4411/1) BOROUGH OF DAGENHAM DAC35 THE HEA LTH ■ ■ ■ . . OF DAGENHAM IN 1961 1 BOROUGH OF DAGENHAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1961 J. ADRIAN GILLET, M.B.,Ch.B., D.P.H., F.R.S.H. Civic Centre, Dagenham, Essex Telephone : Dominion 4500 r INDEX Page Adolescent Clinic 51-53 Ante-natal Clinics 36 Atmospheric Pollution 18 Audiometric Tests 58 Bentry Special School 62-64 Care of Mothers and Young Children 33 Child Guidance 58 Chiropody 41 Committee for Education 5 Convalescence 42 Council—Members of 3 Day Nurseries 38 Deaths—Causes of 12 Dental Services m54-55 Diseases of Animals (Waste Foods) Orders 1957 20 Domestic Help 39-40 Education (General Purposes) Sub- Committee 5 Enuresis 49 Factories Acts, 1937 and 1948 20 Food and Drugs—Sampling 24 Food Hawkers—Registration 22 Food—Inspection and Supervision 21-25 Food Poisoning 22 Food—Unsound 22 Handicapped Children 60-61 Health Area Sub-Committee 4 Health Education 28-32 Health Visiting and School Nursing 34-35 Home Safety 29 Housing 16-17 Houses in multiple occupation 17 Ice Cream 21-22 Immunisation: Diphtheria 45 Whooping Cough 44 Improvement Grants 16 Infant Mortality 13 Infant Welfare Centres 33 Infectious Diseases 26-27 Inspection and Supervision of Food 21-25 Kingsley Hall Day Centre for Handicapped Children Under Five 65-66 Page Laundry Service for the Incontinent Aged 17 Maternity Services 36-37 Midwifery Service (domiciliary) 36 Milk 21 National Assistance Act, 1948 17 Noise Abatement 18-19 Occupational Therapy (domiciliary) 42 Ophthalmic Clinic 57-58 Orthopaedic Clinic 56 Over Sixties Clinic—Oxlow Lane 43 Pet Animals Act, 1951 19 Premature Infants 37 Prevention of Damage by Pests Act, 1949 19-20 Public Health Committee 3 Public Swimming Baths 16 Rag, Flock and Other Filling Materials- Act, 1951 19 Recuperative Holidays 43 Relaxation Classes 37 Rent Act, 1957 16 Riding Establishments Act 1939 20 Sampling—Food and Drugs 24 Sanitary Inspection of the District 14 School Clinics 50-53 School Health 46-49 Sewerage and Sewage Disposal15 Slum Clearance 16 Smoke Control Areas 18 Specialist Services 56-60 Special School—Bentry 62-64 Speech Therapy 59-60 Staff 6-7 Tents, Vans and Sheds 17 Tuberculosis 27 Unsound Food 22 Vaccination: B.C.C 44 Poliomyelitis 45 Smallpox 44 Vital Statistics 11-13 Water14-15 2 MEMBERS OF THE COUNCIL (as at 31st December, 1961) MAYOR: Councillor W. A. Parish, J.P. DEPUTY MAYOR: Councillor H. P. Larking ALDERMEN: W. E. Bellamy, J.P. M. Eales R. Blacklikn, J.P. E. M. Millard, (Mrs.) F. Brown, E.C.C. D. O'Dwyer G. H. A. Crouch P. F. Bell C. H. C. Blake H. V. Butt D. A. L. G. Dodd D. O. Grandison J. P. Hollidge, J.P. R. W. Kirk D. Linehan W. G. Noyce COUNCILLORS: A. B. Palmer A. C. V. Rusha B. R. Seeney, (Mrs.) M. J. Spencer D. W. Taylor A. R. Thomas, (Mrs.) J. S. Thomas L. W. Todd M. A. Warren, (Mrs.) F. F. Woods, (Mrs). PUBLIC HEALTH COMMITTEE CHAIRMAN: Alderman (Mrs.) E. M. Millard VICE-CHAIRMAN: Alderman D. O'Dwyer His Worship the Mayor Councillor A. B. Palmer Councillor W. A. Parish, J.P. Councillor D. W. Taylor The Deputy Mayor Councillor (Mrs.) A. R. Thomas Councillor H. P. Larking Councillor (Mrs.) F. F. Woods 3 DAGENHAM HEALTH AREA SUB-COMMITTEE (as at 31st December, 1961) CHAIRMAN: Alderman (Mrs.) E. M. Millard VICE-CHAIRMAN: Alderman D. O'Dwyer Members:— Borough Council County Council The Mayor Councillor W. A. Parish, J.P. The Deputy Mayor Councillor H. P. Larking Councillor P. F. Bell Councillor C. H. C. Blake Councillor D. Linehan Councillor W. G. Noyce Councillor A. B. Palmer Councillor A. C. V. Rusha Councillor M. J. Spencer Councillor D. W. Taylor Councillor J. Thomas Councillor (Mrs.) H. A. Warren Councillor (Mrs.) F. F. Woods Alderman (Mrs.) D. M. Glenny Alderman (Mrs.) E. C. Saywood Councillor A. C. Berry Councillor (Mrs.) S. M. Bovill Councillor (Mrs.) I. M. Brockelbank Councillor (Mrs.) N. E. Willis Hospital Management Committee: Executive Council for Essex: Local Medical Committee for Essex: Local Voluntary Organisations: Mrs. A. R. Thomas Mr. F. A. Wortley, E.C.C. Dr. A. Hetherington Miss N. Lightfoot Mrs. S. M. Hoxley Mrs. B. Stevens Mr. J. Walsh 4 DAGENHAM COMMITTEE FOR EDUCATION (as at 31st December, 1961) CHAIRMAN: Alderman R. Blackburn, J.P. VICE-CHAIRMAN: Councillor A. C. V. Rusha Representative Members: Alderman W. E. Bellamy, J.P. Alderman F. Brown, E.C.C. Alderman M. Eales Alderman (Mrs.) E. M. Millard Alderman D. O'Dwyer Councillor P. F. Bell Councillor C. H. C. Blake Councillor H. V. Butt Councillor D. O. Grandison Councillor R. W. Kirk Councillor D. Linehan Councillor (Mrs.) B. R. Seeney Councillor M. J. Spencer Councillor (Mrs.) F. F. Woods Nominated Members: County Councillors A. F. J. Chorley, M.B.E., J.P. and Dr. N. L. Anfilogoff Co-pted Members: Mr. A. Boyle Mrs. I. M. Brockelbank, E.C.C. Mr. E. E. Hennem Mr. F. C. Jones Mrs. E. F. Lambert Mr. J. Walsh EDUCATION (GENERAL PURPOSES) SUB-COMMITTEE (as at 31st December, 1961) (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: Alderman D. O'Dwyer Councillor (Mrs.) B. R. Seeney Councillor D. O. Grandison Mrs. I. M. Brockelbank, E.C.C. Councillor D. Linehan Mr. E. E. Hennem Councillor A. C. V. Rusha 5 OFFICERS OF THE HEALTH SERVICE (as at 31st December, 1961) 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: Vacant Assistant Medical Officers: Katherine Fitzpatrick, M.B., B.Ch. (C) Wiihelmina C. Maguire, Fannie Hirst, M.B., Ch.B., D.P.H. (C) L.R.C.P., L.R.C.S.I. (C) Maureen Joyce Hodgson, M.B., B.S., Madeline Weizmann, M.R.C.S., L.R.C.P. (C) M.R.C.S., L.R.C.P., D.C.H. (C) Edwin H. Massey, M.B., B.Ch., (C) Dental Officers: V. Foy, L.D.S., R.C.S., (Eng.) (part-time) (C) C. Sumsawaste, L.D.S., R.C.S., (part-time) (C) A. Roberts, L.D.S., R.C.S., (part-time) (C) Chief Public Health Inspector: L. E. Prior, (1), (2) Public Health Inspectors: J. W. Allam (1), (2), (4) G. S. Self (1), (2), (4) F. W. S. Fox (1), (2), (3), (4) F. W. Silverthorne (1) J. Powell (1), (2), (4) Superintendent Health Visitor: (C) B. Long, (5), (6), (7), (28) Health Visitors: (C) A. E. Boorman (5), (6), (7) M. Nelson (5), (6), (7) P. J. Broad (5), (8), (17) D. B. Rudd (5), (6), (7) P. G. Collyer (5), (6), (7), (12) M. F. Savage (5), (6), (7) L. Dunbar (5), (6), (7) D. E. Smith (5), (7), (8), (15) I. A. Garrard (5), (16) R. E. Walker (5), (6), (7), (15), (16) F. W. Jacobsen (5), (6), (7), (16) P. I. Jefford (5), (6), (7), (24) L. Ling (5), (6), (7) D. J. Millbank (5),(6), (7), (10), (25), (26) Non-Medical Supervisor of Midwives: (C) Miss R. K. Jesson (5), (6), (27) Midwives: (C) B. E. Back (5), (6) M. Teather (5), (6) E. M. Crump (5), (6), (27) A. B. Showell (5), (6) J. E. Clarke (5), (6) P. Vanbrook (6) L. M. Grant (6), (9) 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) A. Ward (5) (part-time) 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: J. Hathway Trainee Public Health Inspector: I. Fox Clerks : E. Adams (C) P. Floodgate (C) M. Oates (C) I. Throssell (C) B. J. Butt G. K. Harris I. Page (C) M. A. Watts (C) N. Briand (C) J. Lambert (C) J. Pearmine (C) P. Woodward (C) J. Butterworth (C) S. B. Leader (C) K. Richards (C) K. Bird (C) (part-time) N. E. Cloke (C) F. H. Martin (18,) (C) G. Shannon (C) P. Page (C) (part-time) D. Duff (C) J. Morgan (C) H. Prutton D. Ellis (C) E. Neport (C) J. B. Smith (C) 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: C. Engwell (5) Chadwell Heath. Kingsley Hall Day Centre for Sister-in-Charge : M. Morrice (5) Handicapped Children, Hobart Road, Dagenham. Domestic Help Organiser: (C) G. Hickinbotham Chiropodists : (C) N. Freeman R. Fenton (14) (part-time) M. Kelly (14) Dental Surgery Assistants: (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: (C) Z. Mercer 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) State Registered Nurse (6) Stated 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 (28) Royal College of Nursing Certificate of Public Health Administration 8 Public Health Department, Civic Centre, Dagenham. To the Mayor, Aldermen and Councillors of the Borough of Dagenham. 1961 proved a very difficult year mainly because Dr. Mair left early on in the year and it was not found possible to replace her. My secretary Mrs. Fraser left during the year and was replaced by Miss Hathway who came in October. It was largely therefore a year when it was not found possible to make as much progress in the Department as I would have wished. However, certain things have been achieved which are worthy of comment. Perhaps health education should receive pride of place. Details of much of what was achieved will be seen in the section dealing with health education, but mention should be made of a film strip "Food Hints for the Over Sixties" which was produced by Camera Talks here in Dagenham, with the help of the staff of the St. George's Hospital, Hornchurch as well as their patients and some of the old people of Dagenham. The film dealing with health education and produced by the Dagenham Film Society made very slow progress and was still not complete by the end of the year. I had hoped to be in a position to make one or two short films of a few minutes duration for use in health teaching. Unfortunately I will have to defer consideration of these until the main film is completed. The British Medical Association subject of the year for discussion by doctors was health education. In the report which has been issued a good many of the points quoted from the South Essex contribution came from my Department. Various articles were contributed to the Dagenham Post and talks given to both local and national organisations. One to which I contributed was a Symposium at the Royal Society of Medicine, organised by the British Geriatric Society and the Society of Medical Officers of Health, which took as its subject " Teaching the Elderly." Kingsley Hall Assessment Centre attracted a good deal of interest and continued to fulfil a useful function. Unfortunately because of limitations of time, I was unable to give as much time as I would have liked to the Oxlow Lane Over Sixties Clinic, but at the time of writing this : report the new Deputy Medical Officer of Health, Dr. Packer, has taken over the admini istrative side of the clinic. 9 An enormous amount of time has been taken up by such activities as the assessment of housing priorities on medical grounds, and attempts to co-ordinate services and make liaison with a multiplicity of organisations. It is often said that the Medical Officer of Health should act as a liaison between his Department and others without considering the implications and the time taken in making the necessary contacts. Speaking for myself, I find that Advisory Committees, of one sort or another, Maternity Liaison Committees, Cross Infection Committees, Hospital House and Management Committees, British Medical Association meetings, meetings of the voluntary associations in the area as well as a new appointment as one of the Medical Advisors to the Health Committee of the Association of Municipal Corporations, while all providing interesting work, consume a good deal of my time, so that the struggle to keep abreast of modern scientific developments is a difficult one. Last year I drew attention to the heavy burden placed on the Public Health Inspectorate by the Clean Air Act. This in no way decreased particularly as the survey of number four area got under way during 1960. Fortunately the Council, recognising the need, agreed to the appointment of an additional public health inspector. No Medical Officer of Health's report in the London conurbation could be complete without some reference, however brief, to the Royal Commission on Local Government and the White Paper consequent upon it. Changes which are foreshadowed will provide increasing problems in the future, though it may be that if it achieves its aim of bringing local services nearer to local people it will have been worth while. Once more I must thank the staff of the Department for their help during the year and the Public Health Committee and the Health Area Sub-Committee for their support and understanding. J. Adrian Gillet, Medical Officer of Health. 