DAG36 BOROUGH OF DAGENHAM THE HEALTH OF DAGENHAM IN 1962 BOROUGH OF DAGENHAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1962 J. ADRIAN GILLET, M.B., Ch.B., D.P.H., F.R.S.H. Civic Centre, Dagenham, Essex Telephone: Dominion 4500 INDEX Page Adolescent Clinic 56-58 Ante-natal Clinics 38 Atmospheric Pollution 19-20 Bentry Special School 64-65 Care of Mothers and Young Children 38-42 Child Guidance 54 Chiropody 45 Comittee for Education 5 Convalescence 47 Council—Members of 3 Day Nurseries 40-42 Deaths—Causes of 14 Dental Services 59-60 Diseases of Animals (Waste Foods) Orders 1957 22 Domestic Help 43-44 Education (General Purposes) Committee 5 Factories Acts, 1937 and 1948 22 Food and Drugs—Sampling 26 Food Hawkers—Registration 24 Food—Inspection and Supervision 23-28 Food Poisoning 24-25 Food—Unsound 24 Handicapped Children 61-63 Health Area Sub-Committee 4 Health Education 30-35 Health Visiting and School Nursing 36-37 Home Safety 31 Housing 17-18 Houses in multiple occupation 18 Ice Cream 23-24 Immunisation: Diptheria 50 Whooping Cough 50 Improvement Grants 17-18 Infant Mortality 13 Infant Welfare Centres 39 Infectious Diseases 28-29 Inspection and Supervision of Food 23-28 Kingsley Hall Day Centre for Handicapped Children under Five 67-70 Page Laundry Service for the Incontinent Aged 19 Maternity Services 38-42 Midwifery Service (domiciliary) 42 Milk 23 National Assistance Act, 1948 18-19 Noise Abatement 20-21 Occupational Therapy (domiciliary) 46 Orthopaedic Clinic 66 Over Sixties Clinic—Oxlow Lane 47-48 Pet Animals Act, 1951 21 Premature Infants 39 Prevention of Damage by Pests Act, 1949 21 Public Health Committee 3 Public Swimming Baths 17 Rag, Flock and Other Filling Materials Act, 1951 21 Recuperative Holidays 47 Relaxation Classes 39 Rent Act, 1957 17 Riding Establishments Act, 1939 22 Sampling—Food and Drugs 26 Sanitary Inspection of the District 15 School Clinics 56 School Health 51-58 Sewerage and Sewage Disposal 16-17 Slum Clearance 17 Smoke Control Areas 20 Specialist Services 54-55,66 Special School—Bentry 64-65 Speech Therapy 54-55 Staff 6-7 Tents, Vans and Sheds 18 Tuberculosis 29 Unsound Food 24 Vaccination: B.C.G 49-50 Poliomyelitis 50 Smallpox 49 Vital Statistics 12-14 Water 15-16 2 MEMBERS OF THE COUNCIL (as at 31st December, 1962) MAYOR: Councillor D. A. L. G. Dodd, J.P. DEPUTY MAYOR: Councillor W. A. Parish, J.P. ALDERMEN: W. E. Bellamy, J.P. M. Eales R. Blackburn, J.P. E. M. Millard, (Mrs.) F. Brown, E. C. C. D. O'Dwyer G. H. A. Crouch COUNCILLORS: C. H. C. Bla££ A. B. Palmer D. O. Grandison F. A. Pink J. P. Hollidge, J.P. A. C. V. Rusha R. W. Kirk B. R. Seeney, (Mrs.) Daniel Linehan M. J. Spencer David Linehan A. R. Thomas, (Mrs.) W. G. Noyce J. S. Thomas C. W. Jillings L. W. Todd H. P. LarkJno- 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 Daniel Linehan The Deputy Mayor Councillor (Mrs.) A. R. Thomas Councillor A. B. Palmer Councillor (Mrs.) F. F. Woods 3 DAGENHAM HEALTH AREA SUB-COMMITTEE (as at 31st December, 1962) CHAIRMAN: Alderman (Mrs.) E. M. Millard VICE-CHAIRMAN: Alderman D. O'Dwyer Members:— Borough Council The Mayor The Deputy Mayor Councillor C. H. C. BlaKE Councillor C. W. Jillings Councillor David Linehan Councillor Daniel Linehan Councillor A. B. Palmer Councillor M. J. Spencer Councillor (Mrs.) M. A. Warren Councillor (Mrs.) F. F. Woods County Council Alderman (Mrs.) D. M. Glenny Alderman (Mrs.) E. C. Saywood Councillor (Mrs.) S. M. Bovill Councillor A. C. Berry Councillor (Mrs.) I. M. Brockelbank Councillor (Mrs.) N. E. Willis Hospital Management Committee Mrs. A. R. Thomas Executive Council for Essex Mr. F. A. Wortley, E.C.C. Local Medical Committee for Essex Dr. A. Hetherington Local voluntary organisations MRS. R. DYMOND MISS J. CHADBORN MRS. R. STEPHENS MR. J. WALSH 4 DAGENHAM COMMITTEE FOR EDUCATION (as at 31st December, 1962) CHAIRMAN: Alderman R. Blackburn, J.P. VICE-CHAIRMAN: Councillor A. C. V. Rusha Representative Members: Nominated Members: Alderman W. E. Bellamy, J. P. County Councillors A. F. J. Chorley, Alderman F. Brown, E.C.C. M.B.E., J.P. Alderman M. Eales Dr. N. L. Anfilogoff Alderman (Mrs.) E. M. Millard Alderman D. O'Dwyer Councillor C. H. C. BLAkE Councillor D. O. Grandison Co-opted Members: Councillor R. W. Kirk Mr. A. Boyle Councillor David Linehan Mr. E. E. Hennem Councillor (Mrs. B. R. Seeney Mr. D. M. Jones Councillor M. J. Spencer Mr. J. Walsh Councillor (Mrs.) F. F. Woods Mr. F. C. Jones Councillor C. W. Jillings Mr. S. J. Russell EDUCATION (GENERAL PURPOSES) SUB-COMMITTEE (as at 31st December, 1962) (This Sub-Committee deals, inter alia, with the School Health Service) CHAIRMAN: Alderman R. Blackburn, J.P. VICE-CHAIRMAN: Councillor A. C. V. Rusha MEMBERS: Alderman F. Brown Mr. E. E. Hennem Alderman D. O'Dwyer Mr. D. M. Jones Councillor D. O. Grandison Mr. F. Chorley Councillor M. J. Spencer 5 OFFICERS OF THE HEALTH SERVICE (as at 31st December, 1962) 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: J. M. Packer, M.B., Ch.B., D.P.H. Assistant Medical Officers: (C) Katherine Fitzpatrick, M.B., B.Ch. Edwin H. Massey, B.Sc., M.B., B.Ch. Maureen Joyce Hodgson, Madeline Weizmann, M.R.C.S., L.R.C.P. M.B., B.S., M.R.C.S., L.R.C.P., D.C.H. Elsie Wallace, L.R.C.P. & S.I. Dental Officers: (C) V. Foy, L.D.S., R.C.S., (Eng.) (part-time) C. Sumsawaste, L.D.S., R.C.S., (part-timfe) A. Roberts, L.D.S., R.C.S., (part-time) M. Price, L.D.S., R.C.S., (part-time) D. Karia, L.D.S. 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) D. F. Edge (1), (2) Superintendent Health Visitor: (C) Health Visitors: (C) M. Bass (5), (6), (7) O. Ologunro (5), (6), (7) A. E. Boorman (5), (6), (7) L. Ling (5), (6), (7) P. J. Broad (5), (8), (7), (17) D. J. Millbank (5), (6), (7), (10), (25), (26) L. Dunbar (5) (6), (7) D. B. Rudd (5), (6), (7) I. A. Garrard (5), (16) M. F. Savage (5), (6), (7) P. I. Jefford, (5), (6), (7), (24) D. E. Smith (5), (7), (8), (15) R. E. Walker (5)j (6), (7), (15), (16) D. Wint (5), (6), (7) Non-Medical Supervisor of Midwives: (C) Miss R. K. Jesson (5), (6), (27) Midwives: (C) E. M. Crump (5), (6), (27) M./leather (5), (6) L. M. Grant (6), (9) P. Varibrook (6) F. Harrington (5), (6), (17) A. Long (5), (6) Scho6l Nurses: (C) J. Cornish (5) E. McGheyne (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) Clinic Nurses: (C) E. Anderson (5), (15) M. Laycock (5) Speech Thrapists: (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. Hath way Clerks: E. Adams (C) P. Floodgate (C) I. Page (C) P. Page (C) (part-time) B. J. Butt G. K. Harris K. Richards (C) L. Summers N. Briand (C) S. B. Leader (C) G. Shannon (C) P. Saville (C) J. Butterworth (C) F. H. Martin (18), (C) H. Prutton J. Setter (C) N. E. Cloke (C) J. Morgan (C) J. B. Smith (C) D. Rolph (C) D. Duff (C) E. Neport (C) M. A. Watts (C) M. Newman (C) (part- D. Ellis (C) M. Oates (C) K. Bird (C) (part-time) time) E. Harsent (C) (part-time) Day Nurseries (C) Goresbrook Nursery, Matron: E. Maddison (15) Dagenham Avenue, Deputy : K. Graham (9) Dagenham. Chadwell Heath Nursery, Matron: P. Coffee (17) Ashton Gardens, Deputy: 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 C. Strachan Occupational Therapist: (C) Z. Mercer Public Analyst: Hubert Hammence, Ph.D., M.Sc., F.R.I.C., (part-time) Seconded from the 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. (part-time) E. Ottley, M.C.S.P. A. Brand, M.C.S.P. (part-time) Officers employed by the Essex County Council are indicated thus (C) 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) State Certified Midwife (7) New Health Visitor's Certificate (8) Midwifery, Part I (9) State Enrolled 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, I have to report on the health of the citizens of the Borough of Dagenham during 1962. This was a busy year although the only event which made the headlines was the occurrence of a number of cases of smallpox in Gt. Britain. This aroused people's consciences and made them feel they wished to have immediate vaccination against this disease. Mass vaccination is not considered good preventive medicine and in fact every effort was made to convince people that there was no need for this and that immediate vaccination was only necessary in certain cases. However, it was felt that an emergency clinic should be opened so that those who were really concerned about themselves could be offered vaccination. Great demands were made on the staff and they responded nobly to the occasion for which I give my grateful thanks. I am grateful too to the general practitioners who offered their services at a time when they were also overworked due to demands for vaccination from their own patients. Apart from this the Department continued to function reasonably satisfactorily, and the arrival of Dr. Packer as my Deputy was very much welcomed. Once again I feel that much progress was made in health education and if I only mention certain aspects of it, it is because the section dealing with health education which makes interesting reading gives much detail. I was particularly interested to have the experience of broadcasting to school children on the B.B.C. home service during Health Week in December. This programme went out each morning at 11.00 o'clock and showed me what enormous possibilities there are for health education in sound broadcasting. The preparation of the programmes was an exercise in condensing into a quarter of an hour a good deal of material. The response from both children and teachers who are invited to give their comments, was most encouraging. There were of course a number of criticisms and I hope to " do better next time." I have also been greatly encouraged during the year by the numbers of enquiries about the activities of the department from many sources. Particularly the numbers of enquiries about the Oxlow Lane Over Sixties Clinic and the Kingsley Hall Assessment Centre. I have also been encouraged by the numbers of invitations I have received, all of which it was impossible to accept, to speak about the social and medical aspects of old age. This included an invitation to the Cite Universitaire of Paris where I was invited to talk on the subject of "The Medical Importance of the Home Help Service in Gt. Britain" which necessarily involved a good deal which related to the elderly in their own homes. This talk created some interest and I have included a shortened version of it at the end of this Annual Report. 9 Progress has been made in spite of difficulties of staffing (which I must mention later) in the health visiting section and their health education activities expanded. The requests for ante-natal preparation classes increased and the demand goes on increasing. The change in emphasis from the physical to the psychological in the teaching of expectant mothers has aroused a good deal of interest and the Pierre Vellay method is becoming accepted as the method of choice. I must mention too the progress made in food hygiene in the Borough, not only in the teaching of the bakery staffs in their own bakeries but also that the Rush Green Technical College invited our co-operation in running courses for food handlers. Towards the end of the year discussions were held on the running of a Diploma Course for senior people engaged in the food industry which it is hoped will start in 1963. Some progress has also been made in health education in schools particularly in relation to talks on cancer and smoking. Having mentioned some of the achievements during the year I must now draw attention to some of the difficultes that have been experienced. The main one is that of shortage of health visiting staff and the fact that the County policy following the lead given by the Ministry of Health some years ago, has turned away from the use of school nurses in an attempt to staff the health visiting and school nursing service entirely with health visitors and clinic nurses. This has meant that the health visitors in short supply already, have had to attempt to cover wider areas in their visiting and the clinic nurses were not allowed to visit people in their own homes. This increased staffing difficulties in spite of re-adjustment of staff duties. In my view there is need now to look very carefully at the staffing of the department and to consider the introduction of social workers as members of the health department team. One other aspect of health education which I must also mention is the need for constant refreshing and for constant revision of teaching techniques. If the staff is to carry out group teaching in an effective manner using modern teaching aids it must be given the opportunity of refreshing and looking at new methods of putting over health education to different groups. Much of our health education involves the teaching of health to adult audiences. This is a very different matter from the teaching of health to school children in schools. The child in school is a member of a captive audience whereas the adult can come and go as he pleases. If the teaching is not done in an attractive, interesting and informative manner it will fail to attract and to keep audiences. One great difficulty experienced during the year was that the health visitors were overworked and over-oppressed with requests for help with personal problems which streamed into the department. Many of these problems related to mental health. These are time consuming and exhausting to deal with and not easily solved. 10 I was a little disappointed that no progress was possible in my dealings with what I called in my reports for 1959 and 1960 " families with special difficulties " but perhaps more commonly referred to as "problem families." I had hoped that some special arrangement might have been made for supervising them more closely by means of a specialist worker and for attempts at preventive work by the use of a day centre for teaching the elements of budgeting, child care etc. This is good preventive medicine and if we are to make any impact on these families, in my view it can best be done in this way. It will be slow and not very rewarding in either prestige or in results. In the long term however, it must have its effects. I hope that perhaps within the next year a little more progress will have been made in this direction. The public health inspectors have continued during the year to press forward with the clean air campaign and have been helped by the appointment of an additional public health inspector. Further progress has been made with the film of the department's activities in health education, which, at the time of writing this report has at last been finished. I would like to thank the staff of the department for their help and co-operation during the year and the Chairman and members of the Public Health Committee and the Health Area Sub-Committee for their support and understanding. J. Adrian Gillet, Medical Officer of Health. 11 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area and Population Area (in acres) 6,556 Registrar General's estimation of resident population 109,470 No. of inhabited houses (end of 1962) according to rate books 31,407 Rateable value (December 31st 1962) £1 ,832,685 Sum represented by a penny rate (1962/3) £7,450 Vital Statistics Live Births: Legitimate 1,446 (737 male, 709 female) Illegitimate 81 (41 male, 40 female) Total 1,527 (778 male, 749 female) Illegitimate live births per cent of total live births 5,30 Rate per 1,000 population 13,95 Stillbirths: Legitimate 31(17 male, 14 female) Illegitimate 4 (2 male, 2 female) Total 35 (19 male, 16 female) Rate per 1,000 total live and stillbirths 22,41 Total live and stillbirths 1,562 Infant deaths 33 Infant mortality rates: Total infant deaths per 1,000 total live births 21,61 Legitimate infant deaths per 1,000 legitimate live births 20,75 Illegitimate infant deaths per 1,000 illegitimate live births 37,04 Neonatal mortality rate (deaths under four weeks per 1,000 total live births) 13,75 Early neonatal mortality rate (deaths under one week per 1,000 total live births) 11,79 Perinatal mortality rate (stillbirths and deaths under one week per 1,000 total live and stillbirths) 33,93 Maternal mortality (including abortion): Number of deaths - Rate per 1,000 total live and stillbirths - General mortality: Number of deaths 949 (535 male, 414 female) Death rate per 1,000 population—crude 8,67 Death rate per 1,000 population—adjusted 14,74 Births The total of 1,527 live births notified during the year shows a decrease from the total of 1,625 recorded in 1961, but is similar to the numbers for 1960 (1,518) and 1959, (1,528). The corrected birth rate per thousand population was 13.25, compared with 18.0 for England and Wales. Although there are fluctuations from year to year the general trend of the birth rate since the mid 1950's has been in an upward direction. This is in keeping with the national trend. The illegitimate birth rate remains low, being 5.30 per cent of total live births, but has shown a tendency to rise during the past few years. The stillbirth rate was 22.41 per 1,000 total live and stillbirths. This is higher than the 1 ate for 1961 (15.15) but less than that for i960 (24.42). 