4411(1) BOROUGH OF DAGENHAM DAG 31 THE HEALTH OF DAGENHAM IN 1957 67960 BOROUGH OF DAGENHAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1957 J. ADRIAN GILLET, M.B., Ch.B., D.P.H. INDEX Page Ante-Natal Clinics 35 Atmospheric Pollution 17 Audiometry 67 Bentry Special School 72 Care of Mothers and Young Children 32-37 Child Guidance 67 Chiropody 48 Clean Air Act, 1956 17 Committee for Education 5 Convalescence 50 Council—Members of 3 Day Nurseries 36-37 Deaths—Causes of 11-13 Dental Services 62-64 Domestic Help 46-47 Education (General Purposes) Sub- Committee 5 Factories Acts, 1937 and 1948 19 Food and Drugs—Sampling 23-24 Food Hawkers 22 Food Hygiene Regulations, 1955 21 Food—Inspection and Supervision 19-25 Food Poisoning 22 Food—Unsound 22 Handicapped Children 69-71 Handicapped Children—Survey 38-42 Health Area Sub-Committee 4 Health Education 28-29 Health Visiting 33 Housing 15-16 Ice Cream 20 Immunisation 51-53 Diphtheria 52 Whooping Cough 51 Improvement Grants 16 Infant Mortality 13 Infant Welfare Centres 32 Infectious Diseases 26 Laundry Service 17 Page Maternal Mortality 34 Maternity Services 34 Medico-Social Assessment Centre for the over Sixties 45 Midwifery Service 34 Milk 20 National Assistance Act, 1948 16 Occupational Therapy 49 Opthalmology 65 Orthopaedic Clinic 66 Oxlow Lane Clinic 43-44 Pet Animals Act, 1951 18 Premature Infants 35 Public Health Committee 3 Public Relations—Seminar 30-31 Rag Flock and Other Filling Materials Act, 1951 18 Recuperative Holidays 50 Relaxation Classes 35 Rent Act, 1957 15 Rodent Control 18 Sampling—Food and Drugs 23-24 Sanitary Inspection of the District 14-17 School Clinics 58-60 School Health, 1957 54-57 School Health Service 50 School Nursing—Home Visiting 61 Seminar on Public Relations 30-31 Slum Clearance 15 Specialist Services 65-68 Special School—Bentry 72 Speech Therapy 68 Staff 6-7 Tents, Vans and Sheds 16 Tuberculosis 27 Unsound Food 22 Vaccination: 51-53 B.C.G. 51 Poliomyelitis 53 Smallpox 51 Vital Statistics 11-13 Water 14 2 MEMBERS OF THE COUNCIL (as at 31st December, 1957) MAYOR: Councillor R. Blackburn, J.P. DEPUTY MAYOR: Alderman G. H. A. Crouch ALDERMEN: W. E. Bellamy, J. P. D. O'Dwyer F. Brown, E.C.C. A. E. Prendergast, (Mrs.) F. Grindrod, J.P. C. Prendergast COUNCILLORS: G. Broadbent, (Mrs.) D. A. L. G. Dodd M. Eales A. J. Fry, A.R.I.C.S., A.A.I. A. S. Haddock B. L. Hollingsworth, B.Sc., Ph.D., A.R.I.C. H. P. Larking A. J. Levine, M.B., Ch.B. E. M. Millard, (Mrs.) J. F. Moultrie, J.P., F.A.I. W. A. Parish B. M. Roadknight, (Mrs.) A. C. V. Rusha B. Seeney, (Mrs.) L. S. Snelling, (Mrs.) J. Swift F. G. Thomas, J.P. J. S. Thomas L. W. Todd S. J. C. Warr PUBLIC HEALTH COMMITTEE Alderman (Mrs.) A. E. Prendergast, Chairman Councillor M. Eales, Vice-Chairman His Worship the Mayor Councillor R. Blackburn, J.P. The Deputy Mayor Alderman G. H. A. Crouch Councillor (Mrs.) G. Broadbent Councillor (Mrs.) E. M. Millard Councillor S. J. C. Warr Alderman D. O'Dwyer 3 DAGENHAM HEALTH AREA SUB-COMMITTEE Chairman: Alderman (Mrs.) A. E. Prendergast Vice-Chairman: Councillor M. Eales Members:— Borough Council The Mayor: Councillor R. Blackburn, J.P. The Deputy Mayor: Alderman G. H. A. Crouch Alderman D. O'Dwyer Councillor (Mrs.) G. Broadbent Councillor A. J. Fry, A.R.I.C.S., A.A.I. Councillor A. S. Haddock Councillor (Mrs.) E. M. Millard Councillor W. A. Parish Councillor A. C. V. Rusha Councillor (Mrs.) L. S. Snelling Councillor F. G. Thomas, J.P. Councillor S. J. C. Warr (one vacancy) County Council Alderman K. E. B. Glenny, O.B.E., J.P. Councillor A. C. Berry Councillor (Mrs.) S. M. Bovill Councillor S. W. Deeks Councillor L. F. Saunders Councillor W. A. Sibley (one vacancy) Hospital Management Committee Mrs. A. R. Thomas, E.C.C. Executive Council for Essex Mr. F. A. Wortley, E.C.C. Local Medical Committee for Essex (Vacancy) Voluntary Organisations Mrs. S. M. Hoxley, Miss N. L. Odell Miss A. Told Mr. J. Walsh 4 DAGENHAM COMMITTEE FOR EDUCATION ( as at 31st December, 1957) Chairman: Alderman D. O'Dwyer Vice-Chairman: Councillor (Mrs.) L. S. Snelling Representative Members: The Mayor Councillor R. Blackburn, J.P. Alderman W. E. Bellamy, J.P. Alderman (Mrs.) A. E. Prendergast Councillor (Mrs.) G. Broadbent Councillor M. Eales Councillor A. J. Fry, A.R.I.C.S., A.A.I. Councillor B. L. Hollingsworth, B.Sc., Ph.D., A.R.I.C. Councillor H. P. Larking Councillor A. J. Levine, M.B., Ch.B. Councillor (Mrs.) E. M. Millard Councillor W. A. Parish Councillor (Mrs.) B. M. Roadknight Councillor J. Swift Councillor F. G. Thomas, J.P. Nominated Members: County Councillor L. F. Saunders County Councillor A. W. Sibley Co-opted Members: Mrs. I. M. Brockelbank Mr. A. F. J. Chorley, M.B.E., J.P., E.C.C. Mr. E. E. Hennem Mrs. E. F. Lambert Mr. J. Walsh Mr. D. Williams EDUCATION (GENERAL PURPOSES) SUB-COMMITTEE (as at 31st December, 1957) (This Sub-Committee deals, inter alia, with the School Health Service) Chairman: Alderman D. O'Dwyer Vice-Chairman: Alderman (Mrs.) A. E. Prendergast Members: Councillor B. L. Hollingsworth, B.Sc., Ph.D., A.R.I.C. Councillor H. P. Larking Councillor (Mrs.) L. S. Snelling Councillor F. G. Thomas, J.P. Mrs. I. M. Brockelbank Mr. A. F. J. Chorley, M.B.E., J.P., E.C.C. Mr. E. E. Hennem 5 OFFICERS OF THE HEALTH SERVICES (as at 31st December, 1957) Medical Officer of Health and Area Medical Officer: J. Adrian Gillet, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health and Assistant Medical Officer: Helen E. Mair, M.B., Ch.B., D.P.H. Assistant Medical Officers: Catherine Fitzpatrick, M.B., B.Ch. (C) Fannie Hirst, M.B., Ch.B., D.P.H. (C) Edmund Percival James, M.R.C.S., L.R.C.P., D.R.C.O.G. (C) Wilhelmina C. Maguire, L.R.C.P., L.R.C.S.I. (C) Madeline Weizmann, M.R.C.S., L.R.C.P., (C) Dental Officers: F. Brown, L.D.S., R.C.S., (part time) J. Craig, L.D.S., R.C.S., (part time) A. D. Everitt, L.D.S., R.C.S., (full time) V. Foy, L.D.S., R.C.S., (Eng.) (part time) C. McKenzie, L.D.S., R.C.S., (part time) A. S. Roberts, L.D.S., R.C.S., (part time) Chief Public Health Inspector: L. E. Prior, (1), (2) Public Health Inspectors: J. W. Allam (1), (2), (4), F. W. S. Fox, (1), (2), (3), (4), G. Dovey (1), (2) A. J. James (1) Superintendent Health Visitor: (C) D. Gordon (5), (6), (7), (13), (19), Health Visitors: (C) A. E. Boorman (5), (6), (7), L. Ling (5), (6), (7) P. G. Collyer (5), (7), (8), (12) M. Neslon (5), (6), (7) L. Dunbar (5), (6), (7) D. B. Rudd (5), (6), (7) J. R. France (5), (6), (7) D. E. Smith (5), (7), (8), (15) I. A. Garrard (5), (16) D. B. Stewart (5), (6), (7) A. K. Gibson (5), (6), (7) E. Valentine (5), (6), (7), (15) R. E. Walker (5), (6), (7), (15), (16) Senior Midwife (C) E. M. Bedford (5), (6) Midwives: (C) M. Goodbun (5), (6) M. Rock (6) H. Mitson (5), (6) M. Teather (5), (6) M. M. Robson (6) ,(13) P. Vanbrook (6) School Nurses (C) K. Ayres (5), (6), (10) A. MacColl (5) J. Denyer (5), (8), (10) E. McCheyne (5) J. Hobein (5), (17) N. Rand (5), (15), (16) E. Hogg (5) M. Twomey (5) J. Hogg (5) N. Yarnell (5), (10) Speech Therapists: (C) E. Shipley (22) E. Symes (22), (23) 6 Clerical Staff: Chief Clerk (C) F. W. Knight (1), (2) Medical Officer of Health's Secretary: B. Park Trainee Public Health Inspector: J. Powell Clerks: E. Adams (C) I. M. Bishop (C) N. Briand (C) A. M. Brown (C) L. M. Butler (C) N. E. Cloke (C) D. Duff (C) D. B. Ellmore (C) G. K. Harris S. B. Leader (C) O. M. Lewsey (C) M. A. Watts (C) L. A. Manning (C) F. H. Martin (18), (C) J. Morgan (C) E. Neport (C) I. Page (C) K. Richards (C) G. Shannon (C) F. W. Silverthorne J. B. Smith (C) I. Throssell (C) Goresbrook Nursery, Dagenham Avenue, Dagenham. Chad well Heath Nursery, Ashton Gardens, Chadwell Heath. Kingsley Hall Nursery, Parsloes Avenue, Dagenham. Day Nurseries: (C) Matron: E. Maddison (15) Deputy: K. Graham (9) Matron: P. Coffee (17) Deputy: M. Carter (20), (21) Warden: D. Howes (21) Domestic Help Organiser: (C) G. Hickinbotham Chiropodists: (C) C. K. Bower (14) (part time) N. Freeman (full time) M. Kelly (14) (full time) Dental Attendants: (C) M. A. Brideson (full time) A. Horlock (part time) Officers employed by the Essex County Council are indicated thus (C) Part Time Staff: Public Analyst: Hubert Hammence, Ph.D., M.Sc., F.R.I.C. Occupational Therapist: D. M. Coldwell (C) Seconded from Regional Hospital Board Consulting Staff: Orthopaedic Surgeon: A. M. A. Moore, F.R.C.S. (part time) Ophthalmologists: L. H. Macfarlane, M.D., D.P.H., D.O.M.S. (part time) T. J. Regal, M.D., (Berlin), D.O.M.S. (part time) Physiotherapists: F. C. Cocker, M.C.S.P. (full time) A. Brand, M.C.S.P. (part time) 7 Qualifications (1) Certificate of Royal Sanitary Institute (2) Meat Inspector's Certificate (3) Sanitary Science as applied to Building and Public Works Certificate (4) Smoke Inspector's Certificate (5) General Trained Nurse (6) State Certified Midwife (7) New Health Visitor's Certificate (8) Midwifery, Part I (9) State Enrolled Assistant Nurse (10) Ex Queen's Nurse (11) State Certified Mental Certificate (12) Neurological Certificate (13) Registered Mental Nurse (14) Member of Society of Chiropodists (15) State Registered Fever Nurse (16) Tuberculosis Certificate (17) Certificate of National Nursery Examination Board (18) Diploma in Public Administration (19) Certificate of Royal Medico Psychological Association (20) Certificate of National Society of Children's Nurses (21) Certificate of Child Care Reserve Course (22) Diploma of Licentiateship of College of Speech Therapists (23) Diploma in Social Science 8 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, For the first time I am able to submit, as I promised last year, a combined report on the work of the Public Health, Area Health and School Health departments for the year. This integration of the three has meant a good deal of extra work for the staff, as the report is made up of various sections contributed by different members of the staff, edited and collated to make the whole. I am grateful to the staff for their co-operation and hope that the result is an easily assimilated picture of the health of the people of Dagenham during 1957. A start was made on the improvement and redecoration of the Ford Road dental clinic and permission was given and money allocated to improve the rest of the premises. I propose to make suggestions during 1958 to improve the Becontree Clinic so as to bring it up to a higher standard. The facilities for dental treatment were improved by the opening of Oxlow Lane Clinic, which provided up to date premises for many of thefcvaried activities of a modern public health department. An increased number of dental sessions was held, which although very far short of what is needed, is a step in the right direction. It gives me a great deal of personal satisfaction that I was able to put into effect an ambition I have had for a number of years. In September the Oxlow Lane MedicoSocial Assessment Centre was opened. There the over sixties are welcomed and encouraged to talk about their difficulties—social, economic and medical, and are able to have a general medical check up and advice about their many problems. I am indeed grateful for the co-operation I have had from the general practitioners in this endeavour. I would like to draw particular attention both to the survey of handicapped children and to the detailed report on the pre-school handicapped for which Dr. Mair has been responsible. There was an increase in immunisation of children against diphtheria carried out in the schools (1,890 in 1957 as against 826 in 1956). This was in great part due to Dr. Mair's initiative. The organisation resulting in the increased number of home visits paid by school nurses, largely in connection with the handicapped child has also been her special care. I have particular pleasure in drawing attention to the very successful Seminar on Public Relations and the Health Department, held in December. The lecturers and the course tutors were provided by the Central Council for Health Education, but much of the responsibility for organising the seminar was carried by Mr. Prior. This entailed a considerable amount of extra work. 9 In connection with health education generally, during 1957 a number of talks listed in the report were given by Mr. Prior and members of his staff. Legislation of recent years, e.g. the Food and Drugs Act and the Food Hygiene Regulation 1955, the Rent Act 1957—has made necessary much education of the public if it is to be effectively operated, and much explanation and discussion in order to secure the willing co-operation of all those concerned. This necessary health education demands continuous and persistent effort if it is to be properly organised. In the near future, consideration should be given to the appointment of a specialist officer in this branch of Public Health, with the necessary time and equipment at his disposal to arrange for organised courses in health education instead of the occasional lecture as at present. It is gratifying to record a further drop in the Infant Mortality rate which was 16.76 as compared with 20.87 in 1956. The stillbirth rate, however, showed an increase from 21.66 to 22.53. Note must be taken of the fact that of the 24 babies who died during the year no less than 16 did so during the first week of life, and of these 9 deaths were attributed to prematurity alone. It is the sum of stillbirths and deaths during the first week which constitute the perinatal deaths. Research into the causes of perinatal deaths is to be carried out on a national basis during 1958. Home accidents have been receiving ever increasing attention during recent years and it is considered that inquiries into their causes as well as their prevention is as much the concern of health departments as diphtheria and poliomyelitis. During the year it was suggested that the formation of a Home Safety Committee was desirable and I hope to be able to report progress in this field at the end of 1958. In conclusion I would like to express my thanks to the Chairman and members of the Committees concerned with the administration of the services covered by this report, for their consideration and support of my efforts to maintain and improve the health of the people of Dagenham, and to members of my staff for their contribution. The year that is behind us has been a year of progress in many directions but much still remains to be done if we are not to be satisfied with mere absence of disease but are to achieve that state of positive health which is so desirable. Our tasks are changing and we must adapt ourselves to those changing tasks. The emphasis is slowly shifting from what we can do to help people by central action to what we can teach them to do to help themselves, but— ‘Amidst change it should be remembered that the end is not mere life it is rather a good quality of life.’ (Aristotle) J. Adrian Gillet, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. 