HAC 115 LONDON BOROUGH OF HACKNEY Library ANNUAL REPORT on the HEALTH OF THE BOROUGH for the year 1965 R.G. Davies, M.D., D.P.H., Barrister at Law Medical Officer of Health and Principal School Medical Officer LONDON BOROUGH OF HACKNEY ANNUAL REPORT on the HEALTH OF THE BOROUGH for the year 1965 R.G. Davies, M.D., D.P.H., Barrister at Law Medical Officer of Health and Principal School Medical Officer CONTENTS Page Health Committee 1 Staff 2 Health Department Establishments 3 Introduction 6 Vital statistics 10 Prevention and treatment of disease 16 Personal Health Services (National Health Service Act, 1946) 21 Other Personal Health Services 34 Environmental Health Services 42 School Health Service 59 Index 76 1 HEALTH COMMITTEE as at 31st December, 1965 Ex-Officio - Councillor R.J. Tallantire, J.P. (Mayor) Chairman - Alderman L. Sherman, J.P. Vice-Chairman - Councillor C. H. Turner, B. E. M. Alderman Mrs. Bessie Benabo, J.P. Councillor M. Blitz " E. H. Claridge " A.J. Cohen " J. W. Cox " S. C. Davis Councillor Miss L. Karpin " S.J.S. Lee " Mrs. R. Lipman " C. E. Medhurst " Mrs. O.B. Wager " D. E. Ward Co-opted members Dr. J. Denhara D. W. Parren, Esq., L. D. S., R. C. S. (Eng) Miss G. Smith, S. R. N., S. C. M., M. T. D. One vacancy REPRESENTATION ON ORGANISATIONS CONCERNED WITH HEALTH WORK Hackney and Bethnal Green Tuberculosis Alderman Mrs. Bessie Benabo, J.P. Care Committee: Councillor J.W. Cox " S.J.S. Lee Hackney and stoke Newington Chest Alderman Mrs. Bessie Benabo, J.P. Diseases Care Committee: Councillor J.W. Cox " S.J.S. Lee " S.C. Davis Hackney and Queen Elizabeth Group Alderman Mrs. Bessie Benabo, J.P. Hospital Management Committee: " A.W. Linzell Councillor M. Ottolangui Alderman L. Sherman, J.P. Inner London Education Authority: Alderman L. Sherman, J.P. Inner London Executive Council for Alderman L. Sherman, J.P. the National Health Service: London and Home Counties Clean Air Councillor E.H. Claridge Advisory Council: " J.W. Cox " C.H. Turner, B.E.M. London Boroughs Training Committee Councillor A. Heath (Health, Welfare and Children's Services); Deputy - Councillor A. Samuels National Association for Maternal and Councillor E.H. Claridge Child Welfare: National Society for Children's Councillor Mrs. R. Lipman Nurseries: National Society for Clean Air: Councillor A.J. Cohen " J.W. Cox " Mrs. R. Lipman " C.H. Turner, B.E.M. St. Matthew's Hospital Club Committee: Councillor Miss L. Karpin " C.H. Turner, B.E.M. 2 STAFF OF THE HEALTH DEPARTMENT as at 31st December, 1965 Medical Officer of Health and Principal School Medical Officer - R.G. Davies Deputy Medical Officer of Health and Deputy Principal School Medical Officer L.M. Pry Principal Medical Officers School Health and Epidemiology J.L. Evans Mental Health and Community Care G. Grasset-Molloy Maternity and Child Welfare A.P. Whitfield . Assistant Medical Officers - Pull-time (6), Sessional (25) Chief Dental Officer and Principal School Dental Officer J.H. Forrester Dental Officers - Pull-time (5), Part-time (2). Sessional (10) Co-ordinating Nursing Officer L.E. Arrow Senior Nursing Officers I. Holt J.E. Kedge M. T. Roche E. Rogerson Centre Superintendents (7), Health Visitors (27), Tuberculosis Health Visitors (3), Clinic Nurses (13), Clinic and Nursing Auxiliaries (7), School Nurses (12). Day Nursery Matrons (7). Day Nursery Deputy Matrons (7), Day Nursery Wardens (5), Staff Nursery Nurses (19), Nursery Assistants (18), Nursery Students (24), District Nursing and Midwifery Staff (41). Chief Chiropodists H. Piper E.V. Gregory Chiropodists - Pull-time (3), Sessional (13) Principal Mental Health Social Worker G. Dawson Deputy Principal Mental Health Social Worker H.T. Lockwood Senior Mental Health Social Workers (7), Mental Health Social Workers (4), Supervisors of Training Centres (3), Assistant Supervisors of Training Centres (14), Supervisors of Day Centres (1), Deputy Supervisors of Day Centres (1), Craft Instructors (4). Principal Health Social Worker E. P. Tate Senior Health Social Worker V.P. Doughty Family Case Workers (2), Health Social Workers - Part-time (2), Social Workers, Chest Clinics (2), Social Worker, V. D. - 1 Vacancy. Home Help Organisers (3) - 1 vacancy. Assistant Home Help Organisers (5) Chief Public Health Inspector T.H. Marshall Deputy Chief Public Health Inspector T. A. Wilson Senior Supervisory Inspector C.V. Frisby Senior Clean Air and Factories Inspector (1), Senior District Inspectors (3), District Inspectors (17) - 12 vacancies, Technical Assistants (8), Pupil Public Health Inspectors (5), Superintendent, Disinfecting Station (1), Deputy Superintendent, Disinfecting Station (1), Rodent Officers/Drainage Foremen (2), Mortuary Keeper (1). Chief Administrative Assistant L.J. Pike Principal Administrative Assistant F. Spearing Senior Administrative Assistants (6), Administrative and Clerical Assistants (100), Medical Officer of Health's Secretary (1), Typing Supervisor (1), Deputy Typing Supervisor - 1 vacancy, Shorthand-Typists (10). Joint Public Analysts H. Amphlett-Williams J. S. Lea J.H. She1ton 3 HEALTH DEPARTMENT ESTABLISHMENTS Particulars of clinics held and services provided as at 31st December, 1965 Centre Ante- and Post- Natal * Child Welfare Vaccination and Immunization Food Sales Occasional Creche Family Planning Minor Ailments Dental Chiropody BARTON HOUSE, 233, Albion Road, N. 16. Telephone: CLI.4704 Th. p.m. M. p. m. W. p.m. F. a.m. M. a. m. M. a.m. & p.m. Tu. a.m. W. a. m. & p.m. Th. a.m. & p.m. F. a.m. & p.m. Tu. p.m. W. a.m. M. a. m. Tu. a.m. W. a.m. Th. a. m. F. a. m. M. a.m., p.m. and evening Tu. a.m. & p.m. W. a. m. & p.m. Th. a.m., p.m. and evening F. a.m. & p.m. M. a.m., p.m. and evening Tu. a.m. & p.m. W. a.m. & p.m. Th. a.m. & p.m. F. a, m. & p. m. Other services: Sewing Class, Tu. p.m. CRANSTON. Cranston Estate, N. 1. Th. p.m. thu. p.m. ELSDALE STREET, 28 Elsdale Street, E. 9. Telephone: AMH:5368 Th. p.m. M. a. m. & p. m. W. p.m. Til. p.m. M. a.m. & p.m. Tu. p.m. W. a.m. & p.m. Th. p.m. W. a.m. Th. p.m. F. a.m. M. a.m., p.m. and evening Tu. a.m., p.m. and evening W. a. m. & p. m. Th. a.m., p. m. and evening F. a.m. & p.m. Other services: Mothercraft and Relaxation, Tu. a.m.,; Sewing Classes, Tu. p.m. JOHN SCOTT HEALTH CENTRE, Woodberry Down, Green Lanes, N. 4. Telephone: ST A. 0111 M. p.m. Tu. p. m. M. p.m. Tu. p.m. Th. p.m. W. p. m. M. p.m. Tu. p. m. Th. p.m. F. p. m. M. a.m. & p. m. Tu. a.m. & p. m. W. a. m. & p.m. Th. a.m. & p.m. F. a, m. & p.m. M. a.m. Tu. a. m. W. a. m. Th. a.m. F. a.m. M. a.m., p.m. and evening Tu. a.m. & p.m. W. a.m. & p.m. Th. a.m. & p.m. F. a.m. & p.m. M. a.m., p.m. and evening Tu. a.m. & p.m. W. a.m. & p.m. Th. a. m., p. m. and evening F. a.m. Other services: Auditory Training for the Young Deaf, M. a.m. & p.m., Tu. a.m., W. a.m. & p.m., Th. a.m. & p.m., P. a.m. & p.m.; Speech Therapy, M. a.m., Tu. a.m. & p.m., F. a.m. and p.m.; Physiotherapy, M. a.m., & evening, Th. a.m. & p.m.; Audiometry M. p.m., Th. a.m., F. a.m.; Vision Clinic, Tu. p.m., W. p.m., Th. p.m., F. p.m.; Mothercraft and relaxation, Tu. p.m., W. p.m.; Mothers' Club W. p.m; Audiology, F. p.m.; Special Investigation Clinic Th. a.m. LOWER CLAPTON, 28 Lower Clapton Road, E. 5. Telephone: AMH. 2316 W. a.m. M. p.m. Tu. a.m. & p.m. Th. p.m. F. p. m. M. a.m. & p.m. Tu. a.m. & p.m. W. a. m. Th. a.m. & p.m. F. a.m. & p.m. M. a.m. & p. m. Tu. a. m., p.m. and evening Th. a. m. & p. m. F. a.m. & p.m. Other services: Mothercraft and Relaxation, w. p.m.; Sewing Classes m W. A F. p.m. * In addition to Child Welfare Clinics, Toddlers Clinics are held at most centres by appointment. Commencing times for most clinics are: Morning 9.30 a.m., afternoon 1.30 p.m., evening 5.00 p.m. 4 Centre Ante- and postNata * Child Welfare Vaccination and Immunization Pood Sales Occasional Creche Family Planning Minor Ailments Dental Chiropody RICHMOND ROAD, 136 Richmond Road, E. 8. Telephone: CLI.6374 M. p.m. W. a.m. & p.m. Th. p.m. P. a.m. Tu. p.m. M. p.m. Tu. p. m. W. a. m. & p.m. Th. p. m. F. a.m. & p.m. M. a.m. Tu. a.m. Th. a.m. Tu. a.m. Th. a.m. M. a.m. Tu. a.m. W. a.m. Th. a. m. P. a.m. M. a.m.ft p.m. Tu. a.m., p.m. and evening W. a.m. & p.m. Th. a.m. &p.m. F. a.m. & p.m. M.a.m., p.m. and evening Tu. a.m. & p.m. W. a.m. & p.m. Th&&. p.m. and evening F. a.m. & p.m. Other services: Mothercraft and Relaxation, Th. p.m.; Sewing Classes P. p.m. SHOREDITCH HEALTH CENTRE, 210 Kingsland Road, E. 2. Telephone: SH0.8351 M. p.m. M. p.m. Tu. p. m. W. p.m. W. p. m. M. a.m. & p. m. Tu. a.m. & p. m. W. a.m. & p.m. Th. a.m. & p.m. P. a.m. & p.m. Tu. evening M. a.m. Tu. a. m. W. a.m. Th. a.m. P. a.m. M. a.m., p.m. and evening Tu. a.m. & p.m. W. a.m. & p.m. Th. a.m. & p.m. F. a.m. & p.m. M. a.m., p.m. and evening Tu. a.m., p.m. and evening W. a.m. & p.m. Th. a.m. F. a.m. & p.m. (Further sessions are held at the Goodwill Mission, New North Road, N. 1.) Other services: Special Investigation Clinic, M. a.m.; Bathing Centre, M, W, and F. a.m.; Vision Clinic, M. p.m., P. a.m. (alt. wks.); Speech Therapy, Tu. a.m., Th. a.m. & p.m., P. a.m.- Mothercraft and Relaxation, Tu. a.m.,; Sewing Classes Tu. p.m.; Marriage Guidance, Tu. evening; Special Advisory Clinic, Th. a.m.; Mothers' Club, Th. p.m. UPPER CLAPTON. 186 Upper Clapton Road, E. 5. Telephone: UPP. 2420 M. a. m. Tu. a.m. & p.m. W. a.m. & p.m. Th. p.m. M. a.m. Tu. a.m. & p.m. W. a. m. & p.m. P. a. m. M. a. m. Tu. a. m. W. a.m. Th. a.m. F. a.m. WEST HACKNEY, St. Paul's Church Hall. Evering Road, N. 16. Telephone: CLI. 3132 M. a. m. Tu. a.m. Tu. p. m. Th. a.m. & p.m. M. p. m. Tu. p.m. Th. a.m. & p.m. WICK. 29 Cadogan Terrace, E.9. Telephone: AMH.6808 M. p.m. P. p.m. Tu. a.m. M. p.m. Tu. a.m. P. p.m. M. a.m. Tu. a.m. W. a. m. Hi. a.m. F. a.m. M. a.m., p.m. and evening Tu. a.m. & p.m. W. a. m. & p. m. Th. a.m. & p.m. F. a.m. & p.m. Other services: Vision Clinic, F. a.m. * In addition to Child Welfare Clinics, Toddlers Clinics are held at most centres by appointment. Commencing times for most clinics are: Morning 9.30 a.m., afternoon 1.30 p.m., evening 5.00 p.m. 5 CHEST CLINICS T.B. Dispensary, London Chest Hospital, Victoria Park, E. 2. ADV. 1214 Metropolitan Chest Clinic, Metropolitan Hospital, 335 Kingsland Road, E.8. CLI. 2156 Shoreditch Chest Clinic, 204 Hoxton Street, N.1. SHO. 8878 DAY NURSERIES Open Mondays to Fridays, 7.45 a.m. to 5.30 p.m. No. of approved places Telephone Fernbank, 1A Fountayne Road, N.16. 56 UPP. 4463 Hillside, 135a Holmleigh Road, N. 16. 60 ST A. 7325 St. John's, St. John's Churchyard, Mare Street, E. 8. 51 AMH. 2993 Sun Babies, Branch Place, N. 1. 60 SHO. 3950 Victorian, Victorian Grove, N.16. 60 CLI. 6197 Wetherell, Wetherell Road, E. 9. 50 AMH. 5705 Woodberry Down, Green Lanes, N.4. 42 STA. 0111 CLEANSING AND DISINFECTING STATION Open Mondays to Fridays, 8.00 a.m. to 5.00 p.m. Millfields Road, E.5. AMH. 5930 HOME HELP OFFICES Open Mondays to Fridays, 8.30 a.m. to 4.45 p.m. Barton House, 233 Albion Road, N.16. CLI. 4704 Elsdale Street, 28 Elsdale Street, E. 9. AMH. 4283 Shoreditch, 210 Kingsland Road, E. 2. SHO. 8351 Upper Clapton, 186 Upper Clapton Road, E. 5. UPP. 1415 HOME NURSING Hackney, 6/10 Lower Clapton Road, E.5. AMH. 5322 Shoreditch, 210 Kingsland Road, E.2. SH0« 8351 Stoke Newington, 233 Albion Road, N.16. CLI. 4704 MENTAL HEALTH TRAINING CENTRES Open Mondays to Fridays, 9.30 a.m. to 4.00 p.m. No. of PI aces Dalston, Congregational Hall, Bay Street, E.8. 60 CLI. 2786 Hackney, Ickburgh Road, E.5. 120 UPP. 4638 Shoreditch, Thurtle Road, E.2. 80 SHO. 4102 Wigan House, Warwick Grove, E.5. 20 - - - MENTAL HEALTH DAY CENTRES Open Mondays to Fridays, 9.30 a.m. to 4.00 p.m. Clifton Lodge, 96 Dalston Lane, E. 8. 40 CLI. 5945 Hindle House, Areola Street, E.8. 30 SPA. 1181 Shoreditch, 210 Kingsland Road, E.8. 20 SHO. 8351 MORTUARY St. John's Churchyard, Mare Street, E. 8. AMH. 2808 SCHOOL TREATMENT CENTRES Open Mondays to Fridays, morning 9.30 a.m., afternoon 1.30 p.m., evening 5.00 p.m. Hackney, 13 Goulton Road, E.5. AMH. 4637 Hoxton, Sarah Street, N.1. SHO. 9145 6 HEALTH DEPARTMENT, MUNICIPAL OFFICES, 380 OLD STREET. E. C. 1. Telephone: AMHerst 3351 To His Worship The Mayor, and to the Aldermen and Councillors of the London Borough of Hackney Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report for 1965, the first annual report of the new London Borough of Hackney. It incorporates work done by each of the three metropolitan boroughs - Hackney, Shoreditch and Stoke Newington - and that of Division 4 of the London County Council. The year has seen one of the greatest re-organisations of local government in this country for at least 75 years, if not in the entire history of local government as we know it. It did two things; it dissolved the large London County Council which for many of its services covered the whole of Inner Londonand covered them in many aspects with an excellent organisation, and at the same time it united three metropolitan borough authorities - one comparatively large, and two comparatively small. There was a long period of ground work undertaken by officers of the previous county authorities and metropolitan boroughs to provide a scaled down framework in which the local health authorities of the new boroughs could work. Much praise must be given to the various working parties who prepared reports that have been invaluable in the transitional period and in the first months of the working of the new authorities. Without the type of continuity that these reports gave, the institution of the new borough would have been virtually impossible. Apart from these working parties, the new borough owed much to the work undertaken in the year immediately previous to 1965, by officers and members alike in trying to lay down working structures for the new departments. For many months before 1st April, 1965, there was a general feeling of restlessness amongst the staffs who foresaw upsets both in their working and personal circumstances. It says much for the London Borough of Hackney that most of the staff of the three metropolitan borough health departments, as well as the Health Division No. 4 of the London County Council, decided to accept appointments with the new borough and did not look elsewhere. The new Health Department faced immediately two problems, that of integrating staff from varying disciplines; staff who had worked for one of the greatest urban local authorities in the world, and staff who had worked for boroughs of some 50,000 people. It also faced a geographical change from a small corner of Hackney Town Hall, and various offices of the London County Council, to working in what had been previously the Shoreditch Town Hall - an excellent building, but one which had been adapted for a very different type of administrative set up. The Health Department was the first department to move to new accommodation and it would be foolish to say that there was no initial confusion in the placing of staff, telephonic communication, etc. The main aim of the staff was to continue to give to the public a service that was as little disturbed as possible, and in the main this object was achieved although perhaps not 100%. For most of the year many of the staff worked long hours in winding up affairs of the London County Council and trying to put our own house in order, and I would express my gratitude to them for doing this. Few of the senior staff from Hackney left, but the loss of some of the staff from the London County Council (Finance Section), and also of the Public Health Inspectorate caused considerable difficulties. 7 The main body of the Report covers the many aspects of the work of the three metropolitan borough and the Division 4 health departments before the 1st April, 1965, and of the joint Health Department from that date. In this preface I would only wish to draw attention to some of the more important or striking aspects of the work as seen in 1965. For the first time for many years diphtheria returned to the Borough. The first case came to light after a young boy had been admitted to the Eastern Hospital from the Reception Centre in Morning Lane, with chickenpox. Although at that time the department was busily engaged in reorganisation, the work had temporarily to be left. All the inhabitants of Morning Lane were swabbed repeatedly, and also children of the nearby schools. Some 1,800 throat swabs were taken, and as a result 40 carriers were discovered and a further 4 cases were notified. Some of the cases spilled over the boundary into what is now Tower Hamlets, and they also had cases and carriers there. A great deal of work was laid on the staff of the Health Department of the then Metropolitan Borough of Hackney, and also the staff of Health Division 4 of the London County Council: work cheerfully undertaken, although all staff at that time were busy with reorganisation, and, what might have been an explosive situation was soon brought under control. The attack rate of tuberculosis continues to show the decline it has been showing for the last few years, but the Hackney rate of 0.53 per thousand is still somewhat above the national average. Lung cancer still shows as one of the main causes of death and, as has been expected, is becoming an increasing cause of death in females. The personal health services are new to many members of the Health Committee and to many members of the Council in general - they are described in detail in the main body of the Report. Amongst the many good services we inherited from the London County Council, one of the show pieces is the health centre at Woodberry Down. This was the first health centre to be built under the National Health Service Act. Its planning was ambitious and it is still probably the biggest health centre in the country. It is visited by important visitors from all over the world, and it is a centre to which many teaching bodies send their students to learn about health centres and the various aspect of health centre services. As a token of respect to the late Dr. John Scott who as Deputy Medical Officer of Health and, subsequently. Medical Officer of Health to the London County Council, had very much to do with the setting up and subsequent running of the Health Centre, The Council decided to re-name the Woodberry Down Health Centre. It is now called the John Scott Health Centre, Woodberry Down. The new Authority is now responsible for the many aspects of the nursing services outside hospital. Prior to 1st April, 1965, the district nursing service was carried out on an agency basis by the various voluntary nursing associations covering Hackney, Shoreditch and Bethnal Green, and Stoke Newington. Before amalgamation the Shoreditch and Bethnal Green Association split up; the main part amalgamated with the East London District Nursing Association serving Tower Hamlets, the part remaining becoming the responsibility of the Hackney District Nursing Association. The two remaining voluntary associations then indicated to the new London Borough that they did not wish to continue to function after 31st March, 1965. As a result, the district nursing service in now run directly by the new London Borough. I would in this Report, which covers the last period of their existence, wish to thank the voluntary District Nursing Associations for all the good work they did for the district nursing service in the past. Apart from the district nurses, the Department has a number of grades of nursing staff. There are seven day nurseries in the Borough, caring for children during the day-time and employing 70-80 nursery nursing staff. 