AC 44110 ILF 39 Borough of IIford 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 1964-65 1 Public Health Committee — Members — Municipal Year 1964-65 2 Ilford Health Area Sub-Committee - Representatives 2 Ilford Committee for Education — Members — Municipal Year 1964-65 3 Officers of the Public Health Services 4-7 Preface 8-11 Reports by:— CONSULTANTS - Dr. Gurassa — Psychiatrist 124 Mr. Korvin — Orthopaedic Surgeon 113 Mr. Lee — Orthopaedic Surgeon (C.P.U.) 124 Miss Mason — Ear, Nose and Throat Surgeon 118 Dr. Thome — Ophthalmologist 112 ASSISTANT MEDICAL OFFICERS - Dr. Gross — Ethel Davis School 122 Dr. O'Connor Wilson — Remedial Exercises 116 Dr. Pooley — Enuresis and Toddlers Clinic 127 Dr. Taylor — Health Education 132 Mr. Daly — Chief Public Health Inspector 32,132 Mr. Haigh — Area Dental Officer 104,120 Miss Gascoyne and Miss Watt - Education Psychologists 125 Miss Oliver — Superintendent Health Visitor 76,131 Miss Copping — Welfare Officer for Old Folk 23 Mrs. Tingey — Speech Therapist 119 STATISTICS & SOCIAL CONDITIONS (SECTION A.) - Physical Features 12 Population 12 3irths and Deaths 12-15,18 Rainfall 13 Vital Statistics (Tables) 15-17 GENERAL PROVISION OF HEALTH SERVICES (SECTION B.) - Home Nursing 19 Laboratory Facilities 19 Legislation in Force 19,20 National Assistance Act 20-23 Laundry Service for the Aged Incontinent 26 Hospitals 26,27 Ambulance Facilities 27 Clinics and Treatment Centres 28-31 Page SANITARY CIRCUMSTANCES OF THE AREA (SECTION C.)- Water Supply 37-39 Swimming Baths 39 Drainage and Sewerage 40 Rivers and Streams 40 Refuse Collection and Disposal 41 Sanitary Inspection of the Area 41 Shops Act 42 Offices, Shops and Railway Premises Act, 1963 42 Slaughter of Animals Acts 43 Rag Flock and Other Filling Materials Act 43 Land Charges Act 44 Clean Air Act — Smoke Control Orders 44 Atmospheric Pollution 44 HOUSING (SECTION D.)- Overcrowding 45 Clearance Areas 45 Statistics 46,47 Housing Acts (Permitted number) 47 Housing Repairs and Rents Acts 47,48 INSPECTION AND SUPERVISION OF FOOD (SECTION E.) - Milk 49,50 Ice Cream 51 Meat and Other Foods — Inspection and Supervision 52 Food Hygiene 52 Food and Drugs Sampling 53 Hawkers 54 Food Preparation — Registration 54 Food Surrendered 54 Foreign Bodies in Food 55 Food Poisoning 55 Bakehouses 55 Merchandise Marks Act 55 MISCELLANEOUS - Diseases of Animals (Movement Orders, etc.) 55,56 Prevention of Damage by Pests Act (Rodent Control) 57,58 Pet Animals Act 59 Animal Boarding Establishments Act 59 Petroleum (Consolidation) Act 59 Litter Act 59 Noise Nuisances 59 INFECTIOUS DISEASES (PREVALENCE AND CONTROL) (SECTION F.) - Notifiable Diseases 60-63 Page Table showing total notifications received, 1964 62 Tuberculosis - Notifications, Deaths, etc 63,65 V.D. Treatment Centres 65,66 Health Education 66 Examination of Officers and Servants 67 Mass Radiography 67,68 FACTORIES (SECTION G.) - Inspections, defects and Outwork 69,70 PART III SERVICES. NATIONAL HEALTH SERVICE ACTS, 1946-57(RESPONSIBLE AUTHORITY - ESSEX COUNTY COUNCIL) Births 71 Care of Premature Infants 72 Infant Mortality 72 Neonatal Mortality 74 Illegitimate Births and Deaths 74 Health Visitors and School Nurses 75-79 Day Nurseries 80 Nurseries and Child Minders Regulation Act 81 Development of Local Authority Health Services 81 Health Services Clinics 81 Infant Welfare Centres — Attendances 82,83 Toddlers Clinic 84,85 Phenylpyruvic Amentia 85 Vaccination and Immunisation 87-90 Midwives 91 Gas and Air Analgesia 93 Maternal Mortality 95 Domestic Help Service 95,96 Invalid Night and Day Attendance Service 96,97 Prevention of Break-up of Families 97 Convalescent Facilities 97,98 Loan of Sick Room Equipment 99 Chiropody Service 100 Visits by T.B. Visitors 101 Occupational Therapy 101 T.B. Care and After Care 102 Medical Exams-Staff 103 Home Nursing 103 Health Education 103 Dental Treatment 104-106 Home Safety 103 Welfare Food Distribution 106 Page CLINICS - Ante-Natal 94 Artificial Sunlight 87 Diphtheria Immunisation 87 Ear, Nose and Throat 87 Midwives 92 Minor Ailments 91 Obstetric Consultant 95 Ophthalmic 86 Orthopaedic 85 Poliomyelitis Vaccination 89,90 Post-Natal 95 Smallpox Vaccination 90 Speech 87 Whooping Cough Immunisation 87,88 Tetanus Immunisation 87,88 SCHOOL HEALTH SERVICE (RESPONSIBLE AUTHORITY - ESSEX COUNTY COUNCIL) School Roll and Premises 108 Medical Inspection and following up 108 Staff 108,142-144 Chiropody Clinics 109 Infectious Diseases 109 New or Original Work 109 Recuperative Holidays 112 Ethel Davis School (Physically Handicapped) 122-124 School Psychological Service 125 Handicapped Children 129 General Welfare 130 B.C.G. Vaccination 133 Medical Examination of Staff and Teachers 133 Causes of Deaths (Schoolchildren) 133 Ministry of Education — Statistical Tables 134-141 Heights and Weights Table 145,146 CLINICS - Artificial Sunlight 117 Child Guidance 124 Dental 120 Ear, Nose and Throat 118 Enuresis 127 Minor Ailments 110-112 Ophthalmic 112 Orthopaedic 113-116 Orthoptic 113 Physiotherapy 117 Speech 119 1 1LF0RD BOROUGH COUNCIL Municipal Year 1964-65 ALDERMAN MRS. LILIAN FALLAIZE, J.P. (E.C.C.) Mayor COUNCILLOR FRANCIS HERBERT JAMES (E.C.C.) Deputy Mayor. Aldermen: COLVIN, GILBERT, C.B.E., F.C.I.S. HEADLEY, CECIL AUBREY. J.P. COWAN, HAROLD DOUGLAS, MASTERS, FRANK ROBERT. F.A.C.C.A., F.C.C.S. PEARSON, FREDERICK THOMAS. GIBSON, CYRIL IRVING. ROOT, HAROLD GOLDSTONE, M.S.M. GLEED, SYDNEY GEORGE. SHAW, ARNOLD JOHN, B.A. GOOCH, LIONEL ARCHER SCOTT. TERRY, MISS ANNE SYLVIA, J.P. Councillors: ALY, HARRY REGINALD BERTRAM. MARTIN, ROBERT. BELLAMY, GORDON SYDNEY. MASON, VICTOR WILLIAM. BYSOUTH, HENRY ALBERT, F.I.A.C. MURPHY, JOHN LOUGHLIN, J.P., CANNON, STANLEY FREEMAN. A.R.I.N.A., A.I.Mar.E. CARRADICE, DENNIS ANNESLEY. NATZLER, ISAAC BERNARD. CHAMBERLIN, MRS. GRACE MARY, NORWOOD, JOHN HENRY. (E.C.C.) OSBORNE, ALAN FRANK. CLACK, ARTHUR HENRY. PARKER, HENRY CECIL CHESNEY. DAVIES, DAVID SAMUEL. ROLFE, CYRIL GEORGE, A.I.S.T. DAVIES, GEORGE EVELEIGH, J.P., (to 3.2.1965) B.Sc. RYDER, JOHN LOUIS. EAREY.ERIC RAYMOND, J.P.,F.V.I. SHUMAN,CHARLES AVROM AUBREY. EERRIER, VIVIAN WILFRED. SOLEY, JOSEPH EDWARD. FROST, ARTHUR GEORGE, M.Sc. STONHAM, JOHN PETER, B.Sc. GILES, ROGER MICHAEL, B.Sc., VINCENT, JOHN ANTHONY. A.R.C.S. WATSON, GEORGE HENRY. GRANT, FRANK LIONEL. WORTLEY,FREDERICK ALEXANDER HARRIS, EDGAR FRANK, (E.C.C.) (E.C.C.) HITCHCOCK, LEONARD, A.I.B. YEOMAN, ALFRED JAMES. LOVELESS, SYDNEY FRANK. 2 PUBLIC HEALTH COMMITEE Municipal Year 1964-65 COUNCILLOR L. HITCHCOCK, A.I.B., Chairman. ALDERMAN MISS A.S. TERRY, J.P., Vice-Chairman. ALDERMAN MRS. L. FALLAIZE, J.P., (E.C.C.) (Mayor). COUNCILLOR H.A. BYSOUTH, COUNCILLOR V.W. MASON. F.I.A.C. COUNCILLOR J. H. NORWOOD. COUNCILLOR D. A. CARRADICE. COUNCILLOR C.G. ROLFE,A.I.S.T. COUNCILLOR MRS. G.M. (to 3.2.1965) CHAMBERLIN, (E.C.C.) COUNCILLOR J.E. SOLEY. COUNCILLOR D.S. DAVIES. COUNCILLOR J.P. STONHAM, B.Sc. COUNCILLOR A. G. FROST, M.Sc. COUNCILLOR G.H. WATSON. COUNCILLOR F.H. JAMES, (E.C.C.) COUNCILLOR A.J. YEOMAN. (Deputy Mayor) ILFOBD HEALTH AREA SUB-COMMITTEE OF THE HEALTH COMMITTEE OF THE ESSEX COUNTY COUNCIL Municipal Year 1964-65 Ilford Borough Council Representatives: ALDERMEN COLVIN, GLEED, MASTERS, MISS TERRY, (Chairman); COUNCILLORS BELLAMY, MRS. CHAMBERLIN (Vice-Chairman), CLACK, G.E. DAVIES, FERRIER, FROST, HITCHCOCK, NORWOOD,ROLFE (to 3.2.1965), STONHAM, VINCENT, WATSON. Essex County Council Representatives: ALDERMEN MRS. BOVILL, GLENNY; COUNCILLORS BERRY, JAMES, SWEETLAND, MRS. WILLIS, WORTLEY. The Executive Council for Essex Representative: MRS. V.L. WILSON. Local Medical Committee Representative: DR. T.C. MAYER (from 24.8.64). Hospital Management Committee Representative: ALDERMAN MRS. L. FALLAIZE. Voluntary Organisations' Representatives: MRS. G.M. BUTLER, MRS. V. COPLEN, MRS. C.M. DOLDEN, MRS. R.E. EAST. 3 ILFORD COMMITTEE FOR EDUCATION Municipal Year 1964-65 ALDERMAN C. I. GIBSON Chairman. ALDERMAN F. R. MASTERS, Vice-Chairman. ALDERMAN G. COLVIN, C.B.E., COUNCILLOR G.E. DAVES. F.C.LS. COUNCILLOR S.F. LOVELESS. ALDERMAN MRS. L. FALLAIZE, J P (E.C.CC) COUNCILLOR V.W. MASON. ALDERMAN S.G. GLEED. COUNCILLOR J. L. MURPHY, J.P, A.I.R.N.A., A.I.Mar.E. ALDERMAN F.T. PEARSON. COUNCILLOR A.F. OSBORNE. ALDERMAN A.J. SHAW, B.A. COUNCILLOR H.C.C. PARKER. ALDERMAN MISS A.S. TERRY, J.P. COUNCILLOR C.G. ROLFE, A.I.S.T. COUNCILLOR H. R. B. ALY. (t0 3.2.65) COUNCILLOR D. A. CARRADICE. COUNCILLOR C.A.A. SHUMAN. COUNCILLOR MRS. G.M. COUNCILLOR J.A. VINCENT. CHAMBERLIN, (E.C.C.) COUNCILLOR A.J. YEOMAN. Co-opted Members: MR. T. F. COBB, A.I.A.C. 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. MISS F. STEVENS. MR. T. E. WILLIAMS. County Nominated Members: COUNTY COUNCILLOR A.F.J. CHORLEY, M.B.E., J.P. 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, Ilford Health Area Sub-Committee: I. GORDON, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. (Edin.). Deputy Medical Officer of Health: (Part-time) D.M.B. GROSS, M.D., Ch.B., (Leeds), M.M.S.A., D.P.H. (Lond.). Chief Public Health Inspector: S. R. DALY, LL.M., B.Sc., D.P.A. (Lond.), Barrister-at-Law. Deputy Chief Public Health Inspector: R.E.SMALLEY Public Health Inspectors: A.C.R. NEALE. J.COOK. T.F.JOHNSON. F. NAU. C. BROOMFIELD. D. F. W. SCOTT L. W. COLE Chief Administrative Assistant (I.B.C.): A.E.TOURLE. R. SOUTH (from 1.7.64) L. BARKER (from 2.11.64) Welfare Officer for Old Folk: Miss M.J. COPPING, Dip. Social Sc. (Lond.). Public Analyst: J. HUBERT HAMENCE, M.Sc., Ph.D. (Part-time). Essex County council Assistant County Medical Officers: D.M.B. GROSS, M.D., Ch.B. (Leeds), M.M.S.A., D.P.H. (Lond.) (Part-time). F.E. O'CONNOR WILSON, B.A.,M.B.,B.Ch.,B.A.O.,D.P.H.(T.C.Dub.).L.M.(Rot.). D.J. GORDON-SMITH, M.B., B.Ch. (Witwatersrand), D.P.H. (Lond.) (to 19.4.64). H.B. GRANGE, M.B., B.S. (Lond.) (Part-time). J.M. POOLEY, M.B., B.S. (Lond.), D.C.H. (Part-time). G.B. TAYLOR, M.B., B.S. (Lond.), D.C.H., D.Obst. R.C.O.G. (Part-time). M. B. GEE, M.B., Ch.B. (Bristol), D.C.H., (Part-time). W.H. TOMS, M.B., Ch.B. (Edin.) (from 4.8.64). E.B. KILSBY, M.R.C.S., L.R.C.P., B.Sc. (Lond.), B.A. (Cantab.) (Part-time, from 28,9.64). Area Dental Officer: E.V. HAIGH, L.D.S., R.C.S. (Eng.). 5 Officers of the Public Health Services - continued. Dental Officers: G.H. WILSON, L.D.S., R.C.S. (Eng.). J. J.A. BOWE, L.D.S. (Belfast). E.B. BODGSON, B.D.S. (Durham). Y.G. TOOLSEY, B.D.S. (Durham). Sessional Dental Officers: R. A. SOAR, B.D.S. R.C, BIGMORE. W.V. VICTORS, L.D.S., B.D.S. N.B. DAVIS, B.D.S. (to 30.12.64). N.D. GLICKMAN, L.D.S. (to 31.7.64). Non-Medical Supervisor of Midwives: MISS R. K. JESSON. Superintendent Health Visitor: MISS J. M. OLIVER. Health Visitors and School Nurses: MISS I.L. MOBBS. MRS. W.R. BEYWOOD (part-time). MISS E. M. P. COLLINS. MRS. V.I. BAYLB. MISS M.G. DUGUID. MRS. E.T. FERGUSON. MISS H. ARNOLD. MRS. D. M. RASOR (part-time). MISS P. M. LEAVETT (to 5.4.64). MRS. J. P. WILLCOX. MRS. J.M. WESTON. MBS M.E. COOKE. MISS A.F. RIDPATB. MRS. A.M. MURRAY. MRS. C.D. CONSTABLE. MRS. C.A. ROBERTSON (to 26.9.64), MISS R. A. BARTON. MRS. 0. ELDRIDGE (part-time). MRS. L.K. LAWRENCE (part-time). MRS. K. M. RICB (part-time) (from MRS. J.H. GADD. 2.3.64). MISS I. HARRIS (part-time). MBS P.M. YOUNG (from 1.9.64). MRS. M. WELLER (part-time). MRS. F.O. ERINLE (from 11.9.64). MISS N.L. HALL. Tuberculosis Visitors: MRS. K.M. PARKES MRS. M.J. MOORE. MRS. C. EARWAKER. 6 Officers of the Public Health Services - continued. Educational Psychologists: MISS B. S. GASCOYNE, B.A. (Hons. Psych.). MISS C. H. F. WATT, B.A. (Hons.). Psychiatric Social Workers: MISS M. D. BOYD. MISS R. P. O'HARE (to 31.3.64). MRS. B. BENJAMIN Child Psycho-Therapists (Non-Medical) (Part-time): MRS. D. HANDJA. DR. I. MUNARI. Speech Therapists: MRS. P. A. PRETIOUS, L.C.S.T. MRS. B. G. TINGEY, L.C.S.T. (Part-time). MISS G.S. MEYERSBERG, L.C.S.T. (Part-time) (to 16.10.64). MRS. T.M. OLIVER (to 21.11.64). Physiotherapists (Cerebral Palsy Unit): MR. A. BRAND, M.C.S.P. (from 2.3.64). MISS A. DOTZLER, M.C.S.P. (from 25.5.64). MR. W. P. MORRIS, M.C.S.P. (to 19.1.64). Occupational Therapists (Cerebral Palsy Unit): MISS M.P. MOORHOUSE. Nursing Assistants (Cerebral Palsy Unit): MRS. B. LLEWELLYN. MRS. V.E. WAITES (from 7.9.64). Occupational Therapist (T.R. Cases): MISS Z.E. MERCER (Part-time). Chiropodis ts: MR. F.W.GIBSON, M.Ch.S. MISS M.I. MERCER, M.Ch.S. MR. L.N.C. MARTIN, M.Ch.S. MR. R.P. BROWN, A.Ch.S. (from 4.8.64). MR. R. J. P. BUNDER, M.Ch.S. (Part-time). MRS. R. V. PAY, M.Ch.S. (Part-time). MR. B.L. SCLARE, L.Ch. (Part-time). MR. G.P. BLACKMAN, M.Ch.S. (Part-time) (from 2.4.64). Matrons of Day Nurseries: Goodmayes Lane MRS. E. DROWER. Ley Street MISS G.M. GROSS. 7 Officers of the Public Health Services — continued. Chief Administrative Assistants (E.C.C.): MISS H. M. NUNN E. S. JENKINS Domestic Help Organisers: MRS. L. G. LAWRENCE MRS. K. M. BEDWELL 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., B.S., D.O., D.O.M.S. P. LANCER, M.B., B.S. Surgeon in charge of Ear, Nose and Throat Clinic: MARGARET M. MASON, M.A., F.R.C.S. Child Guidance Clinic: Medical Director: W. P. GURASSA, M.D., M.R.C.P. Psychiatrist: H. J. ALTSCHULOVA, M.D. Consultant to the Cerebral Palsy Unit: H. B. LEE, F.R.C.S. Orthoptist: MISS J.C. DIXON, D.B.O. (to 24.7.64). MBS M. WARD, D.B.O. (from 29.7.64.) 8 Preface HEALTH & WELFARE DEPARTMENT, Telephone: 17/23 Clements Road, ILFord 3020 ILFORD. August, 1965. Mr. MAYOR, LADIES and GENTLEMEN, I submit herewith the last Annual Report of the Health Services of the Borough of Ilford. Perforce this report must be presented to the new London Borough of Redbridge, as the Borough of Ilford ceased to exist on 31st March, 1965. Reports of other officers in the Public Health Department are as usual included. Most fittingly, the health statistics for this last year are probably the best ever and show in many cases a remarkable improvement over the previous year, even although the 1963 ones were good. The new borough will be set a difficult task to maintain this standard. In each case the figures in brackets refer to 1963. There were 29 (40) stillbirths, the infant mortality rate was 12.36 (20.36) per 1000 live births. The neonatal mortality rate was 7.68 (14.18) per 1000 live births in the first four weeks of life. The early neo-natal mortality rate, i.e. under one week, was 7.01 (13.9). The perinatal mortality rate 16.54 (27.23) thus also improved. There were no maternal deaths, and the adjusted death rate for the borough was 10.59 (11.84). There were 2994 (2751) live births in the town, bringing the adjusted birth rate to 17.23 (15.74). Notified infectious disease fell to 1660 (2063), the main drops being in dysentery 142 (295), measles 1131 (1277), whooping cough 98 (183) and food poisoning 19 (36). There were 6 (12) deaths from tuberculosis and 134 (212) from pneumonia. On the debit side, the percentage of illegitimate births is still rising, 5.61% (5.10%), and the incidence of cancer of the lung, with 95(91) deaths, continues to warn us against the risks of cigarette smoking. The change-over from Ilford to Redbridge is still so fresh in my mind that perhaps this preface is an apt opportunity to comment on a few features. The take-over proceeded smoothly and without fuss, and all services are at least as good as they were before. This hurdle is now over and the next step is to make sure that we improve the services even 9 further, to which purpose the new local government structure is better designed as compared with that which existed before. Unlike the position in nearly all the other London boroughs, the loss to Redbridge by transferring elsewhere of Ilford officers working in the health department has been negligible. Without doubt remaining with us has been a great strain on the loyalty of many, for the salary structure in Redbridge, adopted a year or more ago and then considered reasonable (witness our rise in rates of only 6d. as compared with the rise in most of the other boroughs), is in many cases far below that adopted for doing similar (or less) work elsewhere within easy travelling distance. We are in the middle of a financial epidemic, which might be called the London Disease, incubated by the London County Council before its passing, by the Greater London Council and many of the inner London boroughs, each determined to attract staff from the other. There is no means of quarantine against this affliction; staff, like viruses, need take no account of borough boundaries. Whilst the Health and Welfare Department of Redbridge is grateful to those who have resisted the temptation to transfer to more lucrative but doubtless less happy positions elsewhere, a time must come when the pressure will prove irresistible and we will lose staff. Such a crack has already appeared in the resistance of the public health inspectorate. Of the many advantages of the new order, I would only stress one at this juncture, the presence in one building of the environmental, personal, school and mental health services, the welfare service, and the children's department. Both field workers and administration in all these sections have easy access with each other, sharing the same canteen and using the same conference room and the organisation of case conferences is facilitated. The general public come to one building instead of half-adozen scattered over the old Essex, with offices as far apart as Wanstead, Chelmsford and Romford. The reorganisation has enabled a start to be made to ensure that a certain criticism often directed against the variety of home visitors has no validity, if ever it really had; i.e. that numerous social workers of one kind or another visit the same home, giving conflicting advice, and often in ignorance of each other's activities. A register will be kept of individuals who have been visited by social workers of the health and welfare, children's, education and housing departments, which will indicate which social workers have visited and when. There will be no further details, and any social worker will be at liberty to consult the register. Social workers of other statutory authorities in the borough, such as hospitals, and probation officers, have been invited to co-operate, and attended with our social workers a meeting convened to discuss this matter. It was, however, noted with a degree of disappointment that certain social workers (not in the employ of the local authority) are somewhat 10 reluctant to join, giving as the reason that if their clients' names were on a list it would have unfavourable effects upon confidentiality. This viewpoint was maintained in spite of the fact that the register would be kept in the health and welfare department, where confidentiality of medical and social documents was a well established principle and that the names were anyway probably on one of the many lists kept in the same department. The problem of liaison with workers of voluntary associations was also discussed. It was decided that this would best be done by resuming the luncheon meetings that were once organised by Canon Lewis, but this time under the aegis of the llford Social Service Association. Has the change-over had anydisadvantages?There is one; it involves the position of the Medical Officer of Health. With the increase in population, increase in responsibilities and increase in staff, he is inevitably more isolated from the people for whom the services cater, i.e. the troubled parent, the head teacher, the family doctor, the case of infectious disease, the disturbed child, the individual seeking a better home, convalescence, or any one of dozens of other needs. With the necessary interposition of senior officers, the Medical Officer of Health is at least one step further removed from the citizen. Many of his own staff will now be strangers. I find it hard to understand why in the field of social welfare there are those who would wish for large local government units. A quarter of a million population is, if anything, the maximum size for a health and welfare authority. It is argued that large authorities bring economy and efficiency. Whilst not accepting this, even if it were true, the argument is not decisive. It would doubtless be more economical and efficient (I believe the experiment has been tried in China) to cease to have families in units and put them all in large institutions with food prepared by skilled dieticians, cleaning and laundering done by specialists, infants and children looked after by trained nurses; case-workers at hand to deal with family quarrels and fully staffed sick-bays for father or mother when they catph cold. We all realise that such economy and efficiency would in the long run fail miserably to produce happy and worthy citizens. I realise that it is easy to pick holes in this analogy between local government and family structure, but it has enough truth for my purpose. Large units are needed for planning, and services which cannot adequately be carried out by smaller ones. Social welfare does not require the techniques of mass production. For the last time as an llford officer, I would like to thank the volunteers of the llford Federation of Voluntary Workers, llford Social Service Association, W.V.S., Red Cross, and many others for their consistent and necessary help. The Chairmen, Vice-Chairmen and members of the llford and Essex 11 Committees have given me help and encouragement, likewise my fellow Chief Officers and other officers in the various departments, for which I am very grateful. I have the honour to be Your obedient servant, I. GORDON, Medical Officer of Health. 12 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 1931) 131,061 (Census 1951) 184,706 (Census 1961) 178,024 Registrar-General's Estimate of resident Populations:- June 30th 1961 177,760 1962 177,460 1963 176,550 1964 175,490 Number of inhabited houses (April 1st, 1964) according to Rate Books (approx.) 53,469 Rateable Value — April 1st, 1964 £8,863,836 Sum represented by a penny rate, April 1st, 1964 (approx.) £36,600 1963-64 1964-65 Combined Rate (all services) 9s. 6d. 10s. 0d. in the £ in the£ The following figures as to unemployment were supplied by the Ministry of Labour:- Males Females As at December, 1963 477 84 As at December, 1964 452 61 1964 1963 Live Births 2,994 2,751 Live Birth rate per 1,000 population — Crude rate 17.06 15.58 Adjusted rate 17.23 15.74 Illegitimate Live Births per cent of total live births 5.61 5.10 Stillbirths 29 40 Stillbirth rate per 1,000 total live and stillbirths 9.95 14.33 Total Live and Stillbirths 3,023 2,791 Infant deaths (under 1 year) 37 56 Total Infant deaths per 1,000 total live births 12.36 20.36 Legitimate " " " legitimate " 12.03 21.06 Illegitimate " " " illegitimate " 17.86 7.14 Neo-natal mortality rate per 1,000 live births (first four weeks) 7.68 14.18 Early Neo-natal mortality rate per 1,000 total live births (under one week) 7.01 13.9 Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 16.54 27.23 Maternal deaths (including abortion) Nil 1 Maternal mortality rate per 1,000 live and stillbirths 0.00 0.36 Deaths (all cases) 1,937 2,178 Death rate per 1,000 population — Crude rate 11.03 12.34 Adjusted rate 10.59 11.84 Percentage of total deaths occurring in public institutions 53.27 42.51 Deaths from Cancer (all ages) 431 384 " " Measles (all ages) Nil " " Whooping Cough (all ages) Nil " " Diarrhoea (under 2 years of age) Nil Nil 13 1. RAINFALL Total rainfall registered in the district, taken as an average over the stations in the five Parks, during the year was 19.86 inches; the greatest fall in 24 hours was registered on 14th March, 1964, 1.32 inches. June 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 for the year 1964 are 1.01 for the birth and 0.96 for the death rates respectively. 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 2,994. Males Females Legitimate 1,437 1,389 Illegitimate 82 86 i-e. 5.6 per cent of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was 5.1 (1963), 3.8, 3.7, 3.3, 2.7, 2.8, 2.6, 2.2, 3.0. 14 The adjusted birth rate, calculated on the estimated population of 175,490 is 17.23 per 1,000. 4. DEATHS The total number of deaths of Ilford residents was 1,937. This is obtained by taking the total number of deaths registered in the district (1,466), subtracting the deaths of non-residents occurring in the district (190), and adding the deaths of Ilford residents registered as having died in other districts (661). The number of deaths of non-residents registered in the district was as follows:— King George Hospital 67 Chadwell Heath Hospital 32 Claybury Hospital 40 Goodmayes Hospital 30 Ilford Maternity Hospital 2 Other Non-residents 19 Total 190 The number of deaths of Ilford residents registered as having died in other districts during the year was as follows, and includes deaths at the following Institutions:— Oldchurch Hospital, Romford 67 Wanstead Hospital 52 Westminster Hospital 5 London Hospital and Brentwood Annexe 109 St. Bartholomew's Hospital 14 Rush Green Hospital 31 St. Joseph's Hospice, Hackney 20 East Ham Memorial Hospital 38 St. George's, Hornchurch 52 Dagenham Hospital 15 Barking Hospital 8 Whipps Cross Hospital 45 Queen Mary's Hospital, Stratford 8 St. Mary's, Plaistow 6 St. Andrew's Hospital, Billericay 15 Harts Hospital, Woodford Green 8 In other Hospitals, Institutions and residences outside the Ilford district 168 Total 661 15 The adjusted death rate, calculated on the estimated population of 175,490 is 10.59 per 1,000. Inquests. — During the year, 68 inquests were held on deaths occurring in Ilford, 59 on Ilford residents, and 9 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 5 11 22 29 DEATH RATES FROM CANCER, 1964. The following Table shows the death-rates for 1964 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 .541 .535 Cancer, other forms 1.915 1.674 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 1964, arranged according to the age groups at which deaths occurred. 