10 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 6,556 Registrar-General's estimate of resident population, 1957 114,400 Number of inhabited houses (end of 1957) according to Rate Books 30,632 Rateable value (December 31st, 1957) £1,330,713 Sum represented by a penny rate (approximate 1957-8) £5,410 Extracts from Vital Statistics for the Year Live Births: Total Male Female Legitimate 1,385 668 717 Birth rate per 1,000 of the estimated resident population 12.52 Illegitimate 47 22 25 Stillbirths: Legitimate 32 18 14 Rate per 1,000 total (live and still) births 22.53 Illegitimate 1 — 1 Deaths 794 444 350 Death rate per 1,000 of the estimated resident population 6.94 Deaths from pregnancy, childbirth, abortion Deaths — — — Rate per 1,000 total (live and still) births - Death rate or lnlants under one year ol age: All infants per 1,000 live births 16.76 Legitimate infants per 1,000 legitimate live births 16.61 Illegitimate infants per 1,000 illegitimate live births 21.28 Deaths from Cancer (all ages) 185 ,, „ Measles (all ages) — ,, ,, Whooping Cough (all ages) — ,, ,, Gastritis, Enteritis and Diarrhoea (all ages) 8 Births 1,432 live births were notified during the year, there being 690 males and 742 females. There is a decrease of total births from 1,581 in 1956 to 1,432. The corrected birth rate per thousand population was 11.52 compared with 16.1 for England and Wales. The illegitimate birth rate continues to be very low, being only 3.28 per cent of total live births. The rate of illegitimate stillbirths is 3.03 per cent of total stillbirths. Death Rate Total deaths in district 640 Outward transfers 196 Inward transfers 350 Deaths of residents 794 Of the deaths of non-residents occurring in the district, 172 took place at Rush Green Hospital and 7 at Dagenham Hospital. Of the deaths of local residents taking place outside this area, most occurred in institutions. Of these 228 occurred at Oldchurch Hospital; 17 at King George Hospital; 11 at Harold Wood Hospital; 17 at London Hospital; 9 at St. Joseph's Hospital; 7 at the Ilford Isolation Hospital; 7 at the Victoria Hospital, Romford; 5 at St. Andrew's Hospital, Billericay and 4 at the London Chest Hospital. The crude death rate of 6.94 when corrected becomes 12.08 and compares with 11.5 for England and Wales. 11 The following is a table giving causes of death and the age periods in which they occurred. Causes of Death 1957 under 1 yr. 1 and under 5 yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and over Total M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory - - - - - - - - 1 1 2 1 1 1 - 1 4 4 2. Tuberculosis, other - - - - - - - - - - - - - - - - - - 3. Syphlitic disease - - - - - - - - - 1 - - - - - - - 1 4. Diptheria - - - - - - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - 6. Meningococcal Infections - - - - - - - - - - - - - - - - - - 7. Acute Poliomyelitis - - - - 1 - - - - - - - - - - - 1 — 8. Measles - - - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases - - - - - - - - - - 1 1 - - - - 1 1 10. Malignant neoplasm, stomach - - - - - - - - 1 1 9 3 7 4 2 1 19 9 11. Malignant neoplasm, lung, bronchus - - - - - - - - 2 1 24 1 14 1 1 - 41 3 12. Malignant neoplasm, breast - - - - - - - - - 2 1 16 - 6 1 4 2 28 13. Malignant neoplasm, uterus - - - - - - - - - 1 - 9 - 1 - - - 11 14. Other malignant and lymphatic neoplasms .. - - - - - - 1 1 2 7 12 17 8 11 9 4 32 40 15. Leukaemia, aleukaemia - - - - 1 - — — 1 2 - 3 - - — — 2 5 16. Diabetes - - - - - - - - - - 2 3 1 2 — 2 3 7 17. Vascular lesions of nervous system - - - - - - - - - - 12 9 13 12 9 7 34 28 18. Coronary disease, angina - - - - - - - - 4 — 43 12 27 17 9 10 83 39 19. Hypertension with heart disease - - - - - - - - - - 6 2 2 1 4 9 6 20. Other heart disease - - - - - - - - 1 6 13 17 11 10 12 27 37 60 21. Other circulatory disease - - - - - - - 1 — 4 5 2 4 3 3 3 12 13 22. Influenza — - 1 — — 1 — — 1 — — 2 — 1 — — 2 4 Pneumonia 4 1 - - - - - 1 - - 7 4 12 3 6 4 29 13 24. Bronchitis - - - - - - - - - 1 24 3 22 6 13 6 59 16 25. Other diseases of respiratory system - - - - - - 1 - - — 5 2 3 — — — 9 2 26. Ulcer of stomach and duodenum - - - - - - - - - - 3 1 3 — 2 — 8 1 27. Gastritis, enteritis and diarrhoea 1 - - - - - - - - 1 2 2 - - 1 1 4 4 28. Nephritis and nephrosis — — — — — — — 1 — 1 2 — — — — 1 2 3 29. Hyperplasia of prostate - - - - - - - - - - - - - - - - - - 30. Pregnancy, childbirth and abortion - - - - - - - - - - - - - - - - - - 31. Congenital Malformations - 2 - - - 1 - - 1 - - 1 - - - - - 4 32. Other defined and illdefined diseases 7 9 2 1 - - 1 - 3 3 6 6 7 10 4 10 30 39 33. Motor vehicle accidents — — — — 1 — 3 — 3 — 3 1 — — — 1 10 2 34. All other accidents - - - - - - 1 - - - 2 1 1 2 3 1 7 4 35. Suicide - - - - - - - - - - - - - - - 1 — 3 36. Homicide and operations of war — — — — — — — — — — — — — — — — - — 12 12 3 1 3 2 7 4 20 32 184 119 138 92 77 88 444 350 12 INFANT MORTALITY Details of deaths of children under one year of age registered during 1957 Under lwk. 1—2 wks. 2—3 wks. 3—4 wks. Total under 4 wks. 4 wks. and under 3 mo. 3 mo. and under 6 mo. 6 mo. and under 9 mo. 9 mo. and under 12 mo. Total deaths under 1 year Prematurity 9 — — — 9 — — — — 9 Prematurity with associated cause 2 — - - 2 - - - - 2 Congenital Abnormality with Bronchopneumonia - - - 1 1 1 - - - 2 Congenital Abnormality with Meningitis - - - - - - - 1 - 1 Congenital Abnormality (uncomplicated) 1 - - - 1 - - - - 1 Birth Trauma—Inhalation of infected liquor amnii 1 - - - 1 - - - - 1 Birth Trauma—Intracranial Haemorrhage 1 - - - 1 - - - - 1 Atelectasis 2 — — — 2 — — — — - Bronchopneumonia — — — — — 1 2 — — - Gastro-Enteritis - - - - - 1 - - - 1 Acute Meningitis - - - - - 1 - - - 1 TOTALS 16 — — 1 17 4 2 1 — 24 13 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR sanitary inspection of the district (a) Nature and number of visits:— Overcrowding and Housing Conditions 1,220 Nuisances under Public Health Acts:— Dwelling houses 3,538 Other premises 968 Bakehouses 44 Milkshops and dairies 91 Foodshops, stalls and itinerant vendors 3,137 Cafes and canteens 723 Infectious disease enquiries 816 Visits to foster-mothers' premises 78 Number of complaints investigated 933 Factories 384 Outworkers' premises 43 Workplaces and offices 76 Rag Flock, etc. 25 Tents, vans and sheds 321 Stables 12 Pet Shops 31 Hairdressers' and barbers' premises 96 Shops Act 60 Ice Cream premises and vehicles 305 Houses disinfested 17 Other visits 412 (ib) Notices served:— Complied with:— Statutory 80 65 Informal 636 516 WATER The water supply is satisfactory in quality and quantity. During the year two chemical and two bacteriological samples were taken from the Company's mains in this Borough; all were satisfactory. The water is not liable to have plumbo-solvent properties and no action was called for in respect of any form of contamination. Approximately .022 per cent of the inhabited houses and .014 per cent of the population of the Borough take their water from standpipes. 14 During the year the mains laid in the Borough were as follows:— Lenghts of Mains Yards Diameter 901 3" I5523 4" 1 6" 9 9" 1 10" 46 15" 27 18" 260 21" 372 supplies were afforded to houses during the year. The Chief Engineer of the South Essex Waterworks Company has furnished me with the following report:— “Bacteriological and chemical examinations are made of the raw river water, of the water in its various stages of treatment and of the water going into supply and of both raw and chlorinated water from the Company's wells. Analyses are also made of samples obtained from consumers’ taps in the various parts of the Company's district and all proved to be satisfactory. Over 3,890 chemical, bacteriological and biological examinations have been made during the year. All water going into supply was wholesome." HOUSING Slum Clearance During the year one area containing two houses has been officially represented. In addition, a further three houses have been dealt with informally. The Council's five-year programme consists of 58 properties and at the end of the year action had been commenced in respect of 31. Rent Act, 1957 This Act operated from 6th July, 1957 and up to the end of the year 51 applications for certificates of disrepair had been received from tenants. The appropriate notice (in only 23 cases did the list of defects include all those asked for by the tenant) was issued in each case informing the landlord (a copy was sent to the landlord's agent) of of the Council's intention of issuing a certificate of disrepair. Undertakings were given in respect of 36 properties; certificates of disrepair were issued in respect of 14 properties 15 and of these four were subsequently cancelled on the completion of the repairs. In one case the tenant's original notification to the owner was not satisfactorily completed and formal action by the Council was, therefore, impossible; the owner, however, gave an informal undertaking to do the repairs. This was the only instance of a tenant's failure satisfactorily to complete the necessary forms preventing the Council from taking the appropriate action. Advice was given to tenants and they were able to purchase the necessary forms from the Civic Centre. There are 186 dwellings in the Borough with a rateable value of over £40 per annum and only one definite application was received by the Council's Housing Department from a tenant who anticipated eviction when the property was decontrolled. Improvement Grants Applicants for improvement grants under the Housing Acts are encouraged to make preliminary enquiries before any expense in, say, the preparation of plans, is incurred. During the year enquiries were received in respect of 15 houses; in two cases the work had been completed before the applications were made and in several of the others the suggested improvements were either not eligible for a grant or the total cost was under the minimum of £100. Five applications were considered by the Council. One was refused because the Council hoped to re-develop the area within the next 15 years. Grants (half the cost) were made in respect of the other four houses; in each case the property was occupied by the owner. Tents, vans and sheds Two applications under the provisions of the Public Health Act, 1936, Section 269, were received in respect of caravans to be sited at gravel pits. Both applications were refused. NATIONAL ASSISTANCE ACT, 1948 Section 47 The surveillance of elderly persons who are unable properly to look after themselves continues to receive the attention of the department. Compulsory removal was not necessary in any case during the year. Section 50 One person (male 48 years) was buried under the provisions of this Section. 16 LAUNDRY SERVICE FOR THE INCONTINENT AGED This service continues to meet a real need in the home at a time when help is usually most urgent. Each year since its commencement in December 1953 the demand for the service has increased. Soiled articles are collected and laundered articles returned each Monday, Wednesday and Friday. A small metal bin is provided in the home for the reception of soiled articles after they have been rinsed in cold water. The service worked well and the co-operation of the laundry staff at Barking Hospital continues to be excellent. From the commencement of the service to the end of the year 139 cases have received assistance. During the year 33 new cases have been helped, 18 cases died and nine were removed to hospital or no longer needed the service. At the end of the year 18 cases were still participating in the service. The number of articles laundered during the year was 11,492 compared with 8,551 articles for the previous year. ATMOSPHERIC POLLUTION Systematic observations are made of the chimneys of industrial premises; there was no need for statutory action during the year. The Council continue to operate at the Civic Centre and in the vicinity of Valence House instruments for the measurement of air pollution. Several lectures, with the title "The Air We Breathe," were given to local organisations. The problem (both local and national) of air pollution was stated together with the opportunities available to individual householders to co-operate in ensuring an improvement. Clean Air Act, 1956 The provisions of the Act which control the installation of new furnaces are dealt with by the Public Health Committee; the control of the height of new chimneys is the responsibility of the Housing and Town Planning Committee subject to the concurrence of the Public Health Department with each proposal. The Council supported the efforts made in opposing the Order transferring powers in respect of certain works and processes from local authorities to the alkali inspectorate. Smoke Control Areas The Council agreed in principle, in co-operation with the neighbouring Borough of Ilford, to make the Marks Gate housing estate the first smoke control area established in this Borough under the 1956 Act. The Dagenham section of the estate covers nearly 130 acres and when completed will contain about 1,000 dwellings. Action was deferred until after the joint conference of local authorities in the East London Area held at Leyton in October 1957 at which matters of common interest in regard to air pollution were discussed. 17 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Two premises which have been registered under Section 2 of the Act have operated during the year. One licence for the manufacture and one licence for the storage of rag flock have been issued during the year. Samples are taken regularly at the three factories in the Borough where filling materials are manufactured. 35 informal samples were taken during the year; all were satisfactory. The details are as follows:— Material No. of Samples submitted for analysis Rag Flock 10 Cotton Felt 8 Kapok 7 Sisal 5 Coir Fibre 3 Kapok mixed with cotton 1 Millpuffs 1 PET ANIMALS ACT, 1951 Five licences authorising the keeping of pet shops have been renewed. The conditions attached to the licences are those approved by the Association of Municipal Corporations; no serious breach of the conditions occurred. The attention of proprietors of pet shops was drawn to leaflets on the feeding, care and management of various pets which could be purchased and were very suitable for distribution to customers with a view to avoiding unnecessary distress to animals arising from ignorance on the part of the purchaser. PREVENTION OF DAMAGE BY PESTS ACT, 1949 Disinfestation of rats and mice is carried out under the supervision of the district inspectors by the manual employee attached to the department. The service is free to householders but a charge on a time and material basis is made for business premises. Following a 10 per cent test-baiting of all sewer manholes in the Borough, two treatments, at six monthly intervals, were carried out in areas where there was evidence of infestation. 18 FACTORIES ACTS, 1937 AND 1948 Inspections Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 19 27 2 - Factories with mechanical power 167 274 6 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 24 83 6 - TOTAL 210 384 14 - Defects Found Number of defects Found Remedied To H.M. Inspector Referred By H.M. Inspector Number of Prosecutions instituted Want of cleanliness 1 1 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - 1 - - Ineffective drainage of floors - - - - - Sanitary Conveniences:— Insufficient 5 4 - - - Unsuitable or defective 9 7 - 4 - Not separate for sexes - - - - - Other Offences - - - - - TOTAL 15 12 1 4 - Outwork No. of outworkers in August list 16 Nature of work—Making etc., wearing apparel. INSPECTION AND SUPERVISION OF FOOD The numbers and types of food premises in the Borough are as follows:— 5 Bakehouses 23 Bakers and Confectioners 60 Butchers 169 Cafes and Canteens 25 Fishmongers 53 Fruiterers and Greengrocers 120 Grocers 21 Licensed Premises 12 Off-licensed Premises 95 Sweets, etc. 19 All food premises are regularly inspected and during the year 4,018 visits were paid. In addition to numerous verbal warnings and suggestions to management and staff during these routine visits, 71 informal notices were served upon owners or occupiers. 234 inspections were carried out in connection with itinerant vendors and stalls; much of this work, especially in respect of itinerant vendors, is done at weekends. The position under the Food and Drugs Act, apart from registrations in respect of ice cream, is as follows:— 37 butchers' premises and six other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 518 visits were paid. One application for the cooking of hams at a grocer's premises was refused as the construction of the room proposed to be used for the purpose and the facilities available were not considered satisfactory. 