REDBRIDGE HEALTH & WELFARE RED 1 TABLE OF CONTENTS Page HEALTH COMMITTEE 1 WELFARE COMMITTEE 1 EDUCATION COMMITTEE 2 STAFF 3-6 PREFACE 7-10 VITAL STATISTICS AND SOCIAL CONDITIONS 11 EPIDEMIOLOGY 12-24 NATIONAL HEALTH SERVICE ACT, 1946 25-55 EDUCATION ACT, 1944 56-88 MENTAL HEALTH 89-93 ENVIRONMENTAL HEALTH 94-121 WELFARE 122-133 INDEX 134-138 1 HEALTH COMMITTEE Municipal Year 1965-1966 ALDERMAN MISS A. S. TERRY, J.P. Chairman COUNCILLOR MRS. G. M. CHAMBERLIN, Vice-Chairman S. F. LOVELESS, Mayor Councillor ALDERMAN R. A. DAL TON, J.P. ALDERMAN MRS. L. FALLAIZE, J.P. ALDERMAN L. A. S. GOOCH ALDERMAN C. H. MOSS, M.A. (Cantab.). COUNCILLOR A. C. BERRY COUNCILLOR MRS. M. H. PAIGE COUNCILLOR D. A. CARRADICE COUNCILLOR A. REYNOLDS COUNCILLOR E. R. EAREY, COUNCILLOR J. L. RYDER J.P., F.V.I. COUNCILLOR G. E. TOVEY, F.I.A.C. COUNCILLOR MRS. V. M. GROSE COUNCILLOR J. A. VANE COUNCILLOR MRS.M.J. HARVEY, COUNCILLOR D. E. WIGHTMAN, R.M.N. J.P., B.A. COUNCILLOR MRS. V. L. WILSON COUNCILLOR L. M. HIPKINS, B.A., F.R.S.A., F.R.G.S., F.R.Econ.S., A.C.C.S. COUNCILLOR C. E. LOVELESS, F.A.I.A., (Deputy Mayor) COUNCILLOR J. H. NORWOOD CO-OPTED MEMBER: DR. T. C. MAYER WELFARE COMMITTEE COUNCILLOR E. F. HARRIS, Chairman COUNCILLOR MRS. M. H. PAIGE, Vice-Chairman ALDERMAN R. A. DALTON, J.P. COUNCILLOR A. C. BERRY COUNCILLOR T. F. COBB, A.I.A.C. COUNCILLOR D. S. DAVIES COUNCILLOR MRS. L. A. EMONS COUNCILLOR MRS. V. M. GROSE COUNCILLOR S. F. LOVELESS, (Mayor) COUNCILLOR C. E. LOVELESS, F.A.I.A., (Deputy Mayor) COUNCILLOR F. C. MOUNTIER COUNCILLOR MISS M.N. POWERS COUNCILLOR MRS. A. TOMS COUNCILLOR R. H. AYRES COUNCILLOR R. J. D. UNDERWOOD COUNCILLOR J. A. VANE COUNCILLOR C. J. A. WATSON COUNCILLOR G. H. WATSON COUNCILLOR H. J. WATTS COUNCILLOR K. W. WEBB COUNCILLOR D. E. WIGHTMAN, R.M.N. COUNCILLOR MRS. V. L. WILSON 2 EDUCATION COMMITTEE ALDERMAN MRS. E. F. M. HOLLIS, M.B.E. Chairman ALDERMAN C. I. GIBSON, Vice-Chairman ALDERMAN MRS. L. FALLAIZE, J.P. ALDERMAN F. T. PEARSON COUNCILLOR H. R. B. ALY COUNCILLOR R. H. AYRES COUNCILLOR A. C. BERRY COUNCILLOR L. G. BRIDGEMAN COUNCILLOR D. A. CARRADICE COUNCILLOR T. F. COBB COUNCILLOR G. E. DAVIES, J.P. B.Sc. COUNCILLOR MRS. V. M. GROSE COUNCILLOR MRS. O. HALL COUNCILLOR MRS. M. J. HARVEY, J.P., B.A. COUNCILLOR L. M. HIPKINS, B.A., F.R.S.A., F.R.G.S., F.R.Econ.S., A.C.C.S. ALDERMAN S. G. GLEED ALDERMAN MISS A. S. TERRY, J.P. COUNCILLOR N. C. N. HUNT COUNCILLOR D. K. L'ESTRANGE, B.A., LL.B., F.C.I.S. COUNCILLOR C. E. LOVELESS, F.A.I.A., (Deputy Mayor) COUNCILLOR S. F. LOVELESS, (M ayor) COUNCILLOR MRS. W. J. ROBERTS COUNCILLOR A. J. SHAW, B.A. COUNCILLOR MRS. D. E. SMITH COUNCILLOR O. F. WATERS, J.P. COUNCILLOR C. J. A. WATSON COUNCILLOR A. P. WHITE Co-opted Members: REV. A. J. ADAMS DR. B. H. CHIRGWIN, M.A., B.Sc. MISS R. M. FORDHAM MR. H. GOLDNER VERY REV. CANON M. HANCOCK, B.A. MR. E. R. LOWER, B.A. REV. H. R. NEALE MR. V. H. WILLIAMS 3 OFFICERS OF THE HEALTH AND WELFARE DEPARTMENT Medical Officer of Health, Principal School Medical Officer: I. GORDON, M.D., Ch.B., M.H.C.P. (Lond.)., D.P.H. (Edin.). Associate Medical Officer of Health: F. G. BROWN, M.B., B.Ch., D.P.H. Deputy Medical Officer of Health, Deputy Principal School Medical Officer: A. SHAW, M.B., B.S. (Durham), D.P.H. (Leeds). Associate Deputy Medical Officer of Health: DESIREE M. B. GROSS, M.D., Ch.B. (Leeds), M.M.S.A., D.P.H. (Leeds). (Retired 11.8.65) Principal Medical Officer: SYLVIA F. MEYER, M.B., B.Ch., D.P.H. Departmental Medical Officers: FRANCES E. O'CONNOR WILSON, B.A., M.B., B.Ch., B.A.O., D.P.H. (T.C.Dub.)., L.M. (Rot.). HELEN B. GRANGE, M.B., B.S. (Lond.). G. B. TAYLOR,. M.B., B.S. (Lond,)., D.C.H., D.Obstr. R.C.O.G. M. B. GEE, M.B., Ch.B. (Bristol), D.C.H. W. H. TOMS, M.B., Ch.B. (Edin.). EVELYN B. KILSBY, M.R.C.S., L.R.C.P., B.Sc. (London.), B.A. (Cantab.). ELIZABETH A. LITTLE, M.B., Ch.B. (Aber.). Principal Dental Officer: E. V. HAIGH, L.D.S., R.C.S. (Eng.). 4 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. HODGSON. B.D.S. (Durham). T. G. TOOLSEY, B.D.S. (Durham). MRS. E. KIMELMAN, M.D. (Vienna). Sessional Detital Officers: R. A. SOAR, B.D.S. W. V. VICTORS, L.D.S., B.D.S. R. C. BIGMORE S. J. W. NELKI, L.D.S., R.C.S. (Eng.). Chief Public Health Inspector: S. R. DALY, LL.M., B.Sc., D.P.A. (Lond.)., Barrister-at-Law. Chief Welfare Officer: R. W. HALL, A.M.I.S.W. Deputy Chief Public Health Inspectors: R. E. SMALLEY, A.R.S.H. J. T. S. TEMPLEMAN, M.A.P.H.I. Public Analysts: J. HUBERT HAMENCE, M.Sc., Ph.D. (Part-time). P. S. HALL, F.R.I.C. Non-Medical Supervisor of Midwives: Miss R. K. Jesson, S.R.N., Q.I.D.N., S.C.M. Superintendent of District Nurses: MISS L. E. A. PARISH, S.R.N., S.C.M., Q.I.D.N., H.V. Superintendent Health Visitor: MISS J. M. OLIVER, S.R.N., S.C.M., H.V. 5 Officers of the Public Health Services - continued. Deputy Superintendent Health Visitor: MISS E. M. P. COLLINS, S.R.N., S.C.M., H.V. Senior Mental Welfare Officers: J. F. NORMS S. H. MAURICE Senior Social Worker: MISS G. M. VENNING Chief Administrative Officer: D. H. GODWIN, A.R.S.H. Senior Administrative Assistants: MISS H. M. NUNN E. S. JENKINS H. R. STAN BRIDGE F. W. STREET A. E. TOURLE Regional Hospital Board Surgeons in charge of Orthopaedic Clinics: H. G. KORVIN, D.M., F.R.C.S. M. MASON, F.R.C.S. Ophthalmolo gis ts: J. A. FAIRHURST, M.B., B.S., D.O. P. LANCER, M.B., B.S., M.R.C.S., L.R.C.P., D.O., D.C.H. M. N. LAYBOURNE, M.R.C.S., L.R.C.P., D.O.M.S. G. F. ENSOR, M.R.C.S., L.R.C.P., D.O.M.S. Surgeons in charge of Ear, Nose and Throat Clinics: MARGARET MASON, M.A., F.R.C.S. B. I. COPELAND, M.R.C.S., L.R.C.P. 6 Officers of the Public Health Services — continued. 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. Orthoptists: MISS M. WARD, D.B.O. MRS. J. ASHENDEN 7 Preface HEALTH & WELFARE DEPARTMENT, Telephone: 17/23 Clements Road, ILFord 3020 ILFORD. July, 1966 Mr. Mayor, Ladies and Gentlemen, I submit herewith the first Annual Report of the Health and Welfare Services of the London Borough of Redbridge. There has been some rearrangement of the contents and a new cover (designed by the Architect's Department) to emphasise a new start and a new borough. Epidemiology, formerly discussed in this preface, is now dealt with elsewhere, and as comments on the London Government change-over appeared both in the last Health Report for the Borough of Ilford, which was perforce presented to the Redbridge Borough Council in 1965, and in the first Annual Report of the Council 1965-1966, the topic will not be elaborated upon again. The sudden death of Dr. Brown, my Associate Medical Officer of Health, and formerly Medical Officer of Health for Wanstead and Woodford, was a sad loss to the department. His friendship and support made the transfer much easier, and the shortage of senior medical administrative staff, exacerbated by the retirement of Dr. D. M. B. Gross, Associate deputy Medical Officer of Health, has been the more keenly felt. "Tripartheid" or Triunity Some problems of the Health and Welfare State are repeatedly discovered and rediscovered and publicised by newcomers and amateurs in these fields, without any appreciation of the fact that the difficulties have been known to the professionals for many years, and that solutions are constantly being sought. An example is the assertion that many different kinds of social workers worry 'he same client. Another example, the one I intend to discuss here, is the suggested deleterious effect of the tripartite structure of the health services, i.e. those managed by the Regional Hospital Boards, the Executive Councils and the Local Health Authorities. An enumeration of the areas where we combine or associate may surprise many not familiar with our daily routine. The description that follows has not been set out to show that in Redbridge we have something special, much of this goes on all over the country, with great variation from authority to authority. I have tried to concentrate on efforts that are local, not, for instance, covering all Greater London or similar or larger are as. The most obvious, but by no means the most important, is the cross representation of members and doctors on the statutory committees, i.e. local 8 authority and family doctor representatives on the Hospital Management Committee and its Medical Advisory body, G.P. co-option to the local health committee, local authority and hospital representatives on the Executive Council and M.Os.H. on the Local Medical Committee. Non-statutory liaison groups are flourishing; perhaps the most effective is that organised by the North East London Regional Hospital Board to bring together M.Os.H., Senior M.Os. of the Ministry of Health, and their own senior staff. Analogous are the Geriatric liaison groups for each area, again M.Os.H., geriatricians and other R.H.B. staff, and Chief Welfare Officers. The North East London Executive Council has formed a liaison Committee with the Local Health Authorities of its area. Then there are the well-established Maternity Liaison Committees, with doctors of all three sections of the profession, plus nursing staff, on their membership. On the psychiatric side there is a group of M.Os.H., psychiatrists and their own staff, organised by the R.H.B., dealing mainly with the problems of the fieverely subnormal. At these levels are discussed matters of policy, such as the Ten Year Development Plan of the Hospital Service, and the analogous plan of the Health and Welfare Services. But it is at the "grass-roots" that co-operation is most important, and communications are fundamental. Locally the Health and Welfare Department has initiated the "Redbridge Medical Journal" issued monthly, where, in addition to the publication of departmental matters of interest, hospital doctors, general practitioners and outside authorities largely contribute, and inter-professional correspondence and discussions have a permanent part. The Executive Council is about to issue an information booklet for this area, for issue to the public. Tentative agreement has been reached that next time we might publish a joint venture, as the Health and Welfare Department has had its own under consideration, to follow on one that was issued by the Ilford Public Health Department. It has become almost a platitude to state that the relationships between the Health Department and the family doctors have greatly improved since 1948. Here are some of our points of contact. Besides employing G.Ps. in the school health service, infant welfare centres, first-aid training, etc., two infant welfare centres have been, for many years, set apart entirely for G.Ps. to run, on a rota basis of six months at a time, to familiarise them with the procedures in case they should wish to run such clinics on their own premises. One large partnership conducts its ante-natal work in our clinic. Health visitors, midwives and district nurses are attached to practices on, so far, a small scale. For logistic reasons any great expansion is difficult, but we endeavour to meet all requests, bearing in mind that the work of district nurses and midwives is entirely within the ambit of the family doctor, whereas the health visitor has other interests as well. There has recently been a dramatic change of attitude with respect to working in comprehensive health centres, consultations are proceeding with local G.Ps. with respect to their working in the health centre projected in Goodmayes Lane, and without doubt they will have to be consulted 9 in every future such development. At Heathcote we are planning a geriatric clinic, at first to examine medically all the 65 year-olds of ten practices, the clinicians to be G.Ps. from those practices working on a rota basis. In the autumn the Redbridge B.M.A. branch is associating itself with the borough council in initiating a cancer education campaign. We are daily in contact by telephone with individual G.Ps. on problems of medical priority for rehousing and staff sickness, as we do not find the formal certificate, often given under pressure, of much value. Finally, we meet socially in the local B.M.A.and Ilford Medical Society, where several members of the Health Department have taken a most prominent part in conducting affairs. In the hospital sphere, mutual arrangements are most evident in the psychiatric field. Here we have the sessional use of psychiatrists from the two mental hospitals in the borough, joint employment of psychiatric social workers, and maybe soon a joint integrated social work department with Goodmayes Hospital. Mental Welfare Officers are attached to "psychiatric firms" in those hospitals, attend case conferences and in fact one of the hospitals is their emergency base whence they are called outside office hours, thus ensuring that psychiatrists are in the picture. The M.W.Os. run a club for ex-patients and a psychiatrist is arranging an evening therapy group in one of our clinics. All essential features of our plans for occupational centres and hostels for the mentally ill are discussed with psychiatrists, including the physician superintendent of one of the hospitals, who also advises on local authority appointments in the mental health sphere. These hospitals also give in-service training to our health visitors. In midwifery we staff medically and with health visitors ante-natal clinics for hospital confinements, health visitors visit mothers in the Maternity Hospital before their discharge and naturally we assess social priorities for hospital confinements and conduct Part II training for pupil midwives. It would help considerably in integration if our midwives could conduct deliveries in the Maternity Hospital, but an unwise legal provision makes this difficult. In geriatrics the advice of the geriatrician is freely given, welcomed, and often spontaneously forthcoming, although there is no formal joint appointment. He is a prominent member of the Old People's Welfare Committee, of which the M.O.H. is Chairman. Until recently all those about to be discharged from the geriatric wards were visited by a local authority social worker, now it is by a health visitor, and in the future it is likely to be a jointly employed medical social worker. At the opposite end of the age scale it is to be regretted that there is not a closer relationship with the paediatric department; here there has been a step back, for the consultant paediatrician at the local hospital was once, many years ago, paediatric consultant to the Borough of Ilford, but the associated appointment lapsed. However, our health visitors routinely attend his out-patient sessions. With the consultant pathologist, discussions have 10 been most fruitful in starting the cervical smear clinics. The borough has offered to reciprocate by agreeing to arrange for a 100% mortgage for a house for any technician in that field that the hospital may be lucky to obtain. However comprehensive paper plans may be, they will not work unless personal relationships between medical men in the three branches of the services are good, and confidence exists that any approach to integration will be welcomed. The atmosphere here is such that much of the joint approach has originated from outside the health department. For instance, the psychiatrist suggested the joint social work department, the geriatrician, the joint employment of a medical social worker, the G.Ps., the geriatric clinic and the cancer education campaign; accordingly in Redbridge there is no lack of evidence that local doctors can, when possible, produce an integrated service. When possible! Note there is no mention of integration of hospital and community services for the severely subnormal. This is because the hospital is in Colchester and the community in London. Without doubt almost all the difficulties of the tripartite structure would disappear if hospitals were local and administrative areas coterminous. This is a matter that cannot be arranged locally, any more than the legal impediments to domiciliary mid-wives working in maternity hospitals. Central Government continually exhorts us to liaise, integrate and co-operate; may we respond that we do, and that what is now required is for Government to make our tasks easier by action that only Government can do. Finally, 1 would like to thank all who have made it possible to provide the first year of service in Health and Welfare for the new London Borough of Redbridge — Councillors, the large band of voluntary workers, fellow Chief Officers and my own staff, including Dr. Shaw, my deputy, who has been largely responsible for organising the contents of this report. I have the honour to be Your obedient servant, I. GORDON, Medical Officer of Health. 11 STATISTICS AND SOCIAL CONDITIONS OF THE AREA (Land and Inland Water) Area (in Acres) (Tidal Water) 13,983 TCegistrar-General's Estimate of resident Population:— June 30th 1965 247,960 Number of inhabited houses (April 1st, 1965) according to Hate Books (approx.) 76,310 Hateable Value — April 1st, 1965 (approx.) £12,500,000 Sum represented by a penny rate, April 1st, 1965 (approx.) 651,215 1965-66 General Rate 10s.6d. in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— Males Females As at December, 1965 416 41 1965 Live Births 3,826 Live Birth rate per 1,000 population—Crude rate 15.43 Adjusted rate 15.89 Illegitimate Live Births per cent of total live births 6.85 Stillbirths 61 Stillbirth rate per 1,000 total live and stillbirths 15.69 Total Live and Stillbirths 3,887 Infant deaths (under 1 year) 63 Total Infant deaths per 1,000 total live births 16.47 Legitimate deaths per 1,000 legitimate births 15.99 Illegitimate deaths per 1,000 illegitimate births 22.90 Neo-natal mortality rate per 1,000 live births (first four weeks) 12.28 Early Neo-natal mortality rate per 1,000 total live births (under one week) 10.19 Perinatal mortality rate (stillbirths and deaths under one week combined per 1,000 total live and stillbirths) 25.73 Maternal deaths (including abortion) 2 Maternal mortality rate per 1,000 live and stillbirths 0.51 Deaths (all causes) 2,845 Death rate per 1,000 population — Crude rate 11.47 Adjusted rate 10.89 Comparability Factors — Birth rate 1.03 Death rate 0.95 Total rainfall 1965 25.41 inches 12 EPIDEMIOLOGY 13 EPIDEMIOLOGY (by A. Shaw, M.D., B.S., D.P.II., Deputy Medical Officer of Health) Infectious Disease 23 diseases are notifiable to the Medical Officer of Health. These include common diseases such as pneumonia and whooping cough and exotic ones such as plague and cholera, which have not been recorded in this country for decades. The aim of the infectious disease legislation is to inform the Medical Officer of Health as quickly as possible so that appropriate measures may be taken. The diseases are notified by the patient's medical attendant, who receives a fee from the local authority. Notification In a number of the diseases such as smallpox and typhoid, immediate notification is imperative so that contacts can be traced and prevention of spread started; such diseases are notified rapidly and completely by doctors who are alive to the needs of the community. Other infectious diseases, such as measles, whooping cough and pneumonia, are notified incompletely and as a result of this only a rough approximation can be made of the extent of the disease in the community, although an indication of rise or fall in incidence can be noted. In this category of incompletely notified disease we find that only a small proportion of doctors make notifications and, as a result of this, a first reading of the geographical incidence of the disease would seem to indicate that it was occurring only in certain parts of the borough until it is realised that it is in these parts of the borough that the notifying doctors practise. In addition to the statutory sources of information on infectious disease incidence, very useful epidemiological intelligence is obtained from schools and from the Ministry of Pensions and National Insurance who report on the number of claims for sickness benefit each week. Measles Appendix 1 shows that 4,222 cases of infectious disease were notified during the year, and that 3,393 of these were measles. From an epidemiological viewpoint, it does us no good at all to know that there were 3,393 cases of measles; we knew that 1965 would be a measles year and we knew also that the incidence would fall largely on children up to the age of 7 or 8. If measles vaccination ever became as acceptable and universal as vaccination against poliomyelitis there would be value in notification because it would indicate success or otherwise of the vaccine but at the present it means very little. 14 Whooping Cough It is interesting to record that there were 80 cases of whooping cough notified during the year. In parts of the North of England it was reported that a strain of whooping cough organism which had previously given no trouble was responsible for an outbreak of the disease. The strain in question was not incorporated into most of the commercial vaccines available and the disease had occurred in immunised children. In Redbridge, an immediate change was made to a vaccine incorporating the strain in question. Most of the cases in Redbridge occurred in unimmunised children and it is unlikely that the organism responsible was the one incriminated in the North of England. Whooping Cough is a distressing disease and in young children can have very serious after effects. In a community such as Redbridge, with a high protection rate, 80 cases seems rather high. Unless, the characteristic whoop is present the diagnosis can never be certain until confirmed by bacteriological examination. Dysentery and Food Poisoning 314 cases of dysentery and 17 cases of food poisoning were notified during the year but only in a small proportion were pathogenic organisms isolated. This might mean that the organisms had been eliminated by the antibiotics prescribed by family doctors or that the dysentery was caused by an agent not detectable by the ordinary methods of bacteriological examination, such as viruses. It is an undoubted fact that a large range of viruses can cause diarrhoea but the process of isolation is so long that the outbreak is usually over before results are available. In the absence of any effective chemotherapy the fact of kndwing the name of the virus has no immediate practical value; although it is useful in the long term in perhaps detecting a characteristic pattern of virus illness. In the 17 cases of food poisoning, salmonella was isolated in only 5 cases. The value of knowing the type of salmonella is national rather than parochial. By plotting the occurrence of incidents of salmonella infection the Epidemiological Research Laboratory at Colindale is often able to trace the foodstuff carrying the organism. More often than not the source is imported animal feeding stuffs which infect the animal, whose contaminated flesh in turn infects humans and other meat in the same abattoir or retail outlet. A great deal of the food poisoning in this country is the indirect result of faulty methods of manufacture of foodstuffs abroad. 15 Enteric Fever Imported infectious disease is becoming very common. The only case of paratyphoid occurring in the borough was a direct importation from Spain by a holiday maker. This single Redbridge incident is being repeated all over the country and the total cases of typhoid and paratyphoid contracted in this way must be quite large. It cannot be stressed too hard, therethere, that travellers to the Continent should have T.A.B. vaccine in good time before going. The vaccine is not one hundred per cent effective but provides a high measure of protection. Smallpox Typhoid and paratyphoid are serious enough as imported infections either by the traveller as in our Redbridge case or by corned beef as in Aberdeen but the real danger lies in smallpox which every so often is imported from India and Pakistan. We are perhaps lucky in this respect in having only a small colony of Indians in Redbridge and so the risks are smaller than in the heavy woollen districts of Yorkshire where large numbers of Indians and Pakistanis have settled and where there is a regular traffic of passengers between the countries. However, if the range of travel of holiday makers extends very much further, there are parts of the Near East, such as Turkey and Egypt where the risk of smallpox is much higher than in Europe. Travellers to the Near East and to the Balkans should therefore ensure that they have a successful vaccination or revaccination before setting out. Venereal Disease It is not possible this year to give details of the incidence of venereal disease in the borough. As Redbridge is now a Local Health Authority some method must be found of obtaining details of the incidence. As returns are only required to be made to the Local Health Authority in which the treatment centre is situated a true picture can only be arrived at by full co-operation of other authorities. In the Appendix 2 are shown the figures from the Eastern Hospital, Queen Mary's Hospital and the Albert Dock Hospital. These represent only a partial figure because there are many other treatment centres in London. No conclusions can, or should be drawn from the statistics shown. Methods of more accurate reporting are under consideration in Greater London. Tuberculosis The national figures for tuberculosis over the past 20 years make interesting reading. The steady fall in incidence pays tribute to B.C.G. vaccination, better housing, better nutrition, and unobtrusive work by the Ministry of Agriculture in eliminating tuberculosis from dairy herds. 16 X-ray of Immigrants The main infector pool now lies in elderly people who remain undetected because they have a chronic disease giving rise to few symptons. Often these cases only come to light as a result of diagnosing the disease in contacts and backtracking and examining all the other contacts. It is the impression, also, that a proportion of the disease is imported, some of it from Eire. The Ministry of Health instituted a scheme during the year whereby immigrants must inform Port Medical Officers of their destination in the United Kingdom; Port Medical Officers then inform the Medical Officer of Health of the area and he follows up the immigrant, urges him to register with a doctor and to attend the Chest Clinic for a skin test and chest X-ray. The scheme has obvious drawbacks and as a means of controlling the entry of tuberculosis is inadequate. It relies on voluntary co-operation which is often not forthcoming, the immigrant often moves on quickly from his first port of call and is lost sight of and finally and most important it puts the onus of detecting the disease on the medical staff within the country of entry instead of in the country of origin. Anyone who has spoken to potential emigrants to the United States of America will be aware of the stringent medical requirements which must be met in the country of origin. It is difficult to see why the same system should not apply to our own immigrants. Notification of Tuberculosis There were notified 69 cases of pulmonary tuberculosis and 13 of non-pulmonary tuberculosis during the year. This total of 82 was rather higher than the combined figures for previous years. In Appendix 3 is given the age incidence, sources of notification and composition of the tuberculosis register. It will be seen that the age group 45 — 64 is well represented. 