BARK 66 LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1972 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 BARK 66 LONDON BOROUGH OF BARKING THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1972 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 index Page Ante-natal Clinics 23 Care of Mothers and Young Children 23 Causes of Deaths 17 Causes of Infant Deaths 15 Child Guidance 47 Child Health Centres 24 Chiropody 40 Community Nursing Service 27 Congenital Abnormalities, Incidence of 50 Convalescence 44 Co-ordination of Services 20 Council, Members of 3 Cytology Service 36 Dental Services 51 Education Committee 4 Education (Schools Sub-Committee) 5 Family Planning Service 32 Free School Milk (Provision of) 42 Geriatric Clinic 33 Geriatric Liaison Officer 32 Handicapped Children 49 Health Committee 4 Health Education 21 Health Visiting Statistics 28 Home Nursing Statistics 28 Immunisation 29 Page Infant Mortality 15 Kidney Machines 35 Kingsley Hall Assessment Centre 25 Medical Examination of Staff 35 Midwifery Statistics 28 National Assistance Act 1948 36 Officers of the Health Service 6 Play Therapy 25 Qualifications 12 Rehousing on Medical Grounds 36 School Consultative Clinics 42 School Health 42 School Medical Inspections 43 Sickroom Equipment 34 Social Services Department 29 Speech Therapy 46 Tuberculosis 38 Vaccination 29 Venereal Disease 38 Vital Statistics 14 Vital Statistics, Summary of 16 Welfare Foods 25 2. MEMBERS OF THE COUNCIL (as at 31st December, 1972) Mayor Councillor J.L. JONES, J.P. Deputy Mayor Councillor M.J. SPENCER Leader of the Council Councillor J.A. BUTLER, J.P. Aldermen A.E. BALL, O.B.E., J.P. Mrs. Julia H. ENGWFLL W.E. BELLAMY, J.P. Mrs. A.M. MARTIN G.H.A. CROUCH B.E. ROYCRAFT, O.B.E., J .P. D.A.L.G. DODD, J.P. Mrs. A.R. THOMAS Councillors C.H. AYRES J J. LONGDEN Mrs. M. BALL, O.B.E. E.R. MANSELL RJ. BLACKBURN, J.P. Mrs. P.D. MILLER Mrs. E.E. BRADLEY J. MORTON Mrs. M. BREDO M.A. NESS G.A. BROOKER W.G. NOYCE, J .P. L.J. BRYANT M.J. O'SHEA S.G. COLE, J.P. Mrs. M.S. PRESTON L.A. COLLINS A.C.V. RUSHA F.L. COOMBER G.H. SHAW R.E. COSTER J .S. THOMAS, J .P. J. DAVIS L.A. THOMPSON C.J. FAIRBRASS F.G. TIBBLE Mrs. C.S.M. GODFREY, J.P. H. TINDELL R.H. GODFREY E.A. TURNER D.O. GRANDISON J. CLINTON TWEED Mrs. A. HOWIF, B. WALKER H.J. HOWIE S.J. WARR P.G. JARVIS D.J. WATERS F.C. JONES D.W. WEBB Mrs. E.J. KITCHEN E.J. WHITE J.H. LAWRENCE 3. HEALTH COMMITTEE (as at 31st December, 1972) Chairman Councillor Mrs. M. BALL Vice-Chairman Vacant Members The Mayor Councillor Mrs. D.M. JONES The Deputy Mayor Councillor Mrs. P.D. MILLER The Leader of the Council Councillor J. MORTON Alderman Mrs. J.H. ENGWELL Councillor Mrs. V.H. POOL Alderman Mrs. A.R. THOMAS Councillor M.J. O'SHEA Councillor Mrs. E.E. BRADLEY Councillor Mrs. M.S. PRESTON Councillor F.L. COOMBER Councillor F.G. TIBBLE Councillor R.E. COSTER Councillor J. CLINTON TWEED Councillor Mrs. A. HOWIE Councillor S J. WARR Co-opted Members Mrs. D.L. BELCHAMBER Dr. A.F. MacDONALD Mr. J. SMITH Mrs. A.E. PRENDERGAST EDUCATION COMMITTEE (as at 31st December, 1972) Chairman Councillor A.C.V. RUSHA Vice-Chairman Councillor Mrs. D.M. JONES Representative Members The Leader of the Council Councillor CJ. FAIRBRASS Alderman A.E. BALL Councillor Mrs. C.S. M. GODFREY Alderman W.E. BELLAMY Councillor D.O. GRANDISON Alderman D.A.L.G. DODD Councillor P.G. JARVIS Alderman Mrs. J.H. ENGWELL Councillor F.C. JONES Councillor Mrs. M. BALL Councillor J J. LONGDEN Councillor R J. BLACKBURN Councillor J. MORTON Councillor Mrs. E.E. BRADLEY Councillor Mrs. M.S. PRESTON Councillor LJ. BRYANT Councillor G.H. SHAW Councillor S.G. COLE Councillor H. TINDELL Councillor F.L. COOMBER Councillor E.A. TURNER Councillor R.E. COSTER Councillor D.W. WEBB Councillor J. DAVIS Councillor E J. WHITE 4. Co-opted and Nominated Members Mr. GJ.G. BEANE Mr. D.F. REED Mr. E.W. COOLEY Mr. A. RICHARDS Mr. P. GRIMES The Rev. J.W. ROXBURGH Miss M.C. GROBEL, M.A. Mrs. F. RUSHA Mr. W.E. JOUGHIN Mr. SJ. RUSSELL Mr. F.H. KING SCHOOLS SUB-COMMITTEE (as at 31st December, 1972) (This Sub-Committee deals inter alia, with the School Health Service) Chairman Councillor Mrs. D.M. JONES Vice-Chairman Councillor Mrs. C.S.M. GODFREY Members Alderman W.E. BELLAMY Councillor A.C.V. RUSHA Councillor Mrs. M. BALL Councillor H. TINDELL Councillor S.G. COLE Mr. E.W. COOLEY Councillor R.E. COSTER Mr. W.E. JOUGHIN Councillor C.J. FAIRBRASS Mr. F.H. KING Councillor D.O. GRANDISON Mr. A. RICHARDS Councillor Mrs. M.S. PRESTON The Rev. J.W. ROXBURGH 5. OFFICERS OF THE HEALTH SERVICE (as at 31st December, 1972) Medical Officer of Health J. Adrian GILLET, M B., Ch.B., D.P.H., F.F.C.M., F.R.S.H. Deputy Medical Officer of Health R. BEAVER, M.B., B.S.(Rangoon) D.C.H., D.P.H., M.F.C.M. Medical Officer in Senior Post H.C. GUPTA, M.B., B.S.(Bombay) D.P.H. Senior Medical Officers in Department E. KLEIN, M.D.(Naples), M.D.(Budapest) L.R.C.P. & S. M. WEIZMANN, M.R.C.S., L.R.C.P. Medical Officers in Department G.G. BENNETT, M.B., B.S., D(Obst) R.C.O.G., M.R.C.O.G. D. BURGESS, M.D.(Malta). B.Pharm. K. FITZPATRICK, M.B., Ch.B. G. MICHAEL, M.R.C.S., L.R.C.P., B.A.(Cantab) In addition 14 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 Mrs. L. BENJAMIN, B.D.S.(Eng.) A.M. DIXIT, L.D.S., R.C.S.(Eng.) C. SUMSAWASTE, L.D.S., R.C.S.(Eng.) Senior Dental Surgery Assistant Mrs. F.B. SADLER (20) Dental Surgery Assistants Mrs. J.R. GREGORY (20) Mrs. A. SCALES (20) Mrs. J. HUNTER Miss M. SEALEY Mrs. J.C. MITCHELL (20) Mrs. M. SIPOS (part-time) Mrs. D. MURRAY (20) (part-time) Mrs. M. STRACHAN (9) Dental Auxiliary Mrs. E. CHARD (21) 6. Chief Public Health Inspector Mr. M R. WILLIAMS. (1), (2), (4). Deputy Chief Public Health Inspector Mr. B. SAUNDERS, (1), (2), (4). Divisional Public Health Inspectors Mr. J. ALLAM, (1), (2), (4). Mr. J. POWELL, (1), (2), (4). Public Health Inspectors Mr. C.F. BROWN. (29). Mr. C. NASH, (29). Mr. N BURTON, (1), (2). Mr. B. ORME, (29). Mr. J. COOK, (1), (2), (3). Mr. B. PETERS, (29). Mr. T.W. CLEW, (1), (2). Mr. C.C. PORTER, (29), (33). Mr. G.P. MORRIS, (29). Mr. F. SILVERTHORNE, (1), (2), (33). Mr. H.R. VAUGHAN, (29). Student Public Health Inspectors Mr. P. KING Mr. D.J. PALMER Mr. D. WOODS Director of Nursing Services Miss. E.M. CLARKE, (5), (6), (7), (38). Area Nursing Officers Miss P. BROADBENT, (5), (6), (7). Miss M. DOBSON, (5), (6), (19). Nursing Officers Miss M. TEATHER, (5), (6). Mrs. A. WARD, (5), (7), (25). Miss J.M. SMITH, (5), (6), (19). Mrs. W.D. CLEGG. (5). (6). (7). Mr. R.J. TURPIN, (5), (19). Health Visitors Miss J.D. BALDWIN, (5), (6), (7), (19). Miss O. OLOGUNRO, (5), (6), (7). Miss A.E. BOORMAN, (5), (6), (7), (19). Mrs. B. RABIN, (5), (7), (8). Miss R.D. HUTCHINSON, (5), (6), (7), (19). Mrs. B. RAMSEY, (5), (6), (7), (18). Mrs. A. KHAN, (5), (6), (7), (19). Miss D.B. RUDD, (5), (6), (7). Mrs. M.M. MILLER, (5), (7), (8). Miss M.F. SAVAGE, (5), (6), (7), (13). Mrs. N.M. NAGAR, (5), (7), (25). Mrs. O.J. WILLIAMSON, (5), (6), (7), (19). Miss T. O'KELLY, (5), (7), (8), (19). Miss M.D. WINT, (5), (6), (7). Health Visitor (part-time) Mrs. J. O'BRIEN, (5), (7). Sponsored Student Health Visitors Miss C.A. MANSELL, (5), (6). Miss E. McLOONE, (5), (6). 7. District Nurses Mrs. M.A. BATES, (5), (8). Mrs. Y.V. NICHOLLS, (5), (6), (19). Mrs. J.E. BIGGART, (5). Mrs. B. NOBLE, (5), (6), (19). Mrs. J.M. COTTERILL, (5), (19). Miss N. NORRIS, (5), (6), (19). Mrs. Y.A. DIGNUM, (5), (19). Mrs. M. O'RIORDAN, (5), (8), (19). Mrs. J.R. HARPER, (5). Mrs. M.Y. PARKER, (5), (19). Mrs. A. HAYDEN, (5), (19). Mrs. M. PRONT, (5). Mrs. M.G. KELLY, (5). Miss D.M. RENSHAW, (5), (6), (7), (12), (19). Mr. C.O.E. KING, (5), (10), (19). Miss R. RICHARDS, (5), (6), (19). Mrs. D.J. KITCHEN, (5), (6), (19). Mrs. A.M. ROBINS, (5), (19). Mr. R.D. LINTOTT, (5), (19) Mrs. L.M.T. SANSOM, (9). Mrs. s.w. McQuillan, (9), (19). Mrs. a.b. sarsfield, (5). Miss K.M. MOLLERUP-PETERSON, (5), (19). Mrs. E.A. STIMSON, (9), (19). Mrs. M.E.M. WHATHAM, (5), (8), (12). District Nurses (part-time) Mrs. E.H. BUTCHER, (5), (6), (19). Mrs. N. FLYNN, (5), (8), (19). Mrs. E. COLGATE, (9). Mrs. A.L. HILLAS, (5), (19). Midwives Mrs. N.M. ADAMS, (5), (6). Miss J.M. HALL, (5), (6). Mrs. S.L. BRADLEY, (5), (6), (19), (26). Miss D. HEARSEY, (5), (6). Mrs. I.M. BRONNICK, (5), (6). Mrs. S.M. READ, (5), (6). Mrs. H.V. GOOBY, (5), (6). Miss P.R. SHACKLETON, (5), (6), (9). Mrs. A. GREEN, (5), (6), (19). Miss M. WALKER, (5), (6). Mrs. C.B. WATSON, (5), (6). Midwife (part-time) Mrs. M.E.R. WAINWRIGHT, (5), (6). School Nurses Mrs. E.M. McCHEYNE, (5). Mrs. P.A. PICKEN, (5). Mrs. M.C. TWOMEY, (5). Clinic Nurses Mrs. S.M.C. BARBER, (5). Mrs. L.V. NEWBURY, (5). Mrs. J.J. GIANOTTI, (5). Mrs. M.P. RAMAGE, (9). Miss E.A. RICH, (5), (25). Clinic Nurses (part-time) Mrs. S.J. BROWNE, (9). Mrs. R.M. LEWIN, (5), (6). Mrs. I.M. COLLINGWOOD, (5). Mrs. A. LYONS, (9). Mrs. B. CULLUM, (5). Miss. I.C. MCCARTHY, (5). Mrs. M. IIALLIGAN, (5), (6), (12). Mrs. M.E. MONTGOMERY, (5). Mrs. E.M. HILL, (9). Mrs. G. PRATT, (5). Mrs. D.L. HUNTLEY, (5). Mrs. R.J. SCAMELL, (5), (19). Geriatric Liaison Officer Mrs. J. HARROLD, (5), (12), (28). 