21 fish shops are registered for frying. To these 275 visits were paid. Milk All milk distributed in Dagenham is produced and bottled outside the Borough. Eight premises are registered as dairies. The number of registered distributors is 80 and of these 11 operate from premises outside the Borough. 91 visits were paid to dairies and distributors' premises. During the year 53 samples of milk were taken from roundsmen in the Borough and submitted for bacteriological examination. The only unsatisfactory sample was a bottle of sterilised milk, processed by a large multiple firm, which failed to pass the turbidity test. The "duplicate" sample taken by the roundsman from his vehicle at the time of the "official" sample was examined in the firm's laboratory and found to be satisfactory. Ice Cream The total number of registered premises is 135; of this number two are registered for the manufacture of ice cream. 257 visits were paid to these premises. During the year six applications for the storage and sale of ice cream were granted. One application for the storage and sale of ice cream at a small shop where the principal trade was fruit and greengrocery was refused. A number of premises, mainly grocers' shops, which were registered immediately after the war, had not sold ice cream for several years and with the co-operation of the occupiers the registrations were cancelled. 48 inspections in connection with itinerant vendors were carried out. The use of insulated containers for the storage of hot water on vehicles has not been found altogether satisfactory, especially when vehicles are away from their depots for the whole day. 20 During the year 34 samples of ice cream were submitted for bacteriological examination; they were graded as follows:— Grade I Grade II Grade III Grade IV Total 22 9 3 - 34 In addition 15 samples of ice lollies were submitted for examination; three were unsatisfactory. In each case the lollies were manufactured outside the Borough and the local authorities concerned were notified. 13 samples were taken of ice cream manufactured in the Borough (at the two registered premises) with the following results:— Grade I Grade II Grade III Grade IV Total 7 5 1 - 13 The bulk of the ice cream and lollies sold in the Borough, apart from the two small local producers, is supplied by three or four large manufacturers. Food Hygiene Regulations, 1955 The traders have continued to co-operate and in all cases dealt with during the year informal action secured compliance with the regulations. Two exemption certificates granted to building contractors lapsed during the year; at one running hot water was provided and at the other the canteen closed. Approximately 2,000 copies of a local clean food handbook were distributed to food traders and, with the assistance of the public libraries, to the general public. Lectures were given to food handlers, including films and talks to the staff of the school meals service. In an effort to overcome the difficulty of shop staff leaving the premises to attend lectures arrangements were made, with the co-operation of the management, to hold short discussion groups during the morning or afternoon tea break. The usual 15 minutes break was extended to about 30 minutes and although the group might consist of only three or four food handlers it was considered to be well worth while. A flannelgraph, made up in the department, was used to illustrate the requirements of the regulations. 21 At the Dagenham Town Show held on Saturday and Sunday, 13th and 14th July an exhibition was arranged including dirty and clean empty milk bottles, diseased meat and a light-hearted quiz designed to enable visitors to the Show to check their knowledge as to the difference between horseflesh and beef, and the organs of various animals, together with different types of fish. Unsound Food There has been no decrease in the number of complaints received in respect of food containing foreign substances or otherwise alleged to be unfit for human consumption. Legal proceedings were taken in respect of two complaints (a mouldy pork pie and bread containing rodent excreta); a fine of £10 was imposed in each case. The normal method of disposing of unsound food is to use the incinerator at the Council's refuse disposal works. Occasionally, when there is a quantity of meat, it is disposed of under supervision through the Council's waste food service; the meat is previously cut up and dyed. Registration of Food Hawkers Under the provisions of the Essex County Council Act, 1952, Section 103,13 persons were registered as food hawkers; three had storage premises in the Borough. Food Poisoning 51 cases of food poisoning were notified during the year. The following is a copy of the annual return submitted to the Ministry of Health:— 1st Quarter 16 2nd Quarter 5 3rd Quarter 13 4th Quarter 17 Total 51 Outbreaks due to Identified Agents. Total Outbreaks 2 Total Cases 6 Outbreaks of Undiscovered Cause Total Outbreaks 10 Total Cases 32 Single Cases Agent Identified 4 Unknown Cause 9 Total .. 13 All the outbreaks were confined to individual families and all identified agents were of the Salmonella group. 22 Food and Drugs—Sampling Article Number Examined Number Adulterated, etc. Formal Informal Formal Informal Almonds, Ground - 1 - - Baby Cereal - 1 - - Baking Powder - - - - Beer - 1 - 1 Beverages - 1 - - Blancmange Powder - 1 - - Boracic Crystals - 1 - - Bread 2 - - 2 Bread Roll, Buttered - 1 - 1 Butter - 1 - - Cake - 1 - 1 Cheese Spread - 1 - - Chocolate Spread - 1 - - Cloves - 1 - - Coffee 1 1 - - Cream - - - - Cream of Tartar - 1 - - Curry - 1 - - Dessert Powder - 1 - - Dripping 1 1 - - Egg Custard with Rice - 1 - - Flavouring - - - - Flour 10 3 - 1 Fruit Drinks 1 1 - - Fruit, Mixed - 1 - - Fruit Pie - 1 - - Fruit Salad - 1 - - Glace Cherries - 2 - - Glucose - 1 - - Glucose Tablets - 1 - - Herbs - 2 - - Ice Cream 8 - - - Ice Lollies - 2 - - Icing - 2 - - Instant Pudding - 1 - - Jam - 1 - - Jellies - 3 - - Margarine - 2 - - Marzipan 1 2 - - Milk 28 9 - 7 Milk Bottle - 1 - - Mincemeat - 1 - - 23 Food and Drugs—Sampling cont'd. Article Number Examined Number Adulterated, etc. Formal Informal Formal Informal Mineral Water - 1 - 1 Mint - 1 - - Mustard - 1 - - Non-brewed Condiment 1 - 1 - Nutmeg, Ground - 1 - - Oranges - 1 - - Paste - 3 - - Pastry - 1 - - Peas, Fresh Garden - 1 - - Pea Flour - 1 - - Peel - 1 - - Pepper - 1 - - Pie Filling - 1 - - Pickles - 1 - - Pork, Chopped - 1 - - Puddings - 3 - - Rice, Creamed - 1 - - Rice, Ground - 1 - - Salad Dressing - 1 - - Sausages 8 - - - Semolina - 1 - - Soup - 3 - - Spice, Mixed - 2 - - Sponge Mixture - 1 - - Sponge Sandwich Cream 1 - - - Steak and Kidney Pie - 1 - - Suet 1 2 1 - Synthetic Cream - 1 - - Tea - 3 - - Tomato Juice - 1 - - Tonic Wine - 1 - - Vinegar - 2 - - Wines and Spirits 13 11 2 - Yeast - 1 - - 24 Adulterated Samples, etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 280A Beer Informal Contained mould growth Warning letter 282A Flour Informal 49% deficient in creta preparata Formal sample satisfactory 299A Milk Informal Contained multi-coloured fibres and minute fragments of burnt milk 300A Milk Informal Contained fragments of straw and traces of burnt milk 301A Milk Informal Contained bluish and purple fibres 305A Milk Informal Contained a few cotton fibres and minute black specks, also some minute black globules of oily matter These were a series of samples of school milk from one supplier 306A Milk Informal Contained a few cotton fibres and minute black specks, also some minute black globules of oily matter 307A Milk Informal Contained a few minute black specks and some minute black globules of oily matter. 304A Bread Roll Buttered Informal Contained foreign matter consisting of burnt or charred dough Warning letter 320A Cherry Mineral Water Informal Had a nasty objectionable smell and contained a substantial amount of yeasts in suspension Warning letter 322A Bread Informal Contained two very small rodent excreta Manufacturer prosecuted Fined £10 323A Cake Informal Contained a pin. No action. Insufficient evidence that pin emanated from the source alleged. 324A Milk Informal Contained mould growth on bottom of bottle. Warning letter 359A Bread Informal Contained foreign matter in the form of small masses of earth Warning letter 2350 Whisky Formal Contained 1 % added water Warning letter 2354 Whisky Formal Contained 2.4% added water Warning letter 2386 Shredded Beef Suet Formal 0.8% deficient in fat Further sample satisfactory 2447 Non brewed Condiment Formal 17% deficient in acetic acid Warning letter 25 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES Notifiable Diseases (Other than Tuberculosis) Under 1 year 1—2 3—4 5—9 10—14 15—24 25 and over Total Scarlet Fever 1 11 26 58 30 5 1 132 Whooping Cough 24 52 62 98 22 - - 258 Acute Poliomyelitis:— Paralytic - 1 2 - 1 - 1 5 Non-paralytic - - 2 1 1 1 - 5 Measles 30 238 368 620 24 6 6 1,292 Diphtheria - - - - - - - - Under 5 years 5—14 15—44 45—64 65 and over Total Pneumonia:— Acute Primary 1 5 12 13 6 37 Acute Influenzal 2 4 12 18 5 41 Dysentery 4 5 6 - - 15 Encephalitis, Acute:— Infective - - - - - - Post-Infectious 1 1 - - - 2 Erysipelas - - 2 6 1 9 Meningococcal Infection 2 - - - - 2 Food Poisoning 17 6 24 4 - 51 Puerperal Pyrexia - - 3 - - 3 Ophthalmia Neonatorum 1 - - - - 1 Paratyphoid "B" - - - - - - Notified Admitted to Isolation Hospital, Rush Green Admitted to other Isolation Hospitals Admitted to other Hospitals Diphtheria - - - - Dysentery 15 2 1 1 Encephalitis, Acute 2 1 1 - Enteric Fever - - - - Erysipelas 9 1 1 - Food Poisoning 51 - 2 - Malaria - - - - Measles 1,292 7 2 - Meningococcal Infection 2 2 - - Ophthalmia Neonatorum 1 - - - Paratyphoid Fever - - - - Pemphigus - - - - Puerperal Pyrexia 3 - - - Pneumonia:— Acute Influenzal 41 1 3 - Acute Primary 37 - - - Poliomyelitis:— Paralytic 5 - 5 - Non-Paralytic 5 5 - - Scarlet Fever 132 4 1 - Smallpox - - - - Whooping Cough 258 4 4 - 26 TUBERCULOSIS New Cases Deaths Primary Notifications Brought to notice other than by Form A Pulmonary NonPul monary Pulmonary NonPul monary Pulmonary NonPul monary M F M F M F M F M F M F Under 1 - - - - - - - - - - - - 1— 2 1 - - - 2 - - - - - - 5— - - 1 1 1 2 - 1 - - - - 10— 1 1 1 - - - - - - - - - 15— 4 9 - - 2 3 - - - - - - 20— 1 2 - 1 2 6 1 - - - - - 25— 3 2 - - 10 7 - - - 1 - - 35— 4 5 1 2 7 5 - - 2 - - - 45— 8 - 2 - 3 - - - - - - - 55— 2 2 - - 3 1 - - 3 1 - - 65—and upwards 3 - - - - - - - 6 1 - - 28 22 5 4 28 26 1 1 11 3 - - Register Pulmonary N on-Pulmonary Male Female Male Female No. on register 1st January, 1957 544 424 67 71 During the year:— New notifications 28 22 5 4 New cases brought to notice by Registrars' Death Returns 1 1 - - Deaths 10 2 - - Transfers into area 28 26 1 1 Transfers out of area 31 20 2 4 Removed from register as "Recovered" - 8 - 1 No. on register 31st December, 1957 560 443 71 71 27 HEALTH EDUCATION Each member of the staff has the opportunity to engage in health education as an integral part of the daily work of the department; all are encouraged to do so. In connection with pre-arranged talks or discussion groups, visual aids such as film strips, flannelgraphs, models, etc., are available for illustrating the many and varied aspects of the work. Perhaps the most important part of this work is done by the officer discussing with an individual in the home, clinic, shop, etc., some appropriate aspect of personal or environmental hygiene. It is becoming increasingly true in the public health field that the immediate work is not the discovery of something new and sensational, but the education of the people to use the facilities already provided for them and observe the known and proven ways of maintaining good health of mind and body. Prevention is always better than cure and the health education activities of the department seek to bring this simple but vital axiom into every day living. All local organisations have been informed that members of the departmemt can provide talks and discussions on a number of varied subjects with appeal to local residents of all ages; the diary of talks given below indicates the response. Diary of Talks Date Organisation Subject March Barton's Bakery, Dagenham. (Two lectures). Food Hygiene. ,, Women's Co-op Guild, Chadwell Heath. Old Age. ,, Gale Street Co-op Party. The Food We Eat. ,, Dagenham Town Forum. Atmospheric Pollution. April Rookery Farm Parent Teachers Association. The Food We Eat. ,, Rotary Club, Dagenham. The Sick Child (Film Strip). ,, Women's Co-op Guild, Heathway. Old Age. ,, Essex Association for the Welfare of the Physically Handicapped. Dagenham Branch. Welfare of the Physically Handicapped. May Women's Co-op Guild, Rush Green. The Food We Eat. ,, Chadwell Heath Ratepayers' Association. The Work of the Public Health Inspector. ,, Gale Street Co-op Party. The Air We Breathe. ,, Women's Co-op Guild, Rush Green. The Air We Breathe. ,, Dagenham Welfare Liaison Council. Home Safety. ,, Old Dagenham Methodist Church Sisterhood. The Work of the Health Visitor. ,, British Legion: Women's Section, Becontree and District. The Work of the Public Health Inspector. June Women's Co-op Guild, Gale Street. The Food We Eat. ,, Village Ward, Labour Party. The Work of the Medical Officer of Health (Film Strip). ,, Women's Co-op Guild, Gale Street. The Air We Breathe. 28 Diary of Talks Cont'd. Date Organisation Subject July Women's Co-op Guild, Broad Street. The Air We Breathe ,, Triptons Girls School. The Work of the Public Health Inspector. ,, Women's Co-op Guild, Five Elms. Old Age. ,, Women's Co-op Guild, Gale Street. The Sick Child at Home (Film Strip). ,, Eastbrook Ward, Labour Party. Poliomyelitis (Photographs). ,, Women's Co-op Guild, Broad Street. The Food We Eat. October Fanshawe Ward, Women's Section, Labour Party. The Work of the Medical Officer of Health. ,, Chadwell Heath Ratepayers' Association. The Food We Eat. ,, Wantz Old People's Club. Oxlow Lane Clinic (For the over 60's). ,, Rush Green Over 60's Club. Home Safety. November Dagenham Education Committee School Meals Staff (Two lectures). Food Hygiene (Films and Flannelgraph). ,, Alibon Junior Mixed School. The Work of the Public Health Inspector. ,, Dagenham County High School. Discussion Group on Smoking and Lung Cancer. ,, Heath Ward, Labour Party. The Work of the Medical Officer of Health ,, Parsloes Secondary Girls School. (Two lectures). The Work of the Public Health Inspector. 