9 of the cases were Asians. Mass Radiography The static mass X-ray Unit at the Thompson Rooms, High Road, Ilford, performed again a very useful service to the community. Appendix 4 shows details of the work carried out at the Unit. I am grateful for the willing co-operation of Dr. D. Adler and Dr. M. Weinberger at the Ilford Chest Clinic, Dr. H. Duff Palmer at the Harts Hospital, and Dr. Hugh Ramsay of the Mass Radiography Service. Dr. E. Atkinson and his staff in the Bacteriology Laboratory at Oldchurch Hospital provided courteous and helpful service and advice throughout the vear and to them also I am most grateful. 17 Coronary Disease Non-Infectious Disease Appendix 5 (Registrar General's Short List of Deaths and Causes) shows that in those deaths in which the causes are well defined there are two main categories responsible for most deaths. These are diseases of the heart and arteries, and cancer. Appendices 6 & 7 show comparisons between Redbridge, Greater London and England and Wales. Diseases of the heart and blood vessels (categories 17 — 21) accounted for 1,305 deaths, or 46% of all deaths. Coronary disease and angina alone claimed 559 victims, or 19.6% or one in five of all deaths. The disease caused death mainly in males over the age of 55 but there were 54 deaths under the age of 55 years and 14 of these were under the age of 45. Probably many of these deaths were preventable. Although the cause of coronary disease is not fully understood, there are at least three factors over which the individual can exercise control and reduce the risk of dying from coronary disease. These are cigarette smoking, which should be reduced or stopped altogether, physical activity which should be regular and moderate, and overeating which by causing obesity leads to high blood pressure which in turn carries an increased risk of coronary disease. Lung Cancer Cancer in its many forms (categories 10—15) accounted for 610 deaths or 21.4% of all deaths. The largest category of all cancer deaths was lung cancer which caused 147 deaths or 5.1% of the total deaths of one in twenty of all deaths. Most of the deaths were in men over the age of 55 paying the penalty of twenty a day for 20 years or more. This is an eminently preventable disease to which a great deal of our health education is directed. Female Cancer There were 82 deaths from female cancers, 20 of the uterus and 62 of the breast. Both of these types of cancer give premonitory symptoms and if detected early have a good chance of cure. A special cancer health education campaign is to be started next year. Accidents There were 77 accidental deaths, 26 of these the result of motor vehicle accidents. 7 children under the age of 15 died as a result of accidents but only one of these was a motor vehicle accident. Suicide 26 persons committed suicide, of which 11 were under the age of 45. 18 APPENDIX 1 CORRECTED NOTIFICATIONS OF INFECTIOUS DISEASES FOR THE YEAR 1965 NOTIFIABLE DISEASE At all ages Number of Cases Notified At ages — Years *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 Smallpox - - - - - - - - - Scarlet Fever 228 - 55 155 9 5 4 - - Diphtheria, including Membranous Croup - - - - - - - - - Enteric Fever (Typhoid and ParaTyphoid) 1 - - - 1 - - - - Pneumonia 64 1 5 4 5 26 14 9 248 Puerperal Pyrexia 11 - - - 4 7 - - - Acute Poliomyelitis - - - - - - - - - Acute Encephalitis 2 - - - 1 1 - - - Meningococcal Infection 4 - 2 - 2 - - - - Dysentery 314 19 70 49 63 83 26 4 - Ophthalmia Neonatorum 3 3 - - - - - - - Erysipelas 22 1 - - 1 3 11 6 - Pemphigus Neonatorum 1 1 - - - - - - - Tuberculosis Pulmonary 69 - - 1 11 18 25 14 16 Other Forms 13 - - - 3 5 3 2 1 Anthrax - - - - - - - - - Malaria — Believed contracted in this country - - - - - - - - - Believed contracted abroad - - - - - - - - - Acute Rheumatism - - - - - - - - - Measles 3,393 119 1,872 1,382 11 9 - - - Whooping Cough 80 9 46 25 - - - - - Food Poisoning 17 - 2 2 - 11 1 1 - Typhus Fever - - - - - - - - - Totals 4,222 153 2,052 1,618 1ll 168 84 36 265 *Included in the figures in this column are cases notified in previous years as well as 1965. 19 APPENDIX 2 VENEREAL DISEASES Number of New Cases from Redbridge treated at various Treatment Centres during 1965 Name of Centre Syphilis Gonorrhoea Other Conditions Total Homerton Grove Clinic, Eastern Hospital, E.9. - 9 17 26 Special Clinic, Queen Mary's Hospital E.15. 2 12 51 65 Albert Dock Seamen's Hospital, E.16. 1 4 21 26 Totals 3 25 89 117 APPENDIX 3 TUBERCULOSIS Age Periods New Cases Deaths Respiratory Non Respiratory Respiratory NonRespiratory M F M F M F M F Under 1 year - - - - - - - - 1-4 years - - - - - - - - 5-14 1 - - - - - - - 15-24 9 2 2 1 - - - - 25-44 9 9 4 1 1 1 - - 45-64 16 9 1 2 3 1 1 - 65-74 5 2 1 1 5 - - - Over 75 6 1 - - 3 2 - - Totals 46 23 8 5 12 4 1 - 20 The foregoing new cases were notified from the following sources:— Respiratory Tuberculosis NonRespiratory Tuberculosis Ilford Chest Clinic 37 2 Wanstead and Woodford Chest Clinic 18 - Dagenham Chest Clinic 1 - Local General Practitioners 2 - King George Hospital, Ilford 2 2 Chadwell Heath Hospital 3 - Wanstead Hospital - 1 Hospitals outside the Borough 7 7 70 12 In addition 68 pulmonary and 7 non-pulmonary cases were transferred to Redbridge. Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1965 946 116 1,062 Number of cases entered on the register during the year 137 20 157 Number of cases removed from the register during the year Pul. NonPul. Recovered 63 2 Deceased 20 - Left District 64 7 Lost sight of 1 - Diagnosis not established 2 - 150 9 159 Number of cases remaining on register on 31st December, 1965 933 127 1,060 The treatment of Tuberculosis is under the control of the Regional Hospital Board. On the 31st December, 1965, there were 1,011 Redbridge patients on the registers of the Ilford, Wanstead and Woodford and Dagenham Chest Clinics. The number of patients from Redbridge sent to Institutions under the Regional Hospital Board Tuberculosis Scheme during 1965 was as follows:- Pulmonary Non-Pulmonary Total Males Females Males Females Adults 56 27 - - 83 Children - - - - - 21 APPENDIX 4 MASS RADIOGRAPHY The mass radiography unit stationed at the Thompson Rooms continued to operate on Mondays from 4th January to 12th July, 1965 and again from 6th September to the end of the year. The service is still in operation and Dr. H. Ramsay, the Medical Director, has kindly supplied me with the following details, relating to the period under review. Male Female Total Referred by General Practitioners 1,709 1,614 3,323 General Public 2,180 2,192 4,372 Organised Groups 901 1,224 2,125 Contact Group 11 27 38 Total numbers X-rayed 4,801 5,057 9,858 Requiring further investigation 229 134 363 Pulmonary Tuberculosis Requiring immediate treatment 11 7 18 Requiring close clinic supervision 2 1 3 Requiring occasion clinic supervision 14 7 21 Presumed healed, no further action required 27 25 52 Bronchial carcinoma 31 6 37 Mesothelioma - 1 1 Metastases in the lung and mediastinum 2 2 4 Other abnormalities:— Pulmonary fibrosis—Non-tuberculous 34 16 50 Bacterial and virus infection of lungs 25 5 30 Bronchiectasis 5 2 7 Other various abnormalities 28 28 56 92 51 143 22 APPENDIX 5 Registrar-General's Short List of Deaths and Causes Causes of, and Ages at, Death during the year 1965. 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 15years 15 and under 25years 25 and under 35years 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 2,845 47 16 8 11 17 25 65 181 477 728 1,270 1 Tuberculosis, respiratory 16 - - - - - - 2 3 1 5 5 2 Tuberculosis, other 1 - - - - - - - 1 - - - 3 Syphilitic disease 3 - - - - - - - 1 - 2 - 4 Diphtheria - - - - - - - - - - - - 5 Whooping Cough - - - - - - - - - - - - 6 Meningococcal infection - - - - - - - - - - - - 7 Acute poliomyelitis - - - - - - - - - - - - 8 Measles - - - - - - - - - - - - 9 Other infective and parasitic diseases 4 - - - 1 - - - - - 2 1 10 Malignant neoplasm, stomach 75 - - - - - - 2 3 18 19 33 11 Malignant neoplasm, lung, bronchus 147 - - - - - 2 1 17 49 59 19 12 Malignant neoplasm, breast 62 - - - - - - 2 11 18 13 18 13 Malignant neoplasm, uterus 20 - - - - - - - 3 8 4 5 14 Other malignant and lymphatic neoplasms 291 - - 1 1 2 2 12 19 71 91 92 15 Leukaemia, aleukaemia 15 - - - - 1 - 3 1 2 4 4 16 Diabetes 16 - - - - - - - - 3 6 7 17 Vascular lesions of nervous system 334 - - - 1 1 1 2 18 31 70 210 18 Coronary disease, angina 559 - - - - - - 14 40 140 169 196 19 Hypertension with heart disease 44 - - - - - - 1 1 3 11 28 20 Other heart disease 243 - - - - 1 1 1 8 24 33 175 21 Other circulatory disease 125 - - - - - 1 1 12 9 31 71 22 Influenza 11 - - - - - 1 2 - - 3 5 23 Pneumonia 248 3 7 2 - - - 2 3 12 53 166 24 Bronchitis 156 - - - - - - 2 4 25 52 73 25 Other diseases of respiratory system 30 - 1 - - - 1 - 2 4 13 9 26 Ulcer of stomach and duodenum 21 - - - - - - - - 5 6 10 27 Gastritis, enteritis and diarrhoea 10 - - - - - 1 - - 1 3 5 28 Nephritis and nephrosis 10 - - - - 2 - 1 3 2 2 - 29 Hyperplasia of prostate 9 - - - - - - - - - 3 6 30 Pregnancy, childbirth, abortion 2 - - - - - 1 1 - - - - 31 Congenital malformations 23 11 5 2 1 1 - - 1 - - 2 32 Other defined and ill-defined diseases 265 33 1 - 5 3 3 9 18 39 55 99 33 Motor vehicle accidents 26 - - - 1 5 3 2 2 6 1 6 34 All other accidents 51 - 2 3 1 - 2 1 1 3 16 22 35 Suicide 26 - - - - 1 6 4 9 3 1 2 36 Homicide and operations of war 2 - - - - - - - - - 1 1 Special Causes (included above) Smallpox - - - - - - - - - - - - 23 APPENDIX 6 DEATH RATES FROM CANCER AND HEART DISEASE, 1965. The following Table shows the death-rates for 1965 for Redbridge, compared with the provisional death-rates for Greater London and for England and Wales for the same period per 1,000 population; the figures having been supplied by the Registrar-General:— Redbridge Greater London England and Wales Cancer of lung and bronchus .593 .700 .553 Cancer, other forms 1.403 1.640 1.614 Coronary and arteriosclerotic heart disease 2.254 2.267 2.375 24 APPENDIX 7 Table showing comparison between the Birth-rate, Death-rate, etc., of Redbridge, Greater London and of England and Wales for the Year 1965. 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 18.1 15.8 11.5 19.0 .44 - 17.0 .08 661 Greater London 17.9 14.7 11.0 18.4 .50 - 13.7 - 782 REDBRIDGE (Estimated Population mid-1965 - 247,960) 15.89 15.7 10.9 16.5 - - 44.31 - 10002 A dash (—) signifies that there were no deaths. 111 deaths 2248 deaths 25 NATIONAL HEALTH SERVICE ACT, 1946 26 Clinics SECTION 22 CARE OF MOTHERS AND YOUNG CHILDREN (by A. Shaw, M..B., B.S., D.P.H., Deputy Medical Officer of Health) There are four purpose-built infant welfare centres and 16 hired or adapted premises in the Borough at which clinics are held. Details of the premises are in Appendix 8. 25 infant welfare clinics per week are held and at each of these sessions welfare foods are available for sale. Six toddlers' clinics per month are held at four purpose-built centres. The total number of sessions held during 1965 was 1,303 and the total number of children attending was 9,923, made up in age groups as follows:- Born 1965 - 3,353 1964 - 3,144 1960/63 - 3,426 Attendances Even allowing for removals into the Borough over threequarters of the babies born in 1965 were seen at infant welfare clinics and this proportion dropped only slightly for those born in 1964. Attendances of children over the age of two followed the familiar pattern in falling steeply as young mothers began to need less support from health visitors and others. Relaxation clinics are held at five centres and ante-natal clinics at six centres. 228 sessions were held. Births Congenital Abnormalities There were 3,826 live births and 61 stillbirths during 1965, and of these 262 and three respectively were illegitimate, giving an illegitimacy rate of 6.04%. There were 182 premature live births and 35 premature stillbirths. 63 congenital abnormalities were reported to the Registrar General as part of the scheme introduced after the thalidomide incident to detect early trends in the nature and incidence of congenital abnormalities, so that appropriate action may be taken. Details of the abnormalities reported are in Appendix 9. Children at risk It had become increasingly apparent over the past few years that a procedure would have to be introduced to detect as early as possible in a child's life any deviation from normality so that appropriate corrective or ameliorative measures could be applied. A scheme of registration of children 'at risk' of handicapping conditions was introduced and placed under the control of Dr. Joan M. Pooley, who reports as follows:- 27 "The 'At Risk Register' was first put into effect in the London Borough of Redbridge on 1st December, 1965. It has been referred to since its inception as 'The Observation Register', in order to avoid any unnecessary confusion or worry to the parents of infants who would be included on the register and subsequently followed up. The nature of the observation register, the manner in which it has been compiled and the follow-up procedures resulting therefrom have to a large extent followed the pattern described by Dr. Mary Sheridan as published in the Monthly Bulletin of the Ministry of Health and The Public Health Laboratory Service (1962, 21, 238). However, certain adaptations of Dr. Sheridan's scheme and notification factors were deemed necessary, and considerable thought and investigation was made before the Redbridge Observation Register was finally launched. A form of "notification factors" was drafted and was divided into the following groups of predisposing factors!- 1. Genetic 2. Prenatal 3. Perinatal 4. Postnatal 5. Symptomatic (concerning children during and after the neonatal period) Subsequently the opinions of local consultant obstetricians and paediatricians were sought on relative factors, and Dr. E. V. Kuenssburg (member of the Dunlop Committee on the Safety of Drugs) was consulted on the inclusion of certain additional drugs in the prenatal factor concerning the use of drugs during pregnancy. The final form of notification of factors was then completed and is now in current use. A preliminary explanatory meeting with the Redbridge departmental medical officers, district midwives, and health visitors was held, and the general practitioners in the Redbridge area were circularised or visited personally to explain and request their co-operation in the scheme. Before an infant is actually placed on the registe'r, the notification forms and hospital discharge summaries are carefully examined by the medical officer in charge. A health visitor is then asked to call on the parents of the infant concerned to explain personally the meaning and advantages of 28 such a register. Only then is the mother invited to bring her infant up to the nearest infant welfare clinic (by appointment) when a thorough history is taken and a physical and developmental examination is carried out by the medical officer at the clinic. Urinary investigation is noted and additional visual or auditory testing is effected by means of the Stycar systems appropriate to the age of the infant. This routine examination is repeated at intervals as the infant reaches the age of approximately 6 months, 9 months, 12 months, 18 months and 2 years. In the event of a handicap or abnormality being detected, the appropriate action is taken with the agreement of the infant's general practitioner, and subsequently the infant may either be further observed or be transferred to the Physically Handicapped Register, If by the age of 2 years no abnormality has been detected the infant's name will be removed from the register, but it is intended that the health visitor and medical officer will continue an unofficial follow up through the toddlers clinics at yearly intervals and thereafter the child will be seen at the routine school medical examinations. The school record card of the child concerned will be marked by a purple adhesive label to show the examining medical officer that the child has at some point been on the observation register. For record purposes in the infant welfare centres the consultation record form (0—4 years—MCW 46 revised) is in use, and this is distributed to any general practitioner also if he prefers to follow up his own patients. Certain minor problems are being met—inevitable in the launching of any new scheme: these are being dealt with as they arise. Arising from experience so far, I strongly recommend the standardisation of all hospital discharge forms. This could well commence in the Redbridge Health Area. As the "At Risk" Register (at present voluntary) becomes a nationwide concern, the possibility of a national standard hospital discharge form could eventually be considered. This would ensure that all relevant and necessary information concerning the infant is available quickly and efficiently, thus saving a lot of hospital and local authority clerical time. It was estimated in the London Borough of Redbridge that approximately 20—25% of all live births would be considered 29 to be at risk. This has in fact proved to be the case during the three months 1st December 1965—28th February 1966. Detailed statistics of these figures were published in the March 1966 issue of the Redbridge Medical Journal, and are available on request. It was interesting to note the relatively high incidence of cases being observed for prolonged or assisted delivery, toxaemia and birth anoxia. The co-operation of hospital consultants, general practitioners, medical officers, health visitors and midwives is being greatly appreciated and has largely contributed to the accuracy and practical application of the Register to date." Toddlers Clinlcs In addition to the Observation Register clinics, the Toddlers Clinics continued to play a useful part in the maintenance of normal physical and emotional health in pre-school children as the following reports show. Dr. E. Kilsby reports on the work of the Toddlers Clinics at Kenwood Gardens, Heathcote and Manford Way:- "These clinics have been well attended during the past year and appear to be gaining in popularity. Basically each child is examined once yearly, or more frequently at the request of parent or health visitor. The number of previously undetected defects is not large, but where necessary children can be supervised through the Toddler Clinic or referred to Specialist Clinics. Untreated dental caries is sometimes seen, in spite of the ready availability of treatment in our dental clinics, and obesity occasionally presents in this age group. At Manford Way Infant Welfare Centre a film strip on the care of children's feet has been shown to groups of mothers during the Toddler Clinic sessions and where this is possible it provides a good opportunity for health education. Discussion with the mother, particularly with regard to behaviour problems and, for example, the pros and cons of nursery schools and play groups, is as important as physical examination of the child, and for this the relatively unhurried atmosphere of the toddler clinic is ideal." Dr. W. H. Toms reports:- "A new Toddlers Clinic was started at Mayesbrook this year in answer to a need that was felt to exist. 30 Attendance has been good throughout the period — a very high proportion of appointments being taken up. Many of the usual orthopaedic and visual defects common to young children were diagnosed and most cases referred to the appropriate consultant. We are fortunate at Mayesbrook Clinic because both Ophthalmic and Orthopaedic Specialists attend there and referrals do not necessitate long journeys or much waiting for the families. A great deal of the most valuable work of a Toddlers Clinic consists of the support of the mother faced with behaviour in her child which she cannot understand or accept. Simple explanation and discussion with the mother can be of enormous help and often leads to a richer parent-child relationship and relaxation of tension. The health visiting staff who run the clinic have always been able to give me the fullest information about the children and their backgrounds and I am sure it is largely due to their enthusiasm that this clinic has got off to a good start . The provision of dental services to expectant and nursing mothers and to children under the age of 5 is reported on by Mr. E. V. Haigh, Principal Dental Officer:- Dental Treatment "Full dental treatment was given to all patients willing to attend one of the four surgeries in the Redbridge area where treatment for expectant and nursing mothers and children under five years old was carried out. Two surgeries at Kenwood were for mothers and children living in the northern part of the Borough and two surgeries at Mayesbrook for those in the south. The first significant fact observed from the statistics for 1965 is that the number of expectant and nursing mothers treated fell by approximately 10% from 1964 figures. This continual drop in the demand by these mothers has been observed over the past ten years in most areas, especially in the south of England. This is due to the fact that there is a high usage of the general dental service and also that most mothers are more dentally health conscious. They are under private practitioners supervision prior to the ante-natal or post-natal care and so do not wish to attend the clinic dental surgeon whom she may attend only for twelve months after the confinement. Continuity of treatment is I am sure very important and the fact that they may only attend for a limited period stops many mothers from attending at all. 31 The number of children under five years old, however, increased over the 1964 figure, some 704 children having been examined during 1965. This increase has continued over the past few years. It is due partly to health education, but mainly due to Medical Officers, Health Visitors and Nurses making parents realise the importance of commencing dental supervision and treatment at an early age. The need to get many more of the pre-school children to receive regular dental care must be one of our main aims. This can only be done with the help of the medical and nursing staff. It is interesting to note that more fillings were completed for these children yet the number of extractions fell by 25% over the 1964 statistics. This shows in my opinion that more children are receiving dental care either under the general dental service or local authority clinic. The use of high speed aerators for cavity preparation continued to be of great value. It is surprising how well even very small children accept this method of cavity preparation. Dentures were supplied to patients whenever it was considered necessary, these being made at a local dental laboratory. The sale of toothbrushes continued in dental clinics to assist in furthering dental health education. I have, continued with one evening session per week for mothers who are unable to attend during the day sessions. Many mothers who are at work or unable to leave young children prefer these evening sessions. It is noticeable that these patients are more relaxed due I think to the fact they are able to leave their children at home". Specialists clinics for orthopaedic, ophthalmic, ear, nose and throat and speech defects were held and details of attendances are in Appendix 10. The Council's Day Nurseries The Council has two day nurseries, at Ley Street and at Goodmayes Lane. Both buildings are of the familiar wartime design and structure, with similar layout of rooms. Each nursery can cater for children from the age of a few weeks to five years. Children are admitted on a priority basis and parents are assessed to pay a daily charge. By the nature of the priority groups all of the children accommodated are in one way or another 'deprived', that is to say a full home life is not possible 32 because, for example, the parents may be sick or there may be only one parent, who is the sole breadwinner. By family grouping in the nurseries it is possible to ameliorate in some measure the effects of deprivation of a full home life. Both nurseries are training nurseries and the Council pays for student training to the level of the N.N.E.B. (National Nursery Examination Board). We have been very impressed by the high standard of girls applying to be employed as student nursery nurses. Details of attendances at the nursery are shown in Appendix 11. Private Day Nurseries and Child - Minders Mention must be made here of the activities of the department under the Nurseries and Child-Minders Regulation Act, 1948. There is a flourishing industry of child minding in Redbridge, a result of full employment and ample opportunities for mothers to work. It is fair, I think, to call it an industry because very few people are sufficiently altruistic to go on minding other people's children without adequate recompense. At the end of the year 33 day nurseries and 19 childminders were registered under the Act for the care of 1,559 children. A number of these children were registered in mother's co-operative play groups, but the majority were being after for reward and at a low estimate the total reward is somewhere between £100,000 and £150,000 per year. It is the task of this department to see that children are being looked after properly and a great deal of supervision is carried out. It is necessary to ensure that premises are adequate and properly equipped, that the persons looking after the children are suitable in all respects, that the children are properly fed and that they are happy and occupied. To these ends regular visits are made by health visitors, medical examinations are carried out by medical officers and periodic checks on the sanitary circumstances are made by public health inspectors. These visits are largely unannounced, as are those by a senior medical member of this department. Child-minders and day nursery proprietors are required to have annual chest X-rays, and among other conditions, to report promptly on the sickness of or accident to a child. Arrangements are made for any child-minder who wishes to spend some time observing activities at a Council day nursery to do so. 33 Supervision of child-minders and day nurseries is a very serious business, seriously and energetically tackled. Complaints, rumours and even anonymous letters are investigated immediately and although the whole process is handled tactfully inevitably charges of 'snooping' are made. It is our opinion that if this is indeed snooping, then it is snooping in a good cause and we make no apology. Despite the foregoing, it is true to say that on the whole child-minders and day nursery proprietors take their duties seriously. This is not only humanitarian, but it is also good business because if they do not the parents either withdraw patronage or the Health Department takes rapid action. Changing Emphasis The future holds great promise for constructive change. It is only in the past 20 years that the infant mortality rate has fallen to a level whereby virtually all preventable infant deaths are prevented and efforts are now more fully attained to helping infants and mothers to enjoy a healthy life instead of preventing them from becoming ill. This is evidenced by the changing attitude of health visitors and doctors who now spend more time studying and clarifying family and interpersonal relationships than they do with physical defects. Mothers are more prosperous and more sophisticated and quite rightly want better things both materially and emotionally for their children. They will not accept the authoritarian approach which is still common in clinical medicine and things must be explained to them so clearly that they themselves like action to remedy faulty living attitudes. It will be seen therefore that the full-time doctors and health visitors employed in the care of mothers and young children must be rather special doctors and nurses in that they must be so conversant with the normal child that any deviation from normality is instantly detected; they must also be expert in the techniques of health education and normal and abnormal psychology. These are skills which are acquired only after graduation and a whole new attitude towards medicine is then adopted. It is perhaps a tribute to their interest and dedication to their work that we still have some, but not enough, to do all the work that is there to be done. Efforts must be made to attract the right sort of person to this work and pay alone, inadequate though it is, is not the entire answer. 