruitment of staff (clinical and domiciliary) (2) The founding of a new Foot Clinic in the Becontree district. 48 CHIROPODY SERVICE TREATMENTS FOR THE YEAR 1969 CLINIC Children Adults Total Sessions -5yrs. 5-l6yrs. O.A.P. Others A/N P/H Central 9 165 1,886 88 1 4 2,153 394 Julia Engwell - 23 2,210 - 6 12 2,271 397 Porters Avenue 1 19 2,847 - - 10 2,877 476 Greatfields - 5 2,064 - - - 2,069 346 Thames View - 25 552 - - - 577 90 Ford Road 1 79 2,443 1 2 49 2,575 423 Annie Prendergast 11 40 2,408 30 5 745 3,239 483 Oxlow Lane 1 - 630 - 1 4 636 116 Total 23 356 15,040 119 15 824 16,397 2,725 OLD PEOPLE'S HOMES Mayesbrook 249 249 35 The Lawns 196 196 22 Saywood Lodge 202 202 23 Riverside 226 226 26 Total 873 873 106 Domiciliary West 2,172 22 2,194 757 East 874 874 Louise Graham House 40 40 6 GRAND TOTAL FOR THE YEAR 1969 Section No. of treatments Sessions Worked Clinics 16,397 2,725 Old People's Homes 873 106 Domiciliary 3,068 757 Louise Graham House 40 6 Totals 20,378 3,594 49 TUBERCULOSIS In co-operation with the Chest Physicians, Dr. F. Macken and Dr. H. Loudon, the opportunity was taken to co-ordinate the records held at the Department with those of the Chest Clinic, which resulted in a substantial reduction in the number of notified cases of tuberculosis recorded on the Register at the end of the year. We are again indebted to the Chest Clinic for their help and co-operation during the year. Notifications and Deaths New Cases Deaths Pulmonary Meninges and CNS Other Total Pulmonary Non Pulmonary M F M F M F M F M F Under 5 years 1 - - - - - 1 - - - - 5- 1 3 - - - - 4 - - - - 15- 13 7 - - 4 4 28 - - - - 45- 18 10 - - 1 1 30 1 1 - - 65 & upwards 6 3 - - — - 9 3 3 - — Totals 39 23 - - 5 5 72 4 4 - - Transferred Cases Into Borough Out of Borough Net Increase 16 5 11 Tuberculosis Visiting No. of cases on Register No. of Households Involved No. of Home Visits made 472 403 821 Free Milk On the recommendation of a Chest Physician additional supplies of milk are made available to patients suffering from tuberculosis, and 90 patients were so assisted during the year. MASS MINIATURE X-RAY SERVICE A memorandum issued in December 1969 by the Department of Health and Social Security requested Regional Hospital Boards to consider in consultation with local authorities how the need for chest x-ray services in their regions could best be met in view of a proposal to discontinue this service and integrate the remaining units with hospital radiological departments. 50 Some 2,000 x-ray examinations are required annually to screen those members of staff of this authority who are in close contact with children or engaged in food handling and the Regional Hospital Board were advised of the Council's view that there should be no reduction in the service provided in this respect. Unit 6A of the Service visited the Borough twice during 1969. In May public sessions were held in the car parks at the "Merry Fiddlers" and "Church Elm" public houses, and in November/December at the "Round House", the "Volunteer" and the Magistrates Court, East Street, Barking. In addition some of the larger industrial groups were visited and also old peoples homes in the Borough and I am indebted to the Medical Director for the following details: MASS RADIOGRAPHY LONDON BOROUGH OF BARKING - 1969 Male Female Total Ford Motor Co. Dagenham. 6391 254 6645 Dagenite Ltd., Dagenham. 624 168 792 Riverside Old People's Home, Barking. 11 39 50 Mayesbrook Old Peoples Home, Barking. 13 48 61 The Lawns, Old People's Home, Dagenham. 16 44 60 Telephone Cables Ltd., Dagenham. 6l8 227 845 Merry Fiddlers, Dagenham. 207 283 490 Church Elm, Dagenham. 190 253 443 Magnavox Ltd., Barking. 248 338 586 Magistrates Court, Barking. 801 1120 1921 The Round House, Dagenham. 120 170 290 The Volunteer, Barking 206 93 299 Total Number X-rayed 9445 3037 12482 Requiring further investigation 132 35 167 Groups Attending General Public 1525 1910 3435 Organised Groups 7887 1038 8925 Residents - Old Peoples Homes 33 89 122 9445 3037 12482 Pulmonary Tuberculosis (including previously known cases shown in brackets) Requiring immediate treatment 5 - 5 Requiring close clinic supervision - 2(1) 2 Requiring occasional clinic supervision 19(2) 7(2) 26 Presumed healed, discharged 17(5) 5(1) 22 Groups in which Significant Tuberculosis was discovered. Requiring immediate treatment- organised groups 5 - 5 Requiring close clinic supervision- general public - 2 2 51 Male Female Total Among other abnormalities discovered were: Malignant Neoplasms in Thorax Lung primary 6 1 7 Lung secondary - - - Carcinoma of pleura 1 - 1 Non Malignant tumours 1 - 1 Congenital Abnormalities of the heart and vascular system - 1 1 Acquired abnormalities of the heart and vascular system 9 6 15 Pneumoconiosis (of which 7 were asbestosis) 8 1 9 Bacterial & virus infection of lung 11 - 11 Bronchiectasis 3 1 4 Pulmonary fibrosis (including 1 fibrosing alveolitis) 10 2 12 Abnormalities of the diaphragm & oesophagus 3 1 4 Pleural effusion (non-tuberculous) 1 1 2 Other abnormalities 18 2 20 Did not attend for further investigation 2 1 3 Did not attend for repeat miniature film 13 12 25 52 MENTAL HEALTH SERVICE I give below the report of Dr. S. Fahmy who commenced duty as Psychiatric Adviser to the Borough in September 1969: Throughout the year two consultants sessions have been available to the Borough. Until 22nd September 1969 one locum consultant gave one session to the Children's Department and another gave one session to the Day Centre - thereafter the two sessions (Monday and Tuesdays) have been given by one Consultant. The Children's Department session was largely taken up by assessing children at Woodstock Reception Centre and attendance of case conferences Most of the children seen needed placements on account of home disruption or failure of fostering- some had school avoidance and/or truanting problems which were invariably a reflection of the disturbed home situation in earlier years. The second session was spent at the Day Centre offering support and advice to the staff and having clinical conferences on cases and problems presented by Mental Welfare Officers. These conferences highlighted occasional inco-ordination between decisions taken at Warley Hospital and difficulties of placements of some subnormal patients. Both sessions revealed to me one common feature which was the case load and the consequent confinement of work to crises situations. Meaningful case work that might have averted crises could not be done on account of under-staffing and frequent change of workers. The latter phenomenon discouraged all attempts at doing effective case work with individuals and families. It is not at all clear why there should be such frequent changes. One is driven to the conclusion that on account of the nationwide shortage of case workers some Boroughs tempt experienced personnel by extra pay or emoluments. In addition to these two sessions, some field workers - school teachers and Head-teachers were invited to clinical conferences held on Thursdays at the Child Guidance Clinic. This was a first step in establishing contact with various community agents. Further steps are contemplated, subject to approval and available time. The latter, I suggest, can be found in the Monday session by giving the Day Centre and the Mental Welfare Officers two hours. The third hour would be initially spent in my visits (for introductory purposes) to psychiatric clinics and the different establishments that deal with children - e.g. day nurseries, play groups, nursery schools, paediatric units etc. The next step would be starting seminars for one type of workers e.g. health visitors, nursery school staff, community workers or general practitioners etc., (whichever group shows greater readiness to attend). OSBORNE WORKSHOP, OSBORNE SQUARE, DAGENHAM. Arising out of a review of services for the mentally handicapped undertaken for the Mental Health Sub-Committee, it was decided to drop the title 'Sheltered Workshop' as this caused a certain amount of confusion to industrial users, and the premises from September, 1969 became known as the 'Osborne Workshop'. 53 The unit completed its first full year of operation during the year and has steadily consolidated its purpose of providing a more advanced work programme and trainees with an increasing variety of work. More sophisticated machinery was introduced, and a time clock was installed in the entrance hall to the Workshop. This enabled factory standards to be simulated greatly improving trainees acceptance of time keeping and resulting in a pay structure based on the trainees abilities being introduced. Sales of work dropped slightly but since acquiring knitting machines the sale of bobble hats has improved. Sales of trays have also risen. Contract work has now become the main source of activity. 