8 A staff of approximately 30 health visitors was taken over from the London County Council: these officers, combining both health and social duties, are one of the mainsprings of the Department's service given to the family with the young child, although their work is increasing in extent in all aspects of family life. Their work is, of course, complementary to other field workers such as the public health inspector, mental health social worker, and workers in other Departments such as the child care officer, and welfare officers who work with the aged; these officers forming the basis of the ideal team of fieldworkers for the local authority. The mental health services of the Borough are amongst the best in London. The London County Council Health Division No. 4 had established centres for mentally subnormal children and also centres for the rehabilitation of patients who suffered from mental illness. These the Department inherited, and is in process of reorganising to give an even better service than previously. In addition to services based on static centres, the Department has a staff of mental health social workers who undertake not only statutory duties, but act in support of mentally ill patients by seeing them in their homes and by co-operation with the hospitals during their treatment; and by helping to re-establish in the community by means of clubs, arranging holidays, etc. Unfortunately for Hackney the main psychiatric hospital for Hackney patients is one situated at Epsom. I do not think anyone would pretend that it is ideal for patients to have to go such a long way away for treatment: it makes it difficult for the patient, for the relative, and also for mental health staff who wish to retain contact. It is to be hoped that in the not too distant future there will be increasing facilities for the treatment of mental illness either in Hackney or at least not so far away. Undoubtedly, one of the main problems still affecting Hackney is that of housing. It would seem axiomatic that a place where some people spend twothirds of their time and where young mothers and children might spend the whole of their time, is bound to have a profound effect on their health. I have always considered it one feature, if not the main one, in the prevention of ill-health that persons should live in a good environment. This not only includes clean water, clean air, etc., but must include good housing apart from the usual terms of bricks and mortar, freedom from damp, etc.; housing that contains all the reasonable elements of modern living, such as running hot and cold water, good sanitation, plenty of light and air. The ideal goes even further than this; there must be good community services and all the accepted amenities within easy distance. Unfortunately, all too often, many Hackney residents are without even the minimum of the accepted standards. They live in houses that are damp, dark, with no hot water, no baths, and often with external water closets. Many live in houses in multiple occupation, sharing what amenities there are in the way of water closets and kitchens. In addition to this, many have to fight what might be termed, at the best, the apathy of certain landlords, in an attempt to get even gross defects such as leaking roofs remedied, and to achieve even a minimum standard. The number of cases where the Department was called in during the year is shown in the main body of the Report. In an attempt to improve amenities in houses in multiple occupation the Department has acted under Section 19 of the Housing Act, 1961, in 151 cases during the year. In addition, in order to try to improve conditions in certain houses, the Department has taken steps to bring six houses under Management Orders during the year. The metropolitan boroughs had been in favour of the fluoridation of water, and the Council of the new London Borough is also strongly in favour of this. There is, however, an opposition, and letters from the opposition have appeared in the press, and meetings have been held to protest against the fluoridation of Hackney's water supplies. As, of course, the Authority is not responsible for the provision of water supplies, no action has been taken to add fluoride to the local water. The local water does, in fact, possess a certain amount of natural fluoride (0.25 p.p.m.) 9 The three metropolitan boroughs had already made considerable progress in respect of smoke control before 1st April, 1965. At the end of the year only three areas - one from the old Borough of Shoreditch and two from the Borough of Hackney - remained to be dealt with before the whole of the new London Borough becomes smoke free. The Report contains, for information only, a section on the School Health Service as it appertains to Hackney schools. As you will know, the responsible Authority for the School Health Service, is the Inner London Education Authority. For the purpose of the School Health service the Medical Officer of Health acts in a different capacity as one of the Principal School Medical Officers to the Inner London Education Authority. It is thought, however, that the members would be interested in the School Health Service in Hackney. The new Health Department has survived a year of difficulties following re-organisation, but it already has plans for the future. As required by the Ministry, a draft 10-year plan was submitted to the Ministry at the end of the year. Undoubtedly, this plan will need revision in the light of experience. Plans, however, are already afoot to increase the mental health services; to increase services for family planning; and to make a start on some of the new fields of preventive medicine, such as cervical cytology, and it is hoped that these will have commenced in 1966. The year has been a difficult one for everybody concerned, and I would, therefore, wish to give particular thanks to all my colleagues in other departments: it would be invidious to pick out any special department as we have received help and and advice from them all. I would also like to thank the general practitioners in the Borough, who have been helpful and patient with us in our difficulties, and the staffs of the various hospitals and voluntary organisations for their help. I would also wish to express, on behalf of the Department, thanks to the Chairman and members of the Health Committee for their help, guidance and forbearance for what must have been a busy and difficult year for them as well as the staff. Finally, I personally, would express my gratitude to the whole of the staff of the Department for the work that they have carried out in the past year. Although this Report is signed in my name, it, of course, represents the work of each and every one of the staff of the Health Department. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, ROWLAND GWYN DAVIES Medical Officer of Health 10 VITAL STATISTICS 11 VITAL STATISTICS The London Borough of Hackney came into being on 1st April, 1965, following the implementation of the London Government Act, 1963. It comprises the former Metropolitan Boroughs of Hackney, Shoreditch and Stoke Newington. The boundary of the new Borough is the same as that for the former London County Council Health Division No. 4. The Borough is industrial as well as residential in character, and is divided into twenty wards for local government electoral purposes, each ward being represented by three councillors. Because of the re-organisation necessary during the first year of the new Borough it is only practicable in certain cases to compare the vital statistics of previous years with those of the former London County Council Division No. 4. In the table below the comparable rates for 1964 are shown in brackets. VITAL STATISTICS AREA 4,812 acres Public open spaces 719 acres POPULATION 253,810 Density per acre 52.7 RATEABLE VALUE £14,388, 045 Product of a penny rate £57,400 Number of inhabited homes 65,100 BIRTHS Ma le Fema le Total LIVE BIRTHS - Legitimate 2, 581 2,331 4,912 Illegitimate 472 466 938 3,053 2,797 5,850 CRUDE LIVE BIRTH RATE PER 1, 000 POPULATION 23. 1 (23.8) Birth rate after applying Area Comparability Factor of 0.9 20.7 (21.4) ILLEGITIMATE LIVE BIRTHS PER CENT OP TOTAL LIVE BIRTHS 16.0 (15.5) Ma le Fema le Tota I STILL BIRTHS - Legitimate 32 38 70 Illegitimate 9 3 12 41 41 82 Still birth rate per 1,000 live and still births 13.8 (13.7) Ma le Female Tota I TOTAL LIVE AND STILL BIRTHS - Legitimate 2,613 2, 369 4,982 Illegitimate 481 469 950 3,094 2,838 5,932 DEATHS Ma le Fema le Total ALL CAUSES 1,400 1,414 2,814 CRUDE DEATH RATE PER 1,000 POPULATION 11.1 (11. D Death rate after applying Area Comparability Factor of 1.11 12.3 (12.3) 12  Ma le Fema le Total INFANT DEATHS (Deaths of Infants under one year of age) - Legitimate 53 37 90 Illegitimate 10 9 19 63 46 109 INFANT MORTALITY RATE - All infants per 1,000 live births 18.6 (19.2) Legitimate infants per 1,000 legitimate live births 18. 3 Illegitimate infants per 1,000 illegitimate live births 20.3 Male Female Total NE0-NATAL MORTALITY (Deaths of infants under 4 weeks of age) - Legitimate 32 31 63 Illegitimate 5 5 10 37 36 73 NEO-NATAL MORTALITY RATE All infants per 1,000 live births 12.5 Legitimate infants per 1,000 legitimate live births 12.8 Illegitimate infants per 1,000 illegitimate live births 10.7 EARLY NEO-NATAL MORTALITY RATE PER 1,000 LIVE BIRTHS (Deaths of infants under one week) 11.1 Male Fema le Tota I PERINATAL MORTALITY (82 still births and 65 deaths of infants under one week) 73 74 147 PERINATAL DEATH RATE PER 1,000 LIVE AND STILL BIRTHS 24.8 SUMMARY OF INFANT MORTALITY RATES Death rates per 1,000 live births All infants under 1 year of age 18.6 Infants under 4 weeks of age 12.5 Infants under 1 week of age 11.1 MATERNAL DEATHS (including abortion) 2 (Nil) MATERNAL MORTALITY. The two deaths from causes associated with pregnancy or childbirth were certified as follows:Age Cause of death 20 Cerebral infarction due to therapeutic abortion 28 Haemorrhage from incomplete abortion Death rates per 1,000 live and still births – Maternal causes excluding abortion Due to abortion 0.3 Total Maternal Mortality 0.3 All births occurring in the Borough are required to be notified to the Medical Officer of Health under the provisions of the Public Health Act, 1936. Nearly all the births are notified by general practitioners, midwives and hospitals although the onus for doing so is placed on the father of the child. 13 During 1965, 6,930 births were notified. The figure includes babies born in Hackney to mothers resident outside the Borough but excludes babies born elsewhere whose mothers normally reside in Hackney. After the necessary adjustments had been made the Registrar General calculated that 5,850 babies were born to mothers normally resident in Hackney, giving a crude live birth rate of 23.1 per 1000. Because in some boroughs there are more women of child bearing age than in others, the proportion of these women to the total population is higher than the national average and the birth rate appears to be inflated. The Registrar General has, therefore, calculated for each borough an area comparability factor based on a hypothetical standard population. For Hackney this figure is 0.9 and in consequence the adjusted birth rate was 20.7 per 1,000 which compares with 18.0 for the whole of England and Wales. The percentage of illegitimate live births was 16.0% of the total live births. This figure compares with 15.5% for the previous year. The average for England and Wales is 7.7% and for the inner London Boroughs 14.4%. This figure may partly be accounted for by women moving into the large conurbation of London. DEATHS The commonest single cause of death was coronary heart disease, followed by other heart and circulatory disease. Other important causes of death include vascular lesions of the central nervous system and malignant disease. The latter accounted for a large number of deaths (593) and lung cancer is high amongst these showing also the now accepted fact that there are vastly more men than women dying from this cause. Bronchitis still accounts for a large number of deaths and still presents a formidable challenge to preventive Deaths from motor vehicle accidents into which a tremendous amount of preventive effort has been put, are as high as 32. CAUSES OF DEATH Males Females Total Tuberculosis, respiratory 6 2 8 Tuberculosis, other forms – 1 1 Syphilitic disease – 3 3 Diphtheria – Wiooping Cough – • _ Meningococcal infection 3 . 3 Acute poliomyelitis – _ Measles – 1 1 Other infective and parasitic diseases – 2 2 Malignant neoplasm, stomach 51 34 85 Malignant neoplasm, lung, bronchus . 136 35 171 Malignant neoplasm, breast – 65 65 Malignant neoplasm, uterus – 22 22 Other malignant and lymphatic neoplasms 136 105 241 Leukaemia, aleukaemia 5 4 9 Diabetes 9 22 31 Vascular lesions of nervous systems 95 155 250 Coronary disease, angina 315 267 582 Hypertension with heart disease 9 20 29 Other heart disease 77 133 210 Other circulatory disease 107 166 273 Influenza 1 2 3 Pneumonia 84 106 190 Bronchitis 125 62 187 Other diseases of respiratory system 22 12 34 Ulcer of stomach and duodenum 16 10 26 Gastritis, enteritis and diarrhoea 3 10 13 Nephritis and nephrosis 6 5 11 Hyperplasia of prostate 9 – 9 Pregnancy, childbirth, abortion – 2 2 Congenital malformations 14 13 27 Other defined and ill defined diseases. 99 101 200 Motor vehicle accidents 21 11 32 All other accidents 28 27 55 Suicide 19 13 32 Homicide, etc. 4 3 7 1,400 1.414 2,814 14 CAUSES OF DEATH IN AGE GROUPS Cause of Death Sex Total All Ages Under 4 Weeks 4 Weeks and under 1 Year Age in Years 1 - 4 5 - 14 15 - 24 25-34 35 - 44 45 - 54 55 - 64 65 - 74 75 and over 1. Tuberculosis, Respiratory M 6 - - - - - - - - 2 3 1 F 2 - - - - - - - - 1 1 - 2. Tuberculosis, Other M - - - - - - - - - - - - F 1 - - - - - 1 - - - - - 3. Syphilitic Disease M - - - - - - - - - - - - F 3 - - - - - - - - - - 3 6. Meningococcal Infections M 3 - 3 - - - - - - - - - F - - - - - - - - - - - - 8. Measles M - - - - - - - - - - - - F 1 - - 1 - - - - - - - - 9. Other Infective and Parasitic Diseases M - - - - - - - - - - - - F 2 - - - - - - - - 2 - - 10. Malignant Neoplasm, Stomach M 51 - - - - - 1 1 7 19 10 13 F 34 - - - - - - - 4 3 12 15 11. Malignant Neoplasn, Lung, Bronchus M 136 - - - - - 1 6 18 49 45 17 F 35 - - - - - - 1 4 12 12 6 12. Malignant Neoplasm, Breast M - - - - - - - - - - - - F 65 - - - - - - 4 15 14 13 19 13. Malignant Neoplasm, Uterus F 22 - - - - - - 5 2 8 5 2 14. Other Malignant and Lymphatic Neoplasms M 136 - - 3 - - 4 4 15 34 41 32 F 105 - - - - - - 4 12 19 38 30 15. Leukaemia, Aleukaemia M 5 - - - - - - - - 1 2 2 F 4 - - - - - - - - 1 1 2 16. Diabetes M 9 - - - - - - - - 3 4 2 F 22 - - - - - - 1 1 4 4 12 17. Vascular Lesions of Nervous System M 95 - - - - - 1 2 8 18 30 36 F 155 - - - - - 1 - 4 17 41 92 18. Coronary Disease, Angina M 315 - - - - - - 7 37 103 83 85 F 267 - - - - - 1 4 11 25 84 142 19. Hypertension with Heart Disease M 9 - - - - - - - 2 2 - 5 F 20 - - - - - - - - 3 4 13 20. Other Heart Disease M 77 - - - - 2 1 2 3 9 22 38 F 133 - - 1 - 1 - 4 8 16 28 73 21. Other Circulatory Disease M 107 - - - - - 1 1 2 10 23 70 F 166 - - - - - - 1 4 6 23 132 22. Influenza M 1 - - - - - - - - - - 1 F 2 - - - - - - - - - 1 1 23. Pneumonia M 84 3 11 - 1 - 1 - 4 6 21 37 F 106 2 6 1 1 1 - - 2 10 13 68 24. Bronchitis M 125 - 3 - - - - 1 6 29 41 45 F 62 - 1 - - - - - 1 8 9 43 25. Other Diseases of Respiratory System M 22 - - - - - - 1 1 5 4 11 F 12 - - - - - - - - 1 1 10 26. Ulcer of Stomach and Duodenum M 16 - - - - - - - 1 2 2 11 F 10 - - - - - - 1 - 6 3 27. Gastritis, Enteritis and Diarrhoea M 3 - 1 - - - - - - 1 1 - F 10 - - - - - 1 - - 2 1 6 28. Nephritis and Nephrosis M 6 - - - - 1 - - - - 3 - F 5 - - - - - - 1 1 1 - 2 29. Hyperplasia of Prostate M 9 - - - - - - - - - 2 7 30. Pregnancy, Childbirth, Abortion F 2 - - - - 1 1 - - - - - 31. Congenital Malformations M 14 7 5 - - 1 1 - - - - - F 13 6 1 1 - - - 1 1 1 2 - 32. Other Defined and Ill-defined Diseases M 99 26 2 - 3 5 2 2 9 11 17 22 F 101 27 1 1 2 1 1 - 2 14 18 34 33. Motor Vehicle Accidents M 21 - - - 3 7 - - 3 4 2 2 F 11 - - - 1 - - - - 2 4 4 34. All other Accidents M 28 - 1 - - 3 4 4 7 6 2 1 F 27 1 1 4 1 - - 1 3 8 8 35. Suicide M 19 - - - - 1 5 3 3 5 2 - F 13 - - - - - 2 - 6 2 2 1 36. Homicide and Operations of War M 4 1 - - - - 1 2 - - - F 3 - - - - - 2 - - 1 - - Total all Causes M 1,400 37 26 3 8 22 23 38 126 319 360 438 F 1,414 36 10 9 5 4 14 28 80 176 331 721 Total 2,814 73 36 12 13 26 37 66 206 495 691 1,159 15 LUNG CANCER In view of the interest in this disease I have included a table on lung cancer comparing the deaths in the Borough for 1965 with those in the same area (covered by the London County Council Health Division No.4) for previous years. Year MALE FEMALE All deaths Lung cancer deaths % of all deaths All deaths Lung cancer deaths % of all deaths 1955 1,509 110 7.3 1,357 29 2.1 1961 1,478 129 8.7 1,526 21 1.4 1962 1, 523 134 8.8 1,485 23 1.5 1963 1, 534 144 9.4 1,581 20 1.3 1964 1,433 164 11.4 1,400 27 1.9 1965 1,400 136 9.7 1,414 35 2.5 16 PREVENTION AND TREATMENT OF DISEASE 17 INFECTIOUS DISEASES NOTIFICATIONS Certain infectious and contagious diseases are required to be notified under the provisions of the Public Health Act, 1936. Details of cases notified (confirmed diagnoses) in 1965 were as follows:- Anthrax Nil Cholera Nil Diphtheria 5 Dysentery 154 Encephalitis 2 Enteric (Typhoid or Paratyphoid) fever Nil Erysipelas 9 Food Poisoning 12 Leprosy Nil Malaria Nil Measles 2,446 Membranous croup Nil Meningococcal infection 7 Ophthalmia neonatorum 7 Plague Nil Pneumonia 29 Poliomyelitis Nil Puerperal Pyrexia 40 Scabies 36 Scarlet fever 78 Smallpox Nil Tuberculosis 134 Typhus fever Nil Whooping cough 47 DIPHTHERIA For the first time since 1961 diphtheria was notified in the area now covered by the present Borough. On 4th February, before the formation of the Borough, a young boy was admitted to Eastern Hospital from the Reception Centre, 205 Morning Lane, E.9. with Chickenpox. Subsequently a throat swab revealed that the boy had the organism C. diphtheria mitis. A thorough investigation at the reception centre, a local school and other dwellings was undertaken jointly between the staff of the old Metropolitan Borough of Hackney, and the staff of the London County Council Division No. 4. Over 1,800 throat swabs were taken and as a result 40 carriers were discovered and a further four cases were notified. This incident highlights the need for protection against childhood infectious diseases and my health visiting staff take every opportunity to encourage parents to have their children immunised. All persons found to be cases or carriers were treated in hospital, and the outbreak successfully brought under control. MEASLES This year coincided with the usual biennial outbreak of this infectious disease. Only 98 out of the total of 2,446 needed to be admitted to hospital i.e., 4%. This compares very favourably with the previous year when 14% had to be admitted to hospital. One little girl, aged 2, who also had a congenital abnormality, died from the disease. MENINGOCOCCAL INFECTION Four of the seven cases notified made a satisfactory recovery, but three cases were notifed posthumously. OPHTHALMIA NEONATORUM Of the 7 cases notified five were babies born to Hackney mothers. POLIOMYELITIS It is gratifying to record for the third year running that there were no cases notified. 18 PUERPERAL PYREXIA There was a total of 40 cases notified to the Department; 39 were associated with hospital confinement and one case with a home confinement; 30 of the total number of cases related to Hackney residents or mothers. No. of cases notified over the previous four years:- 1961 - 153 1962 - 100 1963 - 39 1964 - 58 TUBERCULOSIS Of the 203 notifications of Tuberculosis received, 185 related to pulmonary infection and 18 to non-pulmonary. The attack rate per thousand of the population for all forms of Tuberculosis notified for the first time (134 new cases) was 0.53 (as compared with 0.66 in 1964 and 0.59 in 1963). Details of the notified cases are as follows:- Age-Groups Primary Notifications Non-primary Notifications Pulmonary Non-pulmonary Pulmonary Non-pulmonary Male Female Male Female Male Female Male Female 0 - 1 - - - - - - - 1 - 2 1 - - - - - - 2 - 1 4 - - - - - - 5 - 1 2 1 - - 1 - 1 10 - 3 - - - - - - - 15 - 5 2 - - 1 2 1 - 20 - 11 6 - - 4 1 - 2 25 - 18 10 4 - 14 7 - - 35 - 10 7 3 1 13 1 - - 45 - 11 2 - - 1 2 - - 55 - 13 2 1 1 3 2 - 1 65 - 3 2 - 2 3 2 - - 75 - 4 - - - - 1 - - Totals 83 38 9 4 45 19 1 4 Primary notifications relate to persons who had not been previously notified in the area of any authority. The sources of information of the 69 non-primary cases were:- "Transfers" from other areas 68 Posthumous notification 1 In addition 28 other persons on the Tuberculosis register were certified as dying from other causes. The Department's Tuberculosis Register showed the following position:- Pulmonary Non-pulmonary Totals Male Female Male Female Male Female On Register at 1st January 1,337 1,026 169 166 1,506 1,192 Add:- Notifications 84 38 9 4 93 42 Transfers from other areas, etc. 43 18 - 5 43 23 Returned to Hackney 12 11 1 1 13 12 Deduct:- Deaths 40 8 1 3 41 11 Left the Borough 89 60 14 11 103 71 Recovered 75 65 7 9 82 74 Diagnosis not confirmed 1 1 - 1 1 2 From 'Non-pulmonary' to 'Pulmonary' - - - 1 - 1 On Register at 31st December 1, 271 959 157 151 1,428 1,110 19 Various services are provided by the Department for the tuberculous and it would seem appropriate to set out the details here, and a brief summary of help available is set out below:- Home Care - No. of visits by T.B. visitors 5,804 Home Nursing - No. of patients being attended by home nurses at end of year 13 Home Helps - No. of cases being serviced by home helps at end of year 26 boarding out of T.B. contacts - 4 Extra nourishment No. of cases receiving nourishment at end of year 145 B.C.G. Vaccination - No. of contacts vaccinated 259 No. of 13 year old schoolchildren and students vaccinated. 