29 SEMINAR ON PUBLIC RELATIONS This Seminar was arranged by the Central Council for Health Education for the Public Health Department, Dagenham Borough Council, in which members of the Area Health Staff also participated, as well as members of other Departments of the Corporation. It was held at the Civic Centre on 2nd, 3rd, and 4th December 1957 and was opened by the Mayor of Dagenham, Councillor R. Blackburn, J.P., and Alderman (Mrs.) A. E. Prendergast was in the Chair. Mr. Norman H. Rogers, Public Relations Organiser, N.A.L.G.O., gave an interesting talk on Public Relations in Local Government, in which he defined public relations as a deliberately planned and sustained effort to establish and maintain mutual understanding with the public at large. He said it was up to the Department to show the public that what they are getting is what they have asked for and that they should take an interest in local government and how it operates. He suggested that local government is hanging by a thread to-day because the man in the street does not appreciate what it does for him and that good public relations could do a lot to strengthen local government. In the afternoon of the first day the Press and Public Health were discussed and a talk was given by Mr. J. L. Dooley, the Editor of the "Romford Recorder" who appealed for more confidence in the press and said that the press would respect confidences. He did, however, agree that the cub reporter presented great difficulties because he often did not understand the background of the subject with which he was trying to deal. Mr. Dooley was interested in a suggestion put forward that his paper should run a column which would publicize the people, both councillors and officials, concerned with local services and said that he hoped to start such a column in January 1958. It was with deep regret that shortly after this seminar we learnt of the death of Mr. Dooley. We hope that his ideas will be fostered by his successor. The morning of December 3rd was taken up with a panel discussion with the Chief Officers of the Dagenham Corporation, together with Dr. Franklin, the Deputy Medical Officer of Essex County Council, which dealt with complaints put up by four members of the public. These complaints aroused a good deal of discussion and it was later agreed by members that the panel had made a valuable contribution to our understanding of the public's point of view. The afternoon was taken up with demonstrations of the various techniques of communication by four members of the staff of the Central Council for Health Education. Posters, leaflets, flannelgraphs, film strips, audience participation and the use of films were all discussed and demonstrated, and the Press and Liaison Officer of the Central Council for Health Education gave an interesting talk on how to organise a public meeting. Two films were shown, "As Others See Us" and "Mr. Jenkins Pays His Rates." 30 On Wednesday morning, 4th December, there were group discussions and in the afternoon the four groups reported their findings. One group dramatized an incident which had happened in Dagenham where all the services necessary for an emergency delivery were made available within a very short space of time, thus demonstrating the good liaison which exists with other associated agencies. The second group gave details of what they felt necessary to improve public relations as a result of the seminar. A number of points were raised which included: a. The need for self control when interviewing a difficult member of the public. b. The use of juniors in interviewing the public without training was undesirable. c. That the use of press and posters could be a valuable means of letting the public know something about our services. The third group discussed relations between the staff in the Public Health Department and suggested that it might be possible for them to gain some experience of work in other departments of the Corporation so that they would have some background knowledge which would help in public relations. The purpose of the panel discussion (Tuesday morning) was reviewed and the conclusion reached was that intended by the Central Council for Health Education, viz: that this was an opportunity of feeding material into the machine to see how the machine would deal with it and it was not just a matter of a number of criticisms being put forward about the various departments. Finally, the question of press relations was considered and instances were given where members of the press had tried to get officers to give information on matters which were not within their province. The fourth group discussed the services provided in Dagenham for old people and said that these services should be more publicized both to the general practitioners and to the old people themselves. The services mentioned were the health visiting service, the welfare officer, the home nursing service, an optical service, chiropody, domestic help, recuperative holidays, Xmas parcels, free laundry for the incontinent, an old people's clinic and old people's clubs. It was suggested that improvements might be made including young people such as scouts and guides assisting with shopping and other light chores. The final suggestion was that a survey of immobile old people should be carried out and would be of great value. Dr. Ward, the Deputy Director of the Central Council for Health Education, summed up the discussion by saying that he was very impressed by the enthusiasm of the staff and was very grateful to the Dagenham Borough Council, the Public Health Committee and particularly to the Chairman of the Public Health Committee for the personal interest she had shown in the seminar. 31 CARE OF MOTHERS AND YOUNG CHILDREN Infant Welfare Centres Centre Sessions Held Times Sessions Held Average Attendances Average New Cases The Clinic, Ashton Gardens, Weekly Thursday, a.m. 41 2 Chadwell Heath. Weekly Thursday, p.m. 41 2 Becontree Clinic, Weekly Monday, p.m. 38 3 Becontree Avenue, Weekly Tuesday, p.m. 26 2 Dagenham. (discontinued 24/6/57 Weekly Wednesday, a.m. 34 1 The Leys Clinic, Ballards Road, Weekly Thursday, a.m. 26 1 Dagenham. Weekly Thursday, p.m. 30 2 Rush Green Clinic, 179, Dagenham Road, (2nd, 4th &5th in month) Friday, a.m. 15 1 Rush Green. Weekly Friday, p.m. 26 1 The Clinic, Ford Road, Weekly Tuesday, a.m. 29 2 Dagenham. Weekly Tuesday, p.m. 38 2 The Clinic, Manford Way, Hainault. Weekly Monday, p.m. 16 1 London City Mission Hall, Dagenham Road, Weekly Wednesday, p.m. 32 2 Dagenham. Weekly Thursday, a.m. 11 1 (Transferred to Oxlow Lane 29/6/57) Weekly Thursday, p.m. 51 2 15/17, Thompson Road, Weekly Tuesday, p.m. 40 4 Dagenham. Weekly Friday, a.m. 14 1 The Clinic, Oxlow Lane, Weekly Wednesday, p.m. 51 3 Dagenham. Weekly Friday, p.m. 38 2 St. Mark's Church Hall, Marks Gate. Weekly Tuesday, p.m. 14 1 32 HEALTH VISITING During 1957 the visiting undertaken by the health visitors has been more specialised and there has, in consequence, been some decline in routine visiting. It is, of course, necessary to continue routine visits as in many instances defects are found and help can be given. Many more visits were made to the aged as the problem of their welfare is in the forefront of preventive medicine and efforts are made to ensure that they are aware of the facilities which are available. Valuable information regarding the aged and chronic sick in the district is provided as a result of calls for the loan of items of sick room equipment, and subsequent visiting enables an assessment to be made of any additional help that may be required. Initial and follow-up visits to the 'over sixties' who attend the Assessment Centre at Oxlow Lane clinic are also undertaken. This year, health visitors visited mental defectives in their own homes, encouraging the parents and helping them with their problems. A new venture, and one which has been very much appreciated, has been the visiting of adults suffering from epilepsy. Many of the problems with which the health visitor is faced are closely allied to overcrowding and resultant unhappy home conditions. Whilst the power of remedy does not He in their hands, close liaison is maintained with the officers of the borough housing department, who are made aware of any relevant facts which may come to the notice of the health visitor. Work of Health Visitors The following table shows the number of visits paid by the Health Visitors during the year:— (a) To expectant mothers First visits 141 Total visits 417 (b) To children under 1 year of age First visits 1,620 Total visits 7,134 (c) To children between the ages of 1 and 5 years Total visits 10,805 (d) Ineffective visits Total visits 2,932 (e) Other visits Total visits 1,321 Grand Total 22,609 33 MATERNITY SERVICES Maternal Mortality There were no maternal deaths in this area during 1957. Ophthalmia Neonatorium One case of ophthalmia neonatorium was notified—which made a complete recovery. There were 31 cases of other eye conditions occurring in newly-born infants requiring medical treatment. Domiciliary Midwifery Service Below is a table showing the work of the County Midwives, Midwives residing at York House Training Home and Salvation Army Midwives for the year 1957. County Midwives Midwives Residing at York House Training Home Salvation Army Midwives Births Attended: As Midwife 133 155 74 As Maternity Nurse 128 4 3 Miscarriages Attended (included in above) 1 5 2 Visits Paid: As Midwife 4,108 3,116 1,884 As Maternity Nurse 2,362 50 57 Ante-Natal 2,384 1,032 412 Ante-Natal Clinics Attended 347 821 53 Gas and Air Administered: As Midwife 86 125 67 As Maternity Nurse 93 4 2 The domiciliary midwifery undertaken by the staff continues to fall due to the increasing facilities for hospital delivery. A number of patients prefer hospital confinement because of the convenience and others were admitted because of inadequate home conditions. 34 Ante-Natal Clinics Centre Sessions Held Times Sessions Held Average Attendances Average New Cases The Clinic, Ashton Gardens, Chadwell Heath. Weekly Wednesday, p.m. 8 2 The Clinic, Becontree Avenue, Weekly Tuesday, p.m. 9 2 Dagenham. Weekly Wednesday, a.m. 7 1 The Leys Clinic, Ballards Road, Dagenham. Weekly Wednesday, p.m. 11 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (1st & 3rd in in month Friday, a.m. 5 1 York House, Frizlands Lane, Weekly Tuesday, a.m. 10 2 Dagenham. Weekly Tuesday, p.m. 12 2 (Transferred to Oxlow Lane 29/6/57) Weekly Thursday, a.m. 10 2 The Clinic, Ford Road, Dagenham. Weekly Monday, a.m. 12 2 The Clinic, Manford Way, Hainault. Weekly Monday, a.m. 3 1 RELAXATION CLASSES The following were the attendances at the relaxation classes during the year:— The Becontree Clinic 322 Chadwell Heath Clinic 294 Leys Clinic 391 York House Clinic 385 1,392 PREMATURE INFANTS All infants weighing 5½lbs., or less at birth are regarded as premature infants, whatever the length of the pregnancy. Live premature births occurring in the area:— 31b. 4oz. or less 31b. 5oz.— 41b. 6oz. 41b. 7oz.— 41b. 15oz. 51b. 0oz.— 51b. 8oz. Total No. Surviving one week Born alive at home and nursed entirely at home 1 - 2 10 13 11 Born alive at home and transferred to hospital 2 - 1 1 4 3 Born in hospital 11 14 20 37 82 74 35 DAY NURSERIES DAY NURSERY ATTENDANCES JANUARY—DECEMBER 1957 Day Nursery Number of approved places Average Daily Attendance Average No. on Register Total Attendances Goresbrook 70 33 46 8,177 Chadwell Heath 54 36 46 9,237 Kingsley Hall 40 19 25 4,684 TOTALS 164 88 117 22,098 Nursery Widows Parents Separated Desertion Illness of Father Unmarried Mothers Socioeconomic Mothers working to supplement income Total Goresbrook 1 10 - - 7 10 25 53 Chadwell Heath 1 8 - - 3 11 19 42 Kingsley Hall 1 - 2 1 - 11 12 27 Number of children in all Nurseries 1957 3 18 2 1 10 32 56 122 During 1957 there was much discussion both national and local about the future of day nurseries, but the efficiency of the staff remained excellent in spite of these uncertainties. As will be seen from the table, 34 children attending the nurseries did so because of problems associated with the parents—illness of father etc. The biggest single group of 56 includes many cases where to supplement the family income became a social necessity, for example, those in which there is need to purchase their own home to escape from overcrowded conditions. In the socio-economic group are included those admitted on medical advice. Here I would like to mention the increasing number of requests from hospitals and general practitioners for the admission to the nurseries of physically or mentally handicapped children. These children gain inestimable benefits from contact with normal children in the pre-school years and the nurseries are ideal places for them, with the skilled supervision and guidance which may be necessary. The parents' burden is considerably lightened and they are so happy to see how well these children thrive in the atmosphere of the nurseries. 36 In July, members of the public, the staff and the Health Area Sub-Committee were shocked at the damage done when Goresbrook nursery was broken into and the interior completely wrecked. His Worship the Mayor of Dagenham and the Chairman and Vice-Chairman of the Health Area Sub-Committee, as well as the Chairman of the Essex County Council Public Health Committee and the County Medical Officer of Health visited the nursery. In spite of magnificent effort on the part of the staff, the nursery had to be closed for a fortnight. The total cost of repairs and reinstatement of the premises was £150. Two boys, aged 11 and 12, who pleaded guilty were subsequently charged. 37 HANDICAPPED CHILDREN UNDER FIVE YEARS OF AGE REPORT OF A SURVEY BY DR. MAIR The increasing emphasis that is rightly being placed on the early ascertainment of defects, both physical and mental, in children who may need special educational treatment when they come of school age has shown that there is a widespread lack of knowledge of the handicapped children under 5 years of age. These children are not compulsorily notifiable to the health authority by the parents, general practitioners, or hospitals, and many have in the past gone unnoticed except for routine visits to the home by health visitors, and occasional visits to the Infant Welfare Clinics by some mothers and children—but if the treatment they were receiving seemed satisfactory and no action was necessary under the Education Act (e.g. ascertainment of mental defectives over the age of 2), then no central register of their progress was kept. The size of the problem was therefore unknown, and it was obvious that the first essential in any scheme to make provision for these children was a detailed survey of all cases notified to the Health Department from any source and the compilation of a register of all under 5 handicapped children from the health visitors' records. Dagenham has a population of approximately eight thousand 0—4 year olds and our records have brought to light eighty-five children, i.e. 1% in this group with a degree of handicap likely to necessitate special schooling when the time comes. The defects found in this group are many and varied and the degree to which a child is handicapped by his defect varies (a) with the severity of the defect (e.g., no two epileptics will show the same degree of disability), and (b) with the amount of care and attention that can be given to him in the home (one epileptic can be well controlled on drugs and good management while another, having less frequent fits, may be difficult to stabilize in a poor and inadequate home background.) It is also true that the ability of a child to overcome or to learn to adjust to his handicap at an early age is of paramount importance in his later schooling and training, and recent work in hospital departments has emphasized this necessity by training schemes for mothers in the care of disabled children. Many of these children are, by the nature of their defect, barred from the ordinary activities of toddlers and so are compelled to live a solitary life within the home, and it is not until they are admitted to special schools that they can belatedly attempt to adjust themselves to competition and companionship. 38 Such then, is the problem in general terms. A small but increasing number of children who because of mental or physical handicap cannot enjoy a normal childhood. The children under review in this area can be divided into four categories: 1. Severe physical handicap: including spastics, hemiplegias, poliomyelitis and congenital heart defects. 2. Minor degrees of handicap necessitating special treatment: including cleft palate— requiring speech therapy; mild poliomyelitis and spastics requiring physiotherapy. 