30,000 leaflets were distributed and a contract for assembling 120,000 wig stands was completed ahead of schedule at an output of 9,000 per day. Another contract for electrical components involved the installation of a press and 31,000 items on this contract were completed during the year. Six trainees have either been placed in, or have found outside employment and apart from minor problems they have retained their jobs without undue difficulty. The staff and trainees have been very pleased to hear from them all on certain occasions and hope in the near future to see something of them when a proposed fortnightly social evening starts. During the year 3,423 attendances were made at the Workshop and at the end of the year 23 trainees were on the roll. The Workshop earned a total of £585 from its activities, and next year should see a substantial increase in earnings as the work programme gathers momentum. ADULT TRAINING CENTRE, GASCOIGNE ROAD, BARKING. The range of activities provided at the Centre continued to develop during 19&9, and a continuous effort made to find new work and to enlarge existing contracts. Groups of trainees were taken on visits to local factories to 6ee various industrial processes and to a Post Office Sorting Department to see the process of letters through various sorting machines. Outings were made to the Tower of London, Museums, Fishing Boats and Cockle Sheds at Leigh, and to a London Theatre. On many of these trips the trainees were taken by public transport and had meals in local restaurants. In May 80 trainees were taken to St. Mary's Bay for a week's holiday. Whilst there they had a flight on a hovercraft and enjoyed many other outings. In June trainees were taken by coach to Westminster Pier and then by boat to Hampton Court for tea. In September they went to Walton-on-Naze and visited various places of interest. A social evening for parents and trainees is held at the Centre every Monday with an average attendance of 150. A social on a Saturday evening is held approximately every six weeks. Our thanks are due to the staff of the Centre for their support of these activities. During 1969, 19,6l8 attendances were made at the Centre and 108 trainees were on roll at the end of the year. The Centre earned a total of £1,450 from its activities. 54 WORK OF THE MENTAL WELFARE OFFICERS During the year 297 patients were referred to the mental health service. Mentally ill Mentally Sub-Normal Referred by general practitioners 42 1 Referred by hospitals on discharge 79 9 Referred by hospitals after or during out-patient or day treatment 39 1 Referred by Local Education Authority - l4 Referred by police and courts 2 - Referred by other sources, e.g. neighbours, relatives, Ministry of Social Security and other social and welfare agencies, inward transfers from other areas 96 14 258 39 In addition, 85 cases were referred by General Practitioners or Hospitals for assessment/social reports in connection with hospital admission. Mentally ill Mentally Sub-Normal Number of Persons receiving community care at the end of the year 181 390 Number of persons attending day centres 35 197 Number receiving residential care 12 35 Number of admissions for temporary residential care to relieve the family 5 21 During the year the following admissions to mental hospital were dealt with by the department:- Informal 36 Compulsory 59 Via Court 4 RESIDENTIAL ACCOMMODATION The maisonette in Blake Avenue, Barking, providing places for four mentally ill persons continued to be fully occupied during the year, and in view of the success of this project a further maisonette, in Terling Road, Dagenham, also providing 4 places, was allocated by the Housing Committee. The flats were equipped and two tenants were installed by the end of the year, under the supervision of the mental welfare officers. PORTERS AVENUE DAY CENTRE The Centre continued to make a real contribution to the support and rehabilitation of the mentally sick, in some cases reducing the frequency of admission to mental hospital and in others reducing the length of stay in hospital. 55 Although the Centre is deemed to have places for 30 people, this number has been exceeded and at the end of the year there were 36 names on the register and a waiting list of 16. Plans are being made for an extension to the Centre to provide more storage space and for an additional member of staff when financial conditions allow. A total of 9,766 attendances were made during the year. CASTLE SCHOOL The year commenced with 60 children on roll which included 6 children in Special Care. 8989 attendances were made during the year. During the year groups of children were taken out on visits of observation in conjunction with classroom projects and social training. Outings were made to the London Zoo, Brentwood Zoo and Thorpe Bay, Special Care children being included in the latter. Post Christmas excitement continued with a visit to the London Palladium to see "Jack and the Beanstalk". During the month of Kay 20 children went to Pontins Holiday Camp, which proved to be highly successful. During this holiday two boys gained swimming certificates. As in the past year the children put on a play for their parents. This was called Toyland and was performed at St. Margarets Hall. It was very well attended. The School Christmas party was its usual success. Open Day was in June and besides the very many parents and friends who came were the Rev. Cooper, Mrs. Wheeler and Dr. Beaver. Members of the Police Force kept in touch and Road Safety Sam put on a show which always delights the children. Miss Delaforce, Speech Therapist, continued with her good work for one session a week and Dr. Burgess, School Medical Officer made regular inspections throughout the year. A number of children continued to receive weekly swimming instruction whilst most of the school participated in the weekly session of P.E. Both these events talking place at the South Essex Technical College. Visitors to the School were many and included, The Mayor of Hastings, Drs. Gillet, Batham and Beaver, Councillors Mrs. Engwell and Mrs. Ball, Mrs. Bellchamber and friends, Mr. Schiphorst from the Department of Health and Social Security, members of staff from Kingsley Hall and Nurses from Upney Hospital. Three students on Teacher Training Course at the Chiswick Polytechnic came for Teaching Practice, and boys and girls from the Eastbury School, on occasions, helped with the children. Staff:- Mrs. Thorogood attended a day release course on Special Care. 56 Miss Baker, Mrs. Bohannon and Mrs. Hayden joined the Staff whilst we lost the services of Mrs. Measures, Mrs. MacKenzie and Mrs. Jenning. 1969 was a successful year inasmuch, slowly as it may have been, all the children made progress. 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, l8th-29th August, 19&9. The supervision of the Centre was undertaken by a Trained Teacher of the Sub-normal and additional staff was recruited, including students of Teacher Training Colleges and mothers of the trainees. This Centre was attended by trainees-junior and adult-although some only attended for one week due to family holiday commitments. HOSTEL FOR THE MENTALLY SUB-NORMAL The first residential facilities for the mentally sub-normal in the community were provided during the year when on 17th March, 1969, Louise Graham House, was formally opened by Councillor Mrs. C. S. M. Godfrey, J.P. The building provides 24 places for mentally sub-normal adults and two staff flats. It is sited in the Gascoigne redevelopment area not far from the Adult Training Centre in Gascoigne Road so that residents may easily avail themselves of the training facilities provided in the Centre. The hostel offers a home to mentally handicapped persons without relatives, and temporary care for those whose parents are either recovering from illness or availing themselves of a short holiday. Louise Graham House is furnished to a high standard mainly through the efforts of voluntary workers and associations who have made substantial contributions to the furnishings and equipment. A plan of the accommodation is given on page 58. This building will not accommodate all those residents of the Borough who are in need of this type of care, and consideration is being given to the possibility of converting the York House Nurses Training Home to provide additional hostel accommodation if the proposal to discontinue its present use is approved. 