34 New Buildings The plans of two new clinics it is planned to erect at Loxford Lane and Goodmayes Lane are shown on pages 54 and 55. A new feature of these clinics is the inclusion of a soundproof room for audiometry and testing infants' hearing. It is hoped that a start may be made on building in 1966/67. Both of these buildings were designed by the Borough Architect, Mr. H. C. Connell. Mr. Connell has attracted to his staff a group of young and talented architects and it is a pleasure to record here our gratitude and appreciation for the hard work and willing co-operation they have put into the designs. SECTION 23 MIDWIFERY Domiciliary Confinement Rate There were 3,887 live and stillbirths to Redbridge mothers in 1965 and of these 948 were born at home, making a hospital confinement rate of 75.6% and a domiciliary confinement rate of 24.4%. There were no domiciliary stillbirths and no domiciliary maternal deaths, although there were three hospital maternal deaths. Integration with General Practice Many obstetricians think that all mothers should be delivered in hospital, but because of shortage of hospital beds this is not likely to come to pass for very many years, if ever. The tripartite structure of the National Health Service with public health, general medical services and hospital services could, and did, make ante-natal care a vexed subject in the past. Happily, we have a very good liaison with the Ilford Maternity Hospital, which makes for uniformity of ante-natal care. As Miss Jesson remarks in her report, midwives continued to assist four general practitioners with their ante-natal clinics. This is a very useful contact and increasing integration with general practice in ante-natal care is the shape of things to come, to the benefit of patient, doctor and midwife. 48-hour discharge of mothers from maternity hospitals is fortunately very rare in Redbridge. This is an expedient not uncommon in many other parts of London where pressure on beds is acute, but in this area of London, although there are not enough beds for all who ask for them, it is possible to accommodate those mothers who require them on obstetric or social grounds. 35 Miss R. Jesson, Non-Medical Supervisor of Midwives, reports:- "The new London Borough of Redbridge midwifery service employs one Non-Medical Supervisor of Midwives, 16 fulltime midwives and two part-time midwives. In accordance with the rules of the Central Midwives Board, regular inspections of midwives were carried out by the Medical Supervisor of Midwives. 52 pupil midwives had completed their Part II district midwifery training and 11 pupils were still in training at the end of the year, also 17 obstetric nurses completed their course. Ante-natal clinics are held weekly at Mayesbrook and Kenwood Gardens, weekly at Hermon Hill from 1st April, fortnightly at Heathcote and Manford Way and twice monthly at Marks Gate. Four general practitioners continued to retain the services of a midwife to assist at their ante-natal clinics. All midwives are qualified to administer gas and air analgesia, and three Trilene Inhalations. As in previous years midwives with cars carried their own gas and air machines and others were available at the Ambulance Station and were transported to the midwives when necessary by the Ambulance Station or by hired car. During 1965 housing accommodation was provided for five midwives." SECTION 24 HEALTH VISITING Staff On the appointed day there were 23 health visitors working in the Ilford part of the Borough and 4 on the Wanstead and Woodford part. Even with 27 health visitors we are 9 short of establishment and it is the result of very hard work on the part of those health visitors in post that there was no serious breakdown in the service. Emphasis was placed on the most pressing problems and parts of the health visitors work was carried out by State Registered Nurses without the health visitor qualification. The table in Appendix 12 shows the number and type of visits made. 36 Recruitment It is a sobering thought that the intake of younger women into the profession is not as high as it should be if future requirements are to be met. Although training institutes will shortly be turning out large numbers of Younghusband trained social workers there is still cause for concern in the dearth of entrants to health visiting, large areas of which cannot be performed satisfactorily without a nursing training. The decision of the Council to amalgamate the Health and Welfare Departments made contact easier between health visitors and social welfare officers and has resulted in decisions that one officer or the other (but not both, except in certain cases) will be responsible for casework with a particular family. The fact that both sections are in the same building leads also to easier co-ordination. Central Registry of Casework A start was made early in the year on the establishment of a central registry of casework, which is simple in conception and execution. In the past, casework has been bedevilled by multiple visiting by different agencies, each not knowing what the others were doing. The institution of a central registry, available for reference to all caseworkers in the Borough, which' records simply the name and address of the family and which social worker is visiting, is a big step forward and will lead to a better use of available resources. Miss J. Oliver, Superintendent Health Visitor, reports:- "It was pleasing to welcome Miss Collins, Deputy Superintendent Health Visitor, appointed from April, 1965. Now that many of the services work under the same roof, informal conferences on problems have been easy to arrange and helpful to all workers. One of the most startling facts emerging from this is that other social workers have so little knowledge of the health visitors work. The more co-operation health visitors receive, on behalf of various families, the more their work naturally increases. Other workers get to hear of their wide field of knowledge and experience. Many new ideas have been brought into the service during 1965. These have entailed a good deal of discussion and planning. After consultations in April, it was decided that the health visitors would not continue with their visits to the physically 37 handicapped. Social workers are especially trained for this, but should they need nursing knowledge they are free to consult us. The elderly and widows or widowers left on their own continue to be part of our work. Owing to the shortage of mental welfare officers our work with mentally handicapped children has been intensified. As most health visitors know their handicapped children so well this does not prove a difficult task. Early in 1965 a series of seven articles was published in the local newspaper on the health visitors work. The idea came about because we were in need of extra voluntary helpers in our clinics to sell food and weigh babies. The response from the article appealing for help was excellent and so once again a very important part of the service continued to be covered. Fieldwork Instructors Two of the above were appointed from our own health visiting staff, following a special training at Chiswick Polytechnic. The Fieldwork Instructors were allocated two student health visitors each to assist in the practical training of health visiting. The South East Essex Technical College (now renamed the Barking Regional College of Technology) are training three students for Redbridge from September, 1965. Previously two of these students were seconded to the local maternity hospital to do their obstetric training. Following the sponsored training by Redbridge the three students guarantee to give the Local Authority one year's service. In this way we hope to be able to keep the acute shortage of health visiting staff stable. Movement of staff cannot be predicted, retirements are inevitable. Kenwood Gardens Clinic The above Clinic was used to re-establish the social workers luncheon in September, 1965. Informal meetings with a speaker arranged for the last half an hour are most helpful. Information is exchanged and it is an excellent way of getting to know one another. 38 Duke of Edinburgh's Award Eight girls of the Life Brigade were tested for the above Award by Miss Collins and myself. Five a.t the first level, three at the Advanced level. Child-Minders and Private Nurseries Visits to the above premises have been carefully considered this year. Both minders and premises vary considerably— staffing, diet, play material were brought to the owner's notice. Many mothers use the child-minders and private day nurseries because they say they must work. I doubt if few parents stop to think of the harm the early separation of child from the mother does. Our hospital colleagues are continually talking about separation when a child goes into hospital, yet little is said about the type of daily separations we witness in these premises. Claybury Hospital The health visitors working the Wanstead and Woodford end of the Borough have mothers attending Claybury Hospital. We are grateful to the hospital for allowing the health visiting staff to visit the Psychiatrist and discuss any problems on the patient or any other problem they may on the district. Home Accidents 818 children and elderly people have been visited following accidents in the home. Many accidents particularly with dangerous pills could have been avoided. Mothers Clubs These are held at Madeira Grove and Heathcote Clinic. They have a social, educational and theraputic aim." SECTION 25 HOME NURSING Until 1st April the home nursing service was administered from the Lady Payleigh Home in Leytonstone, but since that 39 time it has been a Borough responsibility. The transition took place smoothly and Miss L. Parish, who was Assistant Superintendent, took over as Superintendent of Home Nursing. Most of the home nurses live in their own homes and visit their areas from there, but two are accommodated at Abury House, where most of the requests for visits are telephoned in by family doctors. Well over half the patients attended were over the age of 65, as the following table shows:- Total patients nursed — 2,396 Aged under 5 years — 65 Aged over 65 years — 1,435 Others — 896 Miss Parish reports:- "1965 proved to be an eventful year with the merging of the two Boroughs of Wanstead and Woodford and Ilford into the London Borough of Fedbridge. This event has increased both our staff numbers, and the area which we serve. We now have a staff comprising 33 District Nursing Sisters plus 3 Male Nurses. Included in the above are two part-time Nurses, one of whom is now taking her Queens District Training. Five Nurses have completed their training, and received their Certificates during the past year. Five other members of the staff have left, one due to retirement, the others for domestic reasons. We .hank them for services given, and wish them well in the future. Three new members have been appointed during recent months and have settled in well. The type of work we are called upon to do today is changing. Although the bulk of our work is still with people over 65, the average age of the chronic sick person is now much lower. Included among these are the multiple sclerosis groups, sufferers from poliomyelitis and one who has had a broken neck and most of these are between 30 and 40 years of age. Our task of nursing them is made easier by the availability of hoists, chairs, special beds, walking aids, etc., which are obtainable from the Health and Welfare Department at Clements Road." 40 SECTION 26 VACCINATION AND IMMUNISATION Clinics Protection against whooping cough, diphtheria, tetanus, poliomyelitis and smallpox is given at 16 infant welfare clinics in the Borough, and also by the majority of general medical practitioners practising in the Borough. Until November two different schedules of immunisation were in force in the two constituent parts of the Borough. This was undesirable for many reasons, not least of which was that central direction must speak with one voice otherwise confusion ensues. It was thought desirable that Redbridge and four neighbouring Boroughs should have some uniformity in programme because of movements of population in the area and so medical representatives of all five Boroughs met and designed an entirely new programme, taking into account the most recent research work on the subject. New Immunisation Schedule The new programme of immunisation starts at the age of 3 months when triple antigen (diphtheria, whooping cough and tetanus) is injected and oral polio vaccine is given at the same visit. By the time the child is 6 months old primary protection against all four diseases has been achieved. This is followed up by boosters against all four diseases between the ages of 15 and 18 months and by primary vaccination against smallpox during the second year of life. It is planned to boost against diphtheria, tetanus and polio just before school entry. The programme has the virtue of simplicity; additionally, it is started, and the primary course finished, while the mother is in a most receptive mood and by reducing the number of visits necessary improves the chance of completing the course of injections, before other maternal responsibilities become more pressing. Protection Rates The table in Appendix 13 shows the number of completed courses of immunisation by year of birth. It is estimated that over three-quarters of those children born in 1965 who were eligible to receive protection by reason of age were in fact protected against diphtheria, whooping cough, tetanus and polio. This is a very satisfactory result and is above the level of herd protection which is theoretically necessary to prevent epidemics of these diseases. The number of boosters given against these diseases is shown also in Appendix 14. 41 Smallpox The picture in respect of infant smallpox protection is Vaccination very much different. Only 28.9% of those infants eligible to receive protection (i.e. those born in 1964) did so. The acceptance rate for smallpox vaccination has never been high in the past two decades, but it has fallen even more in the past few years. This is a direct result of the Ministry's (wise) advice to delay vaccination until the child is at least one year old, to reduce the incidence of the complications which are statistically higher during the first year of life. By the time the child is a year old many mothers have stopped attending infant welfare centres and can only be reached by visiting. Also the impression still persists that smallpox vaccination leaves a large disfiguring scar; in fact the smallpox vaccination practised nowadays, when properly performed, leaves only a small scar. This is a case for intensive health education, which goes on daily. Vaccination against tuberculosis is described in that part of the report which deals with the School Health Service. SECTION 28 PREVENTION, CARE AND AFTER CARE including Health Education Convalescent Treatment Provision of Sickroom Equipment Chiropody Tuberculosis Health Education Every member of the staff of the Health and Welfare Department both fieldworkers and administrative staff should be concerned in some way, however small, with health education. It has been our aim to inculcate this idea into staff throughout the year. Many members of the staff make very valuable contributions to health education, but it has been thought for some time that there should be a central point of reference in the department to co-ordinate efforts and to give fresh impetus. Accordingly, a Health Education Officer was appointed in July. Miss K. M. E. Griffiths, Health Education Officer, reports as follows:- 42 "The 'building up' process of a new service takes time, but already the Health Education Section is well equipped and will, it is hoped, be used by increasing numbers of staff and outside organisations. One of the main objectives in health education is to make people aware of their health needs and through special skills enable them to act upon new knowledge in order to change attitudes and behaviour. There are many problems — it is no easy task to change preconceived ideas — it is even difficult to persuade anybody of the need for change. Another difficulty is to find out the naeds of a community and to assess the work that has been carried out. Health education permeates through many activities — it is right that this should be so. In order to make the work meaningful communications and reporting systems need to be effective and continuous. Then the environment needs to such that basic health education principles can be carried outit is useless, for example, teaching principles of hygiene when there are no facilities for practising them. The climate of opinion must be right so that people will be willing to learn — in a subject as personal as health, none of us like to feel we 'don't know'. None of these problems are insurmountable — we need time. Much of the routine work has continued as before and talks, lectures, film shows and "mothercraft" courses are given either by the health visitors, or with their co-operation at Relaxation classes, toddlers clinics, mothers clubs and at local hospitals either as part of a nurse training course or to patients attending clinics. An example of this is a regular course of nine lectures on 'Parentcraft' given to prospective parents at Ilford Maternity Hospital. A wide range of topics are discussed which could be of special benefit to the mother and young child. Smoking and Health — Lectures and talks on this subject are given whenever requested. Publicity material is distributed throughout the Borough. A report by Dr. Taylor on his project in the schools will appear elsewhere. Venereal Disease — Courses have been organised for head teachers and teaching staffs and it was felt that this subject could well form part of a general health education programme in the schools. 43 Dental Health — Talks have been given at clinics and mothers clubs which have underlined the need to follow the simple rules for a healthy mouth, and also to impress mothers of the need to take pre-school age children to the dental clinics for regular 'check-ups'. Environmental Health — Health education has been continued by the public health inspectors in their day-to-day work, for example, dealing with food handlers and the importance of personal or food hygiene. This information will be found in the report from the Chief Public Health Inspector. The importance of health education within the environment and for the community cannot be over emphasised. Health Education can be accomplished through personal contact with the individual, through group discussion and through the mass media. Personal Health Education — This is carried out by all members of staff in their day-to-day work and this is a most valuable contribution. Group Education — This is probably the most effective method though at present most of the work is done on an empirical basis — this needs to be evaluated to test its efficacy. Use of the Mass Media — This is done through the distribution of posters and leaflets which have been analysed beforehand. In the past, use was made of poster sites rented from London Transport at underground stations and British Railways at Ilford Station. This practice of displaying posters each month on a different topic has continued with a considerable increase in the number of sites on all the stations within the Borough, so that the same health education message should appear on all poster sites whether they be on public notice boards or at the clinics at any given time. A circular letter was sent to all the general medical practitioners in the new Borough and more than 50% of them agreed to display publicity material in their surgeries and posters and leaflets are despatched to them at regular intervals on topical subjects. This service could well be extended to dental practitioners and to chemists. Liason with the press is essential — a few words in the local paper can do a great deal to inform and impress. 44 Home Safety — Lectures, talks and film shows are given by the health visiting and other staff to local voluntary organisations, youth clubs and in the schools. There has been considerable expansion in the distribution of printed material and this is now following the pattern of national campaigns, the aim of which is to standardise our efforts with those of the whole country. Other publicity projects are in course of preparation which will deal with aspects of home safety needing most attention. King George Hospital continues to be most co-operative in advising of the number of patients under 5 years and the elderly who were treated for home accidents. This information is of great help to us in that, by reason of cause and numbers involved it enables us to plan our programmes more meaningfully at a local level, and of course health visitors do follow up these individual cases. It has always been the custom to report in statistical terms the amount of work carried out during the year. Though, of course, there is a proven case for statistics in many areas of work it is questionable whether they can be of great value in some areas of health education unless they can relate, for example, to the amount of health education carried out to the total number of people at risk and then an evaluation of the increase in knowledge, change in attitude and habits. However, it should be placed on record that the work of staff and especially the health visitors who, through individual or cooperative efforts have contributed greatly to effective health education during 1965. Convalescent Treatment Facilities exist to send away on convalescent holiday persons recovering from debilitating illnesses. On the whole, the purpose of the holiday is to enable the convalescent more quickly to resume normal life and work. The service is particularly valuable for people suffering from such conditions as chronic bronchitis, although it has been found useful also in the rehabilitation of nervous disorders. Cases are referred by hospitals and by family doctors and the convalescence may be spent at the seaside or in the country, although there is a marked preference for seaside convalescence. The service complements that provided on the one hand by the Regional Hospital Board for patients who need nursing care and that provided by the Welfare Section of the Department which provides holidays for the elderly. 45 A contribution towards the cost of the convalescent holiday is made by the patient after assessment. During the year 102 cases received this service. Provision of Sickroom Equipment Disposable The Department holds a very large stock of sickroom Incontinence equipment, which is issued on loan to persons requiring it Pads because of illness at home. A list of the equipment available is shown in Appendix 15. Items in particularly brisk demand are invalid chairs, air rings, commodes, rubber sheets, bedpans and urinals. Large quantities of disposable paper pads for incontinent patients are issued weekly. If the family is unable to dispose of the soiled sheets by burning, they are collected and burnt in the furnace at Goodmayes Hospital. The Department also runs a laundry service for the bed linen of incontinent patients. Chiropody There are seven Chiropodists on the establishment, but it was not possible to fill all of the posts and a large amount of the work is done by chiropodists employed on a sessional basis. The bulk of the work is concerned with the elderly above pensionable age and a very valuable service is performed in keeping elderly people mobile and self-sufficient. If possible, elderly people are seen at chiropody clinics, but if necessary domiciliary visits are made. A small charge is made to those who can afford it. The service is also available to expectant mothers, the physically handicapped and school children. Details of the patients seen are shown in Appendix 16. Health Visitors Occupational Therapy Tubercolosis After-Care Three full-time Tuberculosis Visitors are attached to the Ilford Chest Clinic and one full-time and one part-time visitor to Harts Hospital. A very close liaison is maintained with the Chest Clinics and the after-care services are closely integrated. The domiciliary occupational therapist who worked parttime in the Borough has resigned and has not been replaced yet. There are not enough tuberculosis patients to warrant the employment of a full-time occupational therapist for this 46 work alone and when a new appointment is made the therapist will be working also with the physically handicapped. Facilities Other facilities which exist for the after-care of tuberculosis patients include assistance in the maintenance charges at rehabilitation settlements, provision of free milk, boarding out of child contacts and assistance towards the travelling expenses of relatives visiting hospital patients. With the exception of free milk provision, which was given to 161 patients during the year, these facilities are rarely used nowadays, an indication of the fallen incidence of tuberculosis. It is of interest, however, that one open-air shelter is still provided by the Borough; this must be one of the very few still in use in the country. Voluntary Statutory services work very closely with voluntary services Bodies and Mr. H. R. Stanbridge, Senior Administrative Officer in the Department's Personal Health Services Section, continues to undertake the secretarial work of the Ilford Tuberculosis and Chest Care Association. Mr. Stanbridge reports as follows:- "The Ilford Tuberculosis and Chest Care Association, now in its forty-sixth year, continued to help those patients resident in the Ilford section of the Borough who are in reduced circumstances, and their families, by providing them with assistance not otherwise available through statutory sources. Patients resident in the Wanstead and Woodford part of the Borough may seek help from the Wanstead and Woodford Chest Care Association, whose administration is conducted from the Chest Clinic, Harts Hospital, Woodford Green. Grants to Ilford patients in the form of extra nourishment account for the major portion of the expenditure, but other forms of relief, such as grants for clothing, household repairs, travelling expenses to visit relatives in hospital, additional heating, assistance with rates, and help with occupational therapy materials are also made to necessitous cases. The Committee are very grateful to the Redbridge Borough Council for the financial assistance they have given, and also for the facilities offered to allow the administration of the Association to be carried on from the Health and Welfare Department. 