16 TABLE I. - VITAL STATISTICS OF WHOLE DISTRICT DURING 1964 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 1960 178,520 1,889 2,512 14.07 (e) 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) 1962 177,460 1,969 2,539 17.31(c) 1,805 10.2 285 623 45 17.7 2,143 12.08 (c) 1963 176,550 2,010 2,751 15.58(c) 1,741 9.9 231 668 56 20.4 2,178 12.34(c) 1964 175,490 2,271 2,994 17.06(c) 1,466 8.4 190 661 37 12.4 1,937 11.03(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. 17 TABLE IA. Table showing comparison between the Birth-rate, Death-rate, etc., of IIford, London (Admin. County), and of England and Wales for the Year 1964. 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 18.4 16.4 11.3 20.0 .93 - 22.0 .08 634 London Admin. County 20.0 14.9 11.0 21.2 - - 8.8 .31 708 ILFORD (Estimated Population mid-1964 - 175,490) 17.23 9.9 10.6 12.4 - - 171 - 7642 A dash (—) signifies that there were no deaths. 13 deaths. 2134 deaths. 18 Registrar-General's Short List of Deaths and Causes TABLE II. Causes of, and Ages at, Death during the year 1964. CAUSES OF DEATH Net Deaths at the subjoined ages of "Residents" whether occurring within or without the district All Ages Under 4 weeks 4 weeks and under 1 year 1 and under 5 years 5 and under 15 years | 15 and under 25 years |25 and under 35 years | 35 and under 45years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 years and over ALL CAUSES 1,937 23 14 1 5 13 17 49 122 322 510 861 1 Tuberculosis, respiratory 6 - - - - - - - - 4 1 1 2 Tuberculosis, other - - - - - - - - - - - - 3 Syphilitic disease 1 - - - - - - - - - - 1 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - - - - - - - - - - - - 6 Meningococcal infection — — — — — — — — — — - - 7 Acute poliomyelitis - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - 9 Other infective and parasitic diseases 3 - - - - - - - - 1 2 - 10 Malignant neoplasm, stomach 55 - - — - - - - 4 10 16 25 11 Malignant neoplasm, lung, bronchus 95 - - - - - - - 9 38 34 14 12 Malignant neoplasm, breast 53 — - - - - - 3 17 16 6 11 13 Malignant neoplasm, uterus 17 - - - - - - 1 3 3 5 5 14 Other malignant and lymphatic neoplasms 211 - - - 1 1 5 13 16 43 59 73 15 Leukaemia, aleukaemia 11 - - - - - 2 — 1 3 2 3 16 Diabetes 11 1 - — - - - — - - 4 6 17 Vascular lesions of nervous system 227 - - - - - - 2 9 22 54 140 18 Coronary disease, angina 392 - - - - - - 16 30 81 133 132 19 Hypertension with heart disease 36 - - - - - - - 2 3 10 21 20 Other heart disease 179 - - - - - - 1 5 16 35 122 21 Other circulatory disease 77 - - - - - - 2 2 11 22 40 22 Influenza 3 - - - - - - - — — 2 1 23 Pneumonia 134 - 3 - - - 1 - 4 10 33 83 24 Bronchitis 112 - 1 - — — 1 - 1 10 40 59 25 Other diseases of respiratory system 11 - - - - - - - - 7 1 3 26 Ulcer of stomach and duodenum 12 - - - - - - - 1 2 2 7 27 Gastritis, enteritis and diarrhoea 12 - - - - - - 1 - - 4 7 28 Nephritis and nephrosis 14 - 1 - - - 1 1 2 2 4 3 29 Hyperplasia of prostate 6 - - - - - - - - - 2 4 30 Pregnancy, childbirth, abortion — - — — - - - - - - — - 31 Congenital malformations 15 4 6 1 1 2 - — - - — 1 32 Other defined and ill-defined diseases 154 18 3 - - 2 - 3 6 25 26 71 33 Motor vehicle accidents 26 - - - 2 5 1 1 4 7 4 2 34 All other accidents 38 - - - - 3 1 1 2 1 6 24 35 Suicide 22 - - - - - 4 3 4 7 2 2 36 Homicide and operations of war 4 - - - 1 - 1 1 — — 1 — Special Causes (included above) Smallpox - - - - - - - - - — - - 19 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 1964 will be found in Part III Services section. (iii) LABORATORY FACILITIES. - Pathological specimens are now sent to the Bacteriological Laboratory, Oldchurch Hospital, Romford, for examination. (iv) BYELAWS EXIST FOR:Prevention of Nuisances. Cleansing of footways and pavements, and cleansing of earth closets, privies, ashpits and cesspools. Dealing with common lodging houses and houses let in lodgings. Houses let in lodgings or occupied by members of more than one family. (Sec. 84, Ilford Act, 1937.) Slaughterhouses and humane slaughtering of animals. Pleasure Fairs. (Sec. 59, Essex C.C. Act, 1952.) Tipping of Dust, Spoil, and Refuse. (Sec. 85, Ilford Act, 1937.) For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (Sec. 53, Ilford Improvement Act, 1898.) Nuisances in connection with the removal of offensive or noxious matter. Depositing of Rubbish, etc. (Sec. 249, Local Government Act, 1933.) 20 Establishments for Massage or Special Treatment. (Essex C.C. Act, 1933, Part IV.) Inspections of licensed establishments are carried out quarterly. During 1964, two new applications and 27 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 1964, 11 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 Ilford Improvement Act, 1898, which has important sanitary provisions; (2) The Ilford Urban District Council Act, 1904, the Section which deals with the control of tuberculosis is repealed, the powers of the Corporation now being contained in the Food and Drugs Act, 1955, and (3) The Ilford Corporation Act, 1937. (vi) ESSEX COUNTY COUNCIL ACT, 1952. - This Act came into operation in 1953. Reference is made in this Report in appropriate sections as to action taken under the Act. (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 1964. (viii) NATIONAL ASSISTANCE ACT, 1948. - The County Welfare Officer has kindly supplied me with the following information. 21 "The County Welfare Committee is responsible to the County Council for functions under Part III of the National Assistance Act, 1948, the main aspects being:— (a) the provision of residential and temporary accommodation and (b) welfare arrangements for blind and other handicapped persons. The following statistics show the extent to which the main services provided by the County Welfare Committee under the National Assistance Act, 1948, have been afforded to persons residing within the Borough of Ilford during the year 1964:— (1) Residential and Temporary Accommodation (a) Number of Ilford residents provided with residential accommodation at 31.12.64:— 207. (b) Aged persons admitted to hostels and other residential establishments in 1964:— 43. (c) Other persons admitted to residential accommodation in 1964:- 2. (d) Persons admitted to temporary accommodation:— Adults 7; Children 14 = 21. 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 and further purpose built homes are envisaged in the ten-year plan. Additionally, an annual grant is made by the County Council towards the cost of welfare services and amenities provided by the Borough in their special accommodation for old people at Stoneleigh Court. (2) B1ind Persons The numbers of registered blind, partially sighted and defective sighted persons resident in the Borough as at 31st December, 1964 were as follows:— 22 (i) Registered as blind 274 (ii) Partially sighted 82 (iii) Defective sighted 12 all of whom were under the supervision of the County Council's Home Teachers. During the year 4 blind residents participated in the Home Workers' Scheme operated through the agency of the Royal London Society for the Blind, and 2 were employed in Workshops for the Blind. In addition, 30 blind and 11 partially sighted persons were employed in open industry. During 1964, 5 blind residents in the Borough were admitted to homes for the blind and 1 partially sighted person to a suitable home. (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. 440 handicapped persons in the Borough of Ilford have registered with the Welfare Department. They are visited by officers appointed to assist them with handicrafts and individual needs. Many of them attend the Occupational Centres for the handicapped at Barking and Ilford. A senior Social Welfare Officer for the Deaf and Dumb has been appointed to co-ordinate the Welfare Services for this particular class of handicapped person." In Ilford the scheme for other handicapped persons, so far as voluntary action is concerned, has been delegated to a Sub-Committee of the Ilford Social Service Association of which the Medical Officer of Health is Chairman. NATIONAL ASSISTANCE ACT, 1948. (a) Section 47 provides for the removal of persons to hospital who are unable to devote to themselves proper care and attention. 23 Six persons were dealt with during the year — a male, aged 76 and females aged 77, 69, 73, 86 and 82 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. Six burials were required to be arranged during 1964:— a a female, aged 87, who died in an old persons' home a male, aged 65, who died in a cinema a male, aged 75, who died at home a male, aged 64, who died at home a male, aged 65, who died at home a female, aged 73, who died at home Miss M.J. Copping, Welfare Officer for Old Folk, reports as follows:— "Case work undertaken by me in 1964 followed an almost identical pattern to that of 1963. The total number of cases dealt with was slightly lower: 620 in 1964; 657 in 1963. Total number of domiciliary visits paid was 638. Interviews numbered 313, and were mostly with relatives or friends of old persons. There were also numerous discussions with other social workers, e.g. Medical Social Workers, Psychiatric Social Workers, National Assistance 3oard Officers and personnel from interested voluntary bodies. There was a slight decrease in new cases referred; the total number being 335 against 390 in 1963. A first visit to an old person about whom the worker has no previous knowledge beyond that furnished in a brief phone call or letter from the source of reference can be very time consuming. Confidence must be won; often against the heavy odds of dogged independence or a pre-determined refusal to co-operate. Sometimes the designation "Welfare Officer" has caused fearful anticipation. The dread of being "put away" is uppermost in the thoughts of many old persons. Deafness may prolong an interview to the length of half a day's work. Certainty that remarks and questions have not been misheard or misunderstood is very important. Wrong information inadvertently imparted or received can have far reaching effects. Hurt feelings too can result, and a consequent refusal of much needed help and advice. Partial deafness and incorrect use or rejection of the hearing aid provided or offered through the National Health Service are very common to find, while complete deafness which may be of a type which cannot be corrected 24 at all by a hearing aid is not uncommon. I saw about 20 "stone deaf persons during the year. For these every question and comment had to be written down. Some had, in addition, very poor vision, consequently bold clear writing was required. The majority shouted their replies, and two for some inexplicable reasons insisted upon writing them, which was a laborious process. In such cases it is difficult to remain patient and almost impossible to convey the sympathy felt for them in a constructive way. Uninitiated critics who query why social workers cannot hurry, or pay a standard number of calls in a given time, could learn much from spending a month with a worker making initial visits to old persons. Problems concerning housing accommodation numbered 107. About one third of these were a continuation of the 109 referred in 1963. The remainder were newly referred. Some of these were assisted in finding alternative rooms in private houses or with the Ilford Housing Trust. Some few were rehoused by Ilford 3orough Council in old persons flats with which they were delighted. Part 3 accommodation was required by 49 and these were referred by letter to the Essex County Council Area Welfare Officer. With the letters went reports of my visits. Advice and help while awaiting admission to Hospital was requested upon behalf of 115 persons who were subsequently admitted. Loan of sick room equipment, laundry service, domestic help service, meals on wheels etc., were arranged in the meantime as appropriate. Some of these people needed a great deal of moral support. Of the persons visited 106 died in Hospital during the year, and 50 others died at home. Of those who died at home there were a few who refused to accept Hospital beds. Some of these were a great problem to their aged spouses or to daughters who for economic reasons were bound to continue to follow employment outside their homes. Everything possible was done to ease their difficulties with domiciliary services, the demand for, and genuine need of which, were again far in excess of what could be supplied. The quality of the services is good but the quantity remains insufficient. Daily meals on wheels would be a boon to many and some, receiving domestic help service once or twice weekly, urgently need it daily. There were 41 requests for holidays for old persons, about half being from the old person direct. These wanted either financial help or help in making a suitable booking at a low cost. The other half were referred by relatives who wanted to arrange for the care of, plus if possible, a pleasant change for the old person, while they took their own annual holiday. As usual there were a few rela-. 25 tives who were very indignant that such arrangements could not be entirely free of cost. Some happy solution was found in each case. Thirty-six families appealed for advice because of difficulty in coping with the care of an old person, usually a parent, but in a few instances an Aunt or Uncle, in one a sister, and in another a cousin, sharing their home or living alone elsewhere. Senility of varying degrees was the cause of the problem in most of these families. Some old active persons were a public nuisance and this reflected upon the family as a whole; sometimes it led to friction with neighbours and tradespeople. More than one old person was taking regular outings on public transport failing to pay the appropriate fare, being found in trains or buses at termini and being put in the care of the Police or being escorted home by transport personnel. Some ordered unwanted goods from local stores; others cancelled orders for essentials such as bread, milk and fuel. They could neither be trusted to go out alone, nor to remain alone in the house. I was able to arrange voluntary help in the way of supervision for some; I asked leaders of Old Age Pensioners Clubs to accept some as members, and to arrange escort by other members to and from meetings and on outings. Some were among those referred to the Essex County Council Area Welfare Officers and some 1 discussed with their Doctors. Of the latter, drugs were then prescribed for some, and a degree of relief resulted. Others were referred by the Doctors to Goodmayes Hospital and a few admitted. Some were sent into Private Homes and settled down. Many of these persons were in the 65 — 75 age group. Yet of about 40 persons of 90 years and over seen by me during the year only 2 or 3 were suffering from a degree of senile dementia and about 50% were very alert indeed. The average age of the persons with whom I am involved rises yearly and is certainly over 80 years. Many are very brave and witty despite physical disabilities and most of the home visiting is pleasurable. The close liaison with the Geriatric Unit, Chadwell Heath Hospital continued. I visit the unit once weekly and interview patients with Dr. Dunn. We discuss their medical and social problems; decide what, if any, services and equipment they will need at home. What difficulties can be anticipated and how they might be overcome. When the discharge date is fixed I next go into action by telephone or in person as the link between the patient and the Organisers of the various domiciliary services. Within a week to ten days of discharge, or earlier if the patient lives entirely alone, I visit to assess the success or otherwise of the arrangements and to advise generally. I then send a written report to Dr. Dunn. If there is a relapse in health or some unforeseen problem I contact 26 him by phone through his Secretary. Special thought is given to the prevention of accidents and to alterations to sleeping arrangements, height of chairs, beds, steps at entrance doors etc., with a view to making mobility easier. Visits following discharge numbered 158. Other Hospitals too referred patients being discharged home. Much time was spent counselling 278 persons who came to me with miscellaneous problems. Many of these wanted little else but a friendly gossip or a word of encouragement. Addresses were given to a Catholic Organisation and to one Old Age Pensioners Club. These were happy occasions with helpful discussions following." 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 106 persons were assisted and 19,936 articles were laundered. (ix) HOSPITALS, etc. Chadwell Heath Hospital. — 161 beds are provided; 57 for general infectious diseases, 96 for geriatric cases, and 8 beds are used for ear, nose and throat cases. Maternity Hospital. — 54 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 1964 Pay Beds 14 Amenity Beds 7 Other Patients Children Medical Surgical Male Female Male Female 208 21 26 18 55 55 33 At 31.12.64. 2 beds were occupied by "chronic sick". The above three hospitals are included in the Ilford and District Group. (Group 12 N.E. Metropolitan Regional Hospital Board). 27 Psychiatric Hospitals. — There are two large Psychiatric Hospitals in the district, the Goodmayes Hospital, with 67 Resident Staff and 1,255 patients (males 560, females 695), and Claybury Hospital, with 199 Resident Staff and 1,901 patients (males 754, females 1,147) in residence on 30th June, 1964. (These Hospitals are Groups 12 and 20 respectively of the North East Metropolitan Regional Hospital 3oard.) Other Institutions. - Australasian Medical Unit (Dr. 3arnardo's Homes), Barkingside, has 60 beds in the Hospital and on 30th June, 1964 there were 30 Resident Staff and 31 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 Ambulance Service in Redbridge is now administered by the Greater London Council. The County Medical Officer of Essex has kindly supplied the following information regarding the operation of the Ambulance Service during the year 1964. "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 by teleprinter with all Ambulance Stations in the Metropolitan Area of the County and by direct G.P.O. telephone line with the Divisional Control at Chelmsford. The Control which is equipped with two-way radio, is also in direct communication with ambulance vehicles operating in the area. In cases of emergency it is only necessary to dial 999. All other requests for ambulance transport should be made, preferably in writing, to the Controller, Ilford Ambulance Control, Aldborough Road, Ilford. Requests for ambulance transport, other than emergency requests, are only accepted from Doctors, Midwives, Mental Welfare Officers and the medical staff of hospitals, and where practicable a minimum of 24 hours notice is required. General medical practitioners, when arranging a patient's 28 admission or first appointment at a hospital, inform the hospital concerned that ambulance transport is necessary and the hospital is then responsible for ordering the ambulance transport. If any difficulty should arise in obtaining an ambulance, a call may be made direct to the Controller, Ilford Ambulance Control, Seven Kings 0123 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, Goodmayes Lane, Goodmayes (for residents Of Becontree 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. 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, Ilford (for residents of Grosvenor Road area) Wednesday, 2.00 p.m. 29 Cecil Hall, Granville Road, Ilford (for residents in the Cranbrook and Park areas) 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, Ilford (for residents of Ilford Lane area) Friday, 2.00 p.m. Parish Hall, Mossford Green, Barkingside (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, Ilford, on Tuesday morning and afternoon, Wednesday morning and afternoon (Obstetric Specialist), Thursday morning and afternoon, Friday morning and afternoon (Obstetric Specialist), Saturday morning; at Mayesbrook Clinic, Goodmayes Lane, on Monday and Thursday mornings, and alternate Saturday mornings; at Manford Way Clinic, Hainault, every Wednesday morning. Midwives Ante-Natal Clinics are held at the Kenwood Gardens Clinic each Friday afternoon; at Mayesbrook Clinic each Monday afternoon; at Manford Way Clinic on alternate Thursday afternoons; at Heathcote Avenue Clinic on alternate Tuesday afternoons and at Marks Gate Clinic on first and third Wednesday afternoons of each month. Post-Natal Clinics. — These Clinics are held at the Maternity Hospital on each Monday afternoon; at the Mayesbrook Clinic, Goodmayes Lane, on alternate Saturday mornings; and at the Manford Way Clinic, Hainault, on the last Monday afternoon of each month. School and other Clinics. — Clinic sessions are held at Health Services Clinics as under:- 30 (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 Infant Welfare Toddlers Midwives' Ante-Natal Relaxation and Mothercraft Enuresis Chiropody (ii) MAYESBROOK CLINIC, Goodmayes Lane, for- Minor Ailments Dental (Children and Expectant and Nursing Mothers) Ophthalmic treatment Artificial Sunlight treatment Ante-Natal and Post-Natal Relaxation and 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 (iii) NEWBURY HALL, Perryman's Farm Road, for - Infant Welfare Chiropody (iv) VALENTINES SCHOOL, Beehive Lane, for - Dental (Children) Speech Therapy (v) LOXFORD HALL, Loxford Lane, for - Child Guidance 31 (vi) MANFORD WAY CLINIC, Hainault, for - Ante-Natal and Post-Natal Relaxation and Mothercraft Infant Welfare Diphtheria, Whooping Cough andTetanus Immunisation Poliomyelitis and Smallpox Vaccination Midwives' Ante-Natal Dental (Children only) Ophthalmic treatment Orthopaedic treatment Chiropody Toddlers (vii) HEATHCOTE AVENUE CLINIC, for - Infant Welfare Midwives' Ante-Natal Mothercraft Diphtheria, Whooping Cough and Tetanus Immunisation Poliomyelitis and Smallpox Vaccination Chiropody Speech Therapy Toddlers (xii) CHEST CLINIC. — A clinic for the diagnosis and treatment of diseases of the chest 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. (special non- tuberculosis cases new and old) Friday 2 to 4.30 p.m. (old cases) Wednesday 6 to 7 p.m. (old cases — Workers' Clinic) Monday 10 to 12 noon (Ambulance cases and contacts for Xray only) For Children — Wednesday 10 to 12 noon Thursday 10.30 a.m. Pre-B.C.G. twice monthly. Tuesday 2.30 p.m. B.C.G. clinic once monthly. 32 SECTION C SANITARY CIRCUMSTANCES OF THE AREA The Chief Public Health Inspector reports as follows:— "GENERAL ENVIRONMENTAL HEALTH SERVICES" The general standard of the Environmental Health Services within the Borough was maintained during the year 1964. The Animal Boarding Establishments Act 1963 imposed new duties on local authorities to licence establishments, wherein animals (cats and dogs) are kept, subject to strict conditions for watering, feeding, protection against fire, prevention of spread of infectious diseases and for maintaining a register of movement of animals. Complaints of pigeon nuisances were received in the department and efforts were made to eradicate them by trapping. Unfortunately the Ministry of Agriculture, Fisheries and Food were reluctant to grant a licence to narcotise the pigeons on the 3alfour Road-Ley Street site by reason of possible public objection. It must be appreciated by the public that these birds cause serious damage to crops and buildings as well as causing embarrassment to passersby and whilst I appreciate fully the love of many people for birds, this particular type when fed on public places is imposing hardship on many others. If those who feed the pigeons would refrain from so doing, it would obviate great expense to the local authority and the necessity to implement the Public Health Act, 1961, which by Section 74 empowers local authorities to reduce the number of pigeons and other birds in built-up areas. The supervision of houses let in multiple occupation continued unabated and it is felt that householders have acquired a sense of responsibility for the provision of a reasonable standard of sanitary amenity, without resort to statutory legal enforcement. 'Directions' regarding the restriction of occupants, have had a salutary effect in mitigating some cases of overcrowding, whilst othprs have induced landlords to better the sanitary circumstances of their tenants. In order to maintain the food supply of the district fit for human consumption and to assuage, those who complained about foreign bodies in articles of food purchased privately, legal proceedings were instituted in 9 cases and penalties imposed in 7. 