I BARK 64 LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1970 J. ADRIAN GILLET, M B., Ch.B., D.P.H., F.F.C.M., F.R.S.H. Aldis House, 56A, Longbridge Road, Barking, Essex. Telephone: 01-594 5718 LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1970 J. ADRIAN GILLET, M.B., Ch.B., D.P.H., F.F.C.M., F.R.S.H. Aldis House, 56A, Longbridge Road, Barking, Essex. Telephone: 01-594 5718 Page Adult Training Centre 66 Ante-natal Clinics 27 Atmospheric Pollution 87 Bentry School 76 Care of Mothers and Young Children 27 Causes of Deaths 18 Causes of Infant Deaths 17 Chief Nursing Officer's Report 40 Child Guidance 72 Child Health Centres 28 Children's Department 44 Chiropody 59 Congenital Abnormalities, Incidence of 78 Convalescence 52 Co-ordination of Services 26 Council, Members of 3 Cytology Service 44 Daily Guardian Scheme 32 Day Nurseries 29 Dental Services 79 Diseases of Animals Act 1950 90 District Nurse Section 40 Education Committee 4 Education (Special Services) Sub-Committee 5 Factories Act 1961 91 Faircross School 74 Family Planning Service 49 Food and Drugs, Sampling 97 Food Hawkers, Registration 95 Food, Inspection and Supervision 94 Food, Imported 95 Food Poisoning 103 Food, Unsound 95 Geriatric Clinic 50 Geriatric Liaison Officer 50 Handicapped Children 77 Hairdressers and Barbers 88 Health Committee 4 Health Education 23 Health Visiting 41 Holiday Play Centre 61 Home Help Service 53 Home Nursing Service Statistics 42 Housing 83 Houses in Multiple Occupation 86 Ice Cream 94 Immunisation 47 Improvement Grants 83 Infant Mortality 16 Infectious Diseases 102 Junior Training Centre, Castle School 60 Page Kidney Machines 54 Kingsley Hall Assessment Centre 32 Laundry Service 86 Local Authority Social Services Act 1970 26 Louise Graham House 62 Mass X-Ray Service 57 Medical Examination of Staff 52 Mental Health 60 Midwifery Service (domiciliary) 40 Milk 94 National Assistance Act 1948 51 Noise Abatement Act 1960 87 Officers of the Health Service 6 Offices, Shops and Railway Premises Act 1963 92 Orthopaedic Clinic 70 Osborne Workshop 61 Pet Animals Act 1951 89 Play Therapy 31 Porters Avenue Day Centre 62 Prevention of Damage by Pests Act 1949 89 Protection of Birds Act 1954 89 Qualifications 13 Rag Flock and Other Filling Materials Act 1951 89 Registration of Nurseries and Child Minders 31 Rehousing on Medical Grounds 54 Rent Act 1957 87 Residential Accommodation 66 Riding Establishments Act 1939 90 Sanitary Inspection of District 81 School Consultative Clinics 67 School Health 67 School Medical Inspections 67 Sewerage and Sewage Disposal 82 Sickroom Equipment 52 Slum Clearance 83 Speech Therapy 71 Swimming Baths 82 Tents, Vans and Sheds 87 Tuberculosis 55 Unmarried Mother, Care of 28 Vaccination 46 Venereal Disease 55 Vital Statistics 16 Vital Statistics, Summary of 22 Voluntary Associations 64 Water 81 Westfield Psychiatric Social Club 64 2 MEMBERS OF THE COUNCIL (as at 31st December, 1970) MAYOR Councillor Mrs. D. M. JONES DEPUTY MAYOR Councillor A. C. V. RUSHA 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. THOMAS 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 LINEHAN 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, J.P. Mrs. M. S. PRESTON L. A. COLLINS L. G. RIMINGTON R. E. COSTER M. J. SPENCER J. T. DEAN, J.P. F. C. SPRAGGINS D. A. L. G. DODD, J.P. J. S. THOMAS, J.P. A. E. EAST F. G. TIBBLE E. G. J. EDQJ H. TINDELL Mrs. J. H.ENGWELL B. P. WALKER Miss J. FACKERELL, J.P. S. J. WARR Mrs. C. S. M. GODFREY, J.P. Mrs. M. A. WARREN D. 0. GRANDISON D. J. WATERS R. F. HAWKEN D. W. WEBB E. E. HENNEM J. G. F. WILLMOTT H. J. HOWIE T. A. WOODCOCK C. W. JILLINGS E. J. WOODS F. C. JONES 3 HEALTH COMMITTEE (as at 31st December 1970) CHAIRMAN Councillor Mrs. M. Ball VICE-CHAIRMAN The Mayor MEMBERS The Deputy Mayor Councillor Mrs. E. J. Kitchen Alderman A. E. Ball Councillor Mrs. P. D. Miller Alderman D. O'Dwyer Councillor Mrs. V. H. Pool Alderman Mrs. A. R. Thomas Councillor F. C. Spraggins Councillor D. W. Barnett Councillor F. G. Tibbie Councillor R. E. Coster Councillor H. Tindell Councillor Mrs. J. Engwell Councillor S. J. Warr Councillor Mrs. C. S. M. Godfrey Councillor J. G. F. Willmott CO-OPTED MEMBERS Mrs. D. L. Belchamber Dr. A. F. MacDonald Mrs. M. Bredo Mrs. A. E. Prendergaat Mr. K. H. Rose EDUCATION COMMITTEE (as at 31st December 1970 CHAIRMAN Councillor G. J. G. Beane VICE-CHAIRMAN The Deputy Mayor REPRESENTATIVE MEMBERS The Mayor Councillor Mrs. Julia Engwell Alderman A. E. Ball Councillor Mrs. C. S. M. Godfrey Alderman W. E. Bellamy Councillor D. 0. Grandison Alderman Mrs. A. Martin Councillor R. F. Hawken Alderman D. 0. Dwyer Councillor C. W. Jillings Alderman J. R. Sweetland Councillor F. C. Jones Councillor D. W. Attridge Councillor Daniel Linehan Councillor Mrs. M. Ball Councillor Mrs. M. S. Preston Councillor L. T. Blake Councillor H. Tindell Councillor J. A. Butler Councillor D. J. Waters Councillor S. G. Cole Councillor D. W. Webb Councillor R. E. Coster Councillor J. G. F. Willmott Councillor D. A. L. G. Dodd Councillor T. A. Woodcock Councillor E. J. Woods CO-OPTED AND NOMINATED MEMBERS Mr. C. J. Fairbrass Mr. D. F. Reed Mr. P. Grimes Mr. A. Richards Miss M. C. Grobel, M.A. The Rev. J. W. Roxburgh Mr. W. E. Joughin Mrs. F, Rusha Mr. F. H. King Mr. S. J. Russell. 4 EDUCATION (SPECIAL SERVICES) SUB-COMMITTEE (as at 31st December 1970) (This Sub-Committee deals inter alia, with the School Health Service) CHAIRMAN Councillor G. J. G. Beane MEMBERS The Mayor Councillor Mrs. M. S. Preston The Deputy Mayor Councillor H. Tindell Alderman Mrs. A. Martin Councillor D. J. Waters Councillor Mrs. L. Blake Councillor J. G. F. Willmott Councillor R. E. Coster Councillor E. J. Woods Councillor Mrs. J. H. Engwell Mr. W. E. Joughin Councillor Mrs. C. S. M. Godfrey Mrs. F. Rusha 5 OFFICERS OF THE HEALTH SERVICE (as at 31st December, 1970) 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 MEDICAL OFFICERS IN DEPARTMENT E. KLEIN, M.D. (Naples), M.D. (Budapest) L.R.C.P. 81 S. M. WEIZMANN, M.R.C.S., L.R.C.P. MEDICAL OFFICERS IN DEPARTMENT D. BURGESS, M.D. (Malta). B.Pharra. K. FITZPATRICK, M.B., Ch.B. G. MICHAEL, M.R.C.S., L.R.C.P., B.A. (Cantab) V. PAIN, M.B., B.S., L.R.C.P., M.R.C.S., D.C.H. 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 AUXILIARIES Mrs. L. Killingley (24) Miss E. Montgomery (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). DIVISIONAL PUBLIC HEALTH INSPECTORS Mr. J. ALLAM, (l), (2), (4). Mr. S. A. LEMMON, (l), (2), (4). Mr. J. POWELL, (l), (2), (4). PUBLIC HEALTH INSPECTORS Mr. N. BURTON, (l), (2). Mr. T. W. GLEW, (l), (2). Mr. J. COOK, (1), (2), (3). Mr. C. NASH, (4l) Mr. E. DAY, (l), (2), (4). Mr. B. ORME, (41) Mr. F. SILVERTHORNE, (1), (2). STUDENT PUBLIC HEALTH INSPECTORS Mr. R. KING Mr. D. WOODS SUPERINTENDENT OF HOME NURSES Miss M. DOBSON, (5), (6), (21). ASSISTANT SUPERINTENDENT OF HOME NURSES Vacant DISTRICT NURSES Mrs. J. E. BIGGART, (5). Miss D. MEEK, (5), (6), (21). Mrs. S. L. BRADLEY, (5), (6), (21), (32). Miss K. M. MOLLERUP-PETERSON, (5), (21). Mrs. J. M. COTTERILL, (5). Mrs. Y. V. NICHOLLS, (3), (6), (21). Mrs. Y. A. DIGNUM, (5), (21). Miss N. NORRIS, (5), (6), (21). Mrs. A. HAYDEN, (5), (21). Mrs. M. 01RIORDAN, (5), (8), (21). Miss J. R. HEATH, (5). Mrs. M. PRONT, (5). Mrs. V. E. HENNESSEY, (3), (21). Miss R. RICHARDS, (5), (6), (21). Mrs. A. L. HILLAS, (5), (21). Mrs. A. M. ROBINS, (5) Mr. C. 0. E. KING, (5), (10). Miss J. M. SMITH, (5), (6), (21). Mrs. D. J. KITCHEN, (5) (6), (21). Mrs. E. A. STIMSON. (9). Mr. R. D. LINTOTT, (5), (16), (21). Mr. R. ^J. TURPIN, (5), (21). Mrs. S. W. MCQUILLAN, (9), (21). Mrs. M. E. M. WHATHAM, (3), (8), (12). DISTRICT NURSES (part-time) Mrs. E. COLGATE, (9). Mrs. N. FLYNN, (5), (8), (21). 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). 7 MIDWIVES Mra. S.M. AITKEN, (5), (6). Miss J.M. HALL, (5). (6). Mrs. N.M. ADAMS, (5), (6). Miss D. HEARSEY, (5), (6). Mrs. I.M. BRONNICK, (5), (6). Mrs. M.E. HEW, (5), (6), (2l). Mrs. H.V. GOOBY, (5), (6). Miss P.R. SHACKLETON, (5), (6), (9). Mrs. A. GREEN, (5), (6), (21). Miss M. WALKER, (5), (6). Mrs. C.B. WATSON, (5), (6). Part-time Midwife Mrs. M.E.R. Wainwright, (5), (6). CHIEF NURSING OFFICER/ SUPERINTENDENT HEALTH VISITOR Miss C. OLDHAM, (5), (6), (7), (45), (46). DEPUTY SUPERINTENDENT HEALTH VISITOR Mrs. C.C. LEDDEN, (5), (6), (7), (2l). SENIOR HEALTH VISITOR Mrs. B. RAMSEY, (5), (6), (7), (20). HEALTH VISITORS Miss J.D. BALDWIN, (5), (6), (7), (21). Miss T. 0'KELLY, (5), (7), (8), (21). Miss A.E. BOORMAN, (5), (6), (7), (21). Miss 0. OLOGUNRO, (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), (14). Miss E.G. LIVINGSTON. (5). (6). (7). Mrs. E.T. TAYLOR, (5), (6), (7). Mrs. M.M. MILLER, (5), (7), (8). Miss A.E. TREACY. (5). (6), (7). Mrs. J. O'BRIEN, (5), (7), Mrs. A. WARD, (5), (7), (31). Miss M.D. WINT, (5), (6), (7). HEALTH VISITOR (part-time) Mrs. M. NELSON, (5), (6), (7). SPONSORED STUDENT HEALTH VISITORS Mrs. B. RABIN, (5), (0). SCHOOL NURSES Mrs. J.I. HOGG, (5). Mrs. p.A. PICKEN, (5). Mrs. E.M. McCHEYNE, (5). Mrs. M.C. TWOMEY, (5). CLINIC NURSES Mrs. S.M.C. BARBER, (5). Mrs. M.A. FLEMING, (5). Mrs. C.V. DYNAN, (9). Mrs. M.P. RAMAGE, (9). 8 CLINIC NURSES (part-time) Mrs. D.R. BEART, (9). Mrs. E.M. HILL, (9). Mrs. I.B. BLAND, (5). Mrs. R.M. LEWIN, (5), (6). Mrs. S.J. BROWNE, (9). Mrs. A. LYONS, (9). Mrs. R.K.D. CLARK, (5), (8). Mrs. M.E. MONTGOMERY, (5). Mrs. I.M. COLLINGW00D, (5). Mrs. G. PRATT, (5). Mrs. B. CULLUM, (5). Mrs. A. RAVEN, (9). Mrs. M. HALLIGAN, (5), (6), (12). Mrs. R.J. SCAMMELL, (5), (2l). Mrs. P.A. WHITE, (5). GERIATRIC LIAISON OFFICER Mrs. J. HARROLD, (5), (12), (36). SPEECH THERAPISTS Miss C.J. DELAFORCE, (18) Miss E.N. SYMES, (18), (19). PHYSIOTHERAPIST Mrs. A. WALKER, (30). PHYSIOTHERAPISTS(Part-time) Mrs. A. LAWRENCE, (29). Mrs. J.M. WARWICK, (29). CHIEF CHIROPODIST Mr. H. LEAVESLEY, (ll). SENIOR CHIROPODISTS Mr. D. DITSELL, (ll). Mrs. M. GOSS, (ll). Mr. N. FREEMAN, (ll). Mrs. M.G. LEAGE, (ll). Mrs. D. MANN, (ll). Mr. H. STENSON, (ll). CHIROPODIST (Part-time) Mr. P. FREEL, (ll). TRAINING CENTRES AND DAY CENTRE CASTLE SCHOOL & TRAINING CENTRE, Supervisors Mrs. M.A. WASHER, (28), (33), (34). Goresbrook Road, Dagenham, Essex. ADULT TRAINING CENTRE, Managers Vacant Gascoigne Road, Barking, Essex. Deputy Manager: Mr. C.E. DODD OSBORNE WORKSHOP, Manager: Mr. C.W. HARE Osborne Square, Dagenham, Essex. Senior 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 9 HOSTEL FOR THE MENTALLY HANDICAPPED LOUISE GRAHAM HOUSE, Resident King Edwards Road, Warden: Mr. G. BARTRIP Barking, Essex. Resident Assistant Mrs. J. BARTRIP Warden: DAY NURSERIES, etc. Goresbrook Day Nursery, Matron: Mrs. H.M. SHEPHERD, (14)- Dagenham Avenue, Dagenham. Deputy: Mrs. I.M. REEVE, (14)• Annie Prendergast Day Matron: Mrs. P.A. ARDLEY, (14). Nursery, Ashton Gardens, Deputy: Mrs. G.E. ELLIS, (14). Chadwell Heath, Romford. Eastbury Day Nursery, Matron: Mrs. B.A. BELL, (5). Blake Avenue, Barking, Essex. Deputy: Mrs. J.M. HOWELL, (37). Kingsley Hall Day Centre Sister-infer Handicapped Children,Charge: Mrs. K.I. DALY, (5), (6), (20). Hobart Road, Dagenham, Essex. PRINCIPAL MENTAL WELFARE OFFICER Mrs. J.W.W. DIXON, (42). SENIOR MENTAL WELFARE OFFICERS Mr. D.G. BISHOP, (10), (26). Mr. G. WELSH, (10), (26). MENTAL WELFARE OFFICERS Miss M. GOMEZ, Mrs. M.V. HARRISON, (39). Mr. R.G. JONES, (10). Mr. R.G. JONES, (10) Mrs. O.B. POLLINGER, (30). Mr. M.J. WILLIMENT, (10). Mr. M.R. WYLDE, (lO). Mr. S.L. WU, (40). HEALTH EDUCATION OFFICER Miss D. MILBANK, (5), (6), (7), (20), (21), (25). ASSISTANT HEALTH EDUCATION OFFICER Mrs. P.M.I. KASIM, (43), (44). PROJECTIONIST/TECHNICIAN Mr. A. PHILLIPS 10 LAY ADMINISTRATIVE OFFICERS Mr. F.W. KNIGHT, (l), (2). Mr. G.H. RUFF SENIOR ADMINISTRATIVE ASSISTANTS Mr. F.H. MARTIN, (15). Mr. B.S. TYRRELL Mr. B.S. WEAVER SECTION HEADS Mrs. P.H. FLOODGATE, Vaccination and Immunisation. Miss G.K. HARRIS, Environmental. Mrs. H. JACKSON, Mental Health. Mrs. M.C. NEWMAN, Care and After Care. Mr. H.J. PITT, Staffing and Management. Mrs. J.B. SMITH, Finance, Supplies, etc. Mr. R.G. TRUCKEL, (47). Maternal and Child Health. MEDICAL OFFICER OF HEALTH'S SECRETARY Mrs. J.M. de BRUIN SECTION CLERICAL STAFF Vaccination and Immunisation Mrs. M. KING Mrs. M.R. BUSHELL Environmental Miss J. HAMILTON Miss N.M. TOMS Miss A.M. LYONS Mrs. J.W. MORGAN Rodent Operative/Driver Mr. H.J. DUFF Care and After-Care Mrs. J.E. BARNES Staffing and Management Mrs. M. BAKER Mrs. I.M.H. DUPREE Miss V.E. CHEAL Miss C.M. SACH Mrs. P. McMILLAN Mrs. I.E. SMITH Miss L. WHITE Finance, Supplies, etc. Mrs. G. ANGER Mr. D.E. WARD Mrs. C.E. SMYTH Maternal and Child Health Miss E.A. ADAMS Mrs. E.M. NOTTAGE Miss E.D. BROWN Mrs. S.B. ORME Miss N.E. CLOKE Mrs. I.A. PAGE Mrs. P.M. COLLINS Mrs. V.N.F. PATIENCE Mrs. K.M. CONROY Mrs. J.R. REDMAN Miss A.C. DAVIES Miss M.A. RHODES Mrs. D.M. ELLIS Miss K. RICHARDS Mrs. D.G. GREEN Mrs. G.K. SHANNON Miss C.A. LINCOLN Miss D. TILSON Mrs. E.J. NEPORT Miss M.A. WATTS Mrs. D. WILKINS 11 Part-time Mrs. K. BIRD Mrs. K.P. HEXTER Mrs. B.K. COPELAND Mrs. S. HOPSON Mrs. E. HARSENT Mrs. A. MCCARTHY HOME HELP SERVICE Senior Organiser Mrs. L. EVERITT Organisers Mrs. P. ARCHER Mrs. J.M. JOHNSON Mrs. G. SANGER Clerical Assistants Mrs. D. NEWMAN Mrs. B. NEWTON 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. (l8; Diploma of Licentiateship of College of Speech Therapists. (19) Diploma in Social Science. (20) Registered Sick Children's Nurse. (21) District Nursing Certificate. f22) Royal College of Nursing Certificate of Public Health Administration. (23) Certificate of Examining Board of Dental Surgery Assistants. (24) Certificate of Proficiency as Dental Auxiliary. (25) Diploma in contents and methods of Health Education. (26) Certificate in Social Work. (27) Member of Association of Occupational Therapists. (28; Diploma of National Association of Mental Health. (29) Member of Chartered Society of Physiotherapy. (30) Member Oslo Orthopaedic Institute of Physiotherapy. (31) Obstetric Nurse Training Course. (32) State Enrolled Assistant Nurse Certificate (Tropical Nursing), Malaysia. (33) Margaret Morris Movement Diploma. (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. (41) Diploma of Public Health Inspectors Education Board. (42) Social Work-Declaration of Experience. (43) University of Cambridge Teaching Certificate. (44) Ministry of Education Certificate in Physical Education. (45) Fellow of the Royal Society of Health. (46) Social Science Diploma (London). (47) Associate of the Chartered Institute of Secretaries. 13 To: THE MAYOR, ALDERMEN AND BURGESSES OF THE LONDON BOROUGH OF BARKING. It is my pleasure to present to you my Annual Report for the year 1970. In many ways this year will be a landmark in the history of your Health Department. There have been two major staff changes during the course of the year. Miss Long, Superintendent Health Visitor retired and her successor Miss C. Oldham was appointed Chief Nursing Officer and Superintendent Health Visitor. We welcomed also to our staff Miss Lambert, Consultant in Obstetrics and Gynaecology at Barking Hospital who will now act as Medical Supervisor of Midwives for the Borough. The health of the population is often reflected in the Vital Statistics. The live birth rate of 13.27 per thousand is well below that for England and Wales. The infant mortality at 12.26 per thousand live births is the lowest recorded in the Borough's five years of existence. The causes of death in the Borough continue to reflect the current spate of death and disease associated with smoking. There were 152 deaths from lung cancer, 363 deaths due to coronary heart disease and 112 deaths due to bronchitis and asthma. It is obvious that much work remains to be done in the field of health education in this area if these unnecessary deaths are to be prevented in the years to come. The Health Education Service continues to fulfil an important role in the work of the Department with an increasing demand for its services in the newly formed comprehensive schools of the Borough. This section is also playing an important part in the Cervical Cytology Campaign which has been initiated this year to increase the number of women living and working in the Borough who are screened by this test. The Kingsley Hall Assessment Centre has now been functioning for eleven years and an opportunity has been taken to describe this Centre in greater detail. Included in this report is a statistical survey of the work of the Centre. This Assessment Centre continues to be a pioneering project which has no equal in other Boroughs. Among the developments this year in the field of immunisation is the commencement of rubella immunisation in girls aged 11-14. The campaign commenced in November and by the end of the year 141 girls had been immunised. The campaign to protect children against measles has also continued and the bulk of children now being immunised are under 4 years of age. Previous reports have described the introduction of the Dermojet for administering B.C.G. vaccination to school children. There has been a further increase in the number of children accepting this valuable protective measure. This year 1,664 children were vaccinated, representing an increase of 403 over the previous year. In the field of environmental health the Department has continued its work and several improvement areas have been initiated to improve the housing standards of residents in the Borough. Measures to maintain a high standard 14 of food hygiene have continued apace. The Chief Public Health Inspector's report describes the occurrence of an outbreak of food poisoning in the maternity unit of Rush Green Hospital. In the field of mental health this year saw the opening of the new Castle School in June 1970. This purpose built Junior Training Centre will continue to provide a valuable service to the mentally handicapped children of this Borough long after its transfer to the educational system in April 1971. The Child Guidance Clinic has continued to operate but here again staff shortages have hampered the work of this service which is of such importance. Only by the prompt application of corrective measures to deal with the root causes of the problem will we be able to prevent disturbed children growing up to be disturbed adults who create further disturbed families in their turn. The Borough has now been in existence for some five years. During this period the Health Department with the support of the Health Committee has built up a Mental Health Service which bears favourable comparison with other Boroughs in the area. These years have seen the opening of new Junior and Adult Training Centres, a Sheltered Workshop for the mentally handicapped, a Day Centre for the mentally ill and the use of maisonettes for the community care of the mentally ill. These projects have consumed a major slice of the Health Department's financial resources. In providing an up to date service progress in other areas has had to be restricted. This is the last year that the statistics for the Mental Health Service, the Home Help Service and the Day Care of pre-school children, will appear in the Annual Reports of the Medical Officer of Health and I would like to take the opportunity of thanking Mrs. Dixon and her team, Mrs. Everitt and her home helps, the Matrons and staff of the nurseries, and finally Mr. Ruff for the many years of valuable service they have given as members of the Health Department. They will shortly be leaving us for the Social Service Department in the year to come, and we wish them well in the new Department. For those who will continue in my Department the future holds out the prospect of change and uncertainty. I have every confidence in their ability to make change into opportunity as we progress together towards a reorganised Health Service in 1974. J. ADRIAN GILLET Medical Officer of Health. 