47 Details of assistance given during 1965 are:- No. of persons assisted Total No. of grants made Extra nourishment grants 42 ( 312 (usually made for a period ( including of one month and renewed as required) ( renewals Other grants 72 81 SECTION 29 HOME HELP SERVICE Home Helps As in previous years, the shortage of home helps prevented a full service being given in many cases. The Home Helps that we do employ are on the whole conscious that their work involves more than mere cleaning. In some Cases it may involve taking charge of a young family when mother is ill and in other cases work far beyond the strict line of duty is perfbrmed willingly. It is surprising, not that so few home helps ate employed but that so many are willing to take on the job at slightly less than 5s.l½d. an hour, when up to 7s.0d. may be earned in private households. The deployment of staff is the responsibility or the Senior Home Help Organiser, Mrs. L. G. Lawrence, assisted by two Home Help Organisers and one Assistant Organiser. Mrs. Lawrence reports as follows:- "In the Borough of Redbridge approximately 1,300 cases per week are served. The demand on the Home Help Service is far greater than the supply. About 75% of these cases are aged and sick. The reason for this percentage is that parents are only the moral responsibility of their children, and in quite a considerable number of cases the children consider it is the duty of the Local Authority to care for their parents. Shortage of hospital beds is another reascin for the great demand. Priority is given to lying-in mothers, families of young children where the mother has been admitted to hospital, persons acutely ill, bedridden and chairbound patients. 48 One of the most important aspects of the Home Help Service is its preventive work. The provision of a Home Help at a critical time can preserve the happiness and prevent break-up of family life, and also enable aged persons to remain in their own homes. The number of Home Helps employed in the London Borough of Redbridge is approximately 246 and many more are needed. It is essential that the women who apply to be 'Home Helps' must have a real desire to help others, have a cheerful disposition and be able to adapt themselves to different households. The duty of the Organiser is to visit the home of the applicant as soon as possible. The main object of this visit is to determine whether the applicant falls into one of the categories in which the Home Help is allowed. If help is to be given, the Organiser takes note of the number of rooms occupied by the Applicant, and the conditions of the house in order to assess the need." 49 APPENDIX 8 CLINIC PREMISES CHADWELL CHRISTIAN MISSION HALL, Essex Road, Chadwell Heath. ALL SAINTS CHURCH HALL, Woodford Wells. BAPTIST CHURCH HALL, Dover Road, E.12. MAYESBROOK CLINIC, Goodmayes Lane, Goodmayes (adjoining Mayfield School). ST. JOHN'S CHURCH HALL (entrance in Devonshire Road), Newbury Park. MANFORD WAY CLINIC, Manford Way (corner of Tufter Road), Chigwell. ASHTON PLAYING FIELDS PAVILION, Chigwell Road, Woodford Green. SF.VEN KINGS METHODIST CHURCH HALL, Seven Kings Road (entrance in Vernon Road), Seven Kings. HEALTH SERVICES CLINIC, Madeira Grove, Woodford Green. ST. ALBAN'S CHURCH HALL, Albert Road, Ilford. KENWOOD GARDENS CLINIC, Kenwood Gardens, (off Cranbrook Road), Gants Hill. BAPTIST CHURCH HALL, George Lane, E.18. HEATHCOTE AVENUE CLINIC, Heathcote Avenue, Clayhall. NEWBURY HALL, Perrymans Farm Road, Barkingside. CECIL HALL, Granville Road, Ilford. 35, WANSTEAD PLACE, E.ll. METHODIST CHURCH HALL, The Drive (at junction with Eastern Avenue), Cranbrook. PARISH HALL, Mossford Green, Barkingside. MEMORIAL HALL, Parish Church, E.18. 93, HIGH ROAD, Woodford, E.18. 50 APPENDIX 9 Details of the cases of Congenital Abnormality as reported to the Registrar General during 1965 Spina Bifida 4 Meningomyelocele 3 Hypospadias 1 Anencephalic 7 Hare lip or Cleft palate 6 Deformity of wrist, hands, etc 6 Mongol 8 Congenital dislocation of hips1 Accessory auricle 1 Congenital Heart Disease 1 Talipes 12 Hydrocele 1 Hydrocephalus 3 Deformity of feet 3 Choanal atresia 1 Crossly deformed stillbirth 1 Congeni tal heart 1 Polonidal Sinus 1 Pre-auricular Sinus 1 Other Malformations 1 APPENDIX 10 Details of attendances of children under 5 years of age at specialists clinics during 1965 Orthopaedic Clinics 138 new cases attended the clinics during the year, and with 183 old cases, made a total of 448 attendances. There were 83 sessions held during 1965. Ophthalnic Clinics A total of 164 children attended these clinics during the year making 300 attendances. 32 pairs of spectacles were prescribed. Ear, Nose and Throat Clinics 31 new cases made 51 attendances at 46 sessions of these clinics and nine operations for Tonsils and Adenoids were performed at local hospitals. Speech Clinics 258 children attended these clinics making 605 attendances for various speech defects. 51 APPENDIX 11 DAY NURSERIES Details of attendances during 1965 Name of Day Nursery Number of Approved Places Total Attendances Average Daily Attendance Ley Street 50 10,533 41.3 Goodmayes Lane 50 10,387 40.7 APPENDIX 12 Cases Visited by Health Visitors Number of Cases 1 Children born in 1965 3,860 2 Children born in 1964 3,418 3 Children born in 1960-63 9,097 4 Total number of children in lines 1—3 16,375 5 Persons aged 65 or over 1,955 6 Number included in line 5 who were visited at the special request of a G.P. or hospital 129 7 Mentally disordered persons 19 8 Number included in line 7 who were visited at the special request of a G.P. or hospital 12 9 Persons, excluding Maternity cases, discharged from hospital (other than mental hospitals) 82 10 Number included in line 9 who were visited at the special request of a G.P. or hospital 75 11 Number of tuberculous households visited 11 12 Number of households visited on account of other infectious diseases 5 Number of tuberculous households visited by tuberculosis visitors 778 52 APPENDIX 13 Completed Primary Courses — Number of persons under age 16 Type of vaccine or dose Year of birth Others under age 16 Total 1965 1964 1963 1962 1958-61 Diphtheria 752 1,412 179 49 83 23 2,498 Whooping Cough 754 1,403 176 46 58 9 2,446 Tetanus 752 1,410 181 51 308 276 2,978 Polio 611 1,832 226 100 184 108 3,061 APPENDIX 14 Reinforcing Doses — Number of persons under age 16 Type of vaccine or dose Year of birth Others under age 16 Total 1965 1964 1963 1962 1958-61 Diphtheria 5 386 323 72 1,163 139 2,088 Whooping Cough 5 381 313 69 512 38 1,318 Tetanus 5 386 323 71 1,037 131 1,953 Polio 2 81 57 21 1,700 126 1,987 53 APPENDIX 15 The following articles of sickroom equipment are available on loan from the Health and Welfare Department Mattress (Dunlopillo and hair) Invalid Chairs Rings (air and Dunlopillo) Back-rests Beds (air, water and ripple) Commodes Fracture Boards Plastic Sheets Medical Sandbags Bed-cradles Bed-pans Diabetic Scales Feeding-cups Urinals Sputum Mugs Bed Blocks Bedstead Sides (pair) Lifting Pole and Chain Commode Sorbo Cushions Rubber Toilet Seat Crutches and Walking Aids Hydraulic Hoists APPENDIX 16 CHIROPODY SERVICE Details of new cases and treatment given in 1965 New Cases Treatments Children under school leaving age 42 280 Expectant mothers - 6 Physically handicapped 74 697 Persons aged 65 years or over 594 17,452 TOTALS 710 18,435 54 55 56 EDUCATION ACT 1944 57 SCHOOL HEALTH SERVICE A major portion of the early part of the year was taken up in a period of transition in preparation for the inauguration of the new London Borough and in this connection I must express my sincere appreciation of the valuable co-operation received from my colleagues of the Essex County Council; the assistance given greatly facilitated the work involved. School Roll & With the advent of the new Borough the number of schools Premises increased from 40 to 52 and the number of departments from 66 to 80. The school roll on 31st December, 1965 was 30,520 compared with 21,640 the previous year for Ilford. In addition approximately 75 children were in attendance at the Ethel Davis Special School for Physically Handicapped. Medical During 1965, 7123 periodic medical inspections were Inspections carried out and of this number it was gratifying to note that only 25 or .35% were deemed to be categorised as unsatisfactory so far as concerns the general physical condition (Appendix 17 (part I. Table A)). In addition, 202 special inspections and 1267 re-inspections were carried out (Appendix 18 (Table B)). The School Dental Service in the Borough continued to function on the lines of previous years with the equivalent of 5 5/llths full-time dental officers as, on the formation of the new Borough, we were unfortunate to lose the services of M.. E. B. Hodgson who was appointed Principal School Dental Officer of the London Borough of Havering. In spite of being below the required establishment the dentists inspected 14,740 children in schools and a further 3,307 at the clinics or 59% of the school population. The Principal School Dental Officer reports more fully elsewhere in the report. (See also Appendix 19-24 for statistics). New and During the year a Keystone Vision Screener was purchased Original Work and it is hoped that in conjunction with an audiometer it will be possible to carry out extensive testing of the vision and hearing of school-children. (Dr. Shaw reports more fully on this later in the report). A nursery class was opened at William Torbitt School In September 1965 and the same facilities for medical inspection and treatment are to be offered these children as others. 58 The Special Remedial Classes were transferred from Valentines to Becontree School in September. All new admissions are medically inspected and a school doctor pays monthly visits to the Classes for special inspections and also attends the Case Conferences. A Speech Therapist has been seconded for one session weekly to treat trainees in attendance at Redbridge Junior Training Centre. As a result of the interest shown by Dr. E. B. Kilsby in the treatment of bed-wetters it was found possible to open a new Enuresis Clinic at Mayesbrook Clinic. (Dr. Pooley and Dr. Kilsby issue a joint report further on in the report). Staff We were pleased to welcome Dr. E. Little as a newly appointed School Medical Officer on 1st May, 1965. Miss R. Sacks, previously a speech therapist with the London Borough of Newham, was appointed on 1st September thus strengthening the depleted ranks of the Speech Therapy service. Special Schools & Specialist Clinic We were also fortunate in completing a full establishment of Psychiatric Social Workers at the Child Guidance Clinic by appointing Mrs. M. R. McGowen and Miss J. A. Somerscales in September but we were sorry to lose the services of Dr. J. Munari, part-time Psycho.Therapist, who returned to Italy. Miss K. M. E. Griffiths was appointed the Borough's Health Education Officer in July. These are the subject of individual reports by Consultants and Medical Officers in charge. Statistics The Department of Education and Science Returns are printed in the Appendix. Medical Minor Ailment Clinics. — 521 children attended various Treatment clinics throughout the Borough in respect of minor ailments. Recuperative During 1965, 20 children were recommended for recupera- Holidays tive holidays and were placed by the Chief Education Officer. 59 Specialist Clinics Ophthalmic Four clinics are evenly spread within various parts of the Clinic Borough. 221 sessions were held throughout the year and 454 new cases and 1,456 old cases made a total attendance of 2,939. 738 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 254 cases the lenses of spectacles were replaced or repairs of of frames were carried out. Dr. J. A. Fairhurst, Ophthalmologist at Kenwood Gardens Clinic, reports as follows:— "This particular school eye clinic is a very pleasant one in which to work. It is well organised and the nursing staff are efficient and kind. The attendance for routine visits remains high and there is an extremely high proportion of parents who attend even with the older children. Arrangements for supply and repair of spectacles are quite satisfactory. Referral following vision screening has been instituted but it is too early yet to comment on the findings. There are two points I would like to stress: — (1) There is a large number of pre-school children attending — this is a good thing as it means that any defects are being picked up early. A longer time, however, has to be spent on those little ones and I try as far as possible to have them in the afternoons when the pressure is not so heavy. (2) The proportion of Squints is extraordinarily high for a school clinic — about twice as high, in fact, as in any other clinic I work in. The numbers so far vary between ¼ — l/3rd of each clinic I work in and on a few occasions it has been as high as ½. Although liaison is good between here and the orthoptist at Mayesbrook, I would think that the number of squints seen here would warrant an orthoptist attending here once a month. I realise that it is difficult to get an orthoptist for existing sessions and this is only a suggestion to be considered when future arrangements are made." 60 Orthoptic Miss M. Ward, Orthoptist, reports as follows:— "During the year of 1965, 228 sessions were held in the Orthoptic Department of Mayesbrook Health Services Clinic. 137 new cases were investigated and the total attendances amounted to 858. 120 cases were discharged. 136 new and old cases were in attendance at the Clinic on the 31st December, 1965. The Clinic has become busier throughout the year and there was a general increase of about 35% on the last year's figures of new cases seen and also on the total number of attendances of patients. The Orthoptic Clinic is an indispensable adjunct to the School Eye Clinic in the treatment and observation of squint cases." In addition at the Woodford Clinic Mrs. Ashenden held 36 sessions at which 133 attendances were made. Orthopaedic As in the case of the Ophthalmic Clinics here again we Clinic are fortunate in being able to serve the whole of the Borough by providing four clinics with the minimum of travel for both parents and patients. Throughout the year 83 sessions were held and 549 attendances were made by 132 new cases and 303 old cases. Mr. H. G. Korvin, E.R.C.S., Consultant Orthopaedic Surgeon, reports as follows:— "No new developments have taken place during the year 1965. The creation of the new London Borough of Redbridge has not affected the work at the clinics. There was a difficult period during July and August when, the physiotherapist, Mr. Brand was absent on study-leave and the treatment-clinics had to be suspended. The nursing-staff very kindly took on his part at the assessment clinics in addition to their own. Mr. Brand used this period for studying the most advanced methods of treating children affected by Cerebral Palsy, and is now making use of the result of his studies in the treatment of suitable cases at the clinic. Attendance at the Clinics was at a reasonable level. Through a modification of the Appointments system the waitingtime for children and their parents has been reduced. I wish to thank all those taking part in these clinics for their unfailing help.* 61 6 children of school age were admitted to East Ham Memorial Hospital for operative treatment. During the year 24 pairs of valgus insoles, 1 pair of surgical boots, 2 pairs Genu Valgum splints, 3 pairs calipers and inverting irons, 126 pairs of wedges to shoes, 1 elbow crutch and 1 urinal were supplied to school children. 125 cases were discharged from the Orthopaedic Clinic, 16 as cured, 25 due to failure to attend for further treatment, 12 left school or left the district and 72 as showing improvement and were kept under observation by the school medical officers. Minor Ortho- Remedial Exercises paedic Defects It is unfortunate that the Ilford and District Hospital Management Committee have been unable to replace the physiotherapist who was seconded for 8 sessions weekly to the Kenwood Gardens and Mayesbrook Clinics but nonetheless, thanks to the co-operation of Mr. Brand who is on the staff of the Ethel Davis School, urgent cases have been seen by him during one session a week each at Kenwood Gardens and Mayesbrook. In addition, Mrs. Haseldine carried out 2 sessions weekly at the Woodford Clinic and Mrs. Pilbeam 2 weekly at Manford Way Clinic. A total of 188 new cases were seen at the four clinics, 60 of which were referred from school medical inspections. The total attendances numbered 988. Ear, Nose & The report on the functions of this clinic normally sub- Throat Clinic mitted by Miss M. M. Mason, F.R.C.S., Ear, Nose and Throat Consultant, cannot unfortunately be included in this year's Report due to Miss Mason's illness. We wish her a speedy recovery. The clinic is held weekly at Kenwood Gardens. 46 sessions were undertaken during the year and 179 new cases and 60 old cases made 500 total attendances. 113 of these children were found to require operative treatment and 77 of these were performed at either King George Hospital or Chadwell Heath Hospital. In addition to the consultations at Kenwood Gardens Clinic, 6 children from the Wanstead and Woodford areas were referred to the Wanstead Hospital Ear, Nose and Throat Department and of these 4 were advised operative treatment. 62 68 cases were tested by pure-tone audiometry at specialist clinic sessions and 61 at school clinic sessions. Speech Clinics Mrs. P. A. Pretious, Senior Speech Therapist, submits the following report:— "Mrs.Tingey — 6 sessions per week; Mayesbrook Clinic and schools. Mrs. Pretious — Full time; Ethel Davis Physically Handicapped School and school clinics. Miss Sacks — Full time; appointed in September. School clinics, schools and Ethel Davis Physically Handicapped School. Miss Sacks joined the staff in September. We are pleased to welcome her and hope that she will enjoy working with us. Her appointment helped to relieve the understaffing which has existed since November 1964 despite repeated advertising. The lack of applicants for the post appears to reflect the general shortage of speech therapists. The decrease in the number of children receiving speech therapy this year is related to this understaffing. This year, with the change in the administrative authority, we were able to provide speech therapy for one session per week in the Junior Training Centre. We have mentioned the desirability of early referral to the speech clinics before, but particularly do we recommend early referral of young children who have any hesitations or repetitions in their speech, even if they have not yet developed a stammer. In many cases, all that is required is the right type of advice to the parent, to prevent the well-intentioned "help" which usually exacerbates the situation." School Dental Mr. E. V. Haigh, Principal School Dental Officer, reports Service as follows:— "At the beginning of 1965 the dental services in the Ilford Area under the Essex County Council continued on similar lines to previous years. The staff position which had improved over the past three years continued unchanged for the first three months with six surgeries almost fully staffed. With this staff position in relation to the school population it was possible to provide a comprehensive dental service to any school child requiring treatment and many dental inspections were carried out in the schools. 63 It was with some doubts and regrets that on the 1st April 1965, we changed from the Essex County Council to the new London Borough of Redbridge. This changeover also meant the amalgamation of Woodford and Wanstead into the new borough which considerably increased the school population. The dental services increased by one surgery at 93 High Road, Woodford, and by 5/7 of the surgery at Manford Way. Prior to April 1965 this clinic was shared by Ilford, Woodford and Dagenham. Manford Way Clinic is now for the complete use of the Borough of Redbridge. Staffing With eight surgeries and only 5 5/llths equivalent full- time Dental Officers it has meant spreading the staff in order to try and cover as many children as possible. Two full-time Officers dividing their time between four surgeries. At the time of the formation of the London Borough of Redbridge I lost the services of the newly appointed Senior Dental Officer, Mr. Hodgson, who was appointed Principal School Dental Officer for the London Borough of Havering. In May Dental Officer, Mr. Toolsey, was appointed Senior Dental Officer and although efforts have been made to replace the vacant posts of dental officers so far it has not been possible. Mrs. Kimelman, Dental Officer at the Woodford Clinic, was transferred to Redbridge and has continued at this surgery. It will be appreciated that although the school population has greatly increased to over 30,000 the dental staff is the same as prior to April 1965. In the latter part of the year it was decided to try and obtain the services of a Dental Auxiliary. Although one has not yet been appointed I have every hope of obtaining one in the near future. These Auxiliaries working under a Dental Officer could be of considerable value especially with young children. Premises Two dental clinics are of the adapted type. These are obviously not ideal. However, a clinic with two surgeries will be built on the site of the present Woodford Clinic to replace the one surgery and another new surgery in the southern part of the borough is envisaged in the next year or two. This will help to bring the dental services nearer to the school children. The location of two double surgeries in close proximity is proving unsatisfactory owing to the distance that some children are having to travel. Attendance is therefore poor. One of the adapted surgeries (Valentines) will no doubt be transferred when the new Loxford Lane Clinic is in operation. The children 64 will not have to travel so far and I am sure the attendance figure will increase considerably from this area. Equipment All surgeries in the borough have Dental Units and Roy Units and high speed compressed air turbine drills. Some of the Dental Units are now becoming aged and although still serviceable they will be replaced on a yearly progressive programme. Dental With the increase in population and with the same number Inspections of Dental Officers it has been impossible to inspect the same percentage as in the previous year. Even so 18,047 inspections were carried out during 1965. The school dental inspection is a very important part of the service as it is the only way that the parents' attention is drawn to the fact that treatment is necessary. With a high general Dental Service in this area the largest percentage of parents take their children to their private practitioner following a school inspection. Conservative The saving of teeth continued to be the main aim of the Treatment service. Each year more children are having teeth saved instead of having extractions. This can be seen from the statistics showing the increased number of fillings and the smaller number of extractions per patient. More children are receiving dental treatment at a much earlier age. It is unusual to see five year olds who have not had some dental treatment. This was not so a few years ago. General These continued to be mainly administered by Medical Anaesthetics Officers; the same anaesthetist and dental surgeon working together as far as possible. This is important because extractions under general anaesthesia in a dental chair calls for team work which greatly adds to the safety factor. Halothane which is now in use in all surgeries as an added anaesthetic has proved to be very effective and safer because of the increase in oxygen during the anaesthetic. Orthodontics These have been carried out by the dental officers interested and capable of dealing with this rather specialised part of dentistry. In a few difficult cases the patient has been referred to a hospital consultant for treatment or advice on the form of treatment to be carried out. Dental Health The senior dental officer arranged the showing of films, Education posters and leaflets in schools and clinics. The main aim of the films is to show the importance of oral hygiene and regular 65 dental inspections. The showing of these films to small groups of children as part of their normal education is of value. The co-operation of teachers. Medical Officers, Health Visitors and Clinic Nurses has been most rewarding. These are the people in contact with the public and so have every change of spreading the need for greater oral hygiene. I have encouraged more dental health instruction to individual patients at the surgeries, this takes time but the results are usually more rewarding. Miss Griffiths was appointed as Health Education Officer during 1965 and part of her duties will be the organising of Dental Health Education. Miss Griffiths has given several talks in schools on dental care, this field of education is, I feel, one that needs trained staff in order to put this difficult subject over properly. Fluoridation Fluoridation of water supplies appear 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. Sale of The sale of toothbrushes continued during 1965 in Dental Toothbrushes Clinics. The toothbrushes are sold for 3d. each, i.e. cost price plus a small handling charge. A small pilot scheme was introduced in one of the Junior Schools in the borough of having toothbrushes for all the children staying to school dinners. It has been very successful and I would like to extend this scheme to other schools when possible." The Ethel This school for physically handicapped pupils was opened Davis School in January 1964 and incorporates the old Benton School and Cerebral Palsy Unit. In addition to suitable education these pupils receive comprehensive treatment. A consultant orthopaedic surgeoD pays a weekly visit to the school and a School Medical Officer who makes two visits weekly is Medical Officer in Charge. The medical auxiliaries comprise 2 physiotherapists, an Occupational Therapist, a Speech Therapist and 2 nurses all of whom are attached to the Cerebral Palsy Unit. It is appropriate under this heading that I should pay tribute to Dr. D. M. B. Gross who retired in August 1965. Dr. Gross had been Medical Officer in Charge since the opening of the original Benton School and of the new school up to the time she left. She had an intense interest in these handicapped children and their welfare. 