o^^>y Dft6r 33 BOROUGH OF DAGENHAM THE HEALTH OF DAGENHAM IN 1959 . BOROUGH OF DAGENHAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1959 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 39 Atmospheric Pollution 22-23 Audiometric Tests 67 Bentry Special School 71-72 Care of Mothers and Young Children 36 Child Guidance 67 Chiropody 48 Clinics and Central Office 42-43 Committee for Education 5 Convalescence 50 Council—Members of 3 Day Nurseries 41 Deaths—Causes of 17 Dental Services 63-64 Domestic Help 44-45 Education (General Purposes) Sub- Committee 5 Factories Acts, 1937 and 1948 24 Families with Special Difficulties 46-47 Food and Drugs—Sampling 28-29 Food Hawkers—Registration 27 Food Hygiene Regulations, 1955 26 Food—Inspection and Supervision 25-30 Food Poisoning 27-28 Food—Unsound 26-27 Handicapped Children 69-70 Handicapped Children—Summary 70 Handicapped School Leavers and After-Care 73-77 Health Area Sub-Committee 4 Health Education 33-34 Health Visiting 37-38 Home Safety 35 Houses Let in Lodgings 20 Housing 20-21 Ice Cream 25-26 Immunisation: 51-53 Diphtheria 52 Whooping Cough 51 Improvement Grants 21 Infant Mortality 18 Infant Welfare Centres 36 Infectious Diseases 31-32 Page Laundry Service for the Incontinent Aged 22 Maternal Mortality Maternity Services 39-40 Midwifery Service 39 Milk 25 National Assistance Act, 1948 22 Occupational Therapy 49 Ophthalmic Clinic 66 Orthopaedic Clinic 65 Over Sixties Clinic—Oxlow Lane 54-55 Pet Animals Act, 1951 24 Premature Infants 40 Prevention of Damage by Pests Act, 1949 24 Public Health Committee 3 Rag Flock and Other Filling Materials Act, 1951 23 Recuperative Holidays 50 Relaxation Classes 40 Rent Act, 1957 20-21 Sampling—Food and Drugs 28-29 Sanitary Inspection of the District 19 School Clinics 61-62 School Health, 1959 56-60 Slum Clearance 20 Smoke Control Areas 22-23 Specialist Services 65-68 Special School—Bentry 71-72 Speech Therapy 67-68 Staff 6-7 Staff Changes 13-14 Tents, Vans and Sheds 21 Tuberculosis 32 Unsound Food 26-27 Vaccination 51-53 B.C.G 51 Poliomyelities 53 Smallpox 51 Vital Statistics 15-16 Water 19-20 2 MEMBERS OF THE COUNCIL (as at 31st December, 1959) MAYOR: Councillor L. W. Todd, J.P. DEPUTY MAYOR: Councillor M. Eales ALDERMEN: W. E. Bellamy, J.P. E. M. Millard, (Mrs.) R. Blackburn A. E. Prendergast, (Mrs.) F. Brown, E.C.C. C. Prendergast, B.E.M., E.C.C. G. H. A. Crouch COUNCILLORS: G. Broadbent, (Mrs.) W. A. Parish H. V. Butt A. C. V. Rusha R. E. Crawley B. Seeney, (Mrs.) D. A. L. G. Dodd M. J. Spencer G. T. Harris J. Swift H. Kay D. W. Taylor E. J. Kitchen, (Mrs.) A. R. Thomas, (Mrs.) H. P. Larking J. S. Thomas D. Linehan S. J. C. Warr D. O'Dwyer PUBLIC HEALTH COMMITTEE CHAIRMAN: Alderman (Mrs.) A. E. Prendergast VICE-CHAIRMAN: Councillor (Mrs.) G. Broadbent His Worship the Mayor Councillor (Mrs.) E. J. Kitchen Councillor L. W. Todd, J.P. Alderman (Mrs.) E. M. Millard The Deputy Mayor Councillor M. Eales Councillor J. Swift Councillor S. J. C. Warr 3 DAGENHAM HEALTH AREA SUB-COMMITTEE (As at 31st December, 1959) Chairman: Alderman (Mrs.) A. E. Prendergast Vice-Chairman: Councillor (Mrs.) G. Broadbent Members:— Borough Council The Mayor Councillor L. W. Todd, J.P. The Deputy Mayor Councillor M. Eales Alderman (Mrs.) E. M. Millard Councillor H. V. Butt Councillor G. T. Harris Councillor (Mrs.) E. J. Kitchen Councillor D. O' Dwyer Councillor W. A. Parish Councillor A. C. V. Rusha Councillor M. J. Spencer Councillor D. W. Taylor Councillor J. S. Thomas 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., L.D.S., Councillor S. W. Deeks R.C.S; Councillor (Mrs.) L. Fallaize, J.P. Councillor (Mrs.) L. A. Irons, J.P. Councillor A. R. P. Sherrell 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 Mrs. I. Linton Miss N. L. Odell Mr. J. Walsh 4 DAGENHAM COMMITTEE FOR EDUCATION (as at 31st December, 1959) Chairman: Alderman R. Blackburn Vice-Chairman: Councillor J. Swift Representative Members: Nominated Members: The Deputy Mayor Councillor M. Eales County Councillor A. F. J. Chorley, Alderman W. E. Bellamy, J.P. M.B.E., J.P. Alderman (Mrs.) E. M. Millard County Councillor L. F. Saunders Alderman (Mrs.) A. E. Prendergast Councillor (Mrs.) G. Broadbent Councillor H. V. Butt Councillor R. E. Crawley Councillor (Mrs.) E. J. Kitchen Co-opted Members: Councillor H. P. Larking Mrs. I. M. Brockelbank Councillor D. Linehan Mr. E. E. Hennem Councillor D. O' Dwyer Mr. F. C. Jones Councillor W. A. Parish Mrs. E. F. Lambert Councillor A. C. V. Rusha Mr. J. Walsh Councillor D. W. Taylor Mr. D. Williams EDUCATION (GENERAL PURPOSES) SUB-COMMITTEE (as at 31st December, 1959) (This Sub-Committee deals, inter alia, with the School Health Service) Chairman: Councillor H. P. Larking Vice-Chairman: Councillor R. E. Crawley Members: Alderman R. Blackburn Mr. A. F. J. Chorley, M.B.E., J.P., E.C.C. Councillor D. O'Dwyer 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, 1959) 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, L.R.C.P., L.R.C.S.I. (C) Fannie Hirst, M.B., Ch.B., D.P.H., (C) Madeline Weizmann, M.R.C.S., L.R.C.P., (C) Maureen Joyce Hodgson, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H., (C) Dental Officers: V. Foy, L.D.S., R.C.S., (Eng.) (part-time) C. Sumsawaste, L.D.S., R.C.S., (part-time) A. Roberts, L.D.S., R.C.S., (part-time) Chief Public Health Inspector: L. E. Prior, (1), (2) Public Health Inspectors: J. W. Allam (1), (2), (4) A. J. James (1) G. Dovey (1), (2) G. S. Self (1), (2), (4) F. W. S. Fox (1), (2), (3), (4) 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) P. I. Jefford (5), (6), (7) D. B. Stewart (5), (6), (7) L. Ling (5), (6), (7) R. E. Walker (5), (6), (7), (15), (16) Non-Medical Supervisor of Mid wives: (C) Miss R. K. Jesson Midwives : (C) L. M. Chalkley (5), (6), (10) M. Teather (5), (6) H. Mitson (5), (6) P. Vanbrook (6) A. B. Showell (5), (6) M. E. Wainwright (5), (6) School Nurses: (C) J. Cornish (5) 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) Nurse on Combined Duties: (C) P. Broad (5), (8), (17) 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 (1) Clerks: E. Adams (C) D. Duff (C) M. Oates (C) J. B. Smith (C) I. M. Bishop (C) G. K. Harris I. Page (C) I. Throssell (C) N. Briand (C) S. B. Leader (C) J. Pearmine (C) M. A. Watts (C) L. M. Butler (C) F. H. Martin (18), (C) K. Richards (C) P. Woodward (C) J. Butterworth (C) J. Morgan (C) G. Shannon (C) K. Bird (C) (part-time) N. E. Cloke (C) E. Neport (C) F. W. Silverthorne 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 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. E. Ottley, 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. To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Last year, my report dealt in considerable detail with the care of handicapped children, and gave a short report on the first year's working of the new assessment centre for the over sixties. I mentioned, too, the changing pattern both in the work and in the informal colour schemes in the clinics. This year, I am happy to report that the changes made then and in the year before have not been idle sweepings of a new broom but that all our new ventures have continued to flourish and extend. The over sixties clinic has been held almost every week and towards the end of the year it was necessary for a second medical officer to attend so that more patients could be seen. Mrs. Broad was appointed during the year as the nurse with special duties associated with the clinic. The exercise classes have continued throughout the year, and Miss Brown, occupational therapist at St. George's Hospital, has brought her knowledge and experience to the discussion groups. The recorded discussion in the body of the report will show the constructive approach the over sixties make to their problems. Special attention has been paid to the handicapped by the continuing survey at 6 monthly intervals of all children with any defects in the ordinary schools who are seen by appointment for review at the school minor ailment clinics, and of the under fives who were seen either by appointment at the clinics or by visits from the medical officers to their homes. Some of the most severely handicapped will be able to attend the Day Centre at Kingsley Hall which has at last been finally agreed in all details by the Ministry and by the County Health Committee, but it will now be early 1960 before we can close the present day nursery and start on the replanning and re-equipping of the premises for the start of the centre in May, 1960. For some time the handicapped school leavers from the Bentry School who have not been able to find employment or are so severely handicapped that they are incapable of outside work, have been followed up at yearly intervals after leaving school by the school medical officer who has contacted the different services—welfare, hospital and voluntary—when further help has been needed. This year, the British Council for Rehabilitation asked for information about the care and after care of handicapped school leavers so a detailed survey of all children in the area who had left special schools in the past 2 years was carried out by the school nurses. Dr. Mair conducted further investigations where necessary and referred to Welfare, Youth Employment, voluntary agencies or hospital those cases in need of further help. A summary of this survey and a detailed report on the after care of the school leaver will be found in this report. The power drill and the paint brush took over Becontree Clinic for three months in the summer for a complete structural repair and redecoration. Leys Clinic is also being 9 reorganised to provide more spacious and self-contained accommodation for the Orthopaedic and Physiotherapy department. As I have said in previous reports and on as many occasions as opportunity has arisen, Health Education is becoming one of our major functions, and this year I am pleased to report the appointment of Mr. Self as Health Education Officer to the Public Health Department of the Borough. Although he has only been here for a few months the department is already becoming more conscious of the value of health education and requests are coming in from members of our staff and from voluntary agencies for talks and films and displays in clinics and clubs. I am grateful to the Borough Librarian for the help he gave in providing a library service of books specially related to the work of the health department to be borrowed on extended loan by members of my staff. The books were chosen to cover all sides of the work; child development, social medicine and social services, public health and sanitary hygiene—especially the newer developments of radiation and radioactivity, and a number related to the problems of the aged and ageing. In comparison with the large industrial areas of the north, Dagenham has few serious problem families (or as I prefer to call them, families with special difficulties) but those we have cause concern and a great deal of extra work for the health visitors, school nurses and home helps. Inadequate housing does not play a great part in the difficulties of these families in Dagenham, for in spite of being comfortably housed many of them fail to maintain even basic standards of care, housewifery, school attendance, general health and nutrition. In an attempt to improve their standards by co-operation and endeavour on their part rather than by the provision of the services of home helps and health visitors, a survey of families in difficulties, based on a similar survey by the London County Council, is being carried out by the health visitors and the possibility of establishing a centre for housecraft is being considered. I hope that next year I shall have more to report of this work. During the year the poliomyelitis vaccination of 15—25 year olds was added to that of the younger children and the successful working of the extra clinic sessions that this has involved is due to the helpful co-operation of all the staff. I am pleased to report that it was not necessary to curtail any of the other work of the medical officers to cover the extra sessions of poliomyelitis immunisation and that we have maintained the level of the past few years of diphtheria and whooping cough immunisation, with the exception of the booster whooping cough at 3 years, and this has fallen sadly, due mainly, I think, j to the fall-off in attendances at infant welfare clinics of the toddler age group. As far as the work of the public health inspectors is concerned, it is a pleasure to report the smoothness with which the first smoke control area was introduced into Dagenham and some preliminary preparation for the second control area was carried out. These two activities necessitated over 8,000 visits being paid by the public health 10 inspectors and the ease with which the first area of 1,000 houses in the Marks Gate estate came into operation on the first of September, 1959, is a tribute to their work. Following a number of unsatisfactory results from bacteriological tests carried out on ice cream and ice lollies, an interview with the manufacturers involved by the Public Health Committee showed their concern over this important problem. This produced some improvement and in view of this further consideration was deferred for six months. A watchful eye is being kept on these commodities and frequent samples taken. The outbreak of dysentery at Rush Green School, part of a community outbreak, found Dagenham no exception to the general trend of this disease throughout the country during 1959. Following much intensive work in which the school nurses, health visitors and public health inspectors co-operated, there was a rapid reduction in the number of cases. An interesting account of a troublesome outbreak of food poisoning due to Clostridium welchii (a fairly new cause of this condition) is reported in the body of the report. Although it is not possible to eliminate the organism from the meat as it is present when the meat is purchased, and not detectable by ordinary methods, precautions were taken in an effort to prevent further infection of this type. It is always sad to say goodbye to staff who have worked with us but to those who have left this year I would say, "thank you," and hope that their retirement or new work will be happy and satisfying, and I would welcome the new staff who have been appointed during the year. The work of the Health Department depends largely on the continuity of staff and this is perhaps a good opportunity to add a word of appreciation to those who have been with us for many years and without whose continuing interest and enthusiasm the wrork reported this year would not have been so successful. J. Adrian Gillet, Medical Officer of Health. 