AC 44111(1) 7H/L ICF 36 Borough of llford Health Report FOR THE YEAR 1961 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 1961-62 1 Public Healtn Committee - Members - Municipal Year 1961-62 2 Ilford Health Area Sub-Committee - Representatives 2 Ilford Committee for Education - Members - Municipal Year 1961-62 3 Officers of the Public Health Services 4-6 Preface 7-8 "Looking Back" - Mr. F. J. Hocking, Chief Administrative Assistant 9-14 Reports by:- CONSULTANTS - Dr. Gurassa - Psychiatrist 128 Mr. Korvin - Orthopaedic Surgeon 117 Miss Mason - Ear, Nose and Throat Surgeon 122 Dr. Thome - Ophthalmologist 116 ASSISTANT MEDICAL OFFICERS - Dr. Gross - Benton School and Cerebral Palsy Unit 126-127 Dr. O'Connor Wilson - Remedial Exercises 120 Dr. Pooley - Enuresis and Toddlers Clinic 84,132 Dr. Taylor - Health Education 104 Mr. Daly - Chief Public Health Inspector 39,139 Mr. Haigh - Area Dental Officer 107,124 Miss Gascoyne and Miss Watt - Education Psychologists 131 Miss Oliver - Superintendent Health Visitor 77,138 Miss Copping - Welfare Officer for Old Folk 26 Mrs. Walker - Speech Therapist 123 STATISTICS & SOCIAL CONDITIONS (SECTION A.) - Physical Features 15 Population 15 Births and Deaths 15-18,21 Rainfall 16 Vital Statistics (Tables) 19,20 Page GENERAL PROVISION OF HEALTH SERVICES (SECTION B.) - Home Nursing 22 Laboratory Facilities 22 Legislation in Force 22,23 National Assistance Act 23-25 Laundry Service for the Aged Incontinent 33 Hospitals 33 Ambulance Facilities 34 Clinics and Treatment Centres 35-38 SANITARY CIRCUMSTANCES OF THE AREA (SECTION C) - Water Supply 40 Swimming Baths 42 Drainage and Sewerage 42 Rivers and Streams 42 Refuse Collection and Disposal 43 Sanitary Inspection of the Area 43 Shops Act 44 Slaughter of Animals Act 44 Rag Flock and Other Filling Materials Act 44 Clean Air Act - Smoke Control Order 45 Atmospheric Pollution 45 Land Charges 44 HOUSING (SECTION D.) - Overcrowding 46,47 Clearance Areas 46 Statistics 46-48 Housing Acts (Permitted number) 48 Housing Repairs and Rents Acts 48,49 INSPECTION AND SUPERVISION OF FOOD (SECTION E.) - Milk 50 Ice Cream 52 Meat and Other Foods - Inspection and Sampling 53,54 Hawkers 55 Food Surrendered 55 Food Poisoning 56 Bakehouses 56 Merchandise Marks Act 56 MISCELLANEOUS - Diseases of Animals (Movement Orders, etc.) 56,57,58 Prevention of Damage by Pests Act (Rodent Control) 58,59 Pet Animals Act 60 Page Petroleum (Consolidation) Act 60 Litter Act 60 Noise Nuisances 60 INFECTIOUS DISEASES (PREVALENCE AND CONTROL) (SECTION F.) - Notifiable Diseases 61-64 Table showing total notifications received, 1961 63 Tuberculosis - Notifications, Deaths, etc 64,66 V.D. Treatment Centres 66-67 Health Education 67 Examination of Officers and Servants 68 Mass Radiography 68 FACTORIES (SECTION G.) - Inspections, defects and Outwork 70,71 PART III SERVICES. NATIONAL HEALTH SERVICE ACTS, 1946-57. (RESPONSIBLE AUTHORITY - ESSEX COUNTY COUNCIL) Births 72 Infant Mortality 74 Neonatal Mortality 76 Illegitimate Births and Deaths 76 Visits by Health Visitors 79 Day Nurseries 80 Nurseries and Child Minders Regulation Act 81 Health Services Clinics 82 Infant Welfare Centres - attendances 83 Toddlers Clinic 84 Phenylpyruvic Amentia 84 Vaccination and Immunisation 88 Midwives 91 Gas and Air Analgesia 93 Maternal Mortality 95 Domestic Help Service 95 Prevention of Break-up of Families 97 Convalescent Facilities 97 Loan of Sick Room Equipment 99 Chiropody Service 100 Visits by T. B. Visitors 101 Occupational Therapy 101 T.B. Care and After Care 103 Page Medical Exams-Staff 104 Invalid Night and Day Attendant Service 96 Home Nursing 104 Health Education 104 Dental Treatment 107 Welfare Food Distribution 109 CLINICS - Ante-Natal 94 Artificial Sunlight 87 Diphtheria Immunisation 88 Ear, Nose and Throat 87 Midwives 92 Obstetric Consultant 95 Ophthalmic 87 Orthopaedic 85 Paediatric 85 Poliomyelitis Vaccination 89 Post-Natal 94 Smallpox Vaccination 90 Speech 87 Whooping Cough Immunisation 88 Tetanus Immunisation 88 SCHOOL HEALTH SERVICE (RESPONSIBLE AUTHORITY - ESSEX COUNTY COUNCIL) School Roll and Premises 1ll Medical Inspection and following up 1ll Staff 111,150 Visits 112 Infectious Diseases 112 New or Original Work 113 Benton School (Physically Handicapped) 126 Cerebral Palsy Unit 127 School Psychological Service 131 Handicapped Children 135 Mental Health Service 136 General Welfare 137 B.C.G. Vaccination 140 Medical Examination of Staff and Teachers 140 Causes of Deaths (Schoolchildren) 141 Ministry of Education - Statistical Tables 141-152 Heights and Weights Table 153,154 Page CLINICS - Artificial Sunlight 121 Child Guidance 128 Dental 124 Ear, Nose and Throat 122 Enuresis 132 Minor Ailments 114 Ophthalmic 116 Orthopaedic 117 Orthoptic 117 Physiotherapy 121 Speech 123 1 ILFORD BOROUGH COUNCIL Municipal Year 1961-62 COUNCILLOR OWEN WATERS, J.P. Mayor. COUNCILLOR L.V. DREW, Deputy Mayor. Aldermen: BARKER, JOHN, C.B.E., J.P. GOOCH, LIONEL ARCHER SCOTT. BENNETT, MRS. FLORENCE EDITH. HEADLEY, CECIL AUBREY, J.P. COLVIN, GILBERT, C.B.E., F.C.I.S. MASTERS, FRANK ROBERT. COWAN, HAROLD DOUGLAS, PEARSON, FREDERICK THOMAS. F.A.C.C.A., F.C.C.S. ROOT, HAROLD COLDSTONE, M.S.M. FALLAIZE, MRS.LILIAN, J.P.(E.C.C.) TERRY, MISS ANNE SYLVIA, J.P. GIBSON, CYRIL IRVING. Councillors: ALY, HARRY REGINALD BERTRAM. BYSOUTH, HENRY ALBERT, F.I.A.C. CARRADICE, DENNIS ANNESLEY. CHAMBERLIN, MRS. GRACE MARY (E.C.C.), CLACK, ARTHUR HENRY. COPSEY, HUGH EDMUND. DA VIES, DAVID SAMUEL. DA VIES, GEORGE EVELEIGH, J.P., B.Sc. DOYLE, THOMAS JOHN. EAREY, ERIC RAYMOND, J.P., F.V.I. FERRIER. VIVIAN WILFRED. GLEED, SYDNEY GEORGE. GROSE, JOHN STANLEY. HARRIS, EDGAR FRANK, (E.C.C.). HERRIDGE, WILLIAM HENRY, J.P., C.A. (E.C.C.). HITCHCOCK, LEONARD, A.I.B. JAMES, FRANCIS HER BERT, (E.C.C.). UTTLEJOHN, MRS. RUTH CONSTANCE, M.A. LIVERMORE, JOHN. LOVELESS, CHARLES EDGAR, F.A.I.A. LOVELESS. SYDNEY FRANK. MARTIN, ROBERT. MURPHY, JOHN LOUGHLIN, J.P., A.R.I.N.A., A.I.Mar.E. NATZLER, ISAAC BERNARD. NORWOOD, JOHN HENRY. OSBORNE, ALAN FRANK. ROLFE, CYRIL GEORGE, A.I.S.T. RYDER, JOHN LOUIS. SEAMAN, ERIC WILLIAM, A.A.C.C.A. SHAW, ARNOLD JOHN, B.A. SHERRELL, ALBERT REGINALD PRENTICE, C.A. (E.C.C.). WATSON, GEORGE HENRY. WATTS, JOSEPH CHARLES. WOODS, DOUGLAS EDWARD. 2 PUBLIC HEALTH COMMITTEE Municipal Year 1961-62 ALDERMAN MISS A.S. TERRY, J.P., Chairman. COUNCILLOR A.R.P. SHERRELL, C.A. (E.C.C.), Vice-Chairman. ALDERMAN J. BARKER, C.B.E., J.P. COUNCILLOR II.A. BYSOUTH, F.I.A.C. COUNCILLOR MRS. G.M. CHAMBERLIN, (E.C.C.). COUNCILLOR H.E. COPSEY. COUNCILLOR T.J. DOYLE. COUNCILLOR L.V. DREW, (Deputy Mayor). COUNCILLOR S.G. GLEED. COUNCILLOR L. HITCHCOCK, A.I.B. COUNCILLOR J.H. NORWOOD. COUNCILLOR A.F. OSBORNE. COUNCILLOR C.G. ROLFE, A.I.S.T. COUNCILLOR OWEN WATERS, J.P. (Mayor). COUNCILLOR G.H. WATSON. COUNCILLOR D.E. WOODS. ILFORD HEALTH AREA SUB-COMMITTEE OF TOE HEALTH COMMITTEE OF THE ESSEX COUNTY COUNCIL Municipal Year 1961-62 llford Borough Council Representatives: ALDERMEN COLVIN, MASTERS, ROOT, MISS TERRY (Chairman); COUNCILLORS MRS. CHAMBERLIN (ViceChairman), CLACK, FERRIER, GLEED, HARRIS, HITCHCOCK, MRS. LITTLEJOHN, C.E. LOVELESS, MURPHY, NORWOOD, ROLFE. Essex County Council Representatives: ALDERMAN GLENNY; COUNCILLORS BERRY, MRS. BOVILL, JAMES, SWEETLAND, MRS. WILLIS, WORTLEY. The Executive Council for Essex Representative: MRS. V.L. WILSON. Local Medical Committee Representative: (One vacancy). Hospital Management Committee Representative: ALDERMAN MRS. L. FALLAIZE. Voluntary Organisations' Representatives: MRS. G.M. BUTLER, MRS. R.E. EAST, MRS. D.M. HOLLOWAY, MRS. TAYLOR. 3 ILFORD COMMITTEE FOR EDUCATION Municipal Year 1961-62 COUNCILLOR S.F. LOVELESS, Chairman. COUNCILLOR O.F. WATERS, J.P., (Mayor) Vice-Choirman. ALDERMAN J. BARKER, C.B.E., J.P. ALDERMAN G. COLVIN, C.B.E., F.C.I.S. ALDERMAN MRS. L. FALLAIZE, J.P. (E.C.C.). ALDERMAN C.I. GIBSON. ALDERMAN F.R. MASTERS. ALDERMAN F.T. PEARSON. ALDERMAN MISS A.S. TERRY, J.P. COUNCILLOR H.R.B. ALY. COUNCILLOR D.A. CARRADICE. COUNCILLOR MRS. G.M. CHAMBERLIN, (E.C.C.). COUNCILLOR G.E. DA VIES. COUNCILLOR T.J. DOYLE. COUNCILLOR MRS. R.C. LITTLEJOHN, M.A. COUNCILLOR J. LIVERMORE. COUNCILLOR J.L. MURPHY, J.P., A.I.R.N.A., A.I.Mar.E. COUNCILLOR C.G. ROLFE, A.I.S.T. COUNCILLOR E.W. SEAMAN, A.A.C.C.A. COUNCILLOR A.J. SHAW, B.A. COUNCILLOR A.R.P. SHERRELL, C.A. (E.C.C.). Co-opted Members: MRS. D.E. CARTER (to 11.12.61.) MR. R.E. DOVER (from 19.12.61.) 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 MISS F. STEVENS. County Nominated Members: COUNTY COUNCILLOR A.F.J. CHORLEY, M.B.E. COUNTY COUNCILLOR MRS. L.E. JACKSON. 4 OFFICERS OF THE PUBLIC HEALTH SERVICES ilford Borough Council Medical Officer of Health, Divisional School Medical Officer, Area Medical Officer, llford Health Area Sub-Committee: I. GORDON, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. (Edin.). Deputy Medical Officer of Health: (Part Time) D.M.B. GROSS, M.D., Ch.B., (Leeds), M.M.S.A., D.P.H. (Lond.). Chief Public Health Inspector: S.R. DALY, LL.M., B.Sc., D.P.A. (Lond.), Barriater-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. B.F. SCOTT. T.F. JOHNSON. J.A. HARRIS. C. BROOMFIELD. Chief Administrative Assistant (I.B.C. and E.C.C.): F.J. HOCKING (to 15.11.61.). Administrative Assistant: A.E. TOURLE. Welfare Officer for Old Folk: MISS M.J. COPPING, Dip. Social Sc. (Lond.). Essex County Council A ss is tanl County Medical Officers: D.M.B. GROSS, M.D., Ch.B. (Leeds), M.M.S.A., D.P.H. (Lond.) (Part Time). F.E. O'CONNOR WILSON, B.A., M.B., B.Ch., B.A.O., D.P.H. (T.C. Dub.),L.M. (Rot.). A. COLLINS, M.B., B.Ch., B.A.O. (Cork). H.B. GRANGE, M.B., B.S. (Lond.) (Part Time). J.M. POOLEY, M.B., B.S. (Lond.), D.C.H. (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.(to Part Time from 9.10.61). 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.). Dental Officer: G.H. WILLSON, L.D.S., R.C.S. (Eng.) (from 7.5.62.). Educational Psychologists: MISS B.S. GASCOYNE, B.A. (Hons. Psych.). MISS C.H.F. WATT, B.A. (Hon.). Psychiatric Social Workers: MISS J.M. BARTON (to 31.5.62.). MISS M. BAKER (to 6.7.62.). MISS M.D. BOYD (from 29.9.61.). Speech Therapists: MRS. M. WALKER, L.C.S.T. MRS. P.A. PRETIOUS, L.C.S.T. Cerebral Palsy Unit: Physiotherapist: MISS G.L. BOWERS, M.C.S.P. Occupational Therapists: MRS. M.I. RAVEN (to 31.3.62.). MRS. P.M. LEVERSEDGE (from 7.5.62.). 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. ROWMER MRS. L.M. ELDRIDGE (to 15.4.61.) MISS M.G. DUGUID MRS. C.D. CONSTABLE MISS H. ARNOLD MISS M.M. STOWER (to 7.1.62.) MISS C. OLDHAM MISS N.L. HALL MISS P.M. LEAVETT MISS R.A. BARTON MRS. J.M. WESTON MRS. M.R. VAN ALTAAN (to 27.6.62.) MRS. J.H. GADD MRS. G. ODLING MRS. L.K. LAWRENCE (Part Time) MRS. M.K. PRESSEY MISS I. HARRIS (Part Time) MRS. M. WEIXER (Part Time) MISS I.L. MOBBS MRS. W.R. HEYWOOD (Part Time) MRS. V.I. RAY],IS (from 1.8.61.) (from 4.4.61.) MRS. D.M. RASOR (Part Time) MRS. E.T. FERGUSON (from 29.8.61.) (from 13.11.61.) MRS. J.P. WILLCOX (from 15.1.62.) Tuberculosis Visitors: MRS. K.M. PARKES MRS. M.J. MOORE. MRS. C. EARWAKER Occupational Therapist (T.R. Cases): MISS 7..E. MERCER. Matrons of Pay Nurseries: Goodmayes Lane MRS. E. DROWER. Ley Street MISS G.M. GROSS. 4 dminis trative ! ssis tants: MISS H.M. NIINN (Part III Services). E.S. JENKINS (School Health Services). Domestic Help Organisers: MRS. L.G. LAWRENCE. MRS. K.M. B1 DWELL. Chiropodists: MR. F.W. GIBSON, M.Ch.S. MISS M.I. MERCER, M.Ch.S. PART TIME:Regional Hospital Board. Surgeon in charge of Orthopaedic Clinic: H.G. KORVIN, D.M., F.R.C.S. Ophthalmologists: H.J.R. THORNE, M.B.. R.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 Eur, 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. ALTSCIIULOVA, M.D. Cerebral Palsy Unit: Consultant: H.B. LEE, F.R.C.S. Orthoptist: MISS M.E. TOWNSEND, D.B.O. (to 15.12.61.) MISS M. LEWIS (from 20.12.61.) Physiotherapist: 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.B.S. R.C. BIGMORE W.V. VICTORS, L.D.S., B.D.S. G.H. WILLSON, L.D.S., R.C.S. (Eng.) (to Whole Time from 7.5.62.) N.B. DAVIS, B.D.S. (from 17.7.61.) MISS S. STEPHENS, B.D.S. (from 31.7.61.) N.D. GLICKMAN, L.D.S. (from 25.9.61.) MISS A. PETERS, L.D.S., R.C.S. (Eng.) (from 3.4.62. to 27.6.62.) Y.J. TOOLSY, B.D.S. (from 31.5.62.) J.A. AKINOSI, B.D.S. (from 1.8.62.) Child Psycho-Therapists (Non-Medical) (Part Time): MISS L. FOLK ART, B.A. MRS. D. HANDJA 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 Telephone: PUBLIC HEALTH OFFICES, VALentine 3401 ILFORD. July, 1962. Mr. MAYOR, LADIES and GENTLEMEN, I submit herewith the Annual Report of the Health Services for the year 1961. With an Infant Mortality Rate of 15.79 and adjusted Death Rate of 11.5, and other indices remaining much as before, it is my pleasure to report that the health of the borough is being well maintained. Mr. Hocking, Chief Clerk of the Department, retired in November 1961, after practically 30 years in that post. His departure is much regretted. He was the last remaining official link on the administrative side between the borough and county staffs. I asked Mr. Hocking to write a review of the changes he had seen in these 30 years; this review follows and is the reason why my preface this year must be brief. I must, however, mention one novelty in local government introduced this year, the Ten Year Development Plan. The pleasure in looking ten years ahead is somewhat dimmed by the knowledge that in three years, with the Re-organisation of Local Government in Greater London, the basis of the plan will be completely altered. DOCTOR OR DISTRICT A problem of immediate importance in the work of the health visitor (HV) is whether she is to be attached to a geographical district (as at present) or to the practice of a doctor (as some doctors would insist, and the Ministry of Health recommend). The former practice many would consider "out of date" and the latter "modern and progressive'. 'Even at the risk of being considered backward, I feel it essential that the logistics of the position must be fairly presented. 8 In IIford approximately 20 HVs must work with 70 GPs; this in itself makes any exclusive arrangement at present impossible. But there is a further problem resulting from free choice of doctor (and free choice of patient). With the help of the Executive Council for Essex an investigation has been made in a street adjacent to the surgery of a local doctor who is most anxious to have his own HV. In that street are the patients of 13GPs (three of whom have their practices centred outside the borough). Thus in that street 13 HVs (half of our staff) will be practising and often more than one (and maybe strangers to each other) serving the same household. Each individual HV will have clients in each ward of the town, and some in adjacent boroughs. Files and records will be in confusion. This cross-movement chaos adds to the harmful effect such a practice would have on the fundamental basis of the HV's professional activities. She is no longer purely a medical auxiliary whose work is confined to helping a specified physician, but a social worker as well, whose client may not even be consulting a doctor. She is interested in the client's family, relations, house, street, school, club, neighbourhood, clinic, friends, neighbours, place of work, park, pub, and indeed everything that goes by the name "local" and the smaller the area she has to cover the better will be her local knowledge. I am not suggesting she should not co-operate with the family doctor. This co-operation should be as close as possible, but each GP should co-operate with more than one HV, who cannot be exclusive to one practice. I am aware that exclusive allotment of HVs to GP practices works in certain areas. I feel sure that this is only because in most cases the practice concerned is the main one in the area,orthe GP is the only one amongst many colleagues who really appreciates and uses the HV's services. Exclusive allotment of HVs to GP practices, if generally carried out, will only lead to confusion and a decline in the quality of the social work that the HV is able to do. I must once again acknowledge the help given to me by my staff and fellow Chief Officers. The support of the members of the Council, Chairmen, Vice-Chairmen, and members of the Ilford Borough and Essex County Committees with which the department is concerned has been most encouraging. Finally, again I wish to thank the numerous helpers in a number of voluntary societies for their continued and essential help. I have the honour to be Your obedient Servant, I. GORDON, Medical Officer of Health. Postscript (from a letter received in the Public Health Department):- "I am writing to ask yon, if you have any vacancies, in the "Valentines Mansions**, as I have heard how very nice it is there for elderly people, and I am wanting to find some-where for my mother-in-Jaw." *The Public Health Department. 9 LOOKING BACK On taking up my duties in Ilford in April 1932, Dr. Burton was the Medical Officer of Health, a Chief Officer with a definite plan of action which defied much opposition, especially in the mid 1930s, when the extensions to the Maternity Home and Isolation Hospital were hotly debated in Committees and Council, but Dr. Burton, with the unflinching support of his Chairmen and Committee Members won through and the subsequent new buildings at both Institutions remain a tribute to his and their progressive outlook. Dr. Burton was one of the pioneers in the campaign for Diphtheria Immunisation, and was prepared to contest the issue with Anti-Vivisectionist speakers in Hyde Park. He was a Barrister-at-law, and I recall many sessions with him poring over legal books etc., e.g. on the Public Health Acts, or the examination of the provisions of the Ilford Corporation Act of 1937; in the latter case a great effort being made to enlarge and strengthen the existing Sanitary Provisions. During the period 1932-1945 the emphasis of the department's work was on the control of infectious diseases, food sampling, overcrowding surveys, the extensions already referred to, building of the Mayesbrook Clinic, and the introduction of the four war-time day nurseries. During the war years the department's work was greatly disrupted, much time, perforce, being devoted to the inception and maintenance of the First Aid Posts, evacuation of expectant mothers and many other unusual tasks, made more difficult by staff shortages and the bombing. Dr. Burton was, unfortunately, for some years much troubled with his health, and his retirement on medical grounds in September 1945 was greatly regretted by all. Following Dr. Burton's resignation, Dr. Weir, the deputy, took up the reins of M.O.H., and was faced with the task of re-assembling all the Health Services from the effects of the war, which he set about with great enthusiasm. Hereabouts the provisions of the Education Act 1944 took effect, and the Borough School Medical Officer became Divisional School Medical Officer after lengthy discussions at Committee level over the Delegated Powers. Worse was to follow, consequent on the National Health Service Act 1946, operative on 5th July 1948, from which date the North East Metropolitan Regional Hospital Board took over both the Isolation Hospital and the Maternity Home, and the Maternity and Child Welfare services came under the jurisdiction of the Essex County Council, the new Local Health Authority. The loss of the control of the two Institutions 10 and the unfettered administration of the M. & C.W. Services was much regretted, but here, maybe, is not the place to record any disadvantages arising from the transfer of these Services. It can be said that multitudes of letters, returns and discussions accompanied the transfer. In the case of the Isolation Hospital and Maternity Home, the department faded out, though for some months after July 1948 we carried on most of the day to day administration of these Institutions on an agency basis. As regards the former M. & C.W. Services, now to be known as Personal Health Services under Part III of the National Health Service Act - we remained in close association, in fact for 2-3 years they were much as before and the several new services which followed were spurred on by the Act. For this new set up Dr. Weir became Area Medical Officer, general policy being the responsibility of the County Medical Officer of Health at Chelmsford. Dr. Weir resigned in February 1950 to take up the appointment of M.O.H. with the Royal Borough of Kensington and the Metropolitan Borough of Chelsea, a departure much regretted by the staff and his many friends. In reflecting on the many changes which have occurred in the field of environmental health over the 29½ years, one is struck by the control of a number of the infectious diseases, e.g., smallpox, typhoid and diphtheria, with tuberculosis on the point of control, but other problems arose with the increasing incidence of poliomyelitis and food poisoning, both calling for close investigation, and occasional field surveys. The new Food and Drugs Act and Regulations thereunder have made for many improvements in the control of foodshops, cafes etc. and in the inspection and sampling of food, milk and ice cream, not forgetting the lectures, with film strips, on food hygiene, given by the Public Health Inspectors to food handlers. The Clean Air Act 1956 and the making of smokeless zones was a new and necessary feature, as also the Housing Act 1957 (attack on slum clearance, still probably the most predominant factor and a link with care and welfare of the aged), and the Litter Act 1958. Another problem was radiation hazards. The welfare of the old folk — a national problem — demanded attention and, while this was, by statute, an Essex County Council function, a lady welfare officer was appointed by the Borough Council and commenced duty in April 1952, and her duties have yearly increased in scope and value. Together, they indicate important steps forward in environmental health and show the everwidening functions of the department's work in this field. Public Relations — generally associated with relations between the Local Authority and the public (the ratepayers) has, since the war, 11 received much attention. For some 6 years each newly elected Councillor to the Borough Council, has been sent a synopsis of all the department's activities with an invitation to visit, raise any points desired and be introduced to the actual methods employed in the Sections (I.B.C. and E.C.C.). This has been well received. A rather unique feature in this field was the holding in 1958 of a public opinion poll on a small scale, approximately 500 questionnaires being distributed to members of the public in receipt of our services, asking for complaints and suggestions. The results were very satisfactory and reassuring and were published in a medical journal. Earlier in the year a 3-day Seminar on Public Relations, organised by the Central Council for Health Education, was held at the Public Health Offices, at which all branches of the health services attended and where we critically examined our procedures before experts. Health Education functions have grown considerably and continue to do so. In the 1930s a few pamphlets were issued, e.g. summer diarrhoea, fly pests, diphtheria immunisation. Now the many leaflets and posters embrace numerous aspects of health — from the expectant mother to old folk - including sex education, smoking and lung cancer, and home accidents. All this is supplemented by lectures (often with films) by the medical and nursing staff, public health inspectors, welfare officer for old folk, and domestic help organisers. That one of the Assistant County Medical Officers devotes a portion of his time to health education indicates the importance of this subject in the present day health services. In 1955 the department organised a Health and Home Safety Exhibition at a business premises in the town, depicting actual treatment sessions, food hygiene, with lectures on health topics. I wish the hard work involved were rewarded by bigger attendances of the public. The post-war years witnessed the inception of several new Clinics — the Paediatric, Child Guidance, Speech, Enuresis, Orthoptic and Chiropody — also the opening of the Manford Way (1951), Kenwood Gardens and Heathcote Avenue (1960) Health Services Clinics, which enabled several of these clinics, as also the Ante-Natal, Ear Nose & Throat, Dental, Orthopaedic, Poliomyelitis Vaccination, Ophthalmic, and Diphtheria Immunisation Clinics to be held at them, as demand occasioned, with modern facilities for staff and patients. Other growth features in the Personal Health Services were: (i) Domestic Help Service, inaugurated in 1946, with a part-time Organiser and 15 helps; to-day there are two full-time Organisers, two clerical 12 assistants and 150 helps, giving assistance to 1,900 cases (approximately) a year; (ii) Convalescent Facilities for mothers and infants, over 70 cases being sent away in 1960; (iii) Loan of Sick Hoom Equipment - 5 articles loaned in 1949, increasing to 1147 in 1960; (iv) Vaccination against Poliomyelitis — at the end of 1960, a total of 49,399 primary courses had been completed; (v) Whooping Cough Immunisation; (vi) Night Attendant Service; (vii) Infant Welfare Centres, many now held at premises with much improved and modern facilities; (viii) Distribution of National Welfare Foods (taken over from the Ministry of Food in 1954); (ix) The ever-widening scope of the work of the Health Visitors, who have now entered the field of the General Social Worker; (x) District Midwifery Service — in 1932 there was one district midwife employed by the Ilford Council; she cycled the area to attend her cases (there were also private midwives in the Town): the Midwives Act of 1936 introduced a salaried municipal district midwifery service and from that date the service greatly expanded: at present there is a non-medical supervisor, 9 full-time and 2 part-time midwives; all the midwives are qualified to administer gas and air analgesia and their labours have been rightly eased by five being allocated County cars and four granted an allowance to use their own cars on official duties; Midwives' Ante-Natal Clinics are now an important feature, being regularly held at five Clinic premises. The infant mortality rate (deaths per 1,000 live births) is often quoted as an index to the health of the district, and Ilford's figures deserve recognition. In 1932 the rate was 39.8 (79 deaths under 1); in 1960, 17.5 ( 44 deaths) — both considerably under the national average. Since the introduction of the National Health Service Act a feature has been the sociological side of the work, reflected in the emphasis now attached to the individual, as