66 Dr. Toms took over the supervision of the school in September. Dr. W. H. Toms, Medical Officer in Charge, reports as follows:— "During 1965 the Ethel Davis School continued to function on the same lines as previously. Two visits a week were made to the school throughout the year; one session was devoted to carrying out the six monthly periodic medical inspections of the pupils and assessing the suitability of possible new entrants who have been referred to us by Private Doctors, Hospitals and other Local Authorities. The second session coincided with the weekly visit of Mr. H. B. Lee, Orthopaedic Consultant, who continued to supervise the medical treatment and general needs of the more severely physically handicapped children. During these two visits, both the medical and teaching staff have the opportunity to discuss any problems which may have arisen concerning the welfare of the children. We remained very fortunate in the staffing position, with the services of two physiotherapists, an occupational therapist and a speech therapist available throughout the year. Because of this, the children were able to receive their therapy at school and no school time was lost which normally would have been spent travelling to and from their supervising hospitals. Mrs. Waites, Nursing Auxiliary, left during August but was replaced by Mrs. Hallows on the 18th November. Mr. Brand, Senior Physiotherapist, attended the Bobath Course of Physiotherapy during July and August and has continued to produce stimulating ideas concerning the treatment of the children by introducing more original equipment. Interest seems to have been aroused concerning the school and as a result of a visit made there by a General Practitioner an article appeared in the 'Medical World' describing the excellent facilities the Ethel Davis School offers. The Nursery Assessment Centre has been used to great advantage during the year and has proved invaluable for assessing the handicaps of children of pre-school age. The Local General Practitioners have been informed of this Centre's existence within the Ethel Davis School in order that they may refer any young children whom they feel might qualify for admission." During 1965 there were 24 admissions and 27 discharges; 67 recommendations for admission wens received from the following sources:— Other Authorities 8 Hospitals 5 Head Teachers 3 Transfers from Other Areas 3 General Practitioners 2 Chief Education Officer 1 Dr. Barnardo's 1 Spastics' Society 1 24 The diagnoses were as follows:— Cerebral Palsy 9 Haemophilia 3 Severe Asthma 2 Poliomyelitis 2 Muscular Dystrophy 1 Bronchitis 1 Spasticity 1 Cerebellar Ataxia 1 Congenital Chorea 1 Sickle Celled Anaemia 1 Hydrocephalus and Partially Sighted 1 Mild Spasticity, Partially Deaf and Petit Mal 1 24 Cerebral Palsy Mr. H. B. Lee, F.R.C.S., Orthopaedic Surgeon, reports as follows:— "The unit has continued on the lines which have been successful in the past. The staff have maintained their high standards, and their ready co-operation ensures that even the most seriously handicapped children are given the best chance of physical improvement, and training in everyday skills as well as the patient and understanding education which they need." 68 Child Guidance Dr. W. P. Gurassa, Medical Director of Child Guidance Clinic Clinic, reports as follows:— "The formation of the new Borough of Redbridge has given an opportunity to re-think our policies, and to integrate our work with the other services in the borough. There has been a gradual transfer of Barking cases to their new Child Guidance Clinic. Because our work is based on the relationships we make with children and their parents, we are continuing to see those children who have already got to know us, while the Barking Clinic has taken over new referrals. At the north of the borough, a similar gradual transfer is taking place so that now all new referrals from Wanstead and Woodford come to this clinic, though a few of the long standing cases continue to attend at Walthamstow Clinic. From time to time there are inevitable administrative complications to be ironed out, e.g. to do with the new boundaries In the main we are benefiting from increased feeling of identity in the new borough now that all services are provided within Redbridge. We welcome increased opportunities of contact with colleagues in other departments which helps the children's progress, e.g. in planning for handicapped school leavers. We would especially like to mention the help given by Doctor Gordon to social workers in promoting a local association through which our psychiatric social workers can keep in contact with other social workers. Within the Clinic our staff record of longevity continues. Three of our staff have now been with us for over 10 years, though we have sadly said goodbye to our "oldest" member, our receptionist-secretary, Mrs. Hill, who after 13 years with us has emigrated to Canada. We are glad to report that our establishment of psychiatric social workers has been increased to four, and that Mrs. McCowen and Miss Somerscales, both recently qualified, have joined us. This enables us to do more work with the parents which we feel to be most important. There is much that a parent can do to help a child in his emotional struggles, but often this only becomes apparent to the parent after discussion in an accepting atmosphere with someone who is outside the family tensions, and who is skilled at understanding family problems. We feel that fathers as well as mothers have much to contribute in this way, and hope to see more of them. Another development this year is that the Clinic has been recognised as a fieldwork training centre for students taking the Certificate of Social Work, at the South East Essex College of Technology. This means that we have a student social 69 worker in the Clinic for three days a week throughout most of the year, working under the supervision of one of our psychiatric social workers. We also continue to take students from the Social Science course at the London School of Economics, and student teachers from the Institute of Education course on teaching maladjusted children. We are glad to be able to contribute to the provision of more and better training facilities for social workers, who are in such demand throughout the country. Once again we should like to thank the Health and Education Departments for their continuing interest and support in all aspects of our work." School Psycho- Miss B. S. Gascoyne and Miss C. H. Watt, Educational logical Service Psychologists, report as follows:— "This is the first time that the name of Redbridge has appeared on this report. The transfer from Essex went very smoothly in the School Psychological Service as preparations had been made for this in advance, and Miss Gascoyne had already made contact with many of the Schools in the Woodford, Wanstead and Chigwell areas in the last quarter of 1964. The Barking Schools now are all served by their own School Psychological Service and from April 1st, Miss Watt transferred this area to Mr. Sheridan. A close liaison between the two psychologists concerned was needed over the transition period, to effect the transfer as readily as possible. Since this transfer the Borough of Redbridge has had two full-time psychologists instead of sharing their services with other areas. One of the great advantages in this from the Psychologists point of view in that almost all the children we now see in Schools are eligible for selection for the same set of special educational facilities as they come under one administrative area. The Remedial Centre moved in September 1965, from Valentines School to the Becontree School building which was vacated by the transfer of the Becontree Secondary Children to a new building. The additional space at Becontree gives room for the expansion of the Remedial Centre to cater for the enlarged borough. A teacher was appointed in August to start an additional class at the Centre in January 1966. Plans have also been made for further expansion during 1966. Mrs. Cameron was appointed to the Observation Class at Easter. We were lucky to find a teacher for this group who had some years of experience of teaching in special Schools and so had 70 siderable experience which is relevant and valuable to the work in this small assessment unit. Mrs. Bowman, who is qualified to teach maladjusted children and who pioneered our Observation Group and gave 3 years of service in establishing and developing this new field, left the Observation Unit in September in order to re-open our daymaladjusted class. It is planned in 1966 to move the Observation Group to another building at Manford Way so that expansion will be possible in both the observation unit and the maladjusted class. At the moment one building is shared by the two units. The proposed move is enabling us to proceed with plans for a second Observation class and a unit for autistic children adjoining the Observation Classes. There will be room also for 3 maladjusted classes in the building they are in at present, once the Observation group has moved. We are awaiting these developments with great enthusiasm and have been closely concerned in the administrative aspects of these plans all along." New Cases 266 Follow-ups for Schools 121 Follow-ups for Clinic 82 Remedial Education Cases 61 Children referred to C.G.C. 34 Enuresis Clinic Dr. Joan Pooley and Dr. E. B. Kilsby report as follows:- "During the 12 months ended December 31st, 1965, the clinic was held weekly at the Kenwood Gardens Centre from 12th November, 1965, an additional Enuresis Clinic was held on alternate weeks at the Mayesbrook Centre. Prior to this it had become necessary to hold the clinic twice weekly at Kenwood Gardens for a time, in order to cope with an increasing waiting list. Sessions and New Cases 46 Sessions were held this year at the Kenwood Gardens Centre and 4 were held at Mayesbrook, the continued figures showing that 110 new cases were seen during the year 1965 which compares favourably with those seen in previous years, as can be seen from the following table:— 71 Year No. of New Cases Seen 1961 55 1962 70 1963 99 1964 107 1965 110 1. Appointment List (both clinics) Under 5 years Over 5 years Boys Girls Boys Girls Recommended by:— Infant Welfare Officers 5 9 School Medical Officers 21 15 General Practitioners 5 2 21 7 Parents 6 3 Health Visitors 4 4 5 2 110 New Cases 15 15 53 27 It is interesting to note that in 196 5 3 5 cases were referred by General Practitioners compared with 22 in 1964. 1965 (Both Clinics) — Old and New Cases = 509 1964 „ „ „ „ =523 1963 „ „ „ „ =463 1962 „ „ „ „ =358 2. Procedure As in previous years the procedure adhered to with each new case is as follows:— (a) Urinalysis. (b) History of Enuresis, temperament, home environment and previous illnesses. (c) Physical examination. (d) Treatment. 3. Treatment The treatments issued or prescribed throughout the year include:— 72 (a) Dexten — the long acting (bonded) dexamphetamine 5 mgms usually at bedtime. (b) Syrup tryptlzole — This treatment was introduced last year for the disturbed,nervous or emotional child and is now proving to be a very effective form of therapy. 77 children were treated with this during the year, in co-operation with the parents and General Practitioners. (c) Routine and Charting only. (d) The Sentinel or Downs Bed-buzzer. — There are now 22 bed-buzzers in use through the Clinic and in all 34 cases (+2 adults) received this treatment during the year. 4. Results (both clinics) 65 cases were discharged dry as compared with 57 in 1964 and 41 in 1963. Over 5 years Under 5 years Boys Girls Boys Girls 46 14 3 2 24 cases were considered "Self-discharged" (in that 3 successive appointments were not kept). Once again one must remark how worthwhile this Clinic is proving, co-operation and interest being well to the fore in all aspects." Screening Tests As mentioned earlier this extension to the Service was of Vision and introduced in the last quarter of the year and I am sure it will Hearing prove to be a useful service and of fundamental importance to the health and welfare of the school-child. Dr. A. Shaw, Deputy Medical Officer of Health, reports as follows:— "A Keystone Vision Screener has been purchased and preliminary results of its use in schools are so promising that Establishment provision has been made for two technicians to work in schools testing vision and hearing exclusively. The Department has a transistorised portable audiometer also and it is envisaged that two technicians will work as a team 73 testing successively vision and hearing as parts of one operation. The eventual aim, which it is hoped to achieve in the next four year's, is to test vision annually and hearing (our times during school life, i.e. at 5, 8, 11 and 14 years." Peripatetic With the ever increasing emphasis on the earliest possible Teacher of the diagnosis of deafness and the need for prompt attention to Deaf special educational treatment the Borough is fortunate in having it's own Peripatetic Teacher and 1 am, therefore, pleased to append her first report. Miss H. C. Hodges, Peripatetic Teacher of the Deaf, submits the following report:— "I have 35 partially-hearing children on my visiting list, 4 pre-school, 8 in primary schools, 18 in secondary schools and 3 in a special school, and 2 in fee-paying schools. During the year I made 423 visits. One 3 year old has been admitted to the West Ham School for the Deaf and another was admitted to the William Morris School for the Deaf. One boy in a special school has left and two senior boys have gone on to Grammar and Technical education in other boroughs. I have one severely partially-deaf child in a primary school waiting to be admitted to a special school for the deaf, and a pre-school child who may need special educational treatment in the near future. These children have been notified by the school medical officer, heads of schools and speech therapists. But should any children be issued with hearing aids through the Borough Health Clinics, they, too, should be receiving any help they need through the peripatetic service for partially-deaf children. Now that Redbridge has its own peripatetic teacher of the partially deaf it is hoped that a close liaison between the education and medical departments regarding deaf children will soon be established." Handicapped Section 33 of the Education Act 1944 and the regulations Children made thereunder, have placed on 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 maintained schools are reported to me with a view to 74 medical examination and ascertainment of their suitability or otherwise to attend an ordinary school. During 1965, for the first time, Independent Schools in the Borough were invited-similarly to advise me of any handicapped pupils on the Registers of their schools. The number of children coming within the various categories and their disposition as on 31st December, 1965 is shown in the table at the end (Appendix 25). B.C.G. VacThis scheme is offered to all pupils of 13 years and over cination of and students attending Universities, Colleges or other School Children lishments of further education. In addition those previously invited who did not accept are given a further opportunity to participate. 3,396 pupils were offered B.C.G. vaccination and of this number 2,013 or 59.3% consented. 1,744 or 51.3% received vaccination. The Health Miss J. M. Oliver, Superintendent Health Visitor, reports Visitor and the as follows:— School Nurse "This has not been a particularly easy year but we can be sure that the schools and children have received the value of the local authority school services at the same level as 1964. Schools in the Wanstead and Woodford area had a close link with their School Nurses. It was important that this should continue although some slight alterations had to be made. A shortage of staff was quickly adjusted and extra clinic nurses were employed to assist the Health Visitor doing combined school duties. We hope that in 1966 better premises will be available to carry out day to day services. If we are to educate school children it is important to bring the parents and children to suitable buildings. We have inherited a mixed bag of schools to carry out our periodic school medical inspections in. Suitable rooms are not always available and this is one of our biggest headaches. One State Registered nurse received training at Tottenham for the detection of deafness. The nurse accompanied a trained audiometrician to schools, learning the system and the technique of operating the audiometer machine. The training since September has been put to full use in the schools. The teachers have been most co-operative especially as the new Keystone 75 apparatus had been purchased for the detection of eye defects. The Keystone and the testing for deafness have therefore operated together with the minimum of disruption of school routine. Health Education in schools will be reported by the Health Education Officer. Grange Hill School now has a regular weekly lecture from the Health Visitor School Nurse. The Head Teacher gave permission for the girls to visit the new Harlow Hospital and they much enjoyed this, being conducted round the premises by young student nurses. Combined mothercraft and parentcraft forms a very needy gap in the educational system." Health Miss K. M. E. Griffiths, Health Education Officer, reports Education in as follows:— Schools "At six schools a health education programme is carried out which includes discussions on personal relationships and other health problems which cause concern amongst young people today. This is surely the most satisfactory way of dealing with health education so that all of its aspects and wider implications are put into perspective rather than "highlighting* certain topics during infrequent visits to a school when the talks have no continuity and where the speaker has no personal relationship with the group. However, talks and discussion groups are given on topics of importance as and when requested at any of the schools. These subjects include Personal Hygiene, Dental Health, Home Safety and First Aid. Several requests have been made by teaching staffs for visual aids or health education literature. This is a service which the health education section is very pleased to supply and it is hoped that more teachers will make use of it so that a useful liaison can be set up between the health and education departments in the implementation of health education programmes in the school. One useful project which was carried out at the end of the year was a small survey carried out amongst Head Teachers of Secondary Schools in the Borough. A questionnaire was sent out to discover the amount of health education carried out at each of the schools and the view of the Head Teacher and Staff in relation to the teaching of sex education. The response was 76 very gratifying — 98% of the questionnaires were completed and returned and the findings will be valuable when considering further expansion of our work in schools and will serve as a useful 'base-line' when we need to evaluate the work. There are many avenues to explore — there are many opportunities for health education within the existing framework. This is our challenge and an exciting prospect for the future" Smoking & Lung Cancer — Lecture and Survey in Schools Dr. Taylor, School Medical Officer, reports as follows:— "Over the past year I carried on giving talks to the boys at Fairlop and Mayfield Schools, and I have now finished the survey which was started some 4 years ago. The questionnaires now have to be analysed, and I shall be able to publish a full account of the survey in the next annual report". General Welfare Work done by the N.S.P.C.C. The following 54 cases were investigated by the Society:— (1) Neglect 37 (2) Ill-treatment cases 6 (3) Other causes 11 122 children (63 boys and 59 girls) were involved,66 being of school age. In addition to this work 287 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 We are indebted to this Association for the case-work and welfare undertaken by its members. The following is a summary of activities during 1965:— Number of Redbridge children placed in holiday homes:- (a) Fees paid by parents 1 (b) Fees paid by voluntary funds 2 Assisted in other ways:— Casework visiting 13 Visiting parents of children still in I.C.A.A. Schools 4 Grant towards television licence 1 Loan of Invalid Chair 2 77 The causes of death among children of school age in Redbridge during 1965 were:— Accidental Death 2 Asthma 2 Brain Damage 1 Hepatitis 1 Muscular Dystrophy 1 Renal Failure 1 8 78 APPENDIX 17 DEPARTMENT OF EDUCATION AND SCIENCE MEDICAL INSPECTION AND TREATMENT RETURN FOR THE YEAR ENDED 31st DECEMBER, 1965. Part I — Medical Inspection of pupils attending maintained Primary and Secondary Schools (including Nursery and Special Schools) TABLE A. - PERIODIC MEDICAL INSPECTIONS Age groups Inspected (By year of Birth) No. of pupils who have received a full medical examination Physical Condition of Pupils Inspected No. of pupils found not to warrant a medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satisfactory Unsatisfactory for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils No No. (1) (2) (3) (4) (5) (6) (7) (8) 1961 and later - - - - - - - 1960 536 535 1 - 10 69 74 1959 1,073 1,061 12 - 28 163 184 1958 123 122 1 - 3 17 20 1957 67 65 2 - 5 14 19 1956 58 57 1 - 4 6 10 1955 51 51 - - - 13 13 1954 178 175 3 - 19 28 44 1953 1,327 1,322 5 - 73 59 128 1952 588 588 - - 31 21 50 1951 637 637 - - 78 40 108 1950 213 and earlier 2,485 2,485 - - 147 86 TOTAL 7,123 7,098 25 - 398 516 863 Col. (3) total as a percentagu of Col (2) 99% total Col (4) total as a percentage of Col (2) .35% total 79 APPENDIX 17 (continued). Part II - Defects Found by Periodic and Special Medical Inspections during the Year. 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 31 - 81 - 5 Eyes - a. Vision 241 2 148 - b. Squint 13 - 11 - c. Other 4 1 10 - 6 Ears - a. Hearing 16 - 25 1 b. Otitis Media 12 - 5 - c. Other 2 1 2 - 7 Nose or Throat 66 1 71 1 8 Speech 31 5 12 - 9 Lymphatic Glands 3 - 7 - 10 Heart and Circulation 6 - 53 - 11 Lungs 15 1 44 - 12 Development - a. Hernia 7 - 7 - b. Other 15 1 29 3 13 Orthopaedic - a. Posture 11 - 45 1 b. Feet 35 - 67 - c. Other 34 1 89 - 14 Nervous system - a. Epilepsy 2 1 4 - b. Other 4 - 12 - 15 Psychological - a. Development 5 - 35 - b. Stability 19 25 61 2 16 Abdomen 2 - 9 - 17 Other 28 10 72 2 80 APPENDIX 18 TABLE B. - OTHER INSPECTIONS NOTES: A special inspection is one that is carried out at the special request of a parent, doctor, nurse, teacher or other person. A re-inspection is an inspection arising out of one of the periodic medical inspections or out of a special inspection. Number of Special Inspections 202 Number of Re-inspections 1,267 Total 1,469 APPENDIX 19 TABLE C. - 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 15,212 (ii) Total number of individual pupils found to be infested 96 (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 45 By parents 51 Part III — Treatment of Pupils attending maintained Primary and Secondary Schools (including Nursery and Special Schools) NOTES: (i) Cases treated or under treatment during the year by members of the Authority's own staff; (ii) cases treated or under treatment during the year in the Authority s school clinics under National Health Service arrangements with the Regional Hospital Board; and (iii) cases known to the Authority to have been treated or under treatment elsewhere during the year. 81 APPENDIX 19 (continued). TABLE A. - EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with External and other, excluding errors of refraction and squint 4 Errors of refraction (including squint) 1,971 Total 1,975 Number of pupils for whom spectacles were prescribed 854 TABLE B. - DISEASES AND DEFECTS OF EAR, NOSE AND THROAT Number of cases known to have been dealt with Received operative treatment — a. for diseases of the ear 14 b. for adenoids and chronic tonsilitis 424 c. for other nose and throat conditions 66 Received other forms of treatment 182 Total 686 Total number of pupils in schools who are known to have been provided with hearing aids — a. In 1965 8 b. In previous years 77 TABLE C. - ORTHOPAEDIC AND POSTURAL DEFECTS Number known to have been treated a. Pupils treated at clinics or out-patients departments 749 b. Pupils treated at school for postural defects 44 Total 793 82 APPENDIX 20 TABLE D. - DISEASES OF THE SKIN (excluding uncleanliness, for which see Table C of Part I) Number of pupils known to have been treated Ringworm — a. Scalp _ b. Body 1 Scabies - Impetigo 1 Other skin diseases 185 Total 187 TABLE E. - CHILD GUIDANCE TREATMENT Number known to have been treated Pupils treated at Child Guidance Clinics 159 TABLE F. - SPEECH THERAPY Number known to have been treated Pupils treated by Speech Therapists 414 TABLE G. - OTHER TREATMENT GIVEN Number known to have been dealt with a. Pupils with minor ailments 521 b. Pupils who received convalescent treatment under School Health Service arrangements 20 c. Pupils who received B.C.G. vaccination 1,744 d. Pupils who attended the Enuresis Clinic 156 Total 2,441 83 APPENDIX 21 DENTAL INSPECTION AND TREATMENT Attendances and Treatment (a) Number of first visits 3,455 (bj Number of subsequent visits 8,730 (c) Number of total visits 12,185 (d) Number of additional courses of treatment commenced 1,226 (e) Number of fillings in permanent teeth 7,180 (f) Number of fillings in deciduous teeth 3,021 (g) Number of permanent teeth filled 6,213 (h) Number of deciduous teeth filled 2,562 ft) Number of permanent teeth extracted 565 (j) Number of deciduous teeth extracted 1,747 (k) Number of extractions under general anaesthetics 658 (I) Number of emergencies treated 254 (m) Number of pupils x-rayed 281 (n) Number of pupils who received prophylaxis 1,025 (o) Number of teeth otherwise conserved 567 (p) Number of teeth root filled 21 (q) Number of inlays 3 (r) Number of crowns 14 (s) Number of courses of treatment completed 3,706 Orthodontics (a) Number of cases remaining from previous year 212 (b) Number of new cases commenced during year 116 (c) Number of cases completed during the year 90 (d) Number of cases discontinued during the year 29 (e) Number of removable appliances fitted 144 ({) Number of fixed appliances fitted 3 (g) Number of pupils referred to Hospital Consultants 16 Dentures (a) Pupils supplied with Full upper or Full lower (first time) — (b) Pupils supplied with other dentures (first time) 8 (c) Number of dentures supplied 63 Anaesthetics Number of General Anaesthetics administered by Dental Officers 37 84 APPENDIX 21 (continued). Inspections (a) First inspection at school — Number of pupils 14,740 (b) First inspection at clinic — Number of pupils 3,307 Number of (a) and (b) found to require treatment 7,718 Number of (a) and (b) offered treatment 7,718 (c) Pupils re-inspected at school clinic 1,888 Number of (c) found to require treatment 1,157 Sessions (a) Number of sessions devoted to treatment 2,288 (b) Number of sessions devoted to inspection 232 (c) Number of sessions devoted to Dental Health Education 6 35 APPENDIX 22 SCHOOL HEALTH SERVICE: STAFF AND SCHOOL CLINICS (As at 31st December, 1965) 1. STAFF OF THE SCHOOL HEALTH SERVICE Principal School Medical Officer I. Gordon, M.D., Ch.B., M.R.C.P.