12 Deaths The infant mortality rate stands at 21.61 per 1,000 live births, compared with 20.7 for England and Wales. This is less than the rates for the two previous years, but is above the very low figure of 16.76 recorded in 1957. As is usual the mortality rate among illegitimate infants is considerably greater than the rate for legitimate children. The causes of death are set out in the following table: Cause of Death Under 1 wk. 1—2 wks. 2—3 wks. 3—4 wks. Total under 4 wks. 4 wks. and under 3 mo. 3 mo. and under 6 mo. 6 mo. and under 9 mo. 9 mo. and under 12 mo. Total deaths under 1 yr. Prematurity 6 - - - 6 - - - - 6 Prematurity with associated cause 2 - - - 2 1 - - - 3 Congenital abnormality 1 1 - 1 3 - 1 2 - 6 Birth trauma 5 - - 1 6 - - - - 6 Bronchopneumonia - - - - - 1 - 2 1 4 Bronchitis - - - - - - 2 1 - 3 Antepartum haemorrhage 1 - - - 1 - - - - 1 Rhesus incompatability 3 - - - 3 - - - - 3 Gastro-enteritis - - - - - - - 1 - 1 TOTAL 18 1 - 2 21 2 3 6 1 33 Among the population as a whole the principal causes of death were as follows:— Heart disease (all forms) 300 deaths Cancer (including leukaemia) 214 deaths Vascular lesions of nervous system 109 deaths Bronchitis 69 deaths Pneumonia 52 deaths The number of deaths due to heart disease shows an increase of 42 over the figures recorded the previous year. The majority of deaths in this group are caused by coronary disease and angina. The commonest form of cancer causing death was lung cancer, there being 54 deaths in men and 13 in women. This is an increase over the previous year, but is less than the total recorded in 1960. The general trend over recent years, however, has been for the number to rise; ten years ago only 26 deaths in men and 2 in women were attributed to this cause. This is particularly tragic when one considers that this condition is believed to be largely preventable. It is gratifying to be able to record that for the fourth year in succession there were no maternal deaths. The adjusted death rate was 14.74/1,000, compared with 11.9 / 1,000 for England and Wales. 13 Causes of Deaths 1962 Under 1 yr. 1 and under 5 yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and over Total M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory - - - - - - - - - 1 - 1 - - - - - 2 2. Tuberculosis, other - - - - - - - - - - - - - - - - - - 3. Syphilitic disease - - - - - - - - - - - - - - - - - - 4. Diphtheria - - - - - - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - 6. Meningococcal infections - - - - - - - - - - - - - - - - - - 7. Acute poliomyelitis - - - - - - - - - - - - - - - - - - 8. Measles - - - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases - - - - 1 - - - - 1 - - - - - - 1 1 10. Malignant neoplasm, stomach - - - - - - - - - 1 13 4 8 2 1 4 22 11 11. Malignant neoplasm lung, bronchus - - - - - - 1 - 1 - 32 4 14 5 6 4 54 13 12. Malignant neoplasm, breast - - - - - - - - - 1 - 6 - 9 - 1 - 17 13. Malignant neoplasm, uterus - - - - - - - - - - - 5 - - - 1 - 6 14. Other malignant and lymphatic neoplasms - - - - - - 1 - 1 1 12 13 20 15 9 15 43 44 15. Leukaemia, aleukaemia - - - - - - - - 1 - 2 - - 1 - - 3 1 16. Diabetes - - - - - - 1 - - - - 2 - 4 - 1 1 7 17. Vascular lesions of nervous system - - - - - - - - - 2 11 14 13 20 22 27 46 63 18. Coronary disease, angina - - - - - - - - 8 - 72 11 37 26 30 16 147 53 19. Hypertension with heart disease - - - - - - - - - - 1 3 - 1 1 8 2 12 20. Other heart disease - - - - 1 - - - 1 3 8 6 12 13 11 31 33 53 21. Other circulatory disease - - - - - - - - 1 1 3 3 4 5 6 9 14 18 22. Influenza - - - - - - - - - - - - 1 1 - 2 1 3 23. Pneumonia 4 1 - 1 - - - 1 1 8 2 10 4 10 10 33 19 24. Bronchitis 2 - - - - - - - -1 - 17 4 17 5 14 9 51 18 25. Other diseases of respiratory system - - - - - - - - - - 4 1 6 - 1 - 11 1 26. Ulcer of stomach and duodenum - - - - - - - - - - 1 - 5 - 1 1 7 1 27. Gastritis, enteritis and diarrhoea 1 1 - - - - - - - - - - - 2 - 2 1 5 28. Nephritis and nephrosis - - - - - - - - - - 1 - 2 2 - - 3 2 29. Hyperplasia of prostate - - - - - - - - - - - - 1 - 1 - 2 - 30. Pregnancy, childbirth and abortion - - - - - - - - - - - - - - - - - - 31. Congenital malformations 4 3 2 2 - 1 - - 1 - 1 1 - - - - 8 7 32. Other defined and illdefined diseases 11 6 - - 1 1 2 - 3 1 7 14 4 7 5 10 33 39 33. Motor vehicle accidents - - - - - - 2 - 4 - 1 2 1 - - 1 8 3 34. All other accidents - - - - - - 1 1 2 3 3 1 - 1 1 1 7 7 35. Suicide - - - - - - 1 - 2 2 1 3 - 3 - - 4 8 36. Homicide and operations of war - - - - - - - - - - - - - - - - - - TOTAL 22 11 2 3 3 2 9 1 27 18 198 100 155 126 119 153 535 414 14 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRICT (a) Nature and number of visits:— Rent Act 180 Housing and Public Health Acts:— Dwelling houses 2,341 Other premises771 Overcrowding and housing applications 796 Bakehouses 43 Milkshops and dairies 25 Foodshops, stalls and itinerant vendors 1,348 Cafes and canteens 341 School kitchens and feeding centres 58 Infectious disease enquiries 1,055 Foster mothers' premises 45 Number of complaints investigated 846 Clean Air Act:— Survey 13,889 Other inspections 6,773 Factories 210 Workplaces and offices 10 Rag Flock and Other Filling Materials Act 17 Tents, vans and sheds 153 Stables 4 Pet shops 9 Hairdressers 38 Shops Act 58 Ice Cream premises and vehicles 215 Houses disinfested 14 Rodent Control 1,054 Other visits 1,010 (b) Notices served:— Complied with:— Statutory 139 141 Informal 374 346 Legal proceedings were instituted in respect of one house to enforce compliance with statutory notices. WATER The water supply is satisfactory in quality and quantity. During the year two chemical and two bacteriological samples were taken from the Company's mains in this Borough; all were satisfactory. The water is not liable to have plumbo-solvent properties and no action was called for in respect of any form of contamination. Approximately .015% of the inhabited houses and .009% of the population of the Borough take their water from standpipes. 15 During the year the following mains were laid:— Length of Mains Yards Diameter 276 " 3" 144 "4" 3 "6" 165 supplies were afforded to houses. The General Manager and Chief Engineer of the South Essex Waterworks Company has furnished the following report:— "Bacteriological and chemical examinations are made of the raw river water, of the water in its various stages of treatment and of the water going into supply and of both raw and chlorinated water from the Company's wells. Analyses are also made of samples obtained from consumers' taps in the various parts of the Company's district and all proved to be satisfactory. Over 4,020 chemical, bacteriological and biological examinations have been made during the year. In addition samples were examined for radioactivity. All water going into supply was wholesome." SEWERAGE AND SEWAGE DISPOSAL The Borough Engineer and Surveyor has supplied the following information:— (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. The Council's Consulting Engineers have completed a comprehensive survey of the foul trunk sewers, and their report is now awaited. 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 desirable. However, the extensive scheme for improvements and extensions that has been under consideration for some years past has now reached a stage where final 16 details and actual construction are more imminent, and work on improving the existing plant has already commenced. The estimated cost of the first stage 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. 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. A portable swimming pool installed at a local junior school has functioned satisfactorily. HOUSING Slum Clearance During the year a further 22 houses were represented as unfit for human habitation. In addition three houses, which had been included in the Council's five-year programme, were demolished voluntarily by the owners after they had arranged the rehousing of the tenants. Rent Act, 1957 13 applications were received from tenants during the year compared with five 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 seven properties. Five Certificates of Disrepair were issued and one cancelled on the completion of the repairs. As in past years 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 defect, 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 17 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. 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 seven for discretionary grants were approved. All the applications were from owner/occupiers. One application was deferred as the prices submitted were considered to be too high; the applicant was requested to obtain further tenders. During the annual routine inspection of houses where grants have been paid it was found in one case that the food cupboard had been removed; this was reinstated. In an effort to increase the number of applications for improvement the Minister has suggested that local authorities should tackle the problem street by street. The Council have agreed the area in which this work should commence; subject to staff being available, arrangements are being made to canvass all the houses in a particular street which are eligible for improvement and discuss the scheme with the occupiers and owners. Houses in Multiple Occupation The service of statutory notices was authorised in respect of three houses. In two houses the additional facilities were provided; in another enforcement was deferred on account of the illness in hospital of one of the tenants. In one of the houses, in addition to the enforcement of the provision of additional facilities, legal proceedings were taken and a fine of £5. 5. o. imposed for overcrowding (letting to an adult female a single room with a floor area of less than 50 sq. ft.). There are no common lodging houses in the Borough. Tents, Vans and Sheds Gypsies still continue to pull their vans on to the few remaining vacant sites in the Borough in an effort to spend at least a few days in the area. During the year inspectors paid 153 visits to various sites in connection with this work. 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 and at the end of the year only two vans remained in occupation. 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 18 by the department continue to improve the lot of many of these unfortunate people who, although they cannot do much for themselves, are unwilling to leave their home in what are inevitably their last days. It was not necessary compulsorily to remove any person during the year. Following representations from this department, the Mental Welfare Officers of the County Council arranged for the removal of an elderly spinster who was living in very insanitary conditions. Section 50 No one was buried under the provisions of this section during the year. LAUNDRY SERVICE FOR THE INCONTINENT AGED This service continues to meet a real need in the home at a time when help is usually most urgent. The days of collection and delivery of laundered articles remain 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 18 cases use the service at any one time. From the commencement of the service in December 1953 to the end of this year 341 cases have received assistance. During the year 26 new cases have been helped, 11 cases have died, nine were removed to hospital and two no longer needed the service. At the end of the year 21 cases were still participating; the number of articles laundered during the year was 12,378 compared with 11,843 articles for the previous year. 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. Action was not called for in respect of any industrial plant in the Borough. 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 regular observations commenced in 1962 at four additional sites. The types of district in which the sites are situated 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). Later it will be possible to compare our figures with those in other parts of the country. 19 Smoke Control Areas The Council have agreed in principle to include the whole Borough in smoke control areas as soon as possible and in any case in not more than 10 years. The progress up-todate is indicated below:— Order No. No. of Houses Date of Operation 1 1,000 (Marks Gate) 1st September, 1959 2 3,722 (L.C.C. estate) 1st November, 1961 3 3,230 ( „ „ ) 1st November, 1962 4 4,562 ( „ „ ) 1st November, 1963 5 1,542 (Chadwell Heath) 1st August, 1964 6 (Survey in progress) 3,100 Approx. (L.C.C. estate) 1 st November, 1964 The extent of the work involved is indicated in that during the year 20,662 visits to premises have been paid by the inspectors. The additional inspector appointed to assist in this work left the Council's service early in 1963. The supply of smokeless fuel continues to provide some problems and during the severe wintry weather of early 1963 householders in smoke control areas, as elsewhere, were glad to obtain any type of fuel. Gloco (coke) although the cheapest solid smokeless fuel is not generally acceptable to the public. In an empty L.C.C. house in the No. 3 Area the burning of Gloco was demonstrated in the grates of the two ground floor rooms; unfortunately there was thick fog during the whole of the two days the house was available to us and very few people attended. There is doubtless a great need of publicity to persuade the householders of the value of Gloco as a fuel and to teach the technique of burning it. The demand for premium fuels (although dearer than Gloco) appears to be based on the fact that they can be burnt on an approved grate as coal would be burnt, that is, without any need to trouble about the regulation of draught. Few householders appreciate that the main benefit of fixing an approved coke-burning grate is to provide a means of draught control which can be operated within fairly narrow limits. NOISE ABATEMENT ACT, 1960 Section 1 of the Act makes noise or vibration which is a nuisance, a statutory nuisance under the Public Health Act, 1936. Seven complaints during the year were in respect of private dwellings; these were all concerned with noisy neighbours. Section 2 of the Act restricts the operation of loud speakers on the highway. This is dealt with by the Council's Shops Act Inspector. During the year legal proceedings were instituted in 16 cases. The Council were successful in each case; fines totalling £76 were imposed and £16 in costs awarded. In addition, proceedings were taken in three cases under the Dagenham Urban District Council Act, 1931, in respect of the use of noisy instruments for the purpose of advertising a trade or business. It would not 20 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 are regularly taken at the three factories in the Borough where filling materials are manufactured. 19 informal samples were taken during the year; one sample of cotton felt was unsatisfactory. The details are as follows:- Material No. of Samples submitted for analysis Rag Flock 4 Cotton Felt 6 Coir Fibre 2 Kapok 4 Sisal 3 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. The only serious infestation encountered during the year was of mice at a first floor maisonette. The elderly female occupant was regularly feeding the mice with biscuits. It was necessary to seek the help of the Mental Welfare Officers and arrange the compulsory removal of the tenant before Disinfestation could be carried out. Although there was a major infestation at this maisonette for at least a year, there was no trouble in the adjoining properties. 21 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. DISEASES OF ANIMALS (WASTE FOODS) ORDER, 1957 Licences were granted to operate plant and equipment for the boiling of waste foods at four piggeries. Legal proceedings were instituted in respect of the use at a piggery of waste foods which had not been boiled in accordance with the provisions of the Order. A fine of £25 with £5 costs was imposed. FACTORIES ACT, 1961 Inspections Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 25 23 - - Factories with mechanical power 162 195 3 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 21 26 - - TOTAL 208 244 3 - Defects Found Number of defects Number of prosecutions instituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness 1 1 - - - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary Conveniences:- Insufficient 2 2 - 1 - Unsuitable or defective 4 4 - - - Not separate for sexes - - - - - Other Offences - - - - - TOTAL 7 7 - 1 - Outwork No. of outworkers in August list 10 Nature of work-Making etc., wearing apparel. 22 INSPECTION AND SUPERVISION OF FOOD The numbers and types of food premises in the Borough are as follows:- 5 Bakehouses 27 Bakers and Confectioners 58 Butchers 162 Cafes and Canteens 26 Fishmongers 57 Fruiterers and Greengrocers 114 Grocers 22 Licensed and 14 Off-licensed Premises 93 Sweets, etc. All food premises are regularly inspected and during the year 1,843 visits were paid. In addition to numerous verbal warnings and suggestions to management and staff during these routine visits, 55 informal notices were served upon owners or occupiers. The threat of legal proceedings has been sufficient to ensure that the work was carried out in the case of a few recalcitrant traders. 