Borough of llford Health Report FOR THE YEAR 1960 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 1960-61. 1 Public Health Committee - Members - Municipal Year 1960-61 2 Ilford Health Area Sub-Committee - Representatives 2 Ilford Committee for Education - Members - Municipal Year 1960-61 3 Officers of the Public Health Services 4-6 Preface 7-12 Reports by:- CONSULTANTS - Dr. Gurassa - Psychiatrist 134 Mr. Korvin - Orthopaedic Surgeon 120 Miss Mason - Ear, Nose and Throat Surgeon 128 Dr. Thorne - Ophthalmologist 119 Mr. Lee - Cerebral Palsy Unit 133 ASSISTANT MEDICAL OFFICERS - Dr. Gross - Benton School and Cerebral Palsy Unit 131-134 Dr. O'Connor Wilson - Remedial Exercises and Foot and Posture Survey 123-126 Dr. Pooley - Enuresis and Toddlers Clinics 89,139 Dr. Taylor - Health Education 108 Mr. Daly - Chief Public Health Inspector 40,146 Mr. Haigh - Area Dental Officer 110,130 Miss Gascoyne and Miss Watt - Education Psychologists 137 Miss Oliver - Superintendent Health Visitor 82, 145 Miss Copping - Welfare Officer for Old Folk. 24 Mrs. Walker - Speech Therapist 129 STATISTICS & SOCIAL CONDITIONS (SECTION A.) - Physical Features 13 Population 13 Births and Deaths 13,14,15 16-19 Rainfall 14 Vital Statistics (Tables) 17-18 Page GENERAL PROVISION OF HEALTH SERVICES (SECTION B.) - Home Nursing 20 Laboratory Facilities 20 Legislation in Force 20-21 National Assistance Act 22-24 Hospitals 33 Ambulance Facilities 35 Clinics and Treatment Centres 35-39 SANITARY CIRCUMSTANCES OF THE AREA (SECTION C.) - Water Supply 42 Swimming Baths 44 Drainage and Sewerage 44 Rivers and Streams 45 Refuse Collection and Disposal 45 Sanitary Inspection of the Area 45 Shops Act 46 Slaughter of Animals Act 46 Rag Flock and Other Filling Materials Act 46 Clean Air Act - Smoke Control Order 46 Atmospheric Pollution 47 Land Charges 46 HOUSING (SECTION D.) - Overcrowding 49 Clearance Areas 49 Statistics 49-51 Housing Acts (Permitted number) 51 Housing Repairs & Rents Acts 52 INSPECTION AND SUPERVISION OF FOOD (SECTION E.) - Milk 53 Ice Cream 55 Meat and Other Foods - Inspection and Sampling 57 Hawkers 59 Food Surrendered 59 Food Poisoning 60 Bakehouses 61 Merchandise Marks Act 61 MISCELLANEOUS - Diseases of Animals (Movement Orders, etc.) 61 Prevention of Damage by Pests Act (Rodent Control) 64 Pet Animals Act 66 Petroleum (Consolidation) Act 66 Litter Act 66 Noise Nuisances 66 Page INFECTIOUS DISEASES (PREVALENCE AND CONTROL) (SECTION F.) - Notifiable Diseases 67-68 Table showing total notifications received, 1960, 69 Tuberculosis - Notifications, Deaths, etc 70-72 V.D. Treatment Centres 72-74 Health Education 74 Examination of Officers and Servants 74 FACTORIES (SECTION G.) - Inspections, defects and Outwork 75 PART III SERVICES. NATIONAL HEALTH SERVICE ACTS, 1946-57. Births 77 Infant Mortality 79-80 Neonatal Mortality 81 Illegitimate Births & Deaths 81 Visits by Health Visitors 84 Day Nurseries 85-86 Nurseries and Child Minders Regulation Act 86 Health Services Clinics 87 Infant Welfare Centres - attendances 87-89 Smallpox Vaccination 96 Midwives 97 Gas and Air Analgesia 99 Maternal Mortality 101 Domestic Help Service 101 Prevention of Break-Up of Families 102 Convalescent Facilities 102 Loan of Sick Room Equipment 104 Chiropody Service 105 Visits by T.B. Visitors 105 Occupational Therapy 105 T.B. Care and After Care 106 Medical Exams-Staff 107 Invalid Night and Day Attendant Service 107 Home Nursing 108 Health Education 108 Dental Treatment 110 Welfare Food Distribution 112 Page CLINICS - Ante-Natal 100 Artificial Sunlight 93 Diphtheria Immunisation 94 Ear, Nose it Throat 93 Midwives 98 Obstetric Consultant 101 Ophthalmic 92 Orthopaedic 90 Paediatric 91 Poliomyelitis Vaccination 95 Post-Natal 101 Smallpox Vaccination 96 Speech 93 Whooping Cough Immunisation 94 SCHOOL HEALTH SERVICE - School Roll and Premises 114 Medical Inspection and following up 114 Staff 114,158 Visits 115 Infectious Diseases 115 New or Original Work 116 Benton School (Physically Handicapped) 131 Cerebral Palsy Unit 133 Handicapped Children 142 Mental Health Service 144 General Welfare 144 B.C.G. Vaccination 148 Medical Examination of Staff and Teachers 148 Causes of Deaths (Schoolchildren) 148 Ministry of Education - Statistical Tables 149-160 Heights and Weights Table 161-162 CLINICS - Artificial Sunlight 127 Child Guidance 134 Dental 130,155 Ear, Nose and Throat 128 Enuresis 139 Minor Ailments 116 Ophthalmic 119 Orthopaedic 120 Orthoptic 120 Physiotherapy 126 Speech 129 1 ILFORD BOROUGH COUNCIL Municipal Year 1960-61 COUNCILLOR L.V. DREW, J.P. Mayor. ALDERMAN H.G. ROOT, Deputy Mayor. Aldermen: BARKER, JOHN, C.B.E., J.P. GOOCH, LIONEL ARCHER SCOTT. RFNNFTT MRS FLORFNCF FDITH HEADLEY, CECIL AUBREY, J.P. BENNETT, MRS. FLORENCE EDITH. MASTERS, FRANK ROBERT. COLVIN, GILBERT, C.B.E., F.C.I.S. PEARSON, FREDERICK THOMAS. COWAN, HAROLD DOUGLAS, TERRY, MISS ANNE SYLVIA, J.P. F.A.C.C.A., F.C.C.S. WOODS, SIDNEY CHARLES VICTOR. (to 13.9.10.60.) FALLAIZE, MRS. LILAN, J.P. YOUNG, MAJOR ALEXANDER O.B.E., T.D., J.P., C.A. (E.C.C.) GIBSON, CYRIL IRVING. (to 9.10.60.) Councillors: ALY, HARRY REGINALD BERTRAM. LOVELESS, CHARLES EDGAR, BYSOUTH, HENRY ALBERT, F.I.A.C. F.A.I.A. CARRADICE, DENNIS ANNESLEY. LOVELESS, SYDNEY FRANK. CHAMBERLIN, MRS. GRACE MARY MARTIN ROBERT (E.C.C.). CLACK, ARTHUR HENRY. MURPHY, JOHN LOUG1ILIN, J.P., A.R.I.N.A., A.I.Mar.E. COPSEY, HUGH EDMUND. DAVIES, DAVID SAMUEL. NATZLER, ISAAC BERNARD. DAVIES, GEORGE EVELEIGH, J.P., NORWOOD, JOHN HENRY. B.Sc. DOYLE, THOMAS JOHN. OSBORNE, ALAN FRANK. EAREY, ERIC RAYMOND. J.P., ROLFE, CYRIL GEORGE, A.I.S.T. F.N.A.A., F.V.I. RYDER, JOHN LOUIS. GLEED, SYDNEY GEORGE. GROSE, JOHN STANLEY. SEAMAN, ERIC WILLIAM, A.A.C.C.A. HARRIS, EDGAR FRANK. SHAW, ARNOLD JOHN, B.A. HERRIDGE, WILLIAM HENRY J.P., SHERRELL, ALBERT REGINALD PRENTICE, (E.C.C.) HITCHCOCK, LEONARD, A.I.B. JAMES, FRANCIS HERBERT. WATERS, OWEN FRANCIS, J.P. LITTLE JOHN ,MRS. RUTH WATSON, GEORGE HENRY. LIVERMORE, JOHN. WOODS, DOUGLAS EDWARD. 2 PUBLIC HEALTH COMMITTEE Municipal Year 1960/61 ALDERMAN MISS A.S. TERRY, J.P., Chairman. COUNCILLOR A.R.P. SHERRELL (E.C.C.), Vive-Chairman. ALDERMAN H.G. ROOT, M.S.M., J.P., COUNCILLOR J. LIVERMORE. (Deputy Mayor). COUNCILLOR H.A. BYSOUTH, COUNCILLOR J.H. NORWOOD. F.I.A.C. COUNCILLOR A.F. OSBORNE. COUNCILLOR MRS. G.M. CHAMBERLIN (E.C.C.). COUNCILLOR C.G. ROLFE, A.I.S.T. COUNCILLOR T.J. DOYLE. COUNCILLOR L.V. DREW, J.P., COUNCILLOR J.L. RYDER. (Mayor). COUNCILLOR G.H. WATSON. COUNCILLOR S.G. GLEED. COUNCILLOR L.HITCHCOCK, A.I.B. COUNCILLOR D.E. WOODS. ILFORD HEALTII AREA SUB-COMMITTEE OF TOE HEALTH COMMITTEE OF TOE ESSEX COUNTY COUNCIL Municipal Year 1960/61 Ilford Borough Council Representatives: ALDERMEN COLVIN, MASTERS, MISS TERRY (Chairman)-, COUNCILLORS MRS. CHAMBERLIN (Vice-Chairman), CLACK, GLEED (from 3.11.60.), HARRIS, HITCHCOCK, MRS. LITTLEJOHN, C.E. LOVELESS, MURPHY, NORWOOD, OSBORNE (to 20.10.60.), ROLFE, ROOT (Deputy Mayor), SHERRELL. Essex County Council Representatives: ALDERMEN MRS. BALL, YOUNG (to 9.10.60.), COUNCILLORS BERRY, MRS. FALLAIZE, MRS. GODFREY (to 19.4.61.), MRS. WELSH, WORTLEY. The Executive Council for Essex Representative: MRS. V.L. WILSON (from 16.11.60.). Local Medical Committee Representative: Dr. S.M. PRUSS. Hospital Management Committee Representative: MR. W.A. PARISH. Voluntary Organisations' Representatives: MRS. G.M. BUTLER, MRS. D.M. HOLLOWAY, MISS N.L. ODELL, MR. C.L. TUTT. 3 ILFORD COMMITTEE FOR EDUCATION Municipal Year 1960/61 COUNCILLOR S. F. LOVELESS, Chairman. COUNCILLOR O.F. WATERS, J.P., Vice-chairman. ALDERMAN J. BARKER, C.B.E., J.P. COUNCILLOR MRS. G.M. ALDERMAN C. COLV,N. C.B.E., CHAMBERLIN (E.C.C.). F.C.I.S. COUNCILLOR G.E. DAVES. ALDERMAN MRS. L. FALLAIZE, J.P. COUNCILLOR T.J. DOYLE. (E.C.C.). COUNCILLOR MRS. R.C. ALDERMAN C.I. GIBSON. UTTLEJOHN, M.A. ALDERMAN F.R. MASTERS. COUNCILLOR J. LIVERMORE. ALDERMAN F.T. PEARSON COUNCILLOR J.L. MURPHY, J.P., ALDERMAN MISS A.S. TERRY, J.P. A.I.R.N.A., A.I.Mar.E. ALDERMAN MAJOR A.M. YOUNG, COUNCILLOR C.G. ROLFE, A.I.S.T. O.B.E., T.D., J.P., C.A. (E.C.C.) COUNCILLOR E.W. SEAMAN, (to 9.10.60.) A.A.C.C.A. COUNCILLOR H.R.B. ALY. COUNCILLOR D.A. CARRADICE. COUNCILLOR A.J. SHAW, B.A. Co-opted Members: MR. S.R. BAKER (to 3.2.61.) MRS. D.E. CARTER. THE VERY REV. CANON M. HANCOCK, B.A. MR. H.S. KENWARD, M.A. MR. E.R. LOWER, B.A. THE REV. H.R. NEALE. MR. J.G. PAGE (from 28.2.61.) MISS F. STEVENS. County Nominated Members: COUNTY ALDERMAN A.R.P. SHERRELL. COUNTY COUNCILLOR A.F.J. CHORLEY, M.B.E. 4 OFFICERS OF THE PUBLIC HEALTH SERVICES Ilford Borough Council. Medical Officer of Health, Divisional School Medical Officer, Area Medical Officer, Ilford Health Area Sub-Committee: I. GORDON, M.D. Ch.B., M.R.C.P. (Lond.), D.P.H. (Edin.). Deputy Medical Officer of Health : (Part Time) D M B. GROSS, M.D., Ch.B., (Leeds), M.M.S.A., D.P.H. (Lond.). Chief Public Health Inspector: S.R. DALY, LL.M., B.Sc., D.P.A. (Lond.), Barrister-at-Law. Deputy Chief Public Health Inspector: P.W. ENGLISH. Public Health Inspectors: G.W. NEWMAN. J. COOK. R.E. SMALLEY. F. NAU. A.C.R. NEALE. D.F. SCOTT. T.F. JOHNSON. J.A. HARRIS C. BBOOMFIELD. Chief Administrative Assistant (I.B.C. and E.C.C.): F.J. HOCKING. Administrative Assistant A.E. TOURLE. 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.I)., 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). 11.B. GRANGE, M R., B.S. (Lond.) (Part Time). J.M. POOLEY, M.B., B.S. (Lond ), D.C.H. (Part Time). R.M. NOORDIN, M.R.C.S., L.R.C.P. (to 31.3.61.) G.B. TAYLOR, M.B., B.S. (Lond.), D.C.H., D. Obst. R.C.O.G. M.B. GEE, M.B., Ch.B. (Bristol) (Part-time) (from 1.8.61.) Area Dental Officer: E.V.. HAIGH, L.D.S., R.C.S. (Eng.). Educational Psychologists: MISS B.S. GASCOYNE, B.A (Hons. Psych.). MISS C.H.F. WATT, B.A. (Hon). Psychiatric Social Workers: MISS P. RADFORD (to 15.1.61.) MISS J.M. BARTON MISS M. BAKER (from 20.6.60.) Speech Therapists: MRS. M. WALKER, L.C.S.T. MRS. P.A. PRETIOUS, L.C.S.T.. Cerebral Palsy Unit: Physiotherapists: MISS G.L. BOWERS, M.C.S.P. MISS G. LE SAGE (to 5.8.61.) Occupational Therapist: MRS. M.I. RAVEN 5 Officers of the Public Health Services—continued. Non-Medical Supervisor of Midwives: MISS R.K. JESSON. Superintendent Health Visitor: MISS J.M. OLIVER. Health Visitors and School Nurses: MISS E.M.P. COLLINS MISS A.E. RIDPATH MISS A.N. BOWMER MRS. L.M. ELDRIDGE (to 15.4.61.) MISS M.G. DUGUID MRS. C.D. CONSTABLE MISS H. ARNOLD MISS M M- STOWER MISS C. OLDHAM MISS N L- HALL (from 16.8.60.) micc P \i i rivrTT MISS R.A. BARTON MRS 1 M WFSTON MRS- MR. VAN ALTAAN US' i'u ™ MRS. G. QDUNG MRS. J.H. GADD MRS M .K. PRESSEY MRS. L.K. LAWRENCE (part-tune) MRS. M. WELLER (part-time) MISS I. HARRIS (part-time) MRS. W..R. HEYWOOD (part-time) MISS I.L. MOBBS (from 4.4.61.) Tuberculosis Visitors: MRS. K.M. PARKES MRS. M.J. MOORE MRS. C. EARWAKER Occupational Therapist (T.B. Cases): MISS Z.E. MERCER. 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. Chiropodists: MR. F.W. GIBSON M.Ch.S. MISS M. I. MERCER M.Ch.S. PART TIME:- RegionalHospital Board. 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. P. LANCER, M.B., B.S. 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 Psychiatrist: W.P. GURASSA, M.D., M.R.C.P. Psychiatrist: H.J. ALTSCHULOVA, M.D. Cerebral Palsy Unit: Consultant: H.B. LEE, F.R.C.S. Orthoptist: MISS C. HAZEL, D.B.O. (to 3.4.61.) MISS M.E. TOWNSEND, D.B.O. (from 2.8.61.) Pysiotherapist: A. BRAND, M.C.S.P. Essex County Council Assistant Dental Officers (Part-time): R.J. NEWMAN, M.B.E., L.D.S., R.C.S. (Eng.), J.P. R.A. SOAR, B.D.S. R.C. BIGMORE Y.G. TOOLSY, B.D.S. (to 30.11.60.) W.V. VICTORS, L.D.S., B.D.S. G.H. WILLSON, L.D.S., R.C.S. (Eng.), (from 16.1.61.) N.B. DAVIS, B.D.S. (from 17.7.61.) MISS S. STEPHENS, B.D.S. (from 31.7.61.) Child Psycho-Therapists (TVon Medical): MISS P. OPPENHEIMER, B.A. (to 31.7.60.) MISS L. FOLKART, B.A. MRS. D. HANDJA (from 4.10.60.) Speech Therapist (Part-time): MRS. B.J. TINGEY, L.C.S.T. Chiropodists (Part-time): MR. R.J.P. BUNDER, M.Ch.S. (from 2.1.61.) MR. C.K. BOWER (from 10.7.61.) Ilford Borough Council Public Analyst: J. HUBERT HAMENCE, M.Sc., Ph.D. 7 Preface Phone:- PUBLIC HEALTH OFFICES. VALentine 3401 ILFORD. July. 1961. MR. MAYOR. LADIES AND GENTLEMEN, I submit herewith the Annual Report of the Health Services for the year 1960. The health of the borough is maintained at a high level; the adjusted death rate of 11. 26 compares with 11. 29 in the previous year. As I do not wish to repeat tediously in detail what I have mentioned in many previous reports, briefly infectious diseases present no real problem to us now whereas cancer, especially of the lung, coronary heart disease, bronchitis, mental disorders, accidents, suicide, remain substantial and unconquered problems. The birth rate is rising, being 14. 07 in 1960 (compared with 12.41 in 1959); 296 more births were registered in the borough than in the previous year. INFANT MORTALITY. It could hardly be hoped that the previous year's extraordinarily low Infant Mortality Rate of 14.9 deaths per 1,000 births could be maintained. The Infant Mortality Rate rose in 1960 to 17.5, still considerably under the national average of 21.9. Further study shows that in 1959 there were 33 deaths and in 1960, 44. In each year only 6 of these deaths occurred after the age of one month, i.e. the increase was entirely in neonatal mortality, and could be accounted for by atelectasis 5 and 9, prematurity 5 and 7, and ''previability" 0 and 6 (1959 figures followed by 1960). This is in general agreement with current experience that prevention of neonatal mortality is a far more difficult problem than infant mortality in later months, once due mainly to 8 infections, which we can now control. NOTIFICATION OF FOOD POISONING AND DYSENTERY. A PUZZLE. In the year ending 31st March 1961, 87 doctors notified 382 cases of food poisoning and dysentery in the borough of Ilford. However, 195 of these patients, i.e. half, were notified by two general practitioners only. The strange thing is that the same two doctors notify a similar proportion of the cases each year, and for many years each notified and suspected case has been followed up by this department, and always there has been sufficient evidence, either by reason of diarrhoea, or vomiting, or both, to justify a suspicion. If all doctors practising in Ilford notified us of 95 cases a year, instead of approximately each (excluding the two doctors mentioned) the number investigated by us would be about 8000 instead of 382. We could get a more valid picture of the state of alimentary infection in the borough, we would certainly have to increase our staff many times over, but I have great doubts if the incidence would thereby be substantially reduced. INFANT WELFARE CENTRES - STOP OR GO. Many uninformed members of the medical profession and some of the laity have expressed a wish to pass a death sentence on the local authority infant welfare centre. But the centres won't die; last year there were 38,560 attendances at Ilford centres as compared with 35,961 the year before. There is no doubt that ideally each family doctor should be interested in such work, should have suitable premises and assistance to carry it out. If such were the case there would be no problem, no need for legislation, and the Council centres would fade away. But this is not the case, the majority of doctors are not interested or cannot do the work, and if it were made impossible for the Council to carry it out probably 90% of the mothers would be deprived of such facilities. Many family doctors throughout the country do give this service; to show my lack of prejudice and willingness to help the enthusiast, a Health Visitor is made available for a general practitioner for his centre at his own surgery, where Council welfare foods can also be bought; and one centre (Ilford Lane at St. Alban's Church Hall) might almost be called a training centre provided for general practitioners by the local authority, for family doctors who have indicated 9 their desire to attend do so each for a period of six months chosen in turn from a long waiting list. As a doctor who has done many years' work in such centres, whose head has been stuffed with all the latest work from paediatric literature, and finally as a parent of a small infant, I recognise my inability to satisfy all varieties of information required by the average mother. Types of clothes, the material to be used, how to cook cereals, which to give, when and how; bottle sterilization, the right sort of pram, where to get it, an infinity of such questions, which are best discussed in infant welfare centres with experienced health visitors. Most family doctors are content to let this continue, recognising, as I do, a medical man's limitations in such knowledge and rapport. They are not vocal on the subject, however, so as not to appear as traitors to their more forceful brethren, who would demand that the services cease, whether or not they can provide a satisfactory alternative. Finally,I think it should be known that, as demand indicates, more and more of the sessions are staffed only by health visitors, without the attendance of local authority doctors. LIAISON WITH GENERAL PRACTITIONERS. BURYING THE HATCHET. It might be thought that local doctors communicate enough with the medical officer of health, round a table at the Ilford Medical Society, at the executive meetings of the local B. M. A. division, or by distribution of news sheets, or the annual report. Such, however, does not seem to be the case, for a desire was recently expressed for special meetings of general practitioners and the medical officer of health and his staff, to discuss current epidemiology and matters of liaison. The first meeting has been held, fifteen local doctors attended, and it was generally considered to have been a success. It will be repeated. As an example of problems raised, a few of the doctors were worried about a reported outbreak of smallpox in Spain and the requirements of travellers to that country who were their patients. A phone call on the spot to the Ministry of Health resolved their difficulties. Unfortunately many local doctors do not attend meetings; the enthusiastic few see each other with great regularity. 10 THE LOCAL HEALTH DEPARTMENT AND RESEARCH FOR OTHERS. It may not be generally realised how much research work is carried on in Public Health Departments in addition to their routine statutory obligations. This work is done voluntarily on behalf of numerous outside bodies that include, from our files in the last few years, various Ministries, the Medical Research Council, University of Oxford, Guy's Hospital, Marie Curie Memorial Foundation, National Birthday Trust Fund and scientists doing their own surveys. The volume of this work may even make it difficult at times adequately to cover normal activities, and if the local medical officer of health wishes to start a research project of his own he must give serious thought to its practicability having regard to other demands on the department's resources. This was forcibly brought to our attention in the last few years when this department and the pathologist of the local hospital group, in co-operation, initiated, carried out and finally published two papers, one in the British Medical Journal on mothers' preferences for home or hospital confinement, and the other in the Lancet on minor sepsis in the new-born. Both these tasks were, however, worth the trouble in view of the widespread interest the results aroused. The health visitors (medico-social workers who visit most homes) naturally carry the greatest burden of this type of field work, but the clerical staff (the backroom boys) may at times be no less involved. School medical officers, midwives, domestic help organisers and district nurses have all been called upon in the past to do their bit. Examples of this work on behalf of others include surveys on nursing of cancer cases at home, problems of prematurity, perinatal mortality, retrolental fibroplasia, leukaemia, transmission of cancer producing factors in breast milk, consequences of virus infections in pregnancy, mongolism, development of school children, effect of infections on poliomyelitis, and the latest, a survey, to last a year, of 1,000 children to determine the intestinal carriage of polio, other viruses and food poisoning organisms. RADIOACTIVITY HAZARDS. Three Public Health Inspectors attended a course of 11 lectures on this subject at the Sir John Cass College in East London. At the request of the Council the premises and X-rayplant of an unqualified practitioner were thoroughly investigated by the Radiological Protection Service. The recommendiations they made have been carried out. Regular meetings of members and officers of local authorities in this area have been held to discuss the problems involved in the hazards of radiation. THE CHILD GUIDANCE CLINIC. Ilford and Barking have reason to be well satisfied with their local Child Guidance Clinic. In spite of the fact that it is administered jointly by the Education and School Health Department, and partly staffed by the Regional Hospital Board, it works as a unit with the minimum of friction, contains a contented and nearly always complete therapeutic staff and has a wide reputation for its service. At one time members of its staff visited infant welfare centres, attended groups in patients' homes and the public health offices, but experience has shown that liaison with the health visiting staff and conferences afford the best means for advising our staff on problems they may encounter with emotional and behaviour difficulties in young children. The Child Guidance Clinic, in co-operation with the Education Department, is developing special classes for the maladjusted. So far the experiment is fulfilling the hopes placed in it. OTHER DEVELOPMENTS. Dr. Taylor, a school medical officer appointed to spend a substantial portion of his time in health education, had a most successful meeting with the heads of the secondary schools to discuss his future programme on bringing to the attention of school children the relation between lung cancer and tobacco smoking. A new Health Services Clinic in Heathcote Avenue was opened. Plans are far advanced and ministerial sanction received for the construction of the new school for the physically handicapped. This will be one of the mostadvanced 12 in the country incorporating the cerebral palsy unit, with a small pool for physiotherapy and a nursery class for earlier diagnosis. We are also giving urgent consideration to the extension of Mayesbrook Health Services Clinic, which is now far too small for the many services it has to contain. ACKNOWLEDGEMENTS Officers in my department have, at my request, made their personal contributions to be found in various parts of the report. I am grateful for the opportunity of adding spice and variety to what might otherwise be only my own views plus a vast collection of statistics and tables. To these Officers and the whole range of staff of the department (borough and county) I give thinks for their loyal support. The various voluntary societies have continued their valuable co-operation and I again thank them, as also the departmental Chief Officers, for their kindly assistance. I have received much encouragement and support from the members of the Council, especially the Chairmen, Vice-Chairmen and members of the Ilford Borough and Essex County Council Committees with whom the department is closely concerned, and I would wish to express my appreciation to them. I have the honour to be Your obedient Servant, I. GORDON, Medical Officer of Health. 13 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Land and Inland Area (in Acres) Water 8,4041 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 1957 179,600 ,, ,, 1958 179,000 ,, ,, 1959 178,600 ,, ,, 1960 178,520 Number of inhabited houses (April 1st, 1960) according to Rate Books (approx.) 52,539 Rateable Value — April 1st, 1960 (Houses and Land) £3,071,178 Sum represented by a penny rate, April 1st, 1960 (approx.) £12,520 1959-60 1960-61 Combined Rate (all services) 20s.6d. 21s.4d, in the £ in the £ The following figures as to unemployment were supplied by the Ministry of Labour:- Males Females As at December, 1959 476 72 As at December, 1960 464 74 1960 1959 Live Births 2,512 2,216 Live Birth rate per 1,000 population — Crude rate 14.07 12.41 Adjusted rate 14.07 12.41 Illegitimate Live Births percent of total live births 3.78 3.70 Stillbirths 37 49 Stillbirth rate per 1,000 total live and stillbirths 14.52 21.63 Total Live and stillbirths 2,549 2,265 Infant deaths (under 1 year) 44 33 Infant mortality rate per 1,000 live births — Total 17.51 14.89 ,, ,, ,, ,, ,, ,, ,, ,,- legitimate 17.51 14.99 ,, ,, ,, ,, ,, ,, ,,-illegitimate 0.00 12.20 Neo-natal mortality rate per 1,000 live births (first four weeks) 15.13 12.18 Early Neo-natal mortality rate per 1,000 total live births (under one week) 13.14 10.38 Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 27.46 31.78 Maternal deaths (including abortion) 1 Nil Maternal mortality rate per 1,000 live and stillbirths 0.39 0.00 Deaths (all causes) 1,970 2,037 Death rate per 1,000 population — Crude rate 11.04 11.41 Adjusted rate 11.26 11.29 Percentage of total deaths occurring in public institntions 48.08 52.91 Deaths from Cancer (all ages) 400 387 ,, ,, Measles (all ages) Nil Nil ,, ,, Whooping Cough (all ages) Nil Nil ,, ,, Diarrhoea (under 2 years of age) 2 Nil 14 1. RAINFALL. Total rainfall registered in the district during the year was 31.66 inches; the greatest fall in 24 hours was registered on 19th May, 1. 08 of an inch; whilst the longest duration occurred on 11th August, 18 hours. October 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 ill or mentally deficient in each area. The figures for Ilford are 1.00 for the birth rate and 1.02 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 2,512. Males Females Legitimate 1,268 1,149 Illegitimate 45 50 i.e., 3.8 per cent of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was 3.7 (1959), 3.3, 2.7, 2.8, 2.6, 2.2, 3.0, 3.9, 2.9, 3.1. 15 The adjusted birth rate, calculated on the estimated population of 178,520 is 14.07 per 1,000. 4. DEATHS. The total number of deaths of Ilford residents was 1,970. This is obtained by taking the total number of deaths registered in the district (1,564), subtracting the deaths of non-residents, occurring in the district (232), and adding the deaths of Ilford residents registered as having died in other districts (638). The number of deaths of non-residents registered in the district was as follows:- King George Hospital 72 Chadwell Heath Hospital 31 Claybury Hospital 77 Goodmayes Hospital 8 Other Non-residents 44 Total 232 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 73 Wanstead Hospital 43 Langthorne Hospital 30 London Hospital and Brentwood Annexe 83 St. Bartholomew's Hospital 14 Rush Green Hospital 14 St. Joseph's Hospice, Hackney 28 Plaistow Hospital 12 St. George's, Hornchurch 100 Dagenham Hospital 10 Mile End Hospital 7 Whipps Cross Hospital 60 In other Hospitals, Institutions and residences outside the Ilford district 164 Total 638 16 The adjusted death rate, calculated on the estimated population of 178,520 is 11.26 per 1,000. Inquests.- During the year, 64 inquests were held on deaths occurring in Ilford, 47 on Ilford residents, and 17 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 - 1 - 3 5 9 20 26 DEATH RATES FROM CANCER, 1960. The following Table shows the death-rates for 1960 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 Cancer of lung and bronchus .498 .481 Cancer, other forms 1. 