A C 4411 (1) Library BOROUGH OF DAGENHAM THE HEALTH OF DAGENHAM IN 1964 BOROUGH OF DAGENHAM ANNUAL REPORT of the MEDIcAL OFFIcER OF HEALTH for the year 1964 J. ADRIAN GILLET, M.B., Ch.B., D.P.H., F.R.S.H., F.R.I.P.H.H. Civic Centre, Dagenham, Essex Telephone: Dominion 4500 INDEX Page Adolescent clinic 52 Ante-natal clinics 33 Atmospheric Pollution 18 Bentry School 56 care of Mothers and Young children 32 Cervioal cytology clinic 62 Child Development 37 Child Guidance 49 Chiropody 40 Convalescence 42 Council - Members of 3 Daily Guardians Scheme 37 Day Nurseries 35 Deaths - causes of 14 Dental Services 58 Diseases of Animals (Waste Foods) Order 1957 20 Domestic Help 39 Education committee 5 Education (General Purposes) Sub-committee 5 Factories Act 1961 20 Food and Drugs - Sampling 25 Food Hawkers - Registration 23 Food - Inspection and Supervision 22 Food Poisoning 23 Food - Unsound 23 Handicapped children 55 Health Area Sub-committee 4 Health Education 30 Health Visiting 32 Home Safety 31 Housing 17 Houses In Multiple Occuuption 17 Ice cream 23 Immunisation Diphtheria 43 Tetanus 44 Whooping cough 43 Improvement Grants 17 Infant Mortality 12 Infant Welfare centres 34 Infectious Diseases 28 Kingsley Hall Assessment centre 61 Page Laundry Service for the Incontinent Aged 18 Maternity Services 32 Midwifery Service (domiciliary) 37 Milk 22 National Assistance Act 1948 18 Noise Abatement Act 1960 19 Nurseries and child Minders Regulation Act 1948 37 Occupational Therapy (domiciliary) 41 Offices, Shops and Railway Premises Act 1963 21 Orthopaedic clinic 60 Over Sixties clinic - Oxlow Lane 42 Pet Animals Act 1951 20 Phenylketonuria 35 Premature Infante 34 Prevention of Damage by Pests Act 1949 20 Public Health committee 3 Public Swimming Baths 17 Rag Flock and Other Filling Materials Act 1951 19 Recperative Holidays 42 Rent Act 1957 17 Riding Establishments Act 1939 20 Sanitary Inspection of the District 16 School clinics 51 School Health 45 Sewerage and Sewage Disposal 16 Sickroom Equipment 41 Slum clearance 18 Smoke control Areas 19 Speech Therapy 49 Staff 6 Tents, Vans and Sheds 18 Tuberculosis 29 Vaccination B.c.G 44 Poliomyelitis 44 Smallpox 43 Vital Statistics 11 Water 15 2 MEMBERS OF THE COUNCIL (as at 31st December, I964) MAYOR Alderman F. BROWN, E.c.c., J.P. DEPUTY MAYOR councillor J. S. THOMAS ALDERMEN W. E. BELLAMY, J.P. M. EALES R. BLAcKBURN, J.P. E. M. MILLARD (Mrs.) G. H. A. cROUcH D. O'DWYER cOUNcILLORS C. H. C. BLAKE W. G. NOYcE D. A. L. G. DODD A. B. PALMER D. O, GRANDISON F. A. PINK J. P. HOLLIDGE, J.P. A. c. V. RUSHA c. W. JILLINGS B. R. SEENEY (Mrs.) R. W. KIRK M. J. SPENcER H. P. LARKING A. R. THOMAS (Mrs.) DANIEL LINEHAN L. W. TODD DAVID LINEHAN M. A. WARREN (Mrs.) W. MILNE F. F. WOODS (Mrs.) PUBLIc HEALTH cOMMITTEE cHAIRMAN Alderman (Mrs.) E. M. MILLARD VIcE-cHAIRMAN Alderman D. 0!DWYER MEMBERS His Worship the Mayor Councillor M. J. SPENcER The Deputy Mayor Councillor (Mrs.) A. R. THOMAS Councillor F. A. PINK Councillor (Mrs.) F« F. WOODS 3 DAGENHAM HEALTH AREA SUB-COMMITTEE (as at 31st December 1964) CHAIRMAN Alderman (Mrs.) E. M. MILLARD VICE-CHAIRMAN Alderman D. O'DWYER MEMBERS Borough council: The Mayor The Deputy Mayor Councillor D. A. L. G. DODD Councillor c. W. JILLINGS Councillor R. W. KIRK Councillor DANIEL LINEHAN Councillor DAVID LINEHAN Councillor A, B. PALMER Councillor M. J. SPENCER Councillor (Mrs.) A. R. THOMAS Councillor (Mrs.) M. A. WARREN Councillor (Mrs.) F. F. WOODS County Council: Alderman K. E. B. GLENNY, O.B.E., J.P. Alderman (Mrs.) E. c. SAYWOOD councillor A. c. BERRY councillor (Mrs.) S. M. BOVILL councillor (Mrs.) I. M. BROcKELBANK councillor (Mrs.) N. E. WILLIS Hospital Management committee: councillor (Mrs.) A. R. THOMAS Executive council for Essex: Mrs. L. FALLAIZE Local Medical committee for Essex: Dr. A. HETHERINGTON Local Voluntary Organisations: Miss J. CHAD BORN Mrs. R. DYMOND Mrs. R. STEPHENS Mr. J. WALSH 4 DAGENHAM Committee FOR EDUCATION (as at 31st December 1964) CHAIRMAN councillor A. C. V. RUSHA VICE-CHAIRMAN Alderman D. O'DWYER Representative Members Nominated Members Alderman W. E. BELLAMY, J.P. Dr. N. L. ANFILOGOFF Alderman R. BLAcKBURN, J.P. county councillor A. F. J. CHORLEY, Alderman M. EALES J.P. Alderman (Mrs.) E. M. MILLARD councillor c. H. c. BLAKE councillor D. A. L. G. DODD co-opted Members councillor D. 0. GRAND ISON Mr. J. M. DA VIES councillor R. W. KIRK Mr. E. E. HENNEM councillor DANIEL LINEHAN Mr. D. M. JONES councillor DAVID LINEHAN Mr. F. c. JONES councillor (Mrs.) B. R. SEENEY Mr. S. J. RUSSELL councillor (Mrs.) M. A. WARREN Mr. J. WALSH councillor (Mrs.) F. F. WOODS EDUcATION (GENERAL PURPOSES) SUB-cOMMITTEE (as at 31st December 1964) (This committee deals, inter alia, with the School Health Service) CHAIRMAN councillor A. c. V. RUSHA VIcE-cHAIRMAN Alderman D. O'DWYER MEMBERS Alderman R. BLAcKBURN councillor (Mrs.) P. F. WOODS Alderman F. BRcWN (Mayor) Mr. D. M. JONES Councillor D. 0. GRAND ISON Mr. E. E. HENNEM Councillor DANIEL LINEHAN 5 OFFICERS OF THE HEALTH SERVIcE (as at 31st December 1964) 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, M.B., B.S., D.P.H., D.I.H. M.R.c.S., L.R.c.P., D.c.H. Madeline Weizmann, M.R.c.S., L.R.c.P. Elsie Wallace, L.R.c.P. & S.I. AREA DENTAL OFFIcER (c) J. K. Whitelaw, L.D.S., R.c.S. DENTAL OFFIcERS (c) D. Berko, B.D.S. (part-time) V. Foy, L.D.S., R.c.S. (part-time) N. 0. Ekanayake, L.D.S. (part-time) A. Roberts, L.D.S., R.c.S. (part-time) R. R. Flindall, B.D.S. (part-time) c. Sumsawaste, LJ).S., R.c.S., (part-time) cHIEF PUBLIc HEALTH INSPEcTOR L. E. Prior (1), (2) PUBLIc HEALTH INSPEcTORS J. W. A11am (1), (2), (4) J. Powell (l), (2).,(4) J. cook (1), (2), (3) G. S. Self (1), (2), (4) F. W. S. Fox (1), (2), (3), (4) F. W. Silverthome (1), (2) SUPERINTENDENT HEALTH VISITOR (c) B. Long (5), (6), (7), (28) HEALTH VISITORS (c) M. F. Bass (5), (6), (7) D. J. Milbank (5), (6), (7), (10), (25), A. E. Boorman (5), (6), (7) (26) P. J. Broad (5), (7), (8), (17) B. Ramsey (5). (6). (7), (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) F. M. Stuart (5), (6), (7) E. P. Heffernan (5), (6), (7), (16) R. E.Walker (5), (6), (7), (15), (16) 0. Olopunro (5), (6), (7) (part-time) M. D. Wint (5), (6), (7) NON-MEDIcAL SUPERVISOR OF MOTIVES (c) R. K. Jesson (5), (6), (27) MOTIVES (c) E. M. crump (5), (6), (27) A. Long (5), (6) L. M. Grant (6), (9) M. Teather (5), (6) F. Harrington (5),(6), (17) Vanbrook (6) 6 ScHOOL NURSES (c) J. M. Hewitt (5) P. A. Picken £5) E. Hogg (5) M. C. Twomey (5) J. Hogg (5) A. Ward (5) (part-time) E. M. Mccheyne (5) N. F. Yamell (5), (lO) CLINIC NURSE (c) D. G. Jarvis (5) (part-time) SPEECH THERAPISTS (c) E. Shipley (22) E. Symes (22), (23) CHIEF CLERK (c) F. W. Knight (l), (2) MEDICAL OFFICER OF HEALTH'S SECRETARY E. S. Bell CLERKS E. A. Adams (c) D. Ellis (c) M.Newman (c) G. Anger (c) M. R. Flint C.Nurton (c) K. Bird (c) (part-time) P. Floodgate (c) (part-time) I.Page (c) B. J. Butt G. K. Harris M. A. Rhodes (c) J. Butterworth (c) E. Harsent (c) (part-time) K.Richards (c) V. E. cheal (c) S. B. Leader (c) D.Rolph (c) N. E. cloke (c) F. H. Martin 18) (c) G.Shanon (c) J. E. cooper (c) J. Morgan (c) B.M.Slater (c) D. L. Duff (c) E. Neport (c) J.B.Smith (c) M.A. Watts (c) DAY NURSERIES (c) Goresbrook Nursery, Matron: E. Maddison (15) Dagenham Avenue, Deputy: J. D. Houghton (17) Dagenham. chadwell Heath Nursery, Matron: P. Ardley (17) Ashton Gardens, Deputy: G. Maddison (17) chadwell Heath. Kingsley Hall Day centre Sister-in-charge: c. V. Torrington (5) for 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. M. Hurford M. E. Sealey c. M. Strachan OccUPATIONAL THERAPIST (c) Z. Mercer 7 PUBLIC ANALYST J. Hubert Hammence, Ph.D., M.Sc., F.R.I.c. (part-time) ORTHOPAEDIc SURGEON (H) A. F. Brison, F .R.c.S. OPHTHALMOLOGIST (H) P. Lancer, M.B., B.S., M.R.C.S., L.R.C.P., D.C.H., D.O. (part—time) PHYSIOTHERAPIST (H) E. Oitley, M.C.S.P. Officers employed by the Essex county council are indicated thus: (c) Officers seconded from the Regional Hospital Board ere indicated thus: (H) 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. Unfortunately, this report has been long delayed because of the multitude of problems created by amalgamation, and it is very difficult at the time of writing this introduction to cast one's mind back to 1964 when the next three months were the preliminary to amalgamation of the Borough with the Borough of Barking to form a new Greater London Borough. During the year there was a slight increase of infant mortality rate. This was due mainly to the increase of deaths due to birth injury, but the general tendency is still for the infant mortality rate to decline year by year. The number of deaths due to heart disease was a little less than 1963 most of the deaths in this group being due to coronary disease and angina. Deaths from lung cancer continue to climb. During 1964, 88 people died as compared with 74 in 1963. In spite of a good deal of intensive health education about the dangers of smoking, we have not yet seen any appreciable effects. This may be because the effect of smoking takes many years to produce cancer of the lung, and therefore it will take many years to reduce deaths from this cause. It is unfortunate that one of the few conditions which we know we can affect by health education responds so poorly to our efforts in this direction. cancer of the cervix in women, which can be detected in the very early stage by taking smears from the neck of the womb and examining them under a microscope, is another type of cancer which lends itself to prevention. A start in this detection service was made in 1964 in a limited way by agreement with the Pathologist at Oldchurch Hospital. This service began in May, and between May and December 92 women were tested. None was discovered to be in need of further treatment. We hope that as the pathological facilities become available this screening procedure will become a major activity in preventive medicine, particularly as the condition is present so often in the mothers of young children. As usual, the Public Health Inspectors were extremely busy during 1964. Almost 10,000 visits were paid in relation to the clean Air Act by the Public Health Inspectors to instance only one activity. The Offices, Shops & Railway Premises Act 1963 came into operation during the year. A start was made on the visiting of shops which dealt with food and all offices, while the Shops Act Inspector visited the non-food shops. The list of foods taken for sampling shows one or two interesting results; for example, in one case nicotinic acid and ascorbic acid were found added to mincemeat, which is not permitted under the Meat Treatment Regulations 1964* Education in food hygiene continued to expand - as it should - because it is largely through education of the food handler and of the public to demand a high standard of food handling that we shall make progress. The power to prosecute is there, but it may well be that in the years to come it will be the absence of prosecutions which proves that progress is being made. There was an increase of activity in the courses for the certificate of the Royal Institute of Public Health and Hygiene, though during the year an attempt to get a Diploma in Bakery Hygiene Examination held was abandoned because of insufficient students to run the second course in September. 