33 cases. Although legal sanctions are the ultimate means of securing compliance with the Food and Drugs Act 1955 and the Regulations made thereunder, it is by no means the sole method of preventing danger to health from unsound food. The food industry is cognizant of its duties to the public to a high degree and where complaints have been made regarding foods, the manufacturers and vendors have done their utmost to eradicate the cause of complaint. But the penal nature of food and drugs law with its absolute liability on the vendor is often a point of controversy. "LONDON HOUSING" A short resume of the history of housing administration in London might be of interest to readers of the Medical Officer of Health's Annual Report particularly having regard to the reconstruction of London Government, and also because of the misconception that housing problems with emphasis on overcrowding, slum clearance and compulsory acquisition are modern tendencies. That these difficulties are of long standing cannot be doubted and the most recent report on the standards of housing of a large section of the population of London would seem to indicate that little has been done to remedy the evils of the mid-nineteenth century. Case law had decided quite early in sanitary history that a nuisance was at one time created whenever a house owner divided a dwelling into separate tenements. One owner in Hereford was required to plead to an indictment for so doing, based on the frequency of such an action in London. It was not very effective however. ..By.35.Eliz. 1 ch.6. 1593, Statute of Elizabeth, it was decreed that each cottage was to have at least 4 acres of land attached except where land was expensive; thus where space about houses was most needed, the statute did not apply, e.g. in London Town. Another temporary Act — 35 Eliz. 1 ch.7 (1593) was passed "for reforming great mischiefs and inconveniences which daily grow and increase by pestering houses with divers families and the harbouring of inmates which practice had been productive of great infection and sickness*. The leading case of King v. Pedley (1834) laid down the rule that an owner who erected a building which was a nuisance or the occupation of which was likely to cause a nuisance and he so let it, was liable on indictment for the nuisance so caused. 34 Dr. Southwood Smith, a leading sanitarian, stated that "at present, no more regard is paid to the construction of houses or to health of the people than is paid to the health of pigs in the making of styes for them" (Select Committee Health of Towns 1840). The gross overcrowding in London was evidenced before the Royal Commission on the Health of Towns in 1847, in terms "there appears to be no available legal means of preventing overcrowding; all we can do is to put it out as a source of evil to be dealt with hereafter.' The frequent occupation of cellars, which were subject to flooding, in contravention of London 3uilding Act of 1844, was dealt with by requiring Overseers to report all offences to the Official Referee who in turn notified the District Surveyors to enforce the Referee's orders. The Common Lodging Houses Act, 1851 which enabled the Police Commissioner to control overcrowding in London lodging houses, was amended and improved in 1853, to require the registration of both premises and keepers thereat and to limit the number of occupants, to prevent overcrowding and for the making of frequent inspections to control such houses. The police were designated the supervisory authority solely because of the refusal or reluctance of the sanitary authorities of the period to discharge their statutory health functions. An attempt to alleviate the gross overcrowding was made by the Artizans and Labourers Dwellings Act, 1868 which permitted local authorities to provide lodging houses for the poor and to borrow money for that purpose, but without avail, however, for the principal defect in sanitary administration lay not in the absence of legal rules but rather in its non-execution and its permissive character. The Sanitary Act, 1866 empowered local sanitary authorities to promulgate regulations to control houses let in lodgings which were to be inspected and approved by the designated officer of the authority and thereafter were to be constantly supervised to prevent overcrowding by fixing the number of occupants, to require the owner to provide suitable sanitary amenities, maintain cleanliness and remedy all nuisances. Once again, however, the law was flouted by the simple practice of not submitting regulations for the approval of the Secretary of State or if they had been so approved, by omitting to appoint the necessary sanitary officers to enforce them. Indeed the Royal Sanitary Commission Report of 1871 some six years after the passing of the Sanitary Act reported "however 35 local the administration of affairs, a central authority will always be necessary to keep the local executive everywhere in action". By then only Chelsea and Hackney had made, implemented, and enforced Regulations under Section 35 of the 1866 Act and had appointed suitable and sufficient enforcement officers to ensure compliance with these salutory rules. So successful were these officers that Chelsea's Medical Officer could say in his Annual Report for 1870 "I have seen no reason to alter my previous opinion of the beneficial effects of the measure by which we have been enabled to bring under direct and constant supervision the majority of houses occupied by the poor*. Progress in housing administration was effected with the Artizans and Labourers Dwellings Act, 1868 (Torren's Act) whereby local health authorities could acquire and improve old houses and secure sanitary improvements in others, where-ever this was necessary. Overcrowding could also be mitigated and the demolition of unfit houses incapable of reasonable repair was prescribed for, after a report by a sanitary officer and enquiry made thereto. New houses were also to be provided by the local authority. Thus the first real attempt to secure due enforcement of standards of fitness for human habitation in poor houses was instituted; but once more the administering authorities failed to accept their responsibilities. Another Statute of 1875 "The Artizans and Labourers Dwellings Act" known as Cross's Act, permitted the clearance of whole areas of slum property with reconstruction on the site to provide dwellings for the working classes, for which purpose compulsory purchase powers were afforded to the sanitary authorities. Owners were compensated for loss on agreement with the Metropolitan Board of Works with disagreements settled by an arbitrator who assessed the loss at a fair market value, regard being had to the nature and conditions of the property. Experience proved Cross's Act to be cumbrous and costly to the rate-payers, because arbitrators valued unfit properties as being sound and available to willing purchasers. Thus dilatory landlords allowed their property to become unfit, knowing that full compensation would be paid on demolition by the local authority. The Sanitary Law Amendment Act, 1874 made the submission for approval and the enforcement of regulations to control houses let in lodgings under Section 35 of the Sanitary Act, 1866 obligatory on all sanitary authorities and a Select Committee on Artizans Dwellings in its Report of 1882, sixteen years after the 1866 Act, stated "that so long as Vestrymen own little properties and so long as 36 their friends and relatives do the same and all are mixed up in a very friendly association, you can never get the prevention of unhealthy tenancies carried through". It would seem that by 1882 there was still the problem of bad housing even after the passing of the Public Health Act of 1848 and the effective powers contained in the Sanitary Act of 1866; Bad sanitary administration by the recalcitrant local authorities was the prime cause, not the absence of sanitary powers. The Royal Commission on Housing of the Working Classes reporting in 1884 averred that Medical Officers of Health being in private practice were thereby under the influence of their employers hence were loath to exercise their sanitary duties, as it might conflict with their far more lucrative private earnings, and would soon bring a hornet's nest about his ears, were he to be diligent in the exercise of his public health duties. On the other hand it was freely acknowledged that the tenants of rented properties, mostly ignorant of health matters were careless of their responsibilities to take due care of the premises they occupied and used them wastefully and negligently thereby aggravating the problems facing sanitary administrators. The Labouring Classes Lodging Houses Acts 1851 and 1857 substituted the Metropolitan Board of Works for the supine Vestries and District 3oards for housing administration purposes and empowered the purchase of certain prison sites for re-housing the poor displaced from the cleared slum properties. It also gave the authority powers of acquisition at insanitary house values only. 3eing permissive in form, these statutes were only occasionally implemented to the detriment of a large section of London's poor. The Housing of the Working Classes Act, 1890 directed the Medical Officer of Health to cause the inspection of insanitary dwellings to be made and to make representations to the London County Council thereon with the resultant clearance of large areas, the building of dwellings thereon for re-housing of the displaced persons and the general improvement of housing conditions of the working classes. Vestries and District Boards were also empowered to carry out minor works for the improvement of houses. Finally the spate of Post (1914/18) War housing legislation imposed Metropolitan housing administration principally on the London County Council thus emphasising the continued reluptance of Parliament to clothe the inferior London sanitary authorities with these important health promoting functions no doubt by reason of their long history of 37 neglect in this important field of local government administration. The 1939/45 War has produced the very same problems. Overcrowding is rife, the slums in London areas extensive as ever and a large section of the community is livingin grave insanitary conditions. Who is to blame? Parliaments have provided adequate housing legislation, local authorities have endeavoured to cope with the ever increasing problems, education has inculcated far higher standards of knowledge of hygiene and sanitation among the less fortunate of mortals, and people are now far more enlightened as to their public rights and duties. The abundance of legislation to deal with dwellings let in multiple occupation affords a reasonable means of dealing with the grosser housing evils by the power to limit the number of occupants and to require the provision of suitable and sufficient sanitary amenities compatible with that limited number of occupants; even to the extent of introducing management orders. But to what extent are the authorities exercising these powers? Social and political factors are of times a deterrent to satisfactory execution. To displace families from even poor or unfit houses creates hardship and the increased cost of re-housing imposes great burdens on local rate-payers. But the law is compelling and must be enforced by the local councils and if hardship is caused thereby, public opinion will ultimately produce an amendment of the law. llford will together with Wanstead and Woodford become a Greater London Borough next year and therefore the problems concomitant with London's housing will affect the new borough. It is an essential part of the Public Health Inspectors duties to investigate and report on the housing conditions in the district and to enforce, as directed, the requirements of the Housing Acts 1957 to 1964, with particular reference to unfit properties and dwellings let in multiple occupation, a duty they are trained to discharge and which plays an ever increasing part in the promotion of satisfactory environmental health conditions. (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. 38 "The water supplied to the Ilford area by the Board is derived from Wanstead Well and River Lee-derived water from Lee Bridge Works in varying and unpredictable proportions." The fluoride content of these supplies is as follows:— Wanstead Well 0.55 - 0.6 of a milligramme per litre F. River Lee derived 0.3 - 0.45 of a milligramme per litre F. "The water supplies have been satisfactory in both quantity and quality during the year. There were no changes in the general scheme of supply and no trunk mains were laid but the length of new service mains laid in the Borough during 1964, was 276 yards. All new and repaired mains are chlorinated before being restored to supply and samples from these are tested to confirm that the quality of the water in them is up to the standard normally supplied." A total of 936 samples was submitted to chemical and/or bacteriological examination. 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, General Manager and Chief Engineer to South Essex Waterworks Co., has kindly supplied me with the following information. "During 1964 over 4,055 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 taken and analysed weekly and all were likewise reported on as above; in addition, samples were taken weekly from houses in various parts of the supply area for bacteriological examination and they were invariably perfectly satisfactory. A supplementary supply of water was obtained from the Metropolitan Water Board during the months of:— 39 April 33.230 m.g. July 50.502 m.g. May 93.470 m.g. November 16.924 m.g. June 79.600 m.g. December 43.982 m.g. Total 317.708 m.g. The water supply of the area and of its several parts has been satisfactory as to quality and quantity." The fluoride content of the various supplies is as follows:— Mill Road Well 1.1 P.P.M. Roding Lane Well 1.1 P.P.M. Grove Road Well 1.4 P.P.M.. Langham, Layer and Hanningfield 0.2 to 0.3 P.P.M. The following mains were laid in Ilford during 1964:— 3 ins. 4 ins. 6 ins. 9 ins. Yards 327 1.0&3 257 5 There are now no public wells in existence. There are a few private wells for domestic and commercial purposes. Four samples of piped water supply (2 South Essex Waterworks Co., and 2 Metropolitan Water Board) were taken by the Department and submitted for Chemical and Bacteriological Examination, and all gave satisfactory analyses. (ii) PUBLIC SWIMMING BATHS. - There are three public swimming baths in the Borough, two indoor, 120,000 gallons and 68,000 gallons respectively and one open-air, of 250,000 gallons approximately. The larger indoor bath and the open-air bath are closed in winter. These are filled with mains water at the commencement of each season, and during the time the baths are open, the water is maintained at a high standard of purity by continuous filtration and chlorination. The smaller bath, which is open throughout the year, receives the same treatment but is emptied biennially for cleaning. Mains water is used for maintaining the level of water in all baths. 40 Four samples of water for examination were taken from the open-air swimming bath from May to August. The samples were satisfactory. Fourteen samples were also taken from the two indoor baths during January, February, 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 following schemes were completed during the year:— (a) Oaks Lane, Brook Road, Suffolk Road Surface Water Sewer £54,428 (b) Extension of Henley Road Storm Relief Sewer £80,179 During the year work commenced on the following:— Beehive Lane, Cranbrook Road area Soil and Surface Water Sewer £200,900 Works scheduled to commence in 1965 are as follows:— (a) Tomswood Hill, Fencepiece Road and Forest Road Soil Sewer £128,000 (b) Oaklands Park Avenue Soil Sewer £11,000 (c) Tomswood Hill, Fullwell Cross and Forest Road Surface Water Sewer £140,500 (d) Green Lane — Hazeldene Road Surface Water Sewer £40,000 (e) Green Lane, Goodmayes Lane and Trenance Gardens Surface Water Sewer £52,000 RIVERS AND STREAMS Pollution of Streams. — Oil pollution of surface water sewers, streams and lakes still persists, particularly in South Park and Goodmayes Park Lakes. 41 (iv) COLLECTION AND DISPOSAL OF REFUSE. - The Borough Engineer also kindly supplied the following information:— Tons Total amount of refuse collected and disposed of 59,486 Collection of Salvage:— Tons Income Wastepaper 1,561 £10,820 Rags, Scrap Metal and Tyres 141 £2,152 (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 26,957 Houses and premises reinspected (work in progress) 15,474 Visits during disinfection 104 Houses in which nuisances were detected 845 Houses in which nuisances were abated 884* Premises disinfected 8 Premises from which articles only disinfected 5 Articles disinfected 32 Premises disinfested for verminous conditions 16 *Includes 103 nuisances detected before 1st January, 1964. Notices served:— Served Complied with Statutory:— Public Health Act, 1936 46 35 Clean Air Act, 1956 - - Housing Acts, 1957 and 1961 6 1 Factories Act, 1961 3 — Shops Act, 1950 - - Provide Dustbin (Ilford Urban District Council Act, 1904) 5 5 Food and Drugs Act, 1955 — — Cleanse Water Storage Cistern (Bye- laws) — — Cover Water Storage Cistern- (Byelaws) — — Informal 341 272 401 313 In addition to the above, 145 notices (35 statutory and 110 informal) served previous to 1st January, 1964, were also complied with. 42 Complaints. — During the year 3,009 complaints of nuisances were received and investigated. The following is a summary:— Animals improperly kept 2 Accumulation of manure and refuse 61 Bad Smells 53 Dampness of premises 41 Defective drains, w.c.s and fittings 849 Defective roofs, gutters, downpipes, etc 64 Defective water fittings 31 Dirty and verminous houses 18 Dirty condition of rearway 5 Flooding of premises 7 Overcrowding 8 Smoke Nuisances 59 Defective or no provision of dustbin 382 Rats and mice 745 Miscellaneous 684 Total 3,009 (vi) SHOPS ACT, 1950 (Section 38).-During the year 284 inspections were made. One informal notice was served in respect of insufficient and unsuitable sanitary accommodation. No Certificate of Exemption from the provisions of Section 38 was granted in 1964. (vii) OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963. This Act, which makes provision for the safety, health and welfare of people employed in offices, shops and railway premises, repealed Sections 37, 38 and 39 of the Shops Act 1950. Certain sections of the Act, including the requirement to register premises came into force on 1st May, 1964, and most of the main provisions on 1st August, 1964. The following statistics relate to the year 1964:— 43  Premises registered during the year Total number of registered premises at end of year Number of registered premises receiving a general inspection during the year Offices 383 383 47 Retail shops 1,271 1,271 23 Wholesale shops, warehouses 34 34 1 Catering establishments open to the public, canteens 112 112 Nil Fuel storage depots Nil Nil Nil Analysis of persons employed in registered premises by workplace Offices 5,940 Retail shops 7,297 Wholesale departments, warehouses 539 Catering establishments open to the public 1,281 Canteens 96 Total 15,153 (6,540 Measles; 8,613 Females) Number of visits of all kinds by Inspectors to registered premises 803 Applications for Exemption Three applications for exemption from the provisions of Section 6 (Temperature) and 1 from the provisions of Section 10 (washing facilities) were received in respect of office premises. All were refused. (viii) SLAUGHTER OF ANIMALS ACTS, 1933 to 1954. - No licence to act as slaughterman was granted during the year. (ix) RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951. Registration has been granted in respect of 13 premises, where filling materials, as specified in the Act, are used. 44 The occupier of registered premises may only obtain "rag flock" from premises licensed under the Act, either for the manufacture of rag flock or as a rag flock store. No licence was issued in 1964 in respect of premises used as a rag flock store. (x) LAND CHARGES ACT, 1925. - During the year 5,022 enquiries were dealt with under this Act. (xi) 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 following Smoke Control Orders are in operation, or will come into operation on the dates stated:— No. 1 — Padnall and Marks Gate Estates 1.11.1960. No. 2 — South Hainault 1.7.1963. No. 3 — South Hainault 1.7.1963. No. 4 — South Hainault 1.10.1963. No. 5 — South Hainault 1.6.1964. No. 6 — South Hainault and Goodmayes 1.8.1965. No. 7 — North Hainault 1.7.1966. Further areas are the subject of detailed inspections with a view to the preparation of future Orders. (xii) ATMOSPHERIC POLLUTION. - Complaints were received of alleged smoke nuisance in 26 instances from factories and other premises in various parts of the Borough. In 4 instances no emission was noted which would have enabled action to be taken under the Public Health Act, 1936, or Clean Air Act, 1956. Letters of warning were sent in two instances and in all other cases verbal intimations and advice were given. Three stations for measurement of atmospheric pollution have been installed in the Borough as follows':- No. 1 — Gantshill Library No. 2 - John Bramston School No. 3 — Ilford Town Hall Each station has a volumetric apparatus. 45 SECTION D. - HOUSING. (i) OVERCROWDING. — Two informal notices were served during 1964. (ii) CLEARANCE AREAS.— Three areas were declared by the Council to be Clearance Areas in 1964. 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- Cl) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,100 (b) Number of inspections made forthe purpose 17,558 (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 18 (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 174 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 142* 3. Action under Statutory Powers during the year:- A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1957. 46 (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 46 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 42* (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 3 (2) Number of dwelling-houses closed in suance of an undertaking given by the owners and still in force 2 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 (ii) Number of families dwelling therein (iii) Number of persons (units) dwelling therein 33½ (b) Number of new cases of overcrowding reported during the year 47 (c) (i) Number of cases of overcrowding relieved during the year 3 (ii) Number of units concerned in such cases 12 (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 1964 of Notices served prior to 1st January, 1964. HOUSING ACTS, 1936 and 1957. During the year 1964 the wdrk of receiving applications, calling for calculations for the "permitted number" was continued with a view to the issue of housing certificates. 3 certificates in respect of 3 houses were issued during the year. MEDICAL PRIORITIES FOR REHOUSING In 1964 50 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) ACTS, 1920 and 1933, AND HOUSING REPAIRS AND RENTS ACTS, 1954 and 1957 Particulars relating to 1964 are as follows: — Application for Certificates of Disrepair received 5 Certificates of Disrepair granted 4 Certificates of Disrepair refused - Applications Withdrawn 1 Certificates of Disrepair issued 1 Undertakings received from landlords 3 48 Unexpired Notices of Proposal to issue Certificates of Disrepair ... 1 Certificates cancelled 1 Applications for cancellations of Certificates applied for but not granted _ Certificates as to remedying of defects specified in Landlord^ Undertaking to remedy Defects: Issued to Landlords - Issued to Tenants - 49 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, 1964:— Persona registered as distributors of milk 135 Premises registered as dairy premises (other than dairy farms) 10 54 inspections of dairy premises were carried out during the year. (ii) MILK (SPECIAL DESIGNATION) REGULATIONS, 1960 and 1963:- The following licences were granted during 1964 for the 5-year period ending 31st December, 1965:— Dealer's (Pre-Packed Milk) Tuberculin Tested 4 Pasteurised 11 Sterilised 7 Untreated 2 (From 1.10.64, the word "Untreated" replaced "Tuberculin Tested" as the special designation for raw milk). 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. 50 (iii) SAMPLING. — The following is the routine practice adopted:- Designated Milks (Raw and Heat treated). - These are sampled bi-monthly and after unsatisfactory reports. 3iological Tests. - Samples of all raw milk (if any) are submitted for biological tests 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 (Pasteurised) Milk 19 19 - - Pasteurised Milk 64 64 - - Sterilised Milk 10 10 - - (iv) BIOLOGICAL TESTS.— No samples of milk were submitted to a biological test for tuberculosis. (v) 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 stated that no cows were found to be suffering from tuberculosis. No samples of milk were sent for bacteriological examination. (vi) LEGAL PROCEEDINGS.— Eleven complaints of the presence of foreign matter in milk were received and investigated. Legal proceedings were taken against the retailers in two instances. A fine of £5, plus £2.2s.0d. costs was imposed in one case and an absolute discharge, on payment of £2.2s.0d. costs was given in the other case. (vii) REGISTRATION.— No application for registration was refused during the year. 51 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 registration, 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. 