BOROUGH OF DAGENHAM THE HEALTH OF DAGENHAM IN 1958 BOROUGH OF DAGENHAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1958 J. ADRIAN GILLET, M.B., Ch.B., D.P.H., F.R.S.H. Civic Centre, Dagenham, Essex Telephone : Dominion 4500 INDEX Page Ante-Natal Clinics 35 Atmospheric Pollution 19—20 Audiometric Tests 60 Bentry Special School 65-67 Care of Mothers and Young Children 33 Child Guidance 60 Chiropody 40 Clinics 38 Committee for Education 5 Convalescence 42 Council—Members of 3 Day Nurseries 37-38 Deaths—Causes of 14 Dental Services 57-58 Domestic Help 39 Education (General Purposes) Sub- Committee 5 Factories Acts, 1937 and 1948 21 Flooding 18 Food and Drugs—Sampling 24-25 Food Hawkers—Registration 24 Food Hygiene Regulations, 1955 23 Food—Inspection and Supervision 21-26 Food Poisoning 24 Food—Unsound 23-24 Handicapped Children 63-64 Handicapped Children—Summary 64 Health Area Sub-Committee 4 Health Education 29 Health Visiting 34 Home Safety 30 Housing 17 Ice Cream 22-23 Immunisation: 43-45 Diphtheria 43—44 Whooping Cough 43 Improvement Grants 17 Infant Mortality 15 Infant Welfare Centres 33 Infectious Diseases 27-28 In-service Staff Training Course for County Council of Essex Health Department 31-32 Laundry Service for the Incontinent Aged 19 Page Maternal Mortality 13 Maternity Services 35-36 Midwifery Service 35 Milk 22 National Assistance Act, 194818 Occupational Therapy 41 Ophthalmic Clinic 59 Orthopaedic Clinic 59 Over Sixties Clinic—Oxlow Lane 46-48 Pet Animals Act, 1951 20 Premature Infants 36 Prevention of Damage by Pests Act, 1949 20 Public Health Committee 3 Rag Flock and Other Filling Materials Act, 1951 20 Recuperative Holidays 42 Relaxation Classes 36 Rent Act, 1957 17 Sampling—Food and Drugs 24-25 Sanitary Inspection of the District 16 i School Clinics 54-56 School Health, 1958 49-53 School Health Service 42 Slum Clearance 17 Smoke Control Areas 19-20 Specialist Services 59-62 Special School—Bentry 65-67 Speech Therapy 61-62 Staff 6-7 Synopsis of Address given by Dr. Helen E. Mair at the Conference of Home Help Organisers on 27th September 1958 68-738 Tents, Vans and Sheds 17—183 Tuberculosis 288 Unsound Food 233 Vaccination 43-456 B.C.G 433 Poliomyelitis 444 Smallpox 433 Vital Statistics 13-155 Water 166 2 MEMBERS OF THE COUNCIL (as at 31st December, 1958) MAYOR: Councillor M. Eales, J.P. DEPUTY MAYOR: Alderman R. Blackburn ALDERMEN: W. E. Bellamy, J.P. A. E. Prendergast, (Mrs.) G. H. A. Crouch C. Prendergast, B.E.M., E.C.C. E. M. Millard, (Mrs.) F. G. Thomas, J.P., (died October 1958) COUNCILLORS: G. Broadbent, (Mrs.) D. O'Dwyer F. Brown, E.C.C. W. A. Parish R. E. Crawley A. C. V. Rusha D. A. L. G. Dodd B. Seeney, (Mrs.) G. T. Harris L. S. Snelling, (Mrs.) H. Kay M. J. Spencer E. J. Kitchen, (Mrs.) J. Swift H. P. Larking J. S. Thomas A. J. Levine, M.B., Ch.B. L. W. Todd J. F. Moultrie, J.P., F.A.I. S. J. C. Warr PUBLIC HEALTH COMMITTEE CHAIRMAN: Alderman (Mrs.) A. E. Prendergast VICE-CHAIRMAN: Councillor (Mrs.) G. Broadbent His Worship the Mayor Councillor A. J. Levine, M.B., Ch.B. Councillor M. Eales, J.P. Alderman (Mrs.) E. M. Millard The Deputy Mayor Councillor J. Swift Alderman R. Blackburn Councillor S. J. C. Warr 3 DAGENHAM HEALTH AREA SUB-COMMITTEE (As at 31st December, 1958) Chairman: Alderman (Mrs.) A. E. Prendergast Vice-Chairman: Councillor (Mrs.) G. Broadbent Members:— Borough Council Alderman R. Blackburn Alderman (Mrs.) E. M. Millard Councillor G. T. Harris Councillor (Mrs.) E. J. Kitchen Councillor A. J. Levine, M.B., Ch.B. Councillor D. O'Dwyer Councillor W. A. Parish Councillor A. C. V. Rusha Councillor M. J. Spencer Councillor (Mrs.) L. S. Snelling Councillor J. Swift Councillor S. J. C. Warr County Council Alderman (Mrs.) M. Ball Alderman (Mrs.) E. C. Saywood Councillor C. S. V. Daniels, M.R.C.S., L.R.C.P., Councillor S. W. Deeks L.D.S., R.C.S. Councillor (Mrs.) L. Fallaize, J.P. Councillor A. R. P. Sherrell (1 vacancy) Hospital Management Committee Mrs. A. R. Thomas Executive Council for Essex Mr. F. A. Wortley Local Medical Committee for Essex (Vacancy) Local Voluntary Organisations Mrs. S. M. Hoxley Miss N. L. Odell Mrs. I. Linton (from 15. 9. 58) Mr. J. Walsh 4 DAGENHAM COMMITTEE FOR EDUCATION (as at 31st December, 1958) Chairman: Alderman R. Blackburn Vice-Chairman: Councillor J. Swift Representative Members: The Mayor Councillor M. Eales, J.P. Alderman W. E. Bellamy, J.P. Alderman (Mrs.) E. M. Millard Alderman (Mrs.) A. E. Prendergast Alderman C. Prendergast, B.E.M., E.C.C. Councillor (Mrs.) G. Broadbent Councillor R. E. Crawley Councillor H. P. Larking Councillor A. J. Levine, M.B., Ch.B. Councillor D. O'Dwyer Councillor W. A. Parish Councillor A. C. V. Rusha Councillor M. J. Spencer Councillor S. J. C. Warr Nominated Members: County Councillor L. F. Saunders (1 vacancy) 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, 1958) (This Sub-Committee deals, inter alia, with the School Health Service) Chairman: Alderman (Mrs.) A. E. Prendergast Vice-Chairman: Councillor H. P. Larking Members: Alderman R. Blackburn Mr. A. F. J. Chorley, M.B.E., J.P., E.C.C. Councillor M. J. Spencer Mr. E. E. Hennem Councillor J. Swift Mrs. E. F. Lambert Mrs. I. M. Brockelbank 5 OFFICERS OF THE HEALTH SERVICES (as at 31st December, 1958) Medical Officer of Health and Area Medical Officer: J. Adrian Gillet, M.B., Ch.B., D.P.H., F.R.S.H. Deputy Medical Officer of Health and Assistant Medical Officer: Helen E. Mair, M.B., Ch.B., D.P.H. Assistant Medical Officers: Katherine Fitzpatrick, M.B., B.Ch., (C) Wilhelmina C. Maguire, Fannie Hirst, M.B., Ch.B., D.P.H. (C) L.R.C.P., L.R.C.S.I. (C) Edmund Percival James, M.R.C.S., Madeline Weizmann, M.R.C.S., L.R.C.P. (C) L.R.C.P., D.R.C.O.G. (C) Dental Officers: J. Craig, L.D.S., R.C.S., (part time) V. Foy, L.D.S., R.C.S., (Eng.) (part time) I. Ebrahim, B.D.S., (part time) C. McKenzie, L.D.S., R.C.S., (part time) A. D. Everitt, 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) M. Nelson (5), (6), (7) P. G. Collyer (5), (6), (7), (12) D. B. Rudd (5), (6), (7) L. Dunbar (5), (6), (7) M. F. Savage (5), (6), (7) I. A. Garrard (5), (16) D. E. Smith (5), (7), (8), (15) A. K. Gibson (5), (6), (7) D. B. Stewart (5), (6), (7) L. Ling (5), (6), (7) E. Valentine (5), (6), (7), (15) R. E. Walker (5), (6), (7), (15), (16) Non-Medical Supervisor of Midwives: (C) Miss R. K. Jesson Midwives: (C) H. Mitson (5), (6) A. B. Showell (5), (6) M. M. Robson (6), (13) M. Teather (5), (6) M. Rock (6) P. Vanbrook (6) School Nurses: (C) K. Ayres (5), (6), (10) A. MacColl (5) J. Hobein (5), (17) E. McCheyne (5) E. Hogg (5) N. Rand (5), (15), (16) J. Hogg (5) M. Twomey (5) J. James (5) N. Yarnell (5), (10) Speech Therapists: (C) E. Shipley (22) E. Symes (22), (23) CLERICAL STAFF: Chief Clerk (C) F. W. Knight (1), (2) Medical Officer of Health's Secretary: I. Fraser 6 Trainee Public Health Inspector: J. Powell Clerks: E. Adams (C) D. Duff (C) J. Morgan (C) F. W. Silverthorne I. M. Bishop (C) D. B. Ellmore (C) E. Neport (C) J. B. Smith (C) N. Briand (C) G. K. Harris I. Page (C) I. Throssell (C) A. M. Brown (C) S. B. Leader (C) J. Pearmine (C) M. A. Watts (C) L. M. Butler (C) O. M. Lewsey (C) K. Richards (C) N. E. Cloke (C) F. H. Martin (18), (C) G. Shannon (C) M. Oates (C) (part time) Day Nurseries: (C) Goresbrook Nursery, Matron: E. Maddison (15) Dagenham Avenue, Deputy: K. Graham (9) Dagenham. Chadwell Heath Nursery, Matron: P. Coffee (17) Ashton Gardens, Deputy: M. Carter (20), (21) Chadwell Heath. Kingsley Hall Nursery, Warden: D. Howes (21) Parsloes Avenue, Dagenham. Domestic Help Organiser: (C) G. Hickinbotham Chiropodists: (C) N. Freeman M. Kelly (14) Dental Attendants: (C) M. A. Brideson A. Horlock (part time) B. N. Hurford 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: Z. Mercer (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. 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 Public Health Department, Civic Centre, Dagenham. "Look to your health; and, if you have it, praise God and value it next to a good conscience; for health is the second blessing that we mortals are capable of; a blessing that money cannot buy." Izaak Walton, The Compleat Angler. To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Last year, I tried to produce an annual report on the health of the citizens of Dagenham which was more readable than those of previous years and I was greatly encouraged by the response to my efforts from members of the Council, from a number of general practitioners in the area and from others. I realise that much of the statistical material of necessity included in the annual report is of very little general interest. I was tempted to relegate it to the end of the report for 1958 but felt it might spoil such balance as it has. I decided, therefore, to write a somewhat longer introduction which I hope will contain the c meat' and will enable the serious reader, if he so wishes, to dip into the body of the report for further information. This plan, however, may tend to make the introduction somewhat disjointed if it is to compress so much into such a small space. During the year one of the matters which occupied the minds of the public and of many medical officers of health was the dangers of radiation from the commercial use of radiation products. In April I attended a short course organised by the Services Group of the Society of Medical Officers of Health, on radiation hazards. This was interesting and well attended but, because of the large amount of technical knowledge put over in the short time available, somewhat heavy going. It would appear, however, that there is much to be done by public health departments in the training of their staffs— medical officers, public health inspectors, health visitors etc., in the detection of radiation hazards and in avoiding any ill effects. The medical officer of health, as watchdog over the health of the people, bears a heavy responsibility in this connection and I hope that in the near future more suitable courses will be organised for all public health personnel. Health education has not been the least important of our activities in which all the staff have played a part. During the year an in-service training course in" The Teaching of Parentcraft" was organised for health visitors, school nurses and nursing staffs, by the Central Council for Health Education at the request of the Essex County Council. This high-lighted modern methods of teaching in this field and the panel discussion (so popular on television and radio) was not neglected as a means of putting over health. It is important, as I have said in the body of the report, that we stick fast to the principle of health education and do not allow ourselves to be led into carrying out disease education which holds such a fascination for the lay public and which, apart from exceptional circumstances, serves very little useful purpose in helping people to lead healthier lives. 9 During 1958, the Borough Council agreed to the appointment of an additional public health inspector to co-ordinate health education activities in the Borough and to undertake special investigations into any environmental problems which might arise. It is my earnest hope that a suitable person will be appointed during 1959 so that we can make a start on organised courses on health instead of the disjointed efforts which limitation of staff imposes upon us at present. The formation of a Home Safety Advisory Committee during 1958 appears to have passed almost unnoticed by the public and the attendances at the committee meetings were disappointing, consisting as they did of the 'faithful few'! Perhaps a few tragic and serious home accidents are needed before public interest can be aroused in this vital subject. I am sure it is not appreciated that more deaths occur and more suffering is caused by accidents in the home than on the roads. The Clean Air Act of 1956 created a good deal of extra work for the public health inspectors in general and for Mr. Prior in particular. Education is vital to the success of the Council's scheme to make Marks Gate housing estate the first smoke control area in the Borough, and Mr. Prior and his staff have risen nobly to the task. I would also like to draw attention to the considerable amount of work entailed by food and drugs sampling which goes on quietly year in and year out and is so vital to the safeguarding of food supplies to the public. During the year, one lady who was severely crippled had to be removed to hospital under the provisions of Section 47 of the National Assistance Act, 1948. This was a most distressing case and was dealt with very reluctantly by the staff concerned. The chief public health inspector, the home help organiser, the health visitor and the near neighbours of the patient, co-operated with the hospital and ambulance service in carrying out what is always, on the very rare occasions it is necessary, a most disagreeable duty. The unauthorised parking of caravans by gypsies caused a good deal of trouble during the year and Mr. Prior accepted the difficult job of dealing with them on a number of occasions. Mrs. Bedford and Mrs. Goodbun both retired from the midwifery service during the year. They had both been with the service for many years, Mrs. Bedford for 20 and Mrs. Goodbun for 16, and both will be greatly missed. Mrs. Bedford particularly left a big gap in the ranks and although an arrangement was made with Ilford to share the services of Miss Jesson, the non-medical supervisor, the arrangements cannot be so satisfactory as when Mrs. Bedford acted as senior midwife and gave detailed supervision and guidance. The appointment of a supervisor (or a senior midwife) for Dagenham may have to be given consideration during 1959, after the recommendations of the Report of the Maternity Services Committee (The Cranbrook Report) are published, if the domiciliary midwifery service is to function satisfactorily. 