11 STAFF CHANGES Medical Officers Dr. E. P. James resigned to take a partnership in general practice but continued to do locum sessions as anaesthetist for the dental clinics. Dr. M. J. Hodgson was appointed and came to Dagenham from Oldchurch Hospital Paediatric Department in June. Health Education Officer Mr. S. Self was appointed to the staff of the Dagenham Public Health Department in September. It is estimated that he will spend 25% of his time on general duties and the rest on health education. He will be responsible particularly for health education in connection with smokeless zones, with food hygiene and in association with the Advisory Committee in Dagenham on Home Safety. He will help to organise demonstrations and film show etc. on general health topics and will be expected to co-operate with the County Health Education Officer in any project in Dagenham, as the Chief Public Health Inspector has done in the past. He will also be responsible for seeing that any health education material needed by the staff is available when required, and I very much hope that this will include materials for health education in schools. Health Visitors Miss Gibson retired in March and has gone to live in Bexhill. Miss P. Jefford was appointed from West Ham in April. Mrs. Valentine resigned in November to take up a post in the Grays Thurrock area. School Nurses Miss K. Ayres resigned in April to be married and is now living in Cheltenham. Mrs. J. Cornish was appointed in April. In May, Mrs. P. Broad was appointed combined duties nurse in connection with the Over Sixties Clinic at Oxlow Lane. Clerical Staff Mrs. K. Bird was appointed in May as a part-time clerical assistant to the Orthopaedic Physiotherapy Department. Miss A. Brown resigned in February to take up a position as a stewardess on the New Zealand Shipping Line. Miss J. Butterworth was appointed as junior clerk in November. Miss Doreen Ellmore resigned in October to take up training in the care of mentally handicapped children. Mrs. V. Hartley was appointed as part-time clerical assistant for the poliomyelitis immunisation scheme in September. Mrs. M. Oates who was engaged as a part-time clinic clerk in May 1958 took up full-time duties in January 1959. Miss P. Woodward was appointed in April. 13 Midwives Mrs. M. Robson resigned in May and Mrs. M. Wainwright was appointed in June and Miss L. Neale was appointed in November. Day Nursery Staff The following staff resigned during the course of the year:— Miss D. Dunn, Nursery Assistant, Chadwell Heath Nursery, in May. Mrs. H. Johnson, Nursery Assistant, Chadwell Heath Nursery, in November. Miss J. M. McEwen, Nursery Assistant, Chadwell Heath Nursery, in June. Miss J. Page, Day Nursery Student, Chadwell Heath Nursery, in August. Miss C. Schneider, Day Nursery Student, Chadwell Heath Nursery, in August. Miss P. Wingrove, Day Nursery Student, Chadwell Heath Nursery, in August. Mrs. P. Wigmore, Warden of Goresbrook Nursery, in November. The following appointments were made during the year:— Miss B. Hughes Staff Nursery Nurse at Chadwell Heath Nursery in June. Miss P. McNally Nursery Assistant at Chadwell Heath Nursery in June. Dental Attendants Mrs. A. Horlock resigned in September and Mrs. P. Burbidge was appointed in October and resigned in December. 14 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 6,556 Registrar-General's estimate of resident population, 1959 114,200 Number of inhabited houses (end of 1959) according to Rate Books 31,313 Rateable value (December 31st, 1959) £1,636,164 Sum represented by a penny rate (1959/60) £6,799 Extracts from Vital Statistics for the Year Live Births: Total Male Female Legitimate 1,473 765 708 Illegitimate 55 26 29 Live birth rate per 1,000 of the estimated population 13.38 Stillbirths: Legitimate 28 14 14 Illegitimate 1 1 — Stillbirths rate per 1,000 live and stillbirths 18.63 Total live and stillbirths 1,557 806 751 Infant deaths 27 Infant mortality rate per 1,000 live births—Total 17.67 Legitimate 16.97 Illegitimate 36.36 Neonatal mortality rate per 1,000 live births (first four weeks) 13.09 Illegitimate live births per cent of total live births 3.60 Maternal deaths (including abortion) — Maternal mortality rate per 1,000 live and still births — Total Male Female Deaths 910 532 378 Death rate per 1,000 of the estimated resident population 7.97 Deaths fromCancer (all ages) 212 „ „ Measles (all ages) 1 ,, „ Whooping Cough (all ages) — ,, ,, Gastritis, Enteritis and Diarrhoea (all ages) 5 Births 1,528 live births were notified during the year, there being 791 males and 737 females. There is a decrease of total births from 1,536 in 1958 to 1,528. The corrected birth rate per thousand population was 16.43 compared with 16.5 for England and Wales. The illegitimate birth rate continues to be very low, being only 3.60 per cent of total live births. The rate of illegitimate stillbirths is 3.45 per cent of total stillbirths. Deaths Total deaths in district 677 Outward transfers 226 Inward transfers 459 Deaths of residents 910 Of the deaths of non-residents occurring in the district, 192 took place at Rush Green Hospital, 22 at Dagenham Hospital and 5 at Hainault Lodge. 15 Of the deaths of local residents taking place outside this area, most occurred in institutions as follows:— Oldchurch Hospital 245 St. George's Hospital, Hornchurch 50 King George Hospital, Ilford 23 London Hospital 23 Chadwell Heath Hospital 8 Severalls Hospital, Colchester 7 St. Bartholomew's Hospital 6 Plaistow Hospital 6 Victoria Hospital, Romford 6 St. Andrew's Hospital, Billericay 5 East Ham Memorial Hospital 5 St. Joseph's Hospice 5 16 Causes of Death 1959 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 2 - 4 - 3 - - - 9 - 2. Tuberculosis, other — — — — - - - — 1 - — - — 1 — - 1 1 3. Syphilitic disease - - - - - - - - - - 2 - - 1 - - 2 1 4. Diphtheria - - - - - - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - 6. Meningococcal infections - - - - - - - - - - - - - - - - - - 7. Acute Poliomyelitis - - - - - - - - - - - - - - - - - - 8. Measles - - - - 1 - - - - - - - - - - - 1 — 9. Other infective and parasitic diseases - - - - - - - - - - - - - 1 - 1 - 10. Malignant neoplasm, stomach - - - - - - - - 1 1 14 6 8 - 5 3 28 10 11. Malignant neoplasm, lung, bronchus - - - - - - - - 4 - 34 4 12 - 5 2 55 6 12. Malignant neoplasm, breast - - - - - - - - - 4 - 9 - 7 - 3 - 23 13. Malignant neoplasm, uterus - - - - - - - - - - - 3 - 1 - 1 - 5 14. Other malignant and lymphatic neoplasms - - - - 2 - - - 4 1 25 20 13 10 7 3 51 34 15. Leukaemia, aleukaemia — — — — — 1 1 — - - 2 2 1 — 1 1 5 4 16. Diabetes - - - - - - - - - - - - 1 1 2 2 3 3 17. Vascular lesions of nervous system - - - - - 1 - - - - 17 12 15 19 17 24 49 56 18. Coronary disease, angina - - - - - - - - 4 - 53 9 38 22 16 20 111 51 19. Hypertension with heart disease - - - - - - - - - 1 3 3 - 2 1 4 4 10 20. Other heart disease - - - - - - - - - 2 10 11 12 11 12 34 34 58 21. Other circulatory disease - - - - - - - - - - 11 3 2 - 3 9 16 12 22. Influenza — — — — — — — — — — 3 — — 1 — 3 3 4 23. Pneumonia 2 1 — — — — 2 — 1 3 8 2 3 9 4 13 20 28 24. Bronchitis - - - - - - - - - - 25 2 21 5 17 3 63 10 25. Other diseases of respiratory system - - - - - - - - - - 6 - 5 - 2 1 13 1 26. Ulcer of stomach and duodenum - - - - - - - - - - 4 1 3 - 2 1 9 2 27. Gastritis, enteritis and diarrhoea - 1 - 1 - - - - - - - 1 - - - 2 - 5 28. Nephritis and nephrosis — — - — — — — - 1 - 2 - — 1 2 - 5 1 29. Hyperplasia of prostate - - - - - - - - - - - - 3 - 3 - 6 - 30. Pregnancy, childbirth, abortion - - - - - - - - - - - - - - - - - - 31. Congenital malformations 3 4 - - - - - - - 1 - - - 1 - - 3 6 32. Other defined and illdefined diseases 6 10 2 - - - - - 2 - 6 9 3 5 5 12 24 36 33. Motor vehicle accidents - - - - - - 1 — 1 1 4 1 — — 1 — 7 2 34. All other accidents - — 1 - — 1 1 — 5 1 - — — 1 1 2 8 5 35. Suicide - - - - - - - - - 2 1 1 — — — 1 1 4 36. Homicide and operations of war - - - - - - - - - - - - - - - - - - 11 16 3 1 3 3 5 - 26 17 234 99 143 98 107 144 532 378 17 INFANT MORTALITY Details of deaths of children under one year of age registered during 1959. under 1 wk. 1—2 wks. 2—3 wks. 3—4 wks. Total under 4 wks 4 wks. and under 3 mo. 3 mo. and under 6 mo. 6 mo. and under 9 mo. 9 mo. and under 12 mo. Total deaths under 1 year Prematurity 4 — — — 4 — — — — 4 Prematurity with associated cause .. 5 - - - 5 - - - - 5 Congenital Abnormality 4 1 — 1 6 2 1 1 — 10 Birth Trauma 1 — — — 1 — — — — 1 Birth Trauma— Intracranial haemorrhage 1 — — — 1 — — — — 1 Atelectasis 1 — — — 1 — — — — 1 Bronchopneumonia — — 1 — 1 1 1 — — 3 Kernicterus 1 — — — 1 — — — — 1 Diarrhoea and Vomiting - - - - - - - - 1 1 17 1 1 1 20 3 2 1 1 27 18 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRICT (a) Nature and number of visits:— Rent Act 409 Housing and Public Health Acts:— Dwelling houses 2,988 Other premises 1,021 Overcrowding and Housing Applications 1,456 Bakehouses 49 Milkshops and dairies 73 Foodshops, stalls and itinerant vendors 2,016 Cafes and canteens 449 School kitchens and feeding centres 153 Infectious disease enquiries 1,254 Visits to foster-mothers' premises 111 Number of complaints investigated 940 Clean Air Act—Survey 8,012 Factories 286 Workplaces and offices 52 Rag Flock, etc 26 Tents, vans and sheds 312 Stables 5 Pet Shops 12 Hairdressers' and barbers' premises 59 Shops Act 82 Ice Cream premises and vehicles 297 Houses disinfested 23 Other visits 1,036 (b) Notices served:— Complied with:— Statutory 67 75 Informal 560 515 Legal proceedings were instituted in respect of two properties to enforce compliance with statutory notices. WATER The water supply is satisfactory in quality and quantity; owing to exceptionally high demand during the extreme drought periods the pressures were at times less than normal. 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. 19 During the year the following mains were laid:— Length of Mains Yards Diameter 653 3" 813 4" 317 6" 100 9" 20 12" 531 21" 130 supplies were afforded to houses 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 4,130 chemical, bacteriological and biological examinations have been made during the year. In addition samples were examined for radioactivity. All water going into supply was wholesome." HOUSING Slum Clearance During the year a further two clearance areas consisting of six houses in all were represented as unfit for human habitation. Houses Let in Lodgings Statutory notices under the Housing Act, 1957, Section 36, were served upon the owner of two houses to provide additional sinks with running water and ventilated food cupboards. Legal proceedings were instituted in respect of one house to enforce compliance with the notice. Rent Act, 1957 39 applications were received from tenants during the year compared with 97 in the previous year. In only one case (in which the fitting did not appear to be defective) 20 did the Council refuse to issue a certificate of disrepair. Undertakings to do the work were given by landlords in respect of 23 properties. Five certificates of disrepair were issued and five cancelled on completion of the repairs. Advice was given to tenants and they were able to purchase the necessary forms at the Civic Centre. The Council have issued several certificates of disrepair which included inter alia defective fencing, and although this item was informally challenged on occasions by the landlord the work was in each case carried out; where tenants included on their applications defective electrical wiring a statement from the local Electricity Board or a competent electrician, indicating the nature of the defects, was required. Improvement Grants Two types of grant are now available; the " discretionary " grant for the more extensive forms of improvement towards the cost of which a grant up to £400 is available and the " standard " grant (which has operated since June 1959) where little or no structural alterations are necessary and a grant up to £155 is available towards the cost of the five standard amenities (fixed bath in a bathroom, wash-hand basin, hot water supply, water closet in or contiguous to the dwelling and satisfactory facilities for storing food). The standard grant conditions have been designed to provide as simple a procedure as possible. The new requirement that the fixed bath or shower should be in a bathroom has caused the Council to consider the properties built between the wars (there may be between 400 and 500 in the Borough) in which the bath is in a recess in the Living Room/ Kitchen; the fact that a W.C. compartment contiguous to the dwelling must be excluded from a standard grant also causes some concern. Applicants are always encouraged to make preliminary enquiries before any expense is incurred. During the year enquiries were received in respect of 31 houses; in several cases the improvements desired were not eligible for grant. 16 preliminary applications were considered by the Council; two formal applications for standard grants were approved. Two applications were refused, one because the Council hope to redevelop the area within the next two years, the other because shop premises were an integral part of the dwelling. Tents, Vans and Sheds As was the case last year no applications were received under the provisions of the Public Health Act, 1936, Section 269. There has been a slight decrease in the number of occasions in which gypsies have pulled their vans onto vacant sites in an effort to spend a few days, at least, in the area. The number of sites with easy access from the road is becoming less each year. During the year inspectors paid 312 visits to various sites in connection with this work. 21 NATIONAL ASSISTANCE ACT, 1948 Section 47 The surveillance of persons who are unable properly to care for themselves receives the constant attention of all members of the department. The various services operated by the department continue to improve the lot of many of these unfortunate people who, although they cannot do much for themselves, are unwilling to leave their home in what is inevitably their last days. It was not necessary compulsorily to remove any person during the year. Section 50 Two persons (female 63 years and male 47 years) were buried under the provisions of this section. 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. To meet new working conditions at the laundry it was necessary to restrict the days of collection and delivery of laundered articles to Mondays and Thursdays. The service continues to work well and this is undoubtedly due in a very 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 15 cases use the service at any one time. From the commencement of the service in December, 1953 to of this year 230 cases have received assistance. During the year 46 new cases have been helped, 31 cases died, 17 were removed to hospital and 2 no longer needed the service. At the end of the year 13 cases were still participating; the number of articles laundered during the year was 11,295 compared with 13,376 articles for the previous year. ATMOSPHERIC POLLUTION 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 2 minutes in the aggregate in any period of 30 minutes. 