Ac 4411(1) ILFORD ILF31 Borough of Ilford Health Report FOR THE YEAR 1956 I. GORDON M.D., Ch B., M.R.C P., D P H. Medical Officer of Health, etc. Table of Contents Page Ilford Borough Council—Members—Municipal Year 1956-57 1 Public Health Committee—Members—Municipal Year 1956-57 2 Ilford Health Area Section—Representatives—Municipal Year 1956-57 2 Ilford Committee for Education—Members 3 Officers of the Public Health Services 4-6 Preface 7-12 Reports by:— Consultants— Dr. Davidson—Psychiatrist 91 Mr. Korvin—Orthopaedic Surgeon 79 Miss Mason—Ear, Nose and Throat Surgeon 83 Dr. Thorne—Ophthalmologist 77 Dr. Woolf—Cerebral Palsy Unit 88 Assistant Medical Officers— Dr. Gross—Open Air School and Cerebral Palsy Unit 87 Dr. O'Connor Wilson—Remedial Exercises 81 Dr. Pooley—Enuresis Clinic 94 Mr. Daly—Chief Public Health Inspector 26 Mr. Haigh—Senior Dental Officer 71, 85 Mr. Pickett—Educational Psychologist 93 Miss Copping—Welfare Officer for Old Folk 21 Miss Hazel—Orthoptist 78 Mrs. Walker—Speech Therapist 84 Statistics & Social Conditions (Section A.)— Physical Features 13 Population 13 Births and Deaths 13-15 Rainfall 14 Vital Statistics (Tables) 16-18 General Provision of Health Services (Section B.)— Home Nursing 19 Laboratory Facilities 19 Legislation in Force 19 National Assistance Acts 20 Hospitals 23 Ambulance Facilities 23 Clinic and Treatment Centres 24-25 Page Sanitary Circumstances of the Area (Section C.)— Water Supply 27 Swimming Baths 28 Drainage and Sewerage 28-29 Rivers and Streams 28 Refuse Collection and Disposal 29 Sanitary Inspections during year 29 Shops Act 30 Slaughter of Animals Act 30 Rag Flock and Other Filling Materials Act 30 Atmospheric Pollution 30 Land Charges 31 Housing (Section D.)— Overcrowding 31 Clearance Areas 31 Statistics 31 Housing Act (Permitted number) 32 Housing Repairs & Rents Act 1954 (Certificates of Disrepair) 32 Inspection and Supervision of Food (Section E.)— Milk 33 Ice Cream 35 Meat and Other Foods 35 Hawkers 37 Food Surrendered 37 Food Poisoning 38 Bakehouses 38 Miscellaneous— Diseases of Animals (Movement Orders, etc.) 38 Prevention of Damage by Pests Act (Rodent Control) 39 Pet Animals Act 41 Petroleum (Consolidation) Act 41 Infectious Diseases (Prevalence and Control) (Section F.)— Notifiable Diseases 42 Table showing total notifications received, 1956 43 Tuberculosis—Notifications, Deaths, etc 45-46 V.D. Treatment Centres 47 Propaganda, etc. 48 Factories (Section G.)— Registration and Inspection 49 PART III SERVICES. NATIONAL HEALTH SERVICE ACTS, 1946-1952. Page Births 50 Infant Mortality 51 Neonatal Mortality 52 Illegitimate Births & Deaths 53 Visits by Health Visitors 53 Day Nurseries 54 Child Minders 56 Infant Welfare Centres—attendances 57 Smallpox Vaccination 63 Midwives 63 Gas and Air Analgesia 65 Maternal Mortality 66 Domestic Help Service 66 Prevention of Break-Up of Families 67 Convalescent Facilities 68 Loan Sick Room Equipment 69 Visits by T.B. Visitors 69 Occupational Therapy 69 T.B. Care and After Care 70 Medical Exams Staff 70 Invalid Night Attendant Service 70 Home Nursing 71 Health Education 71 Dental Treatment 71 Welfare Food Distribution 72 Clinics— Ante-Natal 65 Artificial Sunlight 60 Cardiac 63 Diphtheria Immunisation 61 Ear, Nose & Throat 60 Midwives 64 Obstetric Consultant 66 Ophthalmic 60 Orthopaedic 58 Paediatric 58 Poliomyelitis Vaccination 62 Post-Natal 66 Rheumatism 60 Smallpox Vaccination 63 Speech 61 Whooping Cough Immunisation 61 SCHOOL HEALTH SERVICE— Page School Premises 74 Routine Medical Inspections 74 Follow up examinations 74 School Dental Service 85 Open Air School 87 Cerebral Palsy Unit 88 Treatment for uncleanliness 89 Provision of Meals and Milk 90 N.S.P.C.C 90 Invalid Children's Aid Association 90 Handicapped Children 90 Mental Health Service 91 Employment of School Children 93 Medical Examinations of Staff and Teachers 93 Camp Schools 94 Causes of Death (Schoolchildren) 94 B.C.G. Vaccination 96 Ministry of Education—Statistical Tables 97-104 Infectious Diseases Table 105 Heights and Weights Table 106 Clinics— Artificial Sunlight 82 Child Guidance 91 Ear, Nose and Throat 83 Enuresis 94 Minor Ailments 74 Ophthalmic 76 Orthopaedic 79 Orthoptic 78 Physiotherapy 82 Rheumatism 84 Speech 84 1 ILFORD BOROUGH COUNCIL Municipal Year 1956/57 Alderman Miss A. S. Terry, J.P., Mayor. Alderman F. T. Pearson, Deputy Mayor. Aldermen: Barker, John, J.P. Bryan, William Allen Vernon, J.P. Colvin, Gilbert, C.B.E., F.C.I.S. Cowan, Harold Douglas, F.A.C.C.A., F.C.C.S. Fallaize, Mrs. Lilian, J.P. (E.C.C.) Gibson, Cyril Irving. Gooch, Lionel Archer Scott. Headley, Cecil Aubrey, J.P. Pearson, Frederick Thomas. (Deputy Mayor) Terry, Miss Anne Sylvia, J.P. (Mayor) Woods, Sidney Charles Victor. Young, Major Alexander, OB.E., T.D.. J.P., C.A. (E.C.C.). Councillors: Aiken, Kenneth Leslie. Aly, Harry Reginald Bertram. Bennett, Mrs. Florence Edith. Bysouth, Henry Albert, F.I.A.C. Clack, Arthur Henry Davies, David Samuel. Drew, Leslie Victor. Earey, Eric Raymond, F.N.A.A., F.V.I. East, John, A.M.Inst.Mech. Gleed, Sydney George. Green, Cecil Frederick Herbert, F.A.I.B. Grose, John Stanley. Harris, Edgar Frank. Hewitt, Reginald (died 30/8/56). Hitchcock. Leonard, A.I.B. Hodson, Harold. Hughes, Thomas Bernard. 'ames, Francis Herbert (E.C.C.). Littlejohn, Mrs. Ruth Constance, M.A. Loveless, Charles Edgar, F.A.I.A. Loveless, Sydney Frank. Martin, Robert. Masters, Frank Robert (E.C.C.). Murphy, John Loughlin, A.I.N.A. A.I.Mar.E. Natzler, Isaac Bernard. Parfitt, John Howard. B.Sc. (Econ.). Rolfe, Cyril George, A.I.S.T. Root, Harold Goldstone, M.S.M. Shaw, Arnold John, B.A. Sherrell, Albert Reginald Prentice, C.A. (L.C.C.). Smith, Mrs. Lily Maude, S.R.N. Tullett, Mrs. Ethel Ross. Waters, Owen Francis, J.P. Watts, Mrs. Mabel Lucy. Watson, George Henry. Woodham, Leonard Victor. 2 PUBLIC HEALTH COMMITTEE Municipal Year 1956/57 Councillor Mrs. L. M. Councillor Mrs. E. R. Alderman W. A. V. Bryan, J.P. Alderman F. T. Pearson (Deputy Mayor). Alderman Miss A. S. Terry, J.P. (Mayor). Councillor J. East. A.M.Inst.Mech. Councillor S. G. Gleed. Councillor L. Hitchcock, A.I.B. Councillor F. H. James (E.C.C.). Smith, S.R.N., Chairman. Tullett. Vice-Chairman. Councillor Mrs. R. C. Littlejohn, M.A. Councillor R. Martin. Councillor F. R. Masters (E.C.C.). Councillor C. G. Rolfe, A.I.S.T. Councillor A. R. P. Sherrell. C.A. (E.C.C.). Councillor Mrs. M. L. Watts. ILFORD HEALTH AREA SUB-COMMITTEE OF THE HEALTH COMMITTEE OF THE ESSEX COUNTY COUNCIL Municipal Year 1956/57 Ilford Borough Council Representatives: Aldermen Barker, Colvin, Gibson, Miss Terry (Mayo;); Councillors Clack, Eary, Mrs. Littlejohn, Charles E. Loveless, Masters (Chairman), Murphy, Sherrell, Mrs. Smith, Watson, Mrs. Watts (Vice-Chairman). Essex County Council Representatives: Aldermen Mrs. Ball, Glenny and Young; Councillors A. C. Berry. Mrs. S. M. Bovill, Mrs. G. M. Chamberlin, F. A. Wortley. The Executive Council for Essex Representative: Dr. W. S. Macgowan. Local Medical Committee Representative: Dr. S. M. Pruss. Hospital Management Committee Representative: Alderman Mrs. L. Fallaize. Voluntary Organisations' Representatives: Mrs. V. M. Aylinc., Miss N. L. Odell, Mr. C. L. Tutt and Mrs. H. M. Warren. 8 ILFORD COMMITTEE FOR EDUCATION Municipal Year 1956/57 Alderman G. Colvin, C.B.E., F.C.I.S., Chairman. Alderman C. I. Gibson, Vice-Chairman. Alderman J. Barker, J.P. Alderman Mrs. L. Fallaize, J.P. (E.C.C.). Alderman F. T. Pearson, (Deputy Mayor). Alderman Miss A. S. Terry, J.P. (Mayor). Alderman Major A. Young, O.B.E., T.D.. J.P., C.A. (E.C.C.). Councillor H. R. B. Aly. Councillor Mrs. F. E. Bennett. Councillor E. R. Earey, F.N.A.A., F.V.I. Councillor T. B. Hughes. Councillor Mrs. R. C. Littlejohn, M.A. Councillor Sydney F. Loveless. Councillor F. R. Masters (E.C.C.). Councillor J. L. Murphy, A.I.N.A., A.I.Mar.E. Councillor J. H. Parfitt, B.Sc. (Econ.) Councillor A. J. Shaw, B.A. Councillor Mrs. L. M. Smith, S.R.N. Councillor O. F. Waters, J.P. Councillor Mrs. M. L. Watts. Councillor L. V. Woodham. Co-opted Members: Mr. S. R. Baker. Rev. K. A. Bear, B.A. Mrs. D. E. Carter. Rev. M. Hancock, B.A. Mr. H. S. Kenward, M.A. Mr. E. R. Lower, B.A. Miss F. Stevens. County Nominated Members: County Councillor A. F. J. Chorley, M.B.E. County Councillor F. A. Wortley. 4 OFFICERS OF THE PUBLIC HEALTH SERVICES Ilford Borough Council. Medical Officer of Health, Divisional School Medical Officer, Area Medical Officer, Ilford Health Area Sub-Committee : I. Gordon, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. (Edin.). Deputy Medical Officer of Health : (Part Time) D. M. B. Gross, M.D., Ch.B., (Leeds), M.M.S.A., D.P.H. (Lond.). Chief Public Health Inspector: S. R. Daly, LL.M., B.Sc., D.P.A. (Lond.), Barrister-at-Law. Deputy Chief Public Health Inspector: P. W. English. Public Health Inspectors: A. C. R. Neale. G. W. Newman. R. E. Smalley. T. F. Johnson. J. Cook. F. Nau. D. F. Scott. J. A. Harris. C. Broomfield. Chief Administrative Assistant (I.B.C. and E.C.C.): F. J. Hocking. Administrative Assistant J. J. Holland. Welfare Officer for Old Folk: Miss M. J. Copping, Dip. Social Sc. (Lond.). Essex County Council. Assistant County Medical Officers: D. M. B. Gross, M.D., Ch.B. (Leeds), M.M.S.A., D.P.H. (Lond.) (Part Time). F. E. O'Connor Wilson, B.A., M.B., B.Ch., B.A.O.. D.P.H. (T.C. Dub.) L.M. (Rot.). A. Collins, M.B., B.Ch., B.A.O. (Cork). H. B. Grange, M.B., B.S. (Lond.) (Part-time). J. M. Pooley, M.B.j B.S. (Lond.), D.C.H. (to 31.5.57). R. M. Noordin, M.R.C.S.. L.R.C.P. P. A. C. Wright, M.B., B.S. (Lond.), D.P.H. (Lond.) (from 15.4.57). Senior Dental Officer: E. V. Haigh, L.D.S., R.C.S. (Eng.). Educational Psychologists : K. Pickett, B.Litt. (Oxon), Dip. Psych. Miss B. S. Gascoyne, B.A. (Hons. Psych.). Psychiatric Social Workers: Miss P. Radford (from 1.10.56). Miss J. M. Barton Speech Therapists : Mrs. M. Walker, L.C.S.T. Mrs. P. A. Pretious, L.C.S.T. Cerebral Palsy Unit: Physiotherapists: Miss P. Osburn, M.C.S.P. Mrs. I. M. Goodacre, M.C.S.P. (Part-time). Occupational Therapist: Miss M. I. Bond (from 5.2.57). 5 Officers of the Public Health Services—continued. Superintendent of Midwives: Miss C. Blockley. Superintendent Health Visitor: Miss J. M. Oliver. Health Visitors and School Nurses: Miss E. M. P. Collins Miss A. N. Bowmer Miss M. G. Duguid Miss H. Arnold Miss E. Goodchild Miss C. Oldham Miss P. M. Leavett Miss E. M. Brown Mrs. J. M. Weston Miss T. L. Mobbs Mrs. M. C. Nagel (to 27.4.57) Miss A. E. Ridpath Mrs. R. M. E. Nelson (from 15.10.56) Mrs. L. M. Eldridge (from 13.8.56) Mrs. C. D. Constable (from 30.7.56) Miss R. A. Barton (from 13.8.56) Tuberculosis Visitors: Miss C. McDonald (to 9.3.57) Miss M. Forde Mrs. T. Ivanauskas (to 15.2.57). Miss M. Gibson (from 4.3.57) Mrs. B. P. Makepeace (from 3.6.57). Occupational Therapist (T.B. Cases): Miss N. J. M. Whitelaw (from 8.4.57) Matrons of Day Nurseries: Goodmayes Lane Miss E. Drower. Ley Street Miss G. M. Gross. Administrative Assistants: Miss H. Nunn (Part III Services). E. S. Jenkins (School Health Services). Domestic Help Organisers: Mrs. L. G. Lawrence. Mrs. K. M. Bedwell. Part Time:— Regional Hospital Board. Consulting Obstetrician (Puerperal Pyrexia Regulations): R. C. Percival, F.R.C.S. (Eng.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), M.R.C.O.G. Surgeon in charge of Orthopaedic Clinic : H. G. Korvin, DM., F.R.C.S. Ophthalmologists: H. J. R. Thorne, M B., B.S., D.O., D.O.M.S. A. B. MacClancy, L.R.C.P.(I.), L.R.C.S.(L), L.M., D.O. 6 Officers of the Public Health Services—continued. Surgeon in charge of Ear, Nose and Throat Clinic: Margaret M. Mason, M.A., F.R.C.S. Physician in charge of Paediatric Clinic: A. Russell, O.B.E., M.D., M.R.C.P. Child Guidance Clinic: Consultant Psychiatrists: H. M. S. Davidson, M.B., B.S., M.R.C.S., D.P.M. J. Vincenzi, M.R.C.S., L.R.C.P., D.P.M. Psychiatrist: H. J. Altschulova, M.D. Cerebral Palsy Unit: Consultant Physician: D. L. Woolf, D.Phys.Med., M.R.C.S., L.R.C.P. Orthoptist: Miss C. Hazel, D.B.O. Physiotherapist: A. Brand, M.C.S.P. Essex County Council. Assistant Dental Officers (Part-time): E. M. Sycamore, M.R.C.S., L.R.C.P., L.D.S., R.C.S. (Eng.). R. J. Newman, M.B.E., L.D.S., R.C.S. (Eng.), J.P. J. T. Hutchins. Mrs. I. N. Bravo, L.D.S., R.C.S. T. P. Taylor (to 28.11.56) V. H Foy, L.D.S., R.C.S. Miss L. Y. Gibbs, B.D.S. (from 11.10.56) R. A. Soar, B.D.S. (from 5.3.57) A. J. Cassam, L.D.S., R.C.S. (to 16.5.57) Child Psycho-Therapists (Non Medical) : Miss M. E. Bergen, M.A., B.Sc. (to 31.8.56) Miss P. Oppenheimer, B.A. Miss L. Folkart, B.A. (from 16.11.56). Speech Therapist (Part-time): Mrs. F. M. Hatfield, L.C.S.T. (to 31.8.56). Mrs. E. A. McGill, L.C.S.T. (from 10.9.56). Ilford Borough Council. Public Analysts: George Taylor, F.R.I.C. J. Hubert Hamence,, M.Sc., Ph.D. 7 Preface Public Health Offices, Ilford. July, 1957. To the Mayor, Aldermen and Councillors of the Borough of Ilford. Mr. Mayor, Ladies and Gentlemen, I submit herewith the Annual Report of the Health Services for the year 1956. Births and Deaths. In my Annual Report last year 1 suggested that this year we might, for the first time, find more deaths than births in the Borough. This foreboding, however, has not come true. In 1956, we had 2,115 births as compared with 2,086 deaths, so we are still experiencing a very slight increase in our population. We did complain last year that the death rate in the town was inflated somewhat by the number of deaths in our two large mental hospitals who, together, cater for a large part of Greater London as well as for Ilford. The Registrar General has taken note of these complaints and has given Ilford a new comparability factor (now 0.95 instead of 103). This comparability factor has reduced our adjusted death rate to 10.97, i.e. less than last year, although this year we have actually had more deaths in a slightly smaller population. However, our new adjusted death rate means that the rate in Ilford is now lower than that in England and Wales (which is 11.7), thus giving a more realistic description of the health of the town. We have one most important achievement to bring to your attention from last year. With a rate of 15.6 deaths of children under one year of age per 1000 births, we have achieved our lowest infant mortality rate ever, and probably one of the lowest in the country. The rate for England and Wales is 23.8 and our rate has improved from 20 in the previous year. In actual fact there were only 33 deaths of infants under one year of age last year, and of these deaths 13 were due to congenital malformations, conditions over which, in the present state of our knowledge, we have very little control. The birth rate itself is beginning to rise, being 11.48 as against 11.21 the year before, but we are still, however, far below the rate in England and Wales of 15.6. Infectious Disease. It is pleasing to announce that last year we had no deaths in this town from scarlet fever, enteric fever, diphtheria, measles, whooping cough, infantile diarrhoea, meningococcal infection or smallpox. I could also say truthfully that there had been no deaths from poliomyelitis but unfortunately one person who contracted the disease last year died from it earlier this year. We still have a certain amount of alimentary infection in the schools which sometimes is attributed to food poisoning, but in many cases cannot be due in any way to food consumed within the school. At one time there was some complaint of enteritis in ten Ilford schools. In a few of them the infection was traced to the Sonne bacillus or the Salmonella organism, but in the majority of them we were baffled in finding out the cause of the trouble, which indeed was very mild as it was rare for any of the children to be away from school for more than a day or two. 8 Immunisations. Last year there were 1,545 primary vaccinations against smallpox. When it is considered that there were in that year 2,115 births, it will be recognised that the immunisation rate must be approaching 75 per cent. This is a rate for smallpox vaccination of which any community in this country can be proud. Changes are to come about in diphtheria immunisation. As a result of investigations carried out in this country it has been shown that a certain diphtheria antigen known as A.P.T. is liable to cause a localisation of paralysis in an arm where the injection has been given, if the child has already been infected with Poliomyelitis. The Ministry of Health has now informed us that A.P.T. will no longer be used in official schemes and that the choice will now rest between two other antigens, F.T. and T.A.F. In Ilford we are rather lucky in that A.P.T. has never been used in our clinics but we have continued to use T.A.F. since the scheme was started many years ago by Dr. Burton. Poliomyelitis. An unusual feature of the poliomyelitis last year was the fact that in Ilford it did not occur mainly in the so-called polio season, that is, the late summer and autumn, but most of the cases occurred in the winter. This has caused many people to worry about the coming year and we have been rather disturbed by certain suggestions that we might have a large outbreak. Poliomyelitis vaccination, after some teething troubles, got under way and is now proceeding very satisfactorily except that there is not as much vaccine for distribution as we would like. It is rather strange that last year, when people were asked to volunteer, when it was a new effort, of those who were within the age groups concerned, 29 per cent volunteered. In spite of the fact that polio immunisation is now well-established and shown to be quite harmless, this year, when we are asking two new age groups—those born in 1955 and those born in 1956—to be registered, only 57 per cent of those eligible have done so. This compares with the position in Denmark, where over 90 per cent of those asked not only volunteered, but were actually vaccinated. One wonders if this percentage of 57 will be enough, should the vaccination be completely successful, to abolish the disease from this country. This year we have so far had somewhat more poliomyelitis than usual, although not as much as we have had in certain past years. The outbreak is rather unusual in that it is practically confined so far to two areas—a part in the north of the town between Tomswood Hill and Fencepiece Road, and another group amongst students attending Barley Lane School or their contacts. It has unfortunately been necessary to recommend that pupils attending Barley Lane School should not this year attend their summer camp, as there is a possibility that this condition may spread more easily in the sanitary conditions which appertain to camp life. Certain other causes of death. Cancer.—It is good to note that in spite of the increase in the proportion of old folk amongst us, the number of deaths from cancer diminished from 391 to 366. This was not due to a diminution of cancer of the lung. The readers of this preface will, since 1951, have noted that we have frequently drawn attention to the association between heavy cigarette smoking and cancer of the lung. The rate for this disease in Ilford has risen from 0.407 deaths per 1000 to 0.481 in 1956. We have a larger rate in Ilford in this disease than in the country as a whole, where it is 0.407. The major importance of this condition is further shown by the results of the visit last year of the Mass Radiography Unit. Mass 9 graphy Units were of course originally introduced to detect cases of tuberculosis, but during their visit here they found, as well as 29 new cases of tuberculosis, 22 cases of cancer of the lung. Another cause of death that is diminishing is death from accidents other than those on the road. This has fallen from 31 to 26 and in each of the last two years only one of these cases was under the age of 15. Old People There are two series of statistics which show what an increasing proportion of our services is devoted to dealing with old people and their problems. For example the number of registered blind, partially blind and defective sighted among us has increased yearly; over the last 7 years the numbers are: 282, 278, 293, 315, 346, 330, 385. The laundry service, which also deals almost entirely with old people has, in the last four years, that is since its introduction, more than doubled in the people supplied and the number of articles laundered. In the first year 30 individuals received the service, last year 61. In the first year 2,889 articles were laundered, last year 11,001. Notification of Disease. Members of the medical profession, and Medical Officers of Health in particular, are becoming increasingly aware of the defects of the present notification system. Much of it is outmoded and there are other conditions which we feel should be notifiable, which are not now. As an example, it would be advantageous if during, say, the first five years after the introduction of a new drug, all reactions towards it were notified and thus a true picture obtained at an early stage of its disadvantages. One of the problems with notifications is of course the indifference of some doctors and the greater interest of others. For instance, in 1956 we received 161 notifications of dysentery. Of these, 59 had been notified by one doctor alone. Of the 70 doctors in the town, 40 did not notify any dysentery at all. This pattern is not exceptional; it occurs year by year. We realise that diseases such as measles and whooping cough are not fully notified, largely because mothers do not take the children to the doctor. Less than three-quarters of the cases of measles that have occurred in our two day nurseries this year, when children have been excluded because we knew they had measles, have been notified. Certain other conditions are notified when the original reason for their notification has practically disappeared. I have before referred to the notification of puerperal pyrexia, which was originally introduced to control infection of the genital tract, but now this fever is more likely to be due to other conditions, such as kidney infection. Ophthalmia neonatorum, many years ago, was somewhat of a scourge, due to gonococcal infection. It does appear that the notification of ophthalmia neonatorum is now increasing, certainly in Ilford, even if not nationally. It is almost certainly the case that this infection is now due to the staphylococcus which is largely insensitive to penicillin and probably spread from hospitals. The condition is very mild and usually clears up in a few days even without any treatment. In this town, acute rheumatism in children under 16 has been a notifiable disease since 1935. In that year there were 49 notifications. Last year there were only 8. Acute rheumatism is playing a very much smaller part in the cause of heart disease in the population. A clinic was started in 1933 by the Borough Council and last year was transferred to the Paediatrician at King George Hospital on the resignation of Dr. Playfair, who has conducted this clinic for 21 years. It now deals mainly with congenital heart conditions, so has changed completely from its original conception. 10 Tonsils and Adenoids. In past years we have complained considerably about the large waiting list for tonsils and adenoids operations. In 1949 the waiting list was somewhere in the region of 900. It has dropped progressively. Five years later it was 92, last year it was 44 and at the end of June this year had been reduced to the almost non-existent level of 7. This is an example of cooperation between the Regional Hospital Board and the Local Authority, for beds and a theatre were specially set aside for these operations at the Ilford Isolation Hospital. Because of the small outbreak of poliomyelitis which we have had this year, I have been compelled to recommend that tonsils and adenoids operations be suspended temporarily as it is known that bulbar poliomyelitis is more likely to occur among those who have hud their tonsils removed. I wonder if the authorities have considered releasing poliomyelitis vaccine for those who require to have this operation so that, say, three months after immunisation the operation could be carried out presumably in safety. Health Visiting. The importance and scope of the work of the Health Visitor is continually increasing. Last year the home visits made by Health Visitors, other than those concerned with Maternity and Child Welfare, increased by 50 per cent from 824 to 1,296. This demonstrates more clearly than any other figures that I could give that the Health Visitor is now concerning herself with the problems of all in the family and not only those of the mothers and young children. One general practitioner has asked and been allotted the services of a Health Visitor for his Infant Welfare Centre. This means of co-operation and integration is something which we would like to see expanded. A Health Visitor now attends the Paediatric Clinic at King George Hospital in lieu of our doctors, who now act as clinical assistants at the Paediatric Clinic held at these Offices. In 1956, the Health Visitors carried out 59,754 head inspections in the schools and found only 71 children who were infested. It is becoming increasingly apparent that too much time is being wasted on these examinations which may once have served a very useful purpose but are now somewhat outmoded. The Ilford Education Committee is giving serious consideration to a broadening of the scope of the work that the Health Visitors do in the schools and it is suggested that less time be spent on routine head inspections and more time on a general survey of the children and consultations with the Head Teachers and the staff with respect to children who have any special problems. It should be remembered that the Health Visitor knows the home and should know the private doctor of any of these children and is thus in an excellent position to make further enquiries and recommendations. Infant Welfare Centres. A new infant welfare centre is now under way in the Padnall Estate at St. Mark's Church Hall. This is actually in the Borough of Dagenham, but being easily accessible to the Ilford mothers, the Area Medical Officer of Dagenham has very kindly made facilities available. For the first time for many years the number of attendances at our infant welfare centres is increasing and last year rose from 36,196 to 36,902. It is strange that although infant welfare centres are popular, we have never been able to make a success of toddlers' clinics in this town. Some years ago an attempt was made to start them and this had to be stopped when the war broke out. We started them again last year at Manford Way Clinic but unfortunately the response from the mothers was not enough to allow us to 11 continue this clinic. I think we must accept the fact that mothers are only interested in clinics for their children when they are under one year of age, and need considerable persuasion to attend any clinics with them until they must compulsorily do so when they attend for routine medical inspections on entering school. Owing to a shortage of doctors 1 myself have returned to baby clinic work, doing a centre at Valentines Mansion once a week. This has been a rather salutary experience for me, as I have not been doing this work for about seven years. A return to it has made me feel how necessary it is for administrators to keep in close touch with the practical and clinical aspect of their work. I have introduced a new feature in that when possible a small group of mothers (3 to 6) have been asked into the consulting room for a short discussion lasting 15-20 minutes. This discussion is meant to cover any topics of medical interest, such as polio vaccination, baby feeding, relationships with the medical profession, and such like. It is often difficult to persuade mothers to come to this talk, for they usually feel that a visit to the doctor implies an examination and medical recommendation. Those mothers who do attend have, I am sure, benefitted by the discussion. Preventive Psychiatry. The group discussion method has been introduced in a new feature in which the Child Guidance Clinic are co-operating with us. Dr. Davidson, the Medical Director of the Child Guidance Clinic, and the other members of her staff, do at certain intervals meet groups of mothers for a discussion of various problems connected with mental health. These mothers are not people who have actually been referred to a psychiatrist or Child Guidance Clinic but have problems which, if suitably discussed at an early stage, may lead to better understanding and eventually obviate a more definite mental disturbance in mother or child, and so be truly termed preventive psychiatry. Problem Family Committees. We are still continuing these committees when need arises. We like them to be as small as possible. Only those officers intimately concerned with the problem are asked to attend. We have been very pleased indeed recently to find that the Head Teachers of the schools in which the children attend have been present and also, in two cases, the family doctor. These conferences have shown beyond all doubt that the best co-ordinating officer dealing with the problem family is the Health Visitor. Health Exhibition. Although generally we do not rush into health exhibitions, we often find that we are drawn into one. An opportunity has presented itself this year at the Essex Ideal Homes Exhibition at Gordon Fields. Here the Public Health Inspectorate have produced a most excellent exhibition dealing with problems of clean air and clean food; and the Ilford Home Safety Committee have had a stand next to them, dealing with the problems of flammability of clothing. This stand has been favourably commented upon, and even borrowed. Public Relations. In the autumn we are having a Public Relations Seminar to be conducted by the Central Council for Health Education. This will be mainly for the members of the Public Health Department, but it is hoped that members of other departments and the County Council will join in, for in the wide field of public relations, the relationships between one department and another are also concerned. On one morning it is hoped there will be a panel discussion where the audience will be the members taking part in the Seminar, and the panel group the Chief Officers of the Corporation and a family doctor, with the press in attendance. 