8. Speech Therapists Miss C.J. DELAFORCE, (16). Miss E.M. SYMES, (16), (17). Physiotherapist Mrs. A. WALKER, (24). Physiotherapists (part-time) Mrs. A. LAWRENCE, (23). Mrs. J.M. WARWICK, (23). Chief Chiropodist Mr. G.E. FENN, (11). Senior Chiropodists Mr. D. DITSELL, (11). Mrs. M.G. LEAGE, (11). Mr. N. FREEMAN, (11). Mrs. D. MANN, (11). Assessment Centre Kingsley Hall Day Centre Sister-in-Chargc Mrs. K.I. DALY, (5), (6), (18). for Handicapped Children, Hobart Road, Dagenham. Health Education Officer Miss D. MILBANK, (5), (6), (7), (18), (19), (22). Assistant Health Education Officers Mr. J.T. FISHER Mrs. A.R. MARCUS, (34), (35), (36). Lay Administrative Officer Mr. F.W. KNIGHT, (1), (2). Senior Administrative Assistants Mr. F.H. MARTIN, (14). Mr. B.S. WEAVER Section Heads Mrs. P.H. FLOODGATE, Vaccination and Immunisation. Miss G.K. HARRIS, Environmental. Mrs. M.C. NEWMAN, Care and After Care. Mr. H.J. PITT, ) -Staffing. Mr. P.K. GREEN, ) Finance and Supplies. Mr. R.G. TRUCKEL, (32). Maternal and Child Health. Medical Officer of Health's Secretary Mrs. J.M. de BRUIN, (37). 9. Section Clerical Staff Vaccination and Immunisation Mrs. M. KING Mrs. S.E. ALLEN Environ mental Mrs. E. DAVIDSON Miss N.M. TOMS Miss A.M. LYONS Miss C. WEAVER Mrs. J.W. MORGAN Rodent Operative/Driver Mr. H.J. DUFF Management, Finance and Supplies Mrs. F.E. BRAY Miss S. HAMPTON Mrs. M.R. BUSHELL Mrs. P. McMILLAN Miss V.E. CHEAL Miss C.M. SACH Miss K.I. FIELDING Miss J. WICKS Mr. R.E. WRIGHT Maternal and Child Health Miss E.A. ADAMS Mrs. I.A. PAGE Miss E.D. BROWN Mrs. V.N.F. PATIENCE Miss N.E. CLOKE Mrs. J.R. REDMAN Miss A.C. DA VIES Miss M.A. RHODES Mrs. D.M. ELLIS Miss K. RICHARDS Mrs. M.E. GODFREY Mrs. G.K. SHANNON Mrs. D.G. GREEN Mrs. G.B. STOKES Miss C.A. LINCOLN Miss D. TILSON Mrs. E.J. NEPORT Mrs. D. WILKINS Mrs. M. NOTTAGE Mrs. I.F. FRANKLAND Part-time Mrs. K. BIRD Mrs. A. McCARTHY Mrs. E. HARSENT Mrs. O.E. NASH Mrs. K.F. HEXTER Mrs. H.P. ROBERTS Mrs. S. HOPSON 10. 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. Dr. 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. Royal College of Psychiatrists British Psycho-Analytical Society Ear, Nose and Throat Surgeon Miss M. MASON, F.R.C.S. Physiotherapist Mrs. E. OTTLEY, M.C.S.P. Other Medical Officers attending part-time K.S. HOLT, M.D., Ch.B., F.R.C.P., D.C.H. (Adviser in Child Development, Kingsley Hall) Public Analyst (part-time) J. HUBERT HAMENCE, Ph.D., M.Sc., F.R.I.C. 11. 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. (11) State Registered Chiropodist. (12) State Registered Fever Nurse. (13) Certificate of National Nursery Examination Board. (14) Diploma in Public Administration. (15) Certificate of National Society of Children's Nurses. (16) Diploma of Licentiateship of College of Speech Therapists. (17) Diploma in Social Science. (18) Registered Sick Children's Nurse. (19) District Nursing Certificate. (20) Certificate of Examining Board of Dental Surgery Assistants. (21) Certificate of Proficiency as Dental Auxiliary. (22) Diploma in contents and methods of Health Education. (23) Member of Chartered Society of Physiotherapy. (24) Member Oslo Orthopaedic Institute of Physiotherapy. (25) Obstetric Nurse Training Course. (26) State Enrolled Assistant Nurse Certificate (Tropical Nursing), Malaysia. (27) Certificate of Royal Dental Hospital. (28) Institute of Home Help Organisers. (29) Diploma of Public Health Inspectors Education Board. (30) University of Cambridge Teaching Certificate. (31) Ministry of Education Certificate in Physical Education. (32) Associate of the Chartered Institute of Secretaries. (33) Diploma in Air Pollution Control. (34) B.Sc. (Hons.) Nutrition. (35) State Registration of Dietetics. (36) Qualified Teacher Status (Dept. Education and Science). (37) National Examination Board, Certificate in Supervisory Studies. (38) Nurse Tutor's Certificate. 12. Health Department, Aldis House, 56a, Longbridge Road, Barking. To: The Mayor, Aldermen and Burgesses of the London Borough of Barking. As the reorganisation of the National Health Service looms ever nearer the staff view the situation with very mixed feelings indeed. The move to 'new' premises and the consequent divisions of the Department gave the Aldis House occupants the feeling of being isolated from the mainstream of Local Government, specially as rapid communication with the environmental health section created difficulties especially in times of crisis. It is hoped that the separation of the Health Department from Local Government in 1974 will not increase these difficulties. In the hope that these may be avoided it is suggested that the Gvic Centre should provide office accommodation and staff for the 'proper officer' of the Area Health Authority who will be responsible to the Local Authority for the control of infectious disease and environmental health advice in the new service. During 1972 the infant death rate was 15.22 as against that in 1971 which was 21.16. Health Education activities which are becoming more and more an important part of preventive medicine continued to increase during the year. One fact worthy of note is that 'Maystonisation' of the community nursing services was begun. This involved a restructuring of the nursing services and the appointment of Nursing Officers, an Area Nursing Officer and a Director of Nursing Services. It was hoped to have a total of three Area Nursing Officers - one of whom would undertake duties in the training field. However, the suggestion was made by the Department of Health that two should be sufficient initially. This means that at the end of 1972 one post of Area Nursing Officer remained unfilled. Owing to pressure of work in the Environmental Health Section of the Department, it has not been possible to include in this Report matters dealt with via the Chief Public Health Inspector. These include, inter alia control of infectious diseases and food poisoning, water supply, sewerage and sewage disposal, milk supplies, hygiene of food premises, poultry inspection, inspections under the Factories Act 1971, returns of outwork, and the registration of common lodging houses. It is hoped to publish a separate account of these and other activities of this section when conditions allow. J. Adrian Gillet, Medical Officer of Health 13. VITAL STATISTICS 1972 Registrar General's estimate of residential population, mid-year 1972 158,710 Live Births: Legitimate (1,001 males, 962 females) 1,963 Illegitimate ( 65 males, 75 females) 140 Total (1,066 males, 1,037 females) 2,103 Illegitimate live births per cent of total 6.66 Live birth rate per 1,000 population 13.25 Live birth rate adjusted by comparability factor of 1.11 14.71 Stillbirths: Legitimate ( 23 males, 13 females) 36 Illegitimate ( - males, 1 female ) 1 Total 37 Stillbirth rate per 1,000 live and stillbirths 17.29 Total live and stillbirths 2,140 Deaths: Infant deaths (under 1 year) (18 males, 14 females) 32 Infant death rate per 1,000 live births 15.22 Legitimate infant death rate per 1,000 legitimate live births (17 males, 14 females) 15.80 Illegitimate infant death rate per 1,000 illegitimate live births ( 1 males, - females) 7.14 Neo-natal mortaility rate (deaths under 4 weeks (23) per 1,000 live births) 10.94 Peri-natal mortality rate (stillbirths (3) and deaths under 1 week (18) per 1,000 live and stillbirths) 25.70 General Mortality: Number of deaths (1,106 males, 925 females) 2,031 Death rate per 1,000 population-crude 12.80 Death rate adjusted by comparability factor of 1.02 13.06 14. CAUSES OF INFANT DEATHS Causes 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 5 2 7 Enteritis and other diarrhoeal diseases - 2 2 Other diseases of respiratory system - 2 2 Other causes of perinatal mortality 6 - 6 Meningitis 1 - 1 Pneumonia 2 2 4 Total All Causes 23 9 32 PRINCIPAL CAUSES OF DEATH (All Ages) Diseases of heart and circulatory system 706 Cancer and other malignant diseases 503 Pneumonia, bronchitis and other respiratory diseases 365 Cerebrovasculor disease and other diseases of the brain and nervous system 246 I give below for purpose of comparison the birth and death rates of Barking, Greater London and England and Wales for 1972. Barking Greater London England and Wales Live Births (per 1,000 population) 13.3 14.1 14.8 Stillbirths (per 1,000 live and stillbirths) 17.3 11.2 12.0 Infant Mortality (per 1,000 live births) 15.2 17.1 17.0 Deaths (per 1,000 population) 12.8 11.8 12.1 15. 