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. They have also set up a preschool play group for the children of mentally-ill parents which operates 57 58 LOUISE GRAHAM HOUSE each morning at St. Elizabeth's Church Hall, Wood Lane, Dagenham. 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 ha6 a holiday bungalow at Clacton for selfcatering holidays for the families of the sub-normal. Towards the end of the year a new venture, a Psychiatric Social Club known as the "700 Club" was formed under the aegis of the Barking Association. It meets fortnightly at the Abbey Hall, Axe Street, Barking, under the guidance of Dr. M. I. Adamson. WESTFIELD PSYCHIATRIC SOCIAL CLUB This club meets on one evening per week at the Porters Avenue Day Centre to assist in the rehabilitation of the mentally ill under the guidance of the mental welfare officers. Unfortunately, owing to an acute shortage of mental welfare officers the club was temporarily discontinued in May 1969, but we hope it will recommence as soon as further staff have been recruited. 59 SCHOOL HEALTH SERVICE There are 64 primary and 23 secondary schools in the Borough. We also have two special schools. The Bentry Special School caters for educationally sub-normal pupils, and Faircross Special School for delicate and physically handicapped pupils. In addition there is a unit for partially hearing pupils at Eastbury Infants School. At the end of the year, numbers on roll were as follows:- Primary schools 16,765 Secondary schools 11,280 Special schools 321 Total 28.366 SCHOOL CONSULTATIVE 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, Tuesday and Thursday 9-9.30 a.m. Five Elms Monday p.m., Friday a.m. Ford Road Monday a.m., Friday a.m. Julia Engwell Monday to Friday 9-9.30 a.m. Leys Monday p.m. Marks Gate Friday a.m. Oxlow Lane Wednesday a.m. Porters Avenue Monday, Wednesday and Friday 9 - 9*30 a.m. A total of 1,876 pupils were seen during the year. 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. Number of special inspections 2,001 Number of re-inspections 1,492 3.493 60 Periodic Inspections Age Groups Inspected (by year of birth) No. of Pupils Inspected 1965 and later 158 1964 1,414 1963 848 1962 163 1961 84 1960 78 1959 314 1958 1,439 1957 614 1956 57 1955 308 1954 and earlier 605 6,082 Pupils found not to warrant medical inspection 7,56 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 1965 and later 2 23 22 1964 26 174 162 1963 18 50 59 1962 3 14 15 1961 2 3 5 1960 2 7 8 1959 15 13 27 1958 56 139 187 1957 27 49 74 1956 7 8 13 1955 13 9 18 1954 and earlier 24 37 56 Total 195 526 646 General Condition of Children Out of 6,082 pupils examined, none were considered to be of unsatisfactory general condition. INFESTATION WITH VERMIN During the year 23,236 pupils were examined, and 1,042 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. 39 cases were recommended treatment during the year. 61 DEFECTS FOUND BY MEDICAL INSPECTION Defect or Disease Periodic Inspections Special Inspections Treatment Observation Treatment Observation Skin 148 149 105 29 Eyes: (a) vision 202 537 109 121 (b) squint 30 50 4 7 (c) other 9 27 9 2 Ears: (a) hearing 22 136 56 177 (b) otitis media 9 49 12 1 (c) other 7 38 - 1 Nose and throat 63 391 48 73 Speech 26 95 57 29 Lymphatic glands 3 101 3 - Heart 14 130 16 55 Lungs 19 153 43 40 Developmental: 26 (a) hernia 7 1 2 (b) other 20 145 20 65 Orthopaedic: (a) posture 4 46 4 4 (b) feet 50 130 17 23 (c) other 9 81 72 91 Nervous system: (a) epilepsy 6 25 10 21 (b) other 9 56 39 43 Psychological: 69 26 24 (a) development 6 (b) stability 11 198 68 59 Abdomen 8 59 11 10 Other 73 122 61 153 EMPLOYMENT OF CHILDREN 110 pupils were examined for fitness for employment out of school hours and certificates were granted. 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 16 (b) for adenoids and chronic tonsillitis 133 (c) for other nose and throat conditions Received other forms of treatment 2l8 62 Total number of pupils in schools who are known to have been provided with hearing aids:- (a) in 1969 6 (b) in previous years 83 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 211 (b) at school for postural defects 14 EYE DISEASES, DEFECTIVE VISION AND SQUINT Ophthalmic Specialists of the Regional Hospital Board attended weekly at Central, Porters Avenue and Becontree Avenue Clinics. Pupils known to have been treated (a) External eye diseases and other (excluding errors of refraction and squint) 23 (b) Errors of refraction (including squint) l,393 (c) Number of pupils for whom spectacles were prescribed 979 ENURESIS CLINIC The statistics relating to the work of this clinic are as follows:- Appointments made Attendances New patients 45 44 Old patients 28 21 Total 73 65 DISEASES OF THE SKIN (excluding uncleanliness) Pupils known to have been treated Ringworm: (a) scalp - (b) body 1 Scabies 8 Impetigo 21 Other (plantar warts, etc.) 929 939 63 SPEECH THERAPY The Speech Therapists report as follows:- In 1969 the number of children referred for Speech Therapy by the School Medical Officers increased considerably. This appeared to show that there was growing confidence in the Borough Speech Therapy Services. Closer co-operation between Speech Therapy and other professions in the school clinics was evident. The Head Teachers continued to give valuable help on visits to the schools and they were able to provide useful information on some of the children requiring treatment. Speech Therapy sessions were carried out at Faircross Physically Handicapped School, Bentry, E.S.N. School, and the Junior Training Centre and the co-operation of the staff in these Special Schools was appreciated. There were three full time Speech Therapists in the Borough for the first six months of 1969 and all children requiring Speech Therapy were able to be treated at their local clinic. Unfortunately Miss Heath left the Borough in July to work in a hospital and Central Clinic had no Speech Therapist for the remainder of the year. SPEECH THERAPY STATISTICS Miss Symes Miss Delaforce Total No. of Treatments 1,844 1,152 Total No. of Attendances 544 747 Number of New Patients 71 77 Category of Defect: Articulatory 56 53 Language Disorder 4 20 Stammer 8 Disorder of Resonance - - Cleft Palate - - Other Defect 3 Number of patients discharged during year 70 55 Reasons: Speech normal 45 32 Left district/transfer to another clinic 2 2 Non-attendance, left school etc. 19 21 Discharge at Parent's request No further progress likely 4 Number of patients on Register at end of year 77 125 CHILD GUIDANCE CLINIC After negotiations over a number of years with the Regional Hospital Board, the psychiatric cover at this Clinic was increased to seven sessions per week, and with the addition of two sessions weekly as psychiatric adviser to the Borough Council, a permanent appointment of a Consultant Psychiatrist was made for nine sessions per week. 64 The services of Dr. Danos and Dr. Masani, locum psychiatrists, were discontinued and Dr. Fahmy commenced duty in September, 1969. I am indebted to him for the following report:- As I took over the psychiatric service of the clinic on 22.9.69 this report will be a second hand account of the work done in the first 9 months and my experience in the last three. The clinic is very adequately staffed for educational services (three educational psychologists and five remedial teachers), very poorly staffed for psychiatric services (2 locum consultants providing four and one sessions per week respectively in first 9 months and later one consultant appointed for nine sessions per week with no assistants nor auxiliary staff) and under-staffed on the secretarial side. The following table covering the 4 quarters of the year should give an idea about the size of the demand for and the call on psychiatric service. The largest number of referrals has come from schools, a great number of which are children from disturbed or broken homes with histories of early psychological traumata which have never properly healed. Indeed in many cases very serious early deprivations have left an imprint that can never be erased by any available treatment. An equal number of problems are treatable if auxiliary staff (child therapists, psychiatric social workers and case workers) and time were available. As it happened, no consultant (past or present) could offer regular interviews of adequate duration at weekly or fortnightly intervals, and thus very little psychodynamic changes could take place. The natural process of emotional maturation was bound to be hampered in some children and many would grow into neurotic adults with varying degrees of character disorders. Another result of the inadequacy of the services provided was the chronicity of the disturbances-cases had to be left on the books for years with little significant progress. This in