53 observations were made of the chimneys of industrial premises in the Borough; statutory action was not needed 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. Smoke Control Areas The Council have been represented at the conference of local authorities covering the East London area. The department's stand at the Dagenham Town Show held on 22 Saturday and Sunday nth and 12th July, 1959 was used to publicise the use of solid smokeless fuel; the North Thames Gas Board again co-operated with the department. The Council's first smoke control area (the first in Metropolitan Essex) operated from 1st September, 1959; the area is at Marks Gate and comprises about 1,000 new Council houses. In March 1959, in addition to a public meeting, a house in the centre of the estate was used for demonstration purposes for four days (Wednesday to Saturday); the house was open until 8.00 p.m. and was manned by representatives of the Gas and Electricity Boards and a public health inspector. Many of the residents on the estate visited the demonstration house; the technique of burning coke was carefully explained and any complaints or problems in respect of fuel appliances were followed up. It would appear that for the success of a smoke control area it is essential for residents to acquire the technique of burning coke (this is quite different from burning coal) and in this connection the representatives of the North Thames Gas Board have been extremely helpful. The tenants have co-operated well and there appears not to have been any attempts to defy the requirements of the Order. The Council have agreed in principle their programme for the next five years as required by the Ministry; in addition they propose to include in smoke control areas the whole Borough as soon as possible and in any case in not more than 10 years. The survey for the second smoke control area has commenced; this will include nearly 4,000 houses (mostly owned by the L.C.C.) and covers the South West Corner of the Borough. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Two premises which have been registed under Section 2 of the Act have operated during the year. One licence for the manufacture (the factory has been extensively enlarged) 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 8 Cotton Felt 7 Kapok 6 Kapok mixed with cotton 1 Coir fibre 5 Sisal 2 23 PET ANIMALS ACT, 1951 Four licences (one less than last year) 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 the very few areas where there was evidence of infestation. No serious infestation of either rats or mice was encountered during the year. FACTORIES ACTS, 1937 AND 1948 Inspections Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 27 30 3 - Factories with mechanical power 168 192 1 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 42 64 6 - Total 237 286 10 - Defects Found Number of defects Number of prosecutions instituted Found Remedied Referred To H.M. Inspector Referred By H.M. Inspector Want of cleanliness 3 3 - 2 - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary Conveniences:— Insufficient 3 3 - 1 - Unsuitable or defective 4 3 - - - Not separate for sexes - - - - - Other Offences - - - - - Total 10 9 - 3 - Outwork No. of outworkers in August list 11 Nature of work—Making etc., wearing apparel. 24 INSPECTION AND SUPERVISION OF FOOD The numbers and types of food premises in the Borough are as follows:— 5 Bakehouses 22 Bakers and Confectioners 59 Butchers 175 Cafes and Canteens 25 Fishmongers 55 Fruiterers and Greengrocers 125 Grocers 22 Licensed and 12 Off-licensed Premises 93 Sweets, etc. All food premises are regularly inspected and during the year 2,976 visits were paid. In addition to numerous verbal warnings and suggestions to management and staff during these routine visits, 217 informal notices were served upon owners or occupiers. 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 weekends. The position under the Food and Drugs Act, apart from registrations in respect of ice cream, is as follows:— 37 butchers' premises and 7 other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 464 visits were paid. 21 fish shops are registered for frying. To these 270 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 53, of these eight operate from premises outside the Borough, the remaining 45 distributors operate from 76 premises situate in the Borough. 103 visits were paid to dairies and distributors' premises. During the year 59 samples of milk were submitted for bacteriological examination. One sample (from a refrigerated slot machine) failed to pass the methylene blue test, but in this case the maximum atmospheric shade temperature during the test exceeded the permissible limit of 65 degrees F. Ice Cream The total number of registered premises is 145; of this number two are registered for the manufacture of ice cream. 260 visits were paid to these premises. During the 25 year 7 applications for the storage and sale of ice cream were granted. One application for the sale of wrapped ice cream from a forecourt, without any suitable premises for storage, was refused. 37 inspections in connection with itinerant vendors were carried out. During the year 70 samples of ice cream were submitted for bacteriological examination; they were graded as follows:— Grade I Grade II Grade III Grade IV Total 45 13 6 6 70 In addition 30 samples of ice lollies were submitted for examination; seven were considered to be unsatisfactory. In each case the lollies were manufactured outside the Borough and the local authorities concerned were notified. The products of one manufacturer with premises outside the Borough gave rise to some concern. The six Grade IV results in respect of ice cream and five out of the total of seven unsatisfactory ice lollies were from this manufacturer. The local retailer, together with representatives of the manufacturer, were interviewed by the Public Health Committee; in view of some improvement of the products towards the end of the year consideration by the Committee was deferred for six months. Food Hygiene Regulations, 1955 The traders generally have continued to co-operate although in one or two cases the threat of the institution of legal proceedings (in one case the summons was issued) was necessary to gain compliance with the regulations. The inspectors in their regular visits to food premises make 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 few samples of cooked meat were submitted for bacteriological examination; any reports which are considered not to be altogether satisfactory are used to ensure more hygienic methods of handling cooked food. 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 38 such complaints were considered by the Public Health Committee. In the majority of cases warning letters were sent but in the following four cases legal 26 proceedings were instituted:— Insects in milk Fined £5 Mouldy Jam Sandwich ,, £10 Glass in Orange Drink „ £10 Dirty Milk Bottle Case dismissed. Insufficient evidence. 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, 12 persons were registered as Food Hawkers; one had storage premises in the Borough. One application to sell shell fish and jellied eels was refused as conditions at the site on which the stall was to stand were not considered to be satisfactory. 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 145212 Cases otherwise ascertained—Nil. Symptomless Excreters—Nil. Fatal cases—Nil. Particulars of Outbreak:— No. of Outbreaks No. of Cases Total No. of cases Family Outbreaks Other Outbreaks Notified Otherwise Ascertained Agent identified (Cl. welchii) - 1 - 111 111 Agent not identified 1 - 4 - 4 Single Cases:— No. of Cases Total No. of cases Notified Otherwise Ascertained Agent identified (Salmonella Typhimurium) 5 — 5 Salmonella Infections, not food-borne—Nil. 27 The outbreak in which CI. Welchii was identified as the agent occurred at a Junior Mixed and Infants School. 98 children and 13 members of the staff were affected. The common factor appeared to be the school dinner which was cooked at another school. The chain of events was as follows:— The meat (roast lamb, boned and rolled) was contaminated with CI. Welchii when purchased. The CI. Welchii resisted destruction by the heat and during the two hours or so between cooking and eating multiplied in the anaerobic conditions and produced their toxin. Following this outbreak arrangements were made for cooked meat to be kept in the kitchen at a "safe " temperature until immediately before dispatch to the school. A small outbreak of sonnei dysentery occurred at an Infants school. 45 children and 10 adults (adult members of families where children also had diarrhoea and the school caretaker) were swabbed. The swabs of 15 children and one adult (mother of an affected child) were positive. The outbreak continued for about four weeks. At the very commencement of the investigations arrangements were made for a routine practice of disinfection in respect of sanitary accommodation and the importance of hand washing was emphasised. Food and Drugs—Sampling Article Number Examined Number Adulterated, etc. Formal Informal Formal Informal Almonds, Ground 1 1 - - Apple Charlotte - 1 - - Baby Rice - 1 - - Barley Kernels, Creamed - 1 - - Beverages - 4 - - Biscuits - 2 - - Bread - 2 - 2 Bread Roll, Buttered - 1 - 1 Broth - 1 - - Butter 1 3 - - Butter Scotch - 1 - - Cake Mixture - 1 - - Cheese - 1 - - Chicklettes - 1 - - Cocktail Shrimps - 1 - - Cordials - 6 - 1 Crab, Dressed - 1 - - Cream - 3 - - Curry Powder - 2 - - Dessert Powder - 1 - - Egg Noodle Squares - 1 - - Essences and Flavourings - 1 - - Flour - 3 - - Frying Oil - 1 - - Glace Cherries - 1 - - Gravy Browning - 1 - - Herbs, Dried - 1 - - Honey - 1 - - 28 Food and Drugs—Sampling Cont'd Article Number Examined Number Adulterated, etc. Formal Informal Formal Informal Ice Cream - 12 - - Ice Lollies - 7 - 1 Jelly - 2 - - Lard - 1 - - Lemon Curd - 1 - - Mandarin Oranges (Tin) - 1 - 1 Margarine 1 2 - - Marzipan - 1 - - Mayonnaise - 2 - - Medicinal Samples - 37 - 4 Milk 16 1 - 1 Milk, Evaporated - 1 - - Milk, Dirty Bottle - 1 - 1 Mussels - 1 - - Paste - 2 - - Pepper - 1 - - Pickles - 2 - - Pies 1 1 - - Prawns, Steamed - 1 - - Pudding Mixtures - 2 - - Rusk - 2 - - Salmon - 1 - - Salt - 1 - - Sauces - 3 - - Sausages 18 1 3 - Sausage Meat - 1 - - Spaghetti - 1 - - Spreads - 4 - - Stuffings - 3 - - Suet, Shredded 1 - - - Trifle Pack - 1 - - Vegetable Fat - 1 - - Vinegar - 1 - - Wheat Germ, Stabilized - 1 - - Wines and Spirits 13 2 - - Adulterated Samples, etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 555A Lemonade Informal Had objectionable smell of Sulphuretted Hydrogen—contained 0.1 parts per million of Sulphuretted Hydrogen. Warning letter 559A Diarrhoea Mixture Informal Contained .020% of anhydrous morphine—3 times the quantity stated on the label. Warning letter 563A Influenza and Cold Mixture Informal Morphine ingredient incorrectly stated in list of ingredients. Warning letter 589A Milk Informal Contained a slug Warning letter 624A Chocolate Ice Lolly Informal Contained an excessive quantity of cocoa present as a ' pocket.' Manufacturer informed 29 Adulterated Samples, etc. Cont'd Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 627A Bronchial Mixture Informal Contained only 1/3 of the stated amount of chloroform viz: 2.5% by volume. Withdrawn from sale 657A Buttered Bread Roll Informal Contained black specks and streaks of foreign matter due to atmospheric dust or dirt. Warning letter 658A Bread Informal Contained foreign matter in the form of burnt dough. No action 659A Bottle of Milk Informal Contained brown spots and brown film consisting of mould growth. Prosecution. Case dismissed 661A Cherry and Black Currant Cough Comfort Informal Blackcurrant not included in list of active constituents. Warning letter. Label to be amended 675A Mandarin Oranges Informal Contained an excessive amount of tin. Contamination due to purchaser failing to empty tin after opening. 676A Bread Informal Contained foreign matter in the form of a plastic strip partly covered with coal dust. Warning letter 2527 Beef Sausage Formal Contained 140 parts per million of Sulphur Dioxide. Warning letter 2528 Pork Sausage Formal Contained 200 parts per million of Sulphur Dioxide. Warning letter 2529 Beef Sausage Formal Contained 150 parts per million of Sulphur Dioxide. Warning letter 30 prevalence of, and control over infectious and other diseases Notifiable Diseases (Other than Tuberculosis) Under 1 yr. 1— 2— 3— 4— 5— 10— 15— Over 25 yrs Total Scarlet Fever 1 3 16 11 12 107 43 6 2 201 Whooping Cough 5 4 3 12 7 24 4 1 — 60 Measles 67 177 247 261 262 1,000 19 3 2 2,038 Diphtheria — — — — — — — — — — Dysentery 1 — — 3 2 9 1 2 4 22 Acute Poliomyelitis:— Paralytic - - - - - - - - - - Non-paralytic - - - - - 1 - - - 1 Meningococcal Infection 1 - - - - - - - - 1 Under 5 years 5—14 15—44 45—64 65 and over Total Pneumonia:— Acute Primary 1 4 7 4 5 21 Acute Influenzal — — 4 8 3 15 Encephalitis, Acute:— Infective — — — — — — Post Infectious — — — — — — Erysipelas — — — 2 2 4 Food Poisoning 2 2 5 2 1 12 Puerperal Pyrexia — — 6 — — 6 Ophthalmia Neonatorum 4 — — — — 4 Paratyphoid 'B' — 2 — — — 2 Typhoid — — — — — — Smallpox — — — — — — Notified Admitted to Isolation Hospital, Rush Green Admitted to other Isolation Hospitals Admitted to other Hospitals Diphtheria - - - - Dysentery 22 5 — — Excephalitis, Acute — — — — Enteric Fever — — - - Erysipelas 4 — — — Food Poisoning 12 1 — — Malaria — — - - Measles 2,038 3 3 - Meningococcal Infection 1 1 — — Ophthalmia Neonatorum 4 — — — Paratyphoid Fever 2 1 — — Pemphigus — — — — Puerperal Pyrexia 6 2 — — Pneumonia:— Acute Influenzal 15 - - - Acute Primary 21 - - - Poliomyelitis:— Paralytic — — - - Non-paralytic 1 1 - - Scarlet Fever 201 1 - - Smallpox — — - - Typhoid — — - - Whooping Cough 60 — - - 31 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 - - - - - - - 5— - 1 - - - - - - 1 - - - 10— - - - - - 4 - - - - - - 15— 2 - - - 1 - - - - - - - 20— - - - - 3 5 - - - - - - 25— 7 2 - - 8 11 - - 1 - - - 35— 4 2 1 - 8 8 — 1 1 - - - 45— 6 1 1 - 4 - - - 2 1 - - 55— 2 - - - 6 - - - 5 - - - 65—and upwards 5 1 - - - 1 - - 5 - - 1 26 7 2 - 31 29 - 1 15 1 - 1 Register Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January, 1959 550 435 72 71 During the year:— New notifications 26 7 2 - New cases brought to notice by Registrars' Death Returns 1 Deaths 15 1 - - Transfers into area 31 29 - 1 Transfers out of area 35 34 1 1 Removed from register as "Recovered" 1 - - 1 No. on register 31st December, 1959 556 436 73 70 32 HEALTH EDUCATION As will be seen from the list of talks given by various members of the staff, 1959 was another busy year. A considerable amount of health education is given which is not listed, not only to organised groups such as expectant mothers and to the over sixties, but also to individual parents and children by doctors, health visitors and school nurses in the clinics and in the schools. This year, we undertook to give practical training to students from the University of London Institute of Education, as in previous years. Two of the students were members of the teaching profession and one was a health visitor. Unfortunately, the health visitor did not complete the course but the other two students appeared to be extremely interested in all they saw, and contributed much to the work of the department. In September, Mr. Self was appointed and commenced duty as a public health inspector with special duties in connection with health education, and as will be seen from the list of talks, he did an enormous amount in connection with the " Check That Fall" campaign. At the end of November, he organised a stand on " Home Safety " at the Princess Cinema and the Odeon Cinema,' as well as a display at Valence Library; slides were also shown at three cinemas. From the 7th December until Christmas, the stands were transferred from the two cinemas to Becontree Clinic and Oxlow Lane Clinic. Following a food poisoning outbreak in one of the schools, although no blame for this could reasonably be laid at the door of the staff, the opportunity was taken to reinforce previous advice given to food handlers in the particular school concerned. During the year, also, a certain amount of preliminary discussion about health education in schools was held. Although up to the end of the year very little progress had been made, it is hoped that during 1960 some agreement will be reached on health education in schools and its application. The following is the diary of talks given to local organisations during the year:— #]Date Organisation Subject of Talk Audience Speaker 5.1.59. Ingrebourne Centre, St. George's Hospital. The Aged in the Community 50—60 Dr. Gillet 10.2.59. Rectory Road, Branch Library Women's Meeting Child Welfare 14 Miss Gordon 14.4.59. ,, ,, ,, Environmental Health 12 Mr. Prior 5.5.59. ,, ,, ,, Old Age 12 Miss Gordon 20.5.59. Royal College of Midwives (Dagenham, Romford & Forest Area Branch) Growing Younger 10 Dr. Gillet 33 Mrs. Dunbar, health visitor, gave a series of 9 lectures to junior members of the British Red Cross on nine consecutive Thursday evenings on "Welfare in the Home" and "The Work of a Health Visitor." About 12 children attended on each occasion. 