2,281 The area is covered by three chest clinics - Shoreditch chest Clinic situated at 204 Hoxton Street, N.1., The Metropolitan Chest Clinic at the Metropolitan Hospital, 335 Kingsland Road, E.8., and the T.B. Dispensary, London Chest Hospital, Victoria Park, E. 2. The chest clinics are staffed by medical staff from the Regional Hospital Board, but attached to them are T.B. health visitors or T.B. visitors, employed directly by this Council; these visitors attend at the clinics, and in addition undertake the appropriate social work within the community. As well as the nursing staff, social workers and clerical staff are supplied directly from the Health Department to some of the clinics. Two of the Consultant Chest Physicians report as follows concerning the work of their clinics:- Shoreditch Chest Clinic "Tuberculosis still remains a problem and will remain so for some years. The incidence is however decreasing and 54 new cases were diagnosed in the area covered by this clinic in 1965. The major part of the work of the clinic is concerned with the care of chronic bronchitis and a high proportion of our patients are respiratory cripples in some degree. Regular visits to the clinic appear to keep sufferers of this chronic and disabling condition out of hospital and enable them to lead a more active life than they would otherwise be able to. The incidence of bronchial carcinoma continues to rise. Nineteen cases were diagnosed here during the year and this number will be exceeded in 1966. Co-operation with the Mass Radiography Units and the Local Authority has been maintained, and we are very grateful for their help in solving epidemiological problems." Metropolitan Chest Clinic "A total of 5, 641 patients attended the clinic during the year and of these 480 were referred by General Practitioners for the first time. 33 cases were notified as suffering from Pulmonary Tuberculosis, and there were 7 non-respiratory cases. 101 contacts of these were given B.C.G. Hospital beds are fortunately always available for the treatment of Chronic Bronchitis and Emphysema, and 85 patients were admitted during the year. 52 of these attended the Clinic for the first time. A period in Hospital is followed by supervision by the Chest Clinic. This enables the Bronchitic patients to continue working with more confidence. 20 The increasing incidence of Lung Cancer is disturbing. 25 patients were found to have the disease, and of these, only 8 cases were considered suitable for operation." VENEREAL DISEASE There is one public clinic situated in Homerton Grove which is run by the Hackney Hospital Management Committee, but the Council provides the venereal Disease Social Worker to follow up cases and to track down the source of the infection. This clinic is available to anyone seeking advice. In respect of residents in the Borough the number of new cases noted in the year was 240 (18 Syphilis and 222 Gonorrhoea). PUBLIC HEALTH LABORATORY SERVICE The Department has an arrangement whereby bacteriological specimens are sent to the Public Health Laboratory. The 5,002 specimens submitted for examination were reported on as follows:- Specimens Number Organisms Results Negative Positive Throat and Nose Swabs 1,811 Diphtheria Bacilli 1,721 40 Haemolytic Streptococci 103 20 Vincent's Angina 77 1 Faeces and Rectal Swabs 3, 114 Pathogens 2, 936 - Salmonella Brandenberg - 1 Salmonella Enteriditis - 2 Salmonella London - 7 Salmonella Paratyphi B - 2 Salmonella Typhimurium - 17 Shigella Sonnei - 142 B. Coli - 7 Urine 62 Pathogens 62 - Sputum 15 Pathogens 14 - Staphylococci - 1 21 PERSONAL HEALTH SERVICES provided under the National Health Service Act, 1946 22 SECTION 22 - CARE OF MOTHERS AND YOUNG CHILDREN The National Health Service Act, 1945, forms the basis of the majority of the personal health services. Section 22 requires every local health authority to make arrangements for the care of expectant and nursing mothers and all children who have not attained the age of five years. The aim of the maternal and child welfare element of the Department is to promote the health and welfare of all mothers whether they be confined at home or in hospital, and of their young children, although the pattern of the service is constantly changing to meet present day needs. The high birthrate and the need to provide still better facilities is making more demands than ever before on the hospital and domiciliary maternity services. Fortunately, in this Borough, facilities are available for 88 per cent of mothers to have their babies in hospital. For those women, however, who must, or prefer to, have their babies at home, the Council employs midwives directly, and it also has an arrangement whereby the Mothers' Hospital provides domiciliary service on an agency basis. As far as young children are concerned, it must be remembered that although thanks to the good medical service in this country and the general improvement in housing - 98.5 per cent of children born are splendid, healthy babies, 1.5 per cent of all babies born, who survive the dangers of the first few weeks of life, have suffered some potential danger, such as birth injury, prematurity, or dangers from certain blood diseases. In order to diagnose a possible handicap at the earliest moment, these babies will need constant surveillance so that steps may be taken either to remedy or minimise its effect. The foremost worker in this latter category is the health visitor, who, in the new concept of her training, has been educated to look for precisely these signs of early danger. ANTE-NATAL AND POST-NATAL CLINICS There was a drop in the birth-rate in 1965 over the high level of previous years and this, combined with the high percentage of institutional confinements in the Borough, made it possible to reduce the number of weekly ante-natal sessions run by this Authority by two. There is a tendency at present for more expectant mothers to receive their ante-natal and post-natal care from a general practitioner obstetrician. Many of the women receiving ante-natal care from their G.P.O., or their own doctor, are willing to attend mothercraft and relaxation classes at the local authority centres. Facilities are provided for general practitioner obstetricians to work from centres of their own choice and 11 are doing so. Ante-natal and Post-natal Services Centre No. of sessions No. of women who attended for ante-natal post-natal examination examination Total attendances Barton House 52 292 81 1,453 Elsdale Street 52 205 64 571 John Scott 88 278 40 1,040 Lower Clapton 76 268 114 687 Richmond Road 48 366 144 1,287 Shoreditch 47 106 41 317 Upper Clapton 47 133 80 457 West Hackney 98 224 116 788 508 1,872 680 6,600 23 Mothercraft and psycho-prophylatic clinics were held in the Health Department clinics throughout the year: the number of women who attended during 1965 is shown below: Institutionally booked 188 Domiciliary booked 7 Total attendances 1,202 No. of sessions 182 Mothers are encouraged to obtain post-natal care whenever appropriate. Shortly after the baby is ten days old the mother, wherever she has had her confinement, is visited by the health visitor who explains to her the various services available, gives advice on many problems appertaining to the new baby, not only on feeding problems but such things as relations with other children, relations with the father, possible financial aspects, the need for purchase of prams, baby clothes and early detection of abnormality, etc. This is the modern concept of the health visitor as against that of 25 years ago when the health visitor was mainly concerned with malnutrition, correct feeding and infection. In addition, the health visitor can be of help in advising the unmarried mother who decides to retain her baby and who wishes to meet the inevitable problems of this situation on her own. CHILD WELFARE CLINICS Every mother is also encouraged to bring her baby to her local maternal and child welfare centre and from the figures shown below it will be seen that a very high proportion do. Bearing in mind that some few babies born in 1964 would not be seen until 1965 and those born very late in 1965 would not be seen until 1966, it can be estimated that more than 80% of mothers make use of these centres. The average attendance at each child welfare session was 32. No. of children who attended Hackney Borough Council clinics during 1965:- who were born in 1965 4,742 „ „ „ „ 1964 3,870 „ „ „ „ 1960-63 4,579 Total attendances 62,494 No. of sessions 1,901 No. medically examined 22,650 No. referred elsewhere 610 Child Welfare Attendances Centre No. of Sessions No. of children who attended No. of children referred elsewhere Total attendances Barton House 176 1,220 47 7,194 Cranston 77 334 10 1,550 Elsdale Street 179 1,190 48 5,825 John Scott 198 1,743 88 8,041 Lower Clapton 250 2,200 135 10,640 Richmond Road 253 1,777 14 6,331 Shoreditch 187 903 55 4,588 Upper Clapton 243 1,820 146 7,266 West Hackney 200 1,436 61 7,379 Wick 138 568 6 3,680 1,901 13,191 610 62,494 24 A comparison with the 1964 figures for Health Division No. 4 of the former London County Council, however, shows that there has been a drop in total attendances of children under 5 years of 3,984. This may be due in part to the fact that an increasing number of general practitioners welcome mothers and babies at their surgeries, but also to the fact that there is an acute shortage of health visitors who have to concentrate on selective visiting and have insufficient time at their disposal to do all the repeat visits they would wish to encourage less willing mothers to attend the centres. The number of attendances in the age group 3-5 increased from 4,099 in 1964 to 4,579 in 1965. There are possibly several factors having a bearing on this, not the least of which is the practice of the Department in sending out 'birthday' cards to the parents of toddlers asking them to bring the children for a check-up. THE HANDICAPPED CHILD For some time past the Health Division No. 4 of the London County Council had been endeavouring to obtain from the local hospitals and general practitioners details of children who, because of some abnormality in the pre-natal stage or during birth, might be liable to some handicap, physical or mental, in later life. Negotiations have since been going on with the hospitals to complete records that would help us with this purpose and health visitors, wherever they know of such cases, make a special attempt to watch out for any aberration from the normal developmental process. These handicaps include not merely a physical handicap, but the possibility of slow mental development, hearing loss, delayed speech development, etc. The early assessments of all these handicaps makes it much easier to predict the future needs for special types of education for these children. Even where a handicap is due to an accident after birth, early identification of the defect might be of considerable importance; early detection is particularly important with hearing loss as it is generally accepted that a child's ability to speak and understand language properly later on depends to a large extent on his ability to hear normal human speech during the first year of life. CONGENITAL ABNORMALITIES DETECTED AT BIRTH A standardised form of notification to the Registrar General of all babies born with a detectable abnormality was introduced in 1964, following a directive from the Minister of Health. Its purpose is to show up any seasonal, geographical or other factors hitherto unrecognised, giving rise to increased incidence of a particular abnormality. While it will only be after a considerable time that the findings can be of great significance, it is hoped that definite trends in the patterns of occurrence of some congenital abnormalities will gradually emerge. The primary purpose of studying these abnormalities is to assist in their prevention in the future. During 1965, 99 abnormalities were notified; of these 63 could be considered minor in degree while 36 were major deformities, some being imcompatible with life. The most commonly occurring defect was talipes deformity of one or both feet. A follow-up of cases is carried out if necessary to confirm the diagnosis made at birth, and to follow up the treatment being given at hospital. 25 FAMILY PLANNING Family planning services are provided both directly and on an agency basis through the Family Planning Association. The Council's own clinics can only, by Statute, take women whose health it is considered would be adversely affected by pregnancy; there are two such weekly clinics held in the Borough: other cases are referred to the Family Planning Association clinics. The Family Planning Association run two clinics where they see women referred by the Council and women referred directly by general medical practitioners, hospitals etc. The figures relating to Council clinics are as follows:- No. of persons who attended in 1965 753 Total attendances 1,653 No. of sessions 101 The requirement that local authority clinics should only deal with women where there is a medical reason against pregnancy gives rise to much difficulty. Much must be left to the conscience of the individual doctor. I believe that the narrow view that medical reasons must only include some definite physical reason is now out-dated. A combination of social circumstances, family circumstances, and possibly some minor ailment might constitute a perfectly valid reason for a woman to space her family by modern birth control methods. It is my own feeling that sooner or later local authority clinics should be given authority to give family planning advice to all married women who require it. As far as unmarried women are concerned, advice may not be given at local authority clinics, and at the date of this report, not at the accepted family planning clinics. It is my own personal view that this leaves one of the biggest problems of family planning unanswered. However unwelcome a pregnancy might be in marriage, we still live in a society in which the birth of an illegitimate child is often a tragedy. At the same time, we must accept the fact, whether we like it or not. that patterns of social behaviour are changing. If an unmarried woman is going to indulge in sexual intercourse, then obviously she must run the risk of pregnancy and not to offer to these women advice on pregnancy seems to me completely illogical. Apart from anything else it places a premium on dishonesty. Sooner or later I think we will have to deal with this problem which grows bigger every year, rather than sanctimoniously try to pretend it is not there. DENTAL SERVICE - MATERNAL AND CHILD WELFARE The Local Authority is under a duty to provide dental services for expectant and nursing mothers and to young children. The number of sessions devoted to this service was 557 - the equivalent of the practice of one whole-time dental officer, which is approximately l/10th of total treatment sessions given to school health and maternal and child welfare services combined. This ratio complies with the Ministry of HealthS recommendation. The number of expectant and nursing mothers that receive treatment relative to the number of live births indicates that about 10% make use of this service. This appears to follow the national pattern as reference is made to this situation in the Annual Report of the Chief Medical Officer of the Ministry of Health for 1963. The only good aspect of this is possibly that more attention can be devoted to pre-school children, for it is here among this group that the ravages of dental decay begins, and it is through early loss of deciduous teeth that much dental disease is created in permanent dentition. Our aim is to encourage regular inspections and early treatment thus eliminating the fear created by first contact with dentistry being made when emergency anaesthetic and multiple extractions become necessary as a result of neglect. Dental education is best achieved by working in conjunction with other M. & C.W. services and where possible in the same clinics. 26 Expectant and nursing mothers Children aged under 5 years No. examined in 1965 No. who commenced treatment in 1965 No. of courses of treatment completed in 1965 Treatment Scalings and gum treatment Fillings Silver nitrate treatment Crowns and inlays Extractions General anaesthetics Dentures provided - full upper or lower - partial upper or lower Radiographs 567 422 207 174 1, 271 124 1 336 3 49 78 27 809 455 421 1,044 344 35 4 1 DAY NURSERIES There are seven nurseries in the Borough, the great majority of admissions being of children whose mothers are unable to care for them for reasons of illness or confinement, and alternative provision cannot be made, and where mothers, who are the sole support of their children, must go to work. The special scheme of admission for certain categories of handicapped children which originated with the London County Council has been continued and is of very valuable assistance in providing stimulating, stable surroundings for a small number of those with a hearing loss, or hearing children born to deaf parents, also a few showing retardation of mental development. In the last type of child, admission provides short respites for the mothers from their constant wearing task of caring for difficult children. It is surprising how helpful the time spent in the day nursery has been to the children themselves, although the considerable extra work for the staff dealing with them should not be overlooked. The majority of handicapped children attend part-time only. During 1965, major internal alterations have been proceeding at Sun Babies Nursery as the premises were out of date and very dilapidated. The nursery continued to receive children while the work was going on until the weather became very cold, and conditions became unsuitable for children, and impossible for the staff to work. It was then decided to transfer the nursery temporarily to part of the first floor accommodation, which was vacant, at Shoreditch Health Centre. The number of children admitted had to be kept lower than normal owing to reduced space, but this was inevitable. The renovations were not nearly complete at the end of the year, but it is hoped that the nursery will be able to re-open in improved premises during 1966. The Matron and staff deserve high praise for the cheerful way in which they accepted the task of working for many months in difficult circumstances. The staffing of the day nurseries is becoming increasingly difficult. For senior posts the response to advertisements is poor both in quantity and quality of the applicants, and recruitment of girls for training for the certificate of the Nursery Nurses Examination Board has also become more difficult. OCCASIONAL CRECHES The Creches are provided for the minding of children for a period of three hours while the mother is attending hospital or the clinic, or in certain cases for other reasons. A small charge may be made for this service. 