10 One event of importance which took place during the year was the talk given by Dr. Mair to the Institute of Home Help Organisers. This dealt with the handicapped in both an administrative and a personal fashion and gives such a comprehensive picture of services for the disabled, both young and old, that I have taken the opportunity of publishing it in full in the body of the report. I can recommend a close study of this to all those interested in the welfare of the handicapped. During the year also, Dr. Mair in her concern for the future of handicapped school leavers established close liaison with the County Welfare Department. So as to enable the staff to have a better picture of the capabilities of the children leaving the Bentry Special School she invited the appropriate member of the County Welfare staff to sit in on conferences about school leavers. This liaison was greatly facilitated by Mr. Hurton, the head teacher at the Bentry School, who takes an intense personal interest in his pupils and their future. The extension of the Child Guidance service which took place during 1957 and resulted in the opening of a centre in Romford improved to some extent the facilities available to the Dagenham children and their parents, but I was disappointed that it did not bring a more convenient service to Dagenham, nor did it to any great extent improve the liaison between health visitor, school nurse and medical officer on the one hand and the clinic child guidance team on the other. I feel that the main reason for this is the geographical situation of the Child Guidance Clinic and that the final solution to the problem will only be reached if and when a centre is opened in Dagenham. If this was done a much closer integration of staffs could be secured which would be of value to both staffs, with consequent benefit to the children. The period of waiting before children can be seen by the psychiatrist (3—4 months) is longer than is desirable. Immunisation against diphtheria shows a marked improvement as indicated by the immunity index, a term we now use to indicate the percentage protected by immunisation during the previous five years. In November, the age group of those eligible for vaccination against poliomyelitis was extended to those under 26 years. The open sessions which were held at Oxlow Lane Clinic met with a poor response though at the time of writing the much publicised death of a famous footballer, due to poliomyelitis, has resulted in a sudden and overwhelming demand for immunisation. I have to report progress in the Over Sixties Clinic at Oxlow Lane and to add that at the end of the year, over fifteen months since the centre began to function, a definite pattern seemed to be emerging. It would appear from the limited experience available that mental health becomes more important as we get older. We must try to plan a 11 service which takes account of this and which attempts to stimulate the patient mentally so as to keep him or her more interested in both the present and future than in the past. "More life trickles out through a man's thoughts than through a gaping wound," said Thomas Hardy, and to no age group is this more applicable than to the over sixties. It would be remiss of me if I were not to acknowledge the help I have received from the Chairmen and members of the various committees who have any share in the services which this report covers. My thanks are due to all the members of my staff who have each played a part in the running of the service and on whom the quality of the service must depend. Their co-operation with each other, with other departments and with the public is paramount in providing a first-class service, for as has been said on many occasions, public health is team work. J. Adrian Gillet, Medical Officer of Health. 12 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 6,556 Registrar-General's estimate of resident population, 1958 114,100 Number of inhabited houses (end of 1958) according to Rate Books 31,048 Rateable value (December 31st, 1958) £1,357,885 Sum represented by a penny rate (approximate 1958-9) £5,465 Extracts from Vital Statistics for the Year Live Births: Total Male Female Legitimate .. 1,483 778 705 Illegitimate 53 31 22 Live birth rate per 1,000 of the estimated population 13.46 Stillbirths: Legitimate 28 16 12 Illegitimate 2 1 1 Stillbirths rate per 1,000 live and still births 19.16 Total live and still births 1,566 826 740 Infant deaths 25 Infant mortality rate per 1,000 live births—Total 16.28 Legitimate 15.51 Illegitimate 37.74 Neo Natal mortality rate per 1,000 live births (first four weeks) 11.72 Illegitimate live births per cent of total live births 3.45 Maternal deaths (including abortion) 3 Maternal mortality rate per 1,000 live and still births 1.92 Total Male Female Deaths 834 476 358 Death rate per 1,000 of the estimated resident population 7.31 Deaths from Cancer (all ages) 183 „ „ Measles (all ages) — „ „ Whooping Cough (all ages) — „ „ Gastritis, Enteritis and Diarrhoea (all ages) 4 Births 1,536 live births were notified during the year, there being 809 males and 727 females. There is an increase of total births from 1,432 in 1957t0 I?53^. The corrected birth rate per thousand population was 12.52 compared with 16.4 for England and Wales. The illegitimate birth rate continues to be very slow, being only 3.45 per cent of total live births. The rate of illegitimate stillbirths is 6.67 per cent of total stillbirths. Death Rate Total deaths in district 635 Outward transfers 211 Inward transfers 410 Deaths of residents 834 Of the deaths of non-residents occurring in the district, 180 took place at Rush Green Hospital and 12 at Dagenham Hospital. Of the deaths of local residents taking place outside this area, most occurred in institutions. Of these 240 occurred at Oldchurch Hospital; 55 at St. George's Hospital, Hornchurch; 15 at King George Hospital, Ilford; 14 at London Hospital; 5 at the London Chest Hospital; 5 at Ilford Isolation Hospital; 5 at St. Andrew's, Billericary; 4 at East Ham Memorial Hospital and 4 at Victoria Hospital, Romford. 13 The crude death rate of 7.31 when corrected becomes 12.87 and compares with 11.7 for England and Wales. Causes of Death 1958 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 - - - - - - - - 2 - 3 - - 1 5 2 2. Tuberculosis other - - - - - - - - - - 1 - - - - - l - 3. Syphilitic disease - - - - - - - - - - 1 - - - - - 1 - 4. Diphtheria - - - - - - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - 6. Meningococcal infections 1 - - - - - - - - - - - - - - - 1 - 7. Acute Poliomyelitis - - - - - - - - - 1 1 - - - - - 1 1 8. Measles - - - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases - - - - - - - - - - - - - - - - - - 10. Malignant neoplasm, stomach. - - - - - - - - 1 - 9 3 7 4 2 5 19 12 11. Malignant neoplasm, lung, bronchus - - - - - - - - 1 1 25 4 15 2 2 1 43 8 12. Malignant neoplasm, breast - - - - - - - - - - 2 - 4 - 4 - - - 10 13. Malignant neoplasm, uterus - - - - - - - - - 3 - 3 - 2 - - - 8 14. Other Malignant and lymphatic neoplasms - - - - - - 1 - 2 2 16 17 20 11 9 5 48 35 15. Leukaemia, aleukaemia - - 1 1 - - - 1 - - - - 2 1 - 1 3 4 16. Diabetes - - - - - - 1 - - - - 2 - - 1 2 2 9 17. Vascular lesions of nervous system - - - - - - 1 - 1 2 11 17 18 16 11 20 42 55 18. Coronary disease, angina - - - - - - - - 4 - 49 8 32 18 10 10 95 36 19. Hypertension with heart disease - - - - - - - - - - 3 1 3 4 6 7 12 12 20. Other heart disease - - - - - - - - 2 4 11 16 8 11 18 32 39 63 21. Other circulatory disease - - - - - - - - - 1 3 4 3 3 2 2 8 10 22. Influenza - - - - - - - - - - - - 1 - - 1 1 1 23. Pneumonia 2 - - - - 1 1 - - 1 2 2 6 - 3 5 14 12 24. Bronchitis - - - - - - - - - - 15 2 26 7 13 13 54 22 25. Other diseases of respiratory system - - - - - 1 1 - - - 5 - 2 1 2 1 10 3 26. Ulcer of stomach and duodenum - - - - - - - - - - 2 1 1 - 1 - 4 1 27. Gastritis, enteritis and diarrhoea - - - - - - - - - - - - - 1 2 1 2 2 28. Nephritis and nephrosis - - - - - - - - 1 1 2 - 1 - 1 1 5 2 29. Hyperplasia of prostate - - - - - - - - - - 2 2 - 1 - 5 - 30. Pregnancy, childbirth, abortion - - - - - - - - - - - - - - - - - 3 31. Congenital malformations 3 2 - - 1 - - - 2 - - - - - - - 6 2 32. Other defined and illdefined diseases 8 8 - - - 1 2 - 3 2 7 5 7 9 4 9 31 34 33. Motor vehicle accidents - - - - - - 2 - 3 - 2 - 2 1 - - 9 1 34. All other accidents - - 1 1 - - 1 - - - 3 - 1 1 1 3 7 5 35. Suicide - - - - - - - - - 1 7 3 1 - - - 8 4 36. Homicide and operations - - - - - - - - - - - - - - - - - - of war - - - - - - - - - - - 1 - - - - - 1 14 11 2 2 1 3 10 1 20 24 179 93 161 104 89 120 476 358 14 INFANT MORTALITY Details of deaths of children under one year of age registered during 1958. under 1 wk. 1—2 wks. 2—3 wks. 3—4 wks. Total under 4wks 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 2 - - - 2 - - - - 2 Prematurity with associated cause 5 - - - 5 - - - - 5 Congenital Abnormality (uncomplicated) 4 - - - 4 1 1 - - 6 Birth Trauma 1 - - - 1 1 - - - 2 Birth Trauma—Intracranial haemorrhage 2 - - - 2 - - - - 2 Atelectasis 4 - - - 4 - - - - 4 Bronchopneumonia - - - - - - 2 - - 2 Acute Meningitis - - - - - - - 1 - 1 Tuberculous Meningitis and Pneumonia - - - - - - - 1 - 1 TOTALS 18 - - - 18 2 3 2 - 25 15 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRICT (a) Nature and number of visits:— Rent Act 594 Overcrowding and Housing Conditions 1,892 Nuisances under Public Health Acts:— Dwelling houses 3,271 Other premises 1,066 Bakehouses 42 Milkshops and dairies 88 Foodshops, stalls and itinerant vendors 2,264 Cafes and canteens 662 School kitchens and feeding centres 125 Infectious disease enquiries 852 Visits to foster-mothers' premises 94 Number of complaints investigated 982 Clean Air Act—Survey 880 Factories 262 Workplaces and offices 52 Rag Flock, etc. 25 Tents, vans and sheds 305 Stables 5 Pet Shops 10 Hairdressers' and barbers' premises 88 Shops Act 48 Ice Cream premises and vehicles 237 Houses disinfested 39 Other visits 300 (b) Notices served:— Complied with:— Statutory 75 76 Informal 339 329 Legal proceedings were instituted in respect of three properties to enforce compliance with statutory notices. 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. During the year 191 yards of 4" water mains were laid; 572 supplies were afforded to houses. 16 The Chief Engineer of the South Essex Waterworks Company has furnished 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 4,080 chemical, bacteriological and biological examinations have been made during the year. In addition samples were also examined for radioactivity. All water going into supply was wholesome." HOUSING Slum Clearance During the year a further two houses were reported as unfit for human habitation and subsequently demolished. The Council's five-year programme consists of 58 properties and at the end of the year action had been commenced in respect of 44. Rent Act, 1957 97 applications were received during the year from tenants; in 94 cases the appropriate notice (in only 28 cases did the list of defects include all those asked for by the tenant) was issued informing the landlord (a copy was sent to the landlord's agent) of the Council's intention of issuing a Certificate of Disrepair. Undertakings to do the work were given by landlords in respect of 72 properties; 20 Certificates of Disrepair were issued and 15 cancelled on the completion of the repairs. Advice was given to tenants and they were able to purchase the necessary forms at the Civic Centre. Improvement Grants Applicants 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 16 houses. 11 preliminary applications were reported to the appropriate Committee of the Council and eight were considered suitable for a grant, but at the end of the year none had submitted a final application with details of prices, etc. It may be that some applicants find difficulty in obtaining tenders from three builders for the work. The fact that the Council have been unable to give financial assistance to cover the applicant's portion of the cost has also been a deterrent. Tents, Vans and Sheds Although no applications were received under the provisions of the Public Health Act, 1936, Section 269, considerable time was spent by the district inspectors in dealing with gypsies who pull on to vacant sites (usually land under the control of the Council 17 awaiting housing development) with easy access to the road. During the summer months the gypsies may find agricultural work but during the winter they seek the populous districts and engage in selling flowers and collecting rags and old iron. The day of the horse drawn caravan has almost gone; most of the vans are now pulled by motor vehicles. The method of dealing with this problem is for the inspector to warn the gypsies that if they are not off the site by a specified day and time (usually 10.00 o'clock the next morning) they will be pulled off. The presence of the Police is sought to prevent any breach of the peace and a Council lorry is brought to the site to pull off any vans the owners refuse to remove. Invariably the site is cleared but often some, if not all, the vans go to another site in the Borough. To prevent access to the sites by the erection of fences is usually too expensive to contemplate; it would appear that the problem will remain until all vacant sites to which there is easy access are developed. During the year the inspectors paid 305 visits to various sites in connection with this work. Flooding Following torrential rain in September tributaries of the Beam River overflowed resulting in the flooding of a few houses in three areas in the Southern part of the Borough. His Worship The Mayor gave financial assistance in certain necessitous cases. NATIONAL ASSISTANCE ACT, 1948 Section 47 The surveillance of persons who are unable properly to look after themselves continues to receive the attention of the department. During the year it was necessary to obtain the Court's authority for the compulsory removal of a widow (age 52 years) who was living alone, suffering from a grave chronic disease and completely unable to devote to herself, and was not receiving from other persons, proper care and attention. The patient died in hospital before it was necessary to consider a further application to the Court. The Council gave careful consideration to all the consequences involved in using the powers contained in this section. Section $0 Two persons (males 53 and 22 years, the latter a seaman) were buried under the provisions of this section. 18 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. 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. In order to assist in transport to the laundry (the department operates a small 5-cwts. motor van) it was decided to replace the bins with canvas bags. The service worked well due in a large measure to the helpful, co-operative attitude of the department's driver and the laundry staff at the Barking hospital. An average of about 18 cases use the service at any one time. From the commencement of the service in December 1953 to the end of this year 185 cases have received assistance. During the year 46 new cases have been helped, 20 cases died, 20 were removed to hospital and three no longer needed the service, At the end of the year 18 cases were still participating; the number of articles laundered during the year was 13,326 compared with 11,492 articles for the previous year. ATMOSPHERIC POLLUTION On the 1st June, 1958 all the outstanding provisions of the Clean Air Act, 1956 were brought into operation. The Dark Smoke (Permitted Periods) Regulations 1958 provide the maximum periods for the emission of dark smoke from industrial plants; black smoke is limited to not more than two minutes in the aggregate in any period of 30 minutes. 