12 The Future. A long list of achievements such as I have laid out here in the preface might give rise to the impression that there is less work for the Medical Officer of Health to perform. This is far from true. We shall not be able to rest until we can assure the public of clean air, clean food, no unnecessary noise; that all old people are treated adequately and humanely, and that an effort is being made to reduce the increasing burden of mental ill health in the population, a burden which fills over half the beds in the hospitals and a large proportion of the time of the family doctor. Voluntary Help. Once again I must draw attention to the great help which is given to me in my work by the voluntary associations in the town. In fact, with some such associations, such as the Old People's Welfare Committee, the Handicapped Persons Committee, the new Workrooms for the Elderly, the Ilford Home Safety Committee and the Tuberculosis Care Association, the relationship between the department and the voluntary workers is so close that the distinction between so-called statutory bodies and voluntary bodies is indefinite. The Ilford Federation of Women Voluntary Welfare Workers continues to ease our tasks in the baby clinics. It is with great regret that I must mention the death of Mrs. A. M. Pearce, the late Chairman of the Ilford Tuberculosis Care Committee and one of the representatives of the voluntary bodies on the Ilford Health Area Sub-Committee. Tables may be very dull reading, but things are made easier by the various reports of specialists and other officers that are distributed throughout the report. I would suggest that such reports are consulted. Finally, I would like to acknowledge the efficiency of my staff and the unstinted co-operation that they have given me during the past year. Some of the information for this report has been given to me by Chief Officers of other departments and I would like to thank them for this and also their full co-operation throughout the year. I would like to express my thanks to the members of the Council, especially to the Chairman, Vice-Chairman and Members of the Committees of the Ilford Borough Council and Essex County Council with whom I work. I have the honour to be Your obedient Servant, I. GORDON. Medical Officer of Health. 13 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in Acres) Land and Inland Water 8,404 8,411 Tidal Water 7 Population (Census 1921) 85,194 „ (Census 1931) 131,061 „ (Census 1951) 184,706 Registrar-General's Estimate of resident Population:— June 30th 1953 181,200 „ „ 1954 182,700 „ „ 1955 181,700 „ „ 1956 180,600 Number of inhabited houses (April 1st. 1956) according to Rate Books (approx.) 51,668 Rateable Value—April 1st, 1956 (Houses and Land) £3,016,206 Sum represented by a penny rate, April 1st, 1956 (approx.) £12,150 Education Rate— 1956-57 1955-56 (E.C.C.) 6s. 8-23d. in the £ 10s. 0-69d. in the £ Combined Rate (all services) 17s. 4d. in the £ 23s. 4d. in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— Males Females As at December, 1955 295 70 As at December, 1956 467 78 Live Births— 1956 1955 Total M. F. Birth rate per 1,000 population. Legitimate 2,056 1.045 1,011 Crude rate 11.71 11.56 Illegitimate 59 28 31 Adjusted rate 11.48 11.21 Rate per 1,000 total (live and still) births Stillbirths 43 21 22 19-92 22.80 Death rate per 1,000 population. Deaths 2,086 1,032 1,054 Crude rate 11.55 11.45 Adjusted rate 10.97 11.79 Percentage of total deaths occurring in public institutions 46.65 39.28 No. of Deaths Rate per 1,000 total (live and still) births. 1956 1955 1956 1955 Maternal mortality (heading 30 of the Registrar-General's Short List) (Pregnancy, childbirth and abortion) 2 1 0.93 0.46 Death-rate of Infants under 1 year of age:— All infants per 1,000 live births 15.60 20.00 Legitimate infants per 1,000 legitimate live births 14.59 19.56 Illegitimate infants per 1.000 illegitimate live births 50.85 36.36 Deaths from Cancer (all ages) 366 391 „ „ Measles (all ages) — 1 „ „ Whooping Cough (all ages) — — „ „ Diarrhœa (under 2 years of age) — — 14 1. Rainfall. Total rainfall registered in the district during the year was 23.37 inches; the greatest fall in 24 hours was registered on 11th June, 1.84 of an inch. August was the wettest month. 2. Registrar General's Memorandum on Transfer of Births, Deaths and Stillbirths, dated 17th October, 1952. The Registrar General supplies each town with figures known as the "comparability factor" in connection with the birth and death rates. To make an approximate allowance for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole, the crude birth and death rates for the area are multiplied by the appropriate area comparability factor. The figures for Ilford are .98 for the birth rate and .95 for the death rate, and these are used in calculating these rates in Table la. When local crude birth and death rates have been so adjusted, they are comparable with the crude rate for England and Wales or with the corresponding adjusted rate for any other area. 3. Births. The number of births registered during the year was 2,115. Males Females Legitimate 1,045 1,011 Illegitimate 28 31 i.e., 2.8 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was 2.6 (1955), 2.2, 3.0, 3.9, 2.9, 3.1, 2.4, 3.2, 3.3, 3.1. The adjusted birth-rate, calculated on the estimated population of 180,600 is 11.48 per 1,000. 4. Deaths. The total number of deaths of Ilford residents was 2,086. This is obtained by taking the total number of deaths registered in the district (1,676), subtracting the deaths of non-residents occurring in the district (162), and adding the deaths of Ilford residents registered as having died in other districts (572). The number of deaths of non-residents registered in the district was as follows:— King George Hospital 98 Ilford Isolation Hospital and Sanatorium 26 Other Non-residents 38 Total 162 15 The number of deaths of Ilford residents registered as having died in other districts during the year was as follows, and includes deaths at the following Institutions:— Oldchurch Hospital, Romford 72 St. Margaret's Hospital, Epping 3 Wanstead Hospital 44 Langthorne Hospital 79 London Hospital and Brentwood Annexe 79 St. Bartholomew's Hospital 7 Rush Green Hospital 23 Plaistow Hospital 10 St. Joseph's Hospice, Hackney 11 Queen Mary's Hospital, Stratford 4 East Ham Memorial Hospital 6 Harold Wood Hospital 6 Whipps Cross Hospital 56 Middlesex Hospital 4 London Chest Hospital 1 St. Luke's Hospital 3 In other Hospitals, Institutions and residences side the Ilford district 164 Total 572 The adjusted death rate, calculated on the estimated population of 180,600 is 10.97 per 1,000. Inquests.—During the year, 66 inquests were held on deaths occurring in Ilford. 47 on Ilford residents, and 19 on non-residents. The ages at death were as follows:— Under 1 year 1-2 years 2-5 years 5-15 years 15-25 years 25-45 years 45-65 years 65 years and upwards — — 2 — 2 3 21 38 Death Rates from Tuberculosis and Cancer, 1956 The following Table shows the death-rates for 1956 for Ilford, compared with the provisional death-rates for England and Wales for the same period per 1,000 population; the figures having been supplied by the Registrar-General:— Ilford England and Wales Respiratory Tuberculosis .105 .109 Other Tuberculosis .011 .012 Cancer of lung and bronchus .481 .407 Cancer, other forms 1.545 1.668 5. Tables of Vital Statistics.—Table I gives a comparative statement of the birth-rate and death-rate for the past five years. Table Ia gives a comparison of the vital statistics of Ilford with England and Wales, and other towns. Table II gives a classified statement of the causes of death in 1956, arranged according to the age groups at which deaths occurred. 16 TABLE I.—Vital Statistics of Whole District During 1956 and Previous Years Year Resident population, estimated to middle of each Year Births Total Deaths Registered in the District Transferable Deaths Net Deaths Belonging to the District Uncorrected Number Net (a) of Non-Residents registered in the District of Residents not registered in the District Under 1 year of Age At all Ages Number Rate Number Rate (b) Number Rate per 1,000 Net Births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1952 182,200 1,830 2,323 13.0 1,728 9.4 431 512 44 18.9 1,809 10.1 1953 181,200 1,689 2,231 12.3(c) 1,688 9.3 172 426 45 20.1 1,942 10.7(c) 1954 182,700 1,580 2,193 12.0(c) 1,552 8.5 164 476 41 18.7 1,864 10.2(c) 1955 181,700 1,632 2,100 11.56(c) 1,670 9.2 152 563 42 20.0 2,081 11.45(c) 1956 180,600 1,738 2,115 11.71(c) 1,676 9.3 162 572 33 15.6 2,086 11.55(c) (a) The net number of births is obtained by taking the uncorrected number of births supplied by the local Registrar and adding to or subtracting from it such a number as it supplied for this purpose by the Registrar-General. (b) Calculated on the estimated resident population. (c) Crude rate. 17 TABLE Ia Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1956 (Provisional figures) Rate per 1,000 Population Rate per 1,000 Total (Live and Still) Births Rate per 1,000 Population Rate per 1,000 Related Live Births Death rate per million Population Whooping Cough Diphtheria Influenza Acute Poliomyelitis Pneumonia Live Births Stillbirths Deaths (all ages) Deaths under 1 year England and Wales 15.6 22.9 11.7 23.8 2.1 0.2 59 2.5 519 Great Towns 15.6 23.0 11.6 24.0 1.8 0.2 44 2.0 571 Smaller Towns 15.6 22.7 11.6 24.1 3.4 0.0 50 3.7 450 ILFORD (Estimated Population mid-1956 = 180,600) 11.4 19.9 10.9 15.6 - - 391 - 5202 A dash (—) signifies that there were no deaths. 1 7 deaths. 2 94 deaths. 18 Registrar-General's Short List of Deaths and Causes TABLE II Causes of, and Ages at, Death during the year 1956 CAUSES OF DEATH Net Deaths at the subjoined ages of "Residents" whether occurring within or without the district All Ages Under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 years and upwards ALL CAUSES 2086 33 3 4 7 73 485 578 903 1 Tuberculosis, respiratory 19 1 — — — 4 7 4 3 2 Tuberculosis, other 2 — — 1 — — 1 — — 3 Syphilitic disease 5 — — — — — 1 3 1 4 Diphtheria — — — — — — — — — 5 Whooping cough — — — — — — — — — 6 Meningococcal infections — — — — — — — — — 7 Acute poliomyelitis — — — — — — — — — 8 Measles — — — — — — — — — 9 Other infective and parasitic diseases 6 — — — — — 5 — 1 10 Malignant neoplasm, stomach 50 — — — — 1 11 22 16 11 Malignant neoplasm, lung, bronchus 87 — — — — 3 42 27 15 12 Malignant neoplasm, breast 43 — — — — 4 21 10 8 13 Malignant neoplasm, uterus 12 — — — — 2 5 2 3 14 Other malignant and lymphatic neoplasms 174 — — — — 12 64 54 44 15 Leukaemia, aleukaemia 7 — — — — 2 3 — 2 16 Diabetes 16 — — — — 2 3 5 6 17 Vascular lesions of nervous system 305 — — — — 6 44 106 149 18 Coronary disease, angina 331 — — — — 7 95 111 118 19 Hypertension with heart disease 79 — — — — 1 10 26 42 20 Other heart disease 298 — — — 1 6 34 61 196 21 Other circulatory disease 123 — — 1 — 3 19 30 70 22 Influenza 7 — — — — — 2 2 3 23 Pneumonia 94 4 1 — — 1 9 24 55 24 Bronchitis 120 1 — — — 1 30 33 55 25 Other diseases of respiratory system 29 — — — — — 9 6 14 26 Ulcer of stomach and duodenum 36 — — — — 1 11 10 14 27 Gastritis, enteritis and diarrhoea 6 — — — — 1 1 3 1 28 Nephritis and nephrosis 8 — — — 1 — 5 1 1 29 Hyperplasia of prostate 10 — — — — — 1 3 6 30 Pregnancy, childbirth, abortion 2 — — — — 2 — — — 31 Congenital malformations 21 13 2 — — 2 4 — — 32 Other defined and ill-defined diseases 136 13 — 2 2 6 30 19 64 33 Motor vehicle accidents 14 — — — 2 2 6 3 1 34 All other accidents 26 1 — — — 1 4 7 13 35 Suicide 20 — — — 1 3 8 6 2 36 Homicide and operations of war — — — — — — — — — Special Causes (included above) Smallpox — — — — — — — — — 19 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. I. (i) Public Health Officers of the Authority.—Vide list at the beginning of this report. (ii) Home Nursing.—This service is administered by the Essex County Council. A report of the work performed during 1956 will be found in Part III Services section. (iii) Laboratory Facilities.—Pathological specimens are now sent to the Bacteriological Laboratory, Oldchurch Hospital, Romford, for examination. (iv) Byelaws exist for:— Prevention of Nuisances. Cleansing of footways and pavements, and cleansing of earth closets, privies, ashpits and cesspools. Dealing with common lodging houses and houses let in lodgings. Houses let in lodgings or occupied by members of more than one family. (Sec. 84, Ilford Act, 1937.) Slaughterhouses and humane slaughtering of animals. Pleasure Fairs. (Sec. 59, Essex C.C. Act, 1952). Tipping of Dust, Spoil and Refuse. (Sec. 85, Ilford Act, 1937.) For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (Sec. 53, Ilford Improvement Act, 1898.) Nuisances in connection with the removal of offensive or noxious matter. Depositing of Rubbish, etc. (Sec. 249, Local Government Act., 1933.) Establishments for Massage and Special Treatment. (Essex C.C. Act, 1933, Part IV.) Inspections of licensed establishments are carried out quarterly. During 1956 twenty-four applications for renewal of licences were received. The Council renewed the licences in respect of these establishments. Two new applications were received, which were granted. The licences expire on 31st March of each year. Hairdressers' and Barbers' Premises. (Essex C.C. Act 1933. Part VI). During 1956, 46 visits of inspection were made by the Public Health Inspectors to these premises. Camping Grounds and Moveable Dwellings. (Essex C.C. Act 1933, Part IX.) (v) There are three local Acts in operation—(1) The Ilford Improvement Act, 1898, which has important sanitary provisions: (2) The Ilford Urban District Council Act, 1904, the Section which deals with the control of tuberculosis is repealed, the powers of the Corporation now being contained in the Food and Drugs Act, 1955, and (3) The Ilford Corporation Act, 1937. (vi) Essex County Council Act, 1952. This Act came into operation in 1953. Reference is made in this Report in appropriate sections as to action taken under the Act. 20 (vii) Nurses Act, 1943 (Part 2.) Nurses Agencies. The Essex County Council on application by the llford Council, delegated to them, in pursuance of Section 11 (1) the powers conferred upon the County Council by Part II of the Act, subject to certain conditions. Agencies are inspected before the issue of a licence, and thereafter at intervals of not more than once a quarter. The Medical Officer of Health and Deputy are authorised under Part 2, Section 9 (2) to enter and inspect any such licensed premises in the Borough. No application for a licence was received during 1956. (viii) National Assistance Act, 1948.—The County Welfare Officer has kindly supplied me with the following information. "The County Welfare Committee is responsible to the County Council for functions under Part III of the National Assistance Act, 1948, the main aspects being:— (a) the provision of residential and temporary accommodation, and (b) welfare arrangements for blind and other handicapped persons, The following statistics show the extent to which the main services provided by the County Welfare Committee under the National Assistance Act, 1948, have been afforded to persons residing within the Borough of llford during the year 1956:— (1) Residential and Temporary Accommodation. (a) Aged persons admitted to hostels and other residential establishments:—45. (b) Other classes (admitted to temporary accommodation): — Adults, 4; Children 13:—17. (2) Blind Persons. The numbers of registered blind, partially sighted and defective sighted persons resident in the Borough as at 31st December, 1956, were as follows: — all of whom were under the supervision of the County Council's Home Teachers. During the year 6 blind residents participated in the Home Workers' Scheme operated through the agency of the Royal London Society for the Blind, and 1 was employed in a Workshop for the Blind. In addition, 32 blind and 8 partially sighted residents were employed in open industry. During 1956, 2 blind residents from the Borough were admitted to homes for the blind. (3) Deaf or Dumb and other Handicapped Classes. During the year in question the Welfare Committee continued to develop its activities in respect of Welfare Services for handicapped persons (other than blind as mentioned above) as provided for under Section 29 of the National Assistance Act, 1948, with the support of voluntary organisations acting as the Council's agents in this connection." In llford the scheme for other handicapped persons has been delegated to a Sub-Committee of the llford Social Service Association of which the Medical Officer of Health is Chairman, (i) Registered as blind (ii) Partially sighted (iii) Defective sighted 313 62 10 21 National Assistance Act, 1948. (a) Section 47 provides for the removal of persons to hospital who are unable to devote to themselves proper care and attention. Four persons were dealt with during the year. They were a male of 86 years and three females of 70, 73 and 80 years. All were removed to hospital; two died a few days after admission. The other two returned home after the expiration of the magistrate's order and were kept under observation. (b) Section 50 requires a Local Authority to arrange for the burial or cremation of a person who has died or been found dead, and where it appears to the Local Authority no suitable arrangements are being made for the disposal of the body. The burial of four persons was dealt with during the year as follows: — (1) A male, 70 years, patient in a nursing home. (2) A male, 4 months, died at home. (3) A female, 80 years, found dead at home. (4) A male, 69 years, patient in a nursing home. Miss M. J. Copping, Welfare Officer for Old People reports as follows:— "During 1956, 436 cases were dealt with of which 338 were new cases. Among the 436 cases were some relating to persons known to the Department since 1952. Total home visits paid were 836. This figure does not include visits made by voluntary organisations or othei persons whose interest I was successful in gaining, or visits of a purely social character paid to old persons in Homes or Hospitals who would otherwise have had no visitors. Some of the visits were of short duration, others involved the spending of several hours with one person, and in certain emergencies doing shopping for them and preparing and serving a light meal. In some cases one visit only was necessary, the person concerned then being referred to the Domestic Help Organisers, National Assistance Board, Ministry of Pensions and National Insurance or some other body who are able to solve the problem or take the case over. Other persons have been visited many times either because their problem was an involved one or long term one, or because they needed constant moral support. Some presented an interesting psychological study and were revisited several times purely from the point of view of gaining insight into the problem of ageing generally. In addition to the visits, 252 interviews with old persons, their relatives or representatives of other bodies concerned with their welfare were conducted at the Public Health Offices. There were also numerous telephone enquiries. Some of these telephone calls are of necessity of long duration. Many are from Almoners who found that a patient admitted to their Hospial is known to me. They wish to know the home conditions and social background and often cannot wait for a letter because upon the information received depends the decision as to whether the patient must be detained in Hospital or can be adequately cared for at home or they may wish to contact relatives through me. As opposed to the year 1955 a large proportion of the case work was the result of direct appeals to me from the old persons concerned. This I believe was the result of eight addresses given by me to Old Age Pensioners Clubs and other organisations with a proportion of elderly members. Of 37 persons referred through me to the Essex County Council for Part 3 Accommodation 16 were admitted during the year. 21 persons are still on the waiting list and because the demand for this 22 accommodation far exceeds the quota of places available; a proportion of these will almost certainly never be admitted. A sad feature, is the number of old persons wno made applications solely because they were told repeatedly by their families with whom they were living that they were not wanted. Friction had often arisen because of a failure on the part of the younger generation to attempt to see the old person's point of view or respect his old fashioned standards. With a little give and take on both sides many of these old persons could live happily at home. As in 1955 the most problematic group are those physically fit but mentally confused. There are always some cases known to me who through no fault of their own are a public nuisance. It is a very distressing thing for their relatives, or those who live in close contact with them. There seems to be a need for some special type of accommodation for such persons. Some are of course suitable for mental hospitals and would benefit by treatment therein, but others are not suitable, or could not benefit from treatment and would be merely blocking a bed urgently needed for some person who could benefit. Private Homes are not usually willing to accept this type of person and while some are acceptable to the Essex County Council for Part 3 Accommodation others would be an unfair burden upon the staff, and would upset other residents. Of the cases dealt with 49 were admitted to Hospitals, mostly to Langthorne Hospital or St. George's Hospital, Hornchurch. In about 75 per cent of these cases the General Practitioner had appealed to the Medical Officer of Health for assistance after experiencing difficulty in procuring a bed. Social reports were prepared for submission to the Hospitals through the General Practitioner if he thought fit to use them. In many cases subsequent admission resulted. 61 persons known to me died in their own homes, several of these could not be given sufficient care and attention at home, and while I do not suggest that they would not have died had they been in Hospital, they would have been spared a lot of discomfort and loneliness if they had been admitted. Nursing Home fees average 8-10 guineas weekly and few of the persons referred to me can afford to pay them. A small percentage of the persons admitted to Hospital went there as a result of a home accident. An attempt is always made to discover the cause of such accidents, and constant vigilance is kept in order to take preventive measures against accidents. Home Safety pamphlets have been distributed to old persons and others in close contact with them. Ample opportunity to study and discuss this problem occurs through serving on the llford Home Safety Committee. Of the persons interviewed a large number were seeking Old Age Pensioners' flats. Those who appeared to be eligible for Stoneleigh Court were visited at home and if found suitable their names were placed on the waiting list. The demand from suitable and deserving cases far outnumbers the supply. Reports on other cases not eligible for Stoneleigh Court but badly housed or under notice to quit, etc. were forwarded to the Housing Office. Several were referred to the Basildon Corporation and were housed in flats or Old Persons' bungalows in Basildon New Town. A considerable amount of time has been devoted to correspondence and to the keeping of case histories and other records. Many requests are received from Langthorne Hospital for reports on the progress of persons discharged home. Many of these spend 6 weeks in Hospital and 6 weeks at home alternately and an endeavour is made to maintain contact with them with a view to forming an opinion as to whether this scheme is satisfactory. 23 The laundry service for cleansing of soiled bed linen and personal clothing continued to operate throughout the year, proving of invaluable assistance in very difficult cases. During the year 61 persons were assisted and 11,001 articles were laundered." (ix) Hospitals, Etc. Isolation Hospital.—172 beds are provided; of these 44 are for the treatment of tuberculosis patients. The Regional Hospital Board has not yet finally decided on the use of the 25 beds formerly used for the treatment of tuberculosis patients. It is probable the beds will be used in connection with a geriatric unit. In the meantime they are in use for recovery cases and cases for investigation mainly from King George Hospital. Maternity Hospital.—51 beds for the reception of maternity cases are maintained at the llford Maternity Hospital. King George Hospital.—The following is a return in respect of bed accommodation: — Total number of Beds at 31st December 1956. Pay Beds 14 Amenity Beds ' 7 Other Patients Medical Surgical Children Male Female Male Female 211 21 26 18 55 55 36 The above three hospitals are included in the llford and Barking Group. (Group 12 N.E. Metropolitan Regional Hospital Board). Mental Hospitals.—There are two large Mental Hospital^ in the district, the Goodmayes Hospital, with 68 Resident Staff and 1,379 patients (males 618, females 761), and Claybury Hospital, with 197 Resident Staff and 2,185 patients (males 885, females 1,300) in residence on 30th June, 1956. (These Hospitals are included in Groups 21 and 20 respectively of the North East Metropolitan Regional Hospital Board.) Other Institutions.