104 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 six other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 308 visits were paid. 21 fish shops are registered for frying. To these 101 visits were paid. Milk All milk distributed in Dagenham is produced and bottled outside the Borough. Eight premises are registered as dairies. The number of registered distributors is 51 operating from 82 premises. 25 visits were paid to dairies and distributors' premises. During the year 63 samples of milk were submitted for bacteriological examination. Two samples, both from vending machines, were unsatisfactory; one failed to pass the methylene blue test the other the phosphatase test. Ice Cream The total number of registered premises selling ice cream is 134; of this number one is registered for manufacturing ice cream. 178 visits were paid to these premises. During the year six applications for the storage and sale of ice cream were granted. 37 inspections in connection with itinerant vendors were carried out. 23 During the year 89 samples of ice cream were submitted for bacteriological examination; they were graded as follows:- Grade I Grade II Grade III Grade IV Total Ice Cream other than ' soft' 62 8 2 3 75 ' Soft' ice cream 2 5 2 5 14 These figures indicate, as was anticipated, that the manufacture of 'soft' ice cream on the vehicle calls for strict surveillance. In addition to ice cream, 39 lollies were submitted for examination. Five were considered to be "fair" and one unsatisfactory; in each case the lollies were manufactured outside the Borough and the local authority concerned were informed. 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 25 such complaints were investigated. In most cases warning letters were sent to the persons responsible. Legal proceedings were taken in four cases. A fine of £10 was imposed in one case and £2 in each of two cases; in the other case there was an absolute discharge on payment of five guineas costs. In one case in which the Committee agreed to take proceedings the complainant was unwilling to give evidence. Registration of Food Hawkers Under the provisions of the Essex County Council Act, 1952 Section 103, one person was registered as a food hawker; storage accommodation was outside the Borough. Food Poisoning 16 cases of food poisoning were notified during the year. The following is a copy of the annual return submitted to the Ministry of Health:- 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total - 5 11 - 16 Cases otherwise ascertained 20 Symptomless Excreters Nil Fatal Cases Nil Particulars of Outbreaks:- No. of Outbreaks No. of Cases Total No. of cases Family Outbreaks Other Outbreaks Notified Otherwise Ascertained Agent identified Typhimurium - 1 4 20 24 Agent not identified - - - - - 24 Single Cases:- No. of Cases Total No. of cases Notified Otherwise Ascertained Agent identified Typhimurium 3 - 3 Agent not identified 9 - 9 There was an outbreak of food poisoning at a very large factory in the Borough at which about 800 food handlers are engaged in the preparation and distribution of food for several thousand employees. It was impossible to estimate with any degree of accuracy the number of people affected as notification of the outbreak was not received by the department until three days after its commencement. Some of the earlier cases could, therefore, have returned to work before the investigations of this department commenced. An added complication was the fact that part of the factory premises are in an adjoining local authority district; close liaison with this authority therefore had to be maintained throughout the investigations. There were, however, at least 87 cases that could reasonably be connected v/ith this outbreak, of whom only 24 lived in Dagenham. It was demonstrated that the organism (Salmonella typhimurium) isolated from the patients was also present in unpasteurised frozen egg used in the bakery. It is suspected that the organism was transmitted in synthetic cream contaminated from the frozen egg. 25 Food and Drugs-Sampling Article Number Examined Number Adulterated Formal Informal Formal Informal Almonds, Ground - 1 - - Beef Extract - 1 - - Beverages - 5 - - Biscuits - 3 - 1 Bread - 8 - 5 Butter - 5 - - Cereals - 3 - - Cheese - 3 - 1 Cheese Roll - 1 - 1 Colouring - 1 - - Condiments - 4 - - Confectionery - 4 - - Cordials - 2 - - Cream - 4 - - Essences - 2 - - Fish Fillets - 1 - - Fish, Tinned - 1 - - Fish Cakes - 4 - - Fish Fingers - 1 - - Fruit, Dried - 2 - - Fruit, Tinned - 1 - - Gelatine - 1 - - Herbs - 1 - - Ice Cream - 36 - 2 Jams - 3 - - Jellies - 3 - - Margarine - 4 - - Marzipan - 1 - - Meat, Tinned - 9 - 3 Medicinal Samples - 2 - - Milk 14 - - - Milk Bottle - 2 - 2 Oil - 2 - 1 Paste and Pickles - 3 - - Peel - 1 - - Pie Filling - 1 - - Puree - 1 - - Salad Cream - 1 - - Sandwich - 1 - 1 Sauces - 2 - - Sausages 22 - 2 - Sausages, Tinned - 1 - - Spices - 4 - - Spread - 1 - - Stuffing - 1 - - Suet-Shredded - 1 - - Tea - 2 - - Wines and Spirits - 7 - 3 Yoghourt - 2 -- 2 26 Serial No. Article Formal or Informal Nature or Adulteration or Irregularity Observations 958A Milk Bottle Informal Cement and sand on the bottom of bottle Distributor warned 959A Champagne Perry Informal Mould growth in suspension Manufacturer warned 960A Bread Informal Contained a portion of a cigarette end Manufacturer warned 961A Corned Beef Sandwich Informal Contained a small patch of mould growth Manufacturer warned 965A Stewed Steak (In gravy) Informal Proportion of meat low Manufacturer warned 966A Casserole Meat Informal Proportion of meat low Manufacturer warned 967A Casserole Steak Informal Proportion of meat low Manufacturer warned 973A Cheeses Informal Contained a small dead insect Distributor warned 977A Dry Fry Informal No list of ingredients given on label— label claimed pure vegetable product— analysis found to consist of the residual fatty material which can be claimed to be a vegetable product, the greater bulk of the preparation consisting of a highly volatile solvent. Manufacturer warned 993A Bread Informal Contained iron rust Manufacturer warned 1007A Biscuits Informal Contained excess of Vitamins A, B andC Manufacturers attention drawn to this 1009A Bread Informal Slight discoloration caused by charred dough Manufacturer warned 1036A Cheese Roll Informal Contained foreign matter on top surface of roll which had characteristics of bird excreta Legal proceedings. Fine £2 1037A Dairy Ice Cream Informal Showed traces of brownish colouring matter and insect fragments Manufacturer warned 1038A Ice Cream Informal Showed traces of brownish colouring matter Manufacturer warned 1055A Yoghourt Informal Contained a mould growth and viable mould spores Manafucturers warned 1079A Milk (Dirty Bottle) Informal Contained mould growth Distributor warned 27 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 1080A Iced Bun Ring Informal Contained a fly; no evidence to show that it had been baked in the bun Complaint was drawn to the attention of the manufacturer. Lack of evidence 1081A Yoghourt Informal Contained fragments of leaf tissue Manufacturer warned 1101A Bread Informal Contained insect web, insect excreta, pupae chambers and other insect remains Manufacturer warned 1106A Wine Aperitif Informal In a turbid condition with a substantial deposit Manufacturer warned 1107A Vermouth Informal Slightly deficient in proof spirit Formal sample taken 2672 Pork Sausages Formal 10% deficient in meat Manufacturer warned 2681 Pork Sausages Formal 10% deficient in meat Manufacturer warned PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES Notifiable Diseases (Other than Tuberculosis) Under 1 yr. 1— 2— 3— 4— 5— l0- 15— Over 25 yrs Total Scarlet Fever 2 1 3 9 5 38 11 5 2 76 Whooping Cough 5 4 9 3 7 28 - 2 - 58 Measles 13 25 12 25 22 109 3 4 1 214 Diphtheria - - - - - - - - - - Dysentery - - - - - 2 1 - - 3 Acute Poliomyelitis:— Paralytic - - - - - 1 - - - 1 Non-paralytic - - - - - - - - - - Meningococcal Infection - 1 1 - - - - - - 2 Under 5 yrs. 5—14 15—44 45—64 65 and over Total Pneumonia:— Acute Primary - - 1 6 2 9 Acute Influenzal - - - 2 2 4 Encephalitis, Acute:— Infective - - - - - - Post Infectious - 1 - - - 1 Erysipelas - - - 1 2 3 Food Poisoning - - 3 10 4 17 Puerperal Pyrexia - - 1 - - 1 Ophthalmia Neonatorum - - - - - - Paratyphoid B - - 1 - - 1 Typhoid - - - 1 - 1 Smallpox - - - - - - 28  Notified Admitted to isolation hospital Rush Green Admitted to other isolation hospitals Admitted to other hospitals Dysentery 3 - - - Encephalitis, Acute 1 1 - - Erysipelas 3 - - - Food Poisoning 17 1 - 3 Measles 214 1 - - Meningococcal Infection 2 2 - - Paratyphoid Fever 1 1 - - Puerperal Pyrexia 1 - - - Pneumonia:— Acute Influenzal 9 - - - Acute Primary 4 - - - Poliomyelitis:— Paralytic 1 1 - - Scarlet Fever 76 1 - - Typhoid 1 1 - - Whooping Cough 58 - - - 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— - - - - 4 1 - - - - - - 5— - 2 - - 1 - - - - - - - 10— - - - 1 - 1 - - - - - - 15— 1 - 1 - 1 2 - - - - - 20— 2 4 - - 3 3 - - - - - - 25— 1 3 - - 5 15 1 1 - - - - 35— 5 1 - - 11 2 1 - - 1 - - 45— 8 - - - 2 6 - - 4 - - - 55— 8 - - - 1 - - - 3 - - - 65—and upwards 7 1 - - - 1 - - 8 - - - TOTALS 32 11 1 1 28 31 2 1 15 1 - - Register Pulmonary non-Pulmonary Male Female Male Female No. on register 1st January, 1962 572 451 72 70 During the year:— New Notifications 32 11 1 1 New cases brought to notice by Registrars' Death Returns - - - - Deaths 15 1 - - Transfers into area 28 31 2 1 Transfers out of area 23 16 - 1 Removed from Register as " Recovered " 21 13 6 4 No. on register 31st December, 1962 573 463 69 67 29 HEALTH EDUCATION During 1962 an attempt was made to arrange health education on the basis of organised courses of instruction in preference to the somewhat sporadic lectures which had been given in the past. A nucleus for this did, of course, already exist in the mothercraft classes in the clinics and in the food hygiene courses at the bakeries, but it was felt that if this principle could be extended to other topics much better results would be obtained. Pilot schemes were started in one of the bakeries, in a secondary modern school and in a number of women's organisations (on the subject of home safety and first aid) and although it is as yet too early to assess their value first indications are that they have been well received. Maternity and Child Welfare Health visitors made much more use of the visual aids available in the health education section during 1962, and in particular the films and filmstrips were in great demand. The most popular films were "Your Children Walking," "Breastfeeding " and "To Janet a Son." The latter was only released about the middle of the year and the demand at first far exceeded the number of copies available. It is understood that this difficulty has now been overcome and it will be possible to make more use of the film in the future. The three evening film sessions for mixed audiences were very popular. At one of these the French film "Naissance," dealing with the psycho-prophylactic method of relaxation, was shown and this, supplemented by a number of coloured slides, provided much discussion. Training of Students A lecturer from the Teachers' Training College and a Ghanaian Health Inspector, both of whom were attending the London University Institute of Education course, completed their practical work by Easter and were replaced in the autumn by a teacher in a Secondary School and a Medical Assistant from Kenya. Suitable programmes of visits and discussions were arranged for them. Food Hygiene The training courses for the Royal Institute of Public Health and Hygiene Food Hygiene Certificate were continued throughout the year and a high standard of success in the examinations was maintained, 55 out of 65 candidates being awarded their certificates. During the year it was felt that the demand for these courses was rapidly outstripping the facilities which we, as a Health Department, were able to provide and so the co-operation of the local College of Further Education was sought. As a result one of the autumn courses was held in the College using the same team of lecturers as before. The excellent laboratory and other equipment provided made the task of 30 instruction very much easier. Our thanks are due to Mr. Riley, the Principal, Mr. Fance the head of the Bakery Department and the staff of the Rush Green College for their valuable help with this project. In addition to the courses for the R.I.P.H.H. certificate, two separate courses of instruction in food hygiene were arranged for trainee manageresses of bakers' shops. In these short courses particular attention was paid to the problems of handling fresh cream goods. At the request of various organisations seven talks on food handling were given to members. These were mainly directed at the housewife and dealt with such things as the correct use of refrigeration in the home and the proper handling of frozen foods. Smoking and Lung Cancer The publication of the report of the Royal College of Physicians focussed attention on this very important health topic and this was made the theme of the health department display at the Town Show. A vehicle displaying the appropriate statistics and carrying a tombstone was entered in the parade and the stand itself included X-ray photographs of normal and cancerous lungs. In spite of, or possibly because of the morbid nature of the exhibit, large numbers of people were attracted to the stand and although literature was only given to those who asked for it, almost all the available pamphlets were disposed of on the first day of the Show. At the request of the Organisers, the film " Time Pulls the Trigger " was shown to two Youth Clubs and in each case a suitable talk was given by a member of the Health Department staff. This film was also used in conjunction with a talk given by another member of the staff to a Parent-Teacher Association at the request of the headmaster. Home Safety The theme of the Royal Society for the Prevention of Accidents campaign for 1962/3 was "Teaching Home Safety." This fitted in well with the programme which we had previously arranged for running a series of courses on Home Safety and First Aid, to a number of women's organisations in the Borough. Each course comprised four lectures and demonstrations, and each lecture was divided into two parts. One part dealt with the prevention of a specific type of home accident e.g. falls, and the other with the first aid treatment of the result of such an accident e.g. fractures. The last lecture of each series included a demonstration of " mouth to mouth resuscitation " using a model borrowed from the St. John Ambulance Brigade. The success of these talks was in no small measure due to the willing help offered by the British Red Cross Society and the St. John Ambulance Brigade and we are very much indebted to them for their assistance. 31 Health Education in Schools It is pleasing to note that an increasing number of head teachers are availing themselves of the facilities offered by the Health Department. Two schools were supplied with literature to assist their staff in teaching a variety of health topics. In two others Health Department staff provided talks illustrated by films and in another a talk on the work of the public health inspector. An interesting new project was an experiment in providing a co-ordinated course in health topics for a secondary school. After many discussions with the headmaster and teaching staff, arrangements were made for members of the Health Department Staff and the St. John Ambulance Brigade to give a series of four talks on home safety and first aid. These were to be followed by a series on clean food, and other topics in the new year. If these are found to be useful a complete health education programme will be incorporated in the curriculum for the academic year 1963/4. Films and Filmstrip Production Once again Messrs Camera Talks Ltd., requested our assistance in the production of a filmstrip entitled "Medico-Social Centre for the Over Sixties." This was filmed at the Oxlow Lane Clinic. It has recently been distributed and received favourable comment from the technical press. With the co-operation of the mothers concerned, work has commenced on a film showing various stages of child development. Two sequences were shot, one showing three different babies at approximately 27 weeks and the second showing the same babies when 46 weeks old. In spite of the large number of film strips available on the subject of food hygiene we were unable to find one which exactly met our needs for the various courses which we run. It was therefore decided to produce a series of colour transparences to illustrate the points we wish to make. During 1962 these were prepared within the department and are now used to illustrate food hygiene lectures. Continued difficulties with the Film Society, including the loss of some negative, prevented the Health Department film from being completed during 1962. However, as the appropriate portions have now been re-shot it is hoped that the finished print will soon be available. The following talks were given during 1962 by various members of the staff: Date Organisation Title Audience Speaker 9. 