34 Date Organisation Subject of Talk Audience Speaker 2.6.59. Rectory Road Branch Library Women's Meeting Home Nursing of the Sick Child 40 Dr. Gillet 16.6.59. Chadwell Heath Ratepayers' Association. The Air We Breathe 25 Mr. Prior 23.6.59. Soroptimist Club of East London A Centre for the Over Sixties 35—40 Dr. Gillet 24.6.59. Women's Co-op Guild, St. George's Hall. A Centre for the Over Sixties 25—30 Dr. Gillet 1.9.59. Women's Co-op Guild, Broad Street Branch. Cancer 50 Dr. Gillet 22.9.59. The Housewives' Happy Hour Club, Rookery Farm Social Hall. Home Safety 40 Mr. Prior 27.10.59. School Meals Supervisors Food Poisoning 25 Mr. Self 11.11.59. National Federation of Business & Professional Women's Clubs—Brentwood Branch. Growing Younger 60 Dr. Gillet 24.11.59. Old Folks Fellowship, Central Hall. Check That Fall 85—90 Mr. Self 25.11.59. Rookery Farm Old People's Club. Check That Fall 35 Mr. Self 26.11.59. Five Elms Darby & Joan Club. Check That Fall 150 Mr. Self 4.12.59. Broad St. Old Folks Club. Check That Fall 150 Mr. Self 14.12.59. Old People's Welfare Council. Check That Fall 30—35 Mr. Self HOME SAFETY With the object of enlisting and stimulating the interest of local organisations in the work of home safety, the Home Safety Advisory Committee (under the auspices of the Public Health Committee) has continued to function. It has been difficult to produce in the Borough any real enthusiasm for the work of the Committee and this may well be due, in part at least, to the difficulties encountered in finding ways and means of financing the work of the Committee. The Council cannot, under the existing legislation, make any financial contribution to the Advisory Committee until it has some funds of its own; the problem of how to obtain money from local organisations, in addition to the active co-operation of their members, before the Council make any contribution has not yet been solved. A local programme was arranged in the autumn in connection with the " Check that Fall" campaign. In addition to lectures to local organisations, slides were shown at local cinemas and display stands were erected in the foyer of two cinemas, a public library and two clinics. A questionnaire on falls compiled by the Royal Society for the Prevention of Accidents was distributed to old people through some of the local organisations; the replies are awaited. 35 CARE OF MOTHERS AND YOUNG CHILDREN Infant Welfare Centres Centre Sessions Held Times Sessions Held Average Attendances Average New Cases The Clinic, Ashton Gardens, Chadwell Heath. Weekly Thursday, a.m. 42 2 Weekly Thursday, p.m. 37 2 The Clinic, Becontree Avenue, Dagenham. Weekly Monday, p.m. 31 2 Weekly Wednesday, a.m. 36 2 The Leys Clinic, Ballards Road, Dagenham. Weekly Thursday, a.m. 21 1 Weekly Thursday, p.m. 25 1 Rush Green Clinic, 179, Dagenham Road, Rush Green. (2nd, 4th & 5th in month) Friday, a.m. 11 1 Weekly Friday, p.m. 21 1 The Clinic, Ford Road, Dagenham. Weekly Tuesday, a.m. 36 2 Weekly Tuesday, p.m. 33 2 The Clinic, Manford Way, Hainault. Weekly Monday, p.m. 10 2 The Clinic, 15/17, Thompson Road, Dagenham. Weekly Tuesday, p.m. 27 2 Weekly Wednesday, a.m. 11.7.59.— 31.10.59. 35 Whilst Becontree Clinic was closed for alterations. Weekly Friday, a.m. 14 2 The Clinic, Oxlow Lane, Dagenham. Weekly Wednesday, p.m. 57 3 Weekly Friday, p.m. 54 3 Marks Gate Clinic, Lawn Farm Grove, Marks Gate. Weekly Tuesday, p.m. 35 2 36 HEALTH VISITING The Younghusband Report on social services called to task the present system of health visiting and suggested that social workers, trained in the techniques of case work in social services and administration, might well have a greater part to play in the future of local authority health services. How much routine visiting of the healthy infant is really necessary now that the maternity and child welfare services are known and accepted and now that the general practitioners are taking an increasing interest in the normal development of the children under their care ? Is it not now time to take stock of the position, and having seen with satisfaction the great improvement in the general health of mothers and children, the low maternal and infant mortality (for which much of the credit must go to the tireless energy and enthusiasm of the health visitors) conclude that the time has come for further efforts in different fields ? One problem solved, the next awaits. Which are the next most urgent problems? The old people? The handicapped? The mentally ill? The families with special difficulties (the so-called problem families)? To recapitulate on previous years' reports, the health visitors have visited all neonatal infants and then at intervals have followed the child until its fifth year, both at the clinics and in the home. This year, neonatals have been tested for phenylpyruvic amentia by the phenylketonuria test of the urine at 4 weeks old. 445 babies were tested and all were negative. This condition accounts for the biggest clearly defined group of cases of low grade mental deficiency after mongolism, and although the prognosis for life is fairly good, mental development is extremely poor. If, however, treatment is initiated early enough the mental degeneration can be arrested by arranging for the baby to be fed on a suitable diet. As this condition is extemely rare and results depend upon early treatment, it is important to test all children, particularly as no clinical signs appear at or just after birth. Special visits were paid to mongol children in the area, and each child was "paired " by random sampling with a normal child and visits made to these also. The health visitors continued to visit the families with special difficulties, to follow up children discharged from hospital, and one health visitor attended the hospital paediatric department to act as liaison. The clinic for the over sixties has involved a great deal of work for three of the health visitors specially concerned, but all have made visits to the aged. 37 Work of Health Visitors The following table shows the number of visits paid by the health visitors during the year:— (a) To expectant mothers First visits 160 Total visits 410 (b) To children under 1 year of age First visits 1,587 Total visits 6,274 (c) To children between the ages of 1 and 5 years Total visits 8,806 (d) Ineffective visits Total visits 2,891 (e) Other visits Total visits 2,063 Grand Total 20,444 38 MATERNITY SERVICES Maternal Mortality There were no maternal deaths in this area during 1959. Ophthalmia Neonatorum Four cases of ophthalmia neonatorum were notified, all of which made a complete recovery. There were 20 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 1959. County Midwives Midwives Residing at York House Traing Home Salvation Army Midwives Births Attended: As Midwife 136 200 41 As Maternity Nurse 163 2 6 Miscarriages Attended (included in above) 1 6 3 Visits Paid: As Midwife 2,679 7,671 895 As Maternity Nurse 3,991 147 117 Ante-Natal 2,162 1,443 229 Ante-Natal Clinics attended 246 102 50 Gas and Air Administered: As Midwife 115 92 7 As Maternity Nurse 93 2 1 Pethidine was given in 187 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 1st and 3rd Wednesday, p.m. 11 2 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 5 1 Weekly Wednesday, a.m. 9 2 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. 2 1 The Clinic, Oxlow Lane, Dagenham. Weekly Tuesday, a.m. 8 1 Weekly Tuesday, p.m. 11 1 Weekly Thursday, a.m. 10 1 The Clinic, Ford Road, Dagenham. Weekly Monday, a.m. 11 2 The Clinic, Manford Way, Hainault. Weekly Monday, a.m. 3 1 39 RELAXATION CLASSES The following were the attendances at the relaxation classes during the year:— Becontree Clinic 319 Chadwell Heath Clinic 276 Leys Clinic 456 Oxlow Lane Clinic 423 Total 1,474 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 — 1 4 14 19 19 Born alive at home and transferred to hospital 1 — — — 1 — Born in hospital 15 10 18 42 85 75 40 DAY NURSERIES DAY NURSERY ATTENDANCES JANUARY—DECEMBER, 1959 Day Nursery Number of approved places Average Daily Attendance Average No. on Register Total Attendances Goresbrook 70 26.2 37.5 6,693 Chadwell Heath 54 46 33.3 8,497 Kingsley Hall 40 19.2 13.2 3,380 TOTALS 164 91.4 84 18,570 Nursery Widows Parents Separated Desertion Illness of Mother Illness of Father Unmarried Mothers Socioeconomic Mothers working to supplement income Total Goresbrook — 3 - 5 1 5 5 25 44 Chadwell Heath 2 2 - 3 1 4 6 37 55 Kingsley Hall 2 4 - 2 - - 3 13 24 Number of children in all Nurseries 1959 4 9 - 10 2 9 14 75 123 On the whole the average daily and total attendances were higher than last year but, of course, were still much below capacity. The high fees remain a great deterrent and coupled with this is the difficulty experienced by the mothers in obtaining good jobs. This has been an increasing problem during 1959 and explains some of the fluctuations in our numbers. At least one third of the parents receive assistance with their fees; the remainder find it hard going to pay the full price and countless would-be entrants find the price prohibitive and make other arrangements for the care of their children. The need, unfortunately, has not diminished but for large numbers of people the high price they would have to pay would defeat its own object. But in spite of this, and moreover, in spite of the obvious economic pressure that the maintenance of the nurseries causes the authorities, they nevertheless have remained open. Not only have they remained open (and this is a commendable fact in itself) but they have remained as efficiently run and as generously equipped as when they were operating to full capacity. Both Chadwell Heath and Goresbrook nurseries are recognised training nurseries for the Nursery Nurses Course, and there seems to be no lack of candidates to restaff and no lack of trainees. The few handicapped children have obviously benefited by their stay in the nursery and continued to make progress throughout the year. 41 CLINICS AND CENTRAL OFFICE Becontree Clinic The 'new look' in clinic renovation and decoration was continued this year with the large programme of structural repair and complete re-flooring and redecoration of Becontree Clinic. The scheme met with approval from all concerned and in spite of the difficulties of closing the clinic from July until September, and moving equipment and records to Thompson Road Infant Welfare Centre and Five Elms School Clinic, there was the minimum of disturbance and the maximum of understanding from staff and patients alike. The work was completed within the allotted time by the Borough Engineer's staff, whose friendly co-operation and interest made the work so much easier. Leys Clinic Work was completed on the laying out of a car drive-in at Leys Clinic and was started on internal alterations of the clinic building. The changes were suggested by the Physiotherapy and Orthopaedic Department in the clinic because of the increase in amount of equipment and the inadequacy of the waiting room space. In 1960 the work will be complete and there will be a separate entrance, large enough for wheelchairs and directly accessible by ambulances to the Physiotherapy Department, and a self-contained waiting hall. The larger physiotherapy room will be cubicled. Speech therapy and school health will then be able to take over the other wing of the clinic, leaving the third wing for maternity and child welfare. Marks Gate The new Essex County Council Clinic at Marks Gate was opened in April, 1959, and though considerably smaller than Oxlow Lane is well planned for the limited uses of maternity and child welfare and school health. It is not, however, large enough to provide adequate space for chiropody and physiotherapy, which services are sadly lacking in the north of the borough. The attendances at Marks Gate have shown a steady increase throughout the year as the younger families move out to the new estate. Five Elms School Clinic The Education Department agreed that after 7 years Five Elms Clinic was in sore need of redecoration and this has now been almost completed, giving this quite inadequate accommodation at least a clean, gay look. Although these premises were not designed with the needs of a clinic in mind but are part of the school building, the area and number of schools covered by this clinic and the number of attendances annually make it impossible to consider closing the clinic and increasing the sessions at neighbouring clinics as we were able to do in the other two school clinics held on school premises at Hunters Hall and John Perry Schools. 42 Civic Centre Extensions Many meetings have been held during the year to discuss and plan the proposed extensions of the Civic Centre, one part of which was given Ministry approval in principle following a deputation to the Ministry of Housing and Local Government by members and officers in October. This proposal involves moving the health department to 1½ floors of a new wing behind and to the south of the present building to allow for larger office accommodation for all departments of the borough. Our present floor will be taken into the Borough Treasurer's domain. Centralisation of school health work will then be possible and will eliminate the duplication of all records and memoranda that the present inadequate space makes necessary as the staff cannot be accommodated at the central office. It should improve the facilities for visiting public who come to the department with questions and complaints and have to be interviewed by the staff in an open, overcrowded office, or have to wait their turn in an open corridor; a waiting room, inquiry office and interviewing room are planned in the new office block. 