AC 4411(1)ILFORD ACH31/10/58 ILF 32 Borough of llford Health Report FOR THE YEAR 1957 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 1957-58 1 Public Health Committee—Members—Municipal Year 1957-58 2 Ilford Health Area Sub-Committee—Representatives do. 2 Ilford Committee for Education—Members—Municipal Year 1957-58 3 Officers of the Public Health Services 4 Preface 7 Reports by:— Consultants— Dr. Davidson—Psychiatrist 86 Mr. Korvin—Orthopaedic Surgeon 74 Miss Mason—Ear, Nose and Throat Surgeon 78 Dr. Thome—Ophthalmologist 74 Dr. Woolf—Cerebral Palsy Unit 82 Assistant Medical Officers—- Dr. Gross—Open Air School and Cerebral Palsy Unit 81-83 Dr. O'Connor Wilson—Remedial Exercises 76 Dr. Wright—Enuresis Clinic 91 Mr. Daly—Chief Public Health Inspector 24 Mr. Haigh—Senior Dental Officer 80 Mr. Pickett—Educational Psychologist 88 Miss Copping—Welfare Officer for Old Folk 19 Miss Hazel—Orthoptist 74 Mrs. Walker—Speech Therapist 79 Statistics & Social Conditions (Section A.)— Physical Features 11 Population 11 Births and Deaths 11-13 Rainfall 12 Vital Statistics (Tables) 14-16 General Provision of Health Services (Section B.)— Home Nursing 17 Laboratory Facilities 17 Legislation in Force 17 National Assistance Acts 18 Hospitals 21 Ambulance Facilities 21 Clinic and Treatment Centres 22-23 Page Sanitary Circumstances of the Area (Section C.)— Water Supply 27 Swimming Baths 27 Drainage and Sewerage 28 Rivers and Streams 28 Refuse Collection and Disposal 28 Sanitary Inspections during year 28 Shops Act Slaughter of Animals Act 30 Rag Flock and Other Filling Materials Act 30 Atmospheric Pollution 25,30 Land Charges 30 Housing (Section D.)— Overcrowding 31 Clearance Areas 31 Statistics 31 Housing Act (Permitted number) 32 Housing Repairs & Rents Acts 24, 32 Inspection and Supervision of Food (Section E.)— Milk 33 Ice Cream 35 Meat and Other Foods—Inspection and Sampling 35 Hawkers Food Surrendered 37 Food Poisoning 37 Bakehouses 38 Merchandise Marks Act 38 M iscellaneous— Diseases of Animals (Movement Orders, etc.) 38 Prevention of Damage by Pests Act (Rodent Control) 38 Pet Animals Act 40 Petroleum (Consolidation) Act 40 Infectious Diseases (Prevalence and Control) (Section F.)— Notifiable Diseases 41 Table showing total notifications received, 1957 42 Tuberculosis—Notifications, Deaths, etc. 44 V.D. Treatment Centres 45 Propaganda, etc. 46 Factories (Section G.)— Registration and Inspection 47 PART III SERVICES. NATIONAL HEALTH SERVICE ACTS, 1946-1957. Page Births 48 Infant Mortality 49 Neonatal Mortality 50 Illegitimate Births & Deaths 51 Visits by Health Visitors 52 Day Nurseries 52 Child Minders 54 Infant Welfare Centres—attendances 55 Smallpox Vaccination 61 Midwives 61 Gas and Air Analgesia 63 Maternal Mortality 64 Domestic Help Service 64 Prevention of Break-Up of Families 65 Convalescent Facilities 65 Loan Sick Room Equipment 66 Visits by T.B. Visitors 66 Occupational Therapy 66 T.B. Care and After Care 67 Medical Exams-Staff 67 Invalid Night Attendant Service 67 Home Nursing 68 Health Education 68 Dental Treatment 68 Welfare Food Distribution 69 Clinics— Ante-Natal 63 Artificial Sunlight 58 Diphtheria Immunisation 58 Ear, Nose & Throat 58 Midwives 61 Obstetric Consultant 64 Ophthalmic 58 Orthopaedic 56 Paediatric 57 Poliomyelitis Vaccination 60 Post-Natal 64 Smallpox Vaccination 61 Speech 58 Whooping Cough Immunisation 59 SCHOOL HEALTH SERVICE— Page School Premises 71 Routine Medical Inspections 71 Follow up examinations 71 School Dental Service 80 Benton School (Physically Handicapped) 81 Cerebral Palsy Unit 82 Treatment for uncleanliness 84 Provision of Meals and Milk 85 N.S.P.C.C 85 Invalid Children's Aid Association 85 Handicapped Children 85 Mental Health Service 86 Employment of School Children 89 Medical Examinations of Staff and Teachers 89 Camp Schools 90 Causes of Death (Schoolchildren) 90 B.C.G. Vaccination 93 Ministry of Education—Statistical Tables 94-101 Heights and Weights Table 105-6 Clinics— Artificial Sunlight 77 Child Guidance 86 Ear, Nose and Throat 78 Enuresis 91 Minor Ailments 71 Ophthalmic 73 Orthopaedic 74 Orthoptic 74 Physiotherapy 77 Speech 79 1 ILFORD BOROUGH COUNCIL Municipal Year 1957-58 Councillor A. R. Sherrell, J.P., C.A. (E.C.C.) Mayor. Alderman Miss A. S. Terry, Deputy Mayor. Aldermen: Barker, John, J.P. Gooch, Lionel Archer Scott. Bryan, William Allen Vernon, J.P. Headley, Cecil Aubrey, J.P. (resigned 2.1.58). Pearson, Frederick Thomas. Colvin, Gilbert, C.B.E., F.C.I.S. Terry MissCowan, Harold Douglas, (Deputy Mayor). Woods, Sidney Charles Victor. Fallaize, Mrs. Lilian, J.P. (E.C.C.) Young, Major Alexander, OB.E., T.D.. Gibson, Cyril Irving. J.P., C.A. (E.C.C.). Councillors: Aiken, Kenneth Leslie. Loveless, Charles Edgar, F.A.I.A. Aly, Harry Reginald Bertram. Loveless, Sydney Frank. Banthorpe, Mrs. Ruby Florence, J.P. Martin, Robert. Bennett, Mrs. Florence Edith. Masters, Frank Robert (E.C.C.). (Elected Alderman 28.1.58) Murphy, John Loughlin, A.I.N.A. Bysouth, Henry Albert, F.I.A.C. A.I.Mar.E. Clack, Arthur Henry Natzler, Isaac Bernard. Davies. David Samuel. Norwood, John Henry. Davies, George Eveleigh. Parfitt, John Howard, B.Sc. (Econ.) Drew, Leslie Victor. Rolfe- Cyril George, A.I.S.T. Earey, Eric Raymond, F.N.A.A., F.V.I. Root, Harold Goldstone, M.S.M. Gleed, Sydney George. Seaman, eric William, A.A.C.C.A. Green, Cecil Frederick Herbert, Shaw, Arnold John, B.A. F.A.I.B. Sherrell, Albert Reginald Prentice, Grose, John Stanley. , p c a (E.C.C.). (Mayor). Harris, Edgar Frank. Smith, Mrs. Lily Maude, S.R.N. Hitchcock. Leonard, A.I.B. Waters, Owen Francis, J.P. James, Francis Herbert (E.C.C.) Watts, Mrs. Mabel Lucy. Littlejohn, Mrs. Ruth Constance, M.a. Watson, George Henry. Livermore, John. Woods, Douglas Edward. 2 PUBLIC HEALTH COMMITTEE Municipal Year 1957/58 Alderman John Barker, J.P., Chairman. Councillor Mrs. L. M. Smith, S.R.N., Vice-Chairman. Alderman W. A. V. Bryan, J.P. Councillor F. H. James (E.C.C.). (Resigned 2.1.58). „ , Councillor F. R. Masters (E.C.C.). Alderman G. Colvin, C.B.E., F.C.I.S. Councillor C. G. Rolfe, A.I.S.T. Alderman Miss A. S. Terry, (Deputy Mayor) Councillor E. W. Seaman, A.A.C.C.A. Councillor Mrs. R. F. Banthorpe, J.P. Councillor A. R. P. Sherrell, J.P., Councillor D. S, Davies. C.A. (E.C.C.). {Mayor). Councillor S. G. Gleed. Councillor Mrs. M. L. Watts. Councillor L. Hitchcock, A.I.B. Councillor D. E. Woods. ILFORD HEALTH AREA SUB-COMMITTEE OF THE HEALTH COMMITTEE OF THE ESSEX COUNTY COUNCIL Municipal Year 1957/58 llford Borough Council Representatives: Aldermen Barker, Colvin, Miss Terry (Deputy Mayor)-, Councillors Mrs. Banthorpe, Clack, Earey. Hitchcock, Mrs. Littlejohn, C. E. Loveless, Masters (Chairman), Murphy, Seaman, Sherrell (Mayor), Mrs. Smith, Mrs. Watts (Vice-Chairman). Essex County Council Representatives-. Aldermen Mrs. Ball, Glenny; Councillors Berry, Mrs. Bovill, Mrs. Chamberlin, Hills, Wortley. The Executive Council for Essex Representative: Vacancy. Local Medical Committee Representative: Dr. S. M. Pruss. Hospital Management Committee Representative: Alderman Mrs. L. Fallaize. Voluntary Organisations' Representatives: Mrs. D. V. M. Ayling, Miss N. L. Odell, Mr. C. L. Tutt, Mrs. H. M, Warren. 3 ILFORD COMMITTEE FOR EDUCATION Municipal Year 1957/58 Alderman C. I. Gibson, Chairman. Alderman G. Colvin, C.B.E., F.C.I.S., Vice-Chairman. Alderman J. Barker, J.P. Councillor S. F. Loveless. Alderman Mrs. L. Fallaize, J.P. Councillor F. R. Masters (E.C.C.). (E.C.C.). Councillor J. L. Murphy, A.I.N.A. Alderman F. T. Pearson, Alderman Miss A. S. Terry, (Deputy Mayor). Councillor J. H. Parfitt, B.Sc. (Econ.) Alderman Major A. Young, O.B.E., Councillor C. G. Rolfe, A.I.S.T. T.D., J.P., C.A. (E.C.C.). Councillor E. W. Seaman, A.A.C.C.A. Councillor H. R. B. Aly. Councillor G. E. Davies. Councillor A. J. Shaw, B.A. Councillor E R Earey F N A A Councillor Mrs. L. M. Smith. S.R.N. F.V.I. Councillor O. F. Waters, J.P. Councillor Mrs. R. C. Littlejohn. M.A. Councillor Mrs. M. L. Watts. Co-opted Members: Mr. S. R. Baker. Mrs. D. E. Carter. The Rev. Canon M. Hancock, B.A. Mr. H. S. Kenward, M.A. Mr. E. R. Lower, B.A. The Rev. H Neale. 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 llford Borough Council. Medical Officer of Health, Divisional School Medical Officer, Area Medical Officer, llford 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: G. W. Newman. J. Cook. R. E. Smalley. f.Nau. A- C- R. Neale. L.A. Harms. T. F. Johnson. C. Broomfif.ld. Chief Administrative Assistant (I.B.C. and E.C.C.): F. J. Hocking. Administrative Assistant J. J. Holland (to 31.1.58). A. E. Tourle (from 1.2.58). 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., 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 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. (to 7.9.57). Mrs. I. M. Goodacre, M.C.S.P. (Part-time), (to 8.11.57) Miss S M. Boardman. M.C.S.P. (from 9.9.57) Mrs. B. Lennox, M.C.S.P. (from 6.1.58) Occupational Therapist: Miss M. I Bond. 5 Officers of the Public Health Services—continued. Non-Medical Supervisor of Midwives: Miss R. K. Jesson (from 1.2.58). Superintendent Health Visitor: Miss J. M. Oliver. Health Visitors and School Nurses: Miss E. M. P. Collins Miss I. L. Mobbs Miss A. N. Bowmer Miss A. E. Ridpath Miss M. G. Duguid Mrs. R. M. E. Nelson Miss H. Arnold Mrs. L. M. Eldridge. Miss' E. Goodchild (to 31.1.58). Mrs. C. D. Constable Miss C. Oldham Miss M. M. Stower (from 26,8.57). Miss P. M. Leavett miss L. A. Martin (from 26.8.57). Miss E. M. Brown (to 17.5.58). Miss R. A. Barton. Mrs. J. M. Weston Miss M. R. Males (from 10.2.58). Mrs. J. L. Haynes (from 26.8.57). Tuberculosis Visitors: Miss M. Gibson (to 19.10.57). Miss M. Forde. Miss L. M. Francis (to 8.7.58). Mrs. B. P. Makepeace. Occupational Therapist (T.B. Cases): Miss N. J. M. Whitelaw Matrons of Day Nurseries: Goodmayes Lane Mrs. 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, D.M., F.R.C.S. Ophthalmologists: H. J. R. Thorne, M.B., B.S., D O., D.O.M.S. M. H. Malik, M.B., B.S., 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. (to 28.8.57). 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. V. H. Foy, L.D.S., R.C.S. (to 28.2.58). Miss L. Y. Gibbs, B.D.S. R. A. Soar, B.D.S. R. C. Bigmore (from 20.5.57). Y. G. Toolsy, B.D.S. (from 14.10.57). Child Psycho-Therapists (Non Medical): Miss P. Oppenheimer, B.A. Miss L. Folk art, B.A. Speech Therapist (Part-time): Mrs. E. A. McGill, L.C.S.T. Ilford Borough Council. Public Analyists: George Taylor, F.R.I.C. J. Hubert Hamence, M.Sc.. Ph.D. 7 Preface Public Health Offices, Ilford. July, 1958. To the Mayor, Aldermen and Councillors of the Borough of llfordMr. Mayor, Ladies and Gentlemen, I submit herewith the Annual Report of the Health Services for the year 1957. As usual, in order to make this report more readable, individual officers have made their own short reports, details of which will be seen in the table of contents; note should be taken of the Chief Public Health Inspector's remarks on Clean Air, and the forthright report of the Welfare Worker for the Aged. Various other matters are discussed in my own preface. The bulk of the report otherwise is, of course, for reference and for those who wish to consult details. Births and Deaths. With 2,219 births as compared with 2,164 deaths, my prognostication of a few years back that deaths would soon exceed births has not, fortunately, been fulfilled. The death rate of 11.33 is somewhat greater than the year before but below that for England and Wales (11.5). An interesting feature is the steadily increasing number of deaths that occur in institutions. In 1955 this was 39%, in 1956 47% and last year 49%, practically half. Once again most of the deaths are due to diseases of old age. Of the 2,164 deaths, 643 result from degenerative diseases of the blood vessels, the greater bulk of these being that modern killer of the middle aged male, coronary disease. Various forms of cancer form the next big group and account for 392 deaths. 102 of these are cancer of the lung. The incidence of cancer of the lung in llford is steadily rising. The rate per million is 567 as compared with 481 for the previous year and is considerably above that for the rest of England. This is possibly due to the fact that not only do llford people smoke their fair share of cigarettes but are on the wrong side of London with respect to air pollution. Bronchitis accounted for 119 deaths. The British Isles, of course, have by far the worst record of this disease amongst the countries of the world. The causes are probably very similar to those of cancer of the lung. Once again deaths from accidents, other than road accidents, considerably exceed those on the road, in fact they are more than double. Two signs, one of progress and the other of failure, in the prevention and treatment of disease is that there were only 13 deaths from tuberculosis as compared with 22 from suicide. We seem to be conquering the former but very little seems to be possible to reduce the deaths from suicide, the results of social and personal maladjustment. The birth rate is rising. The rate of 12.23 births per thousand is higher than 11.48 for 1956 and 11.21 for 1955. It is, however, only about three quarters of the rate for England and Wales. We make up for this 8 low infant birth rate in Ilford by conservation of infant life as is shown by our low infant mortality rate of 17.12 deaths per thousand births as compared with the figure rate for England and Wales of 231. Infectious Disease. Once again I have pleasure in reporting that there is a steady diminution in the incidence of significant infectious disease. In fact rumour has it that there should be a change in the name of the Ilford Isolation Hospital. In common with the rest of the world we had our dose of Asian Influenza but there was no great upset in normal activities of the town. This was not the case, however, in the two residential schools at Kennylands and Elmbridge where two thirds of the pupils were affected. The problem imposed on the staff at these schools, where a great majority of the children had to be nursed in the dormitories and very little extra staff was available, may well be imagined. There is a short report in the School Health Section on this matter and I would like to thank the staff for the remarkable way they responded to this emergency. Immunisation continues against various diseases, a newcomer to the list last year being the inoculation of various medical and technical staff against Influenza. This was not a very popular campaign, a number of doctors and others refusing a second dose as a result of reactions to the first. Immunisation against Poliomyelitis proceeds apace. So far in 1958 about 12,260 individuals have been immunised. There have been no ill effects of the inoculation although quite a few people are still rather loath to avail themselves of the foreign Salk vaccine which has not been tested in this Country. I would like to thank the staff of my office and the doctors in the town for the way they have risen to this emergency. Up to date there have been no cases of Poliomyelitis in Ilford although there were 17 cases in 1957. Whether this is just coincidental or partly due to the immunisation campaign, only the future will show. Immunisation against Tuberculosis by B.C.G. vaccine is steadily gaining in popularity. The number of acceptances last year among those school leavers to whom it was offered rose to 62% from 43%. Two diseases have practically disappeared—true Ophthalmia Neonatorum and significant Puerperal Pyrexia. However, notifications of these conditions continue to come in for reasons which were not envisaged years ago when it was decided to make these conditions notifiable. There can be no doubt that a large proportion of the cases of both these conditions is due to infection by antibiotic resistant staphylococci. Of the 61 cases of Puerperal Pyrexia, all notified in the Ilford Maternity Hospital, at least a quarter were due to mastitis probably from this organism. With the co-operation of the Health Visiting staff a comprehensive and inclusive domiciliary survey is being undertaken of staphylococcal infection in the new-born, both those born in hospital and home being included. This is a co-operative research effort, Dr. Elias Jones, the Group Consultant Pathologist, and his staff being equally involved. School Health Service. The gross cost of the provision of School meals in this town is about a quarter million pounds. The School Health Service costs approximately £50,000. This includes provision of medical, dental, administrative and clinical services. The economy is apparent. The health of the children is such that there is no longer any waiting list for Benton School for the Handicapped and in fact the School is not full. An innovation last year was the introduction by Mr. Brand, Physiotherapist, of instruction for suitable children at a special session at the Ilford Swimming Bath which is reserved for the handicapped. 9 The cine camera and projector for the Cerebral Palsy Unit has been delivered and the film section has now started operation. The technical qualities of the first films produced by Mr. Sheffield of the School Health Section have been excellent. These film records will be very helpful in assessing the progress of the children. Public and Internal Relations. Following the excellent seminar which was held towards the end of last year, a departmental committee has been formed which meets when necessary to discuss public and departmental relations. One result of this is that a public opinion poll on a small scale was held in the town. We distributed approximately 500 questionnaires to members of the public who are in receipt of our services asking for complaints and suggestions. The results were very satisfactory and most reassurring to us. They have been published in one of the medical journals. This public opinion survey was on a small scale which meant that it cost practically nothing to carry out and can be repeated at intervals of a few years. Health Education. A departmental sub-committee has also been formed to deal with matters of health education and has already achieved a useful liaison with the Education Department. Dr. Wright, one of the School Medical Officers, has been put in charge of the organisation of health education and has already made a useful start in the schools in an effort to bring the attention of the older children to the health hazards of smoking. Health Visitors. The Health Visiting staff is two below establishment. We are in the unfortunate position of admitting that some months ago when we were up to establishment we had regretfully to refuse applications for appointment. Last year I mentioned one facet of the work of the Health Visitor— that of helping the problem family. This year I would like to draw attention to another part of her work, that is advising handicapped persons with respect to apparatus and minor gadgets that might alleviate the handicaps. This help is given both in its major facets where liaison is made with the County Welfare Committee for the provision of expensive apparatus and adaptations of homes, and also in its minor aspects with regard to the provision of small improvised gadgets which can be produced by the average handyman. One of the Health Visitors has been specially trained to advise in this matter. Hospital Services. The Ilford Borough Council can be justifiably proud in the initiative it has grasped in bringing pressure to bear on the Ministry of Health for the provision of further hospital beds in the area. Whilst the optimum, that is a new hospital, has not been achieved, the Minister has been persuaded to provide capital funds centrally for the provision of further much needed beds in the area. The Hospital Services are to be congratulated in the appointment of a Geriatric Physician in the group with beds in Ilford Isolation Hospital. I his service has just begun but we have great hopes of what it might become Dr.T.B. Dunn, the physician concerned, is making a magnificent effort in his desire to arrange local co-ordination of the services concerned. 10 Voluntary Help. Again I must thank all the voluntary societies for the help which they give to me. For many years I have mentioned them all individually. This year I would like to suggest that this help is a two way affair, for many members of the Public Health Department act voluntarily on these committees such as Workrooms for the Elderly, Ilford Committee for Home Safety, the Sub-Committees of Ilford Social Service Association, the Family Planning Association and the Tuberculosis After Care Association. This year I must report a new venture. A member of my staff, Mr. Brockington, and his wife, have started a music club to teach handicapped children various instruments. The first public performance was given six months after the club was inaugurated and holds much promise for the future. Finally I would like to acknowledge the efficiency of my staff and the unstinted co-operation they have given me during the past year. I must draw attention to the retirement in January, 1958 of Mr. J.J. Holland, Administrative Assistant, and Miss C. Blockley, Non-Medical Supervisor of Midwives, after 43 and 26 years service respectively. 