10 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 6,556 Registrar-General's Estimate of resident population, 1961 109,020 Number of inhabited houses (end of 1961) according to Rate Books 31,407 Rateable value (December 31st, 1961) £1,675,329 Sum represented by a penny rate (1961/62) £7,423 Extracts from Vita! Statistics for the Year Live Births: Total Male Female Legitimate 1,550 833 717 Illegitimate 75 30 45 Live birth rate per 1,000 of the estimated population 14.91 Stillbirths: Legitimate 23 11 12 Illegitimate 2 11 Stillbirths rate per 1,000 live and stillbirths 15.15 Total live and stillbirths 1,650 Infant deaths 37 Infant mortality rate per 1,000 live births—Total 22.77 Legitimate 22.58 Illegitimate 26.67 Neonatal mortality rate per 1,000 live births (first four weeks) 17.85 Illegitimate live births per cent of total live births 4.62 Maternal deaths (including abortion) Maternal mortality rate per 1,000 live and still births Total Male Female Deaths 913 508 405 Death rate per 1,000 of the estimated resident population 8.37 Deaths from Cancer (all ages) 211 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) Deaths from Gastritis, Enteritis and Diarrhoea (all ages) 2 Births 1,625 live births were notified during the year, there being 863 males and 762 females. There is an increase of total births from 1,518 in 1960. The corrected birth rate per thousand population was 14.16 compared with 17.4 for England and Wales. The illegitimate birth rate continues to be very low, being only 4.62 percent of total live births. There were no illegitimate stillbirths. Deaths Total deaths in district 651 Outward transfers 230 Inward transfers 492 Deaths of residents 913 Of the deaths of non-residents occurring in the district, 185 took place at Rush Green Hospital, 24 at Dagenham Hospital and 15 at Hainault lodge. 11 The crude death rate of 8.37 when corrected becomes 14.23 compared with 12.0 for England and Wales. The crude death rate of 8.37 when corrected becomes 14.23 compared with 12.0 for England and Wales. Causes of Death, 1961 Under lyr. 1 and under 5yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45yrs. 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 - - - - - - - - - - 3 - 2 1 - - 5 1 2. Tuberculosis, other - - - 1 - - - 1 - - - - - - - - - 2 3. Syphilitic disease - - - - - - - - - - 1 - - - - - 1 - 4. Diphtheria - - - - - - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - 6. Meningococcal infection 1 - - - - - - - - - - - - - - - 1 - 7. Acute poliomyelitis - - - - - - - - - - - - - - - - - - 8. Measles - - - - - - - 1 - - - - - - - - - 1 9. Other infective and parasitic diseases - - - - - - - - - - 1 - - - - 1 1 1 10. Malignant neoplasm, stomach - - - - - - - - - - 10 4 7 4 - 3 17 11 11. Malignant neoplasm, lung, bronchus - - - - - - - - 2 1 27 4 18 3 3 _ 50 8 12. Malignant neoplasm, breast - - - - - - - - - 1 - 10 - 1 _ 2 - 14 13. Malignant neoplasm, uterus - - - - - - - - - - - 4 - 4 - 2 - 10 14. Other malignant and lymphatic neoplasms 1 1 2 1 - - - 4 5 17 15 23 9 12 11 59 42 15. Leukaemia, aleukaemia - - - - - - - - - - 3 3 1 - - - 4 3 16. Diabetes — — — — — — — — — — — 2 - 2 - 3 - 7 17. Vascular lesions of nervous system - - - - 1 - - - - 1 12 15 15 7 14 35 42 58 18. Coronary disease, angina - - - - - - - - 6 - 52 10 42 20 11 17 111 47 19. Hypertension with heart disease - - - - - - - - - - 3 1 2 3 1 3 6 7 20. Other heart disease - - - - - - - 1 2 2 4 8 10 15 16 29 32 55 21. Other circulatory disease - - - - - - - - 1 - 5 7 4 6 6 11 16 24 22. Influenza - - - - - - - - - 1 1 1 2 3 - - 3 5 23. Pneumonia 2 2 2 - 1 - - - - 1 2 3 8 5 5 4 20 15 24. Bronchitis - - - - - - - - - - 14 3 29 6 12 13 55 22 25. Other disease of respiratory system - - - - - - - - 2 - - - 3 1 - 1 5 2 26. Ulcer of stomach and duodenum - - - - - - - - - - 1 3 1 1 - 5 1 27. Gastritis, enteritis and diarrhoea - - - - - - - - - - - - - 1 - 1 - 2 28. Nephritis and nephrosis - - - - - - 1 - 2 - 3 2 3 - - 1 9 3 29. Hyperplasia of prostate - - - - - - - - - - - - - - 4 — 4 — 30. Pregnancy, childbirth, abortion - - - - - - - - - - - - - - - - - - 31. Congenital malformations 2 2 - 1 - 1 - - - - - 1 - - - 2 5 32. Other defined and illdefined diseases 14 13 - - - - 1 2 3 3 14 7 1 10 5 11 38 46 33. Motor vehicle accidents — — - — — — 6 — — 1 2 2 1 - 1 - 10 3 34. All other accidents - - - - - - - - 2 - 5 1 1 1 1 6 9 8 35. Suicide — - - - - - - - - 1 2 - - 1 - - 2 2 36. Homicide and operations of war - - - - - - - - - - - - 1 - - - 1 - 20 17 3 4 3 1 8 5 24 17 182 103 176 104 92 154 508 405 12 INFANT MORTALITY Details of deaths of children under one year of age registered during 1961 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. deaths under 1 yr. Prematurity 12 1 — — 13 — — — — 13 Prematurity with associated cause 3 3 3 Atelectasis 1 - — — 1 - — — — 1 Congenital abnormality 3 - — 1 4 1 3 — — 8 Birth trauma 3 - — — 3 - — — — 3 Septicaemia - - - - - 1 1 — — 2 Meningitis — 1 — — 1 - — — — 1 Bronchopneumonia 1 - — — 1 - — 1 — 2 Reticulosis - - - - - - 1 - - 1 Placenta praevia 1 - — — 1 - — — — 1 Antepartum haemorrhage 1 - — — 1 - — — — 1 Rhesus incompatability 1 - — — 1 - — — — 1 26 2 - 1 29 2 5 1 — 37 13 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRICT (a) Nature and number of visits:— Rent Act 94 Housing and Public Health Acts:— Dwelling houses 2,437 Other premises 680 Overcrowding and housing applications 790 Bakehouses 45 Milkshops and dairies 89 Foodshops, stalls and itinerant vendors 1,281 Cafes and canteens 337 School kitchens and feeding centres 90 Infectious disease enquiries 926 Visits to foster mothers' premises 61 Number of complaints investigated 1,093 Clean Air Act—Survey 7,997 Factories 283 Workplaces and offices 53 Rag Flock and Other Filling Materials Act 21 Tents, vans and sheds 202 Stables 8 Pet Shops 18 Hairdressers 45 Shops Act 64 Ice Cream premises and vehicles 1ll Houses disinfested 25 Other visits 1,424 (b) Notices served:— Complied with:— Statutory 79 52 Informal 436 395 Legal proceedings were instituted in respect of two premises to enforce compliance with statutory notices. It was necessary to obtain from the local Magistrate's Court a warrant to enter a piggery following refusal (with violence) to allow inspection of the premises. 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 percent of the inhabited houses and .009 per cent of the population of the Borough take their water from standpipes. 14 During the year 266 yards of 4 inch mains were laid and 206 supplies were afforded to houses. The Chief Engineer of the South Essex Waterworks Company has furnished the following report:— " Bateriological and chemical examinations are made of 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 4,120 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 In supplying the following information the Borough Engineer has indicated that the position has not changed since last year:— (a) 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 Wantz surface water drainage 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. (.b) 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 desireable. 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 five 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. 15 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 and chemical examinations of samples have indicated satisfactory conditions. During the year a portable swimming pool was installed at a local Junior School. HOUSING Slum Clearance During the year a further three houses were represented as unfit for human habitation. Rent Act, 1957 Five applications were received from tenants during the year compared with 14 in 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 three properties. Five Certificates of Disrepair were issued and one cancelled on the completion of the repairs. Advice was given to tenants and they were able to purchase the necessary forms at the Civic Centre. The Council have continued to issue Certificates of Disrepair which included, inter alia, defective fencing; where tenants included on their applications defective electric 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 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 if reasonably practicable in the dwelling and satisfactory facilities for storing food). The standard grant conditions are designed to provide as simple a procedure as possible. The requirements that the fixed bath should be in a bathroom and the W.C. if practicable internal have 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 and the W.C. external but contiguous. 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. Seven applications for standard grants and 10 for discretionary grants were approved. In all but one case the applications were from owner/occupiers. 16 An application to convert a normal five-roomed house into two one-bedroom flats was refused. Houses in Multiple Occupation In respect of two houses statutory action was taken to enforce the provision of reasonable facilities for each family. There are no common lodging houses in the Borough. Tents, Vans and Sheds Gypsies still continue to pull their vans on to 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 202 visits to various sites in connection with this work. A closer liason has been sought with the local police. An application under the Caravan Sites and Control of Development Act, i960 has been received in respect of a site (14 vans) which has been in existence for many years. The site is being run down over a period of about 12 months. 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 compulsorarily to remove any person during the year. Section 50 No one was buried under the provisions of this section during the year. LAUNDRY SERVICE FOR THE INCONTINENT AGED This service meets a real need in the home at a time when help is usually most urgent. The days of collection and delivery of laundered articles continue to be 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 315 cases have received assistance. During the year 35 new cases have been helped, 27 cases died, 12 were removed to hospital and two no longer needed the service. At the end of the year 14 cases were still participating; the number of articles laundered during the year was 11,843 compared with 10,439 articles for the previous year. 17 ATMOSPHERIC POLLUTION The Dark Smoke (Permitted Periods) Regulations, 1958 provide the maximum period for the emission of dark smoke from industrial plants; black smoke is limited to not more than two minutes in the aggregate in any period of 30 minutes. Nine observations were made of the chimneys of industrial premises in the Borough; action was not called for in any case. The Council continue to operate at the Civic Centre instruments for the daily measurement of air pollution. In connection with the National Survey of Air Pollution four additional sites have been chosen and equipment purchased for the daily measurement of smoke and sulphur dioxide. The types of district in which the sites are situate are (i) residential with high population density (Bennett Road, Chadwell Heath), (ii) residential with low population density (Thompson Road), (iii) industrial (Ford Motor Company) and (iv) smoke control area (Marks Gate). Regular observations commenced in the Spring of 1962. 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 not more than 10 years. The 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 area includes 3,722 houses (mostly owned by the London County Council) and covers the South West corner of the Borough. The date of operation was the 1st November, 1961. The third area includes 3,230 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; the date of operation is the 1st November, 1962. The survey of the forth area, which includes over 4,000 houses, has been commenced; this area is bounded on the South by the District Railway, the East by Pondfield Road, Wantz Road and Frizlands Lane, the North by Wood Lane and Trefgarne Road and the West by Heathway and Halbutt Street. 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 inevitably the work has entailed a large number of evening visits. The extent of the work involved is indicated in that during the year 7,997 visits to premises have been paid by the inspectors in connection with the survey. The Council later agreed to the appointment of an additional inspector to assist in this work. NOISE ABATEMENT ACT, 1960 The inspectors attended a course of lectures on noise abatement held at the South East Essex Technical College. 18 Section I of the Act makes noise or vibration which is a nuisance, a statutory nuisance under the Public Health Act, 1936. Eight complaints received during the year were in respect of private dwellings; these were mainly concerned with noisy neighbours. A complaint in respect of a loud speaker operating from a shop was satisfactorily dealt with. Complaints emanating from a small industrial estate were being dealt with at the end of the year; some improvement had been obtained but conditions were not altogether satisfactory. Section 2 of the Act restricts the operation of loudspeakers on the highway. This is dealt with by the Council's Shops Act Inspector. During the year legal proceedings were instituted in 20 cases. The Council were successful in each case; fines totalling £85 were imposed and £28 in costs awarded. It would not be proper, however, to convey the idea that all offences, trivial or serious, are automatically dealt with by way of prosecution. The key-note of the Council's enforcement policy is to assist and advise traders. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Three 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. 30 informal samples were taken during the year; one sample of cotton felt was unsatisfactory. The details are as follows:— No. of samples Material submitted for analysis Rag Flock 6 Layered Flock 3 Cotton Felt 9 Coir Fibre 4 Kapok 6 Sisal 2 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. Service is free to householders but a charge on a time and material basis is made for business premises. 19 Although no serious infestation was encountered during the year, there was a slight increase in the number of complaints received in respect of infestations of rats and mice; these occurred mainly in private dwellings. RIDING ESTABLISHMENTS ACT, 1939 There are two riding establishments in the Borough; these are inspected annually by the Council's veterinary surgeon. Conditions have been found to be satisfactory. THE DISEASES OF ANIMALS (WASTE FOODS) ORDER, 1957 Legal proceedings were instituted in respect of a piggery where waste food fed to pigs was inadequately cooked on unlicensed equipment. A fine of £15 was imposed together with £5. 5. o. costs. FACTORIES ACTS, 1937 AND 1948 Inspections Number on Register Inspections Number of Written Notices Occupiers Prosecuted Factories without mechanical power 25 31 — — Factories with mechanical power 172 203 11 1 Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 41 49 Total 238 283 11 1 Defects Found Number of defects Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Number of prosecutions instituted Want of cleanliness 5 5 — 5 — Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences:— Insufficient 2 3 1 1 Unsuitable or defective 9 7 — 2 — Not separate for sexes — — — — — Other Offences 1 — — — — Total 17 15 — 8 1 Outwork No. of outworkers in August list 17 Nature of work—Making etc., wearing apparel. 20 INSPECTION AND SUPERVISION OF FOOD The numbers and types of food premises in the Borough are as follows:— 5 Bakehouses 28 Bakers and Confectioners 58 Butchers 168 Cafes and Canteens 26 Fishmongers 57 Fruiterers and Greengrocers 96 Grocers 22 Licensed and 13 Off-licensed Premises 93 Sweets, etc. All food premises are regularly inspected and during the year 1,831 visits were paid. In addition to numerous verbal warnings and suggestions to management and staff during these routine visits, 50 informal notices were served upon owners or occupiers. In two cases the threat of legal proceedings was sufficient to ensure that the work was carried out. 63 inspections were carried out in connection with itinerant vendors and stalls. 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 362 visits were paid. 21 fish shops are registered for frying. To these 90 vists were paid. Milk All milk distributed in Dagenham is produced and bottled outside the Borough. Eight premises are registered as dairies. The number of registered distributors is 46 operating from 78 premises. 89 visits were paid to dairies and distributors' premises. During the year 60 samples of milk were submitted for bacteriological examination. Two samples failed to pass the methylene blue test, but in both cases the maximum atmospheric shade temperature during the test exceeded the permissible limit of 65 degrees Farenheit. Ice Cream The total number of registered premises selling ice cream is 127; of this number one is registered for manufacturing ice cream. 86 visits were paid to these premises. During the year four applications for the storage and sale of ice cream were granted. 25 inspections in connection with itinerant vendors were carried out. 21 During the year 59 samples of ice cream were submitted for bacteriological examination ; they were graded as follows:— Grade I Grade II Grade III Grade IV Total 37 12 6 4 59 In addition 28 lollies were submitted for examination. Eight were considered to be "fair" and three unsatisfactory; in each case the lollies were manufactured outside the Borough and the local authority concerned were informed. Five samples of ice cream were taken from the one manufacturer in the Borough; four samples were Grade I and one sample Grade II. The advent of ":soft" ice cream manufactured on the vehicle calls for strict surveillance. Unsound Food Complaints continue to be received and considered by the Public Health Committee in respect of food containing foreign substances or otherwise alleged to be unfit for human consumption. During the year 29 such complaints were investigated. Legal proceedings were taken in four cases. A fine of £30 was imposed in one case and £5 in each of two cases; one case was dismissed. Registration of Food Hawkers Under the provisions of the Essex County Council Act, 1952, Section 103, five persons were registered as Food Hawkers; two had storage premises in the Borough. Food Poisoning 10 cases of food poisoning were notified during the year. The following is a copy of the annual return submitted to the Ministry of Health:— 1 st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 1 —3 6 10 Cases otherwise ascertained Nil Symptomless Excreters Nil Fatal Cases Nil Particulars of Outbreak:— No. of Outbreaks No. of Cases Total No. of cases Family Outbreaks Other Outbreaks Notified Otherwise Ascertained Agent identified Typhimurium 1 - 2 - 2 CI. Welchii 1 — 2 — 2 Totals 2 — 4 — 4 Agents not identified — — — — — 22 Single Cases:— No. of Cases Total No. of cases Notified Otherwise Ascertained Agent identified Typhimurium 5 - 5 Agent not identified 1 - 1 23 Food and Drugs—Sampling Article Number Examined Number Adulterated Formal Informal Formal Informal Almonds, Ground — 3 — — Apple Charlotte — 1 — — Beef, Chicken and Turkey Croquettes — 3 — — Beverages 1 1 — 1 Biscuits — 4 — — Blanc-mange Powder — 1 — — Bread — 1 — 1 Bread Rolls — 1 — — Butter 2 — — — Cakes 1 2 — 2 Cake Mixtures — 2 — — Cereals — 1 — 1 Cheese Spread with Shrimps — 1 — — Chicken, Boneless — 1 — — Cloves — 1 — — Cooking Oil — 2 — — Cordials 2 3 — 1 Cream — 2 — — Creamed Milk Puddings 1 1 — 1 Demerara Sugar — 1 — 1 French Capers — 1 — — Fruit, Dried — 2 — — Fruit Juices — 1 — — Fruit, Tinned — 2 — — Fruit Pies — 1 — 1 Ginger, Ground — 1 — — Hamburger — 1 — 1 Ice Cream — 8 — — Ice Lollies — 8 — — Jam — 1 — — Jellies 1 1 — — Malt Extract — 1 — — Margarine 1 2 — — Marzipan Almond Icing — 2 — — Medicinal Samples — 27 — — Milk 24 1 — — Milk Bottle — 1 — 1 Milk, Evaporated — 1 — — Mincemeat — 1 — — Mushrooms, Creamed — 1 — — Salmon Cutlets, Mock — 1 — — Sauces — 3 — — Sausages 28 2 6 — Soups — 2 — — Spreads — 2 — — Steak Cutlets in Gravy — 1 — — Steak and Kidney Pudding — 1 — — Steak Minced with Tomatoe and Spaghetti — 1 — — Stewed Steak with Gravy — 3 — 1 Sweets — 2 — — Tea 2 — — — Turkey in Jelly, Minced — 1 — — Vinegar — 1 — — Wines and Spirits 5 — — — Black Substance Recovered from Vomit — 1 — 1 24 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 835A Hamburger Informal Low in meat content. (Contained 63% meat). Manufacturer warned 845A Demerara Sugar Informal Contained excessive insoluble matter consisting mainly of mould spores. Distributor warned 879A Black Substance recovered from vomit Informal Identified as a piece of burnt or charred potato.Vendor warned 904A Piece of Bread Informal Contained a plastic fibre. No action. sufficient evidence to show origin of fibre 908A Fruit Cake Informal In a mouldy condition. Distributor warned 909A Dirty Milk Bottle Informal Foreign matter on inside of bottle—con- sisting of particles of atmospheric dust adhering to a film of milk. Distributor warned 911A Foreigh matter from Breakfast Oats Informal Consisted of rodent excreta. Distributor warned 913A Irish Stewed Steak Informal Poor in meat content. Manufacturer warned 925A Iced Buns Informal Contained foreign matter in the form of streaks of dirty dough. Legal proceedings Fine £5. Costs £1.1.0. 943A Creamed Rice Milk Pudding Informal Contaminated with a small quantity of vinegar. No action. Insufficient evidence 944A Lemonade Informal Contained traces of whitish suspended matter consisting of mould growth. Manufacturer warned 951A Chocolate Flavoured DrinkInformal Contained a mass of mould growth on the bottom of the bottle. Legal proceedings. Absolute discharge £5. 5. 0. costs 952A Fruit Pies (3) Informal One pie was in a mouldy condition. Legal proceedings Fine £2. Costs £3. 3. 0. 2577 Pork Sausages Formal Slightly deficient in meat. Manufacturer warned 2587 Pork Sausages Formal 7% deficient in meat. 2589 Pork Sausages Formal 13% deficient in meat. Letter 2590 Pork Sausages Formal 15% deficient in meat. to all 2592 Pork Sausages Formal 21% deficient in meat. manufacturers 2659 Pork Sausages Formal 9% deficient in meat. 25 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 - 3 7 8 7 49 5 2 1 82 Whooping Cough 1 2 2 4 4 8 5 1 — 27 Measles 78 212 233 240 241 915 35 10 1 1965 Diphtheria — — — — — — — — — Nil Dysentery — — — — 2 1 1 1 — 5 Acute Poliomyelitis:— Paralytic - - - - - - - - - Nil Non-paralytic - - - - - - - - - Nil Meningococcal Infection - - - - - - - - - Nil Under 5 yrs. 5—14 15—44 45—64 65 and over Total Pneumonia:— Acute Primary 1 — 1 8 5 15 Acute Influenzal — — 5 14 — 19 Encephalitis, Acute:— Infective — — — — — Nil Post Infectious — — — — — Nil Erysipelas — 1 — 3 1 5 Food Poisoning 1 2 3 4 — 10 Puerperal Pyrexia — — 1 — — 1 Ophthalmia Neonatorum 1 1 — — — 2 Paratyphoid B — — — — — Nil Typhoid — — — — — Nil Smallpox — — — — — Nil Notified Admitted to isolation hospital, Rush Green Admitted to other isolation hospitals Admitted to other hospitals Diphtheria — — — — Dysentery 5 — — — Encephalitis, Acute — — — — Enteric Fever 1 — — 1 Erysipelas 5 — — — Food Poisoning 10 3 — 1 Malaria — — — — Measles 1,965 9 — — Meningococcal Infection — — — — Ophthalmia Neonatorum 2 — — — Paratyphoid Fever — — — — Pemphigus — — — — Puerperal Pyrexia 1 — — — Pneumonia:— Acute Influenzal 19 1 — — Acute Primary 15 1 — — Poliomyelitis:— Paralytic — — — — Non-Paralytic — — — — Scarlet fever 82 — — — Smallpox — — — — Typhoid — — — — Whooping Cough 27 — — — 26 TUBERCULOSIS New Cases Deaths Primary Notifications Brought to notice other than by Form A Pulmonary NonPul monary Pulmonary NonPul monary Pulmonary NonPul monary M F M F M F M F M F M F Under 1 - 1 - - - - - - - - - - 1— — — — 2 1 1 - - - - - 1 5— 2 — — — 2 2 — — — — — — 10— - - — — 1 - - 2 — — — — 15— 4 - - 1 - - - - - - - 1 20— — — 1 — 2 6 — — — — — — 25— 6 3 — 1 3 10 - - - - - - 35— — — 1 — 2 8 1 — 1 — — — 45— 4 2 — — 2 — — — — 1 — — 55— — — — — 5 — — — 4 1 — — 65—and upwards 1 1 — — — 1 — — 4 2 — — Totals 17 7 2 4 18 28 1 2 9 4 — 2 Register Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January, 1961 572 443 71 69 During the year:— New Notifications 17 7 2 4 New cases brought to notice by Registrars' Death Returns 1 - - - Deaths 8 4 — 2 Transfers into area 18 28 1 2 Transfers out of area 21 12 1 2 Removed from Register as "Recovered" 7 11 1 1 No. on register 31st December, 1961 572 451 72 70 27 HEALTH EDUCATION Progress in the field of health education was slow but steady throughout 1961 and a wider range of topics was dealt with than was possible during 1960. It was also pleasing to note an increase in the number of head teachers who were able to avail themselves of the facilities offered by the Health Department. Maternity and Child Welfare Films on ante-natal care and the care of children form an integral part of the teaching of expectant mothers and in three of the clinics where facilities for projection are available, wide use was made of this medium for health education. Unfortuately in some clinics blackout difficulties preclude the use of films but groups from these clinics are given the opportunity to join other classes when shows are being held. Once again "My First Baby" and "The British Midwife" were the most widely used films. Two evening sessions to mixed audiences were very popular. The film "Breast Feeding" and one on foot care "Your Children Walking "were also used quite extensively and those on dental care attracted larger audiences than in 1960. In addition to talks in the clinics, health visitors also attended church and other women's groups to discuss care of the feet and dental care. In five cases the talks were supplemented by films which were well received. Adolescent Clinic This new clinic had five film shows during the latter half of 1961 and the subjects ranged from human biology to personal hygiene. It is hoped that it will be possible to make even more use of films in the future. Training of Students The students from the London University Institute of Education who commenced training during 1960 continued to attend for practical work during the Easter term of 1961 and were replaced in the autmn by two others, a lecturer from the Teachers' Training College and a Health Inspector from Ghana. They were given an opportunity to spend one or more sessions with each section of the Department, to visit the various clinics and to attend film shows and exhibitions. Film shows were given in three schools during the year, the subjects chosen being home safety and dental care. In each case the films were supplemented by a talk from a member of the Health Department Staff. In addition one talk on the care of the feet, supported by a film strip, was given by a health visitor to senior pupils of the Junior School. Talks on the work of the Health Department were given in the Civic Centre to two parties of school children one of which was training for the G.C.E. Certificate in human biology. 