(Lond.).,D.P.H. Deputy Principal Medical Officer A, Shaw, M.B., B.S., D.P.H. Principal School Dental Officer E. V. Haigh, L.D.S., R.C.S. Number of Officers Number in terms of full-time Officers employed (a) Medical Officers (including the Principal School Medical Officer) (i) Whole-time School Health Service — — (ii) Whole-time School Health Service and Local Health Service 10 2.45 (iii) General Practitioners working parttime in the School Health Service - (iv) Ophthalmic Specialists — - (v) Other Consultants and Specialists - — (b) Dental Officers (including the Principal School Dental Officer) (i) Whole-time School Health Service — - (ii) Whole-time School Health Service and Local Health Service (including Orthodontists) 5 4.62 (iii) Part-time School Health Service (including Orthodontists) 3 .45 (iv) Dental surgery assistants 7 6.47 (c) (i) Senior Speech Therapists 1 1 (ii) Speech Therapists 2 1.55 (iii) Assistant Speech Therapists - - W (i) Audiometricians (ii) Chiropodists — — (iii) Orthopaedic Nurses — — (iv) Orthoptists — — (v) Physiotherapists 2 2 (vi) Remedial Gymnasts — — (vii) Occupational Therapists 1 1 (*) (i) Nurses 31 9.54 (ii) No. included at (i) who hold Health Visitors' Certificates 31 (iii) Nursing Assistants and Trainee Nurses (including S.E.A. Nurse and Nursing Auxiliary at Cerebral Palsy Unit) 13 6 86 APPENDIX 23 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 ... 15 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) as at 31st December, 1965 where such treatment is provided Directly by the Authority Under arrangements made with Hospital Authorities (1) (2) (3) A. Minor ailment and other non-specialist examination or treatment 6 B. Asthma — — C. Audiology - - D. Chiropody - - E. Dental 5 - F. Ear, Nose and Throat — 1 C. Enuretic 2 - H. Ophthalmic - 4 J. Orthopaedic - 4 K. Orthoptic - 2 L. Paediatric — - M. Physiotherapy 3 2 N. Remedial Exercises 3 2 P. Rheumatism and Heart — - Q. Speech Therapy 7 - R. Sunray - - S. Vaccination and Immunisation 3 - T. Cerebral Palsy Unit — 1 87 APPENDIX 24 IV. - CHILD GUIDANCE CLINICS (i) Number of Child Guidance Centres provided by the Authority - 1. Staff Number employed Aggregate in terms of the equivalent number of whole-time officers by L.E.A. Under arrangements with Hospital Authorities (i) Psychiatrists — 2 .82 (ii) Educational Psychologists 2 2 (iii) Psychiatric Social Workers 4 4 (iv) Play Therapists - - - (v) Social Workers — Qualified — — — Unqualified - - - (vi) Child Psycho- Therapists 1 - 45 88 APPENDIX 23 HANDICAPPED CHILD HEN CATEGORY Number of children of school age on 31st December, 1965 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 - - 6 - - - - - - - - - - 6 Partially Sighted 13 1 3 1 - - 1 - - - - - - 19 Deaf 7 - 1 - - - 3 - - - - - - 11 Partially Deaf 19 2 2 - - - 4 - - - - - - 27 Delicate 8 - 4 2 - - - - - - - - - 14 Physically Handicapped 60 - 13 2 1 - 3 - - - - 1 - 80 E.S.N. 78 16 30 - - - 2 - - - - 1 - 127 Maladjusted 4 - 19 10 3 - 22 - - - - 1 - 59 Epileptic - - 5 - - - - - - - - - - 5 Speech Defect - - 2 1 - - - - - - - - - 3 351 Total 189 19 85 16 4 - 35 - - - - 3 - 89 MENTAL HEALTH 90 MENTAL HEALTH SERVICE by S. F. Meyer, M.B., B.Ch., D.P.H., Principal Medical Officer Mental Welfare The Senior Mental Officers and the three Mental Welfare Officers Officers have built up and maintained a most adequate service of after-care. However, due to a shortage of Psychiatric Social Workers in the Department, all are carrying an excessive load as is shown in the table in Appendix 26. Provision was made for a total of five Mental Welfare Oifficers in the establishment operative from 1st April 1965 all of which were filled, and consideration is being given to the creation of a further post for next year. Psychiatric The original establishment was five posts of Psychiatric Social Workers Social Worker to be appointed jointly with the local Hospital Management Committee. None of these posts have been filled and Council agreed to up-grade three of the posts to the Senior grade and to allow that in the remaining two posts either a Psychiatric Social Worker or a trainee may be recruited. A Trainee Psychiatric Social Worker was appointed and is at present attending the one year full-time Mental Health Diploma Course at the London School of Economics. Junior Training Two trainee Supervisors have been appointed, one of whom Centre has been successful in obtaining a place on the two year Diploma Course at the Chiswick Polytechnic commencing in September 1966. In addition an Assistant Supervisor (Unqualified) has applied to attend a one year course organised by the National Association of Mental Health. A further post was created of Welfare Attendant/Coach Guide. Duties include attendance at the Special Care Unit. Adult Training A new Assistant Supervisor post (female) was created to Centre permit senior girls to be admitted to this Centre. This was successfully filled in September 1965. One member of the staff has applied to attend the one year Diploma Course organised by the National Association of Mental Health. Activities at the Training Centres Junior Training In view of the inadequate facilities at the present further Centre training Centre, plans were started immediately for a new 105 91 place centre to be built at Loxford Lane. These plans have been completed and loan sanction is awaited. The new Centre will include a Special Care Unit divided into two sections, for the physically handicapped child and for the maladjusted child. There will be a Nursery Unit for under 5 years old mentally subnormal children. In addition to the usual classrooms, there will be a well equipped teaching kitchen and laundry, and also a crafts room equipped with pottery kiln, woodwork tables, etc. The hall will have built-in equipment, e.g. climbing frames, etc., for physical training. There has been a change in emphasis in the existing Training Centre — the educational and social aspects are being stressed rather than that of occupation. Learning through play is being introduced to the younger children to prepare them for formal teaching. Facilities were further improved by the provision of an asphalted outdoor play area and outdoor play equipment. Special Care Unit The scope of the Special Care Unit has been increased and children with more severe handicaps are being admitted. Those children requiring physiotherapy are seen by the Physiotherapist in the clinic. Since September 1965 a group of 12 children have attended the Barking Regional College of Technology for swimming instruction undertaken voluntarily by the staff of the College. Weekly individual parent guidance sessions have been held by the Principal Medical Officer at the Centre. The attendance figures are shown in the appendix. Adult Training Centre All suitable trainees under the age of 25 years have participated in education and social training. Industrial contracts have been extended in a limited way only owing to lack of adequate working and storage facilities. Outing Trainees from both Centres were taken on 2 outings during the year and both Centres held Christmas parties. Holidays Eleven trainees attended the holiday camp organised by the Essex County Council, eight from the Junior Training Centre and three from the Senior Training Centre. They were accompanied by a member of the staff. Temporary Care Since April 1965, 22 children have been sent for temporary care to enable parents to have a holiday or to meet some domestic crisis. 92 Hostel Admission Mentally Sub-Normal During the year, one female adult and one female child were admitted to private hostels. Hospital Admissions During the year three mentally sub-normal children and two adults were admitted to hospital and eight are still awaiting admission. The Mentally I11 In the past year a close and cordial relationship has been established between the two hospitals for the mentally ill (Goodmayes and Claybury) and the Department. Weekly case conferences are held at both hospitals and are attended by Mental Welfare Officers. The Goodwill Club This psychiatric social club meets every Thursday evening for both discharged patients and patients still in hospital, under the supervision of the S.M.W.O. This club meets a real need in giving discharged patients a sense of confidence. The attendance varies between 14 and 20 patients. Hostels Five mentally ill patients were admitted to hostels run by local authority or private organisations. School Leavers Three maladjusted and educationally sub-normal school leavers have been referred to the department for after-care after leaving school, and one maladjusted school leaver receives supervision. Training All the Mental Welfare Officers have attended conferences and refresher courses during the year. One Mental Welfare Officer is due to attend a full-time course at the London University from January 1966 — April 1966. Members ol both Centres have attended refresher courses. Approved Medical Practitioners Three Medical Practitioners were approved during the year for the purpose of Section 28 of the Mental Health Act of 1959. Hospital Admissions The number of patients admitted during the year was 219, of these 68 were admitted informally, and the rest under Sections 29, 25 and 26. 93 APPENDIX 26 MENTAL HEALTH SERVICE Mentally Sub-Normal — Case Load No. on Register 346 Total No. of Visits 1,087 Average No. cases / officer 69 Average No. of visits / case 3 Mentally 111 — Case Load No. of cases referred 616 No. of 2nd or subsequent referrals 67 Total No. of visits 1,137 Average No. of visits / officer 225 Average No. of visits / pt. referred 2 Junior Training Centre Male Female Under 16 yrs. Over 16 yrs. Under 16 yrs. Over 16 yrs Total No. on register 31.12.65 29 — 22 19 Average Daily attendance 49 Discharges (inc. transfers to Adult Training Centre) 7 1 These numbers include 11 children from the London Borough of Barking. In addition, 40 children attend the Junior Training Centres in other areas. Adult Training Centre Male Female Total No. on register 31.12.65 64 — Average daily attendance 54 Discharges 8 — 94 ENVIRONMENTAL HEALTH 95 ENVIROMENTAL HEALTH by S. R. Daly, LL.M., B.Sc., D.P.A.(Lond.), Barrister-at-Law Chief Public Health Inspector. Water Supply The water supply of the Borough of Redbridge is provided by two statutory undertakers, namely the Metropolitan Water Board and the South Essex Waterworks Company and has been of satisfactory quality and sufficient quantity during the period under review. The principal source of supply of the former is derived from the River Lee and is treated at the Metropolitan Board's Lee Bridge Works with a small addition of water from the Ferry Lane Works and the Wanstead well. The population supplied by the Metropolitan Board in Redbridge is 133,765, the supply being made direct to houses in every case, there being no stand pipe supply within the Borough. No new source of supply was instituted in the area during 1965 nor has there been any material change in the general supply system. 972 samples were submitted to chemical and/or bacteriological examination. The average fluoride content of these supplies is as follows:— Wanstead Well 0,55 of a milligramme per litre F. River Lee derived 0.25 of a milligramme per litre F. The total distance of the Board's supply mains laid in the Borough by the Board during 1965 was 266 yards. The South Essex Waterworks Company on the other hand derives its supply mainly from the River Stour and from deep wells at Mill Road, Grove Road and Roding Lane. The General Manager and Chief Engineer of the South Essex Waterworks Company states that during 1965 7,867 chemical, bacteriological and biological examinations were made at the Company's Langham Laboratory, all of which indicated that the supplies were wholesome. Some samples were also examined for radioactivity. Samples from the wells situated in the Company's supply area were also taken and analysed weekly and samples were taken from houses in various parts of the supply area for bacteriological examination, all of which proved satisfactory. The fluoride content of the various supplies is (0;25 p.p.m. The following mains were laid in Redbridge during 1965:— 3 ins. 4 ins. 6 ins. Yards 249 71 178 96 The Waterworks Company report that owing to difficulties arising in their supply area, additional water was obtained from the Metropolitan Water Board. The Council has approved in principle the addition of fluoride to public water supplies. The Borough is not supplied with water from any public wells nor are there any private supplies providing domestic water to the general public. The Public Health Inspectors took 7 samples of water during the year, 5 being from the South Essex Waterworks Company supply Area and 2 from that of the Metropolitan Water Board district and both the chemical and bacteriological examinations gave satisfactory results. Public Swimming Baths Strict supervision of the three public swimming baths within the Borough, two of which are indoor of 120,000 gallons and 68,000 gallons capacity respectively and the Open Air Pool having 250,000 gallons capacity, was maintained throughout the year in order to ensure the safety of the water for swimming purposes. The larger indoor bath and the Open Air Pool are closed in winter. Regular sampling of the water supply is made to ensure that the standard of purity required is obtained by the use of continuous filtration and chlorination processes. In all cases the analyses of the samples of water taken (10 from the indoor baths and 2 from the Open Air Pool) proved to be satisfactory. Mains water is used in all baths. Drainage and Sewerage It is a pleasure to report that the number of complaints regarding the flooding arising from heavy rain have been markedly reduced during the year due in no small measure to the extension of the main drainage work carried out under the Ilford main drainage scheme. Work continues apace on the South Woodford scheme which is costing £457,000, whilst loan sanctions have been granted and work will shortly commence on the Monkhams Valley Scheme (£200,000) and that in Sunset Avenue (£34,000). There is no doubt that flooding will be further alleviated by the carrying out of works in a further ten areas, information regarding which can be found in the tables appended hereto, particulars of which have been kindly supplied by the Borough Surveyor: — 1. Tomswood Hill, Forest Road soil and surface water sewer £276,550 2. Green Lane, Goodmayes Lane, Trenance dens surface water sewer £53,600 3. Green Lane, Hazeldene Road surface water sewer £41,200 97 4. Hainault surface water sewer to Tudor Crescent £58,000 5. Relaying defective sewers £75,000 6. Chigwell Road culvert £16,500 7. Chigwell Road surface water sewer £86,500 8. St. Barnabas Road screening chamber and syphon to Eastern Sewage Works £59,750 9. Eastern Sewage Works (deferred works) struction Stage II £7,600 10. Wynn Valley surface water sewer £287,000 Insofar as complaints of choked drains are concerned, the two drainage officers operating in the Wanstead and Woodford area and the Ilford area respectively have ensured that the works to remedy nuisances have been carried out expeditiously. Much praise has been received from ratepayers within the Borough regarding the efficient manner in which this work has been executed. Some complaints have been received regarding pollution of streams and lakes within the Borough, generally the pollution being by oil, as with the increase in the use of the motor car and the parking, not only of private motor cars but also commercial vehicles, in the roadways and the carrying out of repairs thereto on the highways, a great deal of oil has been gaining access to the surface water sewers thereby causing serious pollution of the lakes within the district, particularly at Goodmayes, Cranbrook and South Park. Particular efforts have been made to trace some of the more serious contaminations and one watercourse was the subject of detailed investigation during the year. Refuse Disposal The collection and disposal of refuse which is under the control of the Borough Surveyor, has increased considerably, the 1964 figure being 59,486 tons; that for 1965 amounted to 77,972 tons due no doubt to the amalgamation of the former Boroughs of Ilford and Wanstead and Woodford under the London Local Government Act, 1963. Waste paper salvaged also increased markedly, the figures being 2,717 tons having a value of £20,737; the- figures for Ilford being 1,561 and £10,820 respectively in 1964. Rags, scrap metal and tyres contributed to the income of the Borough in that 149 tons of these commodities were collected and disposed of affording an income of £1,952; which figure, however, fell short of the £2,152 derived from this source in 1964. 98 Sanitary Inspection of the Area This branch of the Environmental Health Services showed only a slight increase over 1964 for with the creation of the London Borough of Redbridge there was a departure of some Inspectors causing heavier work to fall on those remaining. It is hoped that the report for 1966 will provide an improvement because it is felt that applications for appointments within the new Borough will be received in the near future. Statistics. — The number of inspections carried out and the classification thereof together with the notices served in consequence of those inspections are contained in the tables which follow:— Houses and premises inspected 31,245 Houses and premises reinspected (work in progress) 17,237 Houses in which nuisances were detected 1,467 Houses in which nuisances were abated 1,519* Premises disinfected 12 Articles disinfected 177 Premises disinfested for verminous conditions 19 "Includes 57 nuisances detected before 1st January, 1965. Notices served:—- Served Complied with Statutory:— Public Health Act, 1936 95 67 Clean Air Act, 1956 1 1 Housing Acts, 1957 and 1961 6 4 Factories Act, 1961 3 1 Food and Drugs Act, 1955 1 — Informal 523 414 629 487 In addition to the above, 79 notices (16 statutory and 63 informal) served previous to 1st January, 1965 were also complied with. There was an increase in the complaints of nuisances received and investigated by the Inspectors, as follows- 99 Accumulation of manure and refuse 72 Bad Smells 50 Dampness of premises 48 Defective drains, W.C's and fittings 810 Defective roofs, gutters, downpipes, etc 82 Defective water fittings 27 Dirty an verminoushouses 17 Dirty condition of rearway 18 Flooding of premises 6 Overcrowding 18 Smoke Nuisances 68 Defective or no provision of dustbin 251 Rats and mice 785 Miscellaneous 982 3,234 Rag Flock and Other Filling Materials Act, 1951. This Act requires the Local Authority to register premises wherein rag flock and other filling materials are used. Registration has been granted in respect of 15 premises. There is no establishment registered for the manufacture of those commodities as required by this Act, although one premise was licensed in 1965 as a rag flock store. It is interesting to note that no occupier of registered premises may obtain rag flock from premises other than those licensed under the Act either for the manufacture of this commodity or for its storage. Land Charges Act, 1925. Regular enquiries are received and searches carried out to ascertain any outstanding notices or charges on properties arising from the operation of the various Acts and Regulations with which the Department is concerned. 5,527 enquiries were so dealt with during 1965. Litter Act 1958 This Act is in part administered by the Public Health Inspectors although any officer of the council can make report on the deposit of litter in public places. Thus the Borough Surveyor's refuse collecting staff makereference to the authority as do the Inspectors, and the Town Clerk on the instructions of the Council institutes proceedings. Some 233 inspections, particularly of the roadside wastes in the borough, were made and the appropriate references given in specific cases. The Borough Surveyor's department have carried out a great deal of collection and cleaning work in these areas to the betterment of the town generally. 100 Noise Abatement Act, 1960 As the sensitivity of the general public to noise increases so does the number of complaints received rise. Thus the figure for 1964 of 37 rose to 50 in 1965. In 22 of these no conditions were found upon which an action for a statutory nuisance under the Noise Abatement Act, 1960 and the Public Health Act, 1936 could be based. In some 26 instances an informal representation to the person having control of the causative agent secured amelioration of the complaint. Two informal notices were served, one of which was complied with in 1965. A series of complaints regarding a timberyard in the district created some difficulty and necessitated the making of many visits to the premises. A subsequent report to the health Committee and investigation by some Councillors produced a reference to the appropriate authority for action under the Town Planning Act rules. Establishments for Massage and Special Treatment. — Another duty discharged by the Public Health Inspectors relates to the examination of Establishments set up for massage and special treatment under Part IV, Essex County Council Act, 1933 which was made applicable to Redbridge as from 19th August, 1965. These premises are visited quarterly and 36 applications for licences were approved by the Council. Hairdressers and Barbers Establishments. — The former Borough of Ilford had bye-law powers made under the Essex County Council Act, 1933 to supervise the sanitary circumstances obtaining in Hairdressers and Barbers establishments. With the constitution of Redbridge, it was necessary to formulate new rules under powers contained in Section 77 of the Public Health Act, 1961 which were approved by the Central Department in November 1965 and only became operative on 1st March, 1966, hence a mere 15 inspections were made in the short review period to indicate reasonable standards in all these premises. Home Laundry Service Another important and efficacious service provided by the Borough is the laundry service empowered under Section 84 of the Public Health Act, 1936, which enables the local authority to cleanse, at their expense, any filthy articles in order to prevent injury to health. By this means the bed and personal clothing of aged and incontinent persons can be laundered after certification by the Public Health Inspector of its filthy condition. During 1965, 114 persons were assisted and 16,973 articles were laundered. 101 Fertilizers and Feeding Stuffs Act, 1926 Yet another fresh duty has been vested in the new London Borough, namely the implementation of the Fertilizers and Feeding Stuffs Act, 1926 promulgated to require the satisfactory labelling or notification of the chemical constituents of the defined gardening requisites in order that purchasers may know what they are buying. The Chief and Deputy Chief Public Health Inspectors and two Specialist Public Health Inspectors are designated officers for these purposes and they made inspections and took two samples during the reviewyear, both of which were satisfactory It is hoped that improvements in these investigatory fields will be obtained with the recent staff accretion. Factories and Workshops The local authority is clothed with powers to supervise the sanitary circumstances obtaining in factories and workshops but only in regard to the provision of sanitary conveniences, suitable, sufficient and satisfactory; affording separate use for the sexes and in accordance with the provisions of the Regulations made under Section 11(2) of the Factories Act, 1961. This Statute also enables the authority to supervise through the Public Health Inspectors the sanitary conditions in which outwork is done in domestic dwellings, particularly with a view of preventing the spread of infectious diseases. Various commodities are issued to women generally for adapting which would be uneconomical to perform in a factory, especially appendages to clothing such as belts, fasteners, buckles etc. which provide them with an opportunity to augment the family income where she is prevented from working in, or unable to go to, the factory. Twice yearly visits of inspection are made and in general the conditions were found to be very good in the 197 premises under supervision. Details of the administration of the Act are contained in Appendix 27. Offices, Shops and Railway Premises Act, 1963 This Statute imposes a duty on the occupiers of defined premises to provide adequate means for preserving the safety, health and welfare of the persons employed in such premises. The Act, which came into force on May 1st, 1964 required the occupiers to register controlled premises by a specified date and thereafter routine inspection of the premises was undertaken by one Inspector, later augmented by the Inspectors in general. It is regretted that the whole of the area was not completed within the period under review but the figures for 1965 indicate a marked improvement on those for 1964. There were 45 additional premises registered during the year making 102 the total registered premises 552. 