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 Commitees 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 11 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Land and Inland Area (in Acres) 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 1954 182,700 „ 1955 181,700 „ 1956 180,600 „ „ 1957 179,600 Number of inhabited houses (April 1st, 1957) according to Rate Books (approx.) 51,724 Rateable Value—April 1st, 1957 (Houses and Land) £2,856,079 Sum represented by a penny rate, April 1st, 1957 (approx.) £11,500 Education Rate— 1957-58 1956-57 (E.C.C.) 7s. 11.58d. 6s. 823d. in the £ in the £ Combined Rate (all services) 18s. 8d. 17s. 4d. in the £ in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— Males Females As at December, 1956 467 78 As at December, 1957 438 87 Live Births— Birth rate per 1,000 population. Total M. F. 1957 1956 Legitimate 2,158 1,128 1,0301 Crude rate 12.35 11.71 Illegitimate 61 31 30 Adjusted rate 12.23 11.48 Rate per 1,000 total (live and still) births Stillbirths 41 20 21 18.14 19.92 Death rate per 1,000 population. Deaths 2,164 1,110 1,054 Crude rate 12.05 11.55 Adjusted rate 11.33 10.97 Percentage of total deaths occurring in public institutions 49.27 46.65 No. of Deaths. Rate per 1,000 total (live and still) births. 1957 1956 1957 1956 Maternal mortality (heading 30 of the Registrar-General's Short List) (Pregnancy, childbirth and abortion) 2 2 0.88 0.93 Death-rate of Infants under 1 year of age:— All infants per 1.000 live births 17.12 15.60 Legitimate infants per 1,000 legitimate live births 17.60 14.59 Illegitimate infants per 1.000 illegitimate live births — 50.85 Deaths from Cancer (all ages) 392 366 „ „ Measles (all ages) — — „ „ Whooping Cough (all ages) — — „ ,, Diarrhœa (under 2 years of age) 1 — 12 1. Rainfall. Total rainfall registered in the district during the year was 21.14 inches: the greatest fall in 24 hours was registered on 2nd November, 1.36 of an inch. July was the wettest month. 2. Comparability Factor—Births and Deaths. The Registrar-General supplies each town with figures known as the "area comparability factor" in connection with the birth and death rates. These factors make 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 death rate area comparability factors are also adjusted specifically to take account of the presence of any residential institutions in each area, and the birth rate area comparability factors are adjusted specifically to take account of the presence of sterile population in institutions for the mentally iil or mentally deficient in each area. The figures for Ilford are .99 for the birth rate and .94 for the death rate, and these are used in calculating these rates in Table 1A. When local crude birth and death rates have been adjusted (by multiplication by the appropriate area comparability factors) 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 (adjusted for inward and outward transfers) during the year was 2,219. Males Females Legitimate 1,128 1,030 Illegitimate 31 30 i.e., 2.7 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was 2 8 (1956) 2.6, 2.2, 3.0, 3.9, 2.9, 3.1, 2.4, 3.2, 3.3. The adjusted birth-rate, calculated on the estimated population of 179,600 is 12-23 per 1,000. 4. Deaths. The total number of deaths of Ilford residents was 2,164. This is obtained by taking the total number of deaths registered in the district (1,713), subtracting the deaths of non-residents occurring in the district (150), and adding the deaths of Ilford residents registered as having died in other districts (601). The number of deaths of non-residents registered in the district was as follows:— King George Hospital 88 Ilford Isolation Hospital 27 Other Non-residents 35 Total 150 13 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 67 Wanstead Hospital 41 Langthorne Hospital 71 London Hospital and Brentwood Annexe 95 St. Bartholomew's Hospital 19 Rush Green Hospital 25 Plaistow Hospital 7 St. Joseph's Hospice, Hackney 13 Queen Mary's Hospital, Stratford 4 East Ham Memorial Hospital 7 Harold Wood Hospital 7 Whipps Cross Hospital 58 Middlesex Hospital 4 London Chest Hospital 8 Westminster Hospital 4 In other Hospitals, Institutions and residences outside the Ilford district 171 Total 601 The adjusted death rate, calculated on the estimated population of 179,600 is 11.33 per 1,000. Inquests.—During the year, 66 inquests were held on deaths occurring in Ilford, 51 on Ilford residents, and 15 on non-residents. The ages at death were as follows:— Under 1-2 2-5 5-15 15-25 25-45 45-65 65 years and 1 year years years years years years years upwards — 2 — 2 4 6 22 30 Death Rates from Tuberculosis and Cancer, 1957 The following Table shows the death-rates for 1957 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 .007 .085 Other Tuberculosis .005 .012 Cancer of lung and bronchus .567 .426 Cancer, other forms 1.615 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 1957, arranged according to the age groups at which deaths occurred. 14 TABLE I.—Vital Statistics of Whole District During 1957 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 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 2,193 120(c) 1,552 8.5 164 476 41 18.7 1,861 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) 1957 179,600 1,788 2,219 12.35(c) 1,713 9.5 150 601 38 17.1 2,164 12.05(c) (a) The net number of births is obtained by taking the uncorrected number of births supplied by the local Registrar and adjusting for inward and outward transfers. (b) Calculated on the estimated resident population (c) Crude rate. 16 TABLE Ia Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1957 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 16.1 22.5 11.5 23.1 2.0 0.1 149 5.0 524 Great Towns 16.1 22.5 11.5 23.5 1.6 0.2 145 4.4 577 Smaller Towns 16.0 23.2 11.4 23.5 2.7 — 150 3.8 474 ILFORD (Estimated Population mid-1957 = 179,600) 12.23 18.1 11.3 17.1 — — 1721 5.62 4733 A dash (—) signifies that there were no deaths. 1 31 deaths. 2 1 death 3 85 deaths. 16 Registrar-General's Short List of Deaths and Causes TABLE II Causes of, and Ages at, Death during the year 1957 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 2164 38 11 8 11 78 547 545 926 1 Tuberculosis, respiratory 12 - - - - - 6 3 3 2 Tuberculosis, other 1 - - - - - - 1 — 3 Syphilitic disease 6 — — — — 1 2 3 — 4 Diphtheria - - - - - - - - - 5 Whooping cough - - - - - - - - - 6 Meningococcal infections - - - - - - - - - 7 Acute poliomyelitis 1 — — — 1 — — — — 8 Measles - - - - - - - - - 9 Other infective and parasitic diseases 4 - - 1 - - 3 - - 10 Malignant neoplasm, stomach 51 — — — — 3 17 11 20 11 Malignant neoplasm, lung, bronchus 102 - - - - 2 54 27 19 12 Malignant neoplasm, breast 40 — — — — 5 17 6 12 13 Malignant neoplasm, uterus 13 — — — — 2 7 2 2 14 Other malignant and lymphatic neoplasms 186 1 1 - - 12 66 48 58 15 Leukaemia, aleukaemia 11 — — 1 — 1 3 3 3 16 Diabetes 4 - - - - - 1 1 2 17 Vascular lesions of nervous system 272 - - - - 4 52 71 145 18 Coronary disease, angina 371 — — — — 5 120 124 122 19 Hypertension with heart disease 79 - - - - - 18 19 42 20 Other heart disease 314 - - - - 5 36 59 214 21 Other circulatory disease 107 - - - - 3 15 38 51 22 Influenza 31 — 1 — 3 1 10 4 12 23 Pneumonia 85 3 1 2 — — 9 22 48 24 Bronchitis 119 — — — — 2 25 33 59 25 Other diseases of respiratory system 18 1 1 - - - 6 5 5 26 Ulcer of stomach and duodenum 18 - - - - - 6 3 9 27 Gastritis, enteritis and diarrhoea 9 - 2 - - 1 2 — 4 28 Nephritis and nephrosis 19 — — — — 3 7 4 5 29 Hyperplasia of prostate 12 — — — — — 2 3 7 30 Pregnancy, childbirth, abortion 2 - - - - 2 - - - 31 Congenital malformations 14 8 1 — — 2 1 1 1 32 Other defined and ill-defined diseases 189 25 1 2 2 15 39 42 63 33 Motor vehicle accidents 15 — — 1 3 1 5 3 2 34 All other accidents 36 — 3 — — 5 9 4 15 35 Suicide 22 — — — 2 3 9 5 3 36 Homicide and operations of war 1 — — 1 — — — - - Special Causes (included above) Smallpox - - - - - - - - - 17 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 1. (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 Councd. A report of the work performed during 1957 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 1957 twenty five applications for renewal of licences were received. The Council renewed the licences in respect of these establishments. Two new applications were received, both of which were granted. The licences expire on 31st March of each year. Hairdressers' and Barbers' Premises. (Essex C.C. Act 1933, Part VI). During 1957, 49 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. 18 (vii) Nurses Agencies Act 1957. The Essex County Council on application by the Ilford Council, delegated to them, the powers conferred upon the County Council by 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 Section 3(2) to enter and inspect any such licensed premises in the Borough. No application for a licence was received during 1957. (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 Ilford during the year 1957:— (1) Residential and Temporary Accommodation. (a) Aged persons admitted to hostels and other residential establishments : —60. (b) Other persons admitted to residential accommodation:—1. (c) Persons admitted to temporary accommodation:— Adults, 7; Children 8:—15. (2) Blind Persons. The numbers of registered blind, partially sighted and defective sighted persons resident in the Borough as at 31st December, 1957, were as follows:— (i) Registered as blind 328 (ii) Partially sighted 61 (iii) Defective sighted 12 all of whom were under the supervision of the County Council's Home Teachers. During the year 7 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, 30 blind and 8 partially sighted residents were employed in open industry. During 1957, 4 blind residents from the Borough were admitted to homes for the blind. (3) Deaf or Dumb and other Handicapped Classes. The Welfare Committee of the County Council has continued to develop its activities in respect of welfare services for permanently and substantially handicapped persons (other than blind, as mentioned above) as provided for under Section 29 of the National Assistance Act, 1948. and in addition to direct provision such as special equipment on loan, grants towards the cost of structural adaptations to meet special needs, etc. the fullest co-operation has been maintained with specialised organisations in this field of welfare services, many of these bodies acting as the Council's agents in this connection." In Ilford the scheme for other handicapped persons has been delegated to a Sub-Committee of the Ilford Social Service Association of which the Medical Officer of Health is Chairman. 19 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. Two persons were dealt with during the year. They were females of 74 and 80 years. Both were removed to hospital; one died a few days after admission. The other returned home after the expiration of the magistrate's order and subsequently re-entered hospital as a voluntary patient. (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 three persons was dealt with during ihe year as follows:— (a) A female, 75 years, collapsed and died at Darby and Joan Club. (b) A male, 78 years, died at lodgings. (c) A male, 79 years, found dead in street. Miss M. J. Copping, Welfare Officer for Old People reports as follows:— "During the year 1957, 612 cases were dealt with, 356 being new. Home visits totalled 768, and 274 interviews were conducted at the Public Health Offices. Many old people made special requests not to be visited because of objections to visitors made by the persons with whom they reside. On the other hand many with no specific difficulties requested regular friendly visits because of loneliness. Those who were mobile were put in touch with Old Age Pensioners' Clubs. Others were referred to such organisations as the Rotary Clubs. Round Table, Women's Voluntary Service, Townswomen's Guilds, and Mothers' Unions. One Sunday School asked for a list of names of old people and at Easter, Whitsun, Harvest Festival. Christmas, and on the old folks' birthdays, children send cards and visit with flowers, from their own gardens, and small gifts made by the children themselves Contact with certain of these various interested bodies was maintained during the year by addressing members at their regular meetings. The result is a great deal of voluntary visiting, the volume of which cannot be estimated, but the visitors refer to the Department any persons found to be ill or in difficulties, and through this interchange of information it is known that much regular visiting is being carried out and greatly appreciated. In addition to visits and interviews, much work is done by telephone. Relatives of old persons frequently wish to ask some advice without the knowledge of the old person concerned, often they merely need reassurance on some point; occasionally they do not wish to reveal their own identity. An average of ten such telephone calls are received weekly. As in 1956 far more appeals for help were received direct from the old persons concerned, instead of from other sources as formerly and the majority of these particular persons were advised to do so by friends who had received help and advice in the past. The volume of correspondence has greatly increased. Requests from Almoners for visits and reports continued, and the National Assistance Board also referred several persons. Local General Practitioners refer a large number of cases and these usually concern persons for whom the General Practitioner has sought a Hospital bed without success. Of 96 persons known to me who were admitted to Hospital during the year, 31 fell into that category. They 20 were admitted to Hospitals after submission by the practitioner of a report by me on their home conditions. The majority of these cases entered Langthorne or St. George's Hospitals, and many now spend periods of six weeks in Hospital and six weeks at home, on a regular basis. This solves the problem in many cases, giving the relatives regular respite and opportunities to take a holiday, and the patient the feeling that he is having adequate medical care, and yet is not cut off from his home and family. There are a few sad cases where the relatives try to turn over to the State old persons who could well be cared for at home, but my experience is that this is not so common as is occasionally stated. Two cases thought to need a Hospital bed were refused admission after a visit from a Consultant. Of the 96 cases admitted to Hospital, 57 died; the majority were aged 80 or more and were suffering from incurable conditions. From the many persons visited by me on discharge from Hospital, complaints are very rare indeed. The majority speak highly of the kindness, comfort and good food supplied. Several begged me to secure their re-admission for the Christmas holiday because they were warmer and better fed in Hospital than they could afford to be at home. The saddest cases are the mentally confused, many of whom are physically fit, and cause great distress to their relatives because they become social misfits and the subject of complaints from neighbours, shopkeepers, and others whom they annoy. A few of these were admitted to Goodmayes Hospital and some to special wards at Langthorne Hospital, but they are the most difficult group to find accommodation for, even when they can afford to pay well. The greatest general problem of the year was that of accommodation for reasonably fit old persons, and this problem will increase. Many have received notice to quit under the new Rent Act, others are finding the upkeep of a house too much for them, both financially and otherwise. Many are living in large houses of which they only occupy the ground floor because they find climbing the stairs impossible or too exhausting. They are not allowed by landlords to solve their problem by subletting. Others who own a property fear to let rooms lest they become victims of unsuitable tenants which unfortunately is something only too common to find. I referred 29 persons to the Essex County Council Welfare Department for Pact 3 Accommodation but there are very long waiting lists for this, few can afford Private Old People's Homes, average fees for which are six guineas weekly. From those admitted to Part 3 Accommodation I have received many messages and letters praising the conditions. Cases who do not settle happily are most rare. There are approximately 600 elderly and aged persons who have applied for Old Age Pensioners' Flats. Many of these are living in very unsuitable conditions, some having to carry water and coal upstairs, and refuse down. Domestic Help Service relieves the problem in many instances but is never a complete solution to it. Conditions of some of the persons listed are quite good but there is little doubt that most would live a fuller life in a self-contained flat surrounded by persons of their own age group. Tribute must be paid to the W.V.S., and Ilford Social Service Association, who respectively run the Meals on Wheels Scheme. Chiropody Service, night attendant service, meal voucher scheme. Old Age Pensioners' Club and holiday schemes, etc., which bring comfort and brightness into the lives of so many of our old folk. Ilford old people are in the main a very cheerful courageous and independent spirited section of the community and a pleasure and inspiration to work among." 21 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 58 persons were assisted and 13,000 articles were laundered." (ix) Hospitals, Etc. Isolation Hospital.—172 beds are provided: 100 for general infectious diseases, 19 are for the treatment of tuberculosis patients. 50 beds (formerly used by tuberculosis patients) are now in use for chronic sick, and 3 beds are used for sick staff. Maternity Hospital.—51 beds for the reception of maternity cases are maintained at the llford Maternitv HosDital. King George Hospital.—The following is a return in respect of bed accommodation:— Total number of Beds at 31st December 1957. Pay Beds 14 Amenity Beds 7 Other Patients Children Medical Surgical 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 Hospitals in the district, the Goodmayes Hospital, with 87 Resident Staff and 1,384 patients (males 615, females 769), and Claybury Hospital, with 178 Resident Staff and 2,224 patients (males 902, females 1,322) in residence on 30th June, 1957. (These Hospitals are included in Groups 21 and 20 respectively of the North East Metropolitan Regional Hospital Board.) Other Institutions,.—The Village Homes, one of the late Dr. Barnardo's Institutions, has 60 beds in the Hospital and on 30th June, 1957, there were 36 Resident Staff and 33 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 bv 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. General medical practitioners, when arranging a patient's admission or first appointment at a hospital, inform the hospital concerned that ambulance transport is necessary and the hospital is then responsible for ordering the ambulance transport. 22 If any difficulty should arise in obtaining an Ambulance a call may be made direct to the Controller, Ilford 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) Monday, 2 p.m. Chadwell Christian Mission Hall, Essex Road, Chadwell Heath (for residents of Chadwell Heath area) Monday, 2 p.m. Mayesbrook Clinic, Goodmayes Lane, Goodmayes (for residents of Becontree area) Tuesday, 2 p.m. St. John's Church Hall, Devonshire Road, Seven Kings (for residents of Downshall area) Tuesday, 2 p.m. Manford Way Clinic, Hainault (for residents of the Ilford portion of L.C.C. estate) Tuesday, 2 p.m. Congregational Church Hall, Woodford Avenue, Ilford (for residents of Woodford Avenue area) Wednesday, 2 p.m. Cecil Hall, Granville Road, Ilford (for residents of the east side of Cranbrook Road) Wednesday, 2 p.m. Cecil Hall, Granville Road, Ilford (for residents of the west side of Cranbrook Road) Thursday, 2 p.m. Seven Kings Methodist Church Hall. Seven Kings Road (for residents of Seven Kings area) Wednesday, 2 p.m. Newbury Hall, Perryman's Farm Road. Newbury Park (for residents of the Newbury Park area) Thursday, 2 p.m. St. Albans Church Hall, Albert Road. Ilford (for residents of Grosvenor Road area) Wednesday, 2 p.m. Mayesbrook Clinic (for residents of Goodmayes area) Thursday, 2 p.m. St. Mark's Church Hall, Rose Lane, Chadwell Heath (for residents on Padnall Estate) Thursday, 2 p.m. St. Albans Church Hall, Albert Road, Ilford (for residents of Ilford Lane area) Friday, 2 p.m. Valentines Mansion, Emerson Road, Ilford (for residents of Valentines area) Friday, 2 p.m. Parish Hall, Mossford Green, Barkingside (for residents of Fairlop area) Friday, 2 p.m. Ante-Natal Clinics.