20 applications for registration in respect of 20 premises were considered during the year 1964; registration was granted to 3 applicants in respect of the manufacture, storage and sale and to 17 applicants in respect of the storage and sale 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 the 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 salesmen and local retailers. Samples are repeated after unsatisfactory results. In 1964 21 samples were submitted for examination with the following results:— No. of Samples Ministry of Health Provisional grade % of Total Unsatisfactory Samples 9 I 43 - 3 II 14 — 6 III 29 4 3 IV 14 1 21 100 5 52 The Food Standards (Ice-Cream) Regulations, 1959, prescribed standards for ice-cream. During 1964, no samples were submitted for chemical analysis. MEAT AND OTHER FOODS. (i) INSPECTION AND SUPERVISION. The Council made bye-laws under Section 15, Food and Drugs Act, 1938 for securing the observance of sanitary and cleanly conditions and practices in connection with the handling, wrapping and delivery of food sold or intended for sale for human consumption, and in connection with the sale or exposure for sale in the open air of food intended for human consumption. The Public Health Inspectors reported 7 instances of individuals using tobacco whilst engaged in the handling of "open* food contrary to the Food Hygiene (General) Regulations, 1960. In all cases 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. During 1964 4,945 inspections of food shops and food preparing premises were made; 20 informal notices were served under the Food and Drugs Act, and 22 informal notices were complied with including 5 informal notices served prior to 1964. (ii) FOOD HYGIENE. The following gives the numbers of food premises in the area by the type of business:— Cafes and Restaurants 163 Factory Canteens 27 Butchers' Shops 116 Grocers' Shops 255 Fruiterers' and Greengrocers' Shops 123 Fishmongers' and Fishfryers' Shops 47 Bakehouses 14 Bakers' Shops 42 Confectioners' Shops 207 994 53 The practice of inculcating interest in the proprietors, directors and staffs of food handling organisations was continued in 1964, and the catering industry, as a whole, continues to co-operate. Having regard to the National and Local concern over the incidence of typhoid in Scotland, it was decided to intensify the health education of the public with particular reference to hygiene practice in the handling of food. To this end short courses in Food Hygiene and allied matters were arranged with the various branches of the food and catering industries, including the local hospitals and factories. Short talks, together with the use of film strips, were given to 27 groups, with a total attendance of 370. (iii) SAMPLING. The Council has delegated to the Public Health Committee power to institute legal proceedings under the Food and Drugs Act, 1955. 127 samples (114 formal and 13 informal) were obtained during the year 1964. 3 formal and 9 informal samples were not satisfactory as follows:— (a) Lemon & Pure Honey Sweets (formal). — Contained no honey therefore misdescribed as "Lemon & Pure Honey*. A letter of warning was sent in this case. (b) Jewish Hyebread (informal).— Contained brick dust. Referred for action to Authority in whose area the bakehouse was situated. (c) Milk (informal).— Contained foreign matter, mainly algae. No action. (d) Milk (informal).— Contained foreign matter - vegetable tissues and mould growth. Legal proceedings were taken and an abolsute discharge, for 12 months, was given. (e) Milk (informal). — Contained mould growth. No action. (f) Fresh Single Cream (formal).— Contained miscellaneous dirt, vegetable tissue and mould growth. Case referred to Essex County Council as bottled in County area. (g) Pork Sausages (formal).— Contained preservative, but no declaration made at time of sale. No action. 54 (h) Milk (informal).— Contained foreign matter— dried milk film. Referred to neighbouring Authority in whose area milk bottled (i) Loaf of Bread (informal).— Contained a beetle. Legal proceedings were taken and a fine of £3, plus 10s.6d. costs was imposed. (j) (k) and (1) Tropical Fruit Salad (informal).— All contained an excessive proportion of tin. No action. (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 6 persons and 3 premises were also registered during 1964. (v) REGISTRATION OF PREMISES USED FOR THE PREPARATION OR MANUFACTURE OF SAUSAGES, OR POTTED, PRESSED, PICKLED OR PRESERVED MEAT, FISH OR OTHER FOOD INTENDED FOR SALE. Section 80 of the Ilford Corporation Act, 1937, requires registration of such premises. 2 applications for registration were received and granted during 1964. (vi) ARTICLES OF FOOD SURRENDERED. During the year the following articles were surrendered and condemned as being unfit for the food of man:— Bacon, 86 lbs.; Beverages, 107 tins; Biscuits, 125 lbs; Butter, 50 lbs.; Cereals, 116 lbs.; Cheese, 37 lbs.; Cream, 12 tins; Eggs (shell) 1 gross; Fish (Wet and Dry), 392 stone; Fish (tinned), 389 tins; Fish Cakes, 10 Cakes; Flour, 52 lbs.; Fruit (tinned), 7,164 tins; Fruit (Juice), 31 tins; Game, 13 lbs.; Ice Cream, 28 brickettes; Jam (Preserves), 152 lbs.; Jellies, 13; Lard, 9 lbs.; Meat (Fresh), 10,044 lbs.; Meat (tinned), 7,868 lbs; Meat (Pies), 38 Pies; Margarine, 24 lbs.; Milk (tinned), 744 tins; Pastry Mix, 40 pkts.; Pickles, 84 jars; Poultry, 380 lbs.; Salt, 4'A lbs.; Sausages, 147 lbs.; Sugar, 148 lbs.; Soups (tinned), 203 tins; Tea, 155 lbs.; Tomatoes, 4 lbs.; Vegetables (Dried), 32 lbs.; Vegetables (tinned), 392 tins. 55 (vii) FOREIGN BODIES IN FOOD. 29 complaints (including 7 instances referred to in paragraph (iii) (Sampling) were received during 1964 of the presence of foreign bodies in foodstuffs; letters of warning were sent in 2 cases and legal proceedings taken in 9 cases and fines totalling £33 plus £15.2s.6d. costs were imposed. (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 26, Food and Drugs Act, 1955. In 1964, 19 notifications were received. There were 4 family outbreaks, 8 other outbreaks and 3 single cases. The Causual organisms were identified as follows':— Outbreaks Salmonella typhi-murium 1 outbreak involving 7 persons Salmonella Brandenberg 1 outbreak involving 2 persons Salmonella Paratyphoid B 1 outbreak involving 2 persons Staphylococci - including toxin 1 outbreak involving 2 persons No identification 8 outbreaks involving 19 persons Single Cases Salmonella typhi-murium 1 Salmonella Brandenberg 1 No identification 1 (ix) BAKEHOUSES. - There are 14 bakehouses in the district, all of which use motive power, 104 inspections of bakehouses were carried out during the year. (x) MERCHANDISE MARKS ACT, 1926. - No contravention of this Act was reported during 1964. (xi) DISEASES OF ANIMALS (WASTE FOODS) ORDER, 1957. - One person has been licensed to operate a boiling or waste foods plant under the above Order. 56 DISEASES OF ANIMALS ACT, 1950. The following Orders came into effect during 1964:— (i) THE POULTRY PENS, FITTINGS AND RECEPTACLES (DISINFECTION) (AMENDMENT)ORDER, 1963. - Requires the use of approved disinfectants for cleansing poultry pens, fittings and receptacles. (ii) THE LIVE POULTRY (RESTRICTIONS) AMENDMENT ORDER, 1963. — (a) Makes it unlawful to move poultry from premises to which they are delivered until 28 days after delivery thereto; (b) exempts movements from premises without licence under the Fowl Pest Order 1936; and (c) permits the movement of poultry, day old chicks and hatching eggs into Scotland from parts of Great 3ritain, under licence issued by the Secretary of State, subject to quarantine and testing against disease. (iii) THE POULTRY CARCASES (LANDING) AMENDMENT ORDER, 1963. — Includes the Channel Islands among the countries from which the importation of poultry carcases is unconditionally permitted. (iv) THE POULTRY AND HATCHING EGGS (IMPORTATION) AMENDMENT (No. 2) ORDER, 1963.— Includes the Channel Islands among the countries from which the importation of poultry and hatching eggs is unconditionally psrmitted. (v) THE DISEASES OF ANIMALS (MISCELLANEOUS FEES) ORDER, 1964.— Prescribed fees payable to the Ministry in respect of the landing in Great Britain from other countries, and the movement into Scotland from other parts of Great 3ritain, of poultry and hatching eggs. (vi) THE SWINE FEVER (INFECTED AREAS) SPECIAL ORDER NO. 10, 1964.— Licences were issued for the movement of 33 pigs from a local farm to the 3acon Factory at Great Dunmow. (vii) MARKETS (PROTECTION OF ANIMALS) ORDER, 1964. Prescribes conditions to be applied in respect of live animals at marketing establishments. (viii) THE WARBLE FLY(DRESSING OF CATTLE) (REVOCATION) ORDER, 1964.— Revokes previous Orders requiring the periodic dressing of cattle infested with warble fly maggots. (ix) THE IMPORTATION OF CARCASES AND ANIMAL PRODUCTS (AMENDMENTS) ORDER, 1964. - Amends provisions of 1954 Order making it illegal to land in Great Britain dry sausage (salami), fully 57 cured bacon and ham, and sausage casings (cleaned and scraped), originating in France, without a licence. (x) THE TUBERCULOSIS ORDER, 1964.- Amends 1938 Order in part and the Tuberculosis (Slaughter of Reactors) Order 1950, and revokes the Tuberculosis (Area Eradication) Order, 1950. The new Order empowers the Minister of Agriculture, Fisheries and Food to cause to be slaughtered any animal affected or suspected of being affected with tuberculosis or which has been exposed to infection. It also prescribes measures to be adopted and the form of notice to be served where animals are suspected of being affected, including the detention, isolation and, in the case of a cow, sterilisation of its milk. Provisions are also made for the prevention of the spread of tuberculosis and of its eradication. (xi) THE TUBERCULOSIS (COMPENSATION) ORDER, 1964. Lays down the scale of compensation in respect of cattle dealt with under the Tuberculosis Order, 1964. (xii) THE IMPORTATION OF ANIMAL SEMEN (AMENDMENT) ORDER, 1964.— Amends the list of animals included in the Importation of Animal Semen Order 1955, by the addition of horses and the removal of swine therefrom. (xiii) THE POULTRY AND HATCHING EGGS (IMPORTATION) AMENDMENT ORDER, 1964.— Extends the provisions of the Poultry and Hatching Eggs (Importation) Order 1947, as amended to poultry and poultry eggs brought from Northern Ireland to Scotland. 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. The following is a statement of the work carried out during 1964. 58 Type of Property Total Local Authority Dwelling Houses Agricultural All other (including Business and industrial) Total No. of properties in District 266 53,469 19 8,106 61,860 No. of properties inspected as a result of notification 48 679 - 110 837 No. of such properties found to be infested by — Common Rat Major - - - - - Minor 16 64 - 39 119 Ship Rat Major - - - - - Minor - - - - - House Mouse Major - - - - - Minor 21 175 - 38 234 No. of properties inspected In the course of survey under the Act 14 52 1 11 78 No. of such properties found to be Infested by — Common Rat Major - - - - - Minor 12 33 1 6 52 Ship Rat Major - - - - - Minor - - - - - House Mouse Major - - - - - Minor 1 11 - 1 13 No. of properties otherwise inspected - - - 994 994 No. of such properties found to be Common Rat Major - - - - - Minor - - - - - Ship Rat Major - - - - - Minor - - - - - House Mouse Major - - - - - Minor - - - - - Total No. of inspections and reinspections carried out 122 1,299 2 5,134 6,557 No. of infested properties (under II, III and IV) treated by Local Authority 54 473 1 78 606 Total No. of treatments and retreatments -carried out 54 473 1 90 618 No. of Notices served under Section 4 — (1) Treatment - 1 - 3 4 (2) Stru ctural works (i.e.. Proofing) - - - - - No. of cases In which default action was taken by Local Authority following issue of Notice under Section 4 - - - - - Legal proceedings - - - - - No. of "block" control schemes carried out Nil 59 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 17 premises during 1964. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963. - This Act which came into force on 1st January, 1964, provides for the licensing bv local authorities of establishments conducted for the boarding of animals. The Chief and Deputy Chief Public Health Inspectors have been appointed as authorised officers for the purposes of the Act. One licence was granted in 1964. PETROLEUM (CONSOLIDATION) ACT, 1928.- The Public Health Inspectors made 1,107 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 149 and the fees paid to the Council for such Licences was £140.7s.0d. LITTER ACT, 1958.— The Public Health Inspectors are authorised by the Council to investigate and report offences under the Act. During 1964, 11 complaints were received and investigated. Legal proceedings were taken in 3 cases and fines totalling £7.Qs.0d. plus £4.2s.0d. costs were imposed. NOISE NUISANCES- NOISE ABATEMENT ACT, 1960, ILFORD CORPORATION ACT, 1937 AND PUBLIC HEALTH ACT. 1936. Complaints were received of noise nuisances from 37 premises during the year. In 25 cases no nuisance was found to exist in respect of which action could be taken. In 10 cases representations by the Public Health Inspector resulted in abatement of the nuisance. One Statutory Notice under the Noise Abatement Act and one Informal Notice were served and complied with in 1964. 60 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The following diseases are notifiable to the Medical Officer of Health: 1. Under Sections 144 and 343, Public Health Act, 1936. Smallpox Relapsing Fever. Cholera Anthrax (made notifiable by the Local Diphtheria Authority from 1/4/22). Membranous Croup Erysipelas Pemphigus Neonatorum (made notifiable Scarlatina or Scarlet Fever by the Local Authority as from 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 ) . Dysentery P.H. (Infectious Diseases) Regulaltions, Malaria Anthrax Tuberculosis P.H. (Tuberculosis) Regulations, 1952. Acute Rheumatism (up to 16 The Acute Rheumatism (Amendment) Regu- years) lations, 1958 (Revoked with effect from 1/4/65.) 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. 61 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 82 of the Factories Act, 1961. 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 1963 and 1964 were as follows:— 1963 1964 Scarlet Fever - - Enteric Fever — — Diphtheria - - Acute Poliomyelitis - - Measles 1 — Whooping Cough — — Influenza 8 3 Tuberculosis — Pulmonary 12 6 Other forms — — Pneumonia (all forms) 212 134 Meningococcal Infections - - Totals 233 143 The year 1964 showed a lower incidence of infectious disease, mainly due to the decrease in the number of cases of measles, 1,131 occurred as compared with 1,277 in the previous year. There were 98 cases of whooping cough as compared with 183 in the previous year. (a) Smallpox. — No cases were notified during 1964. Vaccination is the responsibility of the Essex County Council and details appear in the Part III Services Section of this Report. (b) Scarlet Fever.— 129 cases occurred in 1964. There were no deaths from this disease. (c) Diphtheria. — No case occurred in 1964. (d) Ophthalmia Neonatorum. — No case occurred in 1964. 62 TABLE III.- CORRECTED NOTIFICATIONS OF INFECTIOUS DISEASES FOR THE YEAR 1964. NOTIFIABLE DISEASE At all Ages Number of Cases Notified At ages— Years Total Cases Notified in each Ward *Total Deaths Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Cranbrook Park Loxford Clementswood Mayfield Coodmayes Fairlop Clayhall Barkingside N. Hainault Seven Kings S. Hainault Smallpox - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 129 - 18 102 8 1 - - 4 4 3 7 3 9 14 6 8 34 22 15 — Diphtheria, including Membranous Croup - - - - - - - - - - - - - - - - - - - - - Enteric Fever (Typhoid and Para-Typhoid) - - - - - - - - - - - - - - - - - - - - - Pneumonia 55 - 4 5 6 9 14 17 9 2 - 2 5 9 5 7 5 4 6 1 134 Puerperal Pyrexia 6 - - - 3 3 - - - - - - - - - - 1 4 - 1 - Acute Poliomyelitis - - - - - - - - - - - - - - - - - - - - - Acute Encephalitis 2 - - - - 2 - - - 1 - - - - - 1 - - - - - Meningococcal Infection 2 - - 1 1 - - - - - - - - - - - 1 - 1 - - Dysentery 142 6 30 18 29 21 27 11 13 18 1 6 7 6 6 29 47 2 4 3 - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - Erysipelas 15 - - - - 2 8 5 2 2 - 3 - - 1 2 1 - 4 - - Pemphigus Neonatorum - - - - - - - - - - - - - - - - - - - - - Tuberculosis Pulmonary 48 - 2 4 9 16 9 8 3 5 3 5 2 1 1 5 9 3 5 6 6 Other Forms 7 - 1 - - 4 2 - 3 - - 1 2 - - - - - 1 - - Anthrax - - - - - - - - - - - - - - - - - - - - - Malaria — Believed contracted in this country - - - - - - - - - - - - - - - - - - - - - Believed contracted abroad - - - - - - - - - - - - - - - - - - - - Acute Rheumatism 6 - 1 5 - - - - - - - - - - - 2 1 - 3 - - Measles 1,131 33 563 530 3 2 - - 99 125 54 77 166 90 56 68 141 139 95 21 - Whooping Cough 98 19 45 29 2 2 1 - 1 4 10 13 2 19 16 8 10 8 6 1 - Food Poisoning 19 - 2 1 6 3 7 - 1 5 1 2 1 - 2 - 1 - 6 - - Typhus Fever - - - - - - - - - - - - - - - - - - - - - Totals 1,660 58 666 695 67 65 68 41 135 166 72 116 188 134 101 128 225 194 153 49 140 * Included In the figures in this column are cases notified in previous years as well as 1964 63 The following figures show the number of cases of Ophthalmia Neonatorum notified during the past five years: 1960, 6; 1961, nil; 1962, 1; 1963, nil; 1964, nil: (e) Enteric Fever (Typhoid and Para-Typhoid). — No cases occurred in 1964. (f) Acute Poliomyelitis. — No case occurred in 1964. (g) Acute Encephalitis.— 2 cases occurred in 1964. — A male, aged 27, who had recently arrived from Spain, and a male, aged 43. Both were admitted to hospital and made satisfactory recoveries. (h) Meningococcal Infection.— 2 cases occurred in 1964. — A boy, aged 6½ and a girl, aged 19. Both were admitted to hospital and made satisfactory recoveries. (i) Pneumonia - Influenzal and Primary.— There were 55 cases during 1964 compared with 82 in 1963. (j) Tuberculosis.— During 1964 there were 48 new notifications of Pulmonary Tuberculosis and 7 of other forms of Tuberculosis. In addition 61 pulmonary and 8 non-pulmonary cases were transferred to the district. The population of Ilford has not varied greatly during the past Jive years and the number of cases added to the register has also shown little change as the following figures show:— Year Population No. of Persons added to list (all forms) Deaths (all forms) No. of Persons on register 31st December 1960 178,520 181 8 1,574 1961 177,760 169 13 1,524 1962 177,460 151 17 1,180 1963 177,550 172 12 1,102 1964 175,490 124 6 1,062 Notifications and Deaths from Tuberculosis of Ilford residents during 1964:- 64 Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year - - - - - - - - 1-4 years 1 1 1 - - - - - 5-14 2 2 — — — - — - 15-24 5 4 - - - - - - 25-44 9 7 - 4 - - - - 45-64 8 1 2 - 3 1 - - 65-74 3 3 — — 1 - - - Over 75 1 1 - - - 1 - - Totals 29 19 3 4 4 2 - - Of the foregoing new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 2 2 Goodmayes Hospital 1 - Chadwell Heath Hospital 1 - Claybury Hospital - - Dr. Barnardo's Village Homes - - Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1964 990 112 1,102 Number of cases entered on the register during the year 109 15 124 Number of cases removed from the register during the year Pul. NonPul. Recovered 90 2 Deceased 15 — Left District 45 9 Lost sight of — - Diagnosis not established 3 - 153 11 164 Number of cases remaining on register on 31st December, 1964 946 116 1,062 65 The treatment of Tuberculosis is now under the control of the Regional Hospital Board. On the 31st December, 1964, there were 549 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 1964 was as follows':- Pulmonary Non-Pulmonary Total Males Females Males Females Adults 27 14 30 5 76 Children - 1 1 2 4 Tuberculosis and Chest Care Association.— Assistance was granted to 44 persons who received 330 extra nourishment grants. 70 other grants (cash, etc.) were also made to 70 patients. As from May 1962 the scope of benefits given by the Association was extended to include patients suffering from certain other chest complaints, as well as those suffering from tuberculosis. (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:- Consultations: Males Females Monday and Tuesday 4 p.m. to 6.30 p.m. Thursday 12 noon to 2 p.m. Monday and Tuesday 4 p.m. to 6.30 p.m. Thursday 12 noon to 2 p.m. Treatments: Monday to Friday 9 a.m. to 7 p.m. Saturday 9 a.m. to 6 p.m. Monday to Friday 9 a.m. to 7 p.m. Saturday 9 a.m. to 6 p.m. Whitechapel. — WhitechaDel Clinic. Turner Street, Milp End, F.nndnn, R.l Consultations': Males Females Monday to Friday 10 a.m. to 7 p.m. Saturday 10 a.m. to 3 p.m. Monday to Friday 10 a.m. to 7 p.m. Saturday 10 a.m. to 3 p.m. 66 Treatments: Males Females Monday to Friday 8 a.m. to 7 p.m. Saturday 8 a.m. to 3 p.m. Monday to Friday 9 a.m. to 7 p.m. Saturday 9 a.m. to 3 p.m. West Ham.— Queen Mary's Hospital, West Ham Lane, Stratford, London,E.15:- Consultations: Males Females Monday 3 to 6 p.m. Thursday 11 a.m. to 1 p.m. and6 to 8 p.m. Saturday 10 a.m. to 12 noon Monday 6 to 8 p.m. Thursday 11 a.m. to 1 p.m. and 3 to 6 p.m. Saturday 10 a.m. to 12 noon 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 1.30 p.m. Wednesday 9 a.m. to 1.30 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 1 p.m. Saturday 9 a.m. to 1 p.m. Albert Dock Seamen's Hospital, Alnwick Road, London, E.16.:- Consultations:- Males Females 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. The work of Health Education was continued during the year by means of talks given by officers of the Department to various Associations and Bodies. 67 Two Medical Officers on the staff of the Essex County Council devote a portion of their time to health education and their reports are included in the Part III and School Health Sections. EXAMINATION OF OFFICERS AND SERVANTS The following medical examinations were carried out during 1964:— Officers Servants New Appointments 58 59 Under Sickness Regulations 2 16 On behalf of other Authorities - - Others 8 9 Total 68 84 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. The mass radiography unit stationed at the Thompson Rooms continued to operate on Mondays from 6th January to 6th July, 1964 and again from 14th 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 1,617 1,463 3,080 General Public 1,713 1,809 3,522 Organised Groups 446 1,658 2,104 Contact Group 10 35 45 Total numbers X-rayed 3,786 4,965 8,751 Requiring further investigation 160 95 255 68  Male Female Total Pulmonary Tuberculosis Requiring immediate treatment 7 2 9 Requiring close clinic supervision 3 1 4 Requiring occasional clinic supervision 10 8 18 Presumed healed, no further action required 28 23 51 Bronchial carcinoma 26 1 27 Mesothelioma - 1 1 Metastases in the lung and mediastinum - 2 2 Other abnormalities:— Pulmonary fibrosis — Non-tuberculous 26 14 40 Bacterial and virus infection of lungs 18 7 25 Bronchiectasis 3 3 6 Other various abnormalities 16 25 41 63 49 112 69 SECTION G. - FACTORIES. Prescribed Particulars on the Administration of the Factories Act, 1961. PART I OF THE ACT. 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 139 110 3 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authorities 568 339 4 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 34 60 - - Total 741 509 7 - 2. Cases in which DEFECTS were found. (If defects are discovered at the premises on two, three or more separate occasions they should be reckoned as two, three or more "cases"). Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M, Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature(S.3) - - - - - Inadequate ventilation (S.4) — - - - - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 3 4 - 1 - (b) Unsuitable or defective 9 10 — 8 - (c) Not separate for sexes - - — - - Other offences against the Act (not including offences relating to Out-work) - - - - - Total 12 14 - 9 - 70 PART VIII OF THE ACT OUTWORK (Sections 133 and 134) Nature of work Section 133 Section 134 No. of oat-workers in August list required by Section 133(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. 142 - - - - - Cosaques, Christmas stockings, etc 41 - - - - - Total 183 - - - - - 71 PART III - SERVICES NATIONAL HEALTH SERVICE ACT, 1946 - 1957. 3IRTIIS.— In accordance with the provisions of the Public Health Act, 1936, all live births and all stillbirths of twenty-eight weeks gestation and over must be notified within 36 hours to the Medical Officer of Health of the area in which the birth took place. The number of live births notified in Ilford under this Act during 1964 was 2,263 (1,167 males and 1,096 females), of which there were 133 (66 males and 67 females) where the ordinary place of residence of the parents was outside Ilford. In addition 857 notifications of live births, (430 males and 427 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 21 stillbirths (15 males and 6 females) notified in Ilford, of which there were 3 (2 males and 1 female) where the ordinary place of residence of the parents was outside Ilford, and notifications of 10 stillbirths (4 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 28 where the home address was stated to be in Ilford, whereas the Registrar-General has allocated 29 stillbirths in Ilford. The following table shows the causes of the 28 stillbirths notified where the usual residence of the parents was stated to be in Ilford:— STILLBIRTHS 1964. Cause of Stillbirth Delivery at Home Delivery at Hospital TOTAL Anencephaly - 2 2 Asphyxia - 2 2 Congenital Malformations - 2 2 Haemorrhage - 8 8 Hydrocephaly 1 1 2 Intra Uterine Infection - 1 1 Maceration - 3 3 Obstructed Labour - 1 1 Placental Insufficiency - 4 4 Unknown 1 2 3 TOTALS 2 26 28 72 CARE OF PREMATURE INFANTS.