28 Food Hygiene The training course instituted in 1960 for the Royal Institute of Public Health and Hygiene Food Hygiene Certificate proved to be very popular particularly when nineteen of the twenty candidates who sat the first examination were successful. The second course for more staff of the same bakery was held early in 1961 and of the twenty-one persons who attended the course, all passed the examination. A request was received from another bakery for a similar course and this was arranged for the autumn. Thirteen members attended the examination which was held in November. Once more our thanks are due to Dr. E. A. Atkinson, Senior Pathologist at Oldchurch Hospital for the bacteriological lectures and to Dr. W. J. Smither who gave some of the food poisoning lectures. The remainder of the talks and demonstrations were given by the staff of the Public Health Department. Smoke Control As survey work in connection with numbers two and three smoke control areas progressed requests were received from various organisations for more information on the subject of smoke control. The Gas Council film "Window to the Sky" was shown to five different groups during 1961 and in each case a representative of the Health Department gave a suitable talk and dealt with the numerous queries which always seem to arise. There was no difficulty in starting a discussion on this subject, the problem was only in terminating it after a reasonable time. Opinions on the subject of smoke control are very divided amongst the general public but most people are quite willing to accept it when the principles and details have been explained to them. There is room for more work in this field. Home Safety The National Campaign of the Royal Society for the Prevention of Accidents for the year 1960/1 on the subject of poisons and the displays mentioned in the 1960 report were passed around the various clinics during the early part of 1961. The theme of the 1961/2 campaign was 'fire prevention' and the co-operation of the Essex County Fire Brigade was sought in the conduct of this campaign. A number of display stands were used in the foyer of a local cinema and subsequently in the foyer of the Civic Centre. Much of the material in the display was supplied by the fire brigade and we are very grateful for their help in this matter. They were also good enough to supply a speaker for a talk on fire prevention to the Childrens Club of the cinema which was arranged in conjunction with our display. A talk on home safety was also given by one of the health visitors to a group of young wives from one of the local churches. Town Show Much publicity had been given during the year to the subject of the misuse of oil heaters, so it was decided to arrange a display on this theme in the Town Show. The 29 co-operation of the Oil Heater Manufacturers Association was obtained, and an excellent display stand was borrowed from them. New and old type heaters were borrowed from manufacturers together with conversion kits where appropriate. At intervals during the show home safety films were shown in the tent and fair sized audiences were obtained. Miscellaneous Progress on the Health Department film was unfortunately held up due to difficulties within the Film Society and although the film was actually completed in 1961 it will be some time before the finished print with sound track will be available. Messrs Camera Talks Ltd., requested permission to prepare a film strip for Food Hints for the Over Sixties at the Oxlow Lane Clinic and assistance was given in the production of the strip, which, when completed, received favourable comment from many quarters. In conjunction with the Commonwealth Technical Training work a careers exhibition was held in Leys Hall. The Council had one stand on which the Health Department was represented. The following talks were given during 1961: Date Organisation Subject of Talk Audience Speaker 17. 1. 61 Mothers Union Work of the Public Health Inspector 12 Mr. Self 3. 3. 61 Hunters Hall School Hygiene 140 Mr. Self 14. 3. 61 Kingsley Hall Adult Club Smoke Control 25 Mr. Self 19. 4. 61 Dagenham Welfare Liaison Council Work of the Public Health Inspector 30 Mr. Self 17. 5. 61 Kingsley Hall Adult Club Smoking and Lung Cancer 12 Dr. Gillet 24. 5. 61 Valence Ward Women's Section Smoke Control 30 Mr. Self 5. 6. 61 Women's Fellowship Dagenham Free Church Work of the Public Health Inspector 20 Mr. Self 13. 6. 61 Students from Dagenham County High School Work of the Public Health Department 10 Mr. Self 11. 7. 61 Co-op Women's Group, Broad St. Smoke Control 40 Mr. Self 2. 10. 61 Women's Fellowship Dagenham Free Church Smoke Control 15 Mr. Self 11. 10. 61 Kingsley Hall Discussion Group Work of the Public Health Inspector 20 Mr. Self 30 The following films and filmstrips were shown to audiences during the year:— Date Organisation Titles of films or filmstrips Audience 6. 2. 61. Ashton Gardens Clinic Breast Feeding 20 10. 2. 61 Becontree Clinic My First Baby Breast Feeding 35 13. 2. 61 Civic Centre, Dagenham Work of the Health Dept. 15 3. 3. 61 Hunters Hall School I'm No Fool With Fire Everybody's Business Human Factor Pond Life 140 (3 showings) 6. 3. 61 Ashton Gardens Clinic A Tooth in Time Let's Keep out Teeth 25 13. 3. 61 Civic Centre, Dagenham Mentally Handicapped Children Growing up Enquiry into General Practice 20 13. 3. 61 Staffords Bakery Food Without Fear 20 14. 3. 61 Kingsley Hall Window to the Sky 25 17. 4. 61 Ashton Gardens Clinic Your Children Walking 30 11. 5. 61 Becontree Clinic My First Baby Breast Feeding 30 15. 5. 61 St. Elizabeth's Church Hall, Wood Lane A Tooth in Time 20 24. 5. 61 Valence House Window to the Sky 30 26. 6. 61 Ashton Gardens Clinic Breast Feeding 15 3. 7. 61 Leys Clinic Brother for Susan Life with Baby The Terrible Two's and The Trusting Three's 30 3. 7. 61 Leys Clinic Life with Baby How we Begin Biography Before Birth Preparation for Parenthood 6 5. 7. 61 Becontree Clinic Life with Baby How we Begin Biography Before Birth Preparation for Parenthood 35 8. 7. 61 Dagenham Town Show Every Five Minutes Are you Safe at Home I'm no Fool with Fire Fabrics and Fireguards 11. 7. 61 Co-operative Hall, Broad Street Window to the Sky 40 19. 7. 61 Becontree Clinic How we Begin Biography Before Birth Preparation for Parenthood 10 4. 9. 61 St. Elizabeth's Church Hall, Wood Lane I'm no Fool with Fire Fabrics and Fireguards Playing with Fire 25 6. 9. 61 Co-operative Hall, Gale Street Window to the Sky 40 8. 9. 61 St. Chad's Church Hall Your Children Walking 80 19. 9. 61 Becontree Clinic Life with Baby Know your Baby My first Baby 40 31 Date Organisation Tiltes of films or filmstrips Audience 25. 9. 61 Health Visitors' Room Brush Your Teeth with Andy Pandy Nature shows the Way Family Circle 10 27. 9. 61 Becontree Clinic Your Skin People at No. 19 Preparation for Parenthood Frustrating Fours and Fascinating Fives 4 28. 9. 61 Hunters Hall Infants School No toothache for Noddy I'm no fool with Fire Brush Your Teeth with Any Pandy How to Catch a Cold Fly about the House Nature Shows the Way Mary's Birthday 250 2. 10. 61 Dagenham Free Church Window to the Sky 15 23. 10. 61 Ashton Gardens Clinic Breast Feeding 20 23. 10. 61 Barton's Bakery Food Without Fear 15 8. 11. 61 Becontree Clinic Making the Best of Yourself 20 15. 11. 61 Co-operative Hall Your Children Walking 80 22. 11. 61 Becontree Clinic Preparation for Parenthood Biography Before Birth Subject discussed Your Skin 29 22. 11. 61 Becontree Clinic My First Baby The British Midwife 60 4. 12. 61 Ashton Gardens Clinic Your Children Walking 20 6. 12. 61 Becontree Clinic Claremont 20 6. 12. 61 Civic Centre None to Trouble Nobody You and Your Eyes The Way to Independence 15 11. 12. 61 Becontree Clinic Up to Date 15 11. 12. 61 Co-operative Hall Your Children Walking 20 15. 12. 61 Rush Green Infants School No Toothache for Eskimos No Toothache for Noddy Brush Your Teeth with Andy Pandy I'm No Fool with Fire How to Catch a Cold Mary's Birthday Fly About the House 265 32 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. 53 3 Ashton Gardens, Chadwell Heath. Weekly Thursday, p.m. 48 4 The Clinic, Weekly Monday, p.m. 61 5 Becontree Avenue, Dagenham. Weekly Wednesday, a.m. 51 4 The Leys Clinic, Weekly Thursday, a.m. 23 2 Ballards Road, Dagenham. Weekly Thursday, p.m. 27 2 Rush Green Clinic, (2nd, 4th & Friday, a.m. 18 1 179, Dagenham Road, 5th in month) Rush Green. Weekly Friday, p.m. 29 2 The Clinic, Weekly Tuesday, a.m. 49 3 Ford Road, Dagenham. Weekly Tuesday, p.m. 37 3 The Clinic, Weekly Tuesday, p.m. 32 3 15/17, Thompson Road, Dagenham. Weekly Friday, a.m. 9 1 The Clinic, Weekly Wednesday, p.m. 63 6 Oxlow Lane, Dagenham. Weekly Friday, p.m. 48 4 Marks Gate Clinic, Weekly Monday, p.m. 25 2 Lawn Farm Grove, Marks Gate. 33 HEALTH VISITING AND SCHOOL NURSING Staff Changes Miss D. Gordon died 17th January 1961 Miss B. M. Long appointed 1st May 1961. Miss M. Stewart retired 1st June, 1961, now living in Canterbury. Mrs. P. Broad appointed 1st September, 1961. Mrs. F. Jacobsen transferred from Hornchurch area 9th October, 1961 Mrs. H. Pettit resigned 21st December, 1961 and is living in Oxford. Health Visiting Health has been defined as "the well-being of a person, physical, mental, social and environmental." The work of the Health Visitor, embracing as it does the whole family, must inevitably deepen and widen, as the implications of this definition are more fully understood and implemented. The duties of a Health Visitor involve the care of expectant and nursing mothers and young children; school children through the School Health Service; the prevention of disease; the giving of advice as to the care of persons suffering from illness (including mental illness), the needs of the young physically and mentally handicapped and the aged. She may be required to give after-care to those receiving treatment for venereal disease, and has a big part to play in Health Education. To fulfil such a programme and to give adequate pertinent advice, continuing education is needful. During the year, residential refresher courses were attended by Health Visitors and School Nurses, as well as other inservice training and lectures. The trend has been towards a closer study of factors underlying ill-health and social breakdown. In October several Health Visitors attended the symposium arranged by the Royal College of Nursing and the College of General Practitioners, to consider the role of the Health Visitor in General Practice. As there is a common purpose and common ground, closer liaison is desirable and some interesting experiments were discussed. Regular paediatric hospital visiting continues to be of mutual benefit. A growing demand for ante-natal preparation classes with parentcraft is apparent, and talks have been given to voluntary organisations. The Health Visitors have assisted in the tuition of health visitor students and groups of district nurses. Nursing students from Oldchurch Hospital have been received for environmental experience. 34 Statistics of visits undertaken Ante-natal First visits 255 Follow up 1,989 Children 0 — 1 yr. 7,618 1 — 5 yr. 11,866 Section 28 458 Daily child minders 61 Others 408 Elderly 653 Ineffective 2,331 Total visits 25,639 35 MATERNITY SERVICES Maternal Mortality There were no maternal deaths in this area during 1961. Ophthalmia Neonatorum Two cases of ophthalmia neonatorum were notified, both of which made a complete recovery. There were 2 cases of other eye conditions occurring in newly-born infants requiring medical treatment. Domiciliary Midwifery Service Below is a table showing the work of the County midwives, midwives residing at York House Training Home and Salvation Army midwives during the year 1961. County Midwives Midwives residing at York House Training Home Salvation Army Midwives Births attended: Doctor present 63 19 38 Doctor not present 241 204 39 Miscarriages attended — — — Visits paid: As Midwife 4,697 5,879 1,348 Ante-natal 2,728 1,265 458 Gas and air administered: Doctor present 31 12 5 Doctor not present 178 129 8 Ante-natal clinics attended 298 — 76 Pethidine was given in 222 cases attended by County midwives. Ante-Natal Clinics Centre Sessions Held Times Sessions Held Average Attendance Average new cases The Clinic, Weekly 1st and 3rd Ashton Gardens, Wednesday, p.m. 7 1 Chadwell Heath. The Clinic, Weekly Tuesday, p.m. 11 2 Becontree Avenue, Dagenham. Weekly Wednesday, a.m. 10 1 The Leys Clinic, Weekly Wednesday, p.m. 10 2 Ballards Road, Dagenham. Rush Green Clinic, (1st and 3rd Friday, a.m. — — 179, Dagenham Road, in month) Rush Green. The Clinic, Weekly Tuesday, a.m. 6 1 Oxlow Lane Weekly Tuesday, p.m. 8 1 Dagenham. Weekly Thursday, a.m. 12 2 The Clinic, Weekly Monday, a.m. 12 2 Ford Road, Dagenham. The Clinic, Weekly Monday, a.m. 4 — Manford Way, Hainault. 