9 Health education in schools expanded considerably. In the health education activities in the over sixties clinic, a film strip was made dealing with exercises for old people, as well as a 16 mm. film at Kingsley Hall Old People's Day centre which shows in attractive form the exercises which are advised for the over sixties. I gave my usual broadcast on the B.B.c. Service Health Talks for Schools Series in December, and was privileged to broadcast short talks for elderly listeners to the B.B.c. Home Service programme „Indian Summer„ and its successor „Home This Afternoon„. In previous reports it has been the custom to list the talks and film shows given, but they are now becoming *so numerous that mention has been made only of organised courses - though as can be seen from the main body of the report, 94 talks and film shows were given to various organisations and schools in the borough. We hope that the health education in schools will progress in co-operation between the health department staff and the teachers. It is interesting to see that while attendance at some of the ante-natal clinics for examination tends to fall, the ante-natal preparation classes where the expectant mother is taught about her condition and about the care of the infant - continue to flourish. During the year, a total of 2,467 attendances were made at the classes, and the demand still continues. One subject which has only two lines in the report, that is routine testing of the urine of young children for phenylketonuria, continued during the year. No cases of the disease were discovered. This is extremely time-consuming work, but is very much the work of the health department. The child development activities organised by Dr. Hodgson continued to prove interesting, and the Health Visitors helping her have shown considerable enthusiasm. In the main body of the report she thanks them for this. The Adolescent clinic, too, continued to be popular. The limitations on the demands are limitations of staff and space, and we hope that this activity which has gone along very quietly but which is an extremely valuable one - will continue to be popular with the children and parents. As this will be the last complete year during which I shall report on the work of the Borough of Dagenham health department, I would be ungracious if I did not acknowledge the debt I owe to the staff of the health department, who work with a will, very often with very little recognition, but with the satisfaction of having done an extremely good job. The health department activities are the activities of a team, and the results achieved must be the results of a team and cannot be attributed to one person. I would also be ungracious if I did not acknowledge the help that Mrs. Millard has given, and the support she has given to me while she has been chairman, sometimes when she has not really been feeling very fit. She has not considered herself or spared herself in the help she has given me. My thanks are due, too, to the Health committee who have put up with me over the years, and with whom we have had some most interesting and stimulating discussions. At the end of 1964 I looked forward - perhaps with some doubts - to the new London Borough of Barking, but with the hope that we would, because of our increased powers, make rapid progress. J. ADRIAN GILLET Medical Officer of Health. 10 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area and Population Area (in acres) 6,728 Registrar General's estimation of resident population 107,060 No. of inhabited houses (end of 1964) according to rate books 32,024 Rateable value (3lst December 1964) £6,318,956 Sum represented by a penny rate (1964/65) €25,774 Vital Statistics Live Births : Legitimate (703 male, 696 female) 1,399 Illegitimate (48 male, 53 female) 101 Total (751 male, 749 female) 1,500 Illegitimate live births per cent of total live births 673 Rate per 1,000 population 14,01 Stillbirths : Legitimate ( 16 male, 7 female) 23 Illegitimate ( 2 male, 1 female) 3 Total (18 male, 8 female) 26 Rate per 1,000 total live and stillbirths 17.04 Total live and stillbirths 1,526 Infant deaths 34 Infant mortality rates: Total infant deaths per 1,000 total live births 22.67 Legitimate infant deaths per 1,000 legitimate live births 22.16 Illegitimate infant deaths per 1,000 illegitimate live births 29.70 Neonatal mortality rate (deaths under four weeks per 1,000 total live births) 16.67 Early neonatal mortality rate (deaths under one week per 1,000 total live births) 16.00 Perinatal mortality rate (stillbirths and deaths under one week per 1,000 total live and stillbirths) 32.77 Maternal mortality (including abortion): Number of deaths Rate per 1,000 total live and stillbirths General mortality: Number of deaths (517 male, 418 female) 935 Death rate per 1,000 population - crude 8.73 Death rate per 1,000 population - adjusted 12.57 Births The total of 1,500 live births notified during the year is virtually the same as that for the previous year (1,499). The corrected birth rate per thousand population was 14.0, compared with 18.4 for England and Wales. The illegitimate birth rate showed a noticeable rise, being 6.7% of total live births, compared with 5.2% in 1963 This is less than the national average, which is 11 The stillbirth rate was 17.0 per 1,000 total live and stillbirths, compared with 16.4 per 1,000 for England and Wales. This is less than the rate of 17.7 per 1,000 births recorded last year. Deaths The infant mortality rate has risen to 22.7 per 1,000 live births, which is greater than the rates recorded in the previous two years but slightly less than the figure recorded in 1961. The national rate for 1964 was 20.0 per 1,000 live births. The infant mortality rate is subject to quite considerable fluctuations from year to year, and when viewed over a number of years it is apparent that the general trend is downwards. The main factors contributing to the present increase were a rise in the number of deaths attributable to birth trauma from 3 in 1963 to 9 in 1964 and three deaths due to less common causes, viz. sarooma, diabetes mellitus, and infanticide. The causes of infant deaths 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 1 yr. Total Deaths under 1 yr. Prematurity 7 - - - 7 - - - - 7 Prematurity with associated cause 5 1 - - 4 1 - - - 5 congenital abnormality - - - - - 2 - - 2 4 Birth trauma 9 - - - 9 - - - - 9 Bronchopneumonia - - - - - - 1 - - 1 Bronohitis - - - - - 1 1 - - 2 Atelectasis 1 - - - 1 - - - - 1 Rhesus incompatibility 2 - - - 2 - - - - 2 Other oauses 2 - - - 2 - 1 - - 3 Among the population as a whole the principal causes of death were:- Heart disease (all forms) 282 deaths Cancer (including leukaemia) 235 „ Vascular lesions of nervous system 96 „ Bronchitis 61 „ Pneumonia 40 „ The number of deaths due to heart disease was a little less than the number (297) recorded the previous year. The majority of deaths in this group are caused by coronary disease and angina. It is my melancholy duty to report that our record has again been broken for deaths due to lung cancer. This year 88 people died of this disease, compared with 74 last year. This is the commonest form of cancer causing death. 12 There was some reduction in the number of deaths due to cancer of other parts of the body, so that the total number of deaths from cancer was slightly less than in 1963 . Deaths due to bronchitis have reverted to their normal level after the high figure of 111 recorded last year (an increase which was associated with severe winter weather). There were no maternal deaths in 1964 The adjusted death rate was 12.6 per 1,000 of the population, compared with 11.3 per 1,000 for England and Wales. 13 14 causes of Death, 1964 Under 1 yr. 1 and under 5 yrs. 5 and under 15 yrs. 15 and under 25 yrs. 25 and under 45 yrs. 45 and under 65 yrs. 65 and under 75 yrs. 75 and over Total M F M F M F M F M F M F M F M F M F 1. Tuberculosis, respiratory - - - - - - - - 2 — 1 — 4 - 2 - 9 - 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 - 10 2 8 - 2 5 21 7 11. Malignant neoplasm, lung, bronchus - - - - - - - - 4 2 32 7 29 5 8 1 73 15 12. Malignant neoplasm, breast - - - - - - - - - 3 - 11 1 7 - - 1 21 13. Malignant neoplasm, uterus - - - - - - - - - - - 6 - 2 - 1 - 9 14. Other malignant and lymphatic neoplasms 1 - - - - - - 1 8 1 8 11 19 17 10 6 46 36 15. Leukaemia, aleukaemia - - - 1 1 - 1 - - - 1 - 1 1 - - 4 2 16. Diabetes - - - - - - - - - - 2 - - 1 - 2 2 3 17. Vascular lesions of nervous system - - - - - - - - 3 - 7 12 11 20 19 24 40 56 18. coronary disease, angina - - - - - - - - 6 - 59 16 39 29 19 27 123 72 19. Hypertension with heart disease - 2 - 3 5 1 6 6 11 20. Other heart disease - - - - - - - - 1 2 5 8 5 12 13 24 24 46 21. Other circulatory disease - - - - - - - 1 - 1 7 6 6 8 12 14 25 30 22. Influenza - - - - - - - - 1 - - - 1 - - - 2 - 23. Pneumonia 1 2 - — - - - - — — 2 2 9 5 10 9 22 18 24. Bronchitis 1 1 - - - - - - - - 8 3 14 4 18 12 41 20 25. Other diseases of respiratory system - - - - - - - - 1 - 3 1 4 1 1 1 9 3 26. Ulcer of stomach and duodenum - - - - - - - - - - 2 - 4 2 - 3 6 5 27. Gastritis, enteritis and diarrhoea - - - - - - - - - - 1 - - 2 - 1 1 3 28. Nephritis and nephrosis - - - - - - - - - - 1 1 - 3 - 1 1 5 29. Hyperplasia of prostate - - - - - - - - - - - - 1 - 2 - 3 - 30. Pregnancy, childbirth and abortion - - - - - - - - - - - - - - - - - - 31. congenital malformations 1 2 - - - 1 - -- - 1 - 1 1 - - 1 2 6 32. Other defined and ill-defined diseases 12 12 - 1 - - - - 2 2 8 8 6 3 4 9 32 35 33. Motor vehicle accidents - - 1 1 — - 4 2 2 - 4 2 — 1 1 - 12 6 34. All other accidents - - - - 1 - 1 1 1 - 3 - 1 - - 4 7 5 35. Suicide - - - - - - 1 - 3 1 - 1 - - - - 4 2 36. Homicide and operations of war - 1 - - - - - - - - - - - - - - - 1 16 18 1 4 2 1 7 5 35 13 167 98 167 128 122 151 517 418 REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR SANITARY INSPECTION OF THE DISTRIcT (a) Nature and number of visits:- Rent Act 84 Housing and Public Health Acts:- Dwelling houses 1,854 Other premises 712 Overcrowding and housing applications 397 Improvement Grants 524 Multiple Occupation 61 Bakehouses 69 Milkshops and dairies 51 Foodshops, stalls and itinerant vendors 1,619 cafes and canteens 328 School kitchens and feeding centres 124 Infectious disease enquiries 912 Number of complaints investigated 1,091 Noise nuisances 138 clean Air Act:- Survey 4,282 Other inspections 5,655 Factories 190 Offices, Shops and Railway Premises Act 252 Rag Flock and Other Filling Materials Act 19 Tents, vans and sheds 46 Pet Shops 14 Hairdressers 39 Ice cream premises and vehicles 152 Houses disinfested 25 Rodent control 568 Other visits 711 (b) Notices served 1- complied with:- Statutory 184 126 Informal 275 215 WATER The water supply is satisfactory in quality; although during the period under review the quantity has been satisfactory there is some apprehension in respect of the future. During the year two chemical and two bacteriological samples were taken from the company's mains in the borough; all were satisfactory. The water is not liable to have plumbo - solvent properties and no action was called for in respect of any form of contamination. Approximately .015 per cent. of the inhabited houses and .009 per cent. of the population of the borough take their water from standpipes. During the year the following mains were laid 15 Length of Mains Yards Diameter 292 12" 75 6" 252 4" 494 3" 93 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 4,005 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 is somewhat inadequate. Work is nearing completion on the construction of a Balancing Lake as part of improvements to the Wantz surface water drainage area and it is anticipated that further works of culverting the Wantz stream through built-up areas will commence in the near future. Proposals by the council's consulting Engineers for improvements to the Foul Trunk Sewerage System have been accepted by the council as necessary works in the near future. (b) Sewage Disposal The council's Riverside Sewage Works continues to operate under considerable pressure due to the high overload with which it is expected to deal. Despite the installation of „Simplex High Intensity cones„ during1963, the final effluent is often far from satisfactory due to the overload. During 1964, however, a start was made on the first of the civil engineering contracts associated with the major extensions to Riverside Works to enable sewage from Dagenham, Hornchurch and Romford to be treated at this one works. The scheme is due for completion some time in 1968. 