16. SUMMARY OF VITAL STATISTICS 1965 - 1972 Year Population Deaths *Death Rate Live Births *Live Birth Rate Deaths under 1 year Infant Death Rate 1965 172,970 1,748 13.34 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 1971 153,870 1,861 15.84 2,174 14.70 46 21.16 1972 158,710 2,031 13.06 2,103 14.71 32 15.22 * Adjusted for comparability Page 17. CAUSE OF DEATH AGE AT DEATH Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 years 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 2 - 1 1 - - - - - - - - - - - 1 3 2 5. Tuberculosis of Respiratory System - - - - - - - - - - - - - 1 1 - 1 1 6. Late effects of Respiratory Tuberculosis - - - - - - - - - - - - - - - - - - 7. Other Tuberculosis - - - - - - - - - - - - - - - - - - 8. Plague - - - - - - - - - - - - - - - - - - 9. Diphtheria - - - - - - - - - - - - - - - - - - 10. Whooping Cough - - - - - - - - - - - - - - - - - - 11. Streptococcal Sore Throat and Scarlet Fever - - - - - - - - - - - - - - - - - - 12. Meningococcal Infection - - 1 - - - - - - - - - - - - - 1 - 13. Acute Poliomyelitis - - - - - - - - - - - - - - - - - - 14. Smallpox - - - - - - - - - - - - - - - - - - 15. Measles - - - - - - - - - - - - - - - - - - 16. Typhus and other Rickettsioses - - - - - - - - - - - - - - - - - - 17. Malaria - - - - - - - - - - - - - - - - - - 18. Syphilis and its sequelae - - - - - - - - - - - - - - - - - - 19. All other infective and parasitic diseases - - - - - - 1 - - - - - 1 - - - 2 - Malignant Neoplasm of: 20. Buccal Cavity and Pharynx - - - - - - - - - - - 1 - - 1 1 1 2 21. Oesophagus - - - - - - - - - - 4 2 - 1 - 1 4 4 22. Stomach - - - - - - - - - - 15 3 15 3 9 11 39 17 23. Intestine - - - - - - - - - - 8 9 9 12 10 7 27 28 24. Larynx - - - - - - - -- - - 1 - - 1 1 - 2 1 Carried forward 2 - 2 1 - - 1 - - - 28 15 25 18 22 21 80 55 Page 18. CAUSE OF DEATH AGE AT DEATH Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 years and over Total M F M F M F M F M F M F M F M F M F Brought forward 2 - 2 1 - - 1 - - - 28 15 25 18 22 21 80 55 Malignant Neoplasm of: 25. Lung Bronchus - - - - - - - - 2 2 49 14 64 12 24 9 139 37 26. Breast - - - - - - - - - 1 - 15 - 13 - 7 - 36 27. Uterus - - - - - - - - - 3 - 4 - 3 - 3 - 13 28. Prostate - - - - - - - - - - - - 12 - 4 - 16 - 29. Leukaemia - - - - - - 1 - 1 1 - - 1 - - 2 3 3 30. Other Malignant Neoplasms - - - 2 1 - 2 - 2 2 30 16 24 21 7 24 66 65 31. Benign and unspecified Neoplasms - - - - - - - - - - 1 2 1 1 1 - 3 3 32. Diabetes Mellitus - - - - - - - - - - 4 5 2 5 2 7 8 17 33. Avitaminoses and other nutritional deficiences - - - - - - - - - - - - - - - - - - 34. Other endocrine, nutritional and metabolic diseases - - - - - 1 - - - - 1 3 - - 1 4 2 8 35. Anaemias - - - - - - - - - - 1 1 - - - 1 1 2 36. Other diseases of blood and blood forming organs - - - - - - - - - - - - - - - - - - 37. Mental disorders - - - - - - 1 - 1 - - 2 - - - - 2 2 38. Meningitis 1 - - - - - - - - - - - - - - - 1 - 39. Multiple Sclerosis - - - - - - - - - - 2 3 - - - - 2 3 40. Other diseases and nervous system and sense organs - - - 1 - 1 1 - 1 - 2 - 3 2 2 2 9 6 41. Active Rheumatic Fever - - - - - - . - - - - - - - - - - - 42. Chronic Rheumatic Heart Disease - - - - - - . - - - 3 4 1 2 1 4 5 10 43. Hypertensive Disease - - - - - - - - - - 2 - 9 9 7 12 18 21 44. Ischaemic Heart Disease - - - - - - - - 7 1 113 26 118 70 74 119 312 216 45. Other forms of Heart Disease - - - - - - - - - - 6 1 8 11 12 24 26 36 46. Cerebrovascular Disease - - - - - - - - - 4 12 24 35 23 49 74 96 125 47. Other diseases of Circulatory System - - - - - - - - 2 - 5 3 13 9 8 22 28 34 48. Influenza - - - - - 2 - - - 1 2 1 1 1 - 2 3 7 Carried forward 3 - 2 4 1 4 6 - 16 15 261 139 317 200 214 337 820 699 Page19. CAUSE OF DEATH AGE AT DEATH Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 years and over Total M F M F M F M F M F M F M F M F M F Brought forward 3 . 2 4 1 4 6 . 16 15 261 139 317 200 214 337 820 699 49. Pneumonia 1 3 - 1 - 2 - - 1 - 10 7 23 23 44 77 79 113 50. Bronchitis and Emphysema 1 - - - - - - - - - 20 4 40 11 48 23 109 38 51. Asthma - - - - - - 1 - - - - - - . . . 1 - 52. Other diseases of Respiratory System - 2 - 1 - - - - - - 2 1 3 1 2 1 7 6 53. Peptic Ulcer - - - - - - - - - - 3 - 3 - 4 5 10 5 54. Appendicitis - - - - - - - - - - - - - . . . . . 55. Intestinal Obstruction and Hernia - - - - - - - - - - - - 2 2 2 2 4 4 56. Cirrhosis of Liver - - - - - - - - - - - - 1 1 1 1 2 2 57. Other diseases of Digestive System - - - - - - - - 1 - - - 3 - 2 4 6 4 58. Nephritis and Nephrosis - - - - - - - - 1 - 4 - - 1 1 2 6 3 59. Hyperplasia of Prostate - - - - - - - - - - - - 2 ■ 1 - 3 . 60. Other diseases of genito-urinary system - - - - - - - - - 1 - 2 3 1 2 7 5 11 61. Abortion - - - - - - - - . . . . . . . . . 62. Other complications of pregnancy, childbirth and puerperium - . . . - - - - - - - - - - - - - - 63. Diseases of skin and subcutaneous tissue - - - - - - - - - - 1 . . . _ 1 1 1 64. Diseases of musculoskeletal system and connective tissue - - - - - - - - - - 1 - 1 1 1 3 3 4 65. Congenital anomalies 4 3 1 - - 1 - - - - 1 2 . 2 . 1 6 9 66. Birth injury, difficult labour and other anoxic and hypoxic conditions 4 5 . . - - - - - - - - - - - - 4 5 67. Other causes of perinatal mortality 5 1 - - - - - - - - - - 1 . . . 5 1 68. Symptoms and ill-defined conditions - - - - - - - - - - . . - . . 1 . 1 69. Motor vehicle accidents - - - - 1 - 4 1 3 1 3 2 - 1 3 2 15 7 70. All other accidents - - - - 1 - 2 - 2 - 4 1 4 1 2 8 15 10 71. Suicide and other self-inflicted injuries - - - - - - - - - 1 1 - 3 1 . . 4 2 72. All other external causes - - - - - - - - - ' - - 1 - - - 1 - Total 18 14 3 6 3 7 13 1 24 18 311 158 407 246 327 475 1106 925 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 ViceChairman 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. Following the appointment of Miss Clarke as the Director of Nursing Services discussions were proceeding with the family doctors as to how to put into operation 'attachment' schemes for nursing staff in spite of the shortage of health visitors. The appointment of Miss Lambert who is the Consultant in Obstetrics and Gynaecology at Barking Hospital as Medical Supervisor of Midwives. During 1972 the scheme allowing the District Midwives to attend cases in Rush Green Hospital was commenced. Meetings between Local Health Authority Medical Officers and family doctors who carry out clinics in the area are held at which common problems and new projects are discussed. 20. HEALTH EDUCATION In January, the Health Education Section, with the rest of the Health Department, moved to Barking. The new offices are now in East Street, with the Health Education Centre at the Old Faircross School in Hulse Avenue. Once again, as far as this section was concerned, 1972 had its share of staff changes; we welcomed to the section in March, Mr. J. Fisher to succeed Mrs. Kasim as Assistant Health Education Officer, and finances enabled us at last to fill the post of the second assistant in October, but unfortunately she was indisposed one month later and was still off sick at the end of the year. It is most pleasing to note that the demand for health education in the Borough still grows. Health Education in Schools, Colleges and Teacher's Centre The demand for "specialised health subjects" in schools has been maintained, the main topics being Human Relationships. Sexually Transmitted Diseases, Contraception, Conception and Development of the Foetus, Birth and the Addictions are included in this subject. A second Comprehensive School invited us to participate in a Family Group - Learning together - Sex Education evening for first year pupils. The response of the parents, pupils and teaching staff was overwhelming, over four hundred people attended. Thanks are due to the school staff for all their cooperation and help. The Child Care Course for the basic certificate of the National Association for Maternal and Child Welfare remains very popular and all oral examinations were carried out by staff from the Health Education section. The Health Education Officer was invited, in an advisory capacity, to attend a committee meeting held by the teachers at Westbury School, to submit a Mode 3 C.S.E. syllabus on "Family Care" to the East Anglian Examinations Board. The General Studies Department of Barking College again asked for help with the "specialised topics" of the health education programme to both day and block release students. A total of eighty-one hours has been given to this during the year. A preview for all teachers of 16 mm films on health topics, which can be borrowed free of charge from the Health Department, was held on four consecutive Monday evenings during October, at the Teacher's Centre, Westbury School. North East London Polytechnic - Teacher's Training Course The Health Education Officer was again invited to give a lecture and demonstration on the "Use of Visual Aids in Health Teaching", to the student teachers attending the above course and one half day was given for this purpose. The attendance was good. British Red Cross Society - Public Health and Hygiene Course A course on Public Health and Hygiene was organised by the Health Education section in conjunction with the British Red Cross Society - Barking and Dagenham Division. Eight weekly two-hour lectures were given by various members of the Local Authority Health and Housing Departments. In spite of electricity cuts the course was well attended and a hundred per cent examination pass was achieved. 