distinct from the community, in respect of the Personal Health Services. The School Medical Services can also point to increasing services. In 1932, there was a school population of 18,187; in 1960 it was 23,383 and, in addition, the Service is now responsible for the medical supervision of the two Boarding Schools in Surrey and Oxfordshire. The Child Guidance Clinic staff and treatment sessions have increased and reference has already been made to the several new Clinics (Specialist and Other) which serve both the school and pre-school child (an economic arrangement for all staff). One interesting and important experiment was the provision in 1950 of a small class for spastic children at the Benton School for the Handicapped. Its success was such that a separate Cerebral Palsy Unit was 13 provided at the former Becontree Day Nursery in 1955, and its inception may be attributed largely to the industry and enthusiasm of Dr. Gordon and Dr. Gross, and the Unit was one of the few then under the control of a Local Education Authority. Another step forward — plans have been approved for the building of a new school for the physically handicapped. This will be one of the most advanced in the country, incorporating the Cerebral Palsy Unit, with a small pool for hydrotherapy, and a nursery class for earlier diagnosis. B.C.G. Vaccination against tuberculosis commenced in 1950, at the outset for children of 13 years of age attending secondary modern schools, in 1960 extended to include all pupils over 13 and students at Universities and Teaching Colleges, and in 1961 further extended to children of 10 years of age and upwards, in the latter cases at the discretion of the Divisional School Medical Officer. Over the years attention is drawn to the decline in the incidence of ringworm and uncleanliness of head and body in school children. In the pre-war days many school children were found with defective footwear; this is now, fortunately, almost unknown, but the trend in modern styles of children's footwear has caused comment and a Foot Survey in 1960 of IIford school children in the age groups 9-11, carried out by an Assistant Medical Officer, suggests that the ability readily to buy shoes has brought a new hazard in footwear. Strides have been made in the past few years in the ascertainment and placing of handicapped children, particularly in the immediate past years with partially deaf and educationally subnormal children, but the shortage of vacancies in special schools persists, but not to the same extent as pre-war. Facilities for operations for tonsils and adenoids have much advanced, the waiting list is very short and the operations performed at a local hospital by the Specialist attending our Ear Nose and Throat Clinic. On reviewing the Ophthalmic Clinic workings, a somewhat large number of children are still prescribed spectacles; one might expect that the overall improvement in community health would reduce the incidence of defective vision. Could it be another case of improved standards of ascertainment, and does T.V. viewing have any effect? The inception of the Orthoptic Clinic enables children to have treatment for squint etc. quickly and locally. A visit to the four Health Services Clinics makes one aware of the modern appliances, fittings, etc. especially in the Orthopaedic and Dental 14 Clinics; the latter clinics are provided with x-ray facilities which obviate delay to the dental officers and travelling for the patients. I recall the small room and the chair, used for anaesthetic sessions, at Valentines Mansion, in the 1930s. The provision at these four Clinics (also at Newbury Hall) of office accommodation for the Health Visitors, serving the adjacent areas, has saved much travel time and enabled many records to be readily available to the Health Visitors. Sessions of most of the Specialist and Other Clinics are now held at the four Health Services Clinics, thus enabling the facilities to be reasonably convenient to most users; we have followed the modern trend of reaching out to the people. Much has been written in the press as to the need for full co-operation in all branches of the National Health Services. Few M.O.Hs. have striven more sincerely than Dr. Gordon to achieve this. I wish he had had more satisfying results, but I know he will go on with his efforts. It is my firm opinion that the health services administered in the Borough are modern, efficiently run, and I believe the majority of those who use the services would agree (the public opinion poll held in 1958 supports this view). Public Health is, and must be, a developing subject with new facets. As the demand for services alters, so do the services. Loyalty to, and enthusiasm for, their duties has been the creed of the administrative and clerical staff with whom I have been fortunate to serve. An important contrast to the numerous changes in the personnel and buildings — I have occupied the same room in the Georgian splendour of Valentines Mansion throughout my 29½ years. I leave a united and happy team, obsessed with one ideal, the furtherance of the health services for the benefit of all residents and their continuing progress will be a delight to me — I shall never lose touch. F.J. HOCKING, Chief Administrative Assistant. Public Health Offices, ILFORD. November, 1961. 15 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. (Land and Inland ) Area (in Acres) ( Water 8,404 ) 8.411 (Tidal Water ... 7 ) Population (Census 1921) 85,194 „ (Census 1931) 131,061 „ (Census 1951) 184,706 Registrar-General's Estimate of resident Population:- June 30th 1958 179,000 „ 1959 178,600 „ 1960 178,520 „ 1961 177.760 Number of inhabited houses (April 1st, 1961) according to Rate Books (approx,) 52,808 Rateable Value — April 1st, 1961 (Houses and Land) £3,100,813 Sum represented by a penny rate, April 1st, 1961 (approx.) £12,780 1960-61 1961-62 Combined Rate (all services) 21s.4d. 23s.0d. in the £ in the £ The following figures as to unemployment were supplied by the Ministry of Labour:- Males Females As at December, 1960 464 74 As at December, 1961 411 69 1961 1960 Live Births 2,533 2,512 Live Birth rate per 1,000 population — Crude rate 14.25 14.07 — Adjusted rate 14.25 14.07 Illegitimate Live Births per cent of total live births 3.79 3.78 Stillbirths 40 37 Stillbirth rate per 1,000 total live and stillbirths 15.55 14.52 Total Live and Stillbirths 2,573 2,549 Infant deaths (under 1 year) 40 44 Total infant deaths per 1,000 total live births 15.79 17.51 Legitimate „ „ „ legitimate 15.18 18.20 Illegitimate „ „ „ illegitimate„ 31.25 0.00 Neo-natal mortality rate per 1,000 live births (first four weeks) 12.24 15.13 Early Neo-natal mortality rate per 1,000 total live births (under one week) 10.66 13.14 Perinatal mortality rate (stillbirths and deaths under on combined per 1,000 total live and stillbirths) 26.04 27.46 Maternal deaths (including abortion) 1 1 Maternal mortality rate per 1,000 live and stillbirths 0.39 0.39 Deaths (all causes) 2.065 1,970 Death rate per 1,000 population — Crude rate 11.62 11.04 — Adjusted rate 11.50 11.26 Percentage of total deaths occurring in public institutions 52.95 48.08 Deaths from Cancer (all ages) 401 400 " Measles (all ages) 1 Nil Whooping Cough (all ages) Nil Nil * Diarrhoea (under 2 years of age) Nil 2 16 1. RAINFALL Total rainfall registered in the district during the year was 23.51 inches; the greatest fall in 24 hours was registered on 4th May, 1.17 of an inch; whilst the longest duration occurred on 19th November, 16.4 hours. December 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 and0.99 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 2,533. Males Females Legitimate 1,280 1,157 Illegitimate 45 51 i.e., 3.8 per cent of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was 3.8 (1960), 3.7, 3.3, 2.7, 2.8, 2.6, 2.2, 3.0, 3.9, 2.9. The adjusted birth rate, calculated on the estimated population of 177,760 is 14.25 per 1,000. 17 4. DEATHS The total number of deaths of llford residents was 2,065. This is obtained by taking the total number of deaths registered in the district (1,660), subtracting the deaths of non-residents, occurring in the district (225), and adding the deaths of llford residents registered as having died in other districts (630). The number of deaths of non-residents registered in the district was as follows:- King George Hospital 70 Chadwell Heath Hospital 40 Claybury Hospital 52 Goodmayes Hospital 28 Other Non-residents 35 Total 225 The number of deaths of llford residents registered as having died in other districts during the year was as follows, and includes deaths at the following Institutions:- Oldchurch Hospital, Romford 59 Wanstead Hospital 42 Langthome Hospital 23 London Hospital and Brentwood Annexe 90 St. Bartholomew's Hospital 17 Bush Green Hospital 12 St. Joseph's Hospice, Hackney 15 East Ham Memorial Hospital 18 St. George's, Hornchurch 93 Dagenham Hospital 15 Barking Hospital 14 Whipps Cross Hospital 45 Plaistow Hospital 11 In other Hospitals, Institutions and residences outside the llford district 176 Total 630 The adjusted death rate, calculated on the estimated population of 177,760 is 11.50 per 1,000. 18 Inquests. - During the year, 76 inquests were held on deaths occurring in Ilford, 61 on llford residents, and 15 on non-residents. The ages at death were as follows:- Under 1-2 3-5 6-15 16-25 26-45 46-65 66 years and 1 year years years years years years years upwards 1 7 17 22 29 DEATH RATES FROM CANCER, 1961. The following Table shows the death-rates for 1961 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 .591 .494 Cancer, other forms 1.665 1.670 5. TABLES OF VITAL STATISTICS. - Table I gives a comparative statement of the birth-rate and death-rate for the past five years. Table IA gives a comparison of the vital statistics of Ilford with England and Wales, and the London Administrative County. Table II gives a classified statement of the causes of death in 1961, arranged according to the age groups at which deaths occurred. 19 TABLE I.- VITAL STATISTICS OF WHOLE DISTRICT DURING 1901 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 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 (c) 1,564 8.8 232 638 44 17.5 1,970 11.04 (c) 1961 177,760 1,928 2,533 14.25 (c) 1,660 9.3 225 630 40 15.8 2,065 11.62 (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. 20 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 1961. 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 17.4 19.1 12.0 21.6 .58 .22 153.8 1.27 649 London Admin. County 18.7 18.3 11.9 21.5 — 1.25 77.4 .31 763 ILFORD (Estimated Population mid-1961 - 177,760) 14.25 15.5 11.50 15.8 - - 1071 - 7882 A dash (—) signifies that there were no deaths. 119 deaths. 2140 deaths. 21 Registrar-General's Short List of Deaths and Causes TABLE II. Causes of, and Ages at, Death during the year 1961. 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 2,065 40 3 8 18 72 485 572 867 1 Tuberculosis, respiratory 12 - - - - 1 7 4 - 2 Tuberculosis, other 1 - - - 1 — - - — 3 Syphilitic disease 3 - - - - 1 2 - — 4 Diphtheria - - - - - - - - - 5 Whooping cough - - - - - - - - - 6 Meningococcal infections - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - 8 Measles 1 - 1 — — — — — — 9 Other infective and parasitic diseases 5 - - - - 1 2 1 1 10 Malignant neoplasm, stomach 43 - - - - - 15 15 13 11 Malignant neoplasm, lung, bronchus 105 - - - - 5 51 38 11 12 Malignant neoplasm, breast 46 - - - - 3 25 12 6 13 Malignant neoplasm, uterus 14 - - - - 1 6 4 3 14 Other malignant and lymphatic neoplasms 193 - - 3 3 9 59 58 61 15 Leukaemia, aleukaemia 5 — - 1 — 1 2 1 — 16 Diabetes 16 - - - - - 1 4 11 17 Vascular lesions of nervous system 279 — - — - 3 35 82 159 18 Coronary disease, angina 353 - - — - 5 128 120 100 10 Hypertension with heart disease 51 - - - - - 6 20 25 20 Other heart disease 231 - - — - 5 28 40 158 21 Other circulatory disease 105 - — — - 2 18 26 59 22 Influenza 19 - 1 - - 2 2 5 9 23 Pneumonia 140 5 - - - 2 12 32 89 24 Bronchitis 112 - - - 1 1 16 49 45 25 Other diseases of respiratory system 20 - - - - - 4 5 11 26 Ulcer of stomach and duodenum 15 - - - - - 3 7 5 27 Gastritis, enteritis and diarrhoea 6 - - - - - 1 4 1 28 Nephritis and nephrosis 16 - - - 1 2 5 2 6 29 Hyperplasia of prostate 10 - - - - - - 3 7 30 Pregnancy, childbirth, abortion 1 — — - - 1 — — — 31 Congenital malformations 22 13 — 1 1 4 2 - 1 32 Other defined and ill-defined diseases 157 22 - 2 1 6 34 28 64 33 Motor vehicle accidents 17 - 1 1 5 1 4 - 5 34 All other accidents 33 - - - 2 4 5 7 15 35 Suicide 32 - - - 3 10 12 5 2 36 Homicide and operations of war 2 - - - - 2 - - - Special Causes (included above) Smallpox - - - - - - - - - 22 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 1961 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, llford Act, 1937.) Slaughterhouses and humane slaughtering of animals. Pleasure Fairs. (Sec. 59, Essex C.C. Act, 1952.) Tipping of Dust, Spoil, and Refuse. (Sec. 85, llford 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, llford Improvement Act, 1898.) Nuisances in connection with the removal of offensive or noxious matter. Depositing of Rubbish, etc. (Sec. 249, Local Government Act, 1933.) 23 Establishments for Massage and Special Treatment. (Essex C.C. Act, 1933, Part IV.) Inspections of licensed establishments are carried out quarterly. During 1961, two new applications and 28 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 1961, 74 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. (v) There are three local Acts in operation— (1) The Uford Improvement Act, 1898, which has important sanitary provisions; (2) The Ilford Urban District Council Act, 1904, the Section which deals with the control of tuberculosis is repealed, the powers of the Corporation now being contained in the Food and Drugs Act, 1955, and (3) The Ilford Corporation Act, 1937. (vi) ESSEX COUNTY COUNCIL ACT, 1952. - This Act came into operation in 1953. Reference is made in this Report in appropriate sections as to action taken under the Act. (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 1961. (viii) NATIONAL ASSISTANCE ACT, 1948.- The County Welfare Officer has kindly supplied me with the following information. 24 "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 underthe National Assistance Act, 1948, have been afforded to persons residing within the Borough of Ilford during the year 1961:- (1) Residential and Temporary Accommodation (a) Number of Ilford residents provided with residential accommodation at 31.12.61:- 261. (b) Aged persons admitted to hostels and other residential establishments:- 77. (c) Other persons admitted to residential accommodation:- Nil. (d) Persons admitted to temporary accommodation:- Adults 9; Children 28 =37. 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 Rorough 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, 1961, were as follows:- (i) Registered as blind 263 (ii) Partially sighted 72 (iii) Defective sighted 20 all of whom were under the supervision of the County Council s Home Teachers. During the year 6 blind residents participated in the 25 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, 32 blind and 10 partially sighted persons were employed in open industry. During 1061, 2 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 field of welfare services, many of these bodies acting as the Council's agents in this connection. 323 handicapped persons in the Borough of 11 ford have registered with the Welfare Department. They are visited by officers appointed to assist them with handicrafts and individual needs. Many of them attend the Occupational Centres for the handicapped at Barking and IIford, the latter being opened in mid-1961." In I]ford the scheme for other handicapped persons, so far as voluntary action is concerned, has been delegated to a Sub-Committee of the IIford Social Service Association of which the Medical Officer of Health is Chairman. NATIONAL ASSISTANCE ACT, 1948. (a) Section 47 provides for the removal of persons to hospital who are unable to devote to themselves proper care and attention. Two persons were dealt with during the year. They were females aged 72 and 87 years, respectively. (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 five persons were dealt with during the year:a male, aged 77, who died at King George Hospital; a male, aged 84, 26 who died at home; a male, aged 21, found dead at Open Air Swimming Pool; a female, aged 59, who died on arrival at King George Hospital; and a male, aged 54, who died at home. Miss M.J. Copping, Welfare Officer for Old Folk, reports as follows:- "During the year 1961 I made 702 visits to the homes of elderly persons or their relatives. Visits to the relatives occasionally entailed a journey to another area and usually took place during evening hours. Most of these visits to relatives were made at the request of the relatives themselves, and such requests are always welcomed by me, as almost invariably they are an indication of a genuine interest in the old person's welfare and of family solidarity. Those relatives who have no inclination to fulfil their responsibilities, or who are trying to dodge them, do not ask to be visited. I also interviewed 308 persons either at the Public Health Offices, or elsewhere to suit the convenience of the persons concerned. For instance I saw a few in public restaurants where we talked while we had a cup of tea together. Others I met in the house of a neighbour who kindly offered the use of a room for an hour to make privacy possible for an old person unable to travel to the Public Health Offices, and without privacy in their own accommodation. Among these, were elderly tenants of rooms in owner occupied houses, whose relationships with their landlords were strained or even openly hostile. Others were living in disharmony with offspring or other relatives and wanted to keep the interview secret. A few were living with a senile partner, and consequently could not have an uninterrupted conversation in their own home. In many of the cases where strained relationships were the primary problem the cause could readily be detected, but some were very complex cases and several visits were necessary before any clear picture of the situation could be formed. I try to persuade my clients to allow me to meet any other persons involved. There is much danger in hearing only one side of the story or in accepting the story of outsiders. I find that the public are predisposed to sympathise with every old person, but I am sorry to say that old age is not invariably the period of sweet reasonableness and endearing mellowness, that the uninitiated are inclined to suppose it to be, 27 and when some indignant onlooker tells me that dear old Mrs. Blank is abominably treated by her family or landlady I am sceptical. On the other hand I have found instances where after painstaking probing, and extreme care upon my own part to be sure that my judgment was unbiased I have been forced to admit that deliberate unkindness was being meted out to an old person in the hope that he would find the situation so unbearable that he would seek accommodation elsewhere or consent to enter welfare accommodation against his inclinations. The cause for these cases is usually bitter resentment by younger persons at having to care for, or share a house with, someone who by reason of physical disabilities, or mental frailty, has become a tie or has developed repulsive or annoying habits etc., or at the worst is dependent, even if sweetly so. I have great sympathy with the younger married woman who would like to seek employment outside the home to supplement the family income, or to broaden and enrich her own life, but who cannot do so because of an old person who cannot be left alone; and with the young mother who would like to take more outings and holidays with her children, or just be free to play with them and enjoy the various stages of their development, but who has to divide her lime between them and a grandparent, who perhaps gives unwelcome advice about their upbringing, or who demands more personal attention than any infant requires. Sympathy however is not enough, it must be translated into practical help, but so often the family want to dictate the form that such help should take. Nothing but permanent removal of the old person to the care of the state in state provided accommodation of some type will satisfy some of them. This is sometimes the right and only step to take and my experience is that where this is so, the step is usually suggested by the G.P. without the relatives having to actively press for it, although not always without a considerable delay, due to waiting lists. What I would like to stress here is that we cannot be expected to know that there is a problem unless someone brings it to our notice. Many families complain bitterly to me that no one cares about the old. Conversation with them reveals that they have suffered some problem in complete silence, expecting some official person to come searching it out. This is quite impractical. There are 25,000 or more elderly persons in Ilford any of whom may have, or be the cause of, problems of varying degrees. 28 Much of the resentment and friction which occurs in families where there is an old person is unnecessary. The primary complaint made to me is that the family cannot go out together and leave the old person. My experience is that there are very few old persons who cannot be left alone for a half day, or an evening while the family have some recreation. What few there are could have the occasional services of an official day attendant, of a volunteer from a church, or of a friendly neighbour. I have met with refusals from offspring to accept offers of such help. These same offspring may have been most bitter in their complaints about being tied to the house. A common reason for the reluctance to accept help, is a false sense of guilt about leaving the aged parent, or a false idea that should an accident occur during their absence, some official will censure them for being away from the house. Over protection of old persons often leads to a state of complete dependence and a genuine need to have someone at hand at every moment. I am frequently told "I do not let mother go out now as she might be run over", "I have told father that he will catch pneumonia if he goes out to his club in this weather*. The habit of going out is broken, the incentive lost, once housebound there is a great temptation to the old person to become bedridden too. How much wiser it would be to advise the old people always to use a pedestrian crossing, and to cross with younger persons when possible, to see that they have a hot, nourishing meal and wear a warm vest before going out in wintry weather, and then let them go their way, thankful that they still have the strength and desire to get out and about. Houseproudness is another frequent cause for the rejection of the assistance which would bring opportunities for relaxation, or allow a younger person to go out to business. Housewives who keep mother and father confined to a bedroom or to a chair rather than do away with the slip mats, or roll up the carpets which are a danger to shuffling feet are many. So are those who refuse to have a commode in the house or a bed on the ground floor because it would spoil the look of the room or disorganise existing routine. Mealson-Wheels have often been refused by relatives who have said "I do not want a stranger to enter my house while I am out. They might spill some food or have muddy shoes". I am sorry to say that in a few homes the goods and chattels are valued above the comfort and well being of some or all of the human beings who make up the family. I try to remember that this may well be a manifestation of an anxiety neurosis built up by the strain of having to care for an old person. An excuse which I deplore is "what will the neighbours think if they see meals being delivered?" This fear of losing face 29 sometimes leads to an old person having to make do at midday with a stale sandwich and with tea put into a flask at breakfast time. If the person is well cared for and the relative's conscience clear does it matter one iota what any outsider thinks9 If the relative is not happy about the care he orshe is able to give but cannot improve upon it, then what neighbours think is of importance only if the said neighbours are willing to give practical help, orcan give advice about obtaining practical help from some other source. Many old people owe a great deal to neighbours who shop, cook, clean for, and comfort them both in times of sickness and in some instances, on a long term basis. I often marvel at what is done. There is a legend that in the British Isles true neighbourliness is found only in the Midlands and North. I say that the Southerner, admittedly more reserved in the main, is equally neighbourly in adversity, and if there are any delays or gaps in the official services I find that as long as the old person will permit it, neighbours willingly make good the deficiencies. My advice to persons who have an ageing relative or friend living with them is this. If you wish to avoid a problem do all in your power in an unobtrusive way to encourage the ageing to remain independent. Never succumb to the temptation to wait upon them in such matters as washing and dressing them because you can do it for them much more quickly. If you do the old person will lose his skills and be unable to help himself when you are unwell yourself, or wanting to leave him alone; or he may so enjoy being pampered, and become so accustomed to having you with him that he will deliberately put on an act of helplessness and refuse to accept attention from any substitute person. Forget your fears about whether he may be ran over, catch cold, fall downstairs or burn himself. In the same way that you let your young children find their wings by taking reasonable risks, so you must let your old folk retain their freedom by doing the same. Clipped wings will mean extra responsibilities for you, and a miserable aimless existence for them. Also, if the old person wishes to help with household tasks accept the offer. The result may not be as you would wish it, but most old people like to feel that they are being useful. I wince when a daughter says to me "I do everything myself, there is no need for mother to lift a finger". This sort of remark is most often made in a precisely neat clinically clean house, and I find more depressed withdrawn, apathetic old persons in such houses, than I do in homes which look a little the worse for wear and tear, and rather untidy. 