turn increased demands on the consultant's time, creating the problem of the waiting list (for consultations and treatment) and reducing the value of the help that can theoretically be offered to children and their families. All these difficulties were somewhat ameliorated by the very ready and eager co-operation of the educational psychologists, the remedial teachers and social workers in the community e.g. the Children's Department and Mental Welfare Officers. However, the social workers were found to be quite overloaded with problem families and this overload created similar difficulties to those experienced in this clinic. Another help was given through the co-operation of the Special Services for boarding some children, Dr. Little of Whipps Cross Hospital who accepted many of the children referred and the E.E.G. Department at Goodmayes Hospital. Co-operation of all these agents has helped me in reducing the waiting period for first consultations from 7 months to 2. However, the quantity of the demands on my time has not yet enabled me to start active therapy on any one case. My work was thus limited to dynamically oriented counselling of parents which did help the few who were eager, insightful, ready to accept some unpalatable truths and change their attitude. I plan to set aside a few hours per week for child treatment even though this is bound to lengthen waiting intervals between referrals and first interviews. To improve the situation I suggest increasing the psychiatric establishment by adding one experienced psychiatric social worker, one experienced family case worker, one therapist and a psychiatric registrar. If and when this additional staff becomes available some of the consultant's 65 time would be freed for helping the different field workers and establishing contact with the paediatric units in the Borough since physical illness and hospitalisations are known to be important traumas in early childhood. In addition a day school for maladjusted children could be of great benefit and might conceivably reduce the need for boarding. As can be seen from the figures, relatively few adolescents and under fives are referred, although these are known to be crucial developmental crises times and relatively small help at such times could avert serious and chronic disturbances. It is not easy to explain this phenomenon-it may well be due to lack of awareness on the part of the referring agents or due to the inevitable discouragement of the waiting list in this clinic or a combination of the two reasons and other unknown factors. On the secretarial side I can only state that without the everready, willing co-operation of the staff and the efficient, conscientious, alert, active hard work of the senior secretary, a large part of the work could not have been achieved. CHILD GUIDANCE SERVICE Statistics 1969 Cases on the books of the Clinic at the end of each Quarter 31.3.69 200 30.6.69 213 30.9.69 165 31.12.69 168 Cases referred during the year:- Children under 5 years 9 Children 5 years and over 117 Total 126 Number initially referred by General Practitioners 17 Head Teachers 19 Consultants 13 Children's Officers 9 School Medical Officers 22 Probation Officers Health Visitors 3 Magistrates 7 Educational Psychologists 13 Parents 23 Treatment carried out:- Number of Interviews Psychiatrist 882 Educational Psychologist 208 No. of Cases awaiting first appointment at end of year - 37 66 HANDICAPPED CHILDREN FAIRCROSS SCHOOL Mr. Holdsworth, the Headmaster, reports as follows:- "This year has been a happy and successful one for the School. On the academic side we received passes in the examinations of the Associated Board of Music, the Royal Society of Arts Commercial Certificates, the East Anglian Examinations Board Certificate of Secondary Examination, Grade I, in Art and Craft, Typewriting and Shorthand. Swimming prowess improves, and several children gained high awards of the Amateur Swimming Association, the Swimming Teachers Association, the Royal Life Saving Society, Bronze, Silver and Gold Medals were awarded for the Personal Survival Tests. Our population of children handicapped by Spina Bifida increased twofold, and we doubled our intake of children handicapped by Spastic Quadriplegia. This increased the pressure of work on our Physiotherapists, Mrs. Walker and Mrs. Lawrence, to whom we are very indebted. The School Journey to Broadstairs in May 1969 was very successful. Hotel accommodation was first class. Educational visits for the week included Dover Castle, Richborough, Canterbury Cathedral. The Centre for the 1970 School Journey is Swanage Dorset. Christmas activities included a performance of "Cinderella" given to parents and friends on the 15th and l6th December 1969. This was full scale musical production, and the tremendous amount of work put into it by both children and staff was much appreciated by the audience. A day's entertainment of the senior citizens from the Almshouses in which a dinner was cooked and provided by the children was much appreciated. The children's generosity was such that additional presents were given to the visitors. I feel very proud of the children for this unselfish thought." I am also grateful to the Senior Physiotherapist, Mrs. A.D. Walker for the following report on her work at the school during the year:- "In 1969 we had 36 children on the list for treatment, each child to attend two or three times a week. They can be grouped under the following diagnoses:- (a) 9 Spina Bifida 3 boys 6 girls 7 have Hydrocephalus, 2 have long calipers and 7 have pelvic bands. They all walk with two clumpers. 1 walking with one stick. 1 walking without aid. (b) 12 Spasties 10 boys 2 girls 9 walking without help. 2 walking short distances with a rolater. 1 not walking. 67 (c) 10 Asthma 7 boys 3 girls 7 frequent severe asthma attacks 3 moderately severe to mild asthma. (d) 2 Poliomyelitis 1 boy 1 girl 1 permanently in a wheelchair. 1 walking with elbow crutches and one long caliper. (e) 3 Muscular Dystrophy 1 boy 2 girls The Spina Bifidas are by far the most time-consuming. During treatment calipers have to come off, contractures controlled, followed by extensive trunk and arm exercises to make them strong enough for walking. Then calipers have to be replaced and walking exercises commenced. As twelve of the children in groups (a) and (b) were from the Infant Class, fifty-per-cent, of valuable treatment time was spent in dressing and undressing, putting calipers on and taking them off. As far as the Hydrotherapy is concerned we have not been able to use it as much as we would have like, due to lack of ancillary help. Without help we can only manage one, sometimes two, children per session, whereas, we ought to be able to do four. One full-time physiotherapist and one part-time doing two days a week is the complete staff. An unqualified helper to do all the dressing and generally help would be very much appreciated. During 1969 it has proved extremely valuable to attend hospital with certain children when they have had their "check-ups" and discuss any problems with the doctor. Good contacts both in other physiotherapy departments and with doctors have been established in this way, and we hope to keep it up in 1970. Unfortunately, the school no longer have a speech therapist and we have approximately twelve children in need of speech therapy. I would like to take this opportunity to express my thanks to the School and the Principal School Medical Officer for the co-operation they have given me in 1969-" BEUTRY SCHOOL I have received the following report from Mr. Hurton the Headmaster:- "The number of children on the School Roll shows little variation from last year despite the fact that we now have a team of Educational Psychologists. The retesting of pupils is causing me some concern as some have not been tested since their admission five to six years ago. I hope that consideration will be given to an Educational Psychologist being attached to the school for one day a week. The Speech Therapist, Miss Delaforce visits the school on Thursday mornings and Mrs. Savage, the audiometrician comes on Thursday afternoons; and we are very grateful for their efforts. Dr. Fitzpatrick visits school every Wednesday morning and we greatly appreciate her interest in the school, and the help given by Nurse Hogg. We are grateful too for the interest they 68 show in our school functions which they attend regularly. The visit to Hainault Camp is now an established feature of our School life and the venture has proved extremely successful. For the first time a mixed party visited the outdoor pursuits course at Trewern near Hereford. The two members of the Staff who