3. Isolated defects including blind and deaf. 4. Mental defectives such as mongols and retarded children. No system of classification is watertight and some of the children have dual defects— but all of them have the same basic needs: (a) Early training within the limits of their incapacity. (b)Special training to overcome the defects, especially speech training and therapy. So far, I have emphasized the needs of the child in relation to training and companionship, but I would like now to consider the problems of the mothers of these children and their relations with the rest of the family. In surveys throughout the country on special groups of handicapped children, questions have been asked about the relationship of the handicapped child with normal children in the family and whether or not other children are neglected because of the presence of the handicapped child. In each of these it has been found that in over 80% of the homes the children get on well together, but that in 30% the mother has felt that the other children are neglected because of the additional attention she has to give to the handicapped child, and in the few cases where there are 2 such children in a family, i.e., 2 mongols, or as we have in a Dagenham family, 2 mentally subnormal epileptics, the percentage is even higher. Not only is it important for us to see that every help that the medical services can give to these children is provided and that their training is adequate and suitable to their needs, but we must also try to give them and their families as much help as we can; and it is here that I feel that the Local Health Authority can provide a valuable service for this important age group by providing nursery accommodation in the area to which as many of these cases as are suitable may be sent for early training, systematized therapy related to the child's special needs and, equally important, relief for the mother and family for some part of the day from the constant care of these children. 39 We have seen that there is a need for such provision but before any proposals were made it was necessary to find out whether the mothers of handicapped children also felt the need and to what extent they were likely to avail themselves of any provisions made; and also to find out what the home circumstances and conditions of each of these children were. This type of investigation must, as far as possible, be objective and therefore in the hands of one investigator, as it has been proved so often that reports from a team of visitors will vary as to standards found and expected. Each of these families was therefore visited by one medical officer and I append a sample of those families seen. The sample has been chosen solely geographically but represents most types of defect. When the disabilities of the handicapped children in this sample are considered in relation to their backgrounds and to the amount of help their mothers can give them, it is apparent that they and their families are in need of some help in overcoming these disabilities or at least in learning to adjust to them. Visits to these homes make it abundantly clear that it is not in the cases of minor physical handicap that help is most needed but where there is a dual defect as there is in a large proportion of the more seriously handicapped, e.g., epileptics and spastics. In these cases the mental retardation slows the progress that might be expected in overcoming the physical disability, and makes the child an increasingly heavy burden on the mother as he grows from infancy to childhood. It should be noted that although this sample of 12 was chosen on grounds of accessibility for visiting, it does include a number of the more seriously handicapped children in the area. 40 The proportion of these in the full survey of 85 children is not exactly the same because the full list includes some with minor degrees of disability who will need no special provisions either before or after they come of school age. Date of birth Defect and degree of disability Home conditions no. in family and whether neglected or not—degree of parental understanding Response to nursery proposal 1. 11. 12. 55 Epileptic. Mental retardation. Unable to sit without support. Heavy child. Good-private house, 3 bedrooms, 2 living rooms. 1 brother aged 16 years. 1 sister aged 11 years. No neglect. Help and understanding from the family. Early rejection of the problem. Now full understanding and good mothering. Mother finds looking after this child tiring. Would welcome nursery relief and training. 2. 19 .8. 52. Mongol-high grade- and associated poor muscle tone. Walks and plays. Good Complete rejection of the problem of this boy's backwardness by the parents. Mother still not reconciled. Mother requested ordinary day nursery accommodation but this child would be unsuitable except in handicapped nursery. 3. 27. 8. 51. Although 6 years old this child is comparable with a 2 year old. Partially sighted: congenital cataracts. Mongol. Walked at 5½ years. Good-Council house. 1 infant brother -now difficult to manage with the defective child. Full understanding by the parents of this child. Requested nursery accommodation two years ago. Cannot give adequate trainingespecially physiotherapy at home. 4. 12. 5. 57. Cleft palate. Hare lip and? mental retardation. Gross physical retardation. Very poor indeed. Council house. Inadequate housewifery. 6 other children all neglected. (1 recently died partly due to neglect). Parents very poor type. Unable to manage. M.O. advised admission to ordinary day nursery as this child cannot be adequately cared for at home. 5. 2. 11. 52. Partially deaf. No speech. Partially psychogenic. Live with mother-in-law. Marked domestic tension. No other children. Parents do not understand the nature of the speech defect. Would welcome special training in nursery but refuse the concept of special schooling. 6. 6. 10. 53. Poliomyelitis. Right side paralysis. Wears caliper. Manages disability very well. Good. No neglect. Mothering excellent. Child given every encouragement to overcome defect. Child requests nursery admission-says she wants to play with other children. Not able to do so at home because of disability. 41 Date of birth Defect and degree of disability Home conditions No. in family and whether neglected or not—degree of parental understanding Response to nursery proposal 7 11. 5. 53. Mental and physical retardation - severe. Unable to stand at 4 years. Good-Council house. Good housewifery. Mother reports that elder children now lacking attention because of this boy and the other children are beginning to worry about his backwardness. Requires intensive pyhsiotherapy and in this case it is the family who need relief in helping to care for the handicapped boy. 8 17. 10. 53. Epilepsy - fairly well stabilized on treatment. Very poor indeed. Mother unable to manage the home or the children. Dirty and unkempt. This child is neglected because of an older epileptic with severe behaviour disorder. Mother is not mentally capable of coping with the two children. Admits she needs help in caring for these two children and welcomes any. 9. 4. 11. 52. Spastic. Severe defect and some mental retardation. Good. No neglect of younger girl. Full under standing by parents - every help given. Mother sought advice re nursery because the child can no longer play with children of her own or sister's age. Requires physiotherapy and speech therapy. 10. 20. 5. 52. Hydrocephalic and Spina Bifida. Severe degree of defect. Good. No neglect but mother is finding it very difficult to manage this boy as he grows bigger. Almost entirely a question of nursing. Requires intensive physiotherapy and will require all forms of training. 11. 18.1.54. Epileptic. Gross overcrowding. Mothering good in very difficult conditions. 2 other children under five years. Mother unable to care for them all adequately. Urgently needs relief in caring for the children and this boy would benefit from nursery admission. 12. 14. 5. 55. Spastic - severe. Mentally retarded. Severe degree of disability. Was living in grandmother's home. Mother severe thryotoxicosis. Unable to manage. Now moved to ground floor flat - doing very well. No other children. Mother is now beginning to understand the degree of disability but unable to give much help. Would benefit from intensive physiotherapy. Mother overanxious to do everything to help him. 42 OXLOW LANE CLINIC Dagenham is proud of the new health service clinic which was opened in September of this year, and the opening of the clinic has brought new life to all branches of the local health services and the number of attendances at all sessions is gratifyingly high. It was built by the Essex County Council to the design of the county architect's department. The services are on much the same lines as all local authority clinics in the area and cover maternity and infant welfare and school health. The ante-natal clinics are supplemented by a relaxation class held once a week for expectant mothers who are given training in relaxation during childbirth, education in the elementary anatomical and physiological aspects, training for motherhood and the care of young babies. The infant welfare clinic is staffed by the assistant county medical officer and the health visitors for that area; the mothers are encouraged to bring the babies and toddlers for regular advice and weighing and periodic medical checks as well as for advice about specific problems. All types of welfare foods and some proprietary brands of infant food can be obtained at the clinic during infant welfare sessions. Informal group discussions between mothers and health visitors are encouraged on all subjects relating to child care. The school clinic deals with the school children attending the neighbouring schools, and again parents are encouraged to bring their children for advice as well as for the treatment of minor ailments. A twin dental-suite provides spacious accommodation for the work of the dental officers who carry out inspection and treatment of school children, and any necessary treatment of the under 5 age group and mothers in the first year after a pregnancy. Such then is the routine pattern of clinic work but in Oxlow Lane we are extending the services to the old people of Dagenham and have arranged to hold an old people's clinic which is staffed by a medical officer and health visitors, to give advice and help in the individual medico-social problems of the aged; especially relating to the prevention and early diagnosis of the remediable diseases of old age. This aspect of the work is being organised in co-operation with the general practitioners and the geriatric hospital services. It is hoped that this new and colourful clinic will become a happy meeting place for both the young and the old of Dagenham. Opening Ceremony Oxlow Lane Clinic was opened on Friday, September 6th 1957 by Alderman K. E. B. Glenny, O.B.E., J.P., Chairman of the Essex County Council Health Committee, and the ceremony was attended by members of the Essex County Council, Dagenham Borough Council, County Council and Dagenham Borough staff, together with local general practitioners and midwives. 43 Alderman (Mrs.) A. E. P rendergast introduced the Mayor of Dagenham, Councillor R. Blackburn, J.P., who welcomed Alderman and Mrs. Glenny, and the Chairman of the Essex County Council, Sir Frank Foster, C.B.E., J.P. Alderman Glenny in his opening speech paid tribute to the helpful co-operation of Dagenham Council and the Health Area Sub-Committee, particularly in all matters requiring joint negotiation between the County and the Borough. He praised the part played by Dagenham Health Area Sub-Committee's Chairman, Alderman (Mrs.) Prendergast, particularly the gracious and charming way in which she persuaded the County Council of Dagenham's needs. This clinic is a lasting example of this untiring work. After the Mayor had thanked Alderman Glenny for opening the clinic, of which Dagenham was justly proud, he stressed that it is local knowledge of an area that makes local government most effective, and he presented Alderman Glenny with an illustrated book of the Borough. Mrs. Prendergast added to the floral gaiety of the occasion by presenting Mrs. Glenny and Mrs. Blackburn with bouquets. There then followed a tour of the clinic which was shown in all its working aspects. The guests saw the work of an infant welfare clinic, and the methods used in training in relaxation classes. Children were having speech therapy, and a tape recording of speech showing improvement with therapy was heard. A new venture is the audiometric testing of children with suspected deafness, and school nurses demonstrated the technique used in assessing degrees of deafness. 44 OXLOW LANE CLINIC Infant welfare session One of the twin Dental Surgeries MEDICO—SOCIAL ASSESSMENT CENTRE FOR THE OVER SIXTIES In September shortly after the new Oxlow Lane clinic was opened, it was decided to inaugurate a centre for the over sixties in the new premises. This centre has been established in order to study old age and to attempt to delay as far as possible the onset of senility by treating minor conditions and by giving helpful and practical advice on the medical and social problems of the ageing. Sessions are held each Friday morning and the centre is staffed by a medical officer and a health visitor; patients are seen by the medical officer by agreement with their general practitioners and by appointment only, although 'old' patients are encouraged to drop in on Friday mornings for a cup of tea. Each patient is encouraged to discuss with the medical officer any problem he has, and various investigations such as X-ray of chest, blood and urine examinations are arranged and a general medical examination is carried out. Only minor remedial treatments are given at the clinic as it is felt that anything more than that is the province of the patient's own doctor, to whom he is referred when necessary. In all cases a full report of the findings is sent to the general practitioner. By the end of the year, even though the session had to be cancelled on a number of occasions because of bad weather, and even though it was possible to see only three patients in a 2\ hour session, it was obvious that there was a need for such a centre. The procedures carried out at the centre are modified from time to time depending on the experience gained; it is hoped however, that a more detailed report can be given at the end of 1958 when a pattern may have been established for the future. It is already evident that the occasional services of a geriatric consultant are needed and that physiotherapy and occupational therapy should be made available to carry out preventive treatment at the centre. 