21. Home Safety Continued support was given to the Royal Society for the Prevention of Accidents, and a representative attended the National Home Safety Conference held at Cheltenham. Many youth organisations teach home safety as part of the Service Section of the Duke of Edinburgh's Award Scheme and eighteen separate oral examinations were held in the Borough with staff from the Health Education Section acting as examiners. Displays and Exhibitions The Health Department's exhibition at the Town Show this year was produced by the Public Health Inspectorate, the theme being "Clean Food. Flies spread Disease", The staffs of both Rush Green Hospital and St. George's Hospital invited the Department to provide displays on their hospital's "Open Day", a display on "Smoking in Pregnancy" was erected at Rush Green in the foyer of the Maternity Wing and a display depicting the links between Hospital and Home for the Geriatric Patient was erected at St. George's Hospital. A further display was also provided at Barking Hospital Maternity Unit for. their "Midwives Study Day". Thanks are due to all the hospital staffs involved for their continued co-operation. Students During the year twelve "Community Care" Students from Barking Hospital, four fourth year General Nursing Students from Rush Green Hospital and six Health Visitor Students have visited the Health Education Section. Film Preview An in-service preview of films that are kept within the Health Department was given on two consecutive days for all Local Authority Nursing Staffs. It is envisaged that this will in future be a regular occurrence. Talks to Outside Organisations Talks on a variety of health topics have been given throughout the year to various organisations such as Young Wives Groups, Y.M.C.A., Medical Section Engine Division of Fords, Royal College of Midwives and several other organisations. Films Once again film loans from the Health Department have been high, a total of 352 film bookings being made throughout the year, the majority of these were for schools and colleges, although the loans to local hospitals have more than doubled. Due to this demand, two films have been replaced and six new films have been added to the library, including two on Family Planning, suitable for all audiences. 22. PERSONAL HEALTH SERVICES Care of Mothers and Young Children During the year 471 mothers attended our clinics for ante-natal care from the midwives. A total of 534 clinic sessions were held and in addition 1,396 attendances were made at Mothercraft and Relaxation Classes. 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, Weekly Thursday, p.m. Lawn Farm Grove, Marks Gate. The Clinic, Weekly Tuesday, p.m. Oxlow Lane, Dagenham. Julia Engwell Clinic, Weekly Wednesday, p.m. Woodward Road, Dagenham. Thames View Clinic, Fortnightly Monday, p.m. Bastable Avenue, Barking. 23 Child Health Centres During the year, 5,584 children attended the following centres:- Centre Frequency of Sessions When held Annie Prendergast Clinic, Weekly Wednesday and Ashton Gardens, Thursday, p.m. Chadwell Heath. The Clinic, Weekly Monday, p.m. Becontree Avenue, Wednesday, a.m. Dagenham. Central Clinic, Weekly Tuesday and Vicarage Drive, Thursday, p.m. Barking. Wednesday, a.m. The Clinic, Weekly Tuesday, a.m. Ford Road, Thursday, p.m. Dagenham. Greatfield Clinic, Weekly Tuesday, p.m. Movers Lane, Barking. Julia Engwell Clinic, Weekly Tuesday and Woodward Road, Friday, p.m. Dagenham. Leys Clinic, Weekly Tuesday, p.m. Ballards Road, Thursday, a.m. Dagenham. Marks Gate Clinic, Weekly Monday, p.m. Lawn Farm Grove, Marks Gate. The Clinic, Weekly Wednesday and Oxlow Lane, Friday, p.m. Dagenham. The Clinic, Weekly Wednesday and Porters Avenue, Friday, p.m. Dagenham. Thames View Clinic, Weekly Wednesday and Bastable Avenue, Friday, p.m. Barking. 24. 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 4,761 packets Vitamin Drops 5,769 bottles Vitamin A and D tablets 692 packets Vitamin A, D and C tablets 508 packets Orange Juice 14,031 bottles PLAY THERAPY REPORT In the April of this year we started another group at Annie Prendergast Clinic. After a rather slow start we are now well established and we had 12 children attending. In the other three groups which are held at Julia Engwell Clinic, Oxlow Lane Clinic and Thames View Clinic we had 68 children attending. Some of these children had difficult home circumstances and 4 had speech difficulties. We also had 4 children attending for play therapy after being assessed at Kingsley Hall. KINGSLEY HALL ASSESSMENT CENTRE The centre continued its useful work throughout 1972. We had 35 admissions and 32 discharges with an average attendance of 12 a day. So it was a busy year for assessments. We had 8 staff for most of the year. We were very sorry to lose Pam Rawlings (who left to have a baby) and our faithful Mrs. Baker who has been in this building for eighteen years. We wish her a very happy retirement. The children made their usual visits to various centres sometimes accompanied by the staff as well as their mothers. These centres include the Nuffield Hearing and Speech Unit, the Wolfson Centre at the Institute for Child Health and the London Hospital Dental Clinic, and various other centres for special examinations such as Electro-encephalography or Chromosome tests. At Kingsley Hall we were lucky this year to obtain the services of an Educational Psychologist for one session a week to help us assess the children, particularly those with communication difficulties. In addition we had for two full days each week the help of Mrs. Warwick our Physiotherapist without whom we would find it very difficult to manage. 25. Apart from dealing with the children in Kingsley Hall our Physiotherapist sees seven or eight children who come in from all parts of Barking. During this year we were visited weekly for about four months by Dr. Peter Rosenbaum who came from Toronto on a Fellowship to Great Ormond Street Hospital and was writing a thesis on the facilities for physically handicapped children who were attending Kingsley Hall. He also interviewed the staff, the health visitors, the social workers etc. This thesis was written in conjunction with investigation at the Physiotherapy Department at Great Ormond Street. His general conclusion was that both children and parents benefited from a small centre in their own neighbourhood where they could spend the whole day as they can at Kingsley Hall more than at a large highly organised centre to which they might have to travel long distances. We have had frequent periodic visits from staff and students at the Wolfson Centre throughout the year both to give us help and to see something of our management of these children. We were very honoured when the local Consultant Paediatrician, Dr. Nauth-Misir, came to see us. He seemed very impressed with the facilities available and the work done at Kingsley Hall. He has used it quite a lot over many years for his handicapped patients but this was his first visit and we hope he will come again often. KINGSLEY HALL - STATISTICS 1972 Jan Feb Mar Apl May Jun Jul Aug Sep Oct Nov Dec Children on Register 18 20 20 18 21 20 22 19 19 19 20 19 Children Admitted 4 5 4 1 5 4 2 1 4 3 2 - Children Discharged 2 3 4 3 2 5 - 4 4 3 1 1 Average Daily Attendances 11 11 12 14 13 14 14 12 13 14 12 8 Children Escorted for Treatment - - 2 4 10 4 1 - 3 1 5 2 Journeys Made - - 1 3 7 3 3 - 2 1 4 2 Children seen for Assessment 6 6 2 2 3 4 2 - 7 4 1 - 26. COMMUNITY NURSING SERVICE This was an eventful year for the Community Nursing Service. The Mayston Management Structure was implemented. Miss E.M. Clarke was appointed as Director of Nursing Services and took up her appointment in April. Miss Dobson was already in post when Miss P. Broadbent commenced duties as Area Nursing Officer in September. Other appointments included five Nursing Officers, vizi- Mrs. Clegg & Mrs. Ward with Special Responsibilities for Health Visitors Miss Smith & Mr. Turpin with Special Responsibilities for District Nurses Miss Teather with Special Responsibilities for Midwives I am happy to report again this year that a full complement of District Nurses and Midwives was maintained. Eight of the ten Midwives are recognised "Teaching Midwives", undertaking, as well as their midwifery duties, the added responsibility of instructing Pupil Midwives from Barking Hospital in Community Midwifery Practice and Care. Altogether 13 pupil midwives received this training. The Midwives have also participated