were in charge, Mr. Cossins and Mrs. Hutchins, brought back a very good report of the children. The programme of factory visits, talks and films for the Senior pupils during the last year at school is re-enforced by visits of the Youth Employment Officer, Mr. Lobley. This ensures that by the time the pupils leave school suitable jobs have been secured for them. Twenty six children left school during the year, including two who were found to be above Educationally Sub-normal range and thus allowed to leave at Fifteen years. Two children went to the Training Centre. No progress has been made with regard to the Work Experience Unit. The premises promised us at the Charlecote Day Continuation Centre were not made available. The school participated, as usual in each section of the Barking Schools' Festivals. This time we entered in both the Junior and Senior School sections. Our Drama work this year culminated in the production of our first pantomime. There were three evening performances and over 300 parents, colleagues and friends attended. They were lavish in their praise of our efforts. The pantomime was written and produced by Mr. C. M. Hughes our Deputy Head. The School Youth Club is now formally established and has thirty-four members. At the Christmas Party the Cabaret Show given by the girls was organised by Mrs. Pass, who joined the Staff in September. The proposed new Bentry School should be commenced in 1970 and I hope that will include all the facilities such as showers, separate Dining Hall, etc., which are essential for our children. 69 70 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS - 1969 31ind Part Sighted Deaf Part Hearing Physically Handicapped Delicate Maladjustec Educationally Sub-normal Epileptic Speech Total Number of children newly assessed in the year - 1 - 1 11 8 l4 43 - - 78 Number of children placed in Special Schools in year 1 1 - 2 11 14 11 51 1 - 92 Number of children requiring places in Special Schools - 1 - 1 1 3 14 10 - - 30 Number of children included above whose parents had refused consent to their admission - - - - - - - 2 - - 2 Number of children on Registers of Special Schools at 22nd January 1970 4 14 - 28 61 67 34 224 8 - 440 Number of children receiving tuition at home or in hospital, etc. - - - - - - - 1 - - 1 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 43 babies:- Central Nervous System Anencephalus 1 Hydrocephalus 2 Microcephalus 1 Other specified malformations of brain or spinal cord 1 Spina bifida 2 Eye and Ear Unspecified malformations of ear 1 Accessory auricle 3 Alimentary System Cleft Lip4 Cleft palate 2 Heart and Circulatory System Unspecified malformations of heart and circulatory system 1 Urino-genital System Undescended testicle 1 Hypospadias, epispadias 3 Limbs Polydactyly 3 Syndactyly 3 Reduction deformity hand or arm 1 Reduction deformity leg or foot 2 Talipes 12 Other specified malformations of upper limb or shoulder 1 Unspecified limb malformations 1 Other parts of Musculo-skeletal System Other malformations of musculoskeletal system (including congenital hernias except hiatus hernia) 1 Other Systems Other unspecified malformations of muscles,skin and fascia 3 Other specified malformations of skin including ichthyosis congenita 2 Other Malformations Down's syndrome (mongolism) 1 71 DENTAL SERVICES SCHOOL POSTAL SERVICE The School Dental Service was able during 1969 to provide full dental treatment for any school child in the Borough receiving education from the local authority including those in special schools. The percentage of the school roll inspected in 1969 was 73% compared with 56% in 1968 and 47% in 1967. The number of patients treated showed a decrease of 666 compared with 1968. CONSERVATION AND ORTHODONTIC TREATMENT Once again I am happy to report that the trend to save teeth rather than extract them is on the increase. The amount of orthodontic treatment carried out during the year has been very satisfactory, and shows an increase of 25% in cases completed compared with 1968. DENTAL HEALTH EDUCATION Once again I would like to say that the dental staff as individuals, did an excellent job of work in this very important field of every-day dental work; talks by our dental auxiliaries were given to various junior and infant schools. While all this is a step in the right direction, I feel that a co-ordinated health education programme in association with the individual effort is essential. The nursing staff and health visitors have also helped in this field of dental work during the year 1969. STAFFING We began the year 1969 without dental auxiliaries due to one marrying and going to South Africa and the other going into hospital work; in midFebruary we recruited one replacement and in June another. However, we only had full establishment until November when one had to leave for health reasons. Advertisements for Dental Officers in the British Dental Journal did not bring forth any satisfactory applicants. I would like once again to thank the Dental Staff for their hard work in 1969 with special mention of the increased number of school inspections. MATERNITY AND CHILD WELFARE DETITAL SERVICES Treatment was available at all Dental Clinics in the Borough for expectant and nursing mothers and children under five years old. The figures for treatment for under fives is very satisfactory despite the fact that our staff of Dental Auxiliaries was rather reduced during the year. GENERAL COMMENTS The year 1969 was a very successful year from a dental point of view. I gratefully appreciate the co-operation from Head Teachers and teachers in schools where dental inspections were carried out. 72 DENTAL SERVICE STATISTICS Sessions (½days) worked 1. Sessions devoted to inspection l6l 2. Sessions devoted to dental health education 6l 3. Sessions devoted to treatment 2,061 4. Sessions devoted to treatment of mothers and young children 160 2,443 School Dental Inspection 5. Number of pupils first inspected at school 20,085 Number of pupils first inspected at clinic 1,867 Number of pupils found to require treatment 12,958 Number of pupils offered treatment 12,958 Number of pupils re-inspected at school or clinic 212 Number of pupils found to require treatment 165 Treatment 6. Number of pupils actually treated 4,996 7. Number of attendances made 12,507 8. Number of fillings in permanent teeth 6,614 9. Number of fillings in deciduous teeth 3,710 10. Permanent teeth extracted 751 11. Deciduous teeth extracted 2,852 12. General anaesthetics given 1,497 13. Number of pupils x-rayed 185 14. Number of pupils supplied with dentures 18 Orthodontics 15. New cases commenced 52 16. Cases remaining from previous year 145 17. Cases completed 51 18. Cases discontinued 5 19. Number of appliances fitted 71 20. Pupils referred to hospitals consultant 5 MATERNITY AND CHILD WELFARE DENTAL TREATMENT Expectant and Nursing Mothers Children under 5 years Numbers of Cases 1. Number of persons examined 32 417 2. Number of persons treated 38 4l6 Treatment Provided 3. Scalings and other prophylaxis 9 83 4. Fillings 36 463 5. Teeth otherwise conserved - 108 6. Crowns and inlays - - 7. Extractions 32 275 8. General anaesthetics 9 113 9. Dentures provided 5 - 10. Patients X-rayed 4 4 73 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF TOE DISTRICT (a) Nature and number of visits:- Rent Act 92 Housing and Public Health Acts:- Dwelling Houses 4,896 Other premises 1,561 Overcrowding and housing applications 39 Improvement grants 598 Improvement areas 48 Multiple Occupation 177 Bakehouses 42 Milkshops and Dairies 61 Foodshops, markets, stalls and delivery vehicles 2,462 Food Factories 28 Cafes and canteens 546 School kitchens and feeding centres 182 Infections diseases enquiries 2,463 Foster mothers' premises 167 Number of complaints investigated 2,500 Noise Nuisance 224 Clean Air Act:- Survey - Other inspections 70 Factories 479 Offices, shops and Railway Premises Act 1,706 Rag Flock and Other Filling Materials Act 4 Tents, vans and sheds 54 Pet shops 24 Hairdressers 93 Ice Cream premises and vehicles 209 House disinfested 59 Rodent control 1,014 Other visits 1,599 (b) Notices served:- Complied with: Statutory 76 91 Informal 1,282 1,088 WATER The water supply still continues to be satisfactory both in quality and quantity. During the year 14 bacteriological and 11 chemical 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 a piped supply inside all houses. During the year the total length of new mains laid was 2,812 yards and 768 new supplies were connected. 