742 1. 676 5. TABLES OF VITAL STATISTICS.- Table 1 gives a comparative statement of the birth-rate and death-rate for the past five years. Table 1A gives a comparison of the vital statistics of Ilford with England and Wales, and the London Administrative County. Table II gives a classified statement of the causes of death in 1960, arranged according to the age groups at which deaths occurred. 17 TABLE I.- VITAL STATISTICS OF WHOLE DISTRICT DURING 1960 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 1956 180,600 1,738 2,115 11.71 (e) 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) 1958 179,000 1,785 2,228 12.45 (c) 1,622 9.1 241 604 37 16.6 1,985 11.09 (c) 1959 178,600 1,802 2,216 12.41 (c) 1,682 9.4 257 612 33 14.9 2,037 11.41(c) 1960 178,520 1,889 2,512 14.07 (e) 1,564 8.8 232 638 44 17.5 1,970 11.04 (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. 18 TABLE IA Table showing comparison between the Birth-rate, Death-rate, etc. , of Ilford, London (Admin. County), and of England and Wales for the Year 1960. 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 17.1 19.8 11.5 21.9 0.8 0.1 23.9 .48 548 London Admin. County 17.8 17.9 11.4 21.6 0.9 - 14.4 .63 650 ILFORD (Estimated Population mid-1960 = 178,520) 14.07 14.5 11.26 17.5 - - 221 - 7112 A dash (—) signifies that there were no deaths. 14 deaths 2127 deaths. 19 Registrar-General's Short List of Deaths and Causes TABLE II Causes of, and Ages at, Death during the year 1960 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 1.970 44 6 7 14 51 476 499 873 1 Tuberculosis, respiratory 7 - - - - 1 3 2 1 2 Tuberculosis, other 1 - - - - - 1 _ _ 3 Syphilitic disease 5 - - - - - 1 2 2 4 Diphtheria - - - - - - - - - 5 Whooping cough - - - - - - - - - 6 Meningococcal infections - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - 8 Measles - - - - - - - - - 9 Other infective and parasitic diseases . - - - - - - 4 - - 10 Malignant neoplasm, stomach 66 - - - - 2 23 19 22 11 Malignant neoplasm, lung, bronchus 89 - - - - - 43 32 14 12 Malignant neoplasm, breast 36 - - - - 4 23 6 3 13 Malignant neoplasm, uterus 9 - - - 1 - 3 3 2 14 Other malignant and lymphatic neoplasms 200 — - - - 6 67 63 64 15 Leukaemia, aleukaemia 12 — 1 1 2 1 2 3 2 16 Diabetes 7 - - - - - 2 2 3 17 Vascular lesions of nervous system 252 - - 1 1 4 55 60 131 18 Coronary disease, angina 350 - - - - 7 99 110 134 19 Hypertension with heart disease 68 - - - - - 7 17 44 20 Other heart disease 216 - - - - 4 21 40 151 21 Other circulatory disease 109 - - - - 2 20 25 62 22 Influenza 4 - - - - - 1 1 2 23 Pneumonia 127 3 1 - 1 2 11 21 88 24 Bronchitis 102 - - - - 2 19 35 46 25 Other diseases of respiratory system 20 - - 1 - - 5 6 8 26 Ulcer of stomach and duodenum 21 - - - - - 5 6 10 27 Gastritis, enteritis and diarrhoea 9 1 1 - 2 - 2 2 1 28 Nephritis and nephrosis 10 — - - 1 1 1 - 7 29 Hyperplasia of prostate 5 - - - - - - 2 3 30 Pregnancy, childbirth, abortion 1 — - - - 1 - - - 31 Congenital malformations 17 10 2 1 _ _ 3 1 - 32 Other defined and ill-defined diseases 160 30 - 1 2 5 38 29 55 33 Motor vehicle accidents 20 - 1 2 3 1 3 5 5 34 All other accidents 20 - - - 1 2 3 3 11 35 Suicide 22 — — - - 6 11 4 1 36 Homicide and operations of war 1 - - - - - - - 1 Special Causes (included above) Smallpox - - - - - - - - - 20 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 Council. A report of the work performed during 1960 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, EssexC.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.) 21 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 1960, three new applications and 26 applications for renewal of licences were received. The Council granted the licences in respect of these establishments. The licences expire on 31st March of each year. Hairdressers' and Barbers' Premises. (Essex C.C. Act 1933, Part VI). During 1960, 65 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). Prevention of Fouling of Public Footway by Dogs. Two instances were reported during the year and legal proceedings were taken. Fines of £1.0. Od. plus 10. Od. costs and £2. 0. Od. plus £2. 2. Od. costs respectively were imposed on the defendants. The Council decided to increase publicity in this matter by arranging for at least one lamp standard in every road in the borough to carry a notice relating to the byelaw and for the display of posters on official notice boards. (v) There are three local Acts in operation - (l) 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 Reportin appropriate sections as to action taken under the Act. 22 (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 I960. (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 1960:- (1) Residential and Temporary Accommodation. (a) Number of Ilford residents provided with residential accommodation at 31. 12. 60:- 257. (b) Aged persons admitted to hostels and other residential establishments:- 79. (c) Other persons admitted to residential accommodation:- 1. 23 (d) Persons admitted to temporary accommodation:- Adults 7; Children 12 = 19. The County Council have two Old People's Homes in Ilford - at Pegram House, Longhayes Avenue, Marks Gate, accommodating 47 residents, and at Heath Gate, Chadwell Heath Lane, Chadwell Heath, which accommodates 60 residents. Additionally, an annual grant is made by the County Council towards the cost of welfare services and amenities provided by the Borough in their special accommodation for old people at Stoneleigh Court. (2) Blind Persons. The numbers of registered blind, partially sighted and defective sighted persons resident in the Borough as at 31st December, I960, were as follows:- (i) Registered as blind 300 (ii) Partially sighted 67 (iii) Defective sighted 16 all of whom were under the supervision of the County Council's Home Teachers. During the year 6 blind residents participated in the Home Workers' Scheme operated through the agency of the Royal London Society for the Blind, and 2 were employed in Workshops for the Blind. In addition, 31 blind and 12 partially sighted persons were employed in open industry. During 1960, 5 blind residents in 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, to which reference is made above) as provided for under Section 29 of the National Assistance Act, 1948; in addition to direct provision such as special equipment on loan, grants have been made towards the cost of structural adaptations to premises to meet special needs, etc., the fullest co-operation has been maintained with specialised organisations in this 24 field of welfare services, many of these bodies acting as the Council's agents in this connection. 282 handicapped persons in the Borough of Ilford have registered with the Welfare Department. They are visited by officers appointed to assist them with handicrafts and individual needs. Some attend an Occupational Centre for the handicapped at Barking and a further Centre will be opened during 1961 in Ilford." In Ilford the scheme for other handicapped persons, so far as voluntary actionis concerned, has been delegated to a Sub-Committee of the Ilford Social Service Association of which the Medical Officer of Health is Chairman." NATIONAL ASSISTANCE ACT, 1948. (a) Section47 provides for the removal of persons to hospital who are unable to devote to themselves proper care and attention. No persons were dealt with during the year. (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 burials of three persons were dealt with during the year:- a male, aged 58 years, who died in a furnished room; a male, aged 70 years, who died in a furnished room; a male, aged 60 years, who died in lodgings. Miss M. J. Copping, Welfare Officer for Old Folk, reports as follows:- "During the year 1960, I paid 684 visits to old persons and their relatives, and interviewed 336 at the Public Health Offices, or at some place other than their own homes; for example I interviewed several in halls where meetings are held, after I had given addresses to organisations. Approximately a third of the interviews at the Public Health Offices were by appointment, and the remaining were interviews with callers, who, being excusably unaware that the bulk of my work is done outside the Office, arrived unexpectedly to see me. 25 The majority of these were advised to call, and I would like to take this opportunity to ask those who recommend persons to come to me to suggest to such persons, that, if possible, an advance 'phone call be made to enquire the most suitable time to attend, or an advance letter sent, giving a brief outline of the problem. If a relative with a different surname writes upon behalf of an old person, as frequently occurs, a reminder to quote the name of the old person is useful. Much unnecessary confusion arises when, for example, a Mrs. Brown writes to say, "You saw my mother a year ago, and no doubt you will remember her case" (mother's name and address are omitted). With over 500 records in the files, and memories of contacts with a score of daughters named Mrs. Brown in the remote corners of my subconscious mind, such letters set me a problem. I receive a considerable amount of correspondence, and replying to it is very time consuming. Failure to supply names and addresses increases the work involved, but worst of all it delays attention to what may be an urgent matter. Likewise failure to ascertain whether I am likely to be in at a certain time, leads to disappointments, tired old feet, and wasted bus fares. On my side, it may lead to being waylaid just as I am leaving the building to keep an appointment, or to attend a Committee meeting, and consequently to making a rather hasty decision about a problem, or giving an impression of lack of patience or sympathy. A major portion of my time is spent interviewing, and my experience is that the most important factor at any interview is for both parties to be as relaxed as possible, and to have a reasonable amount of time for uninterrupted discussion. Many persons prefer to call at the Office to see me because of lack of privacy or strained relationships in their own homes, and it is disconcerting if they find upon arrival that I am not free to give them my undivided attention. Even with careful planning, this is not easy to give, as I receive numerous telephone calls daily, and it is sometimes necessary to break off to receive one. I dealt with 541 cases during the year, and I have made an analysis of them which I hope may be of interest. My records reveal that 357 were new cases, 26 and of the remaining 184 a few were known to me in 1954 and have been visited by me at intervals since. The average age of the persons visited is becoming steadily greater year by year, and is now over 80 years, many being over 85 years and a few over 90 years. Many of those over 85 years are astoundingly alert and active. Housing problems , (among which I include cases referred by the Housing Office for consideration for priority rehousing on medical grounds) numbered 69. Persons visited while listed for, and awaiting admission to Hospital, or within a few days of discharge, numbered 124. These were cases dealt with in close co-operation with Dr. Dunn, Consultant Physician (Geriatrics). The purpose of these visits was to act as a liaison with the Domestic Help Organisers, W.V.S. , Ilford Social Services Association, National Assistance Board, etc. , in arranging domiciliary services to ease the patient, and those ministering to him, during the wait between being listed for admission, and entering Hospital, which probably averaged two weeks. Loan of Sick Room Equipment was arranged; laundry service for the incontinent organised; second-hand linen sometimes begged from some source to help those whose supply was inadequate; marking tapes stitched on for those who, unable to see, or too handicapped to do it themselves, had no one else available to do it for them; letters written to relatives and posted; Club Leaders informed of members' illnesses, and a multitude of other seemingly minor, but to the sick old person, quite important, small services rendered. Visits to these 124 following discharge, were to check that domiciliary services were re-operating and adequate; and that such things as walking aids and wheel chairs, supplied for use at home, were in fact in use, and satisfactory. Arrangements were made for alterations to the height of beds and chairs in some cases, and advice given about how to take precaution against accidents. Many persons were put in touch with voluntary visitors , and many neighbours seen and told how to contact me in an emergency. I leave my name and the office address and telephone 27 number with each old person whom I visit. Thirty seven cases were of persons whose relatives were finding it difficult to cope. These were persons not needing Hospital admission, but presenting some problem, usually a problem arising out of senility. Refusal to co-operate in such things as retiring to bed at a reasonable hour and undressing before going to bed, or alternatively refusing to dress during the day; - rejection of offers of domestic help service; making a scene when asked to take drugs upon the Doctors' instructions; locking themselves in at night so that access would be almost impossible in any emergency, and being careless with gas and paraffin heaters, cookers, etc., were common problems. Some were old people with severe memory loss who tried to go shopping at 2 a.m. , or who wandered out and were unable to find their way home. It was possible to find some means of easing most of these problems. Old persons will often respond to an appeal or command from a stranger far more readily than to a similar one from a close relative. To many a person of 80 years, a daughter of 60 years is still "a child" from whom a perfectly reasonable request is "audacity". The same request from a District Nurse, or Social Worker, may be immediately responded to without the slightest fuss. This is something not always appreciated by doctor and nrrse. They cannot understand why relatives ask for help in bathing or blanket bathing those who to them are perfectly amenable and mobile old persons. They do not always appreciate that they see the old person's best behaviour; but that just as a child may hold himself rigid and say "Shan't wash" to his mother, so do some old people go stiff and say "I am cleaner than you are" to a daughter. Second childhood is a most apt phrase. Families asking for a holiday for the old person, or care for the old person while the family had a holiday, numbered 43. Several of these were able to go to the seaside to Boarding Houses catering specially for old persons during early spring or in the autumn. Average charge for these holidays is £3.10.0. weekly. Some required help in making the journey; and escorts, cars, etc. were arranged, though not without much difficulty. It is a credit to seaside 28 landladies that there are so many who will patiently and sympathetically watch over, humour, and generally supervise old persons, and we should also realise what we owe to the more active and alert among the aged, who so readily accept the not always pleasant task of giving a helping hand and encouraging word to their frail and confused contemporaries. I have a great admiration for Club Leaders who shepherd large parties of old persons on holiday. The leaders often prove to be old in years themselves, but young in spirit, and with a social conscience. All the 43 applicants were accommodated in some way. A few entered private Guest Homes for the Elderly at the expense of themselves or the relatives. Most of these vacancies were found by me and in some instances the proprietors very kindly agreed to reduce the fees. Several who needed supervision or nursing care entered the Geriatric Unit. The remaining 268 cases, I have called "miscellaneous". To me they present a strong argument in justification of the employment of a social case worker in addition to Health Visitors. Their problems were as many and varied as the pebbles on a beach. Among them were 40 who were referred to the Welfare Department of the County Council of Essex for consideration for admission to Part 3 accommodation. In a few instances I felt such an application to be in the very best interests of the applicant, but in many instances I felt very sorry indeed that no alternative could be found. Some were aged parents living with offspring who had quite comfortable homes, sound health, and good incomes, owed perhaps to the foresight and sacrifice of the parents during their earlier years. Reasons put forward for wishing the old person to leave were often incredibly trivial. It seems a very sad thing to me when a son or daughter is not willing to tolerate some eccentric behaviour, or suffer some inconvenience, to keep the old folk within the family circle in their declining years. Others were quite able bodied alert persons whose landlords wished to gain possession of their rooms. These could have lived happily and independently in old person's flatlets and would have 29 been delighted to do so, but the waiting list for flatlets is still very long and many of these persons were not eligible. The waiting list for the Welfare Homes andHostels is also long, an average wait being about 18 months to 2 years. A large number of my interviews were with persons who were awaiting a flat or welfare accommodation. The waiting period is frequently a time of great strain. To live under the same roof as offspring who have made it clear that your presence is distasteful to them or to suffer insults from a landlady who has picked some quarrel with you, or who constantly reminds you that you are preventing her from selling the property, and acheiving some ambition with the capital, must be hard indeed to bear. It has sometimes been possible to make satisfactory alternative arrangements such as admission to privately owned and administered Guest Houses for the elderly, or the sharing of accommodation with another old person with room to spare. The Ilford Social Services Association now has an experimental boarding out scheme, and some cases have been passed on to their boarding out officer. She cannot always place the applicants but it helps them to know that they are borne in mind. Some persons who have longed for the day when a flat would be allocated to them panic when the dream becomes reality. Their furniture is too large, their curtains the wrong size, they have no cash to pay the removal man, or they are too frail and crippled to go about getting estimates for moving, buying curtain material etc., and they worry. Ihave been able to help several by undertaking some of the running about for them. The Housing Assistants also give help in this way. Arguments with neighbours are a common cause of distress among the aged and I have been the channel through which oil has been poured on the troubled waters on many occasions. Untidy gardens and overgrown hedges are irritations that lead to an exchange of rude words and black looks. The Frenford Boys' Clubhave some kindly young members who undertake to do a little gardening without charge, and through their generosity some of these misunderstandings were swept away with the grass and hedge cuttings 30 and good will restored. Other causes for quarrels have been muddy shoes , overflowing wash hand basins, electric fires left on all night, thoughtless gossip, and deafness which led to suspicion. So often I have no remedy to offer, but I listen and a ready listener may be all the old person needs. A grievance is often whittled down from a mountain to a molehill by being poured into an unbiased ear. Loneliness is not so prevalent as the press and popular opinion would have us believe. Where it is a problem I try to find a friendly visitor from some unofficial source, but organising of a visiting service is a full time job fraught with difficulties and I know the pitfalls but lack the time and opportunity to take steps to avoid them. Therefore my introductions sometimes fail lamentably. Living alone and being lonely are two entirely different situations. One can be lonely in spirit in the midst of a crowd, and many persons living with their families are lonely because they are shut in a little back room while the remainder of the household are enjoying themselves elsewhere. I am no longer surprised at the number of old persons who occupy a room with the plaster flaking from the ceiling, and with drab dirty wall paper. I find them almost daily in houses where all the other rooms are bright and attractive. No wonder they feel lonely. The state of being alone caused by death or other unavoidable partings is bearable; this being rejected by one's family is the bitter pill; the true loneliness. No Voluntary Visitor can take the place of the neglectful daughter who lives close at hand yet never calls, or the son who retires to bed without saying "Goodnight". I continue to feel that the very best place for the majority of elderly persons is in a home of their own with domiciliary services to help them maintain it, and to supply their personal needs. The Domestic Help Service is the most practical of all Services, but is still understaffed. When Helps are ill or on holiday those whom they serve often have to do without help until they return, and 31 there may be a time lag of a week between the application and commencement of service. Some who seek the service because of a temporary disability are fully recovered again before service can be provided. Helps have to be moved around frequently and continuity of relationship, which is an important factor with old persons, is lost. Neighbours and younger relatives could step into the breach much more readily than they do. Another problem frequently brought to me is the question of whether the old person should apply for National Assistance. Many who are fully entitled to it are very reluctant to apply. It may be that an old lady wishes to apply but her husband objects. Sometimes children feel that it is a disgrace and offer to subsidise their parents from their own pockets. This is very commendable, but for various obvious reasons it may not be wise, and the offer can cause grave misgivings in the minds of the old persons. I advise them to the best of my ability. In the main I encourage them to see the National Assistance Board Officer pointing out that his is the expert advice on this particular subject. I have enjoyed the contacts with overseas' students who have been observers here as part of their training. Mutual exchange of experience has been helpful to me and I hope to them too, and it is a pleasant relief to spend some time with younger persons. Another enjoyable aspect of the work has been the privilege of addressing various enthusiastic local organisations. These addresses took place as follows:- 12th January. Newbury Park Residents Association, at Newbury Hall. 20th January. Old Age Pensioners' Meeting at Netley Hall. 29th January. Old Age Pensioners' Meeting at St. Margaret's Hall. 23rd February. The Over 20's Club, Cranbrook Park Methodist Church. 24th February. Old Age Pensioners' club, Methodist Church, Blythswood Road. 32 28th April. Women's Co-operative Guild, Labour Hall, High Road. 24th May. Afternoon meeting of the women's Guild at Parish Hall, Mossford Lane. This was a very large group of 130 persons, including visitors from provincial towns, and one or two from overseas who were in London to attend a Towns women's Guild Conference. Their questions showed them to be a very knowledgeable and lively group. 25th October. Women's Fellowship, St. Lawrence Church, Barkingside. This was my second address to the same group and it was very gratifying to be told that the first address had been so helpful that they would welcome a repetition. 22nd November. Old Age Pensioners Club, St. Mary's Hall, High Road. 13th December. Executive Committee of the Old Age Pensioners' Association at St. Margaret's Hall, Perth Road. This little group showed great enthusiasm and it was clear to me that our local old people are shrewd and sensible when electing those who repre sent their interest. Members of this Committee made up of persons chosen to represent their individual clubs were bright, methodical and practical. My Association with Canning Town (West Ham) Settlement, which was formed before I came to Ilford to work, continues. I am a member of the Executive Committee and Chairman of the Sub-Committee which guides the affairs of the Citizens' Advice Bureau. This gives me an opportunity of learning how things are done in another district. I have also been able to interest the Warden in some of Ilford's old people and several are now happy residents of the Settlement's Old People's Home at Theydon Bois. Work among old people is very demanding, it cannot be fitted into conventional office hours or shut into drawers and cabinets at the close of the day; it 33 can and often does intrude into Sundays and Bank Holidays, in fact, to do It conscientiously one must set no bounds other than the securing of a sensible amount of leisure for recreational purposes, without which it would be impossible to carry on, but on the other hand it is richly satisfying. I am frequently asked whether I find my work depressing. I can say with absolute truth that I never do. I am often annoyed, sometimes deeply moved, frequently highly amused, occasionally exhausted in body and mind, but always borne up by an underlying conviction that I am working in the most worthwhile of fields. The onlooker sometimes queries whether I am spending my energies in vain. I can only reply that this is work in which the results cannot readily be seen or judged from without." 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 82 persons were assisted and 17,314 articles were laundered. (ix) HOSPITALS, ETC. Chadwell Heath Hospital. -178 beds are provided; 69 for general infectious diseases, 101 for geriatric cases, and 8 beds are used for ear, nose and throat cases. Maternity Hospital. - 51 beds for reception of maternity cases are maintained at the Ilford Maternity Hospital. King George Hospital. - The following is a return in respect of bed accommodation: - Total number of Beds at 31st December 1960. Pay Beds 14 Amenity Beds 7 Other Patients Children Medical Surgical Male Female Male Female 208 21 26 18 55 55 33 At31.12.60. 3 beds were occupied by "chronic sick." The above three hospitals are included in the Ilford and Barking Group. (Group 12 N.E. Metropolitan Regional Hospital Board). 34 Mr. H. F. Harris, the Hospital Group Secretary, informs me as follows regarding the proposed extensions to the King George Hospital and the Barking Hospital. "The planning of the Barking Hospital Major Development Scheme has progressed and discussions with the Ministry have taken place. At present the Regional Hospital Board are preparing their Capital Programme for the next five years and we hope that this Scheme will be given a definite starting date. Unhappily the King George Hospital Major Development Scheme has not progressed as quickly as Barking, mainly due to the difficulty the Consulting Architects are having in producing a plan which is acceptable to the Ministry. It should be appreciated that this is an extremely difficult project, as we are attempting to build practically a new Hospital on the King George Hospital site and at the same time maintain reasonably normal services. Two new alternative plans will shortly be submitted to the Ministry and it is hoped that one of these will be accepted and detailed planning can commence." Mental Hospitals. - There are two large Mental Hospitals in the district, the Goodmayes Hospital, with 60 Resident Staff and 1,343 patients (males 608, females 735), and Claybury Hospital, with 190 Resident Staff and 2, 107 patients (males 844, females 1,263) in residence on 30th June, 1960. (These Hospitals are included in Groups 21 and 20 respectively of the North East Metropolitan Regional Hospital Board. ) Other Institutions. - Australasian Hospital (Dr. Barnardo's Homes), Barkingside, has 60 beds in the Hospital and on 30th June, 1960, there were 29 Resident Staff and 29 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. 