68 observations were made of the chimneys of industrial premises in the Borough; although there were informal discussions in some cases 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 daily and monthly measurement of air pollution. Several visits were paid to local organisations at which the problem (local and national) of air pollution was discussed. Part of the department's stand at the Dagenham Town Show held on Saturday and Sunday 12th and 13th July, 1958 was used to publicise the use of solid smokeless fuel; the North Thames Gas Board co-operated with the department. Smoke Control Areas The Council continued to co-operate with neighbouring local authorities. Conferences with representatives of Hornchurch and Romford have been attended to discuss the possibilities of co-ordinating policies; a meeting with representatives of Barking and Ilford discussed the question of a programme in respect of the London County Council's Becontree estate. The Council are also represented at the joint conference of local authorities covering the East London area. 19 The Council submitted to the appropriate ministry the Dagenham Smoke Control (No.1) Order. This covers the Dagenham section of the Marks Gate housing estate; the area is about 130 acres and when completed will contain about 1,000 dwellings. It was originally anticipated that Ilford Borough Council would have co-operated and dealt with their section of the estate at the same time; unfortunately this has not happened. The Council have discussed with local merchants the question of the supply and delivery of smokeless fuel, especially coke. The Order has been confirmed by the Minister and will operate from 1st September, 1959. This is the first Order to be confirmed in Metropolitan Essex. 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 continue to be taken regularly at the three factories in the Borough where filling materials are manufactured. 29 informal samples were taken during the year; all were satisfactory. The details are as follows:— No. of Samples Material submitted for analysis Rag Flock 7 Cotton Felt 7 Kapok 7 Coir Fibre 4 Sisal 3 Grey Fibre 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. 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 soil sewer manholes in the Borough, two treatments, at six monthly intervals, were carried out in areas where there was evidence of infestation. No serious infestation of either rats or mice was encountered during the year. 20 FACTORIES ACTS, 1937 AND 1948 Inspections Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 17 24 1 - Factories with mechanical power 169 238 8 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 24 63 4 - TOTAL 210 325 13 — Defects Found Number of defects Number of Prosecutions instituted Found Remedied Referred To H.M. Inspector Referred By H.M. Inspector Want of cleanliness 2 2 - - - Overcrowding 1 1 — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — - Ineffective drainage of floors 1 1 - - - Sanitary Conveniences:— Insufficient 3 2 — 1 - Unsuitable or defective 5 6 — 1 — Not separate for sexes — — — — - Other Offences — — — — — TOTAL 12 12 — 2 — Outwork No. of outworkers in August list 12 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 22 Bakers and Confectioners 63 Butchers 170 Cafes and Canteens 25 Fishmongers 53 Fruiterers and Greengrocers 120 Grocers 21 Licensed and 12 Off-licensed Premises 92 Sweets, etc. 21 All food premises are regularly inspected and during the year 3,324 visits were paid. In addition to numerous verbal warnings and suggestions to management and staff during these routine visits, 141 informal notices were served upon owners or occupiers. A Council house was found to be used immediately before Christmas for the sale of meat and poultry. All food found on the premises was fit for human consumption. The practice was stopped forthwith. 110 inspections were carried out in connection with itinerant vendors and stalls; much of this work, especially in respect of itinerant vendors, is done at week-ends. The inclement weather during the summer months reduced considerably the number of itinerant vendors at week-ends. The position under the Food and Drugs Act, apart from registrations in respect of ice cream, is as follows:— 37 butchers' premises and eight other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 571 visits were paid. 21 fish shops are registered for frying. To these 241 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 persons registered as distributors is 67; of these 12 operate from premises outside the Borough, the remaining 55 distributors operate from 69 premises situate in the Borough. 88 visits were paid to dairies and distributors' premises. During the year 75 samples of milk were taken from roundsmen in the Borough and submitted for bacteriological examination. Four samples failed to pass the methylene blue test, but in each case the maximum atmospheric shade temperature during the tests reached or exceeded the permissible limit of 65 °F. Ice Cream The total number of registered premises is 137; of this number two are registered for the manufacture of ice cream. 208 visits were paid to these premises. During the year 10 applications for the storage and sale of ice cream were granted. Two applications for the sale of wrapped ice cream from launderettes were refused. 29 inspections in connection with itinerant vendors were carried out. During the year 45 samples of ice cream were submitted for bacteriological examination; they were graded as follows:— Grade I Grade II Grade III Grade IV Total 34 8 2 1 45 22 In addition 26 samples of ice lollies were submitted for examination; three were considered to be unsatisfactory. In each case the lollies were manufactured outside the Borough and the local authorities concerned were notified. 12 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 6 6 — — 12 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. The inspectors in their regular visits to food premises seek opportunities through discussions with the staff to inculcate hygienic practices in food handling. In addition several talks on food and food handling were given to local organisations. A number of tenants on one of the Council's housing estates sought registration to use their homes for the peeling of onions. The Housing Committee informed the tenants that such work was considered a breach of the Council's regulations and conditions of tenancy. The applications for registration were, therefore, abandoned. Unsound Food Complaints continue to be received in respect of food containing foreign substances or otherwise alleged to be unfit for human consumption. During the year 27 such complaints were considered by the Public Health Committee. These included the following:— Glass (three complaints) and a bolt in bottles of milk; a dirty milk bottle and a dirty bottle containing orange drink. Flour label, sand and a cockroach in bread; two complaints of dirty dough in bread and one complaint of mould. Paring of a finger nail and newspaper in cakes. Mould in meat pie and in sweets (wrapped caramels). Insect larvae in shelled walnuts and mixed dried fruit. Legal proceedings were taken in the following five cases:— Cockroach in bread Fined £10 Mould in meat pie „ £15 Insect larvae in shelled walnuts ,, £20 Larvae in mixed dried fruit„ £30 Mould in caramels„ £5 23 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, six persons were registered as food hawkers; one had storage permises in the Borough. Food Poisoning 12 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 2nd Quarter 3rd Quarter 4th Quarter Total 7 2 2 1 12 Cases otherwise ascertained—Nil Fatal cases—Nil Particulars of Outbreaks:— No. of Outbreaks No. of Cases Total No. of cases Family Outbreaks Other Outbreaks Notified Otherwise Ascertained Agent identified - - - - - Agent not identified 2 - 7 - 7 Single Cases:— No. of Cases Total No. of cases Notified Otherwise Ascertained * Agent identified 3 — 3 Agent not identified 2 — 2 * Salmonella (Typhi-murium 1. Heidelberg 1. Enteritidis 1.) Salmonella Infections, not food-borne—Nil. Food and Drugs—Sampling Article Number Examined Number Adulterated, etc. Formal Informal Formal Informal Angelica — 1 — — Almonds — 1 — — Baking Powder — 2 — — Batter Mix — 1 — — Beans and Pork Sausages — 1 — — Beverages — 1 — — Blancmange Powders — 3 — — Bread — 3 — 3 Butter — 3 — — Cakes — 2 — 1 Cake Mixtures — 6 — — Cheese — 1 — — Coconut, Desiccated — 1 — — 24 Food and Drugs—Sampling Cont'd Article Number Examined Number Adulterated, etc. Formal Informal Formal Informal Coffee and Chicory — 1 — — Colouring — 1 — — Condiment, Non-brewed 1 — — — Cordials — 1 — 1 Cornflour — 1 — — Cream — 2 — — Custard Powder — 2 — — Essences — 2 — — Fish, Tinned — 3 — — Fruit Cocktail — 1 — — Fruit Juices 1 1 — — Fruit Syrup — 1 — — Glace Cherries — 1 — — Glucose — 1 — — Grill, Mixed — 1 — — Herbs — 1 — — Ice Cream — 11 — — Ice Lollies — 8 — — Icing — 1 — — Jam — 2 — 1 Jellies — 2 — — Lard — 3 — — Lemon Curd — 1 — — Macaroni and Cheese — 1 — 1 Magarine — 2 — — Marzipan — 3 — — Mayonnaise — 1 — — Medicinal Samples 2 8 — — Milk 23 1 — — Milk, Evaporated — 1 — — Olive Oil — 1 — — Pastes — 7 — — Peel — 1 — — Pepper — 1 — — Pie Fillings — 1 — — Pies — 3 — — Pork, Minced — 1 — — Puddings, Various — 5 — — Pudding Mixtures — 5 — — Raisins — 1 — — Rolls, Starch Reduced.. 1 — 1 — Salad Cream — 1 — — Sauces — 3 — 1 Sausage Meat 1 — — — Sausages 19 — 2 — Semolina — 1 — — Soups — 5 — 1 Spices — 1 — — Spirits 9 — — — Spreads, Various — 6 — — Stewed Steak — 2 — — Stuffing — 1 — — Suet 1 1 — — Sweets — 3 — — Tapioca — 1 — — Tea — 3 — 1 Vinegar — 1 — — Welsh Rabbit — 1 — — 25 Adulterated Samples, etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 385A Tea Packet Informal Contained foreign matter consisting of a mass of tea dust bound together by oily matter. Warning letter 386A Orangeade Informal Contained traces of hydrogen sulphide. Warning letter 402A Cup Cakes Informal Had a foreign taint suggestive of vegetables. No action possible 404A Bread Informal Contained foreign matter in the form of pellets. Warning letter 420A Bread Informal Contained foreign matter in the form of quartz sand. Warning letter 432A Sauce Informal Sauce had formed a thick solid deposit in the upper neck of the bottle, and cap of bottle badly corroded. Warning letter 437A Strawberry Jam Informal Contained a foreign body consisting essentially of a piece of fibrous matter of the nature of coarse straw or a plant stem. Warning letter 444A Macaroni and Cheese Informal Portion of grated cheese rancid and had a high proportion of free fatty acids. Label misdescribed the contents of packet. Warning letter 487A Bread Informal Contained foreign matter in the form of a flour label. Warning letter 510A Oxtail Soup Informal Poor in respect of oxtail. Would be more properly described as oxtail flavour. Referred to manufacturer 2476 Pork Sausages Formal Contained sulphur dioxide but no declaration of preservative. Warning letter 2477 Beef Sausages Formal Contained sulphur dioxide but no declaration of preservative. Warning letter 2503 Starch Reduced Rolls Formal Deficient in protein. Warning letter 26 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES Notifiable Diseases (Other than Tuberculosis) Under 1 year 1- 2— 3— 4- 5— 10- 15- Over 25 yrs Total Scarlet Fever 2 7 9 20 24 141 52 29 13 297 Whooping Cough 8 3 6 8 6 14 2 - - 47 Measles 9 25 40 45 43 161 6 - - 329 Diphtheria — — — — — — — - - — Dysentery - - - - - - - - 4 4 Acute Poliomyelitis:— Paralytic - - - - - - - 1 2 3 Non-paralytic - - - - - - - - - - Under 5 years 5—14 15—44 45—64 65 and over Total Pneumonia:— Acute Primary 1 4 5 8 2 20 Acute Influenzal - 1 6 7 4 18 Encephalitis, Acute:— Infective - — — — — — Post-infectious - — — — — — Erysipelas - — — 7 3 10 Meningococcal Infection 1 — — — — 1 Food Poisoning 2 5 2 3 — 12 Puerperal Pyrexia - — 4 — — 4 Ophthalmia Neonatorum - — — — — — Paratyphoid "B" - — — — — — Typhoid - 1 - - - 1 Notified Admitted to Isolation Hospital, Rush Green Admitted to other Isolation Hospitals Admitted to other Hospitals Diphtheria — — — — Dysentery 4 — — — Encephalitis, Acute — — — — Enteric Fever — — — — Erysipelas 10 3 — — Food Poisoning 12 1 — 2 Malaria - - — - Measles 329 - — - Meningococcal Infection 1 1 — - Ophthalmia Neonatorum — - — - Paratyphoid Fever — - — - Pemphigus — - — - Puerperal Pyrexia 4 - — 2 Pneumonia:— Acute Influenzal 18 - — — Acute Primary 20 - — — Poliomyelitis:— Paralytic 3 3 — — Non-paralytic — — — — Scarlet Fever 297 3 1 — Smallpox — — — — Typhoid 1 1 — — Whooping Cough 47 - - - 27 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 - - - - - - - - 1— 2 - - - - - - - - - - - 5— 2 - - - - - - - - - - - 10— - - - - 1 - - - - - - - 15— 2 1 — — 3 — — 1 1 — — — 20— 5 — 1 1 3 6 - - - - - - 25— 5 2 1 3 8 8 - - - - - - 35— 2 3 1 — 2 3 — 1 — 1 — — 45— 8 1 1 — 2 1 — 1 3 — — — 55— 5 4 — — 1 — — — 5 1 — — 65—and upwards 2 2 — — 2 — — — 1 1 — — 33 13 4 5 22 18 — 3 10 3 — — Register Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January, 1958 560 443 71 71 During the year:— New notifications 33 13 4 5 New cases brought to notice by Registrars' Death Returns 1 1 - - Deaths 9 2 — — Transfers into area 22 18 — 3 Transfers out of area 31 21 — 2 Removed from register as "Recovered" 26 17 3 6 No. on register 31st December, 1958 550 435 72 71 28 HEALTH EDUCATION Once more I have to report a busy year as far as health education was concerned, although it has not yet been possible to give organised courses in health education as I said last year. It is very important that we should make health education our subject and not disease education. Occasionally we find that we have to educate in disease but we must be careful that we are not carried away by our enthusiasm and allow ourselves to be side-tracked into too much discussion about disease. The promotion and maintenance of health must remain our aims. Each member of the staff is encouraged to engage in health education as an integral part of his or her daily work. The Council agreed to the appointment of an additional public health inspector whose main duties would be to organise and develop health education in the Borough. The following is the diary of talks given to local organisations during the year:— Date Organisation Subject of Talk January Woodlands Club Old Age February Midwives The Air We Breathe March Inner Wheel The Food We Eat „ Rectory Road Library Discussion Group The Air We Breathe „ John Perry School Parent Teachers' Smoking and Cancer Association April Romford Social Workers' Luncheon Group Old Age „ Gale St. Women's Co-op Guild Home Accidents May Old Dagenham Methodist Church Sisterhood The Food We Eat „ Royal College of Midwives, Dagenham, Health Education and Gadgets Romford & Forest Area Branch „ Fanshawe Women's Section Labour Party The Food We Eat June Rectory Road Library Women's Meeting Accidents in the Home July Labour Party (Fanshawe Ward) Women's The Air We Breathe Section „ Women's Co-op Guild, Broad Street Accidents in the Home „ "The Over Twenties" Central Hall Old Age September Old People's Welfare Committee Preparation for Retirement October Dockland Settlement, Heathway Women's Accidents in the Home Section November Chadwell Heath Townswomen's Guild „ ,, „ „ „ Chadwell Heath Old People (Cecil Road) „ „ „ „ „ Avenue Social Club, Old People „ „ „ „ „ Chadwell Heath Old People (St. Chad's Hall) „ „ „ „ „ Dockland Settlement, Old People „ ,, „ „ „ Kingsley Hall, Old People „ „ „ „ „ Pathfinders—Co-op Hall, „ „ „ „ Becontree Avenue (Youth) „ British Legion, Rectory Road, (Women's Section) „ ,, „ ,, ,, Marlyon Road, Old People „ „ „ „ „ Padnall Road, Old People „ „ „ „ „ Chadwell Heath Ratepayers' Association „ „ ,, „ „ Fanshawe Ward Labour Party (Women's Section) „ „ „ „ „ Y.W.C.A. Married Group „ „ „ „ „ Broad Street, Old People „ „ „ „ December Inner Wheel—Valence House „ „ „ „ „ Women's Voluntary Service „ „ „ „ „ British Legion, Becontree Avenue, ,, ,, „ „ (Women's Section) 29 HOME SAFETY The Council agreed during the year to the establishment of a Home Safety Advisory Committee (under the auspices of the Public Health Committee) with the broad functions of enlisting and stimulating the interest of local organisations in the work of home safety and carrying on a continuous local propaganda campaign to keep the public informed of the gravity and extent of the problem. The first meeting of the Advisory Committee was held in October, 1958. During the national campaign entitled "Guard that Fire" in November, the work undertaken locally included the following:— 22,000 leaflets were distributed through the schools. 