BOROUGH OF DAGENHAM THE HEALTH OF DAGENHAM IN 1960 BOROUGH OF DAGENHAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1960 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 41 Atmospheric Pollution 23 Audiometric Tests 66 Bentry Special School 71-72 Care of Mothers and Young Children 38 Child Guidance 66 Chiropody 46 Committee for Education 5 Convalescence 48 Council—Members of 3 Day Nurseries 43-44 Deaths—Causes of 17 Dental Services 62-63 Domestic Help 45 Education (General Purposes) Sub- Committee 5 Factories Acts, 1937, and 1948 24-25 Food and Drugs—Sampling 29 Food Hawkers—Registration 27 Food Hygiene Regulations, 1960 26-27 Food—Inspection and Supervision 25-30 Food Poisoning 27-28 Food—Unsound 27 Gordon—Miss Daisy 13 Handicapped Children 69-70 Health Area Sub-Committee 4 Health Education 33-37 Health Visiting and School Nursing 39-40 Home Safety 33-34 Housing 21-22 Ice Cream 26 Immunisation 52-54 Diphtheria 53 Whooping Cough 52 Improvement Grants 21-22 Infant Mortality 18 Infant Welfare Centres 38 Infectious Diseases 31-32 Kingsley Hall Day Centre for Handicapped Children Under 5 73-78 Page Laundry Service for the Incontinent Aged 22 Maternal Mortality 15 Maternity Services 41-42 Midwifery Service 41 Milk 26 National Assistance Act, 1948 22 Occupational Therapy 47 Ophthalmic Clinic 65 Orthopaedic Clinic 64 Over Sixties Clinic—Oxlow Lane 49-51 Pet Animals Act, 1951 24 Premature Infants 42 Prevention of Damage by Pests Act, 1949 24 Public Health Committee 3 Public Swimming Baths 21 Rag Flock and Other Filling Materials Act, 1951 24 Recuperative Holidays 48 Relaxation Classes 42 Rent Act, 1957 21 Sampling—Food and Drugs 29 Sanitary Inspection of the District 19 School Clinics 60-61 School Health, 1960 55-59 Sewerage and Sewage Disposal 20 Slum Clearance 21 Smoke Control Areas 23 Specialist Services 64-68 Special School—Bentry 71-72 Speech Therapy 67-68 Staff 6-7 Tents, Vans and Sheds 22 Tuberculosis 32 Unsound Food 27 Vaccination 52 B.C.G. 52 Poliomyelitis 54 Smallpox 52 Vital Statistics 15-16 Water 19-20 2 MEMBERS OF THE COUNCIL (as at 31st December, 1960) MAYOR: Councillor H. P. Larking, J.P. DEPUTY MAYOR: Councillor L. W. Todd ALDERMEN: W. E. Bellamy, J.P. E. M. Millard, (Mrs.) R. Blackburn, J.P. A. E. Prendergast, (Mrs.) F. Brown, E.C.C. C. Prendergast, B.E.M., E.C.C. G. H. A. Crouch COUNCILLORS: H. V. Butt D. O’Dwyer D. A. L. G. Dodd W. A. Parish M. Eales A. C. V. Rusha D. O. Grandison M. J. Spencer J. P. Hollidge, J.P. D. W. Taylor H. Kay A. R. Thomas, (Mrs.) E. J. Kitchen, (Mrs.) J. S. Thomas D. Linehan S. J. C. Warr W. G. Noyce F. F. Woods, (Mrs.) PUBLIC HEALTH COMMITTEE CHAIRMAN: Alderman (Mrs.) A. E. Prendergast VICE-CHAIRMAN: Alderman (Mrs.) E. M. Millard His Worship the Mayor Councillor (Mrs.) E. J. Kitchen Councillor H. P. Larking, J.P. Councillor D. O'Dwyer The Deputy Mayor Councillor L. W. Todd Councillor (Mrs.) A. R. Thomas Councillor S. J. C. Warr 3 DAGENHAM HEALTH AREA SUB-COMMITTEE (as at 31st December, 960) Chairman: Alderman (Mrs.) A. E. Prendergast Vice- Chairman: Alderman (Mrs.) E. M. Millard Members— Borough Council The Mayor Councillor H. P. Larking, J.P. The Deputy Mayor Councillor L. W. Todd Councillor D. A. L. G. Dodd Councillor (Mrs.) E. J. Kitchen Councillor D. Linehan Councillor W. G. Noyce Councillor W. A. Parish Councillor A. C. V. Rusha Councillor D. W. Taylor Councillor J. S. Thomas Councillor S. J. C. Warr Councillor (Mrs.) F. F. Woods 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 (Mrs.) L. Fallaize, J.P. R.C.S. 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. B. Bignell Mrs. S. M. Hoxley Miss N. L. Odell Mr. J. Walsh 4 DAGENHAM COMMITTEE FOR EDUCATION (as at 31st December, 1960) Chairman: Alderman R. Blackburn, J.P. Vice-Chairman: Councillor A. C. V. Rusha Representative Members: Nominated Members: Alderman W. E. Bellamy, J.P. County Councillor A. F. J. Chorley, Alderman F. Brown, E.C.C. M.B.E., J.P. Alderman (Mrs.) E. M. Millard County Councillor L. F. Saunders Alderman (Mrs.) A. E. Prendergast Alderman C. Prendergast, B.E.M., E.C.C. Councillor H. V. Butt Councillor M. Eales Councillor D. O. Grandison Co-opted Members: Councillor (Mrs.) E. J. Kitchen Mr. A. Boyle Councillor D. Linehan Mrs. I. M. Brockelbank Councillor D. O’Dwyer Mr. E. E. Hennem Councillor W. A. Parish Mr. F. C. Jones Councillor (Mrs.) A. R. Thomas Mrs. E. F. Lambert Councillor (Mrs.) F. F. Woods Mr. J. Walsh EDUCATION (GENERAL PURPOSES) SUB-COMMITTEE (as at 31st December, 1960) (This Sub-Committee deals, inter alia, with the School Health Service) Chairman: Alderman R. Blackburn, J.P. Vice-Chairman: Alderman F. Brown, E.C.C. Members: Councillor D. O. Grandison Mrs. I. M. Brockelbank Councillor D. Linehan Mr. A. F. J. Chorley, M.B.E., J.P., E.C.C. Councillor D. O’Dwyer Mr. E. E. Hennem Councillor A. C. V. Rusha 5 OFFICERS OF THE HEALTH SERVICES (as at 31st December, 1960) 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) N. R. Brooks (5), (6), (7) M. Pettit (5), (7), (8) 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), (24) D. B. Stewart (5), (6), (7) L. Ling (5), (6), (7) R. E. Walker (5), (6), (7), (15), (16) D. J. Milbank (5), (6), (7), (10), (25), 26) Non-Medical Supervisor of Midwives: (C) Miss R. K. Jesson (5), (6), (27) Midwives: (C) J. E. Clarke (5), (6) M. Teather (5), (6) L. M. Grant (6), (9) P. Vanbrook (6) A. B. Showell (5), (6) M. E. Wainwright (5), (6) School Nurses: (C) J. Cornish (5) E. McCheyne (5) J. Hewitt (5) P. Picken (5) E. Hogg (5) M. Twomey (5) J. Hogg (5) N. Yarnell (5), (10) Speech Therapists: (C) E. Shipley (22) E. Symes (22), (23) 6 CLERICAL STAFF: Chief Clerk (C) F. W. Knight (1), (2) Medical Officer of Health’s Secretary: I. Fraser Trainee Public Health Inspector: F. W. Silverthorne Clerks: E. Adams (C) P. Floodgate (C) E. Neport (C) J. B. Smith (C) N. Briand (C) I. Fox M. Oates (C) D. Taylor (C) J. Butterworth (C) G. K. Harris I. Page (C) I. Throssell (C) N. E. Cloke (C) S. B. Leader (C) J. Pearmine (C) M. A. Watts (C) I. B. Cohen (C) F. H. Martin (18), (C) K. Richards (C) P. Woodward (C) D. Duff (C) J. Morgan (C) G. Shannon (C) K. Bird (C) (part-time) Day Nurseries: (C) Goresbrook Nursery, Matron: E. Maddison (15) Dagenham Avenue, Deputy: K. Graham (9) Dagenham. Chadwell Heath Nursery, Matron: P. Coffee (17) Ashton Gardens, Deputy: M. Carter (20), (21) Chadwell Heath. Kingsley Hall Day Centre for Sister-in-Charge: A. Cowling (5) Handicapped Children, 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 M. Sealey 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 (24) Certificate of Manchester University for Ascertainment of Defective Hearing in Young Children (25) Diploma of National Society of Day Nurseries (26) Registered Sick Children's Nurse (27) Queen's Nurse 8 Alderman Mrs. ANNIE ELIZABETH PRENDERGAST Public Health Department, Civic Centre, Dagenham. To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Once again it is my duty to report on the health of Dagenham, and at the time of writing this introduction one event has taken place which although it did not occur during the year under review cannot be allowed to pass without mention. It is the retirement of Alderman Mrs. A. E. Prendergast from the Chairmanship of the Public Health Committee and of the Health Area Sub-Committee, as well as her retirement from the Council. Mrs. Prendergast has been associated with health matters in Dagenham for many years and she very kindly agreed to discuss some of her early activities with me so that I could include some of her comments in this introduction to my Annual Report for 1960. Mrs. Prendergast came to Dagenham in 1926 and she describes a situation where there were no schools and the children ran wild, no clinics and, indeed, very few roads as we know them now. People were being housed in Dagenham at the rate of 300 families a week and Mrs. Prendergast describes how a child suffering from whooping cough was treated by the mother with three pennyworth of syrup of squills and ipecacuanha wine, and where a bottle of Scott's Emulsion, which was the treatment during convalescence, cost 10½d to buy and perhaps meant foregoing something on the table. Becontree Clinic, she says, was the first purpose-built clinic, and she played her part in the early efforts of the Tuberculosis Care Association to provide clothing and other help in necessitous cases. She is proud of her activities in the establishment of a "clinic for women over 40," which she felt was so necessary for women after childbearing, where they could get advice following examination and where many of them were referred to hospital for necessary treatment. The war interrupted much of the progress but did not stop the establishment of the chiropody clinics for which Mrs. Prendergast can claim most of the credit and of which she is justifiably proud. Then came the upheaval created by the National Health Service Act of 1946, although the results of it have been of such benefit to many of the people Mrs. Prendergast has been trying to help for so many years. I would like to thank her for the help she has given to me since I came to Dagenham in 1955 and for the enthusiasm with which she has supported my efforts, and to wish her well in the future. 9 The infant mortality rate of 28.33 1960, as compared with 17.67 for 1959, must give cause for concern, although a high proportion of the deaths which occurred were in cases where it appears to have been unavoidable. More detailed record keeping of the events concerning each infant death may, during 1961, give a possible clue to further administrative action to reduce infant deaths. Immunisation came in for its quota of intensive activity during the year and it is pleasing to record that Dr. Mair’s efforts to increase the numbers immunised against whooping cough produced excellent results. We need to press forward with continued publicity in an attempt to raise the proportion of those immunised against all those diseases where immunisation is feasible. The staffing of the dental service continues to be a source of difficulty, and in order to try to provide at least a skeleton emergency service an attempt was made to operate the dental suites at Oxlow Lane Clinic from Monday to Friday. Unfortunately, this meant the withdrawal of dental service from all other clinics and it is hoped that recruitment will improve during 1961. Attention should be drawn to the fact that there is a three months waiting list for the average case attending for child guidance treatment. This must be considered as far from satisfactory. The ophthalmic clinics continue to provide a satisfactory service, although once again both ophthalmic surgeons appeal for the services of a dispensing optician at the clinic. The home help service continues to expand and gives the same story of increased demand. Towards the end of the year consideration was given to the future of chiropody in Dagenham, and a suggestion was made to the County Council for an establishment of 5 full-time chiropodists. As it was possible to secure the services of 2 full-time chiropodists only there existed at the end of the year 3 full-time vacancies The work of the health visitors increased during the year and I would like to draw attention particularly to the visits in connection with housing priorities. During the year the number of housing applications considered, which were brought to the notice of the department by medical certificates, was 196. The report on the Kingsley Hall Day Centre for Handicapped Children under 5 records the progress of these children after the Centre had operated for 7 months. Sister Cowling and her staff worked hard to make it a success and we have thought it worthwhile to include photographs of some of the children which amply justify the comment in the full report—"If you didn't know you'd think they were normal." 10 The Centre will always be a reminder of the valuable work Dr. Mair did for handicapped children during her stay in Dagenham, and we were sorry to lose her in the first half of 1961. I have to record my disappointment that I failed to make progress with my suggestion made last year for dealing with problem families (or what I prefer to call families with special difficulties). I had hoped that we should be able to provide a specialist worker to deal with the families in Dagenham as a preliminary to providing a day housecraft centre. I had felt that a social case worker would be needed for this particular function, but was unable to secure the necessary support for this venture. The quiet way in which the public health inspectors always carry out their routine functions, and the report submitted year after year by Mr. Prior, together with the fact that things usually go smoothly, tends to make us forget the enormous amount of work they do and their valuable contribution to the health of the citizens of Dagenham. The work of the public health inspectors continues to increase as increasing duties are placed upon them, and the outbreak of Sonnei Dysentery, which occurred in the early part of the year, placed a very heavy extra burden upon the ever willing staff. Health Education is beginning to take its rightful place in the activities of the department, as the impressive list of talks and film shows bears witness. I had hoped that organised courses in ‘Health’ could have been commenced but because of shortage of time this was not possible, although the first course in Food Hygiene, held at Staffords Bakery, must be recognised as an important forward step. I must refer to the loss of Miss Gordon, who died in January 1961 and is so missed by all who knew her. A short reference to her will be found in the body of the report. Finally, I must say more than a formal thank you to the staff of the department for their loyal co-operation and to the Public Health Committee and the Health Area Sub-Committee for their support and understanding. Public Health at times seems very slow to produce results and being undramatic receives very little of the limelight, except when things go wrong. Much of what we do or strive to do may take many years to reach fruition and, indeed, we may never see the full results of our planning. I feel that the following, quoted by Professor D. M. Bissell, Health Officer, City of San Jose, California, U.S.A., at the Central Council for Health Education Summer School at Bangor in 1959, sums up something of the philosophy behind the public health service:— "Public Health dreams of a time when there shall be no unnecessary suffering and no premature deaths; when the welfare of the people shall be our highest concern; 11 when humanity and mercy shall replace greed and selfishness; and it dreams that all these things will be accomplished through the wisdom of man. It dreams of these things, not with the hope that we, individually, may participate in them, but with the joy that we may aid in their coming to those who shall live after us. When young men have vision, the dreams of old men come true." Dr. Milton J. Rosenau (U.S.A.) J. Adrian Gillet, Medical Officer of Health. 