35 (x) AMBULANCE FACILITIES : COUNTY AMBULANCE SERVICE. The County Ambulance Service is provided and administered centrally by the Essex County Council. An Ambulance Control at Ilford 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. The Control which is equipped with two-way radio, is also in direct communication with ambulance vehicles operating in the area. 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, Ilford Ambulance Control, Aldborough Road, Ilford, or in cases of urgency by telephone (Valentine 8822). Requests for ambulance transport, other than emergency requests, are only accepted from Doctors, Midwives, Duly Authorised Officers and the medical staff of hospitals. 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. 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 Hralth, County Hall, Chelmsford, Chelmsford 3231. (xi) CLINICS AND TREATMENT CENTRES: MATERNITY AND CHILD WELFARE. - Infant Welfare Centres are held at the following premises:- Chadwell Christian Mission-Hall, EssexRoad, Chadwell Heath (far residents of Chadwell Heath area) Monday, 2 p.m. 36 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 I.C.C. estate) Tuesday, 2 p.m. Marks Gate Clinic, Lawn Farm Grove, Chadwell Heath (for residents on Padnall Estate) Tuesday, 2 p.m. Kenwood Gardens Clinic (for residents of Woodford Avenue area) Heathcote Avenue Clinic, (for residents of Barkingside and Clayhall area) Wednesday, 2 p.m. andF riday,9.15a.m. Wednesday, 2 p.m. Cecil Hall, Granville Road, Ilford (for residents of the east side of Cranbrook Road) Wednesday, 2 p.m. Seven Kings Methodist Church Hall, Seven Kings Road (for residents of Seven Kings area) St. Albans Church Hall, Albert Wednesday, 2 p.m. Road, Ilford (for residents of Grosvenor Road area) Wednesday, 2 p.m. CecilHall, Granville Road, Ilford (for residents of the west side of Cranbrook Road) Thursday, 2 p.m. Newbury Hall, Perry man's Farm Road, Newbury Park (for residents of the Newbury Park area) Mayesbrook Clinic (for residents of Goodmayes area) Thursday, 2 p.m. Thursday, 2 p.m. St. Albans Church Hall, Albert Road, Ilford (for residents of Ilford Lane area) Friday, 2 p.m. Parish Hall, Mossford Green, Barkingside (for residents of Fairlop area) Friday, 2 p.m. Methodist Church Hall, The Drive (for residents of Valentines and Cranbrook area) Friday, 2 p.m. 37 Ante-Natal Clinics. - An Ante-Natal Clinic is held at the Maternity Hospital, Eastern Avenue, Ilford, on Tuesday morning and afternoon, Wednesday morning and afternoon (Obstetric Specialist), Thursday morning and afternoon, Friday morning and 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. Midwives Ante-Natal Clinics are held at the Kenwood Gardens Clinic each Friday afternoon;-at Mayesbrook Clinic each Monday afternoon; at Manford Way Clinic on alternate Thursday afternoons; at Heathcote Avenue Clinic on alternate Tuesday afternoons and at Marks Gate Clinic on first and third Wednesday afternoons of each month. 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 second Monday morning of each month. School and other Clinics. - Clinic sessions are held at Health Services Clinics as under:- (i) KENWOOD GARDENS CLINIC, forMinor Ailments Dental (Children and Expectant Mothers) Orthopaedic and Remedial Exercises treatment Artificial Sunlight treatment Diphtheria and Whooping Cough Immunization Ear, Nose and Throat Ophthalmic treatment Paediatric Infant Welfare Toddlers Midwives Ante-Natal Mothercraft Enuresis B. C. G. Vaccination Poliomyelitis Vaccination Chiropody. 38 (ii) MAYESBROOK CLINIC, Goodmayes Lane, for— Minor Ailments Dental (Children and Expectant Mothers) Ophthalmic treatment Artificial Sunlight treatment Ante-Natal and Post-Natal Mothercraft Diphtheria and Whooping Cough Immunization Orthopaedic and Remedial Exercises treatment Infant Welfare Speech Therapy Midwives Ante-Natal Orthoptic B.C.G. Vaccination Poliomyelitis Vaccination Chiropody (iii) NEWBURYHALL, Perryman's Farm Road, Infant Welfare Chiropody. Mothercraft. (iv) VALENTINES SCHOOL, Beehive Lane, for- Dental (Children) Speech Therapy. (v) LOXFORD HALL, Loxford Lane, for— Child Guidance. (vi) MANFORD WAY CLINIC, Hainault, for— Ante-Natal and Post-Natal Mothercraft Infant Welfare Diphtheria and Whooping Cough Immunization Midwives Ante-Natal Dental (Children only) Ophthalmic treatment Orthopaedic treatment Poliomyelitis Vaccination Chiropody. 39 (vii) HEATHCOTE AVENUE CLINIC, forInfant Welfare Midwives Ante-Natal Mothercraft Diphtheria and Whooping Cough Immunization Poliomyelitis Vaccination Chiropody. Speech Therapy. (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 (by appointment only) are held each week. For Adults - Monday 2 to 4 p.m. (new cases) Friday 10 to 12 noon ( " " ) Tuesday 10 to 11.45 a.m. (old cases) Wednesday 2.30 to 4.15 p.m. ( " " ) Friday 2 to 4.30 p.m. ( " " ) Wednesday 6.30 to 8 p.m. (new & old cases) Monday 10 to 12 noon (Ambulance cases) For Children - Wednesday 10 to 12 noon Contacts Clinic - Tuesday 2.30 p.m. B.C.G. Clinic - Thursday 10.30 a.m. 40 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The Chief Public Health Inspector reports as follows:- "The Clean Air Act, 1956. - The Padnall Estate Smoke Control Area having been instituted last year is operating well. There has been little trouble - indeed no contraventions of the Order were discovered nor has there been any difficulty in obtaining the appropriate 'smokeless fuels'. The co-operation of the owners and the tenants in this project and the advice and information received from the various Government departments and the fuel merchants is gratefully appreciated. Atmospheric pollution measurement was improved by the purchase of a 'Smoke Stain Reflectometer' which eliminates the human errors possible in visual examination and estimation of the density of stains on filter papers used with the Volumetric appliances on the three stations in the Borough. The 'deposit gauges' and the 'lead peroxide' appliances have been discontinued as they are now considered to be inefficacious in general atmospheric pollution measurement. This will mean a considerable curtailment of expenditure on the analysis of the results of the exposures of these instruments. Housing Act, 1957. - The clearance of unfit houses in accordance with the five year programme submitted to the Minister continued and is nearing completion. It is limited by re-housing problems, but these are being dealt with urgently by the Council. A particular problem facing not only the Ilford Council but the larger towns in the country generally, is that created by the acquisition of the larger type of dwelling house by an individual and sub-letting it to separate families to create overcrowding and sanitary chaos in the amenities provided with resultant nuisance and annoyance not only to the occupiers themselves but also to the neighbours. 41 It is appreciated that section 36 of the Act empowers a local authority to require the owner of such properties to reduce the number of occupants and to carry out works to render the house fit for the occupation of the families dwelling therein, having particular regard to the features of section 4 relating to natural lighting, ventilation, water supply, drainage and sanitary conveniences and the means of storing, preparing and cooking food and for disposing of waste water. The Borough Council decided that these premises be dealt with rigorously and to this end required the provision of water supply, sink with drain, food store and cooker, separate for each family with a water closet for the joint user of each pair of families. This resulted in a reduction of families in occupation and an amelioration of the insanitary conditions. This problem was not confined to coloured families and was created undoubtedly by the landlord whose responsibilities were confined to the immediate and expedient object of making an investment pay f<tr higher rewards than were reasonable. It behoves every authority to treat this difficulty with the same seriousness as has the Ilford Council. It will undoubtedly create hardship by the displacement of families but the maxim that 'prevention is better than cure' ought to determine these conditions. In my view the all too frequent permission to allow one sanitary convenience, one water supply etc. for the common use of all the families in occupation is neither sound sanitary practice nor conducive to a good standard of living. It may be that bye-laws for this purpose will have to be re-introduced which would make it an offence for an owner to let houses in contravention of the promulgated rules. Otherwise the comprehensive sanitary law was administered satisfactorily by the Public Health Inspectors at the instructions of the Council. 42 The work of these officers in maintaining the high standards of environmental health in the borough has been so expeditious, such that they have even been commended by the public on occasions, a rare compliment indeed for officers who for so long have been the subject of acrimony, rather than gratitude." (i) WATER SUPPLY. - The district is served by the Metropolitan Water Board and South Essex Waterworks Co. 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 following information. "The part of Ilford in the area of the Metropolitan Water Board is supplied with water derived from the River Lee which is filtered and chlorinated at the Lee Bridge Works. There is also a certain amount of water from the Ferry Lane Works which deals with a mixture of chalk well water and River Lee derived water. The third source is from the Board's well at Wanstead. Samples of water are collected at all stages of purification and a total of 1380 samples was submitted to chemical and/or bacteriological examination. During the year 1960 the total distances of water mains of various diameters laid in the Borough of Ilford was 1,196 yards. All new and repaired mains are chlorinated before being restored to supply and samples from these are tested to confirm that the quality of the water is up to the standard normally supplied. " 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. 43 Mr. Hugh G. Ramsey, Engineer to South Essex Waterworks Co. , has kindly supplied me with the following information. "During 1960 over 4,400 chemical, bacteriological and biological examinations were made at the Langham Laboratory, and all water going into supply was reported as wholesome. In addition samples were examined for radioactivity. Samples taken from the wells situated in the Company's statutory area were analysed weekly and all were likewise reported on as above; in addition samples were taken weekly from houses in various parts of the supply area for bacteriological examination and they were invariably perfectly satisfactory. A supplementary supply of water was obtained from the Metropolitan Water Board during the months of July and August, the total quantity being 30 million gallons. The water supply of the area and of its several parts has been satisfactory as to quality and quantity, no difficulties being experienced in the supply such as occurred in 1959. The following mains were laid in Ilford during 1960: 3" 4" 6" 9" Yards 90 9 5 2 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 by the Department and submitted for Chemical and Bacteriological examination, and all gave satisfactory analyses. 44 (ii) PUBLIC SWIMMING BATHS. - There are three public swimming baths in the Borough. Two indoor, 120,000 gallons and 66,000 gallons respectively and one open-air, of 250,000 gallons approximately. Mains water supply is used in all cases and the method of treatment is by breakpoint chlorination. The water is normally changed once annually in the case of the larger indoor bath and the openair bath, which are closed during the winter months. The smaller indoor bath is, however, in ope ration throughout the whole of the year, and as is the case with all the baths, is "topped up" as necessary. Six samples of water for examination were taken from the open-air swimming bath from April to September. The samples were satisfactory. Fifteen samples were also taken from the two indoor baths during January, March, April, May, June, July, August, September and November: all the samples were satisfactory and of a high standard of bacterial purity. (iii) DRAINAGE AND SEWERAGE. - The Borough Engineer has kindly supplied me with the following:- Main Drainage Progress continued on the relief of flooding in the Borough and the stages of various schemes undertaken during the year are as follows:- Completed: (a) Ley Street/Horns Road Soil and face Water Sewer £161,524 (b) Roding Valley Mid-Level Soil Sewer - Stage I £ 99,787 (c) High Road, Chadwell Heath £ 48,779 (d) Wanstead Park Road/Redbridge Lane Surface Water Sewer £ 38,098 Nearing Completion: (a) Hainault/Trelawney Road Surface Water Sewer £300,500 Commenced: (a) Cranbrook Stage III Surface Water Sewer £102,050 45 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. (iv) COLLECTION AND DISPOSAL OF REFUSE. The Borough Engineer also kindly supplied the following information:- Total amount of refuse collected and disposed of Collection of Salvage:— Tons 53,028 Tons Income Wastepaper 1,418 £10,143 Hags and Scrap Metal 164 £1,638 (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 31,793 Houses and premises reinspected (work in progress) v23,214 Visits during disinfection 210 Houses in which nuisances were detected 759 Houses in which nuisances were abated 764* Premises disinfected 24 Premises from which articles only disinfected 27 Articles disinfected 153 Premises disinfested for verminous conditions 14 *Includes 114 nuisances detected before 1st January, 1960. Notices served:— Statutory: — Served Complied with Public Health Act, 1936 70 57 Housing Acts, 1936 and 1957 — — Factories Acts, 1937 and 1948 5 4 Shops Act, 1950 — — Provide Dustbin (Ilford Urban District Council Act, 1904) 14 13 Food and Drugs Act, 1955 2 2 Cleanse Water Storage Cistern (Byelaws) - - Cover Water Storage Cistern (Byelaws) — — Informal 907 763 998 839 In addition to the above, 182 notices (28 statutory and 154 informal) served previous to 1st January, 1960, were also complied with. Complaints. - During the year 3,072 complaints of nuisances were received and investigated. 46 The following is a summary:- Accumulation of manure and refuse 39 Animals improperly kept 19 Bad smells 63 Dampness of premises 82 Defective drains, w.c.s and fittings 576 Defective roofs, gutters, downpipes, etc. 80 Defective water fittings 34 Dirty and verminous houses 30 Dirty condition of rearway 12 Flooding of premises 40 Overcrowding 21 Smoke nuisances 93 Defective or no provision of dustbin 858 Rats and mice 550 Miscellaneous 575 Total 3,072 (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 101 inspections were made, and 1 Preliminary Notice was served. 1 Statutory and 2 Preliminary Notices (2 served prior to 1960) were complied with. No Certificates of Exemption from the provisions of Section 38 were granted in 1960. (vii) SLAUGHTER OF ANIMALS ACT, 1933 to 1954.No licence to act as slaughterman was granted during the year. (viii) 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. No licence was issued in 1960 in respect of premises used as a rag flock store. (ix) LAND CHARGES ACT, 1925,- During the year 4,017 enquiries were dealt with under this Act. (x) CLEAN AIR ACT, 1956 - Borough of Ilford No. 1 (Padnall and Marks Gate Estates) Smoke Control Order, 1960. - This Smoke Control Order, the first to be made in the Borough was confirmed, without modification, by the Minister of Housing and Local Government, and came into operation on 1st November, 1960. The area covered by the Order is bounded on the north side by Billet Road, on the south by Eastern Avenue, on the east by the Borough boundary, and on the west by Hainault Road. It contains 483 47 dwellinghouses and flats, a public house, an old people's home, 2 shops, 2 farms, a store with office, a church and a social club. Six properties were granted exemption in respect of ignition of smokeless fuel as there is no gas supply available. All necessary adaptations to fireplaces to comply with the Order have been carried out. (xi) ATMOSPHERIC POLLUTION. - Complaints were received of alleged smoke nuisance from 13 factories in the Grove Road, Newbury Park, Green Lane and Ilford Lane areas. In 8 Instances no emission was noted which would have enabled action to be taken under the Public Health Act, 1936, or Clean Air Act, 1956. Five informal notices were served in other instances. Three stations for measurement of atmospheric pollution have been installed in the Borough as follows:- No. 1 - Gantshill Library No. 2 - John Bramston School No. 3 - Ilford Town Hall. Each stationhas a deposit gauge a lead-peroxide instrument and a volumetric apparatus. Details of monthly records for the year 1960 are shown in the following table. 48 ATMOSPHERIC POLLUTION RECORDS JANUARY I960 - DECEMBER I960 Average Daily Concentrations Mg/of SO3/day collection by l00sq.cm. of Batch APbO2 (Louvered cover) Monthly Depoaits TONS per Sq. MILE Smoke in cubic metre Sulphur Dioxide in parts per 100 millions WATER (litzes) P.H. value WATER Insoluble matter ASH Other Combustible matter WATER Soluble matter S.04 STATION N0.1 GANTSHILL LIBRARY 1960 January 0.25 8.4 1.9 3.10 4.4 10.17 6.31 3.86 6.07 1.68 February 0.21 8.3 1.8 2.90 4.5 7.28 5.10 2.18 7.11 0.64 March 0.10 5.3 1.1 2.10 4.8 3.66 2.32 1.34 6.64 0.74 April 0.7 4.5 0.68 0.85 5.5 5.10 3.36 1.74 4.93 0.97 May 0.04 3.3 0.72 3.70 4.4 1.58 1.31 0.27 5.40 1.34 June 0.03 2.6 0.73 1.85 4.8 2.01 1.31 0.70 4.30 0.94 July 0.03 2.1 0.28 6.20 5.2 9.23 7.11 2.12 5.84 0.94 August 0.05 2.3 0.59 7.95 4.5 2.82 1.71 l.11 7.52 1.64 September 0.05 2.4 0.58 7.00 4.4 4.40 2.72 1.68 5.07 1.18 October 0.12 5.5 1.1 10.60 4.4 8.89 6.54 2.35 11.24 3.76 November 0.20 8.0 2.1 5.85 4.4 7.25 4.97 2.28 6.01 1.78 December 0.24 8.6 1.7 5.50 4.1 9.80 7.22 2.58 7.01 1.71 STATION NO.2 JOHN BRAMSTON SCHOOL 1960 January 0.18 4.8 2.3 3.00 4.2 3.45 2.28 1.17 6.68 1.28 February 0.20 4.7 2.2 2.80 4.3 3.29 2.38 0.91 5.67 1.04 March 0.07 2.6 0.98 1.90 4.9 3.76 2.68 1.07 5.00 1.28 April 0.05 2.7 1.1 0.65 — 4.53 3.22 1.31 4.63 0.77 May 0.04 2.6 1.88 2.4 4.5 2.78 1.91 0.87 5.26 1.04 June 0.03 1.9 0.77 2.90 4.8 3.56 2.35 1.21 6.91 1.41 July 0.02 1.7 0.58 6.4 5.1 4.40 3.02 1.38 5.23 1.01 August 0.04 1.8 0.76 5.35 4.6 2.95 2.11 0.84 11.75 1.88 September 0.04 2.05 0.88 6.05 4.5 2.62 1.75 0.87 5.27 1.07 October 0.07 3.04 1.4 10.50 4.6 4.63 3.66 0.97 9.60 2.99 November 0.13 4.02 2.3 5.25 4.2 4.16 2.95 1.21 6.21 1.81 December 0.20 5.06 * - *- * _ *- _ * _ * _ * _ *_ STATION NO.3 ILFORD TOWN HALL 1960 January 0.31 12.9 3.1 2.20 4.1 4.00 2.63 1.37 9.40 2.57 February 0.28 11.5 3.2 2.20 4.3 8.30 5.33 2.97 5.97 2.43 March 0.18 6.6 1.5 1.70 4.8 5.45 3.17 2.28 8.04 1.83 April 0.09 5.9 1.4 0.40 — 5.00 2.03 2.97 5.84 1.40 May 0.06 4.6 1.0 3.6 4.8 4.94 4.04 0.90 5.37 1.67 June 0.04 4.0 0.99 1.85 4.9 4.33 3.10 1.23 6.04 1.33 July 0.03 3.4 0.22 5.40 4.8 6.17 3.94 2.23 7.57 1.33 August 0.06 3.8 1.1 6.75 4.5 3.97 2.40 1.57 11.00 1.20 September 0.05 4.2 1.2 6.75 4.5 4.57 2.74 1.83 5.40 1.70 October 0.19 8.1 1.9 9.85 4.4 9.81 6.94 2.87 12.47 3.70 November 0.22 12.0 3.2 4.50 4.2 8.37 5.27 3.10 8.94 2.67 December 0.31 16.4 3.7 3.75 4.3 11.27 7.67 3.60 8.27 2.10 * Instruments eat of commission. 49 SECTION D. — HOUSING. (i) OVERCROWDING. - Three notices were served during 1960. (ii) CLEARANCE AREAS. - Two areas were declared by the Council to be Clearance Areas, in 1960. The Council makes 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, 754 (b) Number of inspections made for the purpose 18,096 (2) (a) Number of dwelling-houses cluded under sub-head (l)above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 10 (b) Number of inspections made for the purpose 12 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 25 (4) Number of dwelling-houses sive of those referred to under the preceding sub-head)found not to be in all respects reasonably fit for human habitation 323 50 2. Remedy of defects during the year out service of formal Notices:- Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their officers 207* 3. Action under Statutory Powers during the year:- A. Proceedings under 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 fault 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 84 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 58* (b) By local authority in fault of owners 4 C. Proceedings under Section 17(1) of the Housing Act, 1957. (1) Number of dwelling-houses molished as a result of formal or informal procedure 25 (2) Number of dwelling-houses cLosed in pursuance of an undertaking given by the owners and still in force — 51 D. Proceedings under Section 18 of the Housing Act, 1957. Number of separate tenements in respect of which Closing Orders were made — 4. Housing Act, 1957, Part IV Overcrowding:- (a) (i) Number of dwellings crowded at the end of the year 23 (ii) Number of families dwelling therein 28 (iii) Number of persons (units) dwelling the rein 104 (b) Number of new cases of ing reported during the year 6 (c) (i) Number of cases of ing relieved during the year 25 (ii) Number of units concerned in such cases 117 (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 1960 of Notices served prior to 1st January, 1960. HOUSING ACTS, 1936 and 1957. During the year 1960 the work of receiving applications, calling for calculations for the "permitted number" was continued with a view to the issue of housing certificates. 3 certificates in respect of 3 houses were Issued during the year, making a total of 18,366 certificates, in respect of 25,176 houses, issued to the end of 1960. 52 As new premises were constructed and placed upon the rating lists, "permitted number" certificates were issued as required. MEDICAL PRIORITIES FOR REHOUSING. In 1960, 46 recommendations were made to the Housing Committee. In addition to the visits and reports of the Public Health Inspectors on the home circumstances, the Medical Officer of Health has consultations with the private doctors and/or Hospitals. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACT, 1920 and 1933, AND HOUSING REPAIRS AND RENTS ACTS, 1954 and 1957. Particulars relating to 1960 are as follows:- Application for Certificates of Disrepair received 27 Certificates of Disrepair granted 23 Certificates of Disrepair refused Applications Withdrawn 4 Certificates of Disrepair issued 14 Undertakings received from landlords 12 Unexpired Notices of Proposal to issue Certificates of Disrepair 2 Certificates cancelled 13 Applications for cancellations of Certificates applied for but not granted - Certificates as to remedying of defects specified in Landlord's Undertaking to remedy Defects: Issued to Landlords 7 Issued to Tenants- 53 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 (GENERAL) REGULATIONS, 1959.- Persons and premises registered as at 31st December, 1960:- Persons registered as distributors of milk 115 Premises registered as dairy premises (other than dairy farms) 12 184 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 1960:- Tuberculin Tested 36 do. (Supplementary) 10 54 (iii) MILK (SPECIAL DESIGNATION) (PASTEURISED AND STERILIZED MILK) REGULATIONS, 1949 to 1953:- The following licences were granted during 1960:- Pasteurized (Dealer's) 76 do. do. (Supplementary) 10 do. (Pasteurizer's) 1 Sterilized (Dealer's) 104 do. do. (Supplementary) 13 do. (Sterilizer's) 1 Two licences granted by the Essex County Agricultural Executive Committee , in respect of the production of Tuberculin Tested milk at farms in the Borough are in operation. (iv) SAMPLING. - The following is the routine practice adopted:- Designated Milks (Rawand Heat treated).- These are sampled bi-monthly and after unsatisfactory reports. Biological Tests. - Samples of all raw milk (if any) 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. 55 The following results were obtained:- Grade of Milk Total Satisfactory Unsatisfactory Remarks on unsatisfactory results Tuberculin Tested (Pasteurized) Milk 44 43 1 Was decolourized at the end of 25 minutes. Did not satisfy Meth. Blue test. Letter sent to producer. Tuberculin Tested Milk (Farm bottled) — — — — Pasteurized Milk 65 65 — — Sterilized 16 16 — — (v) BIOLOGICAL TESTS. - No samples of milk were submitted to a biological test for tuberculosis. (vi) MILK AND DAIRIES ORDERS, 1926 AND 1938: INSPECTION OF DAIRY HERDS. - Two examinations were 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. - 6 complaints of the presence of foreign bodies in milk were received and investigated. Legal proceedings were taken in one instance and a fine of 40s. plus 20s. costs was imposed, and representations were made to the retailers in all cases. Three of the complaints are detailed in the paragraph on Food and Drug sampling. (viii) REGISTRATION. - No application for registration was refused during the year. ICE CREAM. (i) REGISTRATION. Section 158, Essex County Council Act, 1933. In 1948, the Council delegated to the Public Health Committee 56 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 whyapplications for registration should not be refused or existing registration should not be revoked. 108 applications for registration in respect of 107 premises were considered during the year 1960. Registration was granted to 1 applicant in respect of the manufacture and sale and to 107 applicants in respect of the sale only of icecream. (ii) ICE-CREAM (HEAT TREATMENT, ETC.)REGULATIONS, 1959. The Council has 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 atthe 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 1960, 31 samples were submitted for examination with the following results:- No. of Samples Ministry of Health Provisional grade. % of Total Unsatisfactory Samples. 18 I 58 - 5 II 16 - 4 III 13 1 4 IV 13 - 31 100 1 57 The Food Standards (Ice-Cream) Regulations, 1959, described standards for ice-cream. During 1960, no samples were submitted for chemical analysis. MEAT AND OTHER FOODS. (i) INSPECTION AND SUPERVISION. The Council 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. The Public Health Inspectors reported five instances of individuals using tobacco whilst engaged in the handling of "open" food contrary to the Food Hygiene Regulations, 1955. Legal proceedings were taken and fines of £5 plus £1 1s. costs; £25 plus £1 1s. costs; and £5 plus £1 1s. costs respectively, were imposed by the Court, in three cases. One other case was dismissed and in the remaining case the summons was not proceeded with. Legal proceedings were also taken in respect of the non-display of name and address of the owner, on a greengrocery stall. The defendant was fined 10s. plus 10s. costs. The Essex County Council Act, 1952, Section 105, requires that as from 2nd April, 1953, any person intending touse 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 1960, they made 13,397 inspections of food shops and food preparing premises. 