27 retail shops were also added to the register, giving a total of 1,692, whilst the figure of 53 wholesale shops and warehouses was increased by two during the same period. The figure of premises in which food is supplied to the public was increased from 162 to 165 but no new fuel storage depots were opened within the Borough. The figure of persons employed in registered premises was 19,445 comprising 8,635 males and 10,810 females and the Inspectors paid 1,085 visits to various forms of registered premises. Four applications were received for exemption from the provisions of Section 9 (sanitary conveniences) and four for exemption from the provision of washing facilities under Section 10, all of which after inspection were granted by the Council. Housing The administration of the provisions of the various Housing Acts was continued. Insofar as overcrowding is concerned, six informal notices were served requiring abatement in 1965 and two areas were declared by the Council to be clearance areas in the same period. The main problem in the administration of this important Statute lies in the difficulty in securing suitable and sufficient land and the provision of new houses for occupation by those not only displaced by slum clearance programmes but also those who are in urgent need of housing accommodation. Various figures in relation in the inspections, service of notices, compliance with the notices and the manner of dealing with the various problems relating thereto are contained in the attached Appendix. 28. The ever increasing difficulties arising from the occupation of houses by more than one family has in large measure been curtailed in that regular inspections have been carried out of premises subject to the requirements of the Housing Acts 1961 — 1964. Direction Orders regarding the occupation of such premises in accordance with the standards laid down by the Council have been issued and these have had a salutary effect in reducing the number of occupants of the controlled premises. This of itself does not necessarily solve the problem of satisfactorily housing these people in that they are forced to go to other premises where like conditions are invariably produced. Nevertheless; it does focus the attention of owners of houses on their obligations under the Acts to provide suitable sanitary circumstances in premises having particular regard for the number of occupants thereof. It is pleasing to record that many of the owners have carried out essential works to comply with the Directions given by the Council; in some cases, preliminary inspection and notification of the 103 results thereof have induced owners to either reduce the number of occupants or to make the necessary provisions without recourse to statutory action. Applications for re-housing based on medical priorities amounted to 102 in 1965 in consequence of visits and reports by the Public Health Inspectors on the home circumstances obtaining and as a consequence of consultation with the private medical practitioners and/or the hospital authority. Perhaps the most serious problem relating to housing conditions occurring in the Borough during 1965 arose out of the use of land within the Borough by itinerants occupying an assortment of caravans both mechanically and horse propelled, principally the former. These so called "gypsies" occupied various sites within the Borough and many visits were made by the Public Health Inspectors thereto to ensure that the sanitary circumstances arising from the occupation of these sites was satisfactory. It is unfortunate that the occupiers of these movable dwellings are ignorant of the most elemental of hygiene conditions. Many of the caravans are overcrowded, lack water supply, food storage accommodation and proper sanitary conveniences with the result that the occupants deposit much waste matter, faecal, animal and vegetable, on the land they occupy, they leave a great deal of refuse behind them and cause considerable nuisances to occupiers of adjacent premises with their demand for water and the use of sanitary facilities. They trespass without hindrance on other people's land, damage fences, hedges and trees which results in a continuing number of complaints from the persons who suffer by the depredations of these itinerants. Efforts to solve the problem by carrying out inspections of premises after serving a 24 hour notice of such intention on the occupiers and the service of a preliminary notice has the salutary effect of causing them to move the caravans. This, however, merely provides a temporary alleviation of the nuisances for they transfer them to another site, in many cases they lodge themselves on Council property when speedy action can be taken to remove them by towing them off the land and depositing them on the highway, due care being taken of both person and property, but where the land is in public ownership, controlled by a Central Government Department which is unwilling to take any steps to prevent nuisances being created on land under their jurisdiction, then the problem is amplified simply because this type of itinerant, who is permitted to stay without let or hindrance on land abutting the public highway, 104 diately makes known the availability of such a facility by means of the express "bush telegraph" used so adequately and speedily by these people; the consequence being the aggregation of a large number of caravans on waste land adjacent to the public highways in close proximity to dwelling houses. It is considered that these people do not want permanent stopping sites where they can be controlled as to their sanitary circumstances, their personal hygiene, the prevention of nuisances and above all by the constant supervision by both officials and police. They contribute nothing to the social improvement of either themselves or the area in which they stop and their form of life is such that they want to be unhampered in their movements as and when they so desire and in accordance with their own particular standards of living. It is acknowledged quite freely that these people have a right to live a reasonable life but the obligation to provide them with the right to thus live should not fall upon any specific local authority to which they make no rate contribution, but rather that there should be national sites provided at suitable points and subject to strict control by both Police and Public Health Officers. A reasonable charge should be made on those persons using the accommodation. The prevention of serious nuisances would be ensured by careful supervision and the provision of suitable sanitary amenities regulated by the local authorities. Housing tiepairs and Rents Acts, 1954 and 1957. Rent & Mortgage Interest (Restrictions) Acts, 1920 and 1939. Rent Act 1957 and Rent Act 1965 The administration of these Acts, insofar as the issue of certificates of disrepair was concerned continued much as in 1964, there being only six applications received and six granted, whilst Certificates of Disrepair actually issued numbered only two there being four undertakings received from landlords to carry out specific repairs. There were only three Certificates of Disrepair cancelled during the year. Inspection and Supervision of Food This important branch of the Environmental Health Service is the subject of detailed supervision by the Inspectors, the Redbridge Borough Council having delegated to the Health Committee all its powers and duties under the Food and Drugs Act, 1955 and the Regulations and Orders made thereunder. 179 persons were registered as distributors of milk under the Milk and Dairies (General) Regulations 1959 and 24 dairy premises, not being dairy farms, e.g. premises on which Milk 105 is actually produced which are subject to control by the Ministry of Agriculture, Fisheries and Food, were also registered. The number of inspections of dairy premises made during the year amounted to 78. Furthermore, under the Milk (Special Designation) Regulations 1963 and the Milk (Special Designation) (Amendment) Regulations, 1965, dealers licences were issued in relation to pre-packed milk as follows:— Pasteurised 4 Sterilised 3 Untreated 3 There were no licences issued by the Ministry of Agriculture, Fisheries and Food in respect of the production of milk at farms within the Borough. In order to ensure that the milk supply within the district of the Borough was satisfactory, regular routine sampling of untreated and heat treated designated milks was undertaken and in other cases, where unsatisfactory reports have been received thereon. Biological testing of untreated milk for tuberculosis is also carried out and repeat samples taken if positive results had been obtained after clearance by the Divisional Inspector of the Ministry of Agriculture, Fisheries and Food. In addition, the milk supplied to maintained schools was regularly sampled and results indicated that of 49 pasteurised milk samples, all were satisfactory and one sterilised milk sample also proved to be satisfactory. Under the Milk and Dairies Orders 1926/1938, the inspection of dairy herds is carried out by the Veterinary Officers of the Ministry of Agriculture, Fisheries and Food and the one dairy herd situated within the Borough was the subject of investigation by the Ministry's Divisional Officer which indicated that no cows were infected with tuberculosis, therefore no samples were sent for bacteriological examination. As a consequence of the receipt of seven complaints of the presence of foreign bodies in milk distributed within the district which were made the subject of investigation, legal proceedings were instituted against four of the seven retailers complained of when fines totalling £45 with the addition of £19.18s.0d. costs were imposed by the Court on the proven offenders. Ice Cream The powers under Section 158 of the Essex County Council Act being repealed insofar as the London Borough of Redbridge is concerned, administration of the duties relating to the 106 registration of ice-cream manufacturers and vendors was carried out under Section 16 of the Food and Drugs Act, 1955. During the year six applications for registration were considered in respect of premises within the Borough. Registration was approved in respect of one premise for the manufacture, storage and sale of ice-cream and 4 premises for the storage and sale of ice-cream. An inspection of the remaining applicant's premises, vehicle and equipment revealed unsatisfactory conditions which were reported to the Committee who, under the powers contained in Sections 16 and 18 of the Food and Drugs Act, 1955, served notice on him to appear before the Council to show cause why his application should not be refused but he failed to attend before the Committee and no registration was granted. The Food Standards (Ice-cream) Regulations, 1959 lay down standards for ice-cream but no samples were submitted for chemical analysis due in large measure to the shortage of Inspectorate staff. Samples for bacteriological examination are taken 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 1965 11 samples were submitted for examination with the following results: — No. of Samples Ministry of Health Provisional grade % of Total Unsatisfactory Samples 7 I 64 — 2 II 18 2 1 III 9 1 1 IV 9 1 11 100 4 The four unsatisfactory samples failed the Methylene Blue Reduction test. Difficulties in supervising the manufacture and sale of ice-cream from vehicles which fall outside the definition of premises contained in the Food and Drugs Act, 1955 would be removed if all forms of manufacture and sale were to be registered as well as the person responsible for such production and sale even if from a stall, barrow, vehicle, etc. 107 Meat and Other Foods Continuous supervision and inspection of the food supply of the district was carried out by the Inspectors during the year. 4,046 inspections of shops and other establishments were undertaken by the staff and in general conditions were found to be satisfactory although in five instances breaches of the Food Tlygiene (General) Regulations, 1960, were discovered. Four of these related to food handlers nsing tobacco whilst engaged in the handling of open food — in two cases letters of warning were sent, and legal proceedings were taken in two cases resulting in a fine of £5 with £3.3s.0d. costs in one case, and a conditional discharge on the payment of £3.3s.0d. costs in the other case. The fifth case related to the lack of provision of official notices, nail brushes, towels etc. in a chocolate factory within the district. Legal proceedings were taken and fines totalling £40 were imposed. In addition, 7 informal notices and 1 statutory notice were served under the Food and Drugs Act, 1955; 6 informal notices were complied with including informal notices served prior to 1965. The following information gives the numbers of food premises in the area by the type of business:— Cafes and Restaurants 239 Factory Canteens 35 Butchers' Shops 151 Grocers' Shops 332 Fruiterers' and Greengrocers' Shops 158 Fishmongers' and Fishfryers' Shops 67 Bakehouses 20 Bakers' Shops 59 Confectioners' Shops 277 1,338 Foods, Fitness and Consumer Protection Further protection is offered to the public not only in respect of fitness for human consumption but also to provide that statutory food standards prescribed in various orders and regulations are adhered to. Furthermore consumer protection is also afforded by the Labelling of Food Orders and, as adumbrated elsewhere, the Merchandise Marks Act which requires that statements relating to the weight constituents and added substances be affixed to the foods etc. Frequent inspections are undertaken which, with the procuration of statutory samples of different foods, make certain that all foods as defined in the Food and Drugs Act, 108 1955, and the many Orders etc. made thereunder are suitable for consumption and also that the public are not defrauded by the abstraction of any portion of the food or the addition to it of any harmful substances. Similarly the Inspectors are required to see that no food which is unfit for human consumption is sold, stored, offered or deposited for sale etc., and if found to be unfit for human food, to seize it and institute the statutory procedure for its condemnation by a Magistrate with subsequent legal proceedings by the Council. To obviate this penal proceedure, occupiers of premises who discover 'unfit' food on their premises, surrender it to the Council who through the Inspectorate, examine it, certify its condition and make arrangements for its collection and disposal in such manner as will prevent its use for human food. This is a council service much appreciated by the food traders in the district. Particulars of the work entailed is contained in Appendix 29. Naturally some complaints of the condition of food bought by complainants are received in the department and immediate enquiry is made into the circumstances inducing the complaint. The article complained of is examined immediately, the Medical Officer's opinion obtained and if necessary sent to the Public Analyst for certification of its condition. The vendor is afforded an opportunity of examining the food and written statements taken from prospective witnesses. 82 such complaints were received in 1965. Letters of warning were sent in 5 cases and legal proceedings taken in 20 cases and fines totalling £104.5s.0d. plus £71.10s.0d. costs were imposed. Sampling Officers, in Redbridge the Medical Officers and the Public Health Inspectors, take statutory samples of food and drugs and having satisfied the sampling rules, submit the purchased foods to the Council's appointed Public Analyst who certifies the examined samples and reports to the authority thereon. Should he tender an adverse report, reference is made to the Health Committee who determine to prosecute, warn or take no action as the circumstances warrant. Actions and their consequences as shown in the Appendix 30 indicate clearly the importance of this facet of the work. The Liquid Egg (Pasteurisation) Regulations, 1963 These Regulations require the pasteurisation of liquid egg to be used in food intended for sale for human consumption, other than egg broken out on the food manufacturer's premises and used within 24 hours. The method of pasteurisation and the 109 test to be satisfied (the alpha-amylase test) are prescribed ill the Regulations. There are no egg pasteurisation plants in the Borough but during 1965, two samples of liquid egg were obtained and submitted to the alpha-amylase test and both proved satisfactory. Food Hawkers Hawkers of any food, and premises used for the storage of such food are required to be registered by the local authority under Section 103 of the Essex County Council Act, 1952. A total of 112 persons are at present on the register and their premises are regularly supervised. One new registration was granted during 1965. Food Preparation Premises The Food and Drugs Act, 1955, Section 16, provides for the 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. During 1965, one new registration was granted, making a total of 320 premises registered at the end of the year. Slaughterhouses Slaughter of Animals Acts, 1933 to 1954 There are no registered slaughterhouses within the Borough of Redbridge and no licences were issued to slaughtermen during the year, no applications having been received therefor. The Merchandise Marks Acts 1887-1953 These Statutes afford protection to the public by prescribing trade descriptions regarding the stipulated standards of quality, quantity, materials, strength, performance etc. of goods and foods, the latter forming an important subject of environmental health administration, in that, the inspectors are required to visit premises wherein imported specified foods are offered or exposed for sale to ensure that such commodities are marked or labelled or so notified as to indicate the country of origin and that they are fit for the description so denoted. Pharmacy and Poisons A new function imposed on the London Borough of Redbridge relates to the registration of premises for the sale of those poisons prescribed in Part II of the Poisons List issued under the Pharmacy and Poisons Act, 1933. The Chief and Deputy Chief Public Health Inspectors together with two specialist Public Health Inspectors were designated as authorised Officers for these purposes and inspections were carried out in respect of 173 applications for renewal of entry on the Statutory register, whilst applications for registration of 17 110 new names were investigated. Not one of these was refused. A total of 244 visits elicited the fact that all premises were satisfactory and the Act and Rules conformed to. Diseases of Animals Diseases of Animals Act, 1950 The administration of the Diseases of Animals Act, 1950 and the multifarious regulations, orders and rules made thereunder has produced little above the normal. Generally the movement of swine has progressed without the issue of any licences throughout the year, though in a few instances the movement of pigs into the borough by licence has been made. Diseases of Animate (Waste Foods) Order 1957 5 licences were granted by the Council under this Order which requires the effective sterilisation of all 'pig-swill' in properly constructed appliances to prevent the spread of animal diseases. The Pet Animals Act 1951 Local authorities are required to licence premises wherein designated animals are kept, stored or sold as pets by way of business. During the year under review many inspections were carried out to ensure that 'pets' were dealt with in a humane and healthy manner. There are now 23 such establishments licensed in the Borough and all have been found to be well administered. Animal Boarding Establishments Act 1963 This Act was promulgated to regulate premises used for the boarding of cats and dogs. It enables the local authority to refuse a licence to any person who is disqualified from keeping (a) an animal boarding establishment; (b) a pet animals shop as adumbrated above; (c) by reason of a conviction for cruelty to dogs and (d) consequent upon a conviction of cruelty to any animal. The Act also stipulates conditions relating to accommodation, food, drink, bedding, the prevention of diseases, fire precautions, constant attendance and the keeping of records of animal movements. During the year, periodic inspections were carried out to prove that the Act was well observed by occupiers of the four licensed premises. It is well to note that one premise in which pets were kept ceased to operate during the year. Riding Establishments Act 1964 Another piece of legislation calculated to protect animals was promulgated in 1964 with the Riding Establishments Act. It was a Private Members Bill and strengthens the powers of 111 licensing authorities to control stables where horses etc. are let or hired for riding. The licensing provisions are similar to those in the Animal Boarding Establishments Act but the authority must consider not only the suitability of the premises but also the suitability, qualification and experience of the applicant to manage such premises. Hats and Mice Although many people consider them part and parcel of life, it cannot be denied that they are not only destructive and frightening but particularly in relation to rats, form a positive hazard to health being the vehicle for transmitting to humans the dread disease known as Weils disease. Therefore all possible steps must be taken to disinfest all premises and places. To this end two rodent operatives are engaged in this work under the direction of the district inspectors. Details of this branch of the work are incorporated in Appendix 31. They also serve the public well in disposing of wasps nests to alleviate a serious cause of distress. Atmospheric Pollution Clean Air Prior to 1956 when the Clean Air Act was placed on the statute book atmospheric pollution was controlled by the Public Health Act, 1936 Sections 101 to 106 generally, which empowered local sanitary authorities to deal with 'black' smoke from industrial chimneys under bye-law powers or 'smoke in such quantities as to be a nuisance'. There were escape clauses and the special defence of having "used the best practicable means available for preventing the nuisance from smoke" mitigated seriously the efficacy of the powers. The remarkable nature and serious effects of the 1952 'London Smog' induced the government to constitute the Beaver Committee whose report influenced Parliament to pass the Clean Air Act of 1956, which acknowledged the considered opinion of the Committee that domestic smoke was an important factor in the creation of fogs, the acceleration of respiratory disorders and had damaging effects on buildings, materials and plant life. The Act therefore deals with this smoke problem as follows:- the prevention of smoke emission from domestic chimneys by the creation of smoke control areas in which it is an offence to emit smoke after the house appliances had been adapted to consume approved 'smokeless fuels', a portion of the cost thereof being borne by the authority as to 3/10ths of approved cost and by the Treasury as to 4/10ths, leaving the householder or owner to pay the remaining 3/10ths. The Borough 112 has progressed well in the creation of smokeless zones and the following Smoke Control Orders are in operation, or will come into operation on the dates stated:— Borough of Ilford 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 Good- mayes) 1.8.1965. No. 7 (North Hainault) 1.7.1966. Borough of Wanstead & Woodford No. 1 1.10.1961. No. 2 1.10.1961. No. 3 1.10.1962. No. 4 1.10.1964. No. 5 1.10.1965. No. 6 1.10.1965. Borough of Redbridge No. 8 (Hainault) 1.7.1966. No. 9 (Fairlop) 1.10.1966. No. 10 (Woodford Bridge). 1.10.1966. No. 11 (Woodford Wells) 1.10.1967. No. 12 (Seven Kings) 1.10.1967. No. 13 (Fairlop) 1.10.1967. A map of the areas is shewn in Appendix 32. Complaints were received during 1965 of alleged smoke nuisance in 10 instances from factories and other premises in various parts of the Borough. In 2 instances no emission was noted which would have enabled action to be taken under the Public Health Act, 1936, or Clean Air Act, 1956. Two informal notices were served and complied with and in all other cases verbal intimations and advice were given. Five stations for measurement of atmospheric pollution have been installed in the Borough as follows:— No. 1 — Gantshill Library, Cianbrook Road, Ilford. No. 2 — John Bramston School, Newcastle Avenue,Hainault. No. 3 — Ilford Town Hall. No. 4 — Croft Lodge Close, Snakes Lane, Woodford. No. 5 — Oak Hall Court, Wanstead. Each station has a volumetric apparatus and the two latter stations are selected sites in connection with a National Survey of Air Pollution being conducted by the Department of Scientific and Industrial Research. 113 APPENDIX 27 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 159 65 1 - (ii) Factories not included in (i) in which Section 7 is enforced by Local Authorities 683 436 21 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 67 82 - Total 909 583 22 - 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 1 1 - 1 - (b) Unsuitable or defective 21 14 - 3 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Out-work) - - - - - Total 22 15 - 4 - 114 APPENDIX 27 (continued). PART VIII OF THE ACT OUTWORK (Sections 133 and 134) Nature of Work Section 133 Section 134 No. of out-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 unwhole- some premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing apparel — Making etc 124 - - - - - Cosaques, Christmas stockings, etc 59 - - - - - Making of cardboard boxes 14 - - - - - Total 197 - - - - - 115 APPENDIX 28 HOUSING STATISTICS 1. Inspection of dwelling-houses during 1965. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,758 (b) Number of inspections made for the purpose 9,783 (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 for the 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 41 (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 172 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 178* 3. Action under Statutory Powers during the year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1957. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 2 (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 3* B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 94 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 41* (b) By local authority in default of owners 1 116 APPENDIX 28 (continued). 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 — (2) Number of dwelling-houses closed in pursuance of an undertaking given by the owners and still in force 4 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 8 (ii) Number of families dwelling therein 8 (iii) Number of persons (units) dwelling therein 86 (b) Number of new cases of overcrowding reported during the year 6 (c) (i) Number of cases of overcrowding relieved during the year 5 (ii) Number of units concerned in such cases 1914 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding - (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report - *Includes compliances during 1965 of Notices served prior to 1st January, 1965. 