4. 62 Chad well Heath Townswomen's Guild Food inspection 80 Mr. Self 22. 1. 62 St. Elizabeth's Young Wives Child Care 5 Miss Jefford 21. 2. 62 Dagenham Welfare Liaison Council Clean Air 10 Mr. Self 21. 2. 62 District Nurses Work of the P.H.I. 6 Mr. Self 32 8. 3. 62 St. Elizabeth's Youth Club Smoking and lung cancer 48 Miss Jefford 30. 4. 63 Student H.V.'s Work of the P.H.I. 8 Mr. Self 21. 5. 62 Hunters Hall Junior School Care of the feet 70 Miss Jefford 5. 6. 62 Broad St. Co-op Guild Food inspection 40 Mr. Self 7. 6. 62 Lymington School Work of the P.H.I. 50 Mr. Self 26. 6. 62 Bartons Barkery Handling of cream goods 12 Mr. Self 27. 6. 62 Civic Catering Staffs Clean Food 12 Mr. Self 17. 7. 62 Broad St. Co-op Guild Care of the feet 35 Mrs. Dunbar 2. 10. 62 Triptons Youth Club Smoking and lung cancer 50 Mr. Self 8. 10. 62 Lymington School ParentTeachers Association Smoking and lung cancer 40 Dr. Packer 24. 10. 62 Fords Supervisory Staff Food hygiene 12 Mr. Prior & Mr. Self 30. 10. 62 Chadwell Heath Co-op Guild Clean food 35 Mr. Self 8. 11. 62 Rush Green Co-op Guild Care of the feet 40 Miss Rudd 10. 12. 62 St. John Ambulance Brigade Clean food 5 Mr. Self The following talks were given by Dr. Gillet during the year: Date Organisation Subject 2. 4. 62 Royal College of Nursing Modern threats to the Public Health 3. 4. 62 Broad Street Co-op Guild Teaching the over sixties 6. 5. 62 East London Spastics Society Spastics 6. 7. 62 Broad Street Co-op Guild Spastics 21. 9. 62 International Home Help Organisers Conference, Paris Medical aspects of the home help service 28. 9. 62 Monmouthshire Old People's Welfare Committee The elderly 3. 10. 62 Essex Old People's Welfare Committee Retirement 19. 10. 62 Central Council for Health Education Health Education 15. 10. 62 Local Training Course in Old People's Welfare The 10-Year Plan In addition a series of five broadcasts to schools on the B.B.C. Home Service from the 10th— 14th December as follows:— 10. 12. 62 Why does the school doctor examine you ? 11. 12. 62 Keeping fit in summer and winter 12. 12. 62 Healthy eating 13. 12. 62 First aid 14. 12. 62 Questions please The following is a list of films and filmstrips shown during the year: Date Organsiation Title of film or filmstrip Audience 22. 1. 62 St. Elizabeth's Young Wives The terrible Two's and the Trusting Three's The Frustrating Fours and the Fascinating Fives You and Your Eyes 5 5. 2. 62 Ashton Gardens Clinic Breast Feeding Time Pulls the Trigger 20 33 Date Organisation Title of film or filmstrip Audience 21. 2. 62 Dagenham Welfare Liaison Council Window to the Sky 10 5. 3. 62 Bartons Bakery Food without Fear 50 6. 3. 62 Rush Green Parent-Teachers Association How to Catch a Cold You and Your Ears You and Your Eyes Let's Keep our Teeth 60 8. 3. 62 St. Elizabeth's Young Wives Time Pulls the Trigger Antartic Crossing 48 20. 3. 62 Becontree Adolescent Clinic Preparation for Parenthood Biography before Birth 20 26. 3. 62 Staffords Bakery Food without Fear 40 28. 3. 62 Becontree Clinic My First Baby The British Midwife Toxaemia of Pregnancy 30 16. 4. 62 Ashton Gardens Clinic Breast Feeding Your Children Walking 20 30. 4. 62 Health Visitors A Foot to stand on Care of the Feet The Human Skeleton 15 14. 4. 62 Health Visitors Your Children's Teeth Old Wives Tales Sociable Six to Noisy Nine Nutrition in Pregnancy Guilty or Not Guilty 10 14. 4. 62 Becontree Adolescent Clinic Adolescence 20 21. 5. 62 Hunters Hall Junior School Your Children Walking The Human Skeleton Parts I and II 70 5. 6. 62 Health Visitors Mouth to Mouth Resuscitation 8 6. 6. 62 Personal Service Council Larry 60 25. 6. 62 Ashton Gardens Clinic Breast Feeding 20 27. 6. 62 Civic Centre Catering Staffs Another Case of Food Poisoning Food Without Fear 12 5. 7. 62 Oxlow Lane Clinic Naissance 70 10. 7. 62 Public Health Inspectors Clean Air 9 17. 7. 62 Broad St. Co-op Women's Guild Your Children Walking 35 17. 9. 62 Health Visitors and Staff To Janet a Son The Kinetics of Manual Handling 25 1. 10. 62 Triptons Youth Club Time Pulls the Trigger 50 9. 10. 62 Lymington School Parent-Teachers Association Time Pulls the Trigger 30 22. 10. 62 Ashton Gardens Clinic Breast Feeding 20 8. 11. 62 Avenue Club Your Children Walking 40 14. 11. 62 Ashton Gardens Clinic The Terrible Two's and the Trusting Three's 20 12. 12. 62 Becontree Adolescent Clinic The Best of Yourself Where there's a Will 11 12. 12. 62 Becontree Clinic To Janet a Son 40 Organised courses The following organised courses were arranged during the year: FOOD HYGIENE (R.I.P.H.H.) Staffords Bakery 8th January—10th April 34 Bartons Bakery 15th January—10th April Bartons Bakery 27th August—26th November Rush Green College 17th September—3rd December Food Hygiene (Trainee Manageresses) Bartons Bakery 28th February—14th March Bartons Bakery 28th May—4th June Home Safety and First Aid Chadwell Heath Townswomen's Guild Broad Street Co-op Women's Guild Chadwell Heath Co-op Women's Guild Oxlow Lane Co-op Women's Guild Fanshaw Ward Women's Labour Party Lymington School 12th—20th December 35 HEALTH VISITING AND SCHOOL NURSING It came as a surprise to many people when health visiting celebrated its centenary this year. They had thought that health visiting evolved from the needs of the second world war, particularly the need to follow up evacuated families and to promote the antidiphtheria campaign, whereas in fact, health visiting was pioneered in 1862. Although Florence Nightingale was too busy to undertake the problems of the organisation of health visiting she wrote much advice about how it should be organised. She stressed the qualifications required for what she called "home health bringing" and said that "tact and judgement unlimited" were the prime essentials. The "health missioner" as she was called then must create a new profession, a new type of work amongst women. The first organised training course for health visitors began in North Buckinghamshire in 1891 under the auspices of the newly appointed Medical Officer of Health. This link between health visiting and the Medical Officer of Health has survived the years and must remain unbroken if the health visitor is to continue to carry out the health promotion which was envisaged as her original purpose. Despite progress and improvement in training and qualification and in spite of widening horizons the basic concept of the health visitor as friend and counsellor to the family remains. Many other social workers of one type or another have entered into the field of activity of the health visitor for special purposes, but it still remains true to say that the foundation for all the health visitors' work has been the confidence engendered through mutual trust and respect between mother and health visitor. An Annual Report requires that we take stock of the past year and acknowledge the fact that all we attempted has not been achieved; it also requires that we should reassess needs and try to set our future aims so that we can direct our energies and time and money towards the continuance of the battle against the problems apparent on all sides. These problems must be dealt with if we are to promote healthy living—that is well-being of body, mind and spirit. Many of our problems can be dealt with by a wide dissemination of up-to-date information with simplification of complicated scientific facts in such a way as to render assimilation of knowledge easy. No doubt there are a larger percentage of children born in good health than ever before, yet illness is a current topic and hospitals are meeting greater demands than in the past. We must attempt to distinguish what a person needs from what he wants. Today there is available much that is essential for healthy living and it is in many instances up to the individual to take advantage of whatever is available. The grasping of opportunity is a matter of individual decision to be made by each person. The health department is in a unique position to interpret to the public the factors affecting the health of the community and to put forward the relationship between environmental and personal health. 36 The health visitor is primarily concerned in dealing with personal aspects of health. As the multitudinous problems coming to her notice increase, it is important to concentrate the attention of the health visitor on the priority needs. Health teaching as an instrument of preventive medicine is one of these and more effort must be directed to health teaching although at present, because of limited personnel, this must be at the expense of other aspects of her work. A constant review and adjustment of the health visitor's activities is necessary, in an endeavour to concentrate her efforts on the job for which she is trained. If health education is to succeed the public must accept its teaching and try to apply it in practice. This in the long run will reduce sickness in the population and will prove a saving of time and money. Statistics of visits undertaken Ante-natal first visits 238 total visits 429 Children under 1 year first visits 1,767 total visits 6,348 Children 1—2 years total visits 2,863 2—5 years total visits 5,599 Illness—care and after-care (Sec. 28) 516 Elderly 245 Daily child minders 29 Others 175 Ineffective 1,905 TOTAL VISITS 18,109 37 CARE OF MOTHERS AND YOUNG CHILDREN Ante-natal and post-natal care Ante-natal care and post-natal examinations are carried out at the sessions held at the various centres listed below. During the year 554 expectant mothers attended for ante-natal care, and 146 for post-natal examination. Doubtless some of the mothers who have attended for ante-natal clinics are examined post-natally by their general practitioners, but even allowing for this there must be many mothers who do not appreciate the importance of the post-natal examination. Continued efforts are required to encourage mothers to avail themselves of this service. Ante-natal Clinics Centre Sessions Held Times Sessions Held Average Attendance Average New cases The Clinic, Ashton Gardens, Chadwell Heath. 1st and 3rd in the month Wednesday p.m. 6 1 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday p.m. 11 1 The Leys Clinic, Ballards Road, Weekly Wednesday p.m. 11 1 Dagenham. Weekly Wednesday p.m. 10 1 Rush Green Clinic, 179 Dagenham Road, Dagenham. 1st and 3rd in the month Friday a.m. 1 - The Clinic, Weekly Tuesday a.m. 7 1 Oxlow Lane, Weekly Tuesday p.m. 5 1 Dagenham. Weekly Thursday a.m. 8 2 The Clinic, Ford Road, Dagenham. Weekly Monday a.m. 10 2 The Clinic, Manford Way, Hainault. 2nd and 4th in the month Monday a.m. 2 - Marks Gate Clinic, Lawn Farm Grove, Marks Gate. 2nd and 4th in the month Wednesday p.m. 3 - Towards the end of the year it was decided to amalgamate the sessions held on Tuesday mornings and Tuesday afternoons at Oxlow Lane Clinic. Arrangements were also made with Ilford Health Area Sub-Committee for the care of the Dagenham cases attending the Hainault Clinic. 38 Relaxation Classes Attendance at the relaxation classes was as follows:— Becontree clinic 744 Chadwell Heath clinic 453 Leys clinic 301 Oxlow Lane clinic 399 Marks Gate clinic (commenced 21. 7. 62) 72 TOTA 15969 Infant Welfare Centres A total of 3,995 children were brought to the Centres during the year, and the total number of attendances amounted to 28,981. Centre Sessions Held Times Sessions Held Average attendance Average new cases The Clinic, Ashton Gardens, Weekly Thursday a.m. 58 3 Chadwell Heath. Weekly Thursday p.m. 54 4 The Clinic, Weekly Monday p.m. 54 5 Becontree Avenue, Dagenham. Weekly Wednesday a.m. 50 4 The Leys Clinic, Weekly Thursday a.m. 26 2 Ballards Road, Dagenham. Weekly Tuesday p.m. 32 2 Rush Green Clinic, 179 Rush Green Road, 2nd, 4th & 5th in the month Friday a.m. 27 1 Dagenham. Weekly Friday p.m. 33 2 The Clinic, Weekly Tuesday a.m. 33 3 Ford Road, Dagenham. Weekly Thursday p.m. 33 3 The Clinic, 15/17 Thompson Road, Weekly Tuesday p.m. 35 3 Dagenham. Weekly Friday a.m. 11 1 The Clinic, Weekly Wednesday p.m. 65 6 Oxlow Lane, Dagenham. Weekly J ST Friday p.m. 42 4 Marks Gate Clinic, Lawn Farm Grove, Marks Gate. Weekly Monday p.m. 31 3 Premature Infants All infants weighing 5½ lbs. or less at birth are regarded as premature infants whatever the length of pregnancy. 31b. 4oz. or less 31b. 5oz.— 41b. 6oz. 41b. 7oz.— 41b. 15oz. 51b. Ooz.— 51b. 8oz. Total No. surviving one week Born alive at home and nursed entirely at home - 2 1 9 12 12 Born alive at home and transferred to hospital - - - 1 1 1 Born in hospital 10 11 10 34 65 58 39 Phenylketonuria Phenylketonuria is an uncommon disease in which there is an inborn error of protein metabolism involving inability of the liver to convert phenylalanine to tyrosine. This gives rise to brain damage, which manifests itself in due course by the development of mental deficiency and psychosis. It is important that the condition should be detected before irreversible brain damage takes place, in order that the child may be given a special diet having a low phenylalanine content, which will prevent the occurrence of mental deterioration. Between the second and sixth week of life the health visitor tests each child's urine with a strip of paper impregnated with a reagent. So far, only one positive reaction has been obtained and this proved to be a false positive. Further investigations carried out at hospital showed that this child was not in fact suffering from phenylketonuria. Ophthalmia Neonatorum No cases were reported. Day Nurseries Day Nursery Number of approved places Average daily attendance Average No. on register Total attendances Goresbrook 50 30.4 42.7 7,702 Chadwell Heath 54 36.8 48.1 9,311 TOTAL 104 67.2 90.8 17,013 The reasons for admission are set out in the following table: Widows Parents separated Desertion Illness of mother Illness of father Unmarried mothers Socioeconomic Mothers working to supplement income Total Goresbrook 3 16 1 5 - 5 3 25 58 Chadwell Heath 1 - - 3 1 2 7 22 36 No. of children in all nurseries in 1962 4 16 1 8 1 7 10 47 94 The average daily attendances at both nurseries were slightly higher than in 1961, but even so they continued to be used below their capacity. Both nurseries are recognised by the Ministry as training centres for nursery nurses and vacancies for students are quickly filled. 40 The Matrons of the nurseries have submitted the following observations. Mrs. E. Maddison (Goresbrook) "Most of the children admitted into the nursery are a fine healthy type, fairly well clothed and good footwear though there is always the odd one wearing soft slippers. The young mothers are very co-operative and friendly, willing to take advice when necessary. They are keen on their children having the necessary injections and innoculations and this is done at the nursery by the doctor. The reason for most of the mothers going out to work a full time job is housing conditions. Some live in one room perhaps with in-laws and the playing space for a child is limited or lacking. It is surprising the number of fathers that are interested in the nursery; they ask about diets, rest periods, and all the activities that go on daily. Recently we have had all the floors tiled in gay pretty colours making the nursery look homely and cosy." Miss P. Coffee (Chadwell Heath) "It seems that the nursery nowadays is providing accommodation not so much for the deprived child, as the child who comes from a united family. The need now for young couples to buy their own house necessitates the mother going out to work to supplement the family income to enable them to either save for a deposit on a house, or to repay the mortgage. The nursery also gives a great deal of freedom to those children living in restricted surroundings i.e., flats, furnished rooms etc., but I feel that even more provision could be made in the form of play centres for the 3—5 year old age group (especially only children) in the area, the parents of whom often make enquiries at the nursery to see if we can accept the children for short periods because as they say "he hasn't anyone to play with." Whilst feeling sympathy for these children we must point out that primarily the nurseries are for children whose mothers need to go out to work. One thing that does happen with some new parents is that quite unjustifiably they develop a "guilt complex" about leaving the children all day and compensate by giving too many sweets, being lax in discipline and by over indulging generally, often resulting in difficult relationships between parent and child. Usually we are aware of this, and can advise the parents accordingly. Perhaps one obstacle that we in nurseries must overcome, is that many uninformed people believe that the children are just "minded" by people who happen to like children. When first coming to the nursery people are often amazed at the things the children do learn, and then become most appreciative of the fact that the children are cared for by a trained and experienced staff who also "happen to like children." 