16 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 continued to function satisfactorily. HOUSING Slum clearance During the year two houses included in the council's programme were voluntarily demolished by the owners with a view to redevelopment of the site; two houses (one owned by the council) were represented with a view to closure. Rent Act, 1957 Eleven applications were received from tenants during the year compared with seven 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 the landlord in respect of four properties. Two certificates of Disrepair were issued and two 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. Improvement and conversion Grants The Housing Act 1964 has extended considerably the local authority's powers in respect of the improvement of property. Tenanted property can now be compulsorily improved if the tenant so desires. Local authorities are required to arrange for the inspection of their districts with a view to identifying areas suitable for comprehensive improvement; where they declare defined areas to be improvement areas, this has the effect of applying their powers to compel improvements of tenanted houses in those areas. Two types of grant available are still the 'discretionary' grant and the 'standard' grant, but the maximum of the 'standard' grant has been increased from £155 to £350 if, say, a new bathroom is required to be built. This increase in the amount of the 'standard' grant and the easing, in recent years, of the conditions attached to grants should attract many more applicants. Applicants are always encouraged to make preliminary enquiries before any expense is incurred. Every effort is made to deal with the applications as speedily as possible. During the year many enquiries were received; in some cases the improvements desired were not eligible for grant. Eleven applications for 'standard' grants and six for 'discretionary' grants were approved. All but one of the applications were from owner/occupiers. Houses in Multiple Occupation In one case legal proceedings were authorised but the overcrowding was abated before proceedings could be instituted; a statutory notice was, therefore, served limiting the number of persons that may reside in the house to '5'. In another house statutory action was delayed because of the difficulty of establishing who was the owner. 17 There are no common lodging houses in the borough. Tents, Vans and Sheds The number of gypsies pulling 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, has continued to decrease. During the year inspectors paid 46 visits to the one or two sites used by the gypsies. NATIONAL ASSISTANCE ACT,1948 Section 47 The surveillance of persons who are unable properly to care for themselves continues to receive the constant attention of all members of the department. The various services operated by the department continue to improve the lot of many of these unfortunate people, who, although they cannot do much for themselves are unwilling to leave their homes in what are inevitably their last days. It was not necessary compulsorily to remove any person during the year, although in one or two cases health visitors and inspectors assisted in improving conditions, especially general cleansing, before and after voluntary removal to hospital. Section 50 One female was buried under the provisions of this section during the year. LAUNDRY SERVIcE FOR THE INcONTINENT AGED This service continues to meet the 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. Disposable plastic bags are now used as containers for the soiled linen; this has been a considerable improvement and is cheaper than using linen bags which require regular washing. The helpful, co-operative attitude of the department's driver and the laundry staff at the Barking Hospital in carrying out what is sometimes a very unpleasant task, ensures a very satisfactory service. An average of about 22 cases use the service at any one time. 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 50 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 were commenced in 1962 at four additional sites. The types of district in which the sites are situate are:- (i) Residential with high population density (Bennett Road). (ii) Residential with low population density (Thompson Road). (iii) Industrial (Ford Motor company). (iv) Smoke control area (Marks Gate). 18 Smoke Control Areas The council agreed in principle in 1959 to include the whole borough in Smoke control Areas as soon as possible, and, in any case, in not more than ten years. The programme was drawn up to provide each year an area containing about 3,000 houses and was originally planned to include all houses in the borough by 1970. The progress up-to-date 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 3,046 L. C.C. Estate 1st November, 1964 7 2,690 „ „ 1st November, 1965 The extent of the work involved is indicated in that during the year 9,937 visits to premises have been paid by the inspectors. It is pleasing to report that the rate of progress envisaged in the original programme has been more than maintained. So far 19,792 houses out of a total of nearly 32,000 houses in the borough have been included in Smoke control Orders. In Order No. 7, which completes smoke control work on the whole of the Becontree Estate in the borough, freedom of choice is being given to householders, i.e. between approved appliances using solid fuel (open coke-burning grate, undercolor draught open grate and openable stove), gas, electricity (night storage heaters only) and oil. 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. complaints were received during the year concerning 13 noise nuisances. Eight were in respect of private dwellings and of these six were concerned with noisy neighbours and two with defective plumbing. Three complaints were in respect of places of public entertainment causing a nuisance to adjacent residents. complaints were made in respect of two factories. At one, conditions had been satisfactorily improved by the end of the year, and at the other, assessment and possible remedial action are under consideration. 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 it was found necessary to prosecute in three cases street traders who, after advice and warning, continued to contravene the provisions of the Act by the operation of loud speakers in streets to attract attention for the purpose of selling ice cream. In 18 other cases warning letters were sent, which is the council's policy in the case of first offenders. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Three premises which have been registered under Section 2 of the Act have continued to operate. One licence for the manufacture of rag flock has been issued during the year. Samples are regularly taken at the three factories in the borough where filling materials are manufactured. 19 Eighteen informal samples were taken during the year; two samples of cotton felt were unsatisfactory The details are as follows:- Material No. of Samples Submitted for Analysis Rag Flock 3 Cotton Felt 8 Kapok 3 Sisal 3 Layered Flock 1 PET ANIMALS ACT, 1951 Five licences authorising the keeping of pet shops have been issued. The conditions attached to the licences are those approved by the Association of Municipal Corporation;no serious breach of the conditions occurred. PREVENTION OF DAMAGE BY PESTS ACT, 1949 Disinfestation of rate 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. There was no major infestation of either rats or mice during the year. RIDING ESTABLISHMENTS ACT, 1949 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. No serious breach of the Order was found during the year. FACTORIES ACT, 1961 Inspections Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical 27 15 - - Factories with mechanical power 148 160 10 - Other premises under the Act (including works of building and engineering construction but not including outworkers premises) 11 15 - Total 186 190 10 - 20 Defects Found Number of defects Number of Prosecutions Instituted Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of cleanliness 2 2 _ _ _ Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation _ - - - - Ineffective drainage of floors 1 1 - - - Sanitary conveniences Insufficient 1 1 - 1 . Unsuitable or defective 13 12 - - - Not separate for sexes - - - - - Other offences 2 2 - - - Total 19 18 - 1 - Outwork Number of outworkers In August list 11 Nature of work - Making, etc., wearing apparel. OFFIcES, SHOPS AND RAIIWAY PREMISES AcT, 1963 The council approved as an interim measure that, without drawing a rigid line, the Shops Act Inspector should be responsible for non-food shops and the Public Health Inspectors for food shops and all offices. The following statistics indicate the work done by the Publio Health Inspectors during the year i- No. of Premises registered during the year Total No. of registered premises at end of year No. of registered premises receiving a general inspection during the year Offices 196 196 44 Retail shops 482 482 15 Wholesale departments, warehouses 13 13 2 catering establishments open to the public, canteens 44 44 - 21 class of Workplace Registered in Borough No. of persons employed Offices 1,542 Retail shops 2,473 Wholesale departments, warehouses 323 catering establishments open to the public 451 canteens 2 Fuel storage depots - Total 4,791 Total Males 2,296 Total Females 2,495 During the period a notification of a minor accident was received in respect of a female shop assistant. INSPECTION AND SUPERVISION OF FOOD The numbers and types of food premises In the borough are as follows:- 4 Bakehouses 27 Bakers and confectioners 55 Butchers 203 cafes and canteens 27 Fishmongers 57 Fruiterers and Greengrocers 95 Grocers 22 Licensed and 18 off-licensed premises 89 Sweets, etc# All food premises are regularly Inspected, and during the year 2,124 visits were paid. In addition to numerous verbal warnings and suggestions to management and staff during these routine visits, 73 informal notices were served upon owners and occupiers. Thirty-nine inspections were carried out In connection with itinerant vendors and stalls. The position under the Food and Drugs Act, apart from registrations in respect of ice cream, is as follows:- 36 butchers premises and 6 other food premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these registered premises 369 visits were paid. 21 fish shops are registered for frying. To these 112 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 55 operating from 94 premises. There are four milk vending machines on shop forecourts. Fifty-one visits were paid to dairies and distributors premises. 22 During the year, 78 samples of milk were submitted for bacteriological examination. Two samples, both from vending machines, failed to pass the methylene blue test; in one of the two cases the atmospheric shade temperature during the test exceeded the permissible limit of 65°F. Ice cream The total number of registered premises selling ice cream is 138; of this number, one is registered for manufacturing ice cream. 126 visits were paid to these premises. During the year, two applications for the storage and sale of ice cream were granted. 