122 informal and'2 formal notices were served under the Food and Drugs Act, and 3 formal and 128 informal notices were complied with including 34 informal notices served prior to 1960. 58 (ii) FOOD HYGIENE. The following gives the numbers of food premises in the area by the type of business:- Cafes and Restaurants 155 Factory canteens 26 Butchers' shops 118 Grocers' shops 257 Fruiterers' and Greengrocers' shops 117 Fishmongers' and Fishfryers' shops 50 Bakehouses 20 Bakers' shops 39 Confectioners' shops 212 994 The practice of inculcating interest in the proprietors, directors and staffs of food handling organisations was continued in 1960, 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 1960. 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. 168 samples (103 formal and 65 informal) were obtained during the year 1960; 3 formal and 3 informal samples were not satisfactory as follows:- (a) Adult cough linctus (formal). - Statement of active ingredients incorrectly given on bottle label. A letter of warning was sent to the manufacturer. (b) Wholemeal soda bread mix (formal). - No declaration of proportions of vitamins and minerals claimed to be present. Letter of warning was sent to the manufacturer. 59 (c) Milk bottle (informal). - Contained foreign matter (sawdust and quartz sand). Letter of warning was sent to the retailers. (d) Milk bottle (informal).-Contained foreign matter (dried milk film and atmospheric dust). No action was taken in this case. (e) Pork sausages (formal). - Contained 53% meat being insufficient in opinion of analyst to justify description of "Pork Sausages". No action was taken in this case. (f) Milk bottle (informal). - Contained chicken bone. No evidence found to indicate bone had been subjected to bottle washing process. No action was taken in this case. (iv) FOOD STANDARDS - MEAT PIES. - The Council co-operated in the review of the composition of meat pies being undertaken by the Food Standards Committee of the Association of Municipal Corporations by supplying detailed information of samples taken over a period of six months during 1960. (v) 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 registeredby the local authority. Registration was granted to 12 persons and 7 premises were also registered during 1960. (vi) 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. 3 applications for registration were received and granted during 1960. (vii) ARTICLES OF FOOD SURRENDERED. During the year the following articles were surrendered and condemned as being unfit for the food of man:- 60 Bacon, 396 lbs.; Beverages, 5 tins; Biscuits, 12 pkts; Cereals, 21 lb. + 62 tins; Cheese, 36 lbs.; Cream, 2 tins; Fish (wet and dry), 81 stone; Fish (tinned), 156 tins; Fruit (tinned), 911 tins; Fruit (dried), 2 lb.; Fruit Juice, 30 tins; Jam Preserves , 25 lbs.; Meat (Fresh), 2501 lbs.; Meat (Tinned), 2602 lbs.; Meat Pies, 8 only; Milk (Tinned), 171 tins; Nuts, 23½ lbs.; Pastry and Pudding Mix, 7 pkts; Pickles, 17 jars; Poultry, 135 lbs.; Soups (tins), 49 tins; Vegetables (Tins), 321 tins; Dessicated Coconut, 50 lbs. (viii) FOREIGN BODIES IN FOOD. 14 complaints (including 3 milk samples referred to in paragraph (iii) Sampling) were received during 1960 of the presence of foreign bodies in foodstuffs; letters of warning were sent in 2 cases and legal proceedings taken in 2 cases, in both of which fines of £5 plus £1 1s. costs were imposed. (ix) 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. 117 notifications were received. There were 42 family outbreaks and 46 single cases. In 4 outbreaks (involving 12 persons) the causual organism was identified as Salmonella Typhi-murium; in 1 outbreak (involving 3 persons) as Salmonella Enteriditis; and in 2 outbreaks (involving 6 persons) as C1. Welchii. In the remaining 35 outbreaks (involving 105 persons) no agent was identified. Regarding the single cases, the agents identified were Salmonella Typhi-murium 4, and Salmonella Newport 1. In the remaining 41 cases no organism was identified. With a view to preventing spread of infection an assistant in a fishmongers shop, who was notified as a "carrier" of dysentery was excluded from his employment for a period of 2 weeks and compensation for loss of earnings was paid in respect of this period. 61 (x) BAKEHOUSES. - There are 20 bakehouses in the district, ail of which use motive power, 374 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 6 instances and the requests were complied with in all cases. (xi) MERCHANDISE MARKS ACT, 1926. - Two contraventions of this Act were reported during 1960, regarding the incorrect labelling of apples and tomatoes displayed for sale by a retailer. Preliminary notices were served in both cases. DISEASES OF ANIMALS ACT, 1950. (i) THE MOVEMENT OF ANIMALS (RECORDS) ORDER, 1960, revoked the Order of 1925 to amend the recording ofmovement of bovine animals to require additional particulars of identification which were to be retained for 3 years in respect of bovines and for other animals for one year. THE TUBERCULOSIS (ENGLAND AND WALES ATTESTED AREA) ORDER, 1960. - This Order revoked previous Orders for eradicating tuberculosis and declared England and Wales, subject to exceptions, to be an attested area for that purpose. Under the TUBERCULOSIS (COMPENSATION) AMENDMENT ORDER, 1960, an Order was made to amend the Tuberculosis (Compensation) Order 1950 which increased the maximum compensation payable for a reactor to the test, from £100 to £120 and the compensation payable for an animal in contact with a reactor was increased to its full market value. THE IMPORTATION CF HORSES, ASSES AND MULES (AFRICANHORSE SICKNESS) (PROHIBITION) ORDER, 1960, extended the definition in section 84 of the 1950 Act to include African horse sickness and prohibited the importation into this country of horses believed to be affected with such disease and made minor amendments to the Order of 1957. THE IMPORTATION OF CARCASES AND ANIMAL PRODUCTS (AMENDMENT) ORDER, 1960, amended the Order of 1954 to exclude fresh and refrigerated pork and 62 edible pork offal, originating in Argentina, Brazil, Chile and Uruguay, from the category of meats permitted to be landed in Great Britain. It also required bacon and ham from these countries to be accompanied by a certificate that it has been fully cured. FOWL PEST ORDER OF 1936. - A notice, Form B, was received from the Ministry restricting the movement of poultry at premises in Ilford, which were visited. The poultry were destroyed and the necessary cleansing and disinfection carried out. THE FOWL PEST ORDER OF 1936, as amended in 1947.- Copies of the Restriction of Movement Order served on four persons having control of poultry in the Ilford area were received, which restricted the movement of poultry from the premises without licence from an Inspector of the Ministry of Agriculture, Fisheries and Food. CYANIDE GAS - FOWL PEST. - The Animal Health Division of the Ministry is now using qualified cyanide gas operators under licence from the Home Office to assist in the destruction of poultry affected with fowl pest. Under the Cyanide Regulations it is necessary to give the local Medical Officers of Health notice of intention to use this substance but, as this is impracticable, having regard to the need to destroy birds immediately, the Veterinary Officer dealing with the outbreak will advise local police who in turn will contact the local authority as soon as possible in order that attendance may be made at the site of operation. THE FOWL PEST (SOUTH ESSEX INFECTED AREA) ORDER, 1960. - On the 29th November, 1960, an area which included Ilford, to be an infected area was declared. Publication of this Order was made. This Order was amended on 15th-December which retained Ilford in the area. THE FOOT AND MOUTH DISEASE (INFECTED AREAS) SPECIAL ORDER NO. 12, 1960. - On 6th February the Ministry confirmed foot and mouth disease at Enfield, Middlesex, and declared an infected area which included Ilford. Immediate notice to this effect was sent to all owners of animals covered by the Order. The Order was amended by another dated 16th February contracting the area to exclude Ilford. 63 FOOT AND MOUTH DISEASE (INFECTED AREAS) SPECIAL ORDER NO. 23, 1960.-Notice was received under the Foot and Mouth Disease Order of 1938 specifying an area in the north and west of London as an infected area in accordance with the requirements of Article 7 of the Animals (Miscellaneous Provisions)Order of 1927. Personal notice of this Order was served on all known animal owners affected by it. THE FOOT AND MOUTH DISEASE (CONTROLLED AREAS) SPECIAL ORDER NO. 1, I960. - The Minister of Agriculture, Fisheries and Food on 7th November, 1960 declared an area covering the whole of Essex including Ilford, as a controlled area for the purpose of preventing the spread of foot and mouth disease. THE FOOT AND MOUTH DISEASE (INFECTED AREAS) SPECIAL ORDER NO. 78, 1960.-On 24th November an area which included Ilford was declared to be an infected area. Another Special Order, No. 95, made on 2nd December, declared an area mainly of parts of Norfolk, and East and West Suffolk, to be an infected area. As traders inllford might possibly deal with stock in this area, notices were likewise served on interested parties. On 26th November the Ministry declared an area scheduled in the Special Order No. 9, including the Borough of Ilford, to be a controlled area for the purposes of the Order 95. On 10th December under this Order a licence was issued to the Secretary of the King George Hospital Pig Club, Eastern Avenue, Ilford, permitting the removal of 5 large white pigs from the hospital piggeries to slaughterhouse in Laindon, Essex. The Foot and Mouth Disease (Infected Areas) Special Order No. 10, 1960, declared that the Order No. 9 of 1960, which included Ilford, was to cease to be a controlled area on 11th December, 1960. The Foot and Mouth Disease (Infected Areas) Special Order No. 101, 1960, was amended to exclude, among other districts the Borough of Ilford from the effects of the Order No. 78. 64 Unfortunately foot and mouth disease continued to be prevalent in the area, hence the Minister by telegram notified the making of the Foot and Mouth Disease (Infected Areas) Special Order No. 113, 1960, declaring an area, including Ilford, to be a foot and mouth disease (infected areas) restricted area. On 28th December, 1960, the Foot and Mouth Disease (infected Areas) Special Order No. 128, 1960, amended the Order No. 113 to exclude Ilford as and from 28th December, whilst the remaining area in the original Order ceased to be an infected area as and from 4th January, 1961. The necessary notices were served on persons concerned in the above cases. PREVENTION OF DAMAGE BY PESTS ACT, 1949. The Council has appointed a whole-time Rodent Operative. Where infestation has been ascertained on inspection the services of the Rodent Operative are made available to secure effective 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. 65 The following is a statement of the work carried out during 1960. Type of Property Total Local Authority Dwelling Houses Agricultural All other (including Business and Industrial) I. Total No. of properties in District 223 52,514 25 6,491 59,253 11. No. of properties inspected as result:— (a) of notification 42 513 2 98 655 (b) survey under the Prevention of Damage by Pests Act, 1949 26 8 9 43 (c) otherwise - - - 994 994 ID. Total No. of inspections and re-inspections carried out 171 < 1,232 3 13,609 15,015 IV. No. of properties found to be infested by rats: — Major Minor 30 138 1 25 194 V. No. of properties found to be infested by mice:— Major _ _ Minor 16 160 - 52 228 VI. No. of infested properties (under III and IV) treated by the Local Authority 33 280 1 68 382 VII. No. of notices served under Section 4:— (1) Treatment _ (2) Structural works (i.e., Proofing) — 2 1 2 5 VIII. No. of cases in which default action was taken by Local Authority following issue of notice under Section 4 IX. Legal proceedings - f - - - X. No. of "block" control schemes carried out Nil 66 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 12 premises during i960. PETROLEUM (CONSOLIDATION) ACT, 1928.- The Public Health Inspectors made 1,879 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 152, and the fees paid to the Council for such Licences was £125 15s. LITTER ACT, 1958. - The Public Health Inspectors are authorised by the Council to investigate and report offences under the Act. During 1960, 3 offences were reported. Legal proceedings were taken in one case and a fine of £1 was imposed. A Sub-Committee of the Public Health Committee was formed to consider ways and means of intensifying the anti-litter campaign during 1960. Supplies of publicity material were obtained from appropriate Government Departments and arrangements made for its distribution upon as wide a scale as possible in the Borough. The cooperation of the local press was invited to publicise the campaign and steps were taken, through the Education Authorities to bring the campaign to the notice of school children. NOISE NUISANCES - ILFORD CORPORATION ACT, 1937 AND PUBLIC HEALTH ACT, 1936. - Many complaints were received of noise nuisance in connection with the rebuilding of a large store in High Road. Regular observations were maintained during day and night and as a result a statutory notice was served upon the building contractors to abate the nuisance. 19 other complaints regarding noise nuisances were received during the year. In 15 instances no nuisance was found to exist in respect of which action could be taken, but in 4 instances representations by the Public Health Inspectors resulted in abatement of the nuisances. 67 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 Relapsing Fever. Cholera Anthrax (made notifiable by Diphtheria The Local—Authority as Membranous Croup from l/4/32). Erysipelas Pemphigus Neonatorum Scarlatina or Scarlet Fever (made notifiable by the Typhus Fever Local Authority as from Enteric fever (Typhoid and 29/6/29) Para-typhoid) 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) Dysentery ) Regulations, 1953 and 1960. Malaria ) Anthrax ) Tuberculosis P.H. (Tuberculosis) Regulations, 1952. Acute Rheumatism (up to 16 The Acute Rheumatism years) (Amendment)Regulations, 1958. Measles and Whooping Cough The Measles and Whooping Cough Regulations, 1940. Acute Poliomyelitis ) P.H. (Acute Poliomyelitis, Acute Encephalitis ) Acute Encephalitis and Meningococcal Infection ) Meningococcal Infection) Regulations, 1949. 68 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 year 1960 showed a lower incidence of infectious disease, mainly due to the decrease in the number of cases of measles, 73 cases occurred as compared with 3,322 in the previous year. There were, however, 397 cases of whooping cough as compared with only 48 in the previous year. (a) Smallpox. - No cases were notified during 1960. Under the National Health Service Act, 1946, compulsory vaccination was abolished, and from 5th July, 1948, The total numbers of deaths of Ilford residents from the following infectious diseases during 1959 and 1960 were as follows:- 1959 1960 Scarlet Fever - - Enteric Fever - - Diphtheria - - Acute Poliomyelitis 1 - Measles - - Whooping Cough - - Influenza 25 4 Tuberculosis - Pulmonary 12 7 Other forms 1 1 Pneumonia (all forms) 144 127 Meningococcal Infections - - Totals 183 139 69 TABLE in. - CORRECTED NOTIFICATIONS OF INFECTIOUS DISEASES FOR THE YEAR 1960. 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 year 1 and under 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Cranbrook Park Loxford Clement swood Mayfield Coodmayes Fairlop Clayhall Rarkingside N. Hainault Seven Kings S. Hainault Smallpox - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 234 - 48 181 4 - 1 - 9 29 24 26 13 16 17 20 20 18 13 29 11 - Diphtheria, including Membranous Croup - - - _ - - - - - - - - - - - - - - - - - - Enteric Fever (Typhoid and Para-Typhoid) — — — — — — — — — — - — - - — - - — — - - - Pneumonia 92 2 6 12 2 8 25 37 16 8 3 7 3 15 6 12 8 5 8 1 7 127 Puerperal Pyrexia 47 - - - 21 26 - - - - — 1 1 1 1 - - 43 - - 45 - Acute Poliomyelitis 1 — 1 - - - - - - - - - - - - - - - - 1 1 - Acute Encephalitis — - - - - — - - - - — - - - - - - - _ _ - - Meningoccocal Infection 1 — — 1 — — — - — — — - — - 1 — — — — — 1 — Dysentery 204 8 38 47 18 52 32 9 9 20 6 3 3 10 37 45 33 24 9 5 7 - Ophthalmia Neonatorum 6 6 - - - - - - - - — - - 1 2 1 1 - 1 1 - Erysipelas 14 - - 1 - 2 5 6 - - 1 2 - 1 1 4 4 - 1 - 2 - Pemphigus Neonatorum 1 1 - - - - - - - - - - - - - - 1 - - - - - Tuberculosis Pulmonary 60 - 2 1 11 19 18 9 8 4 1 2 6 4 7 8 3 6 5 6 66 7 Other Forms 9 - - 2 2 2 1 2 1 - 1 - 2 1 2 - 1 1 - - 4 1 Anthrax - - - - - - - - - - - - - - - - - - - - - - Malaria — Believed contracted in this country - - - - - - - - -- - - - - - - - - - - - - - Believed -contracted abroad - - - - - - - - - - - - - - - - - - - - - - Acute Rheumatism 7 - 1 4 2 - - - - - 1 1 - 1 - - 1 - 1 2 4 - Measles 73 8 33 31 - 1 - - 3 9 4 4 6 - 5 3 2 27 7 3 1 _ Whooping Cough 397 27 133 222 1 13 1 - 16 56 41 48 9 21 34 31 46 37 36 22 2 — Food Poisoning 117 3 17 15 20 31 22 9 5 22 2 3 1 1 9 23 19 15 13 4 5 - Typhus Fever - - - - - - - - - - - - - - - - - - - - - - Totals 1,263 55 279 517 81 154 105 72 67 148 84 97 44 72 120 148 139 177 93 74 157 135 * Included in the figures in these columns are cases notified in previous years as well as 1960. 70 this service became the responsibility of the Essex CountyCouncil vide Section 26 of the National Health Service Act, 1948. (b) Scarlet Fever. - 234 cases occurred in 1960. There were no deaths from this disease. Only 13 cases were admitted to hospital, the remainder being nursed at home, (c) Diphtheria. - No cases occurred in 1960. This is the ninth successive year in which it has been possible to record a clean "bill of health" for this disease in Ilford. (d) Ophthalmia Neonatorum. - 6 cases occurred in 1960. The following figures show the number of cases of Ophthalmia Neonatorum notified during the past five years: 1956, 7; 1957, 6; 1958, 1; 1959, nil; 1960, 6. One case of Ophthalmia Neonatorum was due to gonococcal infection. (e) Enteric Fever (Typhoid and Para-Typhoid). - No cases occurred in 1960. (f) Acute Poliomyelitis. - One case occurred during 1960, a male, aged 2 years. He was admitted to Chadwell Heath Hospital and made a good recovery but was referred to the Royal National Orthopaedic Hospital for further supervision. (g) Acute Encephalitis. - No cases occurred in 1960. (h) Meningococcal Infection.- One case was reported: a male of 5½ years who was admitted to hospital and made satisfactory recovery. (i) Pneumonia - Influenzal and Primary. - The number of cases which occurred during 1960 was 92 compared with 184 in 1959. (j) Tuberculosis. - During 1960 there were 60 new notifications of Pulmonary Tuberculosis and 9 of other forms 71 of Tuberculosis. In addition 107 pulmonary and 5 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 fall forms) No. of Persons on register 31st December 1956 180,600 197 21 1,480 1957 179,600 178 13 1,510 1958 179,000 177 11 1,525 1959 178,600 184 13 1,562 1960 178,520 181 8 1.574 Notifications and Deaths from Tuberculosis of Ilford residents during 1960:- Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year — - - - - - - - 1-5 years 1 1 - — — — — — 5 -15 - 1 2 - - — - - 15-25 3 8 1 1 - - - - 25-45 13 6 2 - 1 - - - 45-65 15 3 — 1 3 - 1 - 65 - 75 6 — 1 1 2 - - - Over 75 3 — — - 1 - - - Totals 41 19 6 3 7 - 1 - Of the foregoing new cases, the following were notified from Institutions in the district: - Respiratory Tuberculosis Non- Respiratory Tuberculosis King George Hospital 2 - Goodmayes Hospital 3 - Chadwell Heath Hospital 2 - Claybury Hospital 1 - Dr. Barnardo's Village Homes - - Of the 8 deaths which occurred of Ilford residents, notification had previously been made of 7 of the cases. In the other case the presence of tuberculosis was discovered as a result of post-mortem. 72  Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1960 1,407 155 1,562 Number of cases entered on the register during the year 167 14 181 Number of cases removed from the register during the year Pul. NonPul. Recovered 26 6 Deceased 19 1 Left District 103 5 Lost sight of 6 - Diagnosis not established 1 - 155 14 169 Number of cases remaining on register on 31st December, 1960 1,419 155 1,574 The treatment of Tuberculosis is now under the control of the Regional Hospital Board. On the 31st December, 1960, there were 1,314 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 1960 was as follows:- Pulmonary Non-Pulmonary Total Males Females Males Females Adults 23 8 - - 31 Children - - - - - Tuberculosis Care Association. - Assistance was granted to 21 persons who received 135 extra nourishment grants. 70 other grants (cash, etc.) were also made to 66 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:- The following are the V.D. Treatment Centres situate nearest to Ilford:- 73 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 1 p.m. Monday to F riday 9 a.m. to 7 p.m. Saturday 9 a.m. to 1 p.m. Whitechapel. - Whitechapel Clinic, Tur London, E.1.:- ner Street, Mile End, Males Females Consultations: Monday to F riday 10 a.m. to 7 p.m. Saturday 10 a.m. to 3 p.m. Monday to F riday 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 F riday 9 a.m. to 7 p.m. Saturday 9 a.m. to 3 p.m. West Ham. - Queen Mary's Hospital Stratford, London, E. West Ham Lane, 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. Treatments: Monday 9 a.m. to 6 p.m. Monday 9 a.m. to 8 p.m. Tuesday 9 a.m. to 5 p.m. Tuesday 9 a.m. to 5 p.m. Wednesday 9 a.m. to 1 p.m. Wednesday 9 a.m. to 1 p.m. Thursday 9 a.m. to 8 p.m. Thursday 9 a.m. to 6 p.m. Friday 9 a.m. to 5 p.m. Friday 9 a.m. to 5 p.m. Saturday 9 a.m. to 4.30 p.m. Saturday 9 a.m. to 4.30 p.m. 74 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. HEALTH EDUCATION. 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, Poliomyelitis vaccination and health topics were also given prominence. A Medical Officer has been appointed to give a substantial part of his time to health education and his report is included in the Part III Section, together with a report by the Superintendent Health Visitor on health education at infant welfare centres. EXAMINATION OF OFFICERS AND SERVANTS. The following medical examinations were carried out during 1960:- Officers Servants New Appointments 62 49 Under Sickness Regulations - 11 On behalf of othe r Authorities 2 - Total 64 60 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. 75 SECTION G. - FACTORIES. Prescribed Particulars on the Administration of the Factories Act, 1937. PART I OF THE ACT. 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 161 140 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authorities 448 799 9 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 49 77 4 - Total 658 1,016 14 - 2. Cases in which DEFECTS were found. (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases"). Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.1) - - - - - Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) — — - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 10 8 — 3 — (b) Unsuitable or defective 5 6 - 4 - (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Out-work) - — — - - Total 15 14 - 7 - 76 PART VIII OF THE ACT OUTWORK (Sections 110 and 111) Nature of work Section 110 Section 111 No. of out-workers in August list required by Section 110(1)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing ) Making apparel ) etc. 111 - - - - - Furniture and upholstery 20 - - - - - Cosaques, Christmas stockings, etc. 53 - - - - - Total 184 - - - - - 77 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 1960 was 1,889 (991males and 898 females), of which there were 108 (53 males and 55 females) where the ordinary place of residence of the parents was outside Ilford. In addition 737 notifications of live births (385 males and 352 females) which took place outside the district, although the ordinary residence of the parents was in Ilford, were transferred to this district. There were also 27 stillbirths (16 males and 11 females) notified in Ilford and notifications of 11 stillbirths (9 males and 2 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 38 where the home address was stated to be in Ilford, whereas the Registrar-General has allocated 37 stillbirths to Ilford. The following table shows the causes of the 38 stillbirths notified where the usual residence of the parents was stated to be in Ilford:— 78 STILLBIRTHS 1960 Cause of Stillbirth Delivery in Nursing Home Delivery at Home Delivery in Hospital TOTAL Anencephalic - 1 3 4 Ante-Partum Haemorrhage - - 3 3 Asphyxia - - 4 4 Atelectasis - - 1 1 Cord Round Neck - 1 1 2 Gross Abnormalities - 1 - 1 Hydrocephalus - 1 1 2 Intra-Uterine Death - - 3 3 Placental Insufficiency - - 2 2 Pre-Eclamptic Toxaemia - - 2 2 Retro-Placental Clot - - 1 1 Rhesus Incompatibility - - 2 2 Ruptured Vasa Praevia - - 1 1 Toxaemia - - 1 1 Unknown - 4 5 9 Totals - 8 30 38 CARE OF PREMATURE INFANTS. - Of the 1,889 live births occurring in Word during 1960, 99 weighed 5½ lb. or less at birth; 22 of these babies were born on the district and 77 in Hospital (including 7 where the home address of the parents was outside Ilford). 79 Of the 22 babies born at home:— 18 were nursed entirely at home; 4 were transferred to hospital; 4 died between the ages of one day and one month (3 at home and one in hospital); 18 survived at the end of one month. Of the 77 babies born in hospital:— 12 died during the first 24 hours (including 1 where the home address was outside llford); 3 died between the ages of one day and one month; 62 survived at the end of one month (including 6 where the home address was outside llford). In addition, 47 notifications were received of births outside the district where the ordinary residence of the parents was in llford and the weight of the infant at birth was 5½ lb. or less. Of these there were:— 4 who died within the first 24 hours (in hospital); 1 who died between the age of one day and one month (in hospital); 42 who survived at the end of one month. INFANT MORTALITY. - The number of infants dying within the first year of life was 44, the total number bom being 2,512. 