117 APPENDIX 29 Items of Food surrendered and condemned as being unfit for the food of man, during 1965 Description Quantity Bacon 252 lbs. Beverages 143 tins Biscuits 194 lbs. Butter 86 lbs. Cereals 622 lbs. Cheese 140 lbs Cream 121 tins Eggs 14 gross " (Shell) Fish (Wet & Dry) 635 stones " (Tinned) 721 tins " (Cakes) 25 cakes " (Paste) 19 Jars Flour 165 lbs. Fruit (Tinned) 11,443 tins " (Juices) 146 tins Game 225 lbs. Ice Cream 17 brickettes Jam (Preserves) 287 lbs. Jellies 40 Lard 41 lbs. Meat (Fresh) 10 tons, 7 cwts. 2 stones " (Tinned) 2 tons, 15 cwts, 0 stones " (Pies) 47 pies Margarine 82 lbs. Milk (Tinned) 866 tins Pastry (Mix) 15 packets Pickles 240 Jars Poultry 524 lbs. Salt 44 lbs. Sausages 104 lbs. Sausage Rolls 48 rolls Sugar 222 lbs. Soups (Tinned) 1,432 tins Tea 240 lbs. Tomatoes 42 lbs. Vegetables (Dried) 396 lbs. " (Tinned) 1.988 tins Vinegar 4 bottles 118 APPENDIX 30 FOOD AND DRUGS ACT 1955 List of samples obtained and action taken regarding unsatisfactory samples in 1965 Description Formal Informal Description Formal Informal Blackcurrant Health Drink 1 - Brought forward 26 18 Bread Roll - 1* Liquid Paraffin - 1 Bread - 1* Milkie Loaf 1 - Bacon - 1 Minced Onion 1 - Butter Ginger 1 - Milk 5 3* Chicken Curry 1 - Meat Pudding - 1 Chilli Powder 1 - Minced Beef - 1 Cho-Cho 1 - Orange Nectar 1* - Coconut, Creamed 1 - Onion Salt 1 - Corn Oil 1 - Olive Oil - 1 Crisps 1 - Pea Nut Crumble 1 - Chicken, Continental 1 - Pea Nut Butter 1 - Cockles 1 - Pumpernickel 1 - Cocktail Cherries - 1 Pate de Fois 1 - Cheese, smoked - 1 Patum Peperium 1 - Cheese - 1 Pheasant Consomme 1 - Cold & Influenza Mixture - 1 Puff Crackne 1* - Castor Oil - 1 Pepper, Ground Black - 1 Coffee, instant 1 - Pepper, Cayenne - 1 Corned Beef - 2* Raspberries 1 - Creamed Horseradish 1 - Raspberry Conserve 1 - Cinamon, Ground - 1 Root Liquorice - 1* Calves Liver Sausage 1 - Sauerkraut 1 - Dried Onion 1 - Savory Tango 1 - Dairy Topping 1 - Sausages, cocktail 1 - Egg Noodles 1 - Sausages, beef 1 - French Cream Slices 1* - Soup 3 - Fruit Salad 1 - Steaklets 1 - Flour, self-raising 1 - Strawberries in Syrup 1 - Frankfurters - 1 Salts, Fynnon 1 - Ginger Marmalade 1 - Syrup of Honey Pine - 1 Halva 1 - Sardine&Tomato Paste 1 - Hamburgers 1 - Smoked Salmon Mayonaise 1 - Horseradish Sauce - 1 Tomatoes, peeled 1 - Instant Coffee 1 - Tomato, puree 1 - Instant Milk - 1 Twirl 1 - Jaffa Oranges 1 - Vienee Sausage 1 - Lemon S.quash 1 - Wine Cured Cheese 1 - Lemon Shandy 1 - Wine Vinegar 1 - Liqueur Chocolate - 1* Sliced pressed Ham - 1* Linctus, Gees - 2 Yeastvit 1 - Linctus, Junior - 1 Total 63 30 Carried forward 26 18 *Unsatisfactory samples — see details following. 119 APPENDIX 30 (continued). UNSATISFACTORY SAMPLES (a) Bread roll (informal). — Contained foreign matter in form of dirty dough, insect web and traces of iron. Legal proceedings were taken. (b) French Cream Slices (formal). — Consisted not of cream but artificial cream. Warning letter sent to vendors. (c) Orange Nectar (formal). — Contained excessive metallic contamination. Warning letter sent to retailer. (d) Puff cracknell (formal). — Claimed to aid slimming but no statement to comply with Bread and Flour Regulations, 1963 that to do so must form part of controlled diet. Warning letter sent to the retailers. (e) Bread (informal). — Contained fragments of metallic foreign matter consisting of an alloy, mainly lead. Legal proceedings were taken and the bakers fined £10 and £2.2s. costs. (f) Milk (informal). — Contained numerous insect papae. Legal proceedings were taken and the retailers were fined £20 and £10.10s. costs. (g) Corned beef (informal). — Contained part of a fly. Legal proceedings were taken and the manufacturers were fined £5.5s. and £3.18s. analysts fees. (h) Root liquorice (informal). — Contained mould growth. Local stock surrendered by retailer and local authority of district where goods prepared and packed advised. (i) Milk (informal). — Contained a deposit of milk solids. Letter sent to retailers. (j) Milk (informal). — Contained mould growth. Legal proceedings were taken and a fine of £10 and £2.2s. costs was imposed on the retailers. (k) Corned beef (informal). — Contained piece of zinc oxide plaster. Referred to Ministry of Agriculture, Fisheries and Food who made representations to South African Embassy as beef manufactured in South Africa. (l) Liqueur Chocolates (informal). — Contained larva of date moth. Legal proceedings were taken and fines of £5 on each of two summonses were imposed and £5.5s. costs. (m) Sliced press ham (informal). — Contained a flake of paint. Legal proceedings were taken but the firm concerned was granted an absolute discharge on payment of £10.10s. costs and £9.3s. analysts fees. 120 APPENDIX 31 Prevention of Damage by Pests Act 1949 Record of inspections and treatments carried out — 1965 Type of Property Total Local Authority Dwelling Houses Agricultural All other (including Business and Industrial) Total No. of properties in District 307 76,310 29 11,864 88,510 No. of properties inspected as a result of notification 71 1,026 — 130 1,227 No. of such properties found to be infested by — Common Rat Minor 29 566 — 59 654 House Mouse Minor 42 236 — 52 330 No. of properties inspected in the course of survey under the Act 28 27 _ 4 59 No. of such properties found to be infested by — Common Rat Minor 26 20 — 3 49 House Mouse Minor 2 6 — 1 9 No. of properties otherwise inspected — — — 1,338 1,338 No. of such properties found to be infested by — Common Rat Minor — — — — — House Mouse Minor — — — — — Total No. of inspections and reinspections carried out 213 1,955 — 4,261 6,429 No. of infested properties (under II, III and IV) treated by Local Authority... 93 840 — 106 1,039 Total No. of treatments and retreatments carried out 100 9 26 — 136 1,162 No. of Notices served under Section 4 (1) Treatment — — — — — (2) Structural works (i.e., Proofing) — — — — — No. of "block" control schemes carried out Nil 121 APPENDIX 32 122 WELFARE 123 THE WELFARE SERVICES by R. W. Hall, A.M.I.S.W., Chief Welfare Officer The year under review might properly be described as one in which the foundation of the Welfare Services in Redbridge were designed and partly laid. Limitations were placed upon its development due to the lack of suitably qualified or experienced staff and the volume of work of a day-to-day nature which had to be done to the exclusion of work on development and planning. In reporting on this Service, reference must be made to the fact that until the 1st April, 1965 the work was undertaken by the Essex County Council and appreciation must be expressed to the County Welfare Officer and his staff for their co-operation and assistance when handing over the Service to the new London Borough, so enabling the service to those in need to be maintained during the transitional period. What in fact did the Borough take over? It became responsible for the provision of welfare services for the elderly people, the blind and the partially sighted, the physically handicapped and the deaf, the hard of hearing and the homeless in Redbridge. Some idea of the magnitude of the task can be gleaned from the numbers of people concerned — 30,000 elderly, 565 blind and partially sighted, 610 physically handicapped and many deaf and hard of hearing, whose numbers have not yet been ascertained. In terms of staff, it meant the taking over of persons who were cleaners and clerks, social workers and supervisors, superintendents and matrons, cooks and instructors, administrators and attendants, and welding them into a team. In terms of buildings, it meant taking over and administering three residential homes for the elderly, occupied by 122 elderly citizens; one Day Centre for the elderly; one Occupational Centre for the physically handicapped and two residential homes and one Day Centre for the elderly in the course of construction. (Appendix 33). Add to this situation the care of a number of persons in Homes administered by other Local Authorities and voluntary organisations, holiday arrangements for the physically handicapped, temporary accommodation for the homeless, registration and inspection of private Homes for the elderly, the handicapped and the mentally disordered, and the first picture is complete. (Appendices 34-38.) 124 From these small beginnings progress has been made, sometimes spasmodically and always under heavy pressure of work. The number of registered physically handicapped persons has increased to 730. All of these persons were visited diring the year by three Social Welfare Officers with special knowledge of their problems. Apart from the supply of a great variety of aids and gadgets, (hydraulic hoists, walking aids, aids to dressing and toilet, aids for cooking and household chores etc.) designed to improve the mobility of the handicapped and assist them to overcome their physical limitations, the Social Welfare Officers undertook considerable casework in connection with the problems of the persons they visited and their families. The problem of human relationships in such situations are many and often very involved, and much time is needed in providing the necessary casework support. In addition, a number of adaptations were carried out in the homes of the disabled, including ramps, toilet and bath supports, handrails, installation of ground floor toilets, bathrooms etc. In spite of small and inadequate premises, the Occupational Centre at Fellowship House provided a valuable service to some 72 physically handicapped persons. There they meet in a "club" atmosphere and undertake a variety of handicrafts and so maintain activity and interest. The waiting list for this Centre is becoming increasingly long and the Council is taking steps to provide better and increased facilities. During the year a number of physically handicapped persons enjoyed holidays arranged by the Authority and this provision is one which is most highly appreciated and is most beneficial for these persons. Turning to the Welfare of the elderly, the Council has gone ahead with its programme of increased provision of residential accommodation, Day Centres, holidays, meals service etc., although much remains to be done. One new Home, Rose Park, Heathcote Avenue, has been brought into use and accommodates 60 residents. Another new Home in Loxford Lane is at an advanced stage of construction and plans for a third new Home for 50 residents on a site at Hermon Hill, Wanstead, are being prepared. It is planned to provide care and attention for some 600 elderly persons in this type of accommodation. Some thought will have to be given to the staffing of our Homes, in view of the acute 125 difficulty in obtaining suitable staff for this arduous but rewarding work. The waiting list for admission to homes for the elderly has remained constant at something over 200, in spite of the opening of Rose Park, and this is a matter of considerable concern to the Welfare Committee. During the year a new Day Centre for the elderly was opened in the Church Hall of the Goodmayes Congregational Church and this is gradually gaining in popularity. Scrafton Road Day Centre has for some time been a happy meeting place for the elderly of the district and soon it is hoped to bring the new Centre at Fullwell Cross into use. This latter Centre will have the advantage of being able to provide a midday meal for those attending. Day Centres will play an increasing part in the provisions for the elderly, particularly when transport is available and will assist some of our senior citizens to maintain their independence and continue to live in the community. For the first time in Redbridge the Council arranged to sent a number of elderly persons on holiday to Corton Beach Holiday Camp, near Lowestoft. 500 persons will be catered for, particularly those on low incomes, and it is anticipated that they will derive much benefit from the holiday. In spite of considerable difficulty in obtaining drivers and other assistance, the W.V.S. have managed to supply "meals on wheels" to many of the housebound elderly in the district and during 1966/67 the Council proposes to help this Service to develop by providing drivers, vehicles and clerical assistance (Appendix 39). Due to staffing shortages, the Social Welfare Officers responsible for visiting and helping the elderly have been working under tremendous pressure and there is an urgent need to supplement their number. In the social work field generally there is an increasing appreciation of the need to provide not only services for the elderly, but skilled caseworkers able to assist them and their families with their problems. It is not considered any longer that the answer to the problems of the elderly is to "put them in a Home", and more and more there is a demand for the services of qualified and experienced Social Workers in this field. For many years this Country has had the advantage of a social work service for the blind and partially sighted and Redbridge is fortunate in having four Social Welfare Officers, who are qualified home teachers for the blind, to continue this service in the Borough. 126 The 564 blind and partially sighted are visited regularly by the Social Welfare Officers and assisted with their many and diverse problems, apart from being taught Braille, Moon and a variety of handicrafts. Co-operation with other agencies ensures that blind persons are found employment when suitable and assistance is also given in providing holidays. (Appendix 40). One of the most exciting developments this year was the commencement of a survey of the requirements of the deaf and hard-of-hearing persons in nedbridge. We were fortunate in obtaining two places on a course of training in manual communication with the deaf organised by the Essex County Council Welfare Department. With a countrywide shortage of Welfare Officers for the Deaf, the possibility of appointing a qualified Officer was negligible. The two Officers who have undertaken training have begun their formidible task of visiting the deaf and ascertaining their needs and in future years an appropriate service will be developed. Deafness almost invariably equates with isolation and loneliness, and these conditions in their turn bring many mental problems in their train. Social work of an exceptionally high standard is necessary in this situation and the need to integrate deaf persons into the community is vital. In a small way we have commenced this task. (Appendix 41). Since the National Assistance Act of 1948 was introduced, the Welfare Service has been the Service primarily responsible for dealing with the problems of families, and particularly those who become homeless through unforeseen circumstances. On the 1st April, 1965, there were seven families in temporary accommodation in a joint-user establishment at Hornchurch, and one hundred families "at risk" being visited by the family caseworker. Since then, the number of families "in care" and "at risk" has increased and additional Social Workers will be engaged to undertake the valuable work of rehabilitation and support. The Council has obtained premises in Grosvenor Road, where families will not only be provided with temporary accommodation, but will be assisted with their personal problems and helped where necessary to take their place in society with the same standards and accepting the same obligations. This new unit in Redbridge is far in advance of many such units in the country, demonstrating as it does the Council's belief in the dignity and freedom of the individual, coupled with the acceptance of the community's obligation to the less fortunate, and there are high hopes that this venture will set a pattern for other Authorities to follow. 127 No social service department can work in isolation and all such statutory agencies must acknowledge the valuable work undertaken by a tremendous number of voluntary organisations. Redbridge has not been slow to appreciate this point and has spent a considerable sum of money by way of grants to the many voluntary agencies in the district. The fostering of this relationship is an integral part of the Council's welfare service policy. In future years it is hoped that there will be a closer link between the differing organisations and between those organisations and the Council to improve even further the services designed to help those in need. In conclusion, I would refer to the valuable assistance the Welfare Service has received from colleagues in every department of the Council and from many individuals and organisations outside the Authority's services, and express my keen appreciation of their help. My thanks are also due to the social work, administrative, clerical, Homes and Centres' staff, for their unfailing support and effort. Their task during the past year has been almost overwhelming, but they have done themselves great credit by the way in which they have tackled it. To Dr. Gordon, Medical Officer of Health, I am indebted for his forbearance and support in a difficult first year with this new service in Redbridge. Finally, may I take this opportunity to thank the Chairman and Members of the Welfare Committee for their courtesy and kindness to me and their live interest in the work of the Service and their enthusiastic support of it. 128 APPENDIX 33 LIST OF PREMISES (Local Authority) Name Address Superintendent/Matron Occupants Old People's Homes Heath Gate Chadwell Heath Lane, 60 Mr. and Mrs. Luckett, Chadwell Heath, Ilford. Pegram House Longhayes Avenue, 50 Mr. and Mrs. Hockley. Marks Gate, Romford. Rose Park Heathcote Avenue, 60 Mr. and Mrs. Church. Clayhall, Ilford. Woodside 162, High Road, 15 Mrs. Bond. Woodford Wells. No. on Supervisor Register Occupational Centre Fellowship House Green Lane, Ilford, 73 Mr. Hawkins Day Centres (Local Authority) Scrafton Road Day Scrafton Road, Ilford. Centre Goodmayes Day Broomhill Avenue, Centre Goodmayes. Fullwell Cross Day Fullwell Cross, Centre F alrlop. (This day centre is due to open shortly) Day Centre (Voluntary) Grove Park 2, Grove Park, (Managed by W. & W. O.P.W.A.) Wanstead. List of Homes (Private) Homesdale 7, New Wanstead, 16 Females WAN 0847 Wanstead, E.ll. 129 APPENDIX 33 (continued). List of Homos (Private) (continued) Name Address No. of Occupants (Male & Female) Telephone No. Osmont 8, Grove Park, Wanstead, E.ll. 28 Females WAN 4955 Orwell Lodge 8, Grove Park, Wanstead, E.ll. 14 Females WAN 9267 186, High Road, Knighton. 4 Females BUC 6721 Arden House 40, Emerson Road, Ilford. 20 Male & Female VAL 6198 Belmont 66, Derby Road, South Woodford, E.18. 13 Females BUC 5712 Welcombe 69, Woodford Road, South Woodford, E.18. 26 Male & Female WAN 3696 106, Aldborough Road, Seven Kings, Ilford. 7 Females SEV 3164 29 and 31 Valentines Road, Ilford. 24 Male & Female VAL 2287 St. Anne's 6, Tavistock Road, South Woodford, E.18. 10 Male & Female WAN 4686 Arlington 12, Snakes Lane, Woodford Green. 18 Females BUC 1970 APPENDIX 34 Persons in Care No. Borough Homes 167 Out-Borough Homes 193 Voluntary Homes 90 Total: 450 130 APPENDIX 35 1. Voluntary Organisations to which grants are paid. Wanstead and Woodford Old People's Association. Ilford Social Service Association, Ilford Old People's Welfare Committee. Essex County Association for the Blind. Southern Regional Association for the Blind. Essex Physically Handicapped Association. Ilford Association for the Physically Handicapped. Wanstead and Woodford Physically Handicapped Club. Hainault Association for the Physically Handicapped. Essex League of Hard of Hearing. Royal Association in Aid of Deaf and Dumb. British Epilepsy Association. Spastic Society. South Eastern Regional Association for the Deaf. Central Council for the Disabled. Women's Voluntary Services (Grant in association with Meals-on-Wheels Service) 2. Voluntary organisations to which the Council is affiliated. South East Regional Association for the Deal. Central Council for the Disabled:— Handcrafts Advisory Council. 131 APPENDIX 36 PHYSICALLY HANDICAPPED STATISTICS MINISTRY CATEGORIES Amputation 26 Arthritis and rheumatism 215 Congenital malformations and deformities 10 Diseases of the digestive and genito-urinary systems; of the heart or circulatory system; of the respiratory system (other than tuberculosis) and of the skin 59 Injuries of the face, head, neck, thorax, abdomen, pelvis or trunk. Injuries or diseases (other than tuberculosis) of the upper and lower limbs and of the spine 94 Organic nervous diseases — epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica, etc. 261 Neuroses, psychoses and other nervous and Mental disorders 5 Tuberculosis (respiratory) 2 Tuberculosis (non-respiratory) 6 Diseases not listed above 1 Total 679 APPENDIX 37 Description of Aid Number Issued (including reissued). Bath Aids 77 Toilet Aids 47 Walking Aids 27 Chairs 3 Tables 7 Hoists 5 Small Miscellaneous Aids 35 Total 201 132 APPENDIX 38 PHYSICALLY HANDICAPPED HOLIDAYS, 1965 Hotel or Holiday Camp r of Persons British Epileptic Association (Shanklin) 1 British Rheumatoid and Arthritic Association (Birchington) 2 Cheshire Homes (Seven Rivers, Colchester) 1 Lulworth Court, Westcliff 7 Essex County Council, Westboume Lodge, Clacton 5 Essex Physically Handicapped Association (Holiday Camps) 11 Jewish Association (Bournemouth) 2 Shaftesbury Society, Dovercourt 4 W.V.S. (Grange Farm, Chigwell) 13 Grants given towards private holidays 15 Total 61 APPENDIX 39 Meals supplied by the W.V.S. in both Ilford and Wanstead and Woodford areas. Days per week on which meal received No. of persons 1 4 2 93 3 56 4 50 In addition 16 people receive 2 meals on 1 day. Total average per week zz 590. APPENDIX 40 REGISTERED BLIND AND PARTIALLY SIGHTED PERSONS Male Female Blind 144 249 Partially Sighted 55 86 Defective Sighted 5 14 Total 204 349 133 APPENDIX 41 Registered Deaf and Hard of Hearing (Ascertained to date) Male Female Deaf 16 15 Hard of Hearing 10 7 Total 26 22 134 INDEX Page No. Accident 17 Adult Training Centre 90 Animal Boarding Establishment Act, 1963 110 Ante-N atal 35 Atmospheric Pollution — Clean Air 111 At Risk Register 26 Bakehouse 107 B.C.C. Vaccinations 74 Births 26 Blindness 125 Cancer 17 Care of the Elderly 124 Care of Mothers and their Young 26 Causes of Deaths (School Children) 77 Central Registry of Case Work 36 Cerebral Palsy Unit 67 Clean Air Act — Smoke Control Orders 111 Child Guidance 68 Children at Risk 26 Chiropody Service (including School Health) 45 Clearance Areas 102 Clinics and Treatment Centres 40 — Ante-Natal 35 — Child Guidance 68 — Dental 63 — Diphtheria Immunisation 40 — E.N.T. 61 — Midwives 34 — Minor Ailments 58, 86 — Opthalmic 59 — Orthopaedic60 — Orthoptic 60 — Premises 49 — Speech 62 Congenital Abnormalities 26 Consultants59-61 Convalescent Facilities 44 Coronary Disease 17 Mr. Daly — Chief Public Health Inspector 95 Day Centres 125 Day Nurseries 31 Deafness 126 Dental Health Education 43. 46 Dental Treatment (including Schools) 30, 62-65 Development of L.A. Health Services 33 Diphtheria Immunisation 40, 50 135 Diseases of Animals (Waste Food) Order, 1957 110 Diseases of Animals (Movement Orders, etc.) 110 Diseases (notifiable) 18 Drainage and Sewerage 96 Dysentery and Food Poisoning 14 Ear, Nose and Throat 61 Education Act, 1944 57 Education Committee 2 Enteric Fever 15 Enuresis 70 Environmental Health 94 Epidemiology 12 Ethel Davis School (Physically Handicapped) 65 Dr. Fairhurst — Opthalmologist 59 Factories and Workshops 101 Fertilisers and Feeding Staffs Act, 1926 101 Fieldwork Instructors 37 Fluoridation 65 65 Food and Drugs Sampling 107 Food Hygiene 107 Foods, Fitness and Consumer Protection 107 Food Poisoning 14 Food Preparation — Registration 109 Food Surrendered 117 Foreign Bodies in Food 119 Miss Gascoigne — Education Psychologist 69 Goodwill Club 92 Dr. Gurassa — Psychiatrist 68 Mr. Haigh — Chief Dental Officer 62 Handicapped Children 73 Hawkers 109 Health Committee 1 Health Education (including Schools) 41, 75 Health Services Clinics 49 Health Visitors and School Nurses 35, 45, 74 Home Helps 47 Home Nursing 38 Home Safety 44 Hospital Admissions (Mentally Sub-normal) 92 Hostel Admissions (Mentally Sub-normal) 92 Housing 102 Housing Repairs and Rents Acts 104 Ice Cream 105 Illegitimate Births and Deaths 11 Immunisation 40 Infant Mortality 11 Infant Welfare Centres (Attendances) 49 Infectious Diseases 13, 18 136 Inspections, Defects and Outwork (Factories) 113-114 Inspections and Supervision of Food 104 Incontinence 45 Miss Jesson — Non-Medical Supervisor of Midwives 35 Junior Training Centre 90 Dr. Kilsby — Departmental Medical Officer, Enuresis & Toddlers Clinics 29,70 Mr. Korvin — Orthopaedic Surgeon 60 Laboratory Facilities 108 Land Charges Act 99 Laundry Service for the Aged Incontinent 100 Mr. Lee — Orthopaedic Surgeon 67 Litter Act, 1958 99 Liquid Egg (Pasteurisation) Regulations, 1963 108 Loan of Sick Room Equipment 45 Miss Mason — Ear, Nose and Throat Surgeon 61 Mass Radiography 16 Maternal Mortality 11 Measles 13 Meals on Wheels 125 Meat and Other Foods — Inspection and Supervision 107 Medical Inspection at Schools 57 Mental Health 89 Mental Welfare Officers 90 Merchandise Marks Act 109 Midwifery 34 Milk 105 Ministry of Education — Statistical Tables 78-88 Minor Ailments 58, 86 Mothers Clubs 38 National Assistance Act 123 National Health Service Act 1946 25 Neonatal Mortality 11 New Buildings 33 New and Original Work — School Health 57 Noise Abatement Act, 1960 100 ..Notifiable Diseases 18 Nurseries and Child Minders Regulation Act 32 N.S.P.C.C. 76 Occupational Centre (Fellowship House) 124 Occupational Therapy 45 Officers of the Public Health Services 3 Offices, Shops and Railway Premises Act, 1963 101 Miss Oliver — Superintendent Health Visitor 36, 74 Ophthalmic Clinic 59 Orthodontics 64 Orthopaedic Clinics 60 Orthoptic Clinic 60 Overcrowding 102 137 Partially Sighted 125 Perapatetic Teacher of the Deaf 73 Pet Animals Act, 1951 110 Pharmacy and Poisons 109 Physically Handicapped 124 Physiotherapy 61, 66 Dr. Pooley — Departmental Medical Officer — Enuresis Clinic 70 Poliomyelitis Vaccination 40, 52 Population 7 Preface 7-10 Mrs. Pretious — Speech Therapist 62 Prevention of Damage by Pests (Rodent Control Act) 111,120 Psychiatric Social Workers 90 Bag, Flock and Other Filling Materials, etc. 99 Rainfall 11 Rats and Mice 111 Recuperative Holidays 44, 58 Refuse Collection and Disposal 97 Remedial Exercises 61 Residential Accommodation for the Elderly 124 Riding Establishment Act, 1964 110 Rivers and Streams 97 Sanitary Inspection of the Area 98 Screening Tests of Vision and Hearing 72 School Nurses 74 School Psychological Service 69 School Roll and Premises 57 Sickroom Equipment 45 Slaughter of Animals Act 109 Smallpox Vaccination 15, 41 Special Care Unit 91 Speech 62 Special Schools 88 Staff 3, 58 Statistics — Environmental Health 113-121 — Epidemiology 18-24 — Mental Health 93 — Personal Health 50-55 — School Health 78-88 — Vital and Social 11 — Welfare 128-133 Suicide 17 Swimming Baths 96 Dr. Taylor — Departmental Medical Officer — Smoking and Lung Cancer 76 Temporary Accommodation 126 Temporary Care 91 Tetanus Immunisation 40, 51 Toddlers Clinic 29 133 Dr. Toms — Departmental Medical Officer — Toddlers Clinic & Ethel Davis School 29, 66 T.B. Care and After Care 45-47 T.B. — Notifications, deaths etc 15 Vaccination and Immunisation 40 Venereal Disease 15 Voluntary Bodies 46 Miss Ward — Orthoptist 60 Water Supply 95 Miss Watt — Education Psychologist 69 Welfare 122 Welfare Committee 1 Welfare Food Distribution 26 Whooping Cough Immunisation 14, 52 X-Ray of Immigrants 16