28 inspections in connection with itinerant vendors were carried out. During the year, 95 samples of ice cream were submitted for bacteriological examination; they were graded as follows t- Grade I Grade II Grade III Grade IV Total Wrapped Ice cream 49 15 5 3 72 Loose Ice cream 5 3 19 Soft Ice cream 6 6 2 14 In addition to ice cream, 52 lollies were submitted for examination. Six were unsatisfactory; the lollies were manufactured outside the borough and the local authorities 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, 33 such complaints were investigated. In most cases, warning letters were sent to the persons responsible. Legal proceedings were authorised in three oases; in two cases the complainants were unwilling to give evidence, and in the other a fine of £10 was imposed. Registration of Food Hawkers Under the provisions of the Essex county council Act 1952, Section 103, three persons were registered as food hawkers; in one case, storage accommodation was outside the borough. Food Poisoning One case of food poisoning was notified during the year. The following is a copy of the annual return submitted to the Ministry of Health:- 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 1 - - 1 cases otherwise ascertained 30 Symptomless Excretes Nil Fatal cases Nil 23 Particulars of Outbreaks:- Number of Outbreaks Number of Cases Total No. of cases Family Other Notified Otherwise Ascertained Agent identified - - - - - Agent not identified - 1 - 30 30 Single Cases:- No. of Cases Total No. of cases Notified Otherwise Ascertained Agent identified Salmonella Typhimurium 1 - 1 Agent not identified - - - Food and Drugs - Sampling Article Number Examined Number Adulterated Formal Informal Formal Informal Almonds, Ground _ 1 - - Baking Powder - 1 - - Beef and Ham Burgers - 2 - - Beef, Minced 6 - - - Beer - 1 - - Beverages - 5 - - Biscuits - 3 - - Bread - 7 - 7 Butter - 7 - - Cereals - 1 - 1 Condiments - 4 - - Confectionery - 5 - 4 Cordials - 8 - 1 Cornflour - 1 - - Cream - 1 - - Crisps - 1 - - Custard Powder - 1 - - Fish, Frozen - 6 - - Fish, Tinned - 3 - - Flour - 1 - 1 Foreign Material from School Dinner - 1 - 1 Fruit, Dried - 1 - - Fruit, Tinned - 6 - - Gravy - 2 - - Ice Cream Powder - 1 - - Jams, etc. 2 6 - - Jellies - 3 - - Junket - 1 - - Lemon, Sliced - 1 - 1 Luncheon Meat - 4 - 2 24 Food and Drugs - Sampling (continued) Article Number Examined Number Adulterated Formal Informal Formal Informal Meat, Tinned - 1 - - Medicinal Samples - 3 - - Margarine - 1 - - Meat - 1 - - Meat, Minced 1 - 1 - Milk 12 - - - Milk, Tinned - 1 - - Mousse - 1 - - Oil - 1 - - Pastes - 1 - - Pies - 3 - 3 Pie Fillings - 5 - 1 Potato Puffs - 1 - - Sauces - 1 - - Sausages - 10 - 1 Spaghetti - 2 - - Spices - 3 - - Spreads - 1 - 1 Stock Tablets - 1 - - Sweets - 4 - 1 Syrup - 2 - - Tea 1 2 - - Vegetables, Tinned - 8 - - Wines and Spirits 20 5 2 1 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 1348A Cake Informal Was in a mouldy condition Retailer and Manufacturer warned 1353A Bread Informal Contained foreign matter in the form of charred dough containing traces of iron Manufacturer warned 1354A Bread Informal Was in a mouldy condition Manufacturer warned 1385A Bread Informal Contained discoloured dough caused by incorporation of charred dough Manufacturer warned 1356A Bread Roll Informal Contained the meso- and metathoracic segments of a female cockroach, Blatta Orientalis Manufacturer warned. (Witness would not attend court.) 25 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 1355A Corned Beef In formal Contents of can in a mouldy condition due to a small puncture in lid Manufacturer warned 1358A Pork Pies Informal In a mouldy condition Retailer warned 1359A Steak and Kidney Pies Informal In a mouldy condition Retailer and manufacturer warned 1407A Lemonade Informal Contained a film of mould growth Manufacturer warned 1409A Foreign material taken from school dinner Informal Consisted of compacted masses of vegetable tissue including fragments of peas No action necessary 1426A Apricot Brandy Informal Contained 1.7% less proof spirit than the stated amount (proof spirit 54.3%) Manufacturer warned 2737 Whisky Formal 1% added water Distiller informed 2741 Mincemeat Formal Contained added nicotinic acid and ascorbic acid which is not permitted by the Meat Treatment Regulations 1964 Retailer warned 2747 Whisky Formal 1.4% added water Distiller informed 1303A Bread Informal Contained foreign matter consisting of masses of brownish flour dough Manufacturer warned 1305A Cheese Spread Informal Showed presence of emulsifying salts crystallising out on the outer edges suggesting that it was old stock Retailer warned 1321A Madeira Cake Informal Contained a small house fly Manufacturer warned 1322A Breakfast Sausage Informal Contained foreign matter in the form of a splinter of wood measuring 6 mm. x 3 mm. Manufacturer warned 1323A Cake Informal Was in a mouldy condition Manufacturer warned 26 Serial No. Article Formal or Informal Nature of Adulteration or Irregularity vations 1324A Oats Informal Contained foreign matter e.g. cheese, dried peas, metal foil, piece of card, splinters of wood, remains of a small fly, etc. Legal proceedings • Fined £10, 3 guineas costs 1325A Lemon, sliced Informal Contained a small area of mould growth Retailer warned 1326A Sweets Informal Contained specks of a bluish dyestuff embedded in the top surface of the sweets Manufacturer warned 1327A Bread Informal Contained streaks of greyish discoloured dough due to traces of burnt dough Manufacturer warned 1338A Flour Informal Contained two small fragments of metallic zinc Manufacturer warned 1339A Bread Informal All slices showed the presence of mould growth Manufacturer warned 1340A Pork Pie Informal Was in a mouldy condition Retailer warned 1341A Pork Pie Informal Was in a mouldy condition Retailer warned 1347A Swiss Roll Informal Was in a mouldy condition Retailer and manufacturer warned 1328A Corned Beef Informal Not hermetically sealed due to split in the score strip. Mould growth on contents under split. Manufacturer warned 27 PREVALENCE OF, AND CONTROL OYER INFECTIOUS AND OTHER DISEASES Notifiable Diseases (other than Tuberculosis) Under 1 yr. 1 - 2 - 3 - 4 - 5 - 10 - 15 - Oyer 25 yrs Total Scarlet Fever 3 - 1 3 4 27 2 3 - 43 Whooping Cough 9 5 11 7 4 26 1 - - 63 Measles 33 56 104 78 97 321 8 4 - 701 Diphtheria - - - - - - - - - - Dysentery - - 1 1 - 1 - - 1 4 Acute Poliomyelitis: Paralytic - - - - - - - - - - Non-paralytic - - - - - - - - - - Meningococcal infection - 1 - - - - - - - 1  Under 5 yrs 5 - 14 15 - 44 45 - 64 65 and over Total Pneumonia: Acute Primary 1 1 1 - 6 9 Acute Influenzal - - - - - - Encephalitis, Acute: Infective - - - - - - Post Infectious - - - - - - Erysipelas - 1 - - 1 2 Food Poisoning - - - 1 - 1 Puerperal Pyrexia - - - - - - Ophthalmia Neonatorum 2 - - - - 2 Paratyphoid B - - - - - - Typhoid - - 1 - - 1 Smallpox - - - - - -  Notified Admitted to Rush Green Hospital Admitted to other Isolation Hospitals Admitted to other Hospitals Dysentery 4 - - 1 Encephalitis, Acute: Infective - - - - Post Infectious - - - - Erysipelas 2 1 - - Food Poisoning 1 - - - Measles 701 - - - Meningococcal Infection 1 1 - - Paratyphoid Fever - - - - Puerperal Pyrexia - - - - Pneumonia: Acute Primary 9 - - 2 Acute Influenzal - - - - Acute Poliomyelitis: Paralytic - - - - Non-paralytic - - - - Scarlet Fever 43 - - 1 Typhoid 1 1 - - Whooping Cough 63 1 - 1 28 TUBERCULOSIS New Cases Deaths Primary Notifications Brought to Notice other than by Form A Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F M F M F Under 1 - - - - - - - - - - - - 1 - 4 - 1 - - - - - - - - - - 5 - 9 - - - - - - - - - - - - 10 - 14 - - - - - - - - - - - - 15 - 19 1 2 - - - - - - - - - - 20 - 24 - 2 - - - - - - - - - - 25 - 34 - 1 2 - - - - - 1 - - - 35 - 44 6 2 - - - - - - 1 - 1 - 45 - 54 1 - - - - - - 2 1 - - 55 - 64 4 1 - - - - - - 4 - - - 65 and upwards 4 - 1 - - - - - 6 - 2 1 Totals 16 9 3 - - - - - 14 1 3 1 Register Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January 1964 546 431 69 68 During the year:- New notifications 16 9 3 - New cases brought to notice by Registrars' Death Returns - - - - Deaths 14 1 3 1 Transfers into area 28 13 - 2 Transfers out of area 26 27 1 1 Removed from Register as "Recovered" 6 3 2 1 No. on register 31st December 1964 544 422 66 67 29 HEALTH EDUCATION The impending reorganisation of local government in the Greater London area made 1964 a year of consolidation rather than of expansion of the health education services. Much time was spent in liaison with the staff of the Borough of Barking, so that such new developments as took place followed a pattern acceptable to both parties. Film shows and talks were given to various organisations, and in these use was made of the Health Department film "Help Yourself to Health" which was released in 1963. The outbreak of typhoid in Aberdeen provided the basis for a number of talks on food hygiene, and the latter was adopted as the theme for the Town Show display. Maternity and Child Welfare The demand by health visitors for visual aids for teaching in clinics continued to rise; film strips were in greater demand than ever before, particularly when at the end of the year the long-awaited strip on the psychoprophylactic method of ante-natal preparation became available. The increased use of this method of preparation for childbirth was responsible for a falling off in demand for the film "To Janet a Son" and its replacement by "Birthday". Displays The main annual display was that at the Town Show where, as mentioned above, the theme adopted was "Clean Food". Co-operation from the Gas Board, the Electricity Board and a local school helped to produce some interesting exhibits which included a three foot model fly perched on a dustbin. Advice and literature on refrigeration, hand washing, and the general care of food were provided by the public health inspectorate and the exhibit was well patronised. At one of the clinics a dental display was erected and anti-smoking stands were supplied to three schools. Health Education in Schools The anti-smoking campaign run in 1963 provided an entree to many schools which up to then had not availed themselves of the facilities of the health education section. In consequence, a liaison was established between the health education officer and certain schools1 staffs which will be of great value in the future. During 1964 two "health weeks" were run, one in a primary and the other in a junior school. The first dealt with the twin topics of hand washing and care of the teeth, whereas the second was solely devoted to dental care. The health education section of the Essex County Council health department provided the latter which included film shows and lectures to the whole school (by classes) and a large display complete with a full dental suite. A parent-teacher meeting was held during the week at which parents were invited to see the films and the display and to discuss problems with the dental staff. Generally, school staffs made much greater use than before of the equipment, literature and film strips available in the health department, and only asked for speakers to be provided for specialised topics. However, in a few schools the established pattern of organised health education courses arranged end largely staffed by the health department was continued, but it is rapidly becoming apparent that as more schools take more interest in the subject, staffing problems will restrict the number of specialist speakers who can be allocated annually to any particular school. This is a problem which must be faced jointly by teaching and health staffs, and some restriction of ideas on 30 the teaching of health education would appear to be inevitable. The Training of Students There was a slight modification in the training programme for students from the London University Institute of Education in that instead of them attending for one day each week throughout two terms, arrangements were made for them to come for two whole weeks in their second term, This would appear to be better, as it affords an opportunity for the students to see virtually any function of the health department instead of only those available on a certain day of the week. Films and Film Strips The film strip "Exercises for the Over Sixties" being made in conjunction with Messrs. Camera Talks was completed early in the year and another entitled "Teenagers' Feet" was commenced. Work was continued on the 16 mm. film on Child Development, the majority of the shooting being completed by the end of the year. The main aim of the film is to show the wide range of normal development in children. The assistance of the health education officer from Essex County Council was obtained in the production of a 16 mm. colour cine film on old people's exercises. This was intended to supplement the filmstrip on the same subject and has proved to be very popular and useful - so much so that two additional copies have had to be made. Food Hygiene Courses for the certificate of the Royal Institute of Public Health and Hygiene were continued both at Rush Green College and at one of the bakeries. During the year 52 candidates presented themselves for examination and 48 were successful. Despite the successes in the Diploma in Bakery Hygiene examination held at the beginning of the year, there were insufficient students to run a second course in September. However, arrangements were made for one to commence after Christmas. Apart from examination courses, talks were given to two groups of trainee manageresses at a bakery. Home Safety The main emphasis in home safety training was laid on water safety, safety with electricity and gas poisoning, with particular reference to artificial respiration. A resuscianne model for demonstrating "mouth-to-mouth" resuscitation was purchased, and was extensively used in schools and with nursery staffs. Home safety teaching was included in all health education syllabuses for schools. Support to No. 9 Area Home Safety Committee of RoSPA was continued during the year and assistance was also given in the formation of an Essex Home Safety Liaison Committee. The function of the latter is not only to exchange ideas between members, but also to allow them to borrow and lend display equipment when necessary. This should be of great benefit to the smaller home safety committees whose financial resources are severely restricted. Talks In December I once again broadcast on the B.B.C. Home Service "Health Talks for Schools" series. The broadcasts were daily and of 15 minutes1 duration from 31 Monday, 14th December, to Friday, 18th December, and were entitled s- (a) Why does your school doctor see you? (b) Good health. (c) First aid. (d) Healthy eating. (e) Questions please. I also broadcast a number of short talks for elderly listeners to the B.B.C. Home Service programmes "Indian Summer" and "Home This Afternoon". Throughout the year, 94 talks and film shows were given by health department staff to the various organisations and schools in the borough, in addition to the organised courses referred to earlier. HEALTH VISITING Visits Undertaken First Yisits: Bom 1959 576 1960 854 1961 1,026 " 1962 1,073 " 1963 1,354 " 1964 1,752 Over 65 168 Others 440 Total Visits: Under 5 14,204 Over 65 328 Others 912 Ineffective Visits: Under 5 3,443 Over 65 20 Others 78 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 521 expectant mothers attended for ante-natal care, and 65 for post-natal examination. Doubtless some of the mothers who have attended our ante-natal clinics are examined postnatally 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. 