41 Daily Guardians Scheme At the end of 1962 the number of registered daily minders and the number of children being cared for were as follows:— Number of guardians registered 86 Number of children being cared for 42 Nurseries and Child Minders Regulation Act, 1948 At the end of the year there were 3 child minders caring for 20 children, registered in accordance with this Act. Midwifery A total of 1,522 births were notified, of which 948 (62.3%) occurred in hospital. Domiciliary Midwifery serice County Midwives Midwives residing at York House Training Home Salvation Army Midwives Births attended: Doctor present 66 25 2 Doctor not present 255 172 59 Miscarriages attended 1 1 - Visits paid: As midwife 4,845 5,281 - Ante-natal 2,718 1,571 - Ante-natal clinics attended 266 190 51 Nine County Council Midwives were qualified to administer inhalation analgesia in accordance with the requirements of the Central Midwives Board. Inhalational analgesia ("gas and air" or Trilene) was administered to 412 of the patients they attended. Pethidine was given in 206 cases. A total of 523 cases were delivered in hospital but discharged before the tenth day, and were attended thereafter by County Council Midwives. 42 DOMESTIC HELP An analysis of the hours of service rendered by Domestic Help Service during 1962 is given in the following table:— Type of case No. of cases Hours help provided Maternity 37* 1,257 Tuberculosis 16 3,228 Acute sick 48 1,827 Chronic sick—aged 603 78,910 Chronic sick—others 88 16,505 Aged—not sick 4 318 Others 17 3,193 Night attendance 3 70 TOTAL 816 105,508 * Including toxaemia of pregnancy 9 333 Number of visits paid by Organiser 1,753 Average number of domestic helps employed each week 99 Average number of night attendants 2 Number of visits paid by domestic helps during the year 61,220 Numbr of visits paid by night attendants 7 Although the total figures of the number of cases assisted and the hours of help provided are similar to those for last year, there has been an increase in the demands made upon the service by chronically ill aged patients. In order to keep these elderly people at home, where most of them prefer to be, a daily service is often required. This can be a very satisfactory arrangement, especially where there are relatives who are able and willing to share the responsiblity of caring for the patient. But the Home Help Service cannot, and is not intended to, take over the whole responsibility of such care from the relatives. It is to be noted that shortage of accommodation in chronic-sick hospitals at times delays the admission of patients who really require the attention that only a hospital can give. With the increase in the number of chronic sick aged patients there is an increased number of inconinent cases, for whom the soiled laundry service is invaluable. A brighter note in the care of the elderly was struck recently during the very cold spell. An old lady confined to bed was asked whether she would like her hot water bottle refilled; on turning back the bed clothes to get this the help found that the patient was cuddling her bottle of whisky. She said "have a drop dear, and drink my health." The number of cases of tuberculosis still remains agreeably low and all the helps working in this type of household realise that they are making a big contribution in helping towards recovery. 43 We continue to care in some cases for children—especially those of widowers who leave home early in the morning. The helps go in and give breakfast and supervise children getting ready and where necessary take younger children to school. Every endeavour is made to help in cases of acute illness but when the charge is made known and help is only likely to be required for a short term, other arrangements are often made for this period. One problem met not infrequently in maternity cases is that caused by the need to charge for the service. Many people are under an impression that it is a Tree' service and do not realise that the attendance allowance given in a home confinement is intended to help towards paying for such things as the home help service. A free service is provided for expectant mothers suffering from toxaemia of pregnancy. Help for this type of case is proving invaluable—it does enable the family to be kept together, especially the young children who are unhappy at being moved elsewhere. At the same time the mother can obtain the rest which is essential for her. Although every care is taken to engage the right type of home help, and all the difficulties of the service are explained, not until the help is actually working is it fully understood. Every endeavour is made to make the helps feel that they are an important contribution to the social service and it is thought that if another title could be given to them they would not feel that they were regarded as the 4 charwoman' or 4 cleaner ' as is so often quoted. A home help is a very kindly person, doing all she can to make life easier and happier for the people with whom she comes into contact. Confusion and forgetfulness in the elderly sometimes creates difficulties for the home help. For instance a confused old lady may accuse a home help of being responsible for a missing article she herself has mislaid and until it is found the home help is uneasy and upset as she feels the accusation is a reflection on her honesty and integrity. Fortunately these cases are rare although they do happen. Training courses continue to be held at Chelmsford and all who attend find them most instructive and helpful to their work. The journey to Chelmsford and back each day is found to be rather a burden to the staff. Perhaps arrangements for the holding of local courses would help to solve this difficulty. It is not generally realised that personal care is given by domestic helps outside working hours. It is often brought to notice from an outside source that week-end meals had been provided and taken to a sick person in need. In many cases, the more able bodied old people have been collected by the domestic help and taken to their 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. Owing to the severe weather at Christmas, it was not possible to have an evening social. 44 CHIROPODY 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 as follows:— Ford Road Ashton Gardens 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. — 8.30 p.m. Thursday 9.00 a.m. — 1.00 p.m. Friday 9.00 a.m. — 1.00 p.m. 2.00 p.m. — 5.00 p.m. 5.30 p.m. — 7-3° 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 216 3 29 181 563 Total attendances 989 3 719 2,432 3,381 Cases still being treated at the end of the year 24 — 89 262 297 45 DOMICILIARY OCCUPATIONAL THERAPY During the year 180 visits were made to patients most of whom expressed appreciation for these visits, and relatives have commented on the fact that the patient is not so irritable and difficult, and does not worry so much about his condition. Instruction was given in many types of handicraft, such as weaving, leatherwork, marquetry, rug making. Some of the articles made were sold by the Tuberculosis Care Association at the Dagenham Town Show and sales were made at the Chest Clinic and at the Civic Centre. Many items were also sold throughout the year from the showcase at 15/17 Thompson Road. These sales enabled most patients to pay for the cost of materials used. Summary of Visits First visits 6 Re-visits 174 Ineffective 21 Other visits 68 Total 269 Visits to patients 180 New patients 6 Visits to clinic 20 Number on books 18 46 CONVALESCENCE AND RECUPERATIVE HOLIDAYS Arrangements for convalescence were made as summarised below, on the recommendation of general practitioners and medical officers. Adults Children National Health Service Act: Section 22 (mothers and young children) 2 3 Section 28 (prevention of illness, care and after-care) 46 — School Health Service — 68 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. A total of 61 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 A total of II children were examined by school medical officers before being admitted or re-admitted to camp schools. OXLOW LANE CLINIC FOR THE OVER SIXTIES Two half-day sessions per week are devoted to this clinic. On Thursday afternoons the "exercise class" is held, at which the physiotherapist attends to give instruction in simple physiotherapeutic exercises (which the patients themselves can then perform daily at home), and after this a member of the staff gives a talk on some relevant aspect of health education and, if time permits, the session concludes with a discussion. The Friday morning sessions are devoted to the clinical examination of patients. When a patient first attends, a full medical and social history is taken by the nurse, following which various tests are carried out, viz., audiometry, estimation of visual acuity and visual fields, estimation of vital capacity of the lungs, and urine testing. The patient is then interviewed by the doctor who discusses any matters arising out of the patient's history and explains the purpose of the clinic. A sample of the patient's blood is taken and this is submitted to a local hospital laboratory for testing (haemoglobin estimation, blood count, Wassermann reaction and serum cholesterol estimation). The doctor's 47 physical examination of the patient is usually left until a subsequent attendance because the routine already described is time-consuming and we do not wish to make the procedure arduous for the patient. An appointment is also made for the patient to have a chest X-ray at the Chest Clinic. The most common findings continue to be deafness and need for chiropody. Although these conditions may not be serious from a strictly medical point of view, they can be a serious social handicap, and considerable benefit can be derived from their alleviation. Serious illness is occasionally discovered, as in the case of a 66 year old man who was found to be suffering from a bleeding peptic ulcer: he was taken home by car and his family doctor notified by telephone, but unfortunately he died a few weeks later. During 1962 there were 148 attendances to see the doctor and 889 attendances at the exercise class. The majority of the physical examinations were carried out by Dr. Hodgson in the earlier part of the year and by Dr. Wallace during the second half of the year. As is mentioned elsewhere in this report, Messrs Camera Talks made a filmstrip depicting the activities of this clinic. 48 VACCINATION AND IMMUNISATION The occurrence of a case of smallpox in a nearby district caused a considerable public demand for smallpox vaccination in the early part of the year. This is reflected in the vastly increased figures for vaccination shown in this year's report. During the year a special effort was made to immunise the children of the Borough against tetanus (lockjaw). In addition to the work of the health visitors and other staff in speaking personally to parents, all parents of schoolchildren were sent a circular inviting them to give their consent to their children being immunised either by their general practitioner or by the Local Health Authority. As a result 6,656 children received at least a primary course of immunisation against tetanus. The pre-school children in most cases received this as part of the triple injection (combined immunisation against whooping cough, diphtheria and tetanus.) An important development during the year was the introduction of oral poliomyelitis vaccine. This not only has the advantage of being taken by mouth instead of by injection, but is also believed to produce a greater degree of immunity against the disease. It can also be given to the contacts of a case of poliomyelitis to stop the growth and further spread of disease-producing viruses. We had occasion to use the vaccine in this way during the year when an unvaccinated schoolchild developed poliomyelitis. This was the only case of poliomyelitis notified to the Department in 1962. The state of protection of children against diphtheria, tetanus and poliomyelitis is reviewed at the first and second routine school medical inspections (i.e., at the ages approximately of 5 and 11 years), and parents are invited to consent to their children receiving any immunisations for which they are due. B.C.G. vaccination (against tuberculosis) is offered to children during their second year at secondary school i.e., at about 13 years of age. Vaccination against Smallpox During the year 31,416 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 430 768 - - 1—4 years 1,155 588 252 121 5—14 years 5,633 2,050 1,690 659 15 years and over 7,473 2,431 5,595 2,571 TOTAL ALL AGES 14,691 5,837 7,537 3,351 49 Whooping Cough 1,204 children received immunising doses against whooping cough, including booster doses. Primary Boosters G.P.'s L.H.A. G.P.'s L.H.A. 531 532 86 55 Diphtheria Immunisation Age at final injection Primary iirmunisation Children who received a boosting dose G.P.'s L.H.A. G.P.'s L.H.A. Under 1 year 133 196 5 2 1—4 years 368 457 37 93 5—9 years 79 149 104 165 10—14 years 67 272 48 76 TOTAL ALL AGES 647 1,074 194 336 Tetanus Immunisation Age at final injection Primary immunisation Children who received a boosting dose G.P.'s L.H.A. G.P.'s L.H.A. Under 1 year 153 176 5 3 1—4 years 410 584 69 155 5—9 years 803 1,293 336 723 10—14 years 981 2,256 394 1,242 TOTAL OF ALL AGES 2,347 4,309 804 2,123 Poliomyelitis Vaccination G.P.'s L.H.A. Total Salk Vaccine Primary 658 328 986 3rd injection 908 346 1,254 4th injection 178 11 189 Sabin oral vaccine: Completed course 551 830 1,381 Booster after 2 Salk 1,694 1,427 3,121 Booster after 3 Salk 631 1,012 1,643 B.C.G. Vaccination Number of children skin tested (Heaf test) 813 Number showing positive reaction (not requiring vaccination) 77 Number showing negative reaction (requiring vaccination) 736 Number vaccinated 721 50 SCHOOL HEALTH There are 17 secondary and 44 primary schools in the Borough, also 2 special schools (Bentry School physically handicapped and E.S.N, sections). Children on the registers on 31st December, 1962 totalled 18,323, a decrease of 942 compared with 1961, thus continuing a trend which has been apparent for some years. Medical Inspections Routine medical inspections were performed on the following groups of pupils:— (a) children in their first year at primary school (b) children in their last year at primary school (c) children in their last year at secondary school (d) children attending nursery classes (e) children of any age transferred from other areas to Dagenham schools. In addition to these, special examinations and re-inspections of children with defects were carried out as necessary. This part of the work is, of course, specially prominent at the Bentry Special School. MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (INCLUDING SPECIAL SCHOOLS) A) Periodic Medical Inspection Age groups inspected Number of pupils (by year of birth) inspected 1958 and later 57 1957 691 1956 577 1955 47 1954 29 1953 30 1952 43 1951 1,020 1950 580 1949 58 1948 638 1947 and earlier 1,629 TOTAL 5,399 51 B) Other Inspections Number of special inspections 1,233 Number of re-inspections 933 TOTAL 2,166 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) Individual pupils found to require treatment For defective vision (excluding squint) For any of the other conditions recorded Total individual Pupils (1)* (2)* (3)* (4)* 1958 and later 1 11 12 1957 29 180 182 1956 13 100 104 1955 2 12 12 1954 6 10 10 1953 8 13 13 1952 3 15 15 1951 66 95 154 1950 65 74 112 1949 5 10 10 1948 53 57 91 1947 and earlier 131 148 230 TOTAL 382 725 945 * (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 of pupils Out of 5,399 children seen at periodic medical inspection only 1 was considered to be of unsatisfactory general condition. Infestation with Vermin (a) Total number of individual examinations of pupils in schools by school nurses or other authorised persons 10,552 (b) Number of individual pupils found to be infested 113 (c) Number of informal letters requesting cleansing 113 (<d) Number of individual pupils in respect of whom cleansing notices were issued (Sec. 54 (2) Education Act 1944) — (c) Number of individual pupils in respect of whom cleansing orders were issued (Sec. 54 (3) Education Act 1944) — 52 Defects found by Medical Inspection 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 22 5 44 4 26 13 92 22 30 29 5 Eyes: (a) vision 46 26 140 20 196 44 382 90 25 17 (b) Squint 22 6 8 — 28 10 58 16 4 — (c) other 8 2 7 — 9 7 24 9 24 6 6 Ears: (a) hearing 9 8 3 3 7 23 19 34 16 34 (b) otitis media 12 7 2 9 9 6 24 15 18 7 (c) other 18 2 14 3 8 6 40 11 1 - 7 Nose and throat 69 48 1 3 33 22 103 73 23 13 8 Speech 15 23 1 4 11 14 27 41 41 25 9 Lymphatic glands 28 10 — — 1 3 29 13 3 2 10 Heart 8 11 4 4 5 23 17 38 12 20 11 Lungs 15 13 6 8 16 31 37 52 15 21 12 Deveopmental: (a) hernia 2 1 1 — 5 4 8 5 1 1 (b) other 13 12 1 6 15 19 29 37 2 — 13 Orthopaedic: (a) posture 2 3 6 3 13 7 21 13 4 4 (b) feet 30 15 10 15 28 13 68 43 7 10 (c) other 16 13 12 9 33 29 61 51 48 37 14 Nervous system: (a) epilepsy 1 - 6 2 8 1 15 3 2 3 (b) other 1 — 3 2 9 10 13 11 13 11 15 Psychological: (a) development 11 4 5 4 14 11 30 19 7 6 (b) stability 3 9 3 3 6 11 12 23 11 8 16 Abdomen 1 1 — — 4 1 5 — — 17 Other 13 6 14 3 11 3 38 12 89 253 Treatment of Pupils Eye Diseases, Defective Vision and Squint Category No. of cases dealt with by Minor ailment clinics Ophthalmic clinic External and other (excluding errors of refraction and squint) 275 593 Errors of refraction (including squint) — 1,075 No. of pupils for whom spectacles were prescribed — 540 53 The ophthalmic clinics are held in the Authority's premises and conducted by a consultant seconded by the North-East Metropolitan Regional Hospital Board. Diseases and Defects of Ear, Nose and Throat No. of cases treated By the authority Otherwise Received operative treatment: (a) for diseases of the ear — 22 (b) for adenoids and chronic tonsillitis - 80 (c) for other nose and throat conditions - - Received other forms of treatment 95 25 TOTAL 95 127 Total number of pupils in schools who are known to have been provided with hearing aids:— (a) in 1962 4 (b) in previous years 14 Orthopaedic and Postural Defects (a) Pupils treated at clinics or out-patient departments 296 (b) Pupils treated at school for postural defects 23 Diseases of the Skin (excluding uncleanliness) No. of cases treated By the authority Otherwise Ringworm (scalp) — — Ringworm (body) 1 — Scabies — — Impetigo 6 — Other skin diseases 465 7 Child Guidance A total of 79 children from Dagenham were seen at the Romford Child Guidance Clinic. There is a waiting list of 15 children. Speech Therapy The Speech Therapy Department, which treats children with a speech impediment (both school and pre-school children) continues to employ two full-time speech therapists serving in six separate clinics. Added to this, Miss Symes worked for one term at the Kingsley Hall Nursery for Handicapped pre-school children, treating three spastics, and one case of undiagnosed speech disorder, of which on the latter warranted continued weekly therapy at Five Elms Clinic. 