27 There were 18 creches held each week at 5 maternal and child welfare centres. During the year, however, the 3 creches held at the Richmond Road maternal and child welfare centre had to be closed because of the difficulty in obtaining staff. Centre No. of sessions Total attendances Barton House 104 2,001 Elsdale Street 126 1,195 Richmond Road 88 765 John Scott Health Centre 506 6,653 Total 824 10,614 SECTION 23 - MIDWIFERY SERVICES The Authority is under a statutory obligation to provide midwifery services for those mothers who must or wish to have their babies at home. The new London Borough of Hackney took over four midwives from the London County Council, three from the previous voluntary District Nursing Association, and in addition used on an agency basis five midwives attached to the Mothers' Hospital. As from the 1st April, the District Nursing Associations ceased to exist as far as this Borough was concerned, and their midwives are now directly employed by the Council. fortunately in this borough facilities for hospital confinements are good, but I set out below a table showing the numbers of domiciliary confinements. Confinements Doctor booked Given Analgesia Discharged to midwife before 10th day Council midwives 346 331 288 80 Hospital district midwives 323 270 251 69 Total 669 601 539 149 The Authority is a supervising authority under the Midwives Act, 1951, and employs a non-medical supervisor of midwives, although because of the difficulty of obtaining a suitably qualified person to fill this post for part of the time dispensation was given to the Authority to work on the basis of a medical supervisor of midwives, and this was undertaken by one of the staff of the Health Department. All midwives are required to send each year to all the authorities in whose areas they are intending to practise, notification of their intention to do so. During the year under review 127 such notifications were received. The Council is also required to pay fees to medical practitioners who are not booked but are called in by midwives in an emergency. There is a local Maternity Liaison Committee composed of members of the consultant and nursing staff at the various hospitals, as well as the Medical Officer of Health and the Principal Medical Officer (M. & C. W.) This committee discusses problems on discharge notification forms, question of time of discharge, etc., as and when these subjects may arise. 28 THE CARE OF PREMATURE BABIES The Borough is fortunate in having two large maternity units within its boundary, both of which have fully equipped premature baby units. In the infrequent cases where a premature baby is born at home, a special cot or portable incubator is sent by ambulance, and a midwife accompanies the baby to hospital. The results of the perinatal mortality survey carried out in 1958 showed that babies born more than two weeks prematurely are at a higher risk than those born at full term. Special care needs to be given to all babies whose birth weight is 5½ lbs. or less, or where the pregnancy ends naturally or brought on artificially for a medical reason - before 38 weeks: all such babies are regarded as immature. When early labour is imminent, mothers are admitted immediately to hospital for delivery, where all facilities for resuscitation and specially warmed nurseries and cots are available. Out of a total of 497 premature live and still births notified in 1965 only 34 occurred at home or in a nursing home. Weight at birth Premature live births Premature stillbirths Total premature live and still births Born in hospital Born at home or in a nursing home Died Born Total births in hospital Within 24 hours of birth In one and under 7 days In 7 and under 28 days Nursed entirely at home or in a nursing home Transferred to hospital on/or before 28th day In hospital At home or in a nursing home 2 lb. 3 oz. or less 20 15 5 - - - 12 - 32 Over 2 lb. 3 oz. and up to and including 3 lb, 4 oz. 20 3 - 1 - 1 13 - 34 Over 3 lb. 4 oz. and up to and including 4 lb, 6 oz. 76 5 3 1 - 3 15 - 94 Over 4 lb. 6 oz. and up to and including 4 lb, 15 ozs. 92 - - - 1 2 3 1 99 Over 4lb. 15 oz. and up to and including 5 lb. 8 oz. 209 - 5 - 22 4 3 - 238 Total 417 23 13 2 23 10 46 1 497 29 SECTION 24 - HEALTH VISITING The Authority is under a statutory duty to provide health visitors to care for mothers and young children. As distinct from pre-war when much of the health visitors' work was confined to giving advice on the various problems of the very young baby - her duties have now changed radically. Modern teaching has meant that the health visitor is often the all-purpose visitor to families with children of any age, as in addition to being a health visitor, she is wherever possible the school nurse as well. The number of health visitors at the end of the year was 27. Unfortunately this number is very much below a reasonable establishment for a borough of this size and this fact is giving rise to considerable anxiety to the Department. Cases visited by health visitors No. visited:- At request of G. P. or hospital Others Total Children born in 1965 6,056 Children born in 1964 4,847 Children born 1960 - 63 9,688 Total No. of children born 1960 - 65.. 20,591 Persons aged 65 or over 138 314 452 Mentally disordered persons 17 173 190 Persons, excluding maternity cases, discharged from hospital (other than mental Hospitals) 43 110 153 Tuberculous households.. 6 Households visited on account of other infectious diseases 114* *This includes 103 households visited during first quarter of year due to an outbreak of diptheria. The modern trend is to attach health visitors to group practices where possible in order that they might help family doctors with the social side of their medical work. It is our aim that we should do this, but until such time that either we have more health visitors or more group practices in the Borough, this would seem unlikely to be achieved. SECTION 25 - HOME NURSING SERVICE Prior to 1st January, 1965, all home nursing in the area covered by the London Borough of Hackney was undertaken by three voluntary district nursing associations; namely Hackney, Shoreditch and Bethnal Green, and Stoke Newington. In the discussions leading up to the re-organisation of local government in London, the local district nursing associations indicated that they no longer wished to carry on and asked the Council if it would take over the running of the district nursing service direct. The Authority, of course, is under a statutory obligation to provide a district nursing service. 30 As the district covered by the Shoreditch and Bethnal Green District Nursing Association spread over both the future London Boroughs of Hackney and Tower Hamlets, it was decided that as from 1st January, 1965, the 'Shoreditch' side of the Shoreditch and Bethnal Green District Nursing Association should be absorbed into the Hackney District Nursing Association. Likewise Stoke Newington District Association was to amalgamate with the Hackney District Nursing Association on 1st April. In the event, however, the Hackney District Nursing Association decided to cease as a voluntary organisation and the Council thus assumed direct responsibility for the Home Nursing Service in the London Borough of Hackney on 1st April. I am pleased to be able to take this opportunity of recording my appreciation to all the voluntary workers who have helped to build up this service until the district nurses became part of the directly employed staff of the new London Borough of Hackney on 1st April, 1965. The district nursing service of the new London Borough of Hackney is centred on the old Hackney District Nursing Association's premises - 6 to 10 Lower Clapton Road. It has continued to function smoothly from its inception on the 1st April to the end of the year. The summary of statistics given below indicates briefly the amount of work carried out:- No. of cases being nursed at end of 1965 916 Total no. of patients nursed during year (of these, 113 were aged under 5 years and 1,590 were aged over 65 at their first visit in 1965) 3,225 Total no. of visits during 1965 121,116 SECTION 26 - VACCINATION AND IMMUNISATION The Authority is under a statutory duty to provide for vaccination and immunisation against certain diseases. This is carried out directly by the Council's own staff, and also by family doctors who notify the Health Department of such vaccinations and immunisations carried out in children under the age of 16. Family doctors may obtain materials for vaccination and immunisation directly from the various establishments of the Health Department. Completed Primary Courses Type of vaccine or dose Year of birth Total 1965 1964 1963 1962 1961 1960-58 1957-50 Pre-1950 Diphtheria 2,460 1,984 234 134 87 253 197 7 5,356 Whooping Cough 2,452 1,966 224 116 62 45 10 1 4,876 Tetanus 2,460 1,984 234 135 88 217 186 121 5,425 Poliomyelitis 1,040 2,879 367 290 226 481 267 758 6,308 Reinforcing injections/doses Diphtheria Nil 1,464 1,355 294 342 1,577 485 3 5,520 Whooping Cough Nil 1,445 1,318 269 151 271 14 1 3,469 Tetanus Nil 1,459 1,348 286 336 1,444 223 7 5,103 Po1iomyelitis Nil 2 4 7 77 1,691 385 44 2,210 31 Smallpox Vaccinations Age 0-3 months 3-6 months 6-9 months 9-12 months 1 year 2-4 years 5-14 years 15 years and over Tota1 Primary vaccinations 7 16 24 26 2,097 822 83 149 3,224 Re-vaccinations Nil Nil Nil Nil 4 39 174 711 928 Arrangements are in force whereby the state of Immunity of the children is ascertained and any necessary steps taken to arrange either for immunisation or re-immunisation. SECTION 28 - PREVENTION OF ILLNESS AND AFTER-CARE This section is probably the most comprehensive section in the National Health Service Act, as far as local health authorities are concerned; it can be used, subject to Ministerial approval, to carry out any functions which might prevent illness, allow for the care of illness or to give help to persons who have had illness: its application depends much on the initiative of each borough. As far as this borough is concerned some of its applications fall under the following heads:- CHIROPODY In addition to the general powers to provide foot clinics under this Section of the Act, local authorities have the power to give grants to voluntary organisations who are providing a chiropody service. This Borough holds foot clinics at five of the maternal and child welfare centres and at the Salvation Army Goodwill Centre, New North Road, N.1. Details of attendances are set out in the table below:- Age Children Males Females Total 0-4 5-14 15-64 65+ 15-59 60+ First attendances 5 489 65 106 227 349 1,241 Total attendances 6 2,496 1,353 3,130 6,535 17,837 31,357 Fee paying attendances 7,475 Free attendances 23,882 No. of sessions held 4,310 No. of failures to attend 3,512 Percentage of bookings who failed to attend 10.1 The demand for this service far exceeds that which the Council provides; the main reason being the general shortage of chiropodists. The Government has laid down that chiropodists directly employed by a local authority must be registered in accordance with the provisions of the Professions Supplementary to Medicine Act, 1960. Ideally, of course, a domiciliary service would be highly desirable in order to reach those people who for obvious reasons cannot attend for treatment, and it is hoped in the forth-coming year to look into this question. 32 Apart from the Department's own chiropodists, a chiropody service is also given through the services of the Hackney Association for the Welfare of Old People, and they do, in fact, provide a domiciliary service on a small scale. HEALTH EDUCATION This section of the Act also provides that the Authority may undertake health education. The Department has a section which deals with this, but during the year, for obvious reasons following re-organisation, its work has been limited to a large extent to poster publication and direct health education by the staff. The rationale of the programme was to take each month a separate topic, e.g., clean food, immunisation, and to co-ordinate poster and other visual aids on this topic. The whole subject of health education is, of course, a large one. Not least are lectures given to school children, and arrangements are made for nurses to go into some of the larger schools to lecture on various subjects which although possibly not directly of a health education nature, e.g., parent-craft, have a definite health education connotation. Although the subjects of dental hygiene, venereal disease and smoking are of particular current interest, it is regretted that during the turmoil of re-organisation it has not been possible to give more than superficial coverage to these topics. As part of the campaign warning of the dangers of excessive smoking, the Council decided to include in the lease of sites for advertising purposes a clause prohibiting the display of advertisements relating to smoking. RECUPERATIVE HOLIDAYS Holidays are provided under this Section for adults and children who have suffered from a recent acute illness and who need a short period of rest and fresh air but no medical or nursing care. The homes used for these holidays are mostly situated at pleasant coastal resorts and they include home catering for special invalid and kosher diets. Many letters have been received from patients expressing gratitude for the service given. The numbers sent on recuperative holidays are set out below:- Expectant and nursing mothers 2 Other adults 312 Children under 5 not attending school 21 School children (including nursery school) 109 SECTION 29 - HOME HELP SERVICE Under this section of the National Health Service Act, the Authority is required to provide a home help service for giving help in the home to pregnant women, families with young children, families where there is physical or mental ill health in the house, or families where there is need for help because of old age. The new borough inherited from the former Health Division No. 4, four home help offices each staffed by an Organiser, Assistant Organiser, and the necessary clerical staff, with a total of some 550 whole and part-time home helps. The duties of these home helps are many and varied: briefly they are expected to carry out the duties that the conscientious housewife would normally undertake. As might be imagined this can include anything from washing, looking after children where the mother is sick, to fetching the shopping where a person is housebound. Their work in certain circumstances can be very arduous, and some of them display extreme patience and devotion to duty with some of the difficult cases with which they have to deal. I would instance one case where, through the devotion to duty of a home help, an entire family, who at one time might well have been classed as a problem family, were brought up and were able to reach and lead a normal existence. In addition, certain home helps elect to work in homes where there are tuberculous patients: this is entirely at the discretion of the home help and, of course, in this case, special checks are kept on their health. 33 I give below, briefly, the statistics for the year:- No. of cases who received service in 1965 (of these 3,626 were 65 years of age or more and 82 were maternity cases) 4,591 No. of effective visits by organising staff 7,874 No. of ineffective visits by organising staff 1,188 No. of whole-time home helps at 31.12.65 80 No. of part-time home helps at 31.12.65 451 Total whole-time equivalent 373.5 SECTION 21 - HEALTH CENTRES Two sections of the National Health Service Act have not been dealt with Sections 27 and 21: Section 27 dealing with the Ambulance Service is not the concern of the Hackney London Borough Council, but the concern of the Greater London Council; Section 21 deals with health centres. When the National Health Service Act came into being, Health Centres, combining general practitioner group practices, the local authority personal health services, and even certain of the hospital services, were to be the corner-stone of the new National Health Service. For a variety of reasons, the idea never progressed very far. However, the first, and probably the biggest health centre built, was the Woodberry Down Health Centre, now re-named the John Scott Health Centre. The Centre incorporated all aspects of the local authority health services; provided for six family doctors; a section for the child guidance services of the Education Authority; dental services; other ancillary services such as laboratory, X-ray, and even operating facilities from the hospitals. This Centre became a show-piece the world over, and was visited by important foreign visitors, British visitors, as well as innumerable students - medical, sociological, etc. This Centre was inherited as the Woodberry Down Health Centre on the 1st April, 1965, and during the year, as a tribute to the late Dr. J.A. Scott, Medical Officer of Health to the London County Council, who had so much to do with the inception of this Centre, it was re-named the John Scott Health centre. The Minister of Health, the Rt. Hon. Kenneth Robinson, M.P., honoured the Council by unveiling the plaque commemorating the ceremony. The Centre continues to function, perhaps not quite in the manner originally intended, but still as a centre that houses general practitioners, local authority services, dental services, education services, and to a small extent, services from the hospitals. A booklet was prepared at the re-naming ceremony which members of the Health Committee received, setting out in detail the current services. During 1965, the centre was visited by many foreign visitors representing political and professional organisations, and the centre still continues to receive students of all types. 34 OTHER PERSONAL HEALTH SERVICES 35 MENTAL HEALTH SERVICES On April 1st 1965, the new Borough inherited from the former London County Council the local authority mental health services. We were indeed fortunate in that we inherited good services from the L. C. C. I understand that under the L.C.C. there had been some division of responsibility for the various aspects of the services. However, as from the 1st April, the mental health services which previously had been divorced from the main divisional office were brought under the same roof as the main Health Department; this had the enormous advantage of much closer liaison between mental health social workers and officers in other branches of the health service, e.g., medical officers, health visitors, school nurses, public health inspectors, etc. The L.C.C. had maintained centrally an emergency coverage for mental health service out of office hours, and in order to give a service that was not diminished in any way, an arrangement was entered into with the London Borough of Islington to maintain a similar rota, based for the first year on the John Scott Health Centre. The mental health social workers not only undertake the statutory duties, but also act as supportive workers both for mentally subnormal persons and their families, and for mentally ill persons discharged from hospital and their families. Apart from this aspect of personal service the Borough also inherited three day centres for persons who had been mentally ill and returned to the community, but who needed at least a period of sheltered work before re-entering the "hurly burly" of industrial life. The three centres were at - Clifton Lodge, 96 Dalston Lane, E.8. Hindle House, Arcola Street, E.8. Shoreditch Health Centre, 210 Kingsland Road, E.2. Work at these centres is comparatively simple, but provides useful daytime occupation for the patients. During the year twelve patients from the Clifton Lodge Centre found employment which to date they have retained. In conjunction with these day centres social clubs are held at various locations on week-nights and are well attended. One particularly interesting feature of these social clubs is that they attract many 'normal' teenagers - this is a great help in reorientating persons whohave been mentally ill, to a normal world outside hospital Some of the premises, however, will need to be either altered or replaced in the future. In addition to day centres for the mentally ill there are also centres in the Borough for mentally subnormal adults and children. There is a large purpose built centre, Hackney (Junior) Training Centre, in pleasant surroundings, for children up to 16 years in the centre of the Borough. At the time it was taken over from the L.C.C. it was shared with the new Boroughs of Tower Hamlets, Islington and Camden, but at the end of the year it was already apparent that Camden and Islington would be making other provision for their children. In addition to the Hackney Centre, there is a similar centre in Shoreditch which also caters for mentally subnormal children up to the age of 16 years, and it also is shared with other London boroughs. Children are brought to these Centres in coaches, cared for during the day and taught certain elementary skills and social training. Proposals are afoot to make certain amendments in these Centres when the children are withdrawn by the other boroughs. On 1st April there was also a centre for training older boys and men, but during the year it was possible to open in Council premises at Wigan House a further Centre for older boys and men who were on the waiting list. Neither centre is ideal for the purpose, and at the time of the preparation of this report a completely new and purpose-built building is in the process of erection. Women and elder girls are not catered for in the Borough, but arrangements are in force whereby they attend a training centre in the neighbouring borough of Tower Hamlets. 