12 MISS DAISY GORDON It was with very great concern and sympathy that all members of the department watched Miss Gordon's slow and painful illness thoughout the year—powerless to do more than give what little help they could and to relieve her as far as possible of the burden of her duties. But this was a faint hope as she insisted on working whenever she could and frequently when lesser people would have given in, so it is with very great regret that I have to record her death which occurred at St. Margaret's Hospital, Epping, on 19th January, 1961. It is 16 years since Miss Gordon came to Dagenham as a health visitor. For the next eleven years the sight of her on her bicycle to hundreds of Dagenham's mothers, young children and old people meant cheerful help, encouragement and advice on all their problems. During these years that she lived and worked in Dagenham she was actively associated with the Dockland Settlement and the Civic Players. In 1955, Miss Gordon went to Harlow to continue her health visiting work, but her love of Dagenham remained and she returned to us in October 1957 to take over the position of superintendent health visitor. For the past three years the whole of the Borough has been her domain, and she was never happier than when, in her old car, she was out visiting, helping again the people with their problems. She again gave time and help to the Dockland Settlement, and her new post involved close connections with all the voluntary agencies, but particularly the National Society for Prevention of Cruelty to Children, the Invalid Children's Aid Association and the Dagenham Tuberculosis After Care Association. She had a keen interest in the care of old people, and especially in the work of the Over Sixties Clinic at Oxlow Lane. In spite of progressive ill health her determination and her concern for others compelled her to continue until only a few days before her death with a courage and a Scot's gaiety for which all will remember her with gratitude and affection. Dagenham has lost a valued and familiar figure and the Health Department will long mourn the loss of the irreplaceable Daisy Gordon. 13 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 6,556 Registrar-General's estimate of resident population, 1960 114,760 Number of inhabited houses (end of 1960) according to Rate Books 31,407 Rateable value (December 31st, 1960) £1,675,329 Sum represented by a penny rate (1960/61) £7,423 Extracts from Vital Statistics for the Year Live Births: Total Male Female Legitimate 1,476 773 703 Illegitimate 42 22 20 Live birth rate per 1,000 of the estimated population 13.23 Stillbirths: Legitimate 38 12 26 Illegitimate — — — Stillbirths rate per 1,000 live and stillbirths 24.42 Total live and stillbirths 1,556 807 749 Infant deaths 43 Infant mortality rate per 1,000 live births—Total 28.33 Legitimate 28.46 Illegitimate 23.81 Neonatal mortality rate per 1,000 live births (first four weeks) 22.40 Illegitimate live births per cent of total lives births 2.77 Maternal deaths (including abortion) — Maternal mortality rate per 1,000 live and still births — Total Male Female Deaths 884 504 380 Death rate per 1,000 of the estimated resident population 7.70 Deaths from Cancer (all ages) 217 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Gastritis, Enteritis and Diarrhoea (all ages) 5 Births 1,518 live births were notified during the year, there being 795 males and 723 females. There is a decrease of total births from 1,528 in 1959. The corrected birth rate per thousand population was 12.30 compared with 17.1 for England and Wales. The illegitimate birth rate continues to be very low, being only 2.77 per cent of total live births. There were no illegitimate stillbirths. Deaths Total deaths in district 647 Outward transfers 213 Inward transfers 450 Deaths of residents 884 Of the deaths of non-residents occurring in the district, 160 took place at Rush Green Hospital, 28 at Dagenham Hospital and 17 at Hainault Lodge. 15 Of the deaths of local residents taking place outside this area, most occurred in institutions as follows:— Oldchurch Hospital 259 St. George's Hospital, Hornchurch 52 King George Hospital, Ilford 13 London Hospital 31 Chadwell Heath Hospital 8 Severalls Hospital, Colchester 3 Victoria Hospital, Romford 4 St. Andrew's Hospital, Billericay 3 St. Joseph's Hospice 4 Whipps Cross Hospital 6 Barking Hospital 5 Harold Wood Hospital 6 London Chest Hospital 4 Mile End Hospital 3 Westminster Children's Hospital 3 The crude death rate of 7.70 when corrected becomes 13.40 compared with 11.5 for England and Wales. 16 Causes of Death, 1960 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 2 1 1 - - - 3 3 2. Tuberculosis, other - - - - - - - - - - - - - - - - - 3. Syphilitic disease - — — — — — — — — - — — 1 - 1 - 2 - 4. Diphtheria - - - - - - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - 6. Meningococcal infections - - - - - - - - - - - - - - - - - - 7. Acute poliomyelitis - - - - - - - - - - - - - - - - - - 8. Measles - - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases 1 - 1 2 - - - - - - 1 - - - - - 3 2 10. Malignant neoplasm, stomach - - - - - - - - 1 - 16 7 6 6 - 2 23 15 11. Malignant neoplasm, lung, bronchus - - - - - - - - 2 1 40 1 20 3 4 1 66 6 12. Malignant neoplasm, breast - - - - - - - - - 3 - 7 - 5 - - - 15 13. Malignant neoplasm, uterus - - - - - - - - - - - - - - - - - 5 14. Other malignant and lymphatic neoplasms - - - - - 1 1 1 3 3 22 19 9 9 9 10 44 43 15. Leukaemia, aleukaemia — — — — 2 — — — — — 3 1 — 1 - - 5 2 16. Diabetes - - - - - - - - 1 1 1 1 2 1 1 3 5 6 17. Vascular lesions of nervous system - - - - - - - - - 1 7 9 15 10 13 22 35 42 18. Coronary disease, angina - - - - - - - - 6 - 61 16 29 18 16 15 112 49 19. Hypertension with heart disease - - - - - - - - - - 1 1 8 1 3 6 12 8 20. Other heart disease - 1 - - - - - - -1 1 6 5 6 7 13 47 26 61 21. Other circulatory disease - - - - - - - - 2 1 5 1 7 6 4 9 18 17 22. Influenza - - - - - - - - - - - - - - - - - 1 23. Pneumonia 2 6 1 2 — — — — 1 — 6 4 6 7 4 7 20 26 24. Bronchitis — 1 — — 1 — — — — — 11 5 18 2 10 8 40 16 25. Other diseases of respiratory system - _ _ - - - - - 1 - 2 - 4 1 1 2 8 3 26. Ulcer of stomach and duodenum - - - - - - - - - - 1 - 6 1 1 1 8 2 27. Gastritis, enteritis and diarrhoea - - - - - - - - - - 2 2 1 - - - 3 2 28. Nephritis and nephrosis - - - - - - 1 - 1 1 1 - 1 - 1 - 5 1 29. Hyperplasia of prostate --- — — - — — — — — — 1 - 2 - 4 - 7 - 30. Pregnancy, childbirth, abortion - - - - - - - - - - - - - - - - - - 31. Congenital malformations 4 3 - 2 - - - - - - 1 1 - - - - 5 6 32. Other defined and illdefined diseases 14 11 1 - 1 1 3 - 1 3 5 6 7 9 6 7 38 37 33. Motor vehicle accidents — — — — 1 1 1 1 - - - 3 - - 1 - 3 5 34. All other accidents — — — — 3 - - - - - 2 3 - - 1 1 6 4 35. Suicide — — — — — - 1 - 1 - 3 2 2 1 - - 7 3 36. Homicide and operations of war - - - - - - - - - - - - - - - - - - 21 22 3 6 8 3 7 2 21 18 200 95 151 93 93 141 504 380 17 INFANT MORTALITY Details of deaths of children under one year of age registered during 1960 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 7 1 — — 8 — — — — 8 Prematurity with associated cause - 2 - - 2 - - - - 2 Congenital abnormality 7 1 — 1 9 — — 2 1 12 Birth Trauma—Intracranial haemorrhage 3 .... - - 3 - - - 3 Atelectasis 4 — — — 4 — — - - 4 Bronchopneumonia 1 1 — 1 3 1 1 1 — 6 Haemolytic disease 3 — — — 3 — — — — 3 Purulent Meningitis - - - - - - 1 - - 1 Meconium Ileus — — 1 — 1 — — — — 1 Infantile Bateraemia - - - - - 1 - - - 1 Placenta praevia 1 — — — 1 — — — — 1 Purulent Bronchitis - - - - - - - 1 — 1 26 5 1 2 34 2 2 4 1 43 18 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRICT (a) Nature and number of visits:— Rent Act 349 Housing and Public Health Acts:— Dwelling houses 2,844 Other premises 826 Overcrowding and housing applications 741 Bakehouses 53 Milkshops and dairies 78 Foodshops, stalls and itinerant vendors 1,818 Cafes and canteens 466 School kitchens and feeding centres 128 Infectious disease enquiries 2,516 Visits to foster-mothers' premises 64 Number of complaints investigated 907 Clean Air Act—Survey 8,697 Factories 235 Workplaces and offices 76 Rag Flock, etc 22 Tent, vans and sheds 142 Stables 3 Pet Shops 13 Hairdressers' 73 Shops Act 81 Ice Cream premises and vehicles 138 Houses disinfested 24 Other visits 231 (b) Notices served:— Complied with:— Statutory 29 32 Informal 279 280 Legal proceedings were instituted in respect of one property to enforce compliance with statutory notices. It was necessary to obtain from the local Magistrates' Court a warrant to enter a house; statutory notices were served and complied with in respect of very extensive internal structural defects. WATER The water supply is satisfactory in quality and quantity. During the year two chemical and two bacteriological samples were taken from the Company's mains in this Borough; all were satisfactory. The water is not liable to have plumbo-solvent properties and no action was called for in respect of any form of contamination. Approximately .015 per cent of the inhabited houses and .009 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 151 3" 265 4" 29 6" 278 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 4,400 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." SEWERAGE AND SEWAGE DISPOSAL The Borough Engineer has furnished the following information:— Sewerage The separate drainage systems of the Borough are functioning reasonably well although the capacity of each at times of peak flow tends to be somewhat inadequate. Design work is in hand to improve conditions in the surface water drainage of one area and it is anticipated that in the near future a comprehensive review of the foul trunk sewers will have to be undertaken. Regular maintenance arrangements are in force using up-to-date powered equipment and each year minor improvement schemes are carried out. Sewage Disposal The Council's Riverside Sewage Works are operating under a considerable overload and the quality of the effluent is, therefore, not as high as is desirable. However, the extensive scheme for improvements and extensions that has been under consideration for some years past has now reached a stage where final details and actual construction are more imminent. The estimated cost of the first stage of the scheme is over £2 million and the work would take at least 5 years to complete. In accordance with the instructions of the Ministry of Housing and Local Government the revised works must be capable of extension to deal with sewage from adjacent authorities and negotiations regarding such arrangements are now in hand. 20 PUBLIC SWIMMING BATHS There are two open air swimming baths in the Borough. The water is taken from the mains of the South Essex Waterworks Company. The method of treatment is continuous filtration and sterilisation; the period of turnover is four hours. Bacteriological examination of samples has indicated satisfactory conditions. HOUSING Slum Clearance During the year a further six houses were represented as unfit for human habitation. The Council have agreed that the slum clearance programme for the five years commencing in 1961 should include some no properties. Rent Act, 1957 14 applications were received from tenants during the year compared with 39 in the previous year. In no case did the Council refuse to issue a certificate of disrepair. Undertakings to do the work were given by landlords in respect of six properties. Five certificates of disrepair were issued and four cancelled on the completion of repairs. Advice was given to tenants and they were able to purchase the necessary forms at the Civic Centre. The Council have continued to issue certificates of disrepair which included, inter alia, defective fencing; 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 and Conversion Grants Two types of grant are now available; the "discretionary" grant for the more extensive forms of improvement or conversion towards the cost of which a grant up to £400 is available, and the "standard" grant 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 requirement that the fixed bath should be in a bathroom has resulted in a number of enquiries from the owner / occupiers of properties built between the wars 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 the standard grant has caused some concern; it appears that this condition is to be amended. Applicants are always encouraged to make preliminary enquiries before any expense is incurred. During the year many enquiries were received; in several cases the improvements desired were not eligible for grant. 20 applications for standard grants and five for discretionary grants were approved; one application to convert a large house 21 into two self-contained flats was approved. Two applications were refused, one because shop premises were an integral part of the dwelling and the other because the improvement was not considered to be eligible. In one case, where a condition of the grant was not complied with, the applicant was required to repay the grant. Following a case where work was done before the applicant had received official approval, increased publicity was given to the fact that applicants must not commence work until the Council's written approval has been received. Tents, Vans and Sheds The number of occasions continues to decrease in which gypsies have pulled their vans onto vacant sites in an effort to spend at least a few days in the area. The number of sites with easy access from the road is becoming less each year. During the year inspectors paid 142 visits to various sites in connection with this work. One application under the Caravan Sites and Control of Development Act, 1960 has been received in respect of a site of 14 vans which has been in existence for many years. 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 are inevitably their last days. It was not necessary compulsorily to remove any person during the year. Section 50 One person (female 65 years) was 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. The days of collection and delivery of laundered articles are Mondays and Thursdays. The helpful, co-operative attitude of the department's driver and the laundry staff at the Barking Hospital ensures a very satisfactory service. An average of about 15 cases use the service at any one time. From the commencement of the service in December 1953 to the end of this year 280 cases have received assistance. During the year 50 new cases have been helped, 21 cases died, 16 were removed to hospital and two no longer needed the service. At the end of the year 21 cases were still participating; the number of articles laundered during the year was 10,439 compared with 11,295 articles for the previous year. 22 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. 