15 VITAL STATISTICS 1970 Registrar General's estimate of resident population, mid-year 1970: 166,060 Live Births: Legitimate (1,033 male, 1,029 female) 2,062 Illegitimate ( 67 male, 73 female) 140 Total (1,100 male, 1,102 female) 2,202 Illegitimate live births per cent of total 6.40 Live birth rate per 1,000 population 13.27 Live birth rate adjusted by comparability factor of 1.04 13.80 Stillbirths: Legitimate (17 male, 13 female) 30 Illegitimate (1 male, - female) 1 31 Stillbirth rate per 1,000 live and stillbirths 13.88 2,233 Deaths: Infant deaths (under 1 year) (13 male, 14 female) 27 Infant death rate per 1,000 live births 12.26 Legitimate infant death rate per 1,000 legitimate live births ( 10 male, 13 female) 11.15 Illegitimate infant death rate per 1,000 illegitimate live births ( 3 male, 1 female) 28.34 Neo-natal mortality rate (deaths under 4 weeks (20) per 1,000 live births) 9.08 Peri-natal mortality rate (stillbirths (31) and deaths under 1 week (19) per 1,000 live and stillbirths) 22.38 Early neo-natal mortality rate (deaths under 1 week per 1,000 live births) 10.89 Maternal mortality (deaths from pregnancy, childbirth, abortion) 1. Maternal mortality rate (per 1,000 live and stillbirths) 0.45 General Mortality: Number of deaths ( 984 male, 780 female) 1,764 Death rate per 1,000 population - crude 10.62 Death rate adjusted by comparability factor of 1.31 13.91 The Registrar General's estimate of population shows a further fall from 167,960 for 1969 to 166,060 for 1970. It will be interesting to learn what the actual figure is from the Census taken in 1971 when the Census Report is published. Infant mortality rates for the Borough compare well with national averages. The infant death rate of 12.26 is well below that for England and Wales of 18.0 and for Greater London of 17.8. One maternal death is recorded during 1970. A man was charged with manslaughter following this death and it was not one that could be attributed to any aspect of the maternity services. 16 CAUSES OF INFANT DEATHS Cause of death Age at Death Total Under 4 weeks 4 weeks - 1 yr. Birth Injury, Difficult Labour etc. 9 - 9 Bronchitis and emphysema - 1 1 Congenital Anomalies 3 - 3 Enteritis and other diarrhoeal diseases - 1 1 Other diseases of genito-urinary system 1 - 1 Other diseases of respiratory system - 1 1 Other causes of perinatal mortality 7 - 7 Meningitis - 1 1 Pneumonia - 2 2 Whooping Cough - 1 1 Total All Causes 20 7 27 PRINCIPAL CAUSES OF DEATH (All Ages) Diseases of heart and circulatory system 580 Cancer and other malignant diseases 507 Pneumonia, bronchitis and other respiratory diseases 262 Cerebrovasculor disease and other diseases of the brain and nervous system 202 I give below for purpose of comparison the birth and death rates of Barking, Greater London and England and Wales for 1970. Barking Greater London England and Wales Live Births (per 1,000 population) 13.27 15.2 16.0 Stillbirths (per 1,000 live and still births) 13.88 12.0 13.0 Infant Mortality (per 1,000 live births i) 12.26 17-8 18.0 Deaths (per 1,000 population) 13.91 11.3 11.7 17 18. CAUSES OF DEATH 1970 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 1. Cholera - - - - - - - - - - - - - - - - - - 2. Typhoid Fever - - - - - - - - - - - - - - - - - - 3. Bacillary dysentery and amoebiasis - - - - - - - - - - - - - - - - - - 4. Enteritis and other diarrhoeal diseases 1 - 1 - - - - - - - - - - - - - 2 - 5. Tuberculosis of respiratory system - - - - - - - - - - - - - - - - - - 6. Other tuberculosis including late effects - - - - - - - - - - - - 2 - - 1 2 1 7. Plague - - - - - - - - - - - - - - - - - - 8. Diphtheria - - - - - - - - - - - - - - - - - 9. Whooping Cough 1 - - - - - - - - - - - - - - - 1 - 10. Streptococcal sore throat and scarlet fever - - - - - - - - - - - - - - - - - - 11. Meningococcal infection - - - - - - - - - - - - - - - - - - 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:- (a) buccal cavity etc. - - - - - - - - - - 2 2 1 - - - 3 2 (b) oesophagus - - - - - - - - - - 1 2 6 2 2 - 9 4 (c) stomach - - - - - - - - - - 17 5 13 7 9 5 39 17 (d) intestine - - - - - - 1 - - 2 9 6 11 13 4 14 25 35 (e) larynx - - - - - - - - - - 1 - 1 - 2 - 4 - (f) lung, bronchus - - - - - - - - 1 1 47 9 59 6 21 8 128 24 carried forward 2 - 1 - - - 1 - 1 3 77 25 94 29 38 28 214 85 19. CAUSES OF DEATH 1970 (Contd.) CAUSE OF DEATH AGE AT DEATH Under 1 yr 1 and under 5 vrs. 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 - - - 1 - 1 3 77 25 94 29 38 28 214 85 19. Malignant Neoplasm (contd.) (g) breast . - - - - - - - - 8 - 18 - 9 - 8 - 43 (h) uterus - - - - - - - - - - - 12 - 2 - 3 - 17 (i) prostate - - - - - - - - - - - - 6 - 8 - 14 - (j) Leukaemia - - - - - - - - - - 1 - 2 - 1 - 4 - (k) Other malignant neoplasms - - - 1 1 1 2 - 5 2 27 29 21 22 14 14 70 69 20. Benign and unspecified neoplasms - - - - - - - - - - 3 1 2 2 - 1 5 4 21. Diabetes mellitus - - - - - - - - 1 - 2 3 1 2 1 8 5 13 22. Avitaminoses and other nutritional deficiencies - - - - - - - - - - - - - - - - - - 23. (a) Other endocrine, nutritional and metabolic diseases - - - - - 1 - - - - 1 - 2 2 - 1 3 4 24. Anaemias - - - - - - - - - - 1 - 2 1 1 3 4 4 23. (b) Other diseases of blood and blood forming organs - - - - - - - - - - - - - - - - - - 23. (c) Mental disorders - - - - - - 1 - - - 1 - 1 - 1 4 4 4 25. Meningitis - 1 - - - - - - - - 1 1 1 - - - 2 2 23. (d) Multiple sclerosis - - - - - - - - - - - 2 1 - - - 1 2 23.(e) Other diseases of nervous system and sense organs - - - - - 1 - 1 2 - 3 - 1 3 1 6 7 11 26. Active rheumatic fever - - - - - - - - - - - - - - - - - - 27. Chronic rheumatic heart disease - - - - - - - - 2 - 2 10 7 6 - 5 11 21 28. Hypertensive disease - - - - - - - - 1 - 6 4 2 4 5 13 14 21 29. Ischaemic heart disease - - - - - - - - 10 2 105 22 98 45 47 64 260 133 30. Other forms of heart disease - - - - - - - - 1 - 6 - 10 6 15 21 32 27 31. Cerebrovascular disease - - - - - - - - 2 1 15 14 28 21 31 57 76 93 23. (f) Other diseases of circulatory system - - - - - - - - 1 1 12 4 8 9 10 16 31 30 carried forward 2 1 1 1 1 3 4 1 26 17 263 145 287 163 173 252 757 583 20. CAUSES OF DEATH 1970(Contd.) CAUSE OF DEATH AGE AT DEATH Under 1 yr 1 and under 5yrs 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 brought forvard M F M F M F M F M F M F M F M F M F 2 1 1 1 1 3 4 1 26 17 263 145 287 163 173 252 757 583 12. Influenza - - - - - - - - - - 1 1 6 1 3 4 10 6 11. Pneumonia 1 1 - - - - 1 - - 1 7 1 14 9 31 49 54 61 .14. (a) Bronchitis and emphysema - 1 - - - - - 1 2 - 23 2 28 7 29 19 82 30 14. (b) Asthma - - - - - - - - - - 1 1 1 1 - - 2 2 23. (g) Other diseases of respirator} system 1 - - - - - - - - - 1 - 3 2 1 3 6 5 15. Peptic Ulcer - - - - - - - - - - 1 - 3 - 1 4 5 4 16. Appendicitis - - - - - - 1 - - - 1 1 - - - - 2 1 17. Intestinal obstruction and hernia - - - - - - 1 - - 1 - - 2 2 3 2 6 5 21. (h) Other diseases of digestive system - - - - - - - - - - 1 4 - 1 2 6 3 11 38. Cirrhosis of liver - - - - - - - - - - 2 - - 1 - 2 2 3 39. Nephritis and nephrosis - - - - - - - - - 1 - - - - 1 2 1 3 40. Hyperplasia of prostate - - - - - - - - - - - - - - 2 - 2 - 23. (i) Other diseases, genitourinary system - 1 - - - - - - - 1 - - 3 3 4 2 7 7 41. Abortion - - - - - - - - - l - - - - - - - 1 23. (j) Diseases of musculo-skeletal system - - - - - - - 1 - - 1 1 1 1 - 5 2 8 42. Other complications of pregnancy3 childbirth and peurperium - - - - - - - - - - - - - - - - - - 43. Congenital anomalies 2 1 - 1 - - - - 1 - 1 2 - - - - 4 4 44. Birth Injury, difficult labour and other anoxic and hypoxic conditions 6 3 - - - - - - - - - - - - - - 6 3 carried forward 12 8 1 2 1 3 7 3 29 22 303 158 348 191 250 350 951 737 21. CAUSES OF DEATH 1970 (Contd.) CAUSE OF DEATH AGE AT DEATH Under 1 yr 1 and under yrs 5 and under 15 years 15 and under 25yrs 25 and under 45 yrs 45 and under 65yrs 65 and under 75yrs 75 and over Total brought forward M F M F M F M F M F M F M F M F M F 12 8 1 2 1 3 7 3 29 22 303 158 348 191 250 350 951 737 45. Other causes of perinatal mortality 1 6 - - - - - - - - - - - - - - 1 6 46. Symptoms and ill-defined conditions - - - - - - - - - - - - - - - 1 - 1 47. Motor Vehicle accidents - - - - 2 1 4 2 1 - 3 7 2 2 2 - 14 12 48. All other accidents - - - - 1 - - 1 1 - 4 3 2 2 I 7 9 13 49. Suicide and self-inflicted injuries - - - - - - - - 1 2 4 6 3 - 1 1 9 9 50. All other external causes - - - - - - - - - 1 - 1 - - - - - 2 TOTAL 13 14 1 2 4 4 11 6 32 25 314 175 355 195 254 359 984 780 22 SUMMARY OF VITAL STATISTICS 1965 - 1970 Year Population Deaths *Death Rate Live Births *Live Birth Rate Deaths under 1 yr. Infant Death Rate 1965 172,970 1,748 13.54 2,408 14.48 40 16.61 1966 171,000 1,701 13.23 2,348 14.29 36 15.33 1967 170,100 1,715 13.31 2,296 13.50 45 19.6 1968 169,520 1,857 14.46 2,307 14.15 41 17.77 1969 167,960 1,902 14.72 2,234 13.30 39 17.46 1970 166,060 1,764 13.91 2,202 13.80 27 12.26 *Adjusted for comparability. HEALTH EDUCATION It was with a mixture of regret and pleasure that we learnt that the Health Education Officer, Mr. G.S. Self, was resigning at the beginning of December 1969; regret at his leaving the Section, and pleasure in the knowledge that he had been appointed as Manager, Health Education and Hygiene, by the Forte Food Group. I would like to take this opportunity of thanking him for all his hard work in the past. Miss D.J. Milbank was appointed as Health Education Officer in April, and we welcomed to the team, Mrs. P. Kasim, a former Physical Education Lecturer, as Assistant Health Education Officer, in September 1970. In spite of all staff changes, it was pleasing to note that the demand for health education increased in the Borough during the year, this demand was offset to some extent by the majority of school staffs taking over most of the health education programmes in schools, with specialised talks only, given by the Health Education staff. The demand for visual aids therefore, increased considerably and I am pleased to report that this demand has been met. I would like to thank all Head Teachers and other staff concerned with these programmes. Unfortunately, again this year, financial restrictions have prevented the post of the second Assistant Health Education Officer being filled. Health Education in Schools. The most noticeable change in health education in schools has occurred since the introduction of comprehensive education, since when, the demand for specialised health topics has increased considerably, and at the present moment six of the nine comprehensive schools have received short series of talks by staff of the Health Education Section. The General Studies Department of Rush Green College again asked for help with their health education programme to both day and block release students, and a series of talks and film shows were given to six different groups of engineering, electrical and printing students. The Child Care Course for the basic certificate of the National Association for Maternal and Child Welfare again proved popular, no less than eight separate oral examinations being held in the Borough; the results of these examinations were most satisfactory and several of the girls gained the highest level award. Food Hygiene Education. The routine Certificate and Diploma Courses run in conjunction with Rush Green College have again this year proved worthwhile, the lectures being given by a Public Health Inspector and other members of the Health Department. The examination results were most pleasing, 100 per cent pass in the Certificate Course and eighteen out of twenty two candidates were successful in the Diploma Course. 23 In-Service Training and Use of Health Education Centre. A short two session in-service course on "Teaching Hygiene and Use of Visual Aids Available" was given for the staff of Barking Training Centre during the first half of the year at the Health Education Centre at Gale Street. Other in-service courses have unfortunately had to be curtailed, as have visits to the Centre by various schools, owing to the continuous vandalism since the demolition of the surrounding prefabs. Home Safety. Continued support was given to the work of the Greater London Home Safety Council, a representative being present at the meetings and also at the National Home Safety Conference of the Royal Society for the Prevention of Accidents. The topic is of course included in school health education programmes, and the Health Education Officer was asked to judge the home safety oral examination for the Girls Brigade and to present the Club Trophy to the winning team in April. Duke of Edinburgh Award Scheme. Eleven separate oral examinations at various levels of Home Safety were held in the Borough during the year and the Health Education Officer was very proud and had great pleasure in accepting the invitation sent to her, to be present at Cambell Youth Club, when H.R.H. Prince Philip, Duke of Edinburgh, visited last November. Visitors. Visitors to the Section included two Midwifery Tutor Students, and a student from London University, Institute of Education, who was taking the Content and Methods of Health Education Diploma Course, for two weeks field instruction. Films and Film Making. The film on the "Dental Auxiliary" was completed in July, the actual photography being carried out by the Photographic Department of the then Regional College. The demand for films for use in schools, clinics, clubs and organisations etc., increased during this year, and one film in particular had to be renewed. In all 222 films were lent by the section and it is envisaged that this demand will go on increasing during 1971. Displays and Exhibitions. The theme of the Health Department's exhibition at the Town Show this year was on one aspect of Water Safety. Once again the weather was good and the exhibition was well attended. The staffs of both Barking and Rush Green Hospitals invited the Department to provide displays in the foyers of both Maternity Wings; the topics so far displayed have been "Protection against Burns and Scalds", 24 "Immunisation and Vaccination" and "The Guthrie Test". Leaflets were designed with the co-operation of the Hospital Staffs and were produced by the Department in conjunction with the Guthrie Test display. My most grateful thanks to all the hospital staffs involved for their continued co-operation. It is hoped that during 1971. more displays on various health topics will be produced. Talks to Outside Organisations. Talks to diverse groups on a wide variety of subjects were given throughout the Borough. Speakers were provided for various women's organisations, St. Johns Ambulance Division and the Royal College of Midwives, (Havering Branch), as well as Guides and Brownies. Campaigns. Phase 'A' of the major Cervical Cytology Campaign has been completed and it is proposed to commence Phase 'B' in the New Year. A campaign programme of immunisation against Rubella for all girls in their 14th year of age, was started in September 1970. The general practitioners were firstly notified of the Department's plans, and the Education Authority approached, as the girls were to be contacted through the Secondary Schools in the Borough. The Head Teachers were visited and I am most appreciative of the co-operation we have received from them. Arrangements were made for a Health Education Officer to speak to the girls to explain the dangers of Rubella during pregnancy, and to encourage them to take advantage of the vaccination. Seven of the thirteen schools have been visited so far and consent forms have been returned by six. The response so far has been good. 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. LOCAL AUTHORITY SOCIAL SERVICES ACT 1970 A great deal of time was taken up in 1970 planning the measures needed to implement the above Act which, inter-alia, provided for the setting up of Social Services Committees and the transfer to the new Departments of functions relating to the day care of pre-school children, in day nurseries and nursery groups, the registration of private nurseries and child minders, the provision of mother and baby homes, recuperative holidays, the home help service, the night sitter service and the mental health services, all previously provided through the Health Committee and Health Department. These functions together with the powers and duties of the Children's Committee and the Welfare Committee were to be brought together into a Social Services Department under the leadership of a Director of Social Services. 26 PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN During the year 464 mothers attended our clinics for ante-natal care from the midwives. A total of 454 clinic sessions were held and in addition 1,335 attendances were made at Mothercraft and Relaxation Classes. Following negotiations with the Regional Hospital Board, Miss J. E. M. Lambert, F.R.C.O.G., Consultant Obstetrician and Gynaecologist, Barking Hospital, was appointed Medical Supervisor of Midwives with effect from 1st May, 1970 to succeed Dr. M. I. Adamson, former Associate Medical Officer of Health, who retired in December 19&9. This appointment forged a very useful link between the local authority health service and the hospital service. Centres offering ante-natal care are as follows:- Centre Frequency of Sessions When held Annie Prendergast Clinic Weekly Tuesday, p.m. Ashton Gardens, Chadwell Heath. The Clinic, Weekly Tuesday, p.m. Becontree Avenue, Dagenham. Central Clinic, Weekly Wednesday, p.m. Vicarage Drive, Barking. The Clinic, Weekly Wednesday, p.m. Ford Road, Dagenham. Marks Gate Clinic, Lawn Farm Grove, Weekly Thursday, p.m. Marks Gate. The Clinic, Oxlow Lane, Dagenham. Weekly Tuesday, p.m. The Clinic, Porters Avenue, Dagenham. Fortnightly Wednesday, p.m. Julia Engwell Clinic, Woodward Road, Dagenham. Weekly Wednesday, p.m. Thames View Clinic, Bastable Avenue, Barking. Fortnightly Monday, p.m. 27 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 6 cases. In addition 32 cases who made their own arrangements for confinement were advised and assisted by the Association. CHILD HEALTH CENTRES During the year, 5,761 children attended the following centres:- Centre Frequency of Sessions When Held Annie Prendergast Clinic Ashton Gardens, Chadwell Heath. Weekly Wednesday and Thursday p.m. The Clinic, Becontree Avenue, Dagenham. Weekly Monday p.m. Wednesday a.m. Central Clinic, Vicarage Drive, Barking. Weekly Tuesday and Thursday p.m. 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. 