36 A need, unfulfilled at the birth of the new London Borough, was a place to care for the particularly severely mentally handicapped children, or those children having a physical as well as a mental handicap. At the end of the year plans were in hand to start a small experimental unit for this purpose, and it is hoped that this will be in action early in 1966. During the year, 53 patients were given short-term care in hospital or residential homes in order to relieve family stress and emergency situations. The number of vacancies available for short-term care cases is decreasing, due to several factors and it is necessary to seek vacancies at great distances from London. The provision of short-stay accommodation, near at hand, is becoming increasingly urgent. Arrangements were made for permanent care for 13 patients during the year. The number of vacancies available for permanent care is becoming less, and hospitals have now stated that the criterion for admission is that the patient requires medical and nursing care; this takes no account of patients requiring care and protection on social grounds, and during the year arrangements have had to be made for this type of patient to be accommodated in private homes at great expense. A Special Advisory Clinic is held with the co-operation of a medical officer of the Inner London Education Authority, to give help to parents of children who may be considered to be mentally abnormal. The doctor running this clinic advises anxious parents, and keeps a close check on children to watch their development and to plan for their future placement. In order to give additional help to families where the mother might be housebound because she could not leave a severely mentally subnormal child, the Council approved a scheme for the recruitment of child-minders to mind children of this nature, free of charge to the parents, to allow mothers certain free time. At the end of the year the matter was still awaiting Ministerial approval. A summary of the mental health statistics is set out below:- MENTAL ILLNESS Number of referrals during the year 363 The final arrangements made for these referrals was as follows:- No further action 94 Hospital care:- Admitted informally 175 Admitted compulsorily 17 Psychiatric out-patient or day hospital 14 Admitted to general hospital 3 Number taken into Council's community care 56 Number taken into other community care 4 A further breakdown of the 56 persons taken into Council's community care during the year, showing the type of care arranged, was as follows:- Admitted to residential home, hostel, convent, etc. 13 Receiving visits from Mental Health social Worker 44 Attendance at day re-habilitation centre 5 Attendance at day centre 18 Note:- Some people were receiving more than one type of care. Total number of mentally ill persons receiving community care at the end of the year 235 37 MENTAL SUBNORMALITY Number of new cases during the year 99 The final arrangement made for these new cases was as follows:- No further action 15 Number taken into Council's community care 84 A further breakdown of the 84 persons taken into Council's community care during the year, showing the type of care arranged, was as follows:- Admission to private homes, etc. 5 Receiving visits from Mental Health Social Worker 84 Attendance at training centre 14 Other type of community care 4 Note:- Some people were receiving more than one type of care Total number of mentally subnormal persons receiving community care at the end of the year 501 PREVENTION OF BREAK-UP OF FAMILIES The task of dealing with problem families brings in many of the Health Department workers - the health visitor is probably one of the first to meet the families and notify their existence to the Health Department - the routine work then continues as a matter of liaison between many categories of workers in different departments. As far as the Health Department is concerned the position is as follows:- On January 1st, 1965, there were two full-time caseworkers and a senior social worker with a part-time case load in the former L.C.C. Health Division No. 4. Two long-term students under the supervision of the latter had started work with limited case loads before the changeover. One full-time caseworker moved to another borough and the other was promoted to a senior position on April 1st. During the year two new caseworkers were recruited to take their places. In spite of these difficulties a service of supportive, intensive casework has been maintained throughout the year; service was not withdrawn from any family because of staffing difficulties, and care was taken to ensure that no individual family had more than one change of caseworker. At the beginning of the year 24 families were being supported with a total of 104 children and at the end of the year 21 families with a total of 89 children. Eleven cases were closed during the year, of these nine were thought to be. able to use the normal services and two refused help. Three families were transferred to other agencies. Only eleven new families could be referred to the caseworkers during 1965; the drop in number being due to the fact that one of the new caseworkers was recently appointed and had not built up a full case load. The routine work of the caseworkers consist of weekly and often more frequent visiting to most families and includes evening visiting on an average twice a week. Some families require less support for a time and then may suddenly require intensive daily support during a crisis. A great deal of the caseworkers' time is spent in discussion and correspondence with other people. As an example, one family consists of illiterate parents, the mother being crippled from polio, with five little children. Apart from the help that these parents need to give adequate physical and emotional care to their children, their social problems have involved the caseworker in consultation with the health visitor, head teacher, care committee worker, housing officers (welfare and management), National Assistance Board officers, Income Tax officers, gas and electricity board accounts' departments, Ministry of Pensions and National Insurance, social workers from the Welfare Departments of this and another Borough, British Polio Fellowship, and a hospital medical social worker. 38 Apart from casework the workers in this section have frequent case conferences with analogous workers elsewhere, and their observations are then passed to a Co-ordinating Committee which consists of senior officers of the various Council departments and other bodies. During 1965, some 112 cases had been dealt with, and 20 families had been reviewed. In addition to normal work, this part of the department plays a great part in the training of students for various branches of social science. Amongst some of the students that the Department supervised during the year were two from the London School of Economics and one from the College of Deaf Welfare. Two students from the National Institute of Social Working Training had started with the London County Council, Division 4, and came to the Borough with the rest of the Section. One was a Chief Inspector, National Society for the Prevention of Cruelty to Children and the other a Child Care Officer doing the one year course for experienced officers without training and leading to the National Certificate which was awarded to both of them. They were in the Section three days a week for seven months, and were responsible for working with six families under supervision. LOAN OF HOME NURSING EQUIPMENT The Department holds a large stock of equipment necessary for nursing people at home: these include the following items, the numbers being approximate for the beginning of 1966:- Item Number on Books Wheelchairs 54 Chair Commodes 141 Steel Commodes 121 Hospital Beds 19 Penryn Hoists 18 Easi carri Hoists 8 Sani Chairs 4 Mattresses 28 Bed Pans 8 Back Rests 39 Bed Cradles 32 Air Rings 15 Walking Aids 46 Harboro' Cradle 4 Fracture Boards 92 Rubber Sheets 49 Bed Blocks 19 Sheets 32 There is a growing demand for the loan of these items, which are issued on the recommendation of a doctor, hospital or district nurse, and on occasion it has been necessary, particularly in the case of large items such as wheelchairs or commodes for the patient's name to be placed temporarily on a waiting list whilst delivery of new stock is awaited, or whilst articles are collected from patients who have finished with them. In most cases the articles loaned are delivered to the patient's home and collected when no longer required. Each item is of course disinfected before re-issue. INCONTINENCE PADS AND INCONTINENT LAUNDRY The Department provides a service for bed-ridden and other persons who are incontinent. Depending on the medical need, patients are issued with absorbable pads to absorb urine or faeces or, alternatively, arrangements are 39 made for collecting soiled linen which is laundered at Millfields Cleansing and Disinfecting Station and subsequently returned to the patient's family. The laundry is collected in a suitable container once or twice a week, and returned some three or four days later. Some 7, 000 incontinence pads were issued during the year, but no special arrangement has been made for their disposal. In respect of the incontinent laundry some 38,000 articles were laundered. In addition to the above services, the Department provides facilities for the bathing of old people who have no suitable facilities at Home. With the agreement of the family doctor, if it is thought medically appropriate, old persons are conveyed to the Millfields Centre and bathed and subsequently returned home. Alternatively, where it is thought that an old person should be bathed at home, but not blanket bathed by a district nurse, an appropriate attendant with a van from the Department, hot water, etc., attends on the old person and carries out the bathing at home. some 72 persons had 1,233 baths at the Millfields Centre, and 61 persons received 1,065 baths in their own homes. BLIND PERSONS In accordance with the former London County Council practice, arrangements were made within the Department for the examination of all persons who might be considered blind or partially sighted, in order to ascertain whether their names should be entered in the appropriate register; 169 cases were examined during the year. It is intended in the future that the day-to-day administration of this service should be undertaken by the Welfare Department, although the purely medical arrangements will still be dealt with by this Department. RE-HOUSING ON MEDICAL GROUNDS A Principal Medical Officer, an Administrative Officer and two Housing Officers, hold regular meetings, usually once a month to discuss urgent rehousing problems on medical grounds. Each case is discussed and placed in an urgent or non-urgent category. The figures from the 1st April 1965 to the 31st December 1965 were as follows:- Urgent - 43 Non-Urgent - 5 NURSERIES AND CHILD-MINDERS REGULATION ACT, 1948 Private day Nurseries Under the provisions of the Nurseries and Child Minders Regulation Act, 1948, one private Day Nursery, 'Pam Nursery' was registered with this Borough, and continued to be inspected regularly by a medical officer of the Department until its closure in December, 1965. Two new private day nurseries were in process of being registered one at the Church Hall, Church of Our Lady of Good Counsel, Bouverie Road, N.16, to take up to 40 children of 2-5 years, the other under the direction of the Save the Children Fund, at Hemsworth Street, Hoxton, N.l. Initial inspections of these premises were made by a senior medical officer, and the Co-ordinating Nursing Officer of the Department to report on their suitability; and subsequent and routine inspections ensure that the requirements of the Council are observed. Child Minders During 1965, there was 23 registered child minders in the Borough, receiving each a small number of children. 40 These minders are visited and reported on regularly by medical officers and health visitors, in order that the standards of care shall be maintained at a satisfactory level. Reports are sometimes received from health visitors or members of the public about persons said to be minding children without being registered. In every case, a visit is made to the address given and an investigation made. Voluntary minding We still carry on the former London County Council system of a voluntary child minder registration scheme whereby child minders are paid 6/- a week if they will register voluntarily with the Authority even though there is no statutory requirements for them to do so. NURSING HOMES Under Part VI of the Public Health Act, 1936, and the Nursing Homes Act, 1963, the Council has a duty to register and inspect all nursing homes in the Borough. This includes nursing homes in the accepted sense, and mother and baby homes, but not homes used solely for the purpose of accommodating elderly persons. There were four nursing homes registered with the Department at the end of 1965, as follows:- St. Margaret's Nursing Home, 262 Victoria Park Road, London, E.9. Keeper: Mrs. E. W. Eldridge, S. R.N. , S. C.M. St. Mary's Home for Mothers and Babies, 153 Stamford Hill, N.16. Under the Management of The Community of St. Mary the Virgin, Wantage, Berks. "Crossways" Mother and Baby Home, 9 Amhurst Park, N. 16. Under the Management of the Salvation Army. St. Joseph's Hospice, Mare Street, E.8. Run by The Irish Sisters of Charity. As a corollary to registration the Department has a duty to inspect regularly, and to make any suggestions in respect of the care given (not medical care), and to see that the home discharges its functions in a proper manner. MEDICAL EXAMINATION OF STAFF During the year the Department's own staff commenced to undertake medical examinations to determine medical fitness for employment. The number of new entrants examined totalled 59 and 29 staff were examined in connection with sick pay schemes and superannuation. RESEARCH PROJECTS The Department is often asked to take part in regional or national research projects. Amongst these during 1965 was the survey of childhood malignancies. In the Autumn of 1964, trials were carried out in selected areas (of which the L.C.C. Health Division No. 4 was one) of a measles vaccine; the trials were still going on and information collected when an interim report was published during 1965. A further project in which the Department took part was the National Child Development Survey. The purpose of this survey was to determine the present 41 physical, sociological and educational status of 16, 000 children who are survivors of the 1958 Perinatal Mortality Survey. Some 57 Hackney children were among those included in the survey. LIAISON WITH OTHER DEPARTMENTS The Department does, of course, have considerable liaison with other Departments of the Council on various medical aspects of their work. There is a close tie with the Children's Department in respect of such things as adoptions, the Sick Bay at Hutton Poplars Children Home, etc. In addition the Health Department has contact with the Welfare Department in respect of the Morning Lane Reception centre, and on many individual cases. Relations with the Departments have been uniformly good. Consultation with and advice for the Housing Department is a regular feature of the work of the Department. 42 ENVIRONMENTAL HEALTH SERVICES 43 INTRODUCTION The chief task of the year in the environmental field was the amalgamation of the various procedures of the three metropolitan boroughs. Although subject to the main public health legislation, the byelaws and standards for such things as houses in multiple occupation varied to a'minor degree as between the three Metropolitan boroughs. There were also different procedures within the three Departments and each had their individual approach. The main public health statute is not now the Public Health (London) Act, 1936. The work is now done under the principal Public Health Act, 1936, as amended by the London Government Act 1963 and by various London County Council (General Powers) Acts, which were continued in force by the latter Act. Statistical details of the action taken during the year under the various Public Health enactments are given below:- Notices served Notices complied with Public Health (London) Act, 1936 74 69 Public Health Act, 1936 1,371 1, 154 Public Health Act, 1961 64 60 Byelaws 63 54 1, 572 1, 337 PUBLIC HEALTH ACT, 1936 CLEANSING AND DISINFECTION Treatment of scabies and verminous conditions is carried out in the Council's Cleansing and Disinfecting station in Millfields Road, and the following cases were dealt with:- Scabies Head and body lice Cleansing Baths Cases Treatments Contacts (Preventive treatments) Cases Treatments Cases Treatments Children under 5 years 73 130 7 16 16 _ - Children over 5 years 1 3 _ _ _ _ Adults 105 182 3 36 37 4 4 Totals 179 315 10 52 53 4 4 SUMMARY OF DISINFECTION AND DISINFESTATION WORK CARRIED OUT AT THE STATION AND ELSEWHERE Rooms disinfected 425 Bedding and clothing disinfected 15,862 articles Public Library (including routine disinfection) and other books disinfected 4, 348 Rooms disinfested of vermin 1,908 Open sites cleared (material burned and buried on site) 4 occasions Material removed from open sites 2 bins Articles removed from open sites 19 Materials removed from private houses 250 bins 256 van loads 2,168 articles Wasps destroyed 48 nests Bees destroyed 1 swarm 44 For the disinfection of secondhand clothing prior to export, private firms paid a sum of £99. In addition, charges for removal and destruction of unwanted articles from various premises and sites totalled £255. 2s. 5d. The cleansing or destruction of verminous articles were undertaken as follows:- Verminous articles treated 348 Verminous and other articles destroyed 132 single items 7 dustbin loads 19 van loads Unwholesome Laundry Number of persons for whom service was provided during the year 137 Collections and deliveries made 3,653 Number of articles cleansed 38,057 The Committee ordered the destruction of filthy articles in 35 dwellings. OFFENSIVE BUSINESSES There were six premises at which the business of dresser of fur skins was carried on. No contravention of the relevant bylaws was discovered. MORTUARY At the Council's Public Mortuary which adjoins the churchyard of the Parish Church of St. John-at-Hackney, refrigerated accommodation is provided for fifteen bodies. There is a well equipped post-mortem room, a chapel and a viewing room. The Mortuary Keeper resides in a lodge attached to the premises and other accommodation provides a waiting room and an interviewing room for use by the Coroner's Officer. This mortuary receives bodies from the London Borough of Hackney and the Bethnal Green area of the London Borough of Tower Hamlets. The cost is shared on a population basis. Hackney residents Bethnal Green residents Residents of other areas Total Number of bodies received to await post-mortem examination 370 96 85 551 Causes of death certified by Coroner without inquest Number of inquest cases 306 64 85 11 63 22 454 97 PREVENTION OF DAMAGE BY PESTS ACT, 1949 It is the duty of every local authority to take steps to ensure as far as practicable that their district is kept free from rats and mice. Not only are complaints investigated but routine inspections and treatments are also carried out. Complaints of infestation received 2,048 Premises found to be infested 1,692 Drains examined 82 Drains smoke tested 199 Drains found to be defective 22 45 PREMISES INFESTED AND CLEARED OF VERMIN Business Premises Dwelling House Totals Rats 71 493 564 Mice 125 1, 003 1, 128 196 1, 496 1, 692 No charge is made for the treatment of private dwellings but accounts are rendered in all cases where business premises are treated. One sewer treatment, using Pluorakil, was carried out during the year, during which 1,498 manholes were baited. PET ANIMALS ACT, 1951 There are fifteen licensed pet shops, including stalls in open markets, in the Borough to which twenty visits were made; no infringement of the conditions in the annual licences granted by the Council was discovered. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 No new premises were registered for the use of filling materials, but an annual licence to store rag flock was renewed in respect of six premises. Premises registered for the use of and using filling materials 37 Premises licensed for storage of rag flock 6 Samples of filling materials taken for analysis 8 MASSAGE AND SPECIAL TREATMENT By the provisions of the London County Council (General Powers) Act, 1920 as continued by the London Government Act, 1963 as from the 1st April, 1965, the Borough assumed responsibility for the licensing of establishments carrying out massage and special treatments previously the duty of the former London County Council. At the 31st December, 1965, there were 16 establishments on the register. WATER SUPPLY It is the duty of the local authority to take steps as necessary for ascertaining the sufficiency and wholesomeness of water supplies within its district. The Metropolitan Water Board is responsible for supplying water to the area and their Director of Water Examination has kindly supplied information concerning the water supply in the new borough. During the year, he states that the water supply has been satisfactory both in quality and quantity. The water supplied to Hackney is derived from the River Lee, New River and River Thames. The Lee water is pumped into the supply at Lee Bridge Works. The New River water is pumped direct into the supply from the Stoke Newington Works (Green Lanes) under the head of Crouch Hill service Reservoir, while the Thames water reaches this district via works at Battersea and New River Head (Clerkenwell). Some New River water is also pumped to Maiden Lane Service Reservoir (Dartmouth Park Hill) which also receives Thames water via works at Cricklewood. Water from the River Lee is stored in one or other of the large storage reservoirs in the Lee Valley then filtered and chemically treated at Lee Bridge works and pumped direct into supply. The New River, constructed 1609/13, is now fed from the River Lee, from Chadwell Spring (when flowing) and from a 46 number of wells along its course. This water is filtered and chemically treated at Stoke Newington works. The Thames water is abstracted from the river through intakes above Teddington Weir, and, after storage, flows along an open viaduct to works at Ashford Common, Hampton and Kempton Park, where it is filtered and chemically treated. Regular monitoring of the water as it passes through the Works and in the distribution system is carried out in order to control water purification and to detect any form of contamination. All new and repaired mains are disinfected with chlorine and samples of water from these structures are checked in these laboratories before the water is passed through them into service. The table below sets out the results of bacteriological examination after treatment. The figures quoted are yearly averages. Source of supply No. of samples Agar Plate Count per ml. after 20-24 hours at 37°C Coliform count per cent, samples negative in 100 ml. New River - Derived 514 6.4 100.0 Lee Bridge (Lee-Derived) 514 31.4 99.81 All Thames - Derived 3,888 7. 3 99.92 All samples were 100 per cent Negative in respect of Escherichia coli count. Average results of the chemical examination of water, (Milligrams per litre): New River-derived Lee Bridge (Lee-derived) All Thames derived No. of samples 104 52 363 Ammoniacal Nitrogen 0.053 0.028 0.049 Albuminoid Nitrogen 0.065 0.115 0.091 Nitrate Nitrogen 5.7 5.6 4.3 Oxygen abs. from KMnO4 4 hrs. at 27oc 0.72 1.52 1.20 Hardness (total) CaCO3 302 314 264 Hardness (non-carbonate) CaC03 66 98 68 Magnesium as Mg 5 7 4 Chloride as Cl • 42 53 41 Phosphate as PO4 1.4 3.4 1.9 Silicate as Si02 * 12 11 10 Sulphate as SO4 60 98 64 Natural Fluoride as F 0.25 0.25 0.25 Surface - active material as Manoxol OT 0.07 0.15 0.10 Turbidity units 0.1 0.4 0.1 Colour (Burgess units) 7 19 15 pH Value 7.7 7.8 7.6 Electrical Conductivity (micromhos) 610 680 560 FLUORIDATION The three former Metropolitan Borough councils were in favour of the scheme for adding fluoride to drinking water and this Council re-affirmed its opinion that the addition of fluoride is harmless to health and effective for dental protection. 47 FOOD AND DRUGS ACT, 1955 Food complaints from residents who felt that they had been sold food which was unfit for human consumption totalled 45. A full investigation was made into all these complaints and the vendors of the food in question were informed and invited to submit written explanations. In 3 cases the complaints could not be substantiated and no action could be taken; warning letters were sent to vendors in 31 cases and legal proceedings were authorised in 11 cases. Details of food trades carried on in 1,735 premises situated in the Borough Aerated water manufacture 1 Bakehouses (basement) 8 Bakers' shops and Bakehouses 105 Beer bottlers 1 Butchers 207 Cake decoration manufacture 1 Confectionery (Sweet shops) 503 Fish, wet, fried and curing 101 Food importers 3 Greengrocery 210 Grocery and provisions 489 Ice cream - manufacture and sale 676 Milk distributor 340 Public Houses and Off Licences 398 Preserved food premises 234 Restaurants and Cafes 325 Wholesale food storage 48 3, 650 The position in regard to street traders licensed to engage in the sale of food commodities at 31st December was as follows:- Foodstuffs sold Place of Trading Total number of stalls Nile Street Hoxton St ree t Rid1ey Road Cha t swor th Road Well Street Kings land Road Broadway Other Sites Fruit and vegetables 3 42 53 24 17 4 27 13 183 Fish (wet, dry and shell) - 7 10 4 3 1 4 2 31 Poultry - 2 4 1 - - 1 2 10 Meat and poultry - 2 1 1 - - 1 - 5 Grocery and provisions 2 11 16 4 2 - 3 - 38 Sweets and ice cream - 3 - - - 3 2 2 10 Soft drinks - 3 - - - 1 - 1 5 Cakes and biscuits 1 2 2 2 1 - 2 - 10 Refreshments (Coffee stalls) - - 1 - - 2 - 5 8 Apple fritters - . - - - 1 - - 1 Eggs - - 2 2 2 - 2 1 9 Totals 6 72 89 38 25 12 42 26 310 Notices served under The Food Hygiene (General) Regulations, 1960 Regulation No. 5. Pood business not to be carried on at insanitary premises etc. 14 6. Cleanliness of equipment, etc. 16 8. Pood to be protected from risk of contamination 7 9. Personal cleanliness 2 14. Sanitary conveniences 34 15. Water supply to be provided 1 16. Wash-hand basins to be provided 21 17. First-aid materials to be provided 4 19. Facilities for washing food and equipment 4 21, Ventilation of food rooms 2 23. Cleanliness and repair, etc., of food rooms 40 24. Accumulation of refuse, etc. 6 Total 151 48 Notices served under these regulations relating to defects Bakers 1 Bakehouse 1 Butchers 2 Cafes and restaurants 29 Grocery and provisions 35 Public houses 10 Stalls 1 Itinerant vendor 1 Total 80 There were five new applications for the Preparation or Manufacture of Preserved food intended for sale and at the end of the year there were 163 premises registered. FOOD SAMPLES - SUMMARY OF ANALYSES Description of Article Formal samples Informal samples Number taken Number Adulterated Number taken Number Adulterated Apple turnover 1 1 Asprin tablets 9 2 Baby foods 1 3 1 Baking powder 2 Batter mix 1 Biscuits 11 5 Blancmange powder 1 Brandy 1 Bread 7 3 Butter 4 9 Cake mixes 3 Cheese 8 Christmas puddings 3 Chutney 1 2 Cocktail wine 2 Cocoa 1 Coconut, creamed 2 Coffee 11 Colourings 5 Cookeen 4 Cream, canned 5 fresh 2 Drinks, mineral-soft - etc., 81 Pish, canned 23 1 Flavouring essence 20 1 Flour 2 13 Fruit, bottled 1 canned 29 1 dried 28 fresh 14 Gin 4 Ginger, ground 2 Ice cream 6 21 Jellies 1 15 Lard 11 Liquid paraffin 1 Margarine 1 13 Marmite 1 Marzipan 4 C.F. 24 366 15 49 FOOD SAMPLES (Cont'd.) Description of Article Formal samples Informal samples Number taken Number Adulterated Number taken Number Adulterated B.F. 24 366 15 Meat, canned 39 1 cooked 1 6 1 fresh 10 Medicine, cough liquids 7 cough lozenges 11 Milk 9 1 131 5 Mousse 1 Mustard, prepared 1 Oil, cooking 9 Paste, fish 2 15 meat 7 tomato 1 Peel, cut 3 Pickles 2 Pie-fillings 5 Preserves 2 32 Pudding mixture 1 Rice,canned (milk-pudding) 1 ground 2 Rum 2 Salad cream 1 Sandwich spread 2 Sauces 4 12 Sausages 2 1 Semolina 2 Sleeping tablets 1 Sodium bicarbonate 1 Soup 7 Spices 2 18 Sugar 4 Sweets 12 Syrup 1 Tea 1 29 3 Vegetables, canned 27 dried 1 Vinegar 5 Whisky 2 Total 53 1 772 25 DETAILS OF ADULTERATED OR UNSATISFACTORY SAMPLES Sample Nature or extent of adulteration Action Taken FORMAL Milk Contained added water Submitted to Committee:-legal proceedings instituted INFORMAL Flavouring Essence Insufficient spirit used Shopkeeper withdrew remainder of stock, and destroyed. No further action. Tea Contained lead Manufacturer notified, all stock withdrawn for re-blending Milk Contained added water Formal sample taken which proved genuine. Portion of Pork Pie Contained a small sliver of plastic material Food complaint - submitted to Committee - warning letter to the manufacturers 50 Sample Nature or extent of adulteration Action Taken INFORMAL Portion of Bread Roll Contained rodent hairs Food complaint - submitted to Committee - legal proceedings instituted against the baker Asprins Salicylic acid 2½ times greater than the prescribed limit No action taken Baby Food Contained specks of aluminium powder Submitted to Committee - warning letter to the manufacturer Portion of Apple turnover Decomposing - inside surface covered by a growth of black mould Food complaint - submitted to Committee - legal proceedings instituted against the manufacturer Canned Salmon Contained 3 splinters of wood, one of 3" in length, which had been canned and processed with the salmon Letter to importer Canned Pears Contained tin to 290 parts per million Food complaint - stocks withdrawn. Steak and Kidney pie Meat filling was sour. Food complaint - submitted to Committee - legal proceedings instituted. Butter Osborne Biscuits Not all the fat present was butter fat - therefore description not justified No action taken Butter Thin Biscuits do. do. Buttercake Biscuits do. do. Bread with Foreign Body Contained dead cockroach Food complaint - submitted to Committee - legal proceedings instituted. Bread with Foreign Body Contained a dead housefly Food complaint - submitted to Committee - warning letter to the manufacturers Milk Contained in milk bottletwo aluminium bottle caps Submitted to Committee warning letter to the manufacturer Milk Contained in milkbottle one aluminium bottle cap do. Milk Contained three small particles of black mould No action taken Milk Contained 0.20% free salicylic acid. B.P. limit 0.15% No action taken 51 Sample INFORMAL Nature or extent of adulteration Action Taken Asprin Tablets Contained 0.20% free salicylic acid. B.P. limit 0.15% No action taken Butter Crunch Biscuits Not all the fat present was butter fat - therefore description not justfied No action taken Butter Puff Biscuits do. do. Tea Tips Did not consist of tea tips but of fine, blended tea Letter to Wholesaler - suppliers to delete the word 'tips' from new packets. Tea Tips do. do. MILK AND DAIRIES The register of distributors of milk and dairy premises shows the following entries:- Dairy premises 22 Premises other than dairies 241 Total 263 Dealers' licenses for pre-packed milk issued under the Milk (Special Designation) (Amendment) Regulations, 1965, were as follows:Ultra heat treated 38 Untreated 44 Pasteurised milk 240 Sterilised milk 257 'Pasteurised' milk is required to comply with the Phosphatase Test for adequate heat treatment and with the Methylene Blue Test for Bacterial Cleanliness. The Public Health Laboratory Service reported that the following samples of 'pasteurised' milk satisfied the required tests:- Phosphatase Test 57 Methylene Blue Test 51 Two samples of 'pasteurised' milk failed to pass the Methylene Blue Test. A total of 9 formal and 131 informal samples were submitted to the Council's Public Analyst for examination and all, except 5 that were found to be adulterated, complied with the Sale of Milk Regulations, 1939. The average content of these samples was 3.74% milk fat and 8.74% milk solids other than milk fat. The Regulations require milk to contain not less than 3% milk fat and 8.5% milk solids other than milk fat. ICE CREAM Nine new applications for the sale and/or storage of ice cream were approved. At the end of the year the premises of 705 retailers and 15 manufacturers were registered. The 17 samples of ice cream submitted to the Public Health Laboratory Service for Methylene Blue Test were reported on as follows:- Grade 1 7 Grade 2 3 Grade 3 6 Grade 4 1 52 PHARMACY AND POISONS ACT, 1933 The names of 164 persons and the addresses of their business premises were entered in the Authority' s register for the sale of Part II poisons at the end of the year. HOUSING HOUSING ACT, 1957 Only one Clearance area was declared involving 53 houses and 103 families. As regards individual unfit premises, one house was demolished, one Closing Order made and three undertakings not to use rooms accepted. Closing Orders were made in respect of parts of 58 houses; these included 51 individual underground rooms. During the year one Closing Order for a whole house and 8 Closing Orders for parts of buildings were determined. HOUSING ACT, 1961 The Council decided to make Management Orders following the inspection of six houses which were considered to be in an unsatisfactory state in consequence of failure to maintain proper standards of management. The total number of Management Orders made by the Council is now nineteen. One Management Order was revoked during the year. Overcrowding in Houses in multiple occupation causes the Department some concern. The Housing Departments of the Borough and the Greater London Council and others notify me of suspected cases of overcrowding and inspections are carried out. A total of 232 houses occupied by more than one family were inspected and in 151 instances action leading to the giving of a Direction was taken. HOUSING ACT, 1964 Only one application was received during the year from a tenant of a property in the Borough requesting the provision of a bath, wash-hand basin with hot and cold water supplies to both, and a ventilated food store, but no statutory action was called for. RENT ACT, 1957 Pour applications for Certificates of Disrepair were received. Three certificates were issued and one landlord gave an undertaking to remedy the defects. Six applications for the cancellation of Certificates of Disrepair were received and notice given to the tenants. At the end of the year four certificates had been cancelled. Three certificates as to remedying defects were issued during the year. CLEAN AIR ACT, 1956 The three metropolitan boroughs had already made considerable progress towards making the new London Borough of Hackney completely smoke free. At the end of the year only one area of the Borough remained to be made the subject of a Smoke control Order. The Hackney No. 9 Smoke Control Order came into operation in 1965. Shoreditch (Moorfields) Order was confirmed to come into operation on 1st April, 1966 and a further Order 'The Hackney No. 10 Order' was awaiting confirmation. 53 During the year 1,629 applications for adapting fireplaces serving private dwellings were approved at a total cost to the Council of £25,115 17s. 9d In ten cases relating to 12 adaptations, payment of 100% of the approved cost was made in respect of each adaptation. Pursuant to the provisions of section 30 (duty to notify occupiers of offences) written notice of contraventions of Section 1 or 11 were sent to the occupiers of the three premises concerned. The following table summarises the work of the department in connection with the implementation of the Clean Air Act: No. of complaints received 58 No. of contraventions of Section 1 (Dark Smoke) 1 No. of contraventions of Section 11 (Smoke Control Areas) 2 No. of notifications to occupiers of offences (Section 30) 2 No. of formal smoke nuisances notices served (Section 16) No. of applications for approval of new furnaces (Section 3) 9 No. of informal notices to owners of properties in Smoke Control areas regarding adaptations 331 No. of formal notices served (Section 12) The new London Borough maintained four atmospheric pollution stations, each of which is equipped with a volumetric sulphur dioxide instrument with smoke filter attachment, at the following sites:- Town Hall, Mare Street, Lampard Grove Depot, Rushmore Road Primary School, Metropolitan Hospital. The Greater London Council maintained two stations, one in Victoria Park and another at the Ambulance Station, Brooksby' s Walk. During the year a number of complaints were dealt with regarding the quantity of fuel supplied to various residents of the Borough. These usually related to the alleged substitution of cheaper non-reactive smokeless fuel for the more expensive premium fuels, the physical characteristics being so similar as to make definite identification not possible. A number of complaints have also been dealt with in respect of the delivery of smokeless fuel to flat dwellers, particularly those above first floor level. In all of these cases the Department has been able to satisfy the complainants through the offices of the fuel suppliers concerned or the Society of Coal Merchants. The most important Ministry circulars concerning Clean Air issued in 1965 dealt with an extended and revised list of cost limits for various types of appliances, and a revised method simplifying the calculation of estimates and claims for installations. There is a greater tendency towards the installation of gas fires and solid fuel appliances. Many gas appliances fall into the category 'fixed but readily removable' and where installed by tenants they must be the subject of a deferred grant, half the grant being paid when the appliance is installed and the other half two years after the operative date, if the appliance is still in its original position. The disposal of the large quantity of wood waste which is produced as a result of the concentration of wood working factories (in the Shoreditch area and timber mills (Lea Embankment) has caused the Department some concern. Prior to the enforcement of Smoke Control Areas the greater proportion of such waste was disposed of by means of incineration and now the difficulty of such incineration without the production of smoke has produced a problem of major - significance. 54 Investigations are continually being made with regard to new processes e.g. the briquetting of wood waste and new types of furnaces but to date no completely successful and economical method of disposal of this material has been discovered. Liaison continued with the London Association of Furniture Manufacturers who are equally anxious that some effective means of disposal is afforded to its members as is the Department to secure a 100% compliance with the provisions of the Clean Air Act. FACTORIES ACT, 1961 Details of inspections carried out in accordance with Sections 1-7 of the Factories Act, 1961, are set out in the table below:- Premises Number on Register Number of Occupiers prosecuted Inspections Written Notices Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by local Authorities 111 29 - - Factories not included in (i) in which Section 7 is enforced by the local Authority 1,422 719 30 - Other premises in which section 7 is enforced by the Local Authority (Excluding outworkers' premises) - - - - Total 1,533 748 30 - Particulars Defects Referred Number of cases in which prosecutions were instituted Found Remedied To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1) - _ - - _ Overcrowding (S. 2) " - - - - Unreasonable temperature (S. 3) - - - - - Inadequate ventilation (S.4) - - - - - Ineffective draining of floors (S.6.) _ _ _ _ _ Sanitary conveniences (S.7) - - - - - (a) Insufficient 7 6 - - - (b) Unsuitable or defective 23 22 - 27 - (c) Not separate for sexes - - - - - Other offences against the act (not including offences relating to Outwork) - - - - " Total 30 28 - 27 - OUTWORKERS The current list shows that there are 164 firms employing outworkers at the end of the year and 2,006 outworkers were recorded in the Department to whom 163 were employed by firms from outside the borough. The inspection of outworkers premises is carried out by a Public Health Inspector. 