in Mothercraft Instruction to ante-natal mothers. Three Midwives attended Statutory Refresher Courses. The high standard of nursing care was maintained by the District Nurses. Due to the promotion of Mr. Turpin there remained only two male nurses working in the field. Although recruitment for female nurses is good, we failed to recruit a suitable male nurse. One District Nurse attended a Refresher Course. Two District Nurses received District Nurse Training. Health Visitors recruitment continues to present concern, not only locally, but nationally. Nevertheless, the Health Visitors in post with heavy caseloads have, with support from Ancillary Staff, maintained an excellent service, which is commendable. The Health Visitors held regular Parent Craft Classes in eight of the local authority clinics. Three of the Health Visitors are also Field Work Instructors, each participating in Student Health Visitor Training, in conjunction with the North-East London Polytechnic. Five Health Visitors attended refresher courses during the current year. The two sponsored Health Visitor Students completed their training and were successful in passing their examination. All three branches of the nursing service personnel have, as well as carrying out their normal duties, given instruction to other disciplines, such as Trained Nurses and Student Nurses from neighbouring hospitals, Social Service Staff and their students, taking them on their days' rounds as observers. This was a valuable service and was much appreciated. All staff should be commended for their work during the year. 27. Student Health Visitors As in previous years the Borough sponsored two students for training as Health Visitors. STATISTICS Midwifery Service Number of domiciliary confinements attended by midwives 177 Number of hospital confinements attended by domiciliary midwives 27 Cases delivered in hospitals and attended by domiciliary midwives on discharge within: 2 days 258 3 - 7 days 700 8 or more days 892 Home Nursing Service Total number of persons nursed during the year 2,207 Number of persons who were aged under 5 at first visit 14 Number of persons who were aged 65 or over at first visit 1,436 Health Visiting Service Cases Visited by Health Visitors Number of Cases Children born in 1972 2,578 Other children under 5 4,640 7,218 Persons aged between 5 and 16 seen as part of health visiting 179 Persons aged between 17 and 64 2,109 Persons aged 65 or over 360 Number of tuberculous households visited 122 Number of households visited on account of other infectious diseases 65 Persons included above who are:- Mentally handicapped 48 Mentally ill ... 30 28. SOCIAL SERVICES 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 Director of Social Services any important medical aspects that require observation or treatment. A Medical Officer continued to attend at the Adult Training Centre for one session per week for Medical Inspection of Trainees. The Council's Day Nurseries were also regularly attended by Medical Officers who monitor development and advise on the health of the children. VACCINATION AND IMMUNISATION The following statistics relate to persons protected at Council Clinics or by General Practitioners during 1972:- VACCINATION AGAINST MEASLES 1972 Year of Birth Primary Vaccination 1972 1 1971 760 1970 642 1969 63 1965 - 68 161 Others under age 16 6 Total all ages 1,633 MEASLES NOTIFICATIONS - 1967 - 1972 1967 1,630 1968 175 1969 207 1970 304 1971 234 1972 109 29. WHOOPING COUGH IMMUNISATION Year of Birth Primary Immunisation Children who received a booster dose 1972 8 _ 1971 1,321 13 1970 362 17 1969 48 14 1965-68 26 155 Others under age 16 - 24 Total all ages 1,765 223 DIPHTHERIA IMMUNISATION Year of Birth Primary Immunisation Children who received a booster dose 1972 8 . 1971 1,328 15 1970 364 21 1969 50 37 1965-68 181 1,949 Others under age 16 37 180 Total all ages 1,968 2,202 30. TETANUS IMMUNISATION Year of Birth Primary Immunisation Children who received a booster dose 1972 8 _ 1971 1,328 15 1970 364 25 1969 51 38 1965-68 189 1,991 Others under age 16 359 1,024 Total all ages 2,299 3,093 POLIOMYELITIS VACCINATION Year of Birth Primary Vaccination Children who received a booster dose 1972 8 - 1971 1,359 9 1970 353 25 1969 51 38 1965-68 185 1,995 Others under age 16 63 1,903 Total all ages 2,019 3,970 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 1972, 964 children were given B.C.G. vaccine, a decrease of 401 over 1971. 79 pupils had a Grade 2 or more reaction to Heaf testing and were referred to the Consultant Chest Physician for further investigation. It is now our policy to vaccinate children showing Grade 1 response to Heaf testing as it is more than probable that their response to the Heaf test is due to mycobacteria other than tuberculosis. In addition 194 contacts of tuberculosis were vaccinated by the Chest Physician, and 34 babies were vaccinated at birth. RUBELLA VACCINATION Number of girls vaccinated between their 11th and 14th birthday - 1,844. 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. 31. FAMILY PLANNING SERVICE In October 1972 the Borough Council agreed to provide the family planning service free and it is hoped that this may continue after April 1974,when following reorganisation of the National Health Service the Area Health Authority is due to take over this service from the Council:- The following sessions are now held in the Borough:- Annie Prendergast Clinic - Wednesday, 6.30 p.m. - 8.00 p.m. Barking Hospital - 1st and 3rd Thursday in the month - Afternoon 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 - 2nd and 4th Thursday in the month - 7.00 p.m. - 8.30 p.m. In addition the domiciliary family planning service continued, for those special cases where more intensive care is required. REPORT OF THE GERIATRIC LIAISON OFFICER The Geriatric Liaison Officer continued to pay home visits to advise on the care of the elderly. Cases visited 1972 No. of Cases Referred by Geriatric Consultants on discharge from hospital 196 Referred by General Practitioners 11 Referred by Consultant Physicians on discharge from hospital 121 Miscellaneous Referrals 287 Revisits to cases 664 1,279 32. GERIATRIC CLINIC Our Geriatric Clinic has gained much favour in the past and it was a pity that for the reasons of staff difficulties we could not manage more than two courses during the year. We had 23 patients attending and the attendance was very good. Of these 16 asked for medical examination but there was one gentleman who was under investigation in two hospitals concurrently so he was not examined. The ages of the remaining 15 ranged from 63 to 79 plus a lady aged 52. Attendance at family doctors' surgeries One had not seen her family doctor for more than a year and had hypertension with symptoms. Two had not seen their family doctors for 6 months and one of these had glycosuria, and was very obese (28%). Marital state of those examined F. M. Married and living with spouse 5 2 Widow or widower living alone 4 2 Widow or widower living with relations - 1 Single person living alone - 1 Obesity Grossly Obese Moderate Underweight Normal 6 1 3 5 Hypertension Seven people were found to suffer from hypertension. One was reasonably controlled by treatment while six did not know about the condition. Two had symptoms, one having arrhythmia and another headaches and palpitations but had not seen her family doctor about these symptoms. Other cardiac conditions - One heart block. Deafness One very deaf lady aged 63 was referred to the Otologist and one very deaf gentleman of 77 was using a hearing aid. Seven who were moderately deaf were able to cope fairly well with their disability. Eye Conditions All those who attended were in need of glasses, one for reading only. One 71 year old lady was attending Moorfields for investigation and one lady of 69 suffering from diabetes wa. also under investigation, while one lady aged 63 had cataract. 33. Miscellany One man was under the care of the London Hospital for bronchitis and one 70 year old man had a recurrence of bilateral hernia. The 52 year old female had uterine fibroids and suffered from anxiety state, while another aged 63 suffered from epilepsy for which she was already receiving treatment. It seems that this sort of clinic does play a useful part. At the end of each course we ask for comment and criticism and it is rewarding that each time they find the course interesting and helpful. The course is designed to teach the Over 60's and to encourage them to talk to the staff and doctor; it helps to resolve whatever problems they may have. People do not like to take up the time of the family doctor who they think is very busy and they are grateful for the time we spend with them. They can talk and reveal their anxieties and occasionally we also discover a condition they did not feel was serious enough to trouble their doctor with. There is always the probability that the withdrawn or the more seriously ill will not come to these courses, but the doctor would know about the seriously ill and one hopes that the Health Visitor or Social Worker would know about the withdrawn. One also hopes that working within the community, one gets to know the people and very likely they will draw ones attention to such cases and give the possibility to contact them. LOAN OF SICK-ROOM EQUIPMENT Patients being nursed at home may, on medical recommendation, be loaned a wide variety of equipment to assist in their care. Bulky items are delivered to patients' homes, smaller articles are collected from the health department by relatives. 