49 observations were made of the chimneys of industrial premises in the Borough; statutory action was not needed during the year. Under the provisions of the Clean Air Act, 1956, Section 16, a statutory notice in respect of a nuisance from the burning of factory rubbish was served and complied with. 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. The national organisation sponsored by the Department of Scientific and Industrial Research dealing with the investigation of atmospheric pollution have decided to change the existing scheme of measurement of pollution. Throughout the country 100 towns have been selected at random where measurements will be made daily at possibly five different sites including residential, industrial and commercial areas and a smoke control area. It is anticipated that the measurements made in these selected towns will provide a yard stick against which the measurements from individual towns will be examined. Dagenham has been chosen as one of the 100 towns and the Council have agreed to co-operate in this work. Smoke Control Areas The Council have agreed in principle to include in smoke control areas the whole Borough as soon as possible and in any case in not more than 10 years; they have been represented at the Conference of Local Authorities covering the East London area. The Council's first smoke control area (the first in Metropolitan Essex) operated from the 1st September, 1959; the area is at Marks Gate and comprises about 1,000 new Council houses. The second smoke control area includes nearly 4,000 houses (mostly owned by the London County Council) and covers the South West corner of the Borough; the date of operation is 1st November, 1961. The survey of the third area has been commenced; it includes about 3,000 houses (mostly owned by the London County Council) and is bounded on the South by the District Railway, on the East by Heathway and Halbutt Street, on the North by Wood Lane and on the West by the Barking boundary. In the survey all premises are inspected. At the houses the inspector delivers a letter informing the tenants that he will be calling the following day (indicating either morning or afternoon) and asking the tenant to be at home if possible. There has been good co-operation but the work has entailed a great number of evening visits. The extent of the work involved is indicated in that during the year 8,697 visits to premises have been paid by the inspectors in connection with the surveys. 23 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Two premises which have been registered under Section 2 of the Act have operated during the year. One licence for the manufacture and one licence for the storage of rag flock have been issued during the year. Samples continue to be taken regularly at the three factories in the Borough where filling materials are manufactured. 36 informal samples were taken during the year; all were satisfactory. The details are as follows:— No. of samples Material submitted for analysis Rag Flock 11 Cotton Felt 9 Coir Fibre 7 Kapok 6 Sisal 2 Kapok mixed with cotton 1 PET ANIMALS ACT, 1951 Four licences authorising the keeping of pet shops have been renewed. The conditions attached to the licences are those approved by the Association of Municipal Corporations; no serious breach of the conditions occurred. PREVENTION OF DAMAGE BY PESTS ACT, 1949 Disinfestation of rats and mice is carried out under the supervision of the district inspectors by the manual employee attached to the department. The service is free to householders but a charge on a time and material basis is made for business premises. 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 23 41 2 — Factories with mechanical power 169 194 6 — Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 32 36 1 - Total 224 271 9 — 24 Defects Found Number of defects Number of prosecutions instituted Found Remedied Referred to H.M. Inspector Referred By H.M. Inspector Want of cleanliness 4 4 — 3 — Overcrowding — — — — — Unreasonable temperature 2 1 — 2 — Inadequate ventilation 4 2 — — — Ineffective drainage of floors — — — — — Sanitary Conveniences:— Insufficient 2 — — 1 — Unsuitable or defective 6 7 — 1 — Not separate for sexes 1 1 — — — Other Offences — — — — — Total 19 15 — 7 — Outwork No. of outworkers in August list 44 Nature of work—Making etc., wearing apparel INSPECTION AND SUPERVISION OF FOOD The numbers and types of food premises in the Borough are as follows:— 5 Bakehouses 22 Bakers and Confectioners 59 Butchers 173 Cafes and Canteens 23 Fishmongers 53 Fruiterers and Greengrocers 126 Grocers 22 Licensed and 12 Off-licensed Premises 94 Sweets, etc. All food premises are regularly inspected and during the year 2,629 visits were paid. In addition to numerous verbal warnings and suggestions to management and staff during these routine visits, 33 informal notices were served upon owners or occupiers. 71 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:— 36 butchers' premises and 6 other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 396 visits were paid. 21 fish shops are registered for frying. To these 180 visits were paid. 25 Milk All milk distributed in Dagenham is produced and bottled outside the Borough. 8 premises are registered as dairies. The number of registered distributors is 39 operating from 76 premises. 98 visits were paid to dairies and distributors' premises. During the year 65 samples of milk were submitted for bacteriological examination. All were satisfactory. Ice Cream The total number of registered premises selling ice cream is 131; of this number one is registered for manufacturing ice cream. 210 visits were paid to these premises. During the year 9 applications for the storage and sale of ice cream were granted. 28 inspections in connection with itinerant vendors were carried out. During the year 80 samples of ice cream were submitted for bacteriological examination ; they were graded as follows:— Grade I Grade II Grade III Grade IV Total 50 16 6 8 80 In addition 45 samples of ice lollies were submitted for examination. Six were considered to be 'fair' and three unsatisfactory; in each case the lollies were manufactured outside the Borough and the local authority concerned were notified. Eight samples of ice cream were taken from the one manufacturer in the Borough; all were Grade I As in the previous year the products of one manufacturer with premises outside the Borough gave rise to concern. The eight Grade IV and four of the Grade III results in respect of ice cream and all the 'fair' and unsatisfactory ice lollies were from this manufacturer. In spite of frequent requests to the manufacturer and the local authority concerned there was no real improvement and the two local retailers selling the products of this manufacturer voluntarily agreed to change their source of supply. Food Hygiene Regulations, 1960 The traders generally have continued to co-operate to gain compliance with the regulations. Following a complaint of a cigarette end in a loaf of bread the bakery was visited late at night; an employee was found smoking and was subsequently fined £5 at the Magistrates' Court. 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 talks on food and food handling were given to local organisations. 26 During the summer it was decided to ascertain the bacteriological standard of cooked meats on sale throughout the Borough. Approximately 100 samples, mostly of ham, were taken over a period of about one month; the results obtained provided useful information which can be used as a basis for further work. Excellent reports were received of those hams which had been vacuum packed in transparent plastic material at a large factory; sliced ham, also factory pre-packed by the same firm, was very satisfactory. As would be expected, newly-opened tins were virtually sterile but some of the open-pack hams centrally prepared by certain multiple grocers showed some contamination when they were first opened in the retail shops. No dangerous organisms were found but other results indicated that further work is desirable on practical methods of maintaining a more satisfactory bacteriological standard of cleanliness of slicing machines. 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 26 such complaints were considered by the Public Health Committee; in the majority of cases warning letters were sent. The normal method of disposing of unsound food is to use the incinerator at the Council's Refuse Disposal Works. Occasionally, when there is a quantity of meat, it is disposed of under supervision through the Council's waste food service; the meat is previously cut up and dyed. Registration of Food Hawkers Under the provisions of the Essex County Council Act, 1952, Section 103, six persons were registered as Food Hawkers; one had storage premises in the Borough. Food Poisoning 8 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 1 - 4 3 8 Cases otherwise ascertained (1st Quarter) 2 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 (CI. Welchii) - 1 1 2 3 Agent not identified 1 — 2 — 2 27 Single Cases:— No. of Cases Total No. of cases Notified Otherwise Ascertained Agent identified (Salmonella Typhimurium) 3 - 3 Agent not identified 2 — 2 Salmonella Infections, not food-borne Nil The small outbreak (three cases) in which CI. Welchii was identified as the agent occurred at the canteen of a local bakery; 65 employees used the canteen. Faecal swabs from five employees were submitted for examination; three were positive. A portion of braising steak, the suspected food, was submitted for examination but the result was negative. An outbreak of sonnei dysentery occurred at a Junior and Infants School and extended from the middle of January until the end of March. Many of the children attending the school lived in an adjoining district. Swabbing revealed that 47 Dagenham children were affected and 63 from the adjoining district. At the time of the outbreak a number of children were absent from school (mumps and colds were prevalent); where the cause of absence was not known with certainty an inspector visited the homes. All children suffering from diarrhoea were excluded from school and faecal swabs submitted for examination; a school nurse attended the school each morning. Arrangements were made for a routine practice of disinfection in respect of sanitary conveniences and the importance of hand washing was stressed. 28 Food and Drugs—Sampling Article Number Examined Number Adulterated Formal Informal Formal Informal Anchovies - 1 - - Angelica — 1 — — Apricots, Dried — 1 — — Arrowroot — 1 — — Beverages — 5 — 1 Biscuits — 7 — 1 Bread — 3 — 1 Bread, Starch Reduced — 3 — — Breakfast Grill — 1 — 1 Butter — 1 — — Cakes — 2 — — Cheese — 1 — 1 Cheese with Shrimps — 1 — — Cordials — 5 — 1 Cream — 1 — — Gelatine — 1 — — Hamburgers and Vegetables — 1 — — Herbs — 2 — — Ice Cream — 11 — - Ice Cream Mixture — 1 — 1 Ice Lollies — 3 — — Irish Stew — 1 — — Jam — 2 — — Jelly — 1 — — Kipper Fillets, Buttered — 1 — — Marzipan — 3 — — Meat Pies — 2 — — Medicinal Samples — 44 — 3 Milk Bottles — 2 — 1 Milk 12 3 1 3 Oranges, Mandarin (Tin) — 1 — — Pastes — 4 — — Peel, Mixed — 1 — — Pepper — 2 — — Rice, Creamed — 1 — — Roll, Cheese — 1 — 1 Rolls, Milk 1 2 1 1 Salmon, Tinned — 1 — - Sandwich, Salmon — 1 — - Sausages 14 1 — - Sauces — 2 — - Scones — 1 - - Soups — 1 — — Spice — 7 — — Spreads — 4 — — Sweets — 4 — - Steak Cutlets in Meat Gravy — 1 — - Vinegar — 1 — — Wheat Embryo — 1 — — Wines and Spirits 12 3 — — 29 Adulterated Samples, etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 686A Family Lung Syrup Informal Was almost devoid of chloroform and deficient in glycerine. Warning letter 705A Ice Cream Mixture Informal Description of ingredients unsatisfactory. Warning letter 723A Lactic Cheese Informal Description "creamy" could be misleading. Warning letter 732A Milk Informal Contained foreign matter which covered half the bottom of the bottle and smaller fragments of similar matter in suspension in the milk. Foreign matter consisted of mould growth. Warning letter 733A Dirty Milk Bottle Informal Contained a foreign body in the form of a fragment of leaf tissue. Warning letter 734A Cheese Roll Informal Contained fragments of discoloured gluten. No action 738A Bread Informal Contained foreign matter in the form of stale and burnt dough and very faint traces of iron. Warning letter 766A Breakfast Grill Informal Labelling—ingredients in wrong order. Warning letter 767A Instant Coffee Informal Contained 60 parts per million of Sulphur Dioxide—not permitted. Warning letter 783A Zinc and Castor Oil Cream Informal Contained 0.9% excess Zinc Oxide. Referred to manufacturers 785A Milk Informal Contained foreign matter in the form of mould growth on a milk film. Warning letter 786A Milk Informal Contained foreign matter in the form of mould growth on a milk film. Warning letter 787A Fresh Egg Boudoir Biscuits Informal Composition does not justify claim "nonfattening.'' Warning letter 796A Snowfoam Crystals Informal No declaration of ingredients. Warning letter 799A Milk Rolls Informal Contained insufficient milk solids to justify the description "=milk rolls." Formal sample taken 804A Milk Informal Contained mould growth in suspension on inside of bottle. Warning letter 822A Liquid Extract of Cascara Sagrada Informal Contained a heavy deposit and, therefore, out of condition. Warning letter 2561 Milk Rolls Formal Contained insufficient milk solids to justify description of milk rolls. 