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 17.5. The following table gives the deaths of infants under one year °f age, classified according to age:— 80 INFANT DEATHS 1960. Cause of Death Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 Weeks 1-3 Months 3-6 Months 6-9 Months 9-12 Months TOTAL Anencephaly 2 - - - 2 - - - - 2 Asphyxia 2 - - - 2 - - - - 2 Atelectasis 9 - - - 9 - - - - 9 Broncho-Pneumonia - 1 1 - 2 - - - 1 3 Congenital Abnormalities 1 - - - 1 - - - - 1 Congenital Heart Disease - - - - - 1 1 - - 2 Erythroblastosis Foetalis 1 - - - 1 - - - - 1 Haemorrhagic Broncho-Pneumonia - 1 - - 1 - - - - 1 Hydrocephalus 1 - - - 1 1 1 - - 1 Intracranial Haemorrhage 1 - - - 1 - - - - 1 Meningo-Encephalocele 1 - - - 1 - - - - 1 Prematurity 7 - - - 7 - - - - 7 Previability 5 1 - - 6 - - - - 6 Pulmonary Haemorrhage 1 - - - 1 - - - - 1 Pulmonary Oedema - - - - - 1 - - - 1 Resorption Collapse of Lungs 1 - - - 1 - - - - 1 Ritters Disease 1 - - - 1 - - - - 1 Spina Bifida - 1 - - 1 - - - - 1 TOTALS 33 4 1 - 38 3 2 - 1 44 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 1960 44 17.5 1959 33 14.9 1958 37 16.6 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 81 The mean average Infant Mortality rate for the past 10 years is therefore 18 per 1,000 live births. The following table shows the comparison for 11 ford, England and Wales and London for the past 10 years: — Year Ilford England and Wales London 1960 17.5 22 22 1959 14.9 22 22 1958 16.6 23 23 1957 17.1 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 NEONATAL MORTALITY. - The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 38 deaths of infants under four weeks of age during 1960 and the rate for the year was 15.1 per 1,000 live births. The figures for the past 10 years are as follows: — Year Number Rate 1960 38 15.1 1959 27 12.2 1958 29 13.0 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 ILLEGITIMATE BIRTHS AND DEATHS. - 95 of the live births registered (45 males and 50 females) were illegitimate, that is 3.8% of the births registered. There were no deaths of illegitimate children under one year of age. 82 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 1960 2,417 96.2 44 18.2 95 3.8 — - 1959 2,134 96.3 32 15.0 82 3.7 1 12.2 1958 2,155 96.7 36 16.7 73 3.3 1 13.7 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 20.8 1953 2,164 97.0 43 19.9 67 3.0 2 29.9 1952 2,232 96.1 44 19.7 91 3.9 - - 1951 2,306 97.1 49 21.2 70 2.9 L 14.3 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 Workers for this district. In addition, all cases are followed up by the Health Visitors. HEALTH VISITORS AND SCHOOL NURSES. - Miss J.M. Oliver, Superintendent Health Visitor, reports:— "It has been rather a brighter year for the health visiting staff, chiefly because of our two newly-built health services clinics. Health visitors are based at these centres with their own Offices, thus giving the people improved facilities to make direct contact with them either by calling or telephoning. Plans for Mothercraft and Relaxation classes were prepared beforehand and are going well. A toddlers' clinic at Kenwood Infant Welfare Centre run by an appointment system has proved successful. 83 We now have a total of six Mothercraft and Relaxation Classes per week and in November commenced a seventh in a General Practitioner's Surgery. It is hoped that the mothers whilst attending their own doctor for ante-natal care, will find this extra service valuable. Although these classes are small it is here that as knowledge is acquired so also is peace of mind which ultimately brings better relaxation and assists towards normal delivery. Subjects given are supported by films, film strips, posters and model dolls and time is left for sorting out small worries which cause the mother expecting a baby moments of anxiety. The demand for education in this group widens and it is found that young mothers are receptive and grateful for the help received at classes. Many mothers send full details from the hospital of their complete labour with a card announcing the new arrival. Fathers have not been forgotten and the evening showing of the film "Childbirth without Fear", with Doctor and Health Visitor present, always brings a good audience and varied questions for the Doctor to answer. Three Mothers' Clubs are now held at Manford Way, Newbury Hall and Heathcote Avenue Infant Welfare Centres. Unfortunately the Cecil Hall Club closed down as the Health Visitors found it increasingly difficult to provide a good audience. The speaker was present at the Infant Welfare Centre, which combined with the Mothers' Club, and although the mothers were prepared to come to the Health Visitor tor advice they were not prepared to stop and listen to a speaker. The Manford Way and Heathcote premises have a special afternoon set aside for their Club and the mothers in the Newbury Hall area asked for theirs to be held in the evening. Subjects are varied to give mental stimulation to mothers who are busy with housework and children and do not find it easy to get a break from routine. Outside demonstrators have exhibited and talked on diet, cake icing, preserves, flower demonstration, household furnishings etc. Speakers have included a New Zealand housewife, a clergyman and a school teacher. Suitable topics chosen by the Health Visitor have been on varied subjects and include child development, a discussion on sex education, safety in the home and first aid. Films have been borrowed from County Hall. Considerable time is spent on this type of education and I am grateful to the Health Visitors and other members of the Public Health staff who assist us with these matters. 84 In 1956 the Health Visitors were invited to attend King George Hospital on a Thursday afternoon to be present at the Paediatric Clinic run by Dr. Anderson. The Health Visitors much enjoy this contact, it enables them to keep up with modem trends of treatment and much helpful information is exchanged between the Public Health Department and the Hospital. This year the Health Visitor was invited to be present at the ward round before the Paediatric Clinic commences. Some illnesses and childish difficulties can be accounted for if the family background is known and it is here that the Health Visitor can be of assistance to the Paediatrician. A six-monthly visit to the Ilford Maternity Hospital at Matron's invitation is now an established custom. A further invitation from Goodmayes Hospital at the end of 1960 gave two Health Visitors the opportunity to take a course of lectures. It is hoped that this course will enable the Health Visitors to deal more adequately with mental health problems found on their areas and so really giving "Psychiatric First Aid" in the home. Other Health Visitors will be given an opportunity to attend this course. This report shows that much has been attempted and achieved, much remains to be done, but until the shortage of Health Visitors and better means of transport for our present staff can be overcome, the ideal appears to be far distant." At the end of the year there were 17 full-time and 4 part-time qualified Health Visitors and School Nurses, in addition to the Superintendent Health Visitor, and 5 Clinic Nurses. The following is a summary of the home visits made by the Health Visitors and Clinic Nurses during 1960 as far as Part III Services are concerned: — First visits to newly-bom infants 2,660 Subsequent visits to children under 1 year of age 6,094 Subsequent visits to children over 1 year of age and under 5 13,845 Visits to expectant mothers 1,184 Home visits for other reasons (inc. 1,073 visits to old folk) 3,581 Total visits paid 27,364 85 In addition there were 6,237 visits paid where no reply was received. The Health Visitor who serves in the area has continued to assist at the baby clinic held by one of the general practitioners once a month and this arrangement has proved most satisfactory. DAY NURSERIES (a) The hours of opening at the two Nurseries during 1960 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 remains at 10/6 per child per day. 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. Six Students (3 from the Ley Street Nursery and 3 from the Goodmayes Lane Nursery) entered for the examination during the year, all of whom obtained the Certificate. (d) The following is a table showing the attendances, etc., at the Day Nurseries during 1960:— 86 Situation Accommodation (Children) Average daily attendance during 1960 No. of days "In Quarantine" Reasons for "Quarantine" with Number of Cases No. on Waiting List at 31st Dec. 1960 Chicken Pox Mumps Whooping Cough Scarlet Fever Goodmayes Lane, Goodmayes 50 38 29 - l 5 2 10 (Opened 14.11.51 — replaced Green Lane Nursery, open from 5.5.43 to 9.11.51) 226 - 236, Ley Street, Ilford (Opened 16.8.43) 50 39 99 2 11 - 1 8 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 31/12/59 7 4 Number registered during 1960 3 2 Number removed from register during 1960 3 1 Number on register at 31/12/60 7 5 Number of children provided for at 31/12/60 214 28 87 Of the premises referred to in (a) ante as removed from the register, one was closed by the person in charge as she no longer wished to receive children therein, another due to the removal from the district of the person in charge and the third on the transfer of the Nursery to other premises (included in the number newly registered in 1960). The child-minder whose name was removed from the register (see (b) ante) no longer wished to act in that capacity. CLINIC PREMISES Manford Way Health Services Clinic. - The Family Planning Association continued to use these clinic premises for their sessions on every Monday evening, a charge being made to them to cover the cost of heating, lighting, cleaning and caretaking. Kenwood Gardens Health Services Clinic. - As reported last year, this new clinic was ready for full occupation from 1st February, 1960, when the clinic services previously carried on at Valentines Mansion and Newbury Hall, with the exception of the infant welfare centres, were transferred over, the Health Visitors for the area having taken up occupation early in January. The services provided include an Infant Welfare Centre, Mothercraft Classes, Midwives' Ante-natal Clinics, Immunisation and Vaccination, routine and special examinations of school children, minor ailments, Dental and Chiropody Clinics and certain specialist clinics (Orthopaedic, Ear, Nose and Throat, Paediatric and Ophthalmic); there are also greatly improved facilities for Health Education. Heathcote Avenue Health Services Clinic. - The building of this new Clinic was completed in July, 1960; the premises were equipped and the first session was held there on the 30th August. The Health Visitors serving in the area have their office at the Clinic and the services provided include an Infant Welfare Centre, Mothercraft Classes, Midwives' Antenatal Clinic, Chiropody, Immunisation and Vaccination, routine and special examinations of school children, Speech Therapy and Health Education. INFANT WELFARE CENTRES. - 86 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1960. During the year the following attendances were recorded:— 88 Total number of attendances of infants 38,560 First attendances 2,372 Attendances of children from 1 to 5 years 9,690 Total number of children on roll on 31/12/60 after omission of all those who had not attended for six months 4,460 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 1960 38,560 2,372 4,460 1959 35,961 2,043 3,859 1958 35,756 1,946 3,802 1957 37,948 1,916 3,976 1956 36,902 1,895 3,916 768 sessions were held during the year, the average attendance per session being 50 mothers with their infants. The following are the figures for each Centre:— Sessions Average Attendance Barkingside (until 22/8/60) 31 30 Chadwell 48 64 Becontree 48 48 Downshall 48 56 Manford Way 48 36 Woodford Avenue (until 27/1/60) 4 53 Kenwood Gardens (from 3/2/60) 47 64 Seven Kings 48 57 Grosvenor Road 47 50 Heathcote Avenue (from 31/8/60) 17 48 Cecil Hall (Wednesdays) 47 43 Cecil Hall (Thursdays) 47 40 Newbury Hall 48 53 Marks Gate 48 42 Goodmayes 48 50 Ilford Lane 47 43 89  Sessions Average Attendance Valentines (until 29/1/60) 5 39 Fairlop 48 58 The Drive (from 5/2/60) 44 57 With the transfer of the other clinic services from Valentines Mansion to Kenwood Gardens Clinic, the Valentines Centre was moved to the Methodist Church Hall at the junction of Eastern Avenue and The Drive and was re-named "The Drive Infant Welfare Centre*. The Woodford Avenue Centre which had been held at the Woodford Avenue Congregational Church Hall was also closed, the mothers transferring either to Kenwood Gardens Clinic or to The Drive Centre. On the opening of the Heathcote Avenue Clinic the Barkingside Centre held at the Parish Hall, Mossford Green, Barkingside, was closed down, but the Fairlop Centre at that Hall is continuing in operation. TODDLERS' CLINIC. - Dr. J.M. Pooley reports as follows:— "This Clinic which is held at Kenwood Gardens Clinic has been in existence since February 1960 and is held on Wednesday mornings, once in every three weeks. Eleven sessions were held during these ten months, during which the attendances totalled 155, the children usually attending as soon after the third birthday as is practicable. One would feel that this clinic has been well attended and thoroughly worth while. It has been of particular use in detecting:— 1. Minor eye defects; 2. Dental caries; 3. Children who require inoculations; 4. Two children with previously un-noticed inguinal herniae; 5. Several children who needed chest or metabolic check-up. The question arises as to whether a toddler clinic four-year old routine examination would be more useful than the five-year old routine medical examination at school — it could then be followed by a medical examination at 6 years of age at school, thereby giving the head teachers 12 months in which to observe any defects or problems which might otherwise be un-noticed so early in the child's school career." 90 PHENYLPYRUVIC AMENTIA. - This form of mental backwardness is associated with the presence of phenylpyruvic acid in the urine, and by early detection and dietary treatment mental deterioration that is otherwise unavoidable maybe prevented. From January 1960 arrangements were made for testing by routine the urine of infants at the third to fourth week of life for the detection of the presence of this acid. The testis a simple one and is carried out by the Health Visitors. The following are the statistics with regard to this testing in the year 1960:— (i) Number of children tested:— (a) Where specimen of urine obtained at clinic 910 (b) Where specimen of urine obtained at home 799 1,709 (ii) Number of children tested (included in (i) above) because of suspected mental backwardness 9 (iii) Number of tests which resulted in a positive reaction 1 The case found to be positive to this test was admitted to the Hospital for Sick Children, Great Ormond Street, London, W.C.1, on an arrangement made by the General Medical Practitioner whom the Health Visitor had contacted. The diagnosis was there confirmed. ORTHOPAEDIC CLINIC.- The following table summarises the attendances of children under 5 years, the Kenwood Gardens Clinic replacing Newbury Hall from the 1st February, 1960. Clinic Sessions New Cases Old Cases Attendances Newbury Hall 3 5 10 15 Kenwood Gardens 39 62 90 250 Mayesbrook 24 27 39 89 Manford Way 8 4 18 22 Totals 74 98 157 376 The 255 children were found by the Orthopaedic Surgeon to have the following defects:— 91 Diagnosis New Cases Old Cases A B C D A B C D Deformity of Hips - 2 1 - - 1 - - Genu Valgum 3 22 11 - 3 44 22 4 Pes Valgo-Planus - 3 4 - - 3 1 3 Valgus Ankles 1 10 2 2 5 7 6 6 Congenital Talipes E.V. - 1 1 - - 3 - 1 Intoeing - 8 4 - - 13 - - Deformity of Toes 1 4 - 2 2 6 3 1 Scoliosis - - - - - 1 1 - Metatarsal Varus - 1 1 - - 1 1 - Out. Curvature Tibiae - 2 - - - - 3 1 Genu Varum - 2 - - - 3 1 - Deformity of Foot - 4 - - - 1 - - Spastic Hemiplegia - 1 - - - - - - Hydrocephalus - - - - - 1 - - Torticollis - - 1 - - - - - Other Conditions - 2 2 - - 6 1 2 Totals 5 62 27 4 10 90 39 18 A — Newbury Hall D — Kenwood Gardens C — Mayeabrook D — Manford Way 9 pairs of Valgus Insoles, 6 G.V. night and C.D.H. splints, 96 wedges to shoes, two surgical shoes and two calipers were supplied during 1960. In addition, 5 repairs to surgical shoes and 1 repair to a caliper were undertaken. The Physiotherapist treated 18 children under 5 at Newbury Hall, 61 at Kenwood Gardens Clinic, 47 at Mayesbrook Clinic and 34 at Manford Way, with attendances of 31, 466, 208 and 199 respectively. PAEDIATRIC CLINIC. - Dr. A. Russell, the Consultant Paediatrician, continued to attend this Clinic at Valentines Mansion, transferring to Kenwood Gardens Clinic in February 1960. 19 sessions were held and 78 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 186 attendances were made. 92 Diagnosis Discharged Improved Discharged with advice or for other reasons Discharged No treatment Cored Referred Hospital, Doctor or Clinic Still attending Total Anaemia - - - - - 1 1 Behaviour Problems — 2 — — — 1 3 Bilateral Necrotizing Lesion of Abdominal Wall - - - - - 1 1 Cardiac Murmur — 1 — — 1 2 4 Cephalhaematoma — 3 - - - - 3 Cerebral Palsy — 1 — — 1 — 2 Chronic Constipation - — — — 1 - 1 Congenital Megacephaly — — — — — 1 1 Congenital Retardation of Ossification — — — — — 1 1 Encopresis — 1 — — — - 1 Feeding Problems — 1 — — — 1 2 For observation - — - — 1 4 5 Haemangioma — — — — 1 — 1 Hernia 1 — — - — - 1 Hydrocele — — — — — 1 1 Hydrocephalus — — — - — 1 1 Hypospadias 1 — — — — — 1 Ichthyosis — — — — — 1 1 Jaundice — — - — — 1 1 Migraine — — — - — 1 1 Mongolian Blue Spot - 1 — — — — 1 Mongolism - — — — — 3 3 Naevus 1 — — — — 1 2 Nil abnormality discovered - 9 4 — — I 14 Obesity — 2 — — 2 — 4 Pigeon Chest - - - — — 1 1 Pilonidal Sinus — — 1 — — - 1 Post Anal Dimple — 1 — — — — 1 Prematurity — 1 - - — - 1 Resolving Broncho-Pneumonia — 1 — — — — 1 Retardation — — — — — 1 1 Retraction of Rt. Eyelid — — — — — 1 1 Scleroedema - - — — — 1 1 Septicaemia — 1 — — — — 1 Speech Retardation — 1 — — — 1 2 Sterno-Mastoid Tumour — 1 1 — — — 2 Talipes 2 — — - — 2 4 Traumatic Asphyxia — — — — — 1 1 Upper Respiratory Tract Infection — 2 — — — — 2 Urinary Infection - - - - - 1 1 Totals 5 29 6 - 7 31 78 OPHTHALMIC CLINICS. - Attendances of children under school age for treatment by the Ophthalmologists during 1960 were as follows, Kenwood Gardens Clinic replacing Valentines from February: — Valentines Clinic Kenwood Gardens Clinic Mayesbrook Clinic Manford Way Clinic Total Number of children who attended 7 38 45 11 101 Number of pairs of spectacles prescribed - 8 20 - 28 Total number of attendances made 8 59 95 16 178 93 EAR, NOSE AND THROAT CLINIC. - The E.N.T. Surgeon attended at 43 sessions during 1960, 38 attendances were made by 36 children of pre-school age. 7 children were operated upon for removal of tonsils and adenoids at King George Hospital, Ilford, and 2 at the Chadwell Heath 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 4 1 2 3 2 1 - Mayesbrook 43 2 3 31 1 - 3 Totals 47 3 5 34 3 1 3 Kenwood Gardens Clinic replaced Newbury Hall from February 1960, but no children under the age of five years attended at the 38 sessions held there. The conditions treated were as follows:— Conditions Cases A B Anaemia, Debility, Malnutrition and Catarrh 1 4 Chilblains 1 - Open Fontanelle 1 1 Totals 3 5 A — Newbury Hall. B — Mayesbrook SPEECH CLINIC. - 25 children of pre-school age attended, making 506 attendances. The following is the classification of the defects found by the speech therapist: — Dyslalia 9 Stammering 3 Retarded speech and language 8 Others 4 In one case it was found that no treatment was required. 94 DIPHTHERIA IMMUNISATION. - During 1960 a total of 758 children attended at clinics for diphtheria immunisation (208 at Kenwood Gardens, 310 at Mayesbrook, 161 at Manford Way, 32 at Newbury Hall, 33 at Marks Gate and 14 at Heathcote Avenue), making a total number of attendances of 1,612 (387, 693, 349, 79, 73 and 31 respectively). Diphtheria and whooping cough immunisation is undertaken at the same session and as the numbers attending have not been high, this work is combined at the Kenwood Gardens and Mayesbrook Clinics with the school clinic held for the treatment of minor ailments and at the Manford Way, Newbury Hall, Marks Gate and Heathcote Avenue Clinics immunisation is undertaken at the Infant Welfare Centre sessions. The following table shows the figures over the past five years. No. of primary inoculations: — 1956 1957 1958 1959 1960 At Clinics 338 282 401 373 442 By General Practitioners 1,745 1,492 1,681 1,669 *2,420 Totals 2,083 1,774 2,082 2,042 2,862 No. of re-inoculations:— At Clinics 478 252 330 304 294 By General Practitioners 1,579 888 1,366 888 ø1,725 Totals 2,057 1,140 1,696 1,192 2,019 No. of live births in Ilford 2,115 2,219 2,228 2.216 2,512 * Includes 707 combined Diphtheria and Whooping Cough inoculations. ø Includes 423 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 Kenwood Gardens and Mayesbrook Clinics where sessions were held for this purpose and at the Newbury Hall, Manford Way, Marks Gate and Heathcote Avenue Infant Welfare Centres, together with records of such courses completed by general practitioners. 95  Kenwood Gardens Clinic Mayesbrook Clinic Infant Welfare Centres *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 102 - 301 174 - 512 142 - 498 928 38 Children 5 years of age and over 1 - 8 2 - 4 - - - 18 81 Totals 103 - 309 176 - 516 142 - 498 946 119 *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 707 Re-inoculations 423 VACCINATION AGAINST POLIOMYELITIS. - The programme of vaccination of the eligible groups, i.e. children and adults from the age of six months to 40 years at the date of registration, expectant mothers, and doctors, dentists, nurses, ambulance and certain other Public Health staff and their families proceeded during 1960, sufficient vaccine being made available to cover all those who registered. Registration of the older age group, although not high, has been steady. The general practitioners have continued to play an important part in the scheme and most of those practising in the Area are participating. During 1960 in addition to holding sessions at the various clinics, many of which were combined with school clinic or Infant Welfare Centre sessions, our medical and nursing staff, with the excellent co-operation extended by many of the larger firms in the Area, continued to visit their premises during working hours to vaccinate eligible persons employed by them. The statistics given over-page show the vaccinations carried out by our medical staff:. 96 Premises No. of Sessions Injections given first Second Third Public Health Offices 4 30 35 336 Kenwood Gardens Clinic 38 707 859 1,298 Mayesbrook Clinic 20 441 496 1,117 Manford Way Clinic 44 104 117 336 Newbury Hall 12 8 11 20 Marks Gate Clinic 14 17 21 25 Heathcote Avenue Clinic 5 11 9 5 Factories, etc. 28 1,218 719 404 Totals 165 2,536 2,267 3,541 The medical staff at the Village Homes, Barkingside also carried out a total of 105 primary courses and 312 third injections, and 313 primary courses were undertaken at local hospitals in the case of members of their staff. Record cards received in 1960 from general practitioners were as under- Completed primary courses (two injections) 6,334 Third injections ("boosters") given 10,610 At the 31st December, 1960 a total of 49,399 primary courses had been completed in Ilford (33,489 children under 16 years, 8,517 persons aged 16 to 25 years, 4,989 persons aged 26 to 40 years and 2,404 general practitioners, ambulance staff, dentists, hospital and Public Health staff and their families, etc.). During 1961 a re-inforcing fourth injection has been introduced for all children between the ages of five and twelve years and also those who are under five if they are entering school. SMALLPOX VACCINATION. - During 1960 record cards were received from general practitioners and various hospitals as follows:- Ages up to 14 — No. of children primarily vaccinated 1,376 No. of children re-vaccinated 62 Age 15 and over — No. of adults primarily vaccinated 164 No. of adults re-vaccinated 423 97 In addition 106 children were primarily vaccinated at the Manford Way, Mayesbrook and Marks Gate Clinics. The following table shows the figures over the past five years: — 1956 1957 1958 1959 1960 No. of primary vaccinations 1,545 2,169 1,714 1,529 1,646 No. of re-vaccinations 445 975 537 562 485 Totals 1,990 3,144 2,251 2,091 2,131 No. of live births in Ilford 2,115 2,219 2,228 2,216 2,512 TREATMENT OF MINOR AILMENTS. - Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. Facilities are, however, available at the sessions held for school children at Kenwood Gardens and Mayesbrook Clinics for children under school age to receive treatment for minor ailments, although in practice very few so attend. MIDWIVES. - There were 13 State Certified midwives (including the Non-Medical Supervisor of Midwives, 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 33 State Certified 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. The Midwives (Amendment) Rules 1960, which came into operation on the 1st July 1960, introduced certain changes in the rules regulating, supervising and restricting within due limits the practice of midwives. These included the removal of the distinction between midwives and maternity nurses by abolishing the term "maternity nurse", the reduction of the minimum lying-in period from fourteen to ten days and the removal of the requirement to notify the local supervising authority in each case in which artificial feeding is adopted. Suspension from Practice. - No midwives were suspended from practice during the year. 98 Medical Aid. - Medical aid was sought in four instances where the infant was found to have a discharging eye. The condition of the eye cleared satisfactorily in each case. 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. During the year 589 cases were attended and a Doctor was specially called in by the midwife to 68 of these. Of the infants born there were 6 stillbirths. Seven deaths occurred of infants during the first year of life where the birth had been attended by a domiciliary midwife. During 1960 ante-natal clinics conducted by the domiciliary midwives were held weekly at Kenwood Gardens Clinic, having transferred at the beginning of February from Valentines Mansion, fortnightly at Mayesbrook Clinic and Manford Way Clinic and, from the end of August, also fortnightly at Ileathcote Avenue Clinic. From the beginning of June 1960 two sessions a month were also held at Marks Gate Clinic for expectant mothers living in the Chadwell Heath district, this being by arrangement with the Area Medical Officer for Dagenham, in whose Area the Clinic is situated. The following is a summary of the attendances at these Clinics during the year — First Attendances Subsequent Attendances No, of Sessions Average Attendance per Session Valentines Clinic (January only) 51 98 4 37 Kenwood Gardens Clinic (from February) 374 987 55 25 Mayesbrook Clinic 177 496 24 28 Manford Way Clinic 81 259 25 14 Heathcote Avenue Clinic (from August) 27 68 11 9 Marks Gate Clinic (from June) 27 78 13 8 Totals 737 1,986 132 20 In addition 2,394 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 several occasions during the pregnancy. The examinations take place at the patient's home, the 99 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 llford Health Area Sub-Committee. At the 31st December 1960, one maisonette and two flats were being rented by the County Council from the Borough Council under this arrangement. Since the 1st January 1960, the domiciliary midwives have assisted in the training of pupil midwives from the Thorpe Coombe Maternity Hospital, Walthamstow; eight of the whole-time midwives have been approved by the Central Midwives Board as teaching district midwives. The arrangements are for four or five pupil midwives to come to llford at a time for a period of three months, accommodation being provided in one of the local hospitals or in a private house. 17 pupil midwives completed their district training in the Area during 1960 and 4 were still undertaking this training at the 31st December Salvation Army Midwifery Service. - One Salvation Army midwife, with a further midwife assisting her as required, served in llford during the year. 63 cases were attended by them and a doctor was called in to 31 of these. Of the infants born there were two stillbirths. Gas and Air Analgesia. - During 1960 gas and air analgesia was administered in 554 cases (504 attended by the domiciliary midwives and 50 by the Salvation Army midwives) All the domiciliary midwives employed at the end of the year were qualified to administer gas and air analgesia and the Salvation Army midwives were also so qualified. Arrangements continued in operation for each of the midwives using cars in the course of theirduties to hold a machine at their respective homes to take with them to their own cases and there are also 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. 