2,018 articles were loaned during the year and 3,895 items were out on loan at the year's end. In addition, non-returnable items for incontinent patients were supplied in considerable quantity. 38,400 disposable incontinent pads were issued and 120 patients were supplied with waterproof pants or knickers with disposable linings. Thirty 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. 34. MEDICAL EXAMINATION OF STAFF The medical invagination 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 964 health questionnaires were submitted for scrutiny. 728 candidates were approved without further enquiry and 10 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 166 No. of persons found to be unfit 3 No. of persons accepted conditionally 37 No. of persons examined in connection with sickness payments 27 No. of persons examined for other authorities 2 No. of persons examined by other authorities 13 No. of Chest x-rays arranged in connection with medical examinations ... 375 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 authority to enable the necessary equipment to be installed and operated in hygienic conditions. During the year two homes were adapted and in one case adapted earlier the patient had a successful kidney transplant. During 1972 also it was found that in one case for which adaptation had been made the patient was unable to carry out home dialysis. By arrangement with Redbridge Borough Council the patient was rehoused and a Redbridge patient who could carry out his own dialysis was transferred into the adapted house. 35. REHOUSING ON MEDICAL GROUNDS As in previous years my Department has contiued 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 502 Number of recommended for rehousing 179 NATIONAL ASSISTANCE ACT, 1948 - SECTION 47. During the year, it was not found necessary to remove any person from their home as being unable to care for themselves and not receiving adequate care and attention from others. CYTOLOGY SERVICE 1972 Total number of patients seen was 1,551 of which 331 were residing out of the Borough. This was 100 more than in 1971. We have continued our campaign in trying to reach a wider circle of women and have contacted several larger factories. The response was good and invariably the women showed great enthusiasm and were most appreciative. This accounts for the large number of women residing out of the Borough. We had four positive and four suspect smears. Table 1 shows the positive smears. 36. Table 1. Age Social Class Para Cytology Report Treatment 1. 39 3 1 Numerous greatly atypical cells highly suggestive of malignancy. Cone biopsy - Hysterectomy 2. 47 3 1 An infected smear showing several atypical cells ? ca in situ. Cone biopsy - Hysterectomy 3. 59 3 4 Numerous atypical, mainly poorly differentiated cells present, diagnostic of squamous cell ca. Clinically suspect and referred to Gynaecologist. Cone biopsy - Irradiation 4. 46 3 3 Heavily infected smear with numerous atypical cells highly suggestive of an epidermoid ca. Cone biopsy - Hysterectomy One of the four positive smears was clincally suspect of carcinoma and was immediately referred to the Gynaecologist without actually waiting for the Cytology result. She had a history of bleeding for six weeks previous but did not go to see her G.P. Another of the positive smears had a previous smear two years ago when a few atypical cells were seen. These she was told were due to infection. The smear in 1972 again showed heavy infection but also numerous atypical cells due to epidermoid carcinoma. Table 2 shows the four suspect smears, three had negative reports on further smears and one is still under observation and follow-up. Table 2. Age Social Class Para Cytology Report and follow-up 5. 28 3 3 2.3. mild displasia rep. 2/12 6.6. severe displasia ? ca in situa rep. 1/12. 28.7. non specific infection - negative. 6. 41 3 1 mild displasia rep. 3/12 after 3/12 - negative 7. 27 3 0 mild displasia rep. 1/12 Trichomonas vag. but no malignancy. 8. 40 3 2 mild displasia rep. 3/12 1,551 seems to be a good response but we cannot be complacent. We are still far from reaching the most threatened group of women of social class IV and V which are notoriously the most elusive in all parts of the world. We have to increase our efforts in trying to contact them and use all possible means of education to increase screening in as wide a circle as possible. 37. 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. Miss Dobson (Area Nursing Officer) 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:Annual Report of Dagenham & Barking Chest Clinics 1972. In 1972 the chest services in the London Borough of Barking continued to rely on Barking Hospital Chest Out-patients and Five Elms Chest Clinic, and hospital beds in Dagenham and Chadwell Heath Hospitals. Asthma, bronchitis, carcinoma of lung, tuberculosis and industrial pulmonary disease remain prevalent. 56 new cases of tuberculosis were discovered and 74 cases of carcinoma bronchus. Total attendances between the two Out-patient Departments were over 10,000. Clinic Nurses continue to play an invaluable part in supervising out-patient anti-tuberculous treatment, following up contacts. 38. TUBERCULOSIS STATISTICS NOTIFICATIONS AND DEATHS AGE NEW CASES DEATHS Pulmonary Meninges and C.N.S. Other Total Pulmonary Non–Pulmonary M F M F M F M F M F M F Under 5 2 – – – – – 2 – – – – – 5– 1 6 – – 2 – 3 6 – – – – 15– 7 5 – – 3 1 10 6 – – – – 45– 11 7 – – – – 11 7 – – – – 65 + 6 1 – – – 1 6 2 1 1 – – (18 other notified cases died during the year but tuberculosis was not assessed to be the cause of death) Total 27 19 – – 5 2 32 21 1 1 – – TRANSFERRED CASES Into Borough 7 Outwards 12 Net Decrease 5 TUBERCULOSIS REGISTER No. of cases on Register 466 Free Milk On the recommendation of a Chest Physician additional supplies of milk are made available to patients suffering from tuberculosis, 49 patients were so assisted during the year. 39. CHIROPODY SERVICE 1972 was another difficult year for the Chiropody Service due to staff shortage. Two fulltime chiropodists who left could not be replaced. The Chief Chiropodist reports as follows:– The Chiropody Service was available at the following clinics:– Central Clinic –Operated by the Chief Chiropodist in conjunction with his administrative duties, and assisted by Miss K. Richards in the organisation of the Domiciliary Service. Greatfields Clinic –Operated by Mr. H. Stenson until November when he resigned Thames View Clinic to take up a position in Halifax. Julia Engwell Clinic –Operated by Mrs. D. Mann who also attends Louise Graham House for Mentally Handicapped each month. Porters Avenue Clinic –Operated by Mr. D. Ditsell. Ford Road Clinic –Operated by Mrs. Leage, who also attends Grays Court Old Peoples Home each week. Oxlow Lane Clinic –Operated by Mrs. M. Goss until her remarriage and subsequent resignation in July, owing to commuting difficulties. Service at this clinic has, however, been maintained by reducing the service at other clinics to four days per week. Annie Prendergast Clinic –Operated by Mr. N. Freeman, and assisted by Miss K. Richards, Clerk/Receptionist, when Hospital Car Service sessions are being operated. Old Peoples Homes –Five Old Peoples Homes have been regularly attended by Chiropodists throughout the year. Domiciliary Service –This service continues to have extremely heavy demands made upon it, and is at present operated by Mr. Samuels, also Mr. Fulton (who joined our staff in the Spring), as well as two of our full–time staff working extra sessions. The car transport service –Operated by Mr. Freeman at Annie Prendergast Clinic, and is continuing to function most satisfactorily, and is a great help in relieving the heavy burden made upon the Domiciliary Service. The Staff Meetings which I introduced when I came to the Borough have proved very worthwhile, and as a result of these, a Central Supply Store has been set up, enabling the ordering and supply of drugs and materials to be made more economically, and with less delay to each Chiropodist. The introduction of an amended Treatment Return Sheet has enabled greater accuracy in statistical returns, and shown a more detailed and accurate picture of work output. 