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 2 6 7 14 4 67 18 3 1 122 Whooping Cough 22 19 31 16 31 127 11 4 — 261 Measles 4 4 4 4 1 5 — 1 — 23 Diphtheria — — — — — — — — — — Dysentery 1 6 4 3 2 11 8 9 18 62 Acute Poliomyelitis:— Paralytic - - - - - - - - - - Non-paralytic - - - - - - - - - - Meningococcal Infection - - - - - - - 1 — 1 Under 5 yrs. 5—14 15—44 45—64 65 and over Total Pneumonia:— Acute Primary 4 1 3 11 3 22 Acute Influenzal 2 1 3 5 2 13 Encephalitis, Acute:— Infective 1 — — — — 1 Post Infectious — — — — — — Erysipelas — — 1 6 1 8 Food Poisoning 1 — 6 1 — 8 Puerperal Pyrexia — — 2 — — 2 Ophthalmia Neonatorum 2 — — — — 2 Paratyphoid 'B' — — — — — — Typhoid — — — — — — Smallpox — — — — — — Notified Admitted to Isolation Hospital, Rush Green Admitted to other Isolation Hospitals Admitted to other Hospitals Diphtheria — - - - Dysentery 62 3 — — Encephalitis, Acute 1 1 — — Enteric Fever — — — — Erysipelas 8 2 — — Food Poisoning 8 — — — Malaria — — — — Measles 23 - - - Meningococcal Infection 1 — 1 — Ophthalmia Neonatorum 2 — — — Paratyphoid Fever — — — — Pemphigus — — — — Puerperal Pyrexia 2 — — — Pneumonia:— Acute Influenzal 13 — - - Acute Primary 22 — — — Poliomyelitis:— Paralytic — — — — Non-paralytic — — — — Scarlet Fever 122 1 — - Smallpox — — — — Typhoid — — — — Whooping Cough 261 6 — — 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— - - - - - - - - - - - - 5— 1 — — — 2 3 — 1 — — — — 10— — 1 - - - - - - - - - - 15— 2 2 — — 2 1 — — — — — — 20— 4 3 — — 1 3 2 - - - - - 25— 8 3 1 1 4 11 — 2 — 1 — — 35— 5 3 — — 7 4 — — — 1 — - 45— 4 1 2 — 3 3 — — 5 1 — — 55— 4 1 — — 2 1 — — 3 — — — 65—and upwards 5 — — 1 — 1 — — 4 — — — 33 14 3 2 21 27 2 3 12 3 — — Register Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January, 1960 556 436 73 70 During the year:— New Notifications 33 14 3 2 New cases brought to notice by Registrars' Death Returns 2 - - - Deaths 12 3 — — Transfers into area 21 27 2 3 Transfers out of area 22 29 1 3 Removed from Register as "Recovered" 4 2 6 3 No. on register 31st December, 1960 572 443 71 69 32 FOOD HYGIENE EXHIBITION AT THE CIVIC CENTRE, DAGENHAM HEALTH EDUCATION Health education embraces the whole field of preventive medicine and although it was not possible to cover all aspects of the work during 1960 substantial progress was made in the following directions:— Ante-Natal Care At the request of assistant medical officers and health visitors, film shows were arranged at Becontree Clinic and Ashton Gardens Clinic. The films, "My First Baby" and "The British Midwife" were particularly well received and attracted large audiences. In view of the interest created, two evening sessions were arranged when a number of prospective fathers were able to attend with their wives. After each film opportunities were given for discussion, and questions were answered by the medical officer and health visitor. Other films were shown on nutrition and care of the teeth but these were not so well received as those on childbirth. However, some interest was stimulated by them, particularly as they were co-ordinated with dental displays in the clinics. To assist in their choice of films for health education in the clinics a number of shows were arranged at the Civic Centre and these were attended by clinic staffs, district nurses, midwives, day nursery staff, and public health inspectors where the films were appropriate. This arrangement has proved to be very popular as it enables new films to be seen soon after their release and their merits and demerits discussed before they are shown to lay audiences. Home Safety Work under this heading fell into two portions; the winding up of the "Check That Fall "campaign, commenced in 1959, and the institution of a drive against poisoning accidents—the latter will continue into 1961. The "Check That Fall" campaign was largely directed against accidents of the aged and so most of the work was done in old people's clubs and luncheon clubs. As many of the members attend these organisations for companionship and entertainment rather than for education, it was felt that the pill should be sugared by the inclusion in the programme of travel and other films to supplement the "Check That Fall" filmstrip and talk. This method attracted quite large audiences and led to discussions and complaints of unsatisfactory conditions in the homes of many of the members. Unfortunately, there was little response to several attempts to obtain further details of the complaints by the completion of questionnaires supplied by the Royal Society for the Prevention of Accidents. "Lock Away Dangers in Your Home" was the title of the second campaign, and this was started in November 1960 with a display in a cinema supported by the projection on the screen of a locally designed slide. Emphasis was laid on the frightening similarity 33 between many of the popular children's sweets and dangerous drugs in tablet form. This display was subsequently transferred to the Civic Centre until the end of the year, after which arrangements were made for it to be shown in each of the Maternity and Child Welfare Clinics. The Town Show The theme of the Health Department stand at the 1960 Show was "Kill That Fly," and the centre of attraction was ‘Freddie,’ a six foot model fly, kindly lent by the Fulham Public Health Department. At intervals throughout the Show he told of his filthy habits and other misdeeds, and it was a pity that the torrential rain kept the Show's attendance at its lowest for some years. Smoke Control As survey work was proceeding on the second and third Smoke Control Areas in the Borough, it was felt that education in this field was desirable. The Gas Council film, "Window to the Sky," which deals with Smoke Control Areas from a layman's point of view, was a very useful adjunct to the three talks which were given on the subject. Of all the talks and film shows presented during the year (other than the organised Food Hygiene Course) these proved to be the most provocative and in each case the discussion and questions which followed showed the public's great interest in the subject. More is planned in this field during 1961. Food Hygiene A food hygiene exhibition was staged in a cinema just before Easter and received favourable comment in both technical and local press. Stands included the preparation and cooking of shellfish, the inspection of meat and the production of milk. Later, the exhibition was transferred to the Civic Centre where it attracted considerable attention. A series of six lectures was arranged for the staff of a bakery and these were each attended by approximately 120—150 people. Filmstrips and films were used during the series and so much interest was aroused in the subject that a more advanced course was requested. Arrangements were made for this and the Royal Institute of Public Health and Hygiene accepted it as suitable training for their food hygiene examination. Twentyone senior members of the staff attended the course and twenty sat the examination in December. In this connection our thanks are due to Dr. E. A. Atkinson, Senior Pathologist at Oldchurch Hospital, who gave the bacteriology lectures. The other lectures were given by the staff of the Public Health Department. Students from the London University Institute of Education The two students, both teachers, who commenced training in 1959, attended one day each week during the 1960 Easter term to complete their practical work, and in October were replaced by two other students, a health visitor and a public health inspector. 34 So far as is possible visits are arranged to cover whatever projects the students wish to study but, in addition, by spending one or more sessions with each section they obtain a broad outline of the work of the whole department. They assist in the design and erection of any exhibitions held and also have an opportunity to attend any film shows which are being given during their period of practical training. Health Department Film The Dagenham Borough Council and the Essex County Council gave a grant to the Dagenham Co-operative Film Society so that their film for 1960 should show the work of Health Education in the Health Department. Filming was commenced before Easter but owing to difficulties within the Society it was not possible to complete it during the year. Work is being recommenced and it is expected to be ready during 1961. As will be seen from the list of film shows, we have frequently had to call on the projection staff of the County Health Department, and our thanks are due to them and to their health education staff with whom our relations have been most cordial. Unfortunately, it has only been possible to arrange one project in a school—a lecture and demonstration by Dr. M. J. Hodgson to teenage girls, but it is hoped that in future years more head teachers will take advantage of the facilities offered by the Health Department which cover all aspects of Health Education. The following is the diary of talks given to local organisations during the year:— Date Organisation Subject of Talk Audience Speaker 5. 1. 60. Chadwell Heath Cubs ( 1 Pack) Home Safety 20 Mr. Self 11. 1.60. Chadwell Heath Cubs (2 Pack) Home Safety 15 „ 25. 1. 60. Kingsley Hall Smoke Control 150 „ 27. 1. 60. Rush Green Old Folks Club Check That Fall 90 „ 12. 2. 60. Dockland Settlement „ 35 „ 18. 2. 60. Rush Green Co-op Guild, Avenue Club „ 30 „ 19. 2. 60. W.V.S. Luncheon Club, Chadwell Heath „ 20 „ 20. 2. 60. Staffords Bakery Food Hygiene 150 „ 22. 2. 60. Canteen Staff, Civic Centre „ 3 „ 23. 2. 60. Heath Park Old Folks Club Check That Fall 90 „ 24. 2. 60. Canteen Staff, Civic Centre Food Hygiene 2 „ 25. 2. 60. St. Chad's Old Folks Club Smoke Control 80 „ 27. 2. 60. Staffords Bakery Food Hygiene 120 „ 1. 3. 60. Old Folks Fellowship, Central Hall Work of the Public Health Inspector 100 „ 2. 3. 60. Canteen Staff, Civic Centre Food Hygiene 2 „ 5. 3. 60. Staffords Bakery Food Hygiene 120 „ 9. 3. 60. Rush Green Old Folks Club Home Safety 50 „ 12. 3. 60. Staffords Bakery Food Hygiene 120 „ 17. 3. 60. Royal College of Midwives, York House The Cranbrook Report 19 Dr. Gillet 19. 3. 60. Staffords Bakery Food Hygiene 120 Mr. Self 24. 3. 60. Rush Green Co-op Guild, Avenue Club Smoke Control 25 „ 26. 3. 60. Staffords Bakery Food Hygiene 120 „ 27. 4. 60. School Attendance Officers School Attendance and the Health of the School Child 50 Dr. Mair 35 Date Organisation Subject of talk Audience er 3. 5. 60. Dagenham County High School Pupils Smoke Control 6 Mr. Self 11. 5. 60. Association for the Welfare of the Blind Home Safety 60 „ 20. 6. 60. Business and Professional Women's Club, Grays Oxlow Lane Clinic for the Over Sixties 25 Dr. Gillet 23. 6. 60. Methodist Sisterhood Slum Clearance 35 Mr. Self 28. 6. 60. St. Chad's Old Folks Club, Cecil Hall Oxlow Lane Clinic for the Over Sixties 70 Dr. Gillet 12. 7. 60. Co-op Women's Guild, Broad St. Food Hygiene 50 Mr. Self 19. 9. 60. Old People's Welfare Council Home Safety 27 „ 4. 10. 60. Round Table, Dagenham The Changing Face of Public Health 30 „ 27. 10. 60. Fanshawe Ward Labour Party, Women's Section Smoke Control Areas 30 „ 15. 11. 60. St. Mark's Church Women's Meeting Hygiene in the Home 20 „ 22. 11. 60. Royal College of Midwives A Premature Baby Service 20 Dr. Gillet The following films and filmstrips were shown to audiences during the year:— Date Organisation Title of Film or Filmstrip Audience 25. 1. 60. Kingsley Hall Antarctic Crossing Window to the Sky Guilty Chimneys 150 27. 1. 60. Rush Green Old Folks Club The Land of Robert Burns London's Country Check That Fall 90 3. 2. 60. Becontree Infant Welfare Clinic How to catch a cold Why won't Tommy eat? Centre of Attraction My First Baby 70 12. 2. 60. Dockland Settlement Scottish Highlands Land of Robert Burns Check That Fall 35 18. 2. 60. Rush Green Co-op Guild, Avenue Club Cookery Carnival Methods and Madness Playing with Fire Every Five Minutes 30 19. 2. 60. W.V.S. Luncheon Club, Chadwell Heath Cookery Carnival Methods and Madness Playing with Fire Every Five Minutes 20 23. 2. 60. Heath Park Old Folks Club Methods and Madness Every Five Minutes Playing with Fire 90 25. 2. 60. St. Chad's Old Folks Club Window to the Sky The Land of Robert Burns 80 1. 3. 60. Old Folks Fellowship, Central Hall Distant Neighbours The Public Health Inspector 100 9. 3. 60. Rush Green Old Folks Club Scottish Highlands I'm no Fool with Fire Are you Safe at Home? 50 11. 3.60. Oxlow Lane Maternity and Child Welfare Clinic Let's Keep Our Teeth A Tooth in Time Brush Your Teeth with Andy Pandy 15 16. 3. 60. (a.m.) Becontree Infant Welfare Clinic Let's Keep Our Teeth A Tooth in Time Brush your Teeth with Andy Pandy 15 36 Date Organisation Title of Film or Filmstrip Audience 16. 3. 60. (p.m.) Becontree Ante-Natal Clinic Jenny Comes Home Know Your Baby 30 17. 3. 60. Becontree School Clinic Brush Your Teeth with Andy Pandy Let's Keep Our Teeth 5 22. 3. 60. Ford Road Infant Welfare Clinic Brush Your Teeth with Andy Pandy Let's Keep Our Teeth A Tooth in Time 6 24. 3. 60. Rush Green Co-op Guild, Avenue Club Window to the Sky 25 26. 3. 60. Staffords Bakery Everybody's Business Another Case of Poisoning Fly About the House 120 4. 4. 60. Public Health Dept., Civic Centre Your Children's Ears The Terrible Twos and the Trusting Threes Your Children's Play Your Skin The British Midwife 30 20. 4. 60. Becontree Ante-Natal Clinic Nutrition in Pregnancy 12 27. 4. 60. Ashton Gardens Ante-Natal Clinic My First Baby The British Midwife 45 9. 5. 60. Public Health Dept., Civic Centre The Terrible Twos and the Trusting Threes The Seventh Age Life with Baby Problem Children Foods and Nutrition How to Balance Your Diet Keep it Clean 10 15. 6. 60. Becontree Ante-Natal Clinic The British Midwife My First Baby He Acts His Age 60 23. 6. 60. Methodist Sisterhood One Man's Story 35 13. 7. 60. Ashton Gardens Infant Welfare Clinic Let's Keep Our Teeth A Tooth in Time 6 19. 9. 60. Public Health Dept., Civic Centre The Sorrento Way An Early Start 10 12. 10. 60. Becontree Clinic—Parents' Meeting The British Midwife My First Baby 65 17. 10. 60. Public Health Dept., Civic Centre Quads are Born The Sorrento Way The Human Body A Brother for Susan 20 27. 10. 60. Fanshawe Ward Labour Party, Women's Section Window to the Sky 30 31. 10. 60. Staffords Bakery Show of Hands The Place of Antiseptics in the Control of Infection 20 1. 11. 60. Public Health Inspectors, Civic Centre Food Without Fear The Place of Antiseptics in the Control of Infection 9 14. 11. 60. Ashton Gardens Ante-Natal Clinic Breast Feeding 20 28. 11. 60. Staffords Bakery Food Without Fear 15 12. 12. 60. Public Health Dept., Civic Centre Tailored for Timothy Stop Thief Simple Nutrition Claremont 20 12. 12. 