—An Ante-Natal Clinic is held at the Maternity Hospital, Eastern Avenue, Ilford, 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 the first Friday morning in each month 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, on the first Friday morning of each month. 28 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. (iii) 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, Ilford. 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. 24 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The Chief Public Health Inspector reports as follows: — Housing Repairs in Relation to the Rent Act 1957 and a Comparison with the work carried out under the repealed housing repairs and Rents Act 1954. The statistics appended hereto furnish some idea of the efficaciousness of the 1957 Act and it can be assumed that much more work is being carried out under this Statute than under the former Act, despite the longer period between the landlords undertaking to carry out the works to remedy defects specified by the tenant, and as this part of the Act became operative on the 6th July, 1957, a period of six months was allowed during which those repairs can be carried out. In Ilford there has been very little conflict between landlord and tenant both of whom have readily accepted the information tendered by the officers administering this Act. At the time of writing there had been no appeals against either a Certificate of Disrepair or a Certificate of Revocation. It is only natural that there will be appeals to the County Court under this Act as there appears to be conflict of opinions as to the exact meaning of the item " disrepair." Does it include a fence, gate, boundary wall, external glazed leanto or a coal bunker? Can the painting or enamelling of a bath be required of a landlord on the tenant's application? Does the term include missing door and window furniture to make a door or window defective? Does it include electric lighting and switches or the restitution of a partially choked hot water system which operates somewhat imperfectly? These are frequently listed in the tenants' defects list and oft-times included in the certificate of disrepair, but some consider that this practice is incorrect. Insofar as Ilford is concerned, I consider that the new Act is having a salutary effect in securing an improvement in the sanitary circumstances of the Borough, particularly in the external appearance of many dwellings which in turn produce a high standard of internal maintenance. Housing Repairs and Rents Act 1954. Certificates of Disrepair. Total to end of 1956 During 1957 Total to end of 1957 Applications received ... 134 1 135 Not granted 17 — 17 Certificates issued 117 1 118 Revocations applied for and granted 87 6 93 Revocations applied for and not granted 1 3 4 Revocations not applied for 29 — 21 25 Rent Act, 1957. 1957 Applications received 188 Certificates of Disrepair granted 185 188 Applications withdrawn 3 Certificates of Disrepair issued 41 185 Undertakings received from Landlords 115 Unexpired Notices of Proposal to issue Certificates of Disrepair 29 Applications for Revocation (Outstanding at end of 1957) 4 Housing (Slum Clearance), The implementation of Councils five year programme continued but at a decreased rate by reason of the difficulties of re-housing the persons displaced from those properties included in the areas dealt with during the two previous years. Nevertheless it is felt that the insanitary house problem is being steadily surmounted and it is hoped with an improvement in the nation's economic and financial circumstances the scheme as laid down in 1955 will be fructified by 1960. Comparative figures for the years 1956 and 1957 in this branch of the Public Health Inspectors work are attached: — 1956 Six Clearance Areas declared: — Laburnum Grove. Railway Terrace, Radnor Crescent. Grove Steps. Hainault Farm Bungalows. Green Lane. Mill Road. No. of dwellings = 58 1957 Two Clearance Areas declared: — Vicarage Cottages, Ley Street. Dillys Cottages, Billet Road. No. of dwellings = 10 This brings the total number of properties dealt with under the five year scheme to 129 dwellings. Atmospheric Pollution. The complete details of one full year's recordings of the triple three instrument sites at the Town Hall, Gantshill Library and John Bramston School are furnished hereunder and are not indicative of any more serious contamination of the town's atmosphere than that applicable to the East London area as a whole. It is hoped that a year's comparison with other areas will be available in October 1958. The particular problems arising from the two small industrial areas were again to the forefront and in one instance a heavy financial expenditure was incurred in a effort to obviate the many complaints of odours generated in the industrial process. H. M. Alkali Works Inspector is responsible for the control of this particular cause of complaint and he has endeavoured to cope with the many difficulties arising therefrom. I am pleased to say that the Clean Air Act powers were not invoked to deal with a smoke pollution problem as there were no such emissions from this factory. The areas concerned will be the subject of strict surveillance during the ensuing twelve months. 26 Smoke Observation Records—May, 1957 to April, 1958 Average daily concentrations of :— Mg. of SO3/ day collected by 100 sq. cm. of Batch A PbO2 (louvered cover) Monthly Deposits Tons per sq. mile SMOKE in mg. per cubic metre SULPHUR DIOXIDE in parts per 100 million Water (litres) PH Value Water Insoluble matter Ash Other Combustible matter Water Soluble matter SO4 Station No.l Gantshell Library 1957 May 0.04 1.8 0.94 2.0 4.4 7.25 3.16 4.09 7.69 1.38 June 0.04 1.8 0.60 1.35 4.1 3.39 0.74 2.65 5.50 0.97 July 0.03 1.1 0.58 8.2 4.7 4.3 1.48 2.82 10.33 1.38 August 0.05 1.8 0.61 2.25 4.8 3.93 2.72 1.21 4.73 1.01 September 0.06 2.1 0.85 4.0 4.7 6.04 3.66 2.38 7.68 1.38 October 0.07 5.4 1.5 3.5 4.4 7.69 4.70 2.99 6.74 2.05 November 0.20 6.1 1.7 4.15 5.0 5.30 2.31 2.99 7.85 1.71 December 0.37 14.5 2.7 2.6 4.5 6.88 2.52 4.36 7.01 2.25 1958 January 0.34 9.6 2.3 3.35 3.9 9.67 4.16 5.51 7.59 1.71 February 0.15 7.04 1.8 4.2 3.9 10.43 6.20 4.23 8.28 1.74 March 0.21 7.5 1.60 1.65 4.5 6.37 4.36 2.01 5.67 1.17 April 0.17 4.6 1.1 3.10 4.3 6.68 2.92 3.76 5.84 1.17 Station No. 2 John Bramston School 1957 May 0.03 1.2 0.83 1.15 3.8 6.94 3.79 3.15 7.52 1.51 June 0.03 1.6 0.91 1.7 3.9 5.43 3.49 1.94 6.17 1.04 July 0.02 1.0 0.73 6.65 4.6 3.52 1.61 1.91 8.29 0.84 August 0.03 1.5 0.80 2.55 5.0 1.75 0.87 0.87 5.20 0.77 September 0.05 1.6 1.1 3.65 4.3 4.29 2.88 1.41 5.87 1.27 October 0.06 3.3 1.9 2.85 4.4 2.88 0.67 2.21 5.44 1.41 November 0.17 4.2 2.1 3.75 4.5 3.69 1.95 1.74 7.45 1.44 December 0.30 8.04 3.6 2.25 4.6 5.07 2.72 2.35 7.41 2.11 1958 January 0.24 5.7 2.5 3.5 4.1 6.21 3.76 2.45 8.19 1.88 February 0.13 4.1 2.4 3.6 3.9 7.63 4.84 2.79 6.61 1.34 March 0.12 3.6 1.4 1.35 4.5 4.56 3.12 1.44 4.39 0.57 April 0.12 2.9 1.1 2.40 4.0 4.70 1.91 2.79 4.50 0.97 Station No. 3 Ilford Town Hall 1957 May 0.07 3.0 1.6 1.9 3.9 4.67 1.13 3.54 9.47 0.90 June 0.05 2.9 1.1 0.25 4.1 4.27 2.30 1.97 3.90 1.07 July 0.04 2.8 1.2 7.5 4.7 5.24 2.0 3.24 10.8 1.53 August 0.05 2.9 1.1 1.45 5.1 3.54 2.27 1.27 4.67 1.37 September 0.09 4.0 1.7 2.7 4.3 5.94 3.87 2.07 8.04 2.07 October 0.37 8.9 3.1 2.25 4.1 6.30 3.23 3.07 6.97 2.00 November 0.27 9.1 3.3 2.3 4.5 9.74 5.07 4.67 8.47 1.97 December 0.49 19.1 4.5 2.0 4.3 10.47 4.74 5.73 11.97 3.03 1958 January 0.42 13.5 4.0 1.95 3.6 9.10 5.67 3.43 8.24 0.67 February 0.21 12.8 3.2 2.8 3.8 11.94 6.17 5.77 8.67 2.23 March 0.31 10.5 2.2 1.15 4.2 2.57 0.67 1.90 5.97 1.23 April 0.24 8.2 2.3 2.60 4.1 6.30 0.77 5.53 7.70 1.67 27 (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 1,526 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 Ilford 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 Ilford 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. The length of main laid by the Metropolitan Water Board in Ilford during 1957 was 155 yards of 4 inch. The water provided to the remainder of the Ilford 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. Mr. Hugh G. Ramsey, Engineer to South Essex Waterworks Co., has kindly supplied me with the information that over 3,890 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. Mains were extended by the Company as follows:—1,258 yards of 21 inch; 48 yards of 18 inch; 209 yards of 9 inch; 36 yards of 6 inch 459 yards of 4 inch; and 725 yards of 3 inch. A supplementary supply of water was obtained from the Metropolitan Water Board during the months of June and July, the total quantity supplied being 31 million gallons. 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.—Five samples of water for examination were taken from the open air swimming bath from April to September. The samples were satisfactory. Fourteen samples were also taken from the two indoor baths during February, April, May, July, August, September, October and November: all the samples were satisfactory. Upon a proposal to give facilities for early morning swimming in Valentines Park Lake, a sample of the lake water was taken in August. The sample showed appreciable, though not excessive organic and bacterial impurity for a surface water, but as much of the water consists of surface water drainage from streets, etc., it was not considered desirable to recommend that the lake be used for bathing purposes. 28 (iii) Drainage and Sewerage.— The Borough Engineer has kindly supplied me with the following: — "Ilford Corporation Main Drainage Scheme. Substantial progress was made in the scheme and the surcharge of sewers alleviated in many areas. The Roding Valley Pumping Station, (£100,000 approx.). came into operation in early December and was formally opened by the Minister of Housing and Local Government on 18th April 1958. This official opening marked the completion of the first phase of the Drainage Scheme which commenced in 1953. The Roding Valley Soil Sewer (draining to the Pumping Station) (£138,000) would have been completed in 1957 but for the delay due to negotiations with the Transport Commission. However, work was completed in 1958. A new soil sewer (£127,000) was laid between Cranbrook Road/Beaufort Gardens via Melbourne Road to Ley Street adjacent to Plesseys. The culverting of the Cran Brook Stage 11 (Valentines Park to the Central Line Railway) was completed (£150,000 approx.). Work commenced in December on the Vicarage Lane Soil and Surface Water Scheme (£300,000 approx.). Rivers and Streams. Flooding.—A number of cases of flooding due to surcharge of sewers and watercourses in times of heavy rain were reported. Pollution of Streams.—There was no pollution of consequence reported during the year, Ilford and Barking Joint Sewerage Scheme. Screening Collection Area Improvement The previous installation comprising a sheet metal tray and housing has now been replaced by a reinforced granite concrete structure capable of storing considerably larger volumes of screened rags. This new structure will reduce maintenance charges to a minimum and at the same time improve both working conditions for personnel and hygienic standards. (iv) Collection and Disposal of Refuse.—The Borough Engineer also kindly supplied the following information: — Tons Total amount of refuse collected and disposed of 51,006 Collection of Salvage:— Tons Income Wastepaper 1,015 £8,837 Rags and Scrap Metal 77 £741 (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 30,886 Houses and premises reinspected (work in progress) 25.312 Visits during disinfection 447 Houses in which nuisances were detected 805 Houses in which nuisances were abated 850* Premises disinfected 171 Premises from which articles only disinfected 113 Articles disinfected 640 Premises disinfested for verminous conditions 23 *Includes 179 nuisances detected before 1st January, 1957. 29 Notices served: — Complied Statutory:— Served with Public Health Act, 1936 108 81 Housing Acts, 1936 and 1957 — — Factories Acts, 1937 and 1948 3 3 Shops Act, 1950 — — Provide Dustbin (Ilford Urban District Council Act, 1904) 22 15 Food and Drugs Act, 1955 20 17 Cleanse Water Storage Cistern (Byelaws) — — Cover Water Storage Cistern (Byelaws) — — Informal 952 782 1,105 898 In addition to the above, 355 notices (69 statutory and 286 informal) served previous to 1st January, 1957, were also complied with. Complaints.— During the year 2,944 complaints of nuisances were received and investigated. The following is a summary: — Accumulation of manure and refuse 36 Animals improperly kept 11 Bad smells 57 Dampness of premises 63 Defective drains, w.c.'s and fittings 533 Defective roofs, gutters, downpipes, etc. 103 Defective water fittings 21 Dirty and verminous houses 27 Dirty condition of rearway 14 Flooding of premises 14 Overcrowding 33 Smoke nuisances 112 Defective or no provision of dustbin 941 Rats and mice 536 Miscellaneous 443 Total 2,944 (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 230 inspections were made, 4 Preliminary Notices were served, one of which was complied with. No Certificate of Exemption from the provisions of Section 38 was granted in 1957. 30 (vii) Eradication of Bed Bugs: — Houses found to be infested 23 „ Disinfested 23 (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 1957 in respect of premises used as a rag flock store. (x) Atmospheric Pollution.— Complaints were received of alleged smoke nuisance from 10 factories in the Uphall Road and Grove Road areas. Regular observations were maintained and investigations carried out. In 6 instances no emission was noted which would have enabled action to be taken under the Public Health Act, 1936. but 1 Statutory Notice and 4 informal notices were served in the other instances. A full report on the results of investigations into atmospheric pollution in the Borough is included in the report of the Chief Public Health Inspector. (xi) Land Charges Act, 1925.—During the year 3,546 enquiries were dealt with under this Act. 31 SECTION D— HOUSING. (i) Overcrowding.— No notices were served during 1957. (ii) Clearance Areas.— Two areas were declared by the Council to be Clearance Areas, in 1957. The Council decided to make a grant of £5 towards the removal expenses of any family required to move from a house to which a demolition or closing order applies. (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) 1,780 (b) Number of inspections made for the purpose ... 17,081 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (b) 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 1 (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 525 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 Local Authority or their officers 249* 3. Action under Statutory Powers during the year: — A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 and Sections 9, 10, and 16 of the Housing Act, 1957. (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 — B. Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 130 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 107* (b) By local authority in default of owners 3* 82 c. Proceedings under Sections 11 and 13 of the Housing Act, 1936 and Section 17(1) of the Housing Act, 1957. (1) Number of dwelling-houses demolished as a result of formal or informal procedure 21 (2) Number of dwelling-houses closed in pursuance of an undertaking given by the owners and still in force — d. Proceedings under Section 12 of the Housing Act, 1936 and Section 18 of the Housing Act, 1957. Number of separate tenements in respect of which Closing Orders were made — 4. Housing Acts, 1936 and 1957, Part IV Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 100 (ii) Number of families dwelling therein 119 (iii) Number of persons (units) dwelling therein 441½ (b) Number of new cases of overcrowding reported during the year 10 (c) (i) Number of cases of overcrowding relieved during the year 88 (ii) Number of units concerned in such cases 271½ (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 1957 of Notices served prior to 1st January, 1957. HOUSING ACTS, 1936 and 1957. During the year 1957 the work of receiving applications, calling for calculations for the "permitted number" was continued with a view to the issue of housing certificates. 10 certificates in respect of 10 houses were issued during the year, making a total of 18,330 certificates, in respect of 25,140 houses, issued to the end of 1957. 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 ACTS, 1954 and 1957. During 1957, 189 applications for Certificates of Disrepair were received. Of these, 186 were granted, and 3 were refused. Applications for revocation of Certificates were received in 13 cases. 6 were granted 3 were refused and 4 remained outstanding at the end of 1957. A review of these Acts is included in the Chief Public Health Inspector's report. 88 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 Ilford, 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, 1957: — Persons registered as distributors of milk 119 Premises registered as dairy premises (other than dairy farms) 13 150 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 1957: — Tuberculin Tested 36 do. (Supplementary) 10 (iii) Milk (Special Designation) (Pasteurised and Sterilized Milk) Regulations, 1949 to 1953: — The following licences were granted during 1957: — Pasteurized (Dealer's) 67 do. do. (Supplementary) 11 do. (Pasteurizer's) 1 Sterilized (Dealer's) 98 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 33 83 — — Tuberculin Tested Milk (Farm bottled) 5 5 — — Pasteurized Milk 80 79 1 The sample of milk treated outside the Borough, failed to satisfy the Methylene Blue Reduction Test. The processing firm was communicated with and further samples were found to be satisfactory. Sterilized 30 30 — — (v) Biological Tests.—5 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.—11 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. 85 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. 46 applications for registration in respect of 45 premises were considered during the year 1957. Registration was granted to 2 applicants in respect of the manufacture and sale and to 44 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 mobile salesman and local retailers. Samples are repeated after unsatisfactory results. In 1957. 25 samples were submitted tor examination with the following results:— No. of Samples Ministry of Health Provisional grade. % of Total Unsatisfactory Samples. 21 1 84 — 4 II 16 — — III — — — IV — — 25 100 Nil The Food Standards (Ice Cream) Order 1953 prescribed standards for ice-cream. During 1957, no samples were submitted for chemical analysis. 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. 86 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 1957, they made 12,562 inspections of food shops and food preparing premises. 137 informal and 20 formal notices were served under the Food & Drugs Act, and 20 formal and 210 informal notices were complied with including 3 formal and 104 informal notices served prior to 1957. (ii) Food Hygiene. The following gives the numbers of food premises in the area by the type of business: — Cafés and Restaurants 111 Factory canteens 27 Butchers' shops 120 Grocers' shops 269 Fruiterers' and Greengrocers' shops 125 Fishmongers' and Fishfryers' shops 51 Bakehouses 24 Bakers' shops 42 Confectioners' shops 207 976 The practice of inculcating interest in the proprietors, directors and staffs of food handling organisations was continued in 1957. 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 1957. 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. 208 samples (201 formal and 7 informal) were obtained during the year 1957; 2 formal and 3 informal samples were not satisfactory as follows :— (a) Iodised Lozenges (formal).—Almost completely devoid of menthol and phenol. A letter of warning was sent to the retailer. (b) Honey and Butter Sweets (formal)—.Contained only 3.6% butter fat and therefore misdescribed as "butter." A letter of warning was sent to the retailer. (c) Bottle of Stout (informal).—Analysis for presence of tar acids (phenols) following complaint. Result showed presence of 1 part of tar acids per million parts of stout. Legal proceedings were taken against the brewers. A plea of guilty was entered and an absolute discharge granted on payment of £3. 