30 A total of 906 cases were dealt with; 325 of which concerned persons not previously known either to myself or to the Health Visitors. The number of persons interviewed was 308, approximately half of which were old persons, and the remainder either relatives or friends of old persons. Visits to persons discharged from Hospital, principally from Chadwell Heath, numbered 100. A proportion were already known to me prior to admission and had been visited by me during the period immediately before admission. Some had to wait two or three weeks for a bed and these were helped by arranging domiciliary services, loan of sick room equipment and in some cases the special laundry service. It is not unusual for the relatives of persons waiting for beds to telephone or call at the office dailyoutof a false idea that we can do more to hasten admission. In fact a great deal of valuable time is expended in telling the same persons the same thing over and over again. Seventy three cases were referred to me because the family were having difficulty in coping. Among these were a number where the daughter or daughter-in-law caring for the old person was elderly herself and not very fit physically. In one instance a niece aged 78 years and her husband 80 years were caring for an old lady of 96 years. These were wonderfully fit but were feeling the strain. The old lady was admitted to Hospital while they had a holiday by the sea, and she has since been admitted to Part 3 accommodation. Forty-two of the old persons seen by me were referred to the Essex County Council Welfare Department for investigation with a view to being placed on the waiting list for Part 3 accommodation. Of these about 20 asked me to help them to apply. A further 12 were persons who had been patients in the Geriatric Unit, and been advised by Dr. Dunn not to continue to live alone. Some of these would have preferred to have gone to live with offspring, but offspring either had insufficient accommodation or did not want such an arrangement. While it is hard for the old person to bear deliberate rejection by his family it is I am sure harder still to have to live in a household where one is not really wanted. Some sons and daughters who say quite frankly that they have no affection for their parents and who do nothing at all for them will take them into their homes if they decided to make application for admission to state-provided accommodation. This is because of what neighbours or family friends may say if the old person is allowed to enter a Hostel or Institution. This can be disastrous for the old person, especially for one who is not able to get out to make contact with other people. It may mean that he is spending all his time with persons who resent his presence. 31 About 10 persons were advised by me to apply because they were living in rather squalid conditions and not keeping themselves clean. Among these were some who had lost heart following the death of husband or wife and some who were senile. Forty-eight families appealed to me because they wanted a holiday away from home, but must first arrange care for an old person. Or they wished the old person to have a holiday but could not afford to pay for him. Holiday accommodation by the sea was found for several persons and some were assisted financially from the Mayor's Fund. Some of the 48 were admitted to Private Guest Homes for the elderly, some of which very graciously consented to reduce their fees to make it possible. The balance was paid by the old persons themselves or their relatives. I often feel that relatives could help much more with these payments. Many families tell me that they cannot afford to make the slightest contribution and then reveal that they have booked a very expensive holiday abroad for themselves. Persons with a fairer sense of values would plan a less expensive holiday and use the balance to pay for the support of the old person. Some go as far as to claim part of the person's old age pension for rent even during the period when he is away from home. Also some persons book their own holiday accommodation early in the year and then appeal for care of the old person about 4 weeks or less from the commencement of the holiday. This is unavoidable if the person has just become ill or had an accident, but in many cases the family knew when they made their own holiday arrangements that the old person concerned could not be left alone in the house. I cannot take a firm line with these relatives as I would like to do because if their holiday is cancelled the old person is distressed. Quite frequently thp old persons are mentally confused or very forgetful. Away from their customary surroundings and routine they become more so, and it is not unusual for me to receive an S.O.S. from a boarding establishment that one of my old persons has caused a disturbance, e.g. one hit the proprietor with an umbrella and then walked out of the house, another became intoxicated and quarrelled with other guests, several have wandered into the wrong bedrooms during night hours and others have been taken ill and had to be admitted to Hospital. I try to arrange for relatives to leave with the Proprietors and myself an address of where they will be staying, but if they are going abroad or touring the countryside this is not possible or of little use in an emergency, and it is left to me to sort out the immediate problem. 32 Journeys too have to be arranged as some old persons cannot travel on public transport because of a disablement, or they need escort to help them on flights of steps or escalators at railway stations. Lifts to the station have been given by friends and colleagues, and by various voluntary organisations, such as the Rotary Clubs, Toc H, etc. On one or two occasions the old person has been taken by car to the coast and brought back two weeks later. Enquiries about times of trains and sometimes the procuring of tickets in advance must be undertaken by me. If this demand continues and increases, some recognised scheme will be needed, both because of the special difficulties and the time taken up. It is fast becoming a full time job. The Essex County Council admit some of the old persons to Part 3 accommodation for 2 weeks but the demand is far greater than the number of beds that become available. An increase of such accommodation would, I believe, be the best solution. In addition to those persons who can go to a home, Hotel or Part 3 accommodation are many for whom only a Hospital or a Nursing Home is suitable. Hospital care is free, therefore, I am receiving almost daily requests for my assistance in getting someone into Hospital. G.Ps. refer the public to me; if I am eventually able to persuade the G.P. that the approach should be direct to the Hospital, and not through me, I can relax until the Hospital decides that it cannot assist, when the family are again pursuing me to tell me that they are hoping that I will be able to bring about a reversal of the decision, or to arrange for Nursing Home fees to be paid from some statutory source. Housing problems referred to me numbered 91. Some were subsequently awarded priority for Stoneleigh Court or ground floor old persons flats on medical grounds. Many were not eligible for rehousing. Among these were many who had adequate accommodation but were unhappy with married offspring. These problems remain more or less unchanged from year to year. Among the 906 cases dealt with 127 were admitted to Hospital, 82 died in Hospital, and 70 died at home. There was only one case referred by a G.P. to the Medical Officer of Health for assistance in obtaining a Hospital bed. There were, however, cases which had to wait up to 3 weeks for admission and which were the subject of many enquiries and much misdirected criticism of the Department by relatives and interested persons. 33 As during other years I was invited to address several meetings and made many useful and pleasant contacts as a result. " 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 90 persons were assisted and 18,227 articles were laundered. (ix) HOSPITALS, etc. Chadwell Heath Hospital.— 173 beds are provided; 69 for general infectious diseases, 96 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 1961 Pay Beds 14 Amenity Beds 7 Other Patients Children Medical Surgical Male Female Male Female 208 21 26 18 55 55 33 At 31.12.61. 4 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). Mr. II.F. Harris, the Hospital Group Secretary, informs me as follows regarding the proposed extensions to the King George Hospital. "The latest position with reference to the King George Hospital Major Development Scheme is that it was included in the Government's White Paper issued in January, 1962, as a Scheme to be commenced before 1964/65. The number of beds is to be increased to approximately 300 and in addition nearly all Departments will be 34 replaced by larger up-to-date Units. In fact, the present set of plans which have been recently approved only allow for the retention of the six existing main Ward Blocks, the Administrative Block at the front of the Hospital and the main Nurses' Home. This Scheme is virtually the equivalent of supplying a new 300-bedded Hospital for Ilford. Part of the War Memorial Grounds has now been acquired which will allow the majority of the proposed development to be carried out without having to demolish buildings in advance. This will obviously, reduce the number of stages in the building programme and, even more important, avoid the major disruption of existing services.* Psychiatric Hospitals. — There are two large Psychiatric Hospitals in the district, the Goodmayes Hospital, with 64 Besident Staff and 1,306 patients (males 588, females 718), and Claybury Hospital, with 183 Besident Staff and 2,038 patients (males 829, females 1,209) in residence on 30th June, 1961. '(These Hospitals are Groups 21 and 20 respectively of the North East Metropolitan Begional Hospital Board.) Other Institutions. — Australasian Medical Unit (Dr. Barnardo's Homes), Barkingside, has 60 beds in the Hospital and on 30th June, 1961, there were 31 Besident Staff and 34 patients. Nursing Homes. — There are 2 private registered Nursing Homes in the district for medical and senile cases. All Nursing Homes in the district are visited by the Medical Officer of Health and the Chief Public Health Inspector(or their deputies) quarterly and at other times when necessary. (x) AMBULANCE FACILITIES: COUNTY AMBULANCE SERVICE. 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. 35 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, IIford Ambulance Control, Aldborough Road.Ilford. Requests for ambulance transport, other than emergency requests, are only accepted from Doctors, Midwives, Mental Welfare 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, Uford Ambulance Control, Valentine 8822, or to the County Medical Officer of Health, County Hall, Chelmsford, Chelmsford 3231. (xi) CLINICS AND TREATMENT CENTRES: MATERNITY AND CHILD WELFARE. — Infant Welfare Centres are held at the following premises:- Chadwell Christian Mission Hall, Essex Road, Chadwell Heath (for residents of Chadwell Heath area) Monday, 2.00 p.m. Mayesbrook Clinic, Goodtnayes Lane, Goodmayes (for residents ofBecontree area) Tuesday, 2.00 p.m. St. John's Church Hall, Devonshire Road, Newbury Park (for residents of Downshall area) Tuesday, 2.00 p.m. Manford Way Clinic, Chigwell (for residents of the Ilford portion of L.C.C's. Hainault estate) Tuesday, 2.00 p.m. Marks Gate Clinic, Lawn Farm Grove, Chadwell Heath (for residents on Padnall Estate) Tuesday, 2.00 p.m. Kenwood Gardens Clinic, Gants Hill Wednesday, 2.00 p.m. (for residents of Woodford Avenue and area) Friday, 9.30 a.m. Heathcote Avenue Clinic, Clayhall (for Wednesday, 9.30 a.m. residents of Barkingside and Clayhall and area) Wednesday, 2.00 p.m. 36 Cecil Hall, Granville Road, llford (for residents of the east side of Cranbrook Road) Wednesday, 2.00 p.m. Seven Kings Methodist Church Hall, Seven Kings Road (for residents of Seven Kings area) Wednesday, 2.00 p.m. St. Albans Church Hall, Albert Road, llford (for residents of Grosvenor Road area) Wednesday, 2.00 p.m. Cecil Hall, Granville Road, llford (for residents of the west side ofCranbrook Road) Thursday, 2.00 p.m. Newbury Hall, Perryman's Farm Road, Barkingside (for residents of the Newbury Park area) Thursday, 2.00 p.m. Mayesbrook Clinic (for residents of Goodmayes area) Thursday, 2.00 p.m. St. Albans Church Hall, Albert Road, llford (for residents of llford Lane area) Friday, 2.00 p.m. Parish Hall, Mossford Green, Barking- side (for residents of Fairlop area) Friday, 2.00 p.m. Methodist Church Hall, The Drive (for residents ofValentines and Cranbrook area) Friday, 2.00 p.m. Ante-Natal Clinics. — An Ante-Natal Clinic is held at the Maternity Hospital, Eastern Avenue, llford, 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. 37 Post-Natal Clinics.- These Clinics are held at the Maternity Hospital on each Monday afternoon; at the Mayesbrook Clinic, Goodmayes Lane, on alternate Saturday mornings; and at the Manford Way Clinic, Hainault, on the first Friday morning of each month. School and other Clinics.— Clinic sessions are held at Health Services Clinics as under:- (i) KENWOOD GARDENS CLINIC, for - Minor Ailments Dental (Children and Expectant and Nursing Mothers) Orthopaedic and Remedial Exercises treatment Artificial Sunlight treatment Diphtheria, Whooping Cough and Tetanus Immunisation B.C.G. Vaccination Poliomyelitis and Smallpox Vaccination Ear, Nose and Throat Ophthalmic treatment Paediatric Infant Welfare Toddlers Midwives' Ante-Natal Mothercraft Enuresis Chiropody (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, Whooping Cough and Tetanus Immunisation Poliomyelitis and Smallpox Vaccination B.C.G. Vaccination Orthopaedic and Remedial Exercises treatment Infant Welfare Speech Therapy Midwives' Ante-Natal Orthoptic Chiropody 38 (iii) NEWBURY HALL, Perryman's Farm Road, for — 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, Whooping Cough and Tetanus Immunisation Poliomyelitis and Tetanus Vaccination Midwives' Ante-Natal Dental (Children only) Ophthalmic treatment Orthopaedic treatment Chiropody (vii) HEATHCOTE AVENUE CLINIC, for - Infant Welfare Midwives' Ante-Natal Mothercraft Diphtheria, Whooping Cough and Tetanus Immunisation Poliomyelitis and Smallpox 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 (new cases) Tuesday 10 to 11.45 a.m. (old cases) Wednesday 2.30 to 4.15 p.m. (old cases) Friday 2 to 4.30 p.m. (old cases) Wednesday 6.30 to 8 p.m. (new and old cases) Monday 10 to 12 noon (Ambulance cases) For Children — Wednesday 10 to 12 noon Contacts Clinic — Tuesday 2.30 p.m. B.CG. Clinic — Thursday 10.30 a.m. 39 SECTION C SANITARY CIRCUMSTANCES OF THE AREA The Chief Public Health Inspector reports as follows:- During the year under review the sanitary circumstances of the district have been generally satisfactory. The Council's original five year programme of slum clearance has been delayed somewhat because of the difficulties in obtaining sites forre-housing purposes. Nevertheless the project is nearing completion. The Council's decision to determine high standards in the provision of sanitary conveniences, sinks, water supplies, food cupboards, cooking facilities and dustbins for the use of families occupying houses let in lodgings was efficacious in preventing the widespread letting of houses in separate tenements. When the owners received the Council's notices to provide satisfactory amenities, a speedy reduction in the number of tenancies ensued. But strict control of these premises must be maintained. The proposed new Housing (Management of Houses in Multiple Occupation) Regulations should have an ameliorating effect on housing conditions generally. The Council's proposals for formulating Smokeless zones has grown apace. There are two areas formally approved and three others are in advanced stages of preparation. Nuisances from smoke emission have been reduced somewhat but the problem of soots and smells from one well known industrial plant has continued to cause concern to the occupants of dwellings nearby. This factory is under the control of the Alkali Works Act Inspectorate hence free from action by the Council. As this factory will soon be included in a "Smokeless Zone" perhaps some mitigation of the nuisance will be obtained. It is conceded that most industrialists have co-operated in the diminution of atmospheric pollution by converting appliances and plant to smokeless fuels. Householders too have accepted their responsibilities in this field of health promotion, have assiduously conformed to the advice given by the Public Health Inspectors and have been pleased in general with the salutary effects produced in the smoke control area. 40 In not one case has it been necessary to take action for contravention of the Act in this behalf. Food Hygiene Education has been a major task of the Inspectors vested with this important task. So successful have their efforts been that only in rare instances have there been complaints made regarding the hygienic standards in food premises. Those responsible for the management of these establishments have been anxious to inculcate sound principles of hygiene in their staffs and it is noted with satisfaction that the amount of smoking by them has almost disappeared, due in no small measure to the prosecutions instituted by the Council for offences under the Food Hygiene Regulations of 1960. Some indication of the effectiveness of health education can be seen from the fall in the number of food poisoning notifications from 117 in 1960 to 84 in 1961 and for dysentery from 204 to 129 in the same years. The Litter Act of 1958 has had some effect in reducing the unsightliness in the thoroughfares from deposits produced no doubt in large measure to the prosecution ofoffenders bythe local authority, the frequent advertisements and exhortations in both press and on television by the central government and by local publicity. (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 IIford 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, together with water from the Board's well at Wanstead. Samples of water passing into supply from these works are collected dailyand a total of 306 samples was submitted to chemical and/or bacteriological examination. During the year 1961 there were no new sources of supply instituted by the Board in IIford and no important extensions of trunk mains or changes in the general scheme of supply. The total distances of new water mains of various diameters laid in the Borough of 41 Ilford was 1,057 yards. All new and repaired mains are chlorinated before being restored to supply and samples from these are tested to confirm that the qnalityof 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. Mr. P. Gordon Spencer, Chief Engineer to South Essex Waterworks Co., has kindly supplied me with the following information. "During 1961 over 4,120 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 from the wells situated in the Company's area of supply 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 January, March, April and June, the total quantity being 11 million gallons. The water supply of the area and of its several parts has been satisfactory as to quality and quantity. The following mains were laid in Ilford during 1961:3 ins. 4 ins. 9 ins. 18 ins. Yards 94 49 79 1 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 42 mitted for Chemical and Bacteriological examination, and all gave satisfactory analyses. (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 open-air bath, which are closed during the winter months. The smaller indoor bath is, however, in operation throughout the whole of the year, and as is the case with all the baths, is "topped up" as necessary. Five 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, June, July, August, September, October and December: 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) Hainault/Trelawney Road Surface Water Sewer ... £300,500 (b) Cranbrook Stage III Surface Water Sewer £102,050 Commenced: (a) Woodford Avenue, Claybury Broadway to River Roding Surface Water Sewer £112,996 (b) Roding Valley Mid-Level Soil Sewer Stage II £113,200 RIVERS AND STREAMS Flooding.— A number of cases of flooding occurred in areas which have not yet been dealt with under the Drainage Scheme. 43 Pollution of Streams. — Pollution of streams, particularly by oil continues and more especially on the Seven Kings Water and the Mayesbrook. (iv) COLLECTION AND DISPOSAL OF REFUSE. - The Borough Engineer also kindly supplied the following information:- Tons Total amount of refuse collected and disposed of 53,155 Collection of Salvage:- Tons Income Wastepaper 1,375 £10,375 Rags and Scrap Metal 77 £920 (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 33,865 Houses and premises reinspected (work in progress) 19,996 Visits during disinfection 133 Houses in which nuisances were detected 645 Houses in which nuisances were abated 698* Premises disinfected 18 Premises from which articles only disinfected 25 Articles disinfected 166 Premises disinfested for verminous conditions 14 * Includes 115 nuisances detected before 1st January, 1961. Notices served:- Served Complied with statutory:- Public Health Act, 1936 60 49 Clean Air Act 1956 1 - Housing Acts, 1936 and 1957 8 3 Factories Acts, 1937 and 1948 - - Shops Act, 1950 - - Provide Dustbin (Ilford Urban District Council Act, 1904) 17 15 Food and Drugs Act, 1955 - - Cleanse Water Storage Cistern (Byelaws) - - Cover Water Storage Cistern (Byelaws) - - Informal 730 643 816 710 In addition to the above, 151 notices (14 statutory and 137 informal) served previous to 1st January, 1961, were also complied with. 44 Complaints. - During the year 2,879 complaints of nuisances were received and investigated. The following is a summary:- Accumulation of manure and refuse 58 Animals improperly kept 17 Bad smells 60 Dampness of premises 60 Defective drains, w.c.s and fittings 631 Defective roofs, gutters, downpipes, etc 45 Defective water fittings 52 Dirty and verminous houses 23 Dirty condition of rearway 11 Flooding of premises 20 Overcrowding 23 Smoke nuisances 68 Defective or no provision of dustbin 678 Hats and mice 655 Miscellaneous 478 Total 2,879 (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 220 inspections were made, and 2 Preliminary Notices were served. One Certificate of Exemption from the provisions of Section 38 was granted in 1961. (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 7 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 raf? flock or as a rag flock store. No licence was issued in 1961 in respect of premises used as a rag flock store. (ix) LAND CHARGES ACT, 1925. - During the year 3,794 enquiries were dealt with under this Act. 45 (x) CLEAN AIR ACT, 1956. - The Council has agreed that the whole of the Borough shall become a smokeless area and a programme has been prepared for this to be effected over a period of 10 years. The first Smoke Control Order (Padnall and Marks Gate Estates) came into operation in 1960, the second (No. 2. (South Hainault) Smoke Control Order) and the third (No. 3 (South Hainault) Smoke Control Order), subject to confirmation by the Minister, will come into operation on 1st July, 1963. Further areas are the subject of detailed inspections with a view to the preparation of future Orders. (xi) ATMOSPHERIC POLLUTION. — Complaints were received of alleged smoke nuisance from 15 factories in the Grove Road, Newbury Park, Green Lane and llford Lane areas. In 12 instances no emission was noted which would have enabled action to be taken under the Public Health Act, 1936, or Clean Air Act, 1956. One statutory and two 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 — llford Town Hall. Each station now has a volumetric apparatus only. The use of deposit gauges and lead peroxide instruments at the stations was discontinued, on the recommendations of the Department of Scientific and Industrial Research, as from 31st March, 1961. 46 SECTION D. - HOUSING. (i) OVERCROWDING. — Two notices were served during 1961. (ii) CLEARANCE AREA. — One area was declared by the Council to be a Clearance Area, in 1961. 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) 1,702 (b) Number of inspections made for the purpose 17,745 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 1 (b) Number of inspections made forthe purpose 1 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 11 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 249 2. Remedy of defects during the year without service of formal Notices:- Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 204* 3. Action under Statutory Powers during the year:- A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1957. 47 (1) Number of dwelling-houses in respect of which notices were served requiring repairs - (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners - (b) By local authority in default of owners - B. Proceedings under Public Health Acts:- (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 77 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 48* (b) By local authority in default of owners 1 C. Proceedings under Section 17(1) of the Housing Act, 1957. (1) Number of dwelling-houses demolished as a result of formal or informal procedure 11 (2) Number of dwelling-houses closed in suance of an undertaking given by the owners and still in force - 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 overcrowded at the end of the year 15 (ii) Number of families dwelling therein 16 (iii) Number of persons (units) dwelling therein 54 (b) Number of new cases of overcrowding reported during the year 7 48 (c) (i) Number of cases of overcrowding relieved during the year 15 (ii) Number of units concerned in such cases 82 (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 crowding conditions upon which the Medical Officer of Health may consider it desirable to report - *Includes compliances during 1961 of Notices served prior to 1st January, 1961. HOUSING ACTS, 1936 and 1957. During the year 1961 the work of receiving applications, calling for calculations for the "permitted number" was continued with a view to the issue of housing certificates. 