54 The co-operation and help of the Child Guidance Department and of the schools in the area has always been an important factor in the success of speech therapy, and the department wishes to express appreciation. Miss Symes and Miss Shipley were pleased to be able to attend the Refresher Course in October 1962 which has proved of value in their clinical work. Number of treatments given 2,558 No. of patients ctreated No. of sessions held Five Elms Clinic 63 212 Ashton Gardens Clinic 22 90 Marks Gate Clinic 22 83 Oxlow Lane Clinic 17 72 Leys Clinic 50 169 The Bentry School 24 109 Kingsley Hall 3 13 TOTAL 201 748 At least one session was also held weekly for purposes of school visiting, interviews and tape-recordings. Caseload:— girls, 61; boys, 140; TOTAL 201 Types of Cases Treated Dyslalia 94 Delayed development including aphasia 21 Sigmatism 35 Stammer 30 Stammer and dyslalia 2 Defect associated with hearing loss 6 Cleft palate 3 Disorder of voice 2 Cerebral palsy 6 Unclassified 2 TOTAL 201 Number of cases on register at 31. 12. 62. 130 Reasons for Discharge Speech normal 40 Non-attendance 8 No further progress likely 10 Transferred to other areas 11 Left school — Discharge requested by parent 2 TOTAL 71 55 Other treatment given New cases treated Pupils with minor ailments 505 Pupils who received convalescent treatment under School Health Service arrangements 68 Pupils who received B.C.G. vaccination 721 Chiropody 211 Infectious Diseases Rubella (german measles) and chickenpox were prevalent during the spring and summer terms, and the incidence of measles rose during the autumn term. One unvaccinated child was admitted to hospital with paralytic poliomyelitis. It was considered unlikely that she was infectious at the time of her last attendance at school, but as a precaution the vaccination records of the other members of her class were checked and where necessary oral poliomyelitis vaccine was offered. School Clinics During the year 2,087 children were seen by the school medical officers at their consultation sessions, and 3,362 attendances were made at the nurses' sessions. Attendances at the various clinics were as follows:— Ashton Gardens 308 Bentry School 281 Becontree Avenue 778 Five Elms 1,990 Ford Road 883 King's Wood 108 Leys 247 Marks Gate 279 Oxlow Lane 575 TOTAL 5,449 Employment of Children 196 pupils were examined for fitness for employment out of school hours and certificates given to all these children. Adolescent Clinic This is the second year during which this clinic has been held. The sessions are held once a week in the early evening, and are staffed by Dr. Hodgson and Miss Millbank. Dr. Hodgson reports as follows:— "Compared with the previous year there has been an increase in the attendance at the Adolescent Clinic, which consisted of 26 Wednesday evening sessions plus a 56 lecture given by Mrs. Rose Hacker from the Marriage Guidance Council and a lecture discussion by Dr. Joyce on V.D. There was a total attendance of 300 adolescents—making an average of 11.5 per session. Maximum attending at one session 18 Minimum attending at one session 2 Maximum attendance over the year per child 25 Minimum attendance over the year per child 1 Total number of children who attended over the year 50 Total number of new children who attended over the year 25 The following films were shown: Physiology of sex — attended by 20 boys V.D. and discussion — attended by 22 boys Making the best of yourself — attended by 13 girls 6 Film strips on first aid and prevention of home accidents. Talks were given by: Mrs. Rose Hacker (Marriage Guidance Council) on sex education Dr. Joyce (London Hospital) on V.D. Miss Richards (Dagenham Borough Council) on care of the aged. Miss Wright on the place of godparents in society. Talks and discussions: Series of short lectures on first aid and home safety Series of lectures on baby care: Motherhood and fatherhood Hygiene in the home Food and personal Care of the skin and clothes Other topics: Preparation for marriage (sociological aspect) Parenthood Menstruation Etiquette Sport Jobs, careers and hobbies Separate discussion for the older girls on sex and marriage Short talks by the girls were given on the following topics: Butterflies and moths Athletics Care of pet animals. The majority of the topics discussed this year were chosen by the girls at the beginning of the session and we were again impressed by the interest these girls take in subjects dealing with the care of babies and young children. We were gratified that several of our "old girls" now working have returned to tell us about their jobs. On the whole this has been a fairly satisfying year but Miss Millbank and myself feel that some regular assistance by another member of the staff would enable us to do a little more individual work with the girls. With the somewhat larger groups and the wider age range i.e. 11 to 16 years, we find it advisable on some occasions to divide the 57 girls into older and younger groups and discuss different topics. This means that I am unable to have individual talks with girls and make a socio-medical assessment. This I feel, is my important role, but of course, this would only leave Miss Millbank to do the talks and discussions with only occasional help from me." Home visits by School Nurses A total of 1,354 visits were made by school nurses to the homes of school children during the year. Medical examination of Staff The following examinations were carried out by medical officers during the year:— (a) New appointments: Entrants to the teaching profession and to training colleges 139 Essex County Council 113 Dagenham Borough Council 202 Other authorities 8 (1b) Under sickness regulations 10 (c) Number of consultations with specialists arranged 51 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 chest. The following table shows the number of staff X-rayed during the year; all X-rays were satisfactory. At a Chest Clinic By Mass Radiography Tuberculosis visitors and health visitors doing tuberculosis work 2 Home Nurse/Midwives 9 — All Day Nursery staff 6 30 Occupation Centre staff — — Domestic helps 2 — Others 5 7 Teachers — 143 Non-teaching staff 28 —— 58 DENTAL SERVICES The situation regarding the recruitment of dental officers showed some welcome signs of improvement during the year. In the earlier part of the year another part-time officer joined the staff, bringing the number of part-time officers to four and raising the number of sessions worked to 14 per week. Towards the end of the year the services of a full-time dentist were obtained. This enabled us to re-open the dental surgery at Ford Road Clinic and to re-commence routine dental inspections in the schools served by this clinic. Treatment was also carried out at the Bentry Special School in the temporary dental surgery set up there as described in last year's report. I give below the statistical summary of the year's work:— Periodic Specials (а) Number of pupils inspected 393 923 (б) Number found to require treatment 259 907 (c) Number offered treatment 259 907 (d) Number actually treated 26 646 (e) Number awaiting treatment 542 680 (f) Attendances made by pupils for treatment 140 2,628 (g) Half days devoted by dental officers to: Inspection 52 Treatment 571 (h) Number of X-ray examinations 58 (0 Fillings: Permanent teeth 1,767 Temporary teeth 602 (J) Number of teeth filled: Permanent teeth 1,557 Temporary teeth 525 (k) Extractions (i) permanent teeth: On account of caries 347 For other purposes 10 (ii) temporary teeth: On account of caries 1,098 For other purposes 3 (l) Anaesthetics administered: Local 603 General (i) by medical officers on County Staff 75 (ii) by others 510 Average number of general anaesthetic cases per general anaesthetic session 8 (m) Orthodontics: Cases commenced during the year 8 Cases carried forward from previous year 24 Cases completed during the year 6 Cases discontinued during the year 3 Pupils treated with appliances 12 Removable appliances fitted 2 Fixed appliances fitted — Total attendances 27 Number of sessions devoted to treatment 4 59 (n) Number of pupils supplied with artificial dentures 6 Number of dentures fitted 6 (0) Other operations: Permanent teeth 178 Temporary teeth 75 (p) Analysis of figures in (o) Type of Operation Number Silver nitrate treatment 6 Scaling 21 Syringing sockets 3 Dressings 220 Other operations 3 60 HANDICAPPED CHILDREN The formal ascertainment of any type of handicap in childhood rests entirely with the School Health Service and only the School Medical Officer can recommend to the local education authority any form of special educational treatment. This necessitates not only a very full and up-to-date knowledge of medical conditions but also very complete information as to the provisions of the Education Art 1944 and the facilities available. It also involves close liaison with the parent, family doctor, the hospital consultant, the teacher and where appropriate, the educational psychologist. In order to keep the school medical officer informed of the advances in modern medicine, full advantage must be taken of the post-graduate course available. During the year one medical officer attended a course on the assessment of hearing defects in children and another attended a course on the assessment of mental subnormality. This second medical officer also undertook, at her own expense, a post-graduate course on dermatology at Sheffield University during a week of her annual leave. With the improved general standard of children's health, the careful assessment of the handicapped child, including the child who is failing to make satisfactory educational progress, occupies an increasing proportion of the school medical officer's time. These examinations are often time consuming, but it is of the utmost importance to the child that his condition should be thoroughly investigated. Although statutory ascertainment of handicaps under the provisions of the Education Art, 1944, may not take place before the age of 2 years, it is important for medical and social reasons that handicaps should be discovered as early as possible in a child's fife. A register is kept of all children under the age of 5 years who are either mentally or physically handicapped. 61 Number of children of school age on 31st December 1962 formally ascertained as handicapped pupils requiring special educational treatment (s.e.t.) Blind Partially sighted Deaf Partially Hearing Delicate Physically handicapped E.S.N. Maladjusted Epileptic Speech defect Dual defect * TOTAL Attending day special school — 14 7 7 6 62 158 — — — (15) 254 Awaiting placement in day special school — 1 — — 1 5 15 — — — (1) 22 Attending residential special school — 1 3 — 5 22 15 18 4 — (5) 68 Awaiting placement in residential special school — — — — 5 4 5 1 3 1 - 19 Attending boarding homes - - - - - - - - - - - - Awaiting placement in boarding homes - - - - - - - - - - - - Attending independent schools - - - - - - - - - - - - Awaiting placement in independent schools - - - - - - - - - - - - Attending hospital schools - - - - - - - - - - - - Awaiting placement in hospital schools - - - - - - - - - - - - Receiving education in hospital under Section 56 1 - - - - - - - - - - 1 Receiving home tuition under Section 56 3 - - - - - - - - - - 3 Awaiting home tuition under Section 56 - - - - - - - - - - - - Total No. of children of school age requiring s.e.t. 4 16 10 7 17 93 193 19 7 1 - 367 Children of school age on register of handicapped pupils but not requiring s.e.t. and attending ordinary schools - 4 2 11 21 155 27 7 12 6 (5) 245 Children aged 2—5 years on 31. 12. 62 formally ascertained as handicapped pupils requiring s.e.t. Receiving s.e.t. - - 1 - 2 5 - - - - - 8 Awaiting s.e.t. — 1 — — 2 4 5 — 2 — - 14 Children aged 2—5 yrs. on 31. 12. 62 on register of handicapped pupils but not requiring s.e.t. — — — —— 5 10 1 — 1 — - 17 * Not included in Total 62 Children admitted to special schools during the year:— Admitted to Residential Schools E.S.N 2 Physically handicapped — Delicate 2 Maladjusted 3 Deaf — Diabetic 1 Admitted to the Bentry and other Day Special Schools E.S.N36 Physically handicapped 8 Deaf 3 Partially hearing — Delicate 2 Partially sighted — Of the children who were attending the special schools the following were discharged to other schools during 1962: From Residential Schools Maladjusted — E.S.N. — Delicate 1 to ordinary school Speech defect 1 „ „ „ From Day Special Schools E S N 3 „ „ „ Delicate 3 „ „ „ Physically handicapped 3 „ „ „ 63 THE BENTRY SCHOOL The Bentry School is a day special school which has two sections, one for physically handicapped and the other for educationally subnormal children. A weekly medical session is held in the school, at which medical inspections, intelligence testing and immunisations are carried out. Parents are encouraged to attend, and many problems are solved by discussion with them and with the headmaster. At the examination of school leavers the question of future employment is particularly borne in mind. The school medical officer is then able to make her contribution to the discussions between the parents, headmaster, and youth employment officer in an effort to place the children in suitable employment. We are grateful to the headmaster and the staff for their co-operation which brings about a harmonious working relationship which is essential in this work. The following report has been received from Mrs. F. Cocker the physiotherapist who attends the Bentry School:— "During the past year six children have been admitted to the Bentry School, five of these children were suffering from cerebral palsy, one child was a case of muscular dystrophy; it is interesting to note the decrease in the number of anterior poliomyelitis cases and the greater increases in the number of cerebral palsy cases entering nurseries and schools for the physically handicapped children. With the decrease in the total number of physically handicapped children at the Bentry school it is possible to give more individual treatments, although I am sure that some team games (even if the participant is in a wheel chair) are essential as part of the general treatment, an awareness of a team-spirit and the desire to partake in communal events being extremely important." 