28 Welfare foods and nutrients are sold at these centres during infant welfare sessions and also at Central Clinic on Wednesday afternoons. During the year, the following amounts of welfare foods were issued:- National Dried Milk 5,322 packets Cod Liver Oil 2,516 bottles Vitamin A and D tablets 1,959 packets of 20 Orange Juice 36,278 bottles DAY NURSERY SERVICE The average daily attendance and numbers on registers are shown below for each month of 1970:- Month Goresbrook Annie Prendergast Eastbury Average Daily Attendance No. on Register Average Daily Attendance No. on Register Average Daily Attendance No. on Register January 23.3 37 36.5 44 37.9 44 February 22.0 37 39.1 48 39.2 48 March 31.5 40 44.6 51 36.5 45 April 33.0 45 41.9 50 39.0 44 May 31.1 42 41.3 50 37.9 47 June 29.5 42 42.5 48 35.3 49 July 32.9 42 39.2 48 38.3 48 August 27.7 38 30.5 48 33.2 47 September 30.7 37 36.1 46 37.3 44 October 29.0 40 37.7 45 37.0 43 November 35.0 43 36.0 46 35.3 46 December 29.8 39 35.5 43 37.3 43 Annie Prendergast Day Nursery Matron reports as follows:- The year for us in the nursery ran smoothly and happily although regrettably our numbers were below the average for previous years. Our students were again successful in taking their N.N.E.B. examination, 29 reaching a good standard in their practical work also. As was once commented to me by an observer "I don't know what it is but the girls you have in the nursery seem different, rather special somehow", and I think perhaps they are. Most seem to develop a very special sort of quality of warmth and understanding throughout their training, and seem well equipped to face their future responsibilities. The background of children in the nursery seemed as varied as before ranging from the single income group to professional families i.e. teachers and nurses. The children themselves too come in a variety of shapes, sizes and termperaments! I look forward to the day when we can offer nursery care and education to all pre-school children, even if it is only part-time for we feel we can give so much. Sastbury Day Nursery Matron reports as follows:- 1970 was a busy, interesting and happy year for the children and staff at Eastbury Nursery. Our three students were successful in passing the N.N.E.B. examination, two were promoted to Staff Nursery Nurses, one left to get married and subsequently obtained a post as Staff Nursery Nurse at the London Hospital. In September, six nursery students were appointed; all are making good progress and are interested in the N.N.E.B. course. During the past year we have had a number of partially handicapped children admitted to the Nursery: 3 with speech defects, 1 partially deaf, 3 with physical defects. It is very gratifying to see the progress made by these children. Helped by watching and playing with other children, they gradually learn to form words and associate them with toys and surroundings. They overcome self-consciousness as the other children accept them without question. They learn to accept their handicap by being taught to be more independent and are better adjusted mentally and socially by mixing with other children from an early age. Dental inspection was carried out for the first time last November, and children requiring treatment got appointments to attend their local Dental Clinics. We started a "Tufty Club" with thirty members 3-5 years, complete with badges and certificates of enrolment. With help from our Road Safety Officer, with necessary equipment e.g. flannelgraphs, films, books and song sheets, we feel we have made excellent progress in getting over the road safety message to our young but very energetic members. 30 Goresbrook Day Nursery Matron reports as follows:- There were several changes of staff during the year and in February, Miss Iris Brightwell was appointed as Deputy Matron. During the year three of our students spent a month at Thomas Arnold Infants School, whilst we had their Nursery Student here for a term. All the students felt they benefited by the exchange. Three students were successful in obtaining the N.N.E.B. certificate and moved to other local authority day nurseries. In August the nursery held a Summer Fete to which parents and friends were invited. The weather prevented it being held in the garden as planned, but this did not detract from the success and enjoyment of the afternoon. Christmas brought the usual festivities, a Sale of Work organised by the staff and a party for the children to which parents, friends and colleagues were invited. PLAY THERAPY There have been 74 children helped at the four Play Therapy groups over the past year. At Northbury we have helped 20 children; 6 who had speech defects and 2 with difficult home lives. Also we had a blind and deaf child, owing to the fact that the mother had Rubella during pregnancy. Later she was transferred to Kingsley Hall. We also had 3 immigrant children at this group. At Thames View there have been 18 children, including 3 who had speech defects and 4 who are backward. At Julia Engwell 20 children have been helped including 1 mongol child, 4 mentally backward and b with behaviour problems. At Oxlow Lane 16 children have attended including 1 mongol child and 3 who would not mix with other children and 4 mentally retarded. REGISTRATION OF NURSERIES AND CHILD-MINDERS A marked increase in the number of registrations under the Nurseries and Child-Minders Registration, Act 1948, as amended, took place during the year. 31 This was due in some measure to the increased powers of local health authorities to require registration provided by the amending legislation contained in the Health Services and Public Health Act 1968. At the end of 1970 there were 17 premises registered for the sessional care of 532 children and 88 persons were registered in their own homes to care for 163 children. In 1969 there were 12 premises catering for 376 children and 48 persons registered to care for 96 children. All the establishments were visited regularly by the health visitors. DAILY GUARDIAN SCHEME The amending legislation mentioned above had the effect of requiring all those mothers who had voluntarily registered under the Daily Guardian Scheme to register formally as child-minders. Thus the point of encouraging women to maintain a good standard of care by making them a small payment and registering them voluntarily no longer applied and this scheme which had been in operation since the 1930's was discontinued. In its place it was decided to offer a small payment to suitable child-minders for accepting priority cases at short notice and a small number of volunteers were enrolled. KINGSLEY HALL ASSESSMENT CENTRE Kingsley Hall Assessment Centre was opened in May 1960 and was the outcome of a survey of handicapped children under the age of 5 years which was reported to the Health Committee in 1957. This Centre has now been open for 11 years. THE FUNCTIONS of the Assessment Centre can be described as follows:- Assessment - With the growth of our understanding in the care of children who are not developing normally it is becoming more and more important that the entire child population of a district be kept in close surveillance and that children who are found to be developing at an abnormally slow rate or in an abnormal pattern should be discovered as early as possible and the nature of their disorder assessed. It is also important that even in cases where a child is known to be handicapped that assessment is carried out to determine the extent of the handicap and the measures which are required to assist the child to attain his maximum function at home and at school and in the years that follow. Rehabilitation - This is an important aspect of the care of the young physically handicapped child. Many of the children who attend Kingsley Hall suffer from conditions which affect their mobility e.g. children who are spastic or who suffer from spina bifida. In the 32 absence of physiotherapy these children tend to develop abnormalities of the muscles. They fail to learn how to make the best use of the limbs and their mobility may fail to develop as well as it is possible for it to do. Kingsley Hall Assessment Centre admits children with a wide range of disabilities. In addition to those who require physiotherapy there are children requiring other forms of treatment e.g. children suffering from speech defects are provided with speech therapy and deaf children are given speech training by a visiting teacher of the deaf. Parent guidance and training - This is a very basic function of the Assessment Centre. The parents of children who are handicapped often require as much assistance as their children. Many of them find it difficult to accept that their child is handicapped, others suffer from feelings of guilt, and unless this problem is discussed and resolved parents end up either as grossly over-protective parents or parents who reject their children. Many parents find it difficult to understand the handicap that their child suffers from and it requires prolonged explanation and demonstration to assist them in learning to cope with the needs of their handicapped child. At Kingsley Hall the parents of spastic children are shown how to carry out simple movements of the spastic limbs at home and games and other activities for their children in order to prevent the formation of contractures and other severe abnormalities of the limbs. OTHER USES The Centre has been used for a variety of other purposes. On occasion handicapped children have been admitted for short term care when the parents have been ill or unable to cope with the needs of the child. From time to time children have been admitted to assist a parent who is too fearful to care for a child who has had a prolonged period of hospital care and who require a transitional period to regain their self confidence, to perhaps learn new methods of feeding or care for their child prior to assuming full responsibility for the care of their handicapped child at home. STAFFING The staff of Kingsley Hall consists of:- Sister in Charge, a Warden, 4 Staff Nursery Nurses, and 3 Nursery Assistants. A Medical Officer spends not less than one day per week at Kingsley Hall. In addition to the staff provided by the Borough, Kingsley Hall has been most fortunate in obtaining the assistance of Dr. K. Holt, Director of the Wolfson Centre. Dr. Holt and his staff have been associated with Kingsley Hall over many years, they pay regular visits to the Assessment Centre to assist in the assessment of children and in advising on the treatment of the children who attend there. In addition where more specialist/assessment facilities are required arrangements are made for the children to be conveyed to the Wolfson Centre when necessary. This close liaison with Dr. Holt has been of immense value to the Borough. It has also meant that many children are seen locally who would otherwise have to be taken by their parents to London Hospitals. In addition to assessment at Kingsley 33 Hall children are often escorted by staff to hospitals when specialist advice is necessary. Children are also taken to Ophthalmic Clinics or to the Child Guidance Clinic when necessary. HOURS OF OPENING Children who attend the Assessment Centre are collected from their homes in a mini-bus and arrive at about 9.30 a.m. each morning and they are returned home from 4 p.m. onwards. During the day meals are provided at the Assessment Centre for the children. No charge is made for attendance. PATIENTS The Centre is staffed for 20 children. In view of the severity of their handicaps a high staff ratio is essential to ensure that each child receives the necessary care and attention. In addition to children who are admitted to Kingsley Hall the Centre also provides a service for other handicapped children. Children requiring physiotherapy attend the centre from their homes. Groups of children from Kingsley Hall are conveyed to Faircross Physically Handicapped School for hydrotherapy as no pool is available at Kingsley Hall. No. of children attending Kingsley Hall 1970 J F M A H JUN JUL A S 0 N D No. 19 19 l8 18 18 18 18 17 17 19 19 l8 Admitted 1 0 1 4 0 0 1 0 3 5 1 0 Discharged 1 0 2 4 0 0 1 1 3 3 1 1 Other activities at Kingsley Hall (1970) Children requiring physio-therapy (a) Kingsley Hall 11 (b) Community 5 Hospital visits 33 Ophthalmic clinic 5 Educational Psychologist 2 Reasons for admission to Kingsley Hall (1970) Speech defect 1 Spina bifida 1 Cerebral palsy 2 Autism 1 Hypocalcaemia 1 Developmental retardation 10 Total 16 34 Discharges (1970) Special care unit (Castle School) 2 Junior Training Centre 5 Bentry Special School 1 Partially-sighted school 1 Blind school 1 Left the Area 3 Annie Prendergast Nursery 1 Home (prior to admission to J.T,C. at 5 yrs. 2 Hunters Hall Infants (maladjusted) 1 Total 17 A review of the children who have attended the Assessment Centre was carried out and preliminary data obtained so far as is shown in the following tables I to 5. It is evident that the Centre has provided assessment counselling and care for severely handicapped children residing in the Borough. The future role of the Centre must be modified in the light of circumstances which prevail with the passage of the Social Services Act. The Health Department which was responsible for the total care of handicapped children will no longer be responsible for the provision of day care (nursery) facilities and in consequence the Assessment Centre will concentrate on its primary functions of assessment, rehabilitation and parent guidance. The provision of nursery care will become the responsibility of the Social Service Department. Table I - Age and Sex Distribution Age in Years -1 1- 2- 3- 4- 5- TOTAL No. Per cent Male 3 12 38 23 30 5 111 61 Female 1 12 18 22 16 2 71 39 TOTAL Number 4 24 56 45 46 7 182 Per cent 2.2 13.2 30.7 24.8 25.3 3.8 100 35 36 KINGSLEY HALL ASSESSMENT CENTRE TABLE 2 - Categories of defect present DEFECT Age Under 1 yr. l - 2 - 3 - 4 - 5 - TOTAL Sex M F M F M F M F M F M F Number Per cent Mental Retardation 1 1 3 3 22 7 8 9 13 11 4 1 83 45.5 Cerebral Palsy - - 1 ? 5 2 3 5 4 1 - - 23 12.7 Spins Bifida - - 1 2 - 2 3 2 - - - - 10 5.5 Hydrocephalus - - 1 - 2 2 - - - - - - 5 2.8 Other diseases of the C.N.S. - - - - 1 1 1 - 2 1 - - 6 3.3 Hearing Loss Partial - - - 1 - 1 - 1 - - - 9 4.9 Total 1 - - 2 - 1 1 1 - - - - Visual Loss Partial - - 1 - - - 2 - - - - 9 4.9 Total - - - 1 1 1 - - 1 - 1 - Speech Disorder - - - - - - - - 2 1 - - 6 3.3 Social 4 emotional problems 1 - 5 1 6 1 - 1 1 2 - - 19 10.5 Congenital heart disease - - - - 1 - - 1 ? - - - 6 3.3 Locomotor defects - - - - - - - - 4 - - 1 5 2.8 Cleft Palate - - - - - - 1 - - - - - 1 0.5 TOTAL Number 3 1 12 12 38 18 24 21 30 16 5 2 182 100.0 Per cent 1.6 0.5 6.6 6.6 20.9 9.9 13.2 11.5 16.5 8.8 2.8 1.1 Children are classified according to the most severe handicapping condition present. TABLE 3 - Aetiology or factors associated with handicap in children admitted to Kingsley Hall. Aetiology or associated factor No. Aetiology or associated factor No. (a) Mental Retardation (d) Hearing Loss Down's syndrome 19 Familial deafness 1 Mosaic Down's syndrome 1 Moebius syndrome 1 Deletion of short arm of chromosome 18 1 Rubella syndrome 3 Postmeningitic deafness 1 Rubenstein - Taybi syndrome 1 Cause unassigned 3 Tay - Sach's disease 1 Rubella syndrome 1 (e) Visual Loss Toxoplasmosis 1 Congenital cateracts 3 Threatened abortion 1 Congenital corneal opacities 1 Antepartum haemorrhage 1 Congenital aniridia 1 Prematurity 7 Hydrocephalus 1 Birth asphyxia 6 Retrolental fibroplasia 1 Birth trauma 3 Retinoblastoma 1 Dysmaturity 1 Cause unassigned 1 Hydrocephalus 2 Pseudohypoparathyroidism 1 (f) Speech Disorder Hypercalcaemia 1 Developmental delay 3 Autism 3 Mental retardation (E.S.N.) l Meningitis 2 Maladjustment 1 Motor accident 1 Motor dysphasia 1 Cause unassigned 29 (b) Cerebral Palsy (g) Locomotor disorders Prematurity 5 Muscular dystrophy 2 Thalidomide 1 Birth trauma 4 Poliomyelitis 1 Birth asphyxia 2 Still's disease 1 Rubella syndrome 2 Arrested hydrocephalus 1 Intracranial haemorrhage 3 Cause unassigned 6 (c) Other diseases of the Central Nervous System Marcus Gunn syndrome (agenesis of 9th & 10th cranial nerve) 1 Epilepsy 4 Inoperable brain tumour 1 37 38 KINGSLEY HALL ASSESSMENT CENTRE TABLE 4 - Duration of stay. DEFECT Duration of stay in months -6 6- 12- 18- 24- 30- 36- Still in Assessment Centre TOTAL Number Cerebral Palsy 3 3 4 1 5 1 2 4 23 Mental Retardation 20 20 16 5 5 1 10 8 83 Spina Bifida 1 - 1 3 - - 4 1 10 Hydrocephalus - - - 1 1 - 1 2 5 Other diseases of the C.N.S. - 1 3 - - - 1 1 6 Hearing Loss 1 - 4 1 1 1 - 1 9 Visual Loss 2 3 2 1 - - 1 - 9 Speech disorders 5 1 - - - - - - 6 Emotional disturbance social problem 11 4 3 1 - - - - 19 Congenital heart disease 2 4 - - - - - - 6 Cleft Palate - - 1 - - - - - 1 Locomotor disorders 2 1 2 - - - - - 5 TOTAL Number 47 37 56 11 12 3 19 17 182 Per cent 25.8 20.3 19.8 6.1 6.6 1.6 10.4 9.4 100 39 KINGSLEY HALL ASSESSMENT CENTRE TABLE 5 - Placement of Children DIAGNOSIS PLACEMENT Assessment Centre Moved Away Died Norma] School Junior Training Centre Special School for Hospital Educationally Sub-normal Physically Handicapped Partially Hearing Deaf Partially Sighted Blind Maladjusted Mental retardation - 36 11 - - - - - - 6 8 11 4 Cerebral palsy 2 - 1 13 - - - - - - 4 2 1 Spina Bifida - 2 - 4 - - - - - - 1 1 2 Hydrocephalus 1 - - - - - - - - - 2 1 1 Other defects of the Central Nervous System 2 - - 2 - - - - - 1 1 - Hearing Partial 1 - - - 2 - - - - - - - - Total - - - - - 5 - - - - 1 - - Visual Partial - - - - - - 4 - - - - - - Total - - - - - - - 3 - - - - 2 Speech 3 - 1 - - - - - 1 - - 1 - Emotional and Social problems 8 - - - - - - - 2 - - 9 - Heart Defects 3 - - 1 - - - - - - - 1 1 Locomotor Defects 3 - - 1 - - - - - - - 1 - Hare Lip & Cleft Palate 1 - - - - - - - - - - - - TOTAL Number 24 38 13 21 2 5 4 3 3 6 17 28 11 Per cent 13.2 20.9 7.1 11.5 1.1 2.8 2.2 1.6 1.6 3.3 9.4 15.4 6.1 7 Children (3.8%) are awaiting placement in an E.S.N. School. REPORT OF CHIEF NURSING OFFICER As Chief Nursing Officer, appointed in May of this year, much of my time during the past six months has been spent on the appraisal and assessment of work carried out by staff in the Community Nursing and Health Visiting Service together with other sections for which I am at present responsible, namely - School/Clinic Nurses and Attendants, the Assessment Centre and Play Therapy Groups plus Day Nurseries, Registered Child Minders and Private Play Groups. On paper, an establishment of 196 personnel to cover the above services would appear to be adequate to meet present day demand, but unfortunately, many of these posts are unfilled therefore, I consider that the staff in post should be commended for their efforts in trying under difficult circumstances to maintain a satisfactory service - in particular the Health Visitors, who total eighteen in number against an establishment of forty eight. This is a time of perpetual change and one in which it is essential that we plan to function efficiently by using our limited resources in the most economical way. Every year, statistics appertaining to the number of households visited are recorded by each section. These however, do not necessarily provide a complete picture of the numerous duties performed, neither do they illustrate the changing pattern of work required to meet present day demand. District Nurse Section This Branch complements the hospital service not only in dealing with the elderly to relieve the strain on hospital beds, but also in caring for the chronic sick, pre and post operative treatment, administering drugs, antibiotics and cortisone injections, etc. District Nurses can maintain persons in their own homes thus allowing them the feeling of independence essential to their own self respect and well being. A larger District Nursing team with supporting attendants working in conjunction with general practitioners could do much to relieve the over burdened hospital bed situation and also give relief to the Ambulance Service by reducing the number of people being transported to and from hospital for treatment which could well be performed by the fully qualified district nurses. With the pressure of work in out patient departments and traffic congestion on the roads, a wider use of her skills would do much to provide a more personal and satisfactory service to the Community. District Midwifery Section A marked change in the functions of a district midwife has occurred in recent years caused by the steadily decreasing number of home confinements and the resultant large additional number of home visits to mothers and their babies being discharged from hospital after forty-eight hours still requiring a midwife's care. These mothers in the past, would have received at least ten days of hospital in-patient treatment. 