36 Relaxation Classes The following were the attendances at the relaxation classes during the year:— Becontree Clinic 400 Chadwell Heath clinic 479 Leys Clinic 569 Oxlow Lane Clinic 563 2,011 Premature Infants All infants weighing 5 l/2 1bs 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. 0oz.— 51b. 8oz. Total No. Surviving one week Born alive at home and nursed entirely at home — 2 3 17 22 21 Born alive at home and ferred to hospital 4 - 1 1 6 4 Born in hospital 14 10 21 40 85 67 37 DAY NURSERIES DAY NURSERY ATTENDANCES JANUARY—DECEMBER 1961 Day Nursery Number of approved places Average daily attendance Average No. on register Total Attendances Goresbrook 50 29.8 41.7 7,530 Chadwell Heath 54 35.6 49.2 9,021 TOTALS 104 65.4 90.9 16,551 Nursery Widows Parents separated Desertion Illness of mother Illness of father Unmarried mothers Socioeconomic Mothers working to supplement income Total Goresbrook 1 10 2 6 1 5 6 34 65 Chadwell Heath 1 3 1 2 2 1 4 30 44 Number of children in all nurseries 1961 2 13 3 8 3 6 10 64 109 The good work of the day nurseries has continued throughout the year. On the whole, the average daily attendances were much the same as in 1960—slightly higher in Goresbrook (29.8 compared with 28.8) and slightly lower in Chadwell Heath (35.6 compared with 37.3). These are, of course, still well below capacity, as both nurseries can take 50—54 children. The reasons for attending the nursery do not vary much. Social or economic difficulty—invalidism of parents or absence of one parent—all these reasons make it essential for a nursery service to be kept running. The handicapped children now attend Kingsley Hall Nursery, but we have many children sent to Goresbrook and Chadwell Heath for behaviour problems which are more easily dealt with in a nursery atmosphere than at home. Both nurseries are recognised by the Ministry as training centres for nursery nurses, and vacancies for students are quickly filled. The staff continue to give loyal service and both nurseries are happy places for the children and the people looking after them. 38 DOMESTIC HELP An analysis of the hours of service rendered by Domestic Help Service during 1961 is given in the following table:— Type of case No. of cases Hours help provided Maternity 48 * 2,477 Tuberculosis 15 2,939 Acute 81 3,221 Chronic aged 574 76,570 Chronic others 94 19,224 Aged not sick 3 339 Others 16 3,226 Total 831 107,996 * Including toxaemia of pregnancy 4 527 Number of visits paid by Organiser 1,642 Average number of domestic helps employed each week 96 Average number of night attendants 2 Number of visits paid by domestic helps during 1961 61,672 Number of visits paid by night attendants during 1961 15 Once again the work of the service has increased considerably during the past year, 107,996 hours of help as against 98,337 in 1960. The aim of the service is to help with housekeeping responsibilities and to try to provide the aged, living alone, with a friend to help lessen the burden of loneliness and helplessness in the advancing years. Where there are relatives in the background co-operation is asked. The oldest patient to be helped at present is an old lady of 98 years, and it is very heartening to see the Help caring for her every morning, taking breakfast to her in bed and making sure that there is a nice fire waiting for her in the sitting room when she does get up—she is always cheerful and has many friends who keep contact. Tuberculosis cases are very worthwhile; all the Helps working in this type of household realise that it is the understanding of the illness which will help towards recovery. Care of children is sometimes required in the case of a mother having to enter hospital. The Domestic Help also visits the mother whilst in hospital in order to reassure her that her family is happy, which in turn, helps towards a good recovery. There is also the case of widowers, where the father leaves early in the morning and the domestic help ensures that the children have breakfast and leave clean and tidy to get to school on time. Every endeavour is made to help in the early stages of acute sickness to avoid more serious developments. 39 In maternity cases the work of the Home Helps has been invaluable, and the number of cases has increased slightly. Since the scheme was introduced the service has been given in four cases of toxaemia of pregnancy and this has enabled the mother to remain at home with the family thus avoiding hospital admission. There is always a list of women willing to be domestic helps and every care is taken to engage the right type of workers for this very worthwhile service. Unfortunately many good helps leave the service owing to their sensitiveness to sickness, and the demanding attidue of some of the patients. A domestic help should not be looked upon as the 'cleaner' but a kindly person ready to serve those in need. Training courses are held twice a year at Chelmsford. They are very much appreciated by the Helps who attend. An International Conference was held in London in 1961. A Domestic Help who had been in service for 15 years was selected to attend from Dagenham. All present were unanimous that all nations were united in their efforts to care for the needy. It is not generally realised that personal care is given by domestic helps outside working hours. It is often brought to my notice from an outside source that week-end meals have been provided and taken to a sick person in need. In many cases, the more able-bodied old folk have been collected by the domestic help and taken to her own home in order to be given a change of scenery and to relieve their loneliness. Many Christmas dinners were supplied and delivered by the Helps on Christmas Day. A Christmas Social was held in the Civic Centre—included in the evening's programme was a travel film, which was thoroughly enjoyed by all. 40 CHIROPODY SERVICE Two full-time chiropodists and one part-time chiropodist were employed at the end of the year. Clinics are held at Ford Road, and Ashton Gardens, Chadwell Heath, as follows:— Ashton Gardens, Ford Road Chadwell Heath Monday 2.00 p.m. — 5.00 p.m. 5.30 p.m. — 8.30 p.m. Tuesday 9.00 a.m. — 1.00 p.m. 9.00 a.m. — 1.00 p.m. 2.00 p.m. — 5.00 p.m. 2.00 p.m. — 5.00 p.m. Wednesday 10.00 a.m. — 1.00 p.m. 2.00 p.m. — 5.00 p.m. 5.30 p.m. — 8.30 p.m. Thursday 9.00 a.m. — 1.00 p.m. 2.00 p.m. — 5.00 p.m. Friday 9.00 a.m. — 1.00 p.m. 2.00 p.m. — 5.00 p.m. 5.30 p.m. — 7.30 p.m. A nominal charge of 2/6d. is made for each attendance. Necessitous cases and school children are treated free. The following table indicates the work done during the year:— Children under 15 yrs. of age Expectant mothers Physically handicapped Aged Others New cases treated during the year 198 4 48 197 381 Total attendances 1,019 5 683 2,888 2,834 Cases still being treated at the end of the year 20 0 84 308 359 41 DOMICILIARY OCCUPATIONAL THERAPY Report on the Service Based on Dagenham It has been said of tuberculous patients that "nature heals and the patient helps, by securing rest, fresh air, proper and sufficient food and by maintaining a sanguine and tranquil state of mind." All these, with the exception of the last, the patient secures on on entering a Sanatorium and it is to produce the "sanguine and tranquil state of mind" that occupational therapy has been introduced as part of treatment. For the patient who is discharged from hospital, it has been found that the long months of treatment have combined with the disease to unfit the patient for an abrupt resumption of a normal pattern of living. All his functions and habits are keyed to an inactive existence. Among the many facilities for tuberculosis which are provided by the County Council are the domiciliary occupational therapy arrangements. This service has been in operation for some years. The patients are recommended for domiciliary occupational therapy by Chest Physicians with close co-operation with the tuberculosis health visitors. At present there is one full-time occupational therapist employed to carry out this work. The areas covered by this scheme viz:—Dagenham, Barking, Ilford, Romford, Hornchurch, Forest and Grays are visited for part of one day in each week. The visits to new patients are made weekly at first, then fortnightly and finally, monthly. In view of the fact that there is only one occupational therapist for these areas it will be appreciated that only those patients who need occupational therapy as a treatment can be visited. There could be a tendency to treat this service as a source of cheap materials from a mobile shop to the detriment of the service. The materials provided are paid for by the patient who is also loaned any equipment required to carry out the chosen occupation. Completed work is sold when possible and some patients make items for their homes or for personal use. At the Dagenham Town Show each year a large variety of hand-made articles are sold, followed by a Sale of Work organised by the local Tuberculosis Care Association. Some of the patients enter stimulating and competitive work with good results—this year at the Dagenham Town Show there were 3 first, 3 second and 3 third prizes as well as 2 who received high commendation, out of a total of 20 entries submitted for various classes. Successes were also gained at the Essex Old People's Welfare Committee's Exhibition at Woodford Green, five out of six entries gaining prizes. Many sales are made from a show case at 15/17 Thompsom Road, Dagenham, where the occupational therapist has an office and store-room. Some of the occupations undertaken by patients in 1961 were printing, bookbinding, leatherwork, basketry, needlework, puppets, and rug-making. Two patients have worked on rehabilitation courses with good results. From the foregoing it will be seen that occupational therapy encourages new interests and keeps the patient in the habit of work in order to prepare him for normal work. 42 CONVALESCENCE AND RECUPERATIVE HOLIDAYS School Health Service 75 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. 43 children attended the centre this year. The arrangements were made by the Dagenham Children's Care Committee and all children were examined at the clinics before they left for their holiday. Camp Schools 26 children were examined by school medical officers before being admitted or readmitted to camp schools. OXLOW LANE CLINIC FOR THE OVER SIXTIES The report for 1960 contained a review of the activities of the clinic since its inception, as well as a table giving details of the ages and the physical and social disabilities of patients who attended during that year. Activities at the clinic continued during 1961 as in previous years, and as I have reported in the Introduction to this Annual Report I was not able to give all the time I would have liked to the clinic so that a high proportion of the patients were seen by Dr. Hodgson. During the year 222 attendances were made to see the doctor while 569 attendances were made at the exercise class. One activity which aroused some interest was the making of a film strip by Camera Talks called "Food Hints for the Over 6o's." St. George's Hospital Hornchurch, the Dagenham Old People's Welfare Committee and the Essex County Council cooperated in providing facilities for many of the photographs. The film strip gives details of how a balanced diet can be maintained and how certain facilities such as Civic Restaurants and Luncheon Clubs, as well as Meals on Wheels could help to keep people healthy. The film strip has been, on the whole, well received. It is my ambition not only to increase the number of clinics of this type but to link one of them to a day centre which will provide day care for old people somewhat on the lines of a day nursery and suggestions to this effect have been included in the 10 year plan. 43 VACCINATION AND IMMUNISATION Vaccination against Smallpox During the year 1,320 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 275 525 - - 1—4 yrs. 62 62 14 — 5—14 yrs. 66 5 30 3 15 years and over 97 15 144 22 Total all Ages 500 607 188 25 Whooping Cough 1,627 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. 