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:— "Swimming therapy this year proceeded with the same keenness as always, the aim being to teach the children some "strokes" as nearly resembling the standard as their disability will permit. To keep the keenness of the children, I divide the time into one-third exercise practice and learning "proper," one-third "races," and one-third free. Again I would like to thank Mr. Jones, the Sports Organiser at the Barking Technical College, and his staff for their keenness and help; the staff of Toolpro Ltd., High Road, 64 Ilford, for the wonderful Christmas Party and Summer Outing they organise for the children each year. I would also like to appeal for voluntary helpers, male or female, to enter the water and give me a hand with these lovable little children thus helping them to learn at least one sport or pleasurable hobby, so that they may get the best out of life.” 65 LEYS ORTHOPAEDIC CLINIC This is an out-patient clinic of the Ilford and Barking Group Hospital Management Committee which is located at the Leys Clinic. Children referred from the infant welfare clinics and the school health service attend here for treatment, as well as other patients referred by general practitioners and other sources. Mrs. E. Ottley, the physiotherapist, reports as follows:— “ The 653 patients who attended for physiotherapeutic treatment during 1962 comprised 257 adults, 296 school children, and 100 children below school age. 10.402 treatments were given. Mr. A. M. A. Moore, F.R.C.S., the orthopaedic specialist attended once every four weeks. He saw 212 patients, 77 of whom were new. Children attended in their respective age groups, boys and girls were treated separately in classes for (a) feet, (b) posture, (c) breathing; all children under school age being treated individually. I can only repeat it is a great pity that so many children, girls and boys are allowed to wear such unsuitable shoes. I feel the blame for many of the foot deformities one sees in children's clinics today must lie with the shoe manufacturers. Surely it is possbile for them to produce a reasonably priced well shaped shoe for school children ? I find many parents are only too willing to purchase such shoes but are quite unable to obtain them. No waiting list is kept, all patients (adults) are seen on receipt of referral forms or letters from their own medical practitioners. Children are usually referred from school clinics or infant welfare clinics. The appliance fitter, Mr. Paulding of Messrs. A. E. Cox Ltd., now calls each week to measure patients at the clinic for surgical shoes, splints and belts. Our usual Christmas party was held on 17th December when over 120 patients attended, and a very enjoyable time was had by all. Various patients and relations very kindly gave us presents of cakes, fruit etc.” 66 KINGSLEY HALL DAY CENTRE 1962 in Kingsley Hall has been a year of settling down and consolidation. Most of our “ teething problems ” were over, and a clearer picture was emerging of our aims and ambitions for the Centre; our place in the structure of provisions for handicapped children was clearer. A routine of admission, care and training is now established. When a child is proposed for admission, all records concerning that child are gathered together, including specialist reports, infant welfare records, and a health visitor's up-to-date home report. The parents and child are then interviewed by a Medical Officer, and if acceptable for Kingsley Hall the Medical Officer will explain the provisions available and invite the parents to visit the nursery and talk with Sister-in-Charge before deciding to accept a place for their child. Fairly lengthy gaps are allowed between each admission. This we find greatly benefits both child and staff; the newcomer gets much attention from the staff in the first few days. Invariably, he will find one person to whom he becomes particulary attached, and it will be that member of staff who will introduce the child to the nursery routine and begin his training. This scheme of single admission also allows the staff to become well acquainted with the new personality and more easily observe any signs of stress that the change of environment may cause, and make an early report on his particular needs. Our first aim with a new arrival is to bring his health to its best potential by careful supervision of nutrition, rest, play and fresh air. The dietary requirements of each child are carefully assessed. In the early weeks we have found that supplements of vitamins, high protein and iron are usually required. At this point we must congratulate the kitchen staff on their co-operation, our requirements are sometimes exigent and must appear to them to be a little eccentric to say the least, but they always produce the right thing. We have found that this care in nutrition has paid dividents. The children invariably put on weight (except those who start off too well endowed!); Mr. Sawallow, Senior Lecturer in Dentistry at the London Hospital has congratulated us on the children's teeth; and their attendance has been excellent, despite the terrible weather in November and late December. Our average attendance for 1962 was 16 children a day. The majority of absences were due to hospital or dental appointments and holidays. Sister now supervises all dental and hospital appointments, arranging transport where necessary and occasionally providing an escort. We now have excellent liaison with many of the hospitals where our children attend and most provide us with a detailed and helpful report. 67 We have had many distinguished visitors to Kingsley Hall during 1962, but we would particularly like to thank some of the visitors who helped us greatly with their advice and service. Among these, Mrs. Barber, Psychiatric Social Worker of Romford Child Guidance Clinic has helped us with some of the emotionally disturbed children by visiting parents and making early appointments with the psychiatrist. Miss Gascoyne the Educational Psychologist devoted a whole morning to demonstrating a method of ascertainment for children with poor speech ability, and she also provided some helpful explanation on the background of some of our children. Miss Hodges, the peripatetic teacher of the deaf, has helped us a great deal with our deaf children, and recently obtained for us a Siemens Speech Training Unit for the use of one of our children. She visits us fairly regularly, to give instruction to both children and staff. We are always delighted to welcome visitors to the nursery as we feel this greatly benefits the children. They enjoy a change and delight in showing off their newly acquired skills. This welcome is specially extended to mothers, who are encouraged to come to the nursery as frequently as they are able, and to stay and take part in the nursery routine. We like to feel that in this way the children come to look upon the nursery as an extension of the home and not as a separate entity. The number of new admissions in 1962 was 15:— 3 mentally defective 2 mongols 3 maladjusted 1 hemiplegia 1 partially sighted 1 epileptic 1 cleft palate with poor speech 2 deaf 1 spastic The number of discharges for 1962 was 14:— 1 spastic—discharged to Wilfred Pickles residential school for spastics 2 failures to thrive—discharged home 1 hemiplegia— moved to another area 3 emotionally disturbed (2 going to normal school, 1 home) 1 hemiplegia— to normal school 1 partially sighted—discharged home (since returned to nursery) 1 deaf child—to Nursery for Deaf Children 1 deaf child—discharged home 1 spastic—to Day Centre for Spastic Children 1 congenital heart—to normal school It can be said without reservation that all the children have made progress, some indeed remarkable progress. 68 The work of the nursery has been facilitated by the purchase of a washing machine and a food blender. During the year the heating system was renewed, and the new system is a great improvement despite the difficulties experienced during its introduction. Ordered for 1963 are a walking frame and a special chair for spastic children. Progress Report on children attending Kingsley Hall Name and Age Handicap Remarks 1) 6 yrs Spastic quadriplegia Much improved—accepted and transferred to Wilfred Pickles School for Spastics. 2) 6½ yrs. Microcephalic Grossly M.D.—spastic. No obvious improvement during ’62; awaiting admission to hospital, in the meantime discharged home. 3) 5 yrs. Mentally retarded Improved greatly. Now attending Romford Training Centre. 4) 5 yrs. Mentally retarded More sociable on discharge, awaiting vacancy at Training Centre. 5) 5 yrs. Epileptic—emotionally Temporary improvement only, discharged home. disturbed Admitted to ordinary school but proved able. To be admitted to a psychiatric unit for children. 6) 5 yrs. Hemiplegia Well adjusted and walking well on discharge. dent, to normal school. 7) 5 yrs. Dysarthria Improved socially, to normal school for 1 term. Awaiting admission to Moor House. 8) 5 yrs. Spastic quadriplegia Now crawling, feeding himself, speech intelligible. (athetoid) Still attending (accepted for Wilfred Pickles School in Billinghurst in 2 yrs. time). 9) 4 yrs. Hare-lip and cleft palate Greatly improved both socially and in speech. 10) 4 yrs. Mongol Now saying sentences—recommended for Training Centre. 11) 4 yrs. Mentally retarded, Walking since admission, attempts at feeding himself, epileptic no obvious improvement in mental condition. 12) 4£ yrs. Spastic, paraplegia Great improvement during past year, spent a while in Oldchurch Hospital for stretching right Achilles tendon. Now walking very well. Recommended for normal school. 13) 34 yrs. Maladjusted Condition variable, has phases of temporary ment, but lapses into previous difficult state. 14) 3 yrs. Hemiplegia Now walking well, speech quite clear and is now an independent pleasant little boy. 15) 3 yrs. Severe spastic Appears to be “awaking”, showing interest, now quadriplegia attempting to get around on the floor. It is hoped that this child will benefit greatly from the new walking frames, shortly to be delivered. 16) 3 yrs. Epileptic, anti-social Improved while at Kingsley Hall, now discharged home due to pressure of waiting list. 69 Name and Age Handicap Remarks 17) and 18) Failure to thrive Discharged home much improved. 2½ and 1 yr. 19) 2½ yrs. Mongol Now walking well, saying isolated words, feeding himself, healthy active and sociable. 20) 5 yrs. Spastic quadriplegia Bright, happy child. Now showing interest, feeding ? deaf herself (with a little persuasion), making sounds, getting around on the floor. 21) 3 yrs. Left hemiplegia follow- Walking well now with walking aid (supplied by ing cerebral haemorrhage Oldchurch Hospital), few isolated words, happy child. 22) 4½ yrs. Eczema, unsettled Has remissions depending on home conditions. Under home conditions hospital supervision (Attempts are being made to improve home conditions). 23) 2 yrs. Congenital bilateral Can now walk and feed herself, fairly independent, cateracts happy and co-operative child. 24) 5 yrs. Arr. hydrocephalic, Fairly intelligent child, overprotected, now beginning spastic to integrate. 25) and 26) Mentally retarded No noticeable improvement in mental condition, 4½ yrs. (severe) probably more sociable. 70 “THE MEDICAL IMPORTANCE OF THE WORK OF THE HOME HELP IN GREAT BRITAIN” Lecture given to the International Conference of Home Help Organisers in Paris, October 1962 Introduction In order to understand our present system of social and medical organisation, we must look at the past. This has influenced the way the services have developed and has been responsible for the home help service in Great Britain being a "medical" service. History The history of the various attempts of the State and/or the Local Authorities to care for the citizen in a personal way can be traced back to the Statute of Elizabeth I in 1601, when the first official efforts were made to differentiate between those who were in need and sick and those in need but well. This was responsible for the system of outdoor relief and so made each small parish responsible for its own unemployed. No stranger was welcome to settle in any parish even in times of prosperity because if he became unemployed he would be a charge on the local citizens. The Poor Law Commission of 1832 which initiated the Poor Law Amendment Act of 1834, created the Boards of Guardians. They were elected, and administered a larger area than the parish councils, in which they were responsible for operating the provisions of the Poor Law. Workhouses were built, and an attempt was made to discontinue payment of outdoor relief, although this was a failure. During the next 50 years or so sanitary reforms brought a change of attitude. By 1909 the principle of payment of allowances by way of outdoor relief had been accepted. By this time also, workhouses provided some medical treatment for the inmates who became sick but they would not normally admit a sick person from outside. In the year following the report of the Royal Commission of 1909 the principle of the state being interested in personal health problems of the people came to be accepted. The Midwives Act of 1918 initiated the setting up by local supervising authorities of the domiciliary midwifery service. It was to meet the need of this service that the home helps were called in to take charge of the household during the lying-in period. They were mainly provided by voluntary societies although some local authorities attempted to organise services of this kind. As a result of the 1929 Local Government Act the hospitals were taken over by the local authorities and the Medical Officer of Health, who was responsible for the administration of the hospitals, faced up to trying to provide some solution to the shortage of 71 maternity beds by way of providing home helps and midwives for domiciliary maternity cases. So the home help came to work under the Medical Officer of Health and so became “ medical.” During the 1939—45 war the Defence Regulations allowed the provision of home helps for other than maternity and child welfare cases. When this power lapsed at the end of the war the 1946 National Health Service Act propagated this system. Section 29 allows the provision of a home help in households where such help is required because of the presence of any person who is lying-in, an expectant mother, mentally defective, aged, or a child not over compulsory school age. Present 1) Sources of information Some information about the present service is to be found in Ministry of Health Annual Reports, Annual Reports of the Medical Officers of Health and in special reports by them to their committees. This information was supplemented by discussion with Medical Officers of Health, Home Help Organisers, Home Helps, General Practitioners, as well as the patients themselves. 2) Groupings of authorities In reading the many published details of services it is possible to recognise three groups of authorities:— a) the late starters, or not-so-progressive authorities still in the teething stages of development, b) those who have passed through their teething troubles and are making progress towards the third group, c) the most progressive authorities who have passed through stages (a) and (b) and have reached stability. This means they are able to forecast the needs of the service with a fair degree of accuracy. 3) Categories Unfortunately the cases are not classified according to disease and the majority of authorities use the following classification: the Ministry of Health Report for 1961 gives the following figures:— a) old age and chronic sick—76% of all cases b) maternity—11% c) tuberculosis—1% d) other—12% Some local authorities make special mention of the acutely ill and the mentally sick. Others describe services such as those for the incontinent, problem families and infectious disease. a) The elderly I would like first of all to deal with the elderly. I had hoped to avoid this emphasis on the elderly, because in some areas the home help service is coming to be looked upon 72 as a service exclusively for the elderly and we must avoid this attitude, but we must not shut our eyes to the fact that a high proportion of cases which the home help deals with will be elderly chronic sick, 76% as I have said were those dealt with in 1960. I am influenced in my approach to the problem of the elderly in my own experience in a clinic which I have been running since 1957 where I attempt to keep the elderly as fit as possible and make them as independent as possible. It is very difficult to attempt to separate out the various factors in the health of the elderly but I like to look on them as divisible into physical and mental and into direct and indirect factors. The terms physical and mental are self explanatory, direct and indirect are not so obvious. By direct I mean medical as such, and by indirect those which are outside the scope of direct medical treatment, such as the relief of loneliness in the prevention of deterioration. One of the first things which springs to mind in the physical field as an indirect factor is the provision of adequate food; this can of course both prevent and cure illness and the film strip which I will show later on is one we made in Dagenham to illustrate the effects of wrong feeding on the health of the elderly, and in it you will see the home help providing a good meal for the old lady, and thereby preventing deficiencies due to wrong feeding. The direct effect of the home help on the person's health can be illustrated by the picture I will show you where the home help is seen administering the medicine to a patient. This she does at the request and under the supervision of the home nurse, another one will be seen putting drops in the patient's eyes and this she does again at the instigation and under the instruction of the home nurse. These have a direct effect on the physical health of the patient, the drops cure the eyes, the medicine to cure the cough, and certainly many a home help bandages an old lady's leg if a bandage has come undone and is needed for the treatment of an ulcer of leg, and this would be direct in its effects on the patient's health. On the mental side of the old person's make up, the home help can exert indirect effects by her mere presence which may, and in fact does, in so many cases, prevent loneliness. How many of us have heard or perhaps how many of us have not heard, the stories of the old people who suggest to their home help that she should not bother about doing the work but sit down and have a cosy chat and a cup of tea; and which of us can say that a cosy chat, and particularly a listen, what one has heard called therapeutic listening, is not as effective a therapeutic weapon as anything any psychiatrist ever achieved. How many of us can say that this is not more valuable to the patient than a scrupulously clean household ? This, of course, is not to suggest, and I dare not suggest in front of an audience of this type, that I would encourage the home helps not to do the cleaning in a household, but it is to suggest that this is a point of view worth taking into account. 