100 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 attendance at the ante-natal Clinics during 1960 for patients booked for confinement in hospital:— Maternity Hospital Mayesbrook Clinic Manford Way Clinic Doctors Midwives First attendances 901 _ 285 103 Subsequent attendances 4,276 3,510 2,471 859 Totals 5,177 3,510 2,756 962 Number of sessions 306 247* 133 62 Average attendance at each session 17 14 20 15 *Includes 197 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 Ilford 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 1960 there were 98 sessions at the Mayesbrook Clinic, with 857 attendances, and 99 sessions at Manford Way Clinic, with 788 attendances. A weekly session was also run by Health Visitors at Kenwood Gardens Clinic, 48 sessions being held in the year, with 436 attendances and at Heathcote Avenue Clinic from September 1960, 12 sessions being held, with 75 attendances. Relaxation exercises classes are in addition held by the staff of the Ilford Maternity Hospital for patients attending the Ante-natal Clinic there. 101 POST-NATAL CLINICS. - All patients confined in the Ilford Maternity Hospital and other patients on request are invited to attend the Post-natal Clinics for the first time approximately six weeks after confinement. During 1960 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 824 197 88 Subsequent attendances 131 84 1 Totals 955 281 89 Number of sessions 53 29 14 Average attendance at each session 18 9 6 CONSULTANT CLINIC.-There were two Consulting Obstetricians in 1960 who each held a weekly Clinic for ante-natal and post-natal cases. During the year 104 sessions were held and a total of 1,816 examinations were made. MATERNAL MORTALITY. - During 1960 there was one death of an Ilford mother recorded by the Registrar-General as due to or in consequence of pregnancy or childbirth. This occurred in a hospital outside the district. DOMESTIC HELP SERVICE. - During 1960 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 4 full-time, 141 regularly-employed part-time and 5 casual Helps employed. The following is a summary of the cases dealt with in 1960:— Number of applications received for assistance 1,514 Number of cases where Domestic Helps ' were provided (including 727 who were having service at the commencement of the year) 1,927 Number of cases which on investigation were either not eligible for assistance or did not require the service 61 102 Cases booked but subsequently cancelled 178 Number of cases where, at the end of the year, a domestic help was booked to attend in future months (maternity cases) 51 Other cases awaiting help at end of year 10 Enquiries incomplete at end of year 14 Cases being served at 31st December, 1960 854 One training course, of two weeks' duration, was held by the County Council at Chelmsford in 1960. One domestic help from Ilford attended and she was found to be entirely satisfactory. 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. Arrangements were made under the County Council's scheme for the admission of one family, consisting of mother, father and four children, to the Rehabilitation Unit at Dr. Bernardo's Homes, Barkingside, on the 3rd August, 1960. They were still in residence there on the 31st December. CONVALESCENT FACILITIES. - The following tables show the number of persons sent away for convalescence during 1960: — (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 Stamford Hill Home, Thorpe Bay 1 4 Unaccompanied child Lennox House, Southsea 1 2 Mother and baby Totals 2 6 103 (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 2 3 Bell Memorial Convalescent Home, Lancing 15 12 27 Caxton Convalescent Home, Limpsfield 1 - 1 The Church Army Home, Bexhill-on-Sea 1 - 1 Donkey Club Holiday Home, Lancing 1 - 1 The Hermitage Convalescent Home, Hastings 1 - 1 Mrs. Haywood's Home, Cliftonville 1 - 1 Mildmay Convalescent Home. Worthing 3 2 5 Rustington Convalescent Home, Littlehampton 1 1 2 Samuel Lewis Convalescent Home, Walton-on-Naze 14 — 14 St. Michael's Convalescent Home, Clacton 10 4 14 Mrs. Stewart's Home, Broadstairs 1 - 1 Victorian Convalescent Home, Bognor Regis - 2 2 Totals 49 21 70 104 LOAN OF SICK ROOM EQUIPMENT. - The considerable demand for equipment continues and the following table shows the issues from the Public Health Offices during 1960:— Articles Loaned Number of Articles Articles in store at 31.12.60 on loan at 31.12.59 loaned or reloaned in 1960 on loan at 31.12.60 Mattress (Dunlopillo) 14 3 14 - Mattress (Hair) 1 - 1 4 Invalid Chairs 49 79 59 1 Air Pillows — — — 2 Air Rings 50 174 57 45 Cushions (Dunlopillo) 11 12 12 2 Back Rests 69 176 79 16 Beds 7 5 5 5 Commodes 48 52 57 3 Crutches 12 8 7 9 Fracture Boards 4 2 4 — Pillows 3 6 5 4 Pillow Slips - - - 1* Rubber Sheeting 128 283 141 49 Medical Sandbags — 1 1 - Bed Cradles 25 23 21 4 Air Beds 1 3 - 5 Bed Pans 77 212 90 41 Diabetic Scales 2 1 3 1 Feeding Cups 2 11 2 9 Urinals 43 81 39 26 Sputum Mugs 2 - 2 3 Douche Cans 1 1 1 Water Beds - 1 - 1 Water Pillows — — — 1 Bed Blocks 2 — 1 1 Bowls - - - 2 Bedstead Sides (Pair) 1 i - 1 Lifting Pole and Chain 7 3 10 - Kidney Dishes - — 1 1 Commode Sorbo Cushions - 1 1 Rubber Toilet Seats 2 2 .1 - Restraining Net - 1 1 - Bed Trays - 1 1 - Walking Aid - 1 1 - Hydraulic Hoist - 1 1 — Slings - 2 2 - Sierex Air Mattress - 1 1 - Totals 561 1,147 622 241 1959 Details 517 1,279 561 237 1958 Details 619 1,083 517 238 1957 Details 555 1,062 619 125 1956 Details 519 1,158 555 180 1955 Details 538 1,117 519 1.61 1954 Details 320 975 538 99 1953 Details 161 698 320 54 1952 Details 86 326 161 66 1951 Details 27 162 86 30 *Provided through special funds. 105 CHIROPODY SERVICE. - As was reported last year, with the approval of the Ministry of Health a Chiropody Service was commenced in Ilford during 1960. Two whole-time Chiropodists were appointed, one of whom commenced duty in March and the other in April. Later in the year authority was given for a further appointment to be made, and in the absence of whole-time applicants arrangements were made for a selfemployed Chiropodist to undertake three sessions per week at our clinics from 2nd January, 1961. Another Chiropodist has since arranged to undertake five sessions per week from 10th July, 1961. The main Chiropody Clinic, with two chairs, is held at Newbury Hall in rented accommodation on the ground floor, and in addition sessions are held at each of the Health Services Clinics. Arrangements have also been made for a Chiropodist to visit regularly the two Welfare Committee residential establishments in the area and to undertake domiciliary chiropody in the case of patients who are unable to travel, even by ambulance vehicle, to the Chiropody Clinics. Initially, priority is being given to the provision of chiropody treatment for the elderly, the physically handicapped and expectant mothers, although it is intended that the service will be extended to other categories when circumstances permit. The attendances during the year 1960 were as follows: — No. of Sessions Attendances New Cases Re-attendances Newbury Hall (from April) 229 422 898 Kenwood Gardens (from April) 197 308 821 Manford Way (from May) 69 105 306 Mayesbrook (from August) 23 69 68 Heathcote Avenue (from September) 16 35 58 Welfare Establishments (from July) 13 9 131 Domiciliary Visits (from August) - 20 9 Totals 968 2,291 TUBERCULOSIS VISITORS. - The 3 Tuberculosis Visitors made a total of 2,428 visits to homes in the Borough. DOMICILIARY OCCUPATIONAL THERAPIST. - The Domiciliary Occupational Therapist, who also serves in Romford, Dagenham, Barking and part of the Forest Health Areas, undertook the following visits in Ilford during 1960:- 106 Number of visits to new patients 4 Number of revisits to patients 196 Number of other visits (to Chest Clinics, etc.) 30 REHABILITATION OF TUBERCULOSIS CASES. - No cases required assistance in the maintenance charges at a rehabilitation settlement during 1960. OPEN-AIR SHELTERS FOR TUBERCULOSIS CASES. - One open-air shelter supplied for a tuberculosis patient during 1958, continued in use throughout 1960. 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, continued during 1960. Particulars of the grants made in 1960 are given below: — No. of cases in receipt of free milk at 31.12.59 92 No. of new grants made during 1960 56 No. of grants discontinued during 1960 51 No. of cases in receipt of free milk at 31.12.60 97 BOARDING-OUT OF CHILDREN (TUBERCULOSIS CONTACTS).No applications were received in 1960 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 1960. 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) 21 135 (including renewals) Other grants (Christmas cash gifts, clothing, etc.) 65 69 107 TRAVELLING EXPENSES OF RELATIVES VISITING HOSPITAL PATIENTS. - As in previous years, the County Medical Officer was able to give financial assistance in 1960 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 1960:— Entrants to County Council Service 13 Other purposes 40 For other Authorities 15 NIGHT ATTENDANCE SERVICE. - As was reported last year, from the 1st January, 1960 a directly-provided service has been operating for supplying night attendants to give some relief to those people called upon to sit up constantly at night with sick relatives or friends, or to help sick persons with no one to whom to turn for such assistance. This is integrated with the Domestic Help Service and controlled by the two full-time Organisers under the general direction of the Area Medical Officer. Three night attendants who had been employed by the Ilford Social Service Association, which organisation had previously been running this service, accepted appointments on the County Council's staff. Details of the service during 1960 are as follows: — Number of applications received for assistance 76 Number of cases where Night Attendants were provided 41 Number of cases which on investigation were either not eligible for assistance or did not require the service 34 Number of cases awaiting help at end of year 1 Number of cases being served at 31st December, 1960 3 Total number of hours for which attendants were provided 2,611 Number of attendants on panel at 31st December, 1960 3 DAY ATTENDANCE SERVICE. - The arrangement with the Ilford Social Service Association for providing day attendants in approved cases to sit with sick and infirm persons who cannot afford to meet the charge made by the Ilford Social Service Association, the County Council making agreed payments to the Association, has continued. Only one case was dealt with under this arrangement during 1960, the details being as follows:— 108 No. of cases being attended at .31.12.59 Nil No. of new cases attended during 1960 1 No. of cases discontinued during 1960 1 No. of cases being attended at 31.12.60 Nil Total number of attendances given: — (a) whole days 5 (b) half days 5 HOME NURSING. - The Home Nursing Service in Ilford is undertaken by Nurses under the supervision of the Superintendent of the Lady Rayleigh Training Home at Leytonstone but operating from the Branch Home "Abury House" in Aldborough Road, llford. The work undertaken by Home Nurses in the Ilford area in 1960 was as follows: — Cases attended 2,002 Visits paid 59,802 HEALTH EDUCATION. - Dr. G.B. Taylor, Assistant County Medical Officer, reports:— "When one is faced with the title "Health Education* one immediately thinks of a school class and lecturer. In practice this is not so, although of course part of health education is lecturing. In the Ante-natal Clinics and most Post-natal Clinics advice is constantly being given by both Doctors and Health Visitors, and not only do the practical issues such as feeding difficulties confront the Health Visitors in the Infant Welfare Clinics but also dangers such as poisoning from pills left around the home or burns from unguarded fires. All this is in the normal routine of Public Health Doctors and Health Visitors. However, Boy Scouts, St. John Ambulance, Youth Clubs and Church Groups have asked for lectures on Health, and Health Visitors have complied. Evening and afternoon sessions have proved most popular, the attendances varying from 12 to 50. The subjects varied from Home Nursing to the Boy Scouts and Hygiene for St. John Ambulance and Red Cross. The talk "The Work of the Health Visitor" has been in great demand. One Toc H group asked for a talk on multiple sclerosis as they were interested in helping such people. Mrs. Eldridge, a Health Visitor, has conducted group discussions at Infant Welfare Centres on guarding fires and flameproof materials; she has spoken to over 600 mothers at 50 sessions. Other Health Visitors spoke at 17 sessions to approximately 952 persons on general Health Education subjects. 109 From year to year different medical subjects seem to gain pre-eminence according to the number of deaths which arise. Now-a-days we are no longer threatened by the old fashioned epidemics of typhoid and cholera which ravaged previous populations, but we are confronted with cardio-vascular illnesses and cancer. Cancer in different sites is associated with varied causes. Radio-active substances, irritation from dust such as arsenic and chrome, cancer of the bladder in persons who are engaged in work with aniline dyes are just a few examples. As far as industry is concerned, legislation has now been introduced to reduce the possibilities of cancer. The Public Health Department however, has as its primary cancer concern, cancer of the lung. The majority of medical men now accept the evidence for an association between cigarette smoking and cancer. This evidence is based upon a statistical analysis by Professors Dodd and Hill, and also by certain experimental evidence. In 1960, 22,000 people died from cancer of the lung. If the word epidemic means something falling upon us, we are in the midst of a cancer epidemic. The obvious age group to approach is the school population, for once smoking becomes a habit it is very difficult to break. We propose therefore to conduct a special campaign over the next five years in the schools. It is all very well for Doctors and Health Visitors to speak about health subjects but we must have some means of finding out whether their efforts are effective. This means in practice that any approach to a large section of the community must be as scientific as possible. We intend to institute Health Education about cancer and smoking in 50% of the schools in Ilford and to use the other 50% as a control. At the end of five years we shall analyse questionnaires and hope by this means to come to some conclusion as to the effectiveness of Health Education as regards cancer and smoking in the schools. As I said previously, Health Education is intimately connected with most Public Health activities, but the commencement of this campaign against cancer and smoking will be a special effort early in 1961. The General Practitioners in Ilford have been asked to co-operate with Health Education and cancer and they have been told that our resources such as film strips, films, slides, projector, tape recorders are available for their use. I shall also lecture to voluntary organisations such as Youth Clubs, Church Groups and the W.V.S. and hope by this means over the years to make responsible citizens aware of the dangers 110 from smoking and to impress upon them their responsibility to the younger generation in this matter. There are some parents who not only allow their children to smoke but even encourage it in giving them cigarettes. During I960, 1 gave 9 lectures (1 at an Infant Welfare Centre, 3 to professional organisations, 1 to a Youth Club and 4 to general adult groups), the total attendances being approximately 250.* Posters covering various aspects of Health were displayed at the Public Health Offices and the Health Services Clinics throughout the year. During the year a total of 4 lectures on varied Health subjects were given by other members of the medical staff and domestic help organisers to various organisations and children. In addition 257 lectures on Mothercraft were given by the Health Visitors at their ante-natal relaxation classes at the health services clinics, a series of 12 lectures constituting each course. DENTAL TREATMENT. - Mr. E.V. Haigh, the Senior Dental Officer, has submitted the following report: — "I continued to provide full dental treatment for expectant and nursing mothers and for children under five at Mayeshrook Clinic during 1960. At the beginning of 1960 the dental surgery at Kenwood Gardens Clinic was opened and I have attended there one session per week to treat mothers and children under five who live nearer to this Clinic than to Mayesbrook Clinic. This has meant an increase in total sessions devoted to the treatment of mothers and small children, thus increasing the facilities of this service to many more people who would or could not travel as far as Mayesbrook Clinic. I continued with one evening session per week at Mayesbrook Clinic. This session is very popular with many of the expectant and nursing mothers because they often find it difficult to attend during the day if they are working or unable to find anyone to look after their children. It is noticeable that evening patients are much more at ease and therefore less troublesome to treat. 111 I continued to notice that the dental health of the mothers was improving. This is due to their being more dentally conscious and receiving dental treatment from the time of leaving school. These patients usually require only a small amount of treatment to make them dentally fit. It is not so common to see mothers with grossly neglected mouths as a few years ago. The choice of local or general anaesthesia was available to patients when extractions were required. Most children under five had a general anaesthetic for extractions, this being administered always by a Medical Officer. Dental X-ray facilities which can be very important in the diagnosis of dental abnormalities are now available at all the clinics in the Ilford Area. This can often save the patient pain because a quicker diagnosis is possible. Dentures were supplied when needed to patients; these were made at a local dental laboratory, an arrangement which has been in operation for many years and is satisfactory. In August 1960 new equipment for high speed drilling was introduced at Mayesbrook Clinic. This machine not only makes cavity perforation much quicker but also causes less pain to the patient. Another of these high speed Borden Airotors has been installed at Kenwood Gardens Clinic early in 1961." The number of cases treated at the Clinics during 1960 was as follows:— Examined Needing Treatment Treated Made Dentally Fit Expectant and nursing mothers:- (a) Day Sessions:- Mayesbrook 61 61 64 57 Kenwood Gardens 102 101 101 58 (b) Evening Sessions:- Mayesbrook 11S 115 115 114 Children under 5:- Mayesbrook 84 84 122 111 Kenwood Gardens 105 103 103 62 112 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:- Mayesbrook 271 26 48 164 46 - 58 - 12 9 Kenwood Gardens 39 29 - 140 18 - 26 4 - 2 (b) Evening Sessions:- Mayesbrook 100 75 - 268 152 3 101 22 16 5 Children under 5:- Mayesbrook 177 - 67 214 — - 49 — — - Kenwood Gardens 4 4 - 119 - - 7 - - - In addition there were 237 prophylactic treatments and other operations carried out in the case of expectant and nursing mothers at day sessions (173 at Mayesbrook and 64 at Kenwood Gardens) and 256 at evening sessions (at Mayesbrook). The total number of sessions held for expectant and nursing mothers and children under five years of age was 121, 75½ during the day (42½ at Mayesbrook and 33 at Kenwood Gardens) and 45½ in the evenings (at Mayesbrook). 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. With a view to effecting economy and cohesion in the service this work 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. Owing to the decline in attendances at the branch distribution centre which was open on Fridays at the Goodmayes Methodist Church Hall, Blythswood Road, and having regard to the availability of distribution facilities at the Infant Welfare Centres in the vicinity, this centre was closed on 27th January, 1961. The High Road Methodist Church premises were closed at the end of March 1961 when the new Methodist Church in Ilford Lane was completed. 113 The branch distribution centre at these premises was therefore, by arrangement with the Church authorities, moved to a room in the Church Hall adjoining the new Church, the approach to the centre being from Britannia Road. The dates and times of opening remained unaltered. As from 1st June 1961 the price of orange juice has been increased and a charge has been made for cod liver oil and vitamin tablets which hitherto were issued to beneficiaries free of charge. It has been noted that there has been a considerable decline in the number of issues of these items since these charges came into operation. The following shows the present distribution centres with the days and times they are open: — (a) Main Centre Kenwood Gardens Clinic, Monday to Friday 9.30 a.m. - 5 p.m. Kenwood Gardens, Ilford. Saturday 9.30 a.m. - 12 noon (b) Branch Centre Methodist Church Hall, Ilford Lane (entrance in Britannia Road), Ilford. Tuesday and Friday Saturday (9.15 a.m. - 1 p.m. (2 p.m. - 3.15 p.m. 9.15 a.m. - 12 noon (c) Infant Welfare Centres Chadwell Monday 2-4 p.m. Marks Gate Tuesday 2-4 p.m. Manford Way Tuesday 2-4 p.m. Manford Way Friday 2-4 p.m. Becontree Tuesday 2-4 p.m. Goodmayes Thursday 2-4 p.m. Downshall Tuesday 2-4 p.m. Kenwood Gardens Wednesday 2-4 p.m. Kenwood Gardens Friday 9.30 a.m. - 12 noon Heathcote Avenue Wednesday 9.30 a.m. - 12 noon Heathcote Avenue Wednesday 2-4 p.m. Cecil Hall Wednesday 2-4 p.m. Cecil Hall Thursday 2-4 p.m. Seven Kings Wednesday 2-4 p.m. Newbury Hall Thursday 2-4 p.m. Grosvenor Road Wednesday 2-4 p.m. Ilford Lane Friday 2-4 p.m. The Drive Friday 2 - 4 p.m. Fairlop Friday 2-4 p.m. (d) Private House Mrs. Taylor, 31, Lime Grove, Hainault. Monday to Friday 9 a.m. - 5 p.m. 114 SCHOOL HEALTH SERVICE SCHOOL ROLL AND PREMISES. - There are 39 schools with 65 departments. The number of children on the school roll of Primary and Secondary Schools in Ilford on 20th December, 1960, was 23,383 which figure includes Barking Abbey (443). In addition there were 84 children attending the special schools. The newKenwood Gardens Health Services Clinic was opened in February 1960 and all services previously operating at Valentines Mansion were transferred there. MEDICAL INSPECTION AND FOLLOWING UP.During the year 6,739 periodic medical inspections were carried out and in addition, 745 special inspections and2,256 re-inspections were undertaken. 4,732 parents or 70.3 per cent, attended the full medical inspections. As in previous years the Elmbridge and Kennylands Boarding Schools remained under this authority for the purpose of medical supervision and Dr. Gross visited each school once a term to undertake routine medical inspections and follow-up cases. The existing arrangements, however, whereby Surrey County Council undertook dental inspection and treatment of pupils at Elmbridge School were continued. STAFF. - Fortunately there were no changes in the medical staff during the year but we experienced the usual fluctuations in part-time dental officers and in this sphere we are the equivalent of 1. 35full-time officers below establishment. There were several changes amongst the medical auxiliaries. The two full-time physiotherapy vacancies at the Cerebral Palsy Unit were filled in May 1960 and this Unit has since been working at full strength and in a most satisfactory manner. Mrs. E. A. McGill resigned her appointment as part-time Speech Therapist at our Mayes brook Clinic and we were fortunate in having as her successor Mrs. B.J. Tingey. Many changes of staff took place at the Child Guidance Clinic. Following the increase in the establishment by the addition of a third Psychiatric Social Worker which was filled by Miss M.Baker, we subsequently were faced with the resignation of Miss P. A. Radford and this post has not yet been 115 filled. Miss R. Oppenheimer resigned her part-time appointment as Child Psycho-Therapist but we were able to fill the vacancy by the appointment of Mrs. D. Handja. Dr. D. L. Woolf, who had been Consultant in Physical Medicine at the Cerebral Palsy Unit since its inception in 1955, resigned the appointment during the year and his place was taken by Mr. H. B. Lee, F. R. C. S. VISITS. - (a) The Public Helath Inspectors made 1,038 visits to maintained schools, (1) to enquire as to the milk supplies and (2) to inspect the sanitary arrangements. (b) School nurses made (i) 145 visits to schools (122 for general hygiene and 23 for head inspections) when 18,532 individual children were examined and 18,941 actual examinations were made, (ii) 2,432 home visits in regard to treatment recommended, and (iii) 441 home visits to cases of minor infectious diseases. (c) I have continued my own regular visit to schools in an endeavour to become more fully acquainted with schools and Head Teachers and have set myself the target of conducting one routine medical inspection in each school. This programme, which must depend on the time I have available, is nearing completion. (d) A separate report is furnished by the Chief Public Health Inspector on the general subject of hygiene conditions in schools. INFECTIOUS DISEASES. - Fortunately there were no outbreaks of infectious diseases in the Ilford schools during the year and there is nothing of note to report in this respect apart from the annual fluctuating incidence of scarlet fever and whooping cough. At Kennylands Boarding School, the medical supervision of which is my responsibility, there was rather an acute epidemic of tonsillitis. Nursing difficulties were experienced especially as the Resident School Nurse was also off sick. Although as a temporary measure 3 nurses were supplied from various Health Areas in the County, day and night nursing was required and eventually aid was secured from the British Nurses Co-operative Association at Oxford. 116 There was also a mild outbreak of Haemolytic Streptococcal sore throats at the Elmbridge School, but this was soon under control. MINOR AILMENT CLINICS. - The Minor Ailment clinics functioned as last year, a full session weekly being operated at both the Mayes brook and Kenwood Gardens Clinics. In addition facilities were afforded for any urgent cases to consult the doctor at the immunisation clinics held weekly at Mayes brook Clinic and the Kenwood Gardens Clinic. NEW OR ORIGINAL WORK. - Dr. O'Connor Wilson, one of the School Medical Officers, carried out a foot and posture survey throughout the Ilford schools of children of the age group 9 to 11 years. Of the 5,271 children examined 27. 1% were found to have foot defects and 12.4% postural defects. 543 were referred to the physiotherapist for treatment by exercises and the more severe cases were referred to the Orthopaedic Surgeon for opinion. This survey is the subject of a separate report by Dr. O'Connor Wilson. Dr. Taylor is hoping to introduce a series of lectures in the schools on the relation of lung cancer to smoking. A small day class for maladjusted pupils has been opened in one of the old school premises and although this is restricted to six in number it is hoped in the near future to increase this to two classes. SPECIALIST SERVICES. - The various specialist clinics functioned as in previous years and these are the subject of separate reports by the Consultants included under the particular Clinic details. STATISTICS. - The Ministry of Education Annual Returns and the summary of heights and weights over a period of 10 years are printed at the end of this Report. MEDICAL TREATMENT. (a) Minor Ailments Clinics.