1 certificate in respect of 1 house was issued during the year, making a total of 18,367 certificates, in respect of 25,177 houses, issued to the end of 1961. As new premises were constructed and placed upon the rating lists, "permitted number" certificates were issued as required. MEDICAL PRIORITIES FOR REHOUSING In 1961 48 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 1961 are as follows:- 49 Application for Certificates of Disrepair received 26 Certificates of Disrepair granted 25 Certificates of Disrepair refused - Applications Withdrawn 1 Certificates of Disrepair issued 11 Undertakings received from landlords 16 Unexpired Notices of Proposal to issue Certificates of Disrepair - Certificates cancelled 2 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 5 Issued to Tenants 2 50 SECTION E. INSPECTION AND SUPERVISION OF FOOD MILK SUPPLY The Council has delegated to the Public Health Committee all its powers and duties under the Food and Drugs Act, 1955, and any Regulations which might thereafter be made thereunder. The Milk (Special Designations) (Specified Area) 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, 1961:- Persons registered as distributors of milk 128 Premises registered as dairy premises (other than dairy farms) 10 217 inspections of dairy premises were carried out during the year. (ii) MILK (SPECIAL DESIGNATION) REGULATIONS, 1960:- The followinglicences were granted during l961 for the 5-year period ending31st December, 1965:- Dealer's (Pasteuriser's) 1 do. (Steriliser's) 1 do. (Tuberculin Tested) 1 do. (Pre-Packed Milk) Tuberculin Tested 50 Pasteurised 90 Sterilised 103 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 (Raw and Heat treated). — These are sampled bi-monthly and after unsatisfactory reports. 51 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. The following results were obtained:- Grade of Milk Total Satisfactory Unsatisfactory Remarks on unsatisfactory results Tuberculin Tested (Pasteurized) Milk 42 42 Tuberculin Tested Milk (Farm bottled) 4 4 - - Pasteurized Milk 49 49 - - Sterilized 17 17 - - (v) BIOLOGICAL TESTS. — Two samples of milk were submitted to a biological test for tuberculosis. Both proved to be negative. (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. — 5 complaints of the presence of foreign bodies in milk were received and investigated. Letters of warning were sent to the bottlers and distributors in all cases. One of the complaints is detailed in the paragraph on Food and Drug sampling. (viii) REGISTRATION. — No application for registration was refused during the year. 52 ICE CREAM (i) REGISTRATION. Section 158, Essex County Council Act, 1933. In 1948, the Council delegated to the Public Health Committee its powers and duties with regard to the granting, refusal or revocation of registrations, including the duty of interviewing applicants who are required to show cause why applications for registration should not be refused or existing registration should not be revoked. 31 applications for registration in respect of 30 premises were considered during the year 1961; all were granted in respect of the sale (only) of ice-cream. (ii) ICE-CREAM (HEAT TREATMENT, ETC.) REGULATIONS, 1959. The Council has decided, in accordance with the recommendations of the Ministry of Health, that 4 thermometers should be provided of the following types:- A recording thermometer at the heat treatment stage; An indicating thermometer at the heat treatment stage; An indicating thermometer at the cooling stage; An indicating thermometer at storage stage. (iii) SAMPLING Samples for bacteriological examination are taken monthly from April to September and at regular intervals during the winter months as supplied by all manufacturers to mobile salesman and local retailers. Samples are repeated after unsatisfactory results. In 1961 40 samples were submitted for examination with the following results:- No. of Samples Ministry of Health Provisional grade. % of Total Unsatisfactory Samples 30 I 75 _ 2 II 5 — 5 III 13 — 3 IV 7 1 40 100 1 53 The Food Standards (Ice-Cream) Regulations, 1959, prescribed standards for ice-cream. During 1961, 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 with the sale or exposure for sale in the open air of food intended for human consumption. The Public Health Inspectors reported 37 instances of individuals using tobacco whilst engaged in the handling of "open" food contrary to the Food Hygiene (General) Regulations, 1960. Legal proceedings were taken in four cases and fines of £5 plus £1.1s. costs in three cases and £5 plus £1 costs in the other case were imposed by the Court. In all other instances letters of warning were served. The Essex County Council Act, 1952, Section 105, requires that as from 2nd April, 1953, any person intending to use premises which were not used immediately before that date for the sale, storage, or preparation for sale of any food (other than milk) intended for human consumption shall give not less than 14 days' notice to the Council of his intention so to do. The whole-time services of two Public Health Inspectors are utilised to deal with food preparing premises, factory canteen premises and food and drugs sampling. During 1961, they made 13,192 inspections of food shops and food preparing premises. 67 informal notices were served under the Food and Drugs Act, and 73 informal notices were complied with including 21 informal notices served prior to 1961. (ii) FOOD HYGIENE. 54 The following gives the numbers of food premises in the area by the type of business:- Cafes and Restaurants 162 Factory canteens 28 Butchers' shops 118 Grocers' shops 252 Fruiterers' and Greengrocers' shops 124 Fishmongers' and Fishfryers' shops 50 Bakehouses 20 Bakers' shops 39 Confectioners' shops 213 1,006 The practice of inculcating interest in the proprietors, directors and staffs of food handling organisations was continued in 1961, 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 1961. 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. 193 samples (187 formal and 6 informal) were obtained during the year 1961; 3 formal and 3 informal samples were not satisfactory as follows:- (a) Crispbread (formal). — Claim that commodity was perfect aid to slimming was not justified. No action was taken. (b) Orange Drink (formal). — Contained 8% potable fruit content. No action was taken. (c) Slimbread (informal). — Claim that commodity was useful aid to slimming not justified. No action was taken. (The above items (a), (b) and (c) were referred to the Association of Municipal Corporations for information and any action that may be considered desirable). (d) Gin (formal). — Contained only 67.7% proof spirit which complied with requirement of Food and Drugs Act, 1955, but was stated to contain 70%. No action was taken. 55 (e) Bread (informal). — Contained portions of used surgical dressing. A letter of warning was served. (f) Bottle of Milk (informal). — Contained a metal foil wrapping. Letters of warning were sent to the bottlers and distributors. (iv) HAWKERS OF FOOD. Section 103 of the Essex County Council Act, 1952, came into operation on 2nd April 1953, and provides that hawkers of any food, and premises used for the storage of such food, shall be registered by the local authority. Registration was granted to 10 persons and 3 premises were also registered during 1961. (v) REGISTRATION OF PREMISES USED FOR THE PREPARATION OR MANUFACTURE OF SAUSAGES, OR POTTED, PRESSED, PICKLED OR PRESERVED MEAT, FISH OR OTHER FOOD INTENDED FOR SALE. Section 80 of the IIford Corporation Act, 1937, requires registration of such premises. 3 applications for registration were received and granted during 1961. (vi) ARTICLES OF FOOD SURRENDERED. During the year the following articles were surrendered and condemned as being unfit for the food of man:- Bacon, 64 lbs.; Beverages, 21 tins; Biscuits, 26 pkts; Butter, 3 lbs.; Cereals, 33 lbs.; Cheese, 52 lbs.; Chicklettes, 6 lbs.; Cream, 3 tins; Fish (Wet and Dry), 115 stone; Fish (tinned), 344 tins; Flour, 8 lbs.; Fruit (tinned), 2084 tins; Fruit (Dried), 17 lbs.; Fruit Juice, 22 tins; Jam (preserves), 46 lbs.; Meat — Fresh, 3283 lbs.; Meat (tinned), 4053 lbs.; Meat pies, 62; Milk(tinned), 390 tins; Pastry and Pudding Mix, 13 pkts.; Pickles, 19 jars; Sugar, 96 lbs.; Poultry, 926 lbs; Soups (tins), 11; Vegetables, (tins), 56; Sausages, 99 lbs.; Tea, 4 lbs.; Ice Cream, 333 cartons. (vii) FOREIGN BODIES IN FOOD. 15 complaints (including 1 milk sample referred to in paragraph (iii) Sampling) were received during 1961 of the presence of foreign bodies in foodstuffs; letters of warning were sent in 8 cases and legal proceedings taken in 1 case, which was dismissed. 56 (viii) FOOD POISONING. By virtue of Section 82 of the Ilford Corporation Act, 1937, food poisoning became compulsorily notifiable in Ilford as from 1st October, 1938. It is also notifiable under Section 17, Food and Drugs Act, 1955. 84 notifications were received. There were 29 family outbreaks, 2 other outbreaks, and 31 single cases. In 8 outbreaks (involving 23 persons) the causual organism was identified as Salmonella Typhi-murium; and in 1 outbreak (involving 2 persons) as Salmonella Chicago. In the remaining 22 outbreaks (involving 90 persons) no agent was identified. Regarding the single cases, the agents identified were Salmonella Typhi-murium 19, and Salmonella Chicago 1. In the remaining 11 cases no organism was identified. (x) BAKEHOUSES. — There are 20 bakehouses in the district, all of which use motive power, 366 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 in5 instances and the requests were complied with in all cases. (xi) MERCHANDISE MARKS ACT, 1926. - No contravention of this Act was reported during 1961. DISEASES OF ANIMALS ACT, 1950. (i) FOWL PEST ORDER OF 1936 AND THE FOWL PEST (AMENDMENT) ORDER OF 1947 A Notice, Form C, under this Order was received from the Ministry of Agriculture, Fisheries and Food withdrawing the Notice (Form B) restricting the movement of poultry at a Farm in Essex, and another notice Form A withdrawing the notice declaring the Farm to be an "Infected Place". (ii) FOWL PEST (INFECTED AREAS RESTRICTIONS) ORDER 1956 A Notice was issued permitting the movement of 200 pullets from a 57 Farm in Doncaster, Yorkshire to an Essex Farm. These birds were to replace those destroyed during the recent outbreak of fowl pest at the Farm. (iii) THE FOWL PEST (INFECTED AREAS) SPECIAL ORDER No. 4, 1961 This Order withdrew as from 8th February the restriction of movement in the Southern part of Essex. (iv) FOWL PEST ORDER 1936 A Notice Form B was served on a farm in the Borough restricting the movement of poultry from the area at the side and rear of the premises, there being a suspicion of fowl pest among the poultry on the premises. The premises were visited and the poultry appeared in good health. The suspected fowl pest was not verified. (v)THE FOOT AND MOUTH DISEASE (INFECTED AREAS)SPECIAL ORDER 138, 1960 This Order declared an area, including part of the County of Essex south of the A.127 to be an infected area. Although this did not include Ilford, notices were served on the appropriate persons giving the purpose of this Order. (vi) THE FOOT-AND-MOUTH DISEASE (INFECTED AREAS) SPECIAL ORDER No. 7, 1961 This Order revoked the above-mentioned Order. (vii) THE IMPORTATION OF CARCASES AND ANIMAL PRODUCTS (AMENDMENT) ORDER 1961 The Minister of Agriculture, Fisheries and Food and the Secretary of State, acting jointly, in exercise of the powers vested in them by the Diseases of Animals Act 1950 and the Agriculture (Miscellaneous Provisions) Act 1954, have made the above Order which alters the provisions of the Importation of Carcases and Animal Products Order 1954 so as to make it illegal to land in Great Britain dry sausages (salamis), fully cured bacon and ham, and sausage casings (cleaned and scraped) originating in Spain or Portugal without a licence. (viii) REGULATION OF MOVEMENT OF SWINE ORDER 1959 A licence was issued by the County of Hertford authorising the movement of 19 store pigs from Bishop's Stortford to a farm at Newbury Park. The pigs were kept under supervision and the requirements of the Order were complied with. 58 (ix) SWINE FEVER ORDER OF 1938 A telephonic notice was given on 19th September by the Animal Health Division of the Ministry of Agriculture, Fisheries and Food, Chelmsford, that a pig was suspected as suffering from swine fever. Accordingly a Notice, Form A, under the Order was served on the Farm in the Borough, prohibiting the movement of pigs and for the taking of necessary precautions to prevent the spread of infection. A Notice was received from the Ministry withdrawing the notice in Form A which was served on 19th September in respect of the above premises. 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. 59 The following is a statement of the work carried out during 1961. Type of Property Local Authority Dwelling Houses Agricultural All other (including Business and Industrial) Total I. Total No. of properties in District 221 52,783 25 6,598 59,627 II. No. of properties inspected as a result of notification 54 556 1 115 726 No. of such properties found to be infested by - Common Rat Major - - - - - Minor 16 149 1 23 189 Ship Rat Major - - - - - Minor - - - - - House Mouse Major - - - - - Minor 30 163 - 54 247 III. No. of properties inspected in the course of survey under the Act 13 18 13 44 No. of such properties found to be infested by - Common Rat Major - - - - - Minor 13 9 - 12 34 Ship Rat Major - - - - - Minor - - - - - House Mouse Major - - - - - Minor - 5 - - 5 IV. No. of properties otherwise inspected - - - 1,006 1,006 No. of such properties found to be infested by - Common Rat Major - - - - - Minor - - - - - Ship Rat Major - - - - - Minor - - - - - House Mouse Major - - - - - Minor - - - - - V. Total No. of inspections and reinspections carried out 152 1,215 5 13,423 14,795 VI. No. of infested properties (under II, III and IV) treated by Local Authority 33 328 1 72 434 VII. Total No. of treatments and retreatments carried out . 33 328 1 85 447 VIII. No. of Notices served under Section 4 - (I) Treatment (2) Structura1 works (i.e., Proofing) - 3 - 2 5 IX. No. of cases in which default action was taken by Local Authority following issue of Notice under Section 4 - - - - - X. Legal proceedings - - - - - XI. No. of "block" control schemes carried out - - - - Nil 60 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 11 premises during 1961. PETROLEUM (CONSOLIDATION) ACT, 1928. - The Public Health Inspectors mode 1,633 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 151, and the fees paid to the Council for such Licences was £124.15s. LITTER ACT, 1958. — The Public Health Inspectors are authorised by the Council to investigate and report offences under the Act. During 1961, 3 offences were reported. Legal proceedings were taken in one case and a fine of £2, plus 4s. costs was imposed. A letter of warning was also served in one other instance. NOISE NUISANCES - ILFORD CORPORATION ACT, 1937 AND PUBLIC HEALTH ACT, 1936. Complaints were received of noise nuisances from 31 premises during the year. In 16 cases no nuisance was found to exist in respect of which action could be taken. In 12 cases representations by the Public Health Inspector resulted in abatement of the nuisance. One Statutory Notice was served and complied with, and two Intimation Notices served, one of which was complied with in 1961. 61 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 the Local Diphtheria Authority as from 1/4/22). Membranous Croup Pemphigus Neonatorum (made notifiable F.rysipelas by the Local Authority as from Scarlatina or Scarlet Fever 29/6/29). Typhus Fever Enteric fever (Typhoid and 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. (Infections Diseases) Regulations, Dusentary ) 1953 and 1960. Malaria ) Anthrax ) Tuberculosis P.H. (Tuberculosis) Regulations, 1952. Acute Rheumatism (up to 16 The Acute Rheumatism (Amendment) years) Regulations, 1958. Measles and Whooping Cough The Measles and Whooping Cough Regulations, 1940. Acute Poliomyelitis ) P.H. (Acute Poliomyelitis, Acute Acute Encephalitis ) Encephalitis and Meningococcal Meningococcal Infection) Infection) Regulations, 1949. 3. By Local Act. Food Poisoning Ilford Corporation Act, 1937, and Food and Drugs Act, 1955. 62 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, Phosphorous, Arsenical or Mercurial Poisoning or Anthrax contracted in any factory. The Secretary of State can add other diseases to those mentioned by Regulation. The total numbers of deaths of Ilford residents from the undermentioned infectious diseases during 1960 and 1961 were as follows:- 1960 1961 Scarlet Fever - - Enteric Fever - - Diphtheria - - Acute Poliomyelitis - - Measles - 1 Whooping Cough - - Influenza 4 19 Tuberculosis — Pulmonary 7 12 Other forms 1 1 Pneumonia (all forms) 127 140 Meningococcal Infections - - Totals 139 173 The year 1961 showed a higher incidence of infectious disease, mainly due to the increase in the number of cases of measles, 2,907 occurred as compared with 73 in the previous year. There were, however, only 37 cases of whooping cough as compared with 397 in the previous year. (a) Smallpox. — No cases were notified during 1961. Vaccination is the responsibility of the Essex County Council and details appear in the Part III Services Section of this Report. (b) Scarlet Fever. — 132 cases occurred in 1961. There were no deaths from this disease. Only 3 cases were admitted to hospital, the remainder being nursed at home. (c) Diphtheria. — No cases occurred in 1961. This is the tenth successive year in which it has been possible to record a clean "bill of health" for this disease in llford. (d) Ophthalmia Neonatorum. — No cases occured in 1961. TABLE III. - CORRECTED NOTIFICATIONS OF INFECTIOUS DISEASES FOR THE YEAR 1961. 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 5 and under 15 15 and under 25 25 and under 45 45 au<l under 65 65 and upwards Cranbrook Park Loxford Clementswood Mayfield Coodmayes Fairlop Clayhall liarkingside N. Hainault Seven Kings S. Hainault Smallpox - - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 132 1 25 100 3 3 - - 7 11 4 6 3 4 32 19 20 7 9 10 3 - Diphtheria, including Membranous - - - - - - - - - - - - - - - - - - - - - - Enteric Fever (Typhoid and Para-Typhoid) 1 - - - - - 1 - - - - - - - - 1 - - - - - - Pneumonia 106 2 5 9 2 11 46 31 17 13 5 10 5 8 8 20 10 2 7 1 28 140 Puerperal Pyrexia 43 - - - 21 22 - - 1 - - - - - 1 - - 41 - - 41 - Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - - Acute Encephalitis - - - - - - - - - - - - - - - - - - - - - - Meningoccocal Infection - - - - - - - - - - - - - - - - - - - - - - Dysentery 129 5 28 26 12 30 23 5 13 22 2 2 4 - 6 38 27 6 5 4 - - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - - Erysipelas 21 - - - - 2 14 5 2 4 1 2 1 - 1 3 1 4 1 1 - - Pemphigus Neonatorum 1 1 - - - - - - - - - - - - - 1 - - - - - - Tuberculosis Pulmonary 80 - 2 3 12 25 28 10 7 8 8 4 2 3 8 5 5 10 8 12 79 12 Other Forms 9 - 1 - 2 4 1 1 1 1 - - - - 3 - 2 - 1 1 5 1 Anthrax - - - - - - - - - - - - - - - - - - - - - - Malaria - Believed contracted in this country - - - - - - - - - - - - - - - - - - - - - - Believed contracted abroad 1 - - - 1 - - - - - - - - 1 - - - - - - 1 - Acute Rheumatism 3 - - 3 - - - - - - - - - - - 1 1 1 - - 1 - Measles 2,907 74 1,274 1,533 17 9 - - 318 130 210 263 160 216 306 341 310 242 224 187 15 1 Whooping Cough 37 4 18 14 - - 1 - 2 - 4 4 3 4 3 3 5 3 2 4 - - Food Poisoning 84 - 17 21 11 17 13 5 8 14 - 4 6 5 6 8 18 9 6 - 12 - Typhus fever - - - - - - - - - - - - - - - - - - - - - - Totals 3,554 87 1,370 1,709 81 123 127 57 376 203 234 295 184 241 374 440 399 325 263 220 185 154 * Included in the figures in these columns are cases notified in previous years as well as 1961. 63 64 The following figures show the number of cases of Ophthalmia Neonatorum notified during the past fiveyears: 1957, 6; 1958, 1; 1959, nil; 1960, 6; 1961, nil. (e) Enteric Fever (Typhoid and Para-Typhoid). — One case occurred in 1961. — A male, aged 48. The patient had returned from a continental visit just prior to the onset and it is probable that infection occurred abroad. (f) Acute Poliomyelitis. — No cases occurred in 1961. (g) Acute Encephalitis. — No cases occurred in 1961. (h) Meningococcal Infection. — No cases occurred in 1961. (i) Pneumonia — Influenzal and Primary. — The number of cases which occurred during 1961 was 106 compared with 92 in 1960. (j) Tuberculosis. — During 1961 there were 80 new notifications of Pulmonary Tuberculosis and 9 of other forms of Tuberculosis. In addition 77 pulmonary and 3 non-pulmonary cases were transferred to the district. The population of Ilford has not varied greatly during the past five years and the number of cases added to the register has also shown little change as the following figures show:- year Population No. of Persons added to list (all forms) Deaths (all forms) No. of Persons on register 31stDecember 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 1961 177,760 169 13 1,524 65 Notifications and Deaths from Tuberculosis of Ilford residents during 1961:- 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 - 1 - - - - 5-15 2 1 - - - - - - 15-25 6 6 - 2 - - 1 - 25 - 45 15 10 2 2 - 1 - - 45-65 20 8 1 - 4 3 - - 65-75 4 1 - 1 3 I - - Over 75 4 1 - - - - - - Totals 52 28 3 6 7 5 1 - Of the foregoing new cases, the following were notified from Institutions in the district: - Hespiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital - - Goodmayes Hospital 6 - Chadwell Heath Hospital - - Claybury Hospital 2 - Dr. Barnardo's Village Homes - - Of the 13 deaths which occurred of Ilford residents, notification had previously been made of 11 of the cases. In the other cases the presence of tuberculosis was discovered as a result of post-mortem. Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1961 1,419 155 1,574 Number of cases entered on the register during the year 157 12 169 Number of cases removed from the register during the year NonPul. Pul. Recovered 75 7 Deceased 35 - Left District 79 13 Lost sight of 9 1 Diagnosis not established - - 198 21 219 umber of cases remaining on register on 31st December, 1961 1,378 146 1,524 66 The treatment of Tuberculosis is nowunderthe controlofthe Regional Hospital Board. On the 31st December, 1961, there were 1,282 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 1961 was as follows:- Pulmonary Non-Pulmonary Total Males Females Males Females Adults 39 24 19 4 86 Children 4 1 - - 5 Tuberculosis Care Association.— Assistance was granted to 31 persons who received 190 extra nourishment grants. 66 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:— Romford. — The Annexe, Oldchurch Hospital, Waterloo Road, Romford:- Males Females Consulta lions: Monday and Tuesday 4 p.m. to 6.30 p.m. Monday and Tuesday 4 p.m. to 6.30 p.m. Thursday 12 noon to 3 p.m. Thursday 12 noon to 3 p.m. Treatments: Monday to Friday 8 a.m. to 7 p.m. Monday to Friday 8 a.m. to 7 p.m. Saturday 9 a.m. to 1 p.m. Saturday 9 a.m. to 1 p.m. Whitechapel. — Whitechapel Clinic, Turner Street, Mile End, London, E.l.:- Males Females Consultations: Monday to Friday 10 a.m. to 7 p.m. Monday to Friday 10 a.m. to 7 p-m. Saturday 10 a.m. to 3 p.m. Saturday 10 a.m. to 3 p.m. Treatments: Monday to Friday 7 a.m. to 7 p.m. Monday to Friday 8 a.m. to 7 pm. Saturday 7 a.m. to 3 p.m. Saturday 8 a.m. to 3 p.m. 67 West Ham.-Queen Mary's Hospital, West Ham Lane, Stratford, London, E. 15: — Males Females Consultations: Monday 3 to 6 p.m. Monday 6 to 8 p.m. Thursday 11 a.m. to 1p.m. and 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. 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. 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 various health topics were also given prominence. The Public Health Committee considered the question of smoking and Lung Cancer and decided to co-operate in any way considered desirable. A Medical Officer on the staff of the Essex County Council is endeavouring, with the aid of heads of local schools, to disseminate propaganda on this subject. 68 The Medical Officer devotes 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 1961:- Officers Servants New Appointments 111 52 Under Sickness Regulations 3 11 On behalf of other Authorities 1 - Total 115 63 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. MASS RADIOGRAPHY. A mass radiography unit visited the Borough on Mondays from 13th February to 15th May, 1961 and again from 25th September to the end of the year. The service is still in operation and Dr. H. Ramsey, the Medical Director, has kindly supplied me with the following details, relating to the period under review. Male Female Total Referred by General Practitioners 1,253 1,311 2,564 General Public 2,692 3,873 6,565 Organised Groups 170 803 973 Total numbers X-rayed 4,115 5,987 10,102 Requiring further investigation 144 119 263 Pulmonary Tuberculosis Requiring immediate treatment 6 3 9 Requiring close clinic supervision 3 2 5 Requiring occasional clinic supervision 16 5 21 Presumed healed, no further action required 27 23 50 69  Male Female Total Bronchial carcinoma 13 1 14 Metastases in the lung and mediastinum 4 4 Other abnormalities: — Pulmonary fibrosis — Nontuberculous 9 12 21 Pleural thickening or calcification - Non-tuberculous 6 3 9 Bacterial and virus infection of lungs. 11 6 17 Bronchiectasis 5 5 10 Emphysema 13 - 13 Other various abnormalities 26 21 47 70 47 117 70 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 (includintg inspections made by public Health Inspictors). Premises Nnmber 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 149 134 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authorities 454 660 3 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 38 70 - - Total 641 864 3 - 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) Want of cleanliness (S.l) (2) (3) (4) (5) (6) Overcrowding (S.2) - - - - - Unreasonable temperature(S.3) - - - - - Inadequate ventilation (S.4)... - - - - - Ineffective drainage of floors (S.6) _ — Sanitary Conveniences (S.7) (a) Insufficient — — — - - (b) Unsuitable or defective 5 4 — 3 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Out-work) Total 5 4 - 3 - 71 PART VIII OF THE ACT OUTWORK (Sections 110 and 111) Section 110 Section 111 Nature of work 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. 