73 Then as far as direct effects in mental illness are concerned many cases of senile dementia in the elderly tend to become worse because the patient loses touch with reality, and contact with the outside world and tends to become forgetful and absent minded and may need hospitalisation if this becomes too severe. The home help can help enormously by talking and listening to the patient, and thus helping to keep her in touch with reality and in contact with every day affairs, she can also help by overlooking shortcomings including those little difficulties which come from extreme forgetfulness from which the senile dement so often suffers. b) Maternity Next I would like to consider the maternity cases. This occupies 11% of cases. The demand for this service has reduced slightly. The object of a pregnancy is to produce a healthy infant. The pregnancy itself, though we tend to talk about it as a normal physiological process, produces physical and mental stresses on the mother to a variable extent. It is by relieving the mother of the physical burden of housework and lessening her problems of domestic worries that the home help can be of invaluable assistance, and her influence may well effect the outcome of the pregnancy. The toxaemias of pregnancy are examples of a medical condition where the home help can be invaluable; the toxaemia may be mild or severe, and the home help can help to secure for the mother, if she is a mild case, and is considered not to be in need of hospital care, that essential rest which is very important in the recovery of the toxaemic case. If on the other hand, the mother has to go into hospital, the home help can, by being there in the home to look after the needs of the rest of the family, alleviate a good deal of mental worry on the part of the mother. Other complications of pregnancy such as heart disease bring their problems and in the case of heart disease or heart failure in pregnancy the home help service may make all the difference between recovery and invalidism. When early discharge from hospital after a normal confinement takes place, as it is beginning to do in some cases on the third or fourth day, the part played by the home help may be absolutely vital. c) Tuberculosis I do not propose to say anything about tuberculosis because as far as we are concerned this is a lessening need, although the home helps still make a valuable contribution in these cases. d) Other (i) mentally sick and mentally sub-normal I would like to say something about the mentally sick and the mentally sub-normal because I think this is something of importance for the future of the service in Great Britain. The value of the home help is almost inestimable in this particular field, it can be so important that it can make all the difference between recovery and deterioration. We believe that mental illness is a result of environmental and hereditary factors, possibly more environmental than hereditary, and that on the environmental side we get both physical and mental factors coming into play. The extent and degree of mental 74 down depends on the pressures put upon the person which vary, and the results vary as individuals vary in their make up. The patient may have an exaggerated idea of the antagonism of the world outside which the home help may do something to allay, and she may in fact provide something to which the mental patient may cling at a time of crisis. She can help enormously in the relief of pressure on a child which can be so damaging at an early age to a child in an environment where mental ill health reigns. The modern trend towards the early discharge of mental patients and the early attempts at rehabilitation in the community can be assisted by the services of a home help, and I believe that the future will show this to be of increasing value. Already local authorities in Great Britain are reporting increased demand for services from psychiatric social workers, from psychiatrists and from mental hospitals generally. In the case of the mentally sub-normal, I suppose the biggest contribution the home help can make in the household is to help to relieve the tensions and pressure on parents and relatives brought about by the presence of a sub-normal child or young adult. The degree of subnormality varies widely. In my own area we have a case of a man of 50 who was certified as a mental defective some years ago. Because his home circumstances were good it was decided he would not need help so supervision was discontinued, but the chain of events some three or four years ago caused some confusion and difficulty; the fother died just before Christmas about three years ago, the mother died within a few weeks of the fother and the patient was left on his own in a council house. He is sufficiently intelligent to do a job, although he has great difficulty in looking after his own affairs. The Court of Protection took charge of his finances and the home help took over the running of the household. He has had the same home help ever since. She described to me how when she first tried the job she felt she wanted to run away because she was afraid of what this man might do. In fact she found him very amenable to discipline, he goes out to work and produces the money for her to buy his food and clothes. She now arranges to have her own holiday at the same time as he has his. The only complaint she has is that she might have been told a little more about what to expect when she went into this household. Under certain circumstances it is important that the Organisers should be in possession of the medical details of the cases being served by her staff. Infectious diseases spring to mind in this connection as well as mental illness. It is important that the home help herself should be aware of some of the possible reactions of the patient in cases of mental illness and that she should have some general understanding of people's reactions to situations. To this end a course of training may help. This could either precede service or be given after a couple of years practical experience. This leads us to consider whether the psychiatrist should not be more closely associated with the work of the local authority to be able to give the staff involved some insight into the problems of particular cases, and some help in knowing how to deal with 75 them. I think it is particularly important that the Organiser should have knowledge of the type of cases I mentioned, so that she can communicate to the home help as much information as she feels necessary. (ii) Special services I would like now to say a few words about the contribution the home help can make to the problem family. Her main contribution to my mind is of course teaching which she may give in the home in a practical way. She can show the mother, for example, how to protect food from contamination by flies, she can show the mother the correct way to dispose of her refuse, she can teach her how to care for her children, she can show her the need for a fire guard, the need for prevention of home accidents, she can teach her how to budget and to cook and to provide the right diet for her family. In this way she can exert an enormous influence on the problem family mother which I believe no other person is in a position to exert. As far as acute illness is concerned this presents problems varying with the urgency of the case. There is a great tendency in many families for mother to carry on although she is not fit to do so, and it is in exactly these cases where the home help could be of extreme value providing her assistance is made available quickly. She may in fact be responsible, as in the complications of pregnancy, for avoiding admission to hospital or for hurrying on mother's convalescence. Before I go on to the future of the service, I would just like to consider for a few moments the break-down into categories of 403 elderly patients cared for in Dagenham by the home help service. Certain ones head the list which is reproduced in full in the synopsis of my paper; arthritis, 122 out of 403 heads the list. We can visualise the medical assistance which the home help can give in these cases and I do not propose to go through the list in detail, it in no way pretends to be a complete survey. One would like to see such a survey done on a national basis or perhaps even on an international basis, but it does give some idea of the types of case we have dealt with in my own area. It was very kindly supplied by the home help organiser for the area, Miss Hickinbotham. Complaint No. of patients Arthritis 122 Heart 61 Hypertension 34 Bronchial 53 Rheumatism 26 Stroke 25 Blind or partially blind 17 Varicose veins and/or ulcers 99 Cateract 9 Mental 7 Asthma 5 Parkinson’s disease 5 76 Aged not sick 4 Tuberculosis 3 Amputations 4 Phlebitis 3 Anaemia 2 Thrombosis 3 Diabetes 3 Glaucoma 3 Effects of accident 2 Carcinoma 3 Others from which only one patient suffered:— Dislocated shoulder, osteo-arthritis, internal cysts, fibrositis, shingles, bladder, neurosis, duodenal ulcer, thyroid, sciatica, colostomy diverticulitis, disseminated sclerosis, neuritis, spondylitis, war disabled. Others suffering from more than one complaint:— Arthritis and bronchitis, arthritis and hernia, bronchitis and crippled, diabetic and neurotic, diabetic and varicose veins and husband is blind, bronchitis and leg amputated, arthritis and kidney operation. The Future What about the future of this service ? In the past it has tended to be looked upon as a gap filler to be called in where other services have either failed or felt that they have nothing further to give. I look forward to the time when it will be no longer considered a filler in of gaps but a service with a discipline of its own working under the umbrella of the Health Department in exerting its influence and making for progress from its own knowledge and with its own initiative. And what about the Organiser? Perhaps in this context discretion is the better part of valour and all I will say about this is that the organiser of the future will be a well-trained competent person with her own ' know-how' and techniques leading a section of the health department in much the same way as the Chief Public Health Inspector, in which progress can be made in a strictly medical sense as well as in the social field. And what about the home help herself? I hope that she will be a sensible person with a large measure of the milk of human kindness, competent to take responsibility; not really very different from the home help of today, (a nice experienced housewife as she has been called). And what about the training of the future home help? There appeared an article in the Medical Officer of 17th August of this year entitled " The Shining Hour " by Anne Armstrong which gave the consumer reaction to the home help service. Mrs. Armstrong disabled by poliomyelitis has had some ten thousand home help hours. She says many complimentary things about the home help service but she suggests that there should be four grades of home help, one, two, three and four 77 star. The one star would do the simplest kind of housework; two star has taken a course in housewifery, laundry and cookery; three star gains a Red Cross Home Nursing Certificate or its equivalent; and four star specialises in some form of voluntary nursing and is anxious to look after new mothers and babies and mentally handicapped people, or children whose parents are missing through being in hospital, or some other particular problem of human life. I, however, do not feel I would like to see a service developing which had these four levels of standard of staff. I believe that it would lead to a rigid pattern of service which I hope the home help service will never produce. I look forward to the time when all home helps receive adequate training along the lines done by many authorities though perhaps not available to sufficient home helps. Take the one in my own County of Essex for example. The course there lasts two weeks and contains lectures and practical demonstrations on family budgeting and household management, food values, the care of invalids, prevention of spread of infection, laundry, prevention of accidents in the home, first aid in the home, practical work in bed making etc., cookery, something of the welfare services for the aged and handicapped, the care of children and infants. This type of course, supplemented by information from the organiser, can equip a home help to meet many situations in her daily work. As far as the four grades of qualification are concerned, I am sure that at present most organisers, if they are worth their salt, and providing they have sufficient staff available, allocate to different types of case different types of helps. This allocation of the right type of help is, I believe, one of the most important jobs done by home help organisers. I maintain that the training I have outlined, with a little elaboration, perhaps with a lecture on mental illness and its implications, together with correct briefing by the organiser or her assistant, who in her turn should receive the correct medical information, will give the home help all the insight she requires to do her job. It should enable her to recognise the early signs of something wrong and when there is a need to secure the services of some other worker more appropriate to deal with the problem than herself. She will be able to take charge of a home, feeling secure that the knowledge of a background of experience and information makes it possible for her to deal with difficulties to ensure that the patient receives the basic essentials of home medical care and able to perform adequately the necessary toilet for the sick patient. Some indication of the future direction in which the service will go can be gathered from the report of the Minister of Health Part I for 1961. This shows the similar expansion to that which has taken place in some of the areas which were investigated and whose Annual Reports were read. The figures for 1953 and 1961 are compared, and the figure for instance for 1953 gives percentages; the percentage of old age and chronic sick in 1953 was 58%.but in 1961 were 76%. There 78 has been a slight decrease in maternity; a decrease from 3.5 to 1% in tuberculosis; and a decrease from 21.5 to 12% for others. The total number of cases in 1953 was 198.789. and the total number of cases in 1961 was 328.275. An attempt is made to analyse the cost of the service and to compare different authorities. The classification of the service given includes problem families, mentally confused or disturbed, resident or family helps, disinfestation, laundry, neighbourly help or group schemes, and then the short periods, early morning, during the day and evening and then weekends. The number of authorities taken as a sample was 79. 37 of these provided a service for problem families, 17 provided laundry service, 15 a resident family help, 14 provided evening service, 10 weekend, 8 neighbourly group schemes, or neighbourly help or group schemes. Tribute is paid to the home helps' husbands who have taken a great interest in the work of their wives and go along and do little repair jobs for the elderly people. On one occasion the home help organiser was visited by the husband of one of the helps who said that his wife was ill and he had come to help, he had already visited the patient and lit the fire and prepared the breakfast. The trends of the development of the domiciliary services as a whole in Great Britain and their suggested expansion is shown in the famous 10-year plan which the Minister of Health has had prepared for the hospitals. He is now asking the local authorities to prepare their plans to dovetail in with those of the hospitals. The increasing emphasis is on home care and the home help service will develop its own discipline as distinct from a discipline shared by other branches of the service. I look forward to a service where adequate research is carried out into the content of the home help's duties where her duties, as well as her case load, are more clearly defined than at present. Not in order to limit her activities but to recognise the enormous amount of medical work she really does, but to which no-one ever officially seems to admit. 79 80