- Of the 2,263 live births occurring in Ilford during 1964, 109 weighed 5½ lbs. or less at birth; 16 of these babies were born on the district and 93 in Hospital (including 10 where the home address of the parents was outside Ilford). Of the 16 babies born at home:— 12 were nursed entirely at home; 4 were transferred to hospital; All survived at the end of one month. Of the 93 babies born in hospital:— 4 died during the first 24 hours (including 1 where the home address was outside Ilford); 8 died between the ages of one day and one month (including 1 where the home address was outside Ilford); 81 survived at the end of one month (including 8 where the home address was outside Ilford). In addition, 43 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 N:as 5½ lb. or less. Of these there were:- 3 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 with the first year of life was 37 the total number born being 2,994. 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 12.4. The following table gives the deaths of infants under one year of age, classified according to age:— 73 INFANT DEATHS 1964 Cause of Death Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 Weeks 1-3 Months 3-6 Months 6-9 Months 9-12 Months TOTAL Accidental Haemorrhage 1 - - - 1 — — - - 1 Anencephaly 1 - - - 1 - - - - 1 Atelectasis 6 - - - 6 - — - - 6 Bronchitis - - - - - - - - 1 1 Broncho Pneumonia — - - - - 3 1 - - 4 Cardiac Failure - - - - - - 1 - - 1 Cerebral Atrophy - - - - - - - - 1 1 Congenital Abnormality 2 - - - 2 — — — — 2 Congenital Heart Disease - - - — — 2 — — - 2 Hydrocephalus - - - - - - 1 — - 1 Inter-Ventricular Haemorrhage 1 - - - 1 - - - - 1 Meningitis - - - - - - - 1 1 - Meningomyelocele - 1 — — 1 — — — — 1 Prematurity 6 - 1 - 7 - - - - 7 Renal Haemorrhage 1 - - - 1 - - - - 1 Respiratory Failure 2 - - - 2 1 - - - 3 Sub-Dural Haemorrhage 1 - - - 1 - - - - 1 Uraemia - - - - - - 1 - - 1 Totals 21 1 1 - 23 6 4 1 3 37 The comparative figures for the past 10 years are as follows:— No. of Deaths Rate per 1,000 Year under 1 Year Registered Live Births 1964 37 12.4 1963 56 20.4 1962 45 17.7 1961 40 15.8 I960 44 17.5 195933 14.9 1958 37 16.6 1957 38 17.1 1956 33 15.6 1955 42 20.0 74 The mean average infant Mortality rate for the past 10 years is therefore 16.8 per 1,000 live births. The following table shows the comparison for Ilford, England and Wales and London for the past 10 years:— Year Ilford England and Wales London 1964 12.4 20 21 1963 20.4 21 22 1962 17.7 22 21 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 NEONATAL MORTALITY.- The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 23 deaths of infants under four weeks of age during 1964 and the rate for the year was 7.7 per 1,000 live births. The figures for the past 10 years are as follows:— Year Number Rate 1964 23 7.7 1963 39 14.2 1962 35 13.8 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 ILLEGITIMATE BIRTHS AND DEATHS.- 168 of the live births registered (82 males and 86 females) were illegitimate, that is 5.6% of the births registered. There were three deaths of illegitimate children under one year of age. 75 The following table shows the birth and death rate of legitimate and illegitimate infants for the past ten years:- Year Legitimate Infants Illegitimate Infants Live Births Deaths Live Births Deaths Number Percentage of Registered Births Number Rate per 1,000 Legitimate Live Births Number Percentage of Registered Births Number Rate per l,000l Illegitimate Live Births 1964 2,826 94.4 34 12.0 168 5.6 3 17.8 1963 2,611 94.9 55 21.1 140 5.1 1 7.1 1962 2,425 95.5 44 18.1 114 4.5 1 8.8 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 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.- At the end of the year 1964 there were 17 full-time and 7 part-time qualified health visitors and school nurses, in addition to the Superintendent Health Visitor and 7 full-time clinic nurses. The following is a summary of the home visits made by the health visitors and clinic nurses during 1964 as far as the Part III Services are concerned:— 76 No. of first Visits in 1964 Total Visits in 1964 Children under 5 years of age:— Born in 1959 1,673 ) 31,492 Born in 1960 1,928 ) Born in 1961 1,904 ) Born in 1962 2,422 ) Born in 1963 2,948 ) Born in 1964 3,015 ) Persons aged 65 years or over 1,289 4,028 Other persons (expectant mothers etc.) 1,402 2,714 Totals 16,581 38,234 In addition there were 9,127 visits paid where no reply was received. Miss J. M. Oliver, Superintendent Health Visitor, reports:— "Life is so full of everyday duties for Health Visitors that at the end of a year it is sometimes hard to assess those things which we have achieved. Following a staff meeting of Doctors and Health Visitors the oriticism was made that we were turning our clinics into shops for selling foods and medicaments; also it was agreed that weighing babies was over-done. Every Health Visitor and Doctor received a list of the present medicaments and food sold. Each member of the staff then struck off what they felt could well be done without, bearing in mind that the mothers would suffer no real hardship. Finally a small committee met and decided after studying the lists what should be sold. Although at first a few mothers were not too happy, the new food list is now accepted. The weighing of babies is not so easy to remedy. Working, as the Health Visitors do in church halls, scales cannot be put away in another room. Numbers of mothers attending clinics are still high and whilst the Health Visitors are busy, the mother has placed her baby on the scales. 77 We hope gradually to educate the mothers against repeated weighing. It causes the mothers to go away worrying if a baby has lost weight. Usually a simple explanation can be found but this still does not satisfy an anxious mother. Early in the year discussions were held on the new London areas. In fact 1964 was rather clouded by the approaching changes. All of us were sorry to be parting from our Essex colleagues. Considerable assistance was given to me by the retiring Superintendent Health Visitor of the Forest Area— Staff and Clinics were visited in the Wanstead and Woodford areas. Co-operation with General Practitioners.— As reported last year, it was found possible to allocate the services of two health visitors, on a part-time basis to the practices of two general practitioners. One health visitor attending for 1 session per month commenced in March 1964 and the other health visitor attending for 1 session per week commenced in May, 1964. In-Service Psychiatric Training for Health Visitors.— In consultation with the Physician Superintendent of Goodmayes Hospital, a course of lectures for Health Visitors, given by the medical and other staff at that hospital was arranged in May 1964. The course lasted 5 days and altogether 12 Health Visitors attended, 6 from the Ilford Health Area, 4 from the Forest Health Area and 2 from the County 3orough of West Ham. Toddlers Clinic.- The success of these clinics depend very much on the areas concerned. We hope as word gets round themothers will come to these clinics for assistance. After one year of age, attendances at Clinics tend to stop. By sending appointments to mothers it is hoped that they will continue to use the services offered until the child reaches five years of age. Heathcote Clinic commenced a second Toddlers Clinic each month. Manford Way commenced one per month, this is not such an easy area and the results of attendances are sometimes disappointing. Ethel Davies School.— Two Health Visitors were "decentralised" to their own office in the above new school. They are now situated within easy access to their areas. 78 Relaxation Classes.— During August the classes were temporarily stopped at the Ilford Maternity Hospital as Sister will. The Local Authority Clinics endeavoured to include those mothers in the routine classes. The Mothers Club was abandoned at Newbury Hall because such small numbers were attending. Goodmayes Hospital Relaxation Class.— Very reluctantly this class was closed down in March 1964. The nursing staff and doctors had appreciated the help given to the mentally ill patients. The relaxation appeared to help the patients quite a lot and there was much interest shown in the Health Visitor's group discussions. Council for the training of Health Visitors'.- Many of us have attended meetings to hear about the new training syllabus for Health Visitors which commences in 1965. A tutor attached to the Council visited the Public Health Department to explain many points. It is hoped to attract women to Health Visiting by offering them the shortened course of three months obstetric training and then following on with their Health Visitors training. The new syllabus will enable the student to work side by side with her colleague the Social Worker whilst in training. The ultimate aim is to provide a good Health Visiting service. With the setting up of the new syllabus three Field workers must be appointed if Redbridge wishes to remain a training area for Student Health Visitors. This is essential as we hope to gain new staff by training Students. Health Education.— Under this heading I have included the opportunities the staff have had to broaden their outlook by means of various types of education, often meeting their colleagues in hospital and by invitation from other voluntary bodies. A Geheral Practitioner invited a Health Visitor to his surgery once a month. Although routine check-ups and immunisations are done the emphasis is on health education. The mothers choose subject^ that they would like to hear about. Oldchurch Hospital invited us to their study day. The subjects included cervical cytology and the contraceptive pill. 79 The Ilford Home Safety Committee invited us to a demonstration given by a firm on "flame proof material". Goodmayes Hospital also invited us to a study day. We are always pleased to meet our colleagues in the Psychiatric Hospital. In return charge nurses came out for a day in the Public Health Department visiting various clinics, day nurseries and housing for elderly people. The emphasis is on the help that can be given to those who are mentally ill, particularly when their staff visit homes and realise that the Health Visitor is often the first person to notice early signs of disturbance. Duke of Edinburgh's Award.— Two Health Visitors examined four girls for part of the above award. This year some mothers at the Relaxation Classes have asked to see the film the "Kiss of Life". At one of these sessions the W.V.S. were also invited. W.V.S.— The W.V.S. started their second Mother and 3aby Clinic in April 1964. The Health Visitors encouraged lonely mothers to attend. The Health Visitors assisted in a small way by giving lectures to home helps at their pilot training scheme. Home safety was the main subject with a film. Prevention and First Aid followed to be repeated three times to cover each group. Student nurses in training still out-number other types of students coming out on the district with the Health Visitors. Two Student Health Visitors came from Leicester for two weeks to add to their experience, one from the Royal College of Nursing and three from the S.E.T.C. Dagenham. I myself received much valuable help from the Superintendent Nursing Officer and fellow superintendents in group meetings over the year to discuss various Ministry circulars and a number of studies on Health Visiting." At Risk Register.— On the instructions of the Minister of Health a register has to be kept of all children who, when born, are considered to warrant special attention to ensure that no abnormality or deviation from normal exists. At 31st December, 1964 there were 282 children on this register. 80 DAY NURSERIES (a) The hours of opening at the two nurseries during 1964 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 is ll/6d.per child per day. Provision is made for this charge to be reduced according to scale when the means of the parents do not justify the full fee. Accommodation has continued to be made available to neighbouring Areas for children who can more conveniently attend an Ilford nursery than one in their own Area. (c) The training of students at the Nurseries for the Certificate of the National Nursery Examination Board continued. Six students (3 from the Ley Street Nursery and 3 from the Goodmayes Lane Nursery) entered for the examination during the year, all of whom obtained the Certificate. (d) The following is a table showing the attendances, etc., at the day nurseries during 1964:— Situation Accommodation (Children) Average daily attendances during 1964 No. of days "In Quarantine" Reasons for "Quarantine" with Number of Cases No. on Waiting List at 31st Dec. 1964 Chicken Pox German Measles Mumps Measles Goodmayes Lane, Goodmayes 50 30 36 — — 3 - 6 (Opened 14.11.51 replaced Green Lane Nursery, open from 5.5.43 to 9.11.51) 226-236, Ley Street, Ilford 50 40 77 - 3 6 - 3 (Opened 16.8.43) Goodmayes Lane Day Nursery.— The conversion of the heating at this day nursery to oil fired heating was completed on 24th February, 1964. This effected a considerable saving in the annual cost of fuel and also enabled the services of the boilerman/caretaker to be deployed between the nursery and Mayesbrook Health Services Clinic. 81 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 periodic visits of inspection are paid by authorised members of the staff. The following shows the position regarding registrations under the Act:— (a) Premises (b) Child-minders Number on register at 31.12.63 19 13 Number registered during 1964 5 4 Number removed from registerduring 1964 1 3 Number on register at 31.12.64 23 14 Number of children provided for at 31.12.64 983 74 The premises referred to in (a) above were removed from the register as the person in charge no longer wished to receive children therein. Of the child-minders referred to in (b) above as removed from the register one moved from the area and the other two did not wish to continue caring for children. DEVELOPMENT OF LOCAL AUTHORITY HEALTH SERVICES. As no further review of the Ten-Year Development Plan was requested by the Ministry of Health, the programme as set out in my report for 1963 continued during 1964. HEALTH SERVICES CLINIC PREMISES. Manford Way Clinic.— The Family Planning Association continued to use these clinic premises throughout 1964 for their sessions on every 82 Monday evening, a nominal charge being made to them for the facilities provided. At this clinic probation officers also continued to use accommodation for interviews, those of the Essex Probation Committee on one evening a week and those of the Division of Beacontree for a fortnightly evening session. A charge for these facilities, too, is made. The heating at this clinic was converted from solid fuel to oil fired in March 1964. Some saving in the annual cost of fuel was made and on the retirement of the whole-time boilerman it was necessary only to engage a parttime replacement. Kenwood Gardens Clinic.— An application was received in 1963 from the Catholic Marriage Advisory Council for the use of accommodation at this clinic for their counselling centre. The application at the approved charge was granted and the first weekly session commenced on 3rd January, 1964. As reported last year the site of 15/19 Horseshoe Cottages, Cranbrook Road, Ilford has been purchased and the development of the land to provide an extension to the clinic with a pedestrian entrance from Cranbrook Road was completed in April 1965. At the suggestion of the Essex County Council, a conference was arranged at the Kenwood Gardens Health Services Clinic on 14th May, 1964, whereby representatives of voluntary organisations in Ilford could meet each other and members of the Ilford Health Area Sub-Committee together with officials of the Health Department. The conference was attended by delegates from 24 local voluntary bodies, members of the Essex County Council and of the Ilford Medical Society and the Executive Council for Essex. A useful exchange of ideas took place and the work of each organisation was outlined by its own representative. The use of accommodation at this clinic by the Metropolitan Essex Marriage Guidance Council on Tuesday evenings continued throughout the year. INFANT WELFARE CENTRES.- 95 voluntary lady helpers were engaged in the work at the infant welfare centres at the end of December, 1964. 83 Statistics regarding the children attending the infant welfare centres during 1964 are given below:— Number of children who attended:— (a) Born in 1964 2,714 (b) Others 4,176 Total number of attendances 49,265 The following is a comparison of the attendances at the centres for the past five years:— Year Total No. of attendances of Infants 1964 49,265 1963 41,823 1962 40,828 1961 41,730 1960 38,560 820 sessions were held during the year, the average attendance per session being 60 mothers with their infants. The following are the figures for each centre:— Sessions Average Attendance Chadwell 48 64 Becontree 48 46 Downshall 48 86 Manford Way 48 45 Kenwood Gardens (Wednesdays) 49 63 Kenwood Gardens (Friday mornings) 48 26 Seven Kings 49 76 Grosvenor Road 48 85 Heathcote Avenue (Wednesday mornings ) 49 28 Heathcote Avenue (Wednesday afternoons) 49 54 Cecil Hall (Thursdays) 49 87 Newbury Hall 49 48 Marks Gate 48 33 Goodmayes 49 54 llford Lane 46 82 Fairlop 47 75 The Drive 48 62 84 TODDLERS' CLINICS.- Dr. E. Kilsby reports as follows regarding the Toddlers clinics she attends:— "At toddlers clinics held at Kenwood Gardens, Heathcote and Manford Way Clinics children between the ages of 1 and 5 years are seen for a once-yearly medical check-up by appointment. Between 75 and 80% of appointments sent are taken up and provide an opportunity not only for the detection of minor defects, but for advice on behaviour problems, feeding difficulties- and the facilities offered by the welfare clinic (e.g. dental inspection). Specific appointments at a special clinic of this nature are particularly valuable where the health visitor feels that a family would benefit by further contact with the clinic services and where general invitations to attend the infant welfare centre have not been taken up. Where necessary children are referred to their own general practitioner or to specialist clinics. Few previously undetected physical defects are noted, but mothers are often found to be worrying unnecessarily about the child's diet, size and behaviour (e.g. temper tantrums) and are grateful for reassurance." Another Toddlers' Clinic session is held at Heathcote Clinic and Dr. W. H. Toms who attends there reports:— "This Clinic performs a useful service to the community in two main ways. Firstly, it supports and encourages the young mother in her relationship with her child and helps to explain to her changes in that relationship as the child develops. Simple advice, when taken, is often able to diminish tensions in the home and may stop the formation of unfortunate patterns of behaviour in the upbringing of the child. Secondly, physical defects, particularly orthopaedic, are detected and the toddlers referred to the appropriate consultant. In the majority of cases no abnormalities are found and the parent can be reassured. The immunisation position of the children is reviewed when they are seen and the mothers encouraged to make sure the schedules are completed. As a personal observation I value the lack of pressure at this Clinic. There is ample time to examine the child and assess the family situation and as a result one hopes the interview can be therapeutic." 85 Details of the attendances at the Toddlers' Clinics during 1964 are as follows:— Sessions First Attendances Total Attendances Referrals to Hospitals or other Clinics Kenwood Gardens 21 260 261 26 Heathcote Avenue 22 214 216 11 Manford Way 10 105 115 9 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 out by the health visitors. During the year 1964 tests were made on 2,411 children, and 387 special visits to homes were made by health visitors to collect urine specimens. ORTHOPAEDIC CLINIC.- The following table summarises the attendances of children under 5 years during 1964:— Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 41 84 101 239 Mayesbrook 22 35 40 112 Manford Way 8 14 13 41 Totals 71 133 154 392 The 287 children were found by the Orthopaedic Surgeon to have the following defects:- 86 Diagnosis New Cases Old Cases A B C A B C Deformity of Hips 1 4 - - 1 - Deformity of Toes 5 1 - 2 7 - Deformity of Foot - 1 1 1 1 - Deformity of Knee — — — — 1 - Deformity of Fingers — — — — 1 - Genu Valgum 32 14 1 29 17 2 Genu Varum 1 — — 3 2 - Pes Valgo Planus 2 - - 2 - - Valgus Ankles 21 6 8 18 3 8 Talipes - - - 2 - - Torticollis — 1 — 1 1 - Intoeing 15 4 1 34 5 - Metatarsal Varus — 1 — 3 — - Outward Curvature of Tibiae 3 — 2 1 — - Shortening of Leg - - - 2 - - Postural Defect - Scoliosis 1 1 — — — - Faulty Gait 1 2 - - - 2 Trigger Thumb — — — 1 — - Other Conditions 2 — — 2 — - No abnormality discovered - - 1 - 1 1 Totals 84 35 14 101 40 13 A — Kenwood Gardens B — Mayesbrook C — Manford Way 13 pairs of valgus insoles, 13 G.V. night splints, 191 wedges to shoes and 3 dislocation hip splints were supplied during 1964. The Physiotherapist treated 85 children under 5 at Kenwood Gardens Clinic, 43 at Mayesbrook Clinic and 11 at Manford Way, with attendances of 284 , 217 and 60 respectively. OPHTHALMIC CLINIC.— Attendances of children under school age for treatment by the Ophthalmologists during 1964 were as follows:- Kenwood Gardens Clinic Mayesbrook Clinic Manford Way Clinic Total Number of children who attended 73 68 7 148 Number of pairs of spectacles prescribed 18 18 3 39 Total number of attendances made 108 149 10 267 87 EAR NOSE AND THROAT CLINIC.- The E.N.T. Surgeon attended at 50 sessions during 1964. There were 33 new cases and a total of 57 attendances were made by children of pre-school age. Operations were performed on four children, at King George Hospital and on three children at Chadwell Heath Hospital. ARTIFICIAL SUNLIGHT CLINIC.- Only 17 sessions were held during 1964 as the Physiotherapist resigned his appointment. There were no cases of children under 5 years of age seen at any of these sessions. SPEECH CLINIC.— 75 children of pre-school age attended, making 890 attendances. The following is the classification of the defects found by the speech therapist:— Delayed development including Aphasia 16 Defect of Articulation 21 Stammer and Articulation defect (combined) 5 VACCINATION AND IMMUNISATION.- The County Council's arrangements for vaccination and immunisation provide for a programme throughout childhood, in accordance with advice given to the Minister of Health by the Standing Medical Advisory Committee, 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 has been 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 1964 at the Kenwood Gardens and Mayesbrook Clinics, and at the Manford Way, Seven Kings, Chadwell, Fairlop, Marks Gate and Heathcote Avenue Clinics immunisation was undertaken at the infant welfare centre sessions. In addition, approximately 80% of this work was carried out by general practitioners. 88 Details of the immunisation carried out during the year 1964 are given in the following table:— Form of Immunisation Primary Courses Reinoculations Attendances at Clinics Diphtheria only: Kenwood Gardens Clinic 1 59 61 Mayesbrook Clinic - 72 72 Infant Welfare Centres 1 122 125 Totals at Clinics 2 253 258 General Practitioners 23 291 - Totals 25 544 258 Whooping Cough only: Kenwood Gardens Clinic — — - Mayesbrook Clinic - - - Infant Welfare Centres 4 - 10 Totals at Clinics 4 — 10 General Practitioners 28 8 - Totals 32 8 10 Tetanus only: Kenwood Gardens Clinic 56 - 140 Mayesbrook Clinic 49 2 140 Infant Welfare Centres 79 1 191 Totals at Clinics 184 3 471 General Practitioners 881 28 - Totals 1,065 31 471 Diphtheria, Whooping Cough & Tetanus(combined): Kenwood Gardens Clinic 68 9 267 Mayesbrook Clinic 97 4 294 Infant Welfare Centres 283 15 1,003 Totals at Clinics 448 28 1,564 General Practitioners 1,916 668 - Totals 2,364 696 1,564 Diphtheria and Tetanus (combined): Kenwood Gardens Clinic 18 14 56 Mayesbrook Clinic 11 14 52 Infant Welfare Centres 14 21 80 Totals at Clinics 43 49 188 General Practitioners 52 189 — Totals 95 238 188 Diphtheria and Whooping Cough (combined): Kenwood Gardens Clinic — — - Mayesbrook Clinic 1 - 4 Infant Welfare Centres - - — Totals at Clinics 1 - 4 General Practitioners 8 11 — Totals 9 11 4 Quadrilin: General Practitioners 10 - - 89 The programme now generally operating in clinics in Essex and by many of the general practitioners provides for poliomyelitis vaccination to be undertaken before triple immunisation against diphtheria, whooping cough and tetanus, whereas previously it followed immunisation against first whooping cough and then diphtheria. The following table shows the figures over the past five years':— 1960 1961 1962 1963 1964 Diphtheria Immunisation:— Primary courses 2,151 2,784 1,762 1,997 2,503 Reinoculations 1,577 2,587 960 1,896 1,489 Whooping Cough Immunisations- Primary courses 2,112 2,341 1,523 1,872 2,415 Reinoculations 516 671 373 776 715 Tetanus Immunisation:— Primary courses - 74 1,969 2,829 3,534 Reinoculations - 40 459 1,422 976 No. of live births in Ilford 2,512 2,533 2,539 2,751 2,994 (N.B-- Where combined antigens have been used the figures have been included under each of the headings concerned). 