—Girls' Village Homes, one of the late Dr. Barnardo's Institutions, with 80 beds in the Hospital and on 30th June, 1956, there were 40 Resident Staff and 55 patients. Nursing Homes.—There are 2 private registered Nursing Homes in the district for medical and senile cases. All Nursing Homes in the district are visited by the Medical Officer of Health and the Chief Public Health Inspector (or their deputies) quarterly and at other times when necessary. (x) Ambulance Facilities : County Ambulance Service. A Central Ambulance Control at llford deals with all requests for Ambulance transport arising in the whole of the Metropolitan area of Essex. The Control is manned continuously, is in direct contact with all Ambulance Stations in the Metropolitan area of the County and with the Divisional Control at Chelmsford. In cases of emergency it is only necessary to dial 999. All other requests for ambulance transport should be made, preferably in writing, to the Controller, llford Ambulance Control. Aldborough Road, llford, or in cases of urgency by telephone (Valentine 8822). Requests for Ambulance transport, other than emergency requests, are only accepted from Doctors, Midwives, Duly Authorised Officers and the medical staff of hospitals. 24 If any difficulty should arise in obtaining an Ambulance a call may be made direct to the Controller, llford Ambulance Control, Valentine 8822, or to the County Medical Officer of Health, County Hall, Chelmsford, Chelmsford 3231. (xi) Clinics and Treatment Centres: Maternity and Child Welfare.—Infant Welfare Centres are held at the following premises:— Parish Hall, Mossford Green, Barkingside (for residents of Barkingside area) Chadwell Christian Mission Hall, Essex Road, Chad well Heath (for residents of Chadwell Heath area) Mayesbrook Clinic, Goodmayes Lane, Goodmayes (for residents of Becontree area) St. John's Church Hall, Devonshire Road, Seven Kings (for residents of Downshall area) Manford Way Clinic, Hainault (for residents of the llford portion of L.C.C. estate) Congregational Church Hall, Woodford Avenue, llford (for residents of Woodford Avenue area) Cecil Hall, Granville Road, llford (for residents of the east side of Cranbrook Road) Cecil Hail, Granville Road, llford (for residents of the west side of Cranbrook Road) Seven Kings Methodist Church Hall, Seven Kings Road (for residents of Seven Kings area) Newbury Hall, Perryman's Farm Road, Newbury Park (for residents of the Newbury Park area) Vine Memorial Church Hall, Grosvenor Road, llford (for residents of Grosvenor Road area) Mayesbrook Clinic (for residents of Goodmayes area) St. Mark's Church Hall, Rose Lane, Chadwell Heath (for residents on Padnall Estate) Vine Memorial Church Hall, Grosvenor Road, llford (for residents of llford Lane area) Valentines Mansion, Emerson Road, llford (for residents of Valentines area) Parish Hall, Mossford Green, Barkingside (for residents of Fairlop area) Ante-Natal Clinics.—An Ante-Natal Clinic is held at the Maternity Hospital, Eastern Avenue, llford, on Tuesday morning, Tuesday afternoon (Obstetric Specialist), Wednesday morning and afternoon, Thursday morning and afternoon, Friday morning, Friday afternoon (Obstetric Specialist), Saturday morning; at Mayesbrook Clinic, Goodmayes Lane, on Monday and Thursday mornings, and alternate Saturday mornings: at Manford Way Clinic, Hainault, every Wednesday morning and on Friday mornings as and when required. Midwives Ante-Natal Clinics are held at the Public Health Offices, each Monday afternoon; at Mayesbrook Clinic on 2nd and 4th Wednesday afternoons of each month; at Manford Way Clinic on alternate Thursday afternoons. Post-Natal Clinics.—These Clinics are held at the Maternity Hospital on each Monday afternoon; at the Mayesbrook Clinic, Goodmayes Lane, on alternate Saturday mornings; and at the Manford Way Clinic, Hainault, op the first Friday morning of each month, Monday, 2 p.m. Monday, 2 p.m. Tuesday, 2 p.m. Tuesday, 2 p.m. Tuesday, 2 p.m. Wednesday, 2 p.m. Wednesday, 2 p.m. Thursday, 2 p.m. Wednesday, 2 p.m. Thursday, 2 p.m. Thursday, 2 p.m. Thursday, 2 p.m. Thursday, 2 p.m. Friday, 2 p.m. Friday, 2 p.m. Friday, 2 p.m. 26 School and other Clinics.—Clinic sessions are held at Health Services Clinics as under: — (i) Public Health Offices. Valentines Mansion for— Diphtheria and Whooping Cough Immunization. Ear, Nose and Throat. Ophthalmic treatment. Paediatric. Infant Welfare. Midwives Ante-Natal. Ante-Natal Relaxation Exercises. Enuresis. B.C.G. Vaccination. Poliomyelitis Vaccination. (ii) Newbury Hall, Perryman's Farm Road, for— Minor Ailments. Orthopaedic and Remedial Exercises treatment. Artificial Sunlight treatment. Infant Welfare. B.C.G. Vaccination. Poliomyelitis Vaccination. (lii) Mayesbrook Clinic, Goodmayes Lane, for— Minor Ailments. Dental (Children and Expectant Mothers). Ophthalmic treatment. Artificial Sunlight treatment. Ante-Natal and Post-Natal. Ante-Natal Relaxation Exercises. Diphtheria and Whooping Cough Immunization. Orthopaedic and Remedial Exercises treatment. Infant Welfare. Speech Therapy. Midwives Ante-Natal. Orthoptic. B.C.G. Vaccination. Poliomyelitis Vaccination. (iv) Valentines School, Beehive Lane, for— Dental (Children). Speech Therapy. (v) Loxford Hall, Loxford Lane, for— Child Guidance Clinic. (vi) Manford Way Clinic, Hainault, for— Ante-Natal and Post-Natal. Ante-Natal Relaxation Exercises Infant Welfare Diphtheria and Whooping Cough Immunization. Midwives Ante-Natal. Dental (Children only). Ophthalmic treatment. Orthopaedic treatment. Poliomyelitis Vaccination. (xii) Chest Clinic.—A clinic for the diagnosis and treatment of tuberculosis is provided by the North East Metropolitan Regional Hospital Board at 130-132, Cranbrook Road. llford. The following sessions are held each week: — For Adults—Monday, 2 to 4 p.m.: Tuesday, 10 to 12 noon; Wednesday evening, for workers only, by appointment; Friday, 10 to 12 noon and 2 to 4 p.m. For Children—Wednesday morning 9.30 to 12 by appointment. A Refill Clinic is held on Tuesday evening and Thursday afternoon. 26 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The Chief Public Health Inspector reports as follows: — "Designation of Public Health Inspectors. During the year the Sanitary Inspectors (Change of Designation) Act became law as the result of the recommendations of the Working Party report on the recruitment, training and qualifications of Sanitary Inspectors. Henceforth they are to be called Public Health Inspectors. These officers originated with the Public Health Act 1848 wherein they were described as Inspectors of Nuisances. This Statute, if adopted by local authorities, required the appointment of such an officer, whcse duties were detailed with some minuteness. With the increase in public health legislation the inspectors' duties were multiplied, being variously described in sanitary law as either an Inspector of Nuisances .or a Sanitary Inspector, which latter title later submerged the former. So far removed are the present duties of the erstwhile Sanitary Inspector from those of his earlier predecessor that it was considered by the Working Party that a more appropriate title ought to be given to these important local authority functionaries. That Ihis is right is exemplified by a consideraion of his duties today. The Working Party reported on twenty-three different branches of health duties falling to be performed by this officer and these by no means limited the extent of his duties. Housing (Slum Clearance Programme). One of his most important functions is the housing conditions of a large section of the community, as instanced by the progress of the Council's slum clearance programme envisaged in 1955, when some 291 houses were deemed to be suitable for inclusion in a five year programme of demolitions under clearance and compulsory purchase orders under the Housing Act 1936. During the year under review six clearance areas were made by the Council in Laburnum Grove and Railway Terrace Radnor Crescent, Grove Steps, Hainault Farm Bungalows, Green Lane, and Mill Road, which brought the number of properties dealt with under the five year scheme to 119 dwellings. It is the Council's policy to pursue this programme vigorously until it is completed, particularly in the light of the government's proposal to proffer housing subsidies only in respect of dwellings included in slum clearance areas. Atmospheric Pollution To augment the clean air policy of the government, the Council decided to instal atmospheric pollution measuring instruments at the Town Hall, Gants Hill Library and John Bramston School. These have been set up and are in full operation. It is hoped that in conjunction with the Department of Scientific and Industrial Research. Fuel Research Station, these appliances will determine the extent of air contamination in llford and its relationship to contiguous authorities' problems. The possibility of creating within the Borough a " smokeless zone " or Smoke Control Area is to be considered. This of course warrants earnest consideration by the Council, as its financial and restrictive commitments are extensive. 27 Housing Repairs and Rents Act 1954. The opinion given in the last report that this Statute had not proved effective to secure the object in view is amplified by the figures for certificates of disrepair applied for and granted during the year 1956: — Applications 134 Not granted Certificates issued No. of revocations applied for and granted No. of revocations applied for and not granted No. of revocations not applied for 17 117 87 1 29 The ostensible purpose of this Act is to be the object of additional legislation for the Government now propose to legislate comprehensively on the subject of rent restrictions generally, the decontrol of dwelling houses and, insofar as local authorities are concerned, to amend drastically the procedure entailed in the issue of certificates of disrepair. Food Hygiene Efforts to secure a lessening in the incidence of food poisoning have been continued. The standard of food preparing premises and the principles of food handling in the Borough is reasonably high, though the number of notices under the Food and Drugs Act and the Food Hygiene Regulations has increased this year. A comparison between 1955 and 1956 might be of interest. Number of Notices served under the Act and Regulations: — 1956 1955 Served 302 127 Complied 258 119 (including 35 (including 23 served 1955) served 1954) Number of Food Poisoning notifications to the Medical Officer of Health:— 51 50 (i) Water Supply.—The district is served by the Metropolitan Water Board and South Essex Waterworks Co., both maintaining a constant supply. The subject of the water supply of the Borough was dealt with at length in the Report for 1945. Dr. E. Windle Taylor, Director of Water Examination of the Metropolitan Water Board, has kindly supplied me with the information that 3,425 samples of filtered water were submitted to chemical and bacteriological examination and found to be pure and wholesome. Samples of the water at all stages of purification are analysed daily in the Laboratories. The part of llford in the area of the Board is supplied with water derived from the River Lee, filtered and chlorinated at the Lee Bridge works and Ferry Lane works and then pumped into supply. An additional amount of water is supplied to the llford area from Ferry Lane and Wanstead wells. Contact tanks are now in operation at these works in which the dose of chlorine is able to exert its full effect before the water passes into the distribution system. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested to confirm that the quality of the water is up to that normally supplied. The water is not plumbo-solvent. 28 The length of mains laid by the Metropolitan Water Board in llford during 1956 was 9 yards of 3 inch; 437 yards of 4 inch; 3 yards of 6 inch; 3 yards of 8 inch; 35 yards of 10 inch; and 5,653 yards of 15 inch. Mr. Hugh G. Ramsey, Engineer to South Essex Waterworks Cohas kindly supplied me with the information that over 3,880 chemical bacteriological and biological examinations were made at the Langham Laboratory and all were reported as wholesome. Samples were taken weekly from wells and houses in various parts of the area and were invariably satisfactory. The water provided to the remainder of the llford district by the South Essex Waterworks Co. is obtained from the River Stour and from deep wells at Mill Road, Grove Road and Roding Lane. Mains were extended by the Company as follows:—64 yards of 12 inch; 1,026 yards of 9 inch; 53 yards of 6 inch; 696 yards of 4 inch; and 421 yards of 3 inch. A supplementary supply of water was obtained from the Metropolitan Water Board during the months of February to July inclusive, the total quantity supplied being 130 million gallons. The supply acquired in February was due to the very severe frosty weather in that month and thereafter it was necessary to supplement supplies pending the new supply from the Hanningfield Scheme which came into operation in August. There are now no public wells in existence. There are a few private wells for domestic and commercial purposes. Four samples of piped water supply (2 South Essex Waterworks Co., and 2 Metropolitan Water Board) were taken for Chemical and Bacteriological examination, and all gave satisfactory analyses. (ii) Swimming Baths and Pools.—Samples of water for examination were taken from the open air swimming bath from April to September (6). The samples were satisfactory. Samples were also taken from the two indoor baths during February, April, May, June, July, August, September. October and December (16): all the samples were satisfactory. (iii) Drainage and Sewerage.—The Borough Engineer has kindly supplied me with the following: — "llford Corporaton Main Drainage Scheme. Substantial progress was made in the Main Drainage Scheme during the year. The relaying of the sewers in Albert Road and Sunnyside Road (£125,000) and the soil sewer in Gordon Road (£107,000) and Connaught Road was completed. A storm water over-flow was constructed at Gordon Road/Henley Road junction and a length of relief sewer laid along Henley Road to Sunnyside Road to connect with the length of relief sewer laid in 1953/54. The Gordon Road sewer connects with a length of 57" pipe laid under the Railway pre-war and an extension from the head of this 57" pipe in Ley Street to Vicarage Lane. Work progressed on the new Roden Street Pumping Station (£100,000) and a satisfactory start was made on the Roding Valley Sewer (£140,000) which drains the low level area to the pumping station. Schemes executed under the llford Corporation (Drainage) Act, 1950, included the substantial completion of Cran Brook Stage I (£95,000) up to the Wash and approximately 70 per cent of Stage II (£150,000) i.e. Valentines Park to the Central Line Railway. Rivers and Streams Flooding.—A number of cases of flooding due to surcharge of sewers and watercourses were reported particularly during severe storms in June and July. 29 Pollution of Streams.—There was no pollution of consequence reported during the year. ilford and barking joint sewerage scheme. (a) New Workshop and Mess Room Accommodation. The Committee considered the provision of a new block to replace the old mess room and workshop which were in poor condition and inadequate for present needs and in March 1956 approval was given for the works to proceed at a cost of approximately £21,200. The new block comprises a well equipped modern engineering workshop with good storage accommodation, offices, garages, lavatory units, messroom and kitchen, bathing and cleansing showers, locker room and drying rooms. (b) Housing over Sumps. The completion of a new building designed to totally enclose the sumps in September 1956 provided a great improvement with regard to facilities, access, general operation and maintenance of plant in all weathers. It is anticipated that the secondary function of the Housing, namely the reduction of unpleasant odours, fly nuisance etc. will be more obviously apparent during the summer months. With regard to cleanliness and hygiene, the advantages gained by draining all water from hosing down operations back into the sumps have been considerable since stagnant water pockets have been eliminated." (iv) Collection and Disposal of Refuse.—The Borough Engineer also kindly supplied the following information: — Tons Total amount of refuse collected and disposed of 53,743 Collection of Salvage:— Tons Income Wastepaper 1,164 £10,266 Rags and Scrap Metal 89 £1,335 (v) Sanitary Inspection of the Area.—The following is a summary of the work of the Public Health Inspectors during the year:— Houses and premises inspected 35,111 Houses and premises reinspected (work in progress) 25,630 Visits during disinfection 400 Houses in which nuisances were detected 1,020 Houses in which nuisances were abated 1,035* Premises disinfected 156 Premises from which articles only disinfected 127 Articles disinfected 528. Premises disinfested for verminous conditions 19 *Includes 117 nuisances detected before 1st January, 1956. Notices served:— Complied Statutory:-— Served with Public Health Act, 1936 211 140 Housing Act, 1936 — — Factories Act, 1937 2 — Shops Act, 1950 1 1 Provide Dustbin (llford Urban District Council Act, 1904) 29 24 Food and Drugs Act, 1955 9 6 Cleanse Water Storage Cistern (Byelaws) ... — — Cover Water Storage Cistern (Byelaws) ... 2 2 Informal 1,577 1,317 1,831 1,490 30 In addition to the above, 266 notices (57 statutory and 209 informal) served previous to 1st January, 1956, were also complied with. Complaints— During the year 4,243 complaints of nuisances were received and investigated. The following is a summary:— Accumulation of manure and refuse 42 Animals improperly kept 14 Bad smells 74 Dampness of premises 129 Defective drains, w.c.'s and fittings 542 Defective roofs, gutters, downpipes, etc. 144 Defective water fittings 75 Dirty and verminous houses 19 Dirty condition of rearway 8 Flooding of premises 28 Overcrowding 43 Smoke nuisances 67 Defective or no provision of dustbin 2,097 Rats and mice 541 Miscellaneous 420 Total 4,243 (vi) Shops Act, 1950 (Section 38).—Since this Act came into operation the Public Health Inspectors have made inspections in accordance with Section 38. During the year 142 inspections were made, 1 Preliminary Notice was served, which was complied with. No Certificate of Exemption from the provisions of Section 38 was granted in 1956. (vii) Eradication of Bed Bugs:— Houses found to be infested 19 „ Disinfested 19 (viii) Slaughter of Animals Acts, 1933 to 1954.—No licence to act as slaughterman was granted during the year. (ix) Rag, Flock and Other Filling Materials Act. 1951—Registration has been granted in respect of 15 premises, where filling materials, as specified in the Act, are used. The occupier of registered premises may only obtain " rag flock " from premises licensed under the Act, either for the manufacture of rag flock or as a rag flock store. One licence was renewed in 1956 in respect of premises used as a rag flock store. (x) Atmospheric Pollution.—Complaints were received of alleged smoke nuisance from 9 factories in the Roding Lane, Grove Road and Newbury Park areas. Regular observations were maintained and investigations carried out. In 4 instances no emission was noted which would have enabled action to be taken under the Public Health Act, 1936, but 1 Statutory Notice and 3 informal notices were served in the other instances. The Government Committee on Air Pollution in its report recommended, amongst other matters, that steps should be taken to secure fuller and more frequent measurements of pollution and stated that local authorities could give most valuable service in this respect. The Council decided to provide three sets of apparatus each comprising a deposit gauge, a lead peroxide gauge and a combined volumetric for sulphur dioxide and smoke filter. These have now been installed at the Town Hall, Gants Hill Library and John Bramston School and measurements commenced in 1957. 31 the Essex County Council has decided to provide a laboratory service to carry out chemical examinations of samples from lead peroxide instruments and from deposit gauges, at a reasonable charge. (xi) Land Charges Act, 1925.—During the year 3,441 enquiries were dealt with under this Act. SECTION D—HOUSING. (i) Overcrowding.—One notice was served and complied during 1956. (ii) Clearance Areas.—Six areas were declared by the Council to be Clearance Areas, in 1956. (iii) HOUSING STATISTICS. 1. Inspection of dwelling-houses during the year: — (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,486 (b) Number of inspections made for the purpose 19,654 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (fe) Number of inspections made for the purpose — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 955 2. Remedy of defects during the year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the LocaJ Authority or their officers 707* 3. Action under Statutory Powers during the year:— a. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs ... (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners (b) By local authority in default of owners 32 b. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 242 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 172* (b) By local authority in default of owners 9* c. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses demolished as a result of formal or informal procedure under Section 11 49 (2) Number of dwelling-houses closed in pursuance of an undertaking given by the owners under Section 11 and still in force — d. Proceedings under Section 12 of the Housing Act, 1936:— Number of separate tenements in respect of which Closing Orders were made — 4 Housing Act, 1936, Part IV—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 178 (ii) Number of families dwelling therein 279 (iii) Number of persons (units) dwelling therein 674½ (b) Number of new cases of overcrowding reported during the year 24 (c) (i) Number of cases of overcrowding relieved during the year 40 (ii) Number of units concerned in such cases 146 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report— * Includes compliances during 1956 of Notices served prior to 1st January, 1956. HOUSING ACT, 1936. During the year 1956 the work of receiving applications, calling for calculations for the "permitted number" was continued with a view to the issue of housing certificates. 1 certificate, in respect of 1 house, was issued during the year, making a total of 18,320 certificates, in respect of 25,130 houses, issued to the end of 1956. As new premises were constructed and placed upon the rating lists, " permitted number " certificates were issued as required. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920 and 1933 AND HOUSING REPAIRS AND RENTS ACT, 1954. During 1956, 10 applications for Certificates of Disrepair were received. Of these, 9 were granted, and the other was refused. Applications for revocation of Certificates were received and granted in 8 cases. 83 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. The Council delegated to the Public Health Committee all its powers and duties under the Food and Drugs (Milk and Dairies) Act, 1944, the Milk and Dairies Regulations, 1949, the Milk (Special Designation) (Raw Milk) Regulations, 1949, the Milk (Special Designation) (Pasteurized and Sterilized Milk) Regulations, 1949, the Food and Drugs (Milk, Dairies and Sterilized Milk) Regulations, 1949, the Food and Drugs Act, 1955. and any Regulations which might thereafter be made under the last named Act. The Milk (Special Designations) (Specified Areas) Order, 1951, which came into operation on 1st October, 1951, specified an area, including llford, in which the compulsory use of special designations for retail sales of milk shall operate. (i) Milk and Dairies Regulations. 1949 to 1954.—Persons and premises registered as at 31st December, 1956:— Persons registered as distributors of milk 114 Premises registered as dairy premises (other than dairy farms) 13 170 inspections of dairy premises were carried out during the year. (ii) Milk (Special Designation) (Raw Milk) Regulations, 1949 to 1954:— The following licences were granted during 1956 Tuberculin Tested 37 do. (Supplementary) 10 (iii) Milk (Special Designation) (Pasteurised and Sterilized Milk) Regulations, 1949 to 1953: — The following licences were granted during 1956 :— Pasteurized (Dealer's) 63 do. do. (Supplementary) 11 do. (Pasteurizer's) 1 Sterilized (Dealer's) 94 do. do. (Supplementary) 13 do. (Sterilizer's) 1 One licence, granted by the Essex County Agricultural Executive Committee, in respect of the production of Tuberculin Tested milk at a farm in the Borough is in operation. (iv) Sampling.—The following is the routine practice adopted: — Designated Milks (Raw and Heat treated).— These are sampled bi-monthly and after unsatisfactory reports. Biological Tests.—Samples of all raw milks, are submitted for biological test for T.B. quarterly. Repeat samples if positive after clearance by the Divisional Inspector of the Ministry of Agriculture Fisheries and Food. Milk Supplies to Maintained Schools.—These are sampled monthly and after unsatisfactory results. 34 The following results were obtained:— Grade of Milk Total Satisfactory Unsatisfactory Remarks on unsatisfactory results Tuberculin Tested (Pasteurized) Milk 34 34 — — Tuberculin Tested Milk (Farm bottled) ... 6 5 1 The sample of milk produced at a farm outside the Borough failed to satisfy the Methylene Blue Reduction test. The County Agricultural Executive Committee was communicated with and further samples were taken. Pasteurized Milk 75 75 — — Sterilized 25 25 (v) Biological Tests.—6 samples of milk were submitted to a biological test for tuberculosis, all of which were found negative. (vi) Milk and Dairies Orders, 1926 and 1938: Inspection of Dairy Herds.—One examination was made by the Veterinary Officers of the Ministry of Agriculture, Fisheries and Food. The Ministry's Divisional Officer states that no cows were found to be suffering from tuberculosis. No samples of milk were sent for bacteriological examination. (vii) Legal Proceedings.—8 complaints of the presence of foreign bodies in milk were received and investigated. No legal proceedings were taken, but representations were made to the retailers in all cases. (viii) Registration.—No application for registration was refused during the year, 35 Ice Cream. (i) Registration. Section 158, Essex County Council Act, 1933. In 1948, the Council delegated to the Public Health Committee its powers and duties with regard to the granting, refusal or revocation of registrations, including the duty of interviewing applicants who are required to show cause why applications for registration should not be refused or existing registration should not be revoked. 18 applications for registration in respect of 18 premises were considered during the year 1956. Registration was granted to 18 applicants in respect of the sale only of ice cream. (ii) Ice Cream (Heat Treatment Regulations) 1947 to 1952. The Council decided, in accordance with the recommendations of the Minister of Health, that 4 thermometers should be provided of the following types:— A recording thermometer at the heat treatment stage; An indicating thermometer at the heat treatment stage; An indicating thermometer at the cooling stage; An indicating thermometer at storage stage. (iii) Sampling. Samples for bacteriological examination are taken monthly from April to September and at regular intervals during the winter months as supplied by all manufacturers to tricycle salesmen and local retailers. Samples are repeated after unsatisfactory results. In 1956, 23 samples were submitted for examination with the following results:— No. of Samples Ministry of Health Provisional grade. % of Total Unsatisfactory Samples. 