45 DOMESTIC HELP The table below sets out the various categories of cases in which the service was used and the number of visits paid by the organiser during the year. For the purposes of comparison the figures for 1956 are included in brackets. As will be seen, there was an over-all increase of almost 10,000 hours over the previous year although the number of cases served increased by only one. Type of Case Number of Cases Hours Help Provided Maternity 46 (77) 3,068 (4,944) Tuberculosis 15 (16) 2,177 (3,951) Acute Sick 64 (60) 4,712 (5,435) Chronic Sick (Aged 352 (329) 52,563 (39,598) „ „ (Others) 85 (85) 16,922 (17,544) Aged Not Sick 7 (7) 797 (721) Others 11 (6) 1,792 (1,041) Totals 581 (580) 82,031 (73,234) Number of visits paid by Organizer:— 1,613 (1,234) Average number of Home Helps employed each week 74 (66) Maternity The number of maternity cases helped and the hours of help provided both show a decrease. This is most likely due to the preference that many mothers show for having their babies in hospital. Tuberculosis Here the service met a small though very essential need. Care of the Aged As in previous years the demand for service for the aged increased considerably. More cases were served and many more hours worked than in the previous year. With the increasing emphasis placed on the need to keep old people in their own homes the demand for this type of case may be expected to increase. The service provided for old people cannot be measured in terms of hours of work done as the home help in so many cases is looked upon by the aged as a friend who visits them and helps to lessen the burden of loneliness in their advanced years. The service is only made use of in those cases where the relatives are unable to provide the necessary care. 46 Acute Sick The demand for the service in these cases has remained fairly steady as compared with the previous year. Care of Children One of the most valuable contributions the service makes is in helping to keep a family together in cases where the mother has to enter hospital. As in previous years, in a number of cases the home help has visited the mother in hospital to give her news of her family and to assure her that they are being well looked after during her absence. Recruitment Many recruits came forward during the year, anxious to become home helps, and great care was given by the organiser in selecting suitable types for this very exacting service which is making an ever increasing contribution to the social services. Training As in previous years, a course was held in Chelmsford organised by the County Council for instruction in the duties of a home help and to give the necessary background knowledge of other workers with whom the home help might come into contact. Social Activities A visit to the London Palladium and a Christmas party were both arranged by the organiser but, unfortunately, fog prevented many people from attending the Christmas party. 47 CHIROPODY SERVICE Two full-time and one part-time chiropodists are employed. The part-time chiropodist works four sessions per week. Clinics are held at Ford Road and Ashton Gardens, Chadwell Heath, as follows:— Ford Road Ashton Gardens Chadwell Heath Monday 2.0 p.m.—5.0 p.m. 5.30 p.m.—8.30 p.m. Tuesday 9.0 a.m.—1.0 p.m. 9.0 a.m.—1.0 p.m. 2.0 p.m.—5.0 p.m. 2.0 p.m.—5.0 p.m. Wednesday 10.0 a.m.—1.0 p.m. 2.0 p.m.—5.0 p.m. 5.30 p.m.—8.30 p.m. Thursday 9.0 a.m.—1.0 p.m. 2.0 p.m.—5.0 p.m. Friday 9.0 a.m.—1.0 p.m. 2.0 p.m.—5.0 p.m. 5.30 p.m.—7.30 p.m. A nominal charge of 2/6d. is made for each attendance, necessitous cases and school children are treated free. The following table indicates the work done during the year:— Children under 15 years of age Adult Males Adult Females New cases treated during the year 168 128 379 Total attendances 803 2,067 6,595 Cases still being treated at end of year 60 243 652 48 OCCUPATIONAL THERAPY At the end of the year there were 6 patients remaining on the register for Occupational Therapy. The great majority of the patients shown in the table below were up for a minimum of 4 hours a day and all of them had had treatment in hospital. Some difficulty was experienced in selling the work done by the patients and this limited the scope and effectiveness of the occupational therapy. Although there was a greater demand for goods during the two or three months preceeding Christmas, the demand was never sufficient to enable the patients to be fully occupied and at times some of them discontinued therapy. It is unfortunate that the difficulty of disposing of goods prevents the patients from taking full advantage of their occupational therapy, particularly as a number of them appreciate the therapy as a means to recovery rather than a way to earn extra money. Occupational Therapy for domiciliary chest cases The following is a summary of work carried out from January 1st to December 31st, 1957. Total of Patients Total of New Patients Total of Visits January 20 7 77 February 20 1 59 March 20 6 73 April 23 4 54 May 26 5 128 June 22 1 59 July 18 1 61 August 22 6 82 September 25 3 80 October 27 3 115 November 29 2 51 December 23 1 90 49 CONVALESCENCE AND RECUPERATIVE HOLIDAYS National Health Service Act Arrangements were made for patients as indicated:— Section 28: 31 Bell Memorial Home, Lancing. 8 T.B. cases placed by Spero. 13 St. Joseph's Convalescent Home, Bournemouth. 7 Surrey Convalescent Home, Seaford. 1 Shoreditch Holiday Home, Copthorne. 1 St. Peter's Convent, Woking. 1 Armitage House, Worthing. 1 St. Michael's Convalescent Home, Clacton. Section 22: 2 Mothers with children—Shoreditch Holiday Home 10 Children placed by I.C.A.A. 5 Mothers with children—Lennox House, Southsea. School Health Service As in previous years, convalescent holidays for school children were arranged in conjunction with the Invalid Children's Aid Association. 122 school children were admitted to recuperative holiday homes during the year. Most of the cases referred by the medical officers and general practitioners for convalescent holidays are children from homes showing economic or social stress, and few only of the children are sent on purely medical grounds. Dagenham Children's Care Committee Seaford Holiday Centre Two parties of school children went to St. Mary's Bay Holiday Centre, Romney Marsh, Kent, for a holiday during the summer. 84 children attended the centre this year. The arrangements are made by the Dagenham Children's Care Committee and all children are examined at the clinics before they leave for their holiday. Camp Schools 34 children were examined by school medical officers before being admitted or readmitted to camp schools. 50 VACCINATION AND IMMUNISATION Vaccination against Smallpox During the year 1,856 persons were vaccinated or re-vaccinated by general practitioners and Local Health Authority medical officers. Age at date of vaccination or re-vaccination Vaccinated Re-vaccinated G.P's. L.H.A. G.P's. L.H.A. Under 1 year 246 479 - - 1—4 years 109 90 3 2 5—14 years 182 38 43 - 15 years and over 221 45 273 125 Total all ages 758 652 319 127 Whooping Cough 1,098 children received immunising doses against whooping cough, including booster doses. Primary Boosters Combined Whooping Cough and Diphtheria Vaccine G.P's. L.H.A. G.P's. L.H.A. G.P's. L.H.A. 162 648 67 19 202 - B.C.G. B.C.G. vaccination has continued in the 13-plus age group; this year 1,795 children were offered vaccination. 848 children were tested after the parents' consent had been received. Results of the Multiple Puncture tests:— Negative 759 Positive 89 Of the children with negative reactions (and therefore susceptible) 698 received B.C.G. vaccination. There were no cases of post-vaccination complications. Tuberculosis Vaccines Clinical Trial Of the 312 young people invited for their fifth annual X-ray, 141 attended, i.e., 45% and of these 62% completed the skin tests. In addition, of the 209 who defaulted on the previous occasion, 51 came along this time. 51 DIPHTHERIA IMMUNISATION Diphtheria Immunisation of under fives Diphtheria immunisation has continued in the Infant Welfare clinics and by the general practitioners. Constant encouragement and persuasion must still be given by the health visitors at their routine home visits to families who do not attend the clinic. The following is a summary of the work carried out during the year by Local Health Authority medical officers and general practitioners. A total of 1,464 children received primary immunisation injections and a total of 1,670 received boosting doses. Age (in years) at final injection Primary immunisation Children who received a boosting dose L.H.A. G.P's. L.H.A. G.P's. Under 1 year 476 267 - - 1—4 234 202 47 11 5—9 113 38 527 171 10—14 125 9 854 60 Total all ages 948 516 1,428 242 Diphtheria Immunisation of School Children A total of 1,890 school children were immunised against diphtheria during the year (of which 278 were immunised by private practitioners). This increase of over 100% compared with previous years (1956—total — 826) is due to the emphasis on Booster immunisation in the schools both at the 5 year medical inspection and at school leaving. All children entering and leaving school are being offered immunisation and the parents are encouraged by school medical officers and school nurses to consent. Succeeding years will, I hope, see still further improvement in the state of immunity of the school population, as the parents come to accept the routine booster immunisation of their children at each medical examination. The position at the end of the year in Dagenham regarding immunisation in relation to the child population is given in the following table which gives details of all children who had completed a course of immunisation at any time before that date: 52 Age at 31. 12. 57. i.e. born in year Under 1 yr. 1957 1—4 yrs. 1956-1953 5—9 yrs. 1952- 1948 10—14 yrs. 1947-1943 Under 15 yrs. total Last complete course of injections whether primary or booster 1953—1957 164 3,837 3,802 2,733 10,536 1952 or earlier - - 3,127 5,627 8,754 Estimated mid-year population 1,450 6,400 19,500 27,350 Immunity Index 11.3 60 33.6 38.9 POLIOMYELITIS In 1956 when the Minister of Health embarked on the scheme for Poliomyelitis immunisation he decided that the children who would be eligible to receive the vaccine would be those born between 1954 and 1947 inclusive. It was estimated that in Dagenham there were 8,380 school children and 6,219 children under the age of 5 coming within these groups, giving a total of 14,599. Consents were received for 2,220 children under the age of 5 and 3,896 in the other age groups, making a total of 6,116. Immunisation was carried out during May and June of 1956 when 593 children who were selected by the Ministry were immunised, and a further 72 later on in the year as immunisation was suspended during the summer months. It was resumed in March of this year and by the end of the year 3,532 children had been immunised by officers of my department and 1,243 by general practitioners, making a total of 4,775. Since the beginning of the scheme a total of 5,440 children have been immunised. The system we have operated since vaccination was resumed this year was to start with the younger children, i.e., those born in 1954, but towards the end of the year vaccination was offered to all age groups. It will be remembered that the original intention of the Ministry of Health was to immunise children with the Salk vaccine, but because of one or two mishaps in America it was decided that we would develop our own vaccine which is subject to more stringent tests and which does not contain the virulent Mahoney strain of killed virus contained in the American vaccine. Up to the end of 1957 only British vaccine was offered for immunisation. During the year there were 10 cases of poliomyelitis notified to the department. Five of these were paralytic and five non-paralytic and their ages ranged from 2 years to 61. Unfortunately, one boy of 12 who was notified as suffering from poliomyelitis in 1956 died in January 1957. Total acceptors since commencement of scheme 12,433 Total complete courses since commencement of scheme 5,440 Immunisation By Medical Officers By General Practitioners Total 1957 3,532 1,263 4,775 53 SCHOOL HEALTH, 1957 School Premises There are 14 secondary and 27 primary schools in the Borough, also one special school. Children on the registers on 31st December, 1957 totalled 21,304 a decrease of 167 as compared with 1956. Public Health Inspectors carried out periodic inspections at school kitchens and schools were visited for the purpose of obtaining samples of milk for bacteriological testing; 12 such samples were obtained during the year, all of which proved satisfactory. SCHOOL INSPECTIONS As in the previous year, medical inspection in the schools during 1957 covered 4 groups— (a) Children in their first year of attendance. (b) Children in their last year at Primary School. (c) Children in their last year of attendance. (d) Others. In addition, all children transferred from other areas to Dagenham schools were seen. Special examinations and re-inspections of children with defects were carried out. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING SPECIAL SCHOOLS) A.—Periodic Medical Inpections Number of Inspections in the prescribed Groups:— 5 year age group 1,933 10—12 + years age group 1,965 14 year age group 1,735 Others* 203 Total 5,836 B.—Other Inpsections Number of Special Inspections 2,085 Number of Re-inspections 1,805 3,890 * Children at Special Schools or who missed the usual periodic examinations. 54 5,836 children were medically examined in the schools by school medical officers. Reference to the statistical table following will show in detail the number and type of defects discovered. Defect Code No . Defect or Disease Periodic Inspections Special Inspections Entrants Leavers Total (all groups) Requiring treatment Requiring observation Requiring treatment Requiring observation Requiring treatment Requiring observation Requiring treatment Requiring observation 4 Skin 7 21 20 11 33 46 74 29 5 Eyes—(a) Vision 29 32 80 47 186 157 55 22 (b) Squint 13 13 4 3 23 27 6 3 (c) Other 8 9 8 19 22 49 52 27 (d) Colour vision - - - 46 - 58 - - 6 Ears—(a) Hearing 6 10 3 3 17 17 22 18 (b) Otitis Media 4 - 3 3 10 8 30 10 (c) Other 3 7 23 1 32 12 3 1 7 Nose and Throat 34 130 7 5 48 164 74 56 8 Speech 16 50 - 5 26 69 76 16 9 Lymphatic Glands 1 84 - 1 1 97 2 9 10 Heart 3 12 1 14 10 42 18 25 11 Lungs 19 52 5 9 30 82 45 62 12 Developmental (a) Hernia 1 2 - - 1 3 - - (b) Other 4 5 4 1 9 9 8 8 13 Orthopaedic (a) Posture 13 11 11 14 48 47 7 8 (b) Feet 19 28 15 15 52 63 23 7 (c) Other 20 50 5 21 36 124 165 59 14 Nervous System (a) Epilepsy 2 1 - 1 4 6 7 4 (b) Other - 1 - 1 1 19 12 13 15 Psychological (a) Development 9 9 6 8 21 55 11 11 (b) Stability 9 19 2 2 14 38 27 19 16 Abdomen - - - - - - - - 17 Other 158 40 120 19 335 68 389 318 55 Pupils found to require treatment Number of individual pupils found at periodic medical inspection to require treatment (excluding dental diseases and infestation with vermin). No individual pupil is recorded more than once in any column of this table, therefore, the total in column (4) will not necessarily be the same as the sum of columns (2) and (3). Age group For defective vision (excluding squint) For any of the other conditions recorded in Table IIA Total individual Pupils (1) (2) (3) (4) 5 years 29 328 343 10 — 12 + years 77 194 254 14 years 65 155 210 Other periodic 15 45 53 Total 186 722 860 General Condition Of the total 5,836 children examined only 162 (2.8%) were classified as unsatisfactory in their general condition or nutrition. As in the past few years this small percentage includes those who were previously classified as C or Poor, and the worst of those as B or Fair. The overall picture of the condition of the children in the Borough is reassuringly good. Classification of the general condition of pupils inspected during the year in the age groups Age group (1) Number of Pupils Inspected (2) A Satisfactory B Unsatisfactory No. (3) % of col. 2 (4) No. (5) % of col. 2 (6) 5 years 1,933 1,858 96.12 75 3.88 10 — 12 +years 1,965 1,937 98.58 28 1.42 14 years 1,735 1,714 98.79 21 1.21 Other periodic 203 165 81.28 38 18.72 Total 5,836 5,674 97.23 162 2.77 Uncleanliness The number of children found with vermin and/or nits during the year was 124. No children can be compulsorily cleansed in the Borough as we have no cleansing station now, but frequent attendances of the infested children at school clinics and repeated home visits by school nurses have resolved the problem to a small nucleus of recurrently infested families who require constant supervision, and a larger number of children who are only very temporarily infested and quickly cleansed by the parents. 