79 - - - - - Cosaques, Christmas stockin gs, etc 42 — _ _ _ — Total 121 - - - - - 72 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 ofthe area in which the birth took place. The number of live births notified in llford underthisAct duringl961 was 1,928(1,009males and 919females), of which there were 119 (61 males and 58 females) where the ordinary place of residence of the parents was outside Ilford. In addition 737 notifications of live births (363 males and 374 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 30 stillbirths (18 males and 12 females) notified in Ilford, of which there were 3 (all females) where the ordinary place of residence of the parents was outside Ilford, and notifications of 11 stillbirths (5 males and 6 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 40 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:- 73 STILLBIRTHS 1961. Cause of Stillbirth Delivery unknown found on District Delivery in Nursing Home Delivery at Home Delivery in Hospital TOTAL Achondroplasia - - - 2 2 Anencephalic - - - 1 1 Anoxaemia - - - 1 1 Anoxia - - 1 2 3 Ante-Partum Haemorrhage - - - 4 4 Asphyxia - - - 2 2 Diaphragmatic Hernia - - 1 1 2 Eclampsia - - - 1 1 Hydrocephalic - - - 1 1 Hydrops Foetalis - - - 1 1 Inco-ordinated Uterine Activity - - - 1 1 Intra-Cranial Haemorrhage - - - 1 1 Intra-Uterine Death - - - 3 3 Multiple Abnormalities - - - 4 4 Placental Insufficiency - - 1 3 4 Rhesus Incompatibility - - - 1 1 Unknown 2 - 2 2 6 Totals 2 - 5 31 38 CARE OF PREMATURE INFANTS. - Of the 1,928 live births occurring in Ilford during 1961, 83 weighed 5½ lb. or less at birth, 11 of these babies were born on the district, 71 in Hospital (including 12 where the home address of the parents was outside Ilford), and one in a garage. The last mentioned infant, found abandoned shortly after its birth, was conveyed to hospital after resuscitation by the ambulance driver; the mother was subsequently traced and it was ascertained that her home address was outside Ilford. 74 Of the 11 babies born at home:- 7 were nursed entirely at home; 4 were transferred to hospital; 1 died at the age of three days (in hospital); 10 survived at the end of one month. Of the 71 babies bom in hospital:3 died during the first 24 hours; 2 died between the ages of one day and one month; 66 survived at the end of one month (including 12 where the home address was outside Ilford). The baby bom in the garage survived at the end of one month. In addition, 49 notifications were received of births outside the district where the ordinary residence of the parents was in Ilford and the weight of the infant at birth was 5½ lb. or less. Of these there were:- 9 who died within the first 24 hours (in hospital); 40 who survived at the end of one month. INFANT MORTALITY. — The number of infants dying within the first year of life was 40, the total number bom being 2,533. The latter figure is supplied by the Registrar-General for calculating infant and maternal mortality rates. The infant mortality, or rate of deaths per 1,000 live births, was therefore 15.8. The following table gives the deaths of infants under one year of age, classified according to age:- 75 INFANT DEATHS 1961. Cause of Death Under I 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 Atelectasis 5 — — — 5 — — - — 5 Cerebral Haemorrhage 2 - - - 2 - - - - 2 Circulation Failure 1 - - - 1 - - - - 1 Congenital Heart Disease 2 1 - - 3 2 I 1 - 7 Erythroblastosis Foetalis 1 - - - 1 - - - - 1 Fibroelastosis - - - - - - I - - 1 Haemolytic Disease of the Newborn 2 - - - 2 - - - - 2 Hyaline Membrane Disease 1 - - - 1 - - - - 1 Hydrocephalus - - - I 1 - - - - 1 Intra-Ventricular Haemorrhage 1 - - - 1 - - - - 1 Multiple Abnormalities 2 - - I 3 - - - - 3 Pneumonia 1 — — — 1 3 — — 1 5 Prematurity 7 - - - 7 - - - - 7 Pulmonary Syndrome 1 - - - 1 - - - - 1 Pyelonephritis - - - I 1 - - - - 1 Respiratory Failure 1 - - - 1 - - - - 1 Totals 27 1 - 3 31 5 2 1 1 40 The comparative figures for the past 10 years are as follows:- Year No. of Deaths under 1 year Rate per 1,000 Registered Live Rirths 1961 40 15.8 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 The following table shows the comparison for Ilford, England and Wales and London for the past 10 years:- Year Ilford England and Wales London 1961 15.8 22 21 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 NEONATAL MORTALITY. — The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 31 deaths of infants under four weeks of age during 1961 and the rate for the year was 12.2 per 1,000 live births. The figures for the past 10 years are as follows:- Year Number Rate 1961 31 12.2 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 ILLEGITIMATE BIRTHS AND DEATHS. - 96 of the live births registered (45 males and 51 females) were illegitimate, that is 3.8% of the births registered. There were 3 deaths of illegitimate children under one year of age. 76 The mean average Infant Mortality rale for the past 10 years therefore 17.5 per 1,000 live births. 77 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 1961 2,437 96.2 37 15.2 96 3.8 3 31.2 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 - - 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:- "Care of Widows and Widowers Early in 1961 it was decided that the health visitors would visit the home six weeks after the notification of a death certificate was received at the Public Health Offices. It was felt that remaining partners (although we are not aware of these until we visit) might at this time need assistance. It would appear that this service is appreciated. Many partners are fit, able to 78 return to work or continue happily in their own homes. Others have been referred to social services such as National Assistance, W.V.S. and the Housing Department. We find that many remaining partners are undecided about their future and tactful advice at this stage may prevent them breaking up their home which later they often regret. Home Accidents A considerable number of people continue to be followed up after home accidents. Our liaison with our local hospital has been good and for many years they had been sending us particulars of these monthly. Information was brief giving details of admission, discharge and transfer to other hospitals. Many elderly people were helped following their discharge and discussion on the prevention of avoiding further accidents was one of the health visitor's aims. The local link with the hospital was made more difficult when all such reports went to Chelmsford for information, with the ultimate object of reducing the incidence of home accidents. Our former procedure was more efficient, and reports now come to us first, as an early visit may assist the person recovering from an accident. We continue preventive education against home accidents, taking part in all the RoSPA campaigns locally. Group discussionsin welfare centres were ideal, one health visitor doing this for three months at a time, taking such objects as "Dangerous Pills", "Safe Materials* and "Water Safety" etc. Hospital Discharges Information from hospitals outside the area vary; from hospitals dealing with children it is good and the Almoner always telephones if the matter is urgent. The health visitor visiting the local hospital ward knows of the discharges weekly. Geriatric Wards — notices here again vary from a detailed report by the Almoner to a slip of paper which requests the health visitor to visit and she does so, not even being aware of the patient's illness. This sometimes can lead to confusion and unnecessary overlapping. General Hospitals — unless the patient has an urgent problem or is likely to require considerable care and relatives need support we are not likely to hear of these. I feel, however, that we do know of such very ill or helpless cases usually where hoists, walking aids, laundry service and other facilities come within our province. 79 General Practitioner and Health Visitor One health visitor continues to work twice-monthly with a general practitioner, one session for mothers and babies and another teaching mothercraft to expectant mothers. I am sure the people covered benefit from this combined service. Other general practitioners continue to telephone for assistance via the Public Health Department. Health Education Apart from our campaigns mentioned, our health education efforts continue as last year. The three mothers' clubs are kept going by the efforts of the health visitors. The seven mothercraft and relaxation sessions could I am sure be much better attended. Careers Exhibition and Training of other Students The above exhibition was held in the Town Hall and health visitors assisted the hospital stands. A tree of professions in the nursing world took pride of place and health visiting leaflets were displayed. Any opportunity given to increase suitable candidates to the profession is worth while. Many of the school children visiting the stands knew the health visitor and questions were varied. We continue to train student health visitors, student nurses and other social workers. Tuberculosis Visiting The work of our three tuberculosis visitors has been changing slightly and follow-up of cases of lung cancer now need their attention. The liaison with the nearest chest hospital has improved and visits made to reassure patients worried about home difficulties or to persuade them to accept their treatment have been helpful." At the end of theyear therewerel9 full-time and5 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 1961 as far as Part III Services are concemed:- First visits to newly-born infants 2,505 Subsequent visits to children under 1 year of age6,732 Subsequent visits to children over 1 year of age and under 514,878 Visits to expectant mothers 1,098 Home visits for other reasons (inc. 1,247 visits to old folk) 3,798 Total visits paid 29,011 80 In addition there were 5.833 visits paid where no reply was received. At the request of the Director of the Public Health Laboratory at the Chelmsford and Essex Hospital, assistance has been given in a survey, which has been carried out in selected areas throughout the Country, to determine the intestinal carriage of poliomyelitis, other viruses and food poisoning organisms in young children. The survey was commenced in Ilford in July 1961, with the object of covering over a period of a year about 1,000 children under the age of five years, some 20 children being selected at random in specified age groups each week. A letter sent to the parents explaining the nature of the survey and seeking their cooperation has been followed by a visit from the health visitor and those parents who have agreed to take part have themselves posted to the laboratory a specimen of the child's faeces. The excellent response has been very gratifying and in the six months ended the 31st December 1961, of 505 families contacted by the health visitors 494 had agreed to participate and a total of 459 specimens had been received at the Laboratory. DAY NURSERIES (a) The hours of opening at the two nurseries during 1961 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 10/6d. per child per day. Provision is made for this charge to 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 1961:- 81 Situation Accommodation (Children) Average daily attendance daring 1961 No. of days "In Quarantine" Reasons for "Quarantine" with Number of Cases No. on Waiting List at 31st Dec. 1961 Chicken Pox Mumps Measles Goodmayes Lane, Goodmayes 50 43 54 12 5 13 (Opened 14.11.51 replaced Green Lane Nnrsery, open from 5.5.43 to 9.11.51) 226-236, Ley Street, Ilford 50 40 101 6 1 6 18 (Opened 16.8.43) 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. Certain conditions are laid down to safeguard the welfare of the children received and one of the most recently introduced requirements, as part of the precautions against exposure to infectious diseases, is that all persons to be engaged in caring for the children concerned shall have satisfactorily passed, within the two preceding years, an X-ray examination of the chest and shall thereafter submit themselves annually to such examination. All persons already on the registers were invited to take similar action, so far as concerned themselves and any persons engaged by them to care for the children, and all agreed to comply. The following shows the position regarding registrations under the Act:- 82  (a) (b) Premises Child-minders Number on register at 31.12.60 7 5 Number registered during 1961 7 3 Number removed from register during 1961 1 3 Number on register at31.12.61 13 5 Number of children provided for at 31.12.61 403 28 The premises referred to in (a) above as removed from the register, were closed by the person in charge as she no longer wished to receive children therein. The 3 child-minders whose names were removed from the register (see (b) above)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 throughout 1961 for their sessions on every Monday evening, a charge being made to them to cover the cost of heating, lighting, cleaning and caretaking. INFANT WELFARE CENTRES. - 90 voluntary lady helpers were engaged in the work at the infant welfare centres at the end of December, 1961. During the year a letter was sent to each voluntary helper advising her that all persons working amongst young children should, as a precautionary measure, have an annual chest X-ray and inviting her to attend the Mass X-ray Unit at the Thompson Rooms, Ilford. The response was excellent. In view of the heavy attendances at the Wednesday afternoon centres at the Kenwood Gardens and Heathcote Avenue Clinics, an additional session was arranged at each of these premises, viz. on Friday mornings at the Kenwood Gardens Clinic, commencing on the 6th January, 1961, and on Wednesday mornings at the Heathcote Avenue Clinic, as from the 28th June, 1961. During the year 1961 the following attendances were recorded:- 83 Total number of attendances of infants 41,730 First attendances 2,401 Attendances of children from 1 to 5 years 9,934 Total number of children on roll on 31/12/61 after omission of all those who had not attended for six months 4,287 The following is a comparison of the attendances at the infant welfare centres for the past five years:- Year Total No. of attendances of Infants First attendances Total No. of children on roll on 31st December 1961 41,730 2,401 4,287 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 3,976 834 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 Chadwell 48 58 Becontree 48 56 Downshall 48 59 Manford Way 48 39 Kenwood Gardens (Wednesdays) 48 64 Kenwood Gardens (Friday mornings) (from 6/1/61) 48 19 Seven Kings 48 65 Grosvenor Road 47 50 Heathcote Avenue (Wednesday mornings) (from 28/6/61) 25 14 Heathcote Avenue (Wednesday afternoons) 48 57 Cecil Hall (Wednesdays) 47 47 Cecil Hall (Thursdays) 47 41 Newbury Hall 47 58 Marks Gate 48 38 Goodmayes 48 51 Hford Lane 46 49 Fairlop 47 60 The Drive 48 52 84 TODDLERS' CLINIC. — Dr. J.M. Pooley reports as follows with regard to the Toddlers'Clinic, which is held at theKenwood Garden Clinic:- "During 1961, unfortunately it was only possible to hold 8 toddler clinic sessions; this was due to pressure of other clinics and to illness. However, the clinic was keenly attended and the sessions are now being held on every third Wednesday morning. The mothers are interested and co-operative, and the clinic is proving extremely valuable in detecting speech, visual and minor orthopaedic defects which would not otherwise be dealt with until the child is of school age. The sessions, attendances and referrals for the year were as follows:- Sessions held 8 First attendances 63 Follow-up attendances 49 Referrals to other clinics 16 Referrals to hospital 1 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 may be prevented. The arrangements 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 have continued. The test is a simple one and is carried outbythe health visitors. Thefollowing are the statistics with regard to this testing in the year 1961. (i) Number of children tested:- (a) Where specimen of urine obtained at clinic 1,258 (b) Where specimen of urine obtained at home 734 1,992 (ii) Number of children tested (included in (i) above) because of suspected mental backwardness Nil (iii) Number of tests which resulted in a positive reaction Nil ORTHOPAEDIC CLINIC. - The following table summarises the attendances of children under 5 years during 1961:- 85 Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 43 88 98 307 Mayesbrook 23 34 38 115 Manford Way 7 3 7 11 Totals 73 125 143 433 The 268 children were found by the Orthopaedic Surgeon to have the following defects:- Diagnosis New Cases Old Cases A B C A B C Spastic Paresis 1 - - - - - Deformity of Hips 1 1 — — — — Genu Valgum 33 17 — 39 10 2 Pes Valgo-Planus 3 1 _ 3 _ _ Valgus Ankles 11 2 1 16 6 3 Congenital Talipes E.V 9 1 — 3 _ — Intoeing 12 2 - 7 7 _ Deformity of Toes 2 6 1 7 3 _ Scoliosis _ _ _ 3 _ Metatarsal Varus 2 _ _ _ Out- Curvature Tibiae __ _ _ _ 2 _ Genu Varum _ _ 1 Deformity of Foot _ _ _ 3 _ Hemiplegia _ 1 _ _ _ Postural Defect 1 _ 6 Torticollis 2 _ Kyphosis 1 _ _ 11 9 2 Other conditions 12 1 1 - - - Totals 88 34 3 98 38 7 A — Kenwood Gardens B — Mayesbrook C — Manford Way 12 pairs of valgus insoles, 7 G.V. night splints and 85 wedges to shoes were supplied during 1961. In addition 1 repair to surgical shoes and 2 repairs to splints were undertaken. The Physiotherapist treated 53 children under 5 at Kenwood Gardens Clinic, 38 at Mayesbrook Clinic and 2 at Manford Way, with attendances of 528, 285 and 12 respectively. PAEDIATRIC CLINIC. —Dr. A. Russell, the Consultant Paediatrician continued to attend this Clinic at Kenwood Gardens Clinic during 1961. 28 sessions were held and 114 new cases were examined, having been referred from the infant welfare centres, schools and the Ilford Maternity Hospital for the reasons set out in the following table; a total of 274 attendances were made. 86 Diagnosis Discharged Improved Discharged with advice or for other reasons Discharged No treatment Cared Referred Hospital, Doctor or Clinic Still Attending Total Amentia _ _ _ _ 1 - l Asphyxia Neonatorum — — — - 1 - l Blue Spot - - 1 - - - 1 Bronchospasm - - - - - 1 l Cardiac Murmur 2 3 - - 1 - 6 Cephalhaematoma 1 - 2 - - - Choroidal Atrophy - - - - - 1 1 Cleft Palate — — — - 2 - Congenital Megacephaly - - 1 - - 3 4 Corneal Opacity - - - - 1 - 1 Cryptorchidism - - 1 - - - 1 Cyst - - - - 1 - 1 Deaf Mutism - - - - - 1 1 Ectopic Testis - - - - 1 - 1 Epulis — - - - I - 1 Enuresis — - - - 1 1 2 Erbs Palsy - - - - - 1 1 Facial Palsy - - - - - 1 1 Feeding problems 2 8 1 - - 3 14 Fibrocystic disease - - - - - 1 1 Haemangioma 1 - - - - - 1 Hernia — — - - 2 1 3 Hydrocele 1 1 1 - - - 3 Hypospadias - - 1 - 3 - 4 Jaundice - - - - - 1 1 Malrotation of Midgut - - - - - 1 1 Migraine - 1 - - - - 1 Mongolism - - - - - 1 1 Muscular Dystrophy - - - - 1 - 1 25 No abnormality discovered — 8 13 - - 4 Naevi - — 1 - - 1 2 Obesity - - - - - 1 1 Overlapping toes - - - - - 1 1 Pilonidal dimple - - 2 - - - 2 Plagiocephaly - - 1 - - - 1 Ptosis 1 — — - - - 1 Pyloric Stenosis - — - - 1 - 1 Prematurity - - - - - 1 1 Respiratory Infection 1 - - - - - 1 Scalp Keloid - - 1 - - — 1 Stemo-Mastoid Tumor 1 - - 1 - 1 3 Stress Diarrhoea — — — - - 1 I Sub-Periosteal Haematoma 1 — — - - - 1 Supernumerary Digit - - - - 3 - 3 Talipes - 2 - - - — 2 Under observation - — 1 - 1 4 6 Totals U 23 27 1 21 31 114 87 Special cases are followed-up over a long period, re-attending the clinic for examination periodically, and in cases where special treatment or investigation is required admission is arranged to the Consultant Paediatrician's hospital units. OPHTHALMIC CLINICS. — Attendances of children under school age for treatment by the Ophthalmologists during 1961 were as follows:- Kenwood Gardens Clinic Mayesbrook Clinic Manford Way Clinic Total Number of children who attended 57 64 8 129 Number of pairs of spectacles prescribed 11 21 1 33 Total number of attendances made 88 134 12 234 EAR NOSE AND THROAT CLINIC. - The E.N.T. Surgeon attended at 50 sessions during 1961. There were 20 new cases commenced, and a total of 34 attendances were made by children of pre-school age. Operations were performed on two children, one at King George Hospital and one at Chadwell Heath Hospital. ARTIFICIAL SUNLIGHT CLINIC. - The following table summaries the attendances of children under 5 years:- Clinic Sessions New Cases Old Cases Attendances Discharged Cured Much Improved Left District etc. Kenwood Gardens 44 1 _ 2 1 - _ Mayesbrook 43 2 3 11 1 - - Totals 87 3 3 13 2 - - The conditions treated were anaemia, debility, malnutrition and catarrh. SPEECH CLINIC. — 43 children of pre-school age attended, making 569 attendances. The following is the classification of the defects found hy the speech therapist:- Dyslalia 16 Stammering 4 Retarded speech and language 17 Others 3 In three cases it was found that no treatment was required. 88 VACCINATION AND IMMUNISATION. _ In the autumn of 1961 the County Council approved revised arrangements forvarcination and immunisation in accordance with advice given to the Minister of Health by the Standing Medical Advisory Committee. These provide for a programme throughout childhood involving smallpox and poliomyelitis vaccination and immunisation by the use of combined antigens against diphtheria, whooping cough and tetanus, with appropriate reinforcing doses. The provision of facilities for immunisation against tetanus to all residents in the Administrative County was approved in principle, but for the time being this form of immunisation is limited to children up to school leaving age. Immunisation against Diphtheria, Whooping Cough and Tetanus. Regular sessions for immunisation, combined with the school clinics held for the treatment of minor ailments, were held throughout 1961 at the Kenwood Gardens and Mayesbrook Clinics, and at the ManfordWay, Newbury Hall, Marks Gate and Heathcote Avenue Clinics immunisation was undertaken at the infant welfare centre sessions. In addition, much of this work has, as previously, been carried out by general practitioners. Details of the immunisations carried out during the year 1961 are given in the following table:- Form of Immunisation Primary Courses Reinoculations Attendances at Clinics Diphtheria only: Kenwood Gardens Clinic 108 213 621 Mayesbrook Clinic 197 231 924 Infant Welfare Centres 263 82 962 Totals at Clinics 568 526 2,507 General Practitioners 1,204 1,524 - Totals 1,772 2,050 2,507 Whooping cough only: Kenwood Gardens Clinic 105 _ 314 Mayesbrook Clinic 184 _ 551 Infant Welfare Centres 250 9 803 Totals at Clinics 539 9 1,668 General Practitioners 790 125 - Totals 1,329 134 1,668 Tetanus only: General Practitioners 3 - - Diphtheria and whooping cough (combined) General Practitioners 941 497 - Diphtheria, whooping cough and tetanus (triple): Kenwood Gardens Clinic 1 - 1 General Practitioners 70 40 - Totals 71 40 1 89 For puiposes of comparison, the following summary shows the numbers of children inoculated and reinoculated over the past five years:- 1957 1958 1959 1960 1961 Diphtheria immunisation:- Primary courses 1,774 2,082 2,042 2,862 2,784 Reinoculations 1,140 1,696 1,192 2,019 2,587 Whooping cough immunisation':- Primary courses 1,641 1,798 1,692 2,074 2,341 Reinoculations 322 409 290 542 671 No. of live births in Ilford 2,219 2,228 2,216 2,512 2,533 (N.B. Where combined diphtheria and whooping cough antigens have been used, the figures have been included under both headings). 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 1961. As was mentioned last year, the scheme was further extended in May 1961 by the introduction of a reinforcing fourth injection for all children between the ages of 5 and 12 years and also those who were under 5 if they are attending school. Unfortunately later in the year the administration of this fourth injection had to be suspended owing to a shortage of vaccine, but I am glad to record that it was recommenced in April 1962. The general practitioners have continued to play an important part in the scheme and most of those practising in the Area are participating. During 1961 in addition to holding sessions at the various clinics, most 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 hy them. The statistics given over-page show the vaccinations carried out by our medical staff:- 90 Premises No. of Sessions First Injections given Fourth Second Third Kenwood Gardens Clinic 42 549 584 745 1,193 Mayesbrook Clinic 20 412 368 414 848 Manford Way Clinic 46 115 107 92 266 Newbury Mali 21 25 25 26 275 Marks Gate Clinic 27 50 45 19 33 Heathcote Avenue Clinic 27 150 123 110 248 Factories, etc 17 268 218 818 - Totals 200 1,569 1,470 2,224 2,863 The medical staff at the Village Homes, Barkingside, also curried out a total of 48 primary courses, 26 third injections, and 9 fourth injections. Record cards received in 1961 from general practitioners were as unde incompleted primary courses (two injections) 5,941 Third injections ("boosters") given 5,564 Fourth injections ("boosters") given 6,855 At the 31st December, 1961 a total of 56,858 primary courses had been completed in Ilford (36,648 children under 16 years, 9,663 persons aged 16 to 25 years, 8,061 persons aged 26 to 40 years and 2,486 general practitioners, ambulance staff, dentists, hospital and public health staff and their families, etc.). Towards the end of 1961 information was received that the Ministry of Health had decided on the use of Sabin (oral) vaccine and this became available early in 1962. Smallpox Vaccination. — During 1961 record cards were received from general practitioners and various hospitals as follows:- Children under 2 years of age:- No. primarily vaccinated 1,200 No. re-vaccinated 6 Others (including adults):- No. primarily vaccinated 424 No. re-vaccinated 640 In addition 150 children (142 under the age of two years and 8 over two years) were primarily vaccinated at the infant welfare centres at the Kenwood Gardens, Manford Way, Mayesbrook and Marks Gate Clinics. 91 The following table shows the figures over the past five years:- 1957 1958 1959 1960 1961 No. of primary vaccinations 2,169 1,714 1,529 1,646 1,774 No. of re-vaccinations 975 537 562 485 646 Totals 3,144 2,251 2,091 2,131, 2,420 No. of live births in Ilford 2,219 2,228 2,216 2,512 2,533 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 parttime midwives employed by the County Council), resident and practising in the district at the end of the year. In addition there were 25 State Certified midwives at the llford Maternity Hospital. Supervision of the midwives practising on the district, including regular inspections by the Medical Supervisor of Midwives, was carried out as in previous years, and general supervision, in accordance with the Rules of the Central Midwives Board, was exercised over the midwives practising at the Ilford Maternity Hospital. Suspension from Practice. — It was necessary in 1961 to require two domiciliary midwives to remain off duty, one for 15 days and the other for 10 days, to prevent the spread of infection. Medical Aid. — Medical aid was sought in two 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 603 cases were attended and a doctor was specially called in by the midwife to 78 of these. Of the infants bom there were 5 stillbirths. 