18 I 78.3 — 2 II 8.7 — 3 III 13.0 — — IV — — 23 100.0 Nil One sample of Ice Lolly was also submitted for examination and was found to be very satisfactory. The Food Standards (Ice Cream) Order 1953 prescribed standards for ice-cream. During 1956, 3 samples were submitted for chemical analysis, all of which complied with the Order. Meat and Other Foods. (i) Inspection and Supervision. The Council has made bye-laws under Section 15, Food and Drugs Act, 1938 for securing the observance of sanitary and cleanly conditions and practices in connection with the handling, wrapping and delivery of food sold or intended for sale for human consumption, and in connection with the sale or exposure for sale in the open air of food intended for human consumption. 30 The Essex County Council Act, 1952, Section 105, requires that as from 2nd April, 1953, any person intending to use premises which were not used immediately before that date for the sale, storage, or preparation for sale of any food (other than milk) intended for human consumption shall give not less than 14 days' notice to the Council of his intention so to do. The whole-time services of two Public Health Inspectors are utilised to deal with food preparing premises, factory canteen premises and food and drugs sampling. During 1956, they made 13,847 inspections of food shops and food preparing premises and copies of the bye-laws were supplied where necessary and the implications of them were made known to all persons concerned. 302 informal and 9 formal notices were served under the Food & Drugs Act, and 6 formal and 258 informal notices were complied with including 35 informal notices served prior to 1956. (ii) Food Hygiene. The following gives the numbers of food premises in the area by the type of business: — Caf6s and Restaurants 116 Factory canteens 30 Butchers' shops 116 Grocers' shops 260 Fruiterers' and Greengrocers' shops 131 Fishmongers' and Fishfryers' shops 57 Bakehouses 24 Bakers' shops 45 Confectioners' shops 201 980 The practice of inculcating interest in the proprietors, directors and staffs of food handling organisations was continued in 1956, and the catering industry, as a whole, continues to co-operate. The lectures and demonstrations with film strips and films to food handlers were continued in 1956. Education in food hygiene has been extended to the senior schools and to study groups of various local organisations. (iii) Sampling. The Council has delegated to the Public Health Committee power to institute legal proceedings under the Food and Drugs Act, 1955. 201 samples (195 formal and 6 informal) were obtained during the year 1956; 11 formal and 4 informal samples were not satisfactory as follows :— (a) Creami Doughnuts (formal), and (b) Cream Slices (formal)— Filling consisted not of cream but of imitation cream in both instances. Letters of warning were sent to the retailers. (c) Buttered Rolls (formal).—Fat consisted of margarine and not of butter. A letter of warning was sent to the retailer. (d) Buttered Rolls (formal).—Fat consisted not of butter but of margarine containing approximately 10% of butter. Legal proceedings were taken and a fine of £1 with £2.2s. costs was imposed. (e) Buttered Rolls (format).—Fat consisted not of butter but of margarine. Legal proceedings were taken and a fine of £1 was imposed, 37 (f) Buttered Rolls (formal).—Fat consisted not of butter but of a mixture of margarine and butter, containing 45% butter. Legal proceedings were taken and a fine of £1 was imposed. (g) Cake (informal).—Contained foreign matter which was found to consist of burnt or charred dough. No action was taken in this case. (Ii) Grape fruit juice (formal).—Contained a small proportion of water and was not undiluted grape fruit juice and sugar. A letter of warning was sent to the manufacturers. (0 Gin (formal):—Contained only 65 0% proof spirit, which although in accord with Food and Drugs Act, was below declared strength of 70%. A letter of warning was sent to the retailer. 0) Whisky (formal).—Contained only 66 5% proof spirit, which although in accord with Food and Drugs Act, was below declared strength of 70%. A letter of warning was sent to the retailer. (k) Bread (informal).—Contained foreign matter which consisted of dirty greasy dough and contained mineral oil. A letter of warning was sent to the retailer. (I) Bread (informal).—Contained foreign matter which consisted of dirty dough including fibres, fine quartz sand, a rodent " hair " and a fragment of glass. Legal proceedings were taken and the retailer was fined £5 and £5 costs. (m) Bread (informal).—Contained a decapitated fly and fragments of appendages. A letter of warning was sent to the retailer. (n) Pork sausages (formal).—Contained 260 parts per million of sulphur dioxide (undeclared). A letter of warning was sent to the retailer. (o) Pork sausages (formal).—10% deficient in meat. A letter of warning was sent to the retailer. (iv) Hawkers of Food. Section 103 of the Essex County Council Act, 1952, came into operation on 2nd April, 1953, and provides that hawkers of any food, and premises used for the storage of such food, shall be registered by the local authority. Registration was granted to 4 persons during 1956. The storage premises concerned were not in llford. (v) Registration of Premises used for the Preparation or Manufacture of Sausages, or Potted, Pressed, Pickled or Preserved Meat, Fish or other Food Intended for Sale. Section 80 of the llford Corporation Act, 1937, requires registration of such premises. 1 application for registration was received, and granted, during 1956. (vi) Articles of Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man:— Bacon, 152 lbs. 9 ozs.; Beverages, 20 tins, 12 bottles; Biscuits, 61 lbs. 9 ozs, 32 tins; Butter, 3½ lbs.; Cereals, 59 pkts.; Cheese, 24½ lbs. 78 pkts.; Cream, 74 tins; Eggs, 6 cases, 417 lbs. (frozen); Fats, 2 lbs., 2 pkts.; Fish (Wet and Dry), 70 stones; Fish (Tinned), 175 tins; Fish (Shell), 8 jars; Fish Paste, 7 jars; Flavouring, Colouring, etc. 3 bottles; Flour, 1 lb.; Foods (Medical and Baby), 1 tin; Fruit (Tinned), 1,038 tins; Fruit (Bottled), 60 lbs.; Fruit (Dried), 60 lbs.; Fruit Juice, 25 tins; Jam, Preserves, etc. 70 tins; Meat (Fresh), 2.544 lbs. 12½ ozs.; Meat (Tinned), 2,304 lbs. 5½ ozs.; Meat Pies, 2; Meat Paste, 5 jars; Milk (Tinned), 509 tins; Pastry and Pudding Mixtures, 8 pkts.; Pickles, 14 jars; Potato Crisps, 7 tins; Poultry, 299 lbs. 11 ozs.; 17 tins, 72 chickens, 48 chicklets; Puddings, 4; Sauces, Salad Cream etc., 16 bottles, 1 jar; Sausages, 6 tins, 104 lbs.; Soups, 144 tins; Sugar, 86 lbs.; Sweets, 4 lbs., 80 bars Chocolate, 6 dozen Sweet Cigarettes, 2 dozen Wagon Wheels; Tomatoes (Tinned), 377 tins; Tomato Juice, 27 tins; Vegetables (Tinned), 767 tins, 38 (vii) Foreign Bodies in Food. 15 complaints were received during 1956 of the presence of foreign bodies in foodstuffs. All were investigated and legal proceedings were taken in two cases. A fine of £10, plus £2 4s. 8d. costs was imposed in one case and the other was dismissed on payment of £5 5s. costs. Letters of warning were also sent in four other cases. (viii) Food Poisoning. By virtue of Section 82 of the llford Corporation Act, 1937, food poisoning became compulsorily notifiable in llford as from 1st October, 1938. It is also notifiable under Section 17, Food and Drugs Act, 1955. Fifty-one notifications were received. One outbreak occurred involving 3 persons but only 1 person was actually notified, the cause of the outbreak being due to Salmonella Typhimurium organisms. There were 8 other outbreaks when 28 persons were notified. 35 persons journeyed as a party from Luton to Southend-on-Sea. On the way home a number of the party were taken ill and II were admitted to an llford Hospital and notified as suffering from food poisoning. The cause of the illness in these outbreaks was not discovered, no pathogenic organisms being traced. An outbreak occurred at a local hospital involving four persons but none were notified. It was suggested that the cause was due to Staphylococci and a patient (who was a long term patient at the hospital) died, the cause of death being certified following a post mortem as " Food poisoning, arteriosclerosis and hypertension and diabetes mellitus." Tinned peas which had remained on a service trolley over a period of fifty hours and had been subject to a warming up process were regarded as the possible cause of the outbreak. 22 singles cases were notified but in only 2 was the organism of Salmonella Typhi-murium identified. Investigation of 17 other suspected outbreaks were also made during the year. (ix) Bakehouses.—There are 24 bakehouses in the district, all of which use motive power, 511 inspections of bakehouses were carried out during the year. It was necessary to call upon the occupiers of bakehouses to carry out cleansing and other work in 4 instances, and the requests were complied with in all but one case, where work was in progress. Diseases of Animals Act, 1950. (i) The Foot and Mouth Disease (Infected Areas) Special Order No. 8. 1956.—This order declared an area around Brentwood (including llford) to be an infected area, as fiom 8.5.1956. 20 cattle dispatched from Norwich were un-trucked at Goodmayes railway siding thereby becoming affected by the Order and so preventing their delivery to North London. In the circumstances the Ministry of Agriculture, Fisheries and Food Inspector issued a licence for them to be transferred to Romford for immediate slaughter. The Order was revoked by the Foot and Mouth Disease (Infected Areas) Special Order No. 13, 1956, which amended the infected area, thus excluding llford as from 6th June, 1956. (ii) The Swine Fever (Infected Areas Restrictions) Order. 1956This Order came into force on 19.11.56, and applies to the whole of Great Britain. Its purpose is to enable restrictions to be speedily imDO'.ed. when necessary, on the marketing and movement of swine in areas where swine fever is prevalent, 39 (iii) Fowl Pest. The Fowl Pest (Infected Areas Restrictions) Order, 1956. This Order applies to the whole of Great Britain. Its purpose is to expedite the imposition, where necessary, of " stand-still " restrictions on the movement of live poultry in areas where fowl pest is prevalent, and will replace the detailed area Orders by a short Order bringing into effect, in a prescribed area, the provisions of the general Order. The Live Poultry (Mid-Norfolk) (Amendment) Order, 1956. The Live Poultry (Mid-Lancashire) Order, 1956 (Amendment) Orders, 1956 and (Revocation) Order, 1956. The Live Poultry (Essex) (Amendment) Order, 1956. The first-named Orders reduced the areas described in the 1955 Orders but the last-named extended to the whole of the County of Essex and the County Boroughs of East Ham, West Hum and Southend-on-Sea the area described in ihe 1955 Order. Poultry could only be moved within the area subject to the issue of licences. One licence was issued for the removal from the Borough of 8 hens for slaughter. The Live Poultry (Essex) (Amendment No. 2) Order limited the area to a portion in the north of the County, and excluded llford, and the restrictions were subsequently revoked by the Live Poultry (Essex) (Revocation) Order 1956. The Poultry Premises and Vehicles (Disinfection) Order, 1956. The Poultry Pens, Fittings and Receptacles (Disinfection) Order, 1952. Two notices were served under these Orders requiring premises in the Borough to be cleansed and disinfected. (iv) The Exportation of Horses (Minimum Values) Order, 1956. This Order prescribes minimum values for certain categories of horses which may be exported from Great Britain to any place outside the United Kingdom, the Channel Islands and the Isle of Man. (v) Animals (Landing from Ireland, Channel Islands and Isle of Man), Order, 1933.—And Importation of Canadian Cattle Order 1933. Two Orders were issued by H.M. Veterinary Inspectors for the movement of 22 Heifers and 5 Heifers respectively from Southampton Docks to llford. Supervision of the animals was maintained and they were effectively isolated. Prevention of Damage by Pests Act, 1949.—The Council has appointed a whole-time Rodent Operative, who commenced his duties on 1st January, 1951. Where infestation has been ascertained on inspection the services of the Rodent Operative are made available to secure effective 40 disinfestation. In the case of business premises these services are offered on a contractural basis, a practice which is greatly appreciated by most business firms. The following is a statement of the work carried out during 1956:— Type of Property Total Local Authority Dwelling Houses Agricultural All other (including Business and Industrial) I. Total No. of properties in District 212 51,695 29 5,735 57,671 II. No. of properties inspected as result:— (a) of notification 63 537 2 90 692 (6) survey under the Prevention of Damage by Pests Act, 1949 24 22 1 3 50 (c) otherwise — — — 980 980 III. Total No. of inspections and re-inspections carried out 216 1,285 5 14,055 15,561 IV. No. of properties found to be infested by rats:— Major Minor 45 187 4 21 257 V' No. of properties found to be infested by mice:— Major _ Minor 54 127 — 41 222 VI. No. of infested properties (under III and IV) treated by the Local Authority 41 324 - 60 425 VII. No. of notices served under Section 4:— (1) Treatment - - - - (2) Structural works (i.e., Proofing) — — — — — VIII. No. of cases in which default action was taken by Local Authority following issue of notice under Section 4 - - - - - IX. Legal proceedings — — — — — X. No. of "block" control schemes carried out ... Nil 41 Petroleum (Consolidation) Act, 1928.—The Public Health Inspectors made 1,609 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and the testing of petroleum appliances or fittings. The number of Licences issued was 142, and the fees paid to the Council for such Licences was £106. One Licence was issued for the storage of calcium-carbide, the fee payable being 5s. Pet Animals Act, 1951.—This Act came into force on 1st April, 1952, and the Council is the Local Authority for the Borough. The Chief Public Health Inspector is designated as the officer responsible for the administration of the Act and he and his Deputy are authorised to inspect any premises in the Borough where licences are in force. Licences were granted in respect of 14 premises during 1956. 42 SECTION F PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES The following diseases are notifiable to the Medical Officer of Health: 1. Under Section 144 and 343, Public Health Act, 1936. Smallpox. Enteric fever (Typhoid and Para Cholera. typhoid). Diphtheria. Relapsing Fever. Membranous Croup. Anthrax (made notifiable by the Local Erysipelas. Authority as from 1/4/22). Scarlatina or Scarlet Fever. Pemphigus Neonatorum (made notifiable Typhus Fever. by Local Authority as from 29/6/29). 2. Under Regulations of the Ministry of Health. Plague L.G.B. Order, 19/9/1900. Puerperal Pyrexia The Puerperal Pyrexia (Amendment) Regulations, 1954. Ophthalmia Neonatorum P.H. (Ophthalmia Neonatorum) Regulations, 1926. Acute Primary and Acute 1 Influenzal Pneumonia I P.H. (Infectious Diseases) Regulations, Dysentery 1953. Malaria Tuberculosis P.H. (Tuberculosis) Regulations, 1952. Acute Rheumatism (up to 16 The Acute Rheumafism (Amendment) years) Regulations, 1957. Measles and Whooping Cough The Measles and Whooping Cough Regulations, 1940. Acute Poliomyelitis P.H. (Acute Poliomyelitis, Acute EnAcute Encephalitis cephalitis and Meningococcal Infection) Meningococcal Infection | Regulations, 1949. 3. By Local Act. Food Poisoning llford Corporation Act, 1937, and Food and Drugs Act, 1955. In addition to the above diseases notifiable to the Medical Officer of Health, certain industrial diseases are notifiable to the Chief Inspector of Factories, Home Office, under Section 66 of the Factories Act, 1937. These are cases of Lead, Phosphorus, Arsenical or Mercurial Poisoning or Anthrax contracted in any factory. The Secretary of State can add other diseases to those mentioned by Regulation. The total numbers of deaths of llford residents from the following infectious diseases during 1955 and 1956 were as follows : 1955 1956 Scarlet Fever — — Enteric Fever — — Diphtheria — — Acute Poliomyelitis — Measles 1 — Whooping Cough— — Influenza 11 7 Tuberculosis—Pulmonary 19 19 Other forms 1 2 Pneumonia (all forms) 83 94 Diarrhoea (under 2 years) — Meningococcal Infections— — Totals 116 122 43 TABLE III —Corrected Notifications of Infectious Diseases for the Year 1956 NOTIFIABLE DISEASE | At all Ages Number of Cases Notified At Ages—years Total Cases Notified in each Ward 'Total Cases Admitted to Hospitnl * Total Deaths Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Cranbrook Park Loxford Clementswood Mayfield Goodmayes Fairlop Clayhall Barkingside N. Hainuult Seven Kings S. Hainault Smallpox - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 191 - 44 139 7 1 - - 10 11 11 11 9 15 42 17 3 6 5 51 30 - Diphtheria, including Membranous Croup - - - - - - - - - - - - - - - - - - - - - - Enteric Fever (Typhoid and Para-Typhoid) 7 - 1 4 1 1 - - 1 - - - - - - - 1 - - - - - Pneumonia 159 2 6 9 5 19 65 53 17 15 1? 17 13 10 17 14 16 7 14 7 36 94 Puerperal Pyrexia 73 — - - 33 40 - - - - - - - - - 1 1 69 2 71 - Acute Poliomyelitis 6 - 1 4 1 - - - - - - - - - - - - 1 2 6 - Acute-Encephalitis 2 — — 1 — 1 - - - - 1 - - - - - 1 - - - 2 - Vleningoccocal Infection 4 1 1 2 - - - - - - - - - 1 - 1 - - 1 1 4 - Oysenterv 161 o 22 66 9 30 22 10 4 6 - 3 1 16 20 31 21 8 8 43 21 - Ophthalmia Neonatorum 7 7 — — — — — — - 1 - - 2 1 - - - 1 1 1 2 - Erysipelas 30 — — 5 15 10 2 1 3 2 9, 3 2 2 6 2 5 1 - Pemphigus Neonatorum - - - - - - - - - - - - - - - - - - - - - - Tuberculosis Pulmonary 126 — 4 4 34 37 34 13 9 8 5 17 6 15 14 9 9 10 10 14 90 19 Other Forms 17 — — 3 6 6 2 - 1 3 2 ?, - - 1 - 3 2 1 - - 2 Anthrax - - - - - - - - - - - - - - - - - - - - - - Malaria—Believed contracted in this country - - - - - - - - - - - - - - - - - - - - - - Believed contracted - - - - - - - - - - - - - - - - - - - - 1 - Acute Rheumatism 8 — 1 7 —. — — — 2 1 1 1 . _ 1 2 —1 7 - Measles 502 9 198 290 2 2 1 — 7 8 31 30 93 51 28 53 67 50 51 33 6 - Whooping Cough 396 22 152 212 2 7 1 - 5 30 ?.?, 20 20 20 73 43 46 40 51 26 8 - Food Poisoning 51 — 1 13 6 18 11 2 — 5 2 3 11 5 3 4 1 13 2 2 3 — - - - - - - - - - - - - - - - - - - - - - - Totals 1.741 43 431 754 107 167 151 88 58 89 91 106 158 140 202 177 175 211 147 187 299 115 * Included in the figures in these columns are cases notified in previous years as well as 19.56. 44 The year 1956 showed a very low incidence of infectious disease, especially in the number of cases of measles, only 502 as compared with nearly 3,000 in the previous year. Only 396 cases of whooping cough occurred against 518 in the previous year. (a) Smallpox.—No cases were notified during 1956. Under the National Health Service Act. 1946, compulsory vaccination was abolished, and from 5th July, 1948, this service became the responsibility of the Essex County Council vide Section 26 of the National Health Service Act, 1948. Details of vaccinations during 1956 wili be found in Part 111 section of this report. (b) Scarlet Fever.—191 cases occurred in 1956. There were no deaths from this disease. Only 30 cases were admitted to hospital, the remainder being nursed at home. (c) Diphtheria.—No cases occurred in 1956. This is the fifth successive year in which it has been possible to record a clean " bill of health " for this disease in llford. (d) Ophthalmia Neonatorum.—Seven cases occurred in 1956. The following figures show the number of cases of Ophthalmia Neonatorum notified during the past five years: 1952, nil; 1953, nil; 1954, nil; 1955, nil; 1956, 7. No cases of ophthalmia neonatorum were due to gonococcal infection. (e) Enteric fever (Typhoid and Para-Typhoid). (i) Para-typhoid fever. Six cases (all of which occurred in the springtime) were reported. They were males of 17, 11, 9 and 5 years and females of 10 and years. The patient of 17 years worked as a pastrycook at a local bakery. A brother of 11 years was subsequently also found to be suffering from the same disease. It was finally established that the cause of infection was from artificial cream in cakes in the cases occurring among the male patients. The cases which occurred in the two females were not found to be connected with those previously mentioned. All of the cases were admitted to the llford Isolation Hospital with the exception of the infant of 1± years. All made a satisfactory recovery. (ii) Typhoid fever. One case occurred1 in a female of 31 years in the month of October. The patient was removed to the llford Isolation Hospital and made a good recovery. The source of infection was not traced. (/) Acute Poliomyelitis. Six cases of this disease were notified during the year. They were males of 4, 5, 8, 8 and 18 years and a female of 9 years. All the cases were removed to hospital—five to the llford Isolation Hospital and one to St. Anne's Hospital. Tottenham. The male patient of 18 years died (in 1957) forty days after removal to hospital from a severe attack of bulbo-spinal poliomyelitis. Of the other five patients three recovered without complications, two suffered some paralysis, one being transferred to the Royal National Orthopaedic Hospital for further treatment. (g) Acute Encephalitis. Two cases were reported—males of 10 and 30 years. Both were treated in the llford Isolation Hospital and made a good recovery. (h) Meningococcal Infection. Four cases were reported. They were males of 14 years, 8 years, 2\ years and 11 months. All were removed to the llford Isolation Hospital and made a satisfactory recovery. (i) Pneumonia—Influenzal and Primary. The number of cases which occurred during 1956 was 159 as compared with 139 in 1955. 45 (j) Tuberculosis. During 1956 there were 126 new notifications of Pulmonary Tuberculosis and 17 of other forms of Tuberculosis. In addition 52 pulmonary and 2 non-pulmonary cases were transferred to the district. The population of Ilford has not varied greatly during the past five years and the number of cases added to the register has also shown little change as the following figures show:— Year Population No. of Persons added to list (all forms) Deaths (all forms) No. of Persons on register 3 lst December 1952 182,200 188 21 1.442 1953 181,200 190 28 1,428 1954 182,700 207 27 1,453 1955 181,700 170 20 1,451 1956 180,600 197 21 1,480 Notifications and Deaths from Tuberculosis of Ilford residents during 1956:— Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year - - - - 1 - - - 1-5 years 3 1 - - - - - - 5-15 3 1 2 1 — — — 1 15-25 19 15 1 5 — — - 25-45 20 17 4 2 2 2 — — 45-65 24 10 1 1 6 1 1 - 65-75 12 1 — _ 4 - — - Over 75 — — — — 3 — — — Totals 81 45 8 9 16 3 1 1 Of the foregoing new cases, the following were notified from Institution in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 7 2 Goodmayes Hospital 5 — Claybury Hospital 2 — Ilford Isolation Hospital 7 1 Dr. Barnardo's Village Homes — 2 Of the 21 deaths which occurred of Ilford residents, notification had previously been made of 16 of the cases. In the remaining cases two were notified after death, one was overlooked and in two the presence of tuberculosis was discovered as a result of post-mortem. 46  Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1956 1,295 156 1,451 197 Number of cases entered on the register during the year 178 19 Number of cases removed from the register during the year Pul. NonPul. Recovered 16 6 Deceased 23 2 Left District 104 9 Lost sight of 4 1 Diagnosis not established 3 — 150 18 168 Number of cases remaining on register on 31st December, 1956 1,323 157 1,48 The treatment of Tuberculosis is now under the control of the Regiona Hospital Board. On the 31st December, 1956, there were 1,219 patients or the register of the Ilford Chest Clinic. Pulmonary Non-Pulmonary Total Males Females Males Females Adults 56 29 3 2 90 Children 4 1 — — 5 Mass Radiography A mass radiography survey was conducted in Ilford on alternate weeks from February to July at the Thompson Rooms. The total number of weeks was thirteen and the average attendance was slightly more than 1,000 per week; the highest being 1,392 and the lowest 684. Dr. H. Ramsey, the Medical Director, has kindly supplied me with the following particulars:— (1) Number X-rayed. Male Female Total Referred by General Practitioners 1,396 1,657 3,053 Others 4,331 6,087 10,418 Totals 5,727 7,744 13,471 Recalled for large film. Referred by General Practitioners 177 143 320 Others 152 150 302 Totals 329 293 622 Clinical Interviews. Referred by General Practitioners 117 84 201 Others 88 69 157 Totals 205 153 358 47 (2) Results. Male Female Total Rate per 1,000 cases (a) Tuberculosis Cases requiring close Clinic supervision. General Practitioners Referrals — — — General Public 2 — 0 2 Cases requiring immediate treatment. General Practitioners Referrals 15 3 18 5 9 General Public 6 5 11 15 Comparison with Motional General General Practitioners Mass X-ray Figures Public Referrals Rate per 1,000 cases Ilford 1956 1 2 5 9 Case Rate per 1,000 England and Wales 1955 20 12-1 (b) Carcinoma of Lung Male Female Total General Practitioners Referrals 12 3 15 General Public 6 1 7 Tuberculosis Care Association.—Assistance was granted to 68 persons who received 514 extra nourishment grants, and three persons received nine other grants. Eighty other persons in hospital at Christmas time were presented with a cash gift. (k) Venereal Diseases.—Treatment of these diseases is now the responsibility of the Regional Hospital Board. The following are the V.D. Treatment Centres situate nearest to Ilford:— Romford.—The Annexe, Oldchurch Hospital, Waterloo Road, Romford: — Males Females Consultations: Monday and Tuesday Monday and Tuesday 4 p.m. to 6.30 p.m. 4 p.m. to 6.30 p.m. Thursday 12 noon to Thursday 12 noon to 3 p.m. 3 p.m. Treatments: Monday to Friday Monday to Friday 9 a.m. to 7 p.m. 9 a.m. to 7 p.m. Saturday 9 a.m. to 6 p.m. Saturday 9 a.m. to 6 p.m. Whitechapel.—Whitechapel Clinic, Turner Street, Mile End, London E.l: — Males Females Consultations: Monday to Friday Monday to Friday 10 a.m. to 7 p.m. 10 a.m. to 7 p.m. Saturday 10 a.m. to 3 p.m. Saturday 10 a.m. to 3 p.m. Treatments: Monday to Friday Monday to Friday 7 a.m. to 7 p.m. 9 a.m. to 7 p.m. Saturday 7 a.m. to 3 p.m. Saturday 9 a.m. to 3 p.m. West Ham.—Queen Mary's Hospital, West Ham Lane, Stratford, London, E.l 5: — Males Females Consultations: Monday 3 to 6 p.m. Monday 6 to 8 p.m. Thursday 11 a.m. to Thursday 11 a.m. to 1 p.m. and 6 to 1 p.m. and 3 to 8 p.m. 6 p.m. Saturday 2.30 to 4.30 p.m. Saturday 2.30 to 4.30 p.m. 48 Males Females Treatments: Monday 9 a.m. to 6 p.m. Monday 9 a.m. to 8 p.m. Tuesday 9 a.m. to 5 p.m. Tuesday 9 a.m. to 5 p.m. Wednesday 9 a.m. to Wednesday 9 a.m. to 1 p.m. 1 p.m. Thursday 9 a.m. to 8 p.m. Thursday 9 a.m. to 6 p.m. Friday 9 a.m. to 5 p.m. Friday 9 a.m. to 5 p.m Saturday 9 a.m. to Saturday 9 a.m. to 4.30 p.m. 4.30 p.m. Albert Dock Seamen's Hospital, Alnwick Road, London, E.l6. Males Females Consultations: Monday, Wednesday and No female clinic. Friday 2 to 4.30 p.m. Treatments: Monday to Friday 9.30 a.m. to 5 p.m. Saturday 9.30 a.m. to 12 noon. Publicity and Propaganda, Etc. Public lectures to Voluntary Guilds and Institutes and Church organisations, etc., on health topics were given during the year. The Chairman of the Public Health Committee also made reference at a number of Council meetings to health subjects. Poster displays regarding Diphtheria immunisation and health topics were also given prominence. Examination of Officers and Servants. The following medical examinations were carried out during 1956:— „ Officers Servants New Appointments 54 49 Under Sickness Regulations 1 15 On behalf of other Authorities 1 — Totals 56 64 In addition enquiries were made of General Practitioners and Hospitals in respect of numerous cases, referred under Sickness Regulations, which were not subsequently medically examined at the Public Health Offices. 