336 691 75 137 308 — 80 — B.C.G. B.C.G. vaccination has continued in the 13-plus age group; this year 2,600 children were offered vaccination. 1,569 children were tested after the parents' consent had been received. Results of the multiple puncture tests:— Negative 1,475 Positive 71 Of the children with negative reactions (and therefore susceptible) 1,438 received B.C.G. vaccination. There were no cases of post-vaccination complications. 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 2,067 children received primary immunisation injections and a total of 2,393 received boosting doses. 44 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 515 443 — — 1-4 313 299 109 104 5—9 years 163 117 582 424 10—14 years 140 77 878 296 Total all Ages 1,131 936 1,569 824 Diphtheria Immunisation of School Children A total of 2,677 school children were immunised against diphtheria during the year (of which 914 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. Poliomyelitis In May 1961 I wrote an article which appeared in the Dagenham Post calling on people to accept immunisation against polio in good time before the "polio season" and during the year there was an improvement in the numbers of people accepting immunisation by injection. Towards the end of the year it was realised that oral vaccine would be available during 1962 which we hope will assist in finally stamping out poliomyelitis from the population. During the year a total of 4,200 primary injections (i.e. 2 doses) were given and 3,722 third injections. Immunisation 1961 By Medical Officers By General Practitioners Total Primary 1,873 (1,501) 3,113 (2,719) 4,986 (4,220) 2nd and 3rd 1,275 (5,709) 2,447 (5,402) 3,722 (11,111) 4th injection 4,338 2,611 6,949 The corresponding figures for 1960 are shown in brackets. There were no cases of polio notified to the department in 1961. Total acceptors since commencement of scheme 42,928 Total primary injections since commencement of scheme 37,537 Total 3rd injections since commencement of scheme 31,692 Total 4th injections since commencement of scheme 6,949 45 SCHOOL HEALTH School Premises There are 16 secondary and 45 primary schools in the Borough, also 2 special schools. Children on the registers on 31st December 1961 totalled 19,265, a decrease of 547 compared with 1960. Schools were visited for the purpose of obtaining samples of milk for bacteriological testing. Twelve such samples were obtained during the year, all of which passed the appropriate tests. School Inspections As in previous years, medical inspection in the schools during 1961 covered four groups:— (a) children in their first year of attendance (b) children in their last year at primary school (c) children in the 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 examined. 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 Inspection Number of inspections in the prescribed groups:— (i) 5—14 year age group 3,904 (ii) Others 1,098 Total 5,002 B—Other Inspections Number of special inspections 1,484 Number of re-inspections 1,276 Total 2,760 46 Details of the defects found at these medical inspections are set out below:— Defect Code No. Defect or disease Periodic Inspections Special inspections Entrants Leavers Others Total (all groups) Treatment Observation Treatment Observation Treatment Observation Treatment Observation Treatment Observation 4 Skin 3 3 48 5 8 7 59 15 60 22 5 Eyes: (a) vision 15 19 101 21 86 41 202 81 25 16 (b) squint 13 13 3 3 13 14 29 30 4 3 (c) other — — 1 4 7 6 8 10 20 18 6 Ears: (a) hearing 3 2 5 3 5 9 13 14 23 14 (b) otitis media — 4 5 2 3 2 8 8 11 7 (c) other — 1 3 — 1 1 4 2 — — 7 Nose and throat 56 62 4 5 27 19 87 86 31 24 8 Speech 10 23 — 2 12 3 22 28 40 13 9 Lymphatic glands 26 16 1 — 8 4 35 20 6 2 10 Heart 6 8 6 6 11 34 23 48 8 20 11 Lungs 8 26 8 9 12 22 28 57 16 28 12 Developmental (a) hernia 3 - 1 2 1 1 5 3 1 - (b) other 2 7 — 4 5 12 4 23 — 3 13 Orthopaedic (a) posture - 4 5 4 5 16 10 24 - 4 (b) feet 12 11 18 3 10 9 40 23 11 7 (c) other 8 12 3 1 13 14 24 27 61 42 14 Nervous system (a) epilepsy - 3 3 1 2 5 5 9 1 3 (b) other 3 4 1 1 1 2 5 7 6 13 15 Psychological (a) development 5 9 4 6 24 9 33 24 7 10 (b) stability 1 8 2 5 8 8 11 21 19 10 16 Abdomen — 2 2 — — 1 2 3 — — 17 Other 27 4 27 1 27 6 81 11 143 325 47 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 recorded (3) Total Individual pupils (4) 1957 and later - 17 17 1956 9 78 85 1955 6 52 57 1954 — 10 10 1953 3 4 6 1952 1 16 17 1951 3 5 8 1950 51 93 139 1949 25 44 68 1948 2 1 2 1947 40 6 103 1946 and earlier 62 76 136 TOTAL 202 462 648 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. Out of 5,002 children seen at periodic medical inspections only 4 were considered to be of unsatisfactory general condition. Uncleanliness The number of children found with vermin and/or nits during the year was 107. 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 Sub-Committee take responsibility. Infestation with Vermin All cases of infestation, however slight, are recorded. (i) Total number of examinations in the schools by school nurses or other authorised persons 20,158 (ii) Number of instances of infestation found 118 (iii) Number of cleansing notices issued Section 54 (2) Education Act, 1944 118 (iv) Number of disinfestations carried out: By school nurse 51 By parents 67 48 Visual Defects Vision tests were carried out on all children at the school medical inspections; 231 were referred for treatment at the Ophthalmic Clinics and III kept under observation. Eye Diseases, Defective Vision and Squint Category No. of cases dealt with By the authority Otherwise External and other (excluding errors of refraction and squint) 331 3 Errors of refraction (including squint) — 1,739 No. of pupils for whom spectacles were prescribed — 610 Colour Vision Colour vision testing was continued at all school medical inspections on all pupils at or over the age of II years and the following table shows the number of defects found:— Intermediate periodic medical inspection School leaving inspection Tested for colour vision 1,477 1,849 Found to have defect of colour vision 14 36 Enuresis Children suffering from enuresis are referred to Dr. Hinden at Whipps Cross Hospital. Enuresis buzzer alarms are loaned from this Department to those cases for whom they are recommended by Dr. Hinden. A school nurse takes the apparatus to the child's home and instructs the parent how it should be used. She then visits the home periodically while the apparatus is in use to review progress. The parents are provided with a record card which they are asked to complete each morning to record whether the child has been wet or dry during the night. Unfortunately not all of these records are completed throughout the course of the treatment. The results obtained in the children who have received this treatment so far are as follows:— Became dry every night: 9 Became dry most nights: 4 No change 0 Incomplete record 5 The average duration of treatment has been 3.9 months. Survey of the records shows that the maximum effect of the treatment is nearly always obtained by the end of the first month. It is therefore felt that some reduction could be made in the length of treatment in many cases. This service is greatly appreciated both by the children concerned and their parents. Infectious Diseases That there was no outbreak of infectious diseases disclosed amongst school children during the year calls for special mention. 49 SCHOOL CLINICS During the year 2,642 children were seen by the school medical officers and 4,624 attendances were made at nurses' clinics. The total number of attendances made by school children at each of the minor clinics during 1961 were as follows:— Ashton Gardens 322 Bentry School 395 Becontree Avenue 1,408 Five Elms 2,753 Ford Road 1,095 King's Wood 99 Leys 289 Oxlow Lane 825 Marks Gate 80 7,266 Other Treatment Given New cases treated By the Authority Otherwise Miscellaneous minor ailments 803 20 Other: Heart and rheumatic diseases — 3 Hernia — 1 Major respiratory diaseases — 8 Major digestive diseases — 42 Major injuries — 6 Other major diseases — 28 Enuresis — 16 TOTAL 803 124 Diseases of the Skin (Excluding Uncleanliness) Number of new cases treated during the year By the Authority Otherwise Ringworm (scalp) — — Ringworm (body) — — Scabies 1 — Impetigo 13 — Other skin defects 550 2 Number of examinations made by skin specialist—6 50 Diseases and Defects of Ear, Nose and Throat Number of children referred to Consultants during 1961 — 51. Number of cases treated By the Authority Otherwise Received operative treatment (a) for diseases of the ear — 21 (6) for adenoids and chronic tonsillitis — 101 Received other forms of treatment 82 39 TOTAL 82 161 CHILDREN FOUND AT PERIODIC MEDICAL EXAMINATION TO HAVE UNDERGONE TONSILLECTOMY Age Group Number inspected Number found to have undergone tonsillectomy Boys Girls Boys Girls 5 years 674 706 18 8 10—12 + years 764 713 14 17 14 years 963 886 19 18 Other periodic 165 131 5 1 TOTAL 2,566 2,436 56 44 Employment of Children 241 pupils were examined for fitness for employment out of school hours and certificates given to all these children. Adolescent Clinic The first clinic for adolescents was started in February 1961. The clinic is staffed by a medical officer and a health visitor. The sessions are held in the early evening, and the programme consists of a talk given by one of the staff followed by group discussion. Opportunity is given for those attending to have individual interviews with the staff and also for medical examination where required. Up to the end of the summer term 19 clinics had been held and the number of new attendances was 44 or 2.2 per clinic. The attendance per child varied between 1 and 9 out of 10 clinics, or an average of 36% attendances per child. 51 The reasons for attendance at the clinic were:— 1. Acne and skin disorders 9 2. Obesity and adolescent problems 2 3. Lump in breast and adolescent problems 1 4. Social and adolescent problems 9 5. Discussion groups 23 Source of referral:— 1. Parents 10 2. School 4 3. N.S.P.C.C 1 The remainder were brought by friends or referred from school medical inspections. Topics discussed:— Hobbies and jobs Adolescence in society Personal hygiene Menstruation Personality Anatomy of reproduction Birth of a baby Development of baby With the consent of the parents films on the physiology of sex were shown to the school leavers and were followed by a discussion. We found that the films on the physiology of sex were not popular. The main criticism was "they knew all the main points of the films" and that in any case the detail was much too technical—a criticism which we had made at the preview. The discussions, however, were useful both to us and, I feel, to the adolescents. During 1962 we propose to try a different selection of films and include a film on venereal disease as we have been asked many questions on this by the older children. The most popular discussions were on child development and baby care (with the girls) and hobbies. We were amazed at the wide range of interests our adolescents had, and also their knowledge of these subjects. We found that generally speaking the discussion was best stimulated by a short talk by a member of the staff, and it was interesting to note that whilst there was occasionally severe criticism of adults, this was frequently turned against members of their own group. We also found that routine medical examinations were intensely unpopular. If the children came because of a health worry they co-operated whole-heartedly, but otherwise could not be induced to submit to this so we decided to waive the medical for children attending the discussion groups only. 52 A gratifying point has been that two girls have made a point of coming to see us after leaving school and telling us about their jobs and have said they would like to come again occasionally now they have left school, and another has rung us on several occasions to ask if she could come along to see us. One parent came to say that she thought the clinic a good idea and that she had noticed some improvement in her daughter's behaviour as a result of her attendance. This venture has so far been fairly successful although I am a little disappointed at the smallness of the numters; however, this is not unexpected as the clinic draws from only two senior schools. It is hoped that next year, following discussions with the headmaster of one school, the number of boys attending will increase. Special mention should be made of the wonderful co-operation from the school heads and staff and of the enthusiasm and ability of the health visitors without which none of this would have been possible. Home Visits by School Nurses 2,053 visits were made