300 posters were exhibited throughout the Borough. Two multiple dairy firms and the Borough Council displayed symbols on all their vehicles. The four cinemas in the Borough made some reference to the campaign during the last week of November. 18 talks were given to local organisations. 30 IN-SERVICE STAFF TRAINING COURSE FOR COUNTY COUNCIL OF ESSEX HEALTH DEPARTMENT The Teaching of Parentcraft An In-service Training Course was held at the Civic Centre, Dagenham, on the 21st and 22nd October 1958 for nursing and medical staffs of Dagenham, Romford and S.E. Essex areas. The subject was "The Teaching of Parentcraft" and the course was attended by about 50 midwives, health visitors, school nurses, nursery staffs and doctors. The Chairman of the Dagenham Health Area Sub-Committee, Alderman Mrs. A. E. Prendergast, took the chair at the inaugural meeting when Dr. Dalzell-Ward of the Central Council for Health Education reviewed approaches and modern methods in the teaching of parentcraft. Dr. Ward pointed out that many of our existing methods were out of date; that rigid adherence to programmes of feeding, of potting and the like were harmful to the baby and the mother, and made a plea for discussion as a means of introducing parents or prospective parents to modern ideas on child health, particularly those connected with mental health. Two films entitled, "Bathing Babies in Three Cultures" and "Why Won't Tommy Eat ?," were shown and were discussed at some length. Mr. D. Lynton Porter played a tape recording he had made of senior girls discussing the film on bathing babies, and demonstrated how they had noticed that playing with a baby was very important at bath time and at other times as well. Both mother and baby appeared happier because of the relationship established during play. Food habits in children were discussed and the need for absence of fuss at meal times was stressed. In the afternoon of the 21st October, further discussions took place on group education methods, using for instance the flannelgraph, the filmstrip, the film etc., and various groups for the practical work which was to start the following morning were arranged. On Wednesday afternoon the groups reported on their discussions and showed the material they had made during the morning's work. Group I presented a syllabus for parentcraft which dealt with the baby's first six months and how details of infant care could be presented to an audience of mothers and fathers during the ante-natal period. The syllabus was divided into a number of sessions, each session dealing with a special aspect of the infant, such as feeding, vitamins, clothing, bathing, development etc., and charts, flannelgraphs and models were used. Criticism of the syllabus ranged from the use of yellow which is a bad colour for flannelgraph lettering, to the need for a picture of a beautiful baby as an emotional appeal to the audience. 31 Group II discussed 'milestones' in the infant, 0—2 years and 2—5 years, and how this subject could be presented to a group of actual and prospective parents. Criticism by the audience inferred that general infant welfare had been over stressed at the expense of development which was the subject in hand. Group III gave an excellent demonstration of how to plan a film strip in 13 frames entitled, "To Pot or Not," illustrating by sketches the photographs they would take. Criticisms were few but it was suggested that the strip could have been done in 12 frames instead of 13. Group IV presented a talk on the care of the hands to girls of 14—16 years of age at school and youth clubs. The subject was well chosen and it was felt would appeal to the teenage girls' desire to appear attractive. The speaker stressed, among other things, the dangers of infection of the hands. It was suggested that the girls could do a lot by influencing their boy friends to get them to care for their hands. Group V presented the "Never Wallop Health Centre Mothers' Club," which had a panel discussion with a chairman. There was some criticism of the absence of buildup of the members of the panel by the chairman, which, it was said, was important in making the panel feel good and putting them at ease. At the conclusion of the course, Alderman Mrs. A. E. Prendergast thanked the Central Council for Health Education and the Essex County Council for having arranged the course, and Mr. Rowntree for his help, and said how interesting it had been to her to sit in on some of the discussions. 32 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. 45 2 Chadwell Heath. Weekly Thursday, p.m. 38 2 The Clinic, Becontree Avenue, Weekly Monday, p.m. 37 3 Dagenham. Weekly Wednesday, a.m. 40 2 The Leys Clinic, Ballards Road, Weekly Thursday, a.m. 24 1 Dagenham. Weekly Thursday, p.m. 30 2 Rush Green Clinic, (2nd, 4th & 179 Dagenham Road, 5th in month) Friday, a.m. 13 1 Rush Green. Weekly Friday, p.m. 24 1 The Clinic, Ford Road, Dagenham. Weekly Tuesday, a.m. 30 2 Weekly Tuesday, p.m. 31 2 The Clinic, Manford Way, Hainault. Weekly Monday, p.m. 14 2 The Clinic, 15/17 Thompson Road, Weekly Tuesday, p.m. 27 2 Dagenham. Weekly Friday, a.m. 10 1 The Clinic, Oxlow Lane, Weekly Wednesday, p.m. 52 3 Dagenham. Weekly Friday, p.m. 47 3 St. Mark's Church Hall, Marks Gate. Weekly Tuesday, p.m. 22 1 33 HEALTH VISITING During 1958 there has been a further decrease in routine visiting but more 'selective' visits were paid in accordance with modern methods. This is not to say that routine visits to babies and children under five have been neglected altogether, or those to the expectant and nursing mother. These visits still form the majority of those paid and must continue to do so, even though the health visitor in extending her activities to cover the whole family has a valuable contribution to make to the welfare of the handicapped and the aged. Follow-up visits to patients after discharge from hospital were paid to both the aged and other adult patients, while visits to homes where home accidents have occurred presented the opportunity for some instructive health teaching. One health visitor now attends weekly at the Old church Paediatric Department and thus acts as a link between my department and the hospital, supplying the district health visitors and school nurses with information about the children from their area who are attending hospital or have been admitted, and supplying to the paediatrician any background information required. This pattern of health visitor liaison work could well be repeated in other directions and could help in the care of the elderly, the diabetic, the gastric and the patient suffering from heart disease if sufficient staff were available to spare the necessary time. The health visiting staff attended Oxlow Lane Clinic to assist in the examination of the over sixties and in the conduct of the 'exercise class,' where they made themselves responsible for both health teaching and exercises in much the same way as they are responsible for the ante-natal relaxation classes for expectant mothers. During November, the 'Guard that Fire' campaign gave further opportunities for talks both in clinics and to various organisations in the Borough. 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 vists 144 Total visits 472 (.b) To children under i year of age First visits 1,616 Total visits 6,835 (c) To children between the ages of i and 5 years Total visits 10,629 (d) Ineffective visits Total visits 2,829 (e) Other visits Total visits 1,647 Grand Total 22,412 34 MATERNITY SERVICES Maternal mortality There were 3 maternal deaths in this area during 1958. Ophthalmia Neonatorium One case of ophthalmia neonatorium was notified—which made a complete recovery. There were 21 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 1958. County Midwives Midwives Residing at York House Training Home Salvation Army Midwives Births Attended: As Midwife 134 231 58 As Maternity Nurse 146 3 1 Miscarriages Attended (included in above) 3 1 2 Visit Paid: As Midwife 4,286 7,436 1,207 As Maternity Nurse 2,738 35 20 Ante-Natal 2,688 1,111 232 Ante-Natal Clinics Attended 360 53 51 Gas and Air Administered: As Midwife 92 153 38 As Maternity Nurse 115 2 — Pethidine was given in 154 cases attended by County Midwives. Ante-Natal Clinics Centre Sessions Held Times Sessions Held Average Attendances Average New Cases The Clinic, Ashton Gardens, Chadwell Heath. Weekly Wednesday, p.m. 9 2 The Clinic, Becontree Avenue, Weekly Tuesday, p.m. 7 2 Dagenham. Weekly Wednesday, a.m. 8 1 The Leys Clinic, Ballards Road, Dagenham. Weekly Wednesday, p.m. 11 1 Rush Green Clinic, 179 Dagenham Road, Rush Green. (1st & 3rd in month) Friday, a.m. 3 1 The Clinic, Weekly Tuesday, a.m. 11 3 Oxlow Lane, Weekly Tuesday, p.m. 10 2 Dagenham. Weekly Thursday, a.m. 11 2 The Clinic, Ford Road, Dagenham. Weekly Monday, a.m. 10 2 The Clinic, Manford Way, Hainault. Weekly Monday, a.m. 4 1 35 RELAXATION CLASSES The following were the attendances at the relaxation classes during the year:— Becontree Clinic 301 Chadwell Heath Clinic 348 Leys Clinic 501 Oxlow Lane Clinic 407 Total 1,557 PREMATURE INFANTS All infants weighing 5½ lbs. 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. Ooz.51b. 8oz. Total No. Surviving one week Born alive at home and nursed entirely at home — 2 4 13 19 19 Born alive at home and transferred to hospital — 2 — — 2 2 Born in hospital 9 21 18 27 75 63 36 DAY NURSERIES DAY NURSERY ATTENDANCES JANUARY—DECEMBER 1958 Day Nursery Number of approved places Average Daily Attendance Average No. on Register Total Attendances Goresbrook 70 24 35 6,129 Chadwell Heath 54 31 41 7,837 Kingsley Hall 40 12 17 2,965 TOTALS 164 67 93 16,931 Nursery Widows Parents Separated Desertion Illness of Mother Illness of Father Unmarried Mothers Socioeconomic Mothers working to supplement income Total Goresbrook 3 7 2 3 5 8 25 11 64 Chadwell Heath 2 7 - 2 - 5 27 22 65 Kingsley Hall 1 3 2 7 1 1 12 5 32 Number of children in all Nurseries 1958 6 17 4 12 6 14 64 38 161 The increased charges for day nursery accommodation resulted in a considerable reduction in numbers of children accommodated there. Unfortunately, there does not appear to be any reduction of the reasons for admission as adverse housing conditions, invalidism of one or more parent, illegitimacy, widowhood, divorce etc., are still manifest and it may be that the parents seek a less satisfactory method of securing care for their children. After the initial drop in numbers attending, the position stabilised with smaller average attendances. A number of families took advantage of nursery facilities providing for short term stay of a few weeks or few months during the mother's illness. This facility, providing as it does a relief for the parents and security for the child during a very difficult time, proved a very satisfactory arrangement. There has been a small but constant attendance of handicapped children at all the nurseries throughout the year, continuing the policy we started in 1957. Chadwell Heath Nursery had a child with spastic paraplegia for the greater part of the year. The child attended the orthopaedic clinic twice a week, accompanied by some member of the nursery staff, and gradually most of the staff learnt how to help the child with exercises and how best to handle him. 37 Kingsley Hall Nursery had two mentally retarded children and a child severely retarded by a serious illness in infancy. These children have been treated with care and patience and all have made good progress. Goresbrook Nursery has a deaf child, and the staff have been instructed in methods of handling her and teaching her how to use the little hearing she has, and helping her to develop speech. The hospital is very pleased with her progress. This small number of carefully selected handicapped children fitted quite well into the day nurseries and benefited from association with normal children. For many cases it was not found possible to introduce them in this way, partly because of their unsuitability and partly because of the danger of overloading the nurseries. For this reason we must continue to plan for the nursery for the handicapped where careful assessment can take place and where the parent can secure help and guidance. CLINICS In November this year Ford Road Clinic was completely renovated and redecorated internally at a cost of approximately £800, a great deal of thought and a burst of industry from the borough engineer's department and their contractors who must be thanked for completing the programme of work so quickly and efficiently so that disruption of the maternity and child welfare and school clinics was kept within the allotted month, during which time all sessions were transferred to Leys Clinic. Instead of the dark brown and fawn walls and long, spine-tingling benches, the clinic is now gaily decorated in "house and garden" colours and the waiting and treatment rooms equipped with comfortable, bright chairs and tables. The red polish has been replaced by springy green and blue rubber tiles and, as the photograph shows, a light gaiety has superceded the drabness of the past. Estimates were prepared for Becontree Clinic and it is hoped that this work will be completed in 1959. The second photograph shows Becontree Clinic as it is now. The work at Becontree Clinic will be a major undertaking as structural defects were found by the surveyors so that the total estimate for the work to be done is necessarily greater than that for the smaller clinic at Ford Road. 38 The newly decorated Ford Road Clinic Becontree Clinic, 1958 DOMESTIC HELP An analysis of the hours of service rendered by the Domestic Help Service during 1958 is given in the following table. Figures for 1957 are included in brackets. Type of Case Number of cases Hours help provided Maternity 50 (46) 2,655 (3,068) Tuberculosis 11 (15) 1,438 (2,177) Acute Sick 57 (64) 2,906 (4,712) Chronic Sick Aged 377 (352) 55,601 (52,563) Chronic Sick Others 73 (85) 19,007 (16,922) Aged not Sick 2 (7) 384 (797) Others 17 (11) 3,656 (1,792) TOTALS 587 (580) 85,647 (82,031) Number of visits paid by Organiser 1,343 (1,613) Average number of home helps employed each week 73 (74) Once again there was an increase in service provided by the home helps, and although only seven more cases were served during the year as compared with 1957, over 3,000 more hours of service were given. Care of the Aged It is in the work with the aged sick where most of the increase took place during 1958. As I reported last year, this type of work may be expected to increase steadily each year as our aged population continues to increase and as the public health service plays an increasing part in the home care of patients who not so very many years ago would have been considered suitable only for admission to hospital. The home help service must be recognised as a most valuable instrument in carrying out this policy of increased home care. The organiser and her staff fulfil an important role in maintaining contact with and providing service for a section of the community whose need is very great. Maternity There was an increase in the number of cases helped in 1958 as compared with the previous year, although the hours of service provided show a reduction. Tuberculosis As in previous years there was a further reduction in the tuberculosis households served, in line with the general reduction of tuberculosis. Acute Sick The demands made on the service for the acutely sick remained fairly steady. All urgent calls were met. Recruitment throughout the year was fairly satisfactory, and one home help attended a training course held at Chelmsford in May, which she very much appreciated. Social activities included a trip to the London Palladium to see "Large as Life," starring Harry Secombe. 