49 SECTION G—FACTORIES. The Factory and Workshop Act, 1901, was superseded by the Factories Act, 1937. which came into operation on 1st July, 1938. There are 406 factories with mechanical power on the register. There are 155 factories without mechanical power on the register. There are 318 outworkers on the register. 1—INSPECTION OF FACTORIES AND OTHER PREMISES. Including Inspections made by Public Health Inspectors. Premises Inspections Number of Written Notices Occupiers prosecuted (1) (2) (3) (4) Factories with Mechanical Power 1,192 9 Factories without Mechanical Power ... 188 Other premises (not including Outworkers' premises) 89 1 — Total 1.469 10 — 2.—DEFECTS FOUND IN FACTORIES. Particulars Number of Defects No. of defects in respect of which Prosecutions were instituted Found Remedied Referred to II M. Inspector Want of Cleanliness (S.l) - - - - Overcrowding (S.2) — — — - unreasonable Temperature (S.3) - - - - Inadequate Ventilation (S.4) - - - - Ineffective Drainage of Floors(S.6) - - - - Sanitary Conveniences (S 7):— Insufficient - 1 - - Unsuitable or Defective 9 8 — - Not Separate for Sexes 1 — — - Other Offences — — — - Total 10 9 — — 50 PART III.—SERVICES. National Health Service Acts, 1946—1952. Births.—In accordance with the provisions of the Public Health Act. 1936, all live births and all stillbirths of twenty-eight weeks gestation and over must be notified within 36 hours to the Medical Officer of Health of the area in which the birth took place. The number of live births notified in Ilford under this Act during 1956 was 1,738 (910 males and 828 females), of which there were 161 (97 males and 64 females) where the ordinary place of residence of the parents was outside Ilford. In addition 551 notifications of live births (296 males and 255 females) which took place outside the district, although the ordinary residence of the parents was in Ilford, were transferred to this district. During the year there were no cases in which there was default in complying with the requirements of the Public Health Act relating to the Notification of Births. There were also 33 stillbirths (19 males and 14 females) notified in Ilford including 6 (4 males and 2 females) where the home address of the parents was outside the district, and notifications of 17 stillbirths (7 males and 10 females) which took place outside the district, although the ordinary residence of the parents was in Ilford, were transferred to this district. This represents a total of 44 where the home address was in Ilford, whereas the Registrar-General has allocated 43 stillbirths to Ilford. The following table shows the causes of the 44 stillbirths notified where the usual residence of the parents was in Ilford:— stillbirths, 1956 Cause of Stillbirth Delivery in Nursing Home Delivery by County Council Midwife at Home Delivery in Hospital Total Absence of Foetal Kidneys - - 1 i Accidental Haemorrhage - - 1 i Anencephalic - - 1 i Ante-Partum Haemorrhage - - 1 i Asphyxia - - 5 5 Congenital Heart Disease - 1 — 1 Diabetes Mellitis - - 1 1 Early Separation of Placenta - 1 1 2 Intra Uterine Death 1 - 5 6 Long Cord - - 1 1 Microcephalic Meningocele - - 1 1 Placental insufficiency - - 10 10 R.H. Factor - - 3 3 ? Shock - 1 — 1 Tentorial Tear - - 2 2 Toxaemia - - 4 4 Unknown - 1 2 3 Totals 1 4 39 44 51 Care of Premature Infants.—Of the 1,738 live births occurring in Ilford during 1956, 85 weighed 5ilbs. or less at birth; 18 of these babies were born on the district and 67 in Hospital (including 5 where the home address of the parents was outside Ilford). Of the 18 babies born at home:— 16 were nursed entirely at home; 2 were transferred to hospital; 17 survived at the end of one month; 1 died between the ages of one day and one month. Of the 67 babies born in hospital:— 5 died during the first 24 hours; 2 died between the age of one day and one month (including one where the home address was outside Ilford); 60 survived at the end of one month (including 4 where the home address was outside Ilford). In addition 21 notifications were received of births outside the district where the ordinary residence of the parents was in Ilford and the weight of the infant at birth was 5y lb. or less. Of these there were: — 3 who died within the first 24 hours (in hospital); 1 who died between the age of one day and one month (in hospital); 17 who survived at the end of one month. Infant Mortality.—The number of infants dying within the first year of life was 33, the total number born being 2,115. The latter figure is supplied by the Registrar-General for calculating infant and maternal mortality rates. The infant mortality, or rate of deaths per 1,000 live births, was therefore 15-6. The following table gives the deaths of infants under one year of age, classified according to age:— Infant Deaths—1956 Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 1—3 months 3—6 months 6—9 months 9—12 months Total Anencephaly 1 1 - - 2 - - - - 2 Atelectasis - - - - 2 - - - - 2 Broncho Pneumonia 1 - - - 1 1 3 - - 5 Cerebral Haemorrhage - - - 2 - — - - 2 Congenital Heart Disease 3 1 - - 4 1 — - - 5 Congenital Heart Disease and Mongolism 1 - - - 1 - — 1 - 2 Haemolytic disease of newborn 1 - - - 1 - — - - 1 Hyaline Membrane 1 - - - 1 - — - - 1 Inanition — - - - - 1 — - - 1 Intra-Ventricular Haemorrhage 1 - - - 1 - — - - 1 Multiple Congenital - - - - - - - - - - Abnormalities 1 - - 1 2 - — - - 2 Osteogenesis— imperfecta — - 1 — 1 - — - - 1 Prematurity - - — 4 - — - - 4 Shock Due to Scalds 1 - - 1 - - - 1 Sub-Dural Haemorrhage 1 - - — 1 - — - - 1 Suppurative Meningitis — 1 - — 1 - — - - 1 Tuberculous Meningitis - - - - - - 1 - - 1 Totals 20 3 1 1 25 3 4 1 - 33 52 The comparative figures for the past 10 years are as follows:— Year No. of Deaths under 1 year Rate per 1,000 Registered Live Births 1956 33 15 6 1955 42 200 1954 41 18 7 1953 45 202 1952 44 18 9 1951 50 21 0 1950 45 18-7 1949 53 20 1 1948 62 21-7 1947 82 24-3 The mean average Infant Mortality rate for the past 10 years is therefore 19-9 per 1,000 live births. The following table shows the comparison for Ilford, England and Wales and London for the past 10 years: — Year Ilford England and Wales London 1956 15 6 24 21 1955 200 25 23 1954 18-7 25 21 1953 20-2 27 25 1952 18-9 28 24 1951 210 30 26 1950 18 7 30 26 1949 201 32 29 1948 21-7 34 39 1947 24-3 41 47 Neonatal Mortality.—The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 25 deaths of infants under four weeks of age during 1956 and the rate for the year was 118 per 1,000 live births. The figures for the past 10 years are as follows:— Year Number Rate 1956 25 11.8 1955 30 14.3 1954 29 13.2 3953 34 15.2 1952 32 13.8 1951 40 16.8 1950 32 13.3 1949 33 12.5 1948 37 12.9 1947 51 151 53 Illegitimate Births and Deaths.—59 of the live births registered (28 males and 31 females) were illegitimate, that is 2 8% of the births registered. Three illegitimate children (two males and one female) died under one year of age. The following table shows the birth and death rates of legitimate and illegitimate infants for the past ten years:— Year Legitimate Infants Illegitimate Infants Live Births Percentage of Registered Births Deaths Rate per 1,000 Legitimate Live Births Live Births Percentage of Registered Births Deaths Rate per 1,000 Illegitimate Live Births 1956 2,056 97.2 30 14.6 59 2.8 3 50.8 1955 2,015 97.4 40 19.6 55 2.6 2 36.4 1954 2,145 97.8 40 18.6 48 2.2 1 28.8 1953 2,164 97.0 43 19.9 67 3.0 2 29.9 1952 2,232 96.1 44 19.7 91 3.9 — — 1951 2,306 97.1 49 21.2 70 2.9 1 14.3 1950 2,332 96.9 41 17.6 74 3.1 4 51.0 1949 2,567 97.6 51 19.9 63 2.4 2 31.7 1948 2,757 96.8 58 21.0 91 3.2 4 43.9 1947 3,258 96.7 78 23.9 110 3.3 4 36.4 The Chelmsford Diocesan Moral Welfare Association continued in 1956 to undertake the care of the unmarried mother and her child on behalf of the County Council and there has been direct co-operation through their Moral Welfare Worker for this district. In addition, all cases are followed up by the Health Visitors. Health Visitors and School Nurses.—The recruitment of health visiting staff improved somewhat during the year but Clinic Nurses continued to be employed to relieve the Health Visitors of certain duties. The Essex County Council's Training Scheme for Health Visitors, in conjunction with the S.E. Essex Technical College, has continued and two trainees were allocated to Ilford for practical instruction during 1956. Three trainees, on completing the course in 1956 and passing the examination for the Health Visitors' Certificate of the Royal Institute of Public Health, were appointed as Health Visitors and School Nurses here. At the end of the year there were 17 full-time qualified Health Visitors and School Nurses in addition to the Superintendent Health Visitor, and 5 Clinic Nurses. The following is a summary of the home visits made by the Health Visitors and Clinic Nurses during 1956 as far as Part III Services are concerned :— First visits to newly-born infants 2,141 Subsequent visits to children under 1 year of age 4,869 Subsequent visits to children over 1 year of age and under 5 12,743 Visits to expectant mothers 925 Home visits for other reasons 1,296 Total visits paid 21,974 54 In addition there were 5,000 visits paid where no reply was received. Arrangements were initiated towards the end of 1956 for the Health Visitors to meet the local General Practitioners, as previously in 1954 and 1955, with a view to increasing the degree of co-operation between the Department and the Doctors, but as the Doctors were very busy at that time it was decided to postpone the meeting until the spring. It was consequently held on the 7th May, 1957, at the Public Health Offices. Day Nurseries. (a) The hours of opening at the three Nurseries during 1956 continued to be 7.30 a.m. to 6 p.m., Monday to Friday only. (b) The standard charge for accommodation at the Day Nurseries, previously 7/6 per child per day, was increased to 8/6 per child per day as from the 2nd January, 1956. Provision is made for this charge to be reduced according to scale when the means of the parents do not justify the full fee. Accommodation has continued to be made available to neighbouring Areas for children who can more conveniently attend an Ilford Nursery than one in their own Area. (c) Sunshine House Nursery.—As was reported last year, in view of the continuing low attendances at the Nurseries, approval was given by the County Council to close this Nursery on the 18th May, 1956, the children being transferred to the remaining two Nurseries. (d) Ley Street Nursery.—An enquiry was received from the Ministry of Works, from whom the nursery building was rented, as to whether the County Council would wish to purchase the building. Before a decision was made, the County Land Agent and Valuer enquired of the British Transport Commission, owners of the site on which the Nursery stands, whether that authority would be prepared to sell the site to the County Council or, failing that, to enter into a lease to ensure security of tenure of the site for a period of at least 3 years; this was necessary as the original agreement for the rental of the site provided that the tenancy could be determined by either side giving six months' notice in writing. The British Transport Commission was not prepared to sell the site but agreed to grant a lease from the 1st June, 1956, for a period of three years in the first instance, and thereafter from year to year until determined by either party giving to the other six months' notice in writing. The building was purchased from the Ministry of Works in October 1956 at a cost of £250. (e) The training of Students at the Nurseries for the Certificate of the National Nursery Examination Board continued. Six Students (three from the Ley Street Nursery and three from the Goodmayes Lane Nursery) entered for the examination during the year, five of whom obtained the Certificate, including one who had failed in 1955 but re-sat the examination in 1956. The arrangements for young students to attend part-time courses (on one day a week) at day continuation classes whilst awaiting enrolment for the Nursery Nurses' Course at a Technical College in the September following their sixteenth birthday also continued; this enables them to pursue their studies in general subjects and so improve their general educational standard during this pre-nursery course period. Three students (two from the Ley Street Nursery and one from the Goodmayes Lane Nursery) attended such a course at the St. George's Day Release Centre, Dagenham, in 1956. 55 (f) The following is a table showing the attendances, etc., at the Day Nurseries during 1950:— Situation Date of Opening Accommodation (Children) Average Daily Attendance during 1956 No. of Days in Quarantine Reasons for Quarantine with Number of Cases No. on Waiting List at 31st Dec. Chicken Pox Mumps Measles Scarlet Fever Sunshine House, Girls' Village Homes, Barkingside 17.8.42 Closed on 18.5.56 45 (To date of closure) 14 - - - - - - Goodmayes Lane, Goodmayes (Replaced Green Lane Nursery, open from 5.5.43 to 9.11.51) 14.11.51 50 28 69 2 11 — 2 — 220-236, Ley Street, Ilford 16.8.43 50 36 64 4 — 1 — — 56 Nurseries and Child-minders Regulation Act, 1948.—This Act requires, inter alia, that every local health authority shall keep registers— (a) of premises in their area, other than premises wholly or mainly used as private dwellings, where children are received to be looked after for the day or a substantial part thereof or for any longer period not exceeding six days; (b) of persons in their area who for reward receive into their homes children under the age of five to be looked after as aforesaid. The following shows the position regarding registrations under the Act: — (a) Premises (b) Child-minders Number on register at 31/12/55 5 3 Number registered during 1956 — 5 Number removed from register during 1956 1 1 Number on register at 31/12/56 4 7 Number of children provided for at 31/12/56 109 45 The reason for the removal from the register of the premises referred to above was that the occupier no longer wished to receive children therein to be looked after during the day and she therefore returned the certificate of registration. The child-minder whose name was removed from the register cancelled her registration on leaving the district. • Clinic Premises. Health Services Clinics, Kenwood Gardens and Heathcote Avenue (Couchmore Avenue area).—As was reported last year, although the Minister of Health has given his formal approval to the erection of these two Clinics on parts of the sites reserved for health centres, he is not at present prepared to give loan sanction, in view of the restriction of Local Government expenditure. In the meantime, the County Architect has continued with the preparation of plans and other detailed works, and further representations have now been made to the Ministry to allow the County Council to proceed with both projects, which have been accepted by the County Council as of high priority. Infant Welfare Centres.—95 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1956. During the year the following attendances were recorded:— Total number of attendances of infants 36,902 First attendances 1,895 Attendances of Children from 1 to 5 years 12,151 Total number of children on roll on 31/12/56, after omission of all those who had not attended for six months 3,916 57 The following is a comparison of the attendances at the Infant Welfare Centres for the past five years:— Total No. of attendances of Infants First attendances Total No. of children on roll on 31st December 1956 36,902 1,895 3,916 1955 36,196 1,855 3,687 1954 38,392 1,858 3,5fi5 1953 39,291 1,924 3,629 1952 42,033 1,947 3,701 720 sessions were held during the year, the average attendance at each session being 51 mothers with their infants. The following are the figures for each Centre:— Average Attendance Sessions Barkingside 49 48 Chadwell 49 48 Becontree 48 50 Downshall 48 58 Manford Way 48 34 Woodford Avenue 48 78 Seven Kings 48 65 Cecil Hall (Wednesdays) 48 38 Cecil Hall (Thursdays) 47 52 Newbury Hall 48 40 Goodmayes 48 39 Grosvenor Road 48 58 Ilford Lane 48 47 Valentines 48 51 Fairlop 47 57 In view of the growing number of children on the newly-developed Padnall Estate, approval in principle was given in 1956 to the opening of a temporary Infant Welfare Centre to serve that part of Ilford, pending the erection of the proposed Health Services Clinic on the Dagenham section of the Marks Gate Estate. Arrangements have now been completed for the use of St. Mark's Church Hall, Rose Lane, Chadwell Heath, by both Ilford and Dagenham for infant welfare centre purposes; the Ilford Centre is held on Thursday afternoons, the first session being on the 18th July, 1957. 58 Orthopaedic Clinic. The following table summarises the attendances of children under 5 years:— Clinic Sessions New Cases Old Cases Attendances Newbury Hall 42 56 65 227 Mayesbrook 23 40 28 116 Manford Way 9 11 19 55 Totals 74 107 112 398 The 219 children were found by the Orthopaedic Surgeon to have the following defects:— Diagnosis New Cases Old Cases A B c A B C paralysis:— A.P.M 1 - - 1 - - Deformity of hips — 1 — 3 — — ienu valgum 25 15 7 24 16 11 Pes valgo-planus 3 1 1 7 2 — Valgus ankles 6 7 — 4 1 — Deformity of Chest — — — 1 — — Congenital talipes E.V. 6 1 — 1 1 — [ntoeing 2 1 2 3 — 2 Deformity of toes 1 3 — 3 1 1 Pes Cavus 1 — - - - - Dther conditions 5 10 1 7 5 3 Torticollis 1 — — 1 — 1 Metatarsal varus 2 1 — 7 1 — Dut. Curvature Tibiae 2 — — 1 1 — ienu varum — — — 2 — 1 hemiplegia 1 — — — — - Totals 56 40 11 65 28 19 A—Newbury Hall. B—Mayesbrook. C.—Manford Way. 15 pairs of Valgus Insoles, 1 Metatarsal bar and toe spring, 15 G.y. night splints and 35 wedges to shoes were supplied during 1956. 1 repair to caliper and surgical shoes was also carried out. The Physiotherapist treated 117 children under 5 at Newbury Hall, 61 at Mayesbrook Clinic, 34 at Manford Way, with attendances of 269, 134, 834 respectively. Paediatric Clinic.—Dr. A. Russell, the Consultant Paediatrician, continued to attend the Clinic at Valentines Mansion. 23 sessions were held and 97 new cases were examined, having been referred from the Infant Welfare Centres, Schools and Maternity Hospital for the reasons set out in the following table; a total of 251 attendances were made. 50 nosis Discharged Improved Discharged with Advice or for Other Reasons i Discharged no Treatment Discharged Cured Referred to Hospital, Dr. or Clinic Still attending Total Abdominal Pains - - - - - 1 1 Anaemia 1 — - - - 6 7 Asthma - — - - 1 2 3 Balanitis - 1 - - - — 1 Behaviour Disorder - - - - - 1 1 Brachial Palsy - - - - - 1 1 Cephalhaematoma 1 - - - - - 1 Constipation - - - - - 1 1 Duirnal Incontinence - 1 - - - — 1 Epilepsy - - - - - 1 1 Epiphora - 1 - - - — 1 Facial Palsy 1 — - - - - 1 Feeding Difficulty - - - - - 1 1 Hernia - 1 2 - 2 2 7 Hyaline Membrane - — — - — 1 1 Hydrocele 1 — — - — 2 3 Hypospadias - — — - 3 1 4 Malformation of Toe - 1 — - — - 1 Meibomian Cyst - - — - 1 - 1 Mongolism - 2 — - — 1 3 Naevi - — 1 - 2 2 5 Neonatal Gastro-Enteritis - - - 1 - - 1 Nil Abnormal - - 7 - - - 7 Non Retractable Prepuce - — - - - 1 Obesity - — — - 1 1 2 Petit-Mal - - - - - 2 2 Pilonidal Sinus - - 2 - - 1 3 Plagiocephaly - 1 — - - - 1 Polydactyly - — — - - 1 1 Prematurity 1 3 2 - - 5 11 Sterno-Mastoid Tumour 1 - - - - - 1 Still Under Investigation - — 1 - 2 9 12 Syndactyly Left Hand - - — - 1 - 1 Talipes - 1 1 - - 1 3 Treacher-Collins Syndrome - - - - - 1 1 Upper Respiratory Infection - - - - - 1 1 Urinary Infection - — — - 1 2 3 6 12 17 1 14 47 07 60 Ophthalmic Clinics.—Attendances of children under school age for treatment by the Ophthalmologists during 1956 were as follows:— Valentines Mansion Mayesbrook Clinic Manford Way Clinic Total Number of children who attended 69 57 11 . 137 Number of pairs of spectacles prescribed 13 29 5 47 Total number of attendances made 96 143 25 264 Ear, Nose and Throat Clinic.—The E.N.T. Surgeon attended at 48 sessions during 1956; 68 attendances were made by 34 children of preschool age, and 4 attendances were made by 1 expectant mother. 16 children were operated upon for removal of tonsils and adenoids at King George Hospital, Ilford, and 5 at the Ilford Isolation Hospital. Rheumatism Clinic.—17 sessions were held during the year at Newbury Hall, at which 10 children under 5 years of age, 7 being new cases, made 10 attendances. The following is a summary of the cases treated Condition New Old Total Functional heart murmur 2 1 3 Other forms 4 2 6 No abnormality discovered 1 — 1 Totals 7 3 10 Number of cases referred for X-ray and Electrocardiograph 3 Dr. Kenneth Playfair, Consultant to the Rheumatism Clinic for 19 years, resigned his appointment on reaching retirement age on 5th September, 1956, and the functions of this Clinic were transferred to King George Hospital, Ilford. Artificial Sunlight Clinic.—The following table summarises the attendances of children under 5 years:— Clinic Sessions New Cases Old Cases Attendances Discharged Cured Much Improved Left District etc. Newbury Hall 47 12 18 346 15 1 5 Mayesbrook 46 4 8 142 5 — 1 Totals 93 16 26 488 20 1 6 The conditions treated were as follows:— Conditions Cases A B Anaemia. Debility, Malnutrition and Catarrh 19 7 Wide Fontanelle 3 — Bronchitis 3 — Alopecia 1 — Rickets 2 1 Other conditions 2 4 Totals 30 12 A.—Newbury Hall. B.—Mayesbrook. 61 Speech Clinic.—45 children of pre-school age attended, making 395 attendances. The following is the classification of the defects found by the speech therapist: — Dyslalia 28 Stammering 4 Dyslalia and Stammer 3 Dysarthria 4 Retarded Speech and Hearing Loss 1 Language 5 Diphtheria Immunisation.—During 1956 a total number of 1,710 children attended at the Diphtheria Prevention Clinics (1,094 at Valentines Clinic, 457 at Mayesbrook and 159 at Manford Way) making a total number of attendances of 4,575 (2,934, 1,244 and 397) with an average per session of 57, 24, and 8 respectively. The following table shows the figures over the past five years. No. of primary inoculations:— 1952 1953 1954 1955 1956 At Clinics 793 594 515 398 338 By General Practitioners 1,263 1,425 1,341 1.324 1,745* Totals 2,056 2,019 1,856 1,722 2,083 No. of re-inoculations:— At Clinics 1,198 918 772 437 478 By General Practitioners 1.025 918 1,112 808 l,579t Totals 2,223 1,836 1,884 1,245 2,057 No. of live births in Ilford 2,323 2,231 2,193 2,100 2,115 *Includes 953 combined Diphtheria and Whooping Cough inoculations, †tlncludes 258 combined Diphtheria and Whooping Cough inoculations. Whooping Cough Immunisation. The following are the details of the number of children immunised against whooping cough at the three Ilford clinics held for this purpose together with records of such courses completed by general practitioners. Valentines Clinic Mayesbrook Clinic Manford Way Clinic *General Practitioners Inoculations (full course) Reinoculations (one only) Attendances Inoculations (full course) Reinoculations (one only) Attendances Inoculations (full course) Reinoculations (one only) Attendances Inoculations (full course) Reinoculations (one only) Children under 5 years of age Children 182 — 529 149 — 435 61 — 191 551 33 5 years of age and over 5 15 1 8 45 30 Totals 187 544 150 438 61 — 191 596 63 *For comparison, as it is not the policy of the County Council to use a combined diphtheria/pertussis vaccine, only plain pertussis injections carried out by general practitioners are entered in the above table. The figures for records received of combined diphtheria / pertussis courses of injections are as follows:— Inoculations 953 Re-inoculations 258 62 Vaccination Against Poliomyelitis—In January 1956, the Minister of Health announced his plans for making available vaccination against poliomyelitis to children born in the years 1947 to 1954 inclusive. It was proposed that vaccine would be made available to Local Health Authorities in May and June 1956, that vaccination should be suspended during the months of July to November inclusive, when poliomyelitis is usually more prevalent, and that it would then be resumed, subject to supplies of vaccine being available. As it was known that only a limited amount of vaccine would be available it was proposed that certain selected groups of registered children, based on month and year of birth to be decided by the Ministry of Health, should be offered vaccination in the first instance. In February 1956 information regarding the scheme, incorporating a consent form, was sent to the parent of each child born in the years 1947 to 1954 of whom we had record. With the co-operation of the Borough Education Officer the issue of the forms for school children was made through the schools; those for children under school age were sent to the parents by post; allied to this press publicity was obtained. In all, some 20,000 forms were issued and by the closing date, i.e. 10th April 1956, approximately 6,100 consent forms had been returned for registration. In early May 1956 the first batch of vaccine was received, and we were informed by the Ministry of Health that vaccination, consisting of two injections with an interval of not less than three weeks between the first and second injection, was to be offered to all registered children born in the month of November in each of the years 1947 to 1954 inclusive and to registered children born in March in the years 1951 to 1954 inclusive, the reserve month to replace absentees being August in all the eight years. A second batch of vaccine was received late in May 1956 but the Ministry of Health were unable to issue further supplies until late November, when a very small batch was received to undertake the second injection in the case of children who had received only one injection in May and June. In view of the limited supplies of vaccine for issue and the short time available to organise the scheme the Minister of Health decided that the vaccine issued in 1956 should be administered only on behalf of the Local Health Authority. General medical practitioners have, however, been participating in the scheme since March 1957, from which month regular, although still limited, supplies of vaccine have been received at approximately monthly intervals. During 1957 the offer of vaccination is being extended, when vaccination of all the children registered early in 1956 has been completed, to children born in the years 1955 and 1956 and then to children born in the years 1947 to 1954 whose parents did not register them when the first offer was made. Further, it has been decided that vaccination need not be suspended during the summer and autumn as in 1956. The following statistics show the vaccinations carried out at the clinics in 1956:— Clinic Sessions First injections given Second injections given Public Health Offices 14 387 394 Mayesbrook 4 128 119 Manford Way 2 72 64 Newbury Hall 2 73 63 Totals 22 660 640 63 Smallpox Vaccination.—During 1956 record cards were received from general practitioners and various hospitals as follows: — Ages up to 14—- No. of children primarily vaccinated 1,331 No. of children revaccinated 60 Ages 15 and over— No. of adults primarily vaccinated 186 No. of adults revaccinated 385 In addition. 28 children were primarily vaccinated at the Manford Way Clinic. The following table shows the figures over the past five years:— 1952 1953 1954 1955 1956 No. of primary vaccinations 1,428 1,439 1,359 1,383 1,545 No. of revaccinations 435 469 465 398 445 Totals 1,863 1,908 1,824 1,781 1,990 No. of live births in Ilford 2,323 2,231 2,193 2,100 2,115 Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. A certain number of infants were, however, brought to the Clinics at Newbury Hall and Mayesbrook Clinic to receive treatment for minor ailments. Cardiac Clinic.