40 Midwives now assist in modern screening methods for the detection of abnormalities in the new born child, e.g. phenylketonuria. This requires extra visits to the home. Participation in health education - in conjunction with the Health Visitor - for expectant mothers is another widening aspect. Closer liaison in ante natal clinics with general practitioners in group practice has also enlarged the horizon of the midwives work, all of which improves the service to the community. Midwifery is an essential service and the right of an expectant mother wishing to have a home confinement must be respected as must that of the midwife who wishes to continue to work on the district doing the job for which she has been trained. Health Visiting Section I have already mentioned the deplorable situation regarding the number of staff available to cover the very wide functions for which the Health Visitor has a statutory responsibility. As a highly skilled person she is to date - the only all purpose family visitor fully qualified to give all members of the public guidance on positive physical and mental health. She is prominent in the field of preventive medico-social medicine and acts as liaison officer between doctors, hospitals, social workers, etc., and her families. A small number of less qualified staff assist, very ably, in some aspects of the work and if this serious shortage of staff persists, it will be essential to increase the number of ancillary workers who, with special in-service training, will be able to assist the health visitors still further in their work. Current Events during 1970 In June, discussion took place - at the request of a Paediatrician for one health visitor to commence a weekly Paediatric Liaison session at Oldchurch Hospital, its aim being to provide a better understanding between hospital and home background and an improved hospital after-care service for the families involved. We hope at some future date to extend this type of service. Long standing departmental problems necessitated the reorganisation of staff at the local Chest Clinic. Each health visitor is now responsible for the after-care of families under surveillance on her area, the clinic duties being performed by clinic nurses. Extra nursing attendants have been appointed to relieve the district nurses of simple nursing duties thus allowing them more time for cases requiring the skills of a trained nurse. This is one area of work where there is a further need for expansion. From June to December, health visitors completed sixty four medicosocial assessments on families for whom medical priority certificates had been received for re-housing. Research teams requested information to assist their studies on deaths among asbestos workers and on one-parent families. Health visitors play an important role in this kind of enquiry. Students from numerous organisations spent a considerable amount of time in the various departments observing techniques and visiting with staff to learn the basic principles of preventive medicine carried out by each section. 41 Several staff attended refresher courses and specific study day conferences applicable to their sphere of work. In addition, two members of staff attended middle management courses in preparation for anticipated changes to come. Two health visitors and one district nurse retired with between them, an aggregate of eighty years valuable service to the community - a sad loss to the Department and public alike. Lastly, and by no means least, a great deal of thought and planning has been given to implement the Mayston Report on Management Structure of the Local Authority Nursing Services. Plans have been put to the appropriate Committees for their approval and acceptance the outcome of which is still awaited. My staff and I look forward with hopeful enthusiasm to improved reorganisation in 1971. STATISTICS Midwifery Service Deliveries attended by Domiciliary Midwives - 1970 Doctor present at delivery Doctor not present at delivery Cases delivered in hospital and attended by Domiciliary Midwives on discharge before 10th day. 7 275 1,571 Home Nursing Service Total number of persons nursed during the year 1,918 Number of persons who were aged under 5 at first visit 9 Number of persons who were aged 65 or over at first visit 771 Health Visiting Service Cases Visited by Health Visitors Number of Cases Children born in 1970 2,177 " " " 1969 1,880 " " " 1965-68 4,794 8,851 42 Cases visited by Health Visitors (contd.) Number of Cases Persons aged 65 or over 304 Mentally disordered persons 87 Persons discharged from hospitals (excluding maternity patients) 26 Number of tuberculous households visited 85 Number of households visited on account of other infectious diseases 31 Homes visited by tuberculosis visitors 459 43 CHILDREN'S DEPARTMENT Medical Reports on all children boarded out into foster homes during the year were perused by the Deputy Medical Officer of Health who brings to the notice of the Children's Officer any important medical aspects that require observation or treatment. CYTOLOGY SERVICE 1970 The total number of patients seen in 1970 was 1,941 the best we have had so far and more than double the number of last year. It could be attributed to a successful campaign we launched in an effort to try and reach as many of our female employees as possible. The campaign succeeded in combining the mass approach with individual attention. The former was obtained via the pay envelopes, where an individual letter was enclosed explaining the advantages and limitations of the cytology test and the procedure. At the foot of the letter there was the address to contact if the test was desired. The number of suspect smears was 13 and after investigation 5 proved to be malignant. Let us first consider the 5 positive in more detail:- Table I Age Social Class Parity Papanicolaou Classification Outcome 40 III 2 Grade 3 Hysterectomy 47 IV 2 Grade 2 1969 Cervicitis 1970 Early Carcinoma -hysterectomy 51 III 3 Grade 5 Invasive carcinomahysterectomy 40 III 3 Grade 4 Cone biopsy; carcinoma in situ hysterectomy 36 III 1 Grade 3 cone biopsy carcinoma in situ 3 smears negative 44 A closer look at the remaining 8 cases is perhaps just as relevant:Table II Age Social Class Parity Papanicolaou Classification Outcome 46 III 2 Grade 3 Cone biopsy negative 60 IV 4 Grade 3 Dilation and curet -tage. Cone biopsy negative. 28 III 2 Grade 4 Suspected carcinoma, cone biopsy. Dyscrasia Under close surveillance 42 II 1 Grade 2 Repeat smear negative (Hospital) 24 III 3 Grade 2 5 months pregnant, should be seen again in 6 months 2 more cases Grade II and III and 1 Grade II had moved out of the area and could not be traced. Table II shows Two Grade III had cone biopsy (l also had a dilation and curettage and proved negative. One Grade II had a smear repeated in hospital, it was found to be negative but will be followed up. One Grade IV (suspected carcinoma) had a cone biopsy, findings showed Dyscrasia. Because of her very young age, (28 years) she has been kept under close surveillance instead of a more radical approach. Another very young woman aged 24 years Grade II was 5 months pregnant at the time which could have accounted for some atypical findings and was recommended by the pathologist to be seen again in 6 months. Other gynaecological conditions revealed during the session are as follows Fibroids 10 Ovarian Cyst 3 Erosion 18 Cervical Polypus 34 Leukoplakia 1 Vaginal prolapse 1 Dilation and curettage 4 (irregular bleeding) Vaginal discharge and cervicitis 18 Trichomonas vaginalis 31 Monilia infection 15 45 There has also been a case of intra epithelial - carcinoma of the vagina which came to light in one of our patients whose cervical smear was negative but who was referred to the gynaecologist for post menopausal bleeding. Inflammatory changes were noted in 321 women most of them are to return for a repeat smear in 1 year. Breast examination revealed 6 suspect findings and the patients were referred to a surgeon for consultation. VACCINATION AND IMMUNISATION Measles During the year a total of 2,002 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 - 1Q7O 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 1970 304 VACCINATION AGAINST MEASLES 1970 Year of birth Primary Vaccination 1970 1 1969 707 1968 723 1967 219 1963- 1966 316 others under age 16 36 Total all ages 2.002 46 The following statistics relate to persons protected at council clinic or by general practitioners during 1970: VACCINATION AGAINST SMALLPOX Age at date of vaccination or re-vaccination Vaccinated Re-vaccinated Under 1 year 6 - 1 year 978 4 2-4 years 265 151 5-15 years 97 862 Total all ages 1,346 1,017 WHOOPING COUGH IMMUNISATION Year of Birth Primary Immunisation Children who received a booster dose 1970 24 - 1969 1,258 48 1968 333 381 1967 39 104 1963-66 31 297 Others under age 16 1 22 Total all ages 1,686 852 DIPHTHERIA IMMUNISATION Year of Birth Primary Immunisation Children who received a booster dose 1970 24 - 1969 1,258 49 1968 334 388 1967 40 124 1963-66 131 1,903 Others under age 16 28 138 Total all ages 1,815 2,602 TETANUS IMMUNISATION Year of Birth Primary Immunisation Children who received a booster dose 1970 24 - 1969 1,258 49 1968 334 391 1967 40 128 1963-66 150 1,933 Others under age 16 320 671 Total all ages 2,126 3,172 47 POLIOMYELITIS VACCINATION Year of Birth Primary Immunisation Children who received a booster dose 1970 24 - 1969 1,159 51 1968 442 378 1967 55 106 1963-66 160 1,880 Others under age 16 46 381 Total all ages 1,886 2,796 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 1970, 1,664 children were given B.C.G. vaccine, an increase of 403 over 1969. 100 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. This is a marked increase in the number of acceptances of this vaccination and can be attributed to the use of a new technique of injecting by a jet of air on the skin instead of by needle. In addition 274 contacts of tuberculosis were vaccinated by the Chest Physician. RUBELLA VACCINATION Year of Birth No. Vaccinated 1963 - 66 1 Others under Age 16 140 Total all ages l4l Late in 1970 the Department commenced its programme to immunise girls aged 11 to 14 years against rubella. In order to obtain a maximum acceptance the Health Education Officer and her staff took part in a series of talks and discussions with the older children in this age group. By the end of the year l4l girls had been immunised. This programme of immunisation of girls should, in the years ahead, lead to a declining incidence of children handicapped by the rubella syndrome which includes defects of hearing and vision and also defects of the heart. 48 FAMILY PLANNING SERVICE The Family Planning Association continued to provide services at our clinics and an additional centre was opened at Ford Road Clinic in April 1970. The following sessions are now held in the Borough Annie Prendergast Clinic - Wednesday, 6.30 p.m. - 8.00 p.m. Central Clinic - Monday, 7.00 p.m. - 8.30 p.m. Five Elms Clinic - Tuesday, 7.00 p.m. - 8.30 p.m. Five Elms Road. Ford Road Clinic - Monday, 7.00 p.m. - 8.30 p.m. Thames View Clinic - 4th Tuesday in the Month 2.30 p.m. - 4.00 p.m. In addition the domiciliary family planning service continued, for those special cases where more intensive care is required. 49 PREVENTION OF ILLNESS. CARE AND AFTER-CARE 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 1970 No. of Cases Referred by Geriatric Consultants on discharge from hospital 213 Referred by General Practitioners 14 Referred by Consultant Physicians on discharge from hospital 129 Miscellaneous Referrals 390 Revisits to cases 709 Total visits made 1,455 Geriatric Clinic - Porters Avenue Clinic The number of attendances of our geriatric courses in 1970 were 44. 37 clients asked for a medical examination but since 2 were already under hospital investigation, only 35 were examined. Their ages ranged from 63 to 73 years. Marital State of those examined Female Male Married and living with spouse 18 8 Widow or widower living alone 7 1 Widow or widower living with relations 1 0 26 9 Medical History 13 patients had been attending their General Practitioners regularly. 9 had not consulted their General Practitioner for more than a year. This group is really interesting since they underline the 'raison d'etre' of the clinic. Only 1 was really healthy and in good condition. Another 2 could be considered fairly well if one disregarded their gross obesity, one 20% and the other 35% overweight. The latter patient also had very bad varicose veins which were the reason for consulting her General Practitioner one year ago. The remaining 6 patients were hypertensive, 4 severely so. One with a B.P. of 210/105 and with hypertensive heart disease; another with a B.P. of 210/70 and with complete heart block; the third one with a B.P. of 230/40 and with hypertensive cerebral symptoms; and the fourth with a B.P. of 205/100, grossly obese (50%) and, had hypertensive heart disease 50 Obesity: 27 Gross Moderate Mild Underweight (Over 20%) (10% - 20%) (under 10%) 15 4 8 3 Hypertension: 15 patients exhibited symptoms 3 seemed to be reasonably well controlled. 7 showed hypertensive heart disease. Other heart conditions: 2 seemed to have ischaemic heart disease, 1 was ? Aortic insufficiency and 1 was in cardiac insufficiency with arrhythmia. Lungs: No one seemed to suffer from any severe lung condition. Locomotor Disabilities: 6 patients were suffering from severe and 3 from a mild form of arthritis. 5 had very deformed feet. 1 had an operation for Hallux Valgus. 1 male had a mild form of Dupuytran contraction. Deafness: 5 patients were very deaf. Only 2 had properly working hearing aids. 1 refused to wear an aid and 1 was referred to hospital as in need of a hearing aid, 6 showed moderate deafness but felt that they managed very well without help. Anaemia: Of the 35 blood samples taken only 1 showed a mild degree of anaemia. Vision: No one had intact vision, they all had to wear glasses. There were 3 suffering from cataracts, 1 from glaucoma and another had been blind in one eye since infancy. 2 were found to have unusual eye diseases and were under investigation at Moorfields Hospital. Miscellaneous conditions: 2 elderly males had inguinal hernias and had been wearing trusses for years. They were in rather good condition so it was not quite clear why they did not have the operation in the first place. Only 3 patients gave the indication of having suffered or were suffering from anxiety neurosis and depression. NATIONAL ASSISTANCE ACT. 1948 Section 47 For the first time since 1966 it became necessary to secure the removal to hospital of a patient, age 89 years, not receiving adequate care and attention at home and not being able to care for herself, who could not be persuaded to enter hospital voluntarily. She was admitted to St. Georges Hospital, Hornchurch, and after receiving treatment was transferred to "The Willows" where she has since remained as a voluntary patient. 51 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. 2297 articles were loaned during the year and 3530 items were out on loan at the year's end. In addition, non-returnable items for incontinent patients were supplied in considerable quantity. 37,000 disposable incontinence pads were issued and 69 patients were supplied with waterproof pants or knickers with disposable linings. Ripple beds were also loaned through hiring arrangements with manufacturers; this being the most economical way of obtaining these items in view of their high cost and maintenance charges. 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 appointment is satisfactory. During the year 1045 health questionnaires were submitted for scruitiny. 635 candidates were approved without further enquiry and 38 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 512 No. of persons found to be unfit 4l No. of persons accepted conditionally 50 No. of persons examined in connection with sickness payments 64 No. of persons examined for other authorities 3 No. of persons examined by other authorities 17 No. of Chest x-rays arranged in connection with medical examinations 376 In addition 80 students were medically examined in connection with entry to teacher training colleges, and a further 86 who had completed their course of training at the Barking Regional College were re-examined prior to entry to the teaching profession. CONVALESCENCE Arrangements were made for 24 persons recommended a recuperative holiday by general practitioners or medical officers to go sway for a period, usually of two weeks. 