74 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 the water going into supply. A total exceeding 10,000 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. Analyses have also been made of samples obtained from consumers' taps in the various parts of the Company's district, including that of your Council, and all proved to be satisfactory. SEWAGE AND SEWERAGE DISPOSAL I am indebted to the Borough Engineer and Surveyor who has supplied the following information:- "The drainage systems of the Borough function adequately, although infiltration at times of high intensity storms causes difficulties in isolated instances. Improvements to the Dagenham trunk foul systems are at present under construction and progressive improvement can be expected as the work proceeds with eventual solution upon completion of the contract in April, 1971- Allied with the recent completion of the Riverside Sewage Works the foul drainage system for the Eastern sector of the Borough will cater for present flows and will contain some spare capacity for future requirements. Drainage improvements in the Western sector of the Borough are concentrated in the Barking Central Area. Work is at present at the design stage with implementation scheduled in 1972, giving relief to both surface water and soil systems and incorporating a pumping station and new outfall into the River Roding." SWIMMING BATHS There are three open air and one indoor public swimming pools in the Borough. In addition there is a pool at the Regional College of Technology and four of the schools are provided with small pools. All swimming pools take their water from the mains of the South Essex Waterworks Company. Regular samples have been taken during the year and all results were satisfactory with the exception of two where the chlorine content was higher than considered necessary. Advice was given in these cases and no further trouble was experienced. HOUSING Slum Clearance During the year three Clearance Areas were the subject of Official Representation to the Council. The total number of houses included as unfit dwellings in the three areas was 253. Included in this figure are 219 dwellings in the Gascoigne Ward which comprise the final stage of the Council's scheme for the redevelopment of an area containing over 2,000 houses. 75 In addition to the above, 3 individual dwelling houses were represented to the Council as unfit for human habitation. Undertakings not to relet premises upon the tenants being rehoused were received in two of these cases. Two Compulsory Purchase Orders comprising unfit houses were confirmed by the Minister without modification, no objections to the Orders having been received. On the 5th May 1969 a Public Enquiry was held to determine one outstanding objection to the Gascoigne Road (No. 7) Compulsory Purchase Order which included 6l unfit dwellings. The Order was subsequently confirmed by the Minister without modification. Rent Act, 1957 10 Applications were received from tenants during the year. In no case did the Council refuse to issue a Certificate of Disrepair. Undertakings to do the work were given by landlords in respect of seven properties. Two Certificates of Disrepair were issued and one objection was received from a tenant to the Cancellation of the Certificate of Disrepair. As in past years, advice was given to tenants and they were able to obtain the necessary forms at the Civic Centre. Housing Act, 1969 Between the end of August and 31st December applications for Qualification Certificates under the provisions of this Act numbered 93» Upon receipt of an application a detailed inspection of the dwelling is carried out by the public health inspector when all defects, having regard to the 'Age, Character and Locality' of the dwelling, are noted, together with lacking amenities. In the 93 cases investigated only three houses were found to qualify which is a disappointingly low number reflecting the lack of regular maintenance throughout the years. Improvement and Conversion Grants During August the eagerly awaited Housing Act, 1969 came into operation. This Act made important changes in the law relating to Improvement Grants. The greatest impact stemmed from the vastly increased grants maxima, together with the important extension of grant aid to cover, in many cases, repair. The emphasis in the new grant system was greater flexibility and discretion aimed at encouraging more people to improve their houses. Persuasion was paramount and, especially in Improvement Areas, generosity when assessing an applicant's proposals could encourage other owners to follow the lead of the first few. Before the Act came into operation suitable areas were defined and a comprehensive Improvement Programme was submitted to and adopted by the Council. This programme included both privately owned and municipal estates and detailed surveys of properties in two pilot schemes, one private and one corporation, were commenced. 76 Many owners became aware of the proposed increases and extensions to improvement grants and tended to delay making their applications in order to benefit from the new provisions. As a result, the number of grants dealt with during the year shows a reduction. However, enquiries concerning the new provisions showed an increasing enthusiasm among owners and provided the basis for confidence that a comprehensive programme of Improvement Areas could succeed. Systematic Area Improvement, together with a determined effort to root out all unfit properties could result, in but a few years, in the disappearance of the obsolescent dwelling lacking the amenities which were considered luxuries in time gone by, but have now become recognised as essential to a comfortable and healthy life. The Public Health Inspector has a vital role to play in this bold attempt to solve a difficult and long-standing problem. With his intimate knowledge of housing conditions he can, with little difficulty, identify suitable areas. In the detailed inspection work which must precede the declaration of an Improvement Area he is able to make the often, critical judgement of properties which merit either improvement or demolition. Drawing on his experience of close relations with the public he is able to discuss the merits of improvement and emphasise the benefits to be derived from improved living standards, a more pleasant neighbourhood, the security of at least thirty years life for the houses and the increased values of individual dwellings. Houses in Multiple Occupation 177 visits were paid to these properties during the year. No marked difficulty has arisen during the year and multiple occupation has shown no rapid increase. This may be attributed to the lack of houses of sufficient size in the Borough. All known houses were visited during the year and, where necessary, works have been carried out under supervision to bring them up to standard. In many cases the language barrier has proved the most difficult aspect and it seems, even with a drive in education, this problem will remain for some considerable time. There are no Common Lodging Houses in the Borough. Tents, Vans and Sheds 54 visits have been made by my staff, and although there continues to be a decrease the problem is still one which needs constant surveillance. Occupiers of houses are quick to complain should van dwellers encamp on land close to their homes. It has been found that complaints are fully justified in that a vacant site quickly deteriorates into a filthy, refusestrewn quagmire when occupied by such persons. Action under the nuisance sections of the Public Health Act, 1936 is difficult to envoke as one can never identify the person by whose act or default the nuisance has arisen. 