—During 1956, 7 sessions were held. 25 expectant and nursing mothers were referred from either the ante-natal or post-natal clinics, and with 9 old cases made a total of 48 attendances. The following is a summary of the new cases examined by Dr. K. Playfair:— Condition PostNatal AnteNatal Congenital Cardiac lesion 2 1 Functional Cardiac disorder 3 4 No lesion 1 12 Valvular disease of the heart — 2 6 19 15 of these patients were referred to Queen Mary's Hospital for X-ray and/or electrocardiograph. This Clinic was last held on the 11th August, after which it was transferred to the King George Hospital. This was following the retirement of Dr. Kenneth Playfair. Midwives.—There were 13 State certified midwives (including the Superintendent, Deputy Superintendent, 8 domiciliary midwives and 2 parttime midwives employed by the County Council), resident and practising in the district at the end of the year. In addition there were 24 State certified midwives at the Ilford Maternity Hospital. 64 Supervision of the midwives practising on the district, including regular inspections by the Medical Supervisor of Midwives, was carried out as in previous years, and general supervision, in accordance with the Rules of the Central Midwives Board, was exercised over the midwives practising at the Ilford Maternity Hospital. Suspension from Practice.—No Midwives were suspended from practice during the year. Medical Aid.—Medical aid was sought in 5 instances where the infant was found to have inflamed or discharging eyes. The condition of the eyes cleared satisfactorily. Domiciliary Midwifery Service.—At the end of the year there were 8 Domiciliary Midwives employed by the County Council whole-time and 2 part-time, in addition to the Superintendent and Deputy Superintendent. During the year 509 cases were attended. In 457 cases the midwives were engaged to attend as midwives and in 52 cases as maternity nurses. A Doctor was called in to 73 of the 457 cases in which a midwife had been engaged. Of the infants born there were 4 stillbirths. In 3 of these cases the midwife was engaged as a midwife and in fhe remaining case as a maternity nurse. There were 3 deaths of infants during the first year of life where the birth had been attended by a Domiciliary Midwife, 2 of these occurring during the first two weeks of life. Notices were received from the Domiciliary Midwives stating that artificial feeding had been substituted in respect of 41 infants attended by them during 1956. During 1956 Ante-Natal Clinics conducted by the Domiciliary Midwives were held weekly at Valentines Mansion and fortnightly at Mayes* brook Clinic and Manford Wav Clinic. The following is a summarv of the attendances at these Clinics during the year:— Valentines Clinic Mayesbrook Clinic Manford Way Clinic First attendances 378 137 89 Subsequent attendances 906 377 241 Totals 1,284 514 330 Number of sessions 49 24 25 Average attendance at each session 26 21 13 In addition 2,496 home ante-natal visits were made during the year. The scheme continues whereby the doctor and the midwife have a consultation about their patient on three occasions (at specified intervals) during the pregnancy. The examinations take place at the patient's home, the doctor's surgery or at the Local Health Authority's Clinic, as mutually agreed, but in practice the joint consultation is held in the majority of cases in the doctor's surgery. In view of the difficulty in filling vacancies for domiciliary midwives, it was considered that the position would improve if housing accommodation could be offered to successful applicants. An approach was therefore made to the Ilford Borough Council, who agreed to provide housing accommodation, where necessary, for midwives employed in the service of the Ilford Health Area Sub-Committee. At the 31st December, 1956, two maisonettes and one flat were being rented by the County Council from the Borough Council under this arrangement. Ante-Natal Clinics.—The following is a summary of the attendances at the Ante-natal Clinics during 1956 for patients booked for confinement in hospital:— Maternity Hospital Doctors Midwives Mayesbrook Clinic Manford Way Clinic First attendances 987 — 299 127 Subsequent attendances 5,076 3,664 2,354 1,034 Totals 6,063 3,664 2,653 1,161 Number of sessions 307 253* 131 66 Average attendance at each session 19 14 20 17 65 Salvation Army Midwifery Service.—One Salvation Army Midwife served in Ilford during the year. 45 cases were attended by her, 44 as a midwife and 1 as a maternity nurse. A Doctor was called in to 17 of these cases. Of the infants born there were no stillbirths. Notifications were received from the Salvation Army Midwife that it was proposed to substitute artificial feeding in respect of 6 infants. Gas and Air Analgesia.—During 1956 gas and air analgesia was administered in 426 cases, of which 385 were attended by the Domiciliary Midwives (343 when acting as midwives and 42 when acting as maternity nurses) and 41 were attended by the Salvation Army midwife. All the domiciliary midwives employed at the end of the year were qualified to administer gas and air analgesia and the one Salvation Army midwife was also so qualified. As reported last year, with a view to effecting an economy in the use of ambulance vehicles, arrangements are now in operation for the midwives using cars in the course of their duties each to hold a machine at their respective homes to take with them to their own cases and there are three machines stored at the Ambulance Station for the use of the remaining midwives. With regard to the latter, the relatives of the patient are requested to collect a machine, where possible, but when they cannot do this, arrangements are made for a machine to be transported from the Ambulance Station to the house by a hired car. The Salvation Army midwives also have two machines which are kept at their Branch Home and taken or sent to the home of the patient when required. The service is freely available to all having home confinements, provided there are no medical contra-indications, and each expectant mother on booking the midwife is supplied with a leaflet explaining the nature and the availability of the service. 66 in conjunction with the Ante-Natal Clinics at the Manford Way and Mayesbrook Clinics the Health Visitors hold classes for relaxation exercises. During 1956 there were 51 sessions at the Mayesbrook Clinic, with 679 attendances, and 81 sessions at the Manford Way Clinic, with 886 attendances. Relaxation exercises classes are also run by the staff of the Ilford Maternity Hospital for patients attending the Ante-Natal Clinic there, and a weekly session run by Health Visitors was commenced in June, 1957, at Valentines Mansion. Post-Natal Clinics.—All patients confined in the Ilford Maternity Hospital and other patients on request are invited to attend the Post-Natal Clinics for the first time approximately six weeks after confinement. During 1956 clinics were held at the Maternity Hospital weekly, at Mayesbrook Clinic fortnightly, and at Manford Way Clinic monthly. The following attendances were recorded:— Maternity Hospital Mayesbrook Ciinic Manford Way Clinic First attendances 740 155 88 Subsequent attendances 200 78 7 Totals 940 233 95 Number of sessions 53 26 12 Average attendance at each session ... 18 9 8 Consultant Clinic.—The Consulting Obstretrician, or his Deputy, continued to hold a Clinic twice weekly for ante-natal and post-natal cases. During the year 102 sessions were held and a total of 1,196 examinations were made. Maternal Mortality.—During 1956 there were two deaths of Ilford mothers recorded by the Registrar-General as due to or in consequence of pregnancy or childbirth. Domestic Help Service.—During 1956 the heavy demand for this service continued. The service was controlled by two full-time Organisers, under the general direction of the Area Medical Officer, and at the end of the year there were 8 full-time, 123 regularly-employed part-time and 9 casual Helps employed. The following is a summary of the cases dealt with in 1956:— Number of applications received for assistance 1,522 Number of cases where Domestic Helps were provided (including 564 who were having service at the commencement of the year) 1,665 Number of cases which on investigation were either not eligible for assistance or did not require the service 321 Cases booked but subsequently cancelled 70 Number of cases where, at the end of the year, a domestic help was booked to attend in future months (maternity cases) 63 Other cases awaiting help at end of year 20 Enquiries incomplete at end of year 10 Cases being served at 31st December, 1956 549 67 Two training courses of two weeks duration were held by the County Council in 1956, one in February at the Mid-Essex Technical College, Chelmsford, and one in November at the South-East Essex Technical College, Dagenham. Four domestic helps from Ilford attended and were found to be entirely satisfactory. Prevention of Break-up of Families—Health of Children.— In this Area very few families are taken into care and then only after all other methods have been tried first. A close link with the Domestic Help Service is maintained; if, after the Organiser's visit, help is refused, parents are advised to write to the Children's Officer. It is found that when the responsibility is placed on the parents and they see how difficult it is to get children into care, tRey will often find a relative to assist them. Children in problem families are usually discussed with the teachers. In two instances children were placed in residential boarding school at 11 years of age, to educate them in a better way of life. A close link continues with the psychiatric social workers and the health visitors know that they can discuss their cases with these workers. The children under five are discussed too:— (1) To ascertain that the advice given by the health visitor is correct. (2) To prevent the child becoming a real problem. Problem families are followed up closely by the health visitors. One family had continuous Domestic Help Service for a period of nine months to educate the mother in housecraft. 68 . Convalescent Facilities.—The following tables show the number of persons sent away for convalescence during 1956 :— (a) Under Section 22 of the National Health Service Act, i.e.. nursing mothers and young children. Name of Home No. of Cases No. of weeks' stay Remarks Lennox House, Southsea 1 2 Mother and infant. Winchester House, Shanklin 1 2 Mother and infant. Beach Court, Lancing 1 5 Arranged by Invalid Children's Anna Wilson House, Tankerton 1 o Mother and infant Totals 4 11 3 mothers with infants 1 unaccompanied child (b) Under Section 28 of the Act, i.e., other persons requiring change of air and surroundings to aid recovery and rehabilitation. Name of Home No. of weeks' stay Total Cases 1 2 3 4 Barnsley, The Vale, Broadstairs 1 — — 1 Bell Memorial Home, Lancing 1 13 11 1 26 Belmont Nursing Home, Westgate Mrs. Brooks' Home, Broadstairs — — 2 — 2 — 1 — — 1 Church Army Home, Bexhill — — 1 — 1 Cumberland Convalescent Home, Heme Bay — — 3 — 3 Devonia Hall, Cliftonville — 1 — — 1 Essex Convalescent Home, Clactcn — 10 2 — 12 Hunstanton Convalescent Home — o o 1 — 4 Leconfield, Bonchurch, Isle of Wight — — 2 1 3 Samuel Lewis Home, Walton-on-Naze — 0 1 — 7 Mildmay Convalescent Home, Ramsgate — 1 — — 1 The Quarries, Silverstone, Worcester — — — 1 1 Rustington Convalescent Home, Littlehampton St. Michael's Convalescent Home, Westgate — 10 4 — 14 — 1 1 — 2 Shoreditch Holiday Home, Copthorne " Wayneflete," Hayling Island — 1 — — 1 1 — — — 1 Anna Wilson House, Tankerton — 2 — — 2 Winchester House, Shanklin — — 1 —* 1 Totals 2 50 29 3 84 69 Loan of Sick. Room Equipment.—The considerable demand for equipment continues and the following table shows the issues from the Public Health Offices during 1956:— Articles Loaned Number of Articles Articles in store at 31.12.56 on loan at 31.12.55 loaned or reloaned in 1956 on loan at 31.12.56 Mattress (Dunlopillo) 6 11 11 1 Mattress (Hair) 2 1 2 1 Invalid Chairs 3J 44 41 6 Air Pillows 2 1 2 2 Air Rings 88 210 75 41 Cushions (Dunlopillo) 10 21 7 8 Back Rests 67 138 76 1 Beds 3 6 6 1 Commode Chairs 25 28 28 1 Crutches 8 8 4 2 Fracture Boards (Sets) 3 8 4 — Pillows 4 — 4 4 Pillow Slips *3 2 3 — Rubber Sheeting 120 325 137 26 Medical Sandbags (Sets) 1 1 — 1 Spinal Carriages 1 — 1 — Bed Cradles 11 32 16 — Air Beds 1 14 2 3 Bed Pans 82 200 76 36 Diabetic Scales 3 — 3 2 Feeding Cups 4 14 9 2 Urinals 33 97 39 31 Sputum Mugs 2 1 1 4 Douche Cans 1 — 1 1 Water Beds — 2 — 1 Water Pillows — 2 1 — Bed Blocks (Sets) 2 — 2 — Pails - - — 2 Bowls — — — 2 Bedsteads Sides (Pair) 1 — 1 — Lifting Pole and Chain — 1 1 — Commode Sorbo Cushion 1 — 1 — Kidney Dishes 1 1 1 1 Totals 519 1158 555 180 1955 Details 538 1,117 519 161 1954 Details 320 975 538 99 1953 Details 161 698 320 54 1952 Details 86 326 161 66 1951 Details 27 162 86 30 * Provided through special funds. Tuberculosis Visitors.—The three Tuberculosis Visitors made a total of 4,700 visits to homes in the Borough. Domiciliary Occupational Therapist.—The following shows the visits undertaken by the Domiciliary Occupational Therapist in 1956:— Number of visits to new patients 19 „ „ revisits to patients 269 „ other visits (to Chest Clinics, etc.) 31 The original Occupational Therapist left on the 1st June, 1956, and the replacement commenced duty on the 1st October, 1956, 70 Rehabilitation of Tuberculosis Cases.— No cases required assistance in the maintenance charges at a rehabilitation settlement during 1956. Open-Air Shelters for Tuberculosis Cases.— One open-air shelter, supplied for a tuberculosis patient during 1954, was still in use at the end of 1956. Provision of Free Milk for Tuberculosis Cases.— The County Council's scheme for supplying to tuberculosis patients one pint of milk free of charge, on the recommendation of the Chest Physician, again showed progress during 1956. Particulars of the grants made in 1956 are given below:— No. of cases in receipt of free milk at 31.12.55 ... 209 „ „ new grants made during 1956 129 „ „ grants discontinued during 1956 111 „ „ cases in receipt of free milk at 31.12.56 227 Boarding-out of Children (Tuberculosis Contacts).—No applications were received in 1956 for assistance in the boarding-out of child contacts of tuberculosis patients under the County Council's scheme. Ilford Tuberculosis Care Association.— Mr. H. R. Stanbridge, a member of the Ilford Health Area Office staff, continued to undertake the secretarial work of this Association during 1956. The following shows the assistance given by the Association during the year:— No. of persons Assisted Total No. of Grants made Extra nourishment (grants made usually for periods of one month and renewed as required) 68 514 (including renewals) Other grants (Christmas cash gifts, clothing, etc.) 83 89 Travelling Expenses of Relatives Visiting Hospital Patients:— As in previous years, the County Medical Officer was able to give financial assistance in 1956 only in very special cases to enable them to visit relatives who were in hospital; two Ilford persons were assisted under this scheme. Examination of Officers and Servants.— The following medical examinations by Essex County Council staff were carried out during 1956:— Entrants to County Council Service 22 Other purposes 22 For other Authorities 14 Invalid Night Attendant Service.—The scheme operating in conjunction with the Ilford Social Service Association for the provision of 71 night attendants to provide some relief for those people who are called upon to sit up constantly all night with sick relatives or friends, or to help those who are sick and have no-one to whom they can turn for such assistance, has continued, the County Council making agreed payments to the Association in respect of approved cases where need in meeting the cost of the service provided by the Association's night attendants has been proved. The following are the details of the cases dealt with under the County Council's scheme during 1956:— No. of cases being attended at 31.12.55 3 „ „ new cases attended during 1956 4 „ „ cases discontinued during 1956 7 „ „ „ being attended at 31.12.56 Nil Total nights attendance given 129 Home Nursing.—The Home Nursing Service in Ilford is undertaken by Nurses under the supervision of the Superintendent of the Lady Rayleigh Training Home at Leytonstone but operating from the Branch Home " Abury House " in Aldborough Road, Ilford. The work undertaken by Home Nurses in the Ilford area in 1956 was as follows:— Cases attended 2,750 Visits paid 75,307 Health Education.—Posters covering various aspects of Health were displayed at the Public Health Offices and the Mayesbrook, Manford Way and Newbury Hall Clinics throughout the year. During the year a total of 74 lectures on various Health subjects were given by members of the medical staff of the Department, 11 to mothers attending Infant Welfare and Ante-Natal Clinics, and 63 to various organisations. In addition, lectures on Mothercraft were given by the Health Visitors at their ante-natal relaxation exercise classes at the Mayesbrook and Manford Way Clinics, a series of 12 lectures constituting each course. Dental Treatment.—Mr. E. V. Haigh, the Senior Dental Officer, has submitted the following report: — " The dental treatment of expectant and nursing mothers and children under 5 years of age continued at Mayesbrook Clinic during 1956. The patients were referred from ante-natal, post-natal and welfare clinics. An average of three sessions per week were devoted to treating the above patients. At the beginning of 1956 two evening sessions were introduced for nursing and expectant mothers. Later in the year this was reduced to one session for these patients and one session for school children. These evening sessions have proved to be very useful for patients who are working or have no one with whom to leave young children during the daytime. Most extractions were performed under general anaesthesia, using nitrous oxide and oxygen—this always being administered by a Medical Officer. Conservative treatment, such as fillings, scalings and gum treatments have been carried out whenever possible in order to save as many teeth as possible. Dental X-ray facilities which are available at Mayesbrook Clinic were used where required, thus saving patients pain and inconvenience by a quicker diagnosis. Expectant and nursing mothers received dentures when required, these being made bv a local dental laboratory. This arrangement has been in operation for many years and is still proving satisfactory," 72 The number of cases treated at the Clinic during 1956 was as follows: Examined Needing Treatment Treated Made Dentally - Fit Expectant and nursing mothers (a) Day Sessions 60 60 86 49 (b) Evening Sessions 129 129 134 119 Children under 5 132 132 131 140 The forms of dental treatment provided were:— Extractions Anaesthetics Fillings Scaling or Scaling and Gum treatment Silver Nitrate treatment Dressings Radiographs Dentures Provided, repaired and remade Local General Complete Partial Expectant and nursing mothers (a) Day Sessions 524 33 95 125 37 — 47 6 15 15 (b) Evening Sessions 141 110 - 387 212 - 119 5 43 41 Children under 5 242 1 91 315 — — 50 — — — In addition there were 227 prophylactic treatments and other operations carried out in the case of expectant and nursing mothers at day sessions and 437 at evening sessions. The total number of sessions held for expectant and nursing mothers and children under five years of age was 141½, 68 during the day and 73½ in the evenings. Distribution of National Welfare Foods. Owing to the closure of the local Food Offices, the distribution of national welfare foods (National Dried Milk, orange juice, cod liver oil and vitamin tablets) to beneficiaries has been the responsibility of the local health authorities under the National Health Service since the 28th June, 1954. The Main Store and Distribution Centre at 279 Cranbrook Road was vacated as at June 30th 1957, and the main store and office removed to the former Ambulance Station, Clarks Road. No issues to the public are made from Clarks Road. A new distribution centre was opened at the Public Health Offices as from 1st July, 1957, to serve the mothers in the northern part of Ilford, 73 The following shows the present distribution centres in Ilford, with the days and times they are open:— (a) Branch Centres. Public Health Offices, Valentines Mansion. Monday to Friday 9.15 a.m.—12.30 p.m. 2 p.m.—3.30 p.m. Saturday 9.15 a.m.—12 noon Methodist Church Hall, High Road (entrance in Tuesday and Friday ) 9.15 a.m.—1 p.m. 2 p.m.—3.15 p.m. Cleveland Road), Ilford. Saturday 9.15 a.m.—12 noon Methodist Church Hall, Tuesday 9.15 a.m.—1 p.m. Fremantle Road, Barkingside. 2 p.m.—3.30 p.m. Goodmayes Methodist Church Friday 9.15 a.m.—1 p.m. Hall, Blythswood Road (next to Seven Kings Library), Goodmayes. 2 p.m.—3.30 p.m. (b) Infant Welfare Centres. Barkingside Monday 2—4 p.m. Fairlop Friday 2—4 p.m. Chadwell Monday 2—4 p.m. Manford Way Monday 2—4 p.m. „ „ Tuesday 2—4 p.m. „ „ Friday 2—4 p.m. Becontree Tuesday 2—4 p.m. Goodmayes Thursday 2—4 p.m. Downshall Tuesday 2—4 p.m. Woodford Avenue Wednesday 2—4 p.m. Cecil Hall Wednesday 2—4 p.m. „ „ Thursday 2—4 p.m. Seven Kings Wednesday 2—4 p.m. Newbury Hall Thursday 2—4 p.m. Marks Gate (Padnall) Thursday 2—4 p.m. Grosvenor Road Thursday 2—4 p.m. Ilford Lane Friday 2—4 p.m. Valentines Friday 2—4 p.m. (c) Private Houses Mrs. Taylor, 31, Lime Grove, Hainault. Monday to Friday 9 a.m.—5 p.m. Mrs. Peacock, 15, Culpepper Close, Hainault. Evenings and Weekends only. Mrs. Collyer. 11, Atherton Road, Ilford. Wednesdays 3 p.m.—4.30 p.m. With a view to effecting economy and cohesion in the service, the work with regard to the national welfare foods has been fully integrated with that of the distribution of nutrients and medicaments which has been in operation in the maternity and child welfare service for many years. 74 SCHOOL HEALTH SERVICE. Nutrition. The summary of heights and weights over 10 years which is printed at the end of this Report in Table VIIA. and B. shows no appreciable change. Incidence of Pediculosis and Scabies. (i) Pediculosis.—4 children were found to be infected with living hair vermin as against 7 in 1955, 4 in 1954, 5 in 1953, 13 in 1952, 7 in 1951 and 5 in 1950. (ii) Scabies.—There were two cases reported during the year, as compared with 1 in 1955, none in 1954, 1953 and 1952, and 1 in 1951.— School Premises.—There are 35 schools, with 64 departments, 24,018 children were actually on the rolls on 20th December, 1956, as compared with 24,173 in December, 1955. The figure 24,018 includes Barking Abbey (398) and Ursuline County Placed pupils (327). The number of children in average attendance at school for the year ended 19th December, 1956 = 22,124. The Public Health Inspectors have paid the usual monthly visits to the maintained schools (1) to enquire as to the milk supplies, (2) to inspect the sanitary arrangements. 1,172 visits have been made during the year. Medical Inspection.—As from the 4th August, 1953, the medical inspection has been in accordance with the School Health Service and Handicapped Pupils Regulations, 1953. During 1956, 5,802 parents, or 80 per cent., attended the full routine medical inspections. No schools were closed during the year on account of infectious disease. Table VI shows the incidence of infectious disease in the Ilford schools during 1956. 6 home visits were paid by the School Nurses to cases of minor infectious disease. In addition the Public Health Inspectors paid 291 visits to measles cases, and 190 visits to whooping-cough cases. Following Up.—During 1956, 4,365 home visits by the School Nurses were paid for the purpose, and 3,225 re-examinations of children (some on several occasions) were carried out by the doctors at school; 175 visits to schools were made for this purpose alone, and other children were seen at the visits for routine medical inspection. Medical Treatment. (a) Minor Ailments Clinics.—The attendances during 1956 were as follows:— Newbury Hall Mayesbrook Number of individual children seen 581 593 Number of attendances of children 1,124 1,138 Number of exclusion certificates granted 8 21 Number of certificates of fitness to attend school granted 10 14 75 The following table shows the conditions dealt with at both the Clinics during the year:— Subnormal Nutrition 300 Debility 33 Uncleanliness:— Head 37 Body — Skin:— Ringworm:— Head — Body 1 Scabies — Impetigo 8 Dermatitis 4 Urticaria 2 Furunculosis 6 Eczema 1 Athletes Foot 9 Warts 135 Other Skin Diseases (Non-Tuberculous) 56 Eye:— Blepharitis 4 Conjunctivitis 17 Defective Vision (excluding Squint) 117 Squint 8 Other conditions 50 Ear:— Defective Hearing 4 Otitis Media 4 Other Ear Diseases 6 Nose and Throat:— Chronic Tonsilitis only 7 Adenoids only 2 Chronic Tonsilitis and Adenoids 22 Nasal Catarrh 7 Nasal Obstruction 3 Other conditions 8 Enlarged Cervical Glands (Non-Tuberculous) 11 Defective Speech 13 Teeth—Dental Diseases 94 Heart and Circulation:— Functional 1 Organic — Anaemia 1 Infectious Diseases:— Whooping Cough 2 Colds and Coughs 56 Influenza 1 Lungs:— Asthma 4 Bronchitis 6 76 Pulmonary Catarrh 3 Other Non-Tubercular Diseases 2 Psychological:— Development — Stability 14 Nervous System:— Nervous Debility — Habit Spasm 2 Chorea — Petit Mal — Enuresis 11 Other Conditions 5 Deformities:— Genu Valgum 1 Posture 3 Pigeon Chest — Flat Feet 33 Valgus Ankles 13 Other Forms 31 Minor Injuries 16 Rheumatism 6 Other Defects and Diseases 67 Total number of ailments 1,247 SPECIAL CLINICS. Ophthalmic Clinic. The following table summarises the attendances of school children: — The following table summarises the attendances of school children: — Clinic Sessions New Cases Old Cases Attendances Valentines Mansion 97 264 806 1,351 Mayesbrook 93 187 571 1,220 Manford Way 10 35 64 176 Totals 200 486 1,441 2,747 77 936 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 353 cases the lenses of spectacles were replaced or repairs of frames were carried out. Dr. H. J. R. Thorne, M.B.. B.S., D.O., D.O.M.S., the Ophthalmic Surgeon at Valentines Ophthalmic Clinic, makes the following report:— "Valentines Ophthalmic Clinic has continued to function smoothly and satisfactorily throughout the year and clinics have been well attended. The cases dealt with were of much the same types as in previous years. The majority of children were, as in the past, seen because of defective vision in one or both eyes, usually detected during routine school medical examinations, and due to refractive errors. Of these cases, a not inconsiderable number also had a squint. In addition many cases of true or apparent squint were referred for examination, advice and treatment. All these cases are seen at regular intervals and kept under observation as necessary throughout their school life. A much smaller number of cases was seen because of:— (i) Congenital abnormalities of the eyes and adnexae. (ii) Ocular pathology including congenital cataract (partial or complete), retinal dystrophy, retinal detachment and inflammatory affections. Partially sighted (or blind) children—fortunately few in numberwere seen as required, reported on (on Form B.D.8) and advice given as to schooling and treatment Good co-operation has been obtained from various London Eye Hospitals to which cases were referred as necessary for operation (e.g., for squint) or further detailed (hospital) examination and investigation. The Orthoptist has continued to work at the Orthoptic Clinic at Mayesbrook on three days a week. The Orthoptic Clinic has functioned efficiently as an indispensable adjunct to a School Eye Clinic in the treatment and observation of squint cases—both true and latent and pre- and post-operative. The fitting and supply of spectacles, in the hands of the attending Optician, have continued to be quite satisfactory." 