52 HOME HELP SERVICE (1) General As a result of my recommendation of 28th October, 1969 towards a variation in the establishment of the Home Help Service and following consideration by Domiciliary and Nursing Sub-Committee on 12th May 1970, and Establishment Committee on 29th June, 1970, approval was given to dispense with the two posts of Assistant Organiser, to increase the number of Organisers and Clerks to three. As a result of this decision it was possible to effect re-organisation of the service within the Borough on a three area basis from October. The effect of this re-organisation was not too apparent in the remaining two months of the year, but I am satisfied that this will give rise to a better return in routine visiting by Organiser's and a resultant supervision of service provided. (2) Case Loads (a) Fluctuation from month to month continued, and throughout the year the following cases were served:- Aged over 65 years 1906 Chronic Sick 241 Mentally Disordered 6 Maternity 15 Others 23 2191* *This figure shows an increase of 204 over the previous year. Requests received during the year 1091 Cases not proceeded to during the year (for varying reasons) 248 (b) To assess the needs of new requests and to "follow up" and supervise existing cases, organising staff visited as follows:- Investigation visits 1237 Routine visits 3548 Others 601 5386* *of this figure 767 were "non effective" Total effective visits 4619 (c) Night Attendance provided for one case only. (3) Recruitment of Labour Although the number of Home Helps was increased by 17, it was again necessary to restrict the recruitment of labour having regard to need for overall economy. 53 Wastage and replacement for the year was as follows:- Terminations of employment (for varying reasons) 78 Commencement of employment 95 At the close of the year the labour force stood at 249 (4) Training Due to financial restriction and the demand for service, no training courses for Home Help's were sanctioned. (5) Social Activities The monthly meeting of the Social Club continued to be held, but, unfortunately, with a diminishing attendance, and the value thereof is questionable. The only event which can be looked upon as a success was a Christmas Party held on Wednesday 2nd December, at which we were pleased to welcome the Mayor and members of Domiciliary and Nursing Sub-Committee. 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 two homes were adapted - a private house and a Greater London Council house. In the latter case the patient had not been discharged from hospital by the year's end. Another patient whose home was adapted in 1968 died in hospital during the year. Three patients were having treatment in their own homes at the end of the year. REHOUSING ON MEDICAL GROUNDS As in previous years my Department has continued to act as adviser 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 316 Number recommended for rehousing 110 54 VENEREAL DISEASE Contact Tracing This Borough being conveniently situated for travel to Central London, has patients attending special clinics at most of the major London Hospitals as well as the local centre at Oldchurch Hospital. The Deputy Superintendent Health Visitor is the designated person that special clinics can approach regarding contact tracing in the Borough but requests for assistance are rare. It is understood that in most instances the staff employed by the Hospital Service can cope with the work involved without additional assistance from this authority. Health Education The risk to health of sexually transmitted disease is included as a subject by the Health Education Section in their general health education syllabus for schools, and in talks to adult groups that request it. TUBERCULOSIS I am indebted to Dr. F. Macken, Consultant Chest Physician, for the following report:- Since the opening of Barking Hospital we have had two centres running in the Borough. One in the Out-patients' Department at Barking Hospital and the other in the old Five Elms Clinic:- Five Elms Clinic Number of sessions 311 New patients 2,031 Total attendances 6,348 Barking Hospital Number of sessions 208 New patients 1,082 Total attendances 2,941 Totals Total number of sessions 519 Total new patients 31113 Total attendances 9,289 Infections Fresh cases of tuberculosis 60 Total notifications, including transfers into the area 73 55 On the 1st October 1970 our Clinic Health Visitors were removed from Five Elms and since this time we have been dependent on the co-operation of the area Health Visitors, according to the addresses of our patients. With 3 Clinic Nurses and with the aid of the Health Visitors we find contact tracing and case finding is satisfactory. Tuberculosis continues to be a problem which cannot be ignored, although chronic bronchitis and carcinoma of lung account for most of our deaths. It is a pity that the Government is so mealy-mouthed in the anti-Smoking campaign. The figures for carcinoma cases run alarmingly parallel with our tuberculosis notification figures and we continue to use Dagenham Hospital for the nursing of those cases which become unmanageable at home, which is most valuable. 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 2 - - - - 3 - - - - 5 - - 5 - - 3 1 9 - - - - 15 - 12 9 - - 3 3 27 - - - — 45 - 9 2 - - 1 2 14 5 2 - - 65 & upwards 4 3 — — - - 7 4 - - - Totals 26 21 - - 7 6 60 9 2 - - Transferred Cases Into Borough Out of Borough Net Increase 13 13 nil Tuberculosis Visiting No. of cases No. of Households No. of Home on Register Involved Visits made 453 401 876 Free Milk On the recommendation of a Chest Physician additional supplies of milk are made available to patients suffering from tuberculosis, and 43 patients were so assisted during the year. 56 MASS X-RAY SERVICE Unit 6A of the service visited several factories and the Thames View Estate during the year and I have received the following report from the Medical Director:- BARKING Location Male Female Total Thames Ply Ltd. 151 ^5 196 Remploy 192 48 240 Thames View Estate 175 269 444 Lyons Maid 149 85 234 Wm. Warne Ltd. 545 166 711 Total Number X-rayed 1,212 613 1,825 Requiring further investigation 12 13 25 Groups attending General public 179 269 448 Organised groups 1,033 344 1,377 Pulmonary Tuberculosis Requiring close clinic supervision 1 - 1 Requiring occasional clinic supervision 3 - 3 Presumed healed, discharged 1 5 6 Group in which significant tuberculosis was discovered:- Requiring close clinic supervision- organised groups 1 - 1 Among other abnormalities discovered were:- Non malignant tumour - 1 1 Congenital abnormalities of the heart and vascular system 1 - 1 Pneumoconiosis (including 2 asbestosis) 2 1 3 Bacterial and virus infection of lung - 1 1 Bronchiec tasis 1 - 1 Pulmonary fibrosis (not TB or industrial) 1 1 2 Other abnormalities 1 2 3 Did not attend for further investigation 1 1 2 Did not attend for repeat miniature film 1 - 1 DAGENHAM Location Samuel Williams Ltd, 507 76 583 Staffords Bakery 121 180 301 Total number x-rayed 628 256 884 57 Male Female Total Requiring further investigation 5 5 Pulmonary tuberculosis Requiring immediate treatment 1 1 Requiring occasional clinic supervision 1 1 Among other abnormalities discovered were:- Bacterial and virus infection of lung 1 1 Pulmonary Fibrosis (not TB or industrial) 1 1 Other abnormalities 1 1 58 CHIROPODY SERVICE 1970 was another difficult year for the Chiropody Service. Mrs. Morgan the domiciliary chiropodist who resigned in 1969 could not be replaced despite numerous advertisements, and Mr. Fenton, who for many years had looked after the feet of residents in the Council's Old People's homes resigned in June and again no replacement could be found. The existing staff undertook additional sessions to keep the service going but the old folk were required to wait longer than is desirable between treatments. Notwithstanding the difficulties 21,566 treatments were provided compared with 20,378 in 1969. TREATMENTS FOR THE YEAR 1970 CLINIC Children Adults Total Sessions -5yrs. 5-lbyrs. O.A.P. Others A/N P/H Central 110 1,617 64 — 10 1,805 359 Julia Engwell 2 25 2,410 - - 29 2,466 438 Porters Avenue - 22 2,773 3 2 3 2,803 464 Greatfields 1 6 2,168 - - - 2,175 360 Thames View 2 23 555 - - - 580 90 Ford Road 3 71 2,608 - - 67 2,749 490 Annie Prendergast 7 18 2,752 2 2 150 2,931 484 Oxlow Lane 29 21 2,779 4 — 2 2,835 429 Total 48 296 17,662 73 4 261 18,344 3, ll4 OLD PEOPLE'S HOMES Greys Court — - 63 - - - 63 10 Mayesbrook - - 137 - - - 137 18 The Lawns - - 133 - - - 133 17 Saywood Lodge - - 125 - - - 125 16 Riverside - - 124 - - - 124 16 Total - - 582 - - - 582 77 Domiciliary West - - 1,196 - - - 1,196 298 East - - 1,384 - - - 1,384 346 Louise Graham House - - - - 60 60 10 .Grand Total 48 296 20,824 7? 4 ?21 21,566 3.845 59 MENTAL HEALTH SERVICE Castle School An important event in the service this year was the completion and opening of The Castle School and Training Centre new premises in Goresbrook Road, Dagenham, in June. After many years of "make do and mend" in the old Castle School, the new environment was a delight to both staff and children. The usual outings and visits of observation were made during the year and in May a very enjoyable holiday at Pontins Holiday Camp at Camber Sands, was had by 20 children in the care of 8 staff. At the end of the year 75 children were on roll, including 11 needing special care. attendances were made during the year. Education of Mentally Handicapped Children The Education (Handicapped Children) Act, 1970 received the Royal Assent on 23rd July 1970. It made provision for the Secretary of State for Education and Science to appoint a day from which Section 57 of the Education Act, 1944 would be repealed, severely mentally handicapped children would no longer be classified as "unsuitable for education at school", and local health authorities would cease to have power to provide training for such children. Staff of local health authorities engaged in training these children would transfer to the Education Service, together with the appropriate premises, etc. Education authorities were requested to send their proposals for establishing special schools to the Department of Education and Science and the designation of the newly built Castle School as a Special School for Educationally Sub-normal Children was formally approved as from the Appointed Day (1st April, 1971)* Responsibility for the health of the children will remain within the Health Department, but will become the responsibility of the School Health Service instead of the Mental Health Service. In fact the same medical officer who has the responsibility for the day to day invigilation of the children at Castle Training Centre will be the School Medical Officer for Castle Special School. Close co-operation and planning between the Health and Education Departments will be essential to ensure the smooth transfer of functions from one Department to the other so that the interests of the children are in no way impaired. 60 HOLIDAY PLAY CENTRE A Holiday Play Centre for our sub-normal trainees was again held this year at Castle School from Monday to Friday for the two weeks, 17th - 28th August, 1970- As the Centre was held in the new Castle School building with better facilities and we were able to recruit several of the staff who assisted in 1969, it was decided to include the younger more severely handicapped children who had not been invited in previous years. The Centre was attended by 58 trainees - adults and children the largest number ever, but was nevertheless successful due to the energies of the staff recruited. The majority of the staff were student teachers who found that helping to run the Centre was not only stimulating but provided them with valuable experience. OSBORNE WORKSHOP The installation of the time improvement to the running of the routine, the signal for meals and improvement in work programmes. clock and buzzer has made a great Centre. The clocking in and out tea-breaks, has led to a marked Work from outside contractors has been delivered and collected each morning during peak periods, leading to as much as six different jobs being assembled at once. The four fly presses have been in operation continuously. The trainees handling these press jobs well. Counting of stock has been by weight control and in some cases they have handled this side of the work as well. However, the amount of stock carried in the workshop has led to problems with less amount of working space, incoming and outgoing work requiring separation, unsold completed work needing storing space also. Our work from outside sources only fell off in the late summer and winter period, but at this time we were able to switch over to sales of work material and this has enabled us to continue a high level of payment. To date we have handled seven different press jobs and twelve assembly jobs. A new contract recently has been for 800 plastic disposable aprons weekly. The plastic is delivered in ½ cwt. rolls. The cutting, stapling, punching and bundling into packets of 100 pieces has provided satisfactory work for the higher grade trainees. Two more trainees have been placed in open employment. Only one from the eight employed has returned. The fortnightly social evening has progressed slowly with poor parent attendance, but the trainees have taken full advantage of the Club and really enjoy themselves. Raffles, dancing and bingo being the main attraction. 61 Wages to trainees have moved up since some new prices were negotiated with the companies, and a system of holiday payments has now been introduced. In the Spring 1970 trainees were taken on a very successful week's holiday at the Gunton Hall Holiday Camp near Lowestoft. At the end of the year 25 trainees were on roll and 4,669 attendances had been made during the year. Shortage of Hospital Facilities for the Mentally HandicappedO wing to overcrowding and staff shortages at South Ockendon Hospital the Secretary of State closed the Hospital for admissions and extreme difficulty was experienced during the year in containing certain difficult cases in the community. After fruitless negotiations with the North East Metropolitan Regional Hospital Board a deputation of Members and Officers waited upon the Secretary of State who promised to look into the matter and a scheme was evolved for additional facilities to be made available at Barking Hospital to relieve pressure on South Ockendon Hospital. Louise Graham House This newly built establishment provided a home for 21 mentally handicapped persons during the year and also offered short term care to cover emergency situations in the homes of other cases. Some difficulty was experienced as the building is in the Gascoigne Re-development Area and demolitions were going ahead all around it. Dust, dirt and noise made demands on the patience and good humour of the staff as well as the extra work in keeping the premises to a good standard of cleanliness. Porters Avenue Day Centre During the year the Day Centre continued its work with the mentally ill members of the community. This work keeps many of its members out of hospital, and at the same time gives relief to families in the community. In February the Centre's Occupational Therapist commenced maternity leave and this reduced all attendance to part-time only. This situation continued for six weeks and regrettably some difficulties were experienced both by mentally ill members and their families until the services of a locum occupational therapist were obtained. In July optimal attendance figures were seriously exceeded, and this resulted in a lengthy waiting list. During August the 62 Centre's Occupational Therapist returned to take up her duties and the locum left to become Supervisor in another Day Centre. The waiting list did not decrease until November/December. The major problem experienced within the Centre during the year has been the difficulty of having to cope with several different types of mentally ill patients at the same time. Referrals fall into four groupings:- 1. Adolescents 2. Adult neurotics 3. Adult psychotics 4. Elderly mentally infirm Facilities and staffing have proved inadequate when tackling this problem. It appears that in many cases this problem reflects the lack of preventative measures available to the community in the past. This applies particularly to groups 1 and 2 above. The proposed annexe to the Day Centre will help resolve its internal management problem where these groupings are concerned. During the year the need of a hostel or similar accommodation for the mentally ill has become apparent. Looking ahead, at least one third of Centre members will have the need in the event of loss of parent(s) or spouse. Centre Report In October 1970 Centre staff completed a report covering the previous two and a half years of Centre activity. This report contained statistics, information, and recommendations useful for future policy. Visiting Groups The Centre was visited again in February by students and lecturers from the Chiswick Polytechnic. The function and aim of the Centre was described by Centre staff, questions were dealt with, and afterwards the visitors freely intermingled with all centre members. The centre is also visited from time to time by social workers and students from Warley Hospital. Holiday for Centre Members Centre members who had not been on holiday for many years spent one week at Westgate-on-Sea, Kent. The holiday was organised by the Dagenham Association for Mental Health in conjunction with the Borough's Health Department. One member of the Day Centre staff participated alongside voluntary workers from the Association. This was a pilot scheme and proved very successful. A family consisting of husband, wife and two children took part. Outings Five outings were arranged for members through the year. One day trip to the seaside, two London theatre performances, a barge sailing trip into the North Sea, and one country coach tour. 63 Town Show Centre members designed and made the Dagenham Association for Mental Health Town Show exhibit. This exhibit was awarded a diploma. Remuneration for the work is made over by the Association to the Day Centre. Jumble Sales Two jumble sales were organised at the Centre to augment the Amenities Fund. This fund helps finance social activities (e.g. teas, ice creams, beach expenses, etc.) during outings. Xmas Party The Centre had a well attended Christmas Party, and this was the occasion for the first visit of the Director of Social Services. Gifts, and speeches by Centre members were the order of the day. There was a large Christmas tree, the hall was decorated and a discotheque provided the music. 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 pre-school play group for the children of mentally ill parents which operates 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 has a holiday bungalow at Clacton for self-catering holidays for the families of the sub-normal. 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. The club had to be closed in May 1969 owing to an acute shortage of Mental Health Social Workers, and was re-commenced in January 1970 when the staffing position had improved. 64 WORK OF THE MENTAL WELFARE OFFICERS During the year 412 patients were referred to the Mental Health Service. Referred by Mentally 111 requiring Mentally Handicapped Community Care Services Assessment/ Social Reports re Hospital Admission Investigation passed to other agencies Community Care Services General Practitioners 40 53 16 2 Hospitals on discharge 74 6 1 3 Hospitals after or during out-patient or day treatment. 38 13 2 2 Local Education Authority 1 - - 28 Police and Courts 1 6 2 1 Other sources, e.g. neighbours, relatives. Ministry of Social Security and other social and welfare agencies, inward transfers from other areas. 