by school nurses to the homes of school children during the year. Medical Examinations 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 62 2. Essex County Council 97 3. Dagenham Borough Council 186 4. Other authorities 6 (b) Under sickness regulations 4 (c) Other purposes 25 Number of consultations with specialists arranged 80 X-ray of Staff All new entrants to the County Council Staff who are liable to come into 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 5 — All Day Nursery Staff 24 — Occupation Centre Staff 1 — Domestic Helps 3 — Others 16 2 Teachers 2 68 Non-teaching staff 50 — 53 DENTAL SERVICES The shortage of dental officers continued during the year, and we have only three part-time officers carrying out between them nine sessions per week. Urgent extractions are carried out as quickly as possible, but we are able to arrange only two gas sessions per week; even so, some part of these sessions has to be allocated to maternity and child welfare cases. One session per week is devoted to inspection only, when children suffering from toothache are seen by a dental officer and given an early appointment, the remaining six sessions are devoted to conservative treatment. The pupils at the Bentry Special School have recently been examined by one of the dental officers and arrangements are now being made for their treatment. In order to obviate the difficulty of conveying these children from the school to the Oxlow Lane Dental Clinic, then back to the school again in small batches, arrangements have been made to set up a temporary dental surgery at the school whereby the dental officer can carry out the necessary dental treatment more expeditiously. A modern portable dental engine has been purchased and the necessary dental equipment, not now in use at one of the dental surgeries, transferred temporarily to the school. I give below the figures for the year:— Periodic Specials (a) Number of pupils inspected 206 857 (b) Number found to require treatment 169 848 (c) Number offered treatment 169 848 (d) Number actually treated 19 680 (e) Number awaiting treatment 168 130 (f) Attendances made by pupils for treatment 32 2,210 (g) Half-days devoted by dental officers to:— (i) Inspection 50 (ii) Treatment 369 (h) Fillings: (i) Permanent teeth 1,302 (ii) Temporary teeth 264 (i) Number of teeth filled:— (i) Permanent teeth 1,201 (ii) Temporary teeth 242 (J) Extractions:— (i) Permanent teeth (a) on account of caries 408 (b) for other purposes 18 54 (ii) Temporary teeth (a) on account of caries 980 (b) for other purposes 7 (k) Anaesthetics administered:— (i) Local 612 (ii) General:— (а) by medical officers on county staff 3 (b) by others 580 (l) Orthodontics:— (i) Cases completed 9 (ii) Cases discontinued 3 (iii) Pupils treated with appliances 29 (iv) Removable appliances fitted 9 (v) Fixed appliances fitted — (vi) Total attendances 87 (m) Dentures:— (i) Number of pupils supplied with artificial dentures 20 (ii) Number of dentures fitted 20 (n) Other operations:— (i) Permanent teeth 124 (ii) Temporary teeth 31 (o) Analysis of figures in (n):— Type of operation Number Scaling 4 Syringing sockets 2 Dressings 77 Other operations 72 (p) X-rays 29 55 SPECIALIST SERVICES Leys Orthopaedic Clinic I give below a report received from Mrs. E. Ottley, the physiotherapist:— "During 1961, 594 patients attended for physiotherapeutic treatment, 9,122 treatments being given. There was an increase of 588 in the number of individual treatments given. No waiting list is kept for treatment, all patients are seen on receipt of referral forms or letters, and appointments given. Two mornings a week are devoted to ambulance cases, approximately 25—30 cases being brought in each morning. I would like here to again express my appreciation of this willing and co-operative service. Children attended in their respective age groups, classes for feet, posture and breathing, boys and girls being treated separately. In view of the increasing amount of work, a request was made to the Regional Hospital Board for larger and more up to date apparatus. This was passed by Mr. Moore and an extension has now been installed (large Siemens ultra short wave and combined table). The appliance fitter, Mr. Paulding of A. E. Cox Ltd., now calls each week to fit and measure patients for splints and belts etc. Arrangements are now being made for Xrays requested by the surgeon to be taken locally, as some patients find it extremely difficult to travel any distance. I would like to say how grateful I have been for the cooperation received from the X-ray Department, Chadwell Heath Hospital, in the past. It is a great pity so many children from such an early age—six upwards—are still allowed to wear such unsuitable shoes. I visualise still more foot deformities for both girls and boys unless parents and schools take the necessary steps to see that children are sensibly shod. Patients seen during 1961: infant welfare 81, schoolchildren 249, adults 264, total treatments 9,122. The Orthopaedic Surgeon attended 12 sessions at which 169 patients were seen, 58 of which were new. The Christmas Party this year was held on December 19th from 3.00 p.m. to 6.00 p.m. when over 100 patients attended, and a very good time was had by all. Our thanks are due to Mrs. Payne of Kay's Drapery who organised a raffle, and gave me a cheque for £10 as a result. Various patients brought presents and my husband provided the fruit, also a basket of fruit to rafflle." 56 Ophthalmic Clinic The two specialists who attend weekly run a separate service for different parts of the area, which is divided into three, 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 Becontree Avenue, one 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:— Dr. Regal reports as follows:—"Two ophthalmic sessions have been held each week throughout the year. The North East Metropolitan Regional Hospital Board have authorised the extension of these sessions to an equivalent of two and one-half sessions per week, but owing to the difficulty of obtaining the services of an ophthalmologist, it has not been possible to arrange this additional fortnightly session. 1960 1961 Attendances 771 768 New cases seen 198 206 Glasses ordered for new cases 120 138 Glasses or lenses ordered for old cases 196 188 Numbers of sessions 50 49 As shown in this table there is hardly any difference in the figures, the very small decline in the number of attendances being insignificant, especially as the number of sessions held was one less than in the preceding year. The age of out patients ranges from babyhood, when they are referred to us by the Infant Welfare Clinic, up to school leaving age. We see, of course, all sorts of pathological eye conditions but the bulk is abnormal visual acuity and squints. There especially I can only praise the good co-operation we have from the orthoptic departments, their efficiency and their speedy and detailed reports. I should like also to express my gratitude to the hospitals; our cases are seen there without any delay and the attitude of the Consultant staff is most helpful. We usually see our patients at six monthly intervals, the more settled cases permit a longer interval of nine months, but the very young ones have to be seen more frequently, especially when we wish to satisfy ourselves of the efficacy of the treatment initiated. There is still a delay of 5 weeks for new cases, unless they are urgent ones. This is unfortunately unavoidable owing to the fact that there are always some absentees from our sessions who take away time which could be more profitably used for other patients. In this connection I should like especially to thank our nurses and health visitors for their untiring efforts in visiting the parents and explaining the necessity of ophthalmic treatment for their children. 57 Once again I must repeat my plea for the appointment of a dispensing optician to be present at our sessions. Apart from the obvious advantages in saving our patients time and trouble, it would in no way interfere with the free choice of optician for the patient. I think it speaks for the popularity of the school clinics and welfare clinics that the number of out patients has remained fairly steady." Dr. MacFarlane reports as follows:—"During 1961 a total of 753 cases were seen at the clinic on Friday mornings, of which 129 were new cases. Amongst these patients, the largest number were hypermetropes, with or without astigmatism, and with or without associated squint. Refractions and retests form the bulk of the work, but sometimes pathological conditions are met with. When glasses are prescribed the prescription can be taken to any optician, and this sometimes leads to the patient being lost to the clinic, the optician subsequently taking over the care of the patient. I would plead yet again for the presence of a dispensing optician at the clinic as being most desirable, and this view is shared by the Consultant Ophthalmic Surgeon at Oldchurch Hospital. The clinics are reasonably well attended, but there are always some absentees who have failed to write or telephone that they are not coming. This is particularly the case during the school holidays, when apparently some parents imagine that the clinic does not function. In fact, there is a clinic every week of the year, and parents ought to take advantage of it particularly during holiday time, so that the children do not miss school even for part of a morning. Again I would like to mention the invaluable work of the school nurses, who follow up the non-attenders, find untreated children in school with poor vision and bring them along, and visit the parents to explain. By the end of the year, the situation was such that new cases could be seen within 2 weeks of referral, and the retests of old cases were up to date." Audiometric Tests Eighteen children have been tested with the audiogram. One was referred to hospital, seventeen are being kept under observation. Child Guidance A total of 92 children from Dagenham were seen at the Romford Child Guidance Clinic, there is still a waiting list of 42 children. Other Specialist Clinics School medical officers refer children to hospital consultants for opinion or for treatment at specialist clinics; 204 children were so referred during the year as follows:— 58 Chest Physician 7 Cardiologist 14 Orthopaedic Surgeon 12 E.N.T. 51 Dermatologist 6 Paediatrician 61 Enuresis Clinic 22 Ophthalmologist 5 Audiologist 26 Total 204 Speech Therapy There is little change to report in connection with the work of the Speech Therapy Department during 1961. Miss Shipley and Miss Symes have continued to work full time in the Borough, operating between them seven clinics. There was a slight fall in attendances towards the end of the year, which as speech therapy is partly concerned with preventing disorders, is possibly a good sign. The speech Therapists report:—"We wish to place on record our thanks for the co-operation shown in our work by the school medical officers, although in some instances not all children whom we have selected for treatment at school visits have received the necessary final recommendation from the medical officer. From September to December 1961 both speech therapists carried out treatment sessions weekly at the Junior Training Centre at Osborne Hall, on an experimental basis to see if speech therapy would benefit the mentally handicapped. Only four pupils were selected as being suitable for therapy, and three of these had not made sufficient progress to warrant further treatment. The other one, a girl of twelve, made progress, and is now under weekly treatment at Five Elms Clinic." Speech Therapy Statistical Return 1. Number of treatments given 2,447 2. Number of patients treated:— Five Elms Clinic 70 Ashton Gardens Clinic 14 Marks Gate Clinic 21 Oxlow Lane Clinic 15 Leys Clinic 51 The Bentry School 22 Junior Training Centre (Osborne Hall) 5 TOTAL 198 59 Number of sessions held:— Five Elms Clinic 215 Ashton Gardens Clinic 81 Marks Gate Clinic 89 Oxlow Lane Clinic 76 Leys Clinic 179 The Bentry School 106 Junior Training Centre 18 TOTAL 764 At least one session was held weekly by both Miss Shipley and Miss Symes for purposes of school visits, interviews or tape-recordings. 4. Case load: Boys 134 Girls 64 TOTAL 198 5. Types of cases treated:— Dyslalia 96 Delayed development including aphasia 19 Sigmatism 31 Stammer 32 Stammer and dyslalia 6 Defect associated with hearing loss 6 Cleft palate 4 Disorder of voice 3 Unclassified 1 TOTAL 198 6. Number of cases on register at 31. 12. 