7s. costs. 37 (d) Bread (informal).—Contained foreign matter which was found to be rodent excreta. A letter of warning was sent to the bakers and to the retailer. (e) Bottle of milk (informal).—Contained foreign matter which was found to be a mould growth embedded in milk solids mainly of a fatty nature. 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 8 persons and 5 premises were also registered during 1957. The storage premises concerned in the other cases were not in Ilford. (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 Ilford Corporation Act, 1937, requires registration of such premises. No application for registration was received during 1957. (vi) Articles of Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man: — Bacon, 88 lbs. 6 ozs.; Beverages, 23 tins 9 bottles; Biscuits, 69 lbs. 14 ozs., 6 tins; Butter, nil; Cereals, 50 pkts.; Cheese, 27 lbs. 51 pkts.; Cream, 52 tins; Eggs, 263 lbs. (frozen), 11 cases; Fats, 3 lbs. 4 ozs. 4 pkts.; Fish (Wet and Dry), 79½ stone; Fish (Tinned), 142 tins; Fish (Shell), 7 jars; Fish (Paste), 14 jars; Flavouring, Colouring, etc., 2 Bottles; Flour, 3 lbs.; Fruit (Tinned), 1.135 tins; Fruit (Bottled), 47 lbs.; Fruit (Dried), 68 lbs. 15 ozs.; Fruit Juice, 21 tins; Jam, Preserves. 62 tins; Meat (Fresh), l,128¼ lbs.; Meat (Tinned), 1035 lbs. 3 ozs.; Meat Pies, 4; Meat Paste, 7 jars; Milk (Tinned), 557 tins; Pastry and Pudding Mixtures, 3 pkts.; Pickles. 10 jars; Potatoes, 858 lbs.; Poultry, 1 Chicken. 4 lbs. 6 ozs.; Puddings, 3; Sauces, Salad Creams, etc., 2 jars. 11 bottles; Sausages, 104 tins, 89 lbs.; Soups. 100 tins; Sugar. 82 lbs.; Sweets, 9 lbs. 8ozs. and 41 bars of Chocolate; Tomatoes, 216 tins; Tomato Juice, 25 tins; Vegetables (Tinned), 624 tins. (vii) Foreign Bodies in Food. 13 complaints were received during 1957 of the presence of foreign bodies in foodstuffs. In 4 cases legal proceedings were taken, fines of £3 and £3 3s. costs, and £3 and £2 2s, costs respectively were imposed in two cases, in one case the summons was dismissed and no costs awarded ano in the remaining case an absolute discharge was granted on payment by the defendant of 4s. costs. (viii) Food Poisoning. By virtue of Section 82 of the Ilford Corporation Act, 1937, food poisoning became compulsorily notifiable in Ilford as from 1st October, 1938. It is also notifiable under Section 17, Food and Drugs Act, 1955. 22 notifications were received. One outbreak occurred, involving 5 persons of one family, but the cause of the outbreak was not discovered. Two outbreaks, each involving 2 persons, also occurred. The causual organism was found to be Salmonella Typhi-murium in both cases, 38 In addition 13 single cases were notified and in 9 of these the organism of Salmonella Typhi- murium was identified as the cause. Investigation of 9 other suspected cases was also made during the year. (ix) Bakehouses.— There are 24 bakehouses in the district, all of which use motive power, 394 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 7 instances, and the requests were complied with in all cases. (x) Merchandise Marks Act 1926.—One contravention of this Act was reported during 1957—failure by a retailer to display a show ticket bearing the indication of origin of imported raw tomatoes. A warning letter was sent to the retailer. Diseases of Animals Act, 1950. (i) The Prohibition of Landing of Animals, Carcases and Animal Products, and Hay and Straw from the Channel Islands Order and No. 2 Order 1957. These Orders prohibited the landing in Great Britain of animals, carcases and animal products, and hay and straw brought from the Channel Islands. The Minister of Agriculture, Fisheries and Food later revoked the Orders as no further outbreaks of foot-and-mouth disease occurred in the Islands. (ii) The Importation of Horses, Asses and Mules Order 1957. This Order re-enacted and amended the Order of 1938 regarding the import and export of sporting and show horses. (iii) The Diseases of Animals (Waste Foods) Order 1957. This Order transferred the powers relating to the licensing of waste food boiling and collecting to Local Authorities, including Ilford. One application for a licence to convey and treat waste food collected within the Borough was received. The boiling plant was satisfactory and a licence was issued as and from 1st June 1957. (iv) The Live Poultry (Restrictions) Order 1957. This Order revoked and re-enacted the Live Poultry (Restrictions) Order 1954. by making certain alterations regarding restrictions on the movement of poultry, day-old chicks and hatching eggs, the licensing of exhibitions of poultry and of the holding of sales. (v) Anthrax Order 1938. On 21st October 1957 a Veterinary Inspector reported that a pig had died at a Hospital farm in the Borough under circumstances which suggested the presence of anthrax. Notification was immediately given to the Animal Health Division of the Ministry of Agriculture, Fisheries & Food and the requisite form A Notice served on the Hospital Management Committee. The Ministry's Veterinary Inspector visited the premises, examined the carcase and took blood samples therefrom. On 23rd October notification was received that the examination had given negative results and releasing the premises from the Anthrax Order of 1938. 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 effectivt 39 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 1957:— Type of Property Total Local Authority Dwelling Houses Agricultural All other (including Business and Industrial) I. Total No. of properties in District 214 51,927 29 6,062 58,232 II. No. of properties inspected as result:— (a) of notification 54 477 4 88 623 (b) survey under the Prevention of Damage by Pests Act, 1946 21 22 2 3 48 (c) otherwise — — — 976 976 III. Total No. of inspections and re-inspections carried out 207 1,046 4 12,742 13,999 IV. No. of properties found to be infested by rats :— Major - - - - - Minor 41 162 1 19 228 V. No. of properties found to be infested by mice:— Major - - - - - Minor 23 150 — 44 217 VI. No. of infested properties (under III and IV) treated by the Local Authority 56 296 - 63 415 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 40 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 15 premises during 1957. Petroleum (Consolidation) Act, 1928.—The Public Health Inspectors made 1,673 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 147, and the fees paid to the Council for such Licences was £110. 5s. One Licence was issued for the storage of calcium-carbide, the fee payable being 5s. 41 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 typhoid). Cholera. Diphtheria. Relapsing Fever. Membranous Croup. Anthrax (made notifiable by the Local Authority as from 1/4/22). Erysipelas. Scarlatina or Scarlet Fever. Pemphigus Neonatorum (made notifiable by Local Authority as from 29/6/29) Typhus Fever. 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 Influenzal Pneumonia P.H. (Infectious Diseases) Regulations, 1953. Dysentery Malaria Tuberculosis P.H. (Tuberculosis) Regulations, 1952. Acute Rheumatism (up to 16 years) The Acute Rheumatism (Amendment) Regulations, 1958. Measles and Whooping Cough The Measles and Whooping Cough Regulations, 1940. Acute Poliomyelitis P.H. (Acute Poliomyelitis, Acute Encephalitis and Meningococcal Infection) Regulations, 1949. Acute Encephalitis Meningococcal Infection 3. By Local Act. Food Poisoning Ilford 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 Ilford residents from the following infectious diseases during 1956 and 1957 were as follows: 1956 1957 Scarlet Fever - - Enteric Fever - - Diphtheria - - Acute Poliomyelitis — 1 Measles — — Whooping Cough — — Influenza 7 31 Tuberculosis—Pulmonary 19 12 Other forms 2 1 Pneumonia (all forms) 94 85 Diarrhoea (under 2 years) — 1 Meningococcal Infections — — Totals 122 131 42 TABLE III.— Corrected Notifications of Infectious Diseases for the Year 1957 NOTIFIABLE DISEASE At all Ages Number of Cases Notified At Ages—years Total Cases Notified in each Ward *Total Cases Admitted to Hospital * 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. Hainault Seven Kings S. Hainault Smallpox - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 245 — 58 189 1 2 - - 12 7 21 29 11 38 26 26 18 13 23 21 20 - Diphtheria, including Membranous Croup - - - - - - - - - - - - - - - - - - - - Enteric Fever (Typhoid and Para-Typhoid) - - - - - - - - - - - - - - - - - - - - - - Pneumonia 150 1 5 9 7 25 63 40 27 16 1 4 6 10 19 24 10 17 11 5 25 85 Puerperal Pyrexia 61 - - - 26 35 - - - - - - - - - - - 61 - - 61 - Acute Poliomyelitis 17 - 5 7 3 2 - - - - 2 - 2 1 4 1 1 - - 6 16 1 Acute-Encephalitis 2 - 1 1 - - - - - - - - - - 2 - - - - - 2 — Meningoccocal Infection 1 - 1 - - - - - - - - - - - 1 - - - - - 1 - Dysentery 100 5 14 24 10 22 20 5 5 15 — 1 2 — 15 34 22 3 3 — 1 — Ophthalmia Neonatorum 6 6 - - - - - - - 1 — - - 2 - - 1 2 - - 2 - Erysipelas 33 — — 1 2 8 15 7 1 4 2 1 2 3 1 8 3 4 3 1 1 — Pemphigus Neonatorum 2 2 - - - - - - - - - - - - - 1 - - 1 - - - Tuberculosis Pulmonary 126 — 1 6 26 57 31 5 11 13 14 13 8 11 13 8 5 11 7 12 71 12 Other Forms 10 — — 4 — 3 2 1 2 — — 1 — — — 3 2 1 - 1 1 1 Anthrax - - - - - - - - - - - - - - - - - - - - - - Malaria—Believed contracted in this country - - - - - - - - - - - - - - - - - - - - - - Believed contracted abroad - - - - - - - - - - - - - - - - - - - - - - Acute Rheumatism 7 — 1 5 1 - - - 2 1 - - - - - 1 2 1 - - 5 - Measles 1978 44 828 1100 4 2 — — 195 138 122 84 119 122 234 172 93 153 270 276 22 - Whooping Cough 268 17 122 122 5 2 — — 3 9 10 8 19 26 55 12 32 53 30 11 2 - Food Poisoning 22 — 1 10 1 5 4 1 1 1 - 1 3 4 1 6 3 1 - 1 7 - Typhus Fever - - - - - - - - - - - - - - - - - - - - - - Totals 3.028 75 1032 1478 86 163 135 59 259 205 172 142 172 217 371 296 192 320 348 334 237 99 *Included in the figures in these columns are cases notified in previous years as well as 1957. 43 The year 1957 showed a higher incidence of infectious disease, especially in the number of cases of measles, 1,978 cases occurred as compared with 502 in the previous year. 268 cases of whooping cough occurred as compared with 396 in the previous year. (a) Smallpox.—No cases were notified during 1957. 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 1957 will be found in Part 111 section of this report. (b) Scarlet Fever.— 245 cases occurred in 1957. There were no deaths from this disease. Only 20 cases were admitted to hospital, the remainder being nursed at home. (c) Diphtheria.—No cases occurred in 1957. This is the sixth successive year in which it has been possible to record a clean "bill of health" for this disease in Ilford. (d) Ophthalmia Neonatorum.—Six cases occurred in 1957. The following figures show the number of cases of Ophthalmia Neonatorum notified during the past five years: 1953, nil; 1954, nil; 1955, nil; 1956, 7; 1957, 6. No cases of ophthalmia neonatorum were due to gonococcal infection. (e) Enteric fever (Typhoid and Para-Typhoid).—No cases occurred in 1957. (f) Acute Poliomyelitis.—Seventeen cases of this disease were notified during the year. They were males of 3, 4, 7, 7, 10, 10, 17 and 18 years and females of 1, 3, 4, 7, 9, 10, 18, 26 and 35 years. All the cases were removed to hospital—thirteen to the Ilford Isolation Hospital, three to Rush Green Hospital. Romford and the remaining case to St. Bartholomews Hospital, London. Three cases recovered without complications and the others who suffered some paralysis were receiving further physiotherapy treatment. There was one death (a male patient of 18 years). In this case the onset of the disease occurred in 1956, the patient had been removed to Hospital, where death took place forty days after admission. It was necessary to exclude from their normal employment two persons who had been in direct contact with cases of poliomyelitis. Compensation was paid for the loss of wages in both cases. (g) Acute Encephalitis.—Two cases were reported—males of 6 and 2½ years. The younger child was admitted to King George Hospital but died 12 days after admission. The other child was admitted to Ilford Isolation Hospital and made a good recovery. (h) Meningococcal Infection.—One case was reported—a female of 3 years. She was removed to the Ilford Isolation Hospital and made a satisfactory recovery. (i) Pneumonia—Influenzal and Primary.—The number of cases which occurred during 1957 was 150 as compared with 159 in 1956. 44 (j) Tuberculosis.— During 1957 there were 126 new notifications of Pulmonary Tuberculosis and 10 of other forms of Tuberculosis. In addition 39 pulmonary and 3 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 31st December 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 1957 179,600 178 13 1,510 Notifications and Deaths from Tuberculosis of Ilford residents during 1957: — Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year - - - - - - - - 1-5 years - 1 - - - - - - 5-15 3 3 1 3 - - - - 15-25 12 14 - - - - - - 25-45 30 27 1 2 - - - - 45-65 25 6 2 - 5 1 - - 65-75 4 1 1 - 3 - 1 - Over 75 - - - - 2 1 - - Totals 74 52 5 5 10 2 1 - Of the foregoing new cases, the following were notified from Institutions in the district: — Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 3 1 Goodmayes Hospital — — Claybury Hospital 3 — Ilford Isolation Hospital 5 — Dr. Barnardo's Village Homes — — Of the 13 deaths which occurred of Ilford residents, notification had previously been made of 10 of the cases. 45 In the remainder one was overlooked and in two the presence of tuberculosis was discovered as a result of post-mortem. Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1957 1,323 157 1,480 Number of cases entered on the register during the year 165 13 178 Number of cases removed from the register during the year Pul. NonPul. Recovered 7 2 Deceased 21 3 Left District 99 12 Lost sight of — — Diagnosis not established 2 2 129 19 148 Number of cases remaining on register or 31st December, 1957 1,359 151 1,510 The treatment of Tuberculosis is now under the control of the Regional Hospital Board. On the 31st December, 1957, there were 1,295 patients on the register of the Ilford Chest Clinic. The number of patients from Ilford sent to Institutions under the Regional Hospital Board Tuberculosis Scheme during 1957 was as follows: Pulmonary Non-Pulmonary Total Males Females Males Females Adults 49 27 1 1 78 Children 1 1 — — 2 Tuberculosis Care Association.— Assistance was granted to 61 persons who received 511 extra nourishment grants. 109 other grants (cash etc.) were also made to 108 patients. (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 4 p.m. to 6.30 p.m. Thursday 12 noon to 3 p.m. Monday and Tuesday 4 p.m. to 6.30 p.m. Thursday 12 noon to 3 p.m. Treatments: Monday to Friday 9 a.m. to 7 p.m. Saturday 9 a.m. to 6 p.m. Monday to Friday 9 a.m. to 7 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 10 a.m. to 7 p.m. Saturday 10 a.m. to 3 p.m. Monday to Friday 10 a.m. to 7 p.m. Saturday 10 a.m. to 3 p.m. Treatments: Monday to Friday 8 a.m. to 7 p.m. Saturday 8 a.m. to 3 p.m. Monday to Friday 9 a.m. to 7 p.m. Saturday 9 a.m. to 3 p.m. 46 West Ham.— Queen Mary's Hospital, West Ham Lane. Stratford, London. E.15: — Males Females Consultations: Monday 3 to 6 p.m. Thursday 11 a.m. to 1 p.m. and 6 to 8 p.m. Saturday 2.30 to 4.30 p.m. Monday 6 to 8 p.m. Thursday 11 a.m. to 1 p.m. and 3 to 6 p.m. Saturday 2.30 to 4.30 p.m. Males Females Treatments: Monday 9 a.m. to 6 p.m. Tuesday 9 a.m. to 5 p.m. Wednesday 9 a.m. to 1 p.m. Monday 9 a.m. to 8 p.m. Tuesday 9 a.m. to 5 p.m. Wednesday 9 a.m. to 1 p.m. Thursday 9 a.m. to 8 p.m. Friday 9 a.m. to 5 p.m. Saturday 9 a.m. to 4.30 p.m. Thursday 9 a.m. to 6 p.m. Friday 9 a.m. to 5 p.m Saturday 9 a.m. to 4.30 p.m. Albert Dock Seamen's Hospital, Alnwick Road, London, E.16. Males Females Consultations: Monday, Wednesday and Friday 2 to 4.30 p.m. No female clinic 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. The Department participated in the Essex Ideal Home and Industries Exhibition which took place at Gordon Fields from 13th to 27th July, 1957. Two stands displayed various activities including food hygiene, prevention and measurement of atmospheric pollution and rodent control. Examination of Officers and Servants. The following medical examinations were carried out during 1957: — Officers Servants New Appointments 41 77 Under Sickness Regulations 5 12 On behalf of other Authorities 1 — Totals 47 89 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. 47 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 419 factories with mechanical power on the register. There are 149 factories without mechanical power on the register. There are 328 outworkers on the register. 1.—INSPECTION OF FACTORIES AND OTHER PREMISES. Including Inspections made by Public Health Inspectors. Premises (1) Number of Inspections (2) Written Notices (3) Occupiers prosecuted (4) Factories with Mechanical Power 964 7 - Factories without Mechanical Power 159 - - Other premises (not including Outworkers' premises) 90 — — Total 1,213 7 — 2— DEFECTS FOUND IN FACTORIES. Particulars Number of Defects No. of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.1) - - - - Overcrowding (S.2) - - - - Unreasonable Temperature (S3) - - - - Inadequate Ventilation (S.4) - - - - Ineffective Drainage of Floors (S.6) - - - - Sanitary Conveniences (S.7):— Insufficient 2 1 - - Unsuitable or Defective 6 8 - - Not Separate for Sexes - - - - Other Offences - - - - Total 8 9 - - 48 PART III.— SERVICES. National Health Service Acts, 1946—1957. 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 1957 was 1,788 (926 males and 852 females), of which there were 158 (92 males and 66 females) where the ordinary place of residence of the parents was outside Ilford. In addition 598 notifications of live births (306 males and 292 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 32 stillbirths (15 males and 17 females) notified in Ilford including 7 (5 males and 2 females) where the home address of the parents was outside the district, and notifications of 14 stillbirths (7 males and 7 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 39 where the home address was in Ilford, whereas the Registrar-General has allocated 41 stillbirths to Ilford. The following table shows the causes of the 39 stillbirths notified where the usual residence of the parents was in Ilford: — Stillbirths, 1957. Cause of Stillbirth Delivery in Nursing Home Delivery by County Council Midwife at Home Delivery in Hospital Total Anencephaly - - 2 2 Ante-Partum Haemorrhage - - 4 4 Congenital Abnormalities - 1 1 2 Cord Round Neck - 1 1 2 Hydrops Foetalis - - 1 1 Infarction of Placenta - - 1 1 Intra-Uterine Death - 2 7 9 Knot in Cord - 1 - 1 Placental Insufficiency - - 3 3 Prolapsed Cord - - 2 2 Rhesus Factor Incompatability - - 1 1 Subdural Haemorrhage - - 2 2 Toxaemia - - 1 1 Unknown - 2 6 8 Totals - 7 32 39 49 Care of Premature Infants.— Of the 1,788 live births occurring in Ilford during 1957, 88 weighed 5+lbs. or less at birth; 20 of these babies were born on the district and 68 in Hospital (including 3 where the home address of the parents was outside Ilford). Of the 20 babies born at home:— 16 were nursed entirely at home; 4 were transferred to hospital; 19 survived at the end of one month; 1 died between the ages of one day and one month. Of the 68 babies bom in hospital:— 5 died during the first 24 hours (including 1 where the home address was outside Ilford); 7 died between the age of one day and one month; 56 survived at the end of one month (including 2 where the home address was outside Ilford). In addition 32 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 5½ lb. or less. Of these there were: — 3 who died within the first 24 hours (in hospital); 3 who died between the age of one day and one month (in hospital); 26 who survived at the end of one month. Infant Mortality.—The number of infants dying within the first year of life was 38, the total number born being 2,219. 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 171. The following table gives the deaths of infants under one year of age. classified according to age: — Infant Deaths—1957 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 Acute Laryngo- Tracheitis - - - - - 1 - - - 1 Atelectasis 10 - - - 10 - - - - 10 Broncho-Pneumonia - 2 - - 2 2 - - 1 5 Cerebral Haemorrhage 2 - - - 2 - - - - 2 Congenital Heart Disease 1 - - - 1 1 - - - 2 Fibroelastosis of Heart - - - - - - - 1 - 1 Hyaline Membrane 1 - - - 1 - - - - 1 Immaturity 6 2 - - 8 - - - - 8 Malignant Melanoma of Liver - - - - - - - 1 - 1 Multiple Congenital Abnormalities 3 1 - - 4 - 1 - - 5 Peritonitis - 1 - - 1 - - - - 1 Pulmonary Haemorrhage 1 - - - 1 - - - - 1 Totals 24 6 - - 30 4 1 2 1 38 50 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 1957 38 17.1 1956 33 15.6 1955 42 20.0 1954 41 18.7 1953 45 20.2 1952 44 18.9 1951 50 21.0 1950 45 18.7 1949 53 20.1 1948 62 21.7 The mean average Infant Mortality rate for the past 10 years is therefore 19 2 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 1957 171 23 22 1956 15.6 24 21 1955 20.0 25 23 1954 18.7 25 21 1953 20.2 27 25 1952 18.9 28 24 1951 21.0 30 26 1950 18.7 30 26 1949 20.1 32 29 1948 21.7 34 39 Neonatal Mortality.