43 DOMESTIC HELP An analysis of the hours of service rendered by the Domestic Help Service during 1959 is given in the following table. Figures for 1958 are included in brackets. Type of case Number of cases Hours Help Provided Maternity 50 (50) 2,908 (2,655) Tuberculosis 6 (11) 1,027 (1,438) Acute 41 (57) 2,701 (2,906) Chronic Sick Aged 460 (377) 62,147 (55,601) Chronic Sick Others 92 (73) 17,958 (19,007) Aged Not Sick 3 (2) 361 (384) Others 13 (17) 3,749 (3,656) Totals 665 (587) 90,851 (85,647) Number of visits paid by Organiser 1,400 (1,343) Average number of domestic helps employed each week 80 (73) Number of visits paid by domestic helps 46,332 The chronic sick, whether aged or not, present the greatest problem to the home help section, both in sheer weight of numbers and in the urgency of the help required, and also in the protracted and often permanent need. The work of the home help service has increased considerably during the past year, due chiefly to lack of accommodation in hospital for the aged and chronic sick and the consequent demand for more daily service. The aim of the service is to help to solve the problem of housework responsibilities and to ensure that the aged living entirely alone have a friend in the home help who will lessen the burden of loneliness and helplessness in the advancing years. Whenever and wherever relatives of the chronic sick and aged can be contacted, the home help organiser makes a special plea to them for understanding and help for their older, distressed relatives. Only too frequently, however, they turn a deaf ear and the only help that can be got for many of the most needy cases on our books must come from the home helps themselves or from a kindly neighbour. Unexpected sickness in the housewife or her temporary absence from the chores on "maternity leave" make a smaller but urgent demand on the home help service, and in acute sickness cases every endeavour is made to help in the early stages to avoid more serious developments. The care of children is frequently necessary in the case of a mother having to enter hospital. The home help also visits the mother whilst in hospital to reassure her that her family is happy, which we hope helps towards a speedy recovery. Home help care for tuberculosis patients is now one of the numerically smallest calls on the service, but the few who still need the help find it is given with understanding by all the workers. 44 Recruitment to the service is a matter of careful selection as there is always a list of women willing to be domestic helps and every care must be taken to engage the right type of worker for this very worthwhile service. A training course is held twice a year at Chelmsford and its instruction is very much appreciated by the home helps who attend. This year two attended. It is not generally realised how much personal care and attention is given by home helps outside working hours, and the organiser hears from an outside source that weekend meals have been provided by a home help and taken to a sick person in need. Many times, too, the more able-bodied old folk have been collected by the home helps and taken to their own homes for a change and a little companionship. No report would be complete without a mention of the visit to the London Palladium and a Christmas Party for the staff which was held in Oxlow Lane Clinic. Both these activities were well supported and very much enjoyed by everyone. 45 FAMILIES WITH SPECIAL DIFFICULTIES During the year it was felt that a review should be made of families with special difficulties. I deliberately avoid the term problem families as this has come to have a meaning which is somewhat derogatory and by implication the parents are held to be at fault. As this is so often not the case I feel disinclined to use any expression which infers that it is. I prefer to think of these families as suffering from a social illness which is perhaps no more due to their own fault than physical and mental illness are the fault of those who suffer from them. Following a discussion with the health visitors it was agreed that about 54 families in Dagenham should be classified as families with special difficulties. It was found possible to divide these into three groups, based on a points system worked out in the London County Council. On this system 10 families scored less than 5 points and were regarded as slightly affected, 26 families scored 5—10 points and were more severely affected, while 18 were seriously affected. In order to give an indication of some of the difficulties involved I give below an account of a family with whom the health visitor might be trying desperately to cope. It is important in our dealings with these families that we should disclose no information which may embarrass them and thus interfere with the relationship we try to achieve with them. For this reason I have not described any one family but have used information about a number of families and joined it to form one whole. The family consists of father, mother and six children. They live in a three bedroomed house. The ages of the children range from 16 years to 18 months. The father is a labourer and a good workman (when he feels well enough to work) and the mother is backward because of limited intellectual development; she can read a little but cannot write. The eldest child (aged 16 years) is away in a mental defiicency hospital and the next child (aged 14 years) is at a residential school for maladjusted children. When we visited one day at 11.30 a.m., the youngest child was sitting in his pram, wet and dirty, with a crust of bread in his hand which he was trying to eat, and pus dripping from his ear. The two children of school age were at school, the 5-year-old having just recovered from measles. The 4-year-old rushed out of our sight as we entered the living room (he had been nervous of people since he had whooping cough). The hearth was empty although the living room was hot and stuffy. Dirty clothes were scattered about (mainly in the scullery) and the living room was extremely dirty. Upstairs the paraffin lamp in the front bedroom was still alight and the curtains drawn. The bedclothes were filthy and inadequate, the beds urine stained (all the children are bedwetters) and by the noise which came from under the bed it appeared that the 4-yearold had taken refuge there. 46 Mother said she was feeling much better than she had been, though when it was suggested she should make a more determined effort to wash the clothes she said she had scalded her foot so was unable to do so. She said her husband gave her £9 each week. In the last year she had committed herself to the hire purchase of a new television set, a radiogram and washing machine but because she had fallen behind in her payments these had been taken back by the different firms from whom they came. She was in rent arrears to the amount of £35 as well as owing money for the 14-year-old who is away at a school for maladjusted. An attempt has been made recently to help this mother by supplying a home help to try to educate her to a higher standard but she has not co-operated at all, if indeed she is capable of co-operating. While we were there she promised:— (a) to contact her own doctor about her scalded foot. (b) to treat the baby's ear with drops provided by the health visitor, at her own doctor's suggestion. (c) to get the dirty clothes washed. She will, of course, do none of these things unless coerced or bullied (not too fiercely) by the home help and the health visitor, who feels she is never off the doorstep. This mother has very little knowledge of cooking and appears quite incapable of making a fresh start. Her budgeting is non-existent and though at this both she and her husband may try to improve, efforts are neither sufficiently strenuous not maintained for long enough. Yet, there is in this home an atmosphere of affection—the children are fond of the parents and the parents, in their way, are fond of the children and it would be a mistake to break up this family so all the interested social agencies struggle on doing their best. The general practitioner gives his time and skill, the health visitor advice and help, the home help practical assistance and the home help organiser visits frequently. Many other agencies are involved in trying to lift-up the standard of this socially inadequate family. Dealing with this type of family, fortunately not very common, involves long and tedious hours of not very rewarding work in terms of quick or marked results, and for which the health visitor has perhaps not sufficient time at her disposal. Perhaps some thought should be given not only to the provision of a day housecraft centre but to a specialist worker to deal with selected families. 47 CHIROPODY SERVICE Two full-time and one part-time chiropodists were employed at the end of the year. Clinics are held at Ford Road and Ashton Gardens, Chadwell Heath, as follows:— Ford Road Ashton Gardens, Chadwell Heath Monday 2.00 p.m.—5.00p.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. 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 193 147 365 Total attendances 950 1,960 6,083 Cases still being treated at end of year 85 249 769 48 OCCUPATIONAL THERAPY The occupational therapist spends one day a week in the Dagenham area. There were 359 visits made to patients during the year, when the handicrafts taught were leatherwork, basketry, needlework, rugmaking and toymaking. The value of materials issued was approximately £75 and completed articles were sold at the Town Show by the After Care Association, and later, in November, a sale of work was held. Unfortunately, the foggy weather kept people away and many articles were unsold. A method of selling the work all the year round is very much needed as at present we have to depend on the Town Show and Christmas sales. Consequently, many patients are reluctant to make articles in January and February as there is no way of disposing of them, and the winter is a time when occupational therapy is needed more than ever. Recently, a show case has been installed at the Thompson Road clinic, where goods on show may be bought by the public. There is also a very great need for the services of another occupational therapist who could work mainly with the physically handicapped and with old people. Full use could then be made of the materials and equipment at present at Thompson Road clinic. Occupational Therapy for Domiciliary Chest Cases The following is a summary of work carried out from January 1st to December 31st, 1959:— Total of Patients Total of New Patients Total of Visits January 17 — 18 February 18 — 22 March 12 — 17 April 12 — 26 May 11 — 22 June 11 — 23 July 15 3 46 August 12 2 41 September 12 — 27 October 10 2 34 November 11 1 36 December 12 1 47 49 CONVALESCENCE AND RECUPERATIVE HOLIDAYS National Health Service Act Arrangements were made for patients as indicated:— Section 28: 3 Shoreditch Holiday Home. 1 Mrs. Bryce, The Take, Broadstairs. 12 Friendly Society Convalescent Home, Heme Bay. 1 Samuel Lewis Home, Walton. 1 St. Michael's, Clacton. 37 Bell Memorial Home, Lancing. 13 T.B. cases placed by Spero. 1 St. Joseph's Convalescent Home, Bournemouth. 2 Surrey Convalescent Home, Seaford. 1 Church Army Home, Bexhill. Section 22: 2 Mothers with children—Shoreditch Holiday Home. 2 Mothers with children—Lennox House, Southsea. School Health Service 88 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. 45 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 25 children were examined by school medical officers before being admitted or re-admitted to camp schools. 50 VACCINATION AND IMMUNISATION Vaccination against Smallpox During the year 1,497 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 296 666 - - 1—4 years 59 39 13 1 5—14 61 79 12 1 15 years and over 75 3 150 42 Total all ages 491 787 175 44 Whooping Cough 1,328 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. 264 769 32 2 261 — In the past few years the programme of whooping cough immunisation of the 3 — 4 year age group with a booster dose has been sadly neglected throughout the country, and no less in Dagenham than elsewhere. The reason for this lack of interest in maintaining the immunity conferred in infancy may be partly due to the diminution in the numbers of 3 — 5 year age group attending the infant welfare clinics, or to the more insistent demands of the poliomyelitis immunisation programme. B.C.G. B.C.G. vaccination has continued in the 13-plus age group; this year 1,900 children were offered vaccination. 938 children were tested after the parents' consent had been received. Results of the Multiple Puncture tests:— Negative 882 Positive 56 Of the children with negative reactions (and therefore susceptible) 787 received B.C.G. vaccination. There were no cases of post-vaccination complications. Tuberculosis Vaccines Clinical Trial Of the 477 young people invited for their sixth annual x-ray, 206 attended, i.e., 43% and of these 57% completed the skin tests. In addition, of the 180 who defaulted on the previous occasion, 35 came along this time. 51 DIPHTHERIA IMMUNISATION Diphtheria Immunisation of Under Fives Diphtheria immunisation has continued in the infant welfare clinics and by the general practitioners. The following is a summary of the work carried out during the year by medical officers and general practitioners. A total of 1,608 children received primary immunisation injections and a total of 1,784 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 627 365 2 1 1—4 years 162 141 28 18 5—9 years 165 31 549 225 10—14 years 108 9 832 129 Total all ages 1,062 546 1,411 373 Diphtheria Immunisation of School Children A total of 2,048 school children were immunised against diphtheria during the year (of which 394 were immunised by private practitioners). Booster diphtheria immunisation sessions have been continued in the schools and school clinics for the school entrants and school leavers, and only during the worst of the poliomyelitis immunisation rush in the early summer was it not possible to continue, but a full programme was resumed before the end of the year and all eligible were offered immunisation in the schools. The acceptance rate is still lower than I should like and there are still too many children coming to school who have not been immunised in infancy—some of these accept immunisation in school and a primary course is given to these children. 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. 