32 Ante-natal Clinics Centre Sessions Held Times Sessions Held Average Attendance The Clinic, Ashton Gardens, Chadwell Heath. 1st and 3rd in the month Wednesday p.m. 7 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday p.m. 8 Weekly Wednesday p.m. 9 The Leys Clinic, Ballards Road, Dagenham. Weekly Wednesday p.m. 4 Rush Green Clinic, 179 Dagenham Road, Dagenham. 1st and 3rd in the month Friday a.m. 1 The Clinic, Oxlow Lane, Dagenham. Weekly Tuesday a.m. 7 Weekly Thursday a.m. 7 Marks Gate Clinic, Lawn Farm Grove, Marks Gate. 2nd and 4th in the month Wednesday p.m. 2 The Clinic, Ford Road, Dagenham. Weekly Monday a.m. 9 Ante-natal Preparation Attendance at the classes was as follows:- Becontree Clinic 558 (1 session) Chadwell Heath Clinic 842 (2 sessions) Leys Clinic 348 (2 sessions) Oxlow Lane Clinic 629 (1 session) Marks Gate Clinic 90 (1 session) Total 2,467 33 Infant Welfare Centres A total of 4,325 children were brought to the Centres during the year, and the total number of attendances amounted to 29,251. Centre Sessions Held Times Sessions Held Average Attendance The Clinic, Ashton Gardens, Chadwell Heath Weekly Thursday a.m. 60 Weekly Thursday p.m. 50 The Clinic, Becontree Avenue, Dagenham Weekly Monday p.m. 43 Weekly Wednesday a.m. 32 The Leys Clinic, Ballards Road, Dagenham Weekly Tuesday p.m. 40 Weekly Thursday a.m. 40 Rush Green Clinic, 179 Rush Green Road, Dagenham 2nd, 4th & 5th in the month Weekly Friday a.m. 25 Friday p.m. 25 The Clinic, Ford Road, Dagenham Weekly Tuesday a.m. 31 Weekly Thursday p.m. 36 The Clinic, 15/17 Thompson Road, Dagenham Weekly Tuesday p.m. 30 Weekly Friday a.m. 13 The Clinic, Oxlow Lane, Dagenham Weekly Wednesday p.m. 70 Weekly Friday p.m. 46 Marks Gate Clinic, Lawn Farm Grove, Marks Gate Weekly Monday p.m. 32 Premature Infants All infants weighing 5½ lbs. or less at are regarded as premature infants whatever the length of pregnancy. 3 lb 4 oz or less 3 lb 5 oz - 4 lb 6 oz 4 lb 7 oz 4 lb 15 oz 5 lb Ooz5 lb 8 oz Total No. surviving one week Bom alive at home and nursed entirely at home 1 1 2 9 13 13 Born alive at home and transferred to hospital 3 - - 1 4 4 Born in Hospital 23 15 19 38 95 93 Phenylketonuria Routine testing of the urine of young children for this condition continued during the year. No cases of the disease were discovered. Day Nurseries Day Nursery Number of approved places Average daily attendance Average No. on register per month Total attendances Goresbrook 50 33.7 44.7 8,636 Chadwell Heath 54 40.8 52 10,448 Total 104 74.5 96.7 19,084 The reasons for admission are set out in the following table:- Day Nursery Widows Parents separated Desertion Illness of mother Illness of father Unmarried mothers Socioeconomic Mothers working to supplement income Total Goresbrook 6 18 - 10 4 4 1 32 75 Chadwell Heath - 7 - 6 1 5 1 20 40 Total 6 25 - 16 5 9 2 52 115 Dr. Weizmann reports as follows:- "The two Day Nurseries have continued to work practically to capacity during the year. In fact, throughout the greater part of the year there hare been waiting lists of varying length, particularly for the babies. In Chadwell Heath Nursery just under half the parents have received assistance with their fees, and in Goresbrook those receiving assistance are just over half the total admissions - and this has come to be the usual pattern in both nurseries. The children whose parents paid full fees came in the great majority of cases from families with poor housing conditions, where the mother has gone out to work in order to save money for a house purchase. There were, in addition, many admitted for medical reasons and behaviour problems, and these have shown remarkable improvement after admission to the nursery. Here I would like very much to put in a plea for a scheme whereby some recommended cases could have reduced fees for a short stay. The therapeutic value of even a few weeks in a nursery for children with certain behaviour problems is quite indisputable. Many parents to whom we would like to offer this valuable treatment simply have not the means available under present conditions. I think it would be quite easy to absorb these children (usually in the 3-5 age group) for a short time without straining the capacity of the nursery, and it would be to the very great benefit of both children and parents. 35 This is an appropriate time to consider such a measure, as the strain on the toddler group is likely to be a little relieved by the appearance in Dagenham of various pre-school play groups run by independent associations and taking children for half-days. These are very well run but do not have the trained staff who can deal with problem children; and I feel that if we find our waiting lists for the toddler nurseries are reduced in the future, it would be a great service to consider a scheme for assistance with fees in recommended cases. Both nurseries continue to function as training centres for nursery nurses, and as such are inspected regularly and approved by the Ministry." *************** Observations of the Matron on Goresbrook Day Nursery during 19642:- "Despite the acute shortage of staff, the Nursery has been able to maintain its daily routine. The children's attendance has been good; infection nil. I find that most of the children at four years of age are really ready for school; they are very receptive, wanting to learn, and full of energy. The Nursery doesn't seem big enough for them. We in the Nursery have gone as far as we are allowed to go in teaching them without poaching into education fields, although it is a pity we do not have more nursery school equipment. The installation of new heating is most satisfactory, and we are now able to receive the children into a nice, warm Nursery." *************** Observations of the Matron on Chadwell Heath Day Nursery during 1964:- "The past year has seen the admission into the nursery of many young babies, indicating once again the pressing need for young couples to buy their own house. Many are unable to do so out of the husband's income alone. These admissions have given our students plenty of opportunity to learn how to care for young babies. Indeed, at one time we were bemoaning the fact that we had no small babies, and were not able to teach all that was necessary about them. Now having had a few very exhausting months of continuous feeding, sterilising of bottles, etc., we are glad that many of our babies have now graduated to mixed feeding. Apart from this we have had an increased number of children admitted whose social development has been hindered through varying circumstances. These children often present no problem at the nursery, but appear to thrive in the atmosphere. This often helps parents to regain lost confidence. To the well-adjusted infant the nursery is simply a stepping stone along the way. For the difficult child the nursery does provide some emotional release, and possibly his behaviour problems would be greater by the time he reached school age if he had not had the nursery to help his development. The students' transfer to Homchurch College of Further Education at first caused a little disquiet, but now having attended there for over a term, they are settling to their new surroundings and routine. The newly-formed Advisory Committee that has been established should be of tremendous help to all concerned in the students' training. We are looking forward with mixed feelings to the transfer of the nursery; this of course coinciding with the Boroughs' amalgamation. 36 In the temporary premises we are going to it may mean that we will not see the parents as frequently as we do now, so after a while we are going to discuss the possibilities of monthly parent/nursery staff meetings, if this can be arranged." Daily Guardians Scheme At the end of 1964 the number of registered daily minders and the number of children being cared for were as follows:- Number of guardians registered 24 Number of children being cared for 26 Nurseries and Child Minders Regulation Act, 1948 At the end of the year there was one Nursery caring for 50 children and three child minders caring for 20 children, registered in accordance with this Act, Midwifery A total of 1f517 live births were notified, of which 985 occurred in hospital. Domiciliary Midwifery Service County Midwives Midwives residing at York House Training Home Salvation Army Midwives Births attended: Doctor not booked 52 1 1 Doctor booked 231 175 55 Miscarriages attended 8 - 2 Visits paid: Ante-natal 2,238 1,071 278 Nursing 3,582 3,699 506 Other post-natal 593 982 10 Ante-natal clinics attended 298 281 25 Seven County Council Midwives were qualified to administer inhalation analgesia in accordance with the requirements of the Central Midwives Board. Inhalation analgesia ("gas and air" or Trilene) was administered to 260 of the patients they attended. Pethidine was given in 191 cases. A total of 538 cases were delivered in hospital but discharged before the tenth day, and were attended thereafter by County Council Midwives. CHILD DEVELOPMENT Dr. Hodgson has submitted the following reports- "In the Autumn of this year I was very fortunate in attending a six weeks1 Course on Child Development and The Assessment of Handicapped Children. The aim of the Course was to stimulate an interest in the emotional and physical development of the young child, and to encourage the early diagnosis of single and multiple handicaps. This, as I reported last year, has been the aim of the Child Development Clinic which we started four years ago, but it is rewarding to know that many other people realise the need for a service of this type, and 37 most particularly, that they feel it should be provided by the local authority. In 1964 practically all the children seen were considered "at risk" for one reason or another. These were as follows:- Children seen between 0-28 weeks - 14 " " " 28 - 52 weeks - 19 " " "1 year - 2 years - 21 " " " 2 years - 6 years - 58 Types of tests carried out:- Illingworth or Gessel 21 Ruth Griffiths 39 Speech analysis 15 Terman Merrill 30 Special Hearing and Speech 5 Neurological - "Pretchl" 1 Special Stycar vision tests 2 Hearing Tests only (including Mary Sheridan Tests, Pitch Pipes or Audiogram) 0 - 52 weeks 27 1-3 years 36 3 - 5 years 31 Over 5 years 7 Three of these children were referred to Grays Inn Road E.N.T. Hospital, four referred for speech therapy, and one to Dr. Yudkin's Special Speech Clinic at the E.N.T. Hospital, Grays Inn Road. Defects found or investigated 0-28 weeks - 1 Neurological abnormality 28 - 40 weeks - 1 Visual defect 40 weeks - 2½ years - 1 Visual defect 3 Speech defects 1 Deafness + Mental Retardation 9 Mental Retardation 2½ - 5 years - 10 Speech defects 1 Cerebral Palsy + Mental Retardation 4 Retarded 1 Hearing defect 2 Behaviour problems 1 Possible autistic - being investigated Once more I must thank the Health Visitors for their help and co-operation; their unfailing efforts to persuade mothers of babies "at risk" to bring them to the clinic for investigation, frequently bringing the mother and child along themselves, or baby-sitting whilst mother attends." 