78 Orthoptic Clinic. Miss C. M. Hazel, D.B.O., the Orthoptist, makes the following report: "The Ilford Orthoptic Clinic still functioned throughout 1956 at the Mayesbrook Health Services Clinic, 6 sessions weekly being held, with a total of 272 sessions in the year. 111 new cases of school age were seen and the total attendances of this age group numbered 832. 75 cases were discharged, the majority following satisfactory treatment. It is interesting to note that only 9 children failed to show improvement with treatment. There were 240 cases under treatment at the end of the year." STATISTICAL SUMMARY Month Number of Sessions New Cases 5 years Over Under Old Cases 5 years Over Under Total Attendances 5 years Over Under January 26 12 3 1 - 84 18 22 7 7 3 - 17 March 10 2 — 1 — 40 9 April 24 14 4 3 — 90 24 May 24 16 6 1 — 89 21 June 26 6 9 •> — 69 28 July 26 12 4 2 — 66 32 August 24 8 1 1 — 77 18 September 18 8 3 — — 58 19 October 24 12 1 4 — 79 16 November 26 10 1 — — 65 17 December 22 4 3 1 — 44 12 Totals 272 111 42 19 - 832 231 Discharges. Satisfactory 31 Improved 10 Cosmetic 3 Failure 9 Intractable amblyopia 5 Unsuitable for treatment 2 Transferred 8 Failure to attend 7 75 79 Orthopaedic Clinic. Mr. H. G. Korvin, F.R.C.S., the Orthopaedic Surgeon, makes the following report: — "The clinics held weekly at Newbury Hall and fortnightly at Mayesbrook Clinic ran smoothly throughout the year. The appointments system is working well with comparatively little waiting time for patients and staff. Physiotherapy equipment was brought up to date during the year by acquisition of a new lamp at Mayesbrook Clinic and some repairs. At the Newbury Hall Clinic the lack of ventilation was felt less this year owing to the exceptionally cool summer. Operations were again carried out at East Ham Memorial Hospital where there is no waiting list for children under twelve but a fairly long one for those going to adults' wards. X-ray examinations were done by the Ilford Isolation Hospital. Appliances and footwear were mostly made by Messrs. Pryor and Howard, whose fitter, Mr. Rogers, attends weekly at Newbury Hall. At Mayesbrook Clinic several cases were seen which had been referred for orthopaedic opinion by the newly opened Cerebral Palsy Centre in Stevens Road, thus establishing co-operation between the units. I wish to thank all those taking part in the running of these Clinics for their valuable help." The following table summarises the attendances of school children:— Clinic Sessions New Cases Old Cases Attendances Newbury Hall 42 113 237 498 Mayesbrook 23 51 119 245 Manford Way 9 5 16 35 Totals 74 169 372 778 80 Diagnosis New Cases Old Cases A B C A B C Lordosis - - - 2 - - Paralyses:— - - - - A.P.M. - 1 - 5 9 - Hemiplegia 2 - - 4 — - Monoplegia - - - - - - Spastic diplegia — — - 2 — - Spastic Quadriplegia — — - 2 — - Scoliosis 3 2 - 5 7 - Kyphosis 1 — - - 1 Slack posture 7 2 - 11 — 1 Deformity of hips — — - 4 3 - Deformity of Chest — — - — — - Genu valgum 17 6 1 73 38 5 O.C.T 1 — - 7 8 2 Genu varum 1 — - 6 3 1 Pes valgus-planus 5 — - 39 13 2 Valgus ankles 12 5 1 10 10 - Talipes caleaneo-valgus - - - - - - Congenital talipes E.V. 1 — — 2 — 1 Congenital defect - - - - - - Intoeing - - - 5 1 2 Pes cavus 3 - - - - - Hallux valgus 15 6 — 15 8 - Deformity of toes 5 10 1 13 8 1 NAD 4 — 1 2 2 - Other conditions 26 15 1 17 10 1 Foot strain 6 2 - 3 - - Metatarsal varus 1 — - 3 - - Spastic foot — 1 - — - - Cerebral Palsy — 1 - 1 - - Spina Bifida 1 - - - - - Torticollis — - - 2 3 - Old Osteomyelitis 1 - - - - - Deformity of Foot 1 — — 2 — - Totals 113 51 5 237 119 16 A—Newbury Hall. B—Mayesbrook. C—Manford Way. 19 Children of school age were admitted to East Ham Memorial Hosoital. Particulars as follows: — No. of Cast Operation 2 Subcutaneous Tenotomy 5th toe (left). 6 Arthrodesis 5th and 2nd toes. 1 Division of Sternomastoid. 1 Destapling. 3 Phalangeal Osteotomy Gt. toes. 1 McBride Type Operation. 1 Shelf Operation (Rt.). 1 Manipulation of Hip. 1 Holdsworth Operation on both little toes. 1 Bunionectomy (Rt.). 1 Removal Supernumerary Toenail. During the year 35 pairs of valgus insoles, 22 pairs of surgical boots or shoes, 5 pairs Genu Valgum splints, 3 metatarsal bars, 7 calipers and inverting irons, 3 toe springs for drop foot, 23 repairs to calipers and shoes, and 38 pairs wedges to shoes were supplied to school-children. 81 207 cases were discharged from the Orthopaedic Clinic, 143 as cured. 15 due to absence and were kept under observation at school, 38 were showing improvement and were kept under observation at school, 11 cases left school or left the district. Minor Orthopaedic Defects. Dr. F. E. O'Connor Wilson, one of the school medical officers, has under supervision and attends weekly one of the following Clinics conducted by the Physiotherapist:— Exercises Massage Sunlight and she reports as follows: — " REMEDIAL EXERCISES The clinics for remedial exercises and physiotherapy continued to be very busy during the year 1956. Clinics are held at two centres —Mayesbrook Clinic and Newbury Hall—and cover 6 or 7 sessions a week. Cases were divided into groups for treatment according to the defect to be remedied. Where children were unable to practise the exercises at home following demonstration by the physiotherapist, they were asked to attend classes of group instruction. Mothers accompany the children in some instances with the older children, and always with the younger ones. Their interest and co-operation is helpful to the children and encouraging to the patient instructor. There were 189 new cases during the year and total attendances numbered 1,716. All cases are periodically reviewed by the doctor who discharges them when the defect is cured or further treatment is unnecessary. ARTIFICIAL SUNLIGHT TREATMENT There were 25 new cases for Ultra-Violet Ray treatment during the year. The total attendances were 698. In some instances a break in the continuity of treatment prolongs the attendance at the clinic as the course must be restarted following absence. Children are reviewed quarterly by the doctor and discharged when improved." 82 Physiotherapy Clinics. These are held at Newbury Hall on Monday and Thursday mornings and at Mayesbrook Clinic on Tuesday and Friday mornings. Cases are also seen at the Manford Way Clinic as required. Details of attendances:— Clinic Sessions New Cases Old Cases Attendances Newbury Hall 90 125 190 975 Mayesbrook 90 62 89 522 Manford Way 91 2 6 219 Totals 271 189 285 1,716 Artificial Sunlight Clinics. These are held at Newbury Hall on Tuesday afternoon and at Mayesbrook Clinic on Thursday afternoon. Details of attendances:— Clinic Sessions New Cases Old Cases Attendances Discharged Cured Much Improv’d Left District etc. Newbury Hall 47 12 20 411 16 1 5 Mayesbrook 46 13 9 287 12 — 3 Total 93 25 29 698 28 1 8 The lamp used at each Clinic is a Centrosol Unit. The conditions treated were as follows:— Defects Treated. Cases A ] Anaemia, Debility and Malnutrition 20 10 Bronchitis 7 3 Alopecia 1 — Asthma 1 2 Psoriasis - - Posture - - Acne - - Chilblains - 1 Eczema - — Other Conditions 1 5 Adenitis 2 1 *32 22 A—Newbury Hall Clinic. B—Mayesbrook Clinic. * Of the 32 cases treated 3 were Open Air school-children. 83 Ear, Nose and Throat Clinic. The E.N.T. Clinic is held at Valentines Mansion, the Surgeon attending one session weekly. 48 sessions were held during 1956 and 749 attendances were made by 423 children of school age, of whom 203 were new cases. The Consulting Ear, Nose and Throat Surgeon (Miss Margaret Mason) submits the following report:— "The work of the clinic remains fairly steady; last year 749 attendances were made; 203 new patients attended. The bulk of our work deals, of course, with cases of tonsil and adenoid disease, and this year we were fortunate in having been able to use the 6 beds at the Isolation Hospital for a large part of the year. We were thus able to operate on 204 cases, and the list at the end of the year had fallen to 44, compared with 188 one year ago. This happy state of affairs is largely due to the non-development of any poliomyelitis epidemic during the summer, a situation which may or may not be repeated in future years. An increasing number of children are referred for examination with regard to their hearing, and I am pleased to observe that in many instances this matter is first raised by the parents, who are becoming more 'deafness-conscious'. I would still wish to see the establishment of a specialised deafness clinic for the over-fives in this area. Although we receive the most helpful co-operation from the Audiology Unit in Grays Inn Road, they serve such a large area that, despite the most noble efforts on the part of the staff, patients often have to wait several months before an appointment can be given; and if a period of auditory training is advised, the necessary journeys are costly in both time and money." The following table shows the work of the Clinic:— No. seen Tonsils and Adenoids Infection 296 Deafness 15 Otitis Media 9 Mastoid disease 5 Rhinitis 70 Other defects or diseases 28 423 84 Rheumatism Clinic. The Physician attended 17 morning sessions during the year, and 90 children (48 of these being new cases) made 115 attendances. The 90 children were found to be suffering from the following conditions:— Defects Found New Cases Old Cases Totals Rheumatic Arthritis 1 - 1 Pulmonary Stenosis 8 3 Rheumatic Carditis — 1 1 Other forms of Carditis — 7 7 Tachycardia of Nervous origin — 3 Congenital Heart Disease - 5 Rheumatism — 1 1 No Active Rheumatic Disease 4 3 7 Heart Murmur Functional 23 10 33 Pains Due to Orthopaedic condition 1 — 1 Allergic type 1 2 3 Other conditions 5 6 11 N.A.D 10 1 11 Totals 48 42 90 Number of cases referred to General Hospital (In-patients) 17 „ „ „ Ear, Nose and Throat Surgeon 12 „ „ „ Orthopaedic Surgeon 5 „ „ „ For X-ray and Electro-Cardiogram 33 „ „ „ Blood Sedimentation Rate 12 Upon reaching retirement age on 5th September 1956, Dr. Kenneth Playfair resigned his appointment as Consultant to the Rheumatism Clinic after 19 years service with the Authority. The functions of this Clinic were transferred to King George Hospital, Ilford. Speech Clinics. Mrs. M. Walker, the Senior Speech Therapist, reports on the work at the Speech Clinics as follows:— "There were two changes of appointment during the year 1956, and our therapists are now as follows:— Mrs. Walker—full-time—at Valentines Clinic. Mrs. McGill —6 sessions per week—at Mayesbrook Clinic. Mrs. Pretious—6 sessions per week—Cerebal Palsy Unit. 4 „ „ ,, —Manford Way Clinic. 1 session „ „ —Fairlop School. We are now feeling the benefit of the increased number of Speech Therapists in that waiting lists have at last become manageable. We are pleased to note that more under-fives are being referred, for as stated previously, it is important that a child be sent to a speech clinic as soon as the parents admit to any anxiety, rather than to take the risk of the problem becoming worse as the child grows older. In the event that the parent is over-anxious and that in fact the child's speech ' defect' is merely a stage in normal maturation, reassurance and advice from the speech therapist to the parents can prevent the child being worried into speech difficulty. Attendance in clinics has been slightly lower than last year. We attribute this to an apparent increase in minor ailments among the children. There has been no improvement in attendance during school holidays. 85 This is the first year that a clinic has been held in an Ilford school, and although this is still an experiment, it is interesting to note the advantages and disadvantages of working on school premises. Attendance is more regular, resulting frequently in a quicker discharge rate, and there is of course greater opportunity for discussion with teachers. On the other hand, however, is the disadvantage of seeing parents far less regularly. Apprehensive children can attend with their friends, and by not removing the child from his daily surroundings not only is less attention drawn to the speech defect, but far less schooling is lost than when travelling to and from an outside clinic. Although there has been little school visiting due to the pressure of work in the clinics, we have maintained good contact with head teachers, and we have been grateful for their continued co-operation and assistance. Health Visitors have been most helpful and we have now laid the foundations for more direct contact with individual health visitors so that we can keep in touch with unco-operative parents. There is still no tape-recorder in Ilford for the use of the Speech Therapists. As has been previously stated this could be an invaluable aid to therapy and in certain cases would shorten the period of treatment required." The defects treated were as follows:— Stammering 65 Dyslalia 132 Rhinophonia 6 Cleft Palate 8 Dysphonia 3 Dysarthria 2 Others 33 97 children of school age were discharged from the Clinics during the year. In 59 cases the speech was normal. Of the remaining 38 cases, 7 ceased to attend for treatment, 12 left school or left the district, 6 refused treatment, 13 were referred elsewhere. School Dental Servcie.—Mr. E. V. Haigh, Senior Dental Officer, reports as follows:— "Full dental treatment was given to school children, expectant and nursing mothers and children under 5 years of age. This treatment consisted of conservative dentistry, extractions, orthodontics and the supplying of dentures when necessary. School dental treatment was carried out in the Ilford area at Mayesbrook Clinic and Valentines Dental Clinic, both Clinics having two surgeries, and at Manford Way Clinic with one surgery in use. Emergency treatment on two mornings a week continued during 1956 at Mayesbrook Clinic. Any school child may attend from any school in Ilford without an appointment and receive treatment to relieve toothache or to make an appointment to have an anaesthetic for extractions and conservative dentistry. The attendance on these mornings has averaged 20-30 per session. Most extractions were done under General anaesthesia—these being given by a Medical Officer. One or two sessions were devoted to this per week at each Clinic when an average of 20 patients were treated per session, 86 X-ray facilities are available at Mayesbrook Clinic for patients attending either Valentines or Mayesbrook Dental Clinic. Manford Way Clinic has a separate X-ray Unit. During 1956 I commenced treating school children after school hours. This has been made possible by the introduction of evening sessions which commence at 5.15 p.m. and end at 8.15 p.m. Many older secondary school children studying for examinations prefer not to miss school time and so are grateful to attend during these evening sessions. At the end of 1956 9 part-time dental surgeons were employed in the Ilford area school dental service, accounting for 26 sessions per week between them, thus making the equivalent of 2 36 full-time dental officers. In addition, my proportion (0 85) of School Health Service duties brought the total to 3-21 officers. The number of school children inspected at schools during 1956 was 3,942. It was impossible to inspect more school children owing to the shortage of dental officers." It was possible for the Denists to visit some of the schools for the purposes of inspection, 3,942 children were inspected at schools of which 2,792 required treatment. Children seen by the doctors at routine medical inspections and at the School Clinics, who are found to require dental treatment are referred to the Dental Clinics. In addition to the 2,792 children referred for treatment by the Dental Surgeons at School Inspections there were 2,387 children specially referred by parents, teachers and School Doctors. The amount of dental disease present in children at various ages is shown by the following table relating to school children inspected by the School Dental Officers:— Age Groups (in years) No. of Children inspected at School No. of Children referred for treatment No. of Children specially inspected at the Clinic Total number of Children referred for treatment 5 220 128 256 384 6 327 216 339 522 7 365 282 299 581 8 329 310 269 579 e 479 383 239 622 10 406 320 252 562 11 618 395 218 613 12 431 248 193 441 13 361 247 156 403 14 344 231 122 353 15 62 32 85 117 16 — — 2 2 17 — — — — 18 — — — — 3942 2792 2430 5179 In addition to the ordinary dental work of fillings and extractions, 25 dentures and 344 regulation appliances were supplied. Full details of the dental work are shown in Table V. 87 Open Air School. Dr. D. M. B. Gross. Medical Officer in charge, reports:— "During 1956 the number of children on roll varied, being 108 on 31.12.55 and 100 on 31.12.56. The number of admissions were 25 and discharges 33. Recommendations for admission were received from the following sources:— School Medical Officer 16 Borough Education Officer 4 Chest Physician 1 Others 4 25 The diagnoses were as follows: School Medical Officers Asthma 4 Asthma and collapse of lung 2 Asthma and bronchitis 6 Chronic Bronchitis 1 Spastic diplegia 1 Old T.B. effusion 1 Old bilateral congenital club foot 1 16 Borough Education Officer Talipes equino-varus 1 Old poliomyelitis 2 Chronic bronchitis 1 4 Chest Physician Bronchitis 1 Others Asthma, bronchitis and emphysema ... 1 Coeliac disease ... .. ... ... 1 Bronchitis and asthma ... ... 1 T.B. glands of neck ... ... ... ... 1 4 The 33 children discharged left for the following reasons: Fit for ordinary school 17 Left school over age 4 Admission to special school 3 Left district ... ... ... ... ... 6 Removed to private school ... ... ... 2 Unsuitable owing to very severe disability 1 ~~53 As a result of periodic examinations by the medical officer, children were recommended for treatment as follows:— Extra milk in school 24 Cod liver oil emulsion in school ... ... 24 Referred to: Speech Clinic 1 „ „ Enuresis Clinic 1 „ „ Dental Clinic 2 „ „ Artificial Sunlight Clinic ... 1 „ „ Child Guidance Clinic ... 1 Recommended for convalescent home ... 1 In addition 3 children received artificial sunlight during the year. Children with lung diseases were given daily deep breathing exercises in school, The number of admissions were 25 and discharges 33. Recommendations for admission were received from the following sources:— School Medical Officer 16 Borough Education Officer 4 Chest Physician 1 Others 4 25 The diagnoses were as follows: School Medical Officers Asthma 4 Asthma and collapse of lung 2 Asthma and bronchitis 6 Chronic Bronchitis 1 Spastic diplegia 1 Old T.B. effusion 1 Old bilateral congenital club foot 1 16 Borough Education Officer Talipes equino-varus 1 Old poliomyelitis 2 Chronic bronchitis 1 4 Chest Physician Bronchitis 1 Others Asthma, bronchitis and emphysema 1 Coeliac disease 1 Bronchitis and asthma 1 T.B. glands of neck 1 4 The 33 children discharged left for the following reasons: Fit for ordinary school 17 Left school over age 4 Admission to special school 3 Left district 6 Removed to private school 2 Unsuitable owing to very severe disability 1 33 As a result of periodic examinations by the medical officer, children were recommended for treatment as follows:— Extra milk in school 24 Cod liver oil emulsion in school 24 Referred to: Speech Clinic 1 „ „ Enuresis Clinic 1 „ „ Dental Clinic 2 „ „ Artificial Sunlight Clinic 1 „ „ Child Guidance Clinic 1 Recommended for convalescent home 1 In addition 3 children received artificial sunlight during the year. Children with lung diseases were given daily deep breathing exercises in school, 88 From the above it will be seen that there were no admissions for debility and malnutrition. This re-emphasises the trend noted in previous years towards a satisfactory standard of nutrition among school children. In consequence the evolution is now complete and the school has become truly a school for the physically handicapped. This has now been officially recognised by the recommendation to drop the title of 'Open Air School' in favour of 'Benton School,' and surrounding authorities are beginning to seek admission for suitable cases from their areas." Cerebral Palsy Unit. Dr. D. L. Woolf, Consultant in Physical Medicine to the Cerebral Palsy Unit, reports as follows:— "The Unit is now well established. The recently acquired cine camera will be of great assistance in the clinical assessment of the children admitted. In December 1956, there were 21 children on Roll, 11 males and 10 females. During the year 14 new cases were referred by the School Medical Officer with a view to admission, 7 of whom were accepted, the remainder were considered unsuitable to benefit from combined physical and educational instruction. 4 children were discharged after a reasonable trial period due to their unsuitability, and 1 child was admitted to a Residential School. A recent assessment of children on Roll showed 25 per cent had a mild physical disability, 25 per cent were moderately affected and 50 per cent were severely disabled. The Medical side of the Unit continues to work in close liaison with the Head Teacher and her staff. In conclusion, thanks are recorded to the Ancillary Medical Staff for their assistance during the past year." Dr. D. M. B. Gross, Medical Officer in Charge, makes the following report:— "The Unit opened in May 1955 and during 1956 continued to settle down to its functions. There were 21 children on roll, 11 male and 10 female. During the year 14 new cases were examined with a view to admission; of these 7 were accepted and came from the following areas:— Ilford 2 Walthamstow 1 South East Essex 3 Mid Essex 1 (on waiting list) 7 The 7 children rejected with the reason for rejection, and their Authorities, were:— Ilford 2 (a) May prove suitable for Benton School when 5 years old. (b) Suitably placed in private day school. Romford 1 Mental retardation. Not suffering from cerebral palsy. South Essex 4 (a) Fit for P.H. school when 5 years old. (b) Due to go into hospital for prolonged treatment. To be reviewed on discharge. (c) Fit for ordinary school. (d) May prove ineducable. For review in 1 year. 7 89 During the year 5 children left, as follows:— Ilford 3 (a) Excluded, may prove ineducable, for review later. (b) Transferred to Benton School. (c) Transferred to residential school. Walthamstow I excluded, may prove ineducable, for review later. South East Essex I ineducable. 5 Two of the children seen for admission were under 5 years of age. This indicates a tendency to earlier referral, but there is as yet no nursery class at the Unit. The lack of such a class is a very real gap for the need to institute treatment for these children at the earliest possible time is now generally recognised. There also emerges from these figures a suggestion that the scope of the preliminary examination, which is at present restricted to determining suitability for admission to the Cerebral Palsy Unit only, might usefully be widened into one for general assessment with appropriate recommendations in each case. During the year, new heating was installed which is proving satisfactory and new apparatus such as wall bars, steps, etc., was acquired A cine camera has also been purchased for recording progress and it is hoped soon to have a tape recorder for the speech therapist and a projector. The Unit is now fully staffed The medical auxiliaries are now working well together as a team and I would like to express my gratitude for their all-out effort during the past year." Treatment for Vncleanliness.— The School Nurses paid 221 visits to the schools (an average of 4 visits to each school during the year), for the purpose of inspecting the heads and clothing of the children with the following results:— Number of Individual Children Examined 19,896 Number of Examinations Number of Children Infested 59,754 *71 Percent. 0.12 * Four of this number were found to be infected with living vermin; the remainder with nits only. A child with any nits in the hair at all is included in these figures. The percentages for the past 5 years were as follows: — 1952 0.4 1953 0.3 1954 0.2 1955 0.17 1956 0.12 Other Ailments.— During 1956, 771 children were operated on for the removal of enlarged tonsils and adenoids as follows:— King George Hospital 360 Ilford Isolation Hospital 240 Others 171 90 Provision of Meals and Milk for School-children.— The provision of meals in the schools commenced on 7th October, 1940. The total number of mid-day meals served during 1956 was 2,231,776 approximately. There are 25 kitchens in the Borough, established at the following schools:— Barking Abbey, Barley Lane. Beal, Becontree C.P. Unit. Benton. Caterham, County High Boys, County High Girls, Cleveland, Dane, Fairlop, Goodmayes, Gordon, Loxford, Mayfield Boys, Mayfleld Girls, Mossford Green, Newbury Park, Parkhill, Kedbndge, The Gilbert Colvin, The Glade, The John Bramston, Uphall and Wm. Torbitt. As from 6th August, 1946. milk in school has been supplied free of charge in accordance with the Provision of Free Milk Regulations, 1946. In October 1956, 19,464 children were receiving milk in school. Work done by the N.S.P.C.C.—The following 47 cases were investigated: — (1) Neglect 26 (2) Ill-treatment cases 11 (3) Other cases 10 (Seven cases were reported from the Public Health Department; 40 were reported from other sources for general neglect). 105 children (52 boys and 53 girls) were involved, 66 being of school age. In addition to this work, 222 supervision visits were paid to different cases, some of which were made to those reported during the previous year. The Invalid Children's Aid Association.— Number of Ilford school children:— Sent to Recuperation Holiday Homes (voluntary funds) 15 Loaned television set„ „ 1 Loaned invalid chair „ „ 1 Loaned tricycle „ „ 1 Supplied with clothing „ „ 1 Boy from Benton School sent to Austria for holiday; cost shared by parent and Voluntary Society. Visits to homes at the request of hospitals and voluntary societies, 29. Numerous escorts provided to London or to Convalescent Homes by Voluntary Workers The placing of children for recuperative holidays is now done by the Borough Education Officer and in 1956, 37 children were sent. Handicapped Children. Section 33 of the Education Act, 1944, and the regulations made thereunder have placed on the Local Education Authorities new responsibilities for the provision of suitable education of children suffering from disability of mind or body. A record of all such children is revised annually from returns submitted by all Head Teachers, and any new cases attending local maintained schools are reported to me with a view to medical examination and ascertainment of their suitability or otherwise of attendance at an ordinary school. The several categories of pupils requiring special educational treatment as defined in the Handicapped Pupils (Certificate) Regulations, 1953, came into operation on 16th December, 1953. 91 The number of children coming within these categories and their disposition as on the 31st December, 1956, are tabulated in the following table in accordance with the Handicapped Pupils Regulations, 1953. Return of Handicapped Pupils in the Area on 31st December. 1956 (Aged 2-16 Years) Handicapped pupils. Blind, Partially Sighted Deaf Partially Deaf. Delicate. Physically Handicapped. Educationally Subnormal. Maladjusted. Epileptic. Total 1 2 3 4 5 6 7 8 9 A. Newly placed in 1956 — 2 1 1 23 6 12 15 — 60 B. Newly ascertained in 1956 2 3 1 1 26 8 24 10 — 81 C. (i) Attending Special Schools— Day - 2 9 6 58 47 61 ] - 184 Boarding 5 2 4 — 5 2 16 18 1 53 (ii) Boarded in homes — — — — 1 — 3 — 4 (iii) Attending assisted Schools - - - - - 4 4 16 — 24 D. Unplaced— (i) At no school 3 1 — — — 6 — — — 10 (ii) At ordinary school — 2 — — 2 1 23 6 — 34 E. Receiving home tuition (including those in D). 