59. i.e. born in year Under 1 yr. 1959 1—4 yrs. 1955—1958 5—9 yrs. 1950—1954 10—14 yrs. 1945—1949 Under 15 yrs. Total Last complete course of injections whether primary or booster 1955—1959 278 4,232 4,583 4,139 13,232 1954 or earlier — — 2,682 5,587 8,269 Estimated mid-year population 1,500 5,900 19,100 26,500 Immunity Index 18.5 71.7 45.7 49.9 52 Combined Prophylactics In May 1959 at a symposium on immunisation procedures, a schedule of combined prophylactics was recommended by the Burroughs Wellcome Research Foundation. This was as the result of much research and took into account schemes in many local health authorities, and covered the first 5 years of life. It would seem to have much to recommend it to the hard-pressed mothers who have to find time to take their infants for as many as 12 injections between the ages of 3 months and 5 years under the present scheme in this Area. Poliomyelitis The poliomyelitis immunisation programme for the 15—25 year olds was started in November 1958 and evening sessions were arranged but the response for the first few months was extremely poor until after the unfortunate death of a footballer in spring of this year, when the flood of enquiries and acceptors almost drowned us, and from an average attendance of 10—20 the numbers rose to 300—400 per evening session. After this initial demand a regular evening session once a week was arranged on an appointment system with an average of 200 injections at each session. This was continued until all the registrations in the 15—25 year age group had been dealt with and then the evening session was discontinued, to be started again at the end of 1959 for the booster doses of those who had received their primary course 7 months previously. The figures show that general practitioners have played a great part in the poliomyelitis immunisation scheme in the Area, and I would like to thank them for their understanding co-operation in the collection of vaccine and the completion of registrations. During the year a total of 13,603 primary injections (i.e. 2 doses) were given and 16,859 third injections. Immunisation 1959 By Medical Officers By General Practitioners Total Primary 7,061 (6,225) 6,542 (3,063) 13,603 (9,288) Booster 11,112 5,747 16,859 The corresponding figures for 1958 are shown in brackets. There was one case of non-paralytic poliomyelitis notified to the department in 1959. This was a boy of 6½ years who made a complete recovery. Total acceptors since commencement of scheme 33,419 Total primary injections since commencement of scheme 28,331 Total booster injections since commencement of scheme 16,859 53 THE OVER SIXTIES CLINIC—OXLOW LANE Last year's report contained a fairly full account of the activities at this clinic. It is sufficient to say that the activities extended to weekly exercise classes and that regular discussion groups were held, led by Miss Brown, the occupational therapist on loan from St. George's Hospital, Hornchurch. These are valuable as mental stimulation and in one case, as an experiment, a discharged hospital patient was referred there by the hospital consultant concerned. Unfortunately, the classes were not held frequently enough to answer her need for after-care but it may be that this need may point the way to a future day centre for such a purpose, if premises and staff can be made available, where after-care can be provided. During the year 34 new patients attended, 41 sessions were held and 106 patients were seen. An average of 20 patients attended the weekly exercise classes on alternate weeks. Towards the end of the year the waiting list was mounting and due to other commitments I was not always able to attend the Friday morning clinic, which meant that on some occasions it had to be cancelled. It was decided to use the services of Dr. Hodgson to help out at the clinic and in November she began to attend on Friday mornings, and has taken a great interest in the patients. The discussions held at the Thursday afternoon exercise classes are recorded and there follows an account of one such:— The group were asked whether on retirement they would prefer to live in a little house near their children and families or in a house in an old people's community. One member expressed the view that it was wrong to live near one's children and in any case, he did not see why a council or anybody else should push him around by telling him where to live because he was old. He said that nobody was interested where he lived when he was 20 years old, why should they be interested now. It was then explained that the purpose of the discussion was to find out the members' views on the ideal place for old people to live; whether in a house on their own in an old people's community, in a small house by themselves in a community of younger people, or in a little house somewhere away from anybody. One old gentleman said that he would prefer to live entirely by himself. He said that if old people live with young people "the children are all feet," and if they live with other old people they disagree. One old lady said that she would prefer to live in a bungalow on her own amongst elderly people like herself because they would understand each other better. She said 54 that if old people live in a community of younger people the children are noisy and get on the old people's nerves, and once they realise they are doing so make more noise from sheer bravado. She would much rather live in a bungalow on her own amongst old folk. She then told the group about an encounter she had had with another old lady the previous week at a civic restaurant. The old lady was almost in tears because she was not happy at home with her daughter who had taken her away from an old people's home where she had previously lived and which she wished she had never left. She wanted to go back there to see some of the people she had known. One gentleman thought that dispersal of old people's dwellings was much better than grouping them together. He lived in a block of old people's flats. Some of the occupants were housebound and saw nobody but themselves and those around them, and consequently spent most of their time checking up on the activities of the other tenants and gossiping. A very active lady, who is a member of an old people's concert party, said that she lived on her own in a little house. Her children were very good to her but she would not go to live with them. She was often out late and if she lived with her daughter she might disturb her and the children, whereas now she could come and go as she pleased. Her nearest daughter lived about 10 minutes walk away and this, she felt, was quite near enough. Another lady lived in a square of 26 old people's bungalows. The occupants kept themselves to themselves and rarely came out. A lawn had been provided for the tenants' use but as it was rarely ever used the lady felt that a recreation room would have been much better. The bungalows were built too near a housing estate where there were a lot of children running about and making a noise. One gentleman was definitely against segregating old people's dwellings. He felt that if old people did not mix with the younger generation they would become prematurely old. They had all been through the same phases and therefore this should not be difficult. The main thing was to move with the times. When asked whether they thought that old people had anything to offer the younger generation, the group said that young people do not accept advice and accuse them of being old-fashioned. They did find, however, that they usually turned to them in trouble. A lady who had been living in a council house for a number of years was very happy there, and although her neighbours were younger they got on very well together and were a great help to each other. Her husband was now in poor health and could not look after the garden and she was afraid they would soon have to move to an old people's bungalow because of this. It was generally felt that old people should be consulted by those who plan dwellings for old people. One gentleman felt that as senior citizens old people should be given priority with regard to amenities, whilst another felt that this should not be the case as old people are better off now than ever they were. The whole question of the most suitable living accommodation for old people seemed to depend very much on the individual himself. 55 SCHOOL HEALTH, 1959 School Premises There are 17 secondary and 45 primary schools in the Borough, also 2 special schools. Children on the registers on 31st December, 1959 totalled 20,319, a decrease of 549 compared with 1958. Public health inspectors carried out periodic inspections at school kitchens and schools were visited for the purpose of obtaining samples of milk for bacteriological testing. 12 such samples were obtained during the year, none of which failed to pass the methylene blue test. SCHOOL INSPECTIONS As in previous years, medical inspection in the schools during 1959 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—i.e., children at nursery and special schools, or who missed the periodic examinations. 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:— (i) 5—14 year age group 5,195 (ii) Others 1,153 Total 6,348 B—Other Inspections Number of special inspections 1,625 Number of re-inspections 1,462 3,087 56 6,348 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 Inspection Entrants Leavers Others Total (all groups) Treatment Observation Treatment Observation Treatment Observation Treatment Observation Treatment Observation 4 Skin 15 29 8 3 29 36 52 68 58 26 5 Eyes (a) Vision 25 21 79 23 188 113 292 157 42 29 (b) Squint 26 22 1 4 18 23 45 49 5 5 (c) Other 4 13 - 6 15 23 19 42 32 10 6 Ears (a) Hearing 7 1 7 2 11 13 25 16 30 5 (b) Otitis Media 2 1 3 1 12 - 17 2 28 16 (c) Other 4 2 8 - 6 1 18 3 2 1 7 Nose and Throat 43 96 5 5 33 65 81 166 43 39 8 Speech 13 42 — 2 10 22 23 66 61 18 9 Lymphatic Glands 8 22 — — 5 9 13 31 15 19 10 Heart 9 11 4 4 9 24 22 39 5 26 11 Lungs 7 38 3 11 16 50 26 99 35 36 12 Developmental (a) Hernia 2 4 1 — — 2 3 6 — 1 (b) Other 4 9 2 3 4 15 10 27 4 3 13 Orthopaedic (a) Posture 9 11 3 6 19 37 31 54 4 4 (b) Feet 10 16 7 9 46 40 63 65 13 4 (c) Other 16 45 3 12 16 69 35 126 125 65 14 Nervous System (a) Epilepsy 1 1 — 1 3 6 4 8 3 2 (b) Other — 5 1 4 5 4 11 10 14 15 Psychological (a) Development 22 12 — 2 19 28 41 42 4 7 (b) Stability 8 25 — 2 13 27 21 54 16 13 16 Abdomen 1 — — — 2 2 3 2 — — 17 Other 154 19 30 3 123 25 307 47 186 249 57 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) (1) For defective vision (excluding squint) (2) For any of the other conditions (3) Total Individual Pupils (4) 1955 and later - 23 23 1954 8 109 109 1953 12 185 185 1952 7 43 48 1951 1 10 11 1950 5 1 6 1949 11 14 23 1948 69 205 259 1947 43 114 143 1946 3 6 8 1945 51 118 150 1944 and earlier 82 87 160 Total 292 915 1,125 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 condition 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 Age Groups Inspected (By year of birth) No. of pupils Inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory No. % of Col. 2 No. % of Col. 2 (1) (2) (3) (4) (5) (6) 1955 and later 91 90 98.91 1 1.09 1954 775 769 99.22 6 0.78 1953 793 788 99.36 5 0.64 1952 164 162 98.75 2 1.25 1951 71 68 95.76 3 4.24 1950 44 43 97.72 1 2.28 1949 242 240 99.17 2 0.83 1948 1,426 1,414 99.15 12 0.85 1947 703 698 99.28 5 0.72 1946 26 26 100.00 — — 1945 969 963 99.15 6 0.85 1944 and earlier 1,044 1,042 99.82 2 0.18 Total 6,348 6,303 99.28 45 0.72 58 Uncleanliness The number of children found with vermin and/or nits during the year was 123. 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. Late in the year, arrangements were made with Hackney Borough Council to take persistent offenders to be cleansed in Hackney for a small fee, for which the Education General Purposes Committee agreed to take responsibility. 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 17,479 (ii) Number of instances of infestation found 132 (iii) Number of cleansing notices issued (Section 54 (2) Education Act, 1944) 132 (iv) Number of disinfestations carried out:— By school nurses 21 By parents 111 VISUAL DEFECTS Vision tests were carried out on all children at the school medical inspections and 292 referred for treatment at the Ophthalmic Clinics and 157 kept under observation. Eye Diseases, Defective Vision and Squint Number of cases dealt with By the Authority Otherwise External and other (excluding errors of refraction and squint) 424 249 Errors of refraction (including squint) — 1,266 Number of pupils for whom spectacles were prescribed — 600 59 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 following table shows the number of defects found. Intermediate periodic medical inspections School leaving inspection At age 14 years Tested for colour vision 2,397 1,044 969 Found to have defect of colour vision 34 15 10 X-ray of Staff All new entrants to the County Council staff who are liable to come in contact with children or who handle food are required to have an x-ray of their chest. The following table shows the number of staff x-rayed during the year. Number X-rayed At a Chest Clinic By Mass Radiography Tuberculosis Visitors and Health Visitors doing tuberculosis work — — Home Nurse/Midwives 2 — All Day Nursery Staff 9 — All Occupation Centre Staff 2 — Domestic Helps 1 — Others 3 4 Teachers 16 38 Non-teaching Staff 13 53 60 SCHOOL CLINICS During the year 2,987 children were seen by the school medical officer and 6,073 attendances were made at nurses' clinics. The total number of attendances made by school children at each of the minor ailment clinics during 1959 were as follows:— Ashton Gardens 620 Bentry School 110 Becontree Avenue 1,386 Five Elms 3,133 Ford Road 15877 King's Wood School 575 Leys 355 Oxlow Lane 944 9,000 Other Treatment Given New Cases Treated By the Authority Otherwise (a) Miscellaneous minor ailments 927 61 lb) Other (1) Heart and rheumatic diseases — 22 (2) Hernia — 10 (3) Major respiratory diseases — 36 (4) Major digestive diseases — 90 (5) Major injuries — 27 (6) Other major disease — 89 (7) Enuresis — 20 Total 927 355 Diseases of the Skin (Excluding Uncleanliness) Number of new cases treated during the year By the Authority Otherwise Ringworm (Scalp) - - Ringworm (Body) - - Scabies - - Impetigo 17 1 Other Skin Defects 646 14 Number of examinations made by Skin Specialists 8 61 Diseases and Defects of Ear, Nose and Throat No. of children referred to Consultants during 1959 40 Number of cases treated By the Authority Otherwise Received operative treatment (a) For diseases of the ear — 61 (b) For adenoids and chronic tonsillitis — 122 Received other forms of treatment 132 78 Total 132 261 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 437 429 10 4 10—12 + years 1,248 1,149 63 46 14 years 455 487 10 19 Other periodic 1,162 981 39 33 Total 3,302 3,046 122 102 Employment of Children 178 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 10R Med.) 43 2. Entrants to Teachers' Training Colleges (Forms 4 R.T.C.) 13 3. Essex County Council 65 4. Dagenham Borough Council 139 5. Other Authorities 4 (b) Under Sickness Regulations 5 (c) Other purposes 77 Number of consultations with specialists arranged 49 Home Visits by School Nurses 3,910 visits were made by school nurses to the homes of school children during the year. 62 DENTAL SERVICES Inspection and Treatment No. of Dental Officers at end of December, 1959 3 No. of sessions carried out during the year 914 No. of children on waiting list 253 No. of children on waiting list in 1958 426 No. of children inspected in 1959 3,863 No. of children inspected in 1958 2,031 No. of treatment