40. The appliance and prosthesis work, which I introduced last year, is being carried out very successfully by Mr. Ditsell, Mrs. Leage and myself. The benefit and safety derived by the Physically Handicapped patients, from the installation of the Electric Hydraulic Chair at the Annie Prendergast Clinic and also the introduction of a chiropody drill with dust extractor at Porters Avenue Clinic, has shown the great necessity for more modern and improved equipment in all the clinics, which I hope we shall achieve in due course. During this past year I have attended a Management Course at Oxford, for Chief Chiropodists, and in July, Mr. Ditsell (Senior Chiropodist) attended a Refresher Course at the London Foot Hospital. TREATMENTS FOR THE YEAR 1972 CLINIC Children Adults Total Sessions –5yrs. 5–16yrs. O.A.P. Others A/N P/H Central 3 33 1,880 1 3 16 1,936 349 Julia Engwell 1 16 2,137 6 – 21 2,181 393 Porters Avenue – 37 2,407 26 – 33 2,503 432 Greatfields 5 17 1,901 – – 2 1,925 331 Thames View – 16 507 – – – 523 81 Ford Road – 31 2,586 121 3 89 2,830 413 Annie Prendergast 3 17 2,319 9 1 27 2,376 435 Oxlow Lane 2 14 1,905 26 5 29 1,981 323 Total 14 181 15,642 189 12 217 16,255 2,757 OLD PEOPLE'S HOMES Grays Court – – 318 – – – 318 46 Mayesbrook – – 141 – – • 141 20 The Lawns – – 139 – – – 139 20 Saywood Lodge – – 138 • • – 138 20 Riverside – – 139 – – – 139 20 Total – – 875 – – – 875 126 Domiciliary: West – – 1,414 – – – 1,414 355 East – – 605 – – – 605 151 Hospital Car Service _ _ 644 _ _ _ 644 91 Louise Graham House – – – • – 67 67 11 Grand Total 14 181 19,180 189 12 284 19,860 3,491 41. SCHOOL HEALTH SERVICE Schools There are 62 primary schools, 11 comprehensive secondary schools and 3 special schools in the Borough. The Bentry and Castle Special Schools cater for educationally sub–normal pupils and the Faircross Special School for delicate and physically handicapped pupils. A unit for partially hearing pupils is established at Eastbury Infants school. At the end of the year, numbers on roll were as follows:– Primary Schools 16,828 Secondary Schools 11,731 Special Schools 344 28,903 Provision of Free School Milk As from 1st September 1971 Regulations made under the Education (Milk) Act, 1971, required local education authorities to provide free school milk only to certain categories of pupils in their schools viz:– (a) Pupils in Special Schools. (b) Pupils in other schools up to the end of the summer term next after their seventh birthday. (c) Pupils up to the age of 12 years who are certified by the school medical officer to require free school milk by reason of their health. During 1972, 53 children in category (c) above were nominated to receive free school milk. 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 Tuesday and Thursday 9 – 9.30 a.m. Five Elms Monday p.m., Friday a.m. Ford Road Monday a.m., Friday a.m. Julia Engwell Monday to Friday 9 – 9.30 a.m. Leys Monday p.m. Marks Gate Friday a.m. Oxlow Lane Wednesday a.m. Porters Avenue Monday, Wednesday and Friday 9 – 9.30 a.m. A total of 1,426 pupils were seen during the year. 42. SCHOOL MEDICAL INSPECTIONS Routine school medical inspections are carried out on:– (a) Pupils entering primary school. (b) Pupils in their last year at primary school, and (c) Where considered necessary, on pupils in their last year at secondary school. In addition, pupils entering the Borough from other areas and children found to require observation or treatment are followed up as necessary. Particular attention is paid to pupils at the special schools. Number of special inspections 2,196 Number of re–inspections 1,731 3,927 43. Periodic Inspections Age Groups Inspected (by year of birth) No. of Pupils Inspected 1968 and later 358 1967 1,299 1966 1,064 1965 229 1964 102 1963 81 1962 397 1961 1,321 1960 557 1959 38 1958 44 1957 458 5,948 Pupils found not to warrant medical inspection (Following completion of a Health Questionnaire) 739 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 1968 and later 1 24 22 1967 27 161 166 1966 19 191 178 1965 5 19 19 1964 1 3 4 1963 1 3 3 1962 28 67 84 1961 65 150 183 1960 25 55 68 1959 – 2 2 1958 4 8 11 1957 and earlier 22 47 63 Total 198 730 803 General Condition of Children Out of 5,948 pupils examined, only two were considered to be of unsatisfactory general condition. INFESTATION WITH VERMIN During the year 48,064 pupils were examined, and 363 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. 11 cases were recommended treatment during the year. EMPLOYMENT OF CHILDREN 86 pupils were examined for fitness for employment out of school hours and certificates were granted. 44. 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 17 (b) for adenoids and chronic tonsillitis 154 (c) for other nose and throat conditions 10 Received other forms of treatment 247 Total number of pupils in schools who are known to have been provided with hearing aids:– (a) in 1972 17 (b) in previous years 78 ORTHOPAEDIC AND POSTURAL DEFECTS An Orthopadic Consultant attends monthly at Leys Clinic where a whole–time physiotherapist is also in attendance. Pupils known to have been treated (a) at clinics or out–patient departments 242 (b) at school for postural defects 4 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) 25 (b) Errors of refraction (including squint) 929 (c) Number of pupils for whom spectacles were prescribed. 723 DISEASES OF THE SKIN (excluding uncleanliness) Pupils known to have been treated Ringworm: (a) scalp 3 (b) body 7 Scabies 5 Impetigo 21 Other (plantar warts, etc.) 745 781 SPEECH THERAPY REPORT The Speech Therapists report that the work of the Borough is still being carried out by only two Speech Therapists. They hope, however, that the majority of the children requiring Speech Therapy are receiving help at one of the clinics in the Borough. The Speech Therapists would like to see a better liaison between themselves and other professionals over mutual patients. They consider that case conferences and discussions introducing a team approach to an individual case would be valuable. It is evident from the number of pre–school children referred for Speech Therapy that there is a real case for more nursery schools and play groups in the Borough. The Speech Therapists feel that a diagnostic unit which would be able to assess children with severe speech problems and language disorders would prove invaluable to the Speech Therapy Service. SPEECH CLINICS AND SPECIAL SCHOOLS Total number of attendances during 1972 2,557 Total number of non–attendances during 1972 1,117 Number on Register in December 1972 230 New Patients Category Under 5 Infant Junior Sec. Special Articulation Defects 22 83 18 1 5 Language 13 6 1 – 3 Stammer 5 7 3 1 – Resonance – 1 – 1 1 Cleft Palate – – – – – Total Number of New Patients during 1972 = 171 Discharged Patients Category Under 5 Infant Junior Sec. Special Speech Normal 6 60 37 3 – Left area 1 5 2 – 1 Non–attendance – 29 11 1 – Discharged at patients request 2 4 _ _ _ No further progress likely _ – 4 1 1 Total Number of Patients discharged during 1972 = 168 46. CHILD GUIDANCE CLINIC I am indebted to Dr. S. Fahmy, Consultant Psychiatrist, for the following report:– In 1972 the Clinic's work was markedly helped by the appointment of a Social Worker at the end of last year. The improvement was most noticeable in reducing the waiting period before parents were first seen, in home visits to parents who found attending difficult and in releasing some of the Consultant's time for individual therapy. This progress continued throughout the year but, unfortunately, stopped at its end when the Psychiatric Social Worker decided to return to her country. The following tables covering the four quarters reflect the current call made by referring agencies and under–estimates the real needs. Since many teenagers who go to the Courts are now being dealt with by the Social Services the figures do not show either the true picture of antisocial behaviour or the current incidence of adolescent disturbances. Further, through the increase in the number and activities of the educational psychologists, the schools appear to refer fewer cases than in previous years. This may have reduced the call on the clinic but need not necessarily imply a reduction in the incidence of emotional disturbances or increased community resources in treating them. Analysis of the figures show the steady reduction in the waiting periods and an increase in the number of active treatment sessions given to individual children. It was and remains the hope that this trend would continue and even accelerate when the staffing situation improves. In contrast to this picture the situation in Child Care in the Borough has, if anything, become less effective than in previous years. This is due to the shortage of social workers with experience in dealing with disturbed children. These difficulties hampered and further delayed systematic work with institutions and professional groups mentioned in previous reports. As in previous years psychologists and remedial teachers maintained their eagerness to help with clinic cases and the smooth efficiency of the Clinic's administrative work has depended upon the ever willing, conscientious hard work of the senior secretary. 