- The attendances during 1960 were as follows:- Kenwood Gardens Mayesbrook Number of individual children seen 247 413 Number of attendances of children 370 628 117 Number of exclusion certificates granted 2 34 Number of certificates of fitness to attend school granted 3 34 The following table shows the conditions dealt with at both the Clinics during the year:- Subnormal Nutrition 132 Debility 44 Uncleanliness:- Head 36 Body - Skin:- Ringworm:- Head - Body 1 Scabies - Impetigo 4 Dermatitis 1 Urticaria 3 Furunculosis 4 Eczema 1 Athletes Foot 11 Warts 110 Other Skin Diseases (Non-Tuberculosis) 25 Eye:- Blepharitis 3 Conjunctivitis 3 Defective Vision (excluding Squint) 59 Squint 9 Other conditions 52 Ear:- Defective Hearing 3 Otitis Media 4 Other Ear Diseases 5 Nose and Throat:- Chronic Tonsilitis only 10 Adenoids only 1 Chronic Tonsilitis and Adenoids 2 118 Nasal Catarrh 10 Nasal Obstruction 1 Other conditions 4 Enlarged Cervical Glands (Non-Tuberculous) 4 Defective Speech 7 Teeth - Dental Diseases 31 Heart and Circulation: - Functional 1 Anaemia 1 Infectious Diseases:- Mumps 1 Scarlet Fever 1 Colds and Coughs 27 Lungs Asthma 5 Bronchitis 2 Pulmonary Catarrh 4 Other Non-Tubercular Diseases 2 Psychological: - Development 2 Stability 12 Nervous System:- Enuresis 10 Other Conditions 10 Deformities:- Genu Valgum 3 Posture 6 Pigeon Chest 1 Flat Feet 13 Valgus Ankles 1 Other Forms 12 Minor Injuries 19 Rheumatism 4 Other Defects and Diseases 21 Total number of ailments 738 RECUPERATIVE HOLIDAYS. During 1960, 22 children were recommended for 119 cuperatlve holidays and were placed by the Borough Education Officer. SPECIAL, CLINICS OPHTHALMIC CLINIC. The following table summarises the attendances of school children:- Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 95 261 846 1,469 Mayesbrook 95 204 489 1,307 Manford Way 12 30 81 207 Totals 202 495 1,416 2,983 914 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 300 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 Ophthalmologist, reports as follows:- "The School Eye Clinic - now (with effect from 1st February, 1960,) well accommodated and set up in the new Clinic at Kenwood Gardens, Ilford - has continued to function smoothly and satisfactorily. The Clinic has been well attended at all times throughout the year. The cases seen call for no special comment - the usual school eye clinic "mixture" with refractive errors and squints predominating. Good co-operation has been obtained from London Eye Hospitals and from the Eye Department of King George Hospital, Ilford, to which cases requiring further investigation and/or operation have been referred as necessary. The Orthoptic Department (at Mayesbrook) and the arrangements for fitting and supply of spectacles (by attending Optician) have been quite satisfactory." 120 ORTHOPTIC CLINIC. Miss C. M. Hazel, D. B. O. , makes the following report on the Orthoptic Clinic held atMayesbrook Health Services Clinic for the year ended 31st December, I960. "224 sessions were held throughout the year and 109 new cases were referred for treatment. In addition 84 old cases were under treatment. Total attendances amounted to 598 and 47 patients were discharged. The Orthoptic Clinic functioned efficiently as an indispensible^adjunct to the School Eye Clinic in the treatmentand observation of squint cases - both true and latent and pre- and post-operative." Miss Hazel attended at the Clinic for five sessions a week. ORTHOPAEDIC CLINIC. Mr. H.G. Korvin, F.R.C.S., the Orthopaedic Surgeon makes the following report: - "The great event of the past year was the rehousing of the Newbury Hall Clinic in the new building in Kenwood Gardens. It wasilike moving into another century. The carefully planned layout, the quiet and attractive colour schemes, the up-to-date equipment and installations , they all contribute to make the clinic a model of its kind. The size of the orthopaedic room is considerably smaller than the space that was available for exercises at the Newbury Hall Clinic, but the folding wall allows orthopaedic room and waiting room to be converted into one large hall. The provision of efficient secretarial help makes a morepersonal contact with other clinics and with the referring doctors possible. The arrangements for x-ray examinations, laboratory investigations, hospital admissions, and the provision of appliances remained unaltered. The numbers of attendances appear to be getting smaller. It is hard to say whether this is due to a real decrease in orthopaedic complaints or to the 121 Assistant School Medical Officers taking more of the load on to their own shoulders. It is certainly noteworthy that operations for knock-knees have not been necessary for several years. I wish to thank all those taking part in these clinics for their most valuable help. " The following table summarises the attendances of school children:- Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 42 77 227 431 Mayesbrook 24 41 128 184 Manford Way 8 2 14 16 Totals 74 120 369 631 SUMMARY OF CASES SEEN Diagnosis New Cases Old Cases A B C A B C Cerebral Palsy - - - - - - A. P, M. - - - 4 9 - Hemiplegia - - - 3 - - Scoliosis 2 1 - 2 3 - Kyphosis 3 - - 2 1 - Slack posture 12 5 - 17 14 4 Deformity of Hips 2 1 - 6 1 - Genu valgum 18 9 2 91 37 2 O. C. T. 1 - - - - 2 Genu varum 2 1 - 5 - - Pes valgus-planus 2 4 - 16 6 - Valgus ankles 9 6 - 35 18 - Talipes calcaneo-valgus - 2 - 1 4 3 Intoeing 3 1 - 1 4 - Hallux valgus 6 1 - 6 5 - Deformity of Foot 3 - - 2 - - 122 Deformity of Toes 7 3 - 12 6 - Torticollis - - - 3 - - N. A. D. - 1 - - - Other conditions 4 3 - 13 18 2 Foot strain 1 3 - 2 - Metatarsal varus 2 - - 2 1 1 Osteomyelitis - - - 1 - - Spina Bifida - - - 1 1 - Totals 77 41 2 227 128 14 A - Kenwood Gardens. B - Mayesbrook. C - Manford Way. 18 children of school age were admitted to East Ham Memorial Hospital. Particulars as follows:- No. of Cases Operation 2 Holds worth Operation Rt. and Lt. 2 Lt. Bunionectomy and Phalangeal Osteotomy.. 3 Arthrodesis - Proximal Interphalangeal Joint 3rd Toe. 1 Disarticulation Rt. Little Toe. 2 Tendon Transplantation Lt. 3rd and 4th Toes. 1 Arthrodesis D.I. P. Joint 3rd Toe and P.I.P. Joint 4th Toe both Rt. Foot. 1 Excision Haemangioma from Little Finger. 1 I. P. Wedge and Arthrodesis 2nd Toe Lt. 2 Manipulation Tendon Achilles and Knee in P. O. P. 1 Removal of Nailbed Rt. and Lt. Great Toes. 1 Supracondylar Osteotomy. 1 Arthrodesis 1st Tarso-Metatarsal Joint and Wedge Osteotomy Prox. Phal. Lt. Gt. Toe. During the year 9 pairs of valgus insoles, 9 pairs of surgical boots or shoes, 7 pairs Genu Valgum splints, 1 metatarsal bar, 5 calipers and inverting irons, 14 repairs to calipers and shoes, and 70 pairs wedges to shoes, 1 spinal jacket and 1 hand splint were supplied to school children. 119 cases were discharged from the Orthopaedic Clinic, 60 as cured, 18 due to absence and were kept under 123 observation at school, 30 were showing improvement and were kept under observation at school. 11 cases left school or left the district. MINOR ORTHOPAEDIC DEFECTS. Dr. F.E. O'Connor Wilson, one of the school medical officers, has under supervision and attends periodically one of the following Clinics conducted by the Physiotherapist: - Exercises Massage Sunlight and she reports as follows: - "REMEDIAL EXERCISES The clinic for remedial exercises and physiotherapy were large and busy during I960. There were 565 new cases and 1,402 attendances at Kenwood Clinic. 456 new cases and 1,111 attendances at Mayesbrook. Cases referred for treatment from School Medical Inspections and from Foot and Posture Survey were 874 and these made 1,047 attendances. Total number of new cases at both clinics were 1,021, with 2,513 total attendances. Classes were held to demonstrate the exercises for treatment of the particular defect. ARTIFICIAL SUNLIGHT TREATMENT Ultra-violet treatment was given as usual at the two centres at Kenwood and Mayesbrook. Total attendances were 19 new cases and 452 attendances. Of these 4 new cases and 91 attendances were at Kenwood Clinic, and 15 new cases with 361 attendances at Mayesbrook. " FOOT AND POSTURE SURVEY. Dr. O'Connor Wilson also carried out a Foot and 124 Posture Survey of all school children in the age group nine to eleven years and the following reports are submitted:- FOOT SURVEY 1960 Dr. F. E. O'Connor Wilson reports as follows:- "A survey was taken of foot and leg defects found in children between the age of nine and eleven years throughout all the Ilford schools. During the survey footwear was examined and advice given concerning the proper shoes and socks to be worn. There was a definite improvement shown in the number of foot and leg defects compared with the number found in the last survey in 1955. Number of children examined 5,271 " with defects 1,430 11 of girls with defects 766 " " boys " " 664 The percentage of defects were found to be fairly well distributed over the different areas in which our schools are situated; the schoolchildren in South Ilford having the least number of defects. Feet were examined for cleanliness, deformities of bone and skin abnormalities. Childrenfound to have corns and verrucae who were not being treated privately were referred to the Chiropodist's clinic or local hospital. Flat Feet 176 or 12.3% Genu Valgum 105 „ 7.3% Genu Varum 161 „ 11.2% Hallux Valgus 160 „ 11.2% Skin defects 76 „ 5.4% Valgus Ankles 17 „ 1.2 % Verrucae 105 „ 7.3 % Hammer Toes and Bunions 21 „ 1.5% Curled and Deflected Toes 541 „ 37.8% Corns 68 „ 4.8% Of the total number of children examined 27.1% had foot or leg defects. 125 Hallux Valgus was found in 11. 2% and could be due to wearing shoes which were too narrow and pointed. Curled toes and deflected terminal phalanx of the great toe accounted for 37. 8% of the defects. This is a big percentage of the total and is probablydue to badly fitting shoes. Many shoes favoured by schoolgirls now-a-days are badly shaped. Casuals and shoes with pointed toes are probably responsible for the deformity of toes since casuals and slip-on shoes tend to become loose through wear and the only way to hold them on is by curling the toes to grip the shoes and prevent them slipping. Shoes that are too short also cause bending of the toes, especially where the middle toe is longer than the great toe. Of the few cases of hammer toe found, 1. 5% were probably due to this cause. I would like to stress the importance of having shoes properly fitted in shops where the feet are measured with a foot gauge. Some plimsolls are supplied by the school authority and the fitting of these should be done by an adult and not left to the children. Plimsolls and football boots are worn for short periods only and can be kept for too long to spare expense and the child tends to squeeze his feet into them. Passing on shoes to younger children is a doubtful saving, too, as this may damage the feet. The best type of footwear should be made of leather, have plenty of room for the toes and be big enough to allow for growth. The heel should be stout and not too high and the shoe should fit firmly to the heel; laced or with a strap across the middle of the foot to prevent slipping. Children who had verrucae were advised to keep the affected foot covered when doing physical training and not to go to the baths until better. The few cases of athlete's foot were also warned about infection - most of them were already treated. Of the 5,271 children examined only 96 were found to have dirty feet. " 126 SURVEY OF POSTURE I960 Dr. F. E. O'Connor Wilson reports as follows:- "A survey of the children's posture was done at the same time as that of the feet. The age group was nine to eleven years old. Number of children examined 5271 " with Faulty Posture 654 or 12.4% " of girls with Faulty Posture 365 or 6.9% " " boys " " " 289 or 5.5% All children with postural defects were referred for treatment and will be reviewed in a few months' time. Most of these defects included flat chests and were due to slackness or weakness of the muscles. Poor chest development can result from repeated attacks of tonsillitis and nasal obstruction and when these conditions are left too long before being remedied, the breathing is affected and shallow respirations produce poor development of the chest. Breathing exercises correct these cases when the cause has been removed. Many of the children held themselves badly but could stand correctly when told to do so. Crouching in chairs looking at television programmes or sitting at desks which are too low for them is a frequent cause of round shoulders. Chairs and desks in schools should be the correct height for the pupil, preferably adjustable, owing to the great difference in children's heights. Good posture helps a child mentally as well as physically. It will aid confidence and assist in keeping the brain alert. Many employers prefer children who have a good appearance. This is especially bo where girls are employed and the girl with a good carriage can oftan make a good impression when seeking employment. " PHYSIOTHERAPY CLINICS. These were held at Kenwood Gardens on Monday and Thursday mornings and at Mayesbrook Clinic on Tuesday 127 and Friday mornings. Cases are also seen at the Manford Way Clinic as required. Details of attendances:- Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 84 94 137 852 Mayesbrook 83 53 102 614 Manford Way 80 4 14 67 Totals . 247 151 253 1,533 ARTIFICIAL SUNLIGHT CLINICS. These were held at Kenwood Gardens on Tuesday afternoon and at Mayesbrook Clinic on Thursday afternoon. Details of attendances:- Clinic Sessions New Cases Old Cases Attendances Discharged Cured Much Improved Left District etc. Kenwood Gardens 42 4 4 91 6 1 1 Mayesbrook 43 15 15 361 9 8 2 Total 85 19 19 452 15 9 3 The lamp used at each Clinic is a Centrosol Unit. The conditions treated were as follows:- Defects Treated Cases A B Chilblains 2 3 Anaemia, Debility and Malnutrition 2 15 Bronchitis 3 2 Other Conditions 7 4 14 24 A - Kenwood Gardens Clinic. B - Mayesbrook Clinic 128 EAR, NOSE AND THROAT CLINIC. Miss M. M. Mason, F.R.C.S. , Ear, Nose and Throat Consultant, reports as follows:- "The past year has been a fairly uneventful one for the Ear, Nose and Throat Clinic. 152 new patients attended, 21 of them under 5, and a total of 368 attendances were made. 109 children had operations , mostly for tonsil and adenoid disease. The number of beds available in Chadwell Heath Hospital has now increased to 8, with a corresponding reduction in the waiting time for operative treatment. We were gratified to note that the Clinic seems to be increasing in popularity with local practitioners, several of whom have asked for their patients to be seen here. The children appear to find the less formal atmosphere reassuring, and of course there ie liable to be more delay at a hospital out-patient department than at the clinic. It is hoped that more practitioners will become aware that the clinic is available for referral of their cases should they so desire. " The following table shows the work of the Clinic- No. Diagnosed Tonsils and Adenoids Infection 64 Deafness 1 Otitis Media 3 Hypertrophied Adenoids 31 Rhinitis 5 Other defects or diseases 17 121 No. of Sessions held 43 During 1960 109 children were operated on for the removal of enlarged tonsils and adenoids as follows:- King George Hospital 78 Chadwell Heath Hospital 31 129 SPEECH CLINICS. Mrs. M. Walker, the Senior Speech Therapist, reports on the work of the Speech Clinics during I960 as follows "The Speech Therapists working in Ilford Schools and Clinics in I960 were as follows: - Mrs. M. Walker, L,. C. S. T. Full-time Valentines Clinic and Schools Mrs. P. Pretious, L. C. S. T. Full-time Cerebral Palsy Unit, Valentines and Manford Way Clinics, and Schools. Mrs. B. Tingey, L. C. S. T. Part-time Mayesbrook Clinic. We were very glad to welcome Mrs. Tingey to "our ranks" this year and consider ourselves most fortunate in gaining a colleague with such wide and excellent experience. Mrs. Tingey had a great deal to do with the 'Leicester experiment', giving daily speech therapy treatments to their class of children with 'stubborn' speech defects and disorders who axe housed in an ordinary school, and we have found that deep knowledge and understanding of her work has been invaluable. The number of treatments given annually continues to increase although there has been no increase in the number of speech therapy sessions. Something has had to suffer, so that apart from actual treatments given in some of the larger schools which have a sufficient number of speech defective children to warrant treatment on the premises, there has been little or no school visiting as such. This is unfortunate since many schools now fully appreciate the utter necessity of frequent personal contact between speech therapists and teachers in order to maintain consistency of handling of the children, and to promote an atmosphere conducive to steady improvement. There has been more frequent contact with Ilford Child Guidance Clinic this year, and we are most grateful for the help we receive and know that the benefits are felt by both therapists and children. " 130 The defects treated were as follows:- Stammer 64 Dyslalia 135 Retarded speech and language 11 Hearing losses 3 Cleft Palate 5 Dysarthria 1 Neurological 2 Treatment not needed - Others 10 84 children of school age were discharged from the Clinics during the year. In49 cases the speech was normal. Of thr; remaining 35 cases, 1 left the district, 14 improved, 9 c< isedto attend, 1 left school, 5 were referred elsewhere, 2 did not require treatment, 3 refused further treatment. SCHOOL DENTAL SERVICE. Mr. E. V. Haigh, Area Dental Officer, reports as follows:- "The dental services available to schoolchildren continued during I960 on similar lines as in previous years. In February I960 a new dental clinic was opened at Kenwood Gardens, the dental department being completely separated from the other clinics. It consists of one surgery, with provision for a second surgery when the staff position improves, recovery room, dental mechanics room, x-ray facilities including dark room for developing films, and waiting room. The opening of this new surgery brought the total dental surgeries in Ilford to six; Mayesbrook and Valentines having two surgeries each and one surgery at Kenwood and at Manford Way. Becuase it is impossible to obtain full time dental officers and very difficult to get part-time officers, these surgeries are not fully operational. During 1960 several part-time dental officers resigned and by the end of the year we only had four part-time dental surgeons doing 14 sessions per week 131 which, with my services on school dentistry, made an equivalent strength of two full-time dental officers. The reason for this shortage of staff continues to be the difference in remuneration between private practice and school clinic work. It has been impossible to inspect many children at schools, sufficient numbers applying for treatment to keep available staff fully occupied. I continued with one evening session per week at Mayesbrook Clinic for school children who are unable to attend during the day. These sessions from 5.15 to 8.15 p.m. are very popular with the older children studying for examinations and who do not wish to stay away from school. Dental x-ray facilities are available at all clinics; this not only saves patients' time but also saves them pain, a quicker diagnosis being possible. Most extractions were performed under general anaesthesia, which was always given by a medical officer, the average number of children attending for anaesthetic session being between 20 and 25. Emergency treatment and inspection sessions continued at Mayesbrook Clinic each week. On Wednesday and Friday mornings before 11 o'clock any school child without an appointment could attend and be seen for the relief of pain and inspection. Appointments were made for these children to have extractions under general anaesthesia, conservative or orthodontic treatment. The number of patients attending on these mornings varies from 15 to over 30 per session. " Full details of the dental work are shown in Table V. BENTON SCHOOL. Dr. D. M. B. Gross, Medical Officer in Charge, reports as follows:- "During I960 the number of children on roll varied, being 76 on 31. 12. 59. and 66 on 31. 12. 60. 132 There were 17 admissions and 27 discharges. Recommendations for admission were received from the following:- School Medical Officers 1 Borough Education Officer 8 Hospitals 5 Others 3 17 The diagnoses were as follows:- Sub-acute rheumatism 1 Rheumatoid arthritis 1 Paralysis of legs 1 Muscular dystrophy 1 Slipped left femoral epiphyses 1 Spina bifida 1 Lung collapse 1 Congenital Heart 3 Asthma 2 Left hemiparesis 1 Hemiplegia 1 Mild Cerebral Palsy 1 Nephrosis 1 Bronchiectasis 1 17 The 27 children discharged left for the following reasons:- Fit for ordinary school 10 Left school (over age) 4 Admission to Special School 4 Left district 7 Others 2 27 The work of the school has continued as in previous years and there is nothing outstanding to report. The routine medical inspections have been regularly carried out and childrenhave been referred to special clinics as necessary. In conclusion, I should like to thank all the staff for their continued help and co-operation. " 133 CEREBRAL PALSY UNIT. Mr. H. B. Lee, F. R. C. S. , Consultant Physician In Physical Medicine, reports as follows:- "The School is working most successfully. There are two full-time physiotherapists, an occupational therapist, and a part-time speech therapist, and the essential co-operation between the various sides of the staff provides the children with a happy, stable atmosphere in which the best can be made of their physical and mental abilities. Both the physiothe rapists attended a course on the treatment of cerebral palsy run by the Chartered Society of Physiotherapists. The provision of new premises will greatly help the work of the school, and the treatment bath will be particularly appreciated. " Dr. D. M. B. Gross, Medical Officer in Charge, reports as follows:- "The Unit opened in May 1955. Duringthe year in question the number of children on roll varied, being 24 on 31st December 1959 and 18 on 31st December I960. During the year under review, 7 children were examined with a view to admission; of these 3 were accepted and came from the following areas:- 2 Romford 1 South Essex The 4 children rejected, with the reason for rejection and the responsible Authority concerned, were:- Dagenham Considerable mental retardation South Essex Severe degree of backwardness Romford Mild spastic Walthamsfcxv Too backward and immature 134 During the year 6 children were discharged for the following reasons:- Ilford (A) Removed from Area (B) To Residential Special School Dagenham Transferred to another Day Special School Romford Unable to made progress Upminster School leaving age Mid Essex Removed from area. We were fortunate in appointing two physiotherapists during the year, which has brought the staff up to establishment. Dr. Woolf, the Consultant In Physical Medicine, resigned in June owing to pressure of other work and Mr. H. Lee, Orthopaedic Surgeon, was appointed in his place. He was able to take over at once and there was no gap between the appointments. Several new pieces of apparatus have been ordered and will soon come into use; they will ease the work of teachers and welfare workers. In all respects the work of the Unit is proceeding smoothly. There is one child on the waiting list. " CHILD GUIDANCE CLINIC. Dr. W. P. Gurassa, Consultant Psychiatrist, and Medical Director of the Ilford Child Guidance Clinic, writes as follows "During the year i960 work has proceeded along the lines indicated in the last report, with the demand for diagnosis and treatment as great as ever. We have been helped by the addition of another Psychiatric Social Worker, Miss Baker, who has come to us from St. Bartholomew's, having previously had experience as an Almoner at Great Ormond Street. Unfortunately, this has been off-set by Miss Radford leaving us to take up an appointment at The British Hospital for Functional Nervous Disorders. My long absence through illness during the Autumn was a further setback, but the Clinic was 135 ted by Dr. Shackleton as Locum with Dr. Altschulova In charge. Earlier in the year we lost one of our Therapists, Miss Oppenheimer, and were lucky to replace her fairly soon after with Mrs. Handja. Changes of staff are a recurrent problem in a Clinic of this kind. The diagnostic waiting list is a little longer than it was last year, and there is still a bottle-neck with regard to the provision of more intensive treatment. It is often desirable, but rarely possible to offer treatment more than once-weekly. It had been hoped to start a group, but this has not been possible, partly because of the difficulty in collecting suitable cases and partly because of my absence. There is also a bias in favour of individual treatment in the training background of the Clinic staff. Dr. Altschulova and other members of the Clinic staff have been doing evening sessions for some months, and it has proved to be very useful. Some patients, especially adolescents, very much appreciate being able to come for treatment after school hours, so that they do not miss school, and some found it helpful not to have to tell everybody that they are having treatment. From the point of view of the Psychiatric Social Worker, evening sessions have made it possible for some fathers to take a more active part in the treatment of their children by coming for regular interviews after working hours. We have been most fortunate in a very successful start with the day class for emotionally disturbed children from 5-8 years. The selection of these children was made by the clinic staff as a whole and their progre s s followed with great interest. The absence of facilities in the area for admission of disturbed children and adolescents continues; however, pressure has been brought to bear on the Regional Board and the problem is underactive consideration. There is also a lack of residential school places for older boys and girls. There have been some structural alterations to provide two additional consulting rooms and another office in the Clinic. " 136 The following is a table showing the work undertaken at the Child Guidance Clinic during 1960:- I. 1. (a) Cases awaiting first appointment 26 (b) Cases referred to Clinic during the year (including special diagnostic cases) 165 2. (a) Cases still under investigation 30 (b) Cases diagnosed during the year and found not to require specific treatment (1) Cases closed 11 (ii) Cases kept under supervision 67 (c) Cases diagnosed and which received specific treatment during the year either (i) At the Clinic 11 (ii) By placement in residential school 5 (d) Cases diagnosed and awaiting specific treatment on 31st December of present /ear either (i) At the Clinic 21 (ii) By placement in residential school 6 (e) Cases withdrawn before diagnosis 13 II. 1. (a) Cases carried forward from previous year and which received treatment during the year (i) Supervision 50 (ii) Specific treatment:- At the Clinic 59 (iii) By placement in residential school 6 137 (b) Or cases closed during the year (i) Specific treatment and/or supervision completed 21 (ii) Not taken up further owing to non-co-operation or for other reasons 21 (iii) Improved whilst awaiting specific treatment 13 III. 1. Distribution of treatment or supervision:- (i) Psychiatrists: Children under treatment 59 Children awaiting treatment - Number of cases supervised 50 (ii) Psychotherapist: Number of children treated 46 Number of children awaiting treatment 21 (iii) Psychiatric Social Workers: Number of cases advised 383 Number of cases awaiting advice 21 (iv) Educational Psychologists: Children given remedial education 15 Children awaiting remedial education - SCHOOL PSYCHOLOGICAL SERVICE. Miss B.S. Gascoyne and Miss C.H. Watt, Educational Psychologists, report as follows:- "In September a small class was formed for children from five to eight years who have various problems which make it difficult for them to fit into and make progress in normal schools. The numbers have been kept very low so that the children have the opportunity to adjust to a small group; the teacher, Miss Denoual, has been able to help each child individually, and to support them, so that they can 138 work out their problems in a way which would not be possible with a class of forty children. We feel, even at this early stage, that the results have been very promising and the class has proved to be of absorbing interest to all members of the clinic staff as discussions and conferences with Miss Denoual have been frequent. We feel that we are all learning from this and hope that it will be possible to set up a junior class during this year. Mrs. Thomas, the Welfare Assistant, has proved invaluable as she has entered fully into the care and understanding of the children in a way which has given them, as well as Miss Oenoual, a great deal of help. The special Remedial Classes have still provided a very valuable service, particularly as this year a rather larger proportion than usual of secondary age children have been found to be in need of extra help with their lessons. This creates a problem, as children removed from these schools, for however short a time, inevitably miss the wider range of activities available there, although, where possible, they still attend the craft classes at their secondary schools. This has underlined the importance of retarded children being referred to us while they are still of the junior and infant age, so that remedial work can be started where necessary before too much of a defeatist attitude has made learning in a normal situation almost impossible. To try to change the approach to learning of some of these senior school children, Miss Watt has had a group of them for weekly sessions at the clinic. Progress has been slow because before much formal learning has been possible the children have had to gain sufficient confidence in themselves to feel that they can really tackle the normal school work. We hope that the time spent on this indirect approach will enable them to start learning more quickly and to make more direct and profitable efforts towards formal learning in school. We are fortunate in having a large collection of remedial books at the clinic, which we keep up to date, so that the children can have an extensive choice of books within their ability." 