39 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 226 155 416 Total attendances 1,036 1,975 6,012 Cases still being treated at end of year 92 263 745 40 CHIROPODY SERVICE Two full-time and one part-time chiropodists are employed although at the end of the year the part-time post was vacant. Clinics are held at Ford Road and Ashton Gardens, Chadwell Heath, as follows:— Ashton Gardens Ford Road Chadwell Heath Monday 2.00 p.m.—5.00 p.m. 5.30 p.m.—8.30 p.m. Tuesday 9.00 a.m.—1.00 p.m. 9.00 a.m.—1.00 p.m. 2.00 p.m.—5.00 p.m. 2.00 p.m.—5.00 p.m. Wednesday 10.00 a.m.—1.00 p.m. 2.00 p.m.—5.00 p.m. 5.30 p.m.—8.30 p.m. Thursday 9.00 a.m.—1.00 p.m. 2.00 p.m.—5.00 p.m. Friday 9.00 a.m.—1.00 p.m. 2.00 p.m.—5.00 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. OCCUPATIONAL THERAPY The occupational therapist now spends approximately one day a week in the Dagenham area, where previously three days were allotted. Owing to amalgamation with Ilford, Romford and Forest areas there has been a great deal of work involved in taking over stock and listing and pricing it. Most of the patients had been doing basketry during the long period without a therapist from April to October. There appears to be a great need to find some means of selling the articles made by patients. At present relatives and friends assist and the occupational therapist helps where possible. It is hoped that some means will be found to enable prompt disposal of all goods as they come to hand, thus assisting in a practical manner patients who are being visited by the occupational therapist. Occupational Therapy for Domiciliary Chest Cases The following is a summary of work carried out from January 1st to December 31st, 1958:— Total of Patients Total of New Patients Total of Visits January 23 1 103 February 20 2 78 March 17 - 83 April No occupational therapist May June July August September October 24 4 9 November 24 1 19 December 18 — 26 41 CONVALESCENCE AND RECUPERATIVE HOLIDAYS National Health Service Act Arrangements were made for patients as indicated:— Section 28: 1 Mildmay Convalescent Home, Ramsgate. 1 Hermitage Convalescent Home, Hastings. 4 Friendly Society Convalescent Home, Herne Bay. 1 Samuel Lewis Home, Walton. 2 All Saints Convalescent Hospital, Eastbourne. 34 Bell Memorial Home, Lancing. 10 T.B. cases placed by Spero. 5 St. Joseph's Convalescent Home, Bournemouth. 3 Surrey Convalescent Home, Seaford. 1 Armitage House, Worthing. 1 Victoria Convalescent Home, Bognor Regis. Section 22: 2 Mothers with children—Shoreditch Holiday Home. 3 Mothers with children—Lennox House, Southsea. 2 Children at Stamford Hill Home, Thorpe Bay. School Health Service As in previous years, convalescent holidays for school children were arranged in conjunction with the Invalid Children's Aid Association. 77 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. 78 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 37 children were examined by school medical officers before being admitted or readmitted to camp schools. School Journeys 52 children were examined by the school medical officer respecting their fitness to proceed on a visit to Belgium. 42 VACCINATION AND IMMUNISATION Vaccination Against Smallpox During the year 1,369 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 256 584 1 - 1—4 years 73 36 6 — 5—14 years 93 29 16 — 15 years and over 101 21 134 19 Total all ages 523 670 157 19 Whooping Cough 1,293 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. 289 696 81 20 207 — B.C.G. B.C.G. vaccination has continued in the 13-plus age group; this year 2,186 children were offered vaccination. 851 children were tested after the parents' consent had been received. Results of the Multiple Puncture tests:— Negative 774 Positive 77 Of the children with negative reactions (and therefore susceptible) 588 received B.C.G. vaccination. There were no cases of post-vaccination complications. Tuberculosis Vaccines Clinical Trial Of the 389 young people invited for their sixth annual X-ray, 166 attended, i.e. 43% and of these 62% completed the skin tests. In addition, of the 254 who defaulted on the previous occasion, 40 came along this time. DIPHTHERIA IMMUNISATION Diphtheria Immunisation of Under Fives Diphtheria immunisation has continued in the Infant Welfare clinics and by the general practitioners. 43 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 1,697 children received primary immunisation injections and a total of 1,994 received boosting doses. Age 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 548 341 2 1—4 years 229 162 39 25 5—9 years 187 43 583 328 10—14 years 177 10 624 393 Total all ages 1,141 556 1,246 748 Diphtheria Immunisation of School Children A total of 2,345 school children were immunised against diphtheria during the year (of which 774 were immunised by private practitioners). The continued increase 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. 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:— Age at 31. 12. 58. i.e. born in year Under 1 yr. 1958 1—4 yrs. 1957—1954 5—9 yrs. 1953—1949 10—14 yrs. 1948—1944 Under 15 yrs. Total Last complete course of injections whether primary or booster 1954—1958 890 3,463 4,407 3,527 12,287 1953 or earlier — — 2,934 6,221 9,155 Estimated mid-year population 1,480 6,000 19,300 26,780 Immunity Index 60.1 57.7 41.1 45.8 Poliomyelitis Throughout the year poliomyelitis immunisation has continued and the age limit was increased to 15 years. Sessions of up to 200 were arranged during the year as the vaccine became available. In the autumn the scheme was increased to include all people between the ages of 15 and 25 years inclusive and so it was decided to hold open sessions at Oxlow Lane Clinic on Thursday evenings from 5.00-7.00 p.m. and Saturday mornings from 10.00 a.m.—12 noon. Publicity was given to these open sessions throughout the Borough and the Dagenham Girl Pipers attended the first session. However, attendances at these sessions were very poor and it was decided to discontinue them in 1959. 44 It will be seen from the figures given below that the total acceptors since the commencement of the scheme has doubled and the total complete courses since the commencement of the scheme has tripled. During the year a total of 9,288 courses were completed. There were 3 cases of poliomyelitis notified to the department in 1958, all of which were paralytic. There were 2 males aged 16 and 53 and 1 female of 32 who unfortunately died. Total acceptors since commencement of scheme 24,642 Total complete courses since commencement of scheme 14,728 Immunisation By Medical Officers By General Practitioners Total 1958 6,225 (3,532) 3,063 (1,263) 9,288 (4,795) The corresponding figures for 1957 are shown in brackets. 45 THE OVER SIXTIES CLINIC—OXLOW LANE A number of attempts have been or are being made to further the ideals of preventive medicine as it affects the elderly. Each effort produces a variation of the principal theme and lays emphasis on one aspect or another, but as yet, no established pattern has emerged which would be universally applicable and it may well be that no such pattern ever will appear. As far as the scheme operating in Dagenham is concerned, although it is as yet early days a certain pattern appears to be emerging which may give some clue about the future of this service. In September 1957 this centre opened up at the Essex County Council Clinic at Oxlow Lane. I agreed to operate this on an experimental basis, though with some very hazy ideas about how it could be done. Preconceived ideas suggested (a) that there would be a high incidence of nutritional deficiency and (b) anaemia would be a common finding. The suggested scheme was first discussed at one of our occasional meetings with general practitioners. The clinic, staffed by a health visitor and myself began to operate with one patient, referred by the health visitor and by agreement with her own doctor. Since then the centre has gradually become established and cases are referred by general practitioners and health visitors, or attend because their next door neighbour attended and felt that she received something there she could not get elsewhere. Patients are not seen without the knowledge of their own doctors, but some of those doctors who practise near the centre have very kindly agreed that their prior consent in each case is not necessary. The premises we use are waiting hall, minor ailments room, consulting room, office and a room normally used for ante-natal relaxation classes. The patients are seen by appointment only and transport is arranged on their first visit and thereafter if it is considered necessary. Three patients can be seen in a 2½ hour session, one first attender and two subsequent attenders or vice-versa. At the first attendance the patient is interviewed and is encouraged to talk about her problems, both medical and social; this interview may take three quarters of an hour. On the first visit the blood is taken for routine haemoglobin, arrangements are made for X-ray of the chest, vision and hearing are tested and urine is routine tested. Spirometry is also carried out. On the second visit, normally two weeks later, all the investigation results are available, together with any medical details from the general practitioner which are thought to be of value (and here the general practitioners have been most helpful). A routine physical examination is carried out and any disability noted. If it is felt that further specialist investigations are necessary, the patient is referred to the appropriate 46 hospital department, via her own doctor, although reference to hospital is avoided if at all possible. If all is well it is suggested that the patient should join the 'exercise class' which meets once a fortnight, and where simple general exercises are carried out in an attempt to avoid the disabilities associated with age such as stiffness of fingers, weakness of muscles around knee and ankle and neck stiffness, and in certain cases, breathing exercises. Half-time at the 'exercise class' gives the opportunity for a cup of tea and a discussion on such things as diet, care of dentures, care of feet, mental health etc., and how best to keep fit in old age, both physically, and what the group realises is most important, mentally. In the light of experience gained at the centre I have produced a small booklet, " Health Hints for the Over Sixties " which deals with:— Normal Diet Diet for overweight Care of dentures Breathing The feet Foot and leg exercises Neck and shoulder exercises Finger exercises Lip, tongue and jaw exercises Mental health During 1958, 29 patients whose ages ranged from 61 to 87 years completed their investigations and in practically all of them the need for chiropodial treatment was apparent. In many of them two or more disabilities were present at the same time. One of the most striking things, apart from high frequency deafness which was present in practically all patients, was the lack of effective hearing. In eight patients this was apparent and in four of those syringing restored the hearing to a satisfactory level, but in the four other cases it was necessary to prescribe hearing aids. Diabetes was brought to light in one old lady of 87 who needed simple diet only. In five cases, 3 males and 2 females, the patients were grossly overweight (2 or 3 stones) but it was not possible in three of these to get their co-operation in dieting. In the other two cases satisfactory results were achieved as instanced by weight loss and resultant improvement in breathlessness and ' creaking ' knees. The whole subject of the nutrition of the elderly is one which needs much more attention. Although in the elderly sick undernutrition is of importance, in the 'well' elderly over-eating is a not uncommon finding and overweight of variable degree (as judged by so-called average weights) a common occurrence. 47 Another problem which merits more attention is the vexed question of hypertension. What constitutes hypertension in the elderly and what, if any, treatment is called for ? Inevitably the majority of the elderly have hypertension as recorded on a sphygmomanometer, which may or may not be found to be less at the second or third visit as the patient feels more at home. I have been very fortunate in having the ready help of Dr. McGown, the consultant physician at Oldchurch Hospital, with any difficult cases and with many difficult decisions, and I would like to record my gratitude to him for this. Twelve other patients who attended during 1958 had still not had their investigations completed by the end of the year. 48 PHOTOGRAPHS OF OVER SIXTIES CLINIC A tea break during the exercise class SCHOOL HEALTH, 1958 School Premises There are 14 secondary and 27 primary schools in the Borough, also one special school. Children on the registers on 31st December, 1958 totalled 20,868—a decrease of 436 as compared with 1957. 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. 