60. (p.m.) Ashton Gardens Clinic— Parents' Meeting My First Baby The British Midwife 60 37 CARE OF MOTHERS AND YOUNG CHILDREN Infant Welfare Centres Centre Sessions Held Times Sessions Held Average Attendances Average New Cases The Clinic, Weekly Thursday, a.m. 40 3 Ashton Gardens, Chadwell Heath. Weekly Thursday, p.m. 34 3 The Clinic, Weekly Monday, p.m. 38 4 Becontree Avenue, Dagenham. Weekly Wednesday, a.m. 31 2 The Leys Clinic, Weekly Thursday, a.m. 17 1 Ballards Road, Dagenham. Weekly Thursday, p.m. 28 2 Rush Green Clinic, 179, Dagenham Road, (2nd, 4th & 5th in month) Friday, a.m. 13 1 Rush Green. Weekly Friday, p.m. 23 2 The Clinic, Weekly Tuesday, a.m. 39 3 Ford Road, Dagenham. Weekly Tuesday, p.m. 36 3 The Clinic, Weekly Tuesday, p.m. 26 2 15/17, Thompson Road, Dagenham. Weekly Friday, a.m. 9 1 The Clinic, Weekly Wednesday, p.m. 57 5 Oxlow Lane Dagenham. Weekly Friday, p.m. 51 4 Marks Gate Clinic Lawn Farm Grove, Marks Gate. Weekly Monday, p.m. 27 3 38 HEALTH VISITING AND SCHOOL NURSING The year was marred by the serious illness of the Superintendent Health Visitor whose death early in January, 1961, we record elsewhere. During her absences in hospital Miss Stewart deputised for her and she has submitted the following report. During i960 there have been some significant changes in the work of the health visitors—integration with the school health service has been commenced, and now three health visitors are doing the combined work of school nursing and health visiting. This first step towards complete integration is much appreciated for it has long been felt that interest in the family was cut when the child reached school age. Also in 1960, the appointment of a health vistor responsible for the over sixties was made to replace Mrs. Broad who left to take up health visiting training. Two of the health visitors, Miss Collyer and Miss Rudd, attended an intensive week-end course at the Institute of Natural Childbirth to study the Pierre Vellay method of teaching relaxation to ante-natal patients. Another health visitor, Mrs. Smith, attended a two-weeks' course at Nottingham University, devoted to methods of teaching, and in December seven of the staff attended a two-day course at Chelmsford on mental health. Three student health visitors received practical training under the guidance of the health visitors, and during the year several groups of third-year nurses from Oldchurch Hospital spent two afternoons with health visitors to see something of their work. In December, the health visitors started to re-visit all families who have been rehoused on medical grounds. This investigation has not yet been finished, as over 250 families have to be visited and detailed reports given on each family. Tuberculosis Health Visitors Apart from routine work, the health visitors play an active part on the Committee of the Dagenham Tuberculosis After Care Association. Besides attending meetings of the Association on the third Friday evening of each month, they accompany children and ex-patients on various outings, collect money with other members and hold jumble sales and sales of work. Mrs. Garrard, who is the honorary secretary of the Association, also organises the Christmas Seal Sale. School Nurses The school nursing staff lost three of its more recent recruits during the year and their places were taken by three of the health visitors taking over their schools and clinics. The main work of the school health department, however, still falls to the school nurses who have carried out 2,670 home visits, 520 medical inspections and 3,664 clinic sessions as well as the specialist clinics, the weekly swimming instruction for the physically handicapped children from the special school and a greatly increased number of immunising sessions for poliomyelitis, whooping cough and diphtheria. 39 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 132 Total visits 473 (b) To children under 1 year of age First visits 1,702 Total visits 7,392 (c) To children between the ages of 1 and 5 years Total visits 10,154 (d) Ineffective visits Total visits 2,836 (e) Other visits Total visits 2,315 Grand Total 23,170 40 MATERNITY SERVICES Maternal Mortality There were no maternal deaths in this area during i960. Ophthalmia Neonatorum Two cases of ophthalmia neonatorum were notified, both of which made a complete recovery. There were 11 cases of other eye conditions occuring 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 1960. County Midwives Midwives Residing at York House Training Home Salvation Army Midwives Births Attended: As Midwife 150 236 81 As Maternity Nurse 101 13 3 Miscarriages Attended 1 10 - (included in above) (not included in above) Visits Paid: As Midwife 2,400 8,075 1,645 As Maternity Nurse 2,514 86 61 Ante-Natal 2,332 1,428 257 Ante-Natal Clinics attended 236 - 67 Gas and Air Administered: As Midwife 105 184 81 As Maternity Nurse 44 11 3 Pethidine was given in 161 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. 8 2 The Clinic, Weekly Tuesday, p.m. 10 2 Becontree Avenue, Dagenham. Weekly Wednesday, a.m. 9 1 The Leys Clinic Ballards Road, Dagenham. Weekly Wednesday, p.m. 8 1 Rush Green Clinic, 179, Dagenham Road, Rush Green. (1st & 3rd in month) Friday, a.m. 2 1 The Clinic, Weekly Tuesday, a.m. 7 2 Oxlow Lane, Weekly Tuesday, p.m. 15 3 Dagenham. Weekly Thursday, a.m. 12 3 The Clinic, Ford Road, Dagenham. Weekly Monday, a.m. 10 2 The Clinic, Manford Way, Hainault. Weekly Monday, a.m. 4 1 4i Relaxation Classes The following were the attendances at the relaxation classes during the year:— Becontree Clinic 356 Chadwell Heath Clinic 244 Leys Clinic 428 Oxlow Lane Clinic 398 Total 1,426 PREMATURE INFANTS All infants weighing 5½ lbs. or less at birth are regarded as premature infants, whatever the length of 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 2 4 18 25 23 Born alive at home and transferred to hospital 3 1 - 2 6 2 Born in hospital 9 9 15 41 74 54 42 DAY NURSERIES DAY NURSERY ATTENDANCES JANUARY—DECEMBER, i960 Day Nursery Number of approved places Average Daily Attendance Average No. on Register Total Attendances Goresbrook Chadwell Heath 70 54 28.8 37.3 41.3 50 7,332 9,517 TOTALS 124 66.1 91.3 16,849 Nursery Widows Parents Separated Desertion Illness of Mother Illness of Father Unmarried Mothers Socioeconomic Mothers working to supplement income Total Goresbrook 1 5 - 5 - 3 9 36 59 Chadwell Heath 2 2 - 2 1 2 6 42 57 Number of children in all Nurseries 1960 3 7 - 7 1 5 15 78 116 This year, Kingsley Hall was converted to a Day Centre for Handicapped Children under 5, so the central area of Dagenham had no day nursery service. The few children attending Kingsley Hall were absorbed into Goresbrook and Chadwell Heath nurseries but, of course, the distances are too great to expect any new children from this central area to go to either of the day nurseries. The average daily attendance at Goresbrook was very slightly up on last year and that at Chadwell Heath was slightly lower, although the number on the register was considerably higher. On several occasions there was a waiting list for Chadwell Heath, especially for the baby nursery. This nursery is much more conveniently situated than Goresbrook, of course, and draws on a much larger area. About one third of the children receive assistance for fees. These are children with usually only one parent, or an invalid parent, or some social distress. The remaining two thirds are sent for various reasons—the chief of which is some pressing economic necessity which is dealt with by the mother going out to work. This became more noticeable towards the end of the year when a lot of local factories went on short time. Of course, the charge is uneconomic unless the mother can command a high wage and this is not often possible. 43 We have no seriously handicapped children now in Goresbrook or Chad well Heath, but several are sent for behaviour problems which are more easily coped with in the community of the nursery. This applies especially to the problems of only children in the 3—5 year group whose mothers cannot manage to change their rather isolated life at home. The nursery is the easiest and happiest way to prepare them for school life, and many mothers realise this and make great sacrifices to send them to nursery at about 4 years. Both nurseries continue to be recognised by the Ministry as training nurseries for nursery nurses, and vacancies for students are always quickly filled. The senior staff have on the whole been working for us for many years and this probably accounts for the smooth efficiency with which the nurseries run. Both nurseries are very alive and happy places, in which even the youngest children settle down with the minimum of distress at being separated from their mothers, and that is surely the best indication of success. 44 DOMESTIC HELP An analysis of the hours of service rendered by the Domestic Help Service during 1960 is given in the following table. Figures for 1959 are included in brackets. Type of case Number of cases Hours help provided Maternity 42 (50) 2,115 (2,908) Tuberculosis 14 (6) 2,313 (1,027) Acute 54 (41) 2,488 (2,701) Chronic Aged 513 (460) 71,197 (62,147) Chronic Others 91 (92) 16,361 (17,958) Aged not Sick 3 (3) 371 (361) Others 20 (13) 3,332 (3,749) Night Attendance 4 (-) 160 (-) Totals 741 (665) 98,337 (90,851) Number of visits paid by Organiser 1,545 (1,400) Average number of domestic helps employed each week 85 (80) Number of night attendants on register 2 (—) Number of visits paid by domestic helps 49,504 (46,332) Number of visits paid by night attendants 15 (—) There is little change over the past few years in the type of case calling for the Domestic Help Service, but the demand continues to increase, particularly for the aged and chronic sick. Frequently in these cases, the relatives refuse to help and the home helps and the W.V.S. are the only links the sick and aged have to alleviate their loneliness and boredom. Their needs from the Domestic Help Service are friendship as well as for help in the house. To many of the old and infirm the home helps give much time and care outside their duty hours, such as providing weekend meals and Christmas dinners, or taking the more able-bodied into their own homes to relieve their loneliness. The help given to those with tuberculosis, the service provided for maternity cases, and the care of children whose mothers have had to go into hospital, are the three other main calls on the service, but all together they do not now add up to more than a quarter of the time spent in the care of the sick and elderly. There is always a list of women willing to be home helps and every care is taken to engage the right type of worker for this very worthwhile service, which is a big practical contribution to the social services. A training course is held twice a year at Chelmsford and is very much appreciated by the helps who attend as it keeps them in touch with developments in the service. The usual visit to a London theatre was made this year and was thoroughly enjoyed by all. 45 CHIROPODY SERVICE Two full-time chiropodists were employed at the end of the year, the part-time chiropodist having left in March. Attempts to fill the vacancy were unsuccessful. Clinics are held at Ford Road and Ashton Gardens, Chadwell Heath, as follows:— Ford Road Ashton Gardens, Chadwell Heath Monday 2.00 p.m. — 5.00 p.m. 5.30 p.m. — 8.30 p.m. Tuesday 9.00 a.m. — 1.00 p.m. 9.00 a.m. — 1.00 p.m. 2.00 p.m. — 5.00 p.m. 2.00 p.m. — 5.00 p.m. Wednesday 10.00 a.m. — 1.00 p.m. 2.00 p.m. — 5.00 p.m. 5.30 p.m. — 8.30 p.m. Thursday .. 9.00 a.m. — 1.00 p.m. 2.00 p.m. — 5.00 p.m. Friday 9.00 a.m. — 1.00 p.m. 2.00 p.m. — 5.00 p.m. 5.30 p.m. — 7.30 p.m. A nominal charge of 2/6d is made for each attendance. Necessitous cases and school children are treated free. The following table indicates the work done during the year:— Children under 15 years of age Expectant Mothers Physically Handicapped Aged Others New cases treated during the year 232 5 6 93 363 Total attendances 1,383 10 432 2,715 4,074 Cases still being treated at end of year 99 2 83 319 591 46 OCCUPATIONAL THERAPY Owing to an extension of the areas to be visited weekly, the occupational therapist now spends only part of one day a week visiting in the Dagenham area. In spite of this there were 431 visits made as compared with 359 last year. The value of materials issued was approximately £80. Completed articles were sold at the Town Show and in November, a sale of work organised by the Dagenham Tuberculosis After-Care Association resulted in a further successful effort to sell work made by patients. At the Thompson Road Clinic there have been steady sales throughout the year from the show case which was installed at the close of 1959. There may appear to be undue emphasis on the sale of completed articles, but one must be realistic and patients in the Dagenham area cannot all afford to give away or even to keep their completed work. Most of the money realised from the sales goes towards buying more materials, or enables a patient to make something for himself or his family without depleting the housekeeping purse. Occupational Therapy for Domiciliary Chest Cases The following is a summary of work carried out from January 1st to December 31st, i960:— Total of Patients Total of New Patients Total of Visits January 13 - 37 February 17 4 29 March 19 1 32 April 20 - 18 May 21 3 39 June 23 2 36 July 22 3 51 August 23 1 40 September 23 - 31 October 19 1 42 November 20 - 48 December 16 - 28 47 CONVALESCENCE AND RECUPERATIVE HOLIDAYS National Health Service Act Arrangements were made for patients as indicated:— Section 28: 3 Shoreditch Holiday Home 12 Friendly Society Convalescent Home, Heme Bay 1 Samuel Lewis Home, Walton 1 St. Michael's, Clacton 16 Bell Memorial Home, Lancing 6 T.B. cases placed by Spero 1 St. Joseph's Convalescent Home, Bournemouth 2 Surrey Convalescent Home, Seaford 1 Bannow, St. Leonards Section 22: 1 Mother with children—Lennox House, Southsea 1 Mother with children—Shoreditch Holiday Home 2 Children—Stamford HL1 Children's Home, Thorpe Bay School Health Service 91 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. 44 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 28 children were examined by school medical officers before being admitted or re-admitted to camp schools. 48 OXLOW LANE CLINIC FOR THE OVER SIXTIES Since the clinic has been operating for over three years, this seems an appropriate time to take stock. The numbers of over sixties seen in that time are not very large and this, together with the fact that multiple pathology is the rule rather than the exception, makes classification difficult. A table is appended giving some details of those completing their investigations during 1960. It was unusual to find a patient who did not need chiropody, and varying degrees of deafness were not uncommon—some cured by simple syringing of the ears. The primary purpose of the clinic is to keep people active and well for as long as possible, and in rare instances only has it been found that patients have suffered invalidism and dependence for any length of time. The "exercise classes" continued to function, though perhaps the name is a misnomer in that the activities have extended much beyond simple physical exercises. An average of about 25 patients attended the classes and an attempt was made to encourage the members to select their own leader for group discussion. Towards the end of the year it was becoming obvious that an expansion of present activities of the clinic should be taking place. The chief limiting factor to this expansion is shortage of staff and limited accommodation. With adequate help the mental health of the over sixties could receive more detailed attention and the services of an interested psychiatrist and psychologist, to be called upon as needed, would be of great assistance in dealing with some of the problems which arise. There is a need, also, for a further clinic in another part of the Borough but this could not be undertaken with present limited staff. Inadequate premises have also prevented any attempt at the development of the clinic as an after care centre for patients discharged home from hospital, and in the few cases where this has been attempted the infrequency of sessions was the obvious cause of failure where continual support was needed to help the patient at home. Three or four sessions would be the weekly minimum for this service. Many of the patients who passed through the clinic failed to receive full benefit as they have not attended either the exercise classes or the discussion groups. This has been mainly due to shortage of staff time to follow them up and to encourage them to attend. 