47. CHILD GUIDANCE SERVICE Statistics 1972 Quarter Ended (a) Cases on books at end of quarter 31.3.72 30.6.72 30.9.72 31.12.72 (i) Waiting first Appointment 54 55 39 32 (ii) Seen at regular intervals 38 41 42 51 (iii) Others seen for re–assessment or surveillance 81 77 93 84 Total 173 173 174 167 (iv) Cases included in (iii) but will not be seen again unless requested 12 14 6 11 (b) Cases referred during quarter B G B G B G B G Under 5 years 1 2 2 – – – – – 5–12 years 13 4 9 5 8 – 7 7 12 –18 years 10 4 5 3 6 5 4 2 Total 24 10 16 8 14 5 11 9 (c) Cases closed during quarter (i) Treatment complete and case closed 22 13 9 13 (ii) Other treatment cases closed 8 4 7 10 (iii) Cases closed no treatment received 1 7 1 4 Total 31 24 17 27 (d) Treatment carried out during quarter and cases awaiting treatment (i) By Psychiatrist Individuals seen 102 70 104 81 Interviews 163 96 152 149 Appointments offered and not kept 49 43 51 59 (ii) By Educational Psychologists Individuals seen 10 11 3 18 Interviews 34 24 17 36 Appointments offered and not kept 3 5 2 3 (iii) By Psychiatric Social Worker Individuals seen 46 70 80 64 Interviews 109 115 165 151 Appointments offered and not kept 27 53 66 40 48. HANDICAPPED PUPILS REQUIRING EDUCATION AT SPECIAL SCHOOLS–1972 Blind Part Sighted Deaf Part Hearing Physically Handicapped Delicate Maladjusted Educationally Sub–normal Epileptic Speech Defect Total Number of children newly assessed in the year _ 1 _ 4 7 6 2 48 _ _ 68 Number of children placed in Special Schools in year _ 4 1 5 14 9 5 53 _ _ 91 Number of children requiring places in Special Schools _ _ _ _ 2 2 _ 35 _ _ 39 Number of children on Registers of Special Schools at 21st January 1973 5 16 2 26 75 47 35 291 5 2 504 Number of children receiving tuition at home or in hospital, etc. – – – – 1 – – 2 – – 3 INCIDENCE OF CONGENITAL ABNORMALITIES 1972 The notification and classification of congenital abnormalities apparent in children at birth continued during the year, the following defects being noted in 40 babies:– Central Nervous System Hydrocephalus 1 Spina Bifida 6 Eye and Ear Other specified malformations of ear 1 Alimentary System Cleft lip 3 Cleft Palate 5 Rectal and anal atresia and stenosis 1 Heart and Circulatory System Specified malformations of heart and circulatory system 2 Urino–genital System Hypospadias, epispadias 3 Undescended testicle 2 Hydrocele 2 Other specified malformations of urino–genital organs (includes pseudohermaphroditism) 1 Unspecified malformations of urino–genital organs 1 Limbs Syndactyly 2 Reduction deformity leg or foot 1 Talipes 12 Congenital dislocation of hip 1 Other specified malformations of upper limb or shoulder 1 Other specified malformations of leg or pelvis 1 Unspecified limb malformations 2 Other parts of Musculo-Skeletal System Malformations of spine – scoliosis curvature – lordosis, not otherwise stated 1 Other Systems Branchial cleft, cyst or fistula; pre–auricula sinus 1 Exomphalos, omphalocele (excluding umbilical hernia) 1 Pigmented naevus 3 50. DENTAL SERVICES I am indebted to the Principal Dental Officer for the following report The School Dental Service The School Dental Service was able during 1972 to provide free 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 was 74%, this compares well with the national average which is 58%. It is interesting to note that Headmasters now ring to find out why we are late with our School Inspection, because they have become accustomed to their inspection at a certain time of the school year. However, desirable as this is, it is not always possible, due to staff shortage, to arrange regular inspection. It is also interesting to note that the percentage of first inspections requiring treatment in Barking is 55%, this figure is also the national average. The number of children who commenced a course of treatment in 1972 was 5,059 compared with 4,617 in 1971, this is the first time that we have passed the five thousand mark. There were 11,620 fillings completed, compared with 11,069 in 1971, and also noteworthy is the ratio of permanent teeth filled to each extracted (national average 6.6) London Borough of Barking (11.01). Orthodontic treatment carried out during the year was satisfactory. It is difficult to compare figures for one year with those of another year in orthodontics, as of cases commenced in 1972, some could be completed in months,others may take years. However, the overall demand for this part of the Dental Service is increasing. Dental Health Education The experiment, started in 1970, to distribute Dental Hygiene Kits to all new school entrants was continued. This scheme is proving a great success, the large majority of Head Teachers Teachers are very enthusiastic and co–operative. The Principal School Dental Officer visited all infants schools in 1972 and distributed 2,222 Hygiene Kits. Nine schools requested a further supply. I would like to thank the Health Education Officer for the various talks and film shows that she arranged and gave in various Junior and Infants schools during the year. Staffing The staffing problem has been a "headache" for years. The common factor that governs this problem is salary. During 1972 we could not replace a Dental Auxiliary who left at the end of May, and it was with difficulty that we replaced a full time Dental Officer in February. I would like to repeat what I said in my 1971 report – the continual changing of Den tall Staff at any clinic is the surest way to decreasing attendances of children and subsequently the output of work. Dentistry is and will always be, in my opinion, a very personal service. Maternity and Child Welfare Services Treatment was available at all Dental Clinics for expectant and nursing mothers, and children under five years. During the year 1971 this service expanded well beyond any previous year and I am pleased to report that in 1972 it has again increased in numbers attending and output of work. The number of under fives inspected per Dental Officer was 155 and compares well with the national average of 84. Under fives treated per Dental Officer/Dental Auxiliary was 73 compared with the national average of 46, and the percentage of children age 3–4 years treated was 8% compared with 4.5% national average. 51. General Comments The year 1972 was a successful year from a Dental point of view. I only wish to make one comment, and this is taken from the Annual Report of the Chief Medical Officer to The Department of Health & Social Security: "While the Dental Health of Children continues to improve it is grossly impeded by the failure to provide for water fluoridation, the ceaseless opposition to this humane and safe measure makes a mockery of one aspect of the care of children's heath". Finally, I would like to thank all Dental Staff for their co–operation in 1972, also all teachers and the official staff in the Public Health Department. 52. DENTAL SERVICE STATISTICS Sessions (½ days) worked 1. Sessions devoted to inspection 158 2. Sessions devoted to dental health education 76 3. Sessions devoted to treatment 2,150 3. Sessions devoted to treatment of mothers and young children 162 2,546 School Dental Inspection 5. Number of pupils first inspected at school 19,502 Number of pupils first inspected at clinic 1,749 Number of pupils found to require treatment 11,639 Number of pupils offered treatment 11,639 Number of pupils re–inspected at school or clinic 306 Number of pupils found to require treatment 240 Treatment 6. Number of pupils actually treated 5,059 7. Number of attendances made 13,289 8. Number of fillings in permanent teeth 7,587 9. Number of fillings in deciduous teeth 4,033 10. Permanent teeth extracted 668 11. Deciduous teeth extracted 3,021 12. General anaesthetics given 1,286 13. Number of pupils x–rayed 453 14. Number of pupils supplied with dentures 3 Orthodontics 15. New cases commenced 48 16. Cases remaining from previous year 163 17. Cases completed 30 18. Cases discontinued 7 19. Number of appliances fitted 56 20. Pupils referred to hospital Consultant 4 MATERNITY AND CHILD WELFARE DENTAL TREATMENT Expectant and Nursing Mothers Children under 5 years Number of Cases 1. Number of persons examined 20 758 2. Number of persons treated 33 452 Treatment Provided 3. Scalings and other prophylaxis 21 254 4. Fillings 45 632 5. Teeth otherwise conserved – 116 6. Crowns and inlays 1 – 7. Extractions 20 153 8. General anaesthetics 1 76 9. Dentures provided 1 – 10. Patients x–rayed 9 17 53.