38 DOMESTIC HELP An analysis of the hours of service rendered by the Domestic Help Service during 1964 is given in the following tablet- Type of case No. of cases Hours help provided Maternity 31 * 929 Tuberculosis 13 1,664 Acute sick 40 1,570 Chronic sick - aged 673 88,177 Chronic sick - others 98 17,325 Aged - not sick - - Others 18 3,571 Night attendance 1 190 Total 874 113,426 * Including toxaemia of pregnancy 3 120 Number of visits paid by Organiser 1,920 Average number of domestic helps employed each week 110 Average number of night attendants 1 Number of visits paid by domestic helps during the year 66,450 Number of visits paid by night attendants 19 Care of the Aged The work of the service has Increased during the past year. This is due chiefly to lack of accommodation in hospital for the aged chronic sick. Where relatives are in a position to help, their co-operation is sought. Tuberculosis All the helps working in this type of household realise they can contribute a great deal towards recovery of the patient. Care of Children Needs of children have to be met, especially when the mother enters hospital or where the only surviving parent is a widower who leaves home early in the morning. The help often visits mothers in hospital to give news of children, and ensures that children have breakfast and leave clean and tidy in time for school. Acute Sick Every endeavour is made to meet the needs of the acute sick as soon as possible to assist early recovery, Maternity The demand for the service for maternity cases, never great, was low during the year; perhaps increased charges have affected this demand. 39 Recruitment There is always a list of women willing to be domestic helps, and every care is taken to engage the right type of worker for this very worth while service. Unfortunately, many good helps leave the service owing to their sensitiveness to sickness, and the demanding attitude of some of the patients. A domestic help should not be looked upon as the cleaner, but a kindly person ready to help those in need. Training Course A course was again held twice during the year at Chelmsford. It is very instructive and very much appreciated by the helps who attend. Personal Contact It is not generally realised what personal care is given by the helps outside working hours. It is not unusual for helps to provide and take weekend meals to a sick person, and although they are quite prepared to undertake these duties, it is felt more could be done by the relatives. An old lady living alone, and without relatives, discharged herself from hospital. This entailed a visit by the helps three times a day and at the weekend. Another case which has given great satisfaction is that of a mentally sick woman. She was persuaded to enter hospital for treatment and in the meantime her flat was redecorated and practically refurnished. Eventually she arrived home and the Domestic Help Service provided daily help. She is now a very active member in the Old Folk's Centre, and appreciates everything that is done for her. 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. - 8.3O p.m. Tuesday 9.00 a.m. - 1.00 p.m. 2.00 p.m. - 5.00 p.m. 9.00 a.m. - 1.00 p.m. 2.00 p.m. - 5.00 p.m. Wednesday 10.00 a.m. - 1.00 p.m. 2.00 p.m. - 8.3O p.m. Thursday 9.00 a.m. - 1.00 p.m. 2.00 p.m. - 5.00 p.m. Friday 9.00 a.m. - 1.00 p.m. 2.00 p.m. - 5.00 p.m. 5.30 p.m. - 7.3O p.m. 40 A nominal charge of 2s.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 eases treated during the year 255 6 86 397 636 Total attendances 792 7 597 1,920 2,216 Cases still being treated at the end of the year 22 - 44 270 249 SICKROOM EQUIPMENT During 1964, 1,872 articles of sickroom equipment were loaned, including such things as bedpans, commodes, rubber sheeting, back rests, crutches and fireguards, and 1,975 disposable draw sheets were issued, the majority of these articles being for use by the elderly. In addition, in conjunction with the School Health Service, 21 children were treated for Enuresis by use of night alarm machines supplied through the sickroom equipment loans scheme. DOMICILIARY OCCUPATIONAL THERAPY Miss Mercer, the Occupational Therapist, works in several Health Areas, and usually visits Dagenham only part of one day each week. This time was further reduced during 1964 as she had two months special leave early in the year. Unfortunately she had an accident in November. During her absence, however, patients were kept in touch by post. As usual, articles made by patients gained a high proportion of prizes at the Dagenham Town Show. The Dagenham Tuberculosis Care Association provide assistance by selling completed work at the Town Show and by arranging sales at the Chest Clinic. Patients are referred from the Chest Clinic by the Chest Physician, who is always available for consultation and to give advice when requested. Summary of Visits First visits 5 Re-visits 55 Ineffective visits 11 Other visits 50 Visits to Clinic 10 Total 109 Number of visits to patients 56 New patients 5 Number on register 16 41 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) 26 - School Health Service - 46 Dagenham Children's Care Committee St. Mary's Bay 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 65 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. OXLOW LANE CLINIC FOR THE OVER SIXTIES The activities of this clinic continued during the year now under review on similar lines to those mentioned in previous annual reports. Thirty-two patients were examined by the medical staff (Dr. Wallace and Dr. Packer). There were 318 attendances at the exercise classes. The Chiropodist, Mr. Kelly, who attends at the clinical sessions treated 27 female and 9 male patients over a total of 150 individual visits. It has not proved possible to obtain the services of a physiotherapist, and the exercises are still being supervised by the Health Visitor. Numerous enquiries were made by Medical Officers of Health for Councils considering the setting up of similar clinics. Visits were paid by:- Dr. George Cust, Medical Officer of Health for St. Albans, and some of his staff. Dr. D. Sasieni, Central Council for Health Education. Miss Brown of the Regional Office of the Ministry of Health and two French visitors. Dr. B. Didsbury, Deputy Medical Officer of Health, County Borough of West Ham. Dr. R. D. Pearce, Area Medical Officer, South Essex Area, and Miss Thornhill, Superintendent Health Visitor. 42 VACCINATION AND IMMUNISATION Vaccination Against Smallpox During the year, 834 persons were vaccinated or re-vaccinated by general practitioners or 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 40 114 - - 1-4 years 147 226 10 3 5-14 years 9 14 22 3 15 years and over 85 7 150 4 Total all ages 281 361 182 10 Whooping Cough 2,557 children received immunising doses against whooping oough, including booster doses. Primary Boosters G.P.'s L.H.A. G.P.'s L.H.A. 531 997 369 660 Diphtheria Immunisation Year of Birth Primary immunisation Children who received a boosting dose G.P.'s L.H.A. G.P.'s L.H.A. 1964 135 269 2 7 1963 244 485 48 237 1962 72 110 155 351 1961 29 32 48 58 1960 5 14 25 41 1955-1959 44 84 184 563 1950-1954 20 24 78 268 Total all ages 549 1,018 540 1,525 43 Tetanus Immunisation Year of Birth Primary immunisation Children who received a boosing dose G.P.'s L.H.A. G.P.'s L.H.A. 1964 138 269 2 7 1963 264 491 48 237 1962 78 109 157 350 1961 33 47 54 72 1960 22 59 45 80 1955-1959 162 538 209 575 1950-1954 82 171 98 138 Total all ages 779 1,684 613 1,459 Poliomyelitis Vaccination G.P.'s L.H.A. Total Salk vaccine: Primary 8 - 8 3rd injection 11 - 11 4th injection 6 - 6 Sabin oral vaccine: Primary course 565 1,323 1,888 Booster after 3rd oral 132 182 314 Booster after 2nd Salk 151 162 313 Booster after 3rd Salk 356 722 1,078 B.C.G. Vaccination Number of children skin tested (Heaf test) 985 Number showing positive reaction (not requiring vaccination) 81 Number showing negative reaction (requiring vaccination) 904 Number vaccinated 904 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 1964 totalled 17,612, a decrease of 148 compared with 1963. 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 i960 and later 84 1959 743 1958 724 1957 91 1956 35 1955 37 1954 246 1953 1,082 1952 383 1951 46 1950 603 1949 and earlier 980 Total 5,054 (b) Other Inspections Number of special inspections 1,452 Number of re-inspections 609 Total 2,061 45 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)* 1960 and later - 34 34 1959 19 101 117 1958 23 166 176 1957 3 27 30 1956 3 10 13 1955 4 11 14 1954 18 12 30 1953 76 121 184 1952 33 44 71 1951 2 15 17 1950 58 87 134 1949 and earlier 98 122 201 Total 337 750 1,021 *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 5,054 children seen at periodic medical inspection, only one 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 31,736 (b) Number of individual pupils found to be infested 299 (c) Number of informal letters requesting cleansing 299 (d) Number of individual pupils in respect of whom cleansing notices were issued (Sec. 54(2) Education Act 1944) - (e) Number of individual pupils in respect of whom cleansing orders were issued (Sec. 54(3) Education Act 1944) - 46 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 26 26 9 7 23 8 58 41 365 13 5 Eyes: (a) vision 49 48 102 26 186 47 337 121 66 62 (b) squint 15 17 2 1 6 2 21 20 4 - (c) other 2 4 2 - 10 6 14 10 28 6 6 Ears: (a) hearing 23 18 2 2 17 21 42 41 46 56 (b) otitis media 7 7 4 5 4 5 15 17 18 4 (c) other 2 4 5 1 7 4 14 9 - - 7 Nose and throat 77 56 5 1 35 16 117 73 21 4 8 Speech 42 17 1 1 11 2 54 20 27 5 9 Lymphatic glands 26 14 1 - 4 2 31 16 - 1 10 Heart 5 13 1 4 14 4 20 21 1 3 11 Lungs 15 20 4 2 23 11 42 33 - 10 12 Developmental: (a) hernia 1 5 - - 3 6 4 11 3 - (b) other 7 7 1 2 7 9 15 18 1 75 13 Orthopaedic: (a) posture 8 3 11 3 11 4 30 10 15 3 (b) feet 29 38 18 1 44 11 91 50 4 1 (c) other 10 18 3 7 9 14 22 39 72 9 14 Nervous system: (a) epilepsy 6 - 1 7 4 - 11 7 1 2 (b) other 2 7 - 2 4 3 6 12 8 11 15 Psychological: (a) development 7 16 4 5 33 14 44 35 8 7 (b) stability 9 24 1 - 7 8 17 32 8 7 16 Abdomen 6 4 - - 1 - 7 4 - - 17 Other 50 6 40 4 63 10 153 20 285 259 47 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) 59 431 Errors of refraction (including squint) - 1,195 Number of pupils for whom spectacles were prescribed - 402 Dr. P. Lancer, Consultant Ophthalmologist, reports as follows:- "The work of the clinic continued as in previous years. It is suggested that another clinic be held elsewhere in the borough as the situation of Becontree Avenue Clinic makes it difficult to attend. Again I would make a plea for early referral of any eye defect to prevent the development of amblyopic eyes. Finally, I would like to thank the clinic nurses and staff for their co-operation." Diseases and Defects of Ear, Nose and Throat No. of cases treated By the authority Otherwise Received operative treatments (a) for diseases of the ear - 28 (b) for adenoids and chronic tonsillitis - 72 (c) for other nose and throat conditions - 28 Received other forms of treatment 121 53 Total 121 181 Total number of pupils in schools who are known to have been provided with hearing aids:- (a) in 1964 3 (b) in previous years 13 Orthopaedic and Postural Defects (a) Pupils treated at clinics or out-patient departments 324 (b) Pupils treated at school for postural defects 9 48 Diseases of the Skin (Excluding Uncleanliness) No. of cases treated By the authority Otherwise Ringworm (scalp) - - Ringworm (body) 1 — Scabies - — Impetigo 5 2 Other skin diseases 363 13 Child Guidance Dr. Vincenzi reports:- Number of new referrals in 1964 101 Number on waiting list at 31.12.64 15 Number of cases diagnosed and still open at 31.12.64 101 Speech Therapy The two speech therapists, Miss Symes and Miss Shipley, report as follows:- "1964 has seen little change in the work of the Speech Therapy Department and statistics ran more or less parallel with those of previous years. As usual, more boys than girls have required treatment. For approximately five months the Barking Area had been without a Speech Therapist. In order to reduce the growing waiting list, and to enable the most urgent of the existing cases to resume treatment, we attended for three sessions each week at the Central Clinic over the last three months. We have been delighted with the portable tape recorder supplied to us. For the efficient running of a Speech Clinic, it is of inestimable value to have a reliable Clerical Assistant, who can often do much valuable social work for the Speech Therapists by a sympathetic management of parents and children in the waiting room." Statistical Summary 1. Number of treatments given 2,348 2. Number of patients treated: Five Elms Clinic 79 Ashton Gardens Clinic 27 Marks Gate Clinic 21 Oxlow Lane Clinic 26 Leys Clinic 45 The Bentry School 19 Kings ley Hall 1 Junior Training Centre 3 221 49 3. Number of sessions held: Five Elms Clinic 252½ Ashton Gardens Clinic 82 Marks Gate Clinic 98 Oxlow Lane Clinic 85 Leys Clinic 176 The Bentry School 70 Kings ley Hall 3½ Junior Training Centre 7 Barking 20 794 At least one session was also held weekly for purposes of school visiting, interviews and tape-recording. 