49 PATIENTS ON WHOM INVESTIGATIONS WERE COMPLETED DURING 1960 Sex Age Physical Disability Social Disability Disposal F 74 (1) Prolapse of uterus (2) Right eye removed Lives alone Suggest attends exercise class F 70 Nil Family friction Repeated attempts failed to to help to resolve problems M 61 Nil Family friction J F 79 Long-standing osteoarthritis of knee Nil Exercise class F 75 Rheumatic arthritis Nil Exercise class F 67 Anaemia Nil Referred to own doctor for treatment M 84 Long-standing pompholyx of hands Nil Referred to own doctor F 71 Nil Nil Exercise class F 68 Hiatus hernia Living in house which is too big Try to arrange house exchange. Referred to own doctor for treatment. F 76 (1) Mild anaemia Nil Referred to own doctor for treatment (2) Painful heels F 81 Nil Nil Exercise class M 74 (1) Deaf Lives with daughter and five children Exercise class (2) Enlarged prostate F 71 Overweight Nil Diet and exercise class F 68 Haemangioma of upper lip Lonely Exercise class F 70 Deafness Mentally slow Advised to attend excerise class. Hearing aid prescribed by E.N.T. Department F 78 Heart failure Nil Referred to own doctor F 71 Emphysema Nil Referred to own doctor F 75 Nil Nil Exercise class F 65 (1) Obesity (2) Arthrodesis of hip Lives alone For diet and exercise class F 81 (1) Arthritis (2) Needs new dentures Nil New dentures arranged F 65 Nil Nil Exercise class F 71 Deaf Husband suffers from early senile dementia and is a problem Hearing aid prescribed. Husband seen by psychiatrist M 75 Early senile dementia Nil Admitted to mental hospital F 71 Defective vision Nil Referred to own doctor for glasses M 78 Deafness Nil Referred to E.N.T. Surgeon 50 Sex Age Physical Disability Social Disability Disposal F 73 (1) Inadequate diet Nil Advised about diet. Referred to own doctor (2) Fibrillating F 66 Obesity Nil Advised about diet F 65 Nil Nil Exercise class F 77 Advanced breast tumour Nil Referred to hospital M 74 Amputation of left leg Nil Advised F 73 Nil Family difficulties Advised F 65 Slight deafness Nil Exercise class F 85 No detailed examination carried out Chiropody only F 62 Very fit Nil Exercise class F 76 (1) Obesity Nil Advised about diet (2) Hypertension F 70 (1) Loss of smell Nil Warned about danger of gas and advised to change to electricity if possible. Referred to gynaecologist (2) Prolapse of uterus F 68 Defaulted F 67 Nil Nil Exercise class F 67 Hypertension Nil Attends hospital for treatment M 70 (1) Emphysema Family difficulties Exercise class (2) Scotoma F 67 Nil Family difficulties Exercise class F 69 Fit Nil Exercise class F 82 Slight deafness Nil Exercise class M 84 (1) Dizziness Nil Referred to E.N.T. Surgeon (2) Intermittent deafness (Wears hearing aid) F 79 (1) Mitral stenosis Unsuitable for clinic (2) Deafness (3) Diabetes M 71 Requested treatment for his feet only Transferred to Ford Road Chiropody Clinic F 66 Arthritis knees and hands Nil Exercise class F 70 Fit Nil Exercise class 51 VACCINATION AND IMMUNISATION Vaccination against Smallpox During the year 1,121 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 223 391 - - 1—4 years 64 37 8 3 5—14 years 79 37 20 - 15 years and over 83 1 161 14 Total all ages 449 466 189 17 Whooping Cough 2,667 children received immunising doses against whooping cough, including booster doses. Primary Boosters Combined Whooping Cough and Diphtheria Vaccine Combined Boosters G.P.'s L.H.A. G.P.'s L.H.A. G.P.'s L.H.A. G.P.'s L.H.A. 236 681 292 1,046 318 - 94 - The figures above show how well the campaign to increase immunisation against whooping cough succeeded this year, particularly the previously neglected booster programme. The local health authority gave 1,046 booster injections (last year only 2 were recorded) and general practitioners gave 292 (32 in 1959) and 94 combined diphtheria and whooping cough boosters. This response to the appeal made at the beginning of the year is most gratifying and the programme will be continued. B.C.G. B.C.G. vaccination has continued in the 13-plus age group; this year 2,600 children were offered vaccination. i?444 children were tested after the parents' consent had been received. Results of the Multiple Puncture tests:— Negative 1,340 Positive 104 Of the children with negative reactions (and therefore susceptible) 1,266 received B.C.G. vaccination. There were no cases of post-vaccination complications. Tuberculosis Vaccines Clinical Trial Of the 858 young people invited for their seventh annual x-ray, 553 attended, i.e., 64%. 52 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 1,643 children received primary immunisation injections and a total of 1,850 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 573 405 _ _ 1—4 years 180 144 63 61 5—9 years 143 41 609 250 10—14 years 139 18 748 119 Total all ages 1,035 608 1,420 430 Diphtheria Immunisation of School Children A total of 2,067 school children were immunised against diphtheria during the year (of which 428 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. 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. Immunity Index 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. 60. i.e. born in year Under 1 yr. 1960 1—4 yrs. 1956—1959 5—9 yrs. 1951—1955 10—14 yrs. 1946—1950 Under 15 yrs. Total Last complete course of injections whether primary or booster 1956—1960 276 4,487 5,112 4,859 14,734 1955 or earlier Estimated mid-year — 2,213 5,157 7,370 population 1,517 5,950 18,850 26,317 Immunity Index 18.2 75.6 52.9 56 53 Poliomyelitis Evening and Saturday morning sessions were arranged on an appointment system with an average of 150 injections at each session, as the numbers of requests and booster doses falling due merited. The increase in the age limit up to 40 years brought a poor response and the total for the year for all age groups was considerably reduced. 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 collcction of vaccine and the completion of registrations. During the year a total of 4,220 primary injections (i.e. 2 doses) were given and II,III third injections. Immunisation 1960 By Medical Officers By General Practitioners Total Primary 1,501 (7,061) 2,719 (6,542) 4,220 (13,603) Booster 5,709 (11,112) 5,402 (5,747) 11,111 (16,859) The corresponding figures for 1959 are shown in brackets. There were no cases of poliomyelitis notified to the department in i960. Total acceptors since commencement of scheme 373814 Total primary injections since commencement of scheme 32,551 Total booster injections since commencement of scheme 27,970 54 SCHOOL HEALTH, 1960 School Premises There are 16 secondary and 45 primary schools in the Borough, also 2 special schools. Children on the registers on 31st December, 1960 totalled 19,815, a decrease of 504 compared with 1959. Public health inspectors carried out periodic inspections at school kitchens and schools were visited for the purpose of obtaining samples of milk for bacteriological testing. 12 such samples were obtained during the year, all of which passed the methylene blue test. SCHOOL INSPECTIONS As in previous years, medical inspection in the schools during i960 covered 4 groups:— (a) Children in their first year of attendance (ib) 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 4,471 (ii) Others 842 Total 5,313 B—Other Inspections Number of special inspections 1,647 Number of re-inspections 1,453 3,100 55 5,313 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 14 6 29 20 12 13 55 39 69 32 5 Eyes (a) Vision 19 24 100 45 114 88 233 157 23 23 (b) Squint 33 14 11 11 20 24 64 49 6 7 (c) Other 4 10 5 12 6 11 15 33 14 27 6 Ears (a) Hearing 5 1 5 4 - 5 10 10 14 22 (6) Otitis Media 5 1 2 1 3 3 10 5 11 9 (c) Other 1 2 11 2 1 4 13 8 2 1 7 Nose and Throat 65 86 6 12 44 39 115 137 44 47 8 Speech 19 25 1 1 4 11 24 37 49 15 9 Lymphatic Glands 33 37 1 - 10 10 44 47 5 5 10 Heart 6 13 7 8 17 24 30 45 12 25 11 Lungs 11 23 2 25 10 33 23 81 21 45 12 Developmental (a) Hernia 1 1 - - 3 3 4 4 2 - (b) Other 4 10 3 5 8 18 15 33 3 9 13 Orthopaedic (a) Posture 4 10 2 10 19 15 25 35 5 4 (b) Feet 10 21 5 30 32 21 47 72 10 10 (c) Other 15 34 5 33 9 57 29 124 68 59 14 Nervous System (a) Epilepsy - 1 2 2 4 1 6 4 2 3 (b) Other - 1 2 5 2 5 4 11 6 8 15 Psychological (a) Development 9 10 2 2 27 17 38 29 9 13 (b) Stability 1 20 - 3 7 18 8 41 13 9 16 Abdomen 1 - 1 - 3 3 5 3 - - 17 Other 87 5 16 1 103 5 206 11 141 394 56 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) 1956 and later 1 7 7 1955 10 169 173 1954 8 103 106 1953 4 39 41 1952 1 5 6 1951 1 5 6 1950 15 24 37 1949 64 131 183 1948 22 81 98 1947 4 10 12 1946 64 51 106 1945 and earlier 39 61 96 TOTAL 233 686 871 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) (1) No. of Pupils Inspected (2) Physical Condition of Pupils Inspected Satisfactory Unsatisfactory No. % of Col. 2 No. % of Col. 2 (3) (4) (5) (6) 1956 and later 140 140 100 - - 1955 757 753 99.47 4 0.53 1954 663 655 98.79 8 1.21 1953 128 128 100 - - 1952 43 42 97.67 1 2.33 1951 38 36 94.74 2 5.26 1950 186 186 100 - - 1949 1,097 1,090 99.36 7 0.64 1948 568 567 99.82 1 0.18 1947 25 24 96 1 4.0 1946 973 971 99.80 2 0.20 1945 and earlier 695 694 99.86 1 0.14 TOTAL 5,313 5,286 99.49 27 0.51 57 Uncleanliness The number of children found with vermin and/or nits during the year was 155. Arrangements have been made with Hackney Borough Council for persistent offenders to be cleansed in Hackney for a small fee, for which the Education General Purposes SubCommittee 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 19,505 (ii) Number of instances of infestation found 155 (iii) Number of cleansing notices issued Section 54 (2) tion Act, 1944 155 (iv) Number of disinfestations carried out:— By school nurses 27 By parents 128 VISUAL DEFECTS Vision tests were carried out on all children at the school medical inspections and 117 referred for treatment at the Ophthalmic Clinics and 60 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) 341 151 Errors of refraction (including squint) - 1,504 Number of pupils for whom spectacles were prescribed - 535 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 2,097 695 973 Found to have defect of colour vision 28 6 9 58 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. At a Chest Clinic By Mass Radiography Tuberculosis Visitors and Health Visitors doing tuberculosis work 2 - Home Nurse/Midwives 10 - All Day Nursery Staff 8 24 All Occupation Centre Staff - 7 Domestic Helps 1 - Others 36 16 Teachers - 64 Non-teaching Staff 3 93 59 X-ray of Staff SCHOOL CLINICS During the year 2,920 children were seen by the school medical officers and 6,445 attendances were made at nurses' clinics. The total number of attendances made by school children at each of the minor ailment clinics during 1960 were as follows:— Ashton Gardens 758 Bentry School 949 Becontree Avenue 1,604 Five Elms 2,370 Ford Road 1,678 King's Wood School 851 Leys 348 Oxlow Lane 770 Marks Gate 37 9,365 Other Treatment Given New Cases Treated By the Authority Otherwise (a) Miscellaneous minor ailments 1,050 44 (b) Other (1) Heart and rheumatic diseases — 18 (2) Hernia — 14 (3) Major respiratory diseases — 16 (4) Major digestive diseases — 71 (5) Major injuries — 28 (6) Other major disease — 52 (7) Enuresis — 32 Total 1,050 275 Diseases of the Skin (Excluding Uncleanliness) Number of new cases treated during the year By the Authority Otherwise Ringworm (Scalp) 1 — Ringworm (Body) 1 — Scabies — — Impetigo 12 2 Other Skin defects 891 8 Number of examinations made by Skin Specialists—5 60 Diseases and Defects of Ear, Nose and Throat Number of children referred to Consultants during 1960—55 Number of cases treated By the Authority Otherwise Received operative treatment (a) For diseases of the ear - 47 (b) For adenoids and chronic tonsillitis - 166 Received other forms of treatment 133 62 Total 133 275 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 444 453 9 8 10—12 + years 948 927 19 23 14 years 503 470 3 8 Other periodic 808 760 21 8 Total 2,703 2,610 52 47 Employment of Children 215 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. Entrants to the Teaching Profession and to Training Colleges 67 2. Essex County Council 118 3. Dagenham Borough Council 197 4. Other Authorities (b) Under Sickness Regulations 9 (c) Other purposes 91 Number of consultations with specialists arranged 55 Home Visits by School Nurses 2,670 visits were made by school nurses to the homes of school children during the year. 61 DENTAL SERVICES Inspection and Treatment No. of Dental Officers at end of December, 1960 3 No. of sessions carried out during the year 379 No. of children on waiting list 375 No. of children on waiting list in 1959 253 No. of children inspected in 1960 1,508 No. of children inspected in 1959 3,863 No. of treatment sessions in 1960 379 No. of treatment sessions in 1959 850 No. of children who received treatment in 1960 941 No. of children who received treatment in 1959 1,758 Dental Inspection and Treatment of School Children Periodic Specials (a) Number of pupils inspected 153 1,355 (b) Number found to require treatment 137 1,264 (c) Number offered treatment 137 1,264 (d) Number actually treated 113 828 (e) Number awaiting treatment 141 234 (f) Attendances made by pupils for treatment 182 2,685 (g) Half days devoted by Dental Officers to— (i) Inspection 100 (ii) Treatment 279 (h) Fillings (i) Permanent teeth 1,366 (ii) Temporary teeth 348 (i) Number of teeth filled (i) Permanent teeth 1,262 (ii) Temporary teeth 323 (j) Extractions (i) Permanent teeth (a) on account of caries 724 (b) for other purposes 17 (ii) Temporary teeth (a) on account of caries 1,448 (b) for other purposes 1 (k) Anaesthetics administered (i) Local 822 (ii) General (a) by Medical Officers on County Staff - (b) by others 806 62 (l) Orthodontics (i) Cases completed 32 (ii) Cases discontinued 1 (iii) Pupils treated with appliances 40 (iv) Removable appliances fitted 19 (v) Fixed appliances fitted (iv) Total attendances 139 (m) Dentures (i) Number of pupils supplied with artificial dentures 23 (ii) Number of dentures fitted 23 (n) Other operations (i) Permanent teeth 108 (ii) Temporary teeth 23 (o) Analysis of figures in (n) Type of operation Number Silver Nitrate Treatment 1 Scaling 17 Syringing Sockets - Dressings 35 Inlays fitted - Other operations 78 (p) X-rays 55 Mother and Child Welfare Dental Treatment Expectant or Nursing Mothers Children under five years of age Number of patients examined 122 77 Number of patients needing treatment 111 72 Attendances for treatment 316 118 Number of patients who have completed treatment 63 30 Number of extractions 247 47 Number of fillings 69 75 Number of anaesthetics administered: (a) local 75 7 (b) general 8 17 Number of scalings or scaling and gum treatment 5 — Number of dressings 3 — Number of dentures provided: (a) full 23 — (b) partial 17 — 63 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:— In February i960 we moved into a more spacious treatment room with separate waiting room and cubicles. The appointment system was continued and children attended in their respective age groups classes for feet, posture and breathing, boys and girls being treated separately In all 560 patients attended for physiotherapeutic treatment, 10,467 treatments being given. No waiting list is kept for treatment, all patients are seen on receipt of referral forms or letters and an appointment given. Two mornings a week are devoted to ambulance cases, approximately 20—25 cases being brought in each morning. I would here like to express my appreciation of this willing and co-operative service. In view of the increasing amount of work the present apparatus has been found to be inadequate and a request to the Regional Hospital Board for larger and more up to date apparatus has been made and passed by Mr. Moore as essential. I would like to add that I think it is a great pity so many children from such an early age—6 upwards—are allowed to wear such unsuitable shoes. I visualise many more foot deformities for both girls and now boys unless parents and schools take the necessary steps to see that children are sensibly shod. Patients seen during 1960:— Infant welfare children 48 School children 374 Adults 138 Total 560 Total number of treatments given 10,467 The orthopaedic surgeon attended 11 sessions at which 160 patients were seen, 66 of which were new. 64 Ophthalmic Clinic The two specialists who attend weekly run a separate service for different parts of the Area, which is divided into two, based on the areas of the school nurses responsible for the respective clinics, and the nurses are individually responsible for appointments for children in their area—one based on Ford Road and the other on Five Elms. The two ophthalmic clinics, however, are held at Becontree where there is special provision and equipment. There is much that is similar in the two reports received, and both ophthalmologists again plead for the appointment of a dispensing optician—a request that has been repeated for the past five years. I give below both reports this year instead of combining the two as previously. Dr. Regal reports as follows:— During 1960, I held 50 ophthalmic sessions at Becontree Clinic. 771 children attended, 198 of whom were seen for the first time. This gives an average attendance of 15—16 cases. Our patients are referred to us mainly by the school medical officer or the school nurse, some from the Infant Welfare Clinic, a few are sent by their family doctor, and in some instances parents approach us on their own initiative or prompted by the school teacher. During the year we meet every type of pathological eye condition, but our main work is refraction work and the treatment of squints. Thus, of the 198 new cases 120 were in need of glasses and of the remaining old cases 179 received new glasses, and for another 17 new lenses were fitted into their old frames. As far as the treatment of squints goes, I should like to mention with gratitude and appreciation the very good co-operation we receive from the hospitals and the orthoptic departments. Their reports come speedily and the waiting time for appointments and operations is very short. Unfortunately, each week there are parents who fail to attend without giving reason or notification, thus taking up valuable time from which another child could have benefited. This also makes additional work for the health visitor and clinic nurse who go and visit the absentees, and I should like to express my special gratitude for their untiring efforts. At the end of the year there was a waiting list of 85 old cases and 17 new cases. I will not finish this report without pleading again for the presence of a dispensing optician at our sessions from which everybody would benefit and which might also prevent the ever increasing pirating inclinations of some outside opticians of which we have very concrete evidence. 65 Dr. Macfarlane reports as follows:— Weekly clinics continued to be held during 1960, and a total of 733 cases was seen. Of these, 142 were new cases, and at the end of the year there was no waiting list of new cases, about 3 or 4 of these being fitted in at the clinic each week. There are, however, considerable arrears with regard to the retesting of old cases, and it is impossible to keep up the standard of seeing the patients every 6 months as their numbers are too many. Becontree Clinic is a much pleasanter place to work in since the re-decorations were done, and in particular the waiting room with its chairs for all sizes of children and its gay colours has been improved beyond all recognition. Children with squints continue to form the bulk of the patients seen at the clinic and orthoptic treatment can be obtained for these at Oldchurch Hospital when necessary. Should they require surgery they can be dealt with very quickly at the same hospital or at King George V Hospital, Ilford. Pre-school children are also seen at the clinic, and it has been found that the mothers of these are often more co-operative than those of the older children. As in past years, non-attendance at clinics without any excuse being given is still very prevalent, and is to be deplored. The school nurses are very zealous in their efforts to follow up these patients, and are greatly to be commended. In my opinion the presence of a dispensing optician at the clinic is very desirable, and would probably be welcomed by the parents as it would save them time and effort. Audiometric Tests 27 children have been tested with the audiogram. 8 were referred to Grays Inn Road Hospital, 15 are being kept under observation, 1 is attending school for the deaf, 1 would not co-operate and 2 had normal hearing. Child Guidance 173 children from Dagenham were seen at the Romford Child Guidance Clinic. There is still a 3 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; 227 children were so referred during the year as follows Chest Physician 9 Cardiologist 19 Orthopaedic Surgeon 20 E.N.T 55 Dermatologist 5 Paediatrician 56 Enuresis Clinic 28 Ophthalmologist 4 Audiologist 31 227 66 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 Department has followed an even course throughout the year. Numbers have shown a slight increase on 1959, despite the fact that the total attendance in Infant and Junior Schools still continues to decrease. It is interesting to note that out of a total of 230 cases passing through the Speech Clinics in the course of the year, 100 had a family history of specch defect. No definite conclusion can be drawn from these figures, but it would seem to support the supposition that there is often an inherent familial tendency towards speech weakness. Acquisition of normal speech depends upon a combination of factors, not the least of which is the interest and co-operation of the staffs of the schools concerned, and we would like to record a note of our appreciation of the help afforded us in this way. Looking ahead, we would like to feel that, at some future date, permanent premises might be made available for the Speech Therapy service in the Borough. Speech Therapy Statistical Return 1. Number of treatments given 2,694 2. Number of patients treated:— The Bentry School 28 Five Elms Clinic 89 Oxlow Lane Clinic 21 Leys Clinic 53 Ashton Gardens Clinic 21 Marks Gate Clinic 18 — 230 Both therapists used one session a week for school visits, interviews and tape recordings. 3. Number of sessions held: — The Bentry School 119 Five Elms Clinic 222 Oxlow Lane Clinic 77 Leys Clinic 193 Ashton Gardens Clinic 90 Marks Gate Clinic 94 — 795 4. Case Load— Boys—144 Girls—86 Total 230 67 5. Types of Cases Treated:— 1. Dyslalia 112 2. Delayed Development including aphasia 23 3. Sigmatism 34 4. Stammer 37 5. Stammer and dyslalia 2 6. Defect associated with hearing loss 3 7. Cleft palate 3 8. Disorder of voice 9 9. Unclassified 7 — Total 230 6. No. of cases on Register at 31. 12. 60 121 7. Reasons for discharge:— 1. Speech normal 65 2. Non-attendance 14 3. No further progress likely 16 4. Transferred to another school 8 5. Left school 1 6. Discharge requested by parent 5 — Total 109 68 HANDICAPPED CHILDREN A detailed review of the area showed that there are 223 children with physical defects who are able to continue in ordinary schools. These children are called to the school clinics annually to be examined by the school medical officers, and their progress reported. A detailed file of these children is kept centrally, together with that for the children registered as physically handicapped on Ministry of Education Forms 4.H.P. as in need of special educational treatment. The following table gives a picture of handicapped children in Dagenham, and their placement in school:— Children of school age on 31st December 1960, formally ascertained as handicapped pupils and requiring special education treatment (s.e.t.) N.B. These figures include 27 school children with dual handicaps Blind Partially sighted Deaf Partially Deaf Delicate Physically Handicapped E.S.N. Maladjusted Epileptic Speech Defect TOTAL Attending day special school — 12 8 5 24 53 166 — 1 1 270 Awaiting placement in day special school — 1 — — 4 1 30 — — — 36 Attending residential special school 5 1 3 — 16 7 13 16 1 2 64 Awaiting placement in residential special school — — — — 3 2 6 2 — — 13 Receiving home tuition under Section 56 — — — — 1 1 — — 1 — 3 Total No. of children of school age requiring s.e.t. 5 14 11 5 48 64 215 18 3 3 386 Children of school age on register of handicapped pupils but not requiring s.e.t. and attending ordinary schools - 9 - 14 98 55 22 9 12 4 223 Pre-school children receiving s.e.t. 1 - - - - - - - - - 1 Pre-school children awaiting s.e.t. 1 3 — — 5 9 6 - 2 - 26 Children aged 2-5 years at 31st December 1960 on register of handicapped pupils but not requiring s.e.t. - 2 - - 5 10 - - 5 6 28 Children admitted to Special Schools during i960 Admitted to Residential Schools:— E.S.N 3 Physically handicapped 1 Delicate 5 Maladjusted 6 Epileptic 1 Blind 1 Partially sighted 1 69 Admitted to the Bentry and Other Day Special Schools:— E.S.N 18 Physically handicapped 9 Partially deaf 2 Delicate 5 Partially sighted 6 Of the children who were attending Residential and Special Schools the following were returned to ordinary schools during 1960:— From Residential Schools:— Maladjusted — 4 Recommended for trial period at ordinary school. Delicate — 7 Asthma 5—improved. Delicate 2—improved. From Special Schools:— E.S.N. — 4 Delicate — 5 Asthma 3 Delicate 2 Physically handicapped—1 On trial at ordinary school. 70 BENTRY SCHOOL Throughout the year the school medical officers and school nurse have attended the school. A weekly session of medical examinations and/or intelligence testing has been held, at which the parents and the headmaster are present, and the school nurse attends for minor ailments for 3 sessions a week. The number of physically handicapped children attending remains fairly constant from year to year, but the severity of their handicaps has remarkably increased recently, so that a fair proportion of the younger children are now chairfast or only just beginning to walk. This means a great deal of extra work for and understanding from the staff, and I would like to record my appreciation of their interest in the children's medical progress and their co-operation in the training of the children in walking and self-help. This year we have been fortunate in the extension of the physiotherapy at the school to 4 sessions a week, while still retaining Mr. Brand's services for the therapeutic swimming once a week. The reports of both therapists are given below. Mrs. Cocker reports:— The year 1960 saw the arrival of quite a number of new pupils at the Bentry School. Mostly the children were victims of Anterior Poliomyelitis and were now in need of general after-care and of maintaining at least their physical condition, and where possible, improving it. As always, my main aim has been to instruct children (with parents whenever possible) in a general scheme of exercises so that all parts of the body are used, giving special care to breathing and the awareness and importance of general good posture. The individual schemes of exercises are revised whenever the condition of the patient so decrees, and of course, to prevent boredom, for it is most important that these exercises are continued for many years and the children are encouraged always to keep their exercises going at home. Most of the work with these children is purely physical, very little electrical apparatus being of great value in their treatment, but I do feel that many, especially the spastic and "chesty" children would greatly benefit from general ultra violet ray radiation during the winter months; experience has proved that courses of ultra violet ray treatment help to raise general resistance and so improve general health. Mr. Brand reports:— The swimming classes continued to be as popular as ever. We had a total attendance of 311, including 14 new children. 71 During the year I tried to divide the lesson up a little and while one of the attendants takes the beginners on the side of the bath I am left free to deal with the more severely handicapped children who cannot be left at all. I am at a disadvantage though inasmuch as I can only take one at a time. This means that as there is more than one severely paralysed child the others have to sit around shivering. I would, therefore, be grateful for anyone—nurse or otherwise—who would enter the water and who can handle a severe case. Once again I would like to say thank you to Mr. Jones and his staff for their kind co-operation and helpfulness. 