11 such samples were obtained during the year, two of which failed to pass the methylene blue test, though in neither case was the defect considered to be serious. In one, the maximum atmospheric shade temperature during the test reached the permissible limit of 65°F, in the other the temperature reached was 64°F and the sample was decoloured only at the end of 30 minutes. SCHOOL INSPECTIONS As in previous years, medical inspection in the schools during 1958 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 Inspections Number of inspections in the prescribed groups:— 5 year age group 1,441 10—12 + years age group 1,739 14 year age group 1,949 * Others 1,345 Total 6,474 B—Other Inspections Number of special inspections 2,045 Number of re-inspections 1,969 Total 4,014 * Children at nursery and special schools, or who missed the periodic examinations. 49 6,474 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 Instructions Entrants Leavers Others Total (all groups) Requiring treatment Requiring observation Requiring treatment Requiring observation Requiring treatment Requiring observation Requiring treatment Requiring observation Requiring treatment Requiring observation 4 Skin 8 25 24 34 22 60 54 119 69 25 5 Eyes (a) Vision 29 33 67 45 133 127 229 205 111 31 (b) Squint 11 21 1 9 13 43 25 73 5 — (c) Other 2 15 3 8 7 55 12 78 81 17 6 Ears (a) Hearing 2 1 2 2 3 12 7 15 45 5 (b) Otitis Media 3 2 3 2 3 4 9 8 30 10 (c) Other 1 — — — 3 3 4 3 1 2 7 Nose and Throat 26 142 5 18 30 111 61 271 76 68 8 Speech 17 31 1 3 8 33 26 67 62 20 9 Lymphatic Glands 1 8 — — 19 3 20 11 11 25 10 Heart 3 14 2 8 6 58 11 80 8 28 11 Lungs 8 36 3 21 13 62 24 119 49 56 12 Developmental (a) Hernia 1 5 — — 1 3 2 8 1 2 (b) Other — 11 — 3 3 35 3 49 4 5 13 Orthopaedic (a) Posture 4 10 3 23 23 54 30 87 12 6 (b) Feet 26 17 27 27 65 56 118 100 28 9 (c) Other 7 39 7 22 21 111 35 172 190 55 14 Nervous System (a) Epilepsy 1 4 — 3 5 4 6 11 4 12 (b) Other — 4 1 3 2 16 3 23 13 8 15 Psychological (a) Development 10 14 — 1 11 52 21 67 13 9 (b) Stability 1 24 — 2 9 30 10 56 21 24 16 Abdomen — — — — 6 4 6 4 — — 17 Other 47 13 83 8 142 41 272 62 346 297 50 Pupils found to require Treatment Number of individual pupils found at periodic medical inspection to require treatment (excluding dental diseases and infestation with vermin). Age Groups Inspected (by year of birth) For defective vision (excluding squint) For any of the other conditions Total Individual Pupils (1) (2) (3) (4) 1954 and later 1 21 22 1953 16 86 94 1952 11 84 91 1951 9 24 30 1950 1 3 4 1949 3 - 1 1948 6 9 15 1947 67 217 258 1946 30 102 128 1945 — 1 1 1944 44 136 177 1943 and earlier 41 95 129 Total 229 778 950 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). General Condition The overall picture of the general conditon or nutritional state of the children in the Borough is reassuringly good. CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS Physical Condition of Pupils Inspected Satisfactory Unsatisfactory Age Groups Inspected (By year of birth) No. of pupils Inspected No. % of Col. 2 No. % of Col. 2 (1) (2) (3) (4) (5) (6) 1954 and later 149 139 93.28 10 6.72 1953 701 696 99.3 5 0.7 1952 740 726 98.1 14 1.9 1951 176 167 94.89 9 5.11 1950 36 33 91.67 3 8.33 1949 26 24 92.3 2 7.9 1948 95 92 96.84 3 3.16 1947 1,644 1,634 99.4 10 0.6 1946 734 723 98.5 11 1.5 1945 8 8 100.0 - - 1944 1,159 1,157 99.82 2 0.18 1943 and earlier 1,006 1,003 99.7 3 0.3 Total 6,474 6,402 98.9 72 1.1 51 Uncleanliness The number of children found with vermin and/or nits during the year was 197 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. 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 authorised persons 30,111 (ii) Number of instances of infestation found 209 (iii) Number of cleansing notices issued (Section 54 (2) Education Act, 1944) 209 (iv) Number of disinfestations carried out:— By school nurses 93 By parents 116 VISUAL DEFECTS Vision tests were carried out on all children at the school medical inspections and 229 referred for treatment at the Ophthalmic Clinics and 205 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) 498 464 Errors of refraction (including squint) — 1,258 Number of pupils for whom spectacles were prescribed — 640 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: 55 Total examined Boys 2,281 Girls: 21 „ „ Girls 1,986 52 As mentioned in my last report, 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. 53 SCHOOL CLINICS 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 9.30 a.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 9.30 a.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 Thursday 2 p.m. Nurse Leys Clinic Monday 1.30 p.m. Doctor and Nurse Wednesday 9 a.m. Nurse Friday 9 a.m. Nurse Oxlow Lane Clinic Monday 9 a.m. Nurse Wednesday 9 a.m. Doctor and Nurse Friday 9 a.m. Nurse During the year 3,841 children were seen by the school medical officers and 8,86c attendances were made at nurses' clinics. The total number of attendances made b3 children at minor ailment clinics during 1958 were as follows:— Ashton Gardens 1,123 Bentry School 741 Becontree Avenue 2,508 Five Elms 3,465 Ford Road 2,708 Kings Wood 692 Leys 794 Oxlow Lane 670 12,701 54 Other Treatment Given New Cases Treated By the Authority Otherwise (a) Miscellaneous minor ailments 1,209 31 (b) Other (1) Heart and rheumatic diseases — 6 (2) Hernia — 14 (3) Major respiratory diseases — 27 (4) Major digestive diseases — 87 (5) Major injuries — 29 (6) Other major disease — 50 (7) Enuresis — 14 Total 1,209 258 Diseases of the Skin (Excluding Uncleanliness) Number of new cases treated during the year By the Authority Otherwise Ringworm (Scalp) - - Ringworm (Body) - — Scabies - — Impetigo 22 2 Other Skin Defects 730 15 Number of examinations made by Skin Specialists 16 Diseases and Defects of Ear, Nose and Throat No. of children referred to Consultants during 1958 76 Number of cases treated By the Authority Otherwise Received operative treatment (a) For diseases of the ear — 7 (b) For adenoids and chronic tonsillitis — 172 Received other forms of treatment 140 44 Total 140 223 55 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 719 722 18 31 10—12+ years 896 843 33 97 14 years 1,199 966 43 24 Other periodic 570 559 45 56 Total 3,384 3,090 139 208 Employment of Children 221 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 officers during the year:— (a) New Appointments 1. Intending Teachers (Forms 28 RQ and IOR Med.) 64 2. Entrants to Teachers' Training Colleges (Forms 4 R.T.C.) 9 3. Essex County Council 83 4. Dagenham Borough Council 160 5. Other Authorities 3 (b) Under Sickness Regulations 2 Number of consultations with specialists arranged 115 Home Visits by School Nurses 4,181 visits were made by school nurses to the homes of school children during the year. 56 DENTAL SERVICES Inspection and Treatment No. of Dental Officers at end of December, 1958 5 No. of sessions carried out during the year 829 No. of children on waiting list 426 No. of children on waiting list in 1957 454 No. of children inspected in 1958 2,031 No. of children inspected in 1957 2,469 No. of treatment sessions in 1958 723 No. of treatment sessions in 1957 483 No. of children who received treatment in 1958 1,632 No. of children who received treatment in 1957 1,169 Dental Inspection and Treatment of School Children Periodic Specials (a) Number of pupils inspected 48 1,983 (b) Number found to require treatment 35 1,761 (c) Number offered treatment 35 1,760 (d) Number actually treated 162 1,470 (e) Number awaiting treatment 93 333 (f) Attendances made by pupils for treatment 344 5,008 (g) Half days devoted by (a) Dental Officers to— (i) Inspection 106 (ii) Treatment 723 (h) Fillings (i) Permanent teeth 2,448 (ii) Temporary teeth 572 (i) Number of teeth filled (i) Permanent teeth 1,974 (ii) Temporary teeth 507 (j) Extractions (i) Permanent teeth (a) on account of caries 1,011 (b) for other purposes 27 (ii) Temporary teeth (a) on account of caries 2,224 (b) for other purposes 30 (k) Anaesthetics administered (i) Local 610 (ii) General (a) by Medical Officers on County Staff 1,174 (b) by others 3 (l) Orthodontics (i) Cases completed 17 (ii) Cases discontinued 2 (iii) Pupils treated with appliances 56 (iv) Removable appliances fitted 51 (v) Fixed appliances fitted — (vi) Total attendances 357 57 (m) Dentures (i) Number of pupils supplied with artificial dentures 9 (ii) Number of dentures fitted 9 (n) Other operations (i) Permanent teeth 477 (ii) Temporary teeth 135 (o) Analysis of figures in (n) Type of operation Number Silver Nitrate Treatment 32 Scaling 254 Syringing Sockets 9 Dressings 115 Other operations 84 X-rays 118 Mother and Child Welfare Dental Treatment Expectant or Nursing mothers Children under five years of age Number of patients examined 128 123 Number of patients needing treatment 120 111 Attendances for treatment 296 233 Number of patients who have completed treatment 59 77 Number of extractions 185 142 Number of fillings 132 157 Number of Anaesthetics administered: (a) local 59 6 (b) general 53 59 Number of scalings or scaling and gum treatment 22 1 Number of dressings 4 5 Number of dentures provided: (a) full 12 — (b) partial 19 — 58 SPECIALIST SERVICES 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:— During 1958 there was a slight increase in the number of patients attending the orthopaedic clinic. 399 patients were treated for orthopaedic and postural defects and 84 patients received ultra violet light therapy. In all, the total number of treatments given was 6,671. The orthopaedic surgeon was in attendance for 10 sessions at which 130 patients were seen, 54 being new patients; 7 children were referred to hospital for surgical treatment. The majority of the patients are suffering from mild postural deformities, the lower limbs being mainly affected. One wonders if the modern fashion trend in footwear is responsible for this, as certain deformities such as hallux valgus were seldom seen in children 20 years ago, now we frequently see children under school age with definite signs of this complaint. I still feel that if the clinic was in a more accessible position more patients could be treated satisfactorily. Many patients with respiratory affections have to miss treatment during the bad weather and quite a number of parents complain of the distance they have to travel, the high cost of travelling expenses and the time taken in accompanying the children. Ophthalmic Clinic The ophthalmic clinic continued during 1958 as in previous years. At the 102 sessions held during the year, slightly more children were seen, 1,722 as against 1,645 in 1957. Of these, 1,258 suffered from errors of refraction including squint and 464 from external and other defects of the eye. Of the 229 children found to have defects at periodic medical inspections, 205 were found by the ophthalmologist to require observation only. As last year, the ophthalmologists Dr. Macfarlane and Dr. Regal, who attend the clinics, have been kind enough to submit a report of their work during the year and to give their comments and observations. The following are extracts from their reports:— " Our patients are referred to us mainly by the school medical officer or by the school nurses, some by the infant welfare clinics (28 in the current year), and a few from 59 the family doctor. Occasionally parents approach the clinic of their own initiative. We deal with all sorts of eye diseases but the main work is refraction work and the treatment of squints. Co-operation from the orthoptic departments and the various hospitals is very good indeed and I should like to mention with gratitude the very prompt and exhaustive reports we receive. Unfortunately, we have no dispensing optician present at the sessions and I find that a decisive disadvantage. There are quite a number of parents who cannot be bothered to go to an optician for the measurement of frames etc. Minor repairs, which could be done easily on the spot, are often unduly delayed or not done at all. It would certainly be more satisfactory if the services of a reliable dispensing optician could be obtained without interfering with the right of the parents to see an optician of their own choice, should they prefer to do so." "As in previous years, it has been found that the attendance at the clinics is only moderately good: children fail to attend for no reason and only a small proportion of parents notify the clinic when they or the children are unable or unwilling to attend. Hyoscine continues to be used as a mydriatic when necessary in a number of old cases, though atropine is almost always used for new cases. This has worked out well in practice, and is convenient for children and parents alike. Again it must be pointed out that the presence of a dispensing optician would be of great value to the clinic. Minor repairs to children's glasses could be carried out on the spot, and while no pressure would be brought to bear on the parents, it would probably be a great convenience to many of them to be able to hand in their prescriptions for glasses to the optician at the clinic. Another weekly session is badly needed at this clinic since at present it is impossible to keep the retests up to date or to see the new cases within a reasonable time after referral." Audiometric Tests Forty children have been tested with the audiogram. 6 were referred to Grays Inn Road Hospital, I has been supplied with a hearing aid, 12 are under observation and the others have been referred to the clinic doctor for supervision. Child Guidance 76 children from Dagenham were referred to the Romford Child Guidance Clinic. 60 Other Specialist Clinics School medical officers refer children to hospital consultants for opinion or for treatment at specialist clinics; 286 children were so referred during the year, as follows:— Chest Physician 39 Cardiologist 15 Orthopaedic Surgeon 14 E.N.T. Surgeon 76 Dermatologist 16 Paediatrician 77 Enuresis Clinic 17 Ophthalmologist 2 Audiologist 30 286 Speech Therapy The following is the report of the work of the speech therapists, Miss E. N. Symes and Miss E. R. Shipley. The speech therapy service in the Borough has now been in operation for many years, during which time it has greatly increased in scope. Originally, only one clinic was established and eleven sessions a week were held, whereas during 1958 four clinics operating eighteen sessions a week were open for the treatment of speech defects among school children and pre-school children, the remaining two sessions being spent at schools and home visits. Towards the end of the year consideration was being given to the provision of two sessions weekly at Ashton Gardens. Treatment was available during 1958 at the following clinics:— Five Elms School Clinic, Wood Lane 9 sessions weekly Leys Clinic, Ballards Road 5 „ „ The Bentry School, Heathway 2 ,, „ Oxlow Lane Clinic 2 ,, „ There has been a steady increase of work at the Bentry School, due to the fact that numbers of children originally receiving speech therapy at one or other of the clinics in the area were transferred from ordinary schools to the Bentry School. It is anticipated that in 1959 a further speech session will be necessary for the educationally subnormal children. As usual, speech defects continue to predominate among boys, 171 boys being treated in 1958 and 83 girls. In all, 254 children received treatment, 64 being discharged 61 with normal speech after treatment that ranged from a few weeks to several years. Most patients are treated for one half-hour weekly, but several who are under observation only do not attend so frequently. A recent innovation is the provision of treatment during school holidays. This was started in September 1957, and although attendances for this purpose have been poor it is hoped that they will improve in the future. The need for co-operation and perseverance on the part of the parents cannot be too strongly emphasised. Almost invariably a helpful attitude reduces the length of treatment required. Speech Therapy Review 1. Number of treatments given 2,842 2. Number of patients treated 254 15 patients were treated at The Bentry School 70 „ „ „ „ Leys Clinic 150 „ „ „ „ Five Elms Clinic 19 ,, „ ,, ,, Oxlow Lane Clinic 3. Number of sessions held 70 at The Bentry School 205 „ Leys Clinic 443 „ Five Elms Clinic 72 ,, Oxlow Lane Clinic Total 790 One session was used on most weeks in both the first and second clinics for either school visits or interviews. 