73 12 26 12 TOTALS 227 90 47 48 Mentally Mentally ill Sub-Normal Number of Persons receiving community care at the end of the year 217 395 Number of persons attending day centres 39 217 Number receiving residential care 8 42 Number of admissions for temporary residential care to relieve the family 4 33 During the year the following admissions to mental hospital were dealt with by the department:- Informal 40 Compulsory 64 Via Court 4 65 Adult Training Centre The Adult Training Centre has continued during the year in its task of providing training in important areas of social life to enable those attending the Centre to play a useful part in their homes and to learn simple tasks within their capabilities which not only provides useful occupation but also produces a small "wage packet" each week. In May 1970 73 Trainees were taken to Cliftonville accompanied by 16 staff for a weeks holiday in a group of hotels run by the Surrey Road Hoteliers Association, This was a new venture, in previous years the group had gone to a holiday camp at St. Mary's Bay and the change of venue was appreciated. The usual outings were made to places of interest and Trainees made visits of observation to industrial undertakings as part of their training programme. During 1970, 19t864 attendances were made at the Centre and 109 Trainees were on roll at the end of the year. ResidentialAccommodation The Maisonettes in Blake Avenue, Barking and Terling Road, Dagenham providing places for the rehabilitation of patients discharged from hospital after mental illness continued to be occupied during the year under the supervision of the Mental Welfare Officers. This form of provision is proving a useful form of sheltered accommodation for patients who require support and assistance to live within the community but do not require in-patient hospital care. 66 SCHOOL HEALTH SERVICE There are 63 primary schools in the Borough. In September 1970, the Local Education Authority brought into effect plans for comprehensive secondary education. The number of secondary schools was reduced from 23 to 12 comprehensive units. Most schools still occupied a number of separate premises which did not make any easier the task of administering the School Health Service. 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. A unit for partially hearing pupils is established at Eastbury Infant's School. At the end of the year, numbers on roll were as follows:- Primary schools 16,493 Secondary schools .. •• 11,368 Special schools 300 Total 28,l6l 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. 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 total of 1,487 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 1,917 Number of re-inspections 1,703 3,620 67 Periodic Inspections Age Groups Inspected (by year of birth) No. of Pupils Inspected 1966 and later 157 1965 1,167 1964 952 1963 149 1962 85 1961 75 1960 629 1959 1,636 1958 687 1957 61 1956 168 1955 and earlier 386 6,152 Pupils found not to warrant medical inspection 845 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 1966 and later 1 7 8 1965 13 86 85 1964 18 48 61 1963 2 7 8 1962 — - - 1961 2 5 7 1960 38 118 136 1959 74 182 228 1958 26 56 75 1957 1 3 3 1956 2 9 10 1955 and earlier 22 30 49 Total 199 551 670 General Condition of Children Out of 6,152 pupils examined, only three were considered to be of unsatisfactory general condition. INFESTATION WITH VERMIN During the year 16,037 pupils were examined, and 177 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. 68 DEFECTS FOUND BY MEDICAL INSPECTION Defect or Disease Periodic Inspections Special Inspections Treatment Observation Treatment Observation Skin 183 179 75 88 Eyes: (a) vision 196 497 95 114 (b) squint 20 34 4 4 (c) other 10 28 5 2 Ears: (a) hearing 13 177 49 172 (b) otitis media 12 50 8 2 (c) other 9 28 4 3 Nose and throat 48 291 44 57 Speech 23 89 45 43 Lymphatic glands 2 3A5 - 2 Heart 10 118 3 60 Lungs 23 145 7 99 Developmental: (a) hernia 8 10 1 5 (b) other 21 121 27 113 Orthopaedic: (a) posture - 38 4 29 (b) feet 61 126 6 37 (c) other 9 59 80 164 Nervous system: (a) epilepsy 4 19 l 17 (b) other 8 65 34 78 Psychological: (a) development 7 88 17 70 (b) stability 8 174 28 126 Abdomen 5 71 2 10 Other 87 171 96 173 EMPLOYMENT OF CHILDREN 90 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 18 (b) for adenoids and chronic tonsillitis 158 (c) for other nose and throat conditions 3 Received other forms of treatment 195 69 Total number of pupils in schools who are known to have been provided with hearing aids:- (a) in 1970 11 (b) in previous years 71 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 86 (b) at school for postural defects 12 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) 24 (b) Errors of refraction (including squint) 1,191 (c) Number of pupils for whom spectacles were prescribed 644 DISEASES OF THE SKIN (excluding uncleanliness) Pupils known to have been treated Ringworm: (a) scalp - (b) body Scabies 1 Impetigo 14 Other (plantar warts, etc.) 942 957 70 SPEECH THERAPY The Speech Therapists report as follows: The work has continued as normally, with no outstanding changes. As usual, cases of articulatory defects far out number any other disorder found in the speech of this Borough's School and pre-school children. Even so, one would like to feel that eventually a special Diagnostic Unit might be available to give help, advice and referral to the more specifically speech-handicapped child that one occasionally comes across. Cases of language disorder and poor linguistic ability are slightly higher than in previous years. The Speech Therapy Service is still understaffed, two full-time Therapists coping with the work which should be carried by three Therapists. Our student-trainee Therapists are therefore invaluable to us in the service they render. There are now eight Speech Clinics operating in the Borough, as follows:- Miss Symes Five Elms Clinic Leys Annie Prendergast Marks Gate 0x1ow Lane Miss Delaforce Castle School Training Centre Julia Engwell Clinic The Bentry School SPEECH THERAPY STATISTICS Miss Symes Miss Delaforce Total no. of Treatments 1,864 1,190 Total no. of Attendances 452 656 Number of new Patients 71 95 Category of Defect: Articulatory 49 67 Language Disorder 8 10 Stammer 8 18 Disorder of Resonance 1 - Cleft Palate 3 - Other Defect 2 - Number of patients discharged during year 61 80 Reasons: Speech normal 41 32 Left district/transfer to another clinic etc. 5 4 Non-attendance, left school etC. 9 40 Discharge at Parent's request 3 4 No further progress likely 3 - Number of patients on Register at end of year 89 150 71 CHILD GUIDANCE CLINIC I am indebted to Dr. S. Fahmy, Consultant Psychiatrist for the following report:- During this year there were no changes in the administration or staffing of the Clinic even though the call on the services continued on approximately the same level as in previous years. As stated in a previous report, the staff working on the psychiatric part of the Clinic remains at one consultant (7 sessions a week) and secretarial assistance. As the number of new referrals kept a steady average of 11 - 13 per month and as the initial diagnostic assessment takes anything from 4-8 hours of clinical work, one had to choose between (a) making assessments and refraining from under-taking any intensive or regular treatment or (b) taking on treatment cases that could be managed by one therapist and allowing an everlengthening waiting list. Since both alternatives appeared unsatisfactory, the compromise actually taken left much to be desired, particularly with regard to the treatable responsive cases who could not be taken on and also for the number of crisis situations that could have been materially helped if seen on demand. This situation, though marginally allayed by the ready co-operation and help offered by educational psychologists and remedial teachers, would not be expected to improve until the required auxiliary staff (2 experienced social workers and a child psychotherapist) are found and encouraged to work in this Clinic. The attached tables covering the four quarters of the year indicate the current call on the psychiatric services. The total number of adolescents referred is levelling with 5-12 year referrals. Unfortunately the majority of the former are referred for anti-social behaviour that has reached the Courts or else on account of school refusal. In both cases the nature and circumstances of first contacts undermine any therapeutic endeavour that could be theoretically exploited, given a different set up i.e. more therapists and workers. Hence, the services were confined to advice, support and consultations offered to different agents and authorities. In this respect credit is owed to the devoted work of social workers who, despite their case load, have seldom rejected requests for help for these distressed and distressing children and their families. In view of this demand, the psychiatrist's time in the Clinic and the absence of staff to whom some work could be delegated, a number of projects and work with institutions e.g. schools, nurseries, play groups etc., had to be postponed for the time being. Needless to add, that in addition to the cases actually referred, a much greater number of children and families are in distress and do not receive much help because they do not disturb others around them (or else because of the passivity or insensitivity of the environment). However, these "silent" disturbances frequently erupt in adolescence or later. This is an area of prophylactic psychiatry which can hardly be approached before improvement of staff shortage. 72 This report has concentrated on the clinical (therapeutic and prophylactic) work that has actually been undertaken with a stress on the needs that have not been met. In other respects i.e. the provisions and co-operation of educational psychologists, remedial teachers, secretarial assistance, it has been gratifying to see ever ready co-operation. Were it not for the willing, conscientious hard work of the senior secretary, the working of the Clinic would not have been as smooth as it has actually been. CHILD GUIDANCE SERVICE Statistics 1970 Quarter Ended (a) Cases on the books at end of quarter. 31.3.70 30.6.70 30.9.70 31.12.70 (i) Waiting first Appointment. 47 46 47 48 (ii) Seen at regular intervals. 19 31 33 32 (iii) Others seen for re-assessment or surveillance 119 102 101 95 TOTAL 185 179 181 175 (iv) Cases included in (iii) but will not been seen again unless requested. 28 19 18 17 (b) Cases referred during quarter. B G B G B G B G Under 5 yrs. 1 1 - 3 1 1 3 - 5-12 yrs. 9 4 18 2 12 3 13 7 12 - 18 yrs. 13 11 6 3 11 5 12 3 TOTAL 23 16 24 8 24 9 28 10 (c) Cases closed,during quarter. (i) Treatment complete and case closed 12 25 21 27 (ii) Other treatment cases closed 4 6 2 4 (iii) Cases closed no treatment received. 6 7 8 13 TOTAL 22 38 31 44 (d) Treatment carried out during quarter and cases awaiting treatment. (i) By Psychiatrist. Individuals seen. 91 100 120 115 Interviews. 153 167 135 153 Appointments offered and not kept. 53 39 47 47 (ii) By Educational Psychologists. Individuals seen. 64 73 46 47 Interviews. 99 96 63 63 Appointments offered and not kept. 17 20 12 8 73 HANDICAPPED CHILDREN FAIRCROSS SCHOOL Mr. Holdsworth the Headmaster reports as follows "We celebrated our 4th Birthday with a party in January. The entire festivities were organised by the prefects, head boy and head girl. Class 3 were entirely responsible for refreshments, and they provided a first class buffet meal. The Infants' Party was the responsibility of Class 2 and a very happy time was spent by all. In the year academic progress has been good. The C.S.E., results are very gratifying, as are the R.S.A. Grades I & II, and the passes gained in the I.P.S., Typewriting Examinations pay tribute to the hard work of the children and staff. Despite a long period of absence due to industrial action by bus drivers, these results are very gratifying indeed. This past year we have suffered several break-ins and much damage ensued and loss incurred. It has been arranged by kind permission of Mr. Ager, Principal, Rush Green College, that the more able children will be able to attend the College on a part-time basis, to undertake courses of study which we are unable to offer here. A very successful School Journey lasting 8 days was undertaken to Swanage, Dorset. This was organised and led by Mr. R. D. Norman, Deputy Headmaster. Mrs. L. Maybanks, Welfare Assistant for the past 26 years retired on the 10th July. A real friend of the children and staff, she will be truly missed. We wish her a long and happy retirement. The year closed with the customary Christmas activities. Visits to other Schools' concerts, a film show and Carol Service, to which we invited the senior citizens of the Borough." 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:- "1970 was a very enjoyable year as far as the Physiotherapy Department was concerned. We had 37 children listed for regular treatment, each child to attend two or three times a week, and we grouped them as in the following table DEFECT No. of Children REMARKS Boys Girls (a) Spina Bifida 2 5 All have Hydrocephalus 3 have two long calipers 4 have long calipers with pelvic band 1 walks without sticks 1 walks with a rolator 4 walk with dumpers 1 walks with Canadian crutches 74 DEFECT No. of Children REMARKS Boys Girls (b) Cerebral Palsy 6 3 6 walk without aid 2 walk with rolators 1 walks with walking frame (c) Hemiplegia 6 - - (d) Asthma 3 5 3 have frequent severe asthma attacks 5 have moderately severe to mild asthma (e) Muscular Dystrophy 2 2 All confined to wheel chai (f) Congenital dislocation of hip 1 (g) Cystic Fibrosis 1 (h) Perthes Disease 1 - - In the Department we have got one full-time and one part-time physiotherapist. In May we were very lucky to get an ancillary helper, Mrs, Daniels. She has proved to be of great help both in the Department and in the Hydro-therapy pool. In June we were approached by the Enfield College of Technology on whether or not we needed any mechanical aids for the children. This was to be the diploma work for one of their students. We had some very interesting discussions deciding how a suitable walking frame for spastics could best be designed. A few weeks before Christmas the walking frame was handed over and it seemed to do exactly what we wanted, but of course 1971 will show how much real benefit, if any, it will give our children. The co-operation with the hospital staff concerning the children has been of great value also in 1970. During 1970 our Physiotherapy Department was extended and we now have a small ante-room. This has been in constant use for postural drainage treatment, rest for children after epileptic fits etc. Our Department is adequately equipped. My sincere thanks to the school and to the administrative staff for the co-operation they have given me in 1970." 75 BENTRY SCHOOL I have received the following report from Mr. Hurton the Headmaster:- "At present there are 205 children on the school roll. Of these thirteen receive Speech Therapy, whilst ten children suffer from hearing loss and come under the care of Mrs. Savage, peripatetic teacher of the deaf, who visits the school every Thursday afternoon. In addition we have seven children under sedation, two cerebral palsy children and four who are slightly physically handicapped. There are also eight children whose vision is impaired and who wear glasses for their school work. However, the largest group of dual defect children in the school are those with behaviour difficulties so severe as to be classified as maladjusted. These facts underline the acute need for an Educational Psychologist to spend one session per week at the school. The Summer Term was most successful and the school took part in the Dance, Music, Speech and Drama Sections of the Barking Schools Festivals with conspicuous success. The School Sports were a great success and many parents attended. The "Open Evening" was attended by many parents and their obvious goodwill towards the school is much appreciated by the Staff and myself. Of the twenty children who left during the year, two were transferred to Comprehensive Schools, two to Training Centres, and the remainder were recommended for "Open Employment" and have been successful in obtaining jobs in the locality. This December, the School Pantomime was "Aladdin" and ran for three evenings. It was well supported by parents and friends of the school." 76 HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS - IJfO Blind Part Sighted Deaf Part Hearing Physically Handicapped Delicate Maladjustec Educationally Sub-normal Epileptic Speech Defect Total Number of children newly assessed in the year . 