77 LAUNDRY SERVICE The service continues with a once weekly collection. The department's drivers and the laundry staff at the Chadwell Heath Hospital are very co-operative and they ensure that the service is operating in a satisfactory manner. An average of 35 cases used the service at any any one time, which shows a slight decrease on last year's figure of 40. During the year 224 visits were paid to premises as a result of complaints of noise. This indicates a slight rise on last year thus continuing the trend towards "noise consciousness" by residents. Complaints were varied in nature and included noise from building sites, machinery in a bakery, wood cutting apparatus and from machinery used in the supply and purification of water in a swimming pool. The work is time consuming and night visits are often required as sounds which are lost in the general background levels in day time become prominent during the hours of darkness when these levels reduce. In all cases the owners of plants showed a willingness to co-operate and carry out works to minimise the cause of complaint. It is the policy of the department to deal with all complaints of noise in a formal manner. Informal action can result in a reduction of the nuisance to a level where legal action might fail, while the complainant is still affected and dissatisfied with the action taken. Once again I regret to report that no progress was made in respect of smoke control areas. The Council still felt that the extension of smoke control areas in the Borough must be deferred due to the continued financial crisis. NOISE ABATEMENT ACT, i960 ATMOSPHERIC POLLUTION The present position is as follows:- Dagenham Order No. No. of Houses Date of Operation 1 1,000 (Marks Gate) 1st September, 1959 2 3,722 (G.L.C. Estate) 1st November, 1961 3 3,230 ( „ „) 1st November, 1962 4 4,562 ( „ „ ) 1st November, 1963 5 1,542 (Chadwell Heath) 1st August, 1964 6 3,046 (G.L.C. Estate) 1st November, 1964 7 2,690 ( „ „ ) 1st July, 1966 78 Barking Order No. No. of Houses Date of Operation 1 4,558 (1,756 G.L.C.) 1st January, 1962 2 1,864 (G.L.C. Estate) 1st November, 1962 3 2,365 1st November, 1962 4 1,728 (G.L.C. Estate) 1st November, 1963 5 2,949 (Private) 1st November, 1963 6 1,421 (G.L.C. Estate) 1st November, 1964 7 1,569 1st November, 1964 8 2,446 1st November, 1964 9 589 1st July, 1966 10 1,337 (G.L.C. Estate) 1st July, 1966 11 1,976 1st November, 1966 In all 42,594 premises out of a total of 55,013 premises in the Borough are now within smoke control areas. Industry has continued to play its part in the general improvement and this is demonstrated in that 106 smoke observations were carried out during the year resulting in only two contraventions. One contravention was due to an alarm system which had broken down; this was replaced and conditions were subsequently satisfactory. The second contravention involved car seats and rubber being burned; legal proceedings were taken and a fine imposed. The Council continue to take part in the National Survey on Air Pollution and take readings at the eight stations in the Borough. The readings are transferred to the Ministry for their use. During the summer a complaint was received regarding an emission of offensive fumes from a premises manufacturing fertiliser. Investigation found the Fire Brigade and Police in attendance and the situation well in hand. The incident, which provoked comment in local newspapers, has not been satisfactorily explained, but appears to have been the result of spontaneous heat generation in a large heap of newly prepared fertiliser. Exhaustive investigations by the firm were carried out and modifications to handling routines recommended. No further incident has been reported. There is one premises in the Borough registered under Section 2 of the Act. Regular samples were taken from the premises where fillings are made and used and details are as follows:- Material No. of Samples Submitted for Analysis Cotton Felt 1 Kapok 2 Woollen Mixture Felt 1 OFFENSIVE FUMES RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 The Analyst reported all the samples to be satisfactory. 79 PET ANIMALS ACT. 1951 10 licences were issued during the year; as reported in the past the extent of the livestock in these premises is very small. Regular visits were paid to all premises to ensure no nuisances occurred or breaches of the licensing conditions. Premises generally are of a high standard and it was not necessary to take statutory action. PREVENTION OF DAMAGE BY PESTS ACT. 1949 During the year 609 notifications of infestations were received of which 328 concerned rats. The remaining 28l were in connection with mice. In addition to the above, routine inspections of the district found 54 rat infestations and two of mice. All cases were treated by the two Rodent Operatives with satisfactory results. RIDING ESTABLISHMENTS ACT. 1964 The two riding establishments continued to operate and the staff of the Corporation of London who administer the Act on our behalf were satisfied with the manner in which they are run. No complaints from residents were received during the year. FACTORIES ACT. 1961 Inspections Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 67 49 5 - Factories with mechanical power 472 430 40 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 10 43 - - Total 549 522 45 - 80 Defects Found Number of defects Number of Prosecutions Instituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness 16 10 - - - Overcrowding 1 - - - - Unreasonable temperature 3 1 - - - Inadequate ventilation 7 3 - - - Ineffective drainage of floors 5 1 - - - Sanitary conveniences: Insufficient 3 3 - - - Unsuitable or defective 116 95 - - - Not separate for sexes - - - - - Other offences 13 6 - - - Total 164 119 - - - Outwork Number of outworkers in August list 392 Nature of work - Making, etc. wearing apparel and Christmas novel ties, and boxes. 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 24 246 37 Retail shops 22 911 168 Wholesale shops, warehouses 10 48 36 Catering establishments open to the public, canteens 5 97 44 Fuel storage depots - 4 1 81 Class of workplace Number of persons employed Offices 3,054 Retail shops 4,613 Wholesale departments, warehouses 511 Catering establishments open to the public, canteens 901 Fuel storage depots 16 Total 9,095 Total Males 4,317 Total Females 4,778 During this period 49 notifications of minor accidents were received in respect of employees in registered premises. All offices and shops in this Borough have now received at least one general inspection. Co-operation has been readily secured in the compliance with the Act and, in general, the quality of working conditions within these premises has been raised considerably. DISEASES OF ANIMALS ACT. 1950 The Corporation of London Officials continue to deal with routine prevention and during the year there were no contraventions of the Act. INSPECTION AND SUPERVISION OF FOOD The number and types of food premises in the Borough are as follows 3 Bakehouses 48 Bakers 146 Confectioners 85 Butchers 224 Cafes and Canteens 47 Fishmongers 103 Fruiterers and Greengrocers 109 Grocers 66 Licensed and Off-licensed Premises 22 Multiple Stores 14 Public Houses with Restaurants These premises were subject to frequent inspection during the year when 2,823 visits were made. In addition to verbal warnings and suggestions to managements and staff during the routine visits, l8l informal notices were served upon the owners and occupiers. 328 inspections were carried out in connection with markets, stalls and delivery vehicles, and 12 informal notices were served. 82 The position under the Food and Drugs Act, 1955, apart from registrations in respect of ice cream, is as follows:- 46 butchers' premises and 25 other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 385 visits were paid. 31 fish shops are registered for frying and were subject of 240 visits. Milk All milk which is distributed in the area is produced and bottled outside the Borough. The number of registered distributors is 8l operating from 110 premises. 136 visits were paid to dairies and distributors' premises. Ice Cream The total number of registered premises selling ice cream is 194. Of these one is registered for the manufacture of ice cream. 163 visits were paid to these premises. During the year 12 applications for the storage and sale of ice cream were granted. 46 inspections in connection with itinerant vendors were carried out. During the year 94 samples of ice cream were submitted for bacteriological examination; they were graded as follows:- Type Grade I Grade II Grade III Grade IV Total Wrapped Ice Cream 33 10 2 -- 45 Loose Ice Cream 32 13 - 3 48 Soft Ice Cream 1 - - - 1 In addition to ice cream, 17 lollies and one water ice were submitted for examination. All were satisfactory. Unsound Food During the year the Committee considered 55 complaints concerning unsound food bought by residents and the following action was taken:- 39 cases - Prosecutions taken 2 Dismissed 2 " Absolute Discharge - Costs obtained 8 Warning letters sent 4 " - No action possible. Registration of Food Hawkers Under the provisions of the Essex County Council Act, 1952 Section 103, eight persons were registered as food hawkers during the year. The vehicles used in connection with the businesses were inspected and action taken in appropriate cases. 