92 Five deaths occurred of infants during the first year of life where the birth had been attended by a domiciliary midwife; in four of these the infant was under the age of ten days. During 1961 ante-natal clinics conducted by the domiciliary midwives were held weekly at the Kenwood Gardens and Mayesbrook Clinics, fortnightly at the Manford Way and Heathcote Avenue Clinics and twice a month at Marks Gate Clinic. 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 Kenwood Gardens Clinic 397 1,099 51 29 Mayesbrook Clinic 245 771 45 22 Manford Way Clinic 86 258 26 13 Heathcote Avenue Clinic 58 208 25 10 Marks Gate Clinic 44 163 23 9 Totals 830 2,499 170 20 In addition 2,871 home ante-natal visits were made during the year. The scheme continues whereby the doctor and the midwife have a consultation abouttheir patient on several occasions during the pregnancy. The examinations take place at the patient's home, the doctor's surgery or at the Local Health Authority's clinic, as mutually agreed, but in practice the joint consultation is held in the majority of cases in the doctor's surgery. The Ilford Borough Council continued to provide housing accommodation, where necessary, for midwives employed in the service of the Ilford Health Area Sub-Committee. At the 31st December 1961, one maisonette and two flats were being rented by the County Council from the Borough Council under this arrangement. During 1961, the domiciliary midwives continued to assist in the training of pupil midwives from the Thorpe Coombe Maternity Hospital, Walthamstow; nine of the whole-time midwives have been approved by the Central Midwives Board as teaching district midwives. The arrangements are for six or seven pupils to come to Ilford at a time for a period ofthree months, accommodation being provided in one of the local hospitals or tn a private house. 20 pupil midwives completed their district training in the Area during 1961 and 6 were still undertaking this training at the 31st December. 93 Salvation Army Midwifery Service.—One Salvation Army midwife, with a further midwife assisting her as required, served in Ilford during the year, 56 cases were attended by them and a doctor was called in to 26 of these. Of the infants born there were no stillbirths. One death occurred of an infant where the birth had been attended by a Salvation Army midwife, the age of the infant being one day. Gas and Air Analgesia.—During 1961 gas and air analgesia was administered in 569 cases (538 attended by the domiciliary midwives and 31 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 qualified. Arrangements continued in operation for each of the midwives using cars in the course of their duties 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, or failing this, by an ambulance vehicle. The Salvation Army midwives also have two machines which are kept at their Branch Home and taken or sent to the home of the patientwhen required. The service is freely available to all having home confinements, provided there are no medical contra-indications, and each expectant mother on booking the midwife is supplied with a leaflet explaining the nature and the availability of the service. ANTE-NATAL CLINICS. — The following is a summary of the attendance at the ante-natal clinics during 1961 for patients booked for confinement in hospital:- 94  Mater nity Hospital Mayesbrook Clinic Manford Way Clinic Doctors Midwives First attendances 908 - 246 125 Subsequent attendances 3,908 3,403 2,316 889 Totals 4,816 3,403 2,562 1,014 Number of sessions 304 256* 128 54 Average attendance at each session 16 13 20 19 *Includes 205 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 1961 there were 96 sessions at the Mayesbrook Clinic, with 603 attendances, and 97 sessions at Manford Way Clinic, with 656 attendances. A weekly session was also run by Health Visitors at Kenwood Gardens Clinic, 44 sessions being held in the year, with 312 attendances, and at Heathcote Avenue Clinic there were 45 sessions, with 365 attendances. At Cecil Hall the Health Visitors commenced a weekly class in June and held a total of 16 sessions during 1961, with 88 attendances. Relaxation exercises classes are in addition held by the staff of the Ilford Maternity Hospital for patients attending the ante-natal clinic there. POST-NATAL CLINICS. - All patients confined in the Ilford Maternity Hospital and other patients on request are invited to attend a postnatal clinic for the first time approximately six weeks after confinement. During 1961 clinics were held at the Maternity Hospital weekly, at Mayesbrook Clinic fortnightly, and at Manford Way Clinic monthly. The following attendances were recorded:- 95  Maternity Hospital Mayesbrook Clinic Manford Way Clinic First attendances 754 221 82 Subsequent attendances 143 79 7 Totals 897 300 89 Number of sessions 52 27 12 Average attendance at each session 17 11 7 CONSULTANT CLINIC. — There were two Consulting Obstetricians in 1961 who each held a weekly clinic for ante-natal and post-natal cases. During the year 104 sessions were held and a total of 2,044 examinations were made. MATERNAL MORTALITY. — During 1961 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 hospital. DOMESTIC HELP SERVICE. - During 1961 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 3 full-time, 126 regularly-employed parttime and 13 casual helps employed. Although every effort is made to accelerate recruitment of domestic helps, including periodic advertising of vacancies in the local press, it has not been possible to engage a sufficient number to provide all the service required, but the organisers ensure that the helps available are employed to the best possible advantage to give some assistance to every case requiring it; this can only be achieved by allocating most of the helps to two or three cases in a day. The following is a summary of the cases dealt with in 1961:- Number of applications received for assistance 1,564 Number of cases where domestic helps were provided (including 854 who were having service at the commencement of the year) 2,059 Number of cases which on investigation were either not eligible for assistance or did not require the service 142 Cases booked but subsequently cancelled 98 96 Number of cases where, at the end of the year, a domestic help was booked to attend in future months (maternity cases) 83 Other cases awaiting help at end of year 22 Enquiries incomplete at end of year 14 Cases being served at 31st December, 1961 898 During 1961 the County Council approved the provision of free domestic help service in all cases where a doctor certifies an expectant mother as suffering from toxaemia of pregnancy and such assistance is medically necessary. Although no cases were dealt with under this scheme during that year, this facility has been utilised in 1962. One training course, of two weeks' duration, was held by the County Council at Chelmsford in 1961. One domestic help from Ilford attended and she was found to be entirely satisfactory. NIGHT ATTENDANCE SERVICE. — The service 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, has continued. 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. Details during 1961 are as follows:- Number of applications received for assistance 55 Number of cases where night attendants were provided 38 Number of cases which on investigation were either not eligible for assistance or did not require the service 16 Number of cases awaiting help at end of year 1 Number of cases being served at 31st December, 1961 Total number of hours for which attendants were provided 2,216 Number of attendants on panel at 31st December, 1961 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 97 agreed payments to the Association, has continued. 3 cases were dealt with under this arrangement during 1961, the details being as follows:- No. of cases being attended at 31.12.60 Nil No. of new cases attended during 1961 3 No. of cases discontinued during 1961 3 No. of cases being attended at 31.12.61 Nil Total number of attendances given:- (a) whole days 13 (b) half days 5 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. The one family, consisting of mother, father and four children admitted to the Rehabilitation Unit at Dr. Barnardo's Homes, Barkingside, on the 3rd August 1960, under the County Council's scheme, was discharged on the 31st July, 1961, after having made very good progress. Accommodation was then provided for them by the County Welfare Officer in a hostel, pending rehousing. CONVALESCENT FACILITIES.-The following tables show the number of persons sent away for recuperative holidays during 1961:- (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 Roland House, Littlehampton 2 4 2 unaccompanied children Lennox House, Southsea 1 2 Mother and baby Church Army Home, Bexhill 1 2 Mother and baby Castlehurst Residential Nursery, Whitstable 1 2 Unaccompanied child Mrs. McNeil's Home, Henfield 1 4 Unaccompanied child St. Helen's Convalescent Home, Letchworth 1 3 Unaccompanied child St. Edith's Centre, Leigh-on-Sea 2 3 2 mothers and babies Totals 9 27 5 unaccompanied children 4 mothers and babies 98 (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 14 8 22 Caxton Convalescent Home, Limpsfield 4 - 4 Miss Clark's Home, Brighton 1 - 1 Donkey Club Holiday Home, Lancing 2 - 2 Grange Farm Holiday Centre, Chigwell 1 - 1 The Holiday Home, Bournemouth 1 - 1 John Beech Home, Chingford 1 - 1 Mildmay Convalescent Home, Worthing 6 - 6 Rustington Convalescent Home, Littlehampton 2 2 4 Samuel Lewis Convalescent Home, Walton-on-Naze 10 - 10 St. Michael's Convalescent Home, Clacton 9 3 12 Shoreditch Convalescent Home, Copthorne 3 - 3 Mrs. Stiffell's Home, Clacton 2 - 2 Wooburn Guest House, Thorpe Bay 4* - 4 Totals 60 13 73 *One patient stayed one week only, although arrangements had been made for two weeks. A standard charge of £3.18s.2d. per week is made, but this is subject to reduction, according to scale, in necessitous cases. Travel vouchers are issued in cases where the payment of fares would cause hardship. 99 LOAN OF SICK ROOM EQUIPMENT. - The considerable demand for equipment continues and the following table shows the issues from the Public Health Offices during 1961:- Articles Loaned Number of Articles Articles in store at 31.12.61 on loan at 31.12.60 loaned or reloaned in 1961 on loan at 31.12.61 Mattress (Dunlopillo) 14 12 18 1 Mattress (Hair) 1 1 2 - Invalid Chairs 59 71 66 6 Air Pillows - 1 1 - Air Rings 57 145 56 48 Cushious (Dunlopillo) 12 18 12 2 Back Rests 79 216 104 3 Beds 5 7 9 5 Commodes 57 61 71 2 Crutches 7 12 11 10 Fracture Boards 4 2 6 - Pillows 5 4 5 4 Pillow Slips - - - 1* Rubber or Plastic Sheeting 141 245 148 10 Medical Sandbags 1 1 1 - Bed Cradles 21 46 39 5 Air Beds - 1 - 5 Bed Pans 90 216 104 35 Diabetic Scales 3 1 4 - Feeding Cops 2 22 3 11 Urinal 39 68 43 25 Sputum Mug 2 - 2 3 Douche Cans 1 1 2 - Water Beds - - - 1 Water Pillows - - - 1 Bed Blocks 1 - 1 1 Bowls - 1 - 2 Bedstead Sides (Pair) - - 1 1 Lilting Pole and Chain 10 11 11 - Kidney Dishes 1 3 1 1 Commode Sorbo Cushions - 1 1 - Rubber Toilet Seats 3 1 2 - Restraining Net 1 1 - 1 Bed Trays 1 2 1 1 Walking Aid 1 6 7 1 Hydraulic Hoist 1 2 2 - Slings 2 2 2 - Sierex Air Mattress 1 4 1 - Totals 622 1,186 736 186 1960 Details 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 Detail 519 1,158 555 180 1955 Detail 538 1,117 519 161 1954 Details 320 975 538 99 1953 Details 161 698 320 54 1952 Detail 86 326 161 66 1951 Details 27 162 86 30 *Provided through special funds. 100 In June, 1961, the Health Committee of the County Council authorised the issue of draw sheets on loan to incontinent persons and also the issue of disposable pads to such persons being nursed at home. 20 draw sheets were loaned in 1961, 14 being on loan at the 31st December, and 516 disposable pads were issued. Alarms and pads were also purchased for loan to children attending the Enuresis Clinic. One alarm was loaned during 1961, being still on loan at the end of the year, and 14 pads were issued. CHIROPODY SERVICE. — This service continued during 1961 with two full-time chiropodists and two part-time(one undertaking five sessions per week and the other three sessions per week). Although authority has now been given for the employment of four full-time chiropodists, regular advertising has not yet resulted in a further appointment being made. The main chiropody clinic, with two chairs, is held at Newbury Hall, and in addition sessions are held at each of the health services clinics. One chiropodist regularly visits the two Welfare Committee residential establishments in the Area and also undertakes domiciliary visits to patients unable to travel, even by ambulance, to a chiropody clinic. Owing to the restricted accommodation at the Mayesbrook Clinic, the second dental surgery had been used as a chiropody clinic for a limited number of sessions, but with an improvement in the recruitment of dental officers it was necessary to make other arrangements. No accommodation was available on the ground floor and approval was therefore obtained for certain alterations to be carried out on the first floor of the clinic to provide a chiropody surgery with its own small waiting room. The work was completed in July 1961. Treatment is given only to those patients in the priority groups, i.e. the elderly, the physically handicapped and expectant mothers, although it is intended that the service will be extended to others when circumstances permit. The standard charge is 2/6d. per week, provision being made for reduction or remission, according to scale, where the patient s means do not justify the full charge. The attendances during the year 1961 were as follows:- 101  No. of Sessions Attendances New Cases Re-attendances Newbury Hall 374 180 1,968 Kenwood Gardens Clinic 335 161 1,714 Manford Way Clinic 111 72 605 Mayesbrook Clinic 234 140 1,122 Heathcote Avenue Clinic 36 21 211 Welfare Establishments 26 41 305 Domiciliary Visits 38 64 42 Totals 1,154 679 5,967 TUBERCULOSIS VISITORS. — The 3 Tuberculosis Visitors made a total of 2,417 home visits. DOMICILIARY OCCUPATIONAL THERAPY. - The Domiciliary Occupational Therapist, who undertakes part-time duty in Ilford, has submitted the following report:- It has been said of tuberculous patients that "Nature heals and the patient helps by securing rest, fresh air, proper and sufficient food and by maintaining a saguine and tranquil state of mind". All these, with the exception of the last, the patient secures on entering a sanatorium and it is to produce the "sanguine and tranquil state of mind" that occupational therapy has been introduced as a part of treatment. For the patient who is discharged from hospital, it has been found that the long months of treatment have combined with the disease to unfit the patient for an abrupt resumption of a normal pattern of living. All his functions and habits are keyed to an inactive existence. Among the many facilities for tuberculosis which are provided by the County Council are the domiciliary occupational therapy arrangements. This service has been in operation for some years. The patients are recommended for domiciliary occupational therapy by chest physicians with close co-operation by the tuberculosis visitors. At present there is one full-time occupational therapist employed to carry out this work. The areas covered by this scheme, viz. Dagenham, Barking, Ilford, Romford, Homchurch, Forest and Grays, 102 are visited for part of one day in each week. The visits to new patients are made weekly at first, then fortnightly and finally, monthly. In view of the fact that there is only one occupational therapist for these areas it will be appreciated that only those patients who need occupational therapy as a treatment can be visited. There could be a tendency to treat this service as a source of supply of cheap materials from a mobile shop to the detriment of the service, which is a valuable form of treatment for patients suffering from diseases of long duration. The materials provided are paid for by the patient who is also loaned any equipment required to carry out the chosen occupation. Completed work is sold when possible and some patients make items for their home or for personal use. At the Dagenham Town Show each year a large variety of handmade articles are sold, followed by a Sale of Work organised by the local Tuberculosis Care Association. Some of the patients enter stimulating and competitive work with good results — this year at the Dagenham Town Show there were 3 firsts, 3 seconds, 3 thirds and 2 Very Highly Commendeds gained out of twenty entries submitted for various classes. Similar success was gained at the Essex Old People's Welfare Committee's Exhibition at Woodford Green, five out of six entries gaining prizes. Many sales are made from a show case at 15/17, Thompson Road, Dagenham, where the Occupational Therapist has an office and store-room. Some of the occupations undertaken by patients in 1961 were printing, bookbinding, leatherwork, basketry, needlework, puppets, rug-making. Two patients have worked on rehabilitation courses with good results. From the foregoing it will be seen that occupational therapy encourages new interests and keeps the patient in the habit of work in order to prepare him for normal work." The following visits were undertaken in Ilford during 1961:- Number of visits to new patients 11 Number of revisits to patients 187 Number of other visits (to Chest Clinics, etc.) 61 103 REHABILITATION OF TUBERCULOSIS CASES. - No cases required assistance in the maintenance charges at a rehabilitation settlement during 1961. OPEN-AIR SHELTERS FOR TUBERCULOSIS CASES. - One openair shelter supplied for a tuberculosis patient during 1958, continued in use throughout 1961. 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 1961. Particulars of the grants made in 1961 are given below:- No. of cases in receipt of free milk at 31.12.60 97 No. of new grants made during 1961 46 No. of grants discontinued during 1961 47 No. of cases in receipt of free milk at 31.12.61 96 BOARDING-OUT OF CHILDREN (TUBERCULOSIS CONTACTS). No applications were received in 1961 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 1961. 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) 31 190 (including renewals) Other grants (Christmas cash gifts, clothing, etc.) 66 66 104 TRAVELLING EXPENSES OF RELATIVES VISITING HOSPITAL PATIENTS. — As in previous years, the County Medical Officer was able to give financial assistance in 1961 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 1961:- Entrants to County Council Service 43 Other purposes 15 For other Authorities 7 HOME NURSING. — The home nursing service in Ilford is undertaken by nurses under the supervision of the Superintendent of the Lady Rayleigh Training Home at Leytonstone but operating from the Branch Home "Abury House" in Aldborough Road, Ilford. The work undertaken by home nurses in the Ilford area in 1961 was as follows:- Cases attended 1,865 Visits paid 55,527 HEALTH EDUCATION. — Dr. G.B. Taylor, Assistant County Medical Officer, reports:- "The most important development over the past year has been the report from the Royal College of Physicians on the effects of smoking and cancer. Medically speaking there is nothing new in this report. In Ilford we had been concerned with this problem and had been tackling it long before such report ever came out. The over-riding importance of an official report such as this is that it does give to the public the considered opinions of the most eminent Medical authorities in the land. This report carried very weighty views and it would seem that few members of the public are now unaware of the association between smoking and cancer. The problems of this epidemic are novel. The epidemic cannot be tackled in the classical manner by cutting off the offending cause at its source. If we had a typhoid epidemic in Ilford we could trace the typhoid germ to its source, which may for instance be a faulty water supply, and get rid of the typhoid epidemic by purifying the water. But in this cancer epidemic it is impossible to treat the 105 source by stopping importation of tobacco, and it is impossible to stop people smoking because this would encroach too much on personal choice. We are therefore reduced to health education, and it appears there is very little else we can do in tackling this epidemic. Over the past year I have visited the following organisations:- Teachers at Real Grammar School Teachers at Mayfield Boys' School Teachers at Downshall School Scholars at Downshall School Mothers' Club, St. Francis Church Toe H (Women's) — on two occasions Insurance Institute of Ilford Seven Kings Youth Club — on two occasions The Glenyou Club Ashurst Drive Baptist Youth Barkingside Methodist Youth Club Claybury Park Baptist Men's Club Sans Egal Swimming Club Welsh Club Goodmayes Round Table Soroptomists Men's Fellowship, High Road Baptist The Vinesmen Society of Cogitators Claybury Park Baptist Youth Club Toe H (Barkingside) Head Teachers Conference (at Beal School) St. Francis Youth Club Inner Wheel Club British Legion Chadwell Heath Ratepayers Rotary Club The number I lectured to was 870 and this represents a fair cross section of the Ilford community, ranging from Youth Clubs to Rotary Clubs. The lectures given were illustrated and I showed chest X-rays of people who suffer from chest disease. The Registrar General's figures for the increase in the cancer rate were also included. In these lectures I was only concerned in giving the facts. After that my responsibility finishes and it is then up to people themselves to decide on the facts and consequent action they propose to take. 106 About three months after the lectures I sent questionnaires to the people concerned in order to find out what effect the lectures had had. I felt that it was no good giving questionnaires immediately after the lecture because people are usually influenced for a short time, but the real assessment is what their reactions are some months later. I found from the questionnaires that — (a) the majority of people believed in the association between smoking and cancer, (b) in spite of this not all would like to give it up, (c) those who said they would like to give it up found that they could not because of the tendency for cigarette smoking to produce habit formation. (d) These results were common to all the social classes in Ilford. It seems therefore that health education in and of itself is of very little use when directed towards people who have already acquired the habit of cigarette smoking. If we are to stop this habit we need to use medical means such as the creation of a smokers' clinic rather than educational means. Whether these clinics would be effective in breaking the habit is open to question but at least this appears to be the next step to take. It must be realised that I did this survey before the report of the Royal College of Physicians came out. The report has been very well publicised through the mass media of newspapers and television and it may have had some effect in reducing cigarette smoking. The only factual evidence of this is that I have made enquiries at several Ilford tobacconists who say that the number of cigarettes they are now selling is less than it was before the report came out. From all this there are two future approaches to the cancer problem:- (1) The creation of clinics (2) Continuation of health education in the schools to try to vent the habit being acquired. There is a long-term survey about to start in four schools in Ilford in September of this year. We shall know nothing from this survey for 4 or 5 years. 107 Local authorities, on their own premises, should give a lead on this matter of the prohibition of smoking. The other point in chest disease, the question of atmospheric pollution is simpler to tackle. Here legislation can be made and and individuals are bound to conform. We are in the process of creating smokeless zones in Ilford over the next few years, and when this has been accomplished a potential source of diseases of the chest will have been eradicated. The creation of a smokeless zone by legislation shows how much easier it is to tackle some health problems by legislation than by exhortation." During 1961, apart from the 29 lectures on "Smoking and Cancer" referred to in Dr. Taylor's report ante, 80 lectures on various other Health Subjects were given by him, myself, members of the health visiting staff and the domestic help oragnisers to schools, professional organisations, youth groups and general adult groups, the total attendances being approximately 3,750. In addition 298 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. Posters covering varied aspects of Health were displayed at the Public Health Offices and the health services clinics throughout the year. DENTAL TREATMENT. — Mr. E.V. Haigh, the Senior Dental Officer, has submitted the following report:- "Dentai facilities for expectant, nursing mothers and children under five years old continued at Mayesbrook Clinic and Kenwood Gardens Clinic. The patients were referred from the ante-natal, post-natal, or infant welfare clinics. It is noticeable that the dental health of the expectant and nursing mothers has generally improved over the past few years. Less patients are being referred to, or asking for, treatment at the clinic with grossly neglected mouths requiring many or all teeth extracted. This I am sure is due to the fact that they are receiving more regular dental treatment and examinations by private practicioners. This, however, does not apply to children under five because many private dental surgeons do not wish to treat small children and so their parents request or are referred by the welfare clinics to me. The number of children under school age made dentally fit increased by 30% during 1961. 