139 Summary New cases 115 Follow-ups for clinic 169 Follow-ups for schools 53 Remedial Education 15 Children referred to C. G. C. 9 ILFORD ENURESIS CLINIC. Dr. J. M. Pooley, Medical Officer in charge, reports as follows:- "During the 12 months ended December 31st 1960, the clinic continued to be held on Wednesday mornings and, as from February 1st I960, was transferred from the Public Health Offices to the new Kenwood Gardens Clinic. It can be seen that attendances have shown a marked improvement during this year; indeed the whole atmosphere has been one of enthusiasm and co-operation by both parent and child. I. Appointment List During the 12 months ended December 31st 1960there have been 89 new cases (as compared with 68 in 1959 and 46 in 1958). These 89 have been made up as follows:- Recommended by Under 5 years Over 5 years Boys Girls Boys Girls Parents - - 5 2 General practitioners 3 4 9 8 Infant Welfare Officers 10 6 - - School Medical Officers - - 18 15 Health Visitors 1 - 3 - Hospital and clinic specialists - - 2 3 14 10 37 28 Total: 89 cases Total attendances: 430 (compared with 346 in 1959) Number of sessions: 35 140 II. Procedure The procedure adopted in previous years has been largely adhered to at each clinic, namely:- (a) Urinalysis with special attention to specific gravity. (b) History of Enuresis and of previous illnesses. (c) Physical Examination. (d) Treatment. Considerable time is devoted to explaining the treatment to be used, to talking to and gaining the confidence of the child and finally advice is given to the parent, by means of concise and simple explanation. and direction to the child, as to routine and charting and finally the taking of medicaments if indicated. It has been proved again and again how valuable is the time spent in making suggestions to the child, thus ensuring that his interest is held, and that the suggestions are therefore acted upon more faithfully by the parents. Factors such as housing difficulties, overcrowding and emotional instability in either parents or child must of course be met from time to time. III. Treatment The treatment issued or prescribed has been made up as follows:- No. of Cases (a) Long acting (bonded) Dexamphetamine known as Dexten (as supplied by arrangement with AsproNicholas Ltd.) 39 (b) Main hexamphetamine 16 (c) Phenobarbitone (either at night or in divided doses through the day) 6 (d) Disipidin (posterior pituitary snuff) - (e) Routine and Charting only 13 (f) The Sentinel or Down's Bed-buzzer (9 bed-buzzers are in use at 14 (g) Mist. Potassium Citrate c Hyocyamus 1 89 141 (h) Afew cases were referred to hospital or child guidance clinic and some of the cases treated with the bed-buzzer had previously been treated in the amphetamine series and failed. Thus, out of 89 new cases treated, 55, that is over 60%, of those showed deep sleeping habits sufficient to warrant counter-active treatment. IV. Analysis and Comparison of Results Dexten Dexamphetamine (Short acting) Pot. Cit. Phenobarbitone or Sedative Routine or chart only Bedbuzzer Total A, Completely dry on 13 4 1 1 8 5 32 B. Very marked improvement (i.e. less than 10 wet in 28 nights) 12 3 - 3 1 1 20 C. Improved (more than 10 wet in 28 nights) 5 3 - 1 2 3 14 D, No improvement 4 - - - - - 4 E, Not yet completed Treatment, or Self discharged 9 4 - 1 2 3 19 89 Therefore of 89 cases, 32 (36%) were discharged completely dry and 20 (22. 5%) were much improved and still continuing treatment. In addition, a further 26 cases referred during 1959 were discharged dry in the early months of I960. The bed-buzzer has been a very useful addition to the clinic resources, particularly where children have failed to respond to other forms of treatment. In nearly every case for which the buzzer was used, there was a rapid and marked improvement, and most of the cases took only 3-4 weeks to become dry. These cases remained dry unless the apparatus was removed prematurely. The apparatus was found particularly useful for two educationally subnormal children who had previously failed to respond to treatment. 142 Dosage and Side Effects of Dexten (bonded dexamphetamine) These are 10 mgm. tablets, but In all cases only half tablets (5 mgm. )were recommended at bedtime. This allowed the child (with few exceptions) to go to sleep before the actual effect of the dexamphetamine became manifest, and ensured that the maximum effect of the substance would be between the hours of 2 a.m. and 5 a.m. approximately. (In 1957 Professor A. Kekwick showed, by using crestinine as a marker, that the optimal level of a drug resinate in the blood occurred about 8} hours after its administration, and was maintained for at least 3 hours. ) Thus, the necessity of waking a child to give a second dose of a short acting substance is ruled out. In a very few cases temporary side effects were complained of, such as nightmares, insomnia or daytime irritability. It has been apparent that if treatment with the dexamphetamine group of drugs is going to be effective, 4-6 months of treatment will usually be sufficient to achieve bladder control. In all cases treated, however, any medicinal measures would seem to play a role secondary to thai of the strict routine, the early morning waking, charting and the interest taken by the child and parents in what is being attempted. " HANDICAPPED CHILDREN. Section 33 of the Education Act, 1944, and the regulations made thereunder have placed on the Local Education Authorities 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. 143 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 (amended by 1959 Regulations). The number of children coming within these categories and their disposition as on the 31st December, I960, are tabulated in the following table in accordance with the Handicapped Pupils Regulations, 1953, and amended by the Handicapped Pupils and Special Schools Regulations, 1959, operative with effect from 1st April, 1959. CATECOBY Number of children of school age on 31st December 1960, formally ascertained as handicapped pupils and requiring special educational treatment (s.e.t.) Attending day special school Awaiting placement in day special school Attending residential special school Awaiting placement in residential special school Attending boarding homes Awaiting placement in boarding homes Attending independent schools Awaiting placement in independent schools Attending hospital schools Awaiting placement in hospital schools Receiving Education in hospital under Section 56 Receiving home tuition under Section 56 Awaiting home tuition under Section 56 Total No. of children of school age requiring s.e.t. Blind - - 3 - - - - - - - - - - 3 Partially Sighted 4 - 3 - - - - - - - - - - 7 Deaf 5 - 3 - - - - - - - - - - 8 Partially deaf 15 1 2 - - - - - - - - - - 18 Delicate 20 1 3 2 — - 2 - - - - 1 - 29 Physically handicapped 45 2 1 - - - 10 — — — — 2 - 60 E.S.N 54 8 16 1 — - 7 - - - - 2 1 89 Maladjusted - - 10 13 2 — 20 - - - - 1 1 47 Epileptic - - 2 - - - - - - - - — - 2 Speech defect - - - - - - - 1 - - - - - 1 Total 143 12 43 16 2 - 39 1 - - - 6 2 264 144 MENTAL HEALTH SERVICE. The Training Centre for1 Severely Subnormal 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 Training Centre. Full medical inspection is carried out once a year,, by one ol the School Medical Officers, also a survey visit is made quarterly. GENERAL WELFARE Provision of Meals and Milk for School-children. The provision of meals in the schools commenced on 7th October, 1940. The total number of mid-day meals served during I960 was 2,268,065 approximately. There are 26 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 Boys, Fairlop Girls, 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, I960, 18, 587 children, were receiving milk in school. Provision of Baths. - Shower baths are installed at Beal, County High Boys, Barking Abbey Grammar, Caterham, Dane, Fairlop Boys and Loxford Secondary Schools. Work done by the N.S. P.C. C.- The following48 cases were investigated:- (1) Neglect 26 (2) Ill-treatment cases 11 (3) Other cases 11 145 (Two cases were reported from the Public Health Department 24 were reported from other sources for general neglect). 134 children(78 boys and 56 girls)were involved, 82 being of school age. In addition to this work, 172 supervision visits were paid to different cases, some of which were made to those reported during the previous year. The Invalid Children's Aid Association. - 4 children were placed in convalescent homes and fees paid by voluntary funds. Others assisted were 1 loaned tricycle, 1 loanedT.V. set, and 8 physically handicapped children sent toRed Cross camp. 10 new cases were referred during the year for casework and visiting and 11 old cases were given continued casework and after-care visiting. THE HEALTH VISITOR AND THE SCHOOL NURSE. Miss J. Oliver, Superintendent Health Visitor, submits the following report:- "Work in the schools continues to take up a considerable amount of our time. Co-operation on behalf of the school child covers a wide range of other workers all having the child's interest at heart. We have attended in I960 many sessions at the Child Guidance Clinic, where conferences have been held with other social workers to decide on the best plan to assist certain children with difficulties. Time must also be made to find out why children are failing to wear spectacles andhearing aids, and are failing to keep hospital appointments. Sometimes both parents are seen in the evening and a tactful discussion will bring forth good results; unfortunately all visits are not successful. The opportunity to continue Mother craft Classes at a Secondary School for girls has been carried on all through the school year. Lectures are supported by films and practical demonstrations and followed 146 at the end by group visits to the local hospital, a day nursery and the Infant Welfare Centre. It is hoped that this will assist the girls to enjoy their work when they leave school and provide a firm basis towards a good marriage. Modern magazines and daily papers provide puzzled teenagers with a variety of questions; these the Health Visitor must answer tactfully or frankly. We are still known especially in schools as "nurse" and in many ways this proves useful in discussions as girls will discuss many matters that they feel too shy to ask of their mother or teacher. Given the opportunity we hope our services will expand in this direction. Educational activities outside of schoolhours have been fairly varied. Youth Groups, Boy Scouts and Junior Red Cross Workers have asked for a variety of subjects. " Chiropody. - Although chiropody clinics have been opened inllforditis not yet possible to include in the general scheme treatment for school children. Hygienic Conditions in Schools in the Division.- Mr. S.R. Daly, Chief Public Health Inspector, reports asfollows:- "During the year under, review, routine and systematic inspections of the sanitary circumstances prevailing in the Ilford schools were carried out by the District Inspectors. It is pleasing to note that the works of amendment necessaryto maintain a reasonable standard of hygiene and sanitation in the schools has improved during the year. Of course, it is essential that the standard of sanitation be improved generally, particularly in the provision of better drinking water, washing facilities and sanitary convenience sitings to obviate the effect of inclement weather and of possible contamination. 147 The supply of milk to Bchools in cartons has been introduced and observations have been made regarding the hygiene of the system. Very few complaints have been received and those which were made generally related to the disposal of the empty cartons, misuse of the cartons by the school children and the nuisance arising from the deposit of cartons in the roadway and in front gardens ofhouses adjacent to the schools. Furthermore ithasbeen noticed that some of the cartons have split, thereby causing possible contamination of other cartons in the lower containers; as a result representations have been made to the suppliers on this point. The system has, however, had one pleasing effect - the number of complaints of foreign bodies in milk bottles has been eliminated in those schools where the milkis supplied in cartons. Generally speaking there are no objections to the system from a milk supply viewpoint, but the introduction of abetter system for the disposal of cartons would improve matters considerably. 11 Employment of School-children and Young Persons. During 1960, 119 children were submitted for medical examination in accordance with the Bye-laws 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. - 3 Certificates were granted during the year. 148 B. C. G. VACCINATION OF SCHOOL CHILDREN. In I960 the scheme was extendedto include all pupils over the age of 13 years and students attending Universities, Colleges or other establishments of further education. In addition those previously invited v/ho did not accept were given a further opportunity, hence the large number to whom it was offered. No. of pupils to whom B. C. G. was offered 7,961 No. of pupils whose parents consent to treatment 1,547 No. of pupils undergoing tuberculin test 1,612 Positive: 110 No. of pupils who received B. C. G 1,472 *70 carried forward from previous year. MEDICALEXAMINATION OF TEACHERS, OFFICERS AND SERVANTS. - The following examinations were carried out during 1960:- Officers Servants Teachers Intending Teachers Total New Appointments 22 164 28 67 281 Under Sickness Regulations 2 3 - - 5 THE CAUSES OF DEATH AMONG CHILDREN OF SCHOOL AGE (i. e.. FROM 5-15 YEARS) IN ILFORD, DURING I960 WERE;- Subarachnoid Haemorrhage following rupture congential aneurysm 1 Cerebral necrosis following anaesthesia 1 Laceration of lungs (road accident) 1 Cerebral laceration (road accident) 1 Leukaemia 1 Hepato lentricular degeneration 1 Coronary occlusion complicating congenital heart disease 1 Necrosing tracheo bronchitis following road accident 1 Acute heart failure following open heart operation for Fallots Tetralogy 1 9 149 MINISTRY OF EDUCATION MEDICAL INSPECTION RETURNS YEAR ENDED 318t DECEMBER, I960. TABLE I. Medical Inspection of pupils attending maintained Primary and Secondary Schools including (Special Schools). A. - PERIODIC MEDICAL INSPECTIONS. Number of Inspections 5-14 year age group 5,988 Number of other Periodic Inspections 751 Total 6,739 B. - OTHER INSPECTIONS. Number of Special Inspections 74 5 Number of Re-inspections 2.256 Total 3,001 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). 150 (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). ) Age Groups inspected (by year of birth) (1) For defective vision (excluding squint) (2) For any of the other conditions recorded in Table HA (3) Total individual pupils (4) 1955 33 202 226 1954 28 139 161 1953 9 19 28 1952 10 24 33 1951 16 14 28 1950 20 41 58 1949 251 332 550 1948 132 164 281 1947 16 18 27 1946 113 113 215 1945 and earlier 161 115 265 TOTAL 789 1,181 1,872 -i TABLE II. A. - RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1960. 151 NOTE. - All defects noted at medical inspection as requiring treatment are included in this return, whether or not this treatment was begun before the datp of the inspection. Defect Code No. Defect or Disease (1) Number of Defects Requiring Treatment Number of Defects Requiring Observation but not Treatment Periodic Inspection (2) Special Inspection (3) Periodic Inspection (4) Special Inspection (5) 4 Skin 135 - 45 1 5 Eyes — a. Vision 789 7 296 - b. Squint 64 - 11 - c. Other 30 - 10 - 6 Ears — a. Hearing 13 3 45 1 b. Otitis Media 8 - 17 - c. Other 7 - 13 - 7 Nose or Throat 139 2 368 1 8 Speech 28 8 38 - 9 Lymphatic Glands - - 60 1 10 Heart and Circulation 17 1 79 1 11 Lungs 70 3 139 - 12 Developmental — a. Hernia 5 — 13 — b. Other 23 - 87 2 13 Orthopaedic — a. Posture 323 2 45 - A. Flat foot 215 2 88 1 c. Other 170 4 103 4 14 Nervous system — a. Epilepsy 2 — 7 — b. Other 8 - 21 1 15 Psychological — a. Development 1 4 14 1 b Slability 55 7 108 2 16 Abdomen 9 — 34 — 17 Other 72 17 130 12 152 B. - CLASSIFICATION OF THE GENERAL CONTRITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS. Age Groups inspected (by year of birth) Number of Pupils Inspected No. whose condition was classified Satisfactory Unsatisfactory 1955 1,074 1,065 9 1954 691 683 8 1953 148 147 1 1952 110 106 4 1951 83 81 2 1950 195 190 5 1945 1,789 1,760 29 1948 825 806 19 1947 79 76 3 1946 889 881 8 1945 and earlier 856 852 4 TOTAL 6,739 6,647 92 TABLE III. INFESTATION WITH VERMIN. Allcas-~s 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 authorised persons 18,532 (ii) Total number of individual pupils found to be infested 68 (iii) Number of individual pupils in respect of whom cleansing notices were Issued (Section 54 (2), Education Act, 1944) 153 (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 36 By parents 32 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. 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 1 Scabies - - Impetigo 4 1 Other Skin Diseases 155 59 154 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 126 11 Errors of Refraction (including squint) - 1,900 Total 126 1,911 Number of pupils for whom spectacles were (a) Prescribed - 950 (b) Obtained - 938 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 — - (b) for adenoids and chronic tonsillitis — 485 (c) for other nose and throat conditions - 1 Received other forms of treatment 40 92 Total 40 578 GROUP 4. - ORTHOPAEDIC AND POSTURAL DEFECTS. By the Authority Otherwise (a) Number treated in clinics or out-patients departments 874 864 (b) Pupils treated at school for postural defects 99 - 155 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 105 2 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. By the Authority Otherwise (a) Miscellaneous minor ailments 213 49 (b) Other (1) Sunlight Treatment 38 — (2) Enuresis 111 3 Total 362 52 TABLE V. DENTAL INSPECTION AND TREATMENT CARRIED OUT BY THE AUTHORITY (l) Number of pupils inspected by Dental Officers:- (a) Periodic age groups 1,138 (b) Specials 2,168 Total (l) 3.306 (2) Number found to require treatment 2,716 (3) Number referred for treatment 2,716 (4) Number actually treated 2,830 (5) Attendances made by pupils for treatment 11,393 156 (6) Half-days devoted to: Inspection 8 Treatment 1.209 Total (6) 1.217 (7) Fillings: Permanent Teeth 5,201 Temporary Teeth 1,225 Total(7) 6,426 (8) Number of teeth filled: Permanent Teeth 4.471 Temporary Teeth 1,179 Total (8) 5,650 (9) Extractions: (i) Permanent Teeth:- (a) On account of Caries 479 (b) For other purposes 118 (ii) Temporary Teeth: (a) On account of Caries 1.606 (b) For other purposes 75 (10) Administration of general anaesthetics for extraction 992 (ll) Other operations: Permanent Teeth 2,777 Temporary Teeth 1.094 Total(11) 3,871 (12) Orthodontics (i) Cases corrmenced during year 219 (ii) Cases carried forward from previous year 1,396 (iii) Cases completed during year 131 (iv) Cases discontinued during year 41 (v) Pupils treated with appliances 163 157 (vi) Removable appliances fitted 221 (vii) Fixed appliances fitted - (viii) Total attendances 3,426 (ix) Number of sessions devoted to treatment 253 Number of pupils supplied with artificial dentures 36 Number of dentures fitted 37 158 SCHOOL HEALTH SERVICE STAFF AND SCHOOL C LINICS AS AT 31st DECEMBER, I960. 1. - STAFF OF THE SCHOOL HEALTH SERVICE. Divisional School Medical Officer: I. Gordon, M.D., Ch.B., M.R.C.P. (Lond. ), D.P.H. Area 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 8 2.60 (iii) General Practitioners working part-time in the School Health Service - - (b) Speech Therapists 3 2.54 (c) Physiotherapist C.P. Unit 2 2.00 (d) Occupational Therapist C.P. Unit 1 1.00 (e) School Nurses including Superintendent 22* (Combined posts, H.V. and S.N.) 8.97 (f) Nursing Assistants 6 (Clinic Nurses) 3.75 (g) (i) Senior Dental Officer 1 0.8 (ii) Dental Officers (Part-time) 4 1.27 (iii) Orthodontists — — (iv) Dental Attendants 4 3.8 * All hold Health Visitor's Certificate. 159 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 ... 5 III. - TYPE OF EXAMINATION AND/OR TREATMENT provided at the School Clinics returned in Section II. either directly by the Authority or under arrangements made with the Regional Hospital Board for examination and/or treatment to be carried out at the Clinic. Examination and/or Treatment (1) Number of School Clinics (i.e. premises) where such treatment is provided Directly by the Authority (2) Under arrangements made with R.H.B. &c. (3) A. Minor ailment and other non-specialist examination or treatment 3 B. Dental 4 - 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 J. Remedial Exercises & Physiotherapy 3 2 K. Enuresis 1 - L. Orthoptic - 1 160 IV. — CHILD GUIDANCE CENTRES. (i) Number of Child Guidance Centres provided by the Authority = 1. Staff Numbe r Aggregate in terms of the equivalent number of whole-time officers Psychiatrists 2 0. 82 Educational Psychologists 2 2 Psychiatric Social Workers 3 3 Others:- Child Psychotherapist 2 1 Clerk/Typist 3 3 The Psychiatrists are employed by arrangement with the Regional Hospital Board. 161 161 Table Showing the Average Heights and Weights of Ilford Boys and Girls Examined. Owing to a change in the Presentation of Ministry of Education Returns whereby Periodic Medical Inspections are recorded in Years of Birth, from and Including 1958, the Figures recorded below cannot be compared with the Groups in previous years. 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 BOYS 1958 - - - - - - 573 111 19.7 533 115 21.2 123 120 23.6 71 125 25.9 39 130 28.8 55 136 31.8 1097 143 36.4 630 146 37.7 48 150 41.5 30 155 46.1 635 162 52.3 1959 - - - 589 Ill 20.1 403 114 21.1 152 120 23.0 50 126 26.2 49 132 28.8 34 137 32.5 835 144 36.6 516 146 38.3 95 150 42.0 358 163 53.0 764 163 53.5 106 170 60.4 1960 550 110 19.7 340 112 20.3 81 120 23.6 73 125 25.2 46 130 28.7 92 139 32.7 878 142 36.0 438 144 38.0 45 151 43.3 452 162 53.1 226 166 55.6 123 172 62.3 97 174 64.0 GIRLS 1958 - - - - - - 552 111 19.5 461 115 20.8 118 120 23.1 32 126 25.5 31 129 28.6 41 137 30.0 1005 145 37.6 527 147 39.4 31 149 41.7 23 156 46.3 708 159 51.6 1959 — - - 691 110 19.6 438 114 20.6 200 119 22.9 42 125 25.8 38 129 30.3 24 136 32.0 980 144 37.1 504 148 39.2 59 152 43.5 374 160 52.2 791 159 51.9 95 161 56.1 1960 524 109 19.0 351 111 20.1 67 119 22.6 37 125 22.6 37 129 27.2 103 137 30.3 911 142 36.5 387 146 39.3 34 153 46.5 437 159 51.3 299 160 54.0 81 162 55.4 30 162 57.1 Age Groups Age Groups 5-6 Years 6-7 Years 7—8 Years 8-9 Years 9—10 Y ears 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 Ueight (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) Averatrc 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 (m 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) 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 6f 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 26.6 52 132 29.2 325 141 34.5 863 144 34.9 63 147 38.5 33 153 42.5 485 162 48.3 203 167 57.2 75 171 60.2 43 176 64.1 1953 649 112 20.2 925 116 20.4 82 121 23.6 34 126 26.3 36 133 23.9 194 140 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 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 782 112 19.7 373 117 21.6 91 121 23.1 44 126 26.4 46 134 29.8 438 141 34.9 821 142 37.1 100 150 41.4 57 156 48.1 525 157 50.2 149 160 53.0 128 164 54.1 23 158 54.5 1955 604 113 20.1 637 116 21.5 113 121 24.4 74 126 25.9 54 133 29.9 292 141 34.6 1052 144 36.6 73 149 40.5 34 156 48.8 359 159 50.7 180 159 52.5 68 161 54.8 19 161 54.7 1954 522 111 19.6 605 116 21.3 93 121 22.3 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 16J 56.8 9 164 57.1 1953 657 112 20.0 827 117 21.3 81 119 22.8 38 127 25.8 37 133 28.9 173 140 32.5 841 143 35.5 59 150 39.9 49 156 47.1 374 156 50.9 212 160 53.6 49 162 54.9 5 164 55.6 1952 746 112 19.9 695 115 21.0 70 121 23.3 57 125 24.6 39 132 29.1 124 139 33.5 784 143 35.7 79 148 40.5 29 155 49.8 410 158 50.5 239 156 54.9 67 160 55.0 5 159 49.0 1951 526 112 20.0 542 116 21.0 60 119 22.8 53 128 26.9 36 132 28.4 166 138 32.7 811 144 36.5 48 149 40.1 32 153 43.8 397 158 50.8 248 161 55.0 27 162 56.1