— The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 30 deaths of infants under four weeks of age during 1957 and the rate for the year was 13 5 per 1,000 live births. The figures for the past 10 years are as follows: — Year Number Rate 1957 30 13.5 1956 25 11.8 1955 30 14.3 1954 29 13.2 1953 34 15.2 1952 32 13.8 1951 40 16.8 1950 32 13.3 1949 33 12.5 1948 37 12.9 51 Illegitimate Births and Deaths.—61 of the live births registered (31 males and 30 females) were illegitimate, that is 2-7% of the births registered. No illegitimate children 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:— Legitimate Infants Illegitimate Infants Year 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 1957 2,158 97.3 38 17-6 61 2'7 — 1956 2,056 97.2 30 14 6 59 2-8 3 50.8 1955 2,045 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 1958 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 54.0 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 The Chelmsford Diocesan Moral Welfare Association continued 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 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 llford for practical instruction during 1957. Three trainees, on completing the course in 1957 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 18 full-time qualified Health Visitors and School Nurses in addition to the Superintendent Health Visitor, and 5 Clinic Nurses. 52 The following is a summary of the home visits made by the Health Visitors and Clinic Nurses during 1957 as far as Part III Services are concerned:— First visits to newly-born infants 2,335 Subsequent visits to children under 1 year of age 6,069 Subsequent visits to children over 1 year of age and under 5 14,281 Visits to expectant mothers 1,044 Home visits for other reasons 1,285 Total visits paid 25,014 In addition there were 6,514 visits paid where no reply was received. At the request of one of the general practitioners, arrangements were made for the Health Visitor serving in the area in which his practice is situated to assist at his baby clinic once a month, commencing on the 5th February, 1957. These arrangements have proved most satisfactory. As reported last year, arrangements were made for the Health Visitors to meet the local General Practitioners on the 7th May, 1957, as previously in 1954 and 1955, with a view to increasing the degree of co-operation between the Department and the Doctors. Day Nurseries. (a) The hours of opening at the two Nurseries during 1957 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 continued at 8/6 per child per day throughout 1957 but was increased to 10/6 per child per day as from the 31st March, 1958. 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) The training of Students at the Nurseries for the Certificate of the National Nursery Examination Board continued. Five Students (two from the Ley Street Nursery and three from the Goodmayes Lane Nursery) entered for the examination during the year, all of whom obtained the Certificate. 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, thus enabling them to pursue their studies in general subjects and so improve their general educational standard during this pre-nursery course period. Three students (one from the Ley Street Nursery and two from the Goodmayes Lane Nursery) attended such a course at the St. George's Day Release Centre, Dagenham, during 1957. 53 (d) The following is a table showing the attendances, etc., at the Day Nurseries during 1957:— Situation Date of Opening Accommodation (Children) Average Daily Attendance during 1957 No. of Days in Quarantine Reasons for Quarantine with Number of Cases No. on Waiting List at 31st Dec. Chicken Pox Mumps Measles German Measles Goodmayes Lane, Goodmayes (Replaced Green Lane Nursery, open from 5.5.43 to 9.11.51) 14.11.51 50 27 41 1 — 25 — — 226-236, Ley Street, Ilford 16.8.43 50 36 112 — 11 8 1 - 54 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) (b) Premises Child-minders Number on register at 31/12/56 4 7 Number registered during 1957 3 — Number removed from register during 1957 1 4 Number on register at 31/12/57 6 3 Number of children provided for at 31/12/57 142 18 The reason for the removal from the register of the premises referred to in (a) above was that the occupier no longer wished to receive children therein to be looked after during the day. Of the child-minders whose names were removed from the register (see (b) above), one died, two returned their certificates of registration as they no longer wished to act in that capacity and the last obtained registration of her premises under the Act with a view to caring for a larger number of children therein. Clinic Premises. Manford Way Health Services Clinic.—An application was received from the Area Organiser of the Family Planning Association for permission to use this clinic on the first and third Monday evenings in each month. Approval was granted by the Health Area Sub-Committee, in accordance with the County Council's policy, on the clear understanding that the Association realised that by undertaking their functions in the premises they were in no way acting as agents of the County Council, that all literature published by the Association must clearly indicate that the services provided were not part of the County Health Services and that a notice to the effect that the use of the premises was upon and subject to the strict observance of these conditions must be displayed in the clinic when their session was being held. This Association commenced using the Manford Way Clinic for their sessions in September 1957 and a charge is made to them to cover the cost of heating, lighting, cleaning and caretaking. Health Services Clinics, Kenwood Gardens and Heathcote Avenue (Couchmore Avenue area).—In May, 1958, the Minister of Health gave approval to the erection of the Clinic in Kenwood Gardens on the land already acquired by the County Council, which is part of the site reserved for a health centre, he authorised that tenders be invited and intimated that he would be prepared to recommend loan sanction when the actual cost of the scheme based on tenders was known. With regard to the Clinic in Heathcote Avenue, which it is proposed should be erected on a piece of land to be purchased from the Borough 55 Council, again part of a site reserved for a health centre, the Minister has indicated that he will be prepared to consider its inclusion in his capital building programme for 1958/59 on receipt of revised plans and estimates of cost. Infant Welfare Centres.—103 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1957. During the year the following attendances were recorded:— Total number of attendances of infants 37,948 First attendances 1,916 Attendances of Children from 1 to 5 years 12,052 Total number of children on roll on 31/12/57 after omission of all those who had not attended for six months 3,976 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 1957 37,948 1,916 3,976 1950 36,902 1,895 3,916 1935 36,196 1,855 3,687 1934 38,392 1,858 3,565 1953 39,294 1,924 3,629 744 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:— Sessions Average Attendance Barkingside 48 44 Chad well 48 55 Becontree 49 52 Downshall 49 55 Manford Way 49 35 Woodford Avenue 48 78 Seven Kings 48 62 Cecil Hall (Wednesdays) 48 38 Cecil Hall (Thursdays) 47 43 Newbury Hall 48 50 Goodmayes 48 44 Grosvenor Road 48 61 Ilford Lane 48 48 Valentines 48 51 Fairlop 47 58 Mark's Gate 23 15 As reported last year, in view of the growing number of children on the newly-developed Padnall Estate, arrangements were made 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 being held on Thursday afternoons, from the 18th July, 1957. This is a temporary Centre, pending the erection of the proposed Health Services Clinic on the Dagenham section of the Mark's Gate Estate. The Grosvenor Road and Ilford Lane Infant Welfare Centres were moved from the Vine Memorial Church Hall, Grosvenor Road, to the St. Alban's Church Hall, Albert Road, as from the 1st January, 1958, as it was considered that the latter premises were more suitable as regards both accommodation and location. Orthopaedic Clinic. The following table summarises the attendances of children under 5 years: — Clinic Sessions New Cases Old Cases Attendances Newbury Hall 42 66 56 254 Mayesbrook 23 35 31 99 Manford Way 8 10 14 31 Totals 73 111 101 384 The 212 children were found by the Orthopaedic Surgeon to have the following defects:— Diagnosis New Cases Old Cases A B C A B C Deformity of hips 1 1 1 1 — — Genu valgum 31 12 1 28 14 7 Pes valgo-planus 1 2 2 4 — 1 Valgus ankles 6 7 3 4 5 — Deformity of chest 1 — — — — — Congenital talipes E.V. 1 — — 3 1 — Intoeing 1 5 — 3 — 2 Deformity of toes 4 3 1 1 2 2 Torticollis — — — 1 — — Metatarsal varus 2 1 — 3 2 — Out. curvature tibiae 2 — — 1 — — Genu varum 2 — — 1 — — Other conditions 14 4 2 6 7 2 Totals 66 35 10 56 31 14 A—Newbury Hall. B—Mayesbrook. C.—Manford Way. 12 pairs of Valgus Insoles, 25 G.V. night splints and 74 wedges to shoes were supplied during 1957. The Physiotherapist treated 127 children under 5 at Newbury Hall, 39 at Mayesbrook Clinic, 18 at Manford Way, with attendances of 393, 132, 384 respectively. 56 57 Paediatric Clinic.—Dr. A. Russell, the Consultant Paediatriria n rnntinued to attend the Clinic at Valentines Mansion. 19 sessions were held and 112 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 209 attendances were made. Diagnosis Discharged Improved Discharged with Advice or for Other Reasons Discharged no Treatment Discharged Cured Referred to Hospital, Dr. or Clinic Still attending Total Acrocyanosis - - 1 - - - 1 Anaemia — 3 - - - 1 4 Angioma — — - - - 1 1 Blocked Naso-Lachrymal Duct - - - 1 - - 1 Cephalhaematoma — 1 - 1 - - 2 Cleft Palate — — 1 - 1 - 2 Congenital Heart — 1 - - - 2 3 Cranial Protuberance — — - - - 1 1 Craniostenosis — — - - - 1 1 Cyclical Vomiting — — - 1 - - 1 Cyst of Lumbar Region 1 - - - - - 1 Dwarfing — — - - 1 - 1 Encropresis — — - - 1 - 1 Faints — - 1 - - - 1 Feeding Difficulties — 3 - 1 - 3 7 Hernia 1 - 1 - - 1 3 Hydrocele — — 1 - 1 - 2 Hydrocephalus — — - - - 1 1 Hypospadias — — 2 - - - 2 Infantile Hemiplegia — — — - 1 - 1 Maladjusted — — - - 1 - 1 Mongol — — 1 - - 1 2 Naevus — - - - - 1 1 Nil Abnormal - 2 14 - 1 1 18 Obesity — 3 - - 1 2 6 Petit Mal - - - - - 1 1 Pilonidal Sinus - 2 1 - - 2 5 Plagiocephaly — 1 2 - - - 3 Prematurity — — 3 - - 1 4 Primary Amentia — - - - - 1 1 Sacro-Coccygeal Dimple — — 7 - - - 7 Sep ticaemia — - - - 1 - 1 Shortening of Leg — — - - 1 - 1 Still under Investigation. — 2 - - 9 3 14 Syndactyly — — - - - 1 1 Talipes 1 2 - - 1 4 Undescended Testicle - - - 1 - 1 Upper Respiratory Infection — 1 1 1 1 - 4 2 20 38 5 21 26 112 58 Ophthalmic Clinics.—Attendances of children under school age for treatment by the Ophthalmologists during 1957 were as follows:— 'Valentines Mansion Mayesbrook Clinic Manford Way Clinic Total Number of children who attended 75 49 14 138 Number of pairs of spectacles prescribed 15 32 3 50 Total number of attendances made 110 119 25 254 Ear, Nose and Throat Clinic.—The E.N.T. Surgeon attended at 45 sessions during 1957; 71 attendances were made by 43 children of preschool age. 3 children were operated upon for removal of tonsils and adenoids at King George Hospital, llford, and 3 at the llford Isolation Hospital. 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 45 6 5 106 3 - - Mayesbrook 46 8 1 137 5 1 — Totals 91 14 6 243 8 1 — The conditions treated were as follows: — Conditions Cases A B Anaemia, Debility, Malnutrition and Catarrh 3 5 Bronchitis 1 2 Alopecia 1 — Other conditions 6 2 Totals 11 9 A.—Newbury Hall. B.—Mayesbrook. Speech Clinic.—26 children of pre-school age attended, making 425 attendances. The following is the classification of the defects found by the speech therapist:— Dyslalia 8 Stammering 1 Dyslalia and stammer 3 Dysarthria 3 Retarded speech and language 11 Diphtheria Immunisation.—During 1957 a total number of 534 children attended at the Diphtheria Prevention Clinics (249 at Valentines Clinic, 197 at Mayesbrook and 88 at Manford Way) making a total number of attendances of 3.414 (2.189. 957 and 268) with an average per session of 42, 18 and 2 respectively. 59 The following table shows the figures over the past five years. No. of primary inoculations:— 1953 1954 1955 1956 1957 At Clinics 594 515 398 338 282 By General Practitioners 1,425 1,341 1,324 1,745 1,492* Totals 2,019 1,856 1,722 2,083 1,774 No. of re-inoculations:— At Clinics 918 772 437 478 252 By General Practitioners 918 1,112 808 1,579 888† Totals 1,836 1,884 1,245 2,057 1,140 No. of live births in Ilford 2,231 2,193 2,100 2,115 2,219 *Includes 802 combined Diphtheria and Whooping Cough inoculations. †lncludes 249 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 5 years of age and over 129 - 375 113 - 359 68 - 208 501 38 3 4 2 - 4 - - - 23 35 Totals 132 — 379 115 - 363 68 - 208 524 73 *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 802 Reinoculations 249 60 Vaccination Against Poliomyelitis.—In 1957 batches of vaccine were received at approximately monthly intervals from March onwards and the vaccination programme continued as speedily as possible so far as these limited supplies allowed. General Practitioners have participated in the scheme since March 1957 and as each batch of vaccine has been received this has been allocated between the clinics and those doctors in the scheme in proportion to the number of registrations held. Some 5,400 children born in the years 1947 to 1954 inclusive who were registered by the appointed date in 1956, i.e. the 10th April, were still awaiting vaccination at the 1st January 1957. In May 1957 the Minister of Health decided that the offer of vaccination, to be undertaken when the vaccination of those children was completed, should be extended in the first place to children born in the years 1955 and 1956 and then to all children born in 1947 to 1954 inclusive who were not registered when the first offer was made early in 1956. Publicity was given to this in the local as well as in the national press and a communication was sent to the parents of all children born in 1955 and 1956 of whom we had record inviting registrations. Approximately 57% of the children born in 1955 and 1956 were registered as a result of this, compared with 29% of the 1947 to 1954 group registered early in 1956, and by mid-September 1957 some 2,000 additional children in the latter group had been registered. Vaccination of these groups in the extended scheme commenced towards the end of the year. Late in 1957 the Minister of Health decided upon a further extension of the scheme to include children born in the years 1943 to 1946 inclusive, children born in 1957 who had reached the age of six months and expectant mothers. At the same time he indicated that supplies of imported Salk vaccine would be available for distribution with a view to accelerating the vaccination programme, but parents and expectant mothers were to be given an opportunity of refusing this, although such refusals would no doubt mean some delay in arranging vaccination. The Minister further decided that when increased supplies of vaccine were available as a result of importing Salk vaccine, vaccination should be offered to general practitioners and ambulance staff and to the families of these two groups. With the co-operation of the Borough Education Officer the issue of consent forms for the 1943 to 1946 group was made through the schools in December 1957, forms were sent by post to parents of children born in 1957 who had reached the age of six months, and expectant mothers were given the opportunity of registering at the ante-natal clinics or through the domiciliary midwives; in addition press publicity was given to the extension. At the time of writing this report some 21,000 persons, approximately 58% of the eligible population in Ilford, have been registered, and in view of the large supplies of imported vaccine received in 1958, to supplement the still limited deliveries of British vaccine, it has been possible to complete the vaccination of the majority of these. Apart from those cases where the use of British vaccine is insisted upon it is now possible to offer vaccination almost as soon as application is made. The statistics given opposite show the vaccinations carried out at the Clinics in 1957 and the record cards received from general practitioners during that year in resDect of comoleted courses (two injections) carried out by them. To ensure that the programme could proceed with all possible speed when supplies of vaccine were received, to obviate so far as possible long journeys for the children and their parents and to economise on medical staff, many of the sessions at the Mayesbrook and Newbury Hall Clinics were combined with school clinics and at the Manford Way Clinic with infant welfare centres. 61 Clinic Sessions First injections given Second injections given Public Health Offices 52 1,964 1,785 Mayesbrook 22 620 555 Manford Way 17 221 210 Newbury Hall 18 356 319 Totals 109 3,161 2,869 Record cards received of completed vaccinations undertaken by general practitioners 1,929 Smali.pox Vaccination.—During 1957 record cards were received from general practitioners and various hospitals as follows: — Ages up to 14— No. of children primarily vaccinated 1,757 No. of children revaccinated 184 Ages 15 and over— No. of adults primarily vaccinated 361 No. of adults revaccinated 791 In addition 51 children were primarily vaccinated at the Manford Way Clinic. The following table shows the figures over the past five years:— 1953 1954 1955 1956 1957 No. of primary vaccinations 1,439 1,359 1,383 1,545 2,169 No. of revaccinations 469 465 398 445 975 Totals 1,908 1,824 1,781 1,990 3,144 No. of live births in Ilford 2,231 2,193 2,100 2,115 2,219 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. Midwives.—There were 14 State certified midwives (including the Non-Medical Supervisor of Midwives, her Deputy, 9 domiciliary midwives and 2 part-time midwives employed by the County Council), resident and practising in the district at the end of the year. In addition there were 24 State certfied midwives at the Ilford Maternity Hospital. 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 3 instances where the infant was found to have inflamed or discharging eyes. The condition of the eyes cleared satisfactorily. 62 Domiciliary Midwifery Service.—At the end of the year there were 9 Domiciliary Midwives employed by the County Council whole-time and 2 part-time, in addition to the Non-Medical Supervisor and her Deputy. During the year 544 cases were attended. In 497 cases the midwives were engaged to attend as midwives and in 47 cases as maternity nurses. A Doctor was called in to 79 of the 497 cases in which a midwife had been engaged. Of the infants born there were 5 stillbirths. In all of these cases the midwife was engaged as a midwife. There were 3 deaths of infants during the first year of life where the birth had been attended by a Domiciliary Midwife, all 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 54 infants attended by them during 1957. During 1957 Ante-Natal Clinics conducted by the Domiciliary Midwives were held weekly at Valentines Mansion and fortnightly at Mayesbrook Clinic and Manford Way Clinic The following is a summary of the attendances at these Clinics during the year: — Valentines Clinic Mayesbrook Clinic Manford Way Clinic First attendances 360 129 78 Subsequent attendances 1,006 384 313 Totals 1,366 513 391 Number of sessions 48 24 25 Average attendance at each session 28 21 15 In addition 2,333 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. The Ilford Borough Council continued to provide housing accommodation, where necessary, for midwives employed in the service of the Ilford Health Area Sub-Committee. At the 31st December, 1957. one maisonette and one flat were being rented by the County Council from the Borough Council under this arrangement. Salvation Army Midwifery Service.—One Salvation Army Midwife served in Ilford during the year. 49 cases were attended by her, 45 as a midwife and 4 as a maternity nurse. A Doctor was called in to 19 of these cases. Of the infants born there was 1 stillbirth. Notifications were received from the Salvation Army Midwife that it was proposed to substitute artificial feeding in respect of 6 infants. 