56 Infestation with vermin All cases of infestation, however slight, are recorded. This return relates to instances of infestation and not to individual pupils, (i) Total number of examinations of pupils in the schools by school nurses or other authorized persons 48,402 (ii) Number of instances of infestation found 170 (iii) Number of cleansing notices issued (Section 54 (2) Education Act, 1944) 170 (iv) Number of disinfestations carried out:— By school nurses 40 By parents 130 VISUAL DEFECTS Vision tests were carried out on all children at the school medical inspections and 186 referred for treatment at the Opthhalmic Clinics and 157 kept under observation. Eye Diseases, Defective Vision and Squint Number of cases dealt with By the Authority Otherwise External and other (excluding errors of refraction and squint) 431 266 Errors of refraction (including squint) - 1,324 Number of pupils for whom spectacles were prescribed - 695 Colour Vision Colour vision testing was continued at all school medical inspections on all pupils at or over the age of 11 years and the number of defects found were:— Boys: 78 Total examined Boys 13965 Girls: 29 „ ,, Girls i>735 The importance of colour vision testing in the schools must be stressed as helpful advice can be given to totally or partially colour blind boys regarding future employment and the younger this is done (from 11 years) the better, so that the colour blind boy does not come to his school leaving medical examination with his thoughts directed to employment in the Merchant Navy, or as an engine driver or electrical engineer only to be disillusioned in the last months of his school career, but he and his parents can adjust their ideas on his future from an early age. 57 SCHOOL CLINICS It is important to stress the changing nature of the medical officer's clinic sessions from the miscellaneous minor ailments of the past (which are now mainly dealt with by the school nurses), to the consultative type of sessions where parents and children attend to discuss with the medical officer the problems of child development and behaviour. This change is to be encouraged and supported by both the staff and the public as it is along these lines that the future of the school health service can best be ensured. Minor Ailment and School Clinics Eight minor ailment clinics are now operating in the borough, five at County Council clinics and three on school premises; the days and times of the sessions are as follows:— Ashton Gardens Clinic Monday 9 a.m. Nurse Tuesday 11a.m. Doctor and Nurse Friday 9 a.m. Nurse Becontree Avenue Clinic Monday 9 .30 a.m. Doctor and Nurse Tuesday 9 a.m. Nurse Wednesday 9 a.m. Nurse Thursday 9.30 a.m. Doctor and Nurse Friday 9 a.m. Nurse Five Elms School Clinic, Wood Lane Monday 1.30 p.m. Doctor and Nurse Tuesday 9 a.m. Nurse Wednesday 9 a.m. Nurse Thursday 9 a.m. Nurse Friday 9.30 a.m. Doctor and Nurse Ford Road Clinic Monday 9.30a.m. Doctor and Nurse Thursday 1.30 p.m. Doctor and Nurse Friday 9 a.m. Nurse Bentry Special School Tuesday 2 p.m. Nurse Wednesday 9.30 a.m. Doctor and Nurse Friday 2 p.m. Nurse Kings wood School Monday (1st and 3rd in month) 10 a.m. Doctor and Nurse Wednesday 9 a.m. Nurse Leys Clinic Monday 1.30 p.m. Doctor and Nurse Wednesday 9 a.m. Nurse Friday 9 a.m. Nurse Oxlow Lane Wednesday 9 a.m. Doctor and Nurse During the year 3,890 children were seen by the school medical officers, and 9,945 attendances were made at nurses' clinics. The total number of attendances made by 58 children at minor ailment clinics during 1957 were as follows:— Ashton Gardens 1,184 Bentry School 529 Becontree Avenue 1,808 Five Elms 4.759 Ford Road 1,766 Hunters Hall (up to time of transfer) 2,394 John Perry (up to time of transfer) 85 King's Wood 762 Leys 420 Oxlow Lane 128 13,835 Other Treatment Given New cases treated By the Authority Otherwise (a) Miscellaneous minor ailments 1,308 45 (b) Other (1) Heart and rheumatic diseases - 10 (2) Hernia - 12 (3) Major respiratory diseases - 30 (4) Major digestive diseases - 106 (5) Major injuries - 45 (6) Other major diseases - 72 (7) Enuresis - 19 Total 1,308 339 Diseases of the skin (excluding uncleanliness) Number of new cases treated during the year By the Authority Otherwise Ringworm (Scalp) 2 - Ringworm (Body) - - Scabies - 1 Impetigo 19 - Other Skin Defects 806 11 Number of examinations made by Skin Specialists 15 Ear, Nose and Throat Defects No. of children referred to Consultants during 1957 80 No. admitted for operation 154 Minor defects of the ear, nose and throat involving 192 children were treated at school clinics. 59 Diseases and defects of Ear, Nose and Throat Number of cases treated Received operative treatment (a) For diseases of the ear By the Authority Otherwise - 13 (b) For adenoids and chronic tonsillitis - 141 Received other forms of treatment 192 36 Total 192 190 CHILDREN FOUND AT PERIODIC MEDICAL INSPECTION TO HAVE UNDERGONE TONSILLECTOMY Age Group Number Inspected Number found to have undergone tonsillectomy Boys Girls Boys Girls 5 years 968 965 46 53 10—12 + years 1,068 897 123 94 14 years 901 834 68 85 Other periodic 118 85 11 3 Total 3,055 2,781 248 235 Employment of Children 159 pupils were examined for fitness for employment out of school hours, and certificates given to all these children. Medical Examination of Staff The following examinations were carried out by the medical officer during the year:— (а) New Appointments:— 1. Intending Teachers (Forms 28 RQ) 27 2. Entrants to Teachers' Training Colleges (Forms 4 R.T.C.) 16 3. Essex County Council 81 * 4. Dagenham Borough Council 318 5. Other Authorities 2 (b) Under Sickness Regulations 4 Number of consultations with specialists arranged 101 60 SCHOOL NURSING—HOME VISITING 5,346 home visits were made by school nurses—a 75% increase on previous years. This increase is a significant pointer to the future of the school health service. As the emphasis of school clinics changes from the treatment of minor medical defects to that of an advisory centre for social and developmental problems of childhood, so the school nurse must increasingly be the link between the doctor in the clinic and the patient's home and school background. School nursing is rapidly departing from its old traditions of cleanliness inspections and the treatment of impetigo etc., and widening its scope to include the problems of childhood and adolescence, and health education in the schools and homes. Considerable progress along these lines has been made this year as the home visiting figures show, and the enthusiasm of the older members of the school nursing staff has been enlivened by the recruiting of new, younger members during the year. Hospital follow-up School children who had been in hospital during the year were followed up after discharge to see if any problems had developed as a result of " hospitalisation." During 1957, 175 children between the ages of 4½ and 15 years were followed up from 7 hospitals, of which the majority (169) were in 4 hospitals where daily visiting was allowed, except in 1 hospital where it was allowed on 6 days a week. Of the 169 children, one parent refused to co-operate but 150 apparently neither fretted while in hospital nor showed any alteration in behaviour on return home. Of the remaining 18 the ages ranged from 4 years 6 months to 11 years 6 months and their stay from 2 days to 18 days. 7 of these were miserable for a time while in hospital but settled reasonably well and were settled at home. Of 5 who were fretful or very upset while in hospital, 4 settled down at home quite happily— the fifth appeared unhappy and was still fretful some weeks later (8 years 1 month). Of 4 whose behaviour was unchanged or liked hospital, 2 missed hospital when they returned home, one was an only child. The other 2 appeared to cry more easily than before and were nervous. One child of 4½ years fretted all the time for her mother and the parents were told not to visit her, but she rapidly settled down at home after a stay of 8 days in hospital. One child of 5 years 9 months was very quiet in hospital; he was afraid of having meals in bed as he thought he might spill something on the sheets. He cried when his visitors left and although he was only in for 4 days for adenoidectomy and antrum washout, he had not settled at home and had nocturnal enuresis on two occasions which he associated with dreams of the operating table. 61 DENTAL SERVICES Inspection and Treatment No. of Dental Officers at end of December, 1957 6 No. of sessions carried out per week 20 Two inspection sessions, one extraction clinic (School children) one extraction clinic (M. & C.W.) 16 fillings sessions No. of children on waiting list 454 No. of children on waiting list in 1956 1,992 No. of children inspected in 1957 2,469 No. of children inspected in 1956 1,847 No. of treatment sessions in 1957 483 No. of treatment sessions in 1956 419 No. of children who received treatment 1,169 Dental Sessions There has been a gratifying increase in the number of part time dentists on the staff, and as the clinic session figures and number of children treated show, this has provided a much improved dental service during the year. There is still an urgent need for more dental staff for conservative treatment as much of the time of the present staff is, of necessity, taken up with extraction sessions for urgent cases. Preventive dentistry is still a dream for the future, failing the widespread introduction of fluoridation of water supplies, and until the national dearth of dentists is improved it will remain possible to give treatment only to those already affected with dental caries. The possibility of employing oral hygienists—dental auxiliaries—who can carry out routine inspections and give minor treatment in early cases is being considered in some areas and could relieve the pressure on the fully qualified dentists in the future by the early diagnosis of caries in mass school inspections. Until such time as a fully organized dental service for the children and expectant mothers comes into being we can only report a patchy service working under pressure in as many of our clinics as we can staff from time to time. The opening of Oxlow Lane Clinic in the late summer, where the twin dental suite and recovery room provide up to date equipment in a bright and colourful atmosphere has enormously increased the popularity of the school dental service during the year. Provision of an X-ray unit in the clinic has facilitated improved treatment and enabled the dental staff to treat cases which in the past had to be referred elsewhere. 62 LEYS PHYSIOTHERAPY CLINIC Dental Inspection and Treatment of School Children Periodic Specials (a) Number of pupils inspected 928 1,541 (b) Number found to require treatment 726 1,462 (c) Number offered treatment 726 1,462 (d) Number actually treated 98 1,071 (e) Number awaiting treatment 351 103 (f) Attendances made by pupils for treatment 352 3,371 (g) Half days devoted by (a) Dental Officers to— (i) inspection 116 (ii) treatment 483 (h) Fillings (i) Permanent teeth 1,859 (ii) Temporary teeth 248 (i) Number of teeth filled (i) Permanent teeth 1,462 (ii) Temporary teeth 285 (j) Extractions (i)Permanent teeth (a) on account of caries 545 (b) for other purposes 17 (ii) Temporary teeth (a) on account of caries 1,868 (b) for other purposes 7 (k) Anaesthetics administered (i) Local 855 (ii) General (a) by Medical Officers on County Staff 639 (/) Orthodontics (i) Cases completed 13 (ii) Cases discontinued 37 (iii) Pupils treated with appliances 28 (iv) Removable appliances fitted 28 (v) Fixed appliances fitted — (vi) Total attendances 294 (m) Dentures (i) Number of pupils supplied with artificial dentures 8 (ii) Number of dentures fitted 8 («) Other operations (i) Permanent teenth 135 (ii) Temporary teeth 56 (o) Analysis of figures in (n) Type of operation Number Silver Nitrate Treat- ment 20 Scaling 93 Syringing Sockets 7 Dressings 58 Other operations 13 63 Mother and Child Welfare Dental Treatment Expectant or Nursing mothers Children under five years of age Number of patients examined 109 50 Number of patients needing treatment 105 47 Attendances for treatment 229 55 Number of patients who have completed treatment 64 34 Number of extractions 237 102 Number of fillings 59 1 Number of Anaesthetics administered: (a) local 56 4 (b) general 39 44 Number of scalings or scaling and gum treatment 2 - Number of dressings 2 - Number of dentures provided: (a) full 18 - (b) partial 8 - 64 SPECIALIST SERVICES OPHTHALMOLOGY Defective Vision Ophthalmic clinic sessions are held at the Essex County Council Clinic, Becontree Avenue, on Tuesday and Thursday mornings. Ophthalmologists are provided by the Regional Hospital Board and a school nurse attends each session. 102 sessions were held during 1957, when 1,645 children attended. Children suffering from external and other defects of the eye (excluding errors of refraction and squint) numbered 266, and 1,324 were suffering from errors of refraction (including squint). The number of pupils for whom glasses were prescribed was 695. At periodic medical inspections 186 children were found to have defective vision and referred to the ophthalmologists, and 157 cases were found to require observation only. Children suffering from squint numbered 23 and 22 from some other eye defect. The following are extracts from the reports of the Ophthalmologists attending the clinic. Of the total (1,645) children attending in 1957, 392 attended the clinic for the first time. The number of children seen at each session varies greatly. This year there was a marked decline of attendances during the influenza epidemic in October and November—thus in some instances 25 or more children were seen during one session, and sometimes as few as 12—14. The average attendance is 16. The majority of cases are referred to the clinic by the school medical officer or by the school nurse and a fair number by the infant welfare clinics. There are also some cases sent in by the family doctor and in some instances parents came with their children on their own initiative. The type of cases seen comprise: 1. Congenital abnormalities such as nystagmus, coloboma, cataracts, various types of paresis of the extra-ocular muscles. 2. Birth traumata (Abducens paresis) 3. Traumata. 4. Inflammatory conditions. 5. Refractive errors. 