108 Conservative treatment which consists of fillings, sealings and gum treatment was carried out whenever possible in order to save as many teeth as possible. When however extractions were required these were done under local or general anaesthesia. If a general anaesthetic was used a medical officer was always present to administer it. Most patients prefer a general anaesthetic if they have more than one or two teeth to be extracted and unless there was some medical contra-indication the patient had the choice. I continued with one evening session per week at Mayesbrook Clinic. The evening sessions, from 5.15 to 8.15 p.m. are very popular with the expectant and nursing mothers because many 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 easier to treat. Dental X-ray facilities are available at all clinics in the Area. This can often save the mother's time and pain by a quicker diagnosis. Partial and full dentures were supplied to patients who needed them. These are made at a local dental laboratory, an arrangement which has been in operation for many years and is satisfactory. During 1960 and 1961 high-speed Borden Airotors for fillings have been installed at clinics in Ilford and these are proving to be a great asset in faster cavity preparation and causing less pain to the patient." The number of cases treated at the Clinics during 1961 was as follows:- New Cases Made Dentally Fit Total Attendances Examined Needing Treatment Expectant and nursing mothers:- (a) Day Sessions:- Mayesbrook 38 38 47 181 Kenwood Gardens 88 87 56 178 (b) Evening Sessions:- Mayesbrook 57 57 62 301 Children under 5:- Mayesbrook 69 69 74 173 Kenwood Gardens 127 117 112 168 109 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 238 13 47 76 51 - 45 2 10 7 Kenwood Gardens 36 29 1 128 37 - 28 5 6 6 (b) Evening Sessions:- Mayesbrook 62 40 - 216 156 2 53 3 12 2 Children under 5:- Mayesbrook 156 - 62 235 2 - 27 - - - Kenwood Gardens - - - 225 - - 21 2 - - In addition there were 282 prophylactic treatments and other operations carried out in the case of expectant and nursing mothers at day sessions (185 at Mayesbrook and 97 at Kenwood Gardens) and 239 at evening sessions (at Mayesbrook). The total number of sessions held for expectant and nursing mothers and children under five years of age was 124½, 79½ during the day (42½ at Mayesbrook and 37 at Kenwood Gardens) and 45 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. As was reported last year, the High Road Methodist Church premises were closed at the end of March 1961 when the new Methodist Church in Ilford Lane was completed. 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 until June 1962, when the Friday morning and afternoon sessions were discontinued in view of the decline in attendances. 110 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 decline in the number of issues of these items since these charges came into operation, but this has been largely offset by the take-up of other vitamin preparations. From enquiries made there appears to be no evidence of any vitamin deficiency in Ilford children. 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,11 ford. Saturday 9.30 a.m. -12 noon (b) Branch Centre Methodist Church Hall, Tuesday (9.15 a.m. - 1 p.m. Ilford Lane (entrance in (2 p.m. - 3.15 p.m. Britannia Road), Ilford. Saturday 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. 111 SCHOOL HEALTH SERVICE SCHOOL ROLL AND PREMISES. - There are 40 schools with 66 departments. The number of children on the school roll of Primary and Secondary Schools in Ilford on 20th December, 1961, was 22,913 which figure includes Barking Abbey (457). In addition there were 103 children attending the special schools. MEDICAL INSPECTION AND FOLLOWING UP. During the year 5,063 periodic medical inspections were carried out and in addition, 775 special inspections and 1,778 re-inspections were undertaken. 3,440 parents or 67.9 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 Dupils at Elmbridge School were continued. STAFF. - On 3 1st March, 1961, Dr. Noordin resigned his appointment as a full-time Assistant County Medical Officer of Health. Dr. M. B. Gee was appointed in a parttime capacity and commenced six sessions weekly as from 1st. August, 1961. Dr. G. B. Taylor resigned his full-time appointment on 7th October, 1961, but remained on the staff In apart-time capacity, commencing six sessions weekly as from 9th October, 1961. By the end of the year our parttime dental staff had doubled its strength, both in numbers and sessions, and there were 8 part-time dentists undertaking 29 sessions, in addition to the full-time Area Dental Officer. As a consequence we were able to carry out school dental Inspections to the extent of 32% of the school roll as against what for many years has been 5 - 10%. Miss Radford, Psychiatric Social Worker at the Child Guidance Clinic, resigned her appointment on 15th January, 1961 and Miss M. D. Boyd, who was appointed to her vacancy, commenced duties on 29th September, 1961. 112 Miss LeSage, Physiotherapist at the Cerebral Palsy Unit, resigned on 5th August, 1961, to return home to her own country and Mrs. P. M. Colbert took over her duties on 4t h September, 1961. Mrs. W. Butterworth, who had been Resident School Nurse at Kenny lands Boarding School for many years , resigned on 29th March, 1961, on reaching retirement age. For many months the nursing situation at this school was acute, as they were without a regular nurse. It was not until 13th November, 1961, that Mrs. M. E. Vallance was appointed to the post. VISITS. - (a) The Public Health Inspectors made 1, 132 visits to maintained schools, (1) to enquire as to the milk supplies and (2) to inspect the sanitary arrangements. (b) School nurses made (i) 123 visits to schools (111 for general hygiene and 12for head inspections) when 17,071 individual children were examined and 17,463 actual examinations were made, (ii)2, 276 home visits in regard to treatment recommended, and (iii) 1,345 home visits to cases of minor infectious diseases. (c) I have continued my own regular visitsto 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. - In the IlfordSchools there was a rather extensive outbreak of measles which seemed to follow the usual biennial pattern. It was reported that in quite a few of the Infant Schools the percentage of school roll dropped to as low as 50%. The epidemic was at its height from February to May. During this same period there was a mild outbreak of mumps in some areas. At the Kennylands Boarding School we were beset with the usual difficulties. During the early part of the year there was a mild outbreak of Sonne dysentery which persisted 113 throughout the whole of the Easter Term. This of course once again placed great strain on the nursing staff and it was necessary to call on outside assistance. In October, 1961, the school had a slight epidemic of mumps, followed by chicken pox and German Measles, the latter bringing with it a rather disturbing virus infection. At this time the new Resident School Nurse, Mrs. Vallance, commenced duties but owing to the number of children falling sick it became necessary to turn one of the dormitories into a sick ward and to enlist the aid of the British Nurses Co-operative Association at Oxford for auxiliary nursing duties. The situation did not ease until the end of the term. CHIROPODY CLINICS. - Owing to the pressure on the chiropody clinics from the aged and physically handicapped, sanction has not yet been received for the scheme to include treatment for school children. MINOR AILMENT CLINICS. - The Minor Ailment clinics functioned as last year, a full session weekly being operated at both the Mayesbrook and Kenwood Gardens Clinics. In addition facilities were afforded for any urgent cases to consult the doctor at the immunisation clinics held weekly at Mayesbrook Clinic and the Kenwood Gardens Clinic. NEW AND ORIGINAL WORK. - During the year two interesting surveys were commenced, one on the Mental Sub-normality in Twins and Premature Children, and the other respecting Childhood Malignancies. Dr. Taylor commenced a series of lectures to small groups in Secondary Boys' Schools on the relevancy of smoking to lung cancer. He has also taken the opportunity during routine medical inspections of school leavers in certain selected Grammar Schools of giving sex education to very small groups. A second small class containing a further six maladjusted children was opened during the year. 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. 114 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 1961 were as follows:- Kenwood Gardens Mayesbrook Number of individual children seen 281 338 Number of attendances of children 423 647 The following table shows the conditions dealt with at both the Clinics during the year. Sub-normal Nutrition 135 Debility 64 Uncleanliness:- Head 33 Body - Skin:- Ringworm:- Head - Body - Scabies 1 Impetigo 3 Dermatitis - Urticaria - Furunculosis 1 Eczema 2 Athletes Foot 1 Warts 87 Other Skin Diseases 40 Eye:- Blepharitis 6 Conjunctivitis 8 Defective Vision (excluding Squint) 75 Squint 8 Other conditions 42 115 Ear:- Defective Hearing 4 Otitis Media 3 Other Ear Diseases 5 Nose and Throat:- Tonsilitis only 12 Adenoids only - Tonsilitis and Adenoids 8 Nasal Catarrh 13 Nasal Obstruction 4 Other conditions 14 Enlarged Cervical Glands (Non-Tuberculous) 6 Defective Speech 14 Teeth - Dental Diseases 19 Heart and Circulation:- Functional 1 Anaemia 7 Infectious Diseases:- Mumps 1 Colds and Coughs 22 Influenza 1 Lungs:- Asthma 4 Bronchitis 1 Pulmonary Catarrh 2 Other Non-Tubercular Diseases 8 Psychological:- Development - Stability 5 Nervous System:- Enuresis 9 Other Conditions 9 Deformities:- Genu Valgum 2 Posture 2 Pigeon Chest 2 Flat Feet 23 Valgus Ankles 16 116 Other forms 18 Minor Injuries 18 Rheumatism 4 Other Defects and Diseases 44 Total number of ailments 807 RECUPERATIVE HOLIDAYS. During 1961 20 Children were recommended for recuperative holidays and were placed by the Borough Education Officer. SPECIAL CLINICS OPHTHALMIC CLINIC The following table summarises the attendance of school children:- Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 99 206 869 1,541 Mayesbrook 96 155 529 1,328 Manford Way 11 13 77 169 Totals 206 3 74 1,475 3,038 889 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 311 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 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 but with a few cases of congenital abnormalities and odd cases of pathological change. 117 Good liaison and co-operation have been obtained from London Eye Hospitals and especially 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. ORTHOPTIC CLINIC. Miss M. Townsend, D.B.O.. makes the following report on the Orthoptic Clinic held at Mayesbrook Health Services Clinic for the year ended 31st December, 1961. "206 sessions were held throughout the year and 121 new cases were referred for treatment. In addition 106 old cases were under treatment. Total attendances amounted to 769 and 46 patients were discharged. The Orthoptic Clinic functioned efficiently as an indispensible adjunct to the School Eye Clinic in the treatment and observation of squint cases-both true and latent and pre- and post-operative." Miss Townsend 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. "Some further modifications carried out during the year made the Kenwood Gardens Clinic a most satisfactory place to work in. The tea-kitchen is accessible now from the waiting hall without passing the orthopaedic room. Suspension hooks and a sliding gantry have been fitted on the ceiling. There are still some problems to solve-provision of a filing cabinet for X-ray films and of suitable changing accommodation for children receiving sunlight treatment. A new type of floor-mat has proved very satisfactory. 118 Structural alterations at Mayesbrook Clinic have reduced the space available for orthopaedic exercises, but this has been made up for by modified arrangements. The wall mirror suffered breakage in the course of the alterations and needs replacing. Attendance at the Clinic was satisfactory, and the arrangements were much the same as in past years. Hospital admissions went to East Ham Memorial Hospital, X-ray examinations were carried out at Chadwell Heath Hospital. Mr. Rogers, who had been attending as fitter for surgical appliances, resigned from the firm of Messrs. Pryor and Howard during the year. His place has been taken by Mr. Daniels, of the same firm. Mr. Brand, M.C.S.P. was, as always, the backbone of these Clinics. I wish to thank him and all the others who helped in the running of the Clinic for their untiring efforts." The following table summarises the attendances of school children:- Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 43 81 218 469 Mayesbrook 23 43 82 151 Manford Way 7 1 8 10 Totals 73 125 308 630 SUMMARY OF CASES SEEN Diagnosis New Cases Old Cases A B C A B C Spastic Paresis - - - 1 2 - Cerebral Palsy - - - - - - A. P. M 1 - - 3 8 - Hemiplegia - - - 1 - - Scoliosis 1 2 - 4 - - Kyphosis 2 - - 2 - - Slack Posture 5 4 - 16 5 1 Deformity of Hips - 1 - 3 - - Genu Valgum 15 12 - 76 31 2 O. C. T - - - 3 - - 119 Diagnosis New Cases Old Cases A B C A B C Genu Varum - - - 2 1 1 Pes valgus-planus 7 3 1 10 4 - Valgus Ankles 20 5 - 32 9 1 Talipes calcaneo-valgus - - - - 2 - Intoeing 3 2 - 9 3 - Hallux valgus 1 2 - 8 1 - Deformity of Foot - - - 3 - - Deformity of Chest - - - 2 - - Lumbar Lordosis 1 - - - - - Deformity of Toes 7 6 - 16 5 1 Torticollis - - - 2 1 - N. A. D 1 - - - - - Foot Strain 2 - - 2 1 - Metatarsal varus - - - 7 - 1 Osteomyelitis - - - 1 - - Spina Bifida - - - 1 1 - Hydrocephalus - - - 1 - - Other conditions 15 6 - 13 8 1 Totals 81 43 1 218 82 8 A - Kenwood Gardens. B- Mayesbrook. C - Manford Way. 13 children of school age were admitted to East Ham Memorial Hospital. Particulars as follows:- No. of Cases Operation 1 Removal of Exostosis Rt. Femur 2 Operation Torticollis 1 Transfer flexor Longus to Extensor Expansion 2nd 3rd R. & L. 1 Arthrodesis Gt. Toe Lt. 3rd Toe Rt. 1 Further Eversion Tarsal Lt. 1 Tenotomy & Holdsworth Operation. 1 D. I. P. Arthrodesis I P. I. P. Wedge Arthrodesis. 2nd Toe left foot. 1 Bunionectomy and Phalangeal Osteotomy 1 D. I. P. Arthrodesis 4th Toe Lt. 1 Spinal fusion. 1 Holdsworth Operation Lt. During the year 14 pairs of valgus insoles, 8 pairs of surgical boots or shoes, 5 pairs Genu Valgum splints, 1 metatarsal bar, 7 calipers and inverting irons, 20 repairs 120 to calipers and shoes, and 88 pairs wedges to shoes, 1 spinal jacket and 2 repairs to spinal jackets were supplied to school children. 143 cases were discharged from the Orthopaedic Clinic, 21 as cured, 47 due to absence and 68 were showing Improvement and were kept under observation at school. 7 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:- Exercise Massage Sunlight and she reports as follows:- "REMEDIAL EXERCISES. There were 243 new cases and 1,237 attendances at Kenwood Gardens Clinic, and 157 new cases and 788 attendances at Mayesbrook Clinic. The cases for treatment which were referred from School Medical Inspections numbered 261 and these made 480 attendances. The total number of new cases at both clinics therefore was 661 and the total attendances 2,505. Classes were held to demonstrate the exercises for the treatment of the particular defect. ARTIFICIAL SUNLIGHT TREATMENT. Ultra-violet ray treatment was given as usual at two centres during 1961-Kenwood and Mayesbrook Clinics. There was a total of 29 new cases during the year, with 209 attendances. Of these 3 new cases and 103 attendances were at Kenwood and 26 new cases with 106 attendances at Mayesbrook. 121 The remedial exercises figures are lower this year as there was no Foot and Posture Survey in 1961, also some children were recommended by school doctors to attend school gymnastic classes instead of clinics. These children were reviewed at certain intervals. PHYSIOTHERAPY CLINICS. These were held at Kenwood Gardens on Monday and Thursday mornings and at Mayesbrook Clinic on Tuesday and Friday mornings.. Details of attendances:- Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 84 83 114 951 Mayesbrook 86 56 98 594 Total 170 139 212 1,545 ARTIFICIAL SUNLIGHT CLINICS. These were held at Kenwood Gardens on Tuesday afternoon and Mayesbrook Clinic on Thursday afternoon. Details of attendances:- Clinic Sessions New Cases Old Cases Attendances Discharged Cured Much Improved Left District etc. Kenwood Gardens 44 3 5 103 3 - 1 Mayesbrook 43 26 11 432 20 - 7 Total 87 29 16 535 23 - 8 The lamp used at each Clinic is a Centrosol Unit. The conditions treated were as follows:- Defects Treated Cases A B Alopecia 2 1 Chilblains - 5 Anaemia, Debility and Malnutrition 2 15 Bronchitis 2 5 Other Conditions 2 11 8 37 A. - Kenwood Gardens Clinic. B. - Mayesbrook Clinic. 122 EAR, NOSE AND THROAT CLINIC. Miss M. M. Mason, F.R.C.S., Consultant, Ear Nose and Throat Clinic, makes the following report:- "In 1961, 50 sessions of the AuralClinic took place. In all, 362 children attended, 133 of them for the first time. 78 operations were performed, mainly for tonsil and adenoid disease; 47 were done at King George Hospital and 31 at Chadwell Heath. A list of the main diagnoses met with is appended below. It is an interesting reflection on the changing aspect of disease that only 3 cases of otitis media reached a specialist clinic. This shows that the modern development of effective antibiotics has enabled treatment of the acute attack by the family doctor to be effective in nearly all cases, despite the misgivings many practitioners have experienced as to the possible development of resistance by the bacteria usually responsible. A small but definite number of cases of deafness are still seen each year, many of them of congenital origin. During the year 3 were of sufficient severity to warrant further investigation and this was done at a special Audiology Unit. Cases Diagnosed - 1961. Tonsils and Adenoids Infection 43 Mode rate-Adenoids 3 Maxillary Sinusitis 4 Hypertrophied Adenoids 36 Deafness 5 Eustachian Deafness 5 Nasal Allergy 6 Otitis Media 3 Rhinitis 5 Constitutional 2 Epistaxis 2 Deflected Nasal Septum 1 115 123 SPEECH CLINICS. Mrs. M. Walker, the Senior Speech Therapist, reports on the work of the Speech Clinics during 1961 as follows:- Mrs. Tingey Six Sessions Mayesbrook and per week. schools. Mrs. Pretious Full-time. Cerebral Palsy Unit school clinics and schools. Mrs. Walker Full-time. Valentines Clinic and schools. "Again more children under school age have been seen and this has paid dividends in the form of preventive treatments and a younger age at discharge , although this does not necessarily mean a shorter over-all period of treatment. These children rarely devdop the deep seated emotional problems and feelings of social inadequacy which are already strongly established in most of the children who are referred at a later age. Older patients, mainly those suffering from stammer, tend to take up more and more treatment sessions over a very long term, so that from everyone's point of view the plea is still "the earlier the better". We make it a principle that a child should be placed on the waiting list as soon as the mother expresses anxiety about his speech, or his behaviour in 'speech situations'. Therapists have continued to work full sessions in those schools which have a large enouth number of speech defective children to warrant this. In the pastwe have praised the advantages of this in the resulting better attendances. The disadvantages, however, have gradually revealed themselves as being almost disproportionately large. The lack of the all-important contact with parents has previously been touched upon; added to this is the tendency of treatment sessions to become grossly overcrowded, to the detriment of therapists and patients. (There seems to be a pressing obligation 124 when actually on the premises to see immediately every child in need of treatment, rather than to place on a separate school waiting list.) It remains to be seen whether or not treatment in the schools is a true expedient. There have been several visitors to the speech clinics in the past few years, notably by student health visitors, and we like to think that this accounts, in part at least, for the excellent relationships growing up between this and other departments." The defects treated were as follows:- Stammer 66 Dyslalia 151 Retarded speech and language 13 Hearing losses 4 Cleft Palate 8 Dysarthria 1 Neurological Treatment not needed 4 Others 19 82 children of school age were discharged from the Clinics during the year. In 49 cases the speech was normal. Of the remaining 33 cases, 7 left the district, 4 improved, 5 ceased to attend, 2 left school, 5 were referred elsewhere, 4 did not require treatment, 6 refused further treatment. SCHOOL DENTAL SERVICE. Mr. E. V. Haigh, Area Dental Officer, reports as follows:- "The dental services available to school children in the Ilford Area increased considerably during 1961. At the beginning of the year there were only four part-time dental surgeons doing 14 sessions per week which with my services on school dentistry made an equivalent strength of two fulltime Dental Officers. This shortage however improved slowly during the year and by the end of 1961 we had eight part-time dental officers doing 29 sessions per week. This means that we have four surgeries 125 almost fully staffed. We have been unable to obtain any full time officers. I have approached all the part-time dental surgeons about doing full time service but none of them are interested at the present salary rate. For many years it has been impossible to inspect more than 5-10% of school children each year, sufficient numbers applying for treatment to keep available staff fully occupied. However during 1961 it was possible to inspect 32% of the school population at school inspections and I have every hope that this will be higher in 1962 if we retain the same staff strength. High speed equipment for cavity preparation of fillings has been installed in the four surgeries in constant use in the area and these Airotors are proving to be one of the great improvements in dentistry as they cause less pain to the patient. The children received full dental treatment at the Clinics. Conservative, extractions under local or general anaesthesia and orthodontic appliances fitted as required. 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 5.15-8.15 p.m. are in great demand by older children studying for examinations. Many of these children would not attend during the day and so this is giving a service of value. Emergency treatment and inspection sessions continued at Mayesbrook Clinic. On Wednesday or Friday mornings from 9 a.m.-11 a.m. any school child without an appointment could attend and be seen for the relief of pain or for an inspection. Appointments were made for these children to have extractions, conservative or orthodontic treatment. Dental X-ray facilities are available at each Clinic. This saves time and pain, a quicker diagnosis being possible. Most extractions were performed under general anaesthesia which was always given by a medical officer. The number of children requiring 126 extractions under general anaesthesia has decreased considerably over the past ten years. I do not see so many badly neglected mouths requiring multiple extractions. This I am sure proves that the parents and children are becoming more dentally conscious. " BENTON SCHOOL. Dr. D. M. B. Gross, Medical Officer in Charge, reports as follows:- "During 1961 the number of children on roll varied between 66 on 31st December 1960 and 71 on 31st December, 1961. There were 16 admissions and 11 discharges. Recommendations for admissions were received from the following sources:- School Medical Officers 1 Specialist Consultants 1 Private Doctors 3 Hospitals 4 Borough Education Officer 4 Parents 2 Others 1 16 The diagnoses were as follows:- Fusion of spine 1 Perthes' disease 2 Rheumatic Fever 1 Respiratory Infection 1 Asthma 6 Bronchitis 2 Polyneuritis 1 Muscular Dystrophy 1 Haemophilia 1 16 The 11 children discharged left for the following reasons:- Fit for ordinary school 2 Left school 5 127 Left the Country 1 Admitted to special school, 1 Left district 2 11 The work at the school has proceeded smoothly as in previous years. In addition to the routine medical examinations, an audiometric survey has been started on the lines of the one just finished at the Cerebral Palsy Unit. As in previous years, the trend continues towards admitting more severely handicapped children not only from Ilford but also from surrounding areas, and here again the establishment of a nursery class will increase the scope of the work. The problem of suitable placement of children with a dual handicap, i.e. physical disability and mental retardation, remains a very difficult one which is probably only to be solved at a higher level. In conclusion I should like to thank the staff for their continued help and co-operation, which has made possible the smooth running of the school. " CEREBRAL PALSY UNIT Dr. D. M. B. Gross, Medical Officer in charge, reports as follows:- "During the year in question the number of children on roll varied between 18 on 31st December, 1960, and 23 on 31st December, 1961. In reviewing the work undertaken throughout this period, 8 children were examined in connection with suitability for admission; of these, 5 were accepted and came from the following areas:- Ilford 2 Romford 2 (1 under school age) South Essex 1 The 3 children rejected, with the reason for rejection and the responsible Authority concerned were:- 120 Romford (A) Very young and immature but child was eventually accepted for a National Spastic Society Home. South Essex (A) Progressive muscular dystrophyvery disturbed child and resisted medical examination. The admissions during the year number 7, which include 3 children who were seen in 1960 and admitted in 1961, and 4 of the children found suitable as stated above. This, therefore, leaves two children on the waiting list; one who has yet to reach school age and a child of school age seen in 1959 who is not yet ready for admission. Those pupils discharged numbered 2 and the reason, together with the Authority concerned, is as follows:- Mid-Essex Had reached school leaving age. Ilford Transferred to an ordinary day School. During the year an audiometric survey of all the children at the Unit was undertaken. The results have not yet been collated but already valuable information has been obtained which is of the greatest help in dealing with the children concerned. Otherwise the work of the Unit has proceeded smoothly and I should like once again to thank the staff for their continued co-operation and interest and their efforts in dealing with children who are often very difficult and in whom progress is necessarily very slow. It is hoped that in the comparatively near future the establishment of a nursery assessment class will further increase the scope of the Unit. CHILD GUIDANCE CLINIC. Dr. W. P. Gurassa, Consultant Psychiatrist, and Medical Director of the Ilford Child Guidance Clinic, writes as follows:- "During the first half of the year Dr. Shackleton continued to do two of my sessions as a locum until I was able to take them up again in the summer. 