63 Gas and Air Analgesia.—During 1957 gas and air analgesia was administered in 454 cases, of which 412 were attended by the Domiciliary Midwives (376 when acting as midwives and 36 when acting as maternity nurses) and 42 were attended by the Salvation Army midwife (38 when acting as a midwife and 4 as a maternity nurse). 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. Arrangements continued 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. Ante-Natal Clinics.—The following is a summary of the attendances at the Ante-natal Clinics during 1957 for patients booked for confinement in hospital: — Maternity Hospital Doctors Midwives Mayesbrook Clinic Manford Way Clinic First attendances 1,009 — 264 142 Subsequent attendances 5,072 3,754 2,443 942 Totals 6,081 3,754 2,707 1,084 Number of sessions 307 251* 129 63 Average attendance at each session 20 15 21 17 *Includes 202 running concurrently with Doctors' Clinics. All patients booked for admission to the Maternity Hospital are medically examined at the Ante-Natal Clinics. The first examination takes place at the 10th week of pregnancy, or as soon as possible after that time if the booking for hospital admission is not made until after the 10th week. Further, arrangements are made for all hospital booked patients to see the Obstetric Registrar at either the llford Maternity Hospital or the Mayesbrook Ante-Natal Clinic at about the 35th week of pregnancy. In conjunction with the Ante-Natal Clinics at the Manford Way and Mayesbrook Clinics the Health Visitors hold classes for relaxation exercises. During 1957 there were 98 sessions at the Mayesbrook Clinic, with 685 attendances, and 101 sessions at Manford Way Clinic, with 811 attendances. A weekly session run by Health Visitors was also commenced at Valentines Mansion in June, 1957, and 24 sessions were held in the year, with 172 attendances. 64 Relaxation exercises classes are also run by the staff of the llford Maternity Hospital for patients attending the Ante-Natal Clinic there. Post-Natal Clinics.—All patients confined in the llford 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 1957 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 Clinic Manford Way Clinic First attendances 697 202 82 Subsequent attendances 178 59 6 Totals 875 261 88 Number of sessions 52 25 12 Average attendance at each session 17 10 7 Consultant Clinic.— The Consulting Obstetrician, or his Deputy, continued to hold a Clinic twice weekly for ante-natal and post-natal cases. During the year 103 sessions were held and a total of 1,370 examinations were made. Maternal Mortality.—During 1957 there were two deaths of llford mothers recorded by the Registrar-General as due to or in consequence of pregnancy or childbirth Domestic Help Service.—During 1957 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 7 full-time, 117 regularly-employed part-time and 16 casual Helps employed. The following is a summary of the cases dealt with in 1957 :— Number of applications received for assistance 1,383 Number of cases where Domestic Helps were provided (including 549 who were having service at the commencement of the year) 1,551 Number of cases which on investigation were either not eligible for assistance or did not require the service ... 170 Cases booked but subsequently cancelled 104 Number of cases where, at the end of the year, a domestic help was booked to attend in future months (maternity cases) 65 Other cases awaiting help at end of year 25 Enquiries incomplete at end of year 17 Cases being served at 31st December, 1957 622 A training course of two weeks duration was held by the County Council in October 1957 at the Mid-Essex Technical College, Chelmsford. One domestic help from llford attended and was found to be entirely satisfactory. 65 Prevention of Break-up of Families—Health of Children.— Supervision of the few problem families in the Area continues, the Health Visitors taking the leading role and discussing the problems with interested persons, e.g., General Practitioners, Teachers, Housing Manager and Psychiatric Social Workers. Local case conferences are called as necessary. Convalescent Facilities.—The following tables show the number of persons sent away for convalescence during 1957 :— (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 Mrs. James's Home, Margate 1 2 Mother and three young children (b) Under Section 28 of the Act, i.e., other persons requiring a change of air and surroundings to aid recovery and rehabilitation. Name of Home No. of weeks' stay Total Cases 1 2 3 4 Bell Memorial Home, Lancing 1 14 12 1 28 Brook Lane Rest Home, Brighton — 2 — — 2 Caxton Convalescent Home, Limpsfield — 1 — — 1 Mrs. Chapman's Home, Bournemouth — — 1 — 1 Church Army Home, Bexhill 1 — — — 1 Church Army Home, St. Leonards — 1 — - 1 Miss Clapcott's Home, Ramsgate — 1 — — 1 Mrs. Clark's Home, Broadstairs 1 — 1 — 2 Cumberland Convalescent Home, Heme Bay — — 1 — 1 Mrs. Fennell's Home, Broadstairs — 1 — — 1 Mrs. Hayward's Home, Cliftonville — — 1 1 2 Handicapped People's Holiday Home, Gorleston 1 — — — 1 Hunstanton Convalescent Home, Hunstanton — 6 — — 6 Mrs. Jarvis's Home, Worthing — 1 — — 1 Rustington Convalescent Home, Littlehampton — 6 6 — 12 Samuel Lewis Convalescent Home, Naze 10 5 - 15 Shoreditch Holiday Home, Copthorne — 1 — — 1 St. Michael's Convalescent Home, Clacton — 2 — — 2 St. Michael's Convalescent Home, Westgate — 1 — — 1 Totals 4 47 27 2 80 60 Loan of Sick Room Equipment.—The considerable demand for equipment continues and the following table shows the issues from the Public Health Offices during 1957 :— Articles Loaned Number of Articles Articles in store at 31.12.57 on loan at 31.12 56 loaned or reloaned in 1957 on loan at 81.12.57 Mattress (Dunlopillo) 11 5 11 1 Mattress (Hair) 2 1 1 2 Invalid Chairs 41 47 49 5 Air Pillows 2 1 3 Air Rings 75 172 79 36 Cushions (Dunlopillo) 7 20 9 7 Back Rests 76 135 71 2 Beds 6 2 6 1 Commodes 28 35 29 1 Crutches 4 5 6 3 Fracture Boards (Sets) 4 1 3 1 Pillows 4 5 6 2 Pillow Slips *3 — — 3 Rubber Sheeting 137 283 151 14 Medical Sandbags (Sets) — — — 1 Spinal Carriages 1 — — — Bed Cradles 16 22 19 — Air Beds 2 14 4 1 Bed Pans 76 201 96 9 Diabetic Scales 3 - 3 2 Feeding Cups 9 12 2 9 Urinals 39 89 54 16 Sputum Mugs 1 5 5 1 Douche Cans 1 1 2 — Water Beds — 1 - 1 Water Pillows 1 - - 1 Bed Blocks (Sets) 2 — 1 1 Pails — - — 2 Bowls - - - 2 Bedstead Sides (Pair) 1 - 1 — Lifting Pole and Chain 1 3 5 — Commode Sorbo Cushion 1 1 1 — Kidney Dishes 1 — 1 — Rubber Toilet Seat (inflatable) — 1 1 1 Totals 555 1062 619 125 1956 Details 519 1,158 555 180 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 67 Rehabilitation of Tuberculosis Cases.—No cases required assistance in the maintenance charges at a rehabilitation settlement during 1957. Open-Air Shelters for Tuberculosis Cases.—One open-air shelter was supplied for a tuberculosis patient during 1957. Provision of Free Milk for Tuberculosis Cases.—The County Council's scheme for supplying to tuberculosis patients one pint of milk per day free of charge, on the recommendation of the Chest Physician, showed a slight decline during 1957. Particulars of the grants made in 1957 are given below:— No. of cases in receipt of free milk at 31.12.56 227 „ „ new grants made during 1957 89 „ „ grants discontinued during 1957 121 „ „ cases in receipt of free milk at 31.12.57 195 Boarding-out of Children (Tuberculosis Contacts).—No applications were received in 1957 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 1957. 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) 61 511 (including renewals) Other grants (Christmas cash gifts, clothing, etc.) 109 110 Travelling Expenses of Relatives Visiting Hospital Patients.— As in previous years, the County Medical Officer was able to give financial assistance in 1957 only in very special cases to enable them to visit relatives who were in hospital; no Ilford persons, however, applied for assistance under this scheme. Examination of Officers and Servants.—The following medical examinations by Essex County Council staff were carried out during 1957:— Entrants to County Council Service 60 Other purposes 33 For other Authorities 3 Invalid Night Attendant Service.—The scheme operating in conjunction with the Ilford Social Service Association for the provision of 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. 68 The following are the details of the cases dealt with under the County Council's scheme during 1957 :— No. of cases being attended at 31.12.56 Nil „ „ new cases attended during 1957 6 „ „ cases discontinued during 1957 6 „ „ „ being attended at 31.12.57 Nil Total nights attendance given 34 Home Nursing.—The Home Nursing Service in llford 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 A!dborough Road, llford. The work undertaken by Home Nurses in the llford area in 1957 was as follows: — Cases attended 2,618 Visits paid 68,502 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 and a " Family Doctor" Exhibition Unit, Loaned by the British Medical Association and installed in the entrance hall at Valentines Mansion, was used from July 1957 onwards for illustrative material on selected subjects, the display being changed each month. During the year a total of 57 lectures on various Health subjects were given by members of the medical staff of the Department, 9 to mothers attending Infant Welfare and Ante-Natal Clinics, and 48 to various organisations and children. 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: — "Dental facilities were provided at Mayesbrook Clinic for expectant and nursing mothers and for children under five years of age. These patients always have been referred from ante-natal and welfare clinics. The amount of time devoted to this work was approximately 2 5 sessions per week which was slightly less than necessary last year. One of these sessions is an evening one, which is continuing to be most useful for the mothers who are working or have difficulty in leaving their young children during the day. "The majority of extractions were performed under general anaesthesia, this always being administered by a Medical Officer. "Conservative treatment, which consists of fillings, scalings and gum treatment, was carried out whenever possible in order to save as many teeth as possible. When, however, dentures were required, these were supplied. The dentures were made by a local dental laboratory, an arrangement which has been in operation for many years and is satisfactory. "Dental X-ray facilities which are becoming more important in the quicker diagnosis of dental abnormalities and thus saving the patients pain and inconvenience, continued to be available at Mayesbrook Clinic." 60 The number of cases treated at the Clinic during 1957 was as follows: Examined Needing Treatment Treated Made Dentally Fit Expectant and nursing mothers (a) Day Sessions 77 77 97 49 (b) Evening Sessions Children under 5 83 118 83 118 100 120 91 125 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 355 29 71 88 42 — 59 4 17 10 (b) Evening Sessions 105 68 263 132 — 102 — 25 18 Children under 5 181 80 266 - - 60 - - - In addition there were 187 prophylactic treatments and other operations carried out in the case of expectant and nursing mothers at day sessions and 225 at evening sessions. The total number of sessions held for expectant and nursing mothers and children under five years of age was 115, 65 during the day and 50 in the evenings. Distribution of National Welfare Foods. The distribution of national welfare foods (National Dried Milk, orange juice, cod liver oil and vitamin tablets) to beneficiaries has continued to be the responsibility of the local health authorities under the National Health Service. As reported last year, 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, but 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. 70 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 Cleveland Road), Ilford. Tuesday and Friday 9.15 a.m.—1 p.m. 2 p.m.—3.15 p.m. Saturday 9.15 a.m.—12 noon Methodist Church Hall, Fremantle Road, Barkingside. Tuesday 9.15 a.m.—1 p.m. 2 p.m.—3.30 p.m. Goodmayes Methodist Church Hall, Blythswood Road (next to Seven Kings Library), Goodmayes. Friday 9.15 a.m.—1 p.m. 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 Wednesday 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, Culpeper Close, Hainault. Evenings and Weekends only. 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. 71 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 4 in 1956, 7 in 1955, 4 in 1954, 5 in 1953, 13 in 1952, and 7 in 1951. (ii) Scabies.—There were no cases reported during the year, as compared with 2 in 1956, 1 in 1955, none in 1954, 1953 and 1952. School Premises.—There are 38 schools, with 65 departments, 23,843 children were actually on the rolls on 19th December, 1957, as compared with 24,018 in December, 1956. The figure 23,843 includes Barking Abbey (412) and Ursuline County Placed pupils (335). The number of children in average attendance at school for the year ended 19th December, 1957 = 21,670. 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. 1,020 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 1957, 4,476 parents, or 75 6 per cent., attended the full routine medical inspections. No schools were closed during the year on account of infectious disease. 22 home visits were paid by the School Nurses to cases of minor infectious disease. In addition the Public Health Inspectors paid 1,036 visits to measles cases, and 105 visits to whooping-cough cases. Following Up.—During 1957. 4,013 home visits by the School Nurses were paid for the purpose, and 2,013 re-examinations of children (some on several occasions) were carried out by the doctors at school; 131 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 1957 were as follows: — Newbury Hall Mayesbrook Number of individual children seen 526 563 Number of attendances of children 944 991 Number of exclusion certificates granted 1 11 26 Number of certificates of fitness to attend school granted i 14 22 72 The following table shows the conditions dealt with at both the Clinici during the year:— Subnormal Nutrition 303 Debility 72 Uncleanliness:— Head 20 Body — Skin:— Ringworm:— Head — Body 1 Scabies — Impetigo 20 Dermatitis 2 Urticaria 1 Furunculosis 4 Eczema 1 Athletes Foot 14 Warts 149 Other Skin Diseases (Non-Tuberculous) 50 Eye: — Blepharitis 1 Conjunctivitis 9 Defective Vision (excluding Squint) 113 Squint 9 Other conditions 50 Ear:— Defective Hearing 4 Otitis Media 4 Other Ear Diseases 10 Nose and Throat:— Chronic Tonsilitis only 2 Adenoids only 1 Chronic Tonsilitis and Adenoids 7 Nasal Catarrh 7 Nasal Obstruction 5 Other conditions 26 Enlarged Cervical Glands (Non-Tuberculous) 4 Defective Speech 12 Teeth—Dental Diseases 50 Heart and Circulation:— Functional 4 Organic — Anaemia 6 Infectious Diseases:— German Measles 1 Whooping Cough 1 Colds and Coughs 51 Influenza 2 73 Lungs:— Asthma 7 Bronchitis 4 Pulmonary Catarrh 6 Other Non-Tubercular Diseases 3 Psychological:— Development — Stability 10 Nervous System:— Nervous Debility — Habit Spasm 1 Chorea — Petit Mal — Enuresis 7 Other Conditions 15 Deformities:— Genu Valgum 9 Posture 3 Pigeon Chest — Flat Feet 22 Valgus Ankles 13 Other Forms 39 Minor Injuries 18 Rheumatism 4 Other Defects and Diseases 55 Total number of ailments 1,232 Recuperative Holidays. During 1957, 48 children were recommended for recuperative holidays and were placed by the Borough Education Officcr. SPECIAL CLINICS. Ophthalmic Clinic. The following table summarises the attendances of school children: — Clinic Sessions New Cases Old Cases Attendances Valentines Mansion 98 250 820 1,443 Mayesbrook 94 172 520 1,194 Manford Way 12 40 55 175 Totals 204 432 1,395 2,812 74 1,019 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 364 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. Partially sighted (or blind) children—fortunately few in number— were 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." Orthoptic Clinic. Miss C. M. Hazel. D.B.O., the Orthoptist, makes the following report: "The Uford Orthoptic Clinic still functioned throughout 1957 at the Mayesbrook Health Services Clinic, 6 sessions weekly being held, with a total of 277 sessions in the year. 76 new cases of school age were seen and the total attendances of this age group numbered 528. 67 cases were discharged, the majority following satisfactory treatment. It is interesting to note that only 15 children failed to show improvement with treatment. There were 240 cases under treatment at the end of the year." Orthopaedic Clinic. Mr. H. G. Korvin, F.R.C.S., the Orthopaedic Surgeon, makes the following report: — "During the past year a new feature has been introduced into the Orthopaedic Service of the Ilford School Clinics. A weekly swimming session was added to the exercise classes, mainly for children suffering from postural defects but also for those affected by poliomyelitis, spastic paralysis etc.—Mr. Brand has very kindly taken this as an additional obligation and has been very successful in teaching a number of these children to swim, thus giving them a recreational activity which acts as remedial exercise. At Newbury Hall Clinic a ventilator was installed which made work during summer-heat very much easier. 75 The general arrangements for hospital admissions, X-ray and laboratory investigations, and surgical appliances were unchanged, but, as Messrs. Pryor and Howard had discontinued the manufacture of surgical footwear this branch was taken over by Mr. Philip Rowe, of Leytonstone. Attendance at the clinics is no longer at the excessive level of past years but was most satisfactory except for temporary interference by the influenza epidemic. 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 Sessio New ns Cases Old Cases Attendances Newbury Hall 43 100 231 471 Mayesbrook 23 37 120 208 Manford Way 8 6 14 23 Totals 74 143 365 702 Diagnosis New Cases Old Cases A B C A B c Lordosis - - - 1 - - Paralyses:— A.P.M. - 1 - 6 9 - Hemiplegia - - — 8 - - Monoplegia - - — 1 - - Spastic diplegia 1 - — 1 - - Spastic Quadriplegia - 2 - - 1 - Scoliosis - - - 6 6 - Kyphosis - - - 3 1 - Slack posture 8 - 1 10 6 1 Deformity of hips — 1 — 4 1 - Deformity of Chest — — — 2 - - Genu valgum 24 5 1 70 31 8 OCT — 1 — 7 6 - Genu varum - - - 6 - 1 Pes valgus-planus 6 - 1 37 12 - Valgus ankles 17 6 3 14 7 1 Talipes calcaneo-valgus - - - 1 - - Congenital talipes E. V. - - - - 1 - Congenital defect - - - - 1 - Intoeing 2 - - 4 2 1 Pes cavus 1 - - 4 - - Hallux valgus 6 4 - 15 8 - Deformity of toes 7 2 - 3 10 1 NAD 8 - - 1 2 - Other conditions 16 18 - 14 11 - Foot strain 4 2 - 6 - 1 Metatarsal varus - - - 3 - - Cerebral Palsy - - - - 2 - Torticollis 1 3 - Old Osteomyelitis - - - 1 - - Deformity of Foot — — — 7 — — Totals 100 37 6 231 120 14 A Newbury Hall. B—Mayesbrook. C—Manford Way. 76 9 Children of school age were admitted to East Ham Memorial Hospital. Particulars as follows:— No. of Cases Operation 1 Bone Graft Lt. Hand. 1 Arthrodesis 3rd Rt. and 2nd and 3rd Lt. 1 Lapidus Lt. Phal. Osteotomy Rt. 2 Phalangeal Osteotomy and Tendon Transfer. 1 Phalangeal Osteotomy Gt. toes. 1 Transplant of Flexor Tendon 3rd and 4th toes. 1 Transplant of Tuberosity Tibial. 1 Removal Supernumerary Toenail. During the year 26 pairs of valgus insoles, 20 pairs of surgical boots or shoes, 9 pairs Genu Valgum splints, 1 metatarsal bar, 7 calipers and inverting irons, 7 toe springs for drop foot, 23 repairs to calipers and shoes, and 64 pairs wedges to shoes were supplied to school-children. 191 cases were discharged from the Orthopaedic Clinic, 124 as cured. 19 due to absence and were kept under observation at school, 22 were showing improvement and were kept under observation at school, 26 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 periodically one of the following Clinics conducted by the Physiotherapist:— Exercises Massage Sunlight and she reports as follows:— " REMEDIAL EXERCISES During 1957 clinics for remedial exercises and physiotherapy were continued. The numbers requiring treatment at the two centres— Mayesbrook and Newbury Hall—showed an increase of almost 50%. There were 96 new cases at Newbury Hall with 1,086 attendances; and 51 cases at Mayesbrook with 502 attendances. 