4. Case Load— 171 boys and 83 girls— total 254 5. Types of cases treated:— Dyslalia 121 Stammer 68 Sigmatism 37 Stammer and Dyslalia 6 Cleft Palate 2 Other defects 20 Total 254 6. Reasons for discharge Speech normal 64 Non-attendance 19 No further progress 3 Transferred to other areas 7 Moved away 4 Left school 3 Discharge requested by parents 4 Left local schools to attend private schools 2 Total 106 7. Number of cases on the register at 31st December, 1958— 148 62 HANDICAPPED CHILDREN Children Under 5 There is now a complete register of all children under 5 who are handicapped either mentally or physically. This has been compiled from health visitors' records, information from general practitioners and hospital discharge notes; it is of course an open register to which names are added frequently as more information becomes available. As reported last year, most of these children are at home and present an increasing problem of management and care to their parents as they grow older. It was in an attempt to lighten this burden and give these children pre-school training and the necessary intensive physiotherapy or speech therapy that a special handicapped nursery was proposed for the area. The proposal for such a nursery has met with immediate approval from the parents of handicapped children, eventual approval from the committees through which it has passed, and so far, no comment from the Ministry of Health where the proposal rested at the end of the year. It is, however, hoped that as soon as permission is granted Kingsley Hall Day Nursery will be modified to take up to 20 handicapped children whose need for special training and therapy is greatest and whose parents are most in need of relief from their constant care. To make sure that the small number that can be admitted are those most in need, visits have been paid during the year to the homes of these children to draw up a priority list and also to give help and advice on the home care of the children. School Children The table shows the number of children with classified defects in the school and preschool population. Children who attend normal schools but were registed as handicapped have been seen during the year by school medical officers in minor ailment clinics and a detailed report on each child has been submitted relating to their physical condition and their ability to manage in the normal school. A total of 195 children were seen at these routine follow-up examinations and the following recommendations were made:— (1) Doing well in normal school 169 (2) Referred for hospital check 1 (3) Referred for special schooling:— (a) Residential - (b) Open Air School 3 (c) Special School 1 (d) Did not attend 21 In addition, 8 special recommendations for children to see the youth employment officer regarding employment were made. 63 These are the children on whom a special watch must be kept by the school medical officers and school nurses for any deterioration or inability to manage in the normal schools. This extension of the scheme for care of the handicapped is, I feel, of great value. Those children more severely handicapped are referred for special educational treatment at different schools, both day and residential. SUMMARY OF HANDICAPPED CHILDREN N.B. These figures include 31 school children with dual handicaps and four 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 - - - - - - - - - - - - Attending Day Special School — 6 8 9 32 — 191 3 1 62 2 314 Awaiting Placement in Day Special School — — — — 4 — 12 — — 3 — 19 Attending Residential Special School 2 — 3 2 15 — 13 1 16 6 1 59 Awaiting Placement in Residential Special School — — — — 4 — — — 1 1 — 6 Attending Boarding Homes - - - - - - - - - - - - Awaiting Placement in Boarding Homes - - - - - - - - - - - - Attending Independent Schools - - - - - - - - - - - - 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 2 6 11 11 56 - 216 4 18 75 3 402 Children of school age on register of H. Pupils at ordinary schools — 10 — 8 77 3 32 12 9 41 3 195 Pre-school children on register of H. Pupils 2 4 — 5 32 — 12 10 — 40 5 110 Pre-school children already receiving S.E.T. — 1 — 1 — — 1 — — — — 3 TOTAL 4 21 11 25 165 3 261 26 27 156 11 710 64 BENTRY SCHOOL Educationally Subnormal Children The school now takes educationally subnormal children mainly from the Dagenham area and only a few from the surrounding districts remain, most of those from South East Essex were admitted to the new school in that area. This has meant that those children needing special education in Dagenham had a much shorter wait before admission and school medical officers were able to recommend special schooling with more confidence that the child would be admitted before reaching school-leaving age. The school can, however, only accommodate those children so retarded as not to be able to keep up with the slowest pace of the secondary schools. There remains a nucleus of children in these schools recommended by the school medical officers for special educational treatment. This may mean extra tuition in fundamental subjects, which as yet is not adequately catered for; it is a pity that this demand for special educational treatment outside the special school has not yet been met in the area. The Bentry School is overloaded with children of the lower ranges of intelligence and this prevents the admission of those for whom a short period of intensive tuition is all that is needed. The physical condition of these children is well below the average found in secondary schools and the lack of adequate physiotherapy and group exercises is badly felt. Postural defects and mouth breathing with its resultant nasal and chest defects are present in over 80% of the educationally subnormal children in the school. Much could be done to prevent and treat these conditions if adequate physiotherapy was available for this purpose. Physically Handicapped The total number of physically handicapped children in the school is 57, a large percentage of whom are also educationally subnormal. This in itself creates a problem as it slows the pace of teaching for the more intelligent physically handicapped whose defect necessitates special schooling— and its corollary is that school medical officers are reluctant to send physically handicapped to the school if they can, even with difficulty, remain in normal schools. There are, therefore, a considerable number of quite severely physically handicapped children in normal schools in the area who do not get the benefits of physiotherapy and therapeutic swimming which the Bentry School provides. Frequently, therefore, the intelligent physically handicapped, well adjusted to his defect, remains in the normal school and it is the less intelligent child, less able to overcome his disability, who finds his way to the special school because he cannot be dealt with in the primary and secondary schools. In these days of increasing unemployment it is becoming more difficult to place these children in jobs when they leave school and it is the physically handicapped especially 65 who, though socially and intellectually well adjusted to their defects within the sheltered atmosphere of the school, cannot compete on the open market of employment. It is regrettable that these children have no special vocational training to offer prospective employers— in many cases not even as much as those children leaving secondary schools who have been doing woodwork and typing, and have been learning other manual skills in the school curriculum. In the past year or two, 5 children have left school with serious congenital heart defects, who might have got sedentry jobs if they had had an extra pull over their healthy competitors. In all these cases sheltered employment at Remploy or unpaid occupational work in a Welfare Centre has been the only solution. To help in this problem of bridging the gap between school and employment, visits to the medical inspection sessions have been paid by Dr. Bourne, the medical officer at Barking and Chadwell Heath Remploy factories and Mr. Larter of the County Welfare Department, and this closer co-operation between the school doctor, the headmaster and the sheltered employment and welfare agencies has been most successful. The school nurse has continued to make visits to the homes of all children in the school, regardless of the area in which they live. This arrangement with the divisional school medical officers of the authorities concerned has made possible very much closer co-operation between the school health department and the homes, expecially in cases where the mother has not been able to attend at school medical inspections. Hospital liaison has been good throughout the year and we now have complete records of all hospital attendances of all the children seen during the past years. Towards the end of the year some of the physically handicapped children were supplied with specially modified cutlery from the Ministry of Labour Handicapped Aids Department, and this has helped them to learn to use both hands at meals instead of needing to have their food prepared for them; the co-operation and help of the staff in teaching these children to be as independent as possible is invaluable. No report would be complete without stressing the interest Mr. Hurton and his staff show in the children, and their constant care has its reward in the social maturity and independence of these children. It has been a pleasure for the medical staff to go to the Open Day, Sports Day and Christmas festivities and to be able to share in the achievements of these children, handicapped by physical and educational defect. Physiotherapy The physiotherapist who attends for two sessions a week only, reports that during 1958 an average of 34 children were treated weekly. The total number of treatments 66 carried out was 2,789 in 42 exercise sessions and 42 physiotherapy sessions. 26 children went swimming in 31 sessions, total attendance being 429, a rough average of 16 per session. The baths were closed during part of the summer term for alterations. To stimulate enthusiasm and ambition, arrangements were made for swimming certificates, signed by the Olympic coach, to be presented to any child completing a length or more. The purchase of swimming rings has helped considerably but we would be very grateful for volunteers to enter the water and help with the children, as quite a number require individual attention. It is necessary to have one person each side of the bath and the baths staff at full strength is four. As there are at least 10 children who are quite unable to help themselves, it can be seen that helpers are urgently needed. This problem did not arise in 1957 as there were more senior students available who were most helpful. Exercises at the school included, as in previous years, breathing and posture exercises as well as special exercise for specific conditions such as poliomyelitis and spasticity. With the latter, the treatment combines relaxation and stretching of tight muscles and rhythmical movements done to music. The majority of the children suffering from poliomyelitis are rather severely handicapped so that progress is of necessity both slow and small. The children work hard and with a combination of free exercise and infra red, the Guthrie Smith slings and pulleys for non-weight bearing exercise and massage, some progress is made. 67 Synopsis of an address given by Dr. Helen E. Mair at the Conference of Home Help Organisers on 27th September, 1958 In September, Dr. Mair gave an address to the Conference of Home Help Organisers on, "Aids to the Disabled." This covered the field of the handicapped in such an excellent way and created such widespread interest that I give below a synopsis of the talk which was printed in The Journal of the Institute of Home Help Organisers. "Local authorities have been responsible for the handicapped for only 10 years— too short a time, it might be thought, to justify a critical appraisal of their achievements. But the National Assistance Act, 1948 did not create a new service for the welfare of people who have been deprived by deformity, disease or disablement of the full use of their faculties, it marks only a turning point in the long process by which the community has come to accept this responsibility— and the service as we know it can only be judged in the context of what has gone before. It is important to understand how the strength of the voluntary interest in this field delayed national action, and also how its weaknesses made national action necessary. Historically, since before the days of the Poor Law the parish and town authorities have had permissive powers to help the handicapped or "impotent poor" by providing houses and work for "the aged, decayed or impotent." Until the present century, however, this was regarded primarily as a matter for charity. The social conscience expressed itself in support for independent, voluntary associations of every kind for the relief of the poor and the aid of the sick and maimed, and the State was content to leave the field to them. Following the pattern in all social welfare, the voluntary bodies paved the way for legislation by showing the need and dealing with the problems they met as far as their resources and knowledge allowed. But because they were independent the standard of their service inevitably varied, while their tendency to concentrate on particular disabilities isolated the people they helped from the rest of the community and induced in them a sense of dependence. The National Assistance Act, 1948 empowered local authorities to set up Welfare Committees to help all physically handicapped people on the same basis as they had been helping the blind and deaf for 20 years or more. Now, another 10 years have passed and the picture in England is like a Tachiste painting— a few bold strokes across a hazy background. Some authorities have taken over most of the functions of the voluntary societies and have well organised schemes of service for the welfare of the handicapped in their areas. Others still shed their responsibility with a decreasing shower of pennies to the voluntary Association for the Welfare of the Physically Handicapped, the Spastic Association and many other organisations as one can think of diseases. 