4. Case Loads: Boys 136 Girls 85 221 5. Type of Cases Treated: 1. Dyslalia 105 2. Delayed Development including aphasia 22 3. Sigmatism 28 4. Stammer 35 5. Stammer and Dyslalia 6 6. Defect associated with hearing loss 5 7. Cleft Palate 7 8. Disorder of voice 5 9. Cerebral Palsy 3 10. Unclassified 2 11. Dysarthria 3 221 6. Number of cases on Register at 31st December 1964 134 7. Reasons for Discharges 1. Speech normal 59 2. Non-attendance 3 3. No further progress likely 18 Transferred to other areas 5 5. Left School 2 6. Discharge requested by parent - 87 Other Treatment Given New cases treated Pupils with minor ailments 998 Pupils who received convalescent treatment under School Health Service arrangements 46 Pupils who received B.C.G. vaccination 904 Chiropody 239 50 School Clinics During the year 1,969 children were seen by the school medical officers at the consultation sessions, and 2,922 attendances were made at the nurses1 sessions. Attendances at the various clinics were as follows:- Ashton Gardens 353 Bentry School 150 Becontree Avenue 901 Five Elms 1,497 Ford Road 706 King's Wood 134 Leys 485 Marks Gate 301 Oxlow Lane 364 Total 4,891 Employment of Children 84 pupils were examined for fitness for employment out of school hours and certificates given to all these children. Home Visits by School Nurses A total of 1,624 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 62 Essex County Council 132 Dagenham Borough Council 274 Other authorities 2 (b) Under sickness regulations 4 (c) Number of consultations with specialists arranged 63 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. 51 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 - - Home Nurse/Midwives 5 1 All Day Nursery staff 10 11 Occupation Centre staff - - Domestic Helps - - Others 8 11 Teachers 3 47 Non-teaching staff 37 12 Adolescent Clinic This is the fourth 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, Miss Milbank and Mrs. Broad. Dr. Hodgson reports as follows "It seems hardly possible that it is very nearly four years since we started the first clinic for Adolescents; and one of our "old girls" is now married and expecting her first baby. The early months of 1964 were extremely busy, with an attendance each week of between 20 and 30 girls and an average of 2 to 3 new girls each session - but unfortunately I was away in America for four weeks in the spring and we had to cancel the clinic; it is not really possible to manage large clinics on a smaller staff. The number of children attending dropped quite considerably after this interval. We were, however, very honoured to be asked by the Robert Clack Technical College to arrange some talks for their senior pupils in the summer. This we were glad to do. We arranged two film sessions, followed by group discussion on the physiology of sex and venereal disease. A meeting was also arranged between several of the teaching and medical staff to discuss the teaching of these subjects in school, and we felt that a great deal had been learnt by both professions. I found myself away again for six weeks in the early autumn, and so the Christmas Term was not started until the beginning of November, and at first the number of children attending was again small, but by Christmas they were again increasing, and I expect in a few weeks we shall be back to normal. year- have Despite these two interruptions of the clinic, it has been a satisfying many mothers have enquired about the subjects we teach, and many parents expressed their gratitude for the interest taken in their girls. The clinic numbers were as follows Total number of attendances throughout the year 455 Total number of sessions 26 Total number of new girls 24 Largest number of individual attendances out of possible 26 23 52 53 Smallest number of individual attendances out of possible 26 1 Average number of attendances at each session 17.5% Robert Clack School (not included in the above numbers) 7.7.64 - 46 8.7.64 - 21 14.7.64 - 77 15.7.64 - 30 attendances - Film (mixed) "Physiology of Sex" Parts 1 and 2 attendances - Discussion (girls) Film strip "How Was I to Know" attendances - Film (mixed) "Physiology of Sex" Part 3 attendances - Discussion (girls) "To Janet a Son" "Innocent Party" The film strips and films shown and discussed during the year were :- 29.1.64 "That They May Live" - and also demonstration "British Midwife" 1.4.64 "To Janet a Son" "Your Children's Play" 27.5.64 "The Innocent Party" "My True Account" 14.10.64 "That They May Live" 4.H.64 "Your Very Good Health" "The Ratepayers' Money" "Everybody's Business" 2.12.64 "Old Wives' Tales" "The Story of Menstruation" "My True Account" 9.12.64 "Best of Yourself" "Round Figures" "What is Disease" "Modern Guide to Health" Film strips:- 26.2.64 "Child Development" No. 1 "Good Grooming" 18.3.64 "To Smoke or Not to Smoke" "How Was I to Know" 13.5.64 "Child Development" (Younger group) Subjects for lectures and discussion:- Breast versus bottle feeding Bathing baby Feeding young babies Child development Role plays - "Mother and daughter relationships" Make-up and grooming Fashions - Diet Baby care and clothing Godparents Social Services Menstruation Old people Venereal disease Clothes "Mods" and "Rockers" "Coming in at night" Visitors to the Clinic Dr. Sasieni (Central Council for Health Education) Mr. Goodchild (B.B.C.) Miss Eva (Health Educator, Norwich) Three Sociology Students (South-East Essex Technical College) Once more I must thank Mrs. Broad and Miss Milbank for their unstinting support and hard work, and for voluntarily giving up so much of their own time - but I am sure that they feel, as I do, that although this is physically and mentally a very tiring session, it is also very rewarding." 54 55 HANDICAPPED CHILDREN Blind Partially Sighted Deaf Partially Hearing Physically Handicapped Delicate Maladjusted E.S.N. Epileptic Speech Defects Total (a) Children newly assessed as handicapped during the year ended 31st December 1964 (i) aged 5 or over - 2 - - 4 5 3 29 - - 43 (ii) aged over 2 but under 5 - 1 1 - 8 - - 1 - - 11 (b) Children who, on or about 20th January 1965 were receiving special educational treatment (i) aged 5 or over 4 74 4 8 73 47 10 183 7 4 354 (ii) (iii) aged over 2 but under 5 all ages - 4 2 2 6 1 1 6 4 1 27 4 18 6 10 79 48 11 189 11 5 381 (c) Number in b(iii) receiving special educational treatment (i) at day special schools - 11 5 6 63 21 1 158 2 1 268 (ii) at residential special schools 4 3 - 1 6 25 9 25 4 3 80 (iii) at ordinary schools - - 1 3 5 - 1 6 1 - 17 (iv) elsewhere - 4 - - 5 2 - - 4 1 16 (d) Children who, on or about 20th January 1965 were requiring but not receiving special educational treatment (i) aged 3 or over - 1 - - 2 4 5 26 - 1 39 (ii) aged over 2 but under 5 - 1 - - - 1 - 2 — — 4 (e) Children on register on or about 20th January 1965 not .requiring special educational treatment (i) aged 5 or over — 6 2 5 53 101 4 14 9 7 201 (ii) aged over 2 but under 5 — 4 — — 9 3 — 1 4 3 24 (f) Children with more than one handicap included above Handicaps No. receiving s.e.t. No. awaiting s.e.t. 42 16 5 NOTES: 1. All figures relate to children not defects. 2. Children suffering from more than one handicap are classified under the major handicap in the main table and details given at (f). 3. Children attending independent boarding schools are included in item c(ii). 4. Children receiving s.e.t. in hospital or at home are included in item c(iv). Children admitted to special schools during the year- Admitted to Residential Schools E.S.N 7 Physically handicapped 4 Delicate 3 Maladjusted 3 Deaf 1 Diabetic - Admitted to the Sentry and other Day Special Schools E.S.N 34 Physically handicapped 17 Deaf 1 Partially hearing 1 Delicate 5 Partially sighted - Of the children who were attending the special schools the following were discharged to other schools during 1964:— From Residential Schools Maladjusted 1 to ordinary school E.S.N 1 ,, ,, ,, Delicate 2 ,, ,, ,, Speech defect 1 ,, ,, ,, Prom Day Special Schools E.S.N 5 ,, ,, ,, Delicate 4 ,, ,, ,, Physically handicapped 1,, ,, ,, THE BENTRY SCHOOL Dr. Fitzpatrick reports as followss- 11 The Bentry School continued to be a happy centre during the year, and in spite of many staff difficulties standards were maintained. We were fortunate to obtain the services of a new physiotherapist, Mrs. Wheeler. Mrs. E. Hogg has joined us as our new school nurse, also Mr. Sheridan the new school psychologist. Mr. Roberts (dentist) and Miss Shipley (speech therapist) continue to attend for sessions. We have a good liaison with the eye clinic at Becontree, and where necessary the children are taken by ambulance. Routine assessments and physical examinations are carried out weekly and we aim to see each child at least once a year. Twice yearly we have a conference with the Head and the Youth Employment Officer to assess the children for suitable employment. It is exceptional for a child not to be placed. This year we were joined at the conference by representatives of the mental health service. It is hoped to provide more after-care and community care. The new youth club at the school is proving most successful and is a step in this direction. 56 Last year we had 189 children on roll, 153 educationally subnormal and 36 physically handicapped. Returned to normal school 2 P.H. pupils Hoping to "be placed in residential schools 2 P.H. pupils 1 E.S.N, pupil We were pleased to acquire some nice dressing gowns for the school and also some new toilet equipment." The following report has been received from Mr. T. G. Hurton, Headmaster of the Bentry School:- "The building of a new school at Faircross, Barking, means that in a few months a re-organisation of the School will take place. The physically handicapped children of this school will go to the new school and in exchange the educationally subnormal children of the Barking School will come here. This change is long overdue as there has been a vital need for a school built specifically to suit the needs of physically handicapped children. Owing to earlier diagnosis and increased medical skills, the number of severely physically handicapped children is steadily decreasing. This is in line with the national pattern. However, it means that children admitted in future may be more seriously handicapped still. Thus I feel that urgent consideration should be given to the provision of suitable transport. For far too long these children have been transported by coach and van. A vehicle, similar in design to that used by "The Welfare of the Physically Handicapped Association", would be a great boon. The school has had a good year both educationally and socially. The school has participated in all the Dagenham School Festivals with conspicuous success. In addition, the School Orchestra was asked to play at the Essex County Show. Two pupils of the physically handicapped department were successful in the Royal Society of Arts Examinations last term, whilst, with one exception, all our leavers obtained employment. The School Medical Officer attends the school weekly and also the Dental Officer. Mrs. Wheeler the Physiotherapist attends school two days per week, and Miss Shipley the Speech Therapist two sessions per week. In addition, through the co-operation of Mr. Brand, now Physiotherapist at Ethel Davies Physically Handicapped School, Ilford, our children are able to attend Seven Kings Baths for swimming therapy every Friday. The efforts of all these devoted people are greatly appreciated, and all Staffs co-operate readily and efficiently. I am experiencing tremendous difficulty in obtaining teaching staff and unless there is an improvement by 1st September, admission of pupils to the school must, of necessity, be restricted. In July we lose the services of Miss M. W. Dyer and Mr. H. Sharplin, who will be retiring from the profession. They have given 35 years of loyal and devoted service, and we wish them a long and happy retirement. In conclusion, may I thank all Staffs for their kindness and ready co-operation, and hope that this co-operation will continue when we become part of the new Borough of Barking." 