129 Work has prodeeded along the usual lines, though there has been some slowing-up, partly due to the back-log of cases originally seen by Dr. Shackleton. The waiting list is therefore a little longer than usual at the present time. While it is hoped to bring this back to the former level it has become clear that in order to reduce it substantially we shall require additional psychiatric sessions and application has been made for these. We have been helped by the addition of a third full-time Psychiatric Social Worker, Miss Boyd, who has come to us from the St. Alban's Clinic. She is an experienced person, and is already doing a good deal to relieve the excessive load of workwith parents carried hitherto by her two colleagues. In addition she is also undertaking some preliminary screening interviews with parents of new referrals, to help decide upon the urgency, and to mitigate the effect of the waiting period for diagnosis. We have also been granted two additional sessions for a Child Psycho-therapist, which Mrs. Handja will be taking up in the near future. She already has enough children on the treatment waiting list to fill her additional time. We have continued our policy of encouraging visitors to the Clinic, i.e. School Teachers, Probation Officers, Health Visitors, etc. The response has been gratifying in terms of attendance and interest shown. We aim in this way to help allied workers to handle many of the simpler problems that arise in the course of their work, and aid in the prevention of more established disorders. A notable event has been the extension of the Maladjusted Day Class from Infants to Juniors, with the provision of an additional teacher; this is working well and the teachers attend fairly frequently for consultations, which help them in their work with children and parents. We continue to see a number of children who are unable to attend school, and there is a growing recognition outside the Clinic that these children are often suffering from neurotic disturbances which require treatment, and are not just to be regarded as anti-social delinquent characters. A problem 130 times arises in connection with children referred by the Juvenile Courts where residential treatment is recommended but not available immediately, and sometimes for several months. The Local Authority has been able to help by providing temporary care in a Children's Home or Hostel, and it would be especially helpful if in other cases, not referred by the Courts, similar facilities were available for temporary placement, with a minimum of formality, i.e. for children in disturbed homes who are awaiting placement in a Residential School or admission to a special Psychiatric Treatment Centre. I am pleased to say that facilities for admission of children under 12 now exist in the Paediatric Section of Whipps Cross Hospital, where a pilot experiment has been in progress for some months. Dr. Herbert Davy is the visiting Consultant Psychiatrist, though the beds are technically under Dr. Hinden Consultant Paediatrician. The general policy has been to admit only children who can be coped with in a General Ward, and to exclude children whose behaviour is too grossly disturbing, though they have even managed to cope with some of these. There is still some delay in finding suitable vacancies for in-patient treatment of older and more disturbed children. It has been found useful for members of the Clinic staff to visit and establish personal contact with people working in Residential Schools and Residential Treatment Centres. A few such visits were made during the past year and more are desirable. It has been found to help us with the selection of centres for placement in relation to a particular child and helps those in charge to a fuller appreciation of the child's situation and needs. We also try to maintain contact with parents after a child has been sent away, andwhere possible towork with them, and to prepare them for the eventual return home of their child. It is important in this respect that we are kept fully informed of the child's progress while away, and of any impending changes, for example transfer to another school, or return home. " 131 SCHOOL PSYCHOLOGICAL SERVICE. Miss B. S. Gascoyne and Miss C. H. Watt, Educational Psychologists, report as follows:- "During the year 147 new school cases have been tested as opposed to 115 last year. Also, although it is not reflected in the figures we have been involved in more referrals of school children to the Child Guidance Clinic. 27 children have been referred following consultation between the head teacher and the psychologist. In a number of cases it has proved very useful for the parents to be able to meet the psychologist before referral to the Child Guidance Clinic is officially instigated. The psychologist can provide a personal link between the school, the parents and the clinic andean answer the parents' questions and doubts about referral, which often reassures them. It also means they know someone they can contact if the problem becomes more urgent while waiting for the referral. Two short surveys have been undertaken with the aim of trying to asses the validity of the Binet results in a given age group. This has, we think, been of some value to the teaching staff in learning more accurately the potential of their pupils , as it is difficult to be sure of this only from group tests and it has also served to give a rough estimate of the range of the age group as a whole. To the psychologist it has yielded additional information about the test which becomes more apparent when a series of children of the same age are seen and it has been valuable to see children who are normal, in that they are neither backward in school work nor emotionally maladjusted, although of course one or two children were found to be borderline cases and will be kept under observation. No results of these surveys can be given as the numbers involved are statistically too small and the information was intended only to be of use to the teachers and psychologists in the area. The maladjusted class can now be described more accurately as a class and a half since Mrs. Shaw joined them in September and has taken over the 132 teaching of those children who can respond to more formal work in the mornings but who are not yet sufficiently adjusted emotionally to return to normal schools. This has enabled a few more children to be taken into the school, which comprises both Infant and Junior age groups, as the remaining original members become older. The class continues to be of absorbing interest to the clinic as weekly conferences are held on the progress of the children. The Special Classes at Valentines School are always well up to strength but over the year the waiting list has been of manageable proportions which makes the psychologists' job much easier because instead of asking parents to agree to their child being admitted at an unspecified future date it is now possible to assure them that this should be within two terms. It is encouraging that the number of children needing to have remedial teaching in Secondary Schools seems to have dropped. We hope that this is accounted for by retarded children being reported either at the top of the Infants or in the first two years of the Juniors and that there is not a concealed iceberg base of illiterate seniors, but we have no evidence in the Ilford area to justify such a gloomy prospect. The help the children receive from attending Valentines School continues to be invaluable both to the children themselves and to all the other schools who can refer backward children in the knowledge that something can be done." Summary New cases 147 Follow-ups for clinic 142 Follow-ups for schools 48 Remedial Education 14 Children referred to C.G.C. 2 ILFORD ENURESIS CLINIC Dr. J. M. Pooley, Medical Officer in charge, reports as follows:- During the 12 months ended December 31st, 1961, the clinic continued to be held on Wednesday 133 mornings. The number of sessions held this year had, of necessity, to be reduced from 35 to 22, and therefore the number of new cases seen was unavoidably lower-being 55 seen during the 12 months, as compared with 89 during 1960. I. Appointment List The 55 cases seen throughout the year were made up as follows:- Recommended by Under 5 years Over 5 years Boys Girls Boys Girls Infant Welfare Officers 6 8 - - School Medical Officers - - 17 7 General Practitioners 1 - 7 - Parents 2 - 1 1 Health Visitors 2 1 - - Consultants - - - 2 11 9 25 10 Total: 55 Cases. Total attendances (old and new cases): 280 Number of sessions: 22. II. Procedure The procedure adopted in previous years has been largely adhered to, namely:- (1) Urinalysis (2) History of enuresis and of previous illnesses. (3) Physical examination. (4) Treatment. Time spent in explaining to the child, an interesting charting system, a strict routine and various other suggestions always proves most valuable in that the child's interest is held, and the mother acts upon the instructions more faithfully. Problems such as over crowding, housing difficulties and emotional instability in either parent or child, are commonly met with and should of course be considered carefully in relation to the treatment being adopted. 134 III. Treatment The treatments issued or prescribed are listed below:- (1) Long-acting (bonded) Dexamphetamine-"Dexten" (supplied by arrangement with As pro-Nicholas Ltd. ,)-5mgms. at bedtime. (2) Plain dexamphetamine-5mgms. at bedtime. (3) Phenobarbitone gr. ½ or ¼ (4) Routine and charting only. (5) The Sentinel or Downs bedbuzzer (There are now 17 of these machines in use through the Clinic). (6) "Librium"mgms. v c.m. or b.d. A considerable measure of success has followed the use of this tranquillising drug, which must of course be given only under strict supervision the Librium has been issued by co-operation with the patient's general practitioner. IV. Results A number of cases have been discharged cured during the year, as follows:- Discharged cured Boys Girls Under 5 years 2 2 Over 5 years 22 14 Total 24 16 This number includes a few children who were first seen in 1960, and who were still receiving treatment in 1961. Self-discharged Boys Girls Under 5 years 2 1 Over 5 years 20 10 Total 22 11 Attendances at the clinic have been good, and both mother and child have shown sustained interest. A paper has recently been completed on the subject of pre-waking enuresis and analysing the 135 advantages of a long acting resin-bonded emphetamine such as"Dexten" over the short acting dexamphetamine. The bed buzzers are proving very successful and have provided yet another link of interest between many general practitioners and the Enuresis Clinic. 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. 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, 1961, 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. 136 CATEGORY Number of children of school age on 31st December, 1961, 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 - - 2 - - - - - - - - - - 2 Partially Sighted 5 - 1 1 - - 1 - - - - - - 7 Deaf 4 - 2 - - - 1 - - - - - - 7 Partially deaf 12 - - - - - 2 - - - - - - 14 Delicate 24 - 2 2 - - 4 - - - - - - 31 Physically handicapped 40 1 - 2 - - 9 - - - - 5 - 56 E.S.N 50 5 15 6 - - - - - - - 3 1 78 Maladjusted 1 - 7 10 2 - 16 - - - - 2 - 38 Epileptic - - - - - - 2 - - - - - 1 3 Speech defect - - - - - - - - - - - - - - Dual Defects 2 - - 2 - - 1 - - - - - - 4 Total 138 6 29 23 2 - 36 - - - - 10 2 240 MENTAL HEALTH SERVICE The Training Centre for 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 of the School Medical Officers, also a survey visit is made quarterly. 137 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 1961 was 2, 261, 582 approximately. There are 29 kitchens in the Borough, established at the following schools:- Barking Abbey, Barley Lane, Beal Boys, Beal Girls, Becontree C. P. Unit, Benton, Canon Palmer, Caterham, County High Boys, County High Girls, Cleveland, Dane, Fairlop Boys, Fairlop Girls, Goodmayes, Gordon, Loxford, Mayfield Boys, Mayfield Girls. Mossford Green, Parkhill, Redbridge, South Park, St. Augustines, The Gilbert Colvin, TheGlade, 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 September 1961, 18,421 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. Workdone by the N.S.P.C.C.- The following 38 cases were investigated:- (1) Neglect 26 (2) Ill-treatment cases 3 (3) Other cases 9 (Nine cases were reported from the Public Health Department 29 were reported from other sources for general neglect.) Ninety-seven children (65 boys and 32 girls) were involved, 58 being of school age. In addition to this work, 195 supervision visits were paid to different cases, some of which were made to those reported during the previous year. 138 The Invalid Children's Aid Association.- Once again we are indebted to this Association for the case-work and welfare undertaken by its members. The following is a summary of activities in 1961. Intensive case-work 4 Case-work visiting 5 Supportive visiting 7 Aftercare of children who have been in Residential Schools 2 Grant towards cost of T.V. Licence 1 Invalid chair obtained 1 THE HEALTH VISITOR AND THE SCHOOL NURSE Miss J. Oliver, Superintendent Health Visitor, submits the following report:- "Constant vigilance on the part of parent, schoolteacher andhealth visitor was needed in 1961; many informal inspections were requested. The health visitor's contact with the home makes tactful suggestions on care of the hair and getting rid of infestation fairly easy. Our procedure commenced in 1958 has proved worth while coupled with the higher standard of present day hygiene. It would appear that the families moving into the town to obtain work need our special care. Visits to homes to remind parents that children should wear their spectacles are still far toohigh and it cannot be over-emphasised that this is a parental responsibility. Children's eyes could be permanently damaged through lack of encouragement from parents and it is most unfair that teachers should have this added responsibility of constantly reminding children to wear their spectacles. One more senior school asked for Mothercraft lectures to be given to the girls in a 'C' stream. All pupils were attentive and enthusiastic and their interest was shown on open day when model baby and toddler garments were on show with model diets suitable for various age groups. Bathing the model doll in front of parents and admiring friends always gathered a crowd. The health visitors feel that 139 courses in Mother craft will always be worth while. Good information is spread amongst friends and taken back to the home. There are no reasons to show from visiting homes that the 'C' stream mother fails in her duties to parenthood any more than her 'A' stream sisters. Handicapped pupils need a considerable amount of help and guidance from teachers and parents-many coming within this category hold down good jobs and find a happy niche In the world. I feel it is up to us to help much more and this could well be the health visitor's aim for the future. We continue to carry out medical Inspections In school often in very difficult circumstances. I am quite sure that many parents would like to have a quiet word with the school doctor but find this Impossible as insufficient privacy is given. One senior school made an innovation this year by Inviting parents to see the teachers and the child's new school at the same time as the routine medical inspection. From our point of view this was valuable because more parents than usual attended the medical examination. " Hygienic Conditions In Schools In the Division.- Mr. S.R. Daly, Chief Public Health Inspector, reports as follows:- "During the current year, the Ilford Borough Council Public Health Inspectors have continued to make monthly visits to the Borough Schools to ensure that the sanitary circumstances are satisfactory and that the canteen facilities are maintained at a standard to conform with the Food Hygiene Regulations. As can be expected, defects have been discovered and references to the Borough Education Officer and the Schools Medical Officer have produced a speedy reparation thereof. The use of cardboard cartons for the delivery of milk has continued without any serious complaint this year. I am of opinion that this system might well be augmented. The only complaints regarding the supply of milk to schools emanate solely from the use of glass bottles. 140 It might be considered advisable to reorganise the sanitary conveniences at schools, particularly the old ones, to prevent the undue waste and inconvenience arising from the unsuitable external situation of these facilities which undoubtedly cause discomfort to pupils, staff and administrators. It is also pleasing to note that the water supplies to the schools were sufficient throughout the year, thus preventing complaints arising from the deficiencies of the previous year when certain schools in the Borough were without adequate flushing water to the sanitary conveniences." Employment of School-children and Young Persons.During 1961, 112 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. B. C. G. VACCINATION OF SCHOOL CHILDREN In 1961 the scheme was extended to include all pupils overthe age of 13years and students attending Universities, Colleges or other establishments of further education. In addition those previously invited who 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 2,354 No. of pupils whose parents consent to treatment. 1,401 No. of pupils undergoing tuberculin test *1,479 Positive: 99 No. of pupils who received B. C. G. 1,285 *78 carried forward from previous year. MEDICAL EXAMINATION OF TEACHERS, OFFICERS AND SERVANTS.-The following examinations were carried out during 1961:- Officers Servants Teachers Intending Teachers Total New Appointments 12 42 44 75 173 Under Sickness Regulations - 4 - - 4 141 THE CAUSES OF DEATH AMONG CHILDREN OF SCHOOL AGE (i.e. FROM 5-15 YEARS) IN ILFORD, DURING 1961 WERE:- Bilateral Glioma 1 1 Haemophilia 1 Intracranial Tumour 2 Multiple Injuries (Road Accident) 1 Cerebral Abscess 1 8 MINISTRY OF EDUCATION MEDICAL INSPECTION RETURNS YEAR ENDED 3lBt DECEMBER, 1961. TABLE I. Medical Inspection of pupils attending maintained Primary and Secondary Schools including (Special Schools). A. - PERIODIC MEDICAL INSPECTIONS Number of Inspections 5-15 year age group 4,042 Number of other Periodic Inspections 1,021 Total: 5,063 B. - OTHER INSPECTIONS. Number of Special Inspections 775 Number of Re-inspections 1,778 Total: 2,553 142 C. - PUPILS FOUND TO REQUIRE TREATMENT. Number of Individual Pupils found at Periodic Medical Inspection to Require Treatment (Excluding Dental Diseases and Infestation with Vermin). (No individual pupil is recorded more than once in any column of this Table, and therefore the total on column (4) will not necessarily be the same as the sums of columns (2) and (3). ) Age Ciroups inspected (by year of birth) (1) For defective vision (excluding squint) (2) For any of the other conditions recorded in Table IIA (3) Total individual pupils (4) 1956 11 96 96 1955 19 125 134 1954 3 23 25 1953 4 11 15 1952 4 14 17 1951 2 13 13 1950 193 312 474 1949 101 150 235 1948 5 9 14 1947 88 121 198 1946 and earlier 208 156 337 TOTAL 640 1,0.30 1,558 TABLE II A. - RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1961. NOTE. - All defects noted at medical inspection as requiring treatment are included in this return, whether or not this treatment was begun before the date of the inspection. 143 Defect Code No. Defect or Disease Number of Defects Requiring Treatment Number of Defects Requiring Observation but not Treatment Periodic Inspection Special Inspection Periodic Inspection Special Inspection (1) (2) (3) (4) (5) 4 Skin 97 – 31 – 5 Eyes — a. Vision 640 8 178 1 b. Squint 32 – 9 – c. Other 43 – 9 1 6 Ears — a. Hearing 15 25 24 1 b. Otitis Media 8 – 6 – c. Other 11 – 5 1 7 Nose or Throat 83 3 278 – 8 Speech 32 13 34 3 9 Lymphatic Glands 1 – 40 2 10 Heart and Circulation 21 – 58 – 11 Lungs 40 – 93 1 12 Developmental — a. Hernia 5 – 8 — b. Other 25 1 90 2 13 Orthopaedic — a. Posture 258 2 22 – b. Flat foot 211 2 83 — c. Other 152 2 167 4 14 Nervous system — o. Epilepsy 4 – 6 – b. Other – – 19 – 15 Psychological — a. ment 1 4 6 – b. Stability 39 20 61 — 16 Abdomen 12 2 17 17 Other 113 14 111 5 144 B. - CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE ACE GROUPS. Age Groups inspected by year of birth) Number of Pupils Inspected No. whose condition was classified Satisfactory Unsatisfactory 1956 404 382 22 1955 577 560 17 1954 62 61 1 1953 43 42 1 1952 53 50 3 1951 14 43 1 1950 1,439 1,413 26 1949 648 637 11 1948 47 47 – 1947 725 702 23 1946 and earlier 1,021 1,010 11 TOTAL 5,063 4,947 116 TABLE III. INFESTATION WITH VERMIN. All cases of infestation, however, slight, are recorded. This return relates to individual pupils and not to instances of infestation. (i) Total number of pupils examined in the schools by school nurses or other authorised persons 17,071 (ii) Total number of individual pupils found to be infested – (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) – (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944 – 145 (v) Number of individual pupils disinfected:- By Local Authority 31 By parents 20 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 – 2 Scabies – – Impetigo 3 – Other Skin Diseases 131 33 146 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 139 10 Errors of Refraction (including squint) – 1,849 Total 139 1,859 Number of pupils for whom spectacles were (a) Prescribed – 895 (b) Obtained – 901 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 – 388 (c) for other nose and throat conditions – – Received other forms of treatment 63 80 Total 63 468 GROUP 4. - ORTHOPAEDIC AND POSTURAL DEFECTS. By the Authority Otherwise (a) Number treated in clinics or out-patients departments 661 810 (b) Pupils treated at school for postural defects 46 – 147 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 99 8 GROUP 6. - SPEECH THERAPY By the Authority Otherwise Number of pupils treated by Speech Therapists for the first time 104 3 GROUP 7. - OTHER TREATMENT GIVEN. By the Authority Otherwise (a) Miscellaneous minor ailments 302 53 (b) Other (1) Sunlight Treatment 45 – (2) Enuresis 64 2 Total 411 55 TABLE V. DENTAL INSPECTION AND TREATMENT CARRIED OUT BY THE AUTHORITY (l) Number of pupils inspected by Dental Officers: - (a) Periodic age groups 7,348 (b) Specials 2,030 Total (l) 9,378 (2) Number found to require treatment 5,645 (3) Number referred for treatment 5,645 (4) Number actually treated 2,960 (5) Attendances made by pupils for treatment 12,677 148 (6) Half-days devoted to: Inspection 52 Treatment 1,426 Total(6) 1,478 (7) Fillings: Permanent Teeth 7,095 Temporary Teeth 1,315 Total (7) 8,410 (8) Number of teeth filled: Permanent Teeth 6,276 Temporary Teeth 1,245 Total (8) 7,521 (9) Extractions: (i) Permanent Teeth:- (a) On account of Caries 468 (b) For other purposes 90 (ii) Temporary Teeth:- (a) On account of Caries 1,348 (b) For other purposes 69 (10) Administration of general thetics for extraction 806 (11) Other operations: Permanent Teeth 3,009 Temporary Teeth 1,063 Total (11) 4,072 (12) Orthodontics (i) Cases commenced during year 190 (ii) Cases carried forward from previous year 364 (iii) Cases completed during year 172 (iv) Cases discontinued during year 48 (v) Pupils treated with appliances 147 (vi) Removable appliances fitted 154 149 (vii) Fixed appliances fitted - (viii) Total attendances 3,135 (ix) Number of sessions devoted to treatment 210 Number of pupils supplied with artificial dentures 28 Number of dentures fitted 28 150 SCHOOL HEALTH SERVICE STAFF AND SCHOOL C LINICS AS AT 31st DECEMBER, 1961. 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 2.02 (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 25* (Combined posts, H.V. nnd S.N.) 10.02 (f) Nursing Assistants 6 (Clinic Nurses) 3.75 (g) (i) Area Dental Officer 1 0.76 (ii) Dental Officers (Part-time) 8 2.64 (iii) Orthodontists — – (iv) Dental Surgery Assistants 4 3.76 *A11 hold Health Visitor's Certificate. 151 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 T reatment Number of School Clinics (i.e. premises) where such treatment is provided Directly by the Authority Under arrangements made with R.H.B. &c. (1) (2) (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 – 1 152 IV. — CHILD GUIDANCE CENTRES. (i) Number of Child Guidance Centres provided by the Authority = 1. Staff Number Aggregate in terms of the equivalent number of whole-time officers Psychiatrists 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. 153 154 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. 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 BOYS 1958 – – – – – – – – – 573 111 19.7 533 115 21.2 123 120 23.6 71 125 25.9 39 130 28.8 555 136 31.8 1097 143 36.4 630 146 37.7 48 150 41.5 30 155 46.1 1959 – – – – – – 589 111 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 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 1961 205 112 20.2 294 114 21.0 35 119 23.4 24 125 25.0 30 130 28.1 21 137 32.4 678 141 35.9 328 145 38.8 27 154 41.7 239 162 52.8 284 165 55.4 104 168 60.4 98 174 64.1 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 1.56 46.3 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 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 1961 199 111 20.1 283 112 20.8 27 117 23.7 19 122 24.7 23 131 29.4 23 136 32.7 761 144 37.9 320 147 39.8 20 150 44.7 486 159 52.5 406 161 54.4 77 161 54.9 52 163 55.0 Age Groups 5-6 Years 6-7 Years 7—8 Years 8-9 Years 9—10 Years 10-11 Years 11-12 Years 12-13 Years 13-14 Years 14-13 Years 13-16 Years 16—17 Years 17-18 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) 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 34.6 688 142 36,1 50 145 38 7 37 15? 43.8 575 16? 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 16? 48 3 ?03 167 57 ? 75 171 60.2 43 176 64.1 1953 649 112 20.2 925 116 20.4 82 121 23.6 34 126 26.3 36 133 28.9 194 140 33.3 799 144 34.7 49 145 36.3 22 153 44.0 441 162 51 0 ?59 168 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 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 5?5 157 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 1057 144 36.6 73 149 40.5 34 156 48.8 359 159 50.7 180 159 52.5 68 161 54.8 19 161 54.7 1954 522 111 19.6 605 116 21.3 93 121 22.8 44 125 24.9 52 134 29.2 288 140 33.9 968 144 36.5 71 148 39.8 36 155 46.4 481 158 48.4 216 160 55.0 85 161 56.8 9 164 57.1 1953 657 112 20.0 827 117 21.3 81 119 22.8 38 127 25.8 37 133 28.9 173 140 32.5 841 143 35.5 59 150 39.9 49 156 47.1 374 156 50.9 212 160 53.6 49 162 54.9 5 164 55.6 1952 746 112 19.9 695 115 21.0 70 121 23.3 57 125 24.6 39 132 29.1 124 139 33.5 784 143 35.7 79 148 40.5 29 155 49.8 410 158 50.5 239 156 54.9 67 160 55.0 5 159 49.0