1 - - - 2 1 - - - 4 Mental Health Service. The Occupation Centre for Mentally Defective Children and Adult Female Patients, was opened on 8th September, 1953, at the Methodist Church Hall, Bennett's Castle Lane, Becontree. It is known as the Ilford Junior Occupation Centre. Full medical inspection is carried out once a year, by one of the School Medical Officers, also a survey visit is made quarterly. Child Guidance Clinic.— The Child Guidance Clinic was opened on 3rd January, 1949, at Loxford Hall, Loxford Lane, Ilford. Dr. H. M. S. Davidson, Consultant Psychiatrist at the Ilford Child Guidance Clinic, reports as follows: "For the first time for a long period we have had, since September 1956, a full Clinic staff. Mr. Pickett rejoined us in February and Miss Radford came as Psychiatric Social Worker in Miss Moffatt's place. Miss Oppenheimer and Miss Folkart have come as Child Therapists and Miss Bergen has returned to take up her appointment in America. Now that we have a full staff we hope to put into practice some of the plans we have had to postpone. 92 At a meeting of all the Essex Child Guidance Clinics' Staffs held in Chelmsford on June 9th, the two subjects most discussed were:— (1) Preventive work with young children, and (2) Children in Residential Schools for Maladjusted Children. It was decided at that meeting that prevention was an integral part of our work, and that it was important for us to have first hand knowledge and contact with the Residential Schools for Maladjusted Children. We have had one meeting with the Ilford Health Visitors to discuss how best we can co-operate in the preventive work and it was decided that they would contact us again when they had collected several cases which merited joint consultation. Meanwhile, a number of Health Visitors have visited the Clinic and taken part in case conferences where they have had an opportunity to see how we worked and the type of case we treated. A visit was made by several members of the staff to "The Homestead" at Langham, and we hope to visit Nazeing Park shortly. Mr. Sheward has visited us, and we have had full discussions with him over all the cases we have sent to him from this Clinic. It has given us ample evidence of the enormous value of close contact between the school and Clinic. Our Psychiatric Social Workers do a great deal of work with the families of children we have treated and who are now in Residential Schools, and have done much to prevent parents removing the children from the schools prematurely, and in helping the parents to be able to accept the child back home again. We have had many visitors to the Clinic, and though they cannot be present during the therapeutic interviews we welcome them to the Case Conferences. We have had School Medical Officers, General Practitioners, Social Workers, Health Visitors, Probation Officers, and Children's Officers. We have had two Psychology Students working with us for periods of a month, and Health Visitor Students, and a Student from the Training Course for Teachers of Maladjusted Children, who have been to us for visits of observation. Most of the treatment given is in individual interviews, but we have also had one therapeutic and one observation group for children, and a discussion group for parents. In the individual work we have been particularly interested this year in cases of school phobia and hope to publish some work on this subject later. We have had an Exhibition of Books for children of limited reading ability which has been seen by all the Head Teachers and most of the Assistant Teachers of the area, and a course of lectures has been given to Head Teachers on Secondary School allocation. Lectures have also been given to Parent-Teachers Associations. We have continued to send representatives to the Co-ordinating Committee of Social Workers in Barking. Our waiting list remains high, with several months delay for all but 'urgent' cases, and children who have had a diagnostic survey have usually to wait for a treatment vacancy, but we hope that our case load will be considerably diminished when the Dagenham and Romford Clinic opens, so that these delays can be reduced." Statistical Summary No. of cases referred to Clinic 189 No. of cases diagnosed at Clinic 142 Psychiatrists. Diagnostic interviews 135 Treatment interviews 615 Other interviews 85 No. of Psychiatric Sessions per week 9 93 Psychologists- Clinic cases tested 128 Treatment interviews (remedial education) 310 School visits on behalf of Clinic cases 94 Other interviews 227 Child Psychotherapists. Treatment interviews 739 Psychiatric Social Workers. Interviews at Clinic (Treatment and Social Histories) 808 Interviews elsewhere (Home Visits) 33 Waiting List. Last year 121 This year 61 Cases for diagnosis 65 Awaiting treatment 50 Report by Mr. K. Pickett, Educational Psychologist:— "There have been two psychologists working in the area for the greater part of the year, eleven months in fact. However, the demands of the clinical service have been heavy because of shortage of psychiatric social workers, until the middle of the year, and some time has been devoted to the taking of social histories, etc. The year has been noteworthy for the development of existing projects rather than for the establishment of new ones. Remedial classes in Ilford and Barking have continued successfully. The need for such facilities is still very evident in Dagenham and accommodation difficulties have precluded to date an extension of the provision in Barking. It is hoped that 1957 will see fruition of developmental plans. An interesting experiment in group play is proceeding in the Clinic: Miss Gascoyne having a group of children and Miss Barton, P.S.W., the mothers. Results, though tentative, at this early stage, are promising. A library of books in reading and arithmetic has been established at the Clinic and an exhibition of books for children of limited reading ability has been visited by a large number of teachers. A working party of teachers to review recently published books for retarded readers has been formed. A series of lectures to head teachers in procedure for Secondary School allocation was given and several lectures to groups interested in social studies have been given as usual." Employment of School Children and Young Persons.—During 1956, 204 children were submitted for medical examination in accordance with the Byelaws made under Part II of the Children and Young Persons Act, 1933 and all were found to be medically fit. Employment of Children in Entertainments Provisional Amending Rules.—2 Certificates were granted during the year. Medical Examination of Teachers. Officers and Servants.—The following examinations were carried out during 1956:— Officers Servants Teachers Intending Teachers Total New Appointments 22 14 21 77 134 Under Sickness Regulations — — — — — 94 Camp Schools. The Elmbridge Camp School at Cranleigh, Surrey, and Kennylands Park School at Kidmore End, near Reading, were taken over entirely by the Essex Education Committee on the 1st April, 1948. Admissions and re-admissions of Ilford School-children to these two Camp Schools and the Hydon Heath Camp are medically examined by the Assistant Medical Officers prior to entry. Medical Supervision—Kennylands Park School. Medical Inspection and supervision at Kennylands Park School continued throughout 1956. Dr. D. M. B. Gross made three visits to the school and examined 143 new admissions and leavers. In July 1956, there was a minor outbreak of sickness and diarrhoea but this cleared up in a few days. During the latter part of October eight children were admitted to the sick bay with sore throats. At the request of Dr. Hemphill, the practitioner attending the school, Dr. Woods of the Public Health Laboratory Service at Reading, took nose and throat swabs from 62 children living in the same dormitories as these, and 24 were found to have Group A beta-haemolytic streptococci isolated. Mr. T. Collins undertook dental inspection of the children at the school and carried out necessary treatment at his surgery. 210 children were inspected and 172 were found to require treatment. The Resident School Nurse submitted returns showing the number of children treated for minor ailments and particulars of surveys carried out during the year. Where necessary children were admitted to hospital either for treatment or observation but the vast majority of the cases were dealt with in sick bay at the school. For the first time Diptheria Immunisation was carried out in respect of those cases whose parents had consented to re-inoculation. The Causes of Death among Children of School Age (i.e., from 5—15 Years) in Ilford, during 1956 were: — Broncho pneumonia 1 Status Epilepticus 1 Asphyxia 1 Tuberculous Meningitis 1 4 Ilford Enuresis Clinic. Dr. J. Pooley, School Medical Officer, makes the following report for the 12 months ended 31st December, 1956. "This Clinic continues to be held at the Public Health Offices, Ilford, on Wednesday mornings. Attendances have been much better than those of last year—more new cases have been referred and the number of sessions held this year almost doubled those of last year. The results of treatment have been correspondingly more encouraging. 95 1. Appointment List.— During the 12 months ended December 31st, 1956 there have been 71 new cases, made up as follows :— Recommenced by Under 5 years Over 5 years Boys Girls Boys Girls Parents 1 - 2 - General Practitioners 1 - 1 - Infant Welfare Centre Officers 7 2 - - School Medical Officers 3 2 32 19 Health Visitors 1 — — — 13 4 35 19 Total 71 cases Total attendances (old and new cases) 376 No. of sessions 41 2. Procedure.— The procedure adopted in previous years has been adhered to at each clinic. This includes urinalysis, history of enuresis, physical examination, talking to and gaining the confidence of the child, and finally general advice is given to the parent, this always being given through the child by clear directions as to routine and charting, and finally the taking of medicaments if indicated. Results have again proved that suggestions made to the child in (he presence of the mother have been acted upon more faithfully by the parents. 3. Treatment.—The Treatment issued or prescribed has been as follows:— 1. Amphetamine sulphate (2 5 mgm.—10 mgm.) at night at a No of cases time decided upon for each individual child 53 2. Phenobarbitone gr. ½ at night 4 3. Charting and advice only 11 4. Disipidin (post pituitary snuff) 3 71 5. Cases referred to hospital or Child Guidance Clinic (already included under treatment as above) 4 N.B.—As before only the amphetamine sulphate was issued by the area health office, but it would be extremely helpful if a small supply of phenobarbitone tablets, gr. ½, could be kept at the clinic for use when necessary, as several patients have not returned after being sent with a letter to their general practitioners. 4. Analysis and Comparison of Results. No. of cases in 1956 1955 1954 1953 1952 1. Completely dry 33 or 46.6% 38.5% 41.6% 30% 22% 2. Very marked improvement (i.e., less than 5 wet in 28 nights) 5 3. Marked improvement (i.e., less than 14 wet in 28 nights) 12 4. Some improvement (i.e.. more than 14 wet in 28 nights) 10 5. No improvement 2 6. Not yet re-attended 9 TOTAL 71 cases 96 7. Of the cases referred in 1955 and who were still receiving treatment in 1956, a further 24 were discharged dry. Further analysis and comparison of cases No. of boys dry 20 out of 48 boys referred. No. of girls dry 13 out of 23 girls referred. Average age of boys 6.7 years. Average age of girls 7.5 years. Average number of visits until discharged dry 4 visits. 5. Conclusions.—This year interest in the clinic has increased, although it is discouraging that it is still used by so few general practitioners. It is felt that more time can be given in a clinic of this type to a problem of this nature than can possibly be devoted by a general practitioner in the midst of a busy surgery. As in previous years the same five factors have been common in those cases which have been slow to improve, namely:— (1) Frustration (2) Overcrowding. (3) Mismanagement. (4) Physical defect. (5) Mental retardation. More and more time at the clinic is being devoted to the child, and where the child's genuine interest and often surprise has been obtained, dry nights have almost always followed more quickly. In younger and more impressionable children, that is, those between 5 and 8 years of age, better results occurred when they were seen at 4-weekly intervals, rather than less frequently, thus maintaining their interest. Concerning the children under 5 years of age, strict adherence to a routine for the child by the parents has shown more success than attempts to get the child itself to 'come to grips' with the problem." B.C.G. Vaccination of School Children. No. of pupils to whom B.C.G. was offered 1,815 No. of pupils whose parents consented to treatment 782 No. of pupils undergoing tuberculin test 747 Positive: 85. No. of pupils who received B.C.G. 635 No. of pupils post-tested 633 Converted to Positive 627 Negative 5 Absentees from readings 1 67 Ministry of Education. MEDICAL INSPECTION RETURNS. Year Ended 31st December, 1956 TABLE 1. Medical Inspection of pupils attending maintained Primary and Secondary Schools including (Special Schools). A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 2,382 Second Age Group 2,652 Third Age Group 1,607 Total 6,641 Number of other Periodic Inspections 598 Grand Total 7,239 B.— Other Inspections. Number of Special Inspections 1,434 Number of Re-inspections 4,782 Total 6,216 C.— Pupils Found to Require Treatment. Number of Individual Pupils found at Periodic Medical Inspection to Require Treatment (Excluding Dental Diseases and Infestation with Vermin). (No individual pupil is recorded more than once in any column of this Table, and therefore the total on column (4) will not necessarily be the same as the sum of columns (2) and (3).) Group (1) For defective vision (excluding squint) (2) For any of the other conditions recorded in Table IIA (3) Total individual pupils (4) Entrants 69 597 631 Second Age Group 305 694 918 Third Age Group 246 301 497 Total (prescribed groups) 620 1592 2046 Other Periodic Inspections 82 135 198 Grand Total 702 1727 2244 98 TABLE II. A.—Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1956. Note.—All defects noted at medical inspection as requiring treatment are included in this return, whether or not this treatment was begun before the date of the inspection. Defect Code No. Defect or Disease (1) Number of Defects Requiring Treatment Number of Defects Requiring Observation but not Treatment Periodic Inspection (2) Special Inspection (3) Periodic Inspection (4) Special Inspection (5) 4 Skin 137 1 43 - 5 Eyes— a. Vision 702 3 285 — b. Squint 70 1 20 — c. Other 48 — 17 2 6 Ears— a. Hearing 38 1 44 2 b. Otitis Media 9 2 7 c. Other 5 — 8 — 7 Nose or Throat 252 3 416 3 8 Speech 43 33 52 9 0 Cervical Glands 8 — 156 2 10 Heart and Circulation 81 1 157 1 11 Lungs 137 5 205 3 12 Developmental— a. Hernia 14 1 34 3 b. Other 17 1 84 2 13 Orthopaedic— a. Posture 298 4 19 4 b. Flat foot 396 11 70 1 c. Other 300 4 163 13 14 Nervous system— a. Epilepsy 4 1 6 — b. Other 5 1 16 2 15 Psychological— a. Development 3 7 - b. Stability 37 35 75 16 10 Abdomen 12 1 18 2 17 Other 156 45 74 46 99 B.—Classification of the General Condition of Pupils Inspected During the Year in the Age Groups (See Note (ii) on Table 1). Age Group Number of Pupils Inspected Satisfactory Unsatisfactory No. % of Col. 2 No. % of Col.2 (1) (2) (3) (4) (5) (6) Entrants 2382 2812 97 70 3 Second Age Groups 2652 2590 97.7 62 23 Third Age Groups 1607 1600 99.6 7 04 Other Periodic Inspections 598 584 97.7 14 23 Totals 7239 7086 97.9 153 21 TABLE III. Infestation with Vermin. All cases of infestation, however slight, are recorded. This return relates to individual pupils and not to instances of infestation. (i) Total number of pupils examined in the schools by school nurses or other authorized persons ... 19,896 (ii) Total number of individual pupils found to be infested 71 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) — (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) — (v) Number of individual pupils disinfested:— By Local Authority 37 By parents 34 TABLE IV. Treatment of Pupils Attending Maintained Primary and Secondary Schools (Including Special Schools). Notes:—(a) Treatment provided by the Authority includes all defects treated or under treatment during the year by the Authority's own staff, however brought to the Authority's notice, i.e., whether by periodic inspection, special inspection, or otherwise, during the year in question or previously. (b) Treatment provided otherwise than by the Authority includes all treatment known by the Authority to have been so provided, including treatment undertaken in school clinics by the Regional Hospital Board. 100 Group 1.—Diseases of the Skin (Excluding Uncleanliness, for which see Table III). Number of New Cases Treated during the year By the Authority Otherwise Ringworm (i) Scalp - - (ii) Body — 1 Scabies — 2 Impetigo 8 - Other Skin Diseases 213 12 Group 2.—Eye Diseases, Defective Vision and Squint. Number of cases dealt with By the Authority Otherwise External and other, excluding errors of refraction and squint 196 10 Errors of Refraction (including squint) — 1,907 Total 196 1,917 Number of pupils for whom spectacles were (a) Prescribed — 936 (b) Obtained — 903 Group 3.—Diseases and Defects of Ear, Nose and Throat. Number of cases treated By the Authority Otherwise Received operative treatment (a) for diseases of the ear — 7 (b) for adenoids and chronic tonsillitis - 771 (c) for other nose and throat conditions - 6 Received other forms of treatment 63 136 Total 63 920 Group 4.—Orthopaedic and Postural Defects. By the Authority Otherwise (a) Number treated as in-patients in hospitals - 19 (b) Number treated otherwise, e.g., in clinic* or out-patients departments - 541 101 Group 5.—Chii.d Guidance Treatment. Number of cases treated In the Authority's Child Guidance Clinics Elsewhere Number of individual pupils treated at Child Guidance Clinics 91 5 Group 6.—Speech Therapy. By the Authority Otherwise Number of pupils treated by Speech Therapists for the first time 130 1 Group 7.—Other Treatment Given. New cases treated By the Authority Otherwise (a) Miscellaneous minor ailments 335 43 (b) Other (1) Heart and Rheumatism - 48 (2) Sunlight Treatment — 25 (3) Massage and Remedial Exercises - 189 (4) Enuresis 78 — (5) Hernias - 22 (6) Major Respiratory Diseases - 8 (7) Major Digestive Diseases - 31 (8) Major Injuries — 4 (9) Other Major Diseases — 7 Total 411 405 TABLE V. Dental Inspection and Treatment Carried Out by the Authority. (1) Number of pupils inspected by the Authority's Dental Officers:— (a) Periodic age groups 3,942 (b) Specials 2,430 Total (1) 6,372 (2) Number found to require treatment 5,206 (3) Number referred for treatment 5,179 (4) Number actually treated 3,800 102 (5) Attendances made by pupils for treatment 13,238 (6) Half-days devoted to: Inspection 26 Treatment 1,406 Total (6) 1,432 (7) Fillings Permanent Teeth 5,088 Temporary Teeth 1,757 Total (7) 6,845 (8) Number of teeth filled: Permanent Teeth 4,107 Temporary Teeth 1,611 Total (8) 5,718 (9) Extractions : (i) Permanent Teeth:— (a) On account of Caries 558 (b) For other purposes 149 (ii) Temporary Teeth:— (a) On account of Caries 3,118 (b) For other purposes 173 (10) Administration of general anaesthetics for extraction 1,803 (11) Other operations: Permanent Teeth 7,024 (incl. Orthodontics) Temporary Teeth 1,250 Total (11) 8,274 103 SCHOOL HEALTH SERVICE STAFF AND SCHOOL CLINICS AS AT 31st DECEMBER, 1956. 1.—Staff of the School Health Service. Divisional School Medical Officer: I. Gordon, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. Senior Dental Officer: E. V. Haigh, L.D.S., R.C.S. Number Aggregate staff in terms of full-time officers employed in the School Health Service (a) Medical Officers: (i) Whole time School Health Service - - (ii) Whole time School Health and Local Health Services 7 2.8 (iii) General Practitioners working part-time in the School Health Service - - (b) Speech Therapists 3 2.54 (c) School Nurses including Superintendent *18 (Combined posts, H.V. and S.N.) 81 (d) Nursing Assistants 6 (Clinic Nurses) 3.75 (e) (i) Senior Dental Officer 1 .85 (ii) Dental Officers (PartTime) 9 2.36 (iii) Orthodontists — — (iv) Dental Attendants 4 339 * All hold Health Visitor's Certificate. II—Number of School Clinics (i.e., premises at which Clinics are held for school-children) provided by the L.E.A. for the medical and/or dental examination and treatment of pupils attending maintained primary and secondary schools. Number of School Clinics 6 III—Type of Examination and/or Treatment provided at the School Clinics returned in Section II. either directly by the Authority or under arrangements made with the Regional Hospital Board for examination and/or treatment to be carried out at the Clinic. 104 Examination and/or Treatment Number of School Clinics (i.e. premises) where such treatment is provided Directly by the Authority Under arrangements made withR.H.R.&c. (1) (2) (3) A. Minor ailment and other non-specialist examination or treatment 4 - B. Dental 3 — C. Ophthalmic — 3 D. Ear, Nose and Throat — 1 E. Orthopaedic — 3 F. Pædiatric — 1 G. Speech Therapy 4 — H. Cerebral Palsy Unit — 1 I. Artificial Sunlight — 2 J. Remedial Exercises & Physiotherapy 3 2 K. Enuresis 1 — L. Orthoptic . — 1 IV.—Child Guidance Centres. (i) Number of Child Guidance Centres provided by the Authority =1 Staff Number Aggregate in terms of the equivalent number of whole-time officers Psychiatrists ... 8 0.82 Educational Psychologists 2 2 Psychiatric Social Workers ... 2 2 Others :— Child Psychotherapist ... 2 1 Clerk/Typist 3 3 The Psychiatrists are employed by arrangement with the Regional Hospital Hoard. 105 Summary of Cases of Infectious Diseases among School Children excluded from School Attendance during the Year ended 31st December, 1956. SCHOOLS No. on Roll Scarlet Fever Measles and German Measles Whooping Cough Chickenpox Mumps PolioMyelitis Pneumonia Rheumatic Fever Rheumatism SouneDysen tery Food Poisoning Totals Barley Lane 584 20 - 10 1 - - - - - 22 1 54 Beal Grammar 884 — — 1 — — — — — — 2 — 3 Becontree 1143 — — — — — — 1 — — 5 — 6 Benton 122 1 — 2 — — — — — — — — 3 Caterham 411 — — — — — — — — — 1 — 1 Chadwell 752 13 4 7 2 — 1 — — — — — 27 Christchurch 782 7 — 12 2 3 — — — — — — 24 Cleveland 1029 5 16 1 — — — — — — 1 1 24 County High 1241 — — 1 — 1 — — — — 3 — 5 Dane 753 — — — — — — — — — 1 — 1 Downshall 1233 1 24 14 — 1 1 1 1 — 1 — 44 Fairlop 1863 16 4 24 10 — — — — 1 7 1 63 Gearies 1297 1 37 4 4 24 — — — — — — 70 Goodmayes 763 9 63 8 — — — — — — — 6 86 Gordon 202 1 1 6 — — — — — — — — 8 Highlands 993 6 — 1 — 3 — 1 — 2 — — 13 Loxford 407 — - — — — — — — — — — — Mayfield 1200 2 — 1 — — — — — — — 1 4 Mossford (G.V.H.) 193 — 1 5 1 — — — — — — — 7 Mossford Green 288 1 1 16 — — — — — — 4 — 22 Newbury Park 433 1 - 1 1 1 — — - — - — 6 Parkhill 883 — — 7 — 1 — — — — 3 — 11 St. Augustines 310 2 15 3 49 2 — 1 — — — — 72 SS. Peter and Paul's 784 10 2 3 — — — — — 1 1 — 17 St. Vincent's 203 — — 3 — — — — — — — — 3 South Park 988 4 46 9 — — 1 — — — — 1 61 The Gilbert Colvin 506 5 23 5 — — — — — — 7 — 40 The Glade 484 2 1 — 2 — — 1 — — — — 6 The John Bramston 615 16 6 7 29 19 — — — — 1 — 78 The Mount 337 — — - — — — — — — — — 1 The Redbridge 634 1 14 11 — — — — — — 1 — 27 The William Torbitt 910 — — 10 — 1 — — — 1 — — 12 Uphall 318 7 — 5 — — — 1 — — — — 13 Ursuline 327 1 1 5 — — — - — — — — 7 Woodlands 197 — 18 2 — — — — — — — — 20 St. Bedes (Ann. of SS. P. & P.) — 1 8 2 — — — — — — — — 11 Valentines (Ann. of Fairlop) — — — — — — — — — — — — — Private — 1 4 4 - - - - - - 1 1 11 Totals 24069 134 291 191 101 56 3 6 1 5 61 12 861 In addition to the above table there were 4 eases of Paratyphoid and 1 of Encephalitis. Again there was no Diphtheria. 106 107 Table Showing the Average Heights and Weights of Ilford Boys and Girls Examined. Age Groups Age Groups 5—6 Years 6—7 Years 7—8 Years 8—9 Years 9—10 Years 10—11 Years 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years 16—17 Years 17—18 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight , (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight 1 (in Kilogrammes) Number of Children j Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) 1 Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) BOYS 1956 818 112 20.0 409 117 21.7 89 122 23.9 70 128 27.9 47 135 30.8 555 140 34.6 688 142 36.1 50 145 38.7 37 152 43.8 575 162 51.1 160 168 57.4 104 172 61.2 60 174 64.3 1955 605 113 20.6 842 116 21.9 125 123 24.3 68 124 25.5 38 135 29.9 320 142 34.4 994 144 35.7 46 146 37.3 13 155 47.0 381 162 50.7 200 168 57.8 62 171 61.4 45 175 63.5 1954 561 113 20.4 718 117 21.8 124 123 23.8 73 128 26.6 52 132 29.2 325 141 34.5 863 144 34.9 63 147 38.5 33 153 42.5 485 162 48.3 203 167 57.2 75 171 60.2 43 176 64.1 1953 649 112 20.2 925 116 20.4 82 121 23.6 34 126 26.3 36 133 28.9 194 140 33.3 799 144 34.7 49 145 36.3 22 158 44.0 441 162 51.0 259 168 55.7 84 172 61.2 35 172 56.6 1952 820 113 20.2 799 110 21.2 65 128 24.8 52 127 26.2 44 132 28.6 110 140 32.8 766 143 35.3 46 146 36.2 52 154 41.3 372 161 49.8 226 167 55.9 47 172 60.3 1 176 56.2 1951 611 113 20.8 568 115 21.7 74 123 23.9 50 128 26.6 43 131 28.6 165 140 33.5 715 143 35.9 42 146 37.4 22 153 44.2 373 161 51.2 218 165 53.3 21 170 60.7 1 177 63.4 1950 574 112 20.4 538 116 21.9 100 122 24.1 49 128 26.8 48 130 29.2 203 141 33.9 875 144 35.3 58 149 40.7 34 151 41.1 390 161 50.7 231 167 55.7 14 171 60.4 1 174 73.4 1949 891 113 20.6 433 117 21.9 99 122 24.1 52 127 25.8 55 133 29.2 177 139 32.9 822 143 34.5 51 147 38.9 40 152 41.9 392 160 50.7 247 165 55.3 27 171 61.7 3 173 61.6 1948 764 112 20.2 214 116 21.5 68 122 23.5 52 127 26.6 45 133 28.7 430 137 32.4 602 142 34.2 39 144 37.0 40 153 43.6 298 159 48.6 48 168 55.3 - — - - - - 1947 871 110 19.6 209 115 21.3 91 121 23.4 62 127 26.5 64 131 28.7 369 139 33.1 381 141 33.8 43 145 35.7 139 156 44.7 98 157 46.0 2 157 56.6 - - - - - - GIRLS 1956 782 112 19.7 373 117 21.6 91 121 23.1 44 126 26.4 46 134 29.8 438 141 34.9 821 142 37.1 100 150 41.4 57 156 48 1 525 157 50.2 149 160 53.0 128 164 54.1 23 158 54.5 1955 604 113 20.1 637 116 21.5 113 121 24.4 74 126 25.9 54 133 29.9 292 141 34.6 1052 144 36.6 73 149 40.5 34 156 48.8 359 159 50.7 180 159 52.5 68 161 54.8 19 161 54.7 1954 522 111 19.6 605 116 21.3 93 121 22.8 44 125 24.9 52 134 29.2 288 140 33.9 968 144 36.5 71 148 39.8 36 155 40.4 481 158 48.4 216 160 55.0 85 161 56.8 9 164 57.1 1953 657 112 20 0 827 117 21.3 81 119 22.8 38 127 25.8 37 133 28.9 173 140 32.5 841 143 35.5 59 150 39.9 49 156 47.1 374 156 50.9 212 160 53.6 49 162 54.9 5 164 55.6 1952 746 112 19.9 695 115 21.0 70 121 23.3 57 125 24.6 39 132 29.1 124 139 33.5 784 143 35.7 79 148 40.5 29 155 49.8 410 158 50.5 239 156 54.9 67 160 55.0 5 159 49.0 1951 526 112 20.0 542 116 21.0 60 119 22.8 53 128 26.9 36 132 28.4 166 138 32.7 811 144 36.5 48 149 40.1 33 153 43.8 397 158 50.8 248 161 55.0 27 162 56.1 — - - 1950 553 112 20.0 536 115 21.3 76 121 23.3 51 127 26.1 54 182 29.2 194 140 33.2 837 144 37.0 64 148 41.2 35 152 43.1 401 157 50.8 140 159 53.0 22 163 52.4 4 163 55.6 1949 823 111 19.9 418 115 21.2 82 121 23.5 46 126 26.0 56 130 28.3 216 139 33.4 815 143 3.5.8 57 147 40.7 49 152 44.0 421 158 50.0 257 161 53.8 47 161 55.7 3 163 55.2 1948 699 111 19.4 188 115 20.5 82 120 23.1 56 127 25.8 53 130 27.8 391 138 32.4 569 142 35.0 38 149 39.9 35 154 45.9 303 157 49.1 27 160 51.3 2 160 60.4 - - - 1947 777 111 19.0 224 115 20.7 84 119 23.2 80 126 25.9 65 129 27.4 384 138 3.2 316 141 34.1 29 145 35.9 116 155 45.0 92 157 47.4 1 154 38.7 — — — — — —