83 Food and Drugs Act, 1955 - Sampling Article Number Examined Number Adulterated Formal Informal Formal Informal Biscuits - 1 - - Bread - 11 - 9 Butter - 1 - 1 Cake Mixtures - 1 - - Cakes and Pastries - 5 - 2 Coconut - 1 - - Colouring - 1 - - Condiments - 6 - - Cordials - 4 - - Cream - 5 - 1 Cream-Synthetic - 2 - - Custard Powder - 2 - - Essences - 2 - - Fat - 1 - - Fish- Tinned - 6 - - Flavourings - 2 - - Flour - 1 - - Fruit - Dried - 1 - 1 Fruit - Juices - 1 - - Fruit - Tinned - 6 - - Ginger - 2 - - Grill - 1 - - Jelly - 4 - - Meat - Minced 1 1 1 1 Meat - Pies, Pasties - 3 - 1 Meat Roll - Stuffed - 1 - - Meat - Tinned - 5 - 1 Milk 1 6 - 4 Milk - Tinned - 3 - - Mushrooms - 1 - - Pastes - 8 - - Peel - 3 - - Pickles - 4 - 1 Potato - Mashed - 1 - - Preserves - 13 - - Puddings - 2 - - Puree - 1 - - Ravioli - 2 - - Rice -Creamed - 1 - 1 Rice - Ground - 1 - - Sandwich - 1 - - Sauces - 3 - - Sausages 7 5 1 1 Shandy - 1 - - Soup - 1 - - Spaghetti in Tomato Sauce - 2 - - Spices - 5 - - Suet - 2 - - Sweets - 21 - - Tea - 3 - - Treacle - 1 - - Vegetables - 11 - 1 Wines and Spirits 1 - - - 84 Sample No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 403A Bread Informal Contained a quantity of embedded paper or thin cardboard with blue printing and coloured illustration. Legal Proceedings. Fined £50 and £10 costs. 404A Milk from Churn Informal Contained fragments of iron rust and tiny particles of glass. Legal Proceedings Fined £15 and 10 gns. Costs. 427A Minced Beef and Onion with Gravy Informal Meat 42 per cent. Meat content low for article described as Minced Beef and Onion with Gravy. Formal sample taken See No.136 449A Milk Informal 32 per cent. deficient in fat. Formal sample taken this was satisfactory 132 Pork Sausages Formal Meat 65 per cent. Sulphur Dioxide 100 parts per million. No declaration of preservation. Legal Proceedings. Fined £5 and 5 gns costs. 471A Cream Horn Informal Contained a small piece of paper. Legal Proceedings Absolute Discharge 5 gns. Costs. 472A Cornish Pasty Informal In a mouldy condition Legal Proceedings. Fined £50 and £10 costs. 473A Milk Informal Streaks of earthy matter adhering to inside of bottle. Referred to Borough of Newham. No further action. 474A Loaf of Bread Informal Contaminated with specks of dirt. Legal Proceedings Fined £35 and 5gns. Costs. 136 Minced Beef and Onion. Formal Meat 45 per cent. Meat content low for article described as Minced Beef and Onion with Gravy. Warning letter to manufacturers. 85 Sample No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 514A Currants Informal Contained a pin No action. 515A Sliced Wrapped Loaf Informal Contained three glass fragments. Legal Proceedings. Pleaded Not Guilty Case dismissed. 516A Butter Informal Contained a piece of cotton and traces of atmospheric dust or dirt. Warning letter. 517A Sausages Informal Had small aggregates of dried blood on surface No further action. 518A Fresh Cream and Jam Sponge Informal Contained a house fly. Legal Proceedings. Fined £15. and £10 costs. 519A Bread Informal Contained a foreign body in the form of a piece of rubber. Legal Proceedings. Fined £30. and £10. costs. 520A Uncut White Loaf Informal Contained a nail. Legal Proceedings Fined £75 and £10 costs. 522A Small Loaf 'Seedy' Informal Contained a piece of cotton wool. Legal Proceedings Fined £75 and £10 costs. 539A Loaf of Bread Informal Contained discoloured dough contaminated with iron. Legal Proceedings Fined £30 and 10 gns. costs. 540A Chopped Pork and Ham. Informal Contaminated with fragment of iron rust Legal Proceedings Fined £20 and £10 costs. 541A Creamed Rice Informal Consisted of a glass splinter weighing 21.5mg. Legal Proceedings Manufacturers pleaded guilty. Given absolute discharge £10 costs. 86 Sample No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 542A Sterilised Milk Informal Contained mould growth Legal Proceedings. Fined £100 and lO gns. costs. Dairy appealed fine reduced to £50 560A Uncut White Loaf Informal Contained small fragments of discoloured dough. Warning letter. 561A Cream Informal Iron 24 parts per million. Iron content excessive for a cream. Warning Letter. 563A Mixed Vegetables Informal Contained approximately 16 milligrams of aluminium turnings. Legal proceedings. Fined £10 and £5 costs 564A Sliced Loaf of Bread Informal Contained discoloured dough contaminated with iron. No action. 582A Pickled Red Cabbage Informal Contained an incomplete beetle Warning letter. 87 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 Measles 11 43 33 18 29 68 - 5 - 207 Whooping Cough - 2 3 - - 6 1 - - 12 Dysentery 3 4 - - 3 10 6 5 16 47 Scarlet Fever - 2 1 6 10 36 4 2 - 61 Diphtheria - - - - - - - - - - Acute Meningitis - 1 - - - - - - - 1 Acute Poliomyelitis:- Paralytic - - - - - - - - - - Non-paralytic - - - - - - - - - - Under 5 yrs. 5 - l4 15 - 44 45 - 64 65 and over Total Acute Encephalitis:Infective - - - - - - Post Infectious - - - - - - Leptospirosis - - - - - - Paratyphoid Fever - - -- - -- - Typhoid Fever - - - - - - Food Poisoning 1 2 4 - - 7 Tetanus - - - - - - Infective Jaundice 11 119 69 7 2 208 Smallpox - - - - - - Ophthalmia Neonatorum - - - - - Malaria - - - - - - Yellow Fever - - - - - - 88  Notified Admitted to Rush Green Hospital Admitted to other isolation Hospitals Admitted to Other Hospitals Acute Encephalitis:- Infective - - - - Post Infectious - - - - Paratyphoid Fever - - - - Typhoid Fever 1 1 - - Food Poisoning 24 9 1 1 Infective Jaundice 191 5 9 4 Smallpox - - - - Ophthalmia Neonatorum 4 - - - Malaria - - - - Yellow Fever - - - - Measles 207 8 - - Whooping Cough 12 2 - - Dysentery 44 2 2 8 Scarlet Fever 61 - - - Diphtheria - - - - Acute Meningitis 1 1 - - Acute Poliomyelitis:- Paralytic - - - - Non-paralytic — — — - Food Poisoning The following is a copy of the annual return submitted to the Department of Health and Social Security:- 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 Mo. of cases notified or ascertained Notified or ascertained S. typhimurium - - - - 5 Other salmonellae - - - - - Cl. welchii - 16 - - - Staph. aureus - - - - - Other causes - - - - - Cause unknown - - - - - Total - 16 - - 5 General Information on Food Poisoning The 16 cases of Cl. Welchii type A were identified in a portion of cooked steak from a canteen meal. 89 Typhoid Fever On the 8th August, 1969 a Hornchurch man who had been working in an Hotel in Tangier returned to Barking with his mother, father, sister and younger brother who had been to the hotel on holiday. He had a temperature and had been ill since the 10th July, 1969. On the 9th August he reported to his Local General Practitioner who found his condition satisfactory. On the 10th August this man returned to his own flat in Hornchurch which he shared with two friends. On the 17th August his mother found him ill when she paid a visit to the flat, and she persuaded him to return to the family's home. On the l8th August his General Practitioner, finding no obvious symptoms, decided to send him for tests at a local hospital. On the 24th August the hospital tests proved positive - Salmonella Typhi, and the General Practitioner ordered immediate hospital isolation. The emergency system brought the assistant Medical Officer of Health and the Deputy Chief Public Inspector to the hospital within an hour and all persons at risk were investigated. Tracing of contacts was an enormous job involving hundreds of holidaymakers who visited the hotel in Tangier, the passengers on the homecoming journey, in addition to family, friends, home contacts and neighbours, one of whom worked in an ice cream factory. No secondary case was notified which may be due to luck and the patient's high standard of personal hygiene. While all aspects of a thorough investigation were quickly put in hand, it is alarming to record that several frustrating delays were encountered in the tracing of contacts. The names and addresses of persons staying at the hotel in Tangier during the risk period were not readily available although they comprised organised tours run by a large British Company. This Company could only supply the names of the holidaymakers and the Travel Agents who had booked the holiday. As a result, the department had to contact more than one hundred Travel Agents all over the country by letter and telephone to obtain the home addresses of these clients. To add to this difficulty it was found that some Travel Agents were very reluctant to disclose the necessary information even when the urgency of the situation was explained. Delay was again experienced when the air-line whose aircraft ferried the patient to Heathrow was asked for details of the other passengers on the flight. No list was available in this country and a time-consuming telex was made to Morocco to obtain the information. This is most unsatisfactory and could have resulted in a very serious and widespread outbreak. Since more and more people are now taking holidays abroad the time has come for a thorough re-appraisal of the situation. Information concerning holidaymakers who have had contact with a confirmed case of infectious disease abroad should be readily available to Health Authorities where speedy action is vital. 90