2 3 10 5 19 1 1 41 Number of children placed in Special Schools in year 2 1 - 2 4 9 5 19 2 1 45 Number of children requiring places in Special Schools - - - - 1 5 4 12 1 - 23 Number of children included above whose parents had refused consent to their admission - - - - - 1 - - - - 1 Number of children on Registers of Special Schools at 21at January 1971 6 15 - 22 57 67 27 218 4 1 417 Number of children receiving tuition at home or in hospital, etc. - - - - - - - - - - - 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 30 babies:- Central Nervous System Anencephalus 1 Hydrocephalus 2 Spina bifida 4 Eye and Ear Accessory auricle 2 Alimentary System Cleft Lip 1 Cleft palate 1 Rectal and Anal Atresia and Stenosis 1 Urino-genital System Hypospadias, epispadias 1 Limbs Polydactyly 2 Syndactyly 1 Talipes 8 Unspecified limb malformations 1 Other Systems Other unspecified malformations of muscles skin and fascia 1 Pigmented naevus 2 Exomphalos Omphalocele 1 excluding umbilical hernia Other Malformations Down's syndrome (mongolism) 3 Other syndromes specified due to chromosomal abnormality 1 78 DENTALS E R V I C E S I am indebted to the Principal Dental Officer for the following report:- SCHOOL DENTAL SERVICE The School Dental Service was able during 1970 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 1970 was 83% compared with 79% 1969. The number of courses of treatment commenced in 1970 was 5,024 and the number of these completed was 3,953, this gives a completion rate of 78% compared with 67% in 1969. CONSERVATION AND ORTHODONTIC TREATMENT There were 6,429 fillings in permanent teeth and 3,931 in deciduous teeth, a total of 10,360. The amount of orthodontic treatment carried out during the year was very satisfactory, 49 new cases were commenced and 34 completed; eight children were referred to the Dental Consultant at Whipps Cross Hospital. DENTAL HEALTH EDUCATION Dental Hygiene kits were distributed to all new school entrants in 1970, this experiment was most successful. I would like to thank all the teaching staff in Infant Schools for their co-operation, the Nursing Staff and Health Visitors have also helped in this field of dental work during the year 1970. STAFFING We began the year 1970 with a full staff. However, as the year progressed we had casualties. One full time dental officer became ill in July and was retired on medical grounds in December 1970. Another full time dental officer was incapacitated for three months due to a broken wrist and was also retired in December 1970. I would like to once again thank the dental staff for their hard work in 1970 with special mention of the increased number of school inspections. MATERNITY AND CHILD WELFARE DENTAL SERVICES Treatment was available at all dental clinics for expectant and nursing mothers and children under five years old. In the year 1970 the figures have been increased. During 1969 the number of pre-school children inspected was 417 and in 1970 it was 625. The number of courses of treatment completed in these years were 275 and 347 respectively. The number of fillings increased by 248 over the 1969 figure. GENERAL COMMENTS The year 1970 was the most successful year we have had from a dental point of view. I wish to thank head-teachers, teachers in schools, medical and dental staff in clinics and the administrative staff in the School Health Section of the Civic Centre for their co-operation and help. 79 80 DENTAL SERVICE STATISTICS Sessions (½ days) worked 1. Sessions devoted to inspection 158 2. Sessions devoted to dental health education 74 3. Sessions devoted to treatment 2,082 4. Sessions devoted to treatment of mothers and young children 236 2,550 School Dental Inspection 5. Number of pupils first inspected at school 20,658 Number of pupils first inspected at clinic 2,137 Number of pupils found to require treatment 11,693 Number of pupils offered treatment 11,693 Number of pupils re-inspected at school or clinic 382 Number of pupils found to require treatment 239 Treatment 6. Number of pupils actually treated 4,721 7. Number of attendances made 11,638 8. Number of fillings in permanent teeth 6,429 9. Number of fillings in deciduous teeth 3,931 10. Permanent teeth extracted 599 11. Deciduous teeth extracted 2,767 12. General anasethetics given 1,352 13. Number of pupils x-rayed 207 14. Number of pupils suppiled with dentures 16 Orthodontics 15. New cases commenced 49 16. Cases remaining from previous year 141 17. Cases completed 34 18. Cases discontinued 13 19. Number of appliances fitted 60 20. Pupils referred to hospital consultant 8 MATERNITY AND CHILD WELFARE DENTAL TREATMENT Expectant and Children under Nursing Mothers 5 years Numbers of Cases 1. Number of persons examined 3 - 2. Number of persons treated 3 Treatment Provided 3. Scalings and other prophylaxis - 8 4. Fillings 5. Teeth otherwise conserved 6. Crowns and inlays - 7. Extractions 3 — 8. General anaesthetics 9. Dentures provided - 10. Patients x-rayed 81 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRICT (a) Nature and number of visits:- Rent Act ^1 Housing and Public Health Acts:- Dwelling houses 5,078 Other premises 1,252 Overcrowding and housing applications 30 Improvement Areas 326 Improvement Grants 791 Qualification Certificates 771 Multiple Occupation 107 Bakehouses. 29 Milkshops and Dairies 95 Foodshops, markets, stalls and delivery vehicles 2,l86 Cafes and Canteens 444 School Kitchens and Feeding Centres 112 Infectious Disease enquiries 3,021 Child Minders Premises 86 Number of Complaints investigated 2,728 Noise Nuisance 162 Clean Air Act:- Survey 200 Other inspections 40 Factories 520 Offices, Shops and Railway Premises Act 1,446 Tents, vans and sheds 130 Pet shops 17 Hairdressers 184 Ice Cream Premises and Vehicles 257 Houses Disinfested 94 Rodent Control 863 Other Visits 3,026 (b) Notices served:- Complied with:- Statutory 98 58 Informal 1,674 1,561 WATER The water supply still continues to be satisfactory both in quality and quantity. During the year nine bacteriological and 10 chemical samples were taken from the Company's mains in the borough. 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. 82 During the year 1,560 yards of 4" diameter main and 732 yards of 6" diameter main were laid in the borough. The General Manager and Engineer-in-Chief of the Essex Water 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." SEWERAGE AND SEWAGE 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 completion of the contract anticipated in the autumn of this year. 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 section of the borough are concentrated in the Barking Central Area. Work is progressing on the detailed design with implementation anticipated in 1972, giving relief to both surface water and soil systems and incorporating a new pumping station and outfall into the River Roding." SWIMMING BATOS There are three open air and one indoor public swimming pools in the borough. In addition there is a pool at the North East London Polytechnic Barking Precinct and four of the schools are provided with small pools. All swimming pools take their water from the mains of the Essex Water Company. Regular samples have been taken during the year and all results were satisfactory with the exception of one taken from an open air pool. The organic quality of this sample was of high standard but the bacterial impurity included Bact. coli in appreciable numbers. Investigations were carried out and another sample taken; this proved to be satisfactory. There has been no further trouble in this respect. 83 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 82. This appears to illustrate a dramatic reduction in the drive to eliminate unfit housing in the Borough. But it should be emphasised that all the large areas of unfit dwellings have now been dealt with and the remaining small pockets will be eliminated during the next three years. Work of inspection for clearance purposes has been replaced by surveys of properties for the declaration of General Improvement Areas. Improvement and Conversion Grants During the year four conversions, 30 improvement grants and 8l standard grants were approved. General Improvement Areas During the period under review the Council received a joint report of its officers in respect of two areas recommended as suitable for improvement which were subsequently declared to be General Improvement Areas. The Harrow Road General Improvement Area comprising 240 dwellings is largely privately owned with a high proportion of owner/ occupiers. There has been an increasing tendency during the past two to three years for owners to repair and improve houses in the areas and when the detailed survey of houses was carried out residents were quibk to respond. The public meeting held in a convenient local hall evinced much useful information and provided a general insight into the people's wishes. It became clear that ambitious schemes for environmental improvement would be less likely to succeed, because of isolated pockets of objection, than simple alterations to provide parking bays. One surprising aspect was the general aversion to trees in the streets expressed by a majority of residents. The Eastbury Estate Area adjoins the area described above and is a Municipal Estate built in the 1920's. Included in the area is a small terrace of 12 privately owned houses. The dwellings in general are in good repair, and such disrepair as became evident during the surveys was listed and distributed to the officers involved to be included in the price for overall improvement up to the full standard. A public meeting was well attended and tenants showed an enthusiasm for the scheme as a whole and welcomed not only the proposals for house improvement but also the provision of rear access roads and garages. 84 Show Houses Prior to the declaration of the General Improvement Area the Council repaired and improved two houses in the area and opened them as show houses for four weeks. Co-operation by the Gas Board, Electricity Board and local Furnishers produced an impressive display, while the Borough Engineer exhibited outline proposals for environmental improvements in preparation for the public meetings. The public interest generated by the exhibition indicated that the venture was a valuable addition to other means of publicising grants. Qualification Certificates - Housing Act 1969 During the year the number of applications for Qualification Certificates imposed an additional heavy burden on the housing division. Applications are of two types, (a) where the dwelling ha6 had, since the commencement of the Act, all the standard amenities, (b) where the dwelling is to be provided with some or all of the amenities after the commencement of the Act. Cases arising in the first category present little difficulty. However, in the second case, unless landlords follow the procedures laid down, they run the risk of being disqualified until the law is amended. This has been found to arise where a single amenity is missing and, in his enthusiasm, an owner has installed the fitting without obtaining a Certificate of Provisional approval, a Certificate of Fair Rent or his tenant's consent in writing. Statistics for the operation of this legislation are as follows:- (a) Standard Amenities already provided 1. Number of applications for qualification Certificates received under Section 44(1), i.e. Standard amenities already provided 414 2. Number of Qualification Certificates issued under Section 45 (2) 12 3. Number of Qualification Certificates refused 293 Number of applications pending, i.e. not yet finalised, (includes those where informal letters sent to Owner) 91 5. Number of cases where applications were unnecessary, i.e. premises decontrolled, etc 18 6. Number of cases where minor disrepair noted and informal letters sent to Owner 76 7. Number of cases where Qualification Certificates issued following an informal letter 7 85 8. Number of cases still pending 69 9. Number of cases where premises found to be lacking in respect of standard amenities . 15 10. Number of cases where applications for Qualification Certificate received under Section 44(2), i.e. Improvement cases, as a result of a combined application form being sent by Town Clerk 2 (b) Standard Amenities not wholly provided 1. Number of applications for qualification Certificates received under Section 44(2), i.e. Improvement cases 13 2. Approvals issued 12 3. Number of qualification Certificates issued under Section 46(3) NIL 4. Number of applications refused NIL 5. Number of applications withdrawn 1 6. Number of applications pending, i.e. not yet finalised 12 In conclusion, it is necessary to comment that some applications appear to have been made quite irresponsibly. The serious and extensive disrepair found in many houses indicates that owners and agents either have failed to understand the requirements for qualification or have made application without having looked at the property. Indeed, applications have been received in respect of houses where amenities are missing and even in cases where valid Certificates of Disrepair under the Rent Act, 1957 are still outstanding. This is most unsatisfactory since staffdiortages do not permit for a public health inspector's time to be wasted in this way. Housing Act. 1964 Section 19 of this Act enables a tenant to make representations to the local authority where a landlord has failed to respond to a request to provide missing amenities. This useful section has never received the publicity it deserves with the result that many tenants are not aware of the action a local authority may take on their behalf. During the year five tenants made representations to the Council and the persons having control of the houses were invited to appear to discuss the proposals. Undertakings to carry out the necessary works were given in all cases. 86 Houses in Multiple Occupation 107 visits were paid to these properties during the year. There is relatively no multiple occupation problem within this district. The houses are mainly two storey dwellings and where multiple occupation exists it is well known to the department and rarely exceeds two families to a dwelling except in a small number of hostel-type lettings. Three houses were dealt with under Section 16 "Means of Escape in Case of Fire" and compliance was achieved by informal action in two cases. The third, a proposed Guest House, was not proceeded with. Rent Act. 1957 Four 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 these four properties and four Certificates of Disrepair were issued. As in past years, advice was given to tenants and they were able to obtain the necessary forms at the Civic Centre. Tents. Vans and Sheds 130 visits have been made by my staff during the year which indicates that the problem is still very much unresolved. Since the introduction of The Caravan Sites Act, 1968 (Part II) (Commencement) Order, 1970 this Council has considered the opening, of a temporary site for 15 caravan dwellers at The Chase, Dagenham, and arrangements are being made for the site to be opened early next year. A large number of caravan dwellers occupied land recently cleared of unfit dwellings and awaiting redevelopment. All informal means of effecting their removal having failed, an application was made in the High Court, Queens Bench Division, to secure the removal of all caravans. Writs were issued and at the subsequent Hearing an Injunction was obtained restraining the defendants from remaining on the Council's land. Summonses were issued requiring the removal of the caravans which was effected within two days. Subsequently, caravans were seen to be occupying land owned by the Greater London Council who were requested to take action to secure their removal. LAUNDRY SERVICE The service continues with a once weekly collection. The helpful, co-operative attitude of the department's drivers and the laundry staff at the Goodmayes Hospital in carrying out what 87 is sometimes an unpleasant task, ensures a very satisfactory service. An average of 30 cases used the service at any one time, which shows a slight decrease on last year's figure. NOISE ABATEMENT ACT. 1960 During the year 162 visits were paid to premises as a result of complaints of noise, a reduction on last year's figure. The complaints received included noise from machinery in a Printing Press Factory, motor cycles and mopeds on vacant land, the building of a subway and from a wood cutting machine, the latter being a long standing complaint. The Public Health Inspector made a number of visits to the Printing Press Factory, many of which were made at night. A statutory notice was served and this was complied with. The noise made by motor cycles and mopeds was referred to the Police and no further trouble was experienced. Noise from building operations at the pedestrian subway involved most of those encountered at large construction sites -compressors, drills, pile-drivers and the like. Numerous visits were paid at all times of day and night and the co-operation of the contractors was readily obtained. Compressors were fitted with additional silencers, sides were carefully fixed down,drills were fitted with suitable mufflers and acoustic screens erected near pile-drivers. As a result, nuisance was reduced to an acceptable level. The complaint of noise from the wood cutting machine still exists, although the noise level has been reduced by modifications being made at the factory. It is hoped this matter will, in the very near future, be resolved. As in past years, it is the policy of the department to deal with complaints in a formal manner, although some complaints can be dealt with informally to the satisfaction of the complainant. ATMOSPHERIC POLLUTION No progress was made in respect of smoke control areas during the year. The Council once again felt that the extension of smoke control areas in the Borough must be deferred due to the continued financial crisis. The present position is as follows:- The present position is as follows:- 88 Dagenham Order No. No. of Houses Date of Operation 1 1,000 (Marks Gate) 1st September , 1959 2 3,722 (L.C.C. Estate) 1st November, 1961 3 3,230 (” ”) 1st November, 1962 4 4,56 2 ( " " ) 1st November, 1963 5 1,542 (Chadwell Heath) 1st August, 1964 6 3,046 (L.C.C. Estate) 1st November, 1964 7 2,690 (G.L.C. Estate) 1st July, 1966 Barking 1 4,558 (1,756 L.C.C.) 1st January, 1962 2 1,864 (L.C.C. Estate) 1st November, 1962 3 2,365 1st November, 1962 4 1,728 (L.C.C. Estate) 1st November, 1963 5 2,949 (Private) 1st November, 1963 6 1,421 (L.C.C. Estate) 1st November, 1964 7 1,569 1st November, 1964 8 2,446 1st November, 1964 9 589 1st July, 1966 10 1,337 (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 still continues to play its part in the general improvement. 50 smoke observations were carried out during the year resulting in only one contravention. The Council take part in the National Survey on Air Pollution and continue to take readings at the eight stations in the borough. The readings are transferred to the Ministry for their use. HAIRDRESSERS AND BARBERS A special investigation was carried out of all the registered hairdressers in the borough when they were found to be generally satisfactory. Of 91 Hairdressing Establishments, 17 gave rise to complaint in respect of the hygiene standards of the Bye-laws, but most of these contraventions were of a minor nature. In 10 cases the Proprietor's attention was drawn to matters of cleanliness and methods of sterilisation. In Ladies Hairdressers it is general practice to use special towels when tinting hair and these become quickly stained but are kept specially for this purpose. However, the ordinary towels do get stained by the various processes and these can give the customer the erroneous impression that a dirty towel is being used. I am, however, not satisfied that all the staff of these establishments are fully aware of the requirements of the Bye-laws 89 and Public Health Inspectors have pressed the Proprietors to give their staffs instruction on these matters. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 In previous years regular sampling has been carried out from premises where filling materials are made and used but this year it was discontinued. We were advised that no more testing would be carried out at the laboratories as the Department of Environment were considering the raising of the fees. As soon as we have been notified of the new fees the matter will again be dealt with. PET ANIMALS ACT, 1951 10 licences were issued during the year} the extent of the livestock in these premises is very small. During the year regular visits were paid to all premises to ensure no nuisances occurred or breaches of the licensing conditions. The premises are of a high standard and no statutory action was found to be necessary. PREVENTION OF DAMAGE BY PESTS ACT. 1949 During the year 777 notifications of infestations were received of which 320 concerned rats. The remaining ^57 were in connection with mice. All cases were treated by the two Rodent Operatives with satisfactory results. PROTECTION OF BIRDS ACT. 19514 Pigeons Early in the year staff at the Town Hall objected to an infestation by pigeons emanating from derelict buildings adjacent to their office. This problem was resolved when demolition of the buildings took place. Towards the end of the year complaints were received regarding pigeons roosting on certain high rise blocks of flats in the Borough. Advice was sought of the Pests Division of the Ministry of Agriculture Fisheries and Food and arrangements made for steps to be taken to deal with the problem including narcotising schemes,when the weather permitted. As a further aid, an sir rifle was purchased by the Department and a number of the staff deputed to act as marksmen. Experience has Droved that there is no short cut to the elimination of this pest and 90 it appears that the best one can hope for is to keep the problem within reasonable bounds. This becomes all the more evident when one encounters the attitude of certain sections of the public who oppose the destruction of pigeons and moreover encourage infestations by their regular feeding. RIDING ESTABLISHMENTS ACTS. 1964 and 1970 The one riding establishment 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 it was run. No complaints from residents were received during the year. DISEASES OF ANIMALS ACT. 1950 The Corporation of London Officials deal with routine prevention on behalf of the borough and, during the year, there were no contraventions of the Act. CHRISTMAS CRACKERS A wholesaler in this Borough received a consignment of Christmas Crackers which contained 'indoor fireworks' in tablet form. A complaint was made to this department that a child of 4 years who attended a party where the hosts provided these crackers, had eaten a tablet. Another child had put one in her mouth but spat it out. Both children were taken to hospital but after being examined they were allowed home and asked to return the following day when further examinations were carried out but the children had suffered no ill-effects. Investigations were carried out and the retailer and manufacturers informed us that no further boxes of crackers were in stock. The propriety of selling these fireworks was taken up with the Home Office and the Royal Society for the Prevention of Accidents were informed of the incident. DOMESTIC "FULLY-AUTOMATIC" WASHING MACHINE An accident involving a child of age 23 months occurred in the borough when the little girl opened the front loading door of the machine while it was operating and full of boiling water. The boiling water poured out causing second degree burns to the child's feet. She was admitted to hospital. The machine, which was of foreign make, was examined and it was found that no safety device was fitted which would prevent the loading door from being opened during any part of the washing operation. It was found that the manufacturers had, at one time, fitted locks to the door handles but this practice had been discontinued. The facts were reported to the Home Office who took up investigations. It seems this was the second such accident reported to them. 91 FACTORIES ACT. 1961 Inspections Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 68 55 9 - Factories with mechanical 480 431 57 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises 25 40 1 - TOTAL 573 526 67 - Defects Found Number of defects Number of Prosecutions Instituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness 13 5 - - - Overcrowding - - - - - Unreasonable temperature 2 2 - - - Inadequate ventilation 2 2 - - - Ineffective drainage of floors 6 4 _ - - Sanitary Conveniences: Insufficient 10 4 - - - Unsuitable or defective 68 61 - - - Not separate for sexes 1 - - - - Other offences 2 - — — - TOTAL 104 78 - - - Outwork Number of outworkers in August list 160 Nature of work - Making, etc. wearing apparel and Christmas novelties and boxes. 92 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 16 262 41 Retail shops 15 926 164 Wholesale shops, 4 52 9 Catering establishments open to the public, 1 98 49 Fuel stronge depots - 4 ~ Inspections have been carried out throughout the year and all offices and shops in this district have now received at least one general inspection. Co-operation has been readily secured in compliance with the Act and the quality of working conditions within these premises has been raised considerably. However, the department has been concerned recently with the implementation of the provisions of the Act in Launderettes where difficulty has been experienced in establishing whether persons are employed for a sufficient number of hours to bring the premises within the scope of the Act. Inspection of such premises indicates a general lack of maintenance of the machinery and equipment and these combined facts render both the public and the staff liable to sustain injury without the local authority having any method of control. Whilst informal action by Public Health Inspectors is often effective, I should welcome an amendment to Section 3 of the Act to bring within the scope of the Act, premises of a special nature where the aggregate hours of one or more persons does not exceed 21 hours per week but where the potential hazards to the staff and to the public are of a serious and/or dangerous nature. Some small difficulty has been experienced in assessing a standard for ventilation within the expression "effective and suitable". Cases are on record where workrooms have been found to contain no permanent form of ventilation but were we to have enforced the provision of ventilation it would have appeared harsh to the employer in cases where shop or office doors are alleged to be kept open. If the Minister were to make the Regulations to prescribe the standards then the enforcing authorities and employers would be able to agree within the limits laid down. 93 Class of workplace Number of persons employed Offices 5,570 Retail shops 4,648 Wholesale departments, warehouses 499 Catering establishments open to the public, canteens 912 Fuel storage depots 16 TOTAL 9,645 TOTAL MALES 4,697 TOTAL FEMALES 4,948 During this period 55 notifications of minor accidents were received in respect of employees in registered premises. 94 INSPECTION ASP SUPERVISION OF FOOD The number and types of food premises in the borough are as follows 4 Bakehouses 47 Bakers 145 Confectioners 82 Butchers 98 Cafes and Canteens 44 Fishmongers 97 Fruiterers and Greengrocers 98 Grocers 78 Licensed and Off-licensed premises 29 Multiple Stores 14 Public Houses with Restaurants These premises were subject to frequent inspection during the year when 2,180 visits were made. In addition to verbal warnings and suggestions to managements and staff during the routine visits, 179 informal notices were served upon the owners and occupiers. 280 inspections were carried out in connection with markets, stalls and delivery vehicles, and 26 informal notices were served. The position under the Food and Drugs Act, 1955. apart from registrations in respect of ice cream, is as follows:- 48 butchers' premises and 29 other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 249 visits were paid. 32 fish shops are registered for frying and were the subject of 124 visits. Milk All milk which is distributed in the area is produced and bottled outside the borough. The number of registered distributors is 72 operating from 107 premises. 95 visits were paid to dairies and distributors' premises. Ice Cream The total number of registered premises selling ice cream is 207. Of these one is registered for the manufacture of ice cream. 243 visits were paid to these premises. During the year 27 applications for the storage and sale of ice cream were granted. 14 inspections in connection with itinerant vendors were carried out. 95 During the year 134 samples of ice cream were submitted for bacteriological examination; they were graded as follows:- Grade I Grade II Grade III Grade IV TOTAL 64 44 19 7 134 In addition to ice cream, 16 lollies were submitted for examination. All were satisfactory. Unsound Food During the year the Committee considered 31 complaints concerning unsound food bought by residents and the following action was taken:- 13 cases - Prosecutions taken 13 " - Warning letters sent 4 " - No action possible 1 " - Absolute discharge Registration of Food Hawkers Under the provisions of the Essex County Council Act, 1952 Section 103, three 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. Imported Food Regulations. 1968 The volume of goods being sent to this district from the Ports for Health Inspection Clearance is growing rapidly. This is mainly due to the development of containerisation particularly of food which can be carried vast distances from supply point to destination in insulated vehicles. The part of this district abutting the A.13, i.e. Ripple Road and contiguous areas, is particularly convenient for the setting up of Container Bases and Warehouses and a considerable change in ownership of premises along this stretch of road is taking place. The reason for this can most probably be found in the fact that the borough is practically equidistant from the London and Tilbury Docks, and accordingly, there is little doubt that in future years, if the present trends continue, a major increase in this aspect of the work is to be anticipated. Already the cold store is in the process of doubling its storage capacity to 3 million cubic feet. So far, it has concentrated mainly in serving the Australian and New Zealand Dairy Industry, but there are signs that Importers of Food from American and South American countries will make use of these excellent facilities. 96 An associated company dealing with tinned and dry goods has already doubled its area and is filled to capacity. Numbers of inspections have been made of tinned goods, including large quantities of corned beef, tinned tomatoes as well as flour. In addition we are being called upon to examine containerised foods arriving at yards in this locality which it has not been possible to deal with at the Port of Entry. In this connection a new feature at the cold store has been the arrival of quantities of cooked shellfish which necessitates the procuring of samples for the purpose of bacteriological examination at the Public Health Laboratories, Westminster. Arrangements have now been made for this to become a routine practice when cooked shellfish deliveries arrive. I understand from the Importers that this facet of trade will increase significantly when more space becomes available consequent upon the second phase of the cold store being completed. 97 Food and Drugs Act 1955-Sampling Article Number Examined Number Adulterated Formal Informal Formal Informal Almonds, Ground - 1 - - Beer 1 - - - Beverages - 5 - - Biscuits - 5 - - Bread - 12 - 9 Buns - 2 - 2 Buttered Roll - 1 - 1 Cakes - 6 - 4 Cake Mix - 1 - - Cherries, Glace - 1 - - Chicken in Jelly - 1 - - Coconut - 2 - - Condiments - 3 - - Cordials 3 8 1 2 Cream - 2 - - Cream of Tartar - 1 - - Curried Meat - 1 - - Curry Powder - 1 - - Custard Powder - 1 - - Dripping 2 1 - - Dust from Tea Sack - 1 - 1 Eggs - 1 - - Fats - 1 - - Fish, Tinned - 5 - - Flavourings and Essences - 4 - - Flour - 1 - - Freeze Drink - 1 - 1 Fruit, Dried - 1 - - Fruit, Tinned - 8 - - Gelatine - 1 - - Ginger, Ground - 1 - - Halibut Liver Oil Capsules - 1 - - Herbs - 1 - - Horseradish - 1 - - Ice Cream 1 - - - Jams - 6 - - Juices - 1 - - Meat, Luncheon - 4 - - Meat, Minced 4 1 - - Meat Patty - 1 - - Meat Pies 1 1 - - Meat, Tinned - 3 - - Milk 3 6 - 1 Milk, Evaporated - 5 - 1 Milk Powder - 1 - - Milk Top - 1 - - Nutmeg - 1 - - Pearl Barley - 3 - 1 Peel - 1 - - Pepper — 4 — 1 98 Article Number Examined Number Adulterated Formal Informal Formal Informal Pickles and Pastes - 5 - - Pies - 2 - - Puddings - 2 - - Puree - 1 - - Raising Powder - 1 - - Ravioli - 1 - - Rice - 2 - - Sago - 1 - - Sauces - 2 - - Sausages 13 4 1 3 Sausage Rolls - 1 - 1 Semolina - 1 - - Soups - 2 - - Spices - 2 - - Spirits 4 - - - Spreads - 4 - - Suet - 1 • Sweets - 4 - 1 Tapioca - 1 - _ Tarts _ - - Vegetables - 5 _ 1 Vending Machine-Filter - 1 — - Wrapper-Printing Ink - 1 _ - Water — 1 - - Sample No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 600A Sausages Informal Contained two strips of ferrous metal. Legal proceedings Manufacturers fined £15. and £5. costs. 619A Small Uncut White Loaf Informal Contained fragments of discoloured dough contaminated with iron. Legal proceedings. Manufacturers fined £15. and £4.70 costs Plus Advocates fee. 620A Currant Bun Inf ormal Contained a small strip of ferrous metal. Legal proceedings. Fined £15. and £10. costs 622A Doughnut Informal Contained foreign material of the nature of minute flakes of paint. Warning letter. Insufficient evidence for legal proceedings 623A Buttered Roll Informal Contained foreign matter in the form of fragments of fruit tissue. Warning letter. 637A Lemon Hot Pickle Informal Contained lime pieces and therefore misdescribed as 'Lemon Hot Pickle'. Label to be amended. 639A Uncut Large White Loaf Informal Contained wheat tissue and charred dough. Warning letter. 641A Pork Sausages Informal Meat 55 per cent. Sulphur Dioxide 100 parts per million. 15 per cent deficient in meat and no declaration of preservatives given. Formal sample taken this was genuine. 664A Sliced Wrapped Loaf Informal Contained discoloured dough with traces of iron. Warning letter. Insufficient evidence for legal proceedings 642A Large Cut Wrapped Loaf Informal Consisted of iron particles mixed with a small proportion of atmospheric dust and vegetable oil Legal proceedings. Manufacturers fined £40. and £10. costs. 644 Chocolate Covered Marshmallow Informal Contaminated with minute particles of ferrous metal. Legal proceedings. Manufacturers fined £25. and £5. costs. 99 100 Sample Formal or Nature of Adulteration Article Observations No. Informal or Irregularity 666A Medium Sliced Informal Contained discoloured dough Legal proceedings. Loaf contaminated with iron. Manufacturers fined £20. and £14.62£p.costs. 667A Lime Cordial Informal Cordial contained 0.18% of Matter investigated and empty copper. Heavy bluish green at source and container deposit of copper salts in necessary action empty container. taken to prevent recurrence. 668A Specimen of Lime Informal Copper 28 parts per million Cordial 676A Medium White Informal Contained discoloured dough Legal proceedings. Sliced Loaf contaminated with iron. Manufacturers fined £40. and £15. costs 684A Dust from Tea Informal Consisted of a mixture of Investigations Sacks magnesium sulphate, failed to shed magnesium carbonate, calcium light on mystery, carbonate and potassium sulphate. 699A Currant Bun Informal Contained a small stone No action taken. 700A Large Uncut Loaf Informal Contained discoloured dough Legal proceedings. with a large proportion of Manufacturers iron. fined £50. and £10. costs. 701A Iced Sponge Cake Informal Contained patches of mould Legal proceedings. growth. Manufacturers fined £20. and £14.50 costs. 702A Fruit Cake Informal Contained a small glass Legal proceedings. fragment. Manufacturers fined £10. and £15. costs. 717A Beef Chipolata Informal Contained a steel fragment Legal proceedings. Manufacturers fined £30. and £14.50 costs. 718A Freeze Drink Informal In a mouldy condition Warning letter. Witness not willing to attend Court. 101 Sample Article Formal or Natur of Adulteration Observations No. Informal or Irregularity 728A Chocolate House Informal Contained pieces of cotton Warning letter. Cake thread. 729A Sausage Roll Informal Contained a piece of iron Warning letter. wire. 730A Glass from Informal The glass in peas was found Retailer fined Frozen Peas to be similar to a broken £10. and £10. fluorescent tube. costs. 731A Medium Sliced Informal Contaminated with iron. Legal proceedings. Loaf of Bread Manufacturers fined £50. and £10. costs. 740A Blackcurrant Informal Contains only 18% of stated Warning letter. Health Drink amount of Vitamin C. Unable to obtain formal sample product taken off sale. 745A Milk Informal Contained blood. Warning letter. 750A Evaporated Informal Out of condition due to Warning letter. Milk overheating. 144 Pork Sausages Formal Meat 58 per cent. Warning letter. 10 per cent. deficient Further sample in meat. taken - this was satisfactory. 160 Lime Juice Formal Does not comply with the Legal proceedings. Cordial Soft Drinks Regulation in Absolute discharge. respect of its content of Costs £10.50 sugars and fruit juice. Contained 45% of added water compared with normal production. 102 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 9 36 28 39 34 162 10 4 2 324 Whooping Cough 6 11 11 12 9 36 6 3 1 95 Dysentery 4 5 7 8 6 12 5 8 11 66 Scarlet Fever - 3 4 8 5 36 13 8 2 79 Diphtheria - - - - - - - - - - Acute Meningitis - - - - - - - - - - Acute Poliomyelitis:- Paralytic - - - - - - - - - - Non-paralytic - - - - - - - - - - Under 5 yrs 5-14 15-44 45-64 65 and over TOTAL Encephalitis,Acute - - _ - _ _ Infective - - - - - - Post Infectious - - - - - - Paratyphoid (B) Fever - - - - - - Typhoid Fever - - - - - - Food Poisoning 8 1 6 2 2 19 Infective Hepatitis - 31 48 6 3 88 Smallpox - - - - - - Ophthalmia Neonatorum 4 - - - - 4 Malaria - - - - - - Notified Admitted to Rush Green Hospital Admitted to other Isolation Hospitals Admitted to Other Hospitals Dysentery 66 4 _ 1 Encephalitis,Acute - - - - Infective - - - - Post Infectious - - - - Food Poisoning 19 5 - 1 Measles 324 2 - 1 Acute Meningitis 1 1 - - Paratyphoid Fever - - - - Acute Poliomyelitis - - - - Paralytic - - - - Non-Paralytic - - - - Scarlet Fever 79 - - - Typhoid - - - - Whooping Cough 95 5 - - Malaria - - - - Infective Hepatitis 88 3 - 1 Ophthalmia Neonatorum 4 - - - 103 Food Poisoning The following is a copy of the annual return submitted to the Department of Health and Social Security:- Incidents and Cases General Outbreaks Family Outbreaks Sporadic Cases No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases Notified or ascertained Notified or ascertained S.typhimurium - - - - 5 Other Salmonellae - - - 8 8 C1. welchii - - - - - Staph, aureus - - - - - Other causes - - - - - Cause unknown — - - - - TOTAL - - - 8 11 Details of Food Poisoning due to Salmonellae other than S. Typhimurium Type of Salmonellae Panama - 8 7 Isangi - - 1 During the year there was an outbreak of suspected food poisoning at the Maternity Unit, Rush Green Hospital. Investigations were carried out by the Medical Officer in Senior Post and the Public Health Inspector and at the Hospital Unit 12 of the 63 patients (mothers or expectant) became ill. Only one member of the staff (a student midwife) was ill. The maternity unit was closed temporarily to new admissions. The outbreak occurred in the early hours of the morning and comparatively few specimens of vomit could be obtained. The findings of staphylococcus Aureus in two vomit specimens could be significant but it was difficult to incriminate any particular food, although Clostridium welchii was found in raw beefburgers they were not isolated from a cooked beefburger. It was thought that the high number of patients who vomited is not suggestive of Clostridium welchii food poisoning. Although the results of these investigations were not included in the return, it does point to the revision of a privileged position with regard to hospital kitchens whereby they are exempted from the enforcement of the Food Hygiene Regulations and are not subject to inspection by local authorities officers.