72 KINGSLEY HALL DAY CENTRE Water play Meal time PROGRESS REPORT ON KINGSLEY HALL DAY CENTRE FOR HANDICAPPED CHILDREN UNDER 5 The opening of Kingsley Hall Day Centre for Handicapped Children in May 1960 was the outcome of a report on handicapped children under 5 years of age in Dagenham in 1957 which was put to the Health Committee and published in my annual report for that year. The survey reported brought to our notice 85 children under 5, i.e., 1% of the 8,000 o—4 year-olds in Dagenham with a degree of handicap likely to necessitate special schooling. That was 3 years ago, and the survey of these children, together with new additions to the register of handicapped children under 5 now kept in the Health Department, has been continued by constant home visiting and reviews in the clinics of all children with mental or physical defects. Most of the children originally visited and considered suitable for the proposed Day Centre have now either reached school age and are attending Special Schools, or have died or moved from Dagenham, so that when in the first few months of i960 after all the preliminary obstacles had been overcome, briefly to be summarised as final approval by everyone at local, County and Ministry levels, and then back and forth between the Health Area and the County on matters of detail in planning, converting, equipping, staffing and financing, all but 4 of the original children were no longer in need. The remaining 4 will be discussed later as they presented a problem in itself. At the beginning of 1960 we were able to make a start in the reorganising of the Kingsley Hall Day Nursery which was closed in February and the few remaining children transferred to the other two day nurseries. The staff, too, were transferred, with the exception of the warden who attended Osborne Hall Day Training Centre to gain experience with mentally handicapped children. The Borough Surveyor's Department moved in and it is largely due to their keen interest and enthusiasm that a building which had little promise was converted by skilful floor laying, kitchen modernisation and a happy choice of colour into a gay and welcoming centre in three months. The Warden of Kingsley Hall, from whose Committee the building is rented, deserves our thanks for his agreement and co-operation in the modernisation of their building. The County Council had agreed with the proposal that no charge should be made as the Centre was to be for the ascertainment and the needs of the children in a way in which the day nurseries cannot be, and this generosity has made all the difference in persuading the more needy parents to send their children; in all cases these were the children and parents most in need of help. Staffing was a problem that, looking back from the safe distance of seven months' harmonious working, one wonders what our worries were, but we had a core of day nursery staff to be fitted into the new scheme, and an agreed establishment of Sister-inCharge, 2 Staff Nurses, Warden and 3 Nursery Assistants. 73 The Sister came from hospital duties with no special experience with healthy, handicapped children, but with an enormous enthusiasm and a remarkable aptitude for handling staff. The Warden returned from her visit to the Training Centre, interested in the problems of the mentally retarded, and one Staff Nurse deputises for the Sister and has nursing qualifications, the other has experience in nursery schools and with handicapped children. Of the 3 Nursery Assistants, 2 returned to the centre from the day nursery and one was appointed. All the staff have shown enthusiasm, kindness and understanding of the problems of the children. The Regional Hospital Board agreed to the appointment of a part-time physiotherapist who attended 4 sessions a week, though in the last few months of the year the demands by the hospitals on her time increased and the nursing staff have taken over 2 of the sessions. It has been agreed that 20 mentally or physically handicapped children should attend, and while the work of conversion was going on and staff appointed, visits were made to the homes of those children on the register who were known to be severely handicapped or whose home conditions or family circumstances could not give them the help they needed; or a few cases whose mothers had borne the brunt of the constant care of a severely defective child and were themselves in need of assistance. It is here that we were faced with the problem of the remaining 4 mental defectives who had already been ascertained and reported to the Health Authority, but for whom residential or day placement had not then been found. The parents of these children had been the encouragers and enthusiasts for the scheme throughout the years, and although their children were no longer eligible it was felt that they should be admitted until accommodation could be found for them by the Mental Health Authority. This was rapidly forthcoming in the case of two of the children, and a third was placed after 5 months, and there remains only one whose parents have refused residential training and who is unsuitable for the Day Training Centre because of his associated physical handicap. The first 20 children recommended all had very serious degrees of handicap, which is to be expected as they were those whose mothers were finding it difficult to manage. Of these, 4 were severe spastics—only 1 able to walk with support 1 hemiplegic 1 spina bifida and hydrocephalic—legs paralysed 1 mongol 2 blind 4 mental defectives 2 mentally retarded—no speech 2 congenital heart 1 poliomyelitis 1 premature—severely physically retarded 1 blind and defective 74 Two meetings of the parents and children at the Civic Centre were arranged and the plans discussed. Arrangements were made with a coach hire firm to collect the children and parents for the first day, and thereafter only mothers who wished to bring their children came with them; one of the nursery assistants accompanies the coach on all journeys to and from the centre. After the first few days when the mothers who had been full of foreboding and distress initially, mixed with relief at the prospect of a little freedom, saw that most of the children were settling well, a routine was established which, with modifications, has remained the daily pattern for the children. Only one of the mothers refused to return the second day, and a second stayed in the centre with her son for the greater part of the first two weeks, but her persistent refusal to leave the child to settle made attempts at the much needed help unavailing and he has since remained at home. It says much for the friendly atmosphere that although the staff and children were all new together, within a week or two the isolated units of child, parent and staff, which were so noticeable on the first day, had welded into a community and the children were already part of a large family, giving and receiving help from each other without a trace of self-consciousness or teasing of the more severely handicapped. In the first six months, of the original admissions, two children have died in hospital and one has been admitted to a school for the blind, two others will go to school in the new year; one attended until the bad weather of the summer persuaded his parents to keep him at home a little longer, one has been admitted to a mental hospital and eight other children have been admitted during the year— 3 severe spastics—one also an ament 1 partially sighted 1 muscular dystrophy 1 mongol 1 developmental anomaly 1 retarded—no speech A summary of the progress of the children, mentally and physically, is appended. The children are collected from their homes between 8.30 and 9.30 a.m. in a hired minibus; the journeys are unnecessarily long as the area covered extends to all limits of the Borough, but it is hoped that next year the minibus which has been agreed for the Health Area will be in service, and the journeys can then be divided and shortened. At 10 a.m. the children have milk, and then, after an hour's play in small groups or individually with staff, as the case merits, most of the older children (over 3 years) have "school"—an hour of play teaching suited to their individual handicap. During the morning physiotherapy and exercises are given, either by the physiotherapist or by the staff nurse. 75 Physiotherapy equipment has been kept to a minimum as it is agreed that these children gain most from training with normal play things (pushers, walkers etc.) in the use of their legs and with small toys and puzzles for manipulative skill. Most of these children are so severely handicapped that the basic essentials of moving, standing, supporting themselves and holding things are their main objectives. One or two are so mentally retarded as well as spastic that they cannot actively co-operate in training. After lunch at 12 o'clock, at which all but the very youngest or mentally retarded now feed themselves although only one or two had attempted this at home, an hour's rest and sleep for almost all precedes the afternoon's play and individual training. The children with little or no speech have individual attention in picture and object naming, and those with physical handicaps are helped with play according to their ability. Some of the most severely spastic are seeing their world from the upright position, sitting or standing supported, for the first time as they have spent the first years of life lying in prams, cots or on the floor. Tea is at 3.00 p.m. and after a short time of disorganised play the children are collected at 4.00 and 4.30 p.m. to be taken home by coach. The staff have appreciated the interest shown in their work by members of the committee and visitors to the department, health visitors and the N.S.P.C.C. inspectors. At Christmas, a party was held for the parents, to which the Mayor, Mayoress, Chairman and Vice-Chairman came, and the children, who had been rehearsing for weeks, finally tape recorded and performed a playlet. This in itself justifies the staff's pride in their achievement of making these severely handicapped children as near normal as possible. The parents come to the centre whenever they wish and are asked to attend when the children are seen by the medical officer at regular intervals to discuss their progress, and also come frequently to see Sister and learn how to handle any special problems they may have, especially feeding. Immunisation for whooping cough, diphtheria and poliomyelitis are all given to the children and any treatment recommended by the hospitals they attend is carried out in close consultation with the hospital staff concerned. What conclusions can we draw from this first experiment in the Borough in the care of very young, handicapped children ? Firstly, that apart from their handicap they are normal children with the same likes, dislikes, tempers, mischievousness and need of discipline, and that they rapidly forget the enforced isolation of their home background where they could not join in with healthy children, and develop a community spirit and a noticeable lack of spiteful intolerance of other children's handicaps, so often seen in normal children. That given the chance to do things for themselves and for each other they will make rapid strides towards normality and learn to overcome their disability. Visitors to the centre at playtime or at meal times comment that "if you didn't know you'd think they were normal"—and that is the end in view—to give these children 76 a chance to live as near normal a life as possible in their families and in their schools, and to this end the progress that has been made is entirely due to the exceptional degree of harmony, enthusiasm and happiness in their work that all the staff at the centre have shown in these first months. Name Age Condition on admission Progress—December 1960 J.E. Spastic 2 yrs. Cannot stand or sit without support. No words. Does not feed himself. Smiles Stands with support. Sits. Feeds himself. Few words—short sentences P.J- Spastic 4 yrs. Cannot stand or crawl. Can sit. ? No speech— ? shy Can crawl. Stands with support, few steps with support. Speechchatters when not shy A.A. Spastic 4 yrs. Very severe-cannot hold his head up. Understands words. Smiles Severe chest infections Short stay (2 months). Recurrent chest infections. Own doctor advised home care. Home visitno change S.F. 4 yrs. Cannot walk without support. Walks on knees. Speech poor Runs on tip toes, walks slowly on full feet. Speech much improved—long sentences S.L. Spastic 5 yrs. Cannot walk or sit without support. Moves on his back. Speech attempts sounds (excluded from school on physical condition) Little progress-can now sit. Speech much improved. Understands and can identify objects at 4 year-old level A.S. Spastic, Epileptic Ament, Blind, ? E 2 yrs. )eaf Can only lie. Chronic chest infections No change—except improvement in general health T.C. Spastic Microcephalic 6 mths. Very young—completely rigid. Difficult with feeds ?mental defective General improvement. Mixed feeds-full diet. Takes noticeless retarded S.J. Hemiplegic 3 yrs. No use in right arm (? refuses). Cannot play with children at home. General condition satisfactory Will use hand and leg with encouragement-walk improving A.B. Spina Bifida and Hydrocephalic 4 yrs. Paralysed legs. Uses arms well. Very intelligent, manipulates wheelchair Admitted to hospital for operation. Died post operatively A.H. Muscular Dystrophy 4 yrs. Abnormal gait. ? cause unknown fully investigated Slight improvement in walking E.Y. Old Poliomyelitis 5 yrs. Walks very badly. Admitted for intensive physiotherapy for short time. Very active To be admitted to ordinary school on trial in January 1961 S.J. Congenital heart 4 yrs. Post operative. Still cyanosed needs rest but very active Much improved. Very slightly cyanosed B.K. Congenital heart 3 yrs. Extremely severe. Very poor condition Did not attend after 2 weeks. Home visit—marked deterioration L.T. Congenital heart 2 yrs. Very young-for trial admission because of 2nd floor accommodation at home Short stay-recurrent bronchitis. Admitted to hospital 77 Name Age Condition on admission Progress—December 1960 J.M. Developmental anomaly ? Dwarf 3 yrs. General condition fair. Failure to gain. Management problem Co-operative child. ? for discharge P.Y. Blind 4 yrs. Awaiting admission to Sunshine Home Did not attend after first day K.D. Blind 5 yrs. Awaiting admission to Sunshine Home. Temporary. Healthy, intelligent, manages very well Short stay S.J. Partially sighted 4 yrs. Very difficult child. Cannot cope with disability-frustrated Improved re: Management. More adaptable and cooperative. Can cope better J.Y. Premature 2\ yrs. Grossly retarded. 18 lbs. at 2\ years. Cannot stand Can walk with support. Rapid development D.B. Mongol 3 yrs Feeding and management problem. Very poor condition Improved in 3 months until admitted to hospital with pneumonia—died E.M. Mongol 5 yrs. For short stay—awaiting Training Centre admission Parents sent child to private school B.D. Mongol 2 yrs. Feeding and management problem. Healthy Much improved. Greater parental understanding R.C. Retarded mentally and physically 4 yrs. Cannot walk without help. Shuffles. No speech Walks and runs on broad base. Few words J.M. Retarded microcephalic 4 yrs. Retarded, ? E.S.N. Very poor home conditions Management problem Great improvement. Talks well, can count, knows colours. For trial at ordinary school P.L. Retarded speech 3 yrs. Retarded. ? E.S.N. No speech Recent admission P.V. Mental defective. Blind 3 yrs. Can sit with support. Severe mental defect Little change. Can sit alone M.K. Mental defective 5 yrs. Cannot sit alone, cannot stand Can stand and walk. Admitted to Residential Care P.G. Mental defective 5 yrs. Cannot stand alone sits and rocks Improvement in general condition only 78