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 1964- The general practitioners have continued to play an important part in the scheme and most of those practising in the Area are participating; during 1964 they undertook a little over 62% of this vaccination in Ilford. Sabin (oral) vaccine, as well as being used for new vaccinations, may be administered for the completion of primary courses and/or reinforcing doses where vaccination has been commenced with Salk vaccine (by injection), and although the use of Salk vaccine has continued where preference has been expressed for this, by the end of 1964 the demand for these injections had greatly reduced, the majority of vaccinations now being undertaken by the use of the oral vaccine. 90 The following statistics show the vaccinations carried out by our medical staff:- Premises Sessions Sabin Vaccine (Oral) Salk Vaccine Primary Courses Doses Reinforcing Doses Primary Courses Injections Reinforcing injections 1st 2nd 3rd 1st 2nd 1st 2nd 1st 2nd Kenwood Gardens Clinic 51 193 179 188 24 201 4 5 9 3 Mayesbrook Clinic 40 233 216 223 36 159 11 7 3 - Manford Way Clinic 48 130 123 114 1 89 - - - - Marks Gate Clinic 48 47 44 49 4 44 - - - - Heathcote Avenue Clinic 49 139 124 136 13 94 1 - - 1 Seven Kings Clinic 48 154 142 125 9 38 2 2 - 1 Chadwell Clinic 48 122 107 105 6 45 - - - , Fairlop Clinic 44 59 57 65 3 23 1 1 1 l Totals 376 1077 992 1005 96 693 19 15 13 ll Record cards received in 1964 from general practitioners and the medical staff at Dr. Barnardo's Homes, Barkingside, and Chadwell Heath Hospital were as under:— A B C Sabin Vaccine (oral):- Completed primary courses 1,879 65 16 First reinforcing doses 293 25 - Second reinforcing doses 849 70 2 Salk Vaccine (injections):— Completed primary courses *173 18 - First reinforcing doses *138 3 - Second reinforcing doses 86 1 - A — General practitioners B — Dr. Barnardo's Homes C — Chadwell Heath Hospital *Includes 10 primary courses given with Quadrilin Vaccine. At the 31st December, 1964 a total of 66,148 primary courses, 55,620 third injections or doses and 15,314 fourth injections or doses had been completed in Ilford. Smallpox Vaccination.— The following table details the primary vaccinations and revaccinations carried out in 1964 by our medical staff and shows the number of record cards of completed vaccinations received from general practitioners, hospitals, etc.:— 91 Under 2 years of age Others Primary Vacc. Revacc. Primary Vacc. Revecc. Vaccinations by Council's Staff 83 - 17 6 Record cards received from General Practitioners 852 6 402 811 Totals 935 6 419 817 The following table shows the figures over the past five years:— 1960 1961 1962 1963 1964 No. of primary vaccinations 1,646 1,774 16,800 862 1,354 No. of re-vaccinations 485 646 19,913 650 823 Totals 2,131 2,420 36,713 1,512 2,177 No. of live births in Ilford 2,512 2,533 2,539 2,751 2,994 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 are 13 State Certified midwives (including the Non-Medical Supervisor of Midwives, 10 domiciliary midwives and 1 parttime midwife employed by the County Council), resident and practising in the district at the end of the year. In addition there were 24 (15 full-time and 9 part-time) State Certified midwives at the Ilford Maternity Hospital. Supervision of the midwives practising in 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 not necessary in 1964 to require any domiciliary midwife to remain off duty. 92 Domiciliary Midwifery Service.— At the end of the year there were 10 domiciliary midwives employed by the County Council whole-time and 1 part-time, in addition to the Non-Medical Supervisor. During the year 666 cases were attended and a doctor was specially called in by the midwife to 69 of these. Of the infants born there was 1 stillbirth. Three deaths occurred of infants during the first year of life where the birth had been attended by a domiciliary midwife; in one of these the infant was under the age of ten days. During 1964 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 in 1964 Total Attendances No. of Sessions Average Attendance per Session Kenwood Gardens Clinic 462 1,306 51 25 Mayesbrook Clinic 292 943 48 19 Manford Way Clinic 103 372 26 14 Heathcote Avenue Clinic 85 319 25 12 Marks Gate Clinic 53 149 24 6 Totals 995 3,089 174 17 In addition 3,559 home ante-natal visits were made during the year. The scheme continues whereby the doctor and the midwife have a consultation about their patient on several occasions during the pregnancy. The examinations take place at the patient's home, the 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, 1964, one maisonette and four flats were being rented by the County Council from the Borough Council under this arrangement. 93 During 1964, the domiciliary midwives continued to assist in the training of pupil midwives from the Thorpe Coombe Maternity Hospital, Walthamstow; and Barking Hospital, Barking; nine of the whole-time midwives have been approved by the Central Midwives Board as teaching district midwives. The arrangements are for six or more pupils at a time to come to Ilford for a period of three months, accommodation being provided in one of the local hospitals or in a private house, 34 pupil midwives completed their district training in the Area during 1964 and 10 were still undertaking this training at the 31st December. Co-operation with General Practitioners.— During the year it was found possible to accede to the request of two local General Practitioners for the part-time services of a domiciliary midwife with their practice for ante-natal work. One midwife plus a pupil midwife attend a doctor's surgery fortnightly and the other doctor has the services of a midwife at one session per week. Salvation Army Midwifery Service.— One Salvation Army midwife, with a further midwife assisting her as required, served in Ilford during the year; 49 cases were attended by them and a doctor was specially called in to 19 of these. Of the infants born there was 1 stillbirth. There were two deaths of infants where the birth had been attended by a Salvation Army midwife. In one of these the infant was under the age of 7 days. Gas and Air Analgesia.— During 1964 gas and air analgesia was administered in 590 cases (554 attended by the domiciliary midwives and 36 by the Salvition 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. 94 The Salvation Army midwives also have two machines which are kept at their Branch Home and taken or sent to the home of the patient when required. The service is freely available to all having home confinements, provided there are no medical contra-indications, and each expectant mother on booking the midwife is supplied with a leaflet explaining the nature and the availability of the service. ANTE-NATAL CLINICS.— The following is a summary of the attendance at the ante-natal clinics during 1964 for patients booked for confinements in hospital:— Maternity Hospital Mayesbrook Clinic Manford Way Clinic Doctors Midwives First attendances in 1964 1,305 - 378 173 Total attendances in 1964 6,859 3,960 2,406 1,131 Number of Sessions 355 *252 130 64 Average attendance each Session 19 15 18 17 *Includes 195 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 1964 there were 101 sessions at the Mayesbrook Clinic, with 1,046 attendances, and 99 sessions at Manford Way Clinic, with 877 attendances. A weekly session was also run by Health Visitors at Kenwood Gardens Clinic, 51 sessions being held in the year, with 342 attendances; at Heathcote Avenue Clinic, there were 51 sessions, with 296 attendances; at Cecil Hall there were 47 sessions, with 311 attendances. Relaxation exercises classes are in addition held by the staff of the Ilford Maternity Hospital for patients attending the ante-natal clinic there. 95 POST-NATAL CLINICS.- All patients confined in the Ilford Maternity Hospital and other patients on request are invited to attend a post-natal clinic for the first time approximately six weeks after confinement. During 1964 clinics were held at the Maternity Hospital weekly, at Mayesbrook Clinic fortnightly, and at Manford Way Clinic monthly. The following attendances were recorded:— Maternity Hospital Mayesbrook Clinic Manford Way Clinic. First attendances in 1964 969 199 116 Total attendances 1,104 235 126 Number of sessions 51 26 12 Average attendance at each Session 21 9 10 CONSULTANT CLINIC.— There were two Consulting Obstetricians in 1964 who each held a weekly clinic for ante-natal and post-natal cases. During the year 103 sessions were held and a total of 1,803 examinations were made. MATERNAL MORTALITY.- During 1964 there were no deaths of Ilford mothers recorded by the Registrar-General as due to or in consequence of pregnancy or child-birth. DOMESTIC HELP SERVICE.— During 1964 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 2 full-time, 135 regularly-employed part-time and 12 casual helps employed. The efforts made to accelerate recruitment of domestic helps, including periodic advertising of vacancies in the local press has continued in 1964. 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 1964:— 96 Number of applications received for assistance 1,484 Number of cases where domestic helps were provided (including 1,087 who were having service at the commencement of the year) 2,289 Number of cases which on investigation were either not eligible for assistance or did not require the service 119 Cases booked but subsequently cancelled 67 Cases cancelled before investigation 22 Number of cases where, at the end of the year, a domestic help was booked to attend in future months (maternity cases) 61 Other cases awaiting help at end of year 12 Enquiries incomplete at end of year 1 Cases being served at 31st December, 1964 1,230 The County Council have authorised 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. During 1964 service was given in seven cases under this arrangement. Three training courses of two weeks' duration, were held by the County Council at Chelmsford in 1964. Three domestic helps from Ilford attended and all were found to be entirely satisfactory. In addition during 1964, three local In-Service Training Courses for Domestic Helps were arranged, each course consisting of six sessions, held from 2 to 4.30 p.m. on Tuesdays at Cecil Hall, Granville Road, Ilford. The first course at which 45 Domestic Helps attended commenced on 7th January, 1964. The second and third courses attended by 43 and 36 Domestic Helps commenced on 25th February, 1964 and 7th April, 1964 respectively. 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 fulltime organisers under the general direction of the Area Medical Officer. Details during 1964 are as follows:— 97 Number of applications received for assistance 33 Number of cases where night attendants were provided 22 Number of cases which on investigation were either not eligible for assistance or did not require the service 11 Number of cases awaiting help at end of year — Number of cases being served at 31st December, 1964 1 Total number of hours for which attendants were provided 1,302 Number of attendants on panel at 31st December, 1964 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 make by the Ilford Social Service Association, the County Council making agreed payments to the Association, has continued. One case was dealt with under this arrangement during 1964, the details being as follows:— Number of cases being attended at 31.12.63 1 Number of new cases attended during 1964 Nil Number of cases discontinued during 1964 1 Number of cases being attended at 31.12.64 Nil Total number of attendances given:— (a) Whole days Nil (b) Part-days 27 (c) Weeks 23½ PREVENTION OF BREAK-UP OF FAMILIES- HEALTH OF CHILDREN.— Supervision of the few problem families in the Area continues, the health visitors taking the leading role and discussing the problems with interested persons, e.g. general practitioners, teachers, Housing Manager and psychiatric social workers. Local case conferences are called as necessary. CONVALESCENT FACILITIES.— The following tables show the number of persons sent away for recuperative holidays during 1964:— (a) Under Section 22 of the National Health Service Act, i.e., nursing mothers and young children. 98 Convalescent Home No. of Cases No. of weeks stay Remarks W.V.S. Whitstable 1 2 Unaccompanied child. Highclere, West Gate 1 2 Mother and one child. TOTALS 2 4 1 Unaccompanied child. 1 mother and 1 child. (b) Under Section 28 of the Act, i.e.. other persons requiring a change of air and surroundings to aid recovery and rehabilitation. Convalescent Home No. of weeks' stay Total Cases 1 2 3 4 Bannor Convalescent Home, St. Leonards - 1 - - 1 Bell Memorial Convalescent Home, Lancing - 9 2 1 12 Braemore Court, Bournemouth - — 1 - 1 Caxton Convalescent Home, Limpsfield — 7 — - 7 Dolly Ross Holiday Home, Bournemouth - 1 - - 1 Edenfield, St. Annes - 1 — — 1 Fred Bunting House, Kingston Hill - 1 - — 1 Friendly Society, Heme Bay - 1 1 - 2 John Beech Home, Chingford 1 (2 days) 6 — — 7 Kingsleigh Convalescent Home, Seaford - 12 3 — 15 Linwell Convalescent Home, Cliftonville — 1 - — 1 Lymington Convalescent Home, Westgate — 2 - - 2 Mildmay Convalescent Home, Worthing 1 1 - - 2 Riemore Lodge Hotel, Clacton — — 1 - 1 Rustington Convalescent Home; Littlehampton 1 3 - - 4 Samuel Lewis Convalescent Home, Waltonon-Naze - 18 - - 18 Springbank Pest Home, Tendring Heath - 3 - - 3 St. Michaels Convalescent Home, Clacton — 2 1 - 3 Victorian Convalescent Home, Bognor 1 1 1 - 3 Wooburn Guest House, Thorpe Bay - 2 - - 2 TOTALS 4 72 10 1 87 The standard charges of £4.17s.0d. per week for adults and £3.8s.2d. for children under five years of age, subject to reduction according to scale in necessitous cases, continued to apply throughout 1964. Travel 99 vouchers are issued in cases where the payment of fares would cause hardship. LOAN OF SICK ROOM EQUIPMENT. - The considerable demand for equipment continues and the following table shows the issues from the Public Health Offices during 1964:- Articles Loaned Number of Articles Articles in store at 31.12.64 on loan at 31.12.63 loaned or reloaned in 1964 on loan at 31.12.64 Mattress (Dunlopillo) 15 8 14 8 Mattress (Hair) 2 - 2 2 Invalid Chairs 81 28 90 11 Air Pillows - - 1 Air Rings 47 102 59 43 Cushions (Dunlopillo) 13 22 17 14 Back-rests 95 175 107 15 Beds 8 6 8 6 Commodes 106 163 128 1 Crutches 12 11 12 10 Fracture Boards 9 8 12 2 Pillows 3 4 5 - Pillow Slips - - - 1* Rubber Sheets 157 280 201 76 Medical Sandbags - - - 2 Bed-cradles 43 53 52 4 Air-beds 2 4 3 2 Bed-pans 87 185 93 57 Piabetic Scales 2 - 1 2 Feeding-cups 1 18 4 28 Urinals 45 77 48 42 Sputum Mugs 2 - 1 4 Pouche Cans 1 - 1 2 Water Beds - 1 - 1 Water Pillows - - - 1 Bed Blocks 2 1 3 2 Bowls - - 2 Bedstead Sides (pair) 2 7 2 - Lifting Pole and Chain 12 5 11 2 Kidney Pishes 1 1 2 - Commode Sorbo Cushions - 2 1 - Rubber Toilet Seat 4 3 3 - Restraining Net - - - 1 Walking Aids 31 45 51 12 Hydraulic Hoists 2 2 1 1 Slings 1 - - 2 Sierex Air Mattress - - - 1 Totals 786 1,205 932 358 1963 Details 781 1,127 786 384 1962 Details 736 1,169 781 267 1961 Details 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 Details 519 1,158 555 180 1955 Details 538 1,117 519 161 1954 Details 320 975 538 99 1953 Details 161 698 320 54 *Provided through special funds. 100 The arrangements commenced during 1961 for the issue of draw sheets on loan to incontinent persons and the issue of disposable pads to such persons being nursed at home have proved of considerable benefit and there is a large demand for these items. During 1964 a total of 492 draw sheets were loaned to 65 persons and at the 31st December there were 297 on loan to 52 persons; 24,400 disposable pads were issued to a total of 304 persons during the year. A large number of pads were requested by the District Nurses for terminal cases. Further alarms and pads were purchased for loan to children attending the Enuresis Clinic. Twelve children were provided with alarms on loan during 1964 and 50 pads were issued; 5 alarms were on loan at the end of the year. CHIROPODY SERVICE.— This service continued during 1964 with four full-time and four part-time chiropodists. The part-time chiropodists undertook 6, 4 and 3 sessions per week and 1 session per month respectively, the 3 sessions per week being reduced to 1 per week from 1st September. Sessions were held at the four County Council Health Services Clinics and at Newbury Hall.. In addition one chiropodist continued to visit regularly the two Welfare Committee residential establishments in Ilford and undertook domiciliary visits to patients unable to travel even by ambulance, to a chiropody clinic. Treatment continued to be given only to those patients in the priority groups, i.e. the elderly, the physically handicaped and expectant mothers. The standard charge was 2/6d. per week, provision being made for reduction or remission, according to scale, where the patient's means did not justify the full charge. The attendances during the year 1964 were as follows:— No. of Sessions Attendances New Cases Re-attendances Newbury Halt 498 78 2,587 Kenwood Gardens Clilllc 799 250 4,084 Manford Way Clinic 195 60 1,115 Mayeabrook Clinic 488 98 2,578 Heathcote Avenue Clinic 83 14 404 Welfare Establishments 38 32 338 Domiciliary Visits 348 153 1,366 Totals 2449 685 12,472 101 TUBERCULOSIS VISITORS.- The 3 Tuberculosis Visitors made a total of 2,457 visits to households. DOMICILIARY OCCUPATIONAL THERAPY.- The Domiciliary Occupational Therapist, who undertook part-time duty in Ilford, has submitted the following report:— There were 137 visits made to patients during the year 1964. Three new patients were visited. The co-operation and interest of the clinic staff and Health Visitors contributed to the good progress made during the year. Once again prizes were won when completed work was entered in competitions. One patient has reached a high standard of weaving, another completed a very attractive picture in Marquetry. A high standard was reached with leatherwork, marquetry, canework, toymaking, embroidery. Most of the people eligible for this service are very appreciative of the opportunity to participate in this work. By this means they regain confidence and show initiative in the manner in which they learn new skills. I should like to point out that as a patient becomes more proficient in his chosen subject, the support of the Occupational Therapist is gradually withdrawn. Assistance is still given with regard to sale of work and supplies of materials. In some cases patients eventually obtain all their own supplies. As visits to the more proficient workers are decreased, so new patients can be visited frequently. I would like to take this opportunity to say how much I have enjoyed working in the Area. The interest and help of the members of the Chest Clinic were much valued, and the assistance from the After Care Association when financial help was needed to settle small accounts for patients was much appreciated." The following visits were undertaken in Ilford during 1964:— First Visits 3 Re-Visits 134 Other Visits 29 Visits to Clinics 8 Total Visits 174 No. of Visits to Patients 137 New Patients 3 No., on Register 10 102 REHABILITATION OF TUBERCULOSIS CASES- No cases rerequired assistance in the maintenance charges at a rehabilitation settlement during 1964. OPEN-AIR SHELTERS FOR TUBERCULOSIS CASES.- One openair shelter supplied for a tuberculosis patient during 1958, continued in use throughout 1964. PROVISION OF FREE MILK FOR TUBERCULOSIS AND OTHER CHEST CASES. — The County Council's scheme for supplying to tuberculosis, and other chest patients one pint of milk per day free of charge, on the recommendation of the Chest Physician continued during 1964. Particulars of the grants made in 1964 are given below:— T.B. Cases Others No. of cases in receipt of free milk at 31.12.63 ... 107 5 No. of new grants made during 1964 55 3 No. of grants discontinued during 1964 61 2 No. of cases in receipt of free milk at 31.12.64 101 6 BOARDING-OUT OF CHILDREN (TUBERCULOSIS CONTACTS).No applications were received in 1964 for assistance in the boarding-out of child contacts of tuberculosis patients under the County Council's scheme. ILFORD TUBERCULOSIS AND CHEST CARE ASSOCIATION. Mr.. H. R. Stanbridge, a member of the Ilford Health Area Office staff, continues to undertake the secretarial work of this Association. The following shows the assistance given by the Association during 1964:— No. of persons assisted Total No. of slants made Extra nourishment (grants made usually for periods of one month and renewed as required) 44 330 (including renewals) Other grants (Christmas cash gifts, clothing, etc.) 70 70 103 TRAVELLING EXPENSES OF RELATIVES VISITING HOSPITAL PATIENTS.— As in previous years, the County Medical Officer was able to give financial assistance in 1964 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 1964:— Entrants to County Council's Service 50 Other purposes 13 For other Authorities 9 HOME NURSING.— The home nursing service in Ilford continues to be undertaken by nurses under the supervision of the Superintendent of the Lady Rayleigh Training Home at Leytonstone but operating from the 3ranch Home, "Abury House" in Aldborough Road, Ilford. The work undertaken by home nurses in the Ilford area in 1964 was as follows:— Cases attended 1,737 Visits paid 53,036 HEALTH EDUCATION.- During 1964, 126 lectures on various subjects were given by members of the medical and health visiting staff and the domestic help organisers to schools, professional organisations, youth groups and general adult groups, the total attendances being approximately 2,791. At 10 of the lectures films were shown. In addition 349 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. HOME SAFETY.— For some years King George Hospital have been most co-operative in advising us of the patients treated for home accidents. At our own request this reporting is still being continued but is now confined to children under the age of five years and elderly persons, who are then fellowed-up by the health visitors. 104 DENTAL TREATMENT.- Mr. E. V. Haigh, the Senior Dental Officer, has submitted the following report:— "Dental treatment continued to be available during 1964 at two clinics in the Ilford Area for any expectant or nursing mother and for children under 5 years old. The two clinics being Mayesbrook and Kenwood where full dental facilities were available to any mother or small child wishing to receive dental treatment or advice. 1 am pleased to say that the number of mothers that received dental treatment increased during 1964 by 12%. This is the first time for several years that there has been an increase in demand for treatment by the mothers. This increase has been due to dental health education which has taken place mainly in the clinics by Medical Officers, Health Visitors and Dental staff. The main reason for fewer mothers wishing to attend clinics has been the National Health Service. Most young mothers have become very dentally minded and attend their private practitioners regularly and so prefer to continue whilst pregnant or nursing. Another reason was the removal of denture cost of these patients under the National Health Service. The number of children under 5 examined and treated in the clinics increased by 60%. This very satisfying result was also due to dental health education. Mr. Hodgson arranged dental displays and gave talks to mothers usually in the welfare centres. He has obtained considerable number of varied leaflets and posters to try and maintain the parents interest in their children's teeth. The need to get many more of the under 5 children to receive regular dental care must be one of our main aims in the future. It is by teaching dental health from a very early age that the importance of good teeth and oral hygiene may be realised. Medical Officers and Health Visitors have helped considerably by encouraging mothers to bring their children to the clinics from an early age. Mr. Wilson at Kenwood Clinic has also worked hard to build up these sessions with great success. I continued with one evening session per week at Mayesbrook Clinic for mothers who find it difficult to attend during the day. Extraction of teeth for children were usually performed under a general anaesthetic. Mothers, however, often prefer a local anaesthetic for themselves. I have noticed this has increased over the past few years. This fact suggests that they are now not so worried by dentistry as they used to be. 105 The use of high speed Borden Airators for cavity preparation continued to be of great value, in fact it must now be considered part of modern dental equipment. It is surprising how well small children accept this method of cavity preparation. Partial and full dentures were supplied whenever it was considered necessary for a patient to have them. These being made at a local dental laboratory. With the object of furthering dental hygiene, the Essex County Council introduced, for a trial period, a scheme for the sale of toothbrushes to parents for the use of children under 5 years of age and who were attending the Council's Dental Clinics. The toothbrushes are sold for 3d. each, i.e.. cost price plus a small handling charge, and the scheme commenced in Ilford on 2nd November, 1964." The number of cases treated at the Clinics during 1964 was as follows:— New Cases Made Dentally Fit Total Attendances Examined Needing Treatment Expectant and nursing mothers:— (a) Day Sessions:— Mayesbrook 76 75 56 240 Kenwood Gardens 34 30 23 110 (b) Evening Sessions:— Mayesbrook 83 78 83 295 Children under 5:— Mayesbrook 300 261 255 485 Kenwood Gardens 263 249 209 404 106 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 General Complete Partial Expectant and nursing mothers:— (a) Day Sessions:— Mayesbrook 132 28 155 91 1 226 1 11 7 Kenwood Gardens 8 - 74 24 - 24 6 3 2 (b) Evening Sessions:— Mayesbrook 90 — 183 116 - 316 6 7 4 Children under 5:— Mayesbrook 152 68 335 - 2 194 - - - Kenwood Gardens 49 21 260 - 96 61 - - - In addition there were 505 prophylactic treatments and other operations carried out in the case of expectant and nursing mothers and children under 5 at day sessions (420 at Mayesbrook and 85 at Kenwood Gardens) and 316 at evening sessions (at Mayesbrook). The total number of sessions held for expectant and nursing mothers and children under five years of age was 189½ 145 during the day (82½ at Mayesbrook and 62½ at Kenwood Gardens) and 44½in 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. The following shows the present distribution centres with the days and times they are open:— (a) Main Centre Kenwood Gardens Clinic, Monday to Friday 9.30 a.m.