sessions in 1959 850 No. of treatment sessions in 1958 723 No. of children who received treatment in 1959 1,758 No. of children who received treatment in 1958 1,632 Dental Inspection and Treatment of School Children Periodic Specials (a) Number of pupils inspected 2,094 1,769 (b) Number found to require treatment 1,140 1,617 (c) Number offered treatment 1,140 1,616 (d) Number actually treated 451 1,307 (e) Number awaiting treatment 161 92 (f) Attendances made by pupils for treatment 669 4,497 (g) Half days devoted by (a) Dental Officers to— (i) Inspection 64 (ii) Treatment 850 (h) Fillings (i) Permanent teeth 3,490 (ii) Temporary teeth 836 (i) Number of teeth filled (i) Permanent teeth 2,877 (ii) Temporary teeth 732 (j) Extractions (i) Permanent teeth (a) on account of caries 763 (b) for other purposes 25 (ii) Temporary teeth (a) on account of caries 1,433 (b) for other purposes 5 (k) Anaesthetics administered (i) Local 1,218 (ii) General (a) by Medical Officers on County Staff 182 (b) by others 686 63 (l) Orthodontics (i) Cases completed 12 (ii) Cases discontinued 46 (iii) Pupils treated with appliances 52 (iv) Removable appliances fitted 23 (v) Fixed appliances fitted — (iv) Total attendances 152 (m) Dentures (i) Number of pupils supplied with artificial dentures 10 (ii) Number of dentures fitted 10 (n) Other operations (i) Permanent teeth 582 (ii) Temporary teeth 236 (o) Analysis of figures in (n) Type of operation Number Silver Nitrate Treatment 156 Scaling 179 Syringing Sockets 14 Dressings 310 Inlays fitted 1 Other operations 158 (p) X-rays 154 Mother and Child Welfare Dental Treatment Expectant or Nursing Mothers Children under five years of age Number of patients examined 101 96 Number of patients needing treatment 88 82 Attendances for treatment 311 172 Number of patients who have completed treatment 36 41 Number of extractions 243 72 Number of fillings 157 121 Number of anaesthetics administered: (a) local 91 10 (b) general 22 26 Number of scalings or scaling and gum treatment 17 3 Number of dressings 15 11 Number of dentures provided: (a) full 11 — (b) partial 18 — In 1959 the number of part-time dental surgeons working in the Dagenham area has varied from 6 to 3 at the end of the year. A comparison of the number of children inspected and treated in 1958 and 1959 shows that an adequate service cannot be maintained with only 3 part-time officers. I can only report that when we have adequate staff an adequate service can be offered in clinics accessible to the children. Until such time, or until the School Health Service no longer takes responsibility, however token, for the prevention and treatment of dental caries in children, the figures cannot give a complete picture of those requiring treatment. 64 SPECIALISTS 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 local health authority. The physiotherapist attends five days a week and the surgeon attends once a month. I give below a report received from Mrs. E. Ottley, the physiotherapist:— The Physiotherapy Department re-opened on May 1st, 1959 after being closed for 2½ months, owing to the resignation of Mrs. F. Cocker. All patients on the books were notified of the re-opening and treatments recommenced. An appointment system was started and all infant welfare children were treated individually, and school children were grouped into classes where practicable. Each week 4 foot classes were held for girls and 4 for boys, with approximately 10 children in each class. Posture classes and breathing classes, one of each for boys and one of each for girls, were also held weekly. Two sessions a week were directed to ultra violet ray treatment and 13 infant welfare children, 13 school children and 4 adults were treated since May. Some adults are referred from King George Hospital, Ilford, and others are referred direct from local general practitioners. A waiting list is not kept as a patient is always seen initially to ascertain urgency of treatment, and treatment commenced. Patients seen during 1959:— Infant welfare children 57 School children 366 Adults 43 Total 466 Total number of treatments given 6,174 Included in the above figures are 30 patients who received a total of 300 ultra violet ray treatments. The orthopaedic surgeon attended 8 sessions at which 94 patients were seen, 34 of which were new. As this clinic is so inaccessible by public transport I make greater use of the ambulance service than would otherwise be necessary, and I should like to express my appreciation of the efficient and courteous co-operation given by this service. 65 Ophthalmic Clinic At the ophthalmic sessions held at Becontree Clinic twice a week by Dr. Macfarlane and Dr. Regal, a total of 1,536 children were seen, of which 363 attended for the first time. The following is a report of their work submitted by the doctors:— Patients are referred to us mainly by the school medical officer after the routine examination at school, some are sent from the infant welfare clinics, a few are sent by their family doctor, and in a number of cases the parents approach the clinic on their own initiative. We also find that in some instances it is the teacher who sets the ball rolling, mentioning to the parents any abnormal behaviour in the child which makes it seem advisable that the child's eyes should be examined. New cases referred to the clinic are usually seen within a fortnight or so, but there is an accumulation of old cases needing to be seen again, and it is difficult to keep up with the ideal of 6-monthly visits. An additional weekly clinic is necessary if these retests are to be kept up to date. For three months during 1959 the clinic was held at Five Elms while the premises at Becontree Avenue were being redecorated, but this did not affect the average attendance per clinic. Each week there are parents and children who fail to attend, without any reason being given, and this is very frustrating both to the nurse and to the ophthalmologist. In the course of the year we see all types of congenital abnormalities of the eyes as well as acute and sub-acute pathological conditions, but the majority of cases are those with refractive errors and with squints. Squint cases needing operation can now be referred either to Oldchurch Hospital or to King George V Hospital, where beds can be found for them almost at once. In one of the clinics at which 213 new cases were seen, 125 required glasses and 13 were sent on to an orthoptic department for exercises as part of their squint treatment. Of the remaining 627 old cases, new glasses were prescribed for 256 children and 9 children had the lenses altered, using the old frames. We feel that there is still a need for a dispensing optician to attend at the clinic as many broken glasses could then be repaired on the spot and prescriptions could be dealt with more quickly. This has been proposed to the Regional Hospital Board, but so far with no success. We wish to mention the arduous work of the school nurses who attend the clinics and do all the visiting necessary to supply new cases with mydriatrics and to follow up non-attendance. 66 Audiometric Tests 34 children have been tested with the audiogram. 14 were referred to Grays Inn Road Hospital, of which 2 have been supplied with hearing aids, and the rest are having treatment. 14 are being kept under observation, 3 we were unable to test conclusively and in 3 nothing abnormal was discovered. Child Guidance 76 children from Dagenham were seen at the Romford Child Guidance Clinic. There is still a 3—4 months waiting list, except in court cases when the child is seen within 2—3 weeks. Other Specialist Clinics School medical officers refer children to hospital consultants for opinion or for treatment at specialist clinics; 194 children were so referred during the year as follows:— Chest Physician 12 Cardiologist 16 Orthopaedic Surgeon 11 E.N.T. Surgeon 40 Dermatologist 8 Paediatrician 56 Enuresis Clinic 22 Ophthalmologist 11 Audiologist 18 194 Speech Therapy The following is the report of their work submitted by the speech therapists, Miss E. N. Symes and Miss E. R. Shipley. The work of the Speech Therapy Service has continued throughout the year. Two therapists still hold full-time appointments in the Borough. We are pleased to report that two more clinics have been opened during 1959, at Ashton Gardens and Marks Gate, making a total number of six clinics where treatment is now available. Speech therapy sessions were held at the following clinics during 1959:— Five Elms School Clinic, Wood Lane Miss Symes and Miss Shipley Leys Clinic, Ballards Road Miss Symes Oxlow Lane Clinic Miss Symes The Bentry School, Heathway Miss Shipley Ashton Gardens Clinic, Chadwell Heath Miss Shipley Marks Gate Clinic Miss Shipley 67 We are glad to have the services of three student speech therapists who help for four sessions at the Five Elms Clinic and at the Bentry School. Facilities for audiometry already exist within the Borough and this service is carried out by the school nurses. To relieve pressure of work in that department we would, if desired, be prepared to carry out any audiometric testing of our own cases where impairment of hearing is suspected. For some time we have felt that a quarterly Parents' Meeting is desirable to enable us to meet parents socially and in particular the fathers who, for business reasons, are unable to attend during the day. This matter is under consideration at the moment. Speech Therapy Statistical Return 1. Number of treatments given 2,665 2. Number of patients treated 217 16 patients were treated at The Bentry School 94 „ „ „ „ Five Elms Clinic 24 „ „ „ „ Ashton Gardens Clinic (8 of these were transferred to Marks Gate in September, 1959) 10 „ „ „ „ Marks Gate Clinic (including 8 mentioned above) 52 „ „ „ „ Leys Clinic 21 „ „ „ „ Oxlow Lane Clinic 3. Number of sessions held:— 109 at the Bentry School 332 at Five Elms Clinic 76 at Ashton Gardens Clinic 15 at Marks Gate Clinic 156 at Leys Clinic 77 at Oxlow Lane Clinic 765 One session was used on most weeks in both Miss Shipley's and Miss Symes' clinic for school visits or interviews. 4. Case Load—Boys 144 Girls 73 Total 217 5. Types of cases treated:— Dyslalia 106 Delayed development including aphasia 17 Sigmatism 31 Stammer 40 Stammer and dyslalia 7 Defect associated with hearing loss 2 Cleft palate . 1 Disorder of voice 3 Unclassified 10 6. Number of cases on register at 31st December, 1959 131 7. Reasons for discharge:— Speech normal 52 Non-attendance . . 13 No further progress likely 8 Transferred to another school Left school 7 Discharge requested by parent . . . . 1 Total 86 68 HANDICAPPED CHILDREN Children Under 5 and Kingsley Hall Assessment Centre The review continued with special emphasis on selection of children for the proposed Handicapped Assessment Centre which was finally given Ministerial approval in August and County Council agreement to the detailed plans and proposals in December. By the time this report is printed Kingsley Hall Day Nursery will have closed for three months for structural alterations and complete redecoration, staff appointed and the first children, some of whom were recommended as many as 3 years ago, will have been admitted. Unfortunately, since the initial review many of the most urgent cases have had to be dealt with in other, sometimes less satisfactory, ways where the home situation had become intolerable. In other cases the child has given up the unequal struggle against severe handicap and two of these children have died since the first review in 1957. Others again have survived and are past the 5 year age limit and have been passed over to the education and mental health services. School Children The table shows the number of children with classified defects in the school and pre-school population. Children who attend normal schools but were registered 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 217 children were seen at these routine follow-up examinations and the following recommendations were made:— (1) Doing well in normal school 149 (2) Referred for hospital check 1 (3) Referred for special schooling:— (a) Residential 23 (b) Open Air School 2 (c) Special School for E.S.N. 4 (d) Did not attend 38 In addition, 9 special recommendations for children to see the youth employment officer regarding employment were made. These children are reviewed every 6 months by the medical officers and their progress reported. Those children more severely handicapped are referred for special educational treatment at different schools, both day and residential. 69 SUMMARY OF HANDICAPPED CHILDREN N.B. These figures include 22 school children with dual handicaps and 10 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 (19 with dual defects) — 7 8 8 33 — 177 1 — 62 - 296 Awaiting Placement in Day Special School — 1 - 1 2 — 15 1 — 1 — 21 Attending Residential Special School (2 with dual defects) 4 — 2 1 18 — 14 — 19 6 3 67 Awaiting Placement in Residential Special School — — — — 2 — 1 — 3 — 1 7 Attending Boarding Homes - - - - - - - - - - - - Awaiting Placement in Boarding Homes - - - - - - - - - - - - Attending Independent Schools - - - - - - - - - - - - Awaiting Placement in Independent Schools - - - - - - - - - - - - Receiving Home Tuition - - - - - - - - - 3 — 3 Awaiting Home Tuition - - - - - - - - - - - - Total number of children of school age requiring Special Educational Treatment 4 8 10 10 55 - 207 2 22 72 4 394 Children of school age on register of Handicapped Pupils at ordinary schools (1 with dual defect) - 14 - 10 88 - 33 10 10 49 3 217 Pre-school children on register of Handicapped Pupils 3 3 — 2 6 — 12 6 — 16 2 50 Pre-school children already receiving S.E.T — — — — — — 1 — — — — 1 TOTAL 7 25 10 22 149 — 253 18 32 137 9 662 ] 70 BENTRY SCHOOL Last year, the Bentry Special Schools, both Physically Handicapped and Educationally Subnormal, were the subject of a long report and this year there is nothing new to add, except for the appointment of a physiotherapist for 5 sessions per week to the school, which has already in the last 3 months of the year made considerable difference to the spastics and hemiplegics. Mr. Hurton, the headmaster, has continued to give the medical and nursing staff every help. The school nurse attends three times a week and also goes swimming once a week with the physically handicapped children, and the medical officer has a regular weekly session in the school. During the year a second school medical officer has attended regulary to help to complete the review ascertainment of all the children in the educationally subnormal school. The children had their poliomyelitis and diphtheria immunisation at the school, and for the last few months of the year those urgently requiring dental treatment were transported to the Oxlow Lane Dental Clinic at a weekly session. Physiotherapy The following is the report of Mr. A. Brand:— The year 1959-60 was a successful year for physiotherapy at Bentry School. Over 1,000 treatments in all were carried out up to the autumn term, and considerable improvement noticed. In the autumn term we were fortunate enough to secure the services of another physiotherapist, Mrs. Cocker, who was able to treat the children three times a week while I devoted myself to sessions at the swimming bath. At these swimming sessions my aim is to teach the children to swim so that they have at least one sport or hobby at their command. Even the most severely disabled can then feel that there is something from which they are not barred. We have been quite successful again this year and four of the most severely handicapped children are aow swimming by themselves. Once again I would like to thank Mr. Jones, Sports Organiser at the South-East Essex Technical College, the bath attendants and also the voluntary helpers for their and co-operation and help. Mrs. F. Cocker reports:— As I have been at the Bentry School for only three months I cannot give a very full report on physiotherapy here or report much progress, but I have great hopes for the uture. The children are very happy and co-operative and mostly very keen to help hemselves, but as in all physiotherapy departments, lack of time is my greatest enemy is so many of these physically handicapped children could benefit from daily treatment, i am seeing as many of the parents as possible and trying to instruct them in a scheme if physical activity so that they may help their children at home. 71 I wish it were possible to have a consultant visit the school at regular intervals so that we could discuss such things as walking aids, apparatus etc., instead of working somewhat in the dark in some cases. I do know that this presents a great problem, especially as so many hospitals and authorities are involved; I am not even sure that there is a solution. Treatment of the physically handicapped child under school age is very important; I am sure that much can be done in these vital years before going to school to instruct the parent and help the child, and often save much time and handicap in later years. 