259 were referred from regular Medical Inspections in schools and these made 542 attendances. Thus there was a total of 406 new cases and 2,130 atten dances during the year. Classes were held to demonstrate the exercises for the treatment of the particular defect, at which mothers were present so that they could assist the children to do the exercises at home. The physiotherapist took them at monthly intervals and more often where it was found that no effort was being made at home. Children who are spastic or who are suffering from the effects of poliomyelitis have one hour sessions every week at the Public Baths to enable them to use their muscles and overcome their disability. Those suffering from chest and back deformities also attend at the baths with their parents' consent. ARTIFICIAL SUNLIGHT TREATMENT There were 53 new cases for Ultra-Violet Ray treatment during the year and all cases showed considerable benefit from the treatment. There were 833 total attendances. The continuity of treatment was much better during 1957. Children were reviewed quarterly by the doctor and discharged when fit." 77 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: — New Old Clinic Sessions Cases Cases Attendances Newbury Hall 87 96 211 1,086 Mayesbrook ... 86 51 82 502 Manford Way 91 4 4 93 Totals ... 264 151 297 1,681 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 Dischargec 1 Cured Much Improv'd Left District etc. Newbury Hall ... Mayesbrook Total ... 45 46 24 29 14 4 406 427 10 6 7 8 7 2 91 53 18 833 16 15 9 The lamp used at each Clinic is a Centrosol Unit. Ihe conditions treated were as follows: — Defects Treated. Cases A B Anaemia, Debility and Malnutrition Bronchitis Alopecia Asthma Psoriasis Acne Other Conditions Adenitis 16 11 3 3 2 1 2 13 7 3 1 8 1 *38 33 A—Newbury Hall Clinic. B—Mayesbrook Clinic. "Of the 38 cases treated 4 were Open Air school-children. 78 Ear, Nose and Throat Clinic. The E.N.T. Clinic is held at Valentines Mansion, the Surgeon attending one session weekly. 45 sessions were held during 1957 and 588 attendances were made by 257 children of school age, of whom 167 were new cases. The Consulting Ear, Nose and Throat Surgeon (Miss Margaret Mason) submits the following report: — " During this year the attendances at the Clinic declined somewhat, 588 children being seen, as compared with 749 last year; 167 of these came for the first time. This drop is partly due to a decreased number of referrals, and partly to a shorter waiting list for operative cases, obviating interim attendances. This short waiting list stood at 22 cases at the end of 1957. Our children are now operated on at King George Hospital as well as the Isolation Hospital; in the case of tonsil and adenoid diseases 101 were treated during the year. These were suspended for a period in the summer because of a limited outbreak of poliomyelitis, but the Unit at the Isolation Hospital was kept open during this time for cases such as sinus infection and deflected nasal septum which could be trea.eu with safety. I am pleased to report that during the year we have been supplied with a small pure-tone audiometer by the Essex Health Department. This is at present kept at Barking, but with the kind co-operation of the medical staff there, it is available for our children at short notice. This is a most valuable acquisition and we no longer have to trespass on the hospitality of Hospitals in other Groups for this very necessary testing. We have again tested and desensitised a number of children with nasal allergy, a condition which appears to be rather prevalent in the district, and particularly in children from homes showing a high standard of living." The following table shows the work of the Clinic: — No. Diagnosed Tonsils and Adenoids Infection ... ... 162 Deafness 24 Otitis Media 5 Mastoid disease ... ... ... ... 1 Rhinitis 41 Other defects or diseases ... ... ... 64 297 79 Speech Clinics. Mrs. M. Walker, the Senior Speech Therapist, reports on the work of the Speech Clinics during 1957 as follows:— "The Speech Therapists in the Ilford Area are as follows:— Mrs. Walker —full-time—Valentines Clinic. Mrs. McGill—6 sessions per week—Mayesbrook Clinic. Mrs. Pretious—6 sessions per week—Cerebral Palsy Unit. 4 sessions per week—Manford Way Clinic. 1 session per week-Fairlop School. There were proportionately fewer absolute discharges in 1957 since we now have an improved follow-up system entailing 3 to 6 monthly check-ups, so that a child may not finally be discharged until as much as 2 years after completing regular treatment at the clinics. It is unfortunate that there are some children who are still in need of speech therapy when they leave school. These cases are almost invariably stammerers, and although treatment of stammer is notoriously long-term it is less likely that regular treatment would be necessary at such a late age if all children were referred to us as soon as a stammer became evident. We have made this point before with reference to pre-school children with any speech difficulty, and more of these are now referred to us, but we still come across children who have been stammering with increasing severity for 2 or 3 years before being referred to a speech therapist. Too often it is suggested that parents wait and see if the child will 'grow out' of his stammer. This may be in order to avoid worrying the child by drawing extra attention to his speech, but since he is continually being reminded of his speech difficulty in all his social contacts, and so, in fact 'growing into' a worse form of stammer, it is all the more essential that he receive help as early as possible. Attendance has been average this year except, once again, for the usual fall-off during school holidays. Ilford speech therapy clinics have at last been issued with an excellent tape recorder which has been an invaluable asset to treatment with many different types of cases. We would like to express our gratitude to the increasing number of class teachers who are giving their time to individual speech practice with those children who for one reason or another are unable to receive proper help in the home." The defects treated were as follows:— Stammer 54 Dyslalia 123 Stammer and Dyslalia 5 Hearing Losses 8 Retarded Speech 12 Dysarthria 6 Cleft Palate 7 Rhinolalia 2 Mal Co-ordination 4 Dysphonia 1 Developmental Aphasia 80 54 children of school age were discharged from the Clinics during the year. In 40 cases the speech was normal. Of the remaining 14 cases, 4 ceased to attend for treatment, 5 left school or left the district, 3 refused treatment, 2 were referred elswhere. School Dental Servcie.—Mr. E. V. Haigh, Senior Dental Officer, reports as follows: — "Full dental treatment was carried out in the llford Area at Mayesbrook Clinic, Valentines Clinic and at Manford Way Clinic, Mayesbrook and Valentines Clinics having two surgeries and Manford Way one surgery in use. Owing to the shortage of Dental Officers willing to undertake Clinic work it has been only possible to use Manford Way Surgery for one session per week during 1957. At Mayesbrook and Valentines Surgeries, where there is more demand for dental treatment, it has been possible to keep almost fully staffed during the past year, by employing part-time Dental Officers each doing a few sessions a week. The number of part time Officers employed in Ilford area varied slightly during the year but averaged eight to nine, plus my own full time duties at Mayesbrook Clinic, which together made the equivalent of 3.39 full time Dental Officers. Emergency treatment on two mornings a week continued during 1957 at Mayesbrook Clinic when any child without an appointment from any school in the area could attend and be seen by myself for the relief of pain—further appointments being made for extractions or conservative treatment. During 1957 I continued with one evening session for school children, the time of these sessions being from 5.15 to 8.15 p.m. They have proved to be most satisfactory, especially for the older secondary children studying for examinations who do not wish to miss school time. In fact I now have a waiting list for these evening sessions and only those who cannot possibly attend during the daytime may be given an after school appointment. X-ray facilities are available at Mayesbrook and Manford Way Clinic. Patients attending Valentines Clinic are usually sent to Mayesbrook Clinic if they require X-rays to be taken; the films being sent back to the Dental Surgeon at Valentines Clinic after they have been processed. During 1957 we obtained the services of several part-time Officers who are interested and able to undertake orthodontic treatment of school children. In the past it has been difficult to cope with the number of patients with irregular teeth but at the moment the position is much easier. Most extractions were performed under General Anaesthesia, these being given by a Medical Officer. Usually two sessions were devoted to this per week, when an average of 20 patients were treated per session. The number of school children inspected at schools during the year was 5,972. This is 2,030 children more than last year but still well below the ideal owing to shortage of dental officers." 81 It was possible for the Dentists to visit some of the schools for the purposes of inspection, 5,972 children were inspected at schools of which 3,616 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 3,616 children referred for treatment by the Dental Surgeons at School Inspections there were 1,985 children specially referred by parents, teachers and School Doctors. In addition to the ordinary dental work of fillings and extractions, 25 dentures and 446 regulation appliances were supplied. Full details of the dental work are shown in Table V. Open Air School. Dr. D. M. B. Gross, Medical Officer in charge, reports:— "During 1957 the number of children on roll varied, being 100 on 31.12.56 and 79 on 31.12.57. There were 25 admissions and 42 discharges. Recommendations for admission were received from the following sources:— School Medical Officer 2 Borough Education Officer 2 Private Doctor 2 Head Teacher 3 Parent 4 Hospital 4 Re-admission 1 Others 7 25 The diagnoses were as follows:— Debility 2 Catarrhal Infection 1 Congenital Heart Disease 1 Residual Paralysis 2 Hemiplegia 6 Asthma 4 Nutrition 2 Congenital Deformity 1 Spastic Paraplegia 1 Bronchitis and Emphysema 1 T.B. Lung 2 Poliomyelitis 2 25 82 The 42 children discharged left for the following reasons: Fit for ordinary school 24 Left school (over age) 7 Admission to special school 7 Left district 4 42 Throughout the year periodic medical examinations took place at this school and resulting from these the following recommendations were made:— Registered for Training Centre 1 Milk, Emulsion, Exercises, etc 9 Sunlight 2 Intelligence Testing 1 Convalescence 1 For special school 2 Ophthalmic Clinic 2 Dental Clinic 3 Child Guidance Clinic 1 Paediatric Clinic 1 Children with lung diseases were given daily deep breathing exercises. The work of the school has continued along the same lines as in the previous year. The impression gained is, however, that the children are perhaps more severely handicapped than in the past. The close liaison with the Cerebral Palsy Unit is most helpful in assessing borderline cases, which can be tried out in either school before a final decision is reached." Cerebral Palsy Unit. Dr. D. L. Woolf, Consultant in Physical Medicine to the Cerebral Palsy Unit, reports as follows: — "The Unit has continued to run smoothly during the year and in close liaison with the teaching staff. Co-operation from hospitals which children are attending or have been referred to has been most helpful. Useful work is being done with the cine camera and tape recorder which have been purchased for the Unit. A recent assessment of 22 spastic children attending the Unit shows the proportion of disabled children to be affected as follows:— 36.5% have a severe physical disability 36.5% a mild physical disability 27% a moderate physical disability. It is regrettable there is as yet no nursery class attached to the Unit. The medical side is up to establishment and to the medical auxiliaries thanks are due for their co-operation and assistance during the past year, also to the Head Teacher and her staff." 83 Dr. D. M. B. Gross, Medical Officer in Charge, makes the following report:— "The Unit has been open since May 1955 and at the end of 1957 there were 22 children on roll. 11 males and 11 females; 1 child who appeared on the waiting list for 1956 has been carried forward pending suitable transport arrangements (case from Mid-Essex). During the year 12 children were examined with a view to admission; of these 6 were accepted and came from the following areas:— 2 Ilford 1 Mid-Essex (on waiting list) 1 Dagenham 1 South Essex 1 Romford (on waiting list) The 6 children rejected with the reason for rejection and the responsible Authority concerned were:— Ilford A Not a cerebral palsy B Under school age—for review later Romford Not a cerebral palsy South Essex A Mild cerebral palsy B Not a cerebral palsy C Under school age—for review later During the year 3 children were discharged:— Ilford —Removed to a Hospital Special School Walthamstow—May prove ineducable South Essex —Removed from County area As was the case last year two of the children seen for admission were under 5 years of age and their admission has had to be postponed until they reached school age and the need for a nursery class is re-emphasised. The 22 children on roll fall roughly within the following degrees of severity, and show improvement on 1956:— Corresponding figures for 1956 Severe 8 36.5% 50% Moderate 6 27.0% 25% Mild 8 36.5% 25% 22 The staff has continued to work harmoniously during the year and my thanks are due to them for their efforts which are reflected in the above improvement. A tape recorder to assist the speech therapist has been acquired during the year and it is hoped to have a cine projector shortly. The work of filming the children has started." 84 Treatment for Uncleanliness.—The School Nurses paid 220 visits to the schools (an average of 3 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 Number of Examinations of Children Number Infested Per cent. 19,468 58,406 *48 008 *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:— 1953 0.3 1954 0.2 1955 0.17 1956 0.12 1957 0.08 The Health Visitor and the School Nurse—Change of Emphasis. The Health Visitor/School Nurse, besides her other duties in the school has until now been carrying out routine head inspections of all children, except those at the grammar schools. It has long been felt that this inspection was largely a waste of time; for instance, in 58,000 inspections in 1957, only 53 cases of infestation were recorded. It is felt that the time of the trained Health Visitor could be more usefully employed and in many of the schools this visit tended to be resented by some of the children. After prolonged discussion at Committee level and with the head teachers, the following plan was agreed and will now be implemented:— Routine head inspections will cease unless specially requested by the Head Teacher for the whole school or for a class. It may be noted that some schools still wish head inspections to continue. The Health Visitor will visit the school at the beginning of each term. The school staff will bring forward cases for discussion and the Health Visitor herself from a knowledge of the children and her records will bring cases for discussion with the staff, giving details which she feels they should know. Once a year the Health Visitor should have an opportunity of seeing each child. If necessary, of course, a head inspection for any child will not be excluded. It will be noted that this arrangement is somewhat flexible from school to school and in some, full head inspection may continue as a routine, and in a few other schools annual nursing inspections may not take place. The whole procedure will be reviewed after a year. Other Ailments.—During 1956, 550 children were operated on for the removal of enlarged tonsils and adenoids as follows:— King George Hospital 245 Ilford Isolation Hospital 178 Others 127 85 Provision of Meals and Milk for School-childien.—The provision of meals in the schools commenced on 7th October, 1940. The total number of mid-day meals served during 1957 was 2,123,263 approximately. There are 25 kitchens in the Borough, established at the following schools:— Barking Abbey, Barley Lane, Beal Boys, Beal Girls, Becontree C.P. Unit, Benton, Caterham, County High Boys, County High Girls, Cleveland. Dane, Fairlop, Goodmayes. Gordon, Loxford, Mayfield Boys, Mayfield Girls, Mossford Green, Parkhill, Redbridge, 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 1957, 19,787 children were receiving milk in school. Work done by the N.S.P.C.C.—The following 41 cases were investigated:— (1) Neglect 29 (2) Ill-treatment cases 6 (3) Other cases 6 (Four cases were reported from the Public Health Department; 37 were reported from other sources for general neglect). 88 children (54 boys and 34 girls) were involved, 46 being of school age. In addition to this work, 253 supervision visits were paid to different cases, some of which were made to those reported during the previous year. The Invalid Childrens Aid Association.— Number of Ilford school children:— Loaned invalid wheel chairs 3 Admitted to Regional Hospital Board School 1 Given diet grant on account of coeliac disease 1 16 new cases were referred during the year for casework and visiting. 22 old cases were given continued casework and after care visiting. One Ilford child was admitted to the Association's Pilgrims School, Seaford, and one remained in the Brentwood Home during the whole year. Both were placed by the Education Committee. 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. 86 The number of children coming within these categories and their disposition as on the 31st December. 1957, are tabulated in the following table in accordance with the Handicapped Pupils Regulations, 1953. Return of Handicapped Pupils in the Area on 31st December, 1957. (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 1957 1 1 — 1 11 11 25 9 — 59 B. Newly ascertained in 1957 — 1 — 2 11 10 22 10 — 56 C. (i) Attending Special Schools— Day — 2 8 6 56 45 65 1 — 183 Boarding 4 3 4 1 4 3 14 20 — 53 (ii) Boarded in homes - - - - - - - 5 — 5 (iii) Attending assisted Schools - - - - - 3 4 15 — 22 D. Unplaced— (i) At no school 4 — — — — — 2 — — 6 (ii) At ordinary school — 1 — 1 3 5 17 5 — 32 E. Receiving home tuition (including those in D). 1 - - - - 2 2 - - 5 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:— "This year our plan to explore the possibilities of preventive work through a closer contact with the Maternity and Child Welfare Service has made a beginning, but it is too early yet to assess its results. Four Clinics have been visited, three of them at monthly intervals by members of our staff and discussion groups have been 87 initiated with School Medical Officers and Health Visitors, with a group of mothers of young children and with a group of ante-natal mothers. In one Clinic one of our staff attends regularly to give interviews to individual mothers seeking advice. All mothers have temporary problems of maladjustment with their children from time to time, but we are anxious to know how many fail to clear up without further assistance and are likely to be referred eventually to the Child Guidance Clinic, and in which cases later troubles can be avoided by an earlier approach to the problem. Arising partly from the work with the Maternity and Child Welfare Clinics and partly from an increasing contact with General Practitioners we have had a large number of young children referred this year, and have had a smaller group of pre-school children in treatment for several months. In July the Romford and Dagenham Clinic was opened, and all those Dagenham children who were on our waiting list were transferred. However, because a change of Psycho-therapist is deleterious we have continued to see all those Dagenham children who had already begun treatment. Dr. Vincenzi gave up his work in this Clinic to become Consultant at Romford and Dagenham Clinic. Miss Gascoyne. Educational Psychologist, now divides her time between the two Clinics. With the opening of the Romford and Dagenham Clinic the area which we serve has been decreased, and it might have been expected that the number of children referred to us would also have declined, but owing t.o an increase in the number of referrals from the remaining area our waiting list has remained at approximately the same level. The increased number of referrals from General Practitioners is a result of greater contact with local doctors, who have been invited to attend our Clinic Conferences to discuss the cases they have referred. Several of them have expressed their appreciation of the detailed investigation given to cases before any decision is reached and have said they now understand that the time-lag between referral and investigation is due to the considerable time devoted to each case by the Clinic team. School Medical Officers, Health Visitors, and Head Teachers have also attended Conferences, and have played a valuable part in pooling their information with ours. In addition, we have been visited by Children's Officers, Probation Officers, a Psychiatric Social Worker from America, a Speech Therapist, Psychological Fellows, Social Science Students, and many others. Two visits were made by members of the Staff to Residential Schools for Maladjusted Children, one to Nazeing Park and another to Farney Close. We cannot stress too much how great a help such personal contacts are to us in making recommendations for placement of individual children. This year we have again had a display of educational books, to which Head Teachers were invited; and lectures have been given to Teachers and the Townswomen's Guild. In addition to diagnostic investigation and work with children who need a period of observation and supervision, a large proportion of the children seen require regular treatment over a period or many months. About 40 children are seen weeklv for ¾-hour periods of individual psycho-therapy with a Psychiatrist or Child Psycho-Therapist while their Mothers are given similar help by the Psychiatric Social Workers. We have had 2 grouos, one of Juniors, and one of preschool children. The Mothers of these children are also seen in groups. 