-5 p.m. Kenwood Gardens, Ilford. Saturday 9.30 a.m.-12 noon 107 (b) Branch Centre Methodist Church Hall, Tuesday (9.15 a.m.—1 p.m. Ilford Lane (entrance in Britannia Road), Ilford. Saturday (2 p.m.-3.15 p.m. 9.15 a.m.—12 noon (c) Infant Welfare Centres Chadwell Monday 2—4 p.m. Marks Gate Tuesday 2-4 p.m. Manford Way Tuesday 2 — 4 p.m; Manford Way Friday 2-4 p.m. Becontree Tuesday 2 — 4 p.m. Goodmayes Thursday 2-4 p.m. Downshall Tuesday 2-4 p.m. Kenwood Gardens Wednesday 2—4 p.m. Kenwood Gardens Friday 9.30 a.m.—12 noon Heathcote Avenue Wednesday 9.30 a.m.—12 noon Heathcote Avenue Wednesday 2—4 p.m. Cecil Hall 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. 108 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 31st December, 1964, was 21,641. In addition there were 95 children attending the special school. MEDICAL INSPECTION AND FOLLOWING UP.- 6,099 periodic medical inspections were carried out during 1964 and in addition 250 special inspections and 1,112 re-inspections were undertaken. The School Dental Service in Ilford continued to function with an establishment of dental personnel who completed 81 school dental inspections at which 11,541 pupils were seen. In addition to this figure, 2,453 pupils were seen at special dental inspections. Full details of cases referred for treatment are contained in the Ministry of Education tables at the end of this report. STAFF.— At the beginning of 1964 the resignation of Mr. W. P. Morris, the remaining Physiotherapist at the Ethel Davis School, gave some cause for concern because of the shortage of physiotherapists, especially those experienced in the field of cerebral palsy. However, it was fortunate that Mr. A. Brand, who was employed by the Regional Hospital Board at the Ilford Orthopaedic Clinic, transferred his services to the Local Education Authority as a Superintendent Physiotherapist on 2nd March, 1964. Although this did somewhat interfere with the treatment undertaken by the Board at theSchool Clinics, it did eventually become possible for Mr. Brand, as a temporary measure, to devote a proportion of his time on work connected with his previous appointment since the services of a second Physiotherapist at the Ethel Davis School made this possible. Miss A. Dotzler, a Norwegian National, commenced her duties on 25th May, 1964. I was indeed sorry to lose the services, on 31st March, 1964 of Miss R. P. O'Hare, Psychiatric Social Worker employed at the Ilford Child Guidance Clinic. It has not yet been possible to appoint a replacement, due to the shortage of qualified staff; this applies also to the resignation of Miss R. Riesenberg, Child Psycho-Therapist, who undertook three sessions. Mrs. T. Oliver, Speech Therapist, who was employed full-time, resigned her appointment on 21st November and Mrs. G. Coffey resigned from her six sessions at the Speech Clinic on 16th November, 1964. 109 Dr. D. J. Gordon-Smith, School Medical Officer, became a transferred officer to the Forest Division, on 20th April, and Dr. W. H. Toms was appointed on 4th August. A further appointment was made on 28th September 1964, when Dr. E. Kilsby commenced duties as a School Medical Officer. INFECTIOUS DISEASES.- At the commencement of 1964, two scarlet fever cases were reported at Kennylands Camp School and during the month of February the sick bay facilities were fully utilised following outbreaks of a throat infection. Prior to the transfer to the County Health Department of the administration of both Camp Schools, provision was made for the expenditure of £632 towards new sick bay equipment at Kennylands. In Ilford there were no serious outbreaks of any infectious diseases but during January and February the incidence of mumps rose throughout schools in the area. CHIROPODY CLINICS.- It has not yet been possible to offer this service to school children, although it is envisaged that such treatment will be made available by Redbridge. NEW AND ORIGINAL WORK.— During the year, Mr. E. B. Hodgson, full-time Dental Officer, carried out a comprehensive programme of Dental Health Education in schools, and for the younger audiences this created a wide appeal. A further inducement to dental care was made by the issue of toothbrushes within the Dental Clinics. In the summer, a mobile unit concerned with the campaign against cigarette smoking, and sponsored by the Central Council for Health Education and the Ministry, visited six schools within the area, and was generally well received. In addition to this, both Dr. Gordon-Smith and Dr. Taylor continued to lecture on the subject of Smoking and Lung Cancer to groups in schools, illustrating the subject by films, film strips and other visual aids. A notable event within the area was the opening of the Ethel Davis School on 9th January, 1964. It is considered to be amongst the most up-to-date of such schools and has a Nursery Section and a Hydrotherapy Unit. A more extensive report on this special school is made by the Medical Officer in charge, and this appears elsewhere. 110 SPECIAL SCHOOLS AND SPECIALIST CLINICS.- As in previous years, these are the subject of individual reports by the Consultants and Medical Officers in charge. 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 1964 were as follows:— Kenwood Gardens Mayesbrook Number of individual children seen 252 238 Number of attendances of children 342 339 The following table shows the conditions dealt with at both the Clinics during the year. Sub-normal Nutrition 71 Debility 21 Uncleanliness:— Head 19 Body — Skint- Ringworm:— Head - Body - Scabies - Impetigo 1 Dermatitis 1 Urticaria 1 Furunculosis 1 Eczema 3 Athletes Foot 4 Warts 79 Other Skin Diseases 26 111 Eye:— Blepharitis 3 Conjunctivitis 11 Defective Vision (excluding Squint) 56 Squint 4 Other Conditions 36 Ear:— Defective Hearing 11 Otitis Media 2 Other Ear Diseases 5 Nose and Throat:— Tonsilitis only 10 Adenoids only 2 Tonsilitis and Adenoids 2 Nasal Catarrh 8 Nasal Obstruction 6 Other conditions 9 Enlarged Cervical Glands (Non-Tuberculous) 3 Defective Speech 9 Teeth — Dental Diseases 4 Heart and Circulation:— Functional 1 Anaemia 3 Infectious Diseases:— Colds and Coughs 11 Chicken Pox — Lungs:— Asthma 4 Bronchitis - Pulmonary Catarrh - Other Non-Tubercular Diseases 9 Psychological:— Development 1 Stability 15 Nervous System:— Enuresis 17 Other conditions 3 112 Deformities:— Genu Valgum 5 Posture — Pigeon Chest - Flat Feet 10 Valgus Ankles 13 Other forms 33 Minor Injuries 11 Rheumatism 2 Other Defects and Diseases 14 Total number of ailments 560 RECUPERATIVE HOLIDAYS. During 1964 14 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 95 182 746 1,356 Mayesbrook 92 169 458 1,128 Manford Way 11 18 60 121 Totals 198 369 1,264 2,605 735 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 287 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:— 113 "The School Eye Clinics have continued to function smoothly and satisfactorily. The Clinics have been well attended at all times throughout the year. The cases call for no special comment — the usual school eye clinic "mixture" with refractive errors, amblyopic eyes and squints predominating, but with a few cases of congenital abnormalities and odd cases of pathological change. Equipment and accommodation are adequate and satisfactory. Good liaison has been established with the Eye Department of King George Hospital, Ilford, to which, as far as possible cases requiring further investigation and/or operation have been referred. The London Eye Hospitals have also co-operated as necessary. The Orthoptic Department (at Mayesbrook) and the arrangements for fitting, supply and repair of spectacles (by attending opticians), have been quite satisfactory." ORTHOPTIC CLINIC. "Mrs. J. Lewis (nee Dixon), D.B.O., resigned her appointment as Orthoptist at the Mayesbrook Health Services Clinic on 24th July, 1964, and has been succeeded by Miss M. Ward, D.B.O., who commenced duties on 27th July, 1964. 237 sessions were held throughout the year. 102 new cases were investigated and the total attendances amounted to 636. 53 cases were discharged. 118 new and old cases were in attendance at the Clinic on 31st December, 1964. The Orthoptic Clinic is an indispensable adjunct to the School Eye Clinic in the treatment and observation of squint cases." ORTHOPAEDIC CLINIC. Mr. H. G. Korvin, F.R.C.S., Consultant Orthopaedic Surgeon, reports as follows:— "No major changes have taken place in the running of these clinics during 1964, except for one: Mr. 3rand, the physiotherapist in charge, has resigned in order to take up the post of Superintendent Physiotherapist at the Cerebral Palsy School. He has, however, been given the necessary time off to enable him to continue his 114 work at the clinics. This very helpful arrangement has averted the great danger of being deprived of his most valuable services. In the Clinics one of the major struggles is that against over-eating, now the most common cause of leg-deformities. A limited success has been scored in that operations for knock-knees, quite common ten years ago, have now become a rarity. An equally difficult struggle is that for suitable footwear. The twin enemies are cheap mass-production and fashion. An increasing number of children are brought up because they wear their shoes out within a few weeks. Here the fault lies clearly not with the feet, but with the stuff the shoes are made of, which will not last the six months required for a child's shoe. Others come with trouble in various places of the foot and toes due to pressure or friction by the shoe, which cannot be eliminated as long as fashion prohibits pressure to be applied in more suitable places. In both these cases it is advice and instruction, rather than treatment, that is required from the Clinic." The following table summarizes the attendances of school children:- Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 41 71 194 305 Mayesbrook 22 39 56 114 Manford Way 8 5 3 15 Totals 71 115 253 434 lis SUMMARY OF CASES SEEN Diagnosis New Cases Old Cases A B C A B C Spastic Conditions 1 - - 3 1 - A.P.1V1. - 1 - 1 2 - Osgood — Schlatters Disease 1 - - - - - Scoliosis 1 1 - 3 1 - Kyphosis - - - 4 - - Postural Defect 3 - - 13 - - Deformity of Hips — 1 — 4 - - Genu Valgum 10 10 - 60 26 - O.C.T. - - - - 1 1 Genu Varum 1 - - 1 1 1 Pes valgus-planus 1 1 - 7 2 - Valgus Ankles 21 16 1 34 9 1 Talipes — — - 4 1 - Intoeing 7 — — 17 2 — Hallux valgus 1 2 - 5 2 - Deformity of Foot - - - 2 - - Deformity of Fingers - - - 1 1 - Deformity of Chest — — - 2 - - Deformity of Hand - — - - - - Deformity of Toes 5 2 - 13 1 - N.A.D. 5 1 - - - - Foot Strain 1 3 1 1 - - Faulty Gait 4 - 1 2 2 - Metatarsal varus - - - 1 - - Osteomyelitis - - - 1 - - Exostosis - - 1 1 - - Spina Bifida - - - 4 - - Shortening Leg 1 - - 1 1 - Hydrocephalus - - - 1 - - Hyperdactylism - - - 1 1 - Calcaneodynia 2 - - - - - Other Conditions 6 1 1 4 2 - Totals 71 39 5 194 56 3 A — Kenwood Gardens. B — Mayesbrook. C— Mayford Way. 8 children of school age were admitted to East Ham Memorial Hospital. Particulars as follows:— 116 No. of Cases Operation 1 Holdsworth Operation 5th toe Rt. 1 Holdsworth Operation 5th toe Rt. & Lt. 1 Arthrodesis 1 P.Joint 3rd & 4th toes R. & L. 1 Arthrodesis 1 P.Joint 3rd toe Rt. 1 3ilateral Bunionectomy. 1 L. Bunionectomy. 1 Subcutaneous tendo Achilles tenotomy. 1 Removal of opaque body from tibial tubercle L. During the year 22 pairs of valgus insoles, 2 pairs of surgical boots or shoes, 7 pairs Genu Valgum splints, 1 pair calipers and inverting irons, 88 pairs of wedges to shoes, 1 wrist support, 1 Polythene heel seat were supplied to school children. 144 cases were discharged from the Orthopaedic Clinic, 21 as cured, 27 due to absence and 80 were showing improvement and were kept under observation at school. 16 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 the following Clinics conducted by the Physiotherapists, and she reports as follows:— "REMEDIAL EXERCISES. New Cases Total Attendances Kenwood Gardens Clinic: 75 349 Mayesbrook Clinic: 46 242 Cases referred for treatment from school medical inspections numbered: 127 The total number of new cases at both clinics were 248 and the total attendances were: 718 The cases referred from the school medical inspections had one attendance in each case, when the physiotherapist demonstrated the exercises for treatment of the particular defect, with the mother present,so that she could supervise the exercises at home. The children were reviewed by the medical officer. 117 ARTIFICIAL SUNLIGHT THERAPY. These clinics were held for only two months. At Kenwood Gardens there were two new cases with 51 total attendances, and at Mayesbrook six new. cases with 50 total attendances, making a total of 8 new cases and 101 attendances at both Clinics. The reduction in the number of attendances for follow-up appointments is due to the fact that there has not been a replacement for the physiotherapist who resigned last February and who was loaned to us for one half-day per week at each Clinic." PHTSIOTHERAPYCLINICS. These were held at Kenwood Gardens on Monday afternoons and at Mayesbrook Clinic on Tuesday afternoons. Cases are also seen at the Manford Way Clinic as required. Details of attendances:— Clinic Sessions New Cases Old Cases Attendances Kenwood Gardens 46 75 21 349 Mayesbrook 44 46 6 242 Mayford Way — - 13 64 Total 90 121 40 655 ARTIFICIAL SUNLIGHT CLINICS. These were held at Kenwood Gardens on Tuesday afternoon and Mayesbrook Clinic on Thursday afternoon, for January and February only. Details of attendances:— 118  Sessions New Cases Old Cases Attendances Kenwood Gardens 8 2 8 51 Mayesbrook 9 6 1 50 Total 17 8 9 101 The lamp used at each Clinic is a Centrosol Unit. The conditions treated were as follows:— Defects Treated Cases A B Underweight, Debility and Malnutrition 3 4 Bronchitis and Catarrh 6 - Chilblains - 3 Severe Acne 1 - 10 7 A. — Kenwood Gardens Clinic. B. — Mayesbrook Clinic. EAR, NOSE AND THUOAT CLINIC. Miss M. M. Mason, F.R.C.S., Consultant, Ear, Nose and Throat Clinir, makes the following report:— "The work of the Clinic has increased again this year — attendances were up by nearly 25% — 496 as against 401 last year; of these 274 were new cases. 108 cases were found to require operation, and 79 of these operations were performed in our hospitals. The year showed a recrudescence in the incidence of allergy a finding which appears to have been general throughout the country, the pollen count having been unusually high; several of these cases required treatment with repeated desensitising injections. 104 cases were tested by pure-tone audiometry, and 12 showed sufficient deafness to require further investigation and treatment. The demand for this form of testing continues to increase. 119 "Cases diagnosed during the year:— Tonsils and Adenoids Infections 30 Hypertrophied Adenoids 42 Deafness 6 Epistaxis 2 Maxillary Sinusitis 3 Otitis Media 8 Otitis Externa 2 Vasomotor Rhinitis 7 Rhinitis 1 Cerumen 1 Nasal Allergy 6 Eustachian Catarrh 1 Coryza 1 Tongue Tie 1 Aural Furuncle 1 112 SPEECH CLINICS. Mrs. B. Tingey, Speech Therapist, submits the following report:— Mrs. Coffey (Miss Meyersberg): Six Sessions per week Valentines Clinic and Schools, to October 1964. Mrs. Tingey: Six Sessions per wefek Mayesbrook Clinic and Schools. Mrs. Pretious: Full-time Cerebral Palsy Unit and School Clinics. Mrs. Oliver: Full-time Valentines Clinic and Schools, to November 1964. During 1964 we were sorry to lose the services of Mrs. Coffey and Mrs. Oliver. Mrs. Coffey transferred to a clinic nearer her new home, and Mrs. Oliver resigned for domestic reasons. Both therapists have done very good work in the clinics. We have continued to work full sessions in schools where there are a large enough number of speech defective children. Many children are being referred to the speech clinic shortly after their admission to school, and there is also an increasing 120 number of pre-school referrals. These early referrals are welcomed by the speech therapists as it often enables speech treatment to be given before the child's schooling and/or emotions suffer as a result of the speech or language defect." SCHOOL DENTAL SERVICE. Mr. E. V. llaigh, Area Dental Officer, submits the following report:- "The School Dental Service in Ilford was able, during 1964, to provide full dental treatment to any school child receiving education under the Local Authority. The aim of the service has been not only to treat but also to try and make more children more dentally conscious. The staffing position has remained very good, the six surgeries in the borough having been kept almost fully staffed all the year; five of the surgeries staffed by full-time dental officers, and the sixth by four part-time officers. The Manford Way Clinic, which is shared with Forest Area and Dagenham, has been used by Ilford for one day a week. This has been sufficient to cover the demand for treatment under the Ilford Area at this Clinic. Conservative Treatment The saving of teeth has always been the aim of the School Dental Service; now with more staff it has been possible to enlarge the scope of conservative treatment. Many more teeth are being saved to-day than ever before. This can be seen from the statistics showing the increased number of fillings per patient and the smaller number of teeth extracted. The most marked improvement in dental health has been in the young school child of 5 or 6 years of age. Even 10 years ago in Ilford it was not uncommon for young children to have to lose all their deciduous teeth. This is almost unheard of to-day. More children are receiving dental treatment much earlier in their life either under the National Health Service or the School Dental Service. With the increase in staff it has become possible to spend more time on more prolonged conservative treatments such as root treatment, crowns and inlays. The introduction of new drugs and techniques have also helped. Dental Health Education Mr. Hodgson has continued with this branch of the Dental Service by arranging film shows and talks in schools. We are now showing two films as continuously as possible in the schools, one entitled "The Teeth" for senior children, and the other film entitled 121 "Ever Yours" which seems to appeal to the younger child, the aim of both films being the correct way to clean teeth, and the importance of oral hygiene and regular dental inspection. The showing of these films to small groups of children as part of their normal education I am sure is of value. There seems to be a shortage of new posters and leaflets for display purposes in the clinics; this makes this part of dental health education difficult because the public soon tires of old posters and leaflets. I have encouraged more dental health instruction to individual patients at the surgeries; this takes time but the results are often very rewarding. Mr. Hodgson took part in the concentrated health week held at Fairlop School. Films, slides, models and posters were used. This was followed up by further films later in the year. General Anaesthetics These have been administered mainly by County Medical Officers. As in the past the same anaesthetist and dental surgeon have worked together as far as possible. This is important, because extractions under a general anaesthetic in a dental chair call for team work, which results, not only in easier sessions but, more important, adds to the safety of the patient. In an emergency each member, and this includes the nurse, should know his or her duties and these can only be fully co-ordinated after working together for some time. During the latter part of 1964 "Halothane" was introduced as an added anaesthetic. It has been found to be very good in the more difficult case requiring a longer anaesthetic. The fact that a higher percentage of oxygen can be given adds to the safety of the patient. Very occasionally in an emergency another dental officer has given the anaesthetic when it has been impossible to obtain a medical officer. This, however, only occurs when it would be dangerous not to extract a tooth, or the child was in great pain. Equipment High speed aerotors for cavity preparation have continued to be used in all surgeries and they have now become an essential item of surgery equipment. I have found that even very young children will accept the noise of aerotors as part of normal life and if it is 122 possible to use it from the beginning they do not fear cavity preparation nearly so much. Dental Radiographic facilities are available at all clinics, thus saving patient pain by quicker diagnosis of dental abnormalities. Evening Sessions I continued with one evening per week at Mayesbrook Clinic tor school children who are unable to attend during the day. Appointments for these sessions are in great demand by older children studying for examinations. Many of these children would not attend during the day and so this is a service of value. It is becoming difficult in all parts of the borough to fill the Saturday morning sessions. This is due to the fact that children to-day seem to have more week-end activities, either with their school or with their parents. Added to this, so many parents do not work now on Saturday and therefore they have other interests. Fluoridation of water supplies appears to be the next major step to be taken in the preventive field of dentistry. I hope it will not be too many years before this is possible." THE ETHEL DAVIS SCHOOL. Dr. D. M. B. Gross, Medical Officer in Charge, reports as follows:- "This new school was opened in January 1964 and incorporates the old Benton School and Cerebral Palsy Unit. It will be noted that this year the two sections share the same report instead of each having their own as hitherto. This is in keeping with the policy of intergrating the two as far as possible. The opening in September 1964 of the Nursery Class in the Cerebral Palsy Unit marks a new departure. Its purpose is purely medical as an assessment unit for children from 3 to 5 years of age, i.e. under statutory school age. Any required treatment, physiotherapy, speech and occupational therapy etc., can be provided and the children observed over a period under nursery class conditions. When a child reaches the age of five years it is hoped that it will then have been possible to assess its potentialities and so recommend the most suitable placement, which may indeed not be in the 123 Cerebral Palsy Unit itself, but in the Physically Handicapped section of the school. The lack of such as assessment unit has been felt for many years, and it is a source of great satisfaction that it is now in being. During the year, work in both sections proceeded normally, though there was inevitably a "settling in" period during which minor changes and adjustments were made as the need arose. The new tail lift van has been delivered and is proving invaluable in dealing with the older and heavier chairborne children. The staffing position was also under review. At the opening date we had no physiotherapists. However, Mr. Brand was appointed Superintendent Physiotherapist for the Borough in March 1964, with special duties at the school, and Miss Dotzler was subsequently appointed full-time. In addition we now have a Medical Auxiliary whose duty it is to attend upon the physiotherapists, so freeing the other Welfare Workers for their normal work. As in previous years, cordial relations have been maintained with various hospitals and Local Authorities, and, in conclusion, I should like to thank all the staff of the two sections, now one