72 handicapped school-leavers and after-care A survey of school leavers has been made by the school nurses to find out how much more medical and social help is needed in each case, and whether or not they are still employed. A summary of this survey is given below:— Defect Male Female Working Satisfactorily Unsatisfactory work Not Working Need Help Sheltered Employment T raining Socially Medical Heart 3 3 3 1 1 — — — 1 Delicate 8 8 11 2 2 1 1 — 1 Deaf 1 — 1 - - - - - - Partially Deaf 1 2 3 - - - - - - Blind 1 - - - - - - - 1 Partially Sighted 2 2 4 - - - - - - Cerebral Palsy 3 4 1 — 5 2 — 1 — Epileptic 2 — 1 — — — — 1 — E.S.N 21 14 27 1 5 1 — 1 1 Physically Handicapped e.g. Polio, Congenital defects 13 11 8 3 7 2 - 2 4 Maladjusted 1 1 2 - - - - - - Speech 2 — 2 — — — 1 — — Totals 58 45 63 7 20 6 2 5 8 The table shows that of the 103 children seen, 58 male and 45 female, 63 are in satisfactory employment, 7 are doing unsatisfactory work, 5 are in sheltered employment, 8 are in training establishments and 20 are not working; 8 need further medical or social help. At the school leaving interview the children considered to be unemployable are referred to the Welfare Department of the County which leads us on to the vexed question of welfare provision by the local authorities under the National Assistance Act, 1948. The handicapped school leaver is the end product of a carefully designed but complicated system of ascertainment and provisions by the Education and Health Departments ot local authorities. This system, built up over the years by the Education and School 73 Health Services, fortified as it is by Acts of Parliament and subsequent Regulations—the last and operative of these being the Handicapped Pupils and Special Schools Regulations, 1959, has in itself inherent disadvantages when the school leaver is considered as a potential adult starting a new life in the professional and industrial world. There must be a clear differentiation between the handicapped as defined in the Handicapped Pupils Regulations,1959, categories which are defined for educational purposes only, and those handicapped by mental or physical disability for employment. The two cannot be exactly related because the demands of both are different. From the point of view of the school leaver and the adult handicapped, the categories can and should be broadened and redefined on the basis of the degree of disability and, (a) whether of organic nature, for example, congenital heart, epilepsy, asthma and all the types registered by Handicapped Pupils Regulations as delicate (b) or of a congenital or acquired defect of limb movement and use. The questions that the employment services want answered by the school medical officers fall into these broad outlines and not into the definitions of the education system. Up to a point the National Insurance categories for disablement benefit attempt to do this but this is a retrospective and not a predictive assessment. The aims of the School Health Service are, therefore, twofold. Firstly, to ascertain children for their education, and secondly, to make a predictive assessment of the child at the end of its school life on the suitability of employment, and if this is beyond the scope of the child then to act as liaison between the unemployable child and the welfare services. To fit the child into the education system is now relatively simple; a detailed scheme of ascertainment and placement into a wide variety of schools provided to cover all types of disability ensures that all children can now have education suited to their age, ability and aptitude. As far as the ascertainment and placement of handicapped children is concerned there remains only the problem of the pre-school child who by the nature of his defect or disability is precluded from enjoying the normal activities of the toddler and, most important, frequently remains isolated in the home until he is placed in a special school. Experience in dealing with all types of handicapped children shows that the earlier the child learns to live with his disability and to adjust to mixing with other children, the sooner will he be socially and emotionally mature. So important is it that the handicapped children receive the most suitable education that their accurate ascertainment and correct placing must be assured. To improve this in this area we are starting a special nursery for the pre-school child, handicapped by physical or mental disability, so that they may be more accurately assessed for schooling ; 74 and so that they may learn to mix with other children and be ready for the type of special schooling most suited to their handicap when the time comes. Handicapped school leavers, on the other hand, require a different orientation on the part of the school medical officers from the school child or pre-school child. For these children the question of paramount importance is how they will fit into the pattern of local employment, a pattern which varies greatly throughout the country with 100 years has meant that there is less unskilled labour and it is now less easy to find a niche for the mentally or physically handicapped in highly organised industry where the work of the whole depends on the continuity and speed of the work of each. In many areas the only contact the School Health Department has with local industry is the completion of Ministry of Labour Form Y9. This form is not sufficiendy informative because it is not a medical referral form as it should be between doctor and doctor and is therefore stultified, relating only to what the child cannot do. The school medical officers know little about local industry though a lot about the child's capabilities within the educational system in which they have observed the child for ten or more years. There is, therefore, no one suitably trained or knowledgeable enough to whom the youth employment officer can say, " Can this boy do such and such a job ? " In this area we are fortunate to have two or three large factories with industrial medical officers who assess the school leavers in the light of the vacant job, knowing what that job involves. However, these large factories are mainly heavy industry with a conveyor belt system and cannot easily assimilate handicapped young adults and cannot or will not afford to have slower paced workers. It is in the smaller factories of light industry that the children are most easily and happily placed but where there is little or no medical supervision. Here it is important to differentiate between the physically handicapped and the educationally subnormal school leaver. Frequently, we have found that the educationally subnormal school leavers are socially more mature than the Secondary Modern school leaver because of the greater emphasis placed on social adaptation in the special schools, but they are emotionally immature and will more easily break down under the stress of employment and mixing with the stronger willed teenagers in modern industry. They miss the sheltered atmosphere of the special schools and frequently feel misfits in the pattern of employment for the first two years until their emotional maturity has caught up with the social adjustment, and they have learnt to hide or cover their defective educational attainments or reached an age or found a job where these are no longer of importance. The aim of the training the child receives at school should be to fit him for life outside and not only to educate him in the narrower sense of the academic and scholastic field. Unfortunately, too many of the special schools tend to give too little attention 75 to vocational training of the handicapped so that when they leave school they are not only below the educational standard of their normal competitors for employment but they have no alternative vocational skill which they can flaunt in the face of the opposition. An excellent example is the teaching of shorthand and typing to intelligent physically handicapped children, but in very few special schools are there adequate provisions although this is an accepted part of secondary (modern) education. In Dagenham, the special school teaches boot repairing to the boys with the result that almost all the less intelligent physically handicapped and the educationally subnormal boys want to be boot repairers so the industry locally is saturated and the standards and conditions of employment cannot be improved because there is no shortage of labour. For example, one boy with a T.B. hip and severe contractures who had missed a lot of schooling and was therefore below average in attainment but very good at cobbling, is employed in a local small boot repair shop where the conditions of work are quite unsuitable. The benches necessitate standing all day and there are no facilities for a rest at any time during the over-long hours at work. The manual skill of many of the children from special schools, whether they are educationally subnormal or physically handicapped, is great enough for them to be trained for one or two years after school and so overcome the difficult years between school and open employment, but the Ministry of Labour will not accept a school leaver for training unless a job can be guaranteed for him at the end of his training. This requires an act of faith on the part of local employers and means that the youth employment officer and the school must be completely certain of success—thus excluding many potentially suitable children who have not yet proved themselves in the narrower field of school activities. So far, I have considered only the children who, with or without training, will be able to be employed in open industry—but in periods of unemployment the number of these children from special schools decreases and it is all the more necessary to provide for their employment and training in the type of workshops set up by Remploy. All forms of sheltered employment, meaning work for which a wage is paid but not at competitive market rates, to be wide enough in scope to offer a range of work must be heavily subsidised, and the provision of a complete national network of factories and training establishments for handicapped people is a matter for urgent legislation as part of the social services. If such training establishments and/or sheltered workshops were provided in adequate numbers many of the school leavers who need only a few more years of supervision and training could pass through this phase of assisted, subsidised employment and enter open industry at a later age, equipped with a special skill in one field. A further difficulty in the second group—those requiring training or sheltered employment—is found; the reluctance of disablement resettlement officers to accept a 76 child on leaving school at 16, preferring and using as a defence their instructions to wait until the boy or girl is 18 before placing them in Remploy and thus emphasising to the school leaver the enormous obstacles that face a handicapped person beyond school age. Too frequently these young adults find 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. " 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 16—18 year-olds is urgently needed. Until this is done it is inevitable that these young people should develop into homebound, handicapped adults needing to have ordinary social services brought to them and becoming dependent on outside help in the house. They then become, like those handicapped in adult life through illness or accident, the responsibility of the welfare departments. The third category of school leavers is the unemployable and it is to these children that most help must be given. The number is smaller but still unnecessarily large because instead of three equally workable categories, the fully employable, the assisted employable and die unemployable, we have in fact only those who can find work and those who can't, with a very few who can be placed in the totally inadequate Remploy factories. At the special school in this area arrangements have been made for the youth employment officer, the welfare officer responsible for the handicapped in the County, the school medical officer and the headmaster to attend a full school leaving interview with the children and their parents so that there is as close a liaison between the three departments as possible at this level. The medical officer from the local Remploy factory also comes to the school and sees children considered suitable for referral to Remploy. After this, however, the system breaks down. Of those considered employable, if they do not get the jobs thought to be suitable by the medical officer, headmaster and the youth employment officer, there is no follow-up supervision to reconsider the suitability of alternatives, although on a completely unofficial basis, the youth employment officer and the medical officer responsible for the special school and the headmaster are in frequent contact. The need for an After-Care Committee is self evident and although it would have no statutory powers outside the Education Act, together with members co-opted from the Welfare Department and from voluntary agencies it could do much to follow the progress of the handicapped school leaver and to bring the problems to the notice of the appropriate departments. 77