6. Squints. The vast majority of cases are those with refractive errors. The second largest group of ocular abnormalities in our patients are the squints. Here, our therapeutic endeavour is twofold; a good cosmetic result and the achievement of the normal physiological function of both eyes with normal visual acuity and binocular vision. The treatment thus comprises the correction of refractive errors if present, 65 followed, in indicated cases, by orthoptic treatment. If squint still persists operation might be indicated. There is very good co-operation with the orthoptic department and also with the various hospitals. Unfortunately, there are some parents who will not co-operate for various reasons, either that they do not care, or that they cannot spend the time or find the money for the fares in order to attend the orthoptic clinic which is a fair distance away. In the past mention has frequently been made of the lack of a dispensing optician in the service and both ophthalmologists regret this as it would mean that children could be measured for frames at the first visit and small repairs could be carried out without delay. In many instances considerable time elapses before the parents will go to the optician and necessary repairs are frequently not carried out at all or are left too long. It is suggested that spare pairs of glasses could be given free of charge in cases indicated by the ophthalmologist. High myopes are lost without glasses, and serious setbacks occur in cases of squints if glasses are left off for any lentgh of time. In view of the lengthening waiting list for both new appointments and re-inspections, a request for a further weekly ophthalmology session will be made to the County Health Committee and the Regional Hospital Board. ORTHOPAEDIC CLINIC This clinic is held at Leys Clinic, Ballards Road. A surgeon and physiotherapist are provided by the Regional Hospital Board, nursing staff and clerical assistance by the County Health Authority. The surgeon attends on every second Thursday in each month and the physiotherapist attends all day on Monday, Tuesday, Thursday and Friday. I give below a short report received from Mrs. F. Cocker, the physiotherapist:— 1957 has proved another busy year, 309 patients were treated for orthopaedic and postural defects, and 119 patients received general ultra violet light therapy. In all, the total number of treatments given was 5,941. The orthopaedic surgeon was in attendance for 11 sessions at which 156 patients were seen, 41 being new patients ; 10 children were referred to hospital for surgical treatment. Again the majority of cases have been minor lower limb deformities, most of the patients attending for general ultra violet light treatment are cases of debility. I do feel that with the addition of new apparatus we are to receive in the near future, i.e., short wave machine, wax bath and radiant heat tunnel baths, many of the patients attending hospital for treatment could attend this department and much time lost from school could be avoided. 66 It is unfortunate that our clinic is so far from any means of public transport, as this greatly increases the amount of work we give to the ambulance service; it also means that many patients attending for treatment for respiratory affections have to miss all treatment in bad weather, obviously the time they need it most. AUDIOMETRY In the early part of the year, school nurses attended the Audiology Unit at the Royal National Hospital, Gray's Inn Road, for instruction in the use of the audiometer which was later provided. The audiometric testing has been patchy, and only children seen at medical inspection or minor ailment clinics who were thought to have a degree of deafness were referred for audiometric testing. No adequate survey can be undertaken until one of my medical officers is trained in the diagnostic methods of audiometry. AUDIOMETRIC TESTS Ten children have been tested with the audiogram. One is now under supervision at Oldchurch Hospital, one is attending Rush Green Hospital twice a week for treatment and one is attending Grays Inn Road Hospital for supervision and has been supplied with a hearing aid. The others are very slightly deaf and have been referred to the clinic doctor for supervision. CHILD GUIDANCE Children in Dagenham requiring child guidance have, in the past, attended the Child Guidance clinic in Ilford, but during 1957 a second centre was opened in Romford and most of the children in this area are now referred there—but those referred in previous years who were nearing the end of their treatment continued to attend the Ilford clinic. The total number of children referred in 1957 was 44, of which 43 were transferred to Romford. OTHER SPECIALIST CLINICS School medical officers refer children to hospital consultants for opinion or for treatment at specialist clinics; 240 children were so referred during the year, as follows:— Chest Physician 56 Cardiologist 8 Orthopaedic Surgeon 5 E.N.T. Surgeon 80 Dermatologist 15 Paediatrician 25 Enuresis Clinic 15 Endocrine Clinic 3 Ophthalmologist 3 Audiometrician 16 Psychiatrist 14 240 67 SPEECH THERAPY The following is the report of the work of the speech therapists, Miss E. N. Symes and Miss E. R. Shipley. For the greater part of 1957, two speech therapists have been working in the Borough, except for three months in the summer when there was one vacancy. Miss M. M. Smith, who had worked in Dagenham for eight years, left us in May to take up an appointment in London and her place was taken in September by Miss E. R. Shipley. The work has continued to increase throughout the year and this is no doubt due to the careful selection from the schools of children with speech defects, and to the cooperation which we receive from both the medical and teaching staffs in this matter. We were pleased to have the use of a tape recorder in the clinic at Five Elms towards the end of 1957. Already several cases have been recorded and more will be done in this direction in the future. It is invaluable for recording progress made in the clinic, and it also helps to bring the defect to the notice of the patient concerned. We hope to have the use of small-size tapes in 1958 for the purpose of recording and filing individual cases. We felt that this year a statistical survey might help to convey briefly the nature of the work carried out in the speech clinic. Speech Therapy Review 1. Number of treatments given 2,673 2. Number of patients treated 241 173 patients treated at Five Elms Clinic 58 „ „ „ Leys Clinic 10 ,, ,, ,, The Bentry School 3. Number of sessions held 443 at Five Elms Clinic 189 at Leys Clinic 45 at The Bentry School Total 677 One session was used weekly in both the first and the second clinics for school or home visits, and interviews. 4. Case Load—163 boys and 78 girls—total 241. 5. Types of Cases treated Dyslalia 102 Stammering 66 Sigmatism 44 Cleft Palate 4 Stammering and Dyslalia 7 Other defects 18 Total 241 6. Reasons for Discharge Normal speech attained 71 Non-attendance 24 Left school 5 Transferred 8 Moved away 3 111 7. Number of cases on the Register at 31st December 1957—134. 68 HANDICAPPED CHILDREN A review of the handicapped children in the area over the past year is now almost complete, and the following table shows the categories of defects found and the type of special education treatment provided and required. The child population in Dagenham up to school leaving age is 29,000 and a total of 717 children with defects requiring either special educational treatment or observation in ordinary schools gives a percentage of 2.5 of the school and pre-school population. Blind There were 3 children attending residential special schools. One child under 5 is blind and also mentally retarded. Partially sighted 17 children in the area are registered partially sighted, 4 of whom are attending day special school, and 2 attending residential special school. 9 children are receiving education at ordinary schools and remaining under observation by the school medical officer. 2 pre-school children are registered as partially sighted—both of whom are mentally retarded. Deaf A total of 20 children are registered deaf—18 of whom are of school age. 9 attend day special schools, 1 is awaiting placement in a day special school, 7 are attending residential special school and 1 is attending ordinary school. Of the 2 pre-school children, one is already receiving special educational treatment and the other will be placed at school-entrance age. Partially Deaf 20 children are known to be partially deaf. Of these, 2 attend day special school, I receives education in hospital, 1 is awaiting placement in day special school, 3 are attending residential special school and 2 are attending independent schools. 8 children are on the register but attending ordinary schools and 3 are of pre-school age. The total number of ascertained partially deaf children in ordinary schools may well increase as more systematic audiometric surveys of the school children can be undertaken. Delicate Children in this category are usually asthmatics or heart defects, and require long or short stay at an open air school, either day or residential, or can remain at ordinary school under observation. Of a total of 133 delicate children, there are 50 children of school age having special educational treatment. 1 is receiving education in hospital, 20 attend day special school (most of these children are in Barking's Faircross Open Air School) 15 attend residential special school, 2 await placement in a day special school and II await placement in a residential special school, 1 is receiving home tuition. 79 delicate children attend ordinary schools and are under observation and 4 are of preschool age. 69 Epileptic Of the 26 epileptic children known to the authority, only 5 children of school age are considered so severely handicapped by epilepsy as to require special educational treatment. 2 are attending day special school, 2 are attending residential special school and 1 is awaiting placement. 12 children are attending ordinary schools and of the 9 pre-school children only 1 is receiving special educational treatment and is in a residential nursery. Maladjusted Schooling for maladjusted children is mainly residential as these cases need the constant supervision of staff and more help than can be given in day schools. Of the 18 children requiring special schooling 15 are in residential special school, 2 are awaiting placement in day school and 1 is awaiting placement in residential special school. 6 children are remaining at ordinary schools and 4 are of pre-school age. Physically Handicapped We are fortunate in having the Bentry School to which we send the great majority of the physically handicapped school children in the area, and of a total of 73 school age children requiring special educational treatment, 68 are attending day special school (most of these in Bentry). 1 is receiving education in hospital, 1 is awaiting placement in a day special school and 3 are receiving home tuition. 61 handicapped children can remain in ordinary schools and 47 pre-school children are on the register. Speech Defect 2 school children attend day special school and 1 attends a residential school for speech defects. Educationally Subnormal Bentry School takes the greatest number of educationally subnormal children in Dagenham and with the opening of schools for this type of child in south Essex which have taken children from Bentry to their now areas, the waiting time for admission of Dagenham children has decreased recently. A total of 271 children are ascertained as requiring special educational treatment. 170 children are in day special school (mainly Bentry), 15 children are awaiting placement in day special school, 10 children are in residential special school and 2 are awaiting placement in residential special school. There are also 44 children known to be educationally subnormal attending ordinary schools and of the 9 pre-school children 1 is already receiving special educational treatment. These figures do not include the large number of children still in ordinary schools but considered to be educationally subnormal but not so retarded that they cannot progress slowly up the school at their own pace. What the size of this problem is both the teachers and the school medical officers must determine, because without a knowledge of the need for further provision no persuasive action by educationalists or medical officers can be taken to press for increased provision. 70 Where children are receiving special educational treatment in other areas it would be helpful if school medical officers in those areas seeing the children during their stay in special schools could send reports to the School Health Department on the medical progress of the children so that an up to date register can be kept. As is noted this is done at the Bentry School for all "out of area" children. Summary of Handicapped Children N.B. These figures include 37 School Children with dual handicaps and five pre-school age. Blind Partially Sighted Deaf Partially Deaf Delicate Diabetic E.S.N. Epileptic Maladjusted Physically Handicapped Speech Defect Total Receiving Education in Hospital under Section 56 - - - 1 1 - - - - 1 - 3 Attending Day Special School - 4 9 2 20 - 170 2 - 68 2 277 Awaiting Placement in Day Special School - - 1 1 2 - 15 - 2 1 - 22 Attending Residential Special School 3 2 7 3 - - 10 2 15 - 1 58 Awaiting Placement in Residential Special School - - - - 11 - 2 1 1 - - 15 Attending Boarding Homes - - - - - - - - - - - - Awaiting Placement in Boarding Homes - - - - - - - - - - - - Attending Independent Schools - - - 2 - - - - - - - 2 Awaiting Placement in Independent Schools - - - - - - - - - - - - Receiving Home Tuition - - - - 1 - - - - 3 - 4 Awaiting Home Tuition - - - - - - - - - - - - Total number of Children of School Age requiring Special Educational Treatment 3 6 17 9 50 - 197 5 18 73 3 381 Children of School Age on Register of H.P., at ordinary schools - 9 1 8 79 1 44 12 6 61 6 227 Pre-school Children on Register of H. Pupils 1 2 1 3 4 - 30 8 4 47 7 107 Pre-School children already receiving S.E.T. - - 1 - - - - 1 - - - 2 Total 4 17 20 20 133 1 271 26 28 181 16 717 71 BENTRY SPECIAL SCHOOL All physically handicapped children at this school are seen at six monthly intervals, and reports of each medical inspection are sent to the medical officers of the district in which the child lives; all educationally sub-normal children are seen at the normal periodic inspection but many, in view of their poor physical condition, are seen annually. Again reports are sent to the medical officers concerned. It has recently been arranged with the Borough Education Officer that Dr. H. Mair will, in consultation with Mr. Hurton (Headmaster), interview and examine all physically handicapped applicants to the school in the term before their admission so that any special arrangements necessary can be made, e.g., provision of wheel chairs or walking aids before the child's admission. It is necessary to stress the importance of co-operation between the medical and nursing staff and the head teachers of special schools, and here I would like to thank Mr. Hurton for the increasing co-operation he has given during the year. The following is the report of the physiotherapist, Mr. A. Brand, who attends for two sessions per week:— During the past year 47 pupils received physiotherapy treatment at Bentry School. Total attendance including physiotherapy and exercise was 1,255. By far the biggest event of the year was the introduction of therapeutic swimming, a scheme which I have had in mind for a long time, which with the co-operation of the medical officer and the authorities concerned at South East Essex Technical College, at last bore fruit and we were able to commence in the autumn term. Between 12 and 15 children attended swimming sessions which were carried out at South East Essex Technical College swimming bath weekly on Wednesday afternoons from 2 p.m. to 3 p.m. Most of these were poliomyelitis and spastic children. We have four successes from non-swimmers to swimmers in three weeks and one who, though unable to use her legs, did 13½ lengths of the baths. I think the benefit of the swimming has been great, both physically and mentally. I must thank Mr. Jones, Director of Physical Education at South East Essex Technical College, who arranged for his staff to assist and whose enthusiasm and help has been most encouraging, and also thank the senior students who offered their help in their free time, and organised a Christmas Party for the children. The physiotherapy work at the school has continued on much the same lines as before. The Infra Red Lamp has proved a great help, and of course, the parallel bars and Guthrie-Smith apparatus have been invaluable. 72