88 I would like to call attenion to one point in the annual figures which may give the misleading impression that nearly half the cases referred failed to attend. The number is in reality very much less; it appears unduly high because many cases had been kept open from previous years, and have now been closed after every effort to secure an answer to our letters met with no response." (a) No. of cases awaiting diagnosis at end of previous year 1956 61 (b) No. of new cases referred to Clinic during year 198 (c) No. of cases diagnosed and which received treatment during year 123 (d) No. of cases awaiting diagnosis at end of year 43 (1) Psychiatrist. No. of cases treated 225 No. of interviews 633 (2) Psychologist. No. of cases treated 36 No. of interviews 1,084 (3) Psychiatric Social Worker. No. of parents interviewed or advised 301 No. of interviews 1,254 (4) Educational Psychologist. No. of cases given remedial education 12 No. of interviews 334 (e) No. of children placed in Residential Schools 11 (f) No. of children awaiting treatment at the Clinic 27 (g) No. of cases carried over from previous year which received treatment 54 (h) No. of cases closed: 220 i Treatment completed 120 ii Not taken up, non-co-operation etc. 68 iii Improved whilst awaiting treatment 32 Report by Mr. K. Pickett, Educational Psychologist:— School Psychological Service. "This year has again been one of quiet consolidation of existing projects rather than of outstanding new developments. One major change has occurred: the opening of the Romford Clinic to serve the Dagenham area. As Miss Gascoyne, Educational Psychologist for the Dagenham area, spends only half her time in this Clinic the gain is in the Clinical service as opposed to the School Psychological. It has been possible to maintain the same level of clinical diagnostic service. The remedial classes in the area have continued successfully during the year. The Centre in llford has suffered from frequent staff absences and changes; whilst recruitment for the Barking remedial class lagged because of parental opposition to the necessary change of school. 89 Course of lectures to teachers were given during the year, mainly in the problems of teaching of reading. Occasional lectures were given to groups of parents. Exhibitions of school books have been held at Loxford Hall, and elsewhere, which were visited by large numbers of teachers. At the end of ten years or so service the main developments would seem to be:— (a) increasing acceptance of the value of the psychological service by teachers and all workers in education. (b) the development of the clinical service until balance between the two aspects, the clinical and the school psychological, has been achieved. One outcome of this has been the increasing demands made upon the psychologists for close liaison with the schools, to gain and to give information about the child's development and behaviour. (c) an increasing recognition of the symptom of withdrawal as indicative of emotional difficulty. (d) a recent increase in the provision for special educational treatment within the framework of the normal school. Possibly this is due to the fall in numbers in the age groups now in the Primary Schools. This has led to a change in the emphasis in the nature of the problem of the child entering the Remedial Centre. There are now: (a) more children whose poor adjustment is due to extra school causes. (b) more children in whom the factor of dullness is important. Both factors mitigate against rapid improvement and rehabilitation." Summary New cases seen ... ... ... ... ... 259 Children seen as follow-up 293 552 Children referred to C.G.C. ... ... 74 School visits made for children referred to C.G.C. ... 89 Children given remedial education ... ... ... 12 Attendances for remedial education .. ... ... 334 Employment of School Children and Young Persons.—During 1957, 241 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.—5 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 19 11 22 74 126 Under Sickness Regulations 1 1 — — 2 90 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. Medical Supervision The supervision of the medical arrangements for the pupils at Elmbridge School, Cranleigh, Surrey, became my responsibility during the year and routine medical inspections were carried out by one of my School Medical Officers on similar lines to those already in being for Kennylands Park School in Oxfordshire. The existing arrangements, however, whereby Surrey County Council undertook dental inspection and treatment of pupils at Elmbridge School were continued. In September there was an outbreak of Influenza at Kennylands Park School which, although mild, affected about two-thirds of the pupils and members of the staff and was considered by the General Practitioner in charge of the immediate medical treatment to be of the Asian variety. Unfortunately, the resident school nurse was in hospital at the time, but the situation was admirably coped with under extremely difficult conditions by all members of the staff, in addition to a Health Visitor kindly loaned by Oxfordshire County Council. There was a similar outbreak of Influenza at Elmbridge School in October affecting over two-thirds of the pupils and members of the staff. Again, under very trying circumstances, including lack of suitable emergency equipment and accommodation, all members of the staff, with the help of a Clinic Nurse from my Department, overcame the situation. I visited both schools during the above-mentioned outbreaks. Further investigations are being made with a view to suggesting methods of overcoming some of the problems at these schools. The Causes of Death among Children of School Age (i.e., from 5—15 Years) in Ilford, during 1957 were:— Broncho pneumonia 4 Leukaemia 1 Cirrhosis of Liver 1 Accident 1 Peritonitis 1 8 91 Ilford Enuresis Clinic. Dr. P. A. C. Wright, School Medical Officer in charge of the Clinic since Dr. Pooley left in July, reports as follows for the year ended December 31st 1957. "This clinic, now well established, has continued to be held on Wednesday mornings at the Ilford Public Health Offices. Again there has been an increase in the number of new cases, and rather more of these have come from General Practitioners than in previous years. Total attendances show a very slight fall due to some sessions being cancelled because of illness. During the twelve months ended December 31st 1957 there have been 79 new cases, made up as follows:— Recommended by Under 5 years Over 5 years Boys Girls Boys Girls Parents - - 2 - General Practitioners 4 - 2 1 Infant Welfare Centre Officers 9 0 — — School Medical Officers 1 — 30 20 Health Visitors — 1 2 1 14 7 30 22 Total 79 cases Total attendances (old and new cases) 372 No. of sessions 40 Procedure. The procedure has remained much the same as in previous years. Almost always the child comes with the mother, and often with his brothers and sisters as well. On occasions an older child will arrive alone. This is usually a good sign, often meaning the mother is now less concerned and the child is almost better. (a) Urine.—A morning specimen is brought by each child on every attendance, and a routine analysis is made by the attending Health Visitor. (b) History of the Enuresis.—This has to be taken with some care, for psychological factors play a large part in both causation and cure of the complaint. Domestic upsets, new babies and starting school seem potent factors. (c) Family Background.—The inter-relationship between the child, his mother, and his brothers and sisters is important. (d) General Medical Condition.—Any organic disease has to be excluded. If it is suspected the child is referred to the Paediatric Specialist for his advice. Often, however, the physical examination of a young child is not made until the second visit, when some confidence has been gained. 92 (e) Discussion and Advice.—Often the mother is as hopeless about the condition as the child, and on her attitude a great deal depends. She can make a rather trying task easy or almost impossible. The child is told he will be all right but that he may be attending for some time, getting a little better between visits, and the mother's support of this attitude is required. If the child is already having some dry nights he is asked to keep a chart, being a daily record of his success and improvement, and of considerable therapeutic value in itself. (f) Medicinal Treatment.—Cases are of course considered for drug therapy on their merits. As in past years a supply of amphetamine sulphate was available for direct issue, other drugs being supplied by the patient's own doctor on request, e.g. Disipidin Snuff and Phenobarbitone and some supplies of Dexten were kindly provided by Clinical Products Ltd. Amphetamine Sulphate 63 Phenobarbitone 3 Disipidin Snuff 2 Dexten (Long acting Dex-amphetamine sulphate) 2 Chart keeping—without drugs 9 Analysis of Results. A. Cases first attending in 1957. 1957 1956 (1) Discharged—completely dry 18 33 (2) Ceased to attend 23 (14 of these were much improved when last seen—but failed to attend the final follow-up appointment; 9 appeared unchanged when last seen) (3) Improved—still attending 17 27 (4) Unchanged 2 (5) Worse 3 (all these had become worse after birth of younger sibling) (6) Sent elsewhere—Paediatrician 2 Child Guidance Clinic 1 (7) Not yet re-attended 10 9 (8) Under 3 years old 3 Total 79 71 B. Cases still attending from previous year. (1) Discharged during 1957 18 (2) Ceased to attend 5 (3) Improving 4 (4) Unchanged 1 (5) Referred to Paediatrician Child Guidance Clinic 1 93 Further Analysis of Cases Cured. 1957 1956 No. % No. % Boys Dry 23 46 20 41.66 of total Girls Dry 9 31 13 56.5 of total Average Age: Boys 9.5 years 6.7 years Girls 9.75 „ 7.5 „ Average visits until dry Boys 3.5 4 Girls 3.8 4 Remarks. The General Practitioners have this year shown some increased interest in this clinic, although over 90% are still referred from within the Public Health Services. The children seem to fall into one of two main groups— (i) those who have never become dry, and (ii) those who were all right until upset emotionally by some factor— the birth of a baby sister or brother; starting school; or a quarrel between the parents. A small nucleus of older "chronics" attends the clinic, almost all are from unhappy homes, and many attend the Child Guidance Clinic as well. An electrical device which rings a bell when micturition commences is being loaned to these cases, s.o far with considerable success in one case; some success in a third, and none so far in the present one. As all these 5 children are a residue from past years they have not been included in the figures above. Organic disease of the urinary tract does not seem to account for more than a fraction of enuretic children. Three had daytime frequency of micturition as well as enuresis, and were referred to the paediatric clinic for investigation of this symptom. No history suggested worms as a cause. Mostly the children need faith in their own ability to be normal, as do their mothers very often. The children attend the clinic and pretend to the world that they are unconcerned but the fact that they are desperately worried is made clear by the change in their attitude to life when they start obviously to improve. Even one such child discharged as cured makes a Wednesday morning session well worth while." B.C.G. Vaccination of School Children. No. of pupils to whom B.C.G. was offered 1,938 No. of pupils whose parents consented to treatment 1,200 No. of pupils undergoing tuberculin test 1,022 Positive; 63. No. of pupils who received B.C.G. 889 No. of pupils post-tested 887 Converted to Positive 862 Negative 19 Absentees from readings 6 94 Ministry of Education. MEDICAL INSPECTION RETURNS. Year Ended 31st December, 1957 TABLE I. 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 1,861 Second Age Group 2,708 Third Age Group 979 Total 5,548 Number of other Periodic Inspections 368 Grand Total 5,916 B.—Other Inspections. Number of Special Inspections 1,539 Number of Re-inspections 3,493 Total 5,032 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 sums of columns (2) and (3).) Group For defective vision (excluding squint) For any of the other conditions recorded in Table IIA Total individual pupils (1) (2) (3) (4) 73 419 463 Second Age Group 299 617 835 Third Age Group 166 122 264 Total (prescribed groups) 538 1158 1562 Other Periodic Inspections 49 98 133 Grand Total 587 1256 1695 95 TABLE II. A.—Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1957. 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 Number of Defects Requiring Treatment Number of Defects Requiring Observation but not Treatment Periodic Inspection Special Inspection Periodic Inspection Special Inspection (1) (2) (3) (4) (5) 4 Skin 104 6 9 5 Eyes— a. Vision 587 6 203 2 b. Squint 52 — 17 — c. Other 46 2 23 3 6 Ears— a. Hearing 20 11 30 4 b. Otitis Media 4 - 8 2 c. Other 2 - 3 1 7 Nose or Throat 145 4 325 1 8 Speech 40 19 29 6 9 Cervical Glands 4 — 78 5 10 Heart and Circulation 49 - 72 2 11 Lungs 146 1 99 2 12 Developmental— a. Hernia 5 1 16 2 6. Other 20 1 104 2 13 Orthopaedic— a. Posture 181 6 29 — 6. Flat foot 270 1 42 3 c. Other 229 5 128 7 14 Nervous system— a. Epilepsy 12 — 8 2 b. Other 9 — 9 1 15 Psychological— a. Development 1 3 3 - b. Stability 35 10 55 3 16 Abdomen 6 8 8 - 17 Other 120 38 87 32 96 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. 0/ /o of No. 0/ /o of Col. 2 Col. 2 (1) (2) (3) (4) (5) (6) Entrants 1861 1807 97 54 3 Second Age Groups 2708 2634 97.3 74 2.7 Third Age Groups 979 967 98.8 12 1.2 Other Periodic Inspections 368 360 97.8 8 2.2 Totals 5916 5768 97.5 148 2.5 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 19,468 (ii) Total number of individual pupils found to be infested 48 (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 20 By parents 28 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, 97 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 - - Impetigo 20 2 Other Skin Diseases 221 23 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 204 61 Errors of Refraction (including squint) — 1,796 Total 204 1,857 Number of pupils for whom spectacles (a) Prescribed 1,037 (b) Obtained — 1,019 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 - 4 (b) for adenoids and chronic tonsillitis - 550 (c) for other nose and throat conditions - 14 Received other forms of treatment 66 107 Total 66 675 Group 4.—Orthopaedic and Postural Defects. By the Authority Otherwise (a) Number treated as in-patients in hospitals - 9 (b) Number treated otherwise, e.g., in clinics or out-patients departments - 508 98 Group 5.—Child Guidance Treatment. Number of cases treated In the Authority's Child Guidance Clinics Elsewhere Number of individual pupils treated at Child Guidance Clinics 123 7 Group 6.—Speech Therapy. By the Authority Otherwise Number of pupils treated by Speech Therapists for the first time. 77 2 Group 7.—Other Treatment Given. New cases treated By the Authority Otherwise (a) Miscellaneous minor ailments 365 57 (b) Other (1) Sunlight Treatment 53 - (2) Massage and Remedial Exercises 259 151 (3) Enuresis 79 — (4) Hernias — 12 (5) Major Respiratory Diseases — 7 (6) Major Digestive Diseases — 24 (7) Major Injuries — 1 (8) Other Major Diseases — 6 Total 756 258 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 5,972 (b) Specials 2,080 Total (1) 8,052 (2) Number found to require treatment 5,601 (3) Number referred for treatment 5,601 (4) Number actually treated 3,792 99 (5) Attendances made by pupils for treatment 15,055 (6) Half-days devoted to: Inspection 47 Treatment 1,600 Total (6) 1,647 (7) Fillings Permanent Teeth 6,989 Temporary Teeth 2,156 Total (7) 9,145 (8) Number of teeth filled: Permanent Teeth 5,947 Temporary Teeth 2,005 Total (8) 7,952 (9) Extractions: (i) Permanent Teeth:— (a) On account of Caries 680 (b) For other purposes 131 (ii) Temporary Teeth: (a) On account of Caries 2,532 (b) For other purposes 149 (10) Administration of general anaesthetics for extraction 1,433 (11) Other operations: Permanent Teeth 3,223 Temporary Teeth 1,252 Total (11) 4,475 (12) Orthodontics (i) Cases commenced during year 359 (ii) Cases carried forward from previous year 524 (iii) Cases completed during year 273 (iv) Cases discontinued during year 184 (v) Pupils treated with appliances 270 (vi) Removable appliances fitted 446 (vii) Fixed appliances fitted — (viii) Total attendances 5,242 (ix) Number of sessions devoted to treatment 371 Number of pupils supplied with artificial dentures 25 Number of dentures fitted 26 100 SCHOOL HEALTH SERVICE STAFF AND SCHOOL CLINICS AS AT 31ST DECEMBER, 1957. 1.—Staff of the School Health Service. Divisional School Medical Officer: 1. 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 2.51 (iii) General Practitioners working part-time in the School Health Service (b) Speech Therapists 3 2.51 (c) Physiotherapist C.P. Unit 2 1.54 (d) Occupational Therapist C.P. Unit 1 .54 (e) School Nurses including Superintendent *19 (Combined posts, H.V. and S.N.) 8.5 (f) Nursing Assistants 6 (Clinic Nurses) 3.1 (g) (i) Senior Dental Officer 1 .85 (ii) Dental Officers (PartTime) 10 2.54 (iii) Orthodontists — — (iv) Dental Attendants 4 3.85 *A11 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 11. 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. 101 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.B.&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. Paediatric — 1 G. Speech Therapy 4 — H. Cerebral Palsy Unit — 1 I. Artificial Sunlight 2 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 3 0.82 Educational Psvchologists 2 2 Psychiatric Social Workers 2 2 Others:— Child Psvchotherapist 2 1 Clerk/Typist 3 3 The Psychiatrists are employed by arrangement with the Regional Hospital Board. 105 106 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 (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) 1 Number of Children Examined Averag 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 j Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) BOYS 1957 498 113 20.5 470 116 21.7 62 123 24.7 35 127 26.8 29 132 29.8 603 142 34.9 781 144 36.5 18 145 38.5 8 148 45.2 437 160 50.7 48 167 57.4 59 170 62.4 10 168 63.8 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 50.7 206 168 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 20.6 52 132 29.2 825 141 34.5 863 144 34.9 63 147 38.5 33 153 42.5 485 102 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 22 153 44.0 441 162 51.0 259 168 55.7 84 172 61.2 35 172 56.6 1952 820 113 20.2 799 116 21.2 65 123 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 — — — — — GIRLS 1957 452 113 20.0 441 116 21.1 66 122 24.4 55 128 28.5 41 132 29.7 456 141 34.8 826 144 37.4 24 150 41 .5 13 151 46.6 305 158 50.1 119 160 53.1 44 161 55.0 16 161 55.3 1956 112 19.7 373 117 21.6 91 41 126 26.4 134 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 46.4 481 158 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 <i0 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 54 132 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 35.8 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 32.4 569 142 350 38 149 39.9 35 154 45.9 303 157 49.1 27 160 51.3 2 160 60.4 - - -