school, for their continued support and co-operation. During 1964 the number of children on roll varied, being 88 on 31st December, 1963 and 100 on 31st December, 1964. There were 32 admissions and 20 discharged. Recommendations for admission were received from the following sources:— School Medical Officers 13 Hospitals 3 Borough Education Officer 5 Transfers from other areas 4 Parents 2 General Practitioner 1 Other Boroughs 4 32 124 The diagnosises were as follows:— Bronchitis 1 Asthma and Bronchitis 8 Osteomyelitis 1 Asthma and Congenital Heart 1 Congenital Heart 3 Osteogenesis imperfecta 1 Nephritis 1 Cerebral Palsy 9 Congenital Double Incontinence 1 Glioma, optic chiasma 1 Laurence-Moon-Biedl 1 Muscular Dystrophy 1 Astmas and Epilepsy 1 Perthe's Disease 1 Paralysis (Road Accident) 1 32 ILFORD CEREBRAL PALSY UNIT. Mr. II. 3. Lee, F.R.C.S., Consultant Orthopaedic Surgeon, makes the following report:— "The new buildings have much facilitated co-operation with the other side of the school dealing with children with diverse physical handicaps. The new nursery, class has been useful in helping to reduce the waiting list and give the staff opportunities to observe children and begin the education and treatment of those who would otherwise have had to remain at home till well past the age of five years. Treatment has continued under good conditions, though various troubles with the treatment bath have interfered with its proper use. It is hoped to organise regular service by Ministry representatives of the numerous wheel chairs." CHILD GUIDANCE CLINIC. Dr. W. P. Gurassa, Medical Director, reports as follows:— "Our fortunate position of 1963 of being full-staffed has met with some set-backs during the current year. Miss O' Hare, Psychiatric Social Worker, left us in March to return to Northern Ireland, and Miss Reisenberg, Child Psycho-Therapist, left in the Summer to take an 125 additional training course. We wish them both well, and appreciate their contribution to the work here. So far replacements have not been obtained as there is such a shortage of people in these professions. We are, however, particularly happy to welcome Miss Ballantine as a full-time remedial teacher, who was formerly with us during her student training. The remaining staff have been very fully extended. A good deal of work is involved in taking over the case load of departing colleagues, which includes parents and children who have learned to expect help from the Clinic. This has meant that there has had to be some curtailment of our plans, e.g. to provide freer access for parents to the Clinic. Sometimes they have been disappointed, having to wait, or come another time. We are very much occupied at present with the problems of autistic children, a number of whom are seen here. We now have hopes of a Day Centre, for which premises have already been found, being opened in the area as soon as suitable staff can be found. This, more than anything else, will relieve parents of a very heavy burden, while enabling the children to continue to live in their own homes. Although the pressure of work, number of new referrals, etc. has increased, we have maintained our practice of regular case conferences, to which visitors are welcomed. Recently we have again discussed our need for increased accommodation, and are particularly grateful to the Medical and Educational Departments of the Local Authority for their understanding and helpfulness, in this and all other matters. In April We look forward to functioning in the independent Borough of Redbridge, when we shall have the great advantage of being in personal contact with the Authorities." SCHOOL PSYCHOLOGICAL SERVICE. Miss B. S. Gascoyne and Miss C. Helen Watt, Educational Psychologists, report as follows:— "During the past year we have started to make prepatations, in conjunction with neighbouring school psychological services concerned with the Greater London scheme, for the amalgamation of the areas which will form the new Redbridge 3orough in April 1965. In September, Miss Gascoyne was able to begin visiting the relevant schools in Woodford, Wanstead and Chigwell, so already 126 all the schools affected are within the Ilford School Psychological Service. The children who are referred from these schools for psychiatric investigation are still being seen at Walthamstow Child Guidance Clinic, but in April the whole Redbridge area will come under the present Ilford Child Guidance Clinic. We feel that working out the transfer of the area in stages is proving very valuable because there should not be any hiatus in April. The appointment in August of a psychologist for Dagenham who took over that area from Miss Gascoyne made it possible for her to work full-time in the Redbridge area. In August, Miss Ballantine was appointed as a full-time remedial teacher based on the Child Guidance Clinic. She sees children individually for regular hourly sessions. We are finding her services particularly useful because it enables the mothers to be seen at the same time by the psychiatric social workers. This close contact between teacher and social worker is invaluable especially in helping children whose learning difficulties are bound up with emotional problems. These children can often be helped by this extra individual teaching and support while remaining in ordinary schools. Some attend for a period of observation to see whether they will be able to respond to this type of help. Some cases are taken on direct from the schools without full referral to the Child Guidance Clinic. We find this service very useful for observation or assessment of the educational difficulties. Some of the children are likely to be able to catch up fairly quickly in ordinary schools with this small amount of extra help. In some cases this prevents them getting so far behind that they later need full time placement in remedial classes. It also caters for children who have fallen behind in one aspect of school work but are not showing the all round educational retardation which requires more intensive remedial help. During the year more and more attention has been drawn in the national press to the plight and special needs of autistic children. We have been well aware of this problem for some time and have tried to make provision for them within the area by considering in each case which of the available educational facilities could be of most help to the child in question and placing the child accordingly. We have come to the conclusion that such children need a different method of teaching from most other disturbed children so we are making plans for establishing a teaching unit geared to their needs and we hope that a building is going to be available for this purpose." 127 New Cases 127 Follow ups for schools 133 Follow ups for clinic 114 Remedial Education Cases 28 Children referred to C.G.C 26 ILFORD ENURESIS CLINIC. Dr. Joan M. Pooley, Medical Officer in charge, reports on the Clinic as follows:— "During the 12 months ended December 31st, 1964, the Clinic was held at the Kenwood Gardens Clinic on Wednesday mornings until 31st August, 1964, and thereafter on Monday afternoons. Sessions and New Cases 48 sessions were held this year (as compared with 39 sessions in 1963) during which 107 new cases were seen. The number of new cases seen each year has steadily increased, as can be seen from the following table. Year Number of new cases seen 1961 55 1962 70 1963 99 1964 107 1. Appointment List Under 5 yrs. Over 5 yrs. Boys Girls Boys Girls Recommended by Infant Welfare Officers 19 3 — — School Medical Officers — — 34 14 General Practitioners 3 2 7 10 Parents ,, — 2 3 — Health Visitors 7 1 1 1 -107 new cases 29 8 45 25 Total attendances in 1964 (old and new cases)-523 ,, ,, ,, 1963 (,, ,, ,, ,,)-463 ,, ,, ,, 1962 (,, ,, ,, ,,)-358 128 2. Procedure As in previous years, the procedure adhered to with each new case is as follows:— (1) Urinalysis (2) History of enuresis, temperament and previous illnesses (3) Physical examination (4) Treatment Home or family problems are also discussed when the need arises. 3. Treatment The treatments issued or prescribed throughout the year include:— (1) Dexten — The long acting (bonded) dexamphetamine 5 mgm. at a time decided individually. (2) Syrup Tryptizole - Treatment with this has been duced at the clinic only this year, for the disturbed, nervous or emotional child, with extremely interesting results. (3) Routine and charting only. (4) The Sentinel or Downs 3ed-Buzzer — There are 21 bed- buzzers in use through the clinic, and 35 cases received this treatment during the vear. 4. Results 57 cases were discharged dry (as compared with 41 in 1963). Over 5 years Under 5 years Boys Girls Boys Girls 39 15 2 1 The following cases failed appointments and were considered self-discharged:— Over 5 years 23 boys 16 girls 40 cases in all. Under 5 years 1 boy - 129 I have found this an extremely worthwhile clinic, where appointments have on the whole been enthusiastically kept, and where parents and children alike have shown great interest and co-operation." 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 number of children coming within the various categories and their disposition as on the 31st December, 1964 is shown in the following table:- CATEGORY Number of children of school age on 31st December, 1964, 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 - - 5 - - - - - - - - - - 5 Partially Sighted 5 - - - - - - - - - - - - 5 Deaf 6 - 1 - - - - - - - - - - 7 Partially Deaf 19 - - - - - - 1 - - - - - 20 Delicate 2 - 3 - - - - 1 - - - - - 6 Physically handicapped 96 - 3 - 1 - 3 - 1 - - - - 104 E.S.N 55 - 12 - - - 12 - - - - - - 79 Maladjusted - - 17 23 4 - 12 - - - - - - 56 Epileptic - - 1 - - - 2 - - - - - - 3 Speech Defect - - - - - - - - - - - - - - Dual Defects 5 - 6 4 - - - - - - - - - 15 Total 188 - 48 27 5 - 29 2 1 - - - - 300 130 GENERAL WELFARE. Provision of Meals and Milk for School-Children.— The total number of mid-day meals served in the schools during 1964 was 2,338,447 approximately. There are 29 kitchens in the Borough, established at the following schools:— Barking Abbey, Barley Lane, Beal 3oys, Beal Girls, Becontree C.P. Unit, Canon Palmer, Caterham, County High Boys, County High Girls, Cleveland, Dane, Ethel Davis, Fairlop Boys, Fairlop Girls, Goodmayes, Gordon, Loxford, Mayfield Boys, Mayfield Girls, Mossford Green, Parkhill, Redbridge, South Park, St. Augustines, The Gilbert Colvin, The Glade, The John Bramston, Uphall and Win. Torbitt. Free milk is served in all Departments of all the schools and the total number who received milk on 23rd September, 1964 was 16,978. Provision of Baths.— Shower baths are installed at Beal, County High Boys, Barking Abbey Grammar, Caterham, Dane, Fairlop Boys and Loxford Secondary Schools, Mayfield Girls. Work done by the N.S.P.C.C.— The following 59 cases were investigated:— (1) Neglect 34 (2) Ill-treatment cases 9 (3) Other cases 16 One hundred and thirty-two children (71 boys and 61 girls) were involved, 76 being of school age. In addition to this work, 289 supervision visits were paid to different cases, some of which were made to those reported during the previous year. The Invalid Children's Aid Association.- 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 1964:— 131 Number of Ilford children placed in convalescent homes: Fees paid by voluntary funds 1 Assisted in other ways:— Casework Visiting 17 Visiting parents of children still in l.C.A.A. Schools 3 Grant towards T.V. Licences 1 THE HEALTH VISITOR AND THE SCHOOL NURSE. Miss J. Oliver, Area Superintendent Health Visitor, submits the following report:— "Routine work continues in school, our visits for other purposes show a slight increase this year. School childrens problems continue to be discussed between health visitors, myself, doctors and the school medical service. As the need arises other statutory and voluntary bodies are asked to assist. Case conferences are called and a decision to assist the parents and children reached. Although, as health visitors, we know that to wait until a crisis arises is quite wrong, but with the present shortage of health visitors we cannot hope to give the supportive help necessary. Many a crisis could be avoided and much heart-break in the family if all services were fully geared to prevention. The assistance in our clinics, in schools and on the district we get from our clinic nurses is most valuable. Many routine and humdrum jobs are covered by the nurses thus relieving the health visitors. In Ilford we are particularly lucky that the nurses remain with us for many years thus assisting in the smooth running of the clinics. A small amount of Health Education continues in the same schools each year." 132 Smoking and Lung Cancer Lecture and Survey in Schools Dr. Taylor, Assistant County Medical Officer, reports as follows:- "Work is proceeding on the lines as mentioned in previous Annual Reports and the present survey, which is accompanied by lectures to certain age groups involving the Mayfield and Fairlop Schools, continues to follow a predetermined pattern. At the moment it would be inappropriate to offer comment on the eventual results of this undertaking, but in all probability a truer indication will be evident as the work progresses into the final stages." Hygienic Conditions in Schools in the Division. — Mr. S. R. Daly, Chief Public Health Inspector, reports as follows:— "As has been customary for many years, the sanitary and hygienic supervision of conditions in schools within the Borough of Ilford has been continued and have been reported upon and this year the sanitary circumstances in the schools are the same as previously enunciated. It is very necessary, in the light of modern conditions, that the sanitary conveniences in the Borough Schools be considerably improved. This can only be obtained by a complete re-organisation of the system in our older schools in order that the future generation may be enabled to take the necessary elementary precautions to present the spread of infection which arises from the absence of a knowledge of the rudimentary principles of hygiene, with particular emphasis on personal washing facilities, the satisfactory use of the sanitary conveniences, together with an early appreciation of the need to obviate the reluctance to use either or both by unsatisfactory, inconvenient and inaccessible facilities. Everyone agrees with the principle, the obstacle is provision of finance. Health Education ought to be inculcated in the mind of school children at a reasonably early age. A Health Education Officer might conceivably be permitted to enter our schools for this purpose which has been specifically denied the Public Health Inspectors. It would also improve the sanitary circumstances obtaining in the Borough Schools if more finance were available for a speedy 133 system of repairs to be carried out on notification by the Health Department as well as improvement in some of the canteen and kitchen arrangements for the provision of school meals." Employment of School-Children and Young Persons. — During 1964 67 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 1964 the scheme included all pupils over the age of 13 years 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 to participate. No. of pupils to whom B.C.G. were offered 1,871 No. of pupils whose parents consent to treatment 1,062 No. of pupils undergoing tuberculin test *1,033 Positive: 33 No. of pupils who received B.C.G 964 *68 carried forward from previous year. MEDICAL EXAMINATION OF TEACHERS, OFFICERS AND SERVANTS. — The following examinations were carried out during 1964:— Officers Servants Teachers Intending Teachers Total New Appointments 11 66 76 87 240 Under Sickness Regulations - 5 - - 5 THE CAUSES OF DEATH AMONG CHILDREN OF SCHOOL AGE (i.e. FROM 5-15 YEARS) IN ILFORD, DURING 1964 WERE:- Medulloblastoma 1 Carbon Monoxide Poisoning 1 Accidental Deaths 3 Sub-Aortic Stenosis 1 Fallots Tetralogy 1 7 134 MINISTRY OF EDUCATION MEDICAL INSPECTION RETURNS YEAR ENDED 31st DECEMBER, 1964. 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 6,007 Number of other Periodic Inspections 92 Total: 6,099 B. - OTHER INSPECTIONS Number of Special Inspections 71 Number of Re-inspections 1,225 Total: 1.296 C. - PUPILS FOUND TO REQUIRE TREATMENT Number of Individual Pupils found at Periodic Medical Inspection to Require Treatment (ExcludingDental 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).) 135 Age Groups inspected (by year of birth) For defective vision (excluding squint) For any of the other conditions recorded in Table IIA Total individual pupils (1) (2) (3) (4) 1959 15 152 166 1958 18 157 168 1957 10 59 67 1956 4 7 11 1955 - 4 4 1954 2 7 7 1953 13 26 36 1952 71 107 172 1951 43 45 85 1950 8 8 16 1949 and earlier 182 87 261 TOTAL 366 659 993 TABLE II. A. - RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1964. 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. 136 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 47 - 84 - 5 Eyes — a. Vision 366 - 248 - b. Squint 40 - 11 — c. Other 26 - 15 - 6 Ears — a. Hearing 42 — 63 - b. Otitis Media 3 - 11 - c. Other 3 - 7 - 7 Nose or Throat 112 - 190 - 8 Speech 32 5 20 - 9 Lymphatic Glands 1 - 46 - 10 Heart and Circulation 14 - 102 - 11 Lungs 24 - 144 - 12 Developmental— a. Hernia 8 — 19 - b. Other 18 1 102 - 13 Orthopaedic — a. Posture 51 - 40 - b. Feet 130 1 93 - c. Other 77 - 188 - 14 Nervous system — a. Epilepsy 1 - 3 - b. Other 5 - 18 - 15 Psychological — a. Development 2 - 13 - b. Stability 16 11 46 - 16 Abdomen 2 - 13 - 17 Other 59 — 190 2 137 B. - CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS Age Groups inspected (by year of birth) Number of Pupils inspected Number whose condition was classified Satisfactory Unsatisfactory 1959 965 959 6 1958 902 861 41 1957 303 295 8 1956 49 49 — 1955 24 24 — 1954 18 18 — 1953 182 182 — 1952 1,092 1,080 12 1951 482 471 11 1950 126 126 — 1949 and 1,956 1,947 9 earlier TOTAL 6,099 6,012 87 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 13,246 (ii) Total number of individual pupils found to be infested 62 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944 (v) Number of individual pupils disinfested:- By Local Authority 19 By parents 43 138 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 — 1 (ii) Body - 4 Scabies - - Impetigo 1 1 Other Skin Diseases 115 2 139 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 56 7 Errors of Refraction (including squint) 54 1,626 Total 110 1,633 Number of pupils for whom spectacles were— (a) Prescribed - 759 (b) Obtained - 735 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 - 10 (b) for adenoids and chronic tonsillitis — 306 (c) for other nose and throat conditions - 12 Received other forms of treatment 55 164 Total 55 492 GROUP 4 - ORTHOPAEDIC AND POSTURAL DEFECTS By the Authority Otherwise (a) Number treated in clinics or out-patients departments 127 368 (b) Pupils treated at school for postural defects 55 - 140 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 174 - GROUP 6. - SPEECH THERAPY By the Authority Otherwise Number of pupils treated by Speech Therapists for the first time 100 - GROUP 7. - OTHER TREATMENT GIVEN By the Authority Otherwise (a) Mis cellaneous minor ailments 14 35 (b) Other - - (1) Sunlight Treatment 17 - (2) Enuresis 118 - Total 149 35 TABLE V. DENTAL INSPECTION AND TREATMENT CARRIED OUT BY THE AUTHORITY (i) Number of pupils inspected by Dental Officers: (a) Periodic, age groups 11,541 (b) Specials 2,453 Total (1) 13,994 (2) Number found to require treatment 6,841 (3) Number referred for treatment 6,841 (4) Number actually treated 3,919 (5) Attendances made by pupils for treatment 16,021 141 (6) Half-days devoted to: Inspection 81 Treatment 2,236 Total (6) 2,317 (7) Fillings: Permanent Teeth 7,065 Temporary Teeth 2,861 Total (7) 9,926 (8) Number of teeth filled: Permanent Teeth 6,128 Temporary Teeth 2,507 Total (8) 8,635 (9) Extractions: (i) Permanent Teeth: (a) On account of Caries 443 (b) For other purposes 129 Total 573 (ii) Temporary Teeth: (a) On account of Caries 1,907 (b) For other purposes 48 Total 1,955 (10) Administration of general anaesthetics for extraction 817 (11) Other operations: Permanent Teeth 5,825 Temporary Teeth 1,092 Total (11) 6,917 (12) Orthodontics (i) Cases commenced during year 191 (ii) Cases carried forward from previous year 620 (iii) Cases completed during year 162 (iv) Cases discontinued during year 52 (v) Pupils treated with appliances 121 (vi) Removable appliances fitted 155 (vii) Fixed appliances fitted - (viii) Total attendances 2,334 (ix) Number of sessions devoted to treatment 214 Number of pupils supplied with artificial dentures 30 Number of dentures fitted 35 142 SCHOOL HEALTH SERVICE STAFF AND SCHOOL CLINICS AS AT 31st DECEMBER, 1964. 1. - STAFF OF THE SCHOOL HEALTH SERVICE Divisional School Medical Officer: 1. Gordon, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. 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) (b) Medical Officers: (i) Whole time School Health Service - - (ii) Whole time School Health and Local Health Services 9 2.13 (iii) General Practitioners working part-time in the School Health Service - - Speech Therapists 2 1.55 (c) Physiotherapists 2 2 (d) Occupational Therapist C.P. Unit 1 1.00 (e) School Nurses including Superintendent 25* (Combined posts, H.V. and S.N.) 9.67 (!) Nursing Assistants 9 (Clinic Nurses) 5.85 (g) (0 Area Dental Officer 1 0.76 (ii) Dental Officers (whole time) 4 3.84 (iii) Dental Officers (part-time) 3 0.45 (iv) Orthodontists — — (v) Dental Surgery Assistants 6 5.58 * All hold Health Visitor's Certificate. 143 II.- NUMBER OF SCHOOL CLINICS (i.e., premises at which Clinics are held for school-children) provided by the L.E.A. for the medical and/or dental examination and treatment of pupils attending maintained primary and secondary schools. Number of School Clinics 5 III.-TYPE OF EXAMINATION AND/OR TREATMENT provided at the School Clinics returned in Section II. either directly by the Authority or under arrangements made with the Regional Hospital Board for examination and/or treatment to be carried out at the Clinic. Examination and/or Treatment 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 2 - B. Dental 3 - C. Ophthalmic - 3 D. Ear, Nose and Throat - 1 E. Orthopaedic - 3 F. Paediatric - - G. Speech Therapy 5 - H. Cerebral Palsy Unit - 1 I. Artificial Sunlight - 2 J. Remedial Exercises and Physiotherapy 3 2 K. Enuresis 1 - L. Orthoptic - 1 144 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 2 2 Others:- Child Psychotherapist 2 0.73 Clerk/Typist 4 3.5 The Psychiatrists are employed by arrangement with the Regional Hospital Board. 145 146 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. BOYS 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 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 1959 589 Ill 20.1 403 114 21.1 152 120 23.0 50 126 26.2 49 132 28.8 34 137 32.5 835 144 36.6 516 146 38.3 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 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 1962 - - - - - — 165 112 19.8 305 116 21.8 79 121 24.4 33 127 28.1 24 133 28.1 23 136 30.0 54 143 35.5 586 148 40.5 304 151 43.0 252 162 53.2 566 167 56.2 1963 _ _ _ 558 Ill 20.2 773 115 21 513 119 23.4 98 124 25.3 20 129 27.6 19 138 30.4 61 147 37.7 571 148 40.1 277 151 42.2 30 156 48.0 115 166 55.4 191 172 61.2 1964 506 112 20.4 467 115 21.4 157 120 23.1 715 124 25.9 14 130 27.0 8 136 33.8 36 146 36.6 579 143 40.1 269 150 42.1 83 161 52.6 447 166 56.6 461 170 60.5 187 173 64.5 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 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 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 1961 - - - - — — - - - 199 Ill 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 1962 - - - _ - - 147 113 20.4 250 115 21.2 56 119 22.5 23 127 26.8 8 134 30.4 8 140 31.7 111 148 39.3 455 150 42.5 241 152 44.0 357 158 52.5 399 161 53.5 1963 - - - 531 Ill 19.7 687 114 21.1 482 117 22.3 90 121 23.6 28 129 29.8 12 134 32.7 151 147 40.4 568 150 41.8 282 153 44.5 28 160 51.9 175 161 54.8 161 162 55.4 1964 459 110 19.9 435 114 21.0 146 119 22.0 480 124 24.8 290 129 26.5 10 139 34.0 146 149 39.9 513 149 40.6 213 151 42.5 43 158 51.6 440 159 53.3 337 160 54.5 84 163 55.3 < Age Groups Age Groups 5—6 Years 6-7 Years 7-8 Y'ears 8-9 Years 9—10 Years 10-11 Years 11-12 Years 12—13 Years 13-14 Years 14-15 Years 15-16 Years 16-17 Years 17-18 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres} Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) 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 37 152 43.8 575 162 51.1 160 168 57.4 104 172 61.2 60 174 64.3 1955 605 113 20.6 842 116 21.9 125 123 24.3 68 124 25.5 38 135 29.9 320 142 34.4 994 144 35.7 46 146 37.3 13 155 47.0 381 162 50.7 206 168 57.8 62 171 61.4 45 175 63.5 GIRLS 1957 452 113 20.0 441 116 21.1 66 122 24.4 55 128 28.5 41 132 29.7 456 141 34.8 826 144 37.4 24 150 41.5 13 151 46.6 305 158 50.1 119 160 53.1 44 161 55.0 16 161 55.3 1956 782 112 19.7 373 117 21.6 91 121 23.1 44 126 26.4 46 134 29.8 438 141 34.9 821 142 37.1 100 150 41.4 57 156 48.1 525 157 50.2 149 160 53.0 128 164 54.1 23 158 54.5 1955 604 113 20.1 637 116 21.5 113 121 24.4 74 126 25.9 54 133 29.9 292 141 34.6 1052 144 36.6 73 149 40.5 34 156 48.8 359 159 50.7 180 159 52.5 68 161 54.8 19 161 54.7