61—122 7. Reasons for discharge:— Speech normal 51 Non-attendance 11 No further progress likely 11 Transferred to another school 6 Left school 4 Discharge requested by parent 2 TOTAL 85 HANDICAPPED CHILDREN 1. Children under 5 years of age A register of all children under the age of five years who are either mentally or physically handicapped, is kept at the Civic Centre, to which names are added as more information becomes available. Twenty of these children are attending Kingsley Hall Nursery for Handicapped Children in order to lighten the burden of their parents and to enable them to have some pre-school training, physiotherapy and speech therapy. 2. School Children Children attending normal schools, but registered as handicapped pupils, were seen at varying intervals by the school medical officers, in order to check their ability to cope with normal school work. 60 ERRATUM The order of the headings in the table of handicapped children on page 61 should read as follows:- Blind, partially sighted, deaf, partially deaf, delicate, physically handicapped, E.S.N., maladjusted, epileptic, speech defect, dual defect. Attending residential special school 4 l 2 l 16 6 9 18 1 1 3 59 Awaiting placement in residential special school — — — — 4 — 2 5 — — — 11 Attending boarding homes - - - - - - - - - - - - Awaiting placement in boarding homes - - - - - - - - - - - - Attending independent schools - - - - - - - - - - - - Awaiting placement in independent schools - - - - - - - - - - - - Attending hospital schools - - - - - - - - - - - - Awaiting placement in hospital - - - - - - - - - - - - Receiving education in hospital under section 56 - - - - - - - - - - - - Receiving home tuition under section 56 — — — — 2 - - - - - - 2 Awaiting home tuition under - - - - - - - - - - - - Total number of children of school age requiring s.e.t. 4 18 7 8 49 67 195 24 1 1 27 374 Children of school age on register of handicapped pupils but not requiring s.e.t. and attending ordinary schools - 8 - 15 104 63 21 7 12 5 4 235 Children aged 2—5 years on 31. 12. 61 formally ascertained as handicapped pupils requiring s.e.t. Receiving s.e.t. - 1 - - - - - - - - - 1 Awaiting s.e.t. 1 1 — — 3 2 4 — 1 — — 12 Children aged 2—5 yr. at 31. 12. 61 on register of handicapped pupils but not requiring s.e.t. - - - - - - - - - - - - 61 Number of sessions held:— Five Elms Clinic 215 Ashton Gardens Clinic 81 Marks Gate Clinic 89 Oxlow Lane Clinic 76 Leys Clinic 179 The Bentry School 106 Junior Training Centre 18 TOTAL 764 At least one session was held weekly by both Miss Shipley and Miss Symes for purposes of school visits, interviews or tape-recordings. 4. Case load: Boys 134 Girls 64 TOTAL 198 5. Types of cases treated:— Dyslalia 96 Delayed development including aphasia 19 Sigmatism 31 Stammer 32 Stammer and dyslalia 6 Defect associated with hearing loss 6 Cleft palate 4 Disorder of voice 3 Unclassified 1 TOTAL 198 6. Number of cases on register at 31. 12. 61—122 7. Reasons for discharge:— Speech normal 51 Non-attendance 11 No further progress likely 11 Transferred to another school 6 Left school 4 Discharge requested by parent 2 TOTAL 85 HANDICAPPED CHILDREN 1. Children under 5 years of age A register of all children under the age of five years who are either mentally or physically handicapped, is kept at the Civic Centre, to which names are added as more information becomes available. Twenty of these children are attending Kingsley Hall Nursery for Handicapped Children in order to lighten the burden of their parents and to enable them to have some pre-school training, physiotherapy and speech therapy. 2. School Children Children attending normal schools, but registered as handicapped pupils, were seen at varying intervals by the school medical officers, in order to check their ability to cope with normal school work. 60 Number of children of school age on 31st December 1961 formally ascertained as handicapped pupils requiring special educational treatment (s.e.t.) Blind Partially sighted Deaf Partially deaf Physically handicapped E.S.N. Maladjusted Delicate Epileptic Speech defect Dual defect TOTAL Attending day special school — 16 5 7 23 61 168 1 — — 24 281 Awaiting placement in day special school — 1 — — 4 — 16 — — — — 21 Attending residential special school 4 1 2 1 16 6 9 18 1 1 3 59 Awaiting placement in residential - - - - 4 — 2 5 — — — 11 Attending boarding homes - - - - - - - - - - - - Awaiting placement in boarding - - - - - - - - - - - - Attending independent schools - - - - - - - - - - - - Awaiting placement in independent - - - - - - - - - - - - Attending hospital schools - - - - - - - - - - - - Awaiting placement in hospital - - - - - - - - - - - - Receiving education in hospital under section 56 - - - - - - - - - - - - Receiving home tuition under section - - - - - - - - - - - 2 Awaiting home tuition under section 56 - - - - - - - - - - - - Total number of children of school age requiring s.e.t. 4 18 7 8 49 67 195 24 1 1 27 374 Children of school age on register of handicapped pupils but not requiring s.e.t. and attending ordinary schools - 8 - 15 104 63 21 7 12 5 4 235 Children aged 2-5 years on 31. 12. 61 formally ascertained as handicapped pupils requiring s.e.t. Receiving s.e.t. - 1 - - - - - - - - - 1 Awaiting s.e.t. 1 1 — — 3 2 4 — 1 — — 12 Children aged 2-5 yr. at 31. 12. 61 on register of handicapped pupils - - - - - - - - - - - - 61 BENTRY SCHOOL The Bentry School continues to provide educational facilities for the physically and mentally handicapped children of Dagenham and the surrounding district. A weekly medical session is held in the school. Routine medical inspections, examination of new entrants and immunisations are all carried out at these sessions. Parents are encouraged to attend, and many problems are solved by discussion with them and with the headmaster. We aim at giving the mentally handicapped children a yearly intelligence test, but due to shortage of medical officers who are approved to carry out these tests, this still remains an ideal. School leavers are given a special examination which includes a physical examination and an intelligence test. Their special aptitudes are then discussed with parents, headmaster and youth employment officer, and an effort is made to place them in congenial employment. During the year we found it expedient to curtail the number of children who go swimming; this was so that a small number of severely handicapped children should be given more concentrated attention. The school enjoys a very happy atmosphere which no doubt is due to the co-operation of the headmaster and all the staff. We are always very gratified when parents tell us that their children are much happier and easier to manage since coming to the school. The following report has been received from Mrs. F. Cocker, the physiotherapist who attends at the Bentry School:— "The Bentry School is divided into two parts, one part for the physically handicapped children, the other part for the E.S.N. children; these educationally sub-normal children need very little physiotherapy treatment, a small percentage of the children come to the class for general postural exercises and some children come to the class for foot exercises, as many of these children have a typical congenital pes planus. With regard to the physically handicapped children, 50% come under the heading of cerebral palsied, approximately 20% are suffering from the after effects of anteriorpoliomyelitis, while most of the remaining children are the victims of accidents or postural deformities, three of the children have a severe and fixed scoliosis. In addition there are two or three children with muscular dystrophy or muscular atrophy and one or two with chronic poly-neuritis. 62 I use no electrical apparatus in the treatment of these children except for an infrared lamp, and as far as possible they are treated individually. The most important part of the treatment is the instruction of the parent with the child so that the parent can help the child daily with his or her active, or assisted active, movements at home." In addition to physiotherapy, therapeutic swimming is also arranged for some of the pupils attending the Bentry School and the following report has been submitted by Mr. A. Brand, who is responsible for this type of treatment:— "This year I notice a slight falling off in the attendance at the swimming class. We had only 7 new cases, against last years 14. The enthusiasm of the children however, remains unimpaired. In fact, several of the children are so keen they are not statisfied with just learning to swim—they want to be able to do all the strokes in the book! I would again like to extend my thanks to the Sports Organiser at the South East Essex Technical College, and his staff, for their kind help and co-operation, and the students who gave their help so willingly. I would also like to extend my most grateful thanks to the members of the firm of Toolpro Ltd., of Ilford, who for the past four years have each year organised (and paid for out of their own pockets) a wonderful Christmas Party and Summer Outing for the children. To all who have helped in any way—my sincere thanks." The list below includes all children admitted to special schools during the year:— Admitted to Residential Schools E.S.N. 2 Physically handicapped 2 Delicate 5 Maladjusted 1 Deaf 1 Admitted to the Bentry and other Day Special Schools E.S.N. 29 Physically handicapped 11 Partially deaf 2 Delicate 4 Partially sighted 5 63 Of the children who were attending special schools the following were discharged to other schools during 1961:— From Residential Schools Maladjusted 2 to ordinary school E.S.N. 1 to day special school Delicate 3 to ordinary school From Day Special Schools E.S.N. I to ordinary school Delicate 3 „ „ „ Physically handicapped 1 „ „ „ 64 KINGSLEY HALL DAY CENTRE The Day Centre for young handicapped children was used to capacity during the year, and attracted a good deal of attention from various professional and other people. In particular we welcomed the interest in the Centre shown by Dr. Mary Sheridan of the Ministry of Health. The original intention was that the children admitted should be either physically or mentally handicapped, but the scope of cases has now been enlarged to include some who are suffering from emotional and social disabilities. It was noticeable that in process of time the average age of admission tended to fall somewhat. This trend is beneficial in that the earlier assessment, training and treatment can be instituted, the more effective are they likely to be. But the increased number of younger children laid a greater burden of work upon the staff, to whom we are grateful for their enthusiasm and hard work. In the coming year, when the electrical wiring of the building has been renewed, it is hoped that a washing machine may be obtained which will be a great help in dealing with the washing of nappies and clothing which at present has to be done by hand. The physiotherapist attended for one session a week, during which time she trained the staff nurse in the physiotherapy each child requires. The staff nurse is then able to carry out each child's treatment daily. In December Mr. Swallow, Senior Lecturer in Dentistry at the London Hospital, visited the Centre and examined each child. Arrangements were then made for those children who required treatment to be taken by ambulance to the hospital, where they received treatment immediately upon arrival. In this way dental treatment was made available for many of the children for whom treatment would have been impracticable under ordinary arrangements. We would like to express our thanks to Mr. Swallow for his great help in this matter. During the year the Health Area Sub-Committee acquired a minibus which is used to convey the children to and from the Centre. This enabled the journeys to be divided and shortened, as compared with those previously undertaken by a hired vehicle. Mothers are encouraged to call at the Centre to see their children and to discuss their progress with the Sister in charge. In some cases it is desirable that the staff should be able to give a mother more intensive training in handling her child: in these cases the mother attends for a more prolonged period on a certain day each week. A medical officer visits the Centre frequently to examine the children and to keep in close touch with the progress. 65 It has been remarked that the staff spend a great deal of their time on the floor. This is because the younger and the more severely handicapped children are more mobile if they are allowed to roam on the floor, or, in fine weather, on the lawn outside. It is one of our aims to encourage these children to move around more freely, and to become more independent in every way. The value of the Centre becomes more apparent as time goes by. It is gratifying to see the progress made by nearly every child, while the staff's prolonged acquaintance with the children is of great assistance when subsequent placement is being considered. 66