68 When any local authority or statutory body takes over the responsibility for a social service there must be a clear definition of the categories of people entitled to benefit. A handicapped person is defined in the National Assistance Act 1948, "as a person who appears to the authority to be substantially and permanently handicapped by illness, injury or congenital deformity (not being exclusively attributable to blindness or partialsightedness, deafness or dumbness or a combination of those particular infirmities as defined by the respective schemes made by the authority under Section 29 of the Act) or such other disabilities as may from time to time be prescribed by the Minister by regulations made under the Act, and who is in need of assistance under the scheme." The Act goes on to divide the causes of disablement into three different categories— illness, injury and congenital abnormality; but because the stage of life at which a person is affected plays such an important part in his ability to adjust to his handicap, classification by the age of onset will give a clearer idea of the problems that are presented. (1) Those with congenital deformities and defects. These people have never known all faculties and therefore adjust best. (2) Those whose defects were acquired early in life in the formative years. These people can also be helped over their disabilities by special schooling. (3) Those who have been handicapped in later life by chronic illness, e.g. heart disease; or accidents, e.g. loss of a limb etc. People in this category find it more difficult to adjust. We are concerned here with the end result of all three groups— the handicapped adult who is not able to find employment and who needs help in adjusting to life at home. People in the first two groups are the responsibility of the health and education departments in their early years and much is being done for them as children. Their problems begin when they leave the shelter of their special schools and have to compete for employment with normal healthy school leavers. They will rapidly adjust to community life if we tackle their problems immediately by giving them training, as they have been given schooling, that is suited to their "ability and aptitude." (The policy recently adopted by the Ministry of Labour in days of low employment not to train these children unless employment can be guaranteed them is, one hopes, only a temporary step backwards). Otherwise, they find as young adults that their disabilities have become an insuperable obstacle, after they have learnt to lead a near-normal school life, and they become resentful, mistrustful and difficult at work; they frequently change jobs and often after two years are permanently unemployed. "Half-way house" training schemes between school and employment would overcome some of the difficulties, and a great extension of the present limited facilities for training handicapped 16—18 year-olds is urgently needed. Until this is done it is inevitable that these young people should develop into home-bound, handicapped adults needing to have ordinary social services brought to them and becoming dependent on outside help in the home. They then become, like those handicapped in adult life through illness or accident, the responsibility of the welfare departments. 69 To discharge this responsibility the local authorities must know how many people there are to be dealt with. At present it is unlikely that any service can be complete while registration with the welfare department remains voluntary. It often happens that the people in need of the service hear about it only when some specific need— such as an adjustment in the house, or a recuperative holiday— sends them in search of help, or when they are referred to welfare services by the voluntary agencies dealing with their specific type of handicap. Obviously, the first requirement of a comprehensive welfare service is a complete register of people in need of its services. Such a register cannot be compiled unless the welfare department is supplied with the name and address and medical history of every handicapped school leaver, of every hospital patient discharged with a handicap, and of every person handicapped through illness while under the care of a general practitioner. But doctors in schools, hospitals or general practice should not be called upon to disclose the medical histories of their patients to any organisation which does not employ a medical officer qualified to interpret them in terms of the patient's needs. As yet, few welfare departments have their own medical officers or are under the medical officer of health. In the past year or so I have seen two or three serious consequences of this. e.g. (1) Pseudohypertrophic dystrophy— A 16½ year-old boy was sent for training in a job which required use of hands and in 1 year the disease had so progressed that he had lost the use of his hands. (2) Deaf— A girl who had left school suffering from deafness following tuberculous meningitis but had normal speech was taken by a voluntary worker for tuition in sign language. Some months later she had lost the faculty for lip reading and her family hadn't learnt sign language so she was unable to communicate with them except by writing, whereas she had previously been able to join in family life by careful lip reading. She was withdrawn and showing behaviour problems when she was seen by a medical officer. Medical supervision of such help could have prevented both these well intentioned failures. Welfare services are only just beginning for the adult handicapped, and while they remain entirely in lay administrative hands they cannot progress beyond providing for social and occupational needs— and even these are frequently changing as the pattern of the patient's disease progresses. It is essential that a service dealing specifically with medical problems should have access to, and close liaison with medical services, whether they be hospital, health department or general practice. Most of the problems met with are those of chronic disability which has passed out of the field of active hopsital treatment and into that of home and work, where the general practitioner without a much fuller knowledge of local authority services cannot give as much help as he should. It therefore seems appropriate that the medical officer of health, who is already responsible for ascertainment and care of handicapped children, should also be responsible for handicapped adults. 70 The welfare service as we know it is a hotch-potch of specific provisions, unrelated to any considered view of what the purpose of the service should be. Holidays and outings, for example, have a part to play in any scheme but they should only be a supplementary service. In practice, they represent a major element in voluntary effort and even in some cases of welfare department activities. The aims of any service dealing with the handicapped should be to help the handicapped person towards personal independence and financial independence. Towards personal independence, which is the more easily achieved but not sufficiently considered, the welfare services can help by providing aids to daily living. In the home they can arrange, and in some authorities, pay for the provision of ramps, rails, hoists and alterations to fittings such as doors, windows and kitchen equipment. Mobility in the house and outside is of paramount importance. The National Health Service and the Ministry of Labour provide wheel chairs, motor-propelled carriages and cars, but except in a few authorities, where welfare committees will meet the cost of garages and runways, the patients have to find £20 or so, or at least some part of these relatively small sums. In such ways is the nationally provided ship spoilt for a ha'porth of municipal tar. From the time of his illness or injury every handicapped person has to re-learn almost all the most rudimentary skills (e.g. eating and dressing) and to learn trick movements to overcome his disability. Such is the power of adaptation that a woman born with no arms and with one leg considerably shorter than the other has brought up a healthy family of 6 children, fastening nappy pins, combing hair, cooking and eating with her feet— and such is her degree of skill that her hobby is fine embroidery. For those whose disability comes later in life, and whose adaptability is therefore lessened, the Ministry of Labour has provided a large selection of domestic aids, such as adapted cutlery, combs, nail files and safety razor holders; a list of more than 80 gadgets is supplied. Leisure time, so much prized by those of us who have too little of it, can be an eternity of boredom and idleness to the severely handicapped in their homes. To lighten it, voluntary associations have been able to supply wireless and television to many people; so also have some welfare departments. More could be done by the public libraries in organising mobile library services for the disabled as they do for the schools— because for many of these people reading, watching television and listening are the only enjoyments left. Similarly, a 'meals on wheels' service such as is now provided for old people would benefit handicapped people living alone. Loneliness is a severe problem for the housebound, and especially for those who have become neurotically self-conscious about their handicap. They will not meet other people, go out or be seen because of their deformity or facial contortion. The patient must be helped by his relatives, friends and all who come in contact with him to 71 overcome his self-consciousness. He dislikes feeling that people do things for him out of pity, with the result that he becomes withdrawn and will not meet his old friends. He must be educated to accept his handicap and to acquire other skills and recreations, and his relatives must be educated to avoid over-protectiveness. Group activities can help to overcome loneliness and self-consciousness. Both social and occupational activities, including training in craftwork, are organised in many clubs and centres provided and run by voluntary associations, sometimes with the help of welfare authorities. But what can be done in this way is limited by the knowledge and skill of the voluntary helper; the danger is that patients may be encouraged to engage in unsuitable activities which may be prejudicial to their disabilities. It must also be realised that even where craft training is suited to the patients' disabilities it is of little use in the case of a disabled housewife unless she has first been helped to be personally independent in her own home by aids to daily living. Nor is it of much use to a mentally alert young handicapped man with a long expectancy of life if it is not likely to bring him financial independence. Once personal independence has been established the main aim should be to achieve the maximum degree of financial independence. It is, of course, always difficult for disabled and immobile people to earn an adequate living by their own work; some help from the State there must be, but it should be linked as closely as possible to the efforts of the individual patient. It is better to subsidise the goods which can be made by disabled people, but which cannot be marketed at competitive prices, than to pay handicapped benefit grants. In the past, voluntary associations have often trained homebound patients in craftwork which had no commercial value. Recently, however, some welfare authorities— particularly Derbyshire— have succeeded in training handicapped people to do parts of an industrial process in their own homes (e.g., the making of mop heads or the fixing of hooks to rubber strips) and have co-operated with local factories in the delivery and collection of the goods. But this is a difficult and unreliable scheme to operate. Most people engaged in the rehabilitation of the disabled feel that it is a second-best alternative to the more varied work of an occupational centre and only to be considered when it is quite impossible to provide special transport for homebound patients. Welfare authorities are just beginning to set up occupational centres— which must not be confused with the occupation centres provided for the mentally defective. A great many more are needed, and will, I am sure, be forthcoming in the next few years. They offer handicapped people places where they can go each morning, meet and mix with other disabled people and do work which is within their powers under the close supervision of occupational therapists in a friendly, non-competitive atmosphere. The most successful have been those where the welfare authorities pay the people who make the goods part of the price at which they are sold. In Croydon, for example, where 40-50 people attend the occupational centre, a worker gets 2/6d out of the 25/- received 72 for an article made from materials which cost the welfare authority 20/-. This is not economic independence but at least the patients can feel that it is not charity. It is hoped that as the numbers of occupational centres and trained personnel increase, more and more handicapped people will be able to graduate from home craftwork through occupational centres to more remunerative, though still sheltered, employment under Remploy and similar schemes. (Sheltered employment means work for which a wage is paid but not at competitive market rates). Ideally, of course, rehabilitation of the handicapped in relation to employment should aim at re-training the man for a job which is within his new limited powers. The victims of war injuries or industrial accidents can more easily be re-trained than those disabled by chronic or progressive disease because the nature and degree of the disability can be assessed. The assessment may be made at medical rehabilitation units in the larger hospitals, from which the patients can go on to the Ministry of Labour training schemes. The handicapped— to go back to the Act's definition of them as "those substantially or permanently handicapped by illness, disease or congenital abnormality"— are dealt with by a wide variety of statutory and voluntary agencies. A wide net spreads over the country, closely woven in the intricacies of its arrangements for handicapped children, and for adults who can still work, but only a loose mesh of as yet unrelated threads for severely handicapped or immobile adults. It is for these more unfortunate people that we must now complete the web, so that they too can be given as much opportunity as possible to live a full and useful life." 73