57 As already mentioned, therapeutic swimming is 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:- "As I resigned from the Hospital Service early last year, I feared that I would be unable to continue with the swimming activities for the Bentry School. I was somewhat perturbed by the thought that these activities would be discontinued, as it seemed very probable that you would be unable to get anyone to replace me. Having given the matter some thought, I decided to approach Dr. Gordon, the Medical Officer of Health for Ilford, with a view to combining with my Ilford Orthopaedic Class which I was still continuing. I am happy to say we reached agreement on this, and that the Bentry children now come to the Ilford Swimming Bath every Friday between 12 noon and 1 p.m., this being made possible by Mr. Hurton, the Headmaster, and his Staff on one side, altering the meal time, etc. to suit, and agreement between the two Medical Officers of Health and myself on the other. The children look forward to this session very much, and several have actually learned to swim this year. Last week I tried out a new 'buoyancy' costume which proved better than the use of swimming rings for these children, and I would recommend that some of them are purchased, provided they can be obtained in suitable sizes. Should any of the good people of Dagenham, who are swimmers and have an hour to spare between 12 - 1 on Friday, feel they would like to help with this worth-while task, I will be only too pleased to see them and instruct them on how to help these handicapped children leam a very useful accomplishment." DENTAL SERVICES I give below the statistical summar of the year's work:Sessions (equivalent half-days) 1. School dental inspections 79 2. School dental treatment (excluding orthodontics) 908 3. School dental orthodontic treatment 9 4. Dental treatment of mothers and young children 49 Total sessions 1,045 School Dental Inspection 5. Pupils inspected at periodic inspections 3,752 6. Pupils inspected as specials 998 7. Pupils found to require treatment 4,193 8. Pupils offered treatment 4,135 School Dental Treatment 9. Pupils actually treated (for the first time this year) 1,761 10. Attendances by pupils for treatment 5,349 11. Appointments not kept 1,689 12. Fillings: (a) permanent teeth 3,329 (b) temporary teeth 1,917 58 13. Number of teeth filled: (a) permanent teeth 2,867 (b) temporary teeth 1,365 14. Extractions: (a) permanent teeth: (i) for caries 597 (ii) otherwise 42 (b) temporary teeth 1 (i) for caries 1,602 (ii) otherwise 29 15. General anaesthetics: (a) by Medical Officers - (b) by others 784 16. Number of general anaesthetic sessions (included in 2) 98 17« Number of general anaesthetic cases at sessions inl6 784 18. Number of pupils supplied with artificial dentures 18 19. Number of dentures fitted 16 20. Other operations (except orthodontics)1 (a) permanent teeth 538 (b) temporary teeth 336 21. Operations included in item 20: (a)silver nitrate treatment 154 (b)scaling 208 (c) syringing sockets 13 d) dressings 331 e) inlays fitted 9 f) crowns fitted 9 g) radiographs 83 h) other operations 67 Orthodontic Treatment for Schoolchildren 22. Cases commenced 30 23. Old cases treated for the first time in the current year 3 24. Cases completed 7 25* Cases discontinued 1 26. Pupils treated with appliances 19 27« Removable appliances fitted 16 28. Fixed appliances fitted 3 29* Total attendances 161 *Including attendances shown in item 29. Mother and Child Welfare Dental Treatment Expectant or Nursing Mothers Children under five years of age Number of patients examined 71 109 Number of patients needing treatment 55 87 Attendances for treatment 130 283 Number of patients who have completed treatment 32 89 Number of extractions 111 162 Number of fillings 73 266 Number of anaesthetics (general) administered 11 44 Number of scalings or scaling and gum treatment 9 - Number of dentures provided: (a) full 8 1 (b) partial 5 - 59 LEYS ORTHOPAEDIC C L I N I C 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:- "During 1964, 714 patients attended for physiotherapy - 89 infant welfare, 324 school children, 301 adults - 11,899 treatments being given. The orthopaedic specialist attended 11 sessions and saw 193 patients. We were very sorry to say "Goodbye" in June of this year, to Mr. A. M. A. Moore, F.R.C.S., who has been in charge of this department for over fifteen years. He retired from all his hospital work. The department presented him with a Parker pen and pencil on his last attendance, and his many friends in the clinic came along to wish him a long and happy retirement. In July of this year, we welcomed Mr. Bryson, O.B.E., M.A., F.R.C.S., who was appointed orthopaedio surgeon in charge. He has spent the last 12 years in Nigeria, founding and completely organising orthopaedics in that country. The work of the clinic is as follows:- Adults are treated four sessions weekly. Ambulance cases treated three sessions weekly. These cases are referred by King George Hospital and private practitioners in the district. School children are treated in age groups, in olasses, for foot exeroises, posture exercises and breathing exercises. Under school age children are treated individually - all being referred from school medical examinations or infant welfare clinics. X-rays are now given at Dagenham Hospital by appointment; 52 X-rays were taken. Surgical appliances: Mr. Vogler of Messrs. Fidelis Surgical Appliances Ltd. attended the clinic weekly, by appointment, to measure and fit patients for surgical belts, surgical shoes and appliances. 131 patients were seen and appliances supplied." 60 KINGSLEY HALL ASSESSMENT CENTRE This has been a very busy year for Kingsley Hall, and a very satisfying one. Some of the increase in work has been due to the large number of hospital visits when the child has been accompanied by a member of the staff; 84 appointments have been kept. I am sure that it will be appreciated that this is an essential function of the nursery, both from the point of view of the child and the staff. We have had our usual high turnover of children, with 12 admissions and 15 discharges. These were as follows Admissions Handicap 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Paraplegia - Retarded Mongol Twins - Retarded / Social Maladjustment Mongol Still's Disease Maladjusted Congenital Heart Disease Congenital Cataract. Partially sighted. Retarded - Maladjusted Microcephalic - Athetoid Quadriplegia - Mentally retarded. Discharges Handicap Remarks 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Paraplegic Quadriplegic Mongol Severe Mental Retardation Microcephalic, severe mental retardation Mental retardation Mongol Congenital cataracts Quadriplegic Mongol Still's Disease Maladjusted Spastic quadriplegic - mental retardation Hydrocephalic Maladjusted To normal school To Lingfield Manor Cerebral Palsy School To Training Centre To Residential Mental Hospital To Residential Mental Hospital To E.S.N. School Removed from Dagenham Home To Ethel Davis Cerebral Palsy School To normal school To normal school To normal school Home, awaiting a residential placement Home - to go to normal school To normal school. During the year, it was thought desirable to introduce a system of follow-up of old Kingsley Hall children, whereby we hope to be able to keep a check on their future progress or deterioration. I feel that this is a most important step, as we shall, in retrospect, see whether the placements made so early in life have been successful, and if not, perhaps learn a lesson for the future. A film showing the work and play at the nursery was begun, with most of the indoor scenes having been completed, but the outdoor shots had to be left until next summer since we started too late in the year to complete these. This is a colour film, the technical details of which were carried out by Mr. Williams of Chelmsford, and Mr. Self. 61 It was with great joy that we received the news that we were to have a new equipment shed, which was begun just before Christmas. Sufficient room for storage of equipment has been a great problem at Kingsley Hall, but now, at last, we shall be able to make full use of our exercise room where much of the equipment was previously stored. Also started is a platform for the swimming pool, so that it may be used indoors in the winter. Several very useful pieces of equipment have been acquired during the year these include a walking frame, a set of parallel bars, one cerebral palsy chair and a Bonny Baby Bouncer. We have had our usual number of distinguished visitors, but this year it included a number of Student Health Visitors and Health Educators, and we were very happy to welcome them. Once again, at Kingsley Hall, we have been very fortunate in our new Sister. She has introduced a number of improvements, and despite the severe shortage of staff at times, maintained a very high standard of care for each child. As in previous years, we have to thank the members of the Child Guidance Clinic, and Miss Hodges, Peripatetic Teacher of the Deaf, for their help and support. CERVICAL CYTOLOGY CLINIC It is now possible to detect cancer of the cervix (neck of the womb) in its very early stages, before it begins to cause symptoms. This is done by microscopical examination of a smear taken from the patient's cervix by means of a spatula. Should an early cancer be present, abnormal cells will be detected by this examination. The taking of the smear for the test requires only a few minutes of the patient's time, and is painless. On the other hand, the examination of the smear is time-consuming and can only be carried out by specially trained staff: this is the limiting factor in the number of tests which can be performed. In co-operation with the Pathology Department at Oldchurch Hospital, facilities for these tests came into operation in May 1964 at Becontree Avenue Clinic. Appointments are offered to mothers between the ages of 30 and 55 (the section of the population most at risk). The smears are taken by a clinic nurse who has been trained for this work by a laboratory technician from the hospital. The smears are then transported to the hospital for examination. In addition to the staff of the Health Department, some of the family doctors and medical officers of the Family Planning Association have recommended women to have the test carried out. Between May and December, 92 women were tested. So far, no cases of cancer have been discovered. It is, of course, to be expected that when a screening test is being carried out on symptomless people the great majority of the results will be negative. Nevertheless, this testing is well worth while because of the far greater likelihood of successful treatment resulting from early diagnosis of the condition. The value of this is further enhanced when one takes into account that any cases discovered would probably be the mothers of small children. 62 %