55 Statistics relating to outwork are set out below:- Types of home work carried out by outworkers listed under Section 133 (1) (c) of the Factories Act, 1961. TRADE No. of Outworkers Wearing apparel washing 1, 542 Household linen, table and bed 77 Lace, curtains and nets 17 Curtains and furniture hangings 11 Furniture and upholstery nil Electro plate nil Files nil Articles of brass 30 Fur pulling 17 Iron and steel cables and chains 9 Iron and steel anchors and grapnels nil Cart gear nil Locks, latches and keys nil Umbrellas, sunshades and parasols 2 Artificial flowers 32 Nets other than wire nil Tents nil Sacks nil Racquet or tennis balls nil Paper bags 5 Cardboard boxes 103 Brush making 24 Pea picking nil Feather sorting 2 Carding, boxing or packeting of buttons, hooks and eyes, pins and hair pins 36 Stuffed toys 2 Basket making nil Chocolates or sweetmeats nil Cosaques, Christmas crackers and stockings 1 Weaving textile fabrics nil Lampshades nil Miscellanous Total 96 2,006 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 Statistics relating to registration and general inspections are set out below:- • Class of Premises Number of premises registered during the year Total Number of Registered Premises at end of year Number of Registered premises . receiving a general inspection during the year Offices 78 278 386 Retail shops 202 419 195 Wholesale shops, warehouses 29 181 178 Catering establishments open to the public, canteens 15 89 4 Fuel storage depots - 1 - Totals 324 968 763 The number of visits of all kinds by inspectors to registered premises totalled 873. 56 Analysis of persons employed in registered premises by workplace. Class of Workplace Number of persons employed Offices 5,414 Retail shops 4,417 Wholesale departments, warehouses 2,206 Catering establishments open to the public 642 Canteens 518 Fuel storage depots 42 Total 13,239 Total Males 7,704 Total Females 5,535 There were no prosecutions instituted during the year. 57 SUMMARY OF INSPECTIONS CARRIED OUT BY PUBLIC HEALTH INSPECTORS DWELLING HOUSES Inspections under the Public Health Acts: Complaints 6,604 House to House 166 Infectious Disease 258 Verminous conditions 226 Inspections under the Housing Acts: Advances for house purchase 221 Demolition Orders 22 Closing Orders 125 Clearance Areas 124 Houses in Multiple Occupation 710 Standard Grants 49 Inspections under the Rent Act, 1957: Certificates of Disrepair 6 Cancellation Certificates 7 POOD PREMISES Registrable 317 Non registrable 547 Stalls 117 Markets 86 Pood inspections 200 Pood Complaints 12 OTHER VISITS: Aged and infirm persons 13 Common Lodging Houses 2 Drainage (General) 1,368 Drainage (Rat infestations) 243 Factories 260 Hairdressers' and barbers' premises 20 Noise investigations 221 Offensive trades 12 Outworkers' premises 13 Pet shops 5 Shops Act, 1950 - Section 38 66 Smoke Observations 144 Vacant sites 294 Offices, Shops and Railway Premises Act, 1963 380 MISCELLANEOUS VISITS: Appointments and interviews 998 Attendances at Court 168 Builders Notices (supervision of work) 154 Housing Applications 28 Other visits 92 RE-INSPECTIONS (ALL FORMS) 18,857 58 LEGAL PROCEEDINGS The following is a summary of legal proceedings taken under the various Acts, Orders and Regulations, the administration of which comes within the purview of the Health Committee. PUBLIC HEALTH ACTS, 1936 and 1961 DRAINAGE BYELAWS - CONTRAVENTIONS Pine and costs 3 Withdrawn without costs (work completed) 5 NUISANCES Abatement Orders made - costs awarded 44 Abatement Orders made - no costs awarded 7 Prohibition Order made 1 Withdrawn with costs (work completed) 1 Withdrawn without costs 58 Work completed 53 Change of ownership 3 Summons defective 2 Not served 7 Fine and costs 14 WATER-CLOSET BYELAWS - CONTRAVENTIONS Fine and costs 1 Withdrawn without costs (work completed) 4 PROVISION OF DUSTBINS (NON-COMPLIANCE WITH NOTICE) Fine and costs 3 LONDON COUNTY COUNCIL DRAINAGE BYELAWS, 1961 AS CONTINUED BY THE LONDON GOVERNMENT ACT, 1963 CONTRAVENTIONS: Fine and costs 1 Fine imposed - no costs awarded 1 HOUSING ACTS, 1957 and 1961 CONTRAVENTIONS OF CLOSING ORDERS Withdrawn (defendant accepted Council accommodation) 1 CONTRAVENTIONS OF DIRECTIONS Fine and costs 6 Absolute discharge; costs awarded to Council 1 FOOD AND DRUGS ACT, 1955 AND FOOD HYGIENE (GENERAL) REGULATIONS, 1960 CONTRAVENTIONS Fine and costs 7 Fine imposed, no costs awarded 8 Proved No fine or costs 4 Dismissed 4 Not served 1 59 SCHOOL HEALTH SERVICE 60 SCHOOL HEALTH SERVICE I append a summary of the work of the School Health Service as it affects the London Borough of Hackney up to the 31st December, 1965. As members will know, the overall responsibility for the School Health Service lies with the Inner London Education Authority, and all the staff in that Service, including myself, as Principal School Medical Officer, my Deputy, various nursing and other staffs, act in this capacity as agents for the Inner London Education Authority, although the day to day running of the service is controlled locally. The statistical information was obtained from the Inner London Education Authority and will, of course, ultimately form part of the overall statistics for the inner London area. I also include the report of the Chief Dental Officer. I would take this opportunity to thank the Medical Adviser's Department of the Inner London Education Authority, and also Mr. Kingdom and his staff at the local divisional education office for all the help they have given the department this year. "The Inner London Education Authority is now responsible for deciding overall policy for the school health service, while the detailed day-to-day running of the service is locally administered by each Inner London Borough. Since the London Borough of Hackney is geographically the same area as the fo,rmer London County Council Division 4, it has been possible to continue with most of the administrative procedures and effect a smooth change-over. The maintenance of a close relationship between I.L.E.A. and the borough is vital if the primary function of the service is to be achieved, i.e., the provision of skilled and sympathetic attention to the diverse needs aind general welfare of each individual school child. Normally, a child receives four periodic medical examinations during his school life. Eleven primary schools, however, are taking part in an experimental scheme for selective medical examination at the age of seven years, in which only those children whose health has caused concern to parents or school staff are examined. Under this scheme fewer children are examined but the examinations take longer and there is little, if any saving of medical and nursing man-hours. In general, however, it is felt that medical and nursing skill is being used more profitably by concentrating on the children most in need of medical supervision or advice. The scheme is not applicable to all primary schools, however, as it depends to a large extent on the response of parents to the questionnaire on their child's health. Other factors include the opportunity of teaching staff to observe a child over a reasonable period of time. The latter, will, of course, be affected by the mobility of local families, and the separation of infant and junior schools. Staff Nursing Staff in the School Health Service consists of a mixture of fulltime and part-time nurses. Their duties include working in ordinary or special schools, in various clinics and treatment centres or in various combinations of these. Two nurses have special additional duties in testing the hearing of school children by audiometry. Pour school nurses combine the work of a school nurse with that of a health visitor for the local Borough. The equivalent of four school nurses staff the sick bay at Hutton Poplars children's home. In addition to caring for children who are ill, they carry out treatments, examinations and prophylaxis in the sick bay. 61 The 1946 National Survey on growth and development of children continues and school nurses are still in contact with young adults who were included in the survey and have been examined from time to time. Health Education Eight health visitors attend schools to give weekly talks to senior girls on the care of young children. Senior girls from five schools attend at various day nurseries, each girl spending approximately one week in the nursery. Medical Rooms On the whole, these are satisfactory. When they are not, it is often not possible to carry out the necessary radical alterations owing to the lay-out of the school buildings, and the very pressing demands on the rest of the school's accommodation. Between times, the medical room often has to be used for other purposes. Infectious Diseases in Schools Dysentery: Sonnè dysentery occurs sporadically and in minor epidemics in the schools of all our large cities and London is no exception. In Hackney, apart from sporadic cases, there were minor outbreaks at two primary schools and the necessary measures to limit the spread were taken. In connection with this, there are two important factors. Firstly, we are heavily dependent on the co-operation of family doctors in ensuring that a child being treated for dysentery is quite free from infection before being allowed back to school. The family doctors in Hackney have co-operated very well in this way. « Secondly, the facilities for children to wash their hands properly after using the water closet are woefully inadequate in many schools. In spite of valiant efforts by school staffs, it is well nigh impossible to ensure that a child climbs up to four flights of stairs to wash his hands after using the toilet (such is the case in at least one school). Until adequate facilities are provided, the odds are heavily stacked against a significant decline in the incidence of sonnè dysentery in school children. Tuberculosis: In 1965, there were two cases of potentially infectious tuberculosis in members of school staffs. In both cases, all the children who had been in contact with the person concerned were offered a Mantoux skin test in order to discover those who might have contracted the infection. The latter were then given hospital appointments for further examination and a chest X-ray. I am glad to say that these further investigations were all negative. The rest of the school's staffs were all strongly urged to get their chests X-rayed. Diphtheria: Shortly before the change-over in local government in April, 1965, a small child in hospital with chicken-pox was found to be harbouring the diphtheria organism in his throat. The child had been admitted from 205, Morning Lane, and thorough investigations of all the child's contacts there were undertaken. Several carriers were found and isolated. The investigations were extended to a local school where many of the contacts and carriers were pupils. Further carriers were discovered and isolated. No further cases or carriers were found. This incident underlines the continuing need of the school child for a high level of immunisation against diphtheria. Special Educational Problems Many school children present complex problems of progress and behaviour, and the solution to these problems can only be satisfactorily attempted when the various agencies or workers involved work closely together. These can include teaching staff, school doctor, educational psychologist, child care officer, school enquiry officer, probation officer, school care organiser, etc. 62 Regular case conferences are therefore held, so that problems can be discussed and suitable action decided upon by those workers who are concerned with the cases. The advice of the child psychiatrist is frequently sought, by referring the child to a Child Guidance Unit. Placement of a child in a residential school on the recommendation of a school medical officer, psychiatrist or other medical specialist is the responsibility of the specialist staff at County Hall, who have a wide knowledge of the special schools available to take these children. Foot Classes A number of schools have teachers who have been trained to teach children with certain foot defects suitable exercises for a short period each day. Unfortunately, due to several of these teachers taking posts in schools outside the borough, the number of 'foot classes' has fallen. I am sure these classes are helpful - especially in the indirect way of improving a child's posture and I think the scheme could, with benefit, be extended to cover postural exercises for the whole body Special Investigation Clinics Three Special Investigation Clinics continue to be held regularly; the majority of the children attending have enuresis, but a significant number are over-weight. Only a very few children are referred because of under-weight, or failure to make physical progress. A great deal of time and attention is pàid to the discussion of emotional and management problems. Drugs are sometimes helpfùl and alarm bell machines are available on loan; they are especially useful for the older junior, and secondary age-groups. Mothers and children obtain a great deal of relief from being received with sympathetic interest and finding that their problem need not be a guilty secret, but is shared by many others. Defective Hearing Close individual attention is given to all children in the Borough who are suspected to be suffering from hearing loss or who have been diagnosed as partially hearing, or deaf. Children who fail the hearing test in school, go to John Scott Health Centre for further testing on the pure tone audiometer; if they still show a hearing loss, they are examined by the audiologist who attends weekly. Frequently the loss is slight and is improved by attention to upper respiratory tract conditions, advice to parents on management when the child has colds, and in some cases the child is referred for surgery. A few children are found to need hearing aids which can be obtained from the London Hospital Hearing Centre. Nowadays it is unusual to find a child of school age who is deaf enough to require special schooling. Special clinics are held about once a month for the assessment of babies referred from child welfare centres who are not already attending hospitals for defects of hearing. Many of these babies are severely handicapped, and parents often have difficulty in coping with their child. Another difficulty is the frequency with which some families with a handicapped child move house. Great efforts are therefore made to see that they get all the available services at this vital stage. The services of a social worker and a peripatetic teacher of the deaf are available at all clinics as well as medical staff. The Borough contains one special unit for partially hearing children which functions as an integral part of one of the primary schools. The catchment area extends from Westminster to Tower Hamlets. In addition to the normal supervision by the school medical officer and school nurse, the children are examined every six months by the Borough audiologist, accompanied by a social worker who sees that the home borough is kept informed of the child's progress, and maintains liaison with the social workers who know the family. 63 Vision testing Follow-up of any problems arising f rom the attendance or failure of children to attend at eye clinics at four centres in the Borough is done by the Health Department social workers. The closure of the special school children's clinic at Moorfield's Eye Hospital has resulted in an increasing number of applications for appointments. Conversely, there appears to be some increase in the number of children being prescribed glasses privately by ophthalmic opticians. Special Schools in the Borough Apart from the unit for partially hearing children in one of the primary schools, there are two special day schools - one for the 'delicate' child and the other for the physically handicapped. Stormont House School provides education for children with a wide variety of minor disabilities, ranging from the child who has recently had a lengthy period in hospital to the one who is more timid or anxious than normal. The length of stay is usually three to four terms at the end of which th£ pupil has usually benefited sufficiently to be able to return to ordinary school. The classes are smaller and consequently more attention can be given by the staff to the individual child's needs. The school medical officer attends the school once a week and is thus able to supervise their health and general progress closely. The other special school is Geffrye School - a primary day school for physically handicapped children. It takes children from a wide catchment area and transport to and from the school is provided for virtually all the pupils. The majority of these children continue to need special schooling for the rest of their school lives and some are severely handicapped. The classes are small and a full-time school nurse is in attendance. Physiotherapy and speech therapy are provided on the premises and the school medical officer visits every fortnight. In addition the Education Authority's medical and surgical consultants visit the school approximately once a term. Towards the end of 1966, it is planned to open an all-age day school for partially sighted pupils in Stoke Newington. At present the Borough does not have a day school for educationally subnormal pupils. The school that is used lies just outside the borough boundary in Tower Hamlets. There are, however, special remedial classes in two of the primary schools - for pupils who are educationally retarded but who are expected to be capable of making up lost ground and eventually return full-time to ordinary school. Tutorial classes Two Tutorial Classes are provided for children whose progress at school has been hindered by behaviour disorders, school phobia and other emotional problems, but whose abilities are at least within the average range. Unfortunately, there is a waiting list for these classes and it is hoped to re-open a third class when a suitable teacher becomes available. Social Workers The social workers are called upon from time to time, to make home visits in cases of special difficulty concerning children who are being assessed for special schooling at County Hall or are in attendance at Boarding Schools. One of the social workers has had special experience in working with the parents of autistic children and she attends the Unit which was opened at the Horizon School, Wenlock Road, at the end of the year, working under the instructions of the psychiatrist, Dr. Frommer and making frequent home visits. The Horizon School was formed by the transfer of children and staff from Offord Street Educationally Subnormal School, Islington, and for the sake of continuity, it continues to be administered by Division III (Islington) although the school buildings lie within the Borough of Hackney. 64 The Future The question of extending the selective examination of 7 year old school children to schools not at present included in the scheme is being considered. The planned establishment of new special day schools in the borough (for the partially sighted, the educationally subnormal and possibly for the maladjusted pupil) opens up the prospect of further increasing the scope and interest of school health work for those engaged in it locally.'' SCHOOL MEDICAL INSPECTIONS (EXCLUDING DENTAL AND HEALTH SURVEYS) hackney I.L.E.A. School Roll - 20.1.66. 34, 277 409,664 Routine Inspections Number inspected 12,811 156,936 Number found not to warrant examination 140 1,901 (7 plus 'specials scheme') Percentage of No. inspected of:- Parent present 49.5 51.8 Care Committee present 58.0 81.9 No. vaccinated against smallpox 74. 3 74.6 No. immunised against diphtheria 82.4 86.6 'No. immunised against whooping cough 67. 5 74. 1 No. vaccinated against poliomyelitis 81. 2 82.8 Physical condition unsatisfactory 0. 1 0. 4 Referred for treatment of defects 13.8 13. 3 Referred for treatment of defects other than vision 6.9 6. 3 Non-Routine Inspections (i) Specials 3. 640 50,705 (ii) Re-inspections.. 3, 472 69,520 Total (i) and (ii) 7, 112 120, 225 No. of routine inspections as %age of school roll 37.4 38. 3 No. of non-routine inspections as %age of school roll 20.7 29. 3 ROUTINE MEDICAL INSPECTIONS - DEFECTS Number of children noted for treatment or observation expressed as a rate per 1,000 inspected Hackney I.L.E.A. No. inspected 12.811 156,936 Defects * Skin T 7. 03 5.83 0 6. 09 6.53 Eyes - (a) Vision T 73. 37 75.69 0 48.08 54.70 (b) Squint T 6.09 6.63 0 3.04 4.52 (c) Other T 1.64 2.16 0 1.17 2.17 *T = Treatment 0 = Observation P.T.O. 65 Continued: Hackney I.L.E.A. Defects * Ears - (a) Hear-.ng T 7. 18 4.95 0 3. 98 6. 12 (b) Otitis T 1.33 1.61 Media 0 1.41 3.46 (c) Other T 0.47 0.75 0 0.70 0.75 Nose and Throat T 4. 29 8.26 0 6.79 30. 29 Speech T 2. 34 2. 96 0 3.04 6.77 Lymphatic Glands T 0.39 0.34 0 2.42 6.44 Heart T 2. 11 2.00 0 4.68 7.94 Lungs T 4. 29 3. 54 0 5.62 10.11 Developmental - . (a) Hernia T 1.01 1.05 0 1.87 2.03 (b) Other T 1. 09 1. 12 0 2.89 4. 15 Orthopaedic - (a) Posture T 0.70 1.05 0 4.06 5.53 (b) Feet T 5.85 4. 28 0 6. 17 11.93 (c) Other T 3.75 2. 09 0 5. 23 5.40 Nervous System (a) Epilepsy T 1. 95 1.28 0 1. 56 1. 59 (b) Other T 5.70 0.98 0 1.48 1.70 Psychological (a) Development T 0.86 1. 11 0 2.89 4. 21 (b) Stability T 1.17 1.33 0 3. 20 7.30 Abdomen T 0.31 0.17 0 0.08 0.67 Other T 13.66 14.36 0 24.12 29.39 • T = Treatment, 0 = Observation 66 NON-ROUTINE MEDICAL INSPECTIONS Type of Inspect ion Hackney I.L.E.A. Re inspections 3,472 69. 520 Bathing centre inspections - scabies . 19 " " " other 1 33 Employment certificates 450 4,939 Theatrical children 57 379 School journeys 1, 370 22, 193 Recuperative holidays - pre-departure 109 871 Recuperative holidays - on return - 6 Secondary School annual surveys 66 1,921 Candidates for higher awards.. 3 38 Nautical school entrants - 107 Outward bound courses.. 10 137 Infectious disease investigation - 103 T. B. contacts 4 5 Boarding schools for the Delicate - pre-departure.. 50 213 Boarding schools for the Delicate - on return - 17 Handicapped pupils - statutory examination.. 177 1,781 Handicapped pupils - periodic special defect ination 460 5, 404 Research investigations and enquiries 15 282 « 2,772 38,448 SPECIALS - At request of:- Head teacher - child's name entered in special book 144 1,468 Head teacher - others.. 314 4, 050 School nurse - following health survey 35 807 School nurse - others.. 79 1,686 Divisional (Education) Officer 100 894 District Care Organiser or Care Committee 34 593 Parent 77 1, 131 783 10,629 Others Accident on school premises 2 44 Referred by school medical officer 5 364 Boxing - reference from schools, A. B.A., or similar association 26 31 Rheumatism follow-up (GPH.449) 1 2 For free travel 1 2 Reference: (i) connected with remedial exercises ) foot classes ) - 27 (ii) by gymnast or physiotherapist ) Referred by hospital - 1 Referred by speech therapist - 2 Referred by general practitioner 1 7 Miscellaneous 49 1,148 85 1,628 TOTAL OF ALL NON-ROUTINE MEDICAL INSPECTIONS 7, 112 120,225 67 ROUTINE MEDICAL INSPECTIONS - VISION Number tested - Hackney T.L.E.A. Boys 4, 211 61,571 Girls 4,837 59, 176 Percentage of number tested % % A - Not wearing glasses 6/6 Boys 80.6 80. 3 Girls 77.9 77.6 6/9 Boys 6.0 6. 3 Girls 6.1 6.8 6/12 Boys 5.7 5.8 or worse Girls 5.7 5.9 Noted for treatment - Boys 6.0 5.8 Girls 6.7 6.2 B - Wearing glasses 6/6 Boys 3.9 . 3.7 Girls 5.7 4.6 6/9 Boys 1.9 1.9 Girls 2.6 2.4 6/12 Boys 1.9 2.0 or worse Girls 2.0 2.7 Noted for treatment - Boys 3.6 3.1 Girls 4.4 4.7 C - Boys and Girls Percentage of number tested with and without glasses - Noted for Treatment 10.4 9.8 Noted for Observation 6.8 7. 1 Total noted for treatment or observation 17. 2 16.9 68 COMPARISON OF DEFECTS NOTED AT 7-PLUS ROUTINE AND 7-PLUS 'SPECIAL' MEDICAL INSPECTIONS Number of children noted for treatment and Observation expressed as a rate per 1,000 inspected Hackney I.L.E.A. No. inspected at 7-plus Routine Inspections 2973 33584 No. inspected at 7-plus Experimental Scheme Inspections.. 181 2667 DEFECTS A* B/ A B Skin 12. 45 11. 05 11.73 8.62 Eyes - Vision 142.62 198.89 154. 27 158.61 - Squint 13.45 11.05 11. 31 9. 00 - OtheR 1.68 5. 52 4.88 4. 12 Ears - Hearing 16.48 11.05 15.63 13. 50 - Otitis Media 1.68 - 4. 11 8.62 - Other 0. 34 11.05 1.31 1. 12 Nose and Throat 10.43 5. 52 43. 18 38. 25 Speech 3.03 - 10. 21 16.50 Lymphatic Glands 1.01 5. 52 7.15 12.00 Heart 6. 39 - 9.74 9.75 Lungs 12.45 16. 57 14.71 27.75 Deve lopmenta I - Hernia 1.68 - 2. 95 6.75 - Other 6.05 - 6.61 8.25 Orthopaedic - Posture 4.71 5. 52 7. 18 10.87 - Feet 8. 41 11.05 14. 23 20.62 - Other 6. 39 - 6. 13 6.75 Nervous System - Epilepsy 2.02 - 3. 25 2. 62 - Other 13.12 5. 52 3.07 6. 37 Psycho logic a I - Development 6.05 5. 52 7. 15 18.00 - Stability 5.72 - 9.89 20.62 Abdomen 0.67 - 1.07 1.50 Other 36. 33 66. 30 46.60 93.74 * Column 'A' refers to 7-plus routine medical inspections / Column *B' refers to 7-plus experimental scheme inspections 69 FINDINGS AT HEALTH SURVEYS (Carried out by School Nursing Staff) Hackney I.L.E.A. 1. Comprehensive Surveys (a) Number examined 17,491 271,748 (b) Number (occasions) found verminous 201 2, 874 (c) Percentage found verminous 1.15 1. 06 2. Selective Surveys (a) Number examined 5,154 131,618 (b) Number (occasions) found verminous 162 2,885 (c) Percentage found verminous.. 3. 14 2. 19 3. (a) Total times vermin found (1(b) + 2(b)) .. 363 5,759 (b) Total % found verminous (3 (a) as %of 1(a) + 2(a)) 1.60 1.43 (c) No. of individual pupils found verminous 254 3, 583 (d) % of individual pupils found verminous (of school roll) 0.74 0.87 4. Action taken with verminous cases (a) Advice and/or Lorexane 325 4,835 (b) Further action 38 924 (c) 4(b) expressed as a percentage of 4(a) 11.7 19.1 Analysis of b(b) cases - referrals of hardcore cases to bathing centres Voluntary attendances at bathing centres No. of pupils 38 887 No. of statutory notices issued - 2 No. cleansed at centres following statutory notices Voluntarily - 2 Compulsorily - - 5. Communicable Disease Surveys Number examined for: Athlete' s foot 3,771 59,876 Plantar Warts 4,001 64,456 Dysentery - 4,770 Other communicable diseases 452 34,690 8, 224 163,792 70 SCHOOL MEDICAL TREATMENT Audiometry Hackney Number of children given sweep test 4,257 Number of children given pure tone test 199 Number of children referred to otologist at audiology centre 91 Vision Clinics No. of sessions 298 Number of new cases 1,710 Number per 1,000 population, age 5-14 53 Total attendances 4,647 Errors of refraction and squint 3,857 Other eye defects 48 Spectacles ordered 1,208 Orthoptic Clinics Number of sessions 178 Number of new cases 103 Total attendances 712 Audiology Clinics No. of sessions 36 Number of new cases 117 Total attendances 298 Special Investigation Clinics ' Number of sessions 119 Number of new cases 142 Total attendances 626 Minor Ailment Clinics * No. of sessions 214 Number of new cases seen by nursing sister 150 Number of new cases per 1,000 population, age 5-14 5 Total attendances 2, 385 *A medical officer is not present at these Clinics. Defects treated: Athletes foot 25 Verrucae 74 Ringworm: body 2 Impetigo 2 Other skin diseases 21 Etye disease 38 Ear diseases 1 Miscellaneous: Bruises, lacerations, etc. 193 Bathing centre sessions Number of attendances for: Minor ailments 219 Scabies 38 Impetigo Vermin and nits 263 Total 520 71 REPORT OF THE CHIEF DENTAL OFFICER - J.H. FORRESTER In this new Borough we are, of course, only able to report on the situation as it is, and no comparisons can be made with previous activities. Moreover, the Council is directly responsible for the M. & C.W. dental service, and only jointly responsible with ILEA for the School Dental Service. Staff In this Borough there are 8 clinics comprising 11 surgeries, plus one surgery in the residential home at Hutton Poplars in Essex. There are 3 surgeries used by the London Executive Council. On the 31st December 1965, there were 6 full-time (including Chief Dental Officer), 2 part-time, and 12 sessional dental officers, giving a full-time equivalent of 12.7 officers, within an establishment of 13. This Borough has the largest dental service of the Inner London Boroughs having nearly twice the staff of some boroughs and three times that of others. It is interesting to note that in view of the work done in relation to population, the other Boroughs may be under-established. It should be mentioned here that the average age of full-time officers is 56 years, and that of sessional and part-time officers 46 years. It is obvious that every effort must be made to recruit younger dental officers. There are several young dental surgeons who are enthusiastic about this service, but who have found the starting salaries too low, promotion incentives poor, and have consequently been compelled to leave or remain as part-time officers. It is also necessary to recruit suitable full-time officers, because it is only in this way that continuity of treatment can be given, which is so essential in establishing a good patient/surgeon relationship in the treatment of children. The remainder of the dental staff consists of 14 dental surgery assistants within an establishment of 15, and here again the difficulties of recruitment are largely due to a low starting salary. Clinics It must be said that the majority of our clinics do not have the necessary basic equipment to practise modern dentistry. Most distressing is the complete lack of adequate operating lights in all our surgeries, for one cannot inspect a cellar with a light in the corridor. Here again it must be emphasised that one cannot recruit young dental surgeons without adequate working conditions and equipment. It is somewhat ironic that in some instances school dental officers are working in adjoining surgeries to Executive Council Officers for whom every facility as regards equipment is adequately provided by that authority. In general, the accommodation provided is adequate, with two exceptions that at Lower Clapton Road and Hackney Treatment Centre, which is very poor other departments making joint use of dental accommodation. However, through the ten-year plan for the development of Health and Welfare Services, it is hoped to alleviate these conditions. The rebuilding of the dental suite at Shoreditch Health Centre is progressing satisfactorily, and it is hoped to transfer two surgeries from Hoxton Treatment Centre to this new accommodation in June 1966. 72 Inspections An agreed system of dropping school inspections other thanfornew entrants at age 5 years and substituting an advice letter to parents to obtain a dental 'check up' was introduced with effect from September 1965. This means that children will only receive one inspection during their school lifetime. A clinical estimate of the dental health of our schoolchildren will not now be available, which is, in my view, a retrograde step, for the essential function of the public health dental service is to establish the prevalence of dental disease in order to plan for its control and treatment in relation to the available resources. As the scheme has only been functioning for a very short time, it is difficult to assess its potential success. However, the statistics are as follows:- 1. Quarter ending September 1965 ('Old Scheme') (a) Patients given appointments, 5,628 Acceptance rate Average per session - 6.0 40% (b) Patients attended by appts: 2,286 Average per session - 2.4 2. Quarter ending December 1965 ('New Scheme') (a) Patients given appointments, 6,321 Acceptance rate Average per session - 6.0 40% (b) Patients attending by appts: 2,536 Average per session - 2.4 The acceptance rate has therefore remained constant but, asunder the Did Scheme' , new cases sent for included those who normally attended general practitioners. This indicates that with the new scheme, waiting lists will be reduced by approximately half, thus enabling the recall of patients who accept treatment at our surgeries at more frequent intervals until the desirable period of an inspection every four months is reached. It is alarming to note from the inspections of school entrants - 5 year olds - that almost 80% need treatment. In some of these infant schools there are a large number of immigrant children, and it is significant that their inherited excellent teeth have begun to decay with our dietary habits almost before they have learnt to speak English. Treatment Of 34,982 attendants for treatment, some 26,229 fillings were inserted, and 5,193 extractions were performed as follows:- Age Groups No. of Extractions 5-9 years 3, 231 10-14 1,962 15 & over 228 73 It is a significant fact that the majority of these extractions were in the age group 5-9, and included 3,064 first teeth, that is, before the age when they would be naturally shed, which indicates once more the poor standard of dental health on entry to school. However, the ratio of fillings to extractions in permanent teeth, i.e. older children, is approximately 12:1 - thus maintaining the highest point recorded in L.C.C. records. The number of gas sessions has been increased where necessary, in order to reduce the number of patients attending from 25-30 to 15-20 a session, for to have such vast numbers attending one session turned the surgery into an abattoir, which was distressing to children and exhausting to staff. In the specialised field of orthodontics, with Mr. Pox reaching retirement age, we have been fortunate in obtaining the services of Mrs. Bird, B.D.S., Dip. Orth., who is especially qualified in this work. It would be appropriate to mention that this kind of treatment is essential, for it is to improve function by the correction of irregularities of teeth, thus creating a greater resistance to dental disease and improving personal appearance. The latter is not to be ignored for the effect of such irregularities as buck teeth' etc, can be harmful as a result of ridicule, as can be seen by all concerned in the remarkable change in attitude of the children after treatment. General Comments While acknowledging that so long as there are pain and disease, then priority must be given to its alleviation by immediate action with limited manpower, one of the basic functions of the service is the prevention of dental disease. Here, the Council is to be congratulated on the approval of fluoridation of water supplies which would adjust the existing level of 0. 25 parts per million (Metropolitan Water Board) to the optimum level of 1 p.p.m., as there can be no doubt about its effectiveness in the reduction of dental caries. This fact is overwhelmingly supported by extensive scientific world surveys sponsored by the World Health Organisation, and the governments of the United States of America and Gt. Britain (H.M.S.O. Reports on Public Health and Medical Subjects No. 105). A significant result of the effects of fluoridation on the dentition is the distribution of cavities, which are predominately confined to the occlusal surfaces, while there is a marked reduction of cavities beginning between teeth. Once fluoridation has been introduced, and old cavities properly treated, further dental treatment (much of which can be intricate and costly) can be largely eliminated. Thanks must be expressed to the Council for permitting the attendance of the Principal School Dental Officer at the annual conference of the British Dental Association held in Belfast, which was of great interest and value. During the year three dental surgery assistants took the examination for their National Certificate. Two have been successful, to whom we offer our congratulations, and hope that others will be encouraged to avail themselves of this opportunity. 74 SCHOOL DENTEL STATISTICS Hackney I.L.E.A. 1. School Roll 34,277 409,664 2. Number of Sessions Treatment - ordinary 4,139.4 27,255. 0 Treatment - General Anaesthetic.. 106.5 488.6 Inspection 145.0 965.0 TOTAL 4,390.9 28,708.6 3. First Inspections (a) Number of first inspections in school 13,368 79,879 (b) Number of first inspections at clinic 1,137 38,733 (c) TOTAL 14,505 118,612 (d) Total as percentage of school roll (3(c) as percentage of 1) 42. 3 29. 0 (e) No. inspected found to require treatment.. 9,832 76,575 (f) Percentage of no. inspected found to require treatment 67.8 64.6 (g) No. offered treatment 8,411 68,416 (h) Percentage of no. requiring treatment offered treatment 85.5 89.3 (i) Percentage of no. requiring treatment elected for private treatment 14. 5 10.7 4. Re inspect ions (a) Reinspections at school - 51 (b) Reinspections at clinic 474 12,009 (c) TOTAL 474 12,060 (d) No. of reinspections as percentage of first inspections (4(c) as percentage of 3(c)) 3.3 10. 2 (e) No. reinspected found to require treatment 254 7,910 65.6 (f) Percentage of no. reinspected found to rerequire treatment (4(e) as percentage of 4(c)) 53.6 5. Number of appointments given to: (a) New cases 25,607 163,442 (b) On treatment cases 31,367 186, 267 Number of attendances made by: (c) New cases 10,392 72,187 (d) On treatment cases 23,921 140,944 (e) Emergencies 669 4,931 (f) Total attendances 34,982 218,062 6. Response rate: (a) New cases (5(c) as percentage of 5(a)) 40.6 44. 2 (b) On treatment cases (5(d) as percentage of 5(b)) 76.3 75.7 7. Cases discharged dentally fit 5,809 55,989 8. Lapse Rate (treatment not completed) Item 5(c) plus 5(e) less item 7 expressed as percentage of 5(c)+ 5(e) 47. 5 27.4 75 Analysis of Work done in Dental Surguries by Age Groups AGED 5 to 9 10 to 14 15 and over TOTAL First visits 4,815 3, 491 718 9,024 Subsequent visits 8,662 9,901 1,917 20. 480 Additional courses commenced 534 455 50 1,039 No. of fillings in permanent teeth 5,121 10, 523 2,436 18,080 No. of fillings in deciduous teeth 7, 170 979 - 8, 149 No. of permanent teeth filled 4, 467 9,429 2, 138 16,034 No. of deciduous teeth filled 6,452 884 - 7,336 No. of permanent teeth extracted 167 1, 096 228 1,491 No. of deciduous teeth extracted 3,064 866 - 3,930 No. of general anaesthetics administered 1,225 666 68 1,959 No. of patients X-rayed 378 Prophylaxis 1,716 Teeth otherwise conserved 2,999 Teeth root filled 129 Inlays 23 Crowns 33 Courses of treatment completed 5, 388 N.B. A 'first visit' is the first time a schoolchild attends in the current calender year. Thus the number of children on the 'books' is the total number of first visits. 76 INDEX A H (Contd.) Ante-natal and post - natal 22 Home nursing 29 clinics Home nursing equipment 38 Housing 52 B I Blind persons 39 Ice cream 51 Immunisation 30 c Incontinence pads 38 Incontinent laundry 38 Infectious diseases notif- 17 Care of mothers and young 22 ications children Chiropody 31 Child minders 39 Child welfare clinics 23 L Clean air 52 Cleansing and disinfection 43 Legal proceedings 58 Congenital abnormalities 24 Liaison with other departments 41 Lung Cancer 15 D M Dairies 51 Damage by pests 44 Day nurseries 26 Massage establishments 45 Day nurseries - private 39 Measles 17 Deaths 13 Measles vaccine trial 40 Dental service - maternal and 25 Medical examination of Staff 40 child welfare Meningococcal infection 17 Diphtheria 17,61 Mental health 35 Dysentery 17,61 Midwifery 27 Milk 51 Mortuary 44 F N Factories Act, 1961 54 Family planning 25 Fluoridation 46 National child development 40 Food and drugs 47 survey Food samples 48 Nurseries and child minders 39 Nursing homes 40 H 0 Handicapped children 24 Health education 32,61 Occasional creches 26 Health centres 33 Offensive businesses 44 Health visiting 29 Offices, Shops and Railway 55 Home help service 32 Premises Act, 1963 77 INDEX 0 (Contd.) S Ophthalmia neonatorum 17 School dental service 71 Outworkers 54 P T Pet animals 45 Tuberculosis 18,61 Pharmacy and poisons 52 Poliomyelitis 17 Premature babies 28 Prevention of break up of 37 V families Public health inspection 57 Public health laboratory 20 Vaccination